Various Flashcards
signs and symptoms of RA
symmetrical pattern of dysfunction, small joints first (hands typically)
autoimmune, may experience fatigue, fever, weight loss
other symptoms: increased risk for osteoporosis, heart and lung disease, dry eyes and mouth (Sjogren’s), infections, carpel tunnel
diagnosis: plain films with symmetric involvement, increased WBC and ESR, anemia, elevated rhumatoid factor
PT goals: joint protection, maintain/improve joint mechanics, aerobic conditioning, strengthening of weak muscles. no contract/relax or end range mobilization
ankylosing spondylitis
progressive inflammatory disorder affecting initially axial skeleton, initial onset before 30 (mid to low back pain 3 mo or greater)
HLA-B27 antigen may be elevated
PT goals: trunk flexibility, aerobic capacity, relaxation, breathing strategies to maintain vital capacity
gout
genetic disorder of purine metabolism, elevated serum uric acid, most frequently knee and great toe involvement
PT goals: pt education for injury prevention, early ID of condition with fast implementation of intervention is important
psoriatic arthritis
chronic, erosive inflammation, usually in digits and axial skeleton
PT goals: joint protection, maintain/improve joint mechanics, aerobic conditioning
osteomalacia
decalcificaiton of bones due to vit D deficiency
sxs: severe pain, fx, weakness
osteomyelitis
inflammatory response in bone caused by infection, usually staph aureus
more common in kids and immunocompromised adults
medical treatment of antibiotics
arthrogryposis multiplex congenita
deformity of skeleton and soft tissues, limitation in joint motion and sausage-like appearance of limbs - normal intelligence
PT goals: joint/bone protection, maintain joint mechanics, aerobic conditioning, pt education/assistive devices/orthotics, flexibility exercises to maintain normal joint motion and muscle length
osteogenesis imperfecta
autosomal dominant disorder - abnormal collagen synthesis leading to imbalance b/w bone deposition and reabsorption
bones become thin, easy to fracture
osteochondritis dissecans
separation of articular cartilage from underlying bone, most commonly medial femoral condyle near intercondylar notch, sometimes femoral head and talar dome
PT goals: joint protection, flexibility exercises to maintain motion, aerobic capacity, strength, power, endurance exercises
myositis ossificans
abnormal calcification within a muscle belly, usually after a direct trauma that results in muscle hematoma
surgery only after maturation of lesion (6-24 mo) or if lesion interferes with joint movement or nerve impingement
PT goals: flexibility (not too aggressive), manual therapy (not too aggressive), aerobic capacity
CRPS types
1 - triggered by tissue injury
2 - clearly associated with nerve injury
Paget’s disease (osteitis deformans)
viral infection? metabolic bone disease involving abnormal osteoclast/osteoblast activity
results in spinal stenosis, facet arthropathy, possible spinal fracture
scoliosis intervention
< 25 deg: PT
25-45 deg: orthotics
>45 deg: surgery
autolytic debridement
natural debridement of necrotic tissue under moisture retentive dressings - enzymes inherent in tissues
used for pts on anti-coagulation, who cannot tolerate more invasive debridement.
not for use in infected wounds, immuno-compromised, dry wounds (gangrene, ischemia)
enzymatic debridement
topical chemical to liquify necrotic tissue
used for moist wounds, eschar after cross-hatching, pts who can’t tolerate surgical debridement
not for use on ischemic and gangrene wounds (dry), or clean, granulated tissue
mechanical debridement
includes wet to dry gauze dressing, dexatranomers, pulsed lavage with suction, or whirlpool. May remove healthy tissue
used for wounds with moist necrotic tissue or foreign material
not for use with clean, granulated wounds
sharp debridement
using instrument (scalpel, scissors, forceps, silver nitrate stick) to remove only necrotic tissue - no bleeding induced in viable tissue. Done w/o anesthesia
used to score/excise leathery eschar or excise moist necrotic tissue
not for use on clean wounds, advanced cellulitis, life threatening infection, coagulation disorder/anticoagulation therapy
surgical debridement
for deep (stage 3 or 4) or complicated pressure ulcers - sharp debridement performed, some healthy tissue may be removed, may have bleeding, may be under anesthesia, will need surgical or special procedure room
for most wounds: advanced cellulitis with sepsis, immunocomprimised pts, life threatening infection, clean wounds prior to surgical wound closure, granulation and scar tissue may be excised
contraindication: cardiopulmonary disease, diabetes, severe spasticity, pts with short life expectancy or unable to tolerate surgery or if surgery wouldn’t improve quality of life
ultrasound debridement
20-50 kHz, selective form of debridement
increases angiogenesis, wound bed prep for grafting or flap closure
contraindication: vascular abnormalities, radiation, tumors, electrical devices
precaution over nerves, infection, anesthetic areas
biological debridement
use of maggots, not used often
used when pt cannot tolerate other forms of debridement, all non-healing necrotic wounds in people who are medically stable
not for use in people who think it’s creepy or if pain increases
transparent film dressing
permeable to air, not water, bacteria, or environmental contaminants
used for: stage 1 and 2 pressure ulcers, secondary dressings, autolytic debridement, skin donor sites, cover for hydophilic powder, paste and hydrogels
comfortable, decreased friction
application can be difficult, channeling or wrinkling can occur
not to be used when surrounding skin is fragile or wound is infected, has tracts or lots of drainage
allow 1-2 inch margin around wound, shave hair, dressing change depends on wound condition and location
hydrocolloid dressing
adhesive wafer containing absorptive particles to form gelatinous mass over the wound. Can be a paste to fill shallow cavity wounds
protects partial thickness wounds, assists with autolytic debridement of necrosis or slough, use on wounds with mild exudate
odor with yellow exudate similar to pus is normal when removed, change 3-7 days
not to be used in wounds with heavy exudate, infection, wounds that expose bone or tendon
hydrogel dressings
water or glycerine based gels, insoluble in water, Can be solid sheet, amorphous gels, impregnated gauze
use on full and partial thickness wounds, wounds with necrosis and slough, burns and radiation damage
soothing and cooling, rehydrates dry wound bed, conforms to wound bed, promotes autolytic debridement, amorphous form can be used when infection present, min to mod absorption.
most require second dressing, not for heavily exudating wounds, may dry out and adhere to wound bed, may macerate surrounding skin - use skin barrier to protect surrounding skin
sheet form works well for partial thickness ulcers - but not infection, and may promote growth of pseudomonas and yeast.
Needs to be changed 8-48 hours
foam dressing
can be hydrophilic or hydrophobic
use on partial and full thickness wounds with min to heavy exudate. can be a secondary dressing for wounds with packing to provide additional absorption, provides protection and insulation
some are designed for deep cavities
not for use with dry eschar or wounds with no exudate
change every 1-5 days, protect surrounding skin to prevent maceration
