Test 3 Flashcards
1
Q
Aging and the Renal and Urologic system
A
*Kidneys become less efficient at removing waste
*Urine volumn decreases d/t the decrease in efficiency of waste removal
*Decrease effectivness of sodium regulation(where Na goes, H2O goes)
*Bladder capactiy decreases causing an increase in frequency of voiding
*Urinary time table moves from day to night *Increase in pelvic floor disorders
*Increase for risk of urinary tract disease d/t multiple meds
*Incontinence (dependant living required)
2
Q
UTI
A
Urinary Tract infection can develope on the upper and lower tract Lower includes: Cystitis, Urethritis Common in the general population, increases with age and those in nursing homes
3
Q
Cystitis
A
Bladder infection
4
Q
Urethritis
A
Urethra infection
5
Q
UTI (Risk factors)
A
Age
Immobility
Catheterization
Atonic bladder (SCI, diabetic, neuropathy)
STD
DM
Female
Obstruction
Kidney transplant
6
Q
UTI (SIgns and Symptoms)
A
Frequent Urination
Pain (Shld, bk, flank, low abd)
Urinary urgency
Fever, chills
Hematuria
Costovertebral tenderness
Nocturia
Pyuria
Dysuria
7
Q
Pyuria
A
Urine containing puss
8
Q
UTI Implications for PT
A
Recognize signs (Mental status change) May interfere with therapy
9
Q
Renal Calculi
A
“Kidney stone” 3rd most common urinary tract disorder effects men 30-60 y.o. and women 20-30 y.o.
10
Q
Renal Calculi Risk Factors
A
Excess intake of Ca, Na and sucrose Lack of Ca, K in diet Obese women
11
Q
Renal Calculi Signs and symptoms
A
blood in the urine
pain in the abd
decreases urinary volumn
Flank to groin pain
12
Q
Renal Calculi Implications for PT
A
Recognize syptoms Fever Chill Sweats
13
Q
Chronic Renal Failure
A
The loss of ability for the kidney’s to filter waste and fluids from the blood for greater than 3 months
14
Q
Chronic Renal Failure
Cause
A
Diabetes
Hypertension
Glomerulonephritis
Excessive use of the OTC drugs Age
15
Q
ESRD
A
End stage renal disease 90% loss of kidney function Treated with dialysis and transplantation
16
Q
Renal Transplant Complication
A
Hypertension
Lipid Disorder
Hepatitis
Cancer
Tendinopathies
Osteopenia
17
Q
Dialysis Complications
A
Increase thirst
Weight gain/abd distention leading to distress Increases risk of infection
Fluid retention leading to Hypertension (beginning) Hypotension
Chest and back pain
Hypersensitivity (itching, uticaria)
Thrombosis causing stenosis
18
Q
Chronic Renal Failure Implications for PT
A
NSAID’s and other analgysics can induce renal syndrome Be alert to: malnutrition Med side effects # of body dydtems involved Cognitive changes Renal transplant complications Dialysis Complications Impaired 02 limits exercise
19
Q
Neurogenic Bladder Disorder
A
Malfunctioning bladder d/t a disruption in the innervation
CVA,
dementia,
Parkinson’s,
MS,
Brain tumors,
SCI,
HNP,
Vascualr lesions,
Myelitis,
DM
20
Q
Neurogenic Bladder Disorder Implications for PT
A
Treated with Catheterization, Bladder training, Surgery, and meds Prevent incontinence, bladder distention, UTI’s, and renal damage Empty cath bag encourage pee breaks recognize UTI signs
21
Q
Urinary Incontinence
A
Inability to hold urine. Occurs most often when the bladder’s pressure excees the sphincters resistance Functional Incontinence Stress Incontinence Urge Incontinence Overflow Incontinence Significant factor to pressure sores, UTI’s, institutionalization, Depression and isolation
22
Q
Functional Incontinence
A
Normal urine control with difficulty reaching a toilet in time Muscle of joint dysfunction
23
Q
Stress Incontinence
A
Loss of urine when bladder is under pressure (coughing, laughing, lifting)
24
Q
Urge Incontinence
A
Sudden unexpected urge and uncontrolled loss of urine
25
Overflow Incontinence
Constant leaking of urine from a full bladder that is unable to empty
26
Urinary Incontinence Implications for PT
Rehab m. imbalance pelvic alignment Pelvic m. awareness and function through biofeedback E-stim Thera ex Behavioral managment Designed to prevent reoccurance of impairment and restore m. function. Weight loss, core ex, kegel ex, surgery
27
Male Genitalia and aging
Sex hormone decreases leading to protein synthesis
salt water balance
bone growth and homeostasis
cardiovascular function
Decreases sexual interest
Memory changes
Physical changes (decrease strength, body mass, bone density)
28
Prostate cancer
Adenocarcinoma of the prostate arises from the glandular cells. 1 in 6 men have a lifetime risk of prostate cancer. More die with it rather than from it.
29
Prostate Cancer Risk Factors
\>50 y.o.
Environmental exposure to cadmium
Alcohol consumption
High fat diet
African American
Fam Hx
Geographic (US, Scandonavia)
30
Hormonal Manipulation Side Effects
Muscle atrophy
Decreased bone density
Loss of Labido
Erictile Dysfunction
Hot flashes
Bloating,
Pedal edema
Weight Gain
MI, CVA, DVT
31
Prostate Cancer Implications for PT
Undiagnosed: Be aware of the signs (trouble initiating/ continuing urine strem, frequency, dribbling/continuous leaking) Pain Post-op: Pelvic floor rehab Prevent Osteoporosis with WB exercises
32
Female Genitalia and Aging
Menopause (45-50 y.o.)
Increases risk for: Heart disease HTN CVA Osteoporosis
Depression
Primary reson for rehab: Pelvic floor disorder Post-op rehab following CA
33
Female Genitalia and Exercise
Increas Cardio fitness Decrease adiposity
Helps maintain m. mass and bone density
Excessive may be negative primary/secondary amenorrhea
decrease dietary intake + exercise = infertility + decreased bone density
34
Female Obesity and the reproductive system
Menstrual disorder
Infertility
Miscarriage
Poor pregnancy outcomes
Impaired fetal wellness
Diabetes
35
Pelvic Floor Dysfunction
Pelvic musculature dysfunction and pelvic pain
36
Pelvic Floor Disorder Cause
Pregnancy
Prolapsed Uterus
PMS
Endometriosis
Musculoskeletal injury
Fibromyalgia
Hernia
SCI, Stroke, Parkinson's, MS
37
Pelvic Floor Dysfunction Implications for PT
Educate the patient on Muscualture Consider your pt (modesty, abuse) Postural education
38
Breast Cancer Rsk Factors
\>60 y.o.
Menarche
First live birth at 35 y.o.
Fam Hx
of previoud breast biopsies
39
Breast Cancer Implications for PT
Pre-op: Posture Jt ROM Upper quadrant motion Flexibility Exercise Lymohedema Precautions
Post-op: Acknowledge side effects Breathing Coughing Exercise Functional activity
40
Post-Mastectomy Pain Syndrome
Burning Numbness/tingling or stabing around the incision Axilla, arm, shld imediately, or 3 months post op
41
Down Syndrome
Chromosomal disorder
Characteristics:
Hypotonia
Cognitive delays
Abnormal facial features
Short limbs
Assoc with congenital Heart defects
42
Down Syndrome Implications for PT
Atlantoaxial instability
Resp Problems
Joint hypermobility
Early intervention
Low level aerobics (low peak HR, Low VO2)
43
Scoliosis
Lateral curvature of the spine Idiopathic Osteopathic - d/t bone abn Myopathic - d/t m. weakness Neuropthic - d/t CNS disorder Functional (goes away when caue remedied) Structural
44
Scoliosis Implications for PT
Pediatric: Early detection Trunk strengthening and flexibility
Post-op: Check color, sensation, capillary fill in extremities Deep breathing Mobility withing 24 hrs (surgeon protocol) Bracing
45
Spina Bifida
Congenital neural tube defects resulting in weakness, sensory impairments, hydrocephalus seen as early as birth. prenatal dx
46
Spina Bifida Implicaions for PT
Neonatal ICU - Prone, slight hip flex, leg abd, ankles neutral skin care
Care continues through school age
Be aware of the signs of:
CSF pressure
Shunt failure
Tethering of spinal cord
47
Muscualar Distrophies
Inherited Neuromuscular disorders
Several Varieties characterized by symmetrical m. wasting leading to increaing deformity and disibility
Linked to protein dystophin, enzymatic defects and defects in modifcation of proteins
48
Muscualr Distrophies
Implications for PT
When ill/injuried and immobilized, they can loose all functional abilities
Caution with exercise - too strenuous = m. fiber breakdown
resp precautions
splinting
night positioning
AROM PROM
49
Duchenne's Muscular Atrophy
Onset: 2-4 y.o.
Rapid progression
Loss of walkign by 9-10 y.o.
Death in 20's
M. cells replaced by fatty connective tissue leads to contractures
Fat cells accumulate btwn damage m. fibers
Disorganization of tendon insertion
50
Spinal Muscualr Atrophy
Progressive weakening, m. wasting d/t ant horn degeneration
Severe to mild (TYpe 0-IV)
Inherited (both parents must have mutation)
51
SMA
Implications for PT
Postural support
Bracing
Improve, maintain function
Resp weakness
Prevent musculoskeletal complications
52
Torticollis
"Twisted neck" Contracted SCM
Spasomadic
Positional
53
Torticollis
Implications for PT
Postioning
Exercise to encourage symmetry
Bracing
54
Erb's Palsy
UE paralysis usually assoc with brcahial plexus injury at birth (traction force)
Characteristics: ADD, IR of shoulder, lower arm Pronated with fingers flexed
55
Erb's Palsy
Implications for PT
Encourage UE use
Prevent deformity
PROM
56
Osteogenesis Imperfecta
Congenital disorder of collagen synthesis effecting bones and connective tissue leadin to and increas in fx
Shortened stature
Bruise esaily, thin skin
Increased tendon laxity
Jt hypermobility
Scoliosis
Cardiovasular complications
Delayed motor skills
57
Osteogenesis Imperfecta
Implications for PT
Gentle ROM
Caution with motion, strengthening
Avoid rotation
Family education
Strengthening of hip ext, abd, trunk ext, abd
Positioning
58
Arthrogryposis
Congenital, multiple jt contractures
m. weakness
Articular rigidity
59
Arthrogryposis
Implications for PT
Max benifit a 0-2 y.o
Funtional mobility
AFO's
Post surgical rehab
60
Aging and Bones
Decrease bone formation
Decrease strength
Decrease density
Bone loss (osteoporosis)
61
Aging and Muscles
Decrease in m. fibers
Decrease in fiber size
Decrease response to neural excitation
Loss of m. mass
Loss of m. function
62
Aging and the joint and connective tissue
Decrease in flexibility
CHanges in collagen
Articular catrilage breakdown
Increase in tissue stiffness
Decrease in tendon tensil strength
63
Effects of exercise on the bones
Increases bone mass with WB activities
Resistance exercise
Mod-High intensity
64
Effects of Exercise on the Muscles
Increase in:
strength
Endurance
Function
65
Effects of exercise on the joint and connective tissue
Well regulated exercise does not exacerbate changes
66
Effects of strength training
Increase strength, mass, quality of skeletal m.
Increase endurance
Normalize BP
Increase metabolic rate
Prevent loss of mineral density
Reduce risk factorsfor falls
May reduce pain and dysfunction of OA
67
Exercise guidelines for \>65 y.o.
3-5x a wk
2x a wk (m. strengthening)
8-10 different exercises per session
20- 60 mins cardio
High intensity resistance training (\>60% one rep max)
68
Exercise guideling for \>85 y.o.
2x a wk
20 min total time
40-60% of HR reserve
Resistance training:
2-3sets, 8-12 reps
progress by increasing by 5% wt and decreasing reps
69
Exercise guidelines for an adult
M. mass, endurance and strength
Single set of 15 reps
2x a wk
8-10 diff exercises
Cardio, flexibility
3-5x a wk
55/65-90% of HR max
20-60 mins
70
Osteopororsis
Metablic decrease in bone mass and microdamage to bone sturctures
Primary occure at any age but increases with age
Secondary assoc with meds, or other diseases
Characteristics:
Loss of height
Postural changes
Pain
Fractures (vertebreal compression, Femoral neck, Metatarsal)
71
Osteoporosis
Risk Factors
\>50 y.o.
Women \> Men
Caucasian, Asian
Depression
Estrogen
Physical activity
Meds
Alcoholism
Smoking
Steroid therapy
Androgen withdraw from prostate CA
72
Daily Calcium Req'
Women 25-50: 1000-1200 mg
Post Menopausal (no estrogen therapy): 1500 mg
Men up to 65: 1200 mg
Men \>65: 1500 mg
73
Osteoporosis
Prevention and managment
Prevention:
Education
Increase Ca, Mg intake
Vitamin D
WB physical activity
Decrease soda, caffiene
Decrease animal protein
Decrease meds assoc with osteoporosis
Managment
same as above plus
Meds
Fall prevention
74
Osteoporosis
Implications for PT
Balance of vitamins and exercise
Resistive Exercise:
Builds bone mass
slows bone mass decline
reduce fx risk
Maintain m. mass and strength
Parameters:
Overload
Reversibility
Specificity
Intiial values
Diminishing returns
Maintainence
75
Paget's Disease
Metabolic disease characterzed by excessive bone reabsorption and formation, high bone turnover leading to weaker bones
Bone is replace by coarse irregular bones.
Thicker but weaker
Slow progression
76
Paget's Disease
Implications for PT
Strengthen m. to decrease pain
Exercise to:
Weight control
increase Cardio
Maintain strength
Maintain jt motion
Depends on severity
77
Osteomyelitits
Inflammation of the bone cause by an infection (viral, bacterial, fungal, parasitic)
Can be chronic (persistant) or acute (new)
C/c in adults: back pain, low grade fever
C/c in child: High fever, intense pain, occasionally edema, erythemia, localized tenderness
78
Osteomyelitis
Implications for PT
Prevention of infection
AROM, PROM
Skin care
Position changes
79
Implant and Prosthesis infections
30% caused by hematogenous route
70% caused by wound infection near prosthesis or operative contamination
Persistant jt pain be be the onl symptom
Early infection: fever, jt pain, warmth, redness
Delayed infection: lack of systemic symptoms, jt pain/loosening
MAy req removal of implant
Tx of pathogen
80
Prosthesis and Implants
Implications for PT
Recognize signs of infection
Redness, warmth, heat, decrease function, swelling
Know pt's hx
Weakening of prosthesis
Post-op care
81
Myositis
M. inflammtaion d/t an autoimmune condition or viral, bacterial, parasitic agent. Also assoc with cholestorol lowereing statins
Can be the first sign of malignancy
Types
Dermatomyositis
Polymyositis
Inclusion body myositis
Myositis ossificans
Idiopathic Inflammatory Myopathies
Rhabdomyolysis
Pyomyositis
82
Dermatomyositis
Multpile weak muscle
rash
83
Inclusion body Myositis
Isolation of an infection within a muscle
Slow progressive
Freq falling
trouble with stairs
trouble standing from sitting
84
Myositis
Signs and symptoms
Malaise
Fever
M. swelling
Pain
Tenderness
Lethargy
Flu like symptoms
\*\* for Derma and Poly, symptoms are located in connective tissue and m. fibers
85
Myositis
Implications for PT
M. pain and weakness + Lipid lowering statins = Predispose pt to myotoxicity
Exercise can be a risk factor for the symptomatic presentation of myotoxicity
86
Osteosarcoma
Malignant tumore commonly located in the long bones (femur)
Rapidly destructive = increased pain + swelling = Limited motion
Males \<30 y.o.
Diagnosed with x-ray, CT scan, MRI, biopsy
Tx: Complete surgical removal, limb salvage procedure
87
Osteosarcoma
Implications for PT
Rehab is indivualized, long and intensive
Deep breathing, coughin, precussion, and postural drainage
88
Ewing's Sarcoma
Malignant tumor found in bone or soft tissue
\<20 y.o rare in blacks
Intermittent local bone pain after an injruy (makes it hard to diagnose)
Long bone and pelvis (Femur, tibia, fibula, humerus)
Tx: Chemotherapy
89
Ewings Sarcoma
Implications for PT
patient specific
Intermittent
90
Heterotrophic Ossification
Bone formation in the soft tissue
Cause:
Trauma, fx, surgery
SCI, Traumatic Brain INjury
Burns
Amputations
Dx with:
X-ray, CT, Ultrasound
91
Myositis Ossificans
Bone formation in bruised, damaged or inflammed muscle
92
Heterotrophic Ossification
Implications for PT
Directly related to the cause of changes (Disease, trauma, surgery)
Acute phase (1-2wks post-op):
Decrease swelling
Decrease scar formation
Pain mngmt
Gentle ROM
Inflammatory Phase (2-6wk post injury)
ROM
Gentle strengthening
93
Myofascial Compartment Syndrome
Increased Interstitial fluid within a myofascial compartment comprised of vessel, nerves and muscle
Risk factors include:
Injury, fx, Contusion, Crush inj, Skeletal traction, burns
restictive dressings, cast
94
Myopathy
Non specific M. weakness
May be metabolic, hormonal, autoimmune disease, hereditary, acquired
Diabetes leas to vascular, metabolic, and nurological myopathy
Dx:
M. biopsy
EMG
Lab findings (CPK, aldolase, AST, ALT, LDH)
95
Myofascial Pain syndrome
Overuse, m. stress sydrome
M. developes trigger points
Implications:
Modalities: US, E-stim, compression
Myofascial release
Strengthening
Stretching
96
Diabetic Ketoacidosis
Extreme hypoglycemia
Assoc with the body in a state of saturation
Fruity Breathe
Weak, rapid, pulse
Admin fruit, juice, honey
97
Asthma
Chronic, obstructive lung disease
The imflammation of inner walls, and constriction of smooth m.
Symptoms: Wheezing, coughing, SOB, chest tightness
Risk Factors: Everyone, cold weather, emotional stress, pollen dust
Tx: Fowler's positionm, encourage pursed lip deep breathing
98
Cystic Fibrosis
Inherited chronic defect. Creating a predisposition to airway infections, obstructive lung disease which lead to loss of pulmonary function.
Production of thinick music
Symotoms: Increase in ant/post chest diameter, digital clubbing, weight loss, reccurrent pneumonia, wheezing/SOB, constipation, abd distention
Implications: Airway clearance tech, breathing exercises, improve posture, mobilize thorax
99
Chronis Myelogenous Leukemia
CA of the white blood cells in bone marrow. Uncontrolled production of immature and mature granulocytes
Sign: Fatigue
weght loss
weakness
Abd pain
increased bleeding, bruising
100
Fibromyalgia
M. pain and stiffness
Increase in substance P
Symptoms:
Fatigue
Sleep problems
ANxiety, depression
Spsecific tender points
101
Systemic Lupus Erythematosus
Autoimmune disease effeceting multiple organ systems and skin rashes, poly arthritis and m. pain
Characterized by remission and exaccerbations
Effects the heart, CNS, Renal system, lung, connective tissue (not all at once)
Symptoms: CP with deep breath, Fatigue, m. weakness, mouth sores, jt pain, arthritis, skin rash, vasculitis
Monitor pt's vitals
102
DM
General Guidelines
Safe is btwn 100-250mg/dl, goal is to tighten and moderate
Btwn 70-100 mg/dl = provide carb snack and 15 min rest (symptom dependant)
Do not exercise when pt is over 250 mg/dl with ketosis
Hypoglycemic = juice and honey
Do not exercise at peak insulin times
Increased insulin may be requires if the patient is stressed
Avoid night exercising
103
DM + Exercise
Before
Min 17 oz of fluid
Monitor glucose
Do not exercise when levels are \>250 mg/dl
Exercise i hr after meal (min 2 hrs)
DM1 increase food, or decrease insulin
Increase insulin while menstruating
