systemic tx -- cardiovascular treatment & pregnancy Flashcards

Question

other CI

Answer 1

No full body hydro No prolonged elevation of legs Precautions-deep neck work, passive stretching of neck-may compress blood vessels Modify prolonged, repetitive, broad, full body strokes to short segmental No full body lymphatic drainage. Avoid painful or stimulating techniques (increase SNS = increase BP)

Answer 2

May need to limit time in prone, modify depth of pressure, and limit painful, stimulating techniques depending on how stable BP is.

Answer 3

Goal is to decrease work to the heart-limit anything that will increase heart rate, or blood return to the heart-use shorter strokes, limit elevation of legs

Answer 4

No full body hydro

Answer 5

MFR depending on tissue health PROM, Stretches, Joint mobs if indicated Swedish/petrissage techniques modified to short and segmental strokes

Answer 6

Most patients with Stage 1 or 2 hypertension will require little to no modifications if their BP is stable and managed.

Answer 7

**Is their hypertension managed and stable** current BP? meds? regular checkups? fitness? general health? systemic conditions? pain/claudication? sleep position/activity? respiratory changes? doctor cleared massage? current symptoms? headache?

Answer 8

Left sided=breathing difficulties Right sided=systemic edema (need Dr. consent to treat)

Answer 9

Edema, varicosities, facial colorations, extremity coloration (skin color: flushing, cyanosis), sweating, labored breathing, tissue health (dry, cracked skin, fragile/compromised skin) palpation? Pulses – assess if they are normal, absent, dimished, bounding (compare bilaterally), Edema (pitting vs non pitting), location/extent Skin – temperature (extremities and core), sweating

Answer 10

TOS/neurological

Answer 11

MI refers to shoulder, jaw, down arm and can along back and sternum. Trigger points can also refer to these areas (pec mj/mn, serratus anterior, scalene, levator scapula etc)

Answer 12

blood pressure and respiratory status

Answer 13

capillary refill test, Allen’s test, Manual compression test, Pulses, Leg raise for varicose veins, Pitted edema test, Homan’s test

Answer 14

Use the pad of your finger, not the tip Don’t push too hard or you can occlude the vessel

Answer 15

Sometimes, using a number of fingers along the course of a vessel, and applying firmer pressure with the distal fingers will allow you to feel the pulse better in the proximal fingers

Answer 16

“2/2” if strong “1/2” if weak “0/2” if absent

Answer 17

on the medial side of the wrist find the pisiform bone. Roll your finger laterally from this and the artery runs along here. Harder to find than the radial artery.

Answer 18

along the inguinal ligament, about halfway from the ASIS to the pubic tubercle.

Answer 19

feel along the anterior shin lateral to the tibia. It is easiest to feel halfway down the shin. Branch of the popliteal artery

Answer 20

on the medial side of the ankle find the medial malleolus. Roll your finger towards the angle of the heel and feel for the pulse.

Answer 21

on the top of the foot about 1/3 of the way to the toes, feel laterally to the extensor hallucis longus tendon. The artery runs along side the tendon. This is a branch of the popliteal artery.

Answer 22

only check one at a time. Find the bottom of the lateral edge of the thyroid cartilage. Then feel 1-2 cm lateral to that.

Answer 23

only check one at a time. About 2 cm anterior of the scm along the fold of the jaw line.

Answer 24

find the top part of the ear that is attached to your face (about eye level) and about 1 cm anterior is the pulse.

Answer 25

supine, semi-fowler side-lying?

Answer 26

Don’t increase heart rate or venous return Stage 1 and 2 require little mods USE CLINICAL REASONING Modify position and techniques if BP unstable, higher on spectrum or complex/unknown health history

Answer 27

SKIN INTEGRITY Increase peripheral circulation Avoid restricting blood flow to affected area Consider secondary health concerns

Answer 28

Blood may pool in periphery. Increase circulation-increase venous return. Consider secondary health concerns. (hypertension, edema and causes)

Answer 29

Diseases affecting the blood vessels usually result in some form of peripheral vascular disease (PVD).

Answer 30

PVD can affect the arterial, venous or lymphatic circulatory systems.

Answer 31

Occlusive diseases of the blood vessels are a common cause of disability and usually occur as a result of ATHEROSCLEROSIS Other causes of arterial occlusion include trauma, thrombus or embolism, vaculitis or vasomotor disorders (Raynaud’s).

Answer 32

Thromboangitis obliterans Arteriosclerosis obliterans Arterial thrombosis Arterial embolism

Answer 33

Inflammatory lesions of the peripheral blood vessels are accompanied by thrombus formation and vasospasm occluding blood vessels. A vasculitis, i.e. an inflammatory and thrombotic process, affecting both arteries and vein, primary in the extremities eventually OBLITERATING (destroying) small and medium vessels of the feet and hands

Answer 34

unknown smoking ---> Usually found in men younger than 40 who smoke heavily

Answer 35

Symptoms are episodic and segmental (i.e. come and go intermittently over time and appear in different, asymmetrical anatomic locations) Intermittent claudication in the arch of the foot or the palm of the hand is often the first symptom Symptoms include pain at rest, edema, cold sensitivity, rubor (redness of the skin from dilated capillaries under the skin), cyanosis, and thin, shiny, hairless skin (trophic changes) from chronic ischemia

Answer 36

Intermittent claudication in the arch of the foot or the palm of the hand is often the first symptom

Answer 37

Include increasing circulation to the hand or foot

Answer 38

Proliferation of the intima causes complete obliteration of the lumen of the artery ---> (buildup in tunica intima) A.k.a. peripheral arterial disease Most common occlusive disease (about 95% of cases)

Answer 39

A.k.a. peripheral arterial disease

Answer 40

arteriosclerosis obliterans ???

Answer 41

? Associated with diabetes mellitus Risk factors include smoking, hypertension, hyperlipidemia, obesity, and diabetes

Answer 42

Most often seen in elderly patients

Answer 43

Bilateral, progressive INTERMITTENT CLAUDICATION is usually present in muscles Primary symptom may be a sense of weakness or muscular “tiredness”, both the pain and weakness/fatigue are relieved by rest Pain at rest indicated more severe involvement; may be relieved by dangling limbs (usually leg) over the edge of the bed to use gravity to encourage circulation (dependent position)

Answer 44

good for arterial insufficiency bad for venous insufficiency ?

Answer 45

this dependent position would relieve arterial pain but would increase symptoms of a DVT (venous)

Answer 46

Preventive skin care is a primary goal in treatment; avoid minor injuries, infections and ulceration Exercise to increase collateral circulation and improved function

Answer 47

"Collateral circulation is alternate or 'backup' blood vessels in your body that can take over when another artery or vein becomes blocked"

Answer 48

Diabetic neuropathy with diminished sensation of the toes or feet often occurs, predisposing the patient to injury or pressure ulcers that may progress because of poor blood flow and ongoing loss of sensation

Answer 49

Pain on activity-predicable onset, stops when activity stops. (intermittent claudication) Pain on elevation, relieved on dependent position (legs up vs legs down) Lack of circulation to extremities-skin integrity, diminished pulses

Answer 50

Long term, unmanaged hypertension Diabetes

Answer 51

"Ischemic pain occurs due to a lack of oxygen and nutrients reaching tissues, leading to the buildup of metabolic byproducts like lactic acid, which activates pain receptors and signals pain to the brain" "Excess blood sugar decreases the elasticity of blood vessels and causes them to narrow, impeding blood flow. This can lead to a reduced supply of blood and oxygen" "Diabetes damages small blood vessels (microvascular disease) due to chronically high blood sugar levels, which lead to thickening of the vessel walls, reduced blood flow, and increased risk of complications in organs like the eyes, kidneys, and nerves."

Answer 52

"Arterial thrombosis, a complex process, typically originates from atherosclerotic plaque disruption, leading to platelet activation, aggregation, and fibrin formation, ultimately forming a thrombus that can obstruct blood flow"

Answer 53

“The therapist must be aware that spasms and cramps can be caused by pathologies and medication. In these cases, treatment modifications or referral to a physician may be indicated. For example, calf muscle cramps may occur with arterial disorders, such as: Acute arterial occlusion due to a thrombus or embolism; Chronic arteriosclerotic vascular disorder due to arterial narrowing and fibrosing, which is frequently associated with diabetes mellitus and with the aging process; Other causes: Deep vein thrombosis: Diabetes – neuropathic pain from damaged nerves Muscle cramp- exertion/dehydration/fatigue Intermittent claudication is due to ischemia. Pain and cramping are often noted when the client is walking. They diminish slowly with rest. …”

Answer 54

pulse decreased/absent colour pale, esp elevation, red in dependent position temp cool edema absent/mild skin changes = trophic changes ulceration = at toes, if at all gangrene = possible

Answer 55

pulse normal, but difficult to palpate through edema colour normal, or cyanotic (dependent position) temp normal edema = yes skin = possible stasis dermatitis, brown pigmentation ulceration? @ ankles if present gangrene = no

Answer 56

thin, shiny skin loss of hair in extremities, esp hands/feet nails thickened/ridged (clubbing)

Answer 57

pain during activity (legs usually), underlying cardiovascular ie. Hypertension, or history of heart disease. Other health concerns ie. Diabetes. Ddx (from venous condition) = Pain if limb is elevated, and relieved in dependent position

Answer 58

shiny fragile skin, thickened nail beds, distal ulcers Palpation-cool to touch Movement-elevation increases pain

Answer 59

capillary refill pulse

Answer 60

1. Improve local/collateral circulation 2. Improve exercise tolerance for ADL’s and decrease the incidence of intermittent claudication ---> regular, graded aerobic exercise program of walking, cycling, whatever they’re able to do comfortably (consider compliance) vasodilation by reflex heating 3. Relieve pain at rest ---> sleep with the legs in a dependent position over the edge of the bed, or with the head of the bed slightly elevated 4. Prevent joint contractures and muscle atrophy ---> active or mild resistance Range Of Motion exercises to the extremities 5. Prevent skin ulcerations ---> Educate client in the proper care and protection of the skin, particularly proper shoe selection and fit, avoid use of compression stockings

Answer 61

reduce blood flow & nutrients to mm of extremities

Answer 62

Intermittent episodes of small artery or arteriole constriction of the extremities causing temporary pallor and cyanosis of the digits (usually fingers) These episodes occur in response to the cold temperature or strong emotion (anxiety or excitement)

Answer 63

"Yes, cutting off circulation to a hand can cause paresthesia (a tingling, prickling, or burning sensation) because the peripheral nerves, which rely on blood supply for oxygen and nutrients, are deprived of these essentials, leading to nerve dysfunction"

Answer 64

Arterial vasospasm in the skin  constriction  pale cold skin  blood pools in surrounding tissues  bluish/purplish skin  white  red (as vessels relax and blood flows in)  warm red skin (may experience throbbing, swelling and paresthesia)

Answer 65

Raynaud’s disease: primary condition, vasospastic disorder (idiopathic) Raynaud’s phenomenon: secondary to another disease or underlying cause

Answer 66

80% of people with it are women aged 20-49 years old Idiopathic; seems to be caused by hypersensitivity of digital arteries to cold, release of serotonin, and congenital predisposition to vasospasm

Answer 67

Predicted that 10-20% of the general population has this; usually women between 15-40 years old Secondary to other conditions (buerger’s, connective tissue disorders, hidden neoplasms); has been known to be precipitated by use of pharmacological med’s and by exposure to temperature changes (warm to cool/cold), also injuries to hand (repetitive stress e.g. keyboarding, using crutches) Nicotine constricts small blood vessels; smoking can trigger attacks in people predisposed to this phenomenon

Answer 68

accounts for 65% of people affected by Raynaud’s

Answer 69

"More annoying than medically serious”

Answer 70

Is this condition primary or secondary Underlying health concerns if secondary Current attack Skin integrity Triggers-stress, cold

Answer 71

Has this been diagnosed, is it secondary to an underlying health concern Are you currently having an attack? What are your triggers? Is the skin cracked, thin, or ulcerated? (may observe) Skin integrity is major concern for arterial insuf.

Answer 72

"While Raynaud's phenomenon involves reduced blood flow, it's not a form of arterial insufficiency in the same way as Peripheral Artery Disease (PAD), which involves blockage or narrowing of arteries. Raynaud's is a vasospastic disorder where blood vessels in the extremities, primarily fingers and toes, narrow in response to cold or stress, causing temporary blood flow restriction."

Answer 73

Colour and texture of the skin and nail beds (pallor or cyanosis of the fingers may indicate Raynaud’s) Palpate temperature, where is it cold Look for cracks/ulcers/fragile skin With the pads of your index and middle fingers, palpate the radial pulse on the flexor surface of the wrist laterally. Compare the volume of the pulses on each side.

Answer 74

Arterial occlusion in the arms is much less common than in the legs. If pulses are markedly diminished or absent, however, consider thromboangiitis obliterans (Buerger’s disease), scleroderma, or, possibly, a cervical rib. If arterial insufficiency is suspected, palpate also 1) for the ulnar pulse, on the flexor surface of the wrist medially, and 2) for the brachial pulse, in the groove between the biceps and triceps muscle above the elbow.

Answer 75

Since the normal ulnar artery is frequently not palpable, the Allen Test may be useful. It tests the patency of the ulnar and radial arteries in turn. Ask the patient to rest his/her hands on the table. Place your thumbs over their radial arteries and ask them to clench fists tightly. Compress the radial arterial firmly, then ask the patient to open hands into a relaxed position. Observe the colour of the palms. Normally they should turn pink promptly. Repeat occluding the ulnar arteries. Persistence of pallor when one artery (e.g. the radial) is manually compressed indicates occlusion or compromise of the other (e.g. the ulnar).

Answer 76

Check the finger nails for cracked nails and skin integrity first. Then apply pressure on nail bed for 10 seconds. Release and observe the color of the nail bed. The color should return within 7-10 seconds. If the color remains white longer then there is arterial insufficiency.

Answer 77

Avoid areas where skin is compromised No elevation of affected limb Modify temperature (ie CAB), no temperature extremes. Warm/cool Modify stimulatory/painful techniques during attack. (Raynauds)

Answer 78

Decrease FIDs of attack Increase peripheral circulation Manage stress if it is a trigger Patient education to manage triggers (e.g. cold/stress)

Answer 79

Prone- (unless unmanaged hypertension) Interscap Swedish arm to hand Supine-’glitchy bits’ (?) Scalenes/pec minor/ subclavius Brachialis Pronator teres Carpal tunnel

Answer 80

What is the cause? We need to know the cause before we treat the edema. -trauma? (what stage is the injury) underlying health concerns (CHF, liver/kidney issues) Deep vein thrombosis Infection Cancer

Answer 81

general health history, cardiovascular health, kidney or liver diseases, injuries (when was the injury, MOI, is the joint affected), infections, surgery, pregnancy (BP, has md or midwife assessed) how long they have had it, have they seen a doctor, are they cleared for treatment, are they on medication, do they use any devices to assist with swelling (stockings/bandages etc), are they seeking other treatments?

Answer 82

compare bilaterally for swelling, postural observation, gait, ROM to assess affected joints, skin quality/tissue integrity, color of tissue, area affected Palpation: tenderness, heat, coolness, pulses (may not be able to feel due to swelling), density/quality of edema (firm, boggy, taut) Movement: ROM for joints affected Neurological: nerve compression may be a factor with swelling Referred pain: may be due to nerve compression

Answer 83

Special tests: girth measurement of affected area (test bilaterally if applicable), pitted edema test.

Answer 84

Acute Thrombophlebitis Chronic Venous Disorders -chronic venous insufficiency -varicose veins

Answer 85

Thrombophlebitis is the swelling of a vein due to a blood clot. Clots may be as long as 20 inches along the wall of the vein. This is not a condition that can be treated by RMTs. The risk of dislodging the clot poses serious complications.

Answer 86

Prolonged immobilization Trauma, especially in the legs or pelvis Surgery to legs History of thromboembolism History of heart disease Pregnancy and post partum state Oral contraceptive pill Diabetes mellitus Clotting disorders Nursing home residents

Answer 87

-heat swelling redness along course of vein -pain at rest, worse on elevation or movement -throbbing deep pain -look for risk factors -can be asymptomatic -may be feverish

Answer 88

Have they been diagnosed, have they been cleared of a dvt, associated calf cramping/intermittent claudication, any recent surgery/immobilization/trauma to legs, pregnant/post partum, heart disease, health history (DVT risk factors),

Answer 89

edema, redness cord like swelling. Palpation: pain, heat, swelling, Neurological: compression from edema possible Referred pain: intermittent claudication (?)

Answer 90

??? Movement: pain increase with elevation, pain does not decrease in dependent position. other source: (regarding DVT) "Elevation: Elevating the legs can help to instantly relieve pain." (Chatgpt) "Elevating the legs can actually help reduce pain and swelling associated with a DVT (deep vein thrombosis) by improving circulation and decreasing pressure in the veins"

Answer 91

Homan’s test (rule out dvt) note that sensitivity & specificity is poor ---> not good diagnostic value

Answer 92

Check with Dr. if patient has current DVT diagnosis If you suspect a DVT, immediate medical referral ---> (Refer to MD for diagnosis if you suspect DVT is present)

Answer 93

NO local massage or ROM to affected limb No heat distal or immediately proximal Recent femoral fracture-no treatment to lower limbs (bilateral)

Answer 94

Varicose veins are swollen, twisted, and sometimes painful veins that have filled with an abnormal collection of blood.

Answer 95

Twisted, bulging blue lines running down all or part of a leg Legs that ache or become tired and weak, especially after long periods of sitting or standing Restless legs or legs that are so uncomfortable that a person has difficulty standing on both feet at once Burning or itchy skin on the legs Legs and/or ankles that become swollen and possibly have brownish pigmentation Leg cramps, especially in calf muscles often occur at night

Answer 96

Family history, have they been diagnosed, have they been cleared of a dvt, have they had recent medical intervention to vv, are they painful/sensitive to touch, symptoms they experience, how long have they had them, associated calf cramping/intermittent claudication, history of recent surgery/immobilization, pregnant/post partum, heart disease, health history (DVT risk factors).

Answer 97

Observation: look for twisting, bulging, inflammation, edema Palpation: pain, heat, swelling painful/skin integrity? Movement: would not do with suspected DVT. (?) Neurological: compression from edema possible Referred pain: intermittent claudication or nerve compression Special tests: Homan’s test (rule out dvt), leg elevation

Answer 98

Elevate legs Observe whether “normal” bulging of vein disappears Varicose veins will not disappear completely because the faulty vein has stretched beyond its normal diameter and length

Answer 99

NO deep specific techniques if tissue is dystrophic NO local massage if the varicose veins are painful NO massage 24 hours post medical treatment to varicose veins (i.e. saline injections, surgery etc) until approved by MD NO massage over varicosity if there is no diagnosis of varicosity of thrombophlebitis but the client presents with DVT symptoms

Answer 100

Underlying cardio issues, hypertension, CHF

Answer 101

Pregnancy may be difficult to achieve, unwanted, terminated willingly or unwillingly. You may not be aware of this person's experience around pregnancy, whether they be your friends, classmates, instructors or patients.

Answer 102

weeks 1-12

Answer 103

Nausea & vomiting (morning sickness); most common is first trimester but can continue through the pregnancy

Answer 104

Frequent urination: due to progesterone which relaxes the smooth muscle of the bladder Constipation: progesterone causes relaxation of smooth muscle

Answer 105

Blood pressure drops: progesterone causes relaxation of smooth muscle in vessels

Answer 106

Breast changes: increased fullness, tenderness, sensitivity

Answer 107

"During the first trimester, breasts often feel full and tender due to surging pregnancy hormones like estrogen and progesterone, which cause increased blood flow and breast tissue growth in preparation for breastfeeding." (AI)

Answer 108

Musculoskeletal changes: due to relaxin; affects connective tissue, especially ligaments & joint capsules

Answer 109

Taste and Smell are altered in the early stages of pregnancy Mood swings; most common in the first trimester. Extreme fatigue increase feelings of irritability and depression. Anxiety about pregnancy is common.

Answer 110

(Anxiety about pregnancy is common.) Greatest risk of miscarriage is in the first trimester

Answer 111

Weeks 13-27

Answer 112

Edema: mechanical – weight of uterus on inguinal area causes edema in legs; may also be due to high BP (pre-eclampsia) Hypertension: pregnancy induced – a.k.a. Pre-eclampsia

Answer 113

Supine hypotensive syndrome: due to compression of inferior vena cava by fetus in supine position

Answer 114

Shortness of breath: Mechanical – uterus pushes abdominal contents up into diaphragm, impeding function; Physiological: 20% increase in required oxygen due to increased basal metabolic rate

Answer 115

Backache Abdominal pain Pubic symphysis pain

Answer 116

Backache: lumbar pulled forward by weight of belly; lumbar & pelvic joints are loose (relaxin) & rely on muscles for support

Answer 117

Abdominal pain: ---> uterine ligament referral; ---> diastasis recti – separation of rectus abdominus at linea alba.

Answer 118

Refer to physician for unexplained abdominal pain.

Answer 119

due to relaxin

Answer 120

Varicose veins: compression of vessels at inguinal area Hemorrhoids: straining due to constipation Stretch marks may develop as the body changes

Answer 121

nasal congestion, nosebleeds, headaches

Answer 122

"Nosebleeds during pregnancy are normal and usually not a cause for worry. Most nosebleeds are caused by an increase in blood volume and hormonal changes." "Nosebleeds during pregnancy are common due to hormonal changes that increase blood volume and blood flow, leading to more fragile blood vessels in the nose that are prone to bursting." (AI)

Answer 123

"Experts aren't entirely sure why it happens, but in some people, higher levels of hormones cause the receptors to respond by widening blood vessels in your nose and creating mucus. This can block it and make it hard to breathe."

Answer 124

Weeks 28-40

Answer 125

acquired insulin resistance, causing increased blood glucose levels

Answer 126

"Gestational diabetes mellitus occurs only in women during pregnancy." "Although the exact cause is unknown, the prevailing theory is that the placenta—the organ that delivers water and nutrients to the fetus—produces hormones that block the mother's ability to use insulin effectively."

Answer 127

(ketones) (secondary to diabetes) "your liver breaks down fat for fuel, a process that produces acids called ketones."

Answer 128

"Every year, 5% to 9% of U.S. pregnancies are affected by gestational diabetes. Managing gestational diabetes can help make sure you have a healthy pregnancy and a healthy baby."

Answer 129

"Being overweight or obese. Not being physically active. Having prediabetes. Having had gestational diabetes during a previous pregnancy. Having polycystic ovary syndrome. Having an immediate family member with diabetes. Having previously delivered a baby weighing more than 9 pounds (4.1 kilograms)"

Answer 130

TOS CTS may develop, due to arm & hand edema

Answer 131

(lumbar pulled forward by weight of belly)

Answer 132

intensely painful; walking can be difficult Pelvic discomfort: loose joints causing tight muscles

Answer 133

"A common question I hear from my patients and clients who have been diagnosed with Ehlers Danlos Syndrome (EDS) or Hypermobility Spectrum Disorder (HSD) is, “If my joints are so loose, why do I feel so tight?” A feeling of tightness of the muscles, often resulting in pain and discomfort is very common among those with these diagnoses. EDS and HSD cause increased laxity of the ligaments, which causes “looseness” of the joints. The brain will do whatever it can to attempt to stabilize the joints." "One of the things the brain can do is instruct the muscles surrounding the loose joints to increase their tone. This increased muscle tone can help improve joint stability. However, this can also result in the muscles staying in a hypertonic state. Hypertonic muscles do not fully relax but instead stay “on” all the time."

Answer 134

ischemia poor arterial function? (due to blocked circulation, esp @ inguinal lig) or possibly DVT

Answer 135

Costal margin pain: as uterus compresses lower ribs

Answer 136

PROGESTERONE (smooth mm bladder) BUT ALSO: ---> increased pressure on bladder (increased size of uterus)

Answer 137

Insomnia and restlessness: Heartburn, fetal movement and the need to urinate frequently all contribute to sleep difficulties

Answer 138

"Heartburn is common during pregnancy because of hormonal changes and the growing baby's pressure on the stomach." (AI)

Answer 139

As the uterus grows the ligaments which suspend it in the pelvic cavity are stretched, and can be a source of referred pain.

Answer 140

As the connective tissue in the body is softened by relaxin, the joints become more loose & unstable, so they rely on muscular support for stability.

Answer 141

to anterior/medial thigh & lower abdomen

Answer 142

to posterior hip & thigh

Answer 143

area over sacrum

Answer 144

supine & prone

Answer 145

Lying prone increases intrauterine pressure, and further stresses already taxed uterine ligaments (esp. Sacrouterine) and lumbar joints Prone position may also be uncomfortable on tender breast tissue also ---> There is increased mucous production in pregnancy, so the patient may become uncomfortably congested in prone

Answer 146

Adjustable pillow systems can allow for prone treatment in most healthy pregnancies

Answer 147

The weight of the uterus rests on the inferior vena cava (AND AORTA), resulting in low maternal blood pressure & decreased maternal & fetal circulation (supine hypotensive syndrome) Other symptoms include uneasiness, dizziness, SOB

Answer 148

For patients with healthy pregnancies, it is usually ok for them to be supine for 2-5 minutes without risk You can place a pillow under the right side of the pelvis to shift the weight off the IVC, for extended supine positioning

Answer 149

Semi-fowlers position offers a safe alternative to supine treatments

Answer 150

Side-lying is the recommended position for massage treatment Minimizes strain on uterine ligaments Prevents increased intrauterine pressure Ensures placental & fetal circulation in high risk pregnancies Also ---> Prevents increased sinus pressure & congestion

Answer 151

LEFT Most patients can lie on either side for treatment, although left side-lying allows maximum maternal cardiac functioning

Answer 152

Be cautious with joint mobilization due to the effects of relaxin Avoid deep massage to the low back, sacrum and abdomen in the first trimester (Due to the greater risk of miscarriage -although there is no evidence of massage increasing the risk of miscarriage) Be mindful with fascial techniques due to its stabilizing role

Answer 153

Massage is contraindicated if a sudden change in blood pressure is noticed - refer to MD or midwife

Answer 154

If patient has GD - ensure they have eaten prior to massage

Answer 155

Avoid systemic hot hydro that may change increase maternal temperature

Answer 156

If patient feels unwell in the supine position during the second or third trimester change positions or discontinue treatment

Answer 157

Be aware of the increased risk of blood clots during pregnancy: A patient’s blood clotting capacity increases 4-5 times normal to prevent potential hemorrhaging during delivery. This process also increases the potential for developing BLOOD CLOTS.

Answer 158

Clot formation is greatest in veins in which blood is moving slowly or is stagnant.

Answer 159

iliac, femoral & saphenous veins, due to reduced venous return caused by the fetus blocking blood flow at the inguinal area

Answer 160

AVOID deep treatment to the medial side of the leg and refer to a physician

Answer 161

“Monkey Tail” - Help patient with posterior pelvic tilt ---> Sacral glide with pelvic rotation (maintain the gain while they releases rotation, & continue) to decrease anterior pelvic rotation “Jam-jar” to mobilize SI joint (move ileum on sacrum) or to help correct anterior pelvic rotation

Answer 162

Lumbo-sacral decompression - Cross-hands, iliac crest and thorax

Answer 163

Slow petrissage techniques to back, glutes, legs

Answer 164

Pregnancy & posture Exercise & pregnancy ---> Diastasis Recti ---> Kegel exercises Assessment and Treatment Planning

Answer 165

thoracic kyphosis lumbar lordosis APT tight short mm: cervical extensor lumbar extensor stretched weak mm: thoracic extensor hamstrings

Answer 166

Improves mood and reduces stress Helps with appropriate weight gain Promotes better sleep Improves energy levels Increases muscle strength and endurance Helps build stamina for labour and delivery Speeds up recovery after labour and delivery

Answer 167

If you are new to exercise, talk to a health care provider first. Start with shorter sessions and easier activities and gradually increase until you are exercising for 30 minutes per session If you were active before pregnancy, you can continue with your usual activities and make changes as needed Weight training is safe as long as the resistance is light to moderate. Heavy weights can stress muscles or ligaments Do not exceed normal joint movement or overstretch because of relaxin Exercise at a moderate intensity: use the talk test to make sure you are exercising at an appropriate intensity After the fourth month of pregnancy, avoid exercising on your back for prolonged periods To prevent pubic symphysis pain, avoid front & side lunges & single-leg stance Keep cool and hydrated. Avoid exercising outside on very hot days. Drink lots of water before during and after exercise Talk to your healthcare provider if you experience symptoms after exercise such as vaginal bleeding, dizziness, contractions or swelling pain and redness in the calf of one leg

Answer 168

separation of the rectus abdominis muscles at the mid-line (linea alba) "Diastasis recti (rectus diastasis) or divarication of the recti is a stretching of the linea alba with abnormal widening of the gap between the two medial sides of the rectus abdominis muscle (increased inter-recti distance)."

Answer 169

supine, knees bent; place fingers across linea alba; do a small abd. curl; palpate soft area – how many fingers fit? (1 or 2 is normal)

Answer 170

Avoid traditional crunches Avoid twisting crunches

Answer 171

Strengthen Transverse abdominal muscles

Answer 172

Strengthening exercises for the pelvic floor Better bladder control to prevent incontinence Helps to prevent prolapse

Answer 173

"If you have a prolapse of the bladder (cystocele) or uterus (uterine prolapse), Kegels can be very effective for managing POP."

Answer 174

General health? Health of pregnancy? Trimester? First pregnancy? Complications with previous pregnancies? Major symptoms- Nausea, vomiting, swelling, fatigue, headaches …etc Blood pressure? Pre-eclampsia? Gestational Diabetes? How have ADLs been affected?

Answer 175

Backache: check posture – rounded shoulders? enlarged breasts? excessive lumbar lordosis? Hip pain: check posture – ext. rot’d hips? belly carried forward? is it SI joint pain? Leg cramps: ---> belly carried forward (gripping in feet)? (postural) ---> big belly (compressing inguinal area)? (vascular) Foot pain: flat feet (relaxin)? excessive weight gain? Headaches: head forward? rounded shoulders? hormones??

Answer 176

Blood pressure: gestational diabetes, pre-eclampsia, unusual headache

Answer 177

TOS & CTS special tests: is this due to classic nerve impingement, or is it due to postural changes, blood volume changes... Sciatica? or piriformis syndrome? ---> E.g. via actively contracted external rotation @ hip --> leading to HT piriformis

systemic tx -- cardiovascular treatment & pregnancy Flashcards

(206 cards)