Other systems Flashcards
1
Q
Function of the endocrine system
A
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
Q
Function of the metabolic system
A
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
Q
endocrine/metabolic disorders by gland/organ
A
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
Q
Addison’s disease
A
“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
Q
Cushing’s disease
A
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
Q
hypothyroidism
A
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
Q
Hyperthyroidism
A
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
Q
parathyroid gland function
A
releases parathyroid hormone which regulates calcium and phosphorous metabolism
9
Q
Hyperparathyroidism
A
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
Q
Hypoparathyroidism
A
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
Q
pancreas function
A
dual function:
1- acts as an exocrine gland- producing digestive enzymes
2-acts as endocrine gland- producing insulin and glucagons
12
Q
Diabetes
A
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
Q
Type I DM
A
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
Q
Type II DM
A
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
Q
gestational DM
A
glucose intolerance (high blood sugar) associated with pregnancy; most likely 3rd trimester
16
Q
S&S of hypoglycemia
A
blood glucose
17
Q
S&S of hyperglycemia
A
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
Q
complications of DM
A
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
Q
PT for diabetes
A
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
Q
Obesity
A
BMI = weight (kg)/height2 (meters)
- Overweight= 25-29.9
- Obesity = >30
- Morbid obesity >40
21
Q
fluid deficit/dehydration symptoms
A
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
Q
fluid excess
A
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
23
Q
metabolic alkalosis
A
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
Q
metabolic acidosis
A
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
