Procedures II Exam II

  1. Postpartum depression
    • 8-15% of delievering women
    • etiology and pathogenesis unknown
    • risk factors: history of major depression, PMS, abuse, low socioeconomic status, unplanned pregnancy, lifestyle stress, perinatal loss
    • 50% reoccurrence rate
  2. S/S begin 2-12 mo. post delivery and last 3-14 mo.
    Must have 5
    • Depressive mood most of time
    • diminished interest in normal or pleasurable activities
    • significant involuntart change in wt.
    • insomnia or hypersomnia
    • psychomotor agitation
    • fatigue or loss of energy
    • feelings of worthlessness or guilt
    • diminished ability to think or concentrate
    • recurrent thoughts of death
  3. Female Sexuality Includes
    • self esteem, personality
    • gender roles, relationships
    • body image and female sexual identity
    • *wt. ~excessive thinness, restrictive closths, poor footware
    • *surgeries
    • sexual orientation, sexual behavior
    • * non judgmental, objective, medical communication of the issues affecting PT
    • *same sex family and medical decisions
    • values, attitudes- social, cultural, political, spiritual
  4. Domestic Violence/Partner Abuse
    • 6-25% of pregnant women report physical or sexual abuse during pregnancy
    • Risk factors:
    • *women 17-28
    • *women- single, separated, divorced or planning separation/divorce
    • *women with h/o abuse as child or witnessed abuse as child
    • *women who use ETOH and/or drugs or partners who do so
    • *women whose partners are possessive/jealous
  5. Domestic Violece Effects on PT
    • Missed appointments
    • *cancelled by partner
    • *no transportation, child care
    • *no access to phone to call and cancel
    • *limited money for rx
    • "Therapist hopping"
    • Non compliant w/ rx
    • *unable to obtain/take medications, braces
    • *too tired or stressed to exercise
    • Partner attends PT sessions and speaks for pt
    • Partner attempts to influence PT
    • *intimidating, harassing (rude)
    • *praise PT and portraying himself as good provider
  6. Domestic Violence Screen
    • All women should be asked
    • direct questions about injuries
    • indirect questions about stress
    • assess urgency and danger in current situation
  7. Domestic Violence S/S
    • trunk injuries-throat, chest, abdomen, face
    • sprial fractures
    • injuries in various stages of recovery
    • cigarette burns, teeth marks, etc
    • somatization of pain and hypersensitivity to touch
  8. What to do and not to do
    • DO:
    • mandatory reporting- PT not mandatory reporters unless children present and witnessing the violence; stab wounds, gun shot wounds, or other serious injury
    • know local resources
    • have shelter material in women's bathroom
    • document in objective manner
    • have clear, functional goals and refer if no progress is made
    • NOT TO DO:
    • do not act too quickly- w/out communicating fully w/ pt
    • do not share personal experiences, speak in broad terms using establised stats when able
    • do not hug/touch pt w/out asking first bc may increase discomfort
    • do not approach the partner
  9. Adolescent pregnancy
    • 50% teen pregnancy results in live birth (34% abortion, 14% miscarriage)
    • Higher risks for mom and baby:
    • *higher rates of PTL and bleeding
    • *lower birth weights
    • *more physical abuse
    • *lower maternal wt. gain
    • *more smoking, drugs, ETOH use
    • *more postpartum depression
  10. Female athlete triad
    • 1. osteoporosis
    • 2. amenorrhea
    • 3. disordered eating
    • Common Pattern:
    • negative energy balance
    • external and internal pressure leads to disordered eating
    • often lean body fat <12%
    • decreads estrogen occurs
    • leading to amenorrhea and eventually osteoporosis
    • further resulting in - increased illness, increased injury, longer recovery times, decreased performance
  11. Common impairments associated w/ breast cancer rx
    • decreased should ROM
    • fatigue- chemotherapy
    • fibrosis of the tissue in the anterior chest wall- radiation
    • neural disorder-numbness, neuralgia, nerce entrapment
    • lymphedema
    • psychological effects/ body image
  12. Physiological changes during pregnancy
    • increased O2 consumption and tidal volume
    • increased efficiency to absorb O2
    • rib flare- AP and lateral direction
    • SOB
    • increased blood volume (plasma and RBC)
    • increased cardiac output (SV and resting HR)
    • decreased diastolic pressure
    • venous insufficiency
    • constipation, hemorrhoids
    • decreased peristalsis and esophageal sphincter response--> reflux
    • increased blind spot
    • change in senses
    • sagging pelvic floor and decreased bladder capacity
    • ligaments and tendons loosen
    • mm cramps
    • skin and nail changes
    • hair loss after birth
    • increased sweat production
  13. Preterm labor__ Incompetent cervix__
    Placenta previa__ Premature rupture membranes__
    Pre eclampsia__ Supine hypotension__
    Post partum depression__

    • E.
    • G
    • F
    • C
    • A
    • B
    • E
  14. Postural changes during pregnancy
    • forward shift in COG
    • starting in 2nd tri have changes in balance and postural equilibrium
    • rounded shoulders
    • Upper Xed
    • increased thoracic kyphosis and lumbar lordosis
    • anterior pelvic tilt
    • wider BOS, increased hip ER
    • recurvatum in knees
    • flattened arches of feet
  15. Predictors of LBP during pregnancy
    • previous LBP- pregnant, non, menstrual
    • low socioeconomic class
    • weak evidence: greater parity, fetal wt.
  16. Exercise recommendatoins
    • OLD: HR < 140 and temp <100
    • non- wt. bearing exercises minimize risk of injury
    • avoid supine position after 1st tri or keep < 5min
    • talk test and RPE
    • caution in hot and huid environment
    • 3x/wk for 30 min.
    • good calorie intake (extra 300kcal)
    • same guidelines for post partum 4-6wks
  17. Effects of exercise and normal pregnancy
    • placenta is larger and more efficient
    • immersion exercises eliminates problems w/ placental blood flow, elevated core temp, and possible physical discomfort
    • fetal HR increased 25-35 bpm w/ increased ex. intensity
    • fetal HR drop w/ supine ex.
    • babies may be 11 - 14 oz lighter
  18. ____first time mom
    ____more than on baby at home
    ____length of pregnancy- 280 days, 38-42 wks, 10 lunar months
    ____due date, full term if 2 wks before or after
    ____number of live births
    ____number of pregnancies regardless of outcome
    • Primigravida (primip): first time mom
    • Multigravida (multip): more than on baby at home
    • Gestation: length of pregnancy- 280 days, 38-42 wks, 10 lunar months
    • Expected date of confinement (EDC): due date, full term if 2 wks before or after
    • Parity: number of live births
    • Gravity: number of pregnancies regardless of outcome
  19. Diastasis Recti
    • More than 2 fingers is significant
    • 1st tri- 0
    • 2nd tri- 4 (27%)
    • 3rd tri- 10 (66%)
    • immediate post- 8 (53%)
    • 5 to 7 mo. post- 4 (36%)

    No DR in women who exercised previous to pregnancy
  20. stress urinary incontinence (SUI)__
    urge urinary incontinence (UUI)___
    mixed UI___ overflow incontinence___
    functional incontinence___
    underactive PFM___
    Overactive PFM___

    • G.
    • F
    • D
    • G
    • A
    • B
    • E
  21. Risk factors for urinary or fecal incontinence
    • vaginal delivery: forceps, abnormal presentation, prolonged active 2nd stage, birth wt. >8#, weaker collagen, 3rd degree tear
    • chronic increased intra ab pressure: obesity, chronic cough, asthma, smoking, repetitive lifting, chronic constipation
    • surgery: repair of anal fissure, hemorrhoidectomy, prolapse
  22. Hysterectomies
    • total abdominal hysterectomy: uterus and cervix removed
    • radical hysterectomy: remove uterus, cervix, cardinal ligament, upper vagina, lymph nodes
    • total vaginal: remove uterus and cervix through incision in vagina
    • supracervical: only remove uterus
    • salpingo-oophorectomy: remove fallopian tubes and ovaries
  23. Irritable bowel syndrome__ Painful BS___
    Endometriosis___ BPH___
    Coccygodynia___ Overactive PFM___
    UTI___ Vulvodynia___ Pudendal neuralgia__

    • H.
    • I
    • H
    • A
    • D
    • E
    • B
    • F
    • G
  24. Bladder anatomy
    • Detrusor: middle layer of bladder and responsible for emptying smooth muscle
    • Trigone: specialized area of the detrusor, ureters to internal sphincter
    • Bladder neck: base of bladder, internal sphincter smooth muscle
  25. Info on bladder
    • reservoir stores 400-600 ml urine, 13-20 oz
    • 1st void sensation approx. 1/2 full
    • no more than 67 oz or 2 liters
  26. Neurological Pathways
    • Somatic: pudendal n. and n. to levator ani; S2-4; sensory and motor to PFM
    • Sympathetic: hypogastric n.; T11-L2; bladder relax sphincter contract
    • Parasympathetic: plevic n.; S2-4; bladder contract sphinter relax
Card Set
Procedures II Exam II