GI, renal, endocrine, immunological, & integumentary dis (ch 9)

Question 1

Bedside swallowing evaluation

Answer 1

• assess level of alertness, ability to follow directions, level of awareness of impairment, orientation to activity
• assess sensory and motor components of swallowing
• assess ability to manage own secretions (auscultation of neck to hear elongation of the oropharyngeal structures and listen for gurgling- a sign of insufficient swallow)
• assess swallowing function using trial boluses. Recommend further testing PRN.

Question 2

Tx for GERD

Answer 2

• sleep with more than one pillow (elevation of head discourages regurgitation)
• drug therapy
• diet modification (less spices, small meals more frequently, lower alcohol intake)
• stress management

Question 3

what is neurogenic bowel?

Answer 3

sympathetic nerve impairment, generally in people with SCI above T6; loss of control of anal sphincter; sensory loss resulting in lack of awareness of feces in bowel; motor loss, decreased or lost ability to self-initiate or control bowel movement. flaccidity of muscles results in incontinence. With autonomic dysreflexia an extreme rise in blood pressure can result.

Question 4

risk factors for kidney disease (3)

Answer 4

• diabetes! (10-40% with type 2 DM develop severe kidney disease and End Stage Renal Disease)
• HTN
• systematic lupus erythematosus

Question 5

impact of renal disease on performance skills/client factors

Answer 5

• motor dysfunction (fatigue, muscle pain, edema limiting mobility, weakness)
• sensory system function (neuropathy, vision loss)
• cognitive dysfunction (alteration of body image, delusions due to sepsis or toxicity, dementia: multi-infarct or metabolic)
• perceptual/neurobehavioral dysfunction (dementia: infarct related; stroke related)
• psychological/emotional dysfunction (anxiety disorder, depression, mood/adjustment disorder, poor management of psych disorder can increase risk of cardiac arrest; drug therapy maybe needed.

Question 6

impact of renal disease on performance in areas of occupation

Answer 6

• self-care (alteration in urination, need for sanitation with self-dialysis, adhere to diet, sexual problems, need for AE, energy conservation, altered mobility)
• IADLS (housework, community mobility, meal prep for diet, finances, leisure/sports

Question 7

4 diagnostic stages of cancer

Answer 7

1. tumor present; no perceived spread (operable lesion; good prognosis)
2. localized spread of tumor (operable lesion; usually responds well to tx chemo/radiation/immuno-therapy)
3. extensive evidence of primary tumor that has spread to other organs (tumor can be surgically debulked, but some cells may remain behind; deeper spread of tumor cells in lymphatics)
4. inoperable primary lesion; multiple metastases. (survival dependent on depth and extent of the tumor spread as well as the ability to have the tumor respond to therapy… less than 5% survival rate past 5 years.)

Question 8

Scleroderma (etiology; what is it?)

Answer 8

Unknown etiology. Rheumatic, connective tissue disease associated with impaired immune response. Hardening/tightening of skin and connective tissue (can affect BV’s, organs, digestive tract).
3 components:
-Vascular (Raynaud’s phenomenon; constant recurrent constriction of small bv’s leading to pulmonary hypertension)
-Fibrotic- scar tissue resulting from excess collagen (protein) causing thickness of skin and a burning sensation in the skin. In lungs causes restrictive lung disease.
-Autoimmunity- B-cell-produced antibodies

Question 9

What is Raynaud’s phenomenon?

Answer 9

when cold temperatures or strong emotions cause blood vessel spasms- blocks blood to fingers, toes, ears, and nose.

Question 10

Intervention for Raynaud’s phenomenon

Answer 10

keep fingers and toes warm
dress in layers
drug therapy (vasodialators)
biofeedback

Question 11

Intervention for pulmonary artery problems

Answer 11

drug therapy (coagulants)
nasal oxygen

Question 12

Intervention for fibrosis of the skin

Answer 12

protective gloves (cotton, insulated, mildly compressive)
drug therapy

Question 13

Sequelae of scleroderma (and recommendations)

Answer 13

• poor circulation/Raynaud’s (dressing; biofeedback; education on skin inspection; activity modifications to prevent trauma
• contractures (splinting; silicone gel in palms of hands; electrical vibration)
• facial disfigurement and alteration in body image/self identity (allow client to choose adaptations to ease adjustment; support groups)
• thoracic spinal lesions causing paraparesis, neurogenic bowel/bladder, altered mobility, altered ADLs (neurorehab and biomechanical approaches PRN)
• space occupying lesions in the brain produce stroke-like symptoms (rehab for functional deficits)

Question 14

sequelae of HIV

Answer 14

• generalized lymphadenopathy (fatigue, weight loss, general malaise)
• fever
• diarrhea
• …decreased activity tolerance and lack of energy
• neurological impairment (cognitive impairment; affect changes; sensory changes; ADL impairment, myelopathy, peripheral neuropathy, visual impairment)

Question 15

Methicillin-Resistant Staphylococcus Aureus (MRSA)

Answer 15

usually mild infections (pimples/boils) on skin; or more serious infections on skin; or infection in surgical wounds. Infection can be locally confined or systemic. Is spread with contact with infected body part of another or shared item (towel) used by infected person.

Question 16

Rehab for immunological system disorders:

interventions for impairment level problems

Answer 16

• counsel patient to be compliant with screening and tx
• set personal goals to invest behaviorally in health
• provide support to those dealing with chronic illness
• provide support counseling and social support for psych disorders that can develop (anxiety, depression)
• refer to physician for drug tx for physical and psych disorders

Question 17

Rehab for immunological system disorders:

interventions for activity level problems

Answer 17

• self care… adaptations and training tasks for ease and using energy conservation
• work… work capacity evals; modifications to allow participation; counseling for transition to disease status when work isn’t possible anymore.
• leisure/sports… modify specific tasks; eval interests and skills to introduce new leisure or sports activities to replace others that aren’t possible anymore
• rest… sleep positioning; sleep habits/relaxation techniques

Question 18

Rehab for immunological system disorders:

interventions for participation problems

Answer 18

• needs assessment to determine issues with mobility, social, or political access to environments
• identify and facilitate system changes to allow person access/ability to participate as contributing member of society.

Question 19

Diabetes type 1

Answer 19

insulin-dependent (5-10% of all diagnosed cases of diabetes)

autoimmune, genetic, environmental factors

Question 20

Diabetes type 2

Answer 20

non-insulin-dependent (90-95% of all diabetes)

obesity, family hx, prior hx of gestational diabetes, impaired glucose tolerance, physical inactivity, race

Question 21

Gestational diabetes

Answer 21

2-5% of all pregnancies; 40% may go on later to develop type 2 diabetes later in life. Usually resolves after pregnancy; obesity is risk factor

Question 22

Signs/symptoms of diabetes

Answer 22

frequent urination; excessive thirst; unexplained weight loss; extreme hunger; visual changes; sensory changes in hands/feet (tingling/numbness); fatigue; very dry skin; slow healing of wounds; increased infection rate.

Question 23

Sequelae/complications of diabetes

Answer 23

• fatigue/decreased activity tolerance
• urinary disturbance
• visual loos, low vision, blindness
• peripheral neuropathy (and amputations)
• propensity to develop wounds
• poor general health/ more infections
• hypoglycemia
• hyperglycemic crisis (ketoacidosis; hyperosmolar coma)

Question 24

what is ketoacidosis?

Answer 24

because of lack of insulin, body starts burning fatty acids which produces excess ketone bodies. Symptoms: dehydration, rapid and weak pulse, and acetone breath (fruity smell). More common in type 1.

Question 25

what is hyperosmolar coma?

Answer 25

severe dehydration, increase in osmolarity (relative concentration of a solute), and leads to coma. More common in type 2.

Question 26

OT rehab for diabetes

Answer 26

• preventive exercise
• education concerning compliance and need for medical management
• psychological and emotional support to improve self-care habits
• lifestyle readjustment to complications when and if they occur (low vision, safety assessment/intervention, physical adaptations)
• protective issues regarding peripheral neuropathy (safety, education about risks of sensory loss, skin care, pain mgmnt, AE for ADLs/IADLs)
• education about early attention to wound management
• assistance in problem solving and modifying self-care and medical status changes occur

Question 27

Sequelae and symptoms of Lyme disease

Answer 27

• impairs immune response and affects the neurological and orthopedic systems
• Early symptoms: fatigue, headache, chills/fever, muscle/joint pain, swollen lymph nodes, rash/ erythema migrans (circular red patch at bite site)
• Late symptoms: arthritis, nervous system abnormalities (numbness, pain, Bell’s palsy, meningitis), heart rate irregularities.

Question 28

Stage 1 decubitus ulcer

Answer 28

• skin is intact with visible nonblanchable redness over localized area, typically over bony prominence.
• area may be soft or firm and/or cooler or warmer when compared to adjacent skin.
• area may be painful or itchy
• this stage is “at risk” but can be hard to detect

Question 29

Stage 2 decubitus ulcer

Answer 29

• involves the dermis with partial thickness loss which presents as a shallow open ulcer that can be shiny or dry. Can also present as a blister that is intact or open/ruptured.
• Wound bed is a red pink color without slough or bruising.

Question 30

Stage 3 decubitus ulcer

Answer 30

• depth of tissue loss is not obscured if slough (dead tissue) is present. Bone, tendon, or muscle are not exposed or directly palpable.
• depth of stage 3 ulcer can vary according to anatomical location and can range from shallow in areas that don’t have subcutaneous tissue (like note, ear) to very deep in area with significant fat (like the butt).

Question 31

Stage 4 decubitus ulcer

Answer 31

• involves full thickness tissue loss with bone, tendon, or muscle visible or directly palpable.
• depth of stage 4 ulcer can vary according to location (as stage 3).
• osteomyelitis (infection of bone) is possible if stage 4 ulcer extends into muscle, fascia, tendon, and/or joint capsule.

Question 32

Heat cramps are characterized by…

Answer 32

normal body temp, nausea, diaphoresis, muscle twitching, weakness, and/or severe muscle cramps

Question 33

Heat exhaustion is characterized by…

Answer 33

rapid pulse, decreased blood pressure, nausea, vomiting, cool pallid skin, mental confusion, headache, and/or giddiness but no fever.

Question 34

Heat stroke is characterized by…

Answer 34

hot, dry red skin; body temp higher than 104; slow, deep respiration; tachycardia; dilated pupils; confusion; progressing to seizures and possibly loss of consciousness.