-
Dysphagia - Aspiration - what is easier to aspire liquids or solids?
- Thin liquids
- Tx - thicken liquids
-
Crohn’s disease - pain referral pattern; what receives symptoms?
- Refers pain to pelvic area + hip
- Received by passing gas
-
Pancreatitis - made worse by what?
-
Hiatal hernia - 3
- Hiatal - shoulder pain
- Avoid Valsalva maneuver
- DO NOT exercise in supine
-
Hernias - pain referral patterns - hiatal; femoral; inguinal; umbilical
- Hiatal - shoulder pain
- Femoral - lateral pelvic wall
- Inguinal - groin pain
- Umbilical - around umbilical ring in mid to lower abdomen
-
S/S of dehydration - 7
- Postural hypotension
- Poor skin turgor
- HA
- Irritability
- Incoordination
- Lethargy
- Disorientation
-
Infectious mononucleosis (Mono) S/S - 9
- Fever
- Sore throat
- Swollen lymph glands in neck/armpits
- Swollen tonsils
- HA
- Fatigue
- mm weakness
- Night sweats
- Swollen spleen
-
Stress incontinence - describe; what is weak; what is normal
- Loss of urine w/INC abdominal P: coughing, sneezing, and laughing
- Weak - pelvic floor
- Normal - bladder
- Tx - pelvic floor exercises
-
Urge incontinence - 2
- Overwhelming urgency & frequency of voiding
- Detrusor overactivity (spasm)
-
Overflow incontinence - 3
- Frequent urination or constant dribbling
- Intra-bladder P exceeds urethra’s capacity to remain closed
- LMN - disruption of activity of detrusor mm
-
Detrusor mm - how it presents in urge & overflow incontinence
- Urge - overactive detrusor mm
- Overflow - under-active detrusor mm
-
Functional incontinence - 2
- Difficulty reaching toilet in time
- Bladder functions normally, however mind-body connection is disrupted
-
Kegels - initial; later
- Initial - sitting on toilet, stop & hold flow for 5s during urination - INITIAL BC GRAVITY ASSISTED
- Later - supine, sphincter control for 3s & 10 s holds
-
Renal & urethral pain - 4
- Felt in T10 & L1 dermatome
- Aching & dull in nature
- DOESN’T change w/position
- (+) Murphy’s percussion test - PHYSICIAN REFERRAL
-
Metabolic Syndrome (Syndrome X) - 3 or more of following S/S
- Cluster of risk factors INC likelihood of developing heart disease, stroke or type 2 diabetes
- BP - > 135/85
- Blood glucose >100
- Low HDL - men >40; women >50
- Elevated triglycerides
- Ab obesity - men >40”; women >35”
-
Addison's disease
Define
Early signs
Look
What metabolic changes?
- Under secretion of cortisol by adrenal cortex
- Early S/S - Nonspecific weakness & fatigue (asthenia)
- Look - Hyperpigmentation of skin & mucous membranes (JFK was tan)
- Fluid/electrolyte imbalances - INC potassium (hyperkalemia) + DEC sodium (Hyponatrimia)
-
DEC in cortisol (adrenal insufficiency)
Name disease
What metabolic abnormalities - 2
- Addison's
- Inability to regulate potassium (K) + sodium
- Hyperkalemia
- Hyponatremia - DEC sodium in blood
-
Addison’s & PT safety - 4
- Orthostatic hypotension
- INC bone fx
- Osteoporosis
- Tendon rupture
-
Cushing's syndrome - Define + S/S - 11
- Oversecretion of cortisol by adrenal cortex
- Moon face
- Truncal obesity
- Cervical fat pad (“buffalo hump”)
- Muscle wasting/weakness
- Osteoporosis
- HT
- Easy bruising
- Excessive facial hair
- Slow wound healing
-
Tx for Cushing’s syndrome - 2
- Radiation therapy
- Chemotherapy
-
Hypothyroidism - S/S - 7
- Cold intolerance
- Weight gain
- Excessive fatigue/lethargy
- Dry skin, hair, nails
- HA
- Peripheral edema + neuropathy
- Proximal weakness
- INC TSH
-
Hypothyroidism - PT + red flags - 6
- Risk of Rhabdomyolysis
- Exercise intolerance
- Weakness
- Apathy
- Exercise-induced myalgia
- Reduced CO
-
Hyperthyroidism - S/S - 6 (general)
- Exophthalmia
- Heat intolerance & INC sweating
- Weight loss & inability to gain weight - w/INC appetite
- Hypereflexia
- INC BP + INC HR (tachycadia)
- DEC TSH
-
Hyperthyroidism - MSK changes - 4
- Myopathy
- Weakness
- Fatigue
- Atrophy
-
Hyperthyroidism - cardiopulmonary changes - S/S - 7
- INC HR - tachycardia
- INC BP
- INC RR
- Palpitations
- Dysrhythmias
- Dyspnea - breathlessness
- Fatigue
-
Hyperthyroidism - CNS changes - 4
- Tremors
- Hyperkinesias
- Nervousness
- INC DTRs
-
Grave’s Disease - S/S + PT - 4
- Hyperthyroidism
- Goiter
- Avoid cardiac stress - pts have tachycardia
- No hot aquatics - heat intolerance
-
Tx for thyroid diseases
Radioactive iodine
-
Hyperparathyroidism - S/S - 9
- INC PTH = osteoclastic activity - breaks down calcitonin = INC calcium in blood
- Osteopenia/fractures
- Proximal weakness
- Glove/stocking sensory loss
- Arthralgia/myalgia
- Drowsiness
- Confusion/memory loss
- Pancreatitis
- Gout
- Kidney stones
-
Hypoparathyroidism - S/S - 7
- Low levels of calcium in blood = MM cramps/mm twitching (tetany)
- Neck stiffness
- Seizures
- Cardiac arrhythmias
- Paresthesias (tingling finger tips & mouth)
- Renal stones
- Chvostek's sign (twitching of facial mm w/tapping of facial nerve in front of ear)
-
Calcitonin - does what? released by what?
- Assist w/building of bone (osteoblastic activity)
- RELEASED BY THYROID (NOT parathyroid)
-
DM - Type I - describe; result of what?
- Insulin-dependent / Juvenile onset
- Loss of pancreatic beta-cell function + absolute insulin deficiency
-
DM - Type II - describe; result of what?
- Non-insulin-dependent / Adult onset
- Impaired ability of tissues to use insulin (insulin resistance)
-
DM - Complications of DM - 7
- Retinopathy
- Neuropathy
- Nephropathy
- CVD
- PVD
- Atherosclerosis
- Impaired wound healing
-
DM - Foot care program for diabetes - 6
- Wash (do not soak) feet daily in warm water
- After wash - petroleum jelly/lotion - NOT between toes
- Cut toenails straight across by a podiatrist
- Wear clean, white socks w/minimal wrinkles
- Wide jogging or walking shoes
- Use different shoes or alternate shoes each day
-
DM - hypo vs hyperglycemia - blood glucose #
- Hypoglycemia <70
- Hyperglycemia >180-200
-
DM - S/S of hypoglycemia - 8
- Profuse Sweating
- Shaking
- Disoriented
- Faint
- Unresponsive
- Seizures
- Poor coordination/unsteady gait
- Trouble concentrating
-
DM - S/S of Hyperglycemia - 6
- Polyuria - frequent but scan urination
- Urine - bright yellow & "sweet" smelling
- Fruity breath odor
- Shakiness
- Skin is dry
- Unusual thirst (polydipsia)
- Italics = early signs
-
DM - Ketoacidosis - 6
- Occurs w/Type 1 only - ketone bodies in blood for energy source; broken down into acid
- Fruity breath odor
- Dry mouth
- Nausea
- Vomiting
- Confusion
- Eventual loss of consciousness
- MEDICAL EMERGENCY
-
DM - Hypoglycemia - PT response - pt awake/pt unresponsive
- Pt awake - Provide sugar - juice, candy, etc.
- Pt unresponsive - Seek immediate medical tx - glucagon injection or intravenous glucose
-
DM - At what blood glucose level should PT give carb snack & retest pt after 15 minutes? How much carbs & when?
- Blood glucose level = 70
- 15g initially
- 15g for every hr of intense activity
-
DM - Exercise produces what in a diabetic? How?
- Lowers blood glucose
- By accelerating movement of glucose out of blood & into peripheral tissues
-
DM - Combination of insulin & exercise can result in what?
Hypoglycemia
-
DM - Best time to exercise
- 1 hour after a meal (bc glucose will be INC so less chance of hypoglycemia)
- INC complex carbs at least 24 hrs before & after exercise
-
DM - Insulin injections - where? do not exercise injected part when? DEC insulin dose by how much before exercise?
- Insulin lowers glucose quickly
- Inject into Non-exercising limb or body part
- At least 1 hour following injection – closer to 2-4 hrs
- DEC insulin dose by 30-35% before exercise
-
DM - NO exercise when? - 3
- Blood glucose is 250 w/evidence of urinary ketones
- Blood glucose is at or near 300 with/without urinary ketones
- Do not exercise during peak insulin times - 2-4 hrs after injection
-
DM - Hyper vs Hypo & exercise
- Hyperglycemic - Exercise (lowers blood sugar)
- Hypoglycemic - DO NOT exercise
-
DM - Exercise complications - retinopathy - 2
- Avoid activities that dramatically INC BP (>170 SBP)
- Avoid pounding or jarring activities
-
DM - Exercise complications - neuropathy - 1
Limit WB exercises w/significant neuropathy - INC falls risk
-
DM - Exercise complications - nephropathy - 1
Limit exercise to low-mod intensities
-
DM - athletes w/diabetes - what do carbs do? how to counteract affects of hypoglycemia from exercise (2)
- Carbs INC glucose
- INC carb intake before or after exercise
- DEC insulin
-
DM - hypoglycemia results from what?
Too much insulin
-
DM - Brittle aka Labile Diabetes
- Type 1
- Large swings in blood sugar
-
DM – other conditions associated w/it - 1
Adhesive capsulitis
-
Lyme's disease - location of symptoms MSK?
- Acute -
- Chronic - intermittent arthritis w/marked pain + swelling in LARGE jts
-
Urinary tract infections - S/S - 4
Major sign?
- Lethragic
- Nausea
- Painful urination
- Fever
-
Renal Calculi - Kidney stones - S/S
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