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Advanced clinical practice: examining the complex patient > Week 3 > Flashcards

Week 3 Flashcards

1
Q

What is an infectious disease?

A

An illness caused by a specific infectious agent or its toxic product that results from transmission of that agent or its products from an infected person, animal, or reservoir to a susceptible host, either directly or indirectly through an intermediate plant or animal host, vector or inanimate object

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2
Q

What are the factors that affect the immune system?

A
  • Pregnancy
  • Pre-existing conditions
  • Malignancies or immunosuppressive diseases (cancer, HIV)
  • Stress (emotional or surgical)
  • Malnutrition (calorie insufficiency, decreased protein, iron, zinc)
  • Age
  • Chronic diseases
  • Lymph node dissection
  • Immunosuppressive treatment (corticosteroids, chemo, radiation, anti-rejection drugs)
  • Indwelling lines and tubes
  • Presence of implanted medical devices (total joint implants, pacemakers, pins/screws)
  • Obesity
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3
Q

What is a virus?

A

Subcellular organism made up only of a ribonucleic acid (RNA) or a deoxyribonucleic acid (DNA) covered w/proteins.

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4
Q

What are the characteristics of a virus?

A
  • Rapid replication & high mutation rates
  • Most viruses are self-limiting & do not require specific antiviral therapy
  • Antibiotics NOT effective on viruses
  • Currently available antiviral drugs for herpes, hepatitis, influenza, HIV
  • Antiviral drugs are subject to resistance
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5
Q

What are some examples of a virus?

A
  • Influenza
  • Herpes
  • Hepatitis
  • Some types of Meningitis & Pneumonia
  • Common cold
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6
Q

What is a bacteria?

A

A single-celled microorganism with well defined cell walls that can grow independently on artificial media without the need for other cells.

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7
Q

What are the characteristics of a bacteria?

A
  • Classified by shape and oxygen need
  • Constitute about 38% of human pathogens
  • Treatable by antibiotics, but occasionally need labs to determine specificity of antibiotic resistance (gram stain). There is a high emergence of antibiotic-resistant bacterial strains
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8
Q

What are some examples of a bacteria?

A
  • Various strains of Streptococcus
  • Staphylococcus
  • Clostridium; Escherichia coli
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9
Q

What is a fungi?

A

A single-celled or multicellular organis

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10
Q

What are the forms that a fungi can be in?

A
  • True pathogen (histoplasmosis & coccidioidomycosis): causes infections in healthy persons
  • Opportunistic pathogen (aspergillosis, candidiasis, cryptococcosis): causes infections in immunocompromised persons
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11
Q

Yeast is a common fungus causing ___

A

Yeast is a common fungus causing thrush, diaper rash, & athlete’s foot

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12
Q

What is fungi used for?

A

Used in the development of antibiotics, antitoxins, & other drugs

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13
Q

How is a fungi treated?

A

Antifungals or antivirals applied directly to the skin or injected in the case of serious infection

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14
Q

What is a parasite?

A

An organism that lives on or in a host and gets its food from or at the expense of its host

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15
Q

What are the characteristics of a parasite?

A

More common in rural or developing areas than in developed areas

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16
Q

What is the mode of infection of a parasite?

A

Through mouth or skin

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17
Q

What are the common types of parasite?

A
  • Pinworms
  • Trichomoniasis
  • Toxoplasmosis
  • Intestinal infections giardiasis
  • Cryptosporidiosis;
  • Malaria transmitted by mosquito bite
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18
Q

What are the treatment methods for a parasite?

A

Antiparasitic drugs, but for some no drug is effective

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19
Q

What is a prion?

A

An infections agent composed entirely of protein material that can fold in multiple, structurally distinct ways leading to disease that is similar to viral infection

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20
Q

What is the mode of transmission of prions?

A

Usually animal to human

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21
Q

What are the characteristics of prions?

A

Characterized by a long latent interval in the host that when reactivated cause a rapidly progressive deteriorating state

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22
Q

What are some examples of prions?

A

Cruetzfeldt-Jakob disease, “mad cow” disease

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23
Q

What are the treatment options of prions?

A

None

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24
Q

Where are the areas of the body that infections tend to attack?

A
  • Generalized, systemic
  • Organ systems
  • CNS
  • Hematological
  • Skin/soft tissue
  • Musculotendinous
  • Bone
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25
Q

What are the different direct contact transmission of infectious disease?

A

• Person to Person: touch, droplet, sexual intercourse,
fecal/oral
• Bites from infected insects or animals capable of
transmitting disease & handling animal waste
• Mother to unborn child: through placenta or during passage through the vaginal canal in the birth process

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26
Q

What are the different direct contact transmission of infectious disease?

A

Contact w/contaminated surface or object, food, blood, or water
• Travel through the air: influenza/meningitis

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27
Q

What are the “Big Five” infections that have the greatest impact measured in the world?

A
  • Pneumonia
  • Diarrhea
  • HIV/AIDS
  • Tuberculosis
  • Malaria
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28
Q

What is sepsis?

A

Life-threatening complication of infection occurring when the immune reaction to infection triggers inflammatory responses throughout the body

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29
Q

What are the characteristics of sepsis?

A
  • Inflammation can trigger cascade of changes that damages multiple organ systems leading to failure
  • Can occur in any patient, but particularly dangerous in older adults or the immunocompromised
  • Early treatment improved chances for survival
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30
Q

What are the characteristics of the 1st stage of sepsis?

A

Must exhibit at least two of the following symptoms in addition to probable or confirmed infection:
• Body temp > 101 F (38.3 C) or below 96.8 F (36 C)
• HR>90 bpm
• RR>20 breaths/min

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31
Q

What are the characteristics of severe sepsis?

A 
Exhibits at least one of the following s/s, indicating possible organ failure
• Significantly ↓ urine output
• Abrupt mental status change
• ↓ in platelet count
• Difficulty breathing
• Abnormal heart pumping function
• Abdominal pain
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32
Q

What are the characteristics of septic shock?

A

Exhibits all s/s severe sepsis plus extreme hypotension that does not response adequately to fluid resuscitation

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33
Q

What are the risk factors of sepsis?

A
  • Advanced age or very young age
  • Immunocompromise
  • Hospitalization, particularly in ICU
  • Presence of wounds or injuries (particularly burns)
  • Presence of invasive devices (i.e., intravenous catheters, intubation)
  • Antibiotic resistant bacteria
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34
Q

What are the complications associated with sepsis?

A
  • Impaired organ function
  • Blood clots
  • Death
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35
Q

What is a Healthcare-Associated Infections (HAI)?

A

Infection acquired in a hospital setting

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36
Q

What is a characteristic of HAI?

A

WHO states HAI burden is greater than HIV/AIDS, TB, and Malaria combined

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37
Q

What are the most common forms of HAI?

A
  • Escherichia coli
  • Staphylococcus aureus
  • Enterococcus faecalis
  • Pseudomonas aeruginosa
  • Candida albicans
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38
Q

What are the common sites for HAIs?

A
  • Urinary tract
  • Surgical wounds
  • Joints
  • Lower respiratory tract
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39
Q

What are the risk factors for HAIs?

A
  • Extremes of age
  • Immunodeficiency
  • Immunosuppressed
  • Misuse of antibiotics
  • Use of invasive diagnostic and therapeutic procedures
  • Agitation
  • Surgery
  • Burns
  • Length of hospitalization
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40
Q

What are the precautions to prevent infection and spread of infection?

A

Review standard, airborne, droplet, and contact precautions

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41
Q

What are the characteristics of antibiotic resistant infection: Methicillin-resistant Staphylococcus aureus (MRSA)?

A
  • Mgmt often requires IV Vancomycin and several weeks IV antibiotic treatment
  • May require additional time in a long-term facility after hospitalization
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42
Q

What are the characteristics of antibiotic resistant infection: Vancomycin-resistant Enterococci infection?

A
  • Resistant to vancomycin, aminoglycosides, & ampicillin
  • Treatment options limited
  • Best plan is prevention and proper utilization of antibiotics, inc. Vancomycin
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43
Q

What are the characteristics of antibiotic resistant infection: Multi-drug resistant Acinetobacter baumannii?

A 
• Wide spectrum of antimicrobial resistance
• Particularly found in ICU environments
  - Ventilator-dependent pneumonia
  - Bloodstream infection
  - Wound infections 
  - Nosicomial meningitis
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44
Q

What are the generalized signs and symptoms of an infectious disease?

A
  • Fever
  • Chills
  • Malaise/body aches
  • Fatigue
  • Coughing
  • Diarrhea
  • Palpable lymph nodes
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45
Q

What are the age specific signs and symptoms of an infectious disease seen in older adults?

A

Signs and symptoms may be subtle and atypical!
• Mental status change
• Subnormal body temperature (or normal temp/no fever)
• Brady/tachycardia
• Fatigue (or increased fatigue)
• Lethargy/weakness
• Decreased appetite
• Increased incidence of falls in short period of time

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46
Q

What are the age specific signs and symptoms of an infectious disease seen in young children?

A

• Irritability
• Inconsolability
• Generalized symptoms seemingly not related to
illness (i.e., UTI presents with vomiting; strep throat infection presents with stomach discomfort)
• Lethargy/excessive sleepiness
• Decreased appetite
• Subnormal body temperature

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47
Q

What are the integumentary signs and symptoms of an infectious disease?

A
  • Purulent drainage from an abscess, open wound, surgical incision, or skin lesion (will talk more in another lecture about osteomyelitis)
  • Skin rash, red streaks– CELLULITIS???
  • Bleeding from gums or into joints; joint effusion or erythema
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48
Q

What are the cardiovascular signs and symptoms of an infectious disease?

A
  • Petechial lesions
  • Tachycardia
  • Hypotension
  • Increase or decrease in heart rate
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49
Q

What are the CNS signs and symptoms of an infectious disease?

A
  • Altered level of consciousness, confusion, seizures
  • Headache
  • Photophobia
  • Memory loss
  • Stiff neck, myalgia
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50
Q

What are the screening test that should be used when a person is displaying the CNS symptoms particularly with fever, headache, neck stiffness, and AMS of an infectious disease, particularly meningitis?

A
  • Kernig Sign

* Brudzinski Sign

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51
Q

What is the procedure of the kernig sign test?

A
  1. Patient is supine
  2. Knee is flexed to 90 degs
  3. Hip is flexed to 90 degs

Positive sign: Extension of the knee is painful or limited in extension

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52
Q

What are the locations of lymph nodes palpations?

A
  • Near the submandibular area
  • Axilla
  • Groin
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53
Q

What can help rule out meninigitis?

A

A lumbar puncture

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54
Q

What is the positive Brudzinski Sign?

A

Passve flexion of the neck elicits hip or knee flexion

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55
Q

What are the GI signs and symptoms of an infectious disease?

A
  • Nausea
  • Vomiting
  • Diarrhea
May produce referred pain patterns depending on area infection resides:
• Lumbosacral area
• Lower abdomen
• Mid-thoracic
• R shoulder
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56
Q

What are the genitourinary signs and symptoms of an infectious disease?

A
  • Dysuria or flank pain
  • Hematuria
  • Oliguria
  • Urgency, frequency

May produce referred pain patterns depending on area infection resides:
• L shoulder
• Bladder infection refer to the low back region
• Kidney infection refer to the unilateral subcostal or lower abdominal
• Prostate infection refer to the suprapubic

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57
Q

What are the upper respiratory signs and symptoms of an infectious disease?

A
  • Tachypnea
  • Cough
  • Dyspnea
  • Hoarseness
  • Sore throat
  • Nasal Drainage
  • Sputum production
  • Oxygen desaturation
  • Decreased exercise tolerance
  • Prolonged ventilatory support

May produce referred pain patterns to:
• L shoulder
• Mid-thoracic
• Mid-chest

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58
Q

What are the common infectious causes of fever in a hospitalized patient?

A
  • Urinary tract infection (UTI)
  • Respiratory tract infection
  • Catheter-related infection
  • Surgical wound infection
  • Infected pressure ulcers
  • Other (less common): colitis, peritonitis, meningitis
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59
Q

True or False

New onset of fever in the inpatient environment without investigation for causative agent would preclude physical therapy evaluation until cleared by the physician

A

True. New onset of fever in the inpatient environment without investigation for causative agent would preclude physical therapy evaluation until cleared by the physician

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60
Q

What are some infectious and non infectious causes of a prolonged fever of <102 deg?

A 
• Catheter-assoc. bacteriuria
• Atelectasis
• Phlebitis
• Pulmonary emboli
• Dehydration
• Pancreatitis
• MI
• Uncomplicated wound
infection
• Any malignancy
• Cytomegalovirus
• Hepatitis
• Infectious mononucleosis
• Subacute bacterial
endocarditis
• Tuberculosis
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61
Q

What are some infectious and non infectious causes of a prolonged fever of >102 deg?

A 
• Malignant hyperthermia
• Transfusion reactions
• Urosepsis
• IV-line sepsis
• Prosthetic valve endocarditis
• Intra-abdominal abscess
• C-diff colitis
• Procedure related bacteremia
• Healthcare-acq. pneumonia
• HIV infection
• Heat stroke
• TB
• lymphoma
• Tuberculosis
• Metastasizing carcinoma to
the liver or CNS
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62
Q

Should mobility/PT be performed on a patient whose symptoms are confined to above neck (i.e., runny
nose, nasal congestion, or sore throat)?

A

Participate as able

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63
Q

What are the absolute contraindications for aerobic exercise?

A

• Unstable angina
• Uncontrolled cardiac dysrhythmias causing symptoms of hemodynamic compromise
• Uncontrolled symptomatic heart failure
• Acute or suspected major cardiovascular event (inc. severe aortic stenosis, pulmonary embolus or
infarction, myocarditis, pericarditis, or dissecting aneurysm)
• Acute systemic infection, accompanied by fever, body aches, or swollen lymph glands

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64
Q

What are the relative contraindications for aerobic exercise?

A
  • Known significant cardiac disease (inc. left main coronary stenosis, moderate stenotic valvular disease, hypertrophic cardiomyopathy, high-degree atrioventricular block, ventricular aneurysm)
  • Severe arterial hypertension (systolic BP > 200 mmHg or a diastolic BP of >110 mmHg) at rest
  • Tachydysrhythmia or bradydysrhythmia
  • Electrolyte abnormalities
  • Uncontrolled metabolic disease
  • Chronic infectious disease
  • Mental or physical impairment leading to inability to exercise safely
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65
Q

Should mobility/PT be performed on a patient whose symptoms are systemic symptoms present (i.e., fever, myalgias, diarrhea, elevated resting HR)?

A

Refrain from exercise until symptoms resolve

66
Q

What are the special considerations for PT given to patients with Infectious mononucleosis?

A
  • Suspicion of mono warrants further referral due to danger of splenomegaly and risk of splenic rupture with higher level activity
  • Use judgement according to the activities required of your patient for safety in proceeding with evaluation (if already dx w/mono)
67
Q

What is osteomyelitis?

A

An inflammation of the bone or bone marrow that results from an infection

68
Q

What are the presentation of people that are considered to be high risk for osteomyelitis?

A
  • Weak immune system

- Poor blood circulation due to uncontrolled DM

69
Q

What is hematogenous spread?

A

The process by which bacteria reaches the bone through the bloodstream

70
Q

What is the type of osteomyelitis common in older adults?

A

Vertebral osteomyelitis

71
Q

What is the type of osteomyelitis common in children?

A

Metaphysis osteomyelitis

72
Q

What are another ways that a person can get osteomyelitis?

A
  • Trauma
  • Surgery
  • Infection spreads from one area to another( contiguous spread)
73
Q

What are the cells that try to fight off infection as seen in osteomyelitis?

A

Dendritic cells and macrophages

74
Q

What are the key events of the acute phase of osteomyelitis?

A
  • Bacteria reaches the bone and proliferates
  • Nearby immune cells are alerted
  • Can take up to weeks
75
Q

What often happens in cases of chronic osteomyelitis?

A

Affected bone becomes necrotic and separates from viable bone. This is called the sequestrum

76
Q

What is an involucrum?

A

A layer of new bone growth outside existing bone

77
Q

Where are some places that an osteomyelitis infection may spread to?

A
  • Nearby joint, especially the knee or hip joint in young children
  • Overlying muscle
  • Skin
  • Blood vessels, causing thrombophlebitis
78
Q

What is the most common cause of osteomyelitis?

A
  • Staphylococcus aureus, a bacteria that lives on the skin and can invade the skin and spread contiguously to the bone
79
Q

What are the symptoms of acute osteomyelitis?

A
  • Pain at the site of infection
  • Fever
  • Inflammation
  • May affect use of the bone depending on the location
80
Q

What are the symptoms of chronic osteomyelitis?

A
  • Prolonged fevers

- Weight loss due to chronic inflammatory state

81
Q

How is osteomyelitis usually diagnosed?

A
  • Complete blood count (CBC), which shows an increase in WBC, increase in erythrocyte sedimentation rate (ESR), increase in C-reactive protein (CRP)
  • Xray which might show the thickening of the cortical bone and periosteum, an elevation of the periosteum
82
Q

What are some other findings in a xray that could be indicative of osteomyelitis?

A
  • Loss of the normal bone architecture, especially the trabecular architecture
  • Osteopenia(loss of bone mass), which becomes evident when half of the bone matrix is destroyed
83
Q

Why is a bone scan/MRI done in the diagnosis of osteomyelitis?

A

To confirm the presence of osteomyelitis or to identify a possible abscess

84
Q

Why is a bone biopsy done in the diagnosis of osteomyelitis?

A

To help culture and identify the pathogen responsible to osteomyelitis and to help confirm the diagnosis

85
Q

What is the usual treatment for osteomyelitis?

A
  • Weeks of antibiotics directed at the organism causing the infection
  • Surgery may be needed to remove any necrotic bone, particularly in chronic osteomyelitis, where the sequestrum has to be removed
86
Q

What type of treatment is done when there is an abscess, particularly a vertebral abscess, causing neural compression or spinal instability?

A

Surgery may be required to drain the abscess

87
Q

What are some other causes of osteomyelitis?

A
  • Salmonella, which particularly affects individuals with sickle cell
  • Pasteurella multocida, which usually spreads from the skin to the bone from a cat or dog bite/scratch
88
Q

What is the most common form of infection causing osteomyelitis?

A

Infection via the bloodstream

89
Q

What are the clinical presentation of acute osteomyelitis?

A
  • Pain and/or tenderness in infected area, described as “deep and constant” and causes antalgic gait pattern when in LE
  • Inflammation, redness, & warmth in infected area
  • Fever, chills, and excessive sweating
  • Nausea & malaise
  • Swelling of legs, ankles, feet when in LE
  • Possible presence of suppuration (or pus/purulence)
90
Q

What are the clinical presentation of vertebral osteomyelitis?

A
  • Localized lower back pain & tenderness
  • Paravertebral muscle spasm unresponsive to conservative treatment
  • Radicular pain & extremity weakness in case of more advanced disease process causing spinal cord or nerve root compression
91
Q

What are the clinical presentation of chronic osteomyelitis?

A 
• Pain for months to many years
• Intermittent bone pain, tenderness
• Not as painful as acute osteomyelitis
• May be result of partially successful treatment of acute
osteomyelitis
92
Q

What are the clinical presentation of a prosthetic joint infection?

A
  • Persistent joint pain after total joint arthroplasty may be only symptom
  • Fall into three categories depending on onset of symptoms
93
Q

What are the characteristics of prosthetic joint infection that occurs early: < 3 months post-surgery?

A
  • Present with acute symptoms as for an acute osteomyelitis

* Sinus tract w/purulent drainage

94
Q

What are the characteristics of prosthetic joint infection that occurs delayed: between 3-24 months post-surgery?

A
  • Often lack systemic symptoms
  • Present w/joint pain and/or prosthetic joint loosening which presents as abnormal joint movement and is a cardinal sign of an infection in the joint
95
Q

What are the characteristics of prosthetic joint infection that occurs late: > 24 months post-surgery?

A

• Often from a blood-borne infection “seeding” the prosthetic joint
• Principle symptom is joint pain– unexplained onset of increasing MSK symptoms in
area of prosthetic joint

96
Q

What are the possible anatomic
localizations of osteomyelitis in
adult patients?

A
  • Prosthetic joint infection
  • Vertebral osteomyelitis
  • Diabetic foot infection
  • Post traumatic infection
  • Septic arthritis
97
Q

What is the patient population that is at risk for osteomyelitis?

A

• Those w/systemic involvement that impairs immune surveillance, metabolism, & local vascularity such as:
- Malnutrition
- Renal/hepatic failure (including those on hemodialysis)
- Immune disease/immunosuppression/immune deficiency (esp. systemic lupus erythematosus, diabetes)
- Chronic hypoxia
- Extremes of age
- Impaired circulation (esp. peripheral artery disease, diabetes, sickle cell disease)
• Those w/deep pressure ulcers
• IV-drug users
• s/p open fractures & implanted orthotic devices

98
Q

What are the diagnostic test that a physician will run in the case of a patient with a suspected osteomyelitis?

A

• Lab work: CBC: leukocytosis, elevated ESR & C-reactive protein
• X-ray: may not be abnormal for 2-4 weeks, though
• CT/MRI, If X-ray is not diagnostic and it can also show adjacent infections or abscesses assoc. w/osteo
• Bone scan: shows abnormalities earlier, but cannot distinguish btn infection, fractures, and tumors
• Bone biopsy: to give definitive antibiotic treatment (culture of any drainage
doesn’t necessarily give the pathogen)

99
Q

What is the role of PT in the process of osteomyelitis?

A

• Vital in screening role: look for signs and symptoms in individuals at risk
• Prevention
- Chronic osteomyelitis often result of complication s/p treatment of open fx
- Many infections occur in immediate post-op period
• Look for early warning signs such as pus at incision line and other clinical presentations from previous slide

100
Q

What are the different interventions that can be done once a positive identification of osteomyelitis has been done?

A
  • Long-term IV antibiotic treatment (may or may not require hospitalization). Vancomycin, 3rd/4th gen. cephalosporin, if it continues >3 wks post-surgery– IV then follow
  • Possible surgery for abscess drainage, constitutional symptoms, potential spinal instability, removal of necrotic bone/debridement of necrotic soft tissue, removal of any medical devices (prosthetic joints, surgical stabilizing devices, etc)– ** but not all cases require surgery!
  • May need skin grafts or wound care
  • May need amputation or continued bone reconstructive surgery
  • Follow-up physical therapy management of functional deficits and wounds
101
Q

What are some of the chemicals that affects the mood and is often abused?

A
  • Caffeine (Coffee, black tea, chocolate and soft drinks)
  • Cannabis (Marijuana)
  • Depressants (Alcohol, sedatives, and tranquilizers)
  • Narcotics
  • Stimulants
  • Anabolic androgenic steroids
  • Tobacco
102
Q

What are the effects of substances when they are abused?

A 
• Impair judgement
• Delay wound healing
• Slow rehabilitation process
• Societal ramifications include:
  - Violence
  - Homicide
  - Assault
  - Accidental injury
  - Suicide
  - STDs
  - 50% of MVAs
103
Q

What age group is susceptible to the use of substances?

A

Adolescents

104
Q

What are the criterias that successful drug abuse prevention programs use?

A
  1. Target the most critical age groups
  2. Provide Multiple years of intervention
  3. Include a well-Tested, standardized intervention with detailed lesson plans and student materials
  4. Teach drug-resistance skills through interactive methods
  5. Foster positive social bonding to the school and community
  6. Contain appropriate content
  7. Promote positive peer influence and antidrug social norms
  8. Emphasize skills training teaching methods and include enough sessions
  9. Retain core elements of the effective intervention design, training, and monitoring, and undergo periodic evaluation
105
Q

What is caffeine abuse?

A

Recent consumption of caffeine, usually more than 250

mg (the equivalent of two to three cups of coffee or more)

106
Q

What is the manifestation of caffeine intoxication?

A 
Five or more of the following developing during or shortly
after caffeine consumption:
• Restlessness
• Nervousness
• Excitement
• Insomnia
• Flushed face
• Diuresis
• Gastrointestinal disturbance
• Muscle twitching
• Rambling flow of thought or speech
• Tachycardia or cardiac arrhythmia
• Periods of inexhaustibility
• Psychomotor agitation
107
Q

What are the manifestations of caffeine withdrawal?

A
  • Headache
  • Lethargy
  • Fatigue
  • Muscle pain and stiffness
  • Dysphoric mood changes
108
Q

What is the CAGE instrument?

A

A tool used to help determine the need for a consultation and consist of 4 questions

109
Q

What are the questions consisted in the CAGE instrument?

A

• Have you ever felt you should Cut down on your drinking?
• Have people Annoyed you by
criticizing your drinking?
• Have you ever felt bad or Guilty about your drinking?
• Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (Eye-opener)?

110
Q

What are the potential manifestations of alcohol abuse?

A 
• Missing appointments
• Inappropriate behaviors
• Outbursts of anger or
mood swings
• Undue defensiveness when
asked about alcohol or drug use
111
Q

What is a standard drink in the U.S.?

A

0.6oz, 14g or 1.2 tbsp of pure alcohol

112
Q

What level of alcohol consumption is considered at risk drinking?

A
  • Long term consumption of 15 or more drink per week for men

- Long term consumption of 8 or more drink per week for men

113
Q

What are the substance abuse effects on the cardiovascular system?

A
  • Cardiomyopathy
  • Cardiovascular disease, including increased risk of MI, CVA and PVD
  • Arrhythmias (esp. amphetamines and cocaine)
  • Endocarditis or heart valve infection (from use of needles)
  • Hypertension
114
Q

____ drugs are more associated with cardiovascular disease

A

Stimulants in opioid drugs are more associated with cardiovascular disease

115
Q

What are the substance abuse effects on the pulmonary system?

A
  • Respiratory depression
  • Impaired cough & gag reflex
  • Aspiration
  • Lung infections
  • Pulmonary edema in long term cocaine/crack users
  • Nasal passageway infection
  • Interstitial lung disease
116
Q

What are the substance abuse effects on the gastrointestinal system?

A
  • Gastritis mostly caused by alcohol
  • Esophageal cancer
  • Decreased gastric and intestinal motility
  • Malabsorption
  • Other cancers of the GI tract
  • Ischemic colitis
  • Constipation → small bowel obstruction
117
Q

What are the substance abuse effects on the hepatic system?

A 
• Alcoholic effects:
 - Fatty liver
 - Alcoholic hepatitis
 - Cirrhosis
 - Hepatic encephalopathy
• Drug-induced liver injury (DILI)
118
Q

What are the substance abuse effects on the pancreatic system?

A
  • Pancreatitis: Chronic & acute
  • Pancreatic cancer

especially with alcohol abuse

119
Q

What are the substance abuse effects on the gallbladder system?

A

Gallstones. More common with alcohol

120
Q

What are the substance abuse effects on the renal system?

A

• Hyponatremia caused by hypovolemia, due to the true volume depletion caused by GI fluid losses
- “Beer potomania syndrome” caused by alcohol binge drinking
• Renal tubular dysfunction
• Acute renal failure

121
Q

How do opioid drugs increase the risk of vascular heart disorders?

A

By disrupting the balance of neurotransmitter catecholamines in the body and brain, which may lead to dose dependent changes in BP, abnormalities in the normal rhythm of the heart, increased blood clotting and increased arterial plaque formation

122
Q

How does cocaine cause damage and death to the cardiac muscles?

A

By upsetting the balance of calcium at the cellular level, which then increases the risk of HTN, stroke, aneurysm, and damage to the cardiac tissue

123
Q

What can a single use of cocaine lead to?

A

Variant angina, which results from coronary arterial vasospasm

124
Q

What does opioid use over time lead to?

A

May aggravate the risk of cardiovascular disease by elevating the biochemical hallmarks of disorders related to various conditions, which include increases in the concentration of LDLs

125
Q

What are the major classes of drugs that cause respiratory manifestations?

A
  • Opiate stimulants

- Cannbonoids

126
Q

What are some of the early indications of a nasal passageway infection?

A
  • Random nose bleeds

- Tender and dry passageways

127
Q

The most advanced form of alcoholic liver injury is alcoholic cirrhosis. What marks this condition?

A

Progressive development of scar tissue that chokes off the blood vessels and distorts the normal architecture of the liver

128
Q

What are the characteristics of hepatic encephalopathy?

A
  • Decreased mental status

- Liver flap/asterixis, which is a tremor of the hands that looks like a bird flying

129
Q

What is the most common cause of drug-induced liver injury (DILI)?

A

Overdose of acetaminophen

130
Q

What are the presenting features of pancreatitis?

A
  • Abdominal pain which is centered in the mid epigastrium and radiates to the back
  • Exacerbated by lying down
  • Severe nausea, vomiting
  • Feeling of fullness due to the decreased intestinal motility
131
Q

What causes chronic pancreatitis?

A

Ingestion of relatively low alcohol over a long period of time

132
Q

What are the characteristics of chronic pancreatitis?

A

Slow and insidious onset, with a presentation that includes:

  • Chronic abdominal pain that is made worse by large fatty meals
  • Weight loss
  • Malabsorption
  • Foul smelling, bulky stools
  • Diarrhea
133
Q

What are the presentations of a gallbladder infection?

A
  • Fever
  • Jaundice
  • Abdominal pain
134
Q

Continuous insult to the pancreas can lead to ___

A

Continuous insult to the pancreas can lead to pancreatic cancer

135
Q

What are the signs of beer potomania syndrome?

A
  • Generalized weakness
  • Nausea and vomiting
  • Muscle cramping
  • Peripheral edema
  • Cerebral edema
  • Changes in mentation/memory
  • Restlessness and irritability
  • Gait disturbances
  • Uncontrolled tremors
  • Seizures and coma
136
Q

What can beer potomania syndrome lead to?

A

Severe morbidity and mortality, mainly due to overly rapid correction of serum sodium, can lead to brain edema

137
Q

The abnormalities seen with renal tubular dysfunction usually disappear after how long?

A

4 weeks of alcohol abstinence

138
Q

What is acute renal failure a result of?

A

During alcohol overuse, there is a skeletal muscle myopathy that can progress to abnormal and excessive breakdown, called rhabdomyalysis

139
Q

What are some of the neurological effects of substance abuse?

A
  • Cognitive
  • Behavioral/psychological
  • Disorders of movement
  • Peripheral nervous system
  • Mixed effects
  • Other effects
140
Q

What is the mechanism of neurological effects of substance abuse due to?

A
  • Direct influence on central and peripheral nervous system caused by either withdrawal effects or changes in structure
  • Indirect effects of effects on other organs (i.e., liver) that interferes with CNS/PNS function, such as nutritional deficiencies, or toxic accumulation of byproducts normally eliminated through other organ systems
  • Trauma caused during intoxication
141
Q

What are some common neurological conditions associated with substance abuse?

A
  • Headache
  • Stroke
  • Seizures
  • Coma
  • Transient neurological deficits
  • Memory impairment
  • Impaired concentration
  • Wernicke-Korsakoff disease
  • Alcoholic cerebellar degeneration
  • Alcoholic myopathy
  • Pain
  • Head trauma
142
Q

What are the effects of addiction?

A

• Alters normal brain structure & function in areas of essential cognitive functions (learning, memory, attention, reasoning, & impulse control)
• Cognitive shifts promote continued drug use through maladaptive learning &
hinders acquisition of adaptive behaviors that support abstinence
• Particularly disruptive when abuse occurs during brain development (prenatal – adolescence, those w/mental disorders)
• Multiple implications for therapeutic agents to treat addiction

143
Q

What are the individuals that are susceptible to drug abuse?

A

Individuals w/mental disorders & ADHD particularly susceptible to drug abuse
• Abuse patterns higher than in general population
• May represent attempts to “self-medicate” symptoms of disorders

144
Q

What are the characteristics of behavioral/psychiatric effects of substance abuse: substance-induced psychosis?

A
  • Condition characterized by delusions & hallucinations, commonly assoc. w/mental illness
  • More common w/methamphetamines, cannabis, cocaine, alcohol, & psychedelic drugs
  • May wear off after use is stopped, but some persist after long-term abuse
  • May lead to Korsakoff’s Syndrome
145
Q

What are the characteristics of Korsakoff’s Syndrome?

A
  • Associated w/long-term alcohol use
  • Progression from untreated Wernicke Syndrome
  • An amnestic syndrome characterized w/impaired recent memory & relatively intact intellectual function
146
Q

What are the characteristics of Alcohol abuse-related Dementia?

A
  • Generally a dx of exclusion

* Hx of chronic alcohol use, usually tend to be 10 yrs younger than those dx w/Alzheimer’s

147
Q

When can substance induced psychosis occur?

A
  • Taking too much of a drug
  • Adverse reaction as a result of mixing drugs
  • Withdrawal from a drug
  • Underlying mental issues
148
Q

What does korsakoff syndrome result from?

A

Thiamine deficiency and is usually preceded by wernicke’s encephalopathy

149
Q

What is the presentation of korsakoff syndrome?

A
  • Loss of recent memory
  • Inability to store recent memory into long term memory
  • Poor insight and judgment
  • Apathy or flattened affect
  • Little to no response to treatment, once it has developed
150
Q

What medication has shown some improvement in the treatment of korsakoff syndrome?

A

Clonodine

151
Q

What is the presentation of alcohol abuse- related dementia in its early stages?

A
  • Fatigue
  • Loss of interest
  • Depression
  • Anxiety
  • Agitation
  • Social withdrawal
  • Irritability
  • Impulsive
  • Socially unacceptable behavior
152
Q

What is the presentation of alcohol abuse- related dementia in its later stages?

A
  • Confusion
  • Disorientation
  • Recent memory loss
  • Poor judgement
  • Lack of insight
  • Deterioration of learning and memory processes that include: visual and motor problem solving, and constructual skills
  • Spasticity of the LEs
  • Scissoring gait
  • Fine picking movements
153
Q

What are the characteristics of stroke and substance abuse?

A

• In alcoholics: cerebral atrophy increases susceptibility to subdural hematomas & coagulation
disorders which increases risk of ischemic CVA
• Illicit drug use main cause of CVA in those <35 years of age
• Commonly cocaine, amphetamines, MDMA/ecstasy, LSD, PCP

154
Q

What are the characteristics of cerebellar degeneration and substance abuse?

A
  • Assoc. w/chronic alcohol use

* Broad-based unstable gait, incoordination, upper limbs rarely involved

155
Q

What are the characteristics of transient chorea/buccolingual dyskinesias and substance abuse?

A
  • “Crack dancing”
  • Self-limiting, choreoathetoid movements involving orofacial and limb musculature that may be assoc. w/akathisia
  • Can last several days, but not life-threatening
  • Must be distinguished from other choreas
156
Q

What are the characteristics of tremors and substance abuse?

A
  • Seen in withdrawal syndromes
  • Postural tremor w/alcohol, present when sustaining a position against gravity seen in late stage dependence or early withdrawal
  • Myoclonus w/opioids
157
Q

What are the characteristics of peripheral neuropathy and substance abuse?

A
  • Chronic alcohol use
  • Symmetrical, bilateral mixed sensory & motor types, usually of the lower limbs
  • May be asymptomatic or present w/pain, numbness, burning, hyperaesthesia
  • May have muscle weakness, diminished tendon reflexes
  • Assoc. w/thiamine deficiency and may show some recovery w/alcohol abstinence & thiamine supplementation (usually permanent damage, though)
158
Q

What are the characteristics of autonomic neuropathy and substance abuse?

A
  • Chronic alcohol use

* Impairs control of BP, HR, sweating, bowel/bladder emptying, digestion

159
Q

What is Wernicke’s encephalopathy (aka Wernicke-Korsakoff syndrome)?

A

Bleeding in the brainstem & hypothalamus caused by thiamine deficiency due to excessive and chronic alcohol abuse

160
Q

What are the presentation of Wernicke’s encephalopathy (aka Wernicke-Korsakoff syndrome)?

A
  • Progressive external ophthalmoplegia
  • Horizontal nystagmus
  • Bilateral rectus palsy
  • Ataxia
  • Confusion
  • Disorientation
  • Can progress to complete paralysis & if not treated to Korsakoff’s syndrome
161
Q

What is the treatment and prevention method of Wernicke’s encephalopathy (aka Wernicke-Korsakoff syndrome)?

A

Prevention & treatment via thiamine replacement

162
Q

What causes seizures/convulsions?

A
  • Abrupt decline of the brain alcohol levels
  • May occur before the alcohol content returns to zero, due to partial withdrawal either during sleep or a time where the alcoholic can’t afford normal level of consumption

Advanced clinical practice: examining the complex patient (7 decks)

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