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Flashcards in Other systems Deck (120)
1

Function of the endocrine system

HORMONAL REGULATION

endocrine system uses hormones (chemical messengers) to relay info to cells and organs and regular many of the body functions (digestion, use of nutrients, growth and development, electrolyte and water balance and reproduction)

The hypothalamus and pituitary gland, along with the NS, may up the central network that exerts control over many other glands in the body with wide ranging functions.
*also closely linked with immune system

2

Function of the metabolic system

Normal glucose control: the result of nutrient, neural and hormonal regulation

Hormones: released by islets of Langerhans in the pancreas
-Insulin: allows uptake of glucose from the bloodstream; suppresses hepatic glucose production, lowering plasma glucose levels; secreted by beta cells
-Glucagon: stimulates hepatic glucose production to raise glucose levels, especially in fasting state; secreted by alpha cells

3

endocrine/metabolic disorders by gland/organ

Adrenal gland:
-Addison's disease
-Cushing's syndrome

Thyroid gland:
-hypothyroidism
-hyperthyroidism

Parathyroid:
-hyper and hypo

Pancreas:
-diabetes mellitus

Other metabolic disorders:
-fluid deficit/dehydration
-fluid excess
-metabolic alkalosis
-metabolic acidosis
-Gout
-hemochromatosis
-metabolic bone disease
-obesity

4

Addison's disease

"primary adrenal insufficiency"
autoimmune process that causes the adrenal glands to underproduce cortisol and aldosterone

tx: diet high in complex carbs and protein

Difficult to diagnose d/t early symptoms of nonspecific weakness and fatigue

symptoms:
-hyper-pigmentation of the skin and mucous membranes
-progressive fatigue
-GI disturbance
-nausea, vomiting
-weight loss
-tendon calcification
-hypoglycemia
-may cause potassium elevation which can lead to ascending myopathy, causing flaccid paraplegia and polyneuropathy

5

Cushing's disease

over secretion of cortisol by the adrenal cortex or by long term use of corticosteroids d/t inflammatory disorders

symptoms:
-moon face appearance
-cervical fat pad
-truncal obesity
-muscle wasting and weakness
-osteoporosis
-HTN
-easy bruising
-depression
-excessive facial hair
-ruddy complexion
-slow wound healing

6

hypothyroidism

condition resulting from decreased thyroid hormone
-causing generalized depression of metabolism
-diagnosed if TSH level is elevates

Symptoms:
-cold intolerance
-excessive fatigue and lethargy
-headaches
-weight gain
-dry skin
-increasing thinness/brittleness of hair and nails
-peripheral edema
-peripheral neuropathy
-proximal weakness

Red flag:
-can lead to exercise intolerance, weakness, atrophy, exercise induced myalgia, reduced CO

7

Hyperthyroidism

condition resulting from excessive production of thyroid hormone (Grave's disease)
-resulting in a generalized elevation of body's metabolism
-diagnosed if TSH level is depressed

Symptoms:
-tachycardia
-increased sweating
-heat intolerance
-increased appetite
-dyspnea
-weight loss and inability to gain weight
-anxiety
-Goiter- enlargement of thyroid gland
-exophthalmia- hypertrophy of eye muscles and increase in CT in the orbit- eye appears to "bulge out"

8

parathyroid gland function

releases parathyroid hormone which regulates calcium and phosphorous metabolism

9

Hyperparathyroidism

excessive PTH leads to elevated calcium level and decreased serum phosphate level

causes demineralization of bone and subsequent loss of bone strength and density

most often discovered as asymptomatic hypercalcemia upon dx

Symptoms:
-proximal weakness
-fatigue
-drowsiness
-arthralgia/myalgia
-depression
-glove/stocking sensory less
-osteopenia/fractures
-confusion/memory loss
-pancreatitis
-gout

10

Hypoparathyroidism

decreased or absent production of PTG
-most commonly due to removal/injury of the parathyroid gland
-dx with a low serum calcium and high phosphorous and low PTH level

Symptoms:
-neck stiffness/muscle cramps
-seizures
-irritability
-depression
-skeletal muscle twitching
-cardiac arrhythmias
-paresthesias
-

11

pancreas function

dual function:
1- acts as an exocrine gland- producing digestive enzymes
2-acts as endocrine gland- producing insulin and glucagons

12

Diabetes

chronic systemic disorder caused by defective or deficient insulin action in the body and disruption of the metabolism of carbs, fats and proteins

Dx criteria: fasting glucose level of >126 mg/dL OR "casual" blood glucose level of 200 plus symptoms of DM

Symptoms:
-Hypoglycemia: blood glucose 180 mg/dL
-glycosuria: elevated sugar in urine
-polyuria: excessive urination
-polydipsia: excessive thirst
-unexplained weight loss
-fatigue
-blurred vision, headaches

13

Type I DM

insulin dependent DM or juvenile onset

immune mediated, causes beta cell destruction that usually results in absolute insulin deficiency

insulin dependent: requires insulin delivery by injection, insulin pump or inhalation

prone to ketoacidosis: presence of ketone bodies in the urine, the by products of fat metabolism

14

Type II DM

Non-insulin dependent diabetes or adult onset

characterized by defective insulin production and/or impaired receptor binding of insulin
"insulin resistant"

occurs mainly in adults >30 y/o with a gradual onset and slow progression of symptoms

obesity, family history, race, or women with high birth weight babies can be factors

treatment includes diet and exercise

15

gestational DM

glucose intolerance (high blood sugar) associated with pregnancy; most likely 3rd trimester

16

S&S of hypoglycemia

blood glucose

17

S&S of hyperglycemia

blood glucose >180 mg/dL

skin is dry, flushed
fruity odor breath
frequent urination-polyuria
unusual thirst- polydipsia
extreme hunger
unusual weight loss (10 lbs in 1 month)
extreme fatigue
irritability
blurred vision
fungal infections
dizziness

18

complications of DM

microvascular disease
-retinopathy
-renal disease
-polyneuropathy
-decreased circulation to skin/organs

macrovascular disease- accelerated atherosclerosis
-CVA
-MI
-PAD
-CAD

Integumentary:
-slow healing
-increased risk for ulcers and infections

MS:
-joint stiffness, increased risk of contractures
-increased risk of adhesive capsulitis, tenosynovitis, plantar fasciitis

neuromuscular:
-diabetic polyneuropathy: stock/glove, paresthesias, motor weakness with gait/balance impairments
-diabetic autonomic nerupathy: increased RHR, exercise intolerance with abnormal HR, BP and CO, exercise induced hypoglycemia, postural hypotension

Kidney failure

vision impairments: diabetic retinopathy (associated with chronic hyperglycemia) and diabetic macular edema

fatty liver disease

19

PT for diabetes

regular exercise improves glucose tolerance and increases insulin sensitivity

exercise produces insulin-like effect on the body by accelerating the movement of glucose out of the bloodstream and into peripheral tissues where it's needed
-combo of exercise and insulin can lead to hypoglycemia***

don't exercise 2-4 hours after insulin injection d/t peak concentration in the blood

don't exercise without eating at least 2 hours before

inject nonexercising limb or body part and don't exercise that part for at least 1 hour - could result in increased insulin uptake and then hypoglycemia

if BG 250- don't exercise

*Foot care
-washed daily, not soaked
-moisturize
-clean white socks, no wrinkles
-cut by podiatrist
-alternate wide shoes

20

Obesity

BMI = weight (kg)/height2 (meters)
-Overweight= 25-29.9
-Obesity = >30
-Morbid obesity >40

21

fluid deficit/dehydration symptoms

initially: thirst and weight loss

when the condition progresses:
-dryness of mouth, throat and face
-absence of sweat
-increased body temp
-low urine output
-postural hypotension
-increased hematocrit

22

fluid excess

results in hyponatremia

water shifts into the brain tisues and dilutes sodium in the vascular space, resulting in:
-decreased mental alertness
-sleepiness
-anorexia
-poor motor coordination
-confusion
-convulsions
-sudden weight gain
-warm, moist skin
-hyperventilation
-mild peripheral edema
-low serum sodium
-low hematocrit
-signs of increased intracerebral pressure: slow pulse, increased SBP and decreased DBP

edema caused by decreased CO, endocrine imbalances, loss of serum proteins, vein obstruction
-

23

metabolic alkalosis

occurs when either an abnormal loss of acid or excess accumulation of bicarbonate occurs

can be caused by upper GI suctioning, diabetic therapy, and ingestion of large amounts of base substances like antacids

Symptoms:
-nausea, prolonged vomiting
-diarrhea
-confusion
-irritability, agitation
-restlessness
-muscle weakness
-paresthesias
-convulsions
-slow shallow breathing
-eventual coma

symptoms can affect muscular function by causing muscle fasciculation and cramping

24

metabolic acidosis

occurs when there is an accumulation of acids or a deficit of bases

can be caused by diabetic ketoacidosis, renal failure, severe diarrhea and drug or chemical toxicity

Symptoms:
-headache
-fatigue
-drowsiness
-lethargy
-nausea, vomiting
-diarrhea
-muscular twitching
-convulsions
-coma
-rapid breathing

25

Gout

excess uric acid in the blood results in the deposition of rate crystals in the joints, soft tissues and kidneys, causing a painful inflammatory response

Symptoms:
-acute monoarticular inflammatory arthritis
-redness
-swelling
-low grade fever
-malaise
-primarily effects peripheral joints of the hand, MTP of great toe, instep, ankle, heel, knee and wrist

TX: urate lowering drugs (colchicine, NSAIDs or steroids, allopurinol to reduce hyperuricemia)

RICE and joint protection during acute phase

26

metabolic bone disease

Osteoporosis:
-combo of decreased bone mass and microdamage to the bone structure resulting in susceptibility to fractures

Osteomalacia:
-softening of bone without loss of bone matrix, caused by vitamin D deficiency in adults
-decalcification of bones takes place primarily in spine, pelvis and LEs

Paget's disease:
-characterized by excessive bone resorption and formation in a haphazard fashion, producing bone that is larger, less compact, more vascular, and more susceptible to fractures
-bones commonly effected: skull, pelvis, spine, sacrum, femur and tibia
-bowing of the long bones, periosteal tenderness

27

cancer

cancer tx pros and cons

rapidly proliferating cellular malignancy that results in unregulated cell growth, lack of differentiation, and the ability to invade local tissues and metastasize

Surgery:
-often used in combo with radiation and chemo
-either curative, by removing a tumor; or palliative by relieving pain or correcting an obstruction

Radiation:
-destroys cancer cells and inhibits cell growth
-also used post-op to shrink tumors and prevent spread of cancer cells
-side effects: radiation sickness, immunosuppression, fibrosis, decreased ROM, burns, delayed wound healing, edema, hair loss, CNS effects

Chemotherapy:
-uses chemicals to kill cancer cells by attacking rapidly dividing cells and affecting both cancerous and noncancerous cells
-the bone marrow contains rapidly dividing cells that form the blood elements and is affected by chemo
-can result in immunosuppression, thombocytopenia, (refrain from performing heavy resistance exercises d/t potential increased bleeding), anemia, alopecia, GI impact (nausea, vomiting, diarrhea, ulcers, or hemorrhage), and neuropathies

28

carcinoma

malignant tumor originating in the epithelial tissues
-stomach, skin, colon, breast, rectum

29

sarcoma

a malignant tumor originating in connective and mesodermal tissues - muscle, bone, fat

30

lymphoma

affecting the lymphatic system
-hodgkin's disease, lymphatic leukemia

31

leukemias and myelomas

affecting the blood (unrestrained growth of leukocytes) and blood forming organs (bone marrow)

32

cancer staging

0= carcinoma in situ

1= tumor is localized,

33

PT concerns for cancer

pain at distal side to initial tumor sit may suggest metastasis

lung, breast, prostate, thyroid, and lymphatic cancers commonly metastasize to bone
-pathological fractures, pain and muscle spasms may result

fatigue-most common symptom

muscular atrophy and weakness with chemo

ROM deficits particularly with radiation therapy

hematological disruptions:
-WBC suppression (leukopenia)- increased risk of infection
-platelet suppression (thrombocytopenia)- increased bleeding
-RBC suppression (anemia)- diminished aerobic capacity

RED FLAG:
-patients with significant bony metastases, osteoporosis or low platelets (100
-severe nausea, vomiting, diarrhea within 24-35 hours, dehydration, poor nutrition
-unusual or extreme fatigue, muscular weakness, recent bone pain
-chest pain, rapid or slow HR, elevated BP, swelling of ankles
-severe dyspnea, pain on deep breath, cough/wheezing
-dizzy, disoriented, confused, blurred vision, ataxia

34

specific considerations for exercise programs for cancer patients

Postmastectomy:
-focus on restoring pain free full ROM of shoulder
-prevent/reduce edema
-restore function
-early post-op day 1

Post bone marrow transplant
-30 day inactivity, strict isolation
-focus on restoring function, re-conditioning
-exercise contraindicated if platelets

35

Exercise guidelines based on platelet count

normal: 150,000 -450,000

36

Exercise guidelines based on WBC

normal: 4800-10,800

5000 light or regular exercise

37

Exercise guidelines based on hemoglobin

normal:
-women: 12-16 g/dL
-men: 13-18 g/dL

10 - regular exercise

38

Exercise guidelines based on hematocrit

% of RBC of whole blood
normal:
-women: 37-48%
-men: 45-52%

25% light or regular exercise

39

functions of the liver

excretes bilirubin
produces 500-1500 mg of bile daily
produces clotting factors
stores vitamins
produces albumin and plasma proteins
contributes to the immune system by reducing the amount of toxins and filtering the blood of our digestive system

40

symptoms of liver disease

can cause GI symptoms:
-edema/ascites
-dark urine
-light colored or clay colored feces
-anorexia
-skin changes- jaundice, spider angiomas, bruising, palmar erythema
-R upper quadrant abdominal pain

MS pain associated with liver disease includes:
-thoracic pain between scapula, R shoulder, R upper trap, R interscapular area, R subscapular areas
-Bilateral carpal tunnel syndrome requires thorough exam since it can be caused by the lack of detoxification of ammonia by the liver- resulting in numbness and tingling bilaterally
-Rhabdomyolysis

Neuromuscular symptoms can include:
-confusion
sleep dirsturbances
-hyperactive reflexes
-asterixis (flapping tremor usually of the hands)

41

rhabdomyolysis

a potentially fatal condition involving the breakdown of muscle tissue

presents with muscle aches, cramps, weakness and soreness

can be caused by liver failure due to statin use (cholesterol-lowering drugs like zocor, lipitor, crestor)

42

Hepatitis

acute or chronic inflammation of the liver due to viral or chemical cause, drug reaction or alcohol abuse

Viral hepatitis: types A, B, C, D, E and G

A&E primarily transmitted via fecal-oral route (contaminated food/water)

B,C, D, G- primarily bloodborne pathogens

3 stages:
1-initial/preicteric (1-3 weeks)
2- icteric/jaundiced (peaks in 1-2 weeks, lasts 6-8 weeks)
3- recovery (3-4 months)

43

cirrhosis

chronic hepatic disease characterized by the destruction of the liver and replacement of CT by fibrous bands, resulting in obstruction of blood and lymph flow
-mostly caused by alcohol abuse

symptoms:
-mild R upper quadrant pain
-GI symptoms- anorexia, indigestion, weight loss, nausea, vomiting, diarrhea, constipation
-dull abdominal ache
-weakness
-quick fatigue

progression will lead to portal hypertension (elevated pressure in the portal vein), causing the blood to bypass the liver through collateral vessels. Symptoms:
-ascites
-dilated collateral veins
-esophageal varices (upper GI)
-hemorrhoids (lower GI)
-splenomegaly
-thrombocytopenia (decreased platelets)

44

gallbladder function

stores bile, which assists in emulsification, absorption and digestion of fat

45

symptoms of gallbladder disease

R upper quadrant pain
jaundice -blocking of bile duct
low grade fever and chills
indigestion
nausea
excessive belching and flatulence
intolerance of fatty foods
persistent pruritus (itching)
sudden excruciating pain mid epigastrium with referral to back and R shoulder (acute cholecystitis)

sudden exacerbation of symptoms after eating indicates gallbladder inflammation

pain and nausea 1-3 hours after eating indicate the presence of gallstones

46

cholelithiasis

the presence or formation of gallstones
-a leading cause of hospitalization among adults

mostly asymptomatic, detected incidentally during medical imaging

problems arise when the gallstones leave the gallbladder, causing obstruction somewhere in the biliary system

Biliary colic: gallstone gets lodged in the neck of the gallbladder
-presents with R upper abdominal pain that comes and goes in waves

Cholecystitis: blockage of gallstones in the cystic duct causing infection or inflammation of the gallbladder
-presents as steady severe pain in R upper quadrant that increases rapidly, lasting several minutes to hours.
-nausea, vomiting, fever, jaundice, GI symptoms, chills, tenderness over gallbladder and 10th R rib anteriorly may be present

Cholangitis: gallstones lodged in the common bile duct
-leads to jaundice, and possible liver infection

47

GI anatomy and function

Upper GI: mouth, esophagus and stomach
-functions for ingestion and initial digestion of food

Middle GI: small intestine (duodenum, jejunum, and ileum)
-major digestive and absorption processes occur here

Lower GI: large intestine (cecum, colon and rectum)
-primar functions include absorption of water and electrolytes, stores and elimination of waste

accessory organs aid in digestion by producing digestive secretions and include the salivary glands, liver and pancreas

GI motility propels food and fluids through the GI system and is provided by rhythmic, intermittent contractions (peristaltic movements) of smooth muscle

Neural control is achieved by the ANS. both sympathetic and parasympathetic plexuses extend along the GI wall.
-Vasovagal (mediated by vagal nerve) reflexes control the secretions and motility of the GI tract

48

common S&S to many types of GI disorders

nausea and vomiting
-triggered by foods, drugs, hypoxia, shock, inflammation of abdominal organs, distention, irritation of the GI tract and motion sickness

diarrhea
-triggered by: infectious organisms, dysentery, diabetic enteropathy, irritable bowel syndrome, hyperthyroidism, neoplasm and diverticulitis

constipation
-triggered by lack of diet, lack of fiber, inadequate fluids, sedentary lifestyle, increasing age and drugs
-obstipation= intractable constipation with facal impaction and obstruction
-can refer pain to ant hip, groin or thigh
-may also result with muscle guarding and splinting (LBP)

anorexia

dysphagia

heartburn

abdominal pain
-result of inflammation, ischemia and mechanical stretching

49

referred GI patterns

visceral pain from the esophagus can refer to the mid back

midthoracic spine pain (nerve root) can appear as esophageal pain

visceral pain from the liver, diaphragm or pericardium can refer to the shoulder

visceral pain from the gallbladder, stomach, pancreas or small intestine can refer to the mid back and scapular regions

visceral pain from the colon, appendix or pelvic viscera can refer to the pelvis, LB or sacrum

50

GERD

inflammation of the esophagus due to back flow of stomach acids and other stomach content (pepsin and bile)

mostly likely caused by intermittent relaxation of the lower esophageal sphincter

must be differentiated from MI

over time, acidic gastric fluids (pH

51

hiatal hernia

protrusion of the stomach upward through the diaphragm or displacement of both the stomach and gastroesophageal junction upward into the thorax

may be congenital or acquired

symptoms: include heartburn from GERD

same tx as with GERD, surgery may be indicated

52

Gastritis

inflammation of the stomach mucosa
-acute or chronic

acute gastritis: caused by severe burns, aspirin or other NSAIDs, corticosteroids, food allergies or viral/bacterial infections
-hemorrhagic bleeding can occur
-S&S: anorexia, nausea, vomiting, pain

Chronic gastritis: occurs with certain diseases (peptic ulcer, bacterial infection, stomach cancer, thyroid disease, Addison's disease)

** patients taking long term NSAIDs should be monitored for stomach pain, bleeding, nausea or vomiting

management is symptomatic and includes avoiding irritating substances (caffeine, nicotine, alcohol), diet and med modification

53

Peptic ulcer disease

loss of the lining of the lower esophagus, stomach and duodenum
-most likely caused b infection with H. pylori (causing duodenal ulcers) or chronic use of NSAIDs (aspirin, ibuprofen, naproxen) causing stomach ulcers
-untreated ulcers can be life threatening- perforating the stomach

S&S:
-epigastric pain described as "heartburn"
-burning, gnawing, cramping pain in the epigastric area, near the xiphoid
-back pain
-pain comes in waves and last several minutes, may radiate below the costal ares into the back
-stomach ulcer pain is related to secretion of acid, presence of food increases the pain
-Duodenal ulcer pain is prominent which the stomach is empty, between meals, and in the early morning

complications:
-hemorrhage and perforation (bright red or coffee ground vomitus)
-dark tarry stools -melena
-weakness, dizziness and other signs of circulatory shock

54

malabsorption syndrome

a complex of disorders characterized by problems in intestinal absorption of nutrients

can be caused by gastric or small bowel resection or a number of different diseases (CF, celiac disease, Crohn's disease, chronic pancreatitis and pernicious anemia), can also be drug induced (NSAID gastroenteritis)

deficiencies of enzymes (pancreatic lipase) and bile salts are contributing factors

S&S
-anorexia
-weight loss
-abdominal bloating
-pain and cramps
indigestion and steatorrhea (abnormal amounts of fats in feces)
-diarrhea can be chronic and explosive


RED FLAGS:
iron deficiency anemia

easy brushing and bleeding due to lack of vitamin K

muscle wekaness and fatigue due to lack of protein, ron, folic acid and vitamin B

bone loss, pain and predisposition to develop fractures from lack of calcium, phosphate and vitamin D

neuropathy including tetany, paresthesias, numbness and tingling from lack of calcium, vitamins B and D, magnesium, potassium

muscle spasms from electrolyte imbalance and lack of calcium

peripheral edema

55

inflammatory bowel disease

refers to 2 related chronic inflammatory intestinal disorders:
-crohn's disease
-ulcerative colitis

both result in inflammation of the bowel and are characterized by remissions and exacerbations

S&S
-abdominal pain
-frequent attacks of diarrhea
-fecal urgency
-weight loss

Red flags:
-joint pain (reactive arthritis) and skin rashes can occur. pain can be referred to the LB
-complications can include intestinal obstruction and corticosteroid toxicity (low bone density, increased fracture risk)
-intestinal absorption is disrupted and nutritional deficiencies are common
chronic IBD can lead to anxiety and depression

56

Crohn's disease

chronic lifelong inflammatory disorder that can affect any segment of the intestinal tract and tissues in other organs

inflammation involves all layers of the bowel wall and is discontinuous

S&S
-intermittent pain in the periumbilical region
-R lower quadrant pain with possible iliopsoas involvement
-relief of LBP after passing stool or gas
-25% present with arthritis

57

ulcerative colitis

chronic inflammatory disagree of the mucosa and submucosa of the colon in a continuous order

S&S:
- rectal bleeding
-diarrhea (20 or more stools/day)
-nausea
-vomiting
-anorexia
-weight loss
-decreased serum potassium
-fever with acute colitis

58

irritable bowel syndrome

AKA spastic colon, irritable colon, nervous indigestion, functional dyspepsia, and laxativ colitis

characterized by abnormal intestinal contractions as result of the digestive tract's response to emotions, stress and certain foods

S&S:
-persistent or recurrent abdominal pain that is relieved by defecation
-may experience constipation or diarrhea, bloating, abdominal cramps, flatulence, nausea, and anorexia
-L lower quadrant pain

59

Diverticular disease

mucosa of the colon balloons out through weakened areas in the wall (diverticulosis)
-can include rectal bleeding
-lack of physical activity and poor bowel habits contribute to its development

leads to infections/inflammation of these micro perforations (diverticulitis)
-pain and cramping in L lower quadrant
-nausea and vomiting
-slight fever and elevated WBC
-complications: bowel obstruction, perforation with peritonitis and hemorrhage

*may complain of LBP

regular exercise is an important component of tx

60

appendicitis

inflammation of the vermiform appendix, which often results in necrosis and perforation with subsequent peritonitis- life threatening

pain is abrupt at onset, localized to the epigastric or periumbilical area and increases in intensity with time

rebound tenderness- Blumberg's sign- present in response to depression of the abdominal wall at a sit distant from the painful area

point tenderness is located at McBurney's point, the site of the appendix located 1.5-2 inches above the ASIS in the R lower quadrant

immediate medical attention required
-elevations in WBC >20,000 are indicative of perforation- surgery needed

61

Peritonitis

inflammation of the peritoneum, the serous membrane lining the abdominal walls

peritonitis results from bacterial invasion and infection of peritoneum

S&S:
-abdominal distension
-severe abdominal pain
-digidity from reflex guarding
-rebound tenderness
-decreased or absent bowel sounds
-nausea and vomiting
-tachycardia
-elevated WBC count
-fever
-electrolyte imbalance
-hypotension

can lead to toxemia and shock, circulatory failure and respiratory distress

tx: control inflammation and infection and restore fluid imbalance
-may need surgery to remove inflamed appendix or close perforation

62

pancreatitis

inflammation of the pancreas (acute or chronic)

chronic alcoholism, gallstones or other agent toxicity may bring on pancreatitis attack

S&S:
-epigastric ain radiating to the back
-nausea
-vomiting
-fever
-perspiration
-tachycardia
-malaise
-weakness
-jaundice

63

pancreatic cancer

clinical presentation: vague and nonspecific, contributing to delay in dx and high mortality

most common symptoms:
-anorexia
-weight loss
-epigastric/upper abdominal pain with radiation to the back
-jaundice
-light colored stools
-constipation
-nausea
-vomiting
-loss of appetite
-weakness

64

colorectal cancer

3rd most common cancer

risk factors: family hx, men >40, ulcerative colitis, crohen's disease, sedentary lifestyle

early symptoms:
-persistent change in bowel pattern
-rectal bleeding (differentiate from diverticulosis)
-abdominal/pelvis/back/sacral pain
-diarrhea or constipation

advanced symptoms:
-constipation progressing to obstipation
-diarrhea with copious amounts of mucus,
-nausea, vomiting
-abdominal distention
-weight loss
-fatigue
-dyspnea

common metastasis to liver, lungs, bone and brain

many are asymptomatic until metastases have occurred

65

anatomy of renal and urological systems

kidneys:
-paired, bean shaped organs outside the peritoneal cavity in the posterior upper abdomen at levels T12-L2
-each kidney is multi lobular, each lobule has >1million nephrons
-each nephron has a glomerulus that filters the blood and nephron tubules. water, electrolytes and other substances vital for function are reabsorbed into the bloodstream, while other waste products are secreted into the tubules for elimination

renal pelvis: wide, funnel shape structure at the upper end of the urethra that drains the kidney into the lower urinary tract (bladder and urethra)

bladder is a membraneous sac that collects urine and is located behind the pubic symphysis

the ureter extends from the renal pelvis to the bladder and moves urine via peristaltic action

the urethra extends from the bladder to an external orifice for elimination of urine from the body

66

functions of the kidney

regulates the composition and pH of body fluids through reabsorption and elimination;
-controls mineral (sodium, potassium, hydrogen, chloride, and bicarbonate ions) and water balance

eliminates metabolic wastes (urea, uric acid, creatine) and drugs/drug metabolites


assists in BP regulation through rennin-angiotensin-aldosterone mechanisms and salt and water elimination

contributes to bone metabolic function by activating vitamin D and regulating calcium and phosphate conservation and elimination

controls the production of RBC in the bone marrow through the production erythropoietin

the glomerular filtration rate is the amount of filtrate that is formed each minute as blood moves through the glomeruli and serves as an important gauge of renal function
-regulated by arterial BP and renal BF
-normal creatinine clearance 115-125 ml/min

blood urea nitrogen (BUN) is urea produced in the liver as a by product of protein metabolism that is eliminated by the kidneys
-elevated with increased protein intake and GI bleeding and dehydration

67

potassium levels

normal: 3.5-5.5

hypokalemia
-causes: deficient potassium or excessive loss due to diarrhea, vomiting, metabolic acidosis, renal tubular disease, alkalosis
-observe for muscle weakness, aches, fatigue; cardiac arrhythmias; abdominal distention; nausea and vomiting

Hyperkalemia:
-causes: inadequate secretion with acute renal failure, kidney disease metabolic acidosis, diabetic ketoacidosis, sickle cell anemia
-often symptomless until very high. observe for muscle weakness, arrhythmias, ECG changes - tall T wave, prolonged PR interval and QRS duration

68

sodium levels

normal: 135-146

hyponatremia:
-causes: water intoxication- excess
- observe for confusion, decreased mental alertness progressing to convulsions, signs of increased intracranial pressure, poor motor coordination, sleepy, anorexia

hypernatremia
-causes: water deficits with dehydration
-observe for: circulatory congestion (pitting edema, excessive weight gain); pulmonary edema with dyspnea, HTN, tachycardia, agitation, restless, convulsions

69

calcium levels

normal: 8.4-10.4

hypocalcemia
-causes reduced albumin levels, hyperphoshatemia, hypoparathyroidism, malabsorption of calcium and vitamin D, alkalosis, acute pancreatitis, vitamin D deficiency
-observe for: muscle cramps, tetany, spasms; paresthesias; anxiety, irritability, twitching convulsion; arrythmias, hypotension

hypercalcemia
-causes: hyperparathyroidism, tumors, hyperthyroidism, vitamin A intoxication
-observe for fatigue, depression, mental confusion, nausea/vomiting, increased urination, occasional cardiac arrhythmias

70

magnesium levels

normal 1.8-2.4

hypomagnesemia:
-causes: hemodialysis, blood transfusions, chronic renal disease, hepatic cirrhosis, chronic pancreatitis, malabsorption syndromes, severe burns, excess loss of body fluid
-observe for: hyperirritability, confusion; leg and foot cramps

hypermagnesemia
-causes: renal failure, diabetic acidosis, hypothyroidism, addison's disease, with dehydration and with use of antacids
-observe for: hyporeflexia, muscle weakness, drowsiness, lethargy, confusion, bradycardia, hypotension

71

metabolic acidosis

causes: diabetes, renal insufficiency or failure, diarrhea

observe for:
-hyperventilation (compensatory
-deep respirations
-weakness, muscular twitching
-malaise, nausea, vomiting and diarrhea
-headache
-dry skin and mucous membranes, poor skin turgor

may lead to stupor and coma

72

metabolic alkalosis

causes:
-excess vomiting
-excess diuretics
-hypokalemia
-peptic ulcer
-excessive intake of antacids

observe for:
-hypoventilation (compensatory)
-depressed respirations
-dysrhythmias
-prolonged vomiting
-diarrhea
-weakness, muscle twitching
-irritability, agitation, convulsions and coma

73

respiratory acidosis

CO2 retention, impaired alveolar ventilation

causes:
-hypoventilation
-drugs/oversedation
-chronic pulmonary disease
-hypermetabolism (sepsis, burns)

observe for:
-dyspnea
-hyperventilation cyanosis
-restlessness
-headache

may lease to disorientation, stupor and coma

74

respiratory alkalosis

diminished CO2, alveolar hyperventilation

causes:
-anxiety attack with hyperventilation
-hypoxia (emphysema, pneumonia)
-impaired lung expansion
-CHF
-PE
-diffuse liver or CNS disease
-extreme stress (stimulation of resp center)

observe for:
-tachypnea
-dizziness
-anxiety
-difficulty concentrating
-numbness and tingling
-blurred vision
-diaphoresis
-muscle cramps
twitching or tetany
-weakness
-arrhythmias
-convulsions

75

upper urinary tract

kidneys and ureters

renal and ureteral pan can be felt t/o the T10 -L1 dermatomes.
-renal pain is felt in the unilateral posterior subcostal and costovertebral region, pain is mostly aching and dull in nature but can be sharp/colic type pain (with obstruction)
-positive murphy's percussion test requires referral to physician

ureteral pain is felt in the groin and genital area

neither renal nor urethral pain is altered by a change i body position

unexplained weight loss, fatigue, fever, back or flank pain, especially in a geriatric population could be symptoms of renal cell carcinoma

severe pain in the flank and radiating to the ground can be the presentation for renal calculi (kidney stones).
-if the stone is high, abdominal pain might occur as well

76

lower urinary track

bladder and urethra

bladder and urethral pain is felt in the suprapubic region and usually characterized as:
-a urinary urgency, sensation to void and dysuria (painful urination)
-low back pain
-pelvic/abdominal pain
-hematuria
-dyspareunia (painful intercourse)

risk factors for UTI:
-immobility
-age
-SCI
-female
-pregnancy
-STD
-chornic health problems- diabetes, gout HTN, obstructive urinary problems
-urinary cathetization

kegel's may play important role in UTI prevention and various forms of incontinence

77

urinary tract infections

lower UTI:
-cystitis- inflammation/infection of bladder
-urethritis- inflammation/infection of urethra
-symptoms: urinary frequency, urgency, burning sensation, cloudy/smelly urine, pain in suprapubic, lower abdominal or groin area

upper UTI:
-pyelonephritis- inflammation/infection of kidneys
-symptoms of systemic involvement: fever, chills, malaise, headache, tenderness and pain over kidneys (back pain), tenderness over costovertebral angle (murphy's sign)

78

renal cystic disease

renal cysts are fluid filled cavities that form along the nephron and can lead to renal degeneration or obstruction

types: polycystic, medullary sponge, acquired and simple renal cysts

symptoms:
-pain
-hematuria
-HTN
-fever can occur with infection
-cysts can rupture producing hematuria

79

renal calculi

"kidney stones"
crystalline structures formed from normal components of urine (calcium, magnesium ammonium phosphate, uric acid and cystine)

S&S:
-renal colic pain -pain from a stone lodged in the ureter made worse by stretching the collecting system
-pain may radiate to the lower abdominal quadrant, bladder area and perineal area
-nausea and vomiting
-clammy skin

80

renal failure

acute renal failure: sudden loss of kidney function with resulting elevation in serum urea and creatinine
-may be d/t circulatory disruption to kidneys, toxic substances, bacterial toxins, acute obstruction or trauma

chronic renal failure
-progressive loss of kidney function leading to end stage failure
-may result from prolonged acute urinary tract obstruction and infection, DM, SLE uncontrolled HTN

uremia: an end stage toxic condition resulting from renal insufficiency and retention of nitrogenous wastes in the blood
-S&S: anorexia, nausea, mental confusion

RED FLAGS: may lead to multi system abnormalities and failure
-dizziness, headaches, anxiety, memory loss, inability to concentrate, convulsions, coma
-HTN, hyspnea on exertion, heart failure
-chronic pain: ischemic leg pain, painful cramps
-edema: peripheral and pulmonary
-muscle weakness; peripheral neuropathy, cramping, restless legs
-skeletal: osteomalacia, osteoporosis, bone pain, fracture
-skin: pallor, ecchymosis, pruritus, dry skin
-anemia, tendency to bleed easily
-decreased endurance, functional losses
-ANS dysfunction: decreased HR, BP, orthostatic hypotension

81

dialysis

process of diffusing blood across a semi permeable membrane for the purposes of removal of toxic substances; maintains fluid, electrolyte and acid-base balance in presence of renal failure; peritoneal or renal (hemodialysis

dialysis disequilibrium: symptoms of nausea, vomiting, drowsiness, headache and seizures- result of rapid changes after beginning dialysis

dialysis dementia: signs of cerebral dysfunction- speech difficulties, mental confusion, myoclonus, seizures, eventually death
- result of long standing years of dialysis treatment

taking BP at the shunt site in contraindicated!

82

urinary incontinence

inability to retain urine
the result of loss of sphincter control

Types;
1-stress
2-urge
3-overflow
4-functional

PT:
-strengthen pelvic floor
-behavioral training- voiding diary
-functional mobility
-environmental modifications

Kegel's
-type 1: 10 second holds, 10 sec rests
-type 2: quick contractions to shut off flow 10-80 reps/day
-functional e-stim
-biofeedback
-progressive strengthening- weighted vaginal cones

83

stress incontinence

sudden release of urine d/t :
-increases in intra-abdominal pressure- coughing, sneezing, laughing
-pelvic floor weakness- urethral sphincter (postpartum, menopause, damage to pudendal nerve)

84

urge incontinence

bladder begins contracting and urine is leaked after sensation of bladder fullness is perceived

an inability to delay voiding to reach toilet d/t:
-detrusor muscle instability or hyperreflexia (Stroke)
-sensory instability (hypersensitive bladder)
-meds, infection and bladder tumor

85

overflow incontinence

(continuous) involuntary loss of urine associated with over distention of the bladder without complete emptying of the bladder

caused by underactive or deficient detrusor muscle, diabetic neuropathy, fecal impaction, lower SCI, detrusor external sphincter dyssynergia (with MS) , or prostate pathology

86

functional incontinence

leakage associated with inability or unwillingness to toilet d/t
-impaired cognition- dementia, depression
-impaired physical functioning- stroke
-environmental barriers

87

normal pregnancy

weight gain 20-30 lbs
40 weeks from conception-delivery

1st trimester (weeks 1-12)
-nausea/vomiting
-very fatigued
-frequent urination
-by the end of week 12: fetus weights ~2oz and can kick, turn its head, swallow, and has a beating heart

2nd trimester (weeks 13-26)
-fatigue and nausea usually disappear
-can feel fetus move
-fetus is ~2lbs and has a slight chance of surviving if premature

3rd trimester (weeks 27-40)
-common complaints: frequent urination, back pain, sciatica, leg edema, fatigue, ligament pain, SOB, constipation
-weight range 5-10 points
-length 16-19 inches

labor and delivery:
-regular and strong involuntary contractions of the smooth muscles of the uterus
-breathing exercises to distract motor from pain and allow relaxation of pelvic region and improve voluntary muscle contraction of the abdominals and diaphragm
-intra abdominal pressure it the primary force expelling the fetus during stage 2
-after the expulsion of the placenta, a hematoma forms over the uterine placenta site to prevent further significant blood loss-- mild bleeding persists fro 3-6 weeks

88

anatomical and physiologic changes of pregnancy

weight gain

pulmonary system:
-increased edema and tissue congestion of the upper respiratory tract early in pregnancy due to hormonal changes
-chest circumference increases 5-7 cm
-diaphragm elevates 4 cm
-tidal volume increases
-15-20% increase in oxygen consumption with a natural state of hyperventilation t/o pregnancy

cardiovascular system:
-blood volume increases 25-50% t/o pregnancy
-in supine, the pressure in the inferior vena cava rises because of compression by the uterus just below the diaphragm (a decline in venous return and resulting decrease in CO may lead to symptomatic supine hypotensive syndrome-- L sidelying reduces the effect of vena cava syndrome)
-RHR usually increases 10-20 bpm by full term
-CO is increased especially in L sidelying (uterus puts the least pressure on the aorta)
-BP decreases early in 1st trimester (if increases significant, the mother may be experiencing pre-eclampsia--medical emergency )

MS system:
-stretches abdominal muscles to their elastic limit
-hormones produce a systemic decrease in ligamentous tensile strength and an increase in mobility o structures supported by ligaments
-joint hyper mobility occurs as a result of ligamentous laxity and may predispose the patient to joint injury especially in the WB joints of the back, pelvics, and LEs
-pelvic floor drops up to 2.5 cm and may be stretched or incised during delivery

Thermoregulatory system:
-basal metabolic rate and heat production increase to meet the 300 kilocalorie per day
-the fasting blood glucose level is normally lower

mechanical changes:
-COG shifts upward and forward and lumbar lordosis increases to compensate
-shoulder girdle and upper back become rounded with scap protraction and UE IR
-FHP develops to compensate shoulder alignment
-weight shifts towards the heels to bring COG posterior
-WBOS to maintain balance

89

list of pregnancy related pathologies

diastasis recti abdominis

pelvic floor disorders

LBP and pelvic pain

SI dysfunction

varicose veins

preeclampsia

cesarean childbirth

joint laxity

90

diastasis recti abdominis

separation of the rectus abdomens muscles in the mid line of the linea alba
>2 cm is significant

causes no discomfort and usually the incidence increases as pregnancy progresses

less prevalent in women with good abdominal tone prior to pregnancy and may or may not resolve spontaneously following childbirth

occasionally produces LBP

Testing:
-pt. in hooklying, lifts head and shoulders until spine of scapula lifts
-measure number of fingers can be placed between rectus muscle bellies

TX:
-teach protection of abdominal ms. -avoid abdominal exercises
-resume ab exercises when separation is

91

pelvic floor disorders

weakness or laxity of PC muscles typically results from overstitching during pregnancy and childbirth

further loss can result in partial or total organ prolapse

cystocele: herniation of the bladder into the vagina

rectocele: herniation of the rectum into the vagina

uterine prolapse: bulging of the uterus into the vagina

92

cesarean section

abdominal surgery for fetus delivery

requires an incision through uterine wall- longitudinal or transverse

indications:
-pelvic disproportion
-failure of the birth process to progress
-fetal or maternal distress
-other complications

TX:
-TENS for post incisional pain - pads placed parallel to incision on either side
-exercise program: diaphragmatic and upper chest breathing, pelvic floor exercises and pelvic mobility exercises --> add in gentle lower trunk rotation and ambulation and progress to more vigorous abdominal exercises
* heavy lift precautions 4-6 weeks

93

preeclampsia

pregnancy induced, acute HTN after the 24th gestation week

may be mild or severe

evaluate symptoms of : HTN, edema, sudden excessive weight gain, headache, visual disturbances or hyperreflexia

*prompt physician referral

94

effects of aerobic exercise during pregnancy

BF is away from the internal organs, including the uterus, and toward the working muscles

RR does not increase proprtionately with mod-severe exercise

hematocrit level during pregnancy is lowered and it rises up to 10 percentage points within 15 min of beginning vigorous exercise

compression of inferior vena cava by the uterus can occur after the 4th month- increased in supine
-reduces venous return and CO

hypoglycemia occurs more often during pregnancy
-adequate carb intake is vital for exercising

core temp decreases in physically fit women during exercise
-regulate core temp , thermal stress to fetus reduced

95

contraindications for exercise during pregnancy

incompetent cervix- early dilation of the cervix before flutter

vaginal bleeding of any amount

placenta previa- placenta located on the uterus in a position where it may detach before delivery

rupture of membranes- loss of amniotic fluid prior to labor

premature labor-

96

precautions to exercise with pregnancy

multiple gestations

anemia- reducted RBC

systemic infection

extreme fatigue

MS complaints/pain

overheating

diastasis recti

uterine contractions (lasting several hours after exercise)

97

menopause

the cessation of ovarian function accompanied by decreased estrogen levels

common conditions after menopause:
-worsening fibromyalgia
-carpal tunnel
-colles' fracture
-impingement syndromes
-adhesive capsulitis
-osteoporosis
-heart disease and stroke

98

female conditions that may result in pelvic, LB or sacral pain:

endometriosis
ectopic pregnancy
ovarian cysts
late stage ovarian cancer
pelvic inflammatory disease

99

endometriosis

ectopic growth and function of endometrial tissue outside of the uterus

common sites: ovaries, fallopian tubes, broad ligaments, uterosacral ligaments, pelvis, vagina or intestines

can lead to cysts and rupture, producing peritonitis and adhesions as well as adhesions and obstruction

S&S:
-pain,
-dysmenorrhea
-dyspareunia- abnormal pain during sex
-infertility
**may complain of back pain
-endometrial implants on muscle (psoas major, pelvic floor muscles - may produce pain with palpation or contraction

TX: pain management, endometrial suppression and surgery

100

pelvic inflammatory disease

an inflammation of the upper reproductive tract involving the uterus (endometritis), fallopian tubes or ovaries

caused by polymicrobial agent that ascends through the endocervical canal

S&S:
-lower abdominal pain that typically starts after menstrual cycle
-purulent cervical dischage
-painful cervix
-fever, elevated WBC
-increased ESR

complications: pelvic adhesions, infertility, ectopic pregnancy, chronic pain and abscesses

101

immune cells

antigen (immunogen) is a foreign molecule that elicits immune response.

antibodies or immunoglobulins are the proteins that are engaged to tag antigens

lymphocytes- primary cells of immune system

macrophages- accessory cells that process and present antigens to the lymphocytes

cytokines- molecules that link immune cells with other tissues and organs

102

immune system: thymus, lymph, spleen

thymus:
-primary central gland of the immune system
-produces mature T lymphocytes

lymph system:
-lymph nodes function to filter the lymph and trap antigens. lymphocytes, monocytes and plasma cells are formed in the lymph nodes

spleen
-large lymphoid organ in the upper L abdominal cavity
-functions to filter antigens from the blood and produce leukocytes, monocytes, lymphocytes and plasma cells in response to infection

103

immunodeficient vs. autoimmune diseases

immunodeficient:
-depressed or absent immune responses
-Primary: congenital disorders
-Secondary: leukemia, bone marrow tumor, chronic diabetes, renal failure, cirrhosis, cancer tx
-organ transplant,

autoimmune:
-excessive immune response
-immune system responses directed against the body's own normal tissues; self destructive processes
-can be organ or system specific

104

human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS)

caused by virus that weakens immune system
-important cells that fight disease and infection are destroyed

reduction of CD4 helper T cells, resulting in CD4 T lymphocytopenia - major defect in the immune system
-a retrovirus- replicates in reverse fashion

transmission - through contact with body fluids- blood saliva, genital fluids, breast milk

HIV S&S:
-flu like symptoms- recurrent fever, chills, night sweats, swollen lymph glands, loss of appetite, weight loss diarrhea, persistent fatigue, infections

AIDS S&S:
-opportunistic infections: pneumonia, TB, toxoplasmosis
-malignancies
-neurological conditions: focal encephalitis, meningitis, AIDS dementia complex, herpes zoster,
-deconditioning, anxiety, depression

105

chronic fatigue syndrome

a complex, chronic syndrome characterized by overwhelming fatigue and other symptoms

major criteria (must have)
-new onset of persistent or relapsing fatigue
must be present for at least 6 months; doesn't resolve with rest and reduces daily activity by 50%
-exclusion of other chronic conditions

symptoms criteria (4/8)
-profound/prolonged fatigue; post exertion malaise >24 hours
-sore throat frequent
-tender lymph nodes
-myalgia
-sleep that isn't refreshing
-headaches
-arthralgia
-short term memory or concentration

women>men

limited recovery: only 5-10% recover completely

overall goal-prevent deconditioning

106

fibromyalgia syndrome

a disorder characterized by widespread MS pain, fatigue with sleep, memory and mood disturbances

most common in ppl with rheumatic disease
women>men

dx: widespread pain lasting >3months and presence of 11/18 tender points

characteristics:
-myalgia
-generalized aching, persistent fatigue (mental and physical)
-multiple tender points
-visual disturbances
-spasm
-cold intolerance
-headaches
-irriatble bladder/bowel
-cognitive problems
-restless legs


daily exercise is important
-focus on aerobic training mild-mod intensity 2-30 min duration, 2x/wk
aquatics ideal

107

tuberculosis

airborne infectious disease

most commonly affects the respiratory system but may also affect the GI and GU systems, bones, joints, and NS and skin

S&S
-pulmonary: productive cough lasting 3 weeks or longer, rales, dyspnea, pain in the chest and hemoptysis
-systemic: weakness or fatigue, low grade fever, chills, night sweats, anorexia and weight loss

transmission through respiratory droplets or sputum
-pulmonary precautions and isolation

108

total blood volume made up of

plasma 55%
RBC 45%
WBC 1%

109

plasma

makes up 55% of total blood volume and is the liquid part of the blood and lymph
-carries cellular elements of blood through the circulation
-carries nutrients, waste products and hormones

serum is plasma without the clotting factors

110

RBC

erythrocytes
make up 45% of total blood volume

contain oxygen carrying protein hemoglobin responsible for transporting oxygen

produced in the marrow of thelong bones and controlled by hormones

time limited, surviving only about 120 days
RBC count varies with age, activity and environment

111

WBC

leukocytes
make up 1% of total blood volume
circulate through the lymphoid tissue

function in immune processes as phagocytes of bacteria, fungi and viruses

also aid in capturing toxic proteins resulting from allergic reactions and cellular injury

produced in the bone marrow

5 types: lymphocytes, monocytes, neutrophils, basophils, eosinophils

112

hematopoiesis

the normal function and generation of blood cells in the bone marrow

disorders of hematopoiesis include aplastic anemia and leukemias

113

erythrocyte sedimentation rate

ESR is the rate of RBC that settle out in a tube of unclotted blood
ml/hour

elevated ESR indicates the presence of inflammation
male

114

hemostasis

the termination or arrest of BF by mechanical or chemical procceses
-vasospasm, platelet aggregation, thombin and fibrin synthesis

blood clotting requires platelets produced in bone marrow

115

hypercoaguability disorders

caused by increased platelet function
-atherosclerosis, DM, elevated blood lipids and cholesterol

accelerated activity of the clotting system as seen in CHF, malignant diseases, pregnancy and use of oral contraceptives, immobility

116

shock

abnormal condition of inadequate BF to the body tissues

associated with hypotension, inadequate CO and changes in peripheral BF resistance

hypovolemic shock caused by hemorrhage, vomiting or diarrhea
-loss of body fluids also occurs with dehydration, addison's disease, burns, pancreatitis or peritonitis

orthostatic changes may develop, characterized by drop in SBP 10-20; pulse and RR increase

progressive shock is associated with restlessness and anxiety, weakness, lethargy, pallor with cool, moist skin and fall in body temp

patient should be placed in supine or in modified trendelenburg position to aid venous return

117

S&S of hematological disorders

easy bruising with spontaneous petechiae and purpura of the skin

external hematomas may also be present - thrombocytopenia

long term use of steroids and NSAIDS can lead to bleeding and anemia

118

anemia

decrease in hemoglobin levels of the blood
-men: 13-18
-women: 12-16
-decrease: anemias, prolonged hemorrhage, RBC destruction (cancer, sickle cell)

decrease in RBC production: nutritional deficiency (iron, vitamin B, folic acid); cellular maturation defects, decreased bone marrow stimulation (hypothyroidism), bone marrow failure (leukemia, aplasia, neoplasm), and genetic defect

destruction of RBCs: autoimmune hemolysis, sickle cell disease, enzyme defects, parasites (malaria), hypersplenism, chronic diseases (RA, TB, cancer)

loss of blood (hemorrhage): trauma, wound, bleeding, peptic ulcer, excessive menstruation

S&S:
-fatigue and weakness with min exertion
-dyspnea on exertion
-pallor or yellow skin of the face, hands, nail beds and lips
-tachycardia
-bleeding of gums, mucous membranes or skin in the absence of trauma
-severe anemia can produce hypoxic damage to liver and kidney, heart failure

PT:
**exhibit decreased exercise tolerance

119

sickle cell disease

group of inherited, autosomal recessive RBC disorders
-erythrocytes, specifically hemoglobin are abnormal
-RBCs are crescent or sickle cell sharped

Sickle cell crisis:
-acute episodic condition occurring in children with sickle cell anemia
-pain: acute and severe from sickle cell clots formed in any organ, bone, joint; acute abdominal pain from cisceral hypoxia; painful swelling of soft tissues of the hands and feet; persistent headache
-bone and joint crises: migratory, recurrent joint pain, extremity and back pain
neurological manifestations: dizzy, convulsions, coma, nystagmus
-pulmonary (acute chest syndrome): chest pain, coughing, dyspnea, tachypnea

Complications:
-vascular: stroke, chronic leg ulcers, bone infarcts, avascular necrosis of femoral head, hand and foot syndrome
-pulmonary HTN
-neurologic: paresthesias, CN palsies, blindness, hemiplegia
-renal: enuresis, nocturia, hematuria, renal failure
-anemic crisis: rapid drop in hemoglobin levels
-aplastic crisis: severe anemia; associated with acute viral, bacterial or fungal infection; increased susceptibility to infection
-splenic: liver and spleen enlargement, spleen atrophy

PT:
-during sickle cell event- pain control (warmth is soothing, relaxation)
**cold is contraindicated, as it increases vasoconstriction and sickling
-exercise training (common intolerance) exaggerated HR response to exercise - low-mod exercise
**high level exercise and dehydration may increase risk of sickle cell crisis

120

hemophilia

group of inherited bleeding disorders
-inherited as sex linked recessive disorder of blood coagulation
-affects males, females are carriers

clotting factor VIII deficiency (hemophilia A)- most common/classic hemophilia

level of severity and rate of spontaneous bleeds varies by % of clotting factor in blood: mild, mod, severe

hemiarthrosis- bleeding into joint spaces
-joint becomes swollen, warm, painful with decreased ROM
-chong term results can include chronic synovitis and arthropathy leading to bone and cartilage destruction

hemorrhage into muscles often affects forearm flexors, calves, and iliopsoas- pain and decreased movement

PT:
-acute stage: RICE, maintain position, prevent deformity
-subacute stage: isometrics, and aquatics , pain management (TENDS, massage, relaxation, ice, biofeedback)
-AAROM progressing to active, isokinetic and open chain resistive exercises (closed chain may put too much compressive force through joint)
-important to strengthen hip, knee, elbow extensors and DFs
-contracture management
**passive stretching rarely used d//t risk of myositis ossificans
-chronic stage: daily HEP for joint function, aerobic fitness and strength