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Examine Complex Patient 6671 > Week3 > Flashcards

Week3 Flashcards

1
Q

This is classified by shape and oxygen need, and constitutes about 38% of human pathogens.

A

Bacteria

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2
Q

Fungi can be one of two forms…

A
  1. True pathogen
    Causes infections in healthy people
    (Histoplasmosis; Coccidioidomycosis)
  2. Opportunistic pathogens
    Causes infection in immunocompromised persons
    (Aspergillosis; Candidiasis; Cryptococcosis)
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3
Q

Virus is a subcellular organism made up of?

A

Only RNA or DNA covered with proteins

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4
Q

Infection agent composed entirely of protein material

A

Prions

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5
Q

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

A

Prions

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6
Q

Indirect contact transmission

A

Contact w/ contaminated surface or object, food, blood, or water

Travel through the air

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7
Q

The “Big Five” infectious diseases according to WHO

A

Have the greatest impact in terms of mortality and DALY (disability-adjusted life year)

  1. Pneumonia
  2. Diarrhea
  3. HIV/AIDS
  4. TB
  5. Malaria
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8
Q

Sepsis

A

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

Inflammation can trigger cascade that damages multiple organ systems leading to failure

Especially dangerous in older adults and immunocompromised

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9
Q

3 stages of sepsis

A

Sepsis->
Severe sepsis->
Septic shock

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10
Q

Sepsis: must exhibit at least 2 of following symptoms in addition to ___?

A
  1. Body temp >101 F or < 96.8 F
  2. HR > 90
  3. RR > 20 breaths/min

And a confirmed infection

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11
Q

Severe sepsis: exhibits at least 1 of the following s/s, indicating possible organ failure

A
  1. Significant decrease in urine output
  2. Abrupt mental status change
  3. Decrease in platelet count
  4. Difficulty breathing
  5. Abnormal heart pumping function
  6. Abdominal pain
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12
Q

Septic shock: exhibits ?

A

All s/s of severe sepsis:

  1. Significant decrease in urine output
  2. Abrupt mental status change
  3. Decrease in platelet count
  4. Difficulty breathing
  5. Abnormal heart pumping function
  6. Abdominal pain

PLUS extreme hypotension that does not respond adequately to fluid resuscitation

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13
Q

Sepsis risk factors

A
  1. Advanced age or very young age
  2. Immunocompromised
  3. Hospitalization, particularly ICU
  4. Presence of wounds- esp burns
  5. Presence of invasive devices (IV, caterers..)
  6. Antibiotic resistant bacteria
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14
Q

Sepsis complications

A

Impaired organ function
Blood clots
Death

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15
Q

WHO states ____ burden is greater than HIV/AIDS, TB and malaria combined

A

HAI: healthcare-associated Infections

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16
Q

Common sites for HAI

A

Urinary tract
Surgical wounds
Joints
Lower respiratory tract

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17
Q

Risk factors for HAI

A
  1. Extremes of age
  2. Immunodeficiency
  3. Immunosuppressed
  4. Misuse of antibiotics
  5. Invasive diagnostic and therapeutic procedures
  6. Agitation
  7. Surgery
  8. Burns
  9. Length of hospitalization
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18
Q

S/S infectious disease

A
  1. Fever
  2. Chills
  3. Malaise/Body aches
  4. Fatigue
  5. Coughing
  6. Diarrhea
  7. Palpable lymph nodes
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19
Q

most palpable lymph node sites

A
  1. Sub mandibular
  2. Axilla
  3. Supra clavicular
  4. Groin

Use light touch

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20
Q

S/S infectious disease

Age-Specific: Older adults

A

May be subtle and atypical

  1. Mental status change
  2. Subnormal body temp (or normal temp)
  3. Bradycardia/Tachycardia
  4. Fatigue (or increased fatigue)
  5. Lethargy/weakness
  6. Decreased appetite
  7. Increased incidence of falls in short period of time
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21
Q

S/S infectious disease

Age-Specific: Young children

A
  1. Irritability
  2. Inconsolability
  3. Generalized symptoms seeming let not related
  4. Lethargy/excessive sleepiness
  5. Decreased appetite
  6. Subnormal body temp
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22
Q

S/S infectious disease

Body system- integumentary

A

Purulent Drainage
Skin rash, red streaks (cellulitis?)
Bleeding from gums or into joints
Joint effusion or erythema

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23
Q

S/S infectious disease

Body system- CV

A

Petechial lesions
Tachycardia
Hypotension
Increase or decrease in HR

24
Q

S/S infectious disease

Body system- CNS

A 
Altered LOC, confusion, seizures 
HA
Photophobia 
Memory loss
Stiff neck, myalgia

With presentation of these symptoms, particularly with fever, HA, neck stiffness, and AMS- use screening tests:
Kernig sign
Brudzinski sign

25
Q

Kernig sign

A

Supine

  1. Knee flexed to 90*
  2. Hip flexed to 90*
  3. Extension of the knee is painful or limited in extension

Screening for CNS infectious disease (like meningitis)

26
Q

Brudzinski sign

A

Supine
1. Passive flexion of neck

Elicits hip and knee flexion

Screening for CNS infectious disease (like meningitis)

27
Q

S/S of infectious disease

Body system- GI

A

Nausea
Vomiting
Diarrhea

May produce referred pain patterns:
Lumbosacral 
Lower abdomen 
Mid-thoracic 
R shoulder
28
Q

S/S of infectious disease

Body system- genitourinary

A

Dysuria or flank pain
Hematuria
Oliguria
Urgency, frequency

May produce referred pain patterns:
L shoulder 
Low back region
Unilateral subcostal or lower abdominal 
Suprapubic
29
Q

New onset of fever in the inpatient environment- implication?

A

Without investigation for causative agent would preclude PT evaluation until cleared by physician

30
Q

Screening question about fever..

A

How long have you had fever, and how high had it been?

102* (above or below this is the cutoff temp for determining causes)

31
Q

Absolute exercise contraindications (aerobic)

A
  1. Unstable angina
  2. Uncontrolled cardiac dysrhythmias causing symptoms of hemodynamic compromise
  3. Uncontrolled symptomatic heart failure
  4. Acute or suspected major CV event
  5. Acute systemic infection, accompanied by fever, body aches, or swollen lymph glands
32
Q

Infectious disease

To proceed or not proceed?

A

Use “neck check” rule:
Symptoms confined to above neck - participate as able

If systemic symptoms present- refrain from exercise until symptoms resolve

Special case- infectious mono : warrants further referral due to danger of spenomegaly and risk of splenic rupture with higher level of activity

33
Q

Acute osteomyelitis

Clinical presentation

A

Pain/tenderness in infected area
Described as “deep and constant”
Causes antalgic gait when in LE

Inflammation, redness and warmth
Fever, chills, excessive sweating
Nausea and malaise
Swelling of legs, ankles, and feet when LE
Possible presence of suppurations, pus/purulence

Rapid dx followed by tx is imperative!

34
Q

Vertebral osteomyelitis

Clinical presentation

A

Localized LBP and tenderness

Paravertebral muscle spasm unresponsive to conservative tx

Radicular pain and extremity weakness in case of more advanced disease process causing spinal cord or nerve root compression

35
Q

Chronic osteomyelitis

Clinical presentation

A

Pain for months to years

Intermittent bone pain/tenderness

Not as painful as acute osteomyelitis
May be result of partially successful tx of acute osteomyelitis

36
Q

Prosthetic joint infection

Clinical presentation

A

Persistent joint pain after total joint arthroplasty may be only symptom

3 categories dependent on onset of symptoms:
1. Early: < 3 months post-surgery
Acute symptoms; Sinus tract w/ purulent drainage
2. Delayed: 3-24 months post-surgery
Often lack systemic symptoms; Joint pain and/or prosthetic joint loosening
3. Late: > 24 month post-surgery
Often blood-born infection “seeding” prosthetic; Joint pain w/ unexplained onset of increasing MSK symptoms

37
Q

Osteomyelitis

Patient population at risk

A

Systemic involvement that impairs immune surveillance, metabolism, and local vascularity
Malnutrition; Renal/Hepatic failure; Cheonic hypoxia; Immunocompromised/suppressed; Extremes of age; impaired circulation

Deep pressure ulcers

IV drug users

S/P open fx and implanted orthotics

38
Q

Osteomyelitis

Diagnostic test

A 
Lab work
X-ray
CT/MRI
Bone scan 
Bone biopsy
39
Q

Osteomyelitis

PT involvement in process

A

Screening role

Prevention

40
Q

Substance abuse effects by system- CV

A

Cardiomyopathy
CV disease (incl MI, CVA, PVD)
Arrhythmia (esp. amphetamines and cocaine)
Endocarditis or heart valve infection (needle drugs)
HTN

41
Q

Substance abuse effects by system- pulmonary

A 
Respiratory depression 
Impaired cough and gag reflex 
Aspiration 
Lung infections 
Pulmonary edema 
Nasal passageway infection 
Interstitial lung disease
42
Q

Substance abuse effects by system- GI

A 
Gastritis
Esophageal cancer 
Decreased gastric and intestinal motility 
Malabsorption 
Cancers of GI tract
Ischemic colitis 
Constipation -> bowel obstruction
43
Q

Substance abuse effects by system- pancreatic

A

Pancreatitis- Chronic and acute

Pancreatic cancer

44
Q

Substance abuse effects by system- gallbladder

A

Gallstones

45
Q

Substance abuse effects by system- hepatic

A 
Alcoholic effects:
Fatty liver
Alcoholic hepatitis 
Cirrhosis
Hepatic encephalopathy

DILI: Drug induced liver injury

46
Q

Substance abuse effects by system- Renal

A

Hyponatremia
Hypovolemia
“Beer potomania syndrome”

Renal tubular dysfunction

Acute renal failure

47
Q

Substance abuse effects by system- neurological effects

A

Cognitive
Behavioral/Psychological
Disorders of movement
Peripheral nervous system

Mixed effects
Other effects

48
Q

Neurological effects of substance abuse

Mechanism due to?

A

Direct influence on CNS and PNS
Withdrawal effects
Changes in structure

Indirect effects on other organs (ie liver) than interferes w/ CNS/PNS function
Nutritional deficiencies
Toxic accumulation of byproducts normally eliminated through other organ systems

Trauma caused during intoxication

49
Q

Addiction is a disorder of altered cognition.

4 key points ?

A
  1. Alters normal brain structure and function in areas of essential cognitive functions
  2. Cognitive shifts promote continued use through maladaptive learning and hinders acquisition of adaptive behaviors that support abstinence
  3. Particularly disruptive when abuse during brain development (prenatal; adolescence, those with mental disorders)
  4. Individuals w/ mental disorders and ADHD particularly susceptible to abuse
50
Q

Korsakoff’s syndrome

A

Thiamine deficiency

Associated w/ long-term alcohol use

Progression from untreated Wernicke syndrome

Amnestic syndrome characterized by impaired recent memory and relatively intact intellectual function

51
Q

Substance abuse- stroke

A

Alcoholics:
Cerebral atrophy increases susceptibility to subdural hematomas and coagulation disorders which increase risk of ischemic CVA

Illicit drug use main cause of CVA < 35 y/o

52
Q

Substance abuse- cerebellar degeneration

A

Associated with chronic alcohol use

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

53
Q

Substance abuse- tremor

A

Seen in withdrawal syndromes

Postural tremor w/ alcohol
Present when sustaining position against gravity seen in Late Stage dependence or early withdrawal

Myoclonus with opioids

54
Q

Substance abuse- PNS (chronic alcohol abuse)

A
  1. Peripheral neuropathy:
    Symmetrical, bilateral mixed sensory and motor types- usually LE
    May be asymptomatic or present w/ pain, numbness, burning, hyperaesthesia
    May have muscle weakness, diminished tendon reflexes
    Assoc w/ thiamine deficiency (usu damage permanent even w/ supplementation)
  2. Autonomic neuropathy:
    Impairs control of BP, HR, sweating, bowel/bladder, digestion
55
Q

Wernicke’s encephalopathy

A

AKA: Wernicke-Korsakoff
Thiamine deficiency
Bleeding in brainstem and hypothalamus

Presentation:
Progressive external ophthalmoplegia, Horizontal nystagmus, Bilateral rectus palsy,
Ataxia, Confusion, Disorientation
Can progress to complete paralysis if untreated to Korsakoff’s
Reversible if treated early (thiamine)

Examine Complex Patient 6671 (8 decks)

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