Week 3 Flashcards
What are the moments for hand hygiene in all physical therapy settings?
- Before touching a patient
- Before clean/aseptic procedure
- After body fluid exposure risk
- After touching a patient
- After touching patient surroundings
According to the CDC, what are the implications to keep in mind when working with a patient with an infection?
- Proper hand-washing
- Follow the isolation or contact precautions as advised
- Wear PPE, where appropriate
- Keep immunizations up to date
- Restrict work during personal illness
What are other implications to keep in mind when working with a patient with an infectious disease?
• Personally follow and educate patients re proper coughing & sneezing hygiene
etiquette
• Recognize unanticipated dangers related to pathogen aerosolization during
common hygiene activities
- Flushing toilet (esp. after diarrhea or vomiting episodes)
- Pulsatile lavage in wound care
What are the effects of an acute infection on the system?
Systemic acute phase mobilizes nutrients for increased needs of
• Activated immune system
• Energy production
• Tissue repair
What happens to the body system as a result of an infection?
- Striated muscle wasting
- Degradation of performance-related metabolic enzymes
- Deteriorated central circulatory function
What does an acute infection result in?
• Decreased muscle and aerobic performance (full recovery may take several weeks to month following just a one-week long febrile episode!)
• Decline in prior compensated systems (cardiopulmonary, MSK,
neuromuscular)
• High resting heart rate and increased susceptibility to orthostatic hypotension (VITALS ARE VITAL!!!!)
• Compounding chronic disease processes
What are the criteria that help determine whether or not to proceed with a patient that might be presenting with an infectious disease?
- Depends on the PT setting
- Primary– safety!
- Newly discovered acute infectious process vs recovery phase
- Urgent nature of addressing movement deficits or activity intolerance
- Goals of session or activity
- Demand of physical therapy intervention(s)
- Overall comfort level of patient
In the outpatient setting, what are some guidelines to help decide whether or not a patient should proceed with therapy?
- Use the “neck check” rule: symptoms confined to above neck (i.e., runny nose, nasal congestion, or sore throat), participate as able
- If systemic symptoms present (i.e., fever, myalgias, diarrhea, elevated resting HR, swollen lymph nodes): refrain from exercise until symptoms resolve
What are the effects of a fever on the body, which may preclude a patient from participating in therapy?
- Fever may affect body’s ability to regulate body temp and cause an increase of fluid loss
- Fever may decrease muscle strength and endurance, decrease exercise tolerance, and increase fatigue; therefore any benefits obtained in exercise may be questionable
What were the results of the J-curve hypothesis that was performed on athletes in regard to immune function and exercise?
• Exercise at “moderate” levels = enhanced immunity, fewer illnesses, shorter duration of
illnesses compared with those who do not exercise at all
• Exercise at “high” levels may = increased risk of infections during intense training/post-major competitions
• In the studied trained athletes, exercise during infectious illness could exacerbate
symptoms, prolong length of illness, and increase risk of potentially serious complications such as myocarditis
How does the result of the J-curve hypothesis apply to the normal patient population suffering from infectious disease processes in an inpatient environment or lower level home health setting?
• Already ill, but the “exercise” we expect of those patients wouldn’t approach that of “exhausting” or even “high level”
• Application may be that “moderate levels” of exercise are beneficial to a hospitalized patient’s recovery by
shortening the duration of illness and enhancing the immune response
• Encouragement of a continued lifestyle of exercise may help decrease further incidence of illness
How does the result of the J-curve hypothesis apply to the normal patient population suffering from infectious disease processes in a higher function home health environment?
• May be recovering hospitalization for infectious illness, therefore inpatient
applications are relevant
• For those who become ill during course of therapy, may need to regress or hold advancement of therapy activities in order to avoid exacerbation of symptoms (i.e.,
this person could be considered as more “trained”)
How does the result of the J-curve hypothesis apply to the normal patient population suffering from infectious disease processes in an outpatient therapy clinic?
Many of these patients could be considered in the more “trained” category, therefore continued exercise/participation in therapy during the illness may be discouraged until symptoms improve
What is the general overview for treating patients with an infectious disease in the inpatient setting?
- Tend to be “sicker” patients
- Treating patient not for the infectious disease, but for the movementrelated impairments resulting from the illness
- May have co-morbidities exacerbated by acute infectious disease process
- Your patient needs to avoid bedrest as much as possible
- Balance need for rest and recovery with PT intervention
- Use critical lab values in day by day decision making
- VITALS!!!!
What is the general overview for treating patients with an infectious disease in the outpatient setting?
May be treating patient after an extended infectious disease process that required hospitalization, so consider:
• Impaired endurance
• Exacerbation or regression of chronic conditions
• New impairments induced by infectious process
What are the decision making components to keep in mind when treating an existing patient that presents with an infectious disease in an outpatient setting?
- Overall health and safety of yourself, clinical personnel and other patients
- May be an overall higher functioning patient who truly needs rest > PT
- Anticipate set-backs, decreasing intensity and duration of exercise, and possibly reformulating goals
What is osteomyelitis?
Inflammation and destruction of bone caused by bacteria, mycobacteria, or fungi.
What are the common infectious pathogens that cause osteomyelitis?
- Staphylococcus aureus (both methicillin-sensitive and methicillin-resistant)
- Pseudomonas aeruginosa
- Salmonella
What are the different ways that the transmission of osteomyelitis occurs?
- Contiguous spread from adjacent infected tissue or open wound
- Hematogenous spread
What are the common sites of transmission of osteomyelitis that spreads contiguously?
Common in feet, at sites where bone was penetrated during trauma or surgery, at sites
damaged by radiation therapy, and in bones contiguous to pressure ulcers
What are the common patient presentation of transmission of osteomyelitis that spreads hematogenously?
- More common in immunocompromised patients, IV-drug users, blood-related diseases, patients on hemodialysis
- Usually source of vertebral osteomyelitis
What are the patient population that are at risk for osteomyelitis?
• 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 orthopedic devices
