Med Conditions II Final Flashcards
(229 cards)
1
Q
ACTH Dependent - Cushings Disease
A
pituitary adenoma- secretes ACTH
2
Q
ACTH independent- Cushing’s syndrome
A
adrenal adenoma- hyper secretion of cortisol
3
Q
S/S of Cushings
A
central obesity: rapid weight gain w/ sparing of limbs (moon face, buffalo hump) thinning of skin, striae, poor wound healing muscle wasting tachycardia; hypertension osteoporosis hyperglycemia/DM Anti-inflammation/immunosuppresion increased infection risk
4
Q
tx for cushing’s
A
tumor removal
adrenalectomy
medications: if iatrogenic, decrease glucocorticoid
5
Q
Second stage of RAAS system- at the lungs
A
lungs convert angiotensin I to angiotensin II w/ ACE
6
Q
What happens in response to release of angiotensin II?
A
vasoconstriction of arteries
Increased aldosterone release from adrenal cortex– leads to increased blood volume through reabsorption. Ultimately leads to increase in blood pressure as needed
7
Q
hyperaldosteronism
A
HTN, hypokalemia, hypernatremia, fatigue
8
Q
Pheochromocytoma
A
tumor of adrenal medulla or extra-adrenal chromatin tissue- HTN, tachycardia, anxiety, panic attacks
9
Q
common s/s of addison’s disease
A
hypotension, hypoglycemia, fatigue/muscle weakness, hyper pigmentation of skin, vomiting/diarrhea
10
Q
cascade of thyroid function
A
hypothalamus–TRH—TSH—thyroid gland–release T3 and T4
11
Q
function of thyroid hormone w/ role of calcium homeostasis
A
produces calcitonin in response to hypercalcemia- opposes parathyroid hormone
12
Q
What happens when calcium levels in the blood are high? low?
A
high: calcitonin stimulates calcium salt deposit in bone
low: parathyroid glands release parathyroid hormone and to break down bone
13
Q
target tissues of thyroid hormone?
A
CNS, heart, bones, liver
14
Q
common s/s of hypothyroidism
A
lethargy/fatigue, poor muscle tone, brady cardia, weight gain, edema, cold intolerance, dry skin, goiter
15
Q
types of hypothryoidism
A
primary: insufficient production of T3/T4
secondary: insufficient production of TSH
tertiary: insufficient production of TRH
16
Q
s/s of hyperthryoidism
A
weight loss, increased appetite, anxiety, irritability, heat intolerance, fatigue, weakness, tremor, osteopenia, hyperglycemia
17
Q
graves disease
A
autoimmune disease-overactive TSH receptor and increase thyroid hormone
18
Q
thyroid storm
A
extreme of hyperthyroidism: stressors can bring it to the surface. s/s: severe tachycardia, dysrhythmias, sudden onset fever, flushing, fatigue, restlessness
19
Q
3 functions of parathyroid hormone
A
- stimulates osteoclasts to release more Ca from bone
- decreases secretion of Ca by kidney
- activates vitamin D which simulates the uptake of Ca from the intestine
20
Q
major risk factors for osteopenia
A
history of fracture as an adult fragility fracture in first degree relative caucasian/asian postmenopausal woman low body weight current smoking use of oral corticosteroids
21
Q
bisphosphonates
A
slow down osteoclast activity- inhibits bone reabsorption by attaching to bony surfaces undergoing active reabsorption and inhibiting action of osteoclasts
22
Q
two types of osteoporosis
A
1: postemenopausaul, hormone driven, cancellous bone, vertebral/colles fractures, age 50ish
2: both genders, age related after 70, cancellous and cortical bone, hip fractures, increased morbidity/ mortality
23
Q
Definition of placebo
A
improvement in symptoms or condition due to expectations or sociomedical context in which a treatment takes place
- -causal effect of a treatment context on outcome
- -there is not one placebo effect, but multiple components/aspects of placebo effects
24
Q
what are the two main contributions of neuroscience to placebo?
A
- mechanism: systems involved- pharmacology, systems, convergence
- intermediate markers- brain prices, stages of processing
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key ingredients of placebo effects
social instruction
reinforcement (learning)
belief 9expectations)
26
2 factors effecting pain intensity
1. social information
| 2. experienced based learning
27
what is the typical inter individual variability with placebo response?
non-responders and responders (some large response, some no response)
28
important aspects of enhancing treatment benefits
individualize treatment
give meaning
build trust
create hope and positive expectations
29
What is the juxtaposition of transplantation?
hoping for the best vs preparing for the worst
30
definition of transplant rejection
failure of immunosuppression medications to prevent activation of immune effector cells
31
common transplant postoperative issues
1. psychologic issues: unfulfilled expectations, agitation, complications
2. medical issues: anemia, hypertension, myopathy, osteoporosis
3. exercise limitations: VO2 max~50-60% normal
4. long term medical concerns post transplant: infection/rejection, renal failure
32
what is the most common diagnosis in adult heart transplants?
myopathy
33
NYHA classification HF
I-no limitations, any activity =7 METS
II- light limitations=5METS
III-moderate limitations
34
3 important things to remember about denervated heart
1. heart rate is not a good monitor of work load during warm-up , cool-down or first five minutes of peak aerobic activity
2. warm up is essential- needed for catecholamines to increase heart rate and 3. isometric exercise not well tolerated
35
how does a denervated heart increase CO?
rely on increases in SV through the Frank-starling mechanism and circulating catecholamine with activity
36
s/s of transplant rejection
fever, dysrhthmias, reduced contractility, increased dyspnea, decreased exercise tolerance.
37
what can chronic transplant rejection lead to?
vasculopathy- concentric wall thickening
38
contraindications to transplant
```
smoking
extremes of weight
profound debility
osteoporosis leading to disability
psychosocial issues
```
39
main reason for lung transplants in adults and kids
adults: COPD
children: CF
* *people w/ CF must always have bilateral transplant
40
lung allocation score
0-100 score- higher score, higher priority
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inpatient management of post lung transplant
ask issues, chest wall pain, limited inspiratory/expiratory volumes and flows
42
surgical approach for lung transplant options
1. bilateral transverse thoracosternotomy
2. thoracotomy
3. median sternotomy
43
s/s of transplantation infection and rejection
fever/malaise/cough
decreased airflow
oxygen desaturation
decreased exercise capacity
44
acute vs chronic rejection
acute: biopsy- increase immunosuppression
chronic: >1 year bronchiolitis obliterates syndrome and worsening PFT-- increase immunosuppression and/or retransplant
45
outcomes associated w/ physical therapy in transplant
1. improved exercise capacity
2. improves myopathy
3. improved bone health
4. improved health related quality of life
5. changes in post op complications
46
HR, RR and BP full term neonate
110-160 bpm
RR= 30-40/min
75/50
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full term neonate tidal volume
20 mL (adult is 500)
48
PaO2 and PaCO2 full term neonate and pH
O2=75-80
CO2=33
pH=7.33
49
what is different about heart pressures in fetal circulation?
feel heart pressures are opposite of postnatal pressures. Right heart > left heart due to a right to left shunt
50
wha are the three shunts present in fetal circulation?
Intracardiac
1. foramen ovale: allows blood to flow from right to left atrium
2. ductus arterioles: allows blood to flow from pulmonary artery to aorta, bypassing fetal lungs
extra cardiac
3. ductus venous: connects umbilical vein and inferior vena cava; bypassing portal circulation
51
important factors involved with fetal circulation
- high pulmonary vascular resistance
- low systemic vascular resistance
- right to left shunt via PFO and DA
- highly reactive to hypercapnia/acidosis
52
what occurs during the transition from neonate to newborn?
aeration and expansion of the lungs: rising paO2 leads to dilation of pulmonary arterioles and decreases PVR and decreases right heart pressures
removal of placenta circulation leads to increased left heart pressures and foramen oval closes- increases blood flow to lungs
-pressure in aorta increases
53
functions of the placenta
connects the developing fetus to the uterine wall to allow nutrient uptake, gas exchange, waste elimination, provides thermo-regulation to the fetus, fights against internal infection produces hormones to support pregnancy and acts as blood reservoir for fetus
54
when does foramen oval close?
as a newborn, about 2-3 months. Left heart pressure becomes greater than right
systemic vascular resistance >PVR
55
when does the ductus arterioles close?
functional closure~15-72 hours
| anatomical ~2-3 weeks
56
what are common congenital heart defects?
PDA- patent ductus arterioles
PFO- patent foramen ovale
Atrial or ventricular septal defects (holes formed)
57
what happens in hypo plastic left heart syndrome?
right ventricle fails to develop. requires early surgical correction
58
what happens in tricuspid atresia
no tricuspid valve so blood cannot pass from RA to RV. Has opening between ventricles. Often staged reconstruction
59
coarctation of the aorta
aorta is narrowed, usually in the area where the ductus arterioles inserts. This increases LV work. If narrowing is after aortic arch, then strong pulse should be expected in UE and weak pulse in LE
60
what is the blood pressure differential in a coarctation of the aorta?
20 mmHg greater in UE than LE. This may also include differential cyanosis, headache, nosebleeds, leg cramps, LE weakness/cold
61
atrial septal defect
patent foramen oval- allows blood flow b/w right and left atria- may cause dysrhythmias, PPHN, HF
62
what does a patent ductus arterioles lead to?
allows ongoing communication b/w pulmonary trunk and descending aorta- left to right shunt develops if remains open and may predispose to heart failure
63
ventricular septal defect
abnormal communication b/w right and left chambers of heart- shunting depends on pressures- usually left to right. fast breathing, respiratory distress, poor feeding and poor weight gain.
64
tetralogy of fallot
4 defects of heart
65
general PT considerations w/ cardiac issues
frequently have reduced exercise capacity. Its w/ mild CHD allowed to participate in all competitive sports.
VO2 max normal increases into adolescence and adulthood.
Will present w/ increased HR rest and decreased HR max.
66
prevalence of respiratory illness in children
>50% of all illnesses in children
67
what stage does surfactant begin to be produced?
at 24 weeks
68
how long is normal term?
40 weeks
69
how long do lungs continue to develop
8-10 years
70
what is the limit of viability?
gestational age at which a prematurely born fetus/infant has 50% chance of long term survival
71
what is the physiological significance of surfactant?
surfactant is a lipoprotein secreted by alveolar epithelium into the alveoli. Reduces surface tension to decrease WOB. Prevents collapse of small alveoli especially during expiration
72
difference in rib angle between newborn/adult
rib angle more horizontal in newborn than adult. Ribs orient obliquely with increased standing/walking at about 2 y/o
73
compliance in newborn chest wall
increased compliance- loss of mechanical efficiency w/ breathing
74
what happens to diaphragm w/ development
increased muscle growth and increased CSA, Increase % type I muscle fibers
75
thoraco-abdominal coupling
contracting chest wall muscle stabilize the infant rib cage. Minimizes inward displacement and encourages mechanical efficient.
76
clinical features of neonatal respiratory distress
substernal and intercostal retractions, nasal flaring, circumoral cyanosis.
77
differences between the child and adult lungs
decreased surface area for gas exchange, horizontal rib alignment, decreased compliance, increased RR, irregular respiratory pattern, diaphragm poorly developed, limited airway clearance abilities, increased WOB
78
infant respiratory distress syndrome
hyaline membrane disease- surfactant deficiency and lung inflammation leading to atelectasis, hypoxemia and decreased compliance. Often worsens over 2-4 days
79
bronchopulmonary dysplasia
often seen following IRDS. associated w/ need for prolonged mechanical vent and oxygen therapy. Usually hypercapnia and hypoxemia. inversely related to birthweight. Fibrotic changes resulting in reduced compliance.
80
meconium aspiration syndrome
meconium: early stool of infant. May be expelled prior to birth in amniotic fluid. Increases risk of fetal distress
81
congenital diaphragmatic hernia
developmental defect. will be cyanotic, dyspneic and tachycardia
82
cystic fibrosis
genetic alteration in chromosome leading to alterations in mucus hyper secretion and plugging combined w/ repeated infection.
83
why are CF kids not allowed to be together?
100% of patients w/ CF are colonized w/ some sort of bacteria
84
asthma s/s and classifications
intrinsic: non-allergic (10%)
extrinsic: mediated by allergic reaction
thickening of airway basement membranes. Edema and inflammation. Thick tenacious mucous in airways.
85
what should asthma action plans include?
modified exercise recommendations- school staff must have access to these.
86
precautions to take w/ patients w/ asthma
1. ensure rescue medication is readily available
2. ensure long warm-up and cool-down
3. monitor environment for potential triggers
4. permit student to monitor breathing status using a peak flow meter
5. be aware of asthma action plan
87
green/yellow/red peak flow meter zone
green>80%: no modification required
yellow50-79%: have student take medication as directed and consider stop/start activities and moist environment
red 0-49%: stop activity and follow emergency asthma plan. Call 911 if not improved
88
PT considerations for pulmonary
airway clearance techniques integral part of pediatric lung disease. Consider pulmonary rehab approach and be aware of asthma action plan
89
3 forms of marijuana
single molecule pharmaceuticals
liquid extract: nabiximols
liquid extract: cannabidiol
90
where are endocannabinoid receptors found?
throughout the body: brain, organs, connective tissues, glands and immune cells. Goal is always homeostasis
91
targets of marijuana?
CB1 receptors and CB2 receptors
92
potential physiologic responses to cannabis
improves sleep, anti-seizure, reduces anxiety and psychotic symptoms, prevents nausea and stimulates appetite, reduces intraocular pressure, bronchodilator, relaxes muscles and reduces muscle spasms, relieves pain and anti-inflammatory
93
common adverse side-effect of marijuana?
slowed reaction time, tachycardia, hypertension, coughing, wheezing, sputum production, lethargy, sedation, slowed reaction time, psychological dysfunction
94
short term negative effects
impaired STM, impaired motor coordination, altered judgment, MVA, paranoia and psychosis
95
effects of long term use
addiction, altered brain development, cognitive impairment, diminished life satisfaction, poor educational outcomes, symptoms of chronic bronchitis and psychosis
96
MMJ vs opiod?
can be used in conjunction for greater cumulative pain relief and reductio opiate use. MMJ can prevent tolerance to opiates and potentially less dangerous
97
most common reason for MMJ use in colorado
pain
98
how should MMJ be studied?
meta-analysis and RCT
99
federally, what is MMJ considered
a schedule I drug
100
what part of MMJ is associated with psychoactive effects?
THC
101
% of people w/ diabetes that will have a wound?
15%
102
type 1 vs type 2 diabetes
type 1: cells that produce insulin are destroyed. results in insulin dependence. earlier onset
type 2: blood glucose levels high due to insulin resistance or lack of insulting production. Usually detected after 40 y/o
103
fasting plasma glucose test values
normal:70-110
110-125 pre diabetic
>125 diabetic
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normal HbA1C
4-6.7%
105
types of neuropathies
1. motor: muscle weakness and changes in shape of foot. Caused by damage to large nerve fibers
2. sensory: diminished sensation-lack of protective sensation caused by damage to small fibers
3. autonomic: decreases sweat and oil production leading to dry, inelastic skin caused by damage to large fibers and sympathetic ganglion. Postural hypotension
106
percentage of diabetics w/ neuropathy 20 years after diagnosis
50 symptomatic 40 asymptomatic
107
how does diabetic neuropathy occur?
axonal thickening w/ progression to axonal loss
basement membrane thickening
decreased capillary blood flow to C fibers
108
description of neuropathic wounds
occur on the foot- usually plantar surface or toes. Caused by mechanical forces or mine trauma. Occur in patients w/ diabetes, PVD or Hansen'sdue to peripheral neuropathies. Relieved w/ ambulation and usually architectural changes in foot. Pink, most, callus formation, plantar surface, skin usually warm, cellulitis. Usually w/ diabetes ro chemotherapy
109
description of arterial wounds
caused by ischemia. usually located at peripheral extremities. Caused by macro or micro disease
often occurs w/ ambulation but has normal appearance of foot. Pale color, dry, hairless, cool to touch and history of PAD
110
wagner scale
neuropathic wound classification w/ 0 being the best and 5 full foot gangrene
111
ABI values
normal ,91-1.3
mild obstruction: .7-.9
moderate: .4-.69
severe: 1.3
112
change in ankle pressure in patient w/ claudication
typically exhibit a >20 mmHg drop in pressure
113
normal capillary refill?
114
what does asymptomatic PAD still predict?
CAD and CVD
115
at what point should exercise w/ PAD have a rest break?
moderate to severe claudication scale
116
most common reason a foot ulcer in a patient w/ diabetes does NOT heal is
lack of pressure relief
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functions of the skin
1. protection
2. thermoregulation
3. sensation
4. metabolism
5. aesthetics and communication
118
layers of epidermis
stratum corner: protect
stratum lucid: adds thickness at "stress points"
stratum granulosum: transitional stage
stratum spinosum: made of cells that have spines
stratum basale: proliferative layer- regenerates the epidermis
basement membrane
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4 primary cell types
1. keratinocytes: produce keratin and antibodies
2. langerhans cells: part of immune system
3. melanocytes: basal layer
4. merkel cells: attached to sensory nerve endings
120
dermis
thickest of 3 layers composed of collagen, elastin and ground substance. supplies oxygen and nutrients and stores much of body's water supply. regulates temperature and contains blood vessels, lymph vessels, hair follicles, sweat glands, sebaceous glands, nerves
121
layers of dermis
1. papillary: body temp, nutrients, blood
| 2. reticular: composed of thicker network of collagen fibers- anchors skin to sub. cu.
122
hypodermis
attaches dermis to bone/muscle. Composed of adipose, vessels, nerves. Shock absorption
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stages of wound healing
1. hemostasis: stopping of blood
2. inflammation: macrophages/cytokines
3. proliferation (includes granulation and epithelialization): contractile cells help wound to shrink and epithelialize
4. remodeling- change of type III collagen into type I (usually day 8-years)
124
classification of wound by skin loss
1. erosion- epidermis only
2. partial thickness- loss of epidermis and part of dermis
full thickness- loss of all epidermis, dermis and into subcutaneous tissue
125
types of wound closure
primary intention: clean, straight line, edges approximated, rapid healing
secondary intention: larger wounds w/ tissue loss- edges not approximated, heals from inside out with longer healing time and larger scars
tertiary intention: delay is typically 3-5 days before the injury is sutured, used to manage infected or unhealthy wounds
126
factors that impede wound healing
pressure, improper moisture, edema, infection, necrotic tissue, incontinence, age, oxygenation, disease, nutrition
127
undermining
destruction of the connective tissue between the dermis and subcutaneous tissue
128
fistula
tunneling that connects with a body cavity
129
eschar
dead cells and fibrin- may be dry and hard or soft and rubbery. If stable and non-darning may choose to leave eschar in place
130
slough
softer, lighter necrotic debris. By-product of autolysis. Usually beneath eschar. More common in inflammatory phase
131
granulation tissue
red "beefy" looking. result of angiogenesis. Composed of new capillaries and extracellular matrix. Anemic to bright red. Necessary for closure by secondary intention
132
adipose tissue
shy, yellow-white globules when health. is poorly vascularized and frequent sources of access formation
133
sanguineous and serosanguineous
red, bloody and serous w/ pink tinge
134
purulent
thick drainage, green, yellow, brown or white in color. infection is present
135
serous
clear, watery
136
types of passive drains
air or fluid moves from area of high pressure to one of lower pressure: penrose, gastrostomy, cystotomy, nephrostomy, t-tube
137
examples of active drain
jackson-pratt, hemovac
138
erythema
abnormal red color. May indicate underlying infection.
139
cyanosis
dusky or bluish color. results from lack of oxygen
140
petechia
small (1-2 mm) red or purple spot on skin
141
purpura
>3 mm
142
eccymosis
>1 cm; commonly called a bruise
143
hemosiderin
brownish-purple color usually in gaiter area of leg. Results form red blood cell sin interstitial tissue. Usually begins distal and common in venous insufficiency
144
definition of edema
excess fluid in the interstitial tissue. impedes healing
145
definition lymphedema
diffuse, spongy edema. caused by obstruction w/ lymph system. may be pitting or indurated
146
definition induration
hard, firm, swollen appearance. may be like orange peel. develops w/ chronic edema
147
rolling wound edge
sign of a halted healing process. cells are termed senescent and unable to reproduce. rolled edge is termed epibole
148
hyperkeratosis wound edge
overdevelopment of horny layer of the skin. appears as a callus or thickened skin
149
what can type of pain tell you about wound?
deep-ischemia or hypoxia
throbbing/localized- infection
superficial tenderness- exposed nerve endings
pain w/ stimulation- living muscle
150
what is considered protective sensation?
5.07 monofilament wire
151
DIMES
debridement, infection/inflammation, moisture balance, edges, support
152
characteristics of chronic wounds
necrotic tissue, bioburden, chronic inflammation, impaired hemodynamics, senescent fibroblasts, chronic wound fluid w/ growth inhibiting proteases, overgrowth of epithelium
153
phases of PVD
1. collateral circulation insufficient for metabolic needs- delayed healing of traumatic wounds
2. claudication- pain w/ activity
3. rest pain- requires revascularization surgery- may have ischemia of digits accompanying
154
causes of chronic venous insufficiency
incompetent valves, obstruction (DVT), lack of venous pump activation w/ gait
155
common skin changes consistent w/ diagnosing chronic venous insufficiency
hyper pigmentation, lipodermatosclerosis, dilated long saphenous vein, edema, dermatitis, thickened skin, cellulitis
156
prevention of venous wound
compression, elevation, exercise, avoid prolonged sitting/standing, avoid crossing legs, skin lubrication
157
another name for pressure ulcer
decubitus ulcer
158
staging of wounds
1: sores are not open. skin may be painful/warm but no breaks or tears. reddened and does not blanch
2: skin breaks open- partial thickness
3: full thickness skin loss involving damage to underlying tissue. fat may be visible but not muscle tendon or bone
4: extensive tissue destruction including damage to muscle, bone or other structures
159
causative factors of pressure ulcers
shear forces, friction forces, pressure forces, moisture
160
friction vs. shear
fricton- mechanical force exerted when two surfaces move against another while shear is a stress resulting from applied forces which cause objects to deform- involves both friction and gravity
161
what are the basic interventions expected from PTs for chronic wounds?
recognize, refer, and patient education. If involves arterial ulcer, remember gait training, footwear, education. Venous, remember COMPRESSION, diabetic- gait trainingg, footwear
162
types of debridement
1. selective: only necrotic. autolytic, enzymatic, biosurgical or sharp are all options
2. non-selective- mechanical debridement- wet to dry
163
3 questions for infection
1. replicating bacteria? (culture), pain?, host reaction (systemic elevated WBC, fever, malaise)
164
definition of contamination
no replicating bacteria, no pain, no host reaction
165
definition of critically colonized?
yes replicating bacteria, yes pain, but no host reaction +1-2 clinical symptoms
166
definition of infected
yes replicating bacteria, yes pain, yes dos reaction w/ >/=3 clinical symptoms- requires both topical and systemic antibiotics
167
cellulitis
superficial tissue infection. dos not always begin from wound
168
amount of time for healing stages
hemostasis: minutes
inflammatory: 3-5 days
proliferative 5 days-several weeks
remodeling: 21 days-years
169
key signs to differentiate between inflammation and infection
infection will have severe pain possibly streaking, purulent drainage or copious amounts of clear drainage and pay attention to systemic symptoms
170
cleansing?
non-infected: drinking water. antiseptic cleanser on infected wounds for 2 weeks. Ionic silver blocks respiratory cycle of bacteria and regulates inflammatory- used for mild local infection
171
ways to add moisture vs ways to absorb
absorb: foam, hydrofiber, alginate (seaweed) skin barrier (protects from maceration) ADD: hydrogel, foam
172
if ACE wrap used for compression, how should it be applied?
50% stretch with 50% overlap
173
recommended compression for venous wound?
2 or 3 layer wraps, tubigrip, JOBST
174
criteria for being admitted to burn department
burn injury >20% TBSA- high risk (face, hands, feet, perineum)
175
survival rate from burn injuries?
96.8%
176
what aspect of dermis must be in tact to allow for cell regeneration after burn?
dermal appendages
177
time for healing in superficial thickness (epidermis only ) burn?
3-7 days- this is not included in TBSA%
178
presentation of partial thickness burns?
blistered, weeping and bright red. Very painful. Usually takes 7-21 days to heal. Minimal to no scarring. Pigment change unlikely
179
presentation of deep partial thickness burns?
pseudoexchar. Mottled white to pink. Epidermis, papillary and reticular dermis. 21-35 days healing. May develop severe hypertrophic scarring. White color indicates collagen
180
presentation of full thickness burn
dry, leathery, charred. No pain. Hair pulls out easily. Skin grafting for healing. Epidermis, dermis to subcutaneous and beyond. No dermal appendages are left
181
temporary coverage vs definitive coverage of burns
temporary: allograft
definitive: autograft
182
causes of burn
thermal (scald, flame, friction)
electrical
chemical
radiation
183
what should constantly be assessed in electrical burns?
asses motor and sensation- can get delayed neurological response
184
rule of 9's
9% for whole head, each arm (4.5 front and back), front of leg, back of leg, lower abdominal, chest, upper back, lower back
185
most immediate life threatening response to injury after burn
hypovolemic shock: decreased bp, increased HR
186
escharotomy
fluid accumulates in extracellular space- oscar acts as tourniquet- can lead to ischemic extremities and compartment syndrome- medical emergency
187
nutritional support for burn injuries
caloric intake 24-45 kcal/kg
| increased protein needs
188
how often should someone splint for burn?
```
new graft (0-5 days) all times
>5 days post op: when not in wound care or therapy
During scar/collagen remodeling: at rest
```
189
MRC breathlessness scale
1-5 (5 too breathless to leave the house)
190
5 commands for exam
1 open/close eyes
2. look at me
3. open your mouth and put out tongue
4. nod your head
5. raise your eyebrows when I have counted up to 5
191
purpose of central venous catheters
used for monitoring pressure and medication administration. Pressure of right atrium.
192
pulmonary artery catheter
monitors hemodynamic status
193
arterial line/catheter
provides measurements of diastolic and mean arterial pressures continuously. Also a good way to assess respiratory status. Need to keep transducer at heart level
194
definition of WOB
work of respiratory muscles to overcome the elastic and resistance factors from the airways, the lungs and the chest wall to expand the chest and lungs
195
what type of ventilation is commonly used?
positive pressure ventilation= application of "super-atmospheric" pressure to the upper airway to initiate or perform inspiration
196
CPAP
continuous positive airway pressure- pressure applied throughout inspiration/expiration to prevent airway collapse during expiration and promote easier inspiration
197
reasons for high/low pressure w/ ventilation
high: mucus plug/bronchospasm/condensation
low: disonnection/tube leak
198
speaking valve use?
be sure that the balloon is deflated before placing speaking valve. This allows patient to exhale air through mouth passing the vocal cords
199
blood cell decision points?
hemoglobin >7 g/dl (>8-10 if known cardiovascular disease), hematocrit >25%, platelets >20,000, WBC if 10,000 consider active infection
200
MRC scoring for muscle strength
0-no contraction
| 5- active movement against full resistance
201
avoidant/restrictive food intake disorder
indifference to eating or food. rigidity and refusal to eat foods based on experience
202
binge eating disorder
recurring episodes of eating significantly more food in a period of time than most people would eat- feelings of lack of control. Feelings of guilt or disgust
203
eating disorder not otherwise specified
catch all term w/out firm diagnosis
204
medical complications w/ AN-BP
sialadeuosis, pseudo-batter syndrome, electrolyte imbalance
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medical complications w/ both AN-BP and AN-R
lagophthalmos, refeeding syndrome, blood glucose imbalances, hepatitis, bone density loss
206
sialadenosis
swelling of parotid glands- typically begins 3-4 days after cessation of purging
207
pseudo-batter syndrome
dehydration: decreased K in urine, secondary hyperaldosteronism- causes body to retain salt and water. Seizures are a risk
208
lagophthalmos
failure of eyelids to close fully due to sunken eyse
209
GI complications common in AN-BP
GERD, Barrett's esophagus, mallory weiss tears (small tear inside esophagus), boerhaave's syndrome (hole in esophagus, painful yawn/pain behind sternum-EMERGENCY), cathartic colon, inert tube due to abuse of stimulant laxatives
210
GI complications w/ AN-R
gastroparesis-delayed emptying, acute gastric dilation- requires NG tube, and superior mesenteric artery syndrome (duodenum becomes compressed between aorta dn SMA due to loss of fat pad)
211
admission criteria for ACUTE
17 and older
| typically
212
goals for stay in acute?
2000-3000 kcal per day- sufficient to gain 2-3 lb/week
normalizing labs
complete refeeding
bowel function improvement
physically strong enough to transition to mental health setting
213
hemophilia
group of hereditary bleeding disorders in which there is a deficiency of one of the factors necessary for coagulation of blood
214
types of hemophilia
hemophilia A-deficiency of FVIII
hemophilia B- deficiency of FIX
von willebrands- vWHF is missing
215
inheritance pattern of hemophilia
x-linked- male are affected, women are carriers. 20% of carrier women have decreased levels as well
216
severity levels of hemophilia
sever=5% factor level
217
common hemorrhages in hemophilia
soft tissue, muscle, going
218
treatment of bleeding episodes
replace missing factor- given intravenously
RICE
bracing/splinting
219
complications related to hemophilia
joint destruction
exposure to plasma viruses
inhibitor development- circulating antibody to factor
220
why is orthopedic surgery useful in patients with hemophilia?
decreases the number of bleeding episodes
decreases pain
increases ROM
promotes independence
221
joints commonly involved w/ hemophilia
knees, ankles, elbows, shoulders, hips
222
factors of knee rehab in hemophilia
```
avoid active movement first 24 hours
RICE
active hip/ankle exercises
splint
move within comfort range after 24 hours
NWB when blood is in the joint
```
223
exercise progression w/ hemophilia
isometric, gentle active motion, progress to resistive (avoid over pressure w/ passive)
224
how long does process of healing take for muscle injury?
20-40 days
225
muscle rehabilitation w/ hemophilia
RICE and infusion therapy. Compression may be contra-indicated if risk of compartment syndrome
NWB gait
can use heat to warm muscle tissue
begin movement at one joint at a time
226
definition of palliative care
patient and family centered. Optimizes quality of life by anticipating, preventing, and treating suffering throughout the continuum of illness. available concurrently w/ curative or life-prolonging care. Facilitates patient autonomy and choice
227
what amount of healthcare expenditure do the sickest 10% account for?
2/3
228
CARING criteria for palliative care
```
C: cancer
A: 2 or more admissions for chronic illness in year
R: resident in nursing home
I: ICU w/ MOF
NG: non cancer hospice guidelines
```
229
GAPS of palliative care
goals of care
advance directives
psycho-social spiritual support
symptoms
