NPTE July 2019 - Set 2

hematocrit values

0.388 - 0.464 (38.8-46.4% SI) for males 0.354 - 0.444 (35.5-44.4% SI) for females

neutrophils values

0.40 - 0.70 40-70% SI

Revised RPE scale

0= nothing 0.5= very, very weak 1=very weak 2=weak 3=moderate 4=somewhat strong 5=strong 7=very strong 10=very, very strong

most common method for emasuring is

circumferential

antimetabolite agents

imapir biosynthesis of geneti materal and interrup thte cellualr athsways tha sytnehs dna and tna careat an impostro to the endogenous metao within the body to form a nonfucntion gnenti producft that s incapable of repdicution radpily divind neoplastic cells stops normal metablism celsl cannot replcaitioe leustatin (cladribine), adrucil (fluororuracil), fludara (fludarabine), texall (methotrexate)

TBI with rango level VII what should the therapist focus on

involve the pt in decision making a monitor for safety trying to stop being so "robot like" bc of highly structured training from earlier stages

brachial

medial to the biceps tendon and lateral to the medial epiondyle of the humerus

upper GI

mouth - initation of mechanical and chemical digestion esophagus - transpot food form the mouth to the stomahc stomach = grincding oof foot secterion og hydrhcolic acid and other exocrine fuunciton section o f horoens taht relaes difestive enyme from the live pancrea sns gall bladder to assit with digestion

sleep apnea

potentially lethal disorder in which breathing stops for 10 seconds or more many time at night it is associated with obesity and anatomical obstruction

turgor

realtivel speed with which the skin reusmes its normal appearnce after being lightlky pinched turgor is an indcator of skin elsaticity and hydration and normally occurs more slowly in older adults

QL function

stabilizer and an extensor of the lumbar spine hip hike

edema and wound healing

some degree of edema is considered a nromal apart of the body inflamm response to a wound however, increase tissue PRESSURE from excessive edema, such as with VENOUS INSUFFICIENY or LYMPHEDEMA can negatively impact both tissue perfusion and the removal of cellular waste this alteration in hemodynamtics decreases the avail of oxygen and nutrients thus delaying healing and increasing risk of infection

oxytocin

target uterus and mammary gladns increases contraction of uterine msucles promotes release of milk from mammary glands nerve impulses from hypothalamus regulates this plus stretching of the cervix and nipple stimulation

parathormone

targets bone kidney intentinal mucosa increases blood calcium hypocalcemia regualtes

thyroid stim hormone

targets tyhroid incraeasse synthesis of T3 and T4 hypothalmus regualtes

subcutaneous wound

extend through integumentary tissues and involve deeper structures such as subcutaneous fat, muscle, tendon or bone typically heal throgh secondary intention

full thickness wound

extends THROUGH the dermis into deep structures such as subcutaneous fat wounds deep that 4mm are typically considered full thickness and heal by secondary intentin

partial thickness wound

extends trhough the epidermis and possible into, but not through, the dermis examples include abraisions, blisters, and skin tears a patrial thickness would will typically heal by re-eiptheliazation or epidermal resurfaciing depending on the depth of the injury

hand and wrist burn

extension or hyperextension of the MCP joint deformity, flexion of the IP joints, adduction and flexion of the thumb, flexion of the wrist wrist splint, thumb spica splint, palmar or dorsal extension splint

tachypnea

faster than 20 breaths per minute

vomtinign

forcible expulsion of the conwetnts of the stomach throgh the mouth

cushings syndrome

form of adrenal dsfucntion that presens with hyperfunciton alllows for excess cortisol production when the pitutaty rodice secessive adrenocorticothropic hormone ACTH with subeqnrt hpertcotosokl is it stermed cushing syndrom sx evolve over yerah and can binclude persistant hyperglucermia growth failure truncal bestiy purpse abdomianl straite moon chasped face buffalo hump at nase of neck weaness acne hypertension male hyunecostma mental changes can inlcude depression poror ocnentration and memory loss tx pharma radiation chemo or surgeyr

key functons of the metabolic system

governs the chemical and phsica changes that tak ephlace within the body enabling it to frow an function brownd of the body complex organic omcoiunds in order to genreate energy fo rall bodily process also generates enrgy for the synthesis of complex sbatnce tha form tissue and organs duringmetabolism organicomonds are brpken down by catbolism while anabolism is the proces ath combines simpke moecures for tissue froqwth many entablare fiacliltesby enzymes the overal sped at which can orangizm carreis out its metabolic processes is termed its metaboli rate or when at rest is basll rmetaboloi rate a

urinary catheters considerations

tubes should be placed below the region being drained since the devices rely on gravity the collection bag should not be raised above the level of the bladder for any sustained period avoid disrupting, stretching, disconnecting or occluding the tube during exercise

L4 dermatome goes all the way from

the medial malleolus to the greater trochanter causes weak quads

high triglycerides is what

>150

four parameters of respiration

rate (# per min) rhythm (regularity) depth (volume) character (effort and sound)

Best source to obtain culture sample from a wound

Exudate in the wound Want minimum contamination by material from adjacent tissues because margins are usually contaminated with environmental bacteria

obstruction classification by %

>100% normal 70-100% mild 60-70% moderate 50 to 60% moderate to severe <50% severe obstruction

1MHz penetrates how deep

>2cm

balloon valvuloplasty

surgical procedure that uses cardiac catheterization to treat stenostic heart valves a balloon tipped catheter is threaded through the veins to the faulty heart valve, then inflated to open the narrowed valve and increase blood flow

lingula left upper lobe drainage

PT on opposite side pt is turned 1.4 from supine on the right side with the foot of the bed elevated 12 inches percussion and vib are performed over the left chest between the axilla and the left nipple

mild hypoxemia

PaO2 60-79 mmHg

severe hypoxemia

PaO2 < 40 mmHg

TOS

Proximal pain (supraclavicular and shoulder) Distal neuro sx

expected outcomes of pulmonary rehab

increase exercise tolerance increase peak oxygen uptake increase endurance time during submax testing increase functional walking distance increase muscle strength and endurance reduce exertional dyspnea improve ability to perform activities of daily living improve health-related quality of life reduce anxiety and depression

medial patellofemoral ligament

injured during a lateral patellar dislocation i.e. when there is a powerful contraction of the quad in combo with sudden flexion and ER of the tibia on the femur (or IR of the femur)

anal triangle

internal analy sphincter, exernal nanly sphinter

signs of myocardial ischemia and infarction

ST segment depression ST segment elevation Q wave T wave inversion

What is prevented with a gradual and prolonged cool down in person in cardiac rehab for heart failure

Venous pooling Because when exercising there is vasodilation and the return to normal arterial dilation is delayed in patients with heart failure

incisional wound

acute wound most often associtaed with surgery and is created intenstionally by means of a sharp object such as a scallpel or scissors

phalens test

carpal tunnel

to improve end range GH flexion what mobilization would you use

anterior glide bc helps with ER

colace (docusate sodium)

anticonstipation can result in mild abdominal cramps and nausea

sprained ankle 4 days ago, 4/10 pain and mod swelling that is getting worse, what should you do

cold/intermittent compression COMBINED with limb elevation rest is required in this case

internal carotid stroke

combines the middle cerebral and anterior cerebral artery strokes

what combo of special tests should you use for good diagnostic utility for ruling in meniscal tear (high specificity and positive liklihood ratio values)

combo of a positive thessaly or mcmurray test along with palpable joint line tenderness

hypertensive crisis

greater than 180 systolic or greater than 120 diastolic

mild cog impiarment

haing lwoe thae epecte ognit perfoamc ehwen compare ot toehr sin the age gorupp gernaly does not interer withfcitie of daily living does not infer taht an indiaul will progess thoeead evleping demntia

depth of respiration

characterized as deeper or shallower than normal tidal volume

trachea deviated to the right what can cause this

left penumothorax (air) or left pleural effusion (fluid) in the pleural space would push the contents of the left hemithorax including the trachea to the right left hemothorax aka trachea will deviate AWAY from the increase in volume

allen test

identify appropriate blood flow of radial and ulnar arteries

neers test is for

impingement

what would tight hip abductors look like during gait

maintained lateral lean during all phases of gait rare

silver nitrate and nitrofurazone attack organisms where

on the surface superficial agents silver - antiseptic nitro - antimicrobial

original vs revised RPE (BORG) scale

original = 6 to 20 revised = 0 to 10

hypothalamus

part of endocrine system part of dienpcephalon located below thalamus and cerebral meiphere hypothalmus connects to the pitutaty flans dthrogh tht einfudibular or pitatry stalk REGULARTION OF THE AUTONOMIC NERVOUS SYSTEM (body temproarey, appereie swrati sthirs sex rage era bp sleep ) THOUGH ITS IMPACT ON THE PITUITARY GLANDS

best exercise for osteoporosis and type 1 diabetic

partial squats (extensor stabilization exercises, i.e. holding onto something) to stimulate bone with decreased risk of muscle strain or injury would do this OVER aquatic bc doesnt stimulate the bone as much

procedure for claudication test

patient walkks on a flat track at maximum speed or on a treadmill at 2.0 mph at a constant grade between 0-12%

nasogastric tube NG tube considerations

patient will not be able to eat food or drink fluids by mouth while the nasogastric tube is in place enteral feedings can be disconnected temporarily for mobility exercise requiring movements of the head and neck should be avoided, esp forward bending

pituitary dysfunction

pitutray tumor i.e. adenomas like polyps ischemic necrosis or infarction infiltative disorders (hemochromatosis aka absorb too much iron) inflammator process i.e. meningitis iatrogenic caused by medical (irradiation aka radiation)

unstageable pressure injury

obscured full thickness skin and tissue loss full thickness skin and tissue loss in which the extent of tissue damge within the ulcer cannot be confirmed because it is obscured by slough or eschar if slough or aschar is removed a stage 3 or 4 will be revvelaed stable eschar (i.e. dry adherent and intact without erythema) on the heel or ischemic limb should not be softened or removed

BERG does not look at

turning while walking it is a test of static and dynamic balance in sitting and standing NOT GAIT

seropurulent

presents as cloudy or opaque with a yellow or tan color and a thin watery consistency may be an EARLY WARNING SIGN of an impending infection and is ALWAYS ABNORMAL

peptide hormones

ie insulin insulin is a hormone secreted by the beat cells of the islets of langehands within the panceas insulin i srelaesd when there is an elevation in the level of tblood glucose insulin procies an increase in cellular uptakke of glucose for metabolism insuline laso stimualtes the skeletal msucles and liver to store the gluceo and increases amino acid transport across heptait muclea dn adipse tissues insulein realesa effeces all systems of the body with its primary goal of reducing blood lgucoes levesl

preclude

prevent from happening; make impossible

amenergic

serotonin dopeamine norepinephrine

hiatal hernia

sharp and localizes to the lower esophagus/upper stomach area

sinus bradycardia

<60 bpm

friable

tissue that readily tears framents or bleeds when gently palpated or manipualted

CN XII test

to stick out the tongue Look for deviation, muscle wasting or fasciculations Articulation problems (dysarthria) can occur from lesion to this nerve

Risk factor for secondary lymphedema

Filariasis Mosquito borne illness that is prevalent in tropical and subtropical climates Not symmetrical swelling

kehrs sign

*Kehr's sign in the left shoulder is considered a classical symptom of a ruptured spleen.*

actual arterial oxygen saturation is +/- what %

+/- 4% of spo2

eosinophils values

0.00 - 0.02 0-2% SI

monocytes values

0.04 - 0.08 4-8% SI

normal infant HR

100-130

10 year old RR

15-20 breaths per min

normal blood volume

4.5-5 L

aspirin aka

Acetylsalicylic acid ASA

Hematopoietic tissues

Bone marrow Plasma cells Leukemia Myelodyplasia Myeloproliferstivr syndromes mutkipen myeloma

PEP flutter device

By breathing out with a moderate force through a resistance, a positive pressure is generated in the airways, helping to keep them open. This positive pressure allows airflow to get beneath the areas of mucus obstruction and move the mucus toward the larger airways, where it can be coughed out. Positive expiratory pressure therapy can also help deliver medication deeper into the lungs when done with nebulized bronchodilator therapy.

erbs palsy

C5-C6 (waiters tip) involving suprascap, msc and axillary C5-C7 is "extended" erbs and includes loss of elbow and finger extension vs klumpkes

Gag reflex is for

CN IX 9 glossopharyngeal X 10 vagus

Shopping cart sign

Central spinal stenosis Flexion helps that's why

Most common injuries nerve

Median then radial then ulnar with displacement of the elbow Refracture is less common Neuro Exam should focus on brachial artery as well as median and radial nerve

History of 2 MIs and one episode of CHF, also claudication pain what is the best initial exercise intervention

Daily walking, using interval training for 10 to 15 min periods This pt needs low intensity (walking), low to mod duration (10 to 15 min) and higher frequencies (daily) Interval or discontinuous training

1st CMC convex in what plane

Dorsal/palmar

Pressure relief in sitting for SCI in w/c

Every 15-20 min

fortin finger test

Have the patient use one finger to localize their pain. A positive test is when the patient twice identifies the painful region as within 1 cm of inferomedial to the PSIS.

biot's

Irregular breathing; breaths vary in depth and rate with periods of apnea; often associated with increased intracranial pressure or damage to the medulla

lymphedema manual drainage

PROXIMAL to distal

Who decision is it to pick out a dressing for a wound

Physician in collaboration with the wound care team

Congestive heart failure what color are they

Slightly blue Slate colored discoloration Along with clubbing nails Cause of chronic heart failure

mnemonic for carpal bones

Some Lovers Try Positions That They Can't Handle Scaphoid Lunate Triquetrum Pisiform Trapezium Trapezoid Capitate Hamate Lateral to medial

Limited tibial advancement means what and is associated with what gait compensation

Spasticity of the plantar flexors and circumduction

Thomas heel

Supports the longitudinal arch and prevents pes valgus

What RC muscle prevents sublux

Supraspinatus However shoulder alignment problems can also influence subluxation ie a downwardly rotates scapula, relative abduction, and IR of the humerus

best outcome meausure to evaluate gait strength and balance in an older person with hx of falls

TUG

Post polio syndrome what is the best INITAL intervention

Therapeutic aquatics 3 days per week for 20 min Warm water can ease muscle and joint pain and bouyancy can aid fatigued limbs Up to 20 min initially in 2 to 4 min intervals If weakness or sx are recent do no more then 15 min

Scaphoid pad

Used to support the longitudinal arch and prevent pes valgus

Clench teeth and hold against resistance what CN

V 5 trigeminal Chewing muscles

Lymphoid tissues

Wherever lymph tissue is present rhougout the body lymph nodes spleen can appear in stomach intestine skin cns bone and tonsils Lymphoma

hep B is transmitted through

blood, body fluids, body tissues not airborne

ileostomy

creation o an oeping form the ilemum thorugh the abdomainal wall

Syndesmosis Injury

high ankle sprain

cystic fibrosis GOLD

inherited disease that affects the ion transport if exocrine glands resulting in impairment of the hepatic, digestive, respiratory, and reproductive systems the disease causes the exocrine glands to overproduce thick mucus (that causes subsequent obstruction), overproduce normal secretions or overproduce sodium and chloride respiratory and GI systems are usually the most involved in the disease process there is an underlying impermeability of epithelial cells to chloride that results in viscosity of mucous gland sectrions within the lungs, sweat glands, pancrease and intestines CF creates an elevation of sodium chloride and pancreatic enzyme insufficiency autosomal recessive genetic disorder (both parents are carriers of the defective gene) and islocated on the long arm of the chromose 7 creates an abnormality in the CF transmembrane conductace regulator CFTR protein CFTR is normally involved with the process that ALLOWS chloride to pass through the palsma membrane of epithelial cells it is estimated the 5% of the population carry a recessive gene for CF presentation = more common LETHAL disorder affecting caucasian children in the US incidence is estimated at 1:2,500 births for caucasians compared to 1:17,000 for AA can be diagnosed shortly after birth, however, it is sometimes not diagnosed for years the most consistent sx is the finding of high concentrations of sodium and cholride in the sweat patients will notice a salty taste when kissing their child other sx = pulmonary, GI, digestive (liver intenstinal pancreatic), genitourinary, and MSK impairements early sx = PERSISTENT COUGH, SALTY SKIN, SPUTUM PRODUCTION, WHEEZING, POOR WEIGHT GAIN, AND RECURRENT INFECTIONS neonates meconium can be tested as a screening tool for albumin the quantitative pilocarpine iontophoresis sweat test is the SOLE diagnostic tool in determining the presence of CF sodium and chloride amounts >60 mEq/I (standard is 40) is a positive diagnosis for CF the sweat test should be performed twice to ensure accuracy may have had a previous dx of failure to thrive and family history CLUBBING OF DIGITS common complication of CF is an exacerbation of OBSTRUCTIVE pulmonary disease decreased forced expiratory volume FEV1 decreased forced vital capacity FVC functional residual capacity FRC and residual volume RV become INCREASED hypoxemia and hypercapnia develop due to the alteration in perfusion chronic pulmonary infections and poor absorption often lead to barrel chest, pectus carinatum (buldging of chest), and kyphosis deformities approx 90% of patients have pancreatic enzyme deficiency, degeneration, and eventual progressive fibrosis of the pancreas this process inferferes with digestion and absorption of nutrients airway obstruction can cause pulmonary hypertension, atelectasis, pneumonia and lung abscess severe complications can include cirrhosis, diabetes, pneumothorax, cardiac pathology, pancreatitis, cor pulmonale, and intenstinal obstruction management = focus on QOL, provided emotional and psychosocial support, and controlling sx NUTRITIONAL SUPPORT NECESSARY pharma to treat infections, thin mucus, replace pancreatic enzymes, reduce inflam and assist with breathing psych counseling often indicated gene therapy is experimental and attempts to correct the defect in CF cells PT is ESSENTIAL for management of the disease chest PT should be performed SEVERAL times a day and includes postural drainage, percussion, vib, breathing and assistive cough, ventilatory muscle training posture training, mobilization of the thorax, and breathing exercises must be incorporated into the overall program pt may also use autogenic drainage, PEP or flutter with indepdedent postural drainage mechanical percussors may be used to ease the time and energy spent on manual percussion physical conditioning including exercise and endurance training are indicated expect with severe lung disease I/M PT throughout life and can improve pulmonary function, increased max work capacity and improve musucs expectoration and increase self esteme CF is a TERMINAL disease however the median age of death has increased to 35 years of age due to early detection and comprehensive management most common cause of death is respiratory failure a child that initially presents with GI symtpoms generlaly has a good clinical course whereas a child that intially presents with resp sx are more likely to deterioreatae at a faster rate, males generally have a better prognosis than females no other ersp disease similar to the etiology of CF HOWEVER COPD has similar lung characteristics COPD is characterized by altered pulmonary fnction tests, difficulty with expiration, cough and sputum production and physical damage to specific portions of the lungs chst PT and pharma are indicated for moderate to advanced COPD

nevi

moles

restrictive vs obstructive

r - cannot fill lungs o - cannot expel air (trapped)

jauncie

skin an dyes turn yelllwo bc inf icnraes ebilriubn in blood

endosonorraphy

visualize the GI oragnis su to the high freq sound waves

who requires more tx for scoliosis

females bc onset is 2 years before males

myofascial pain syndrome s/s vs fibromyalia

few localized trigger points with referred patterns of pain during palpation multiple generalized local tender points in muscle without referred patterns of pain, chronic fatigue, decreased exercise tolerance and HA, IBS and sleep disturbance

side effects of diuretic

orthostatic hypotension and dizziness along with drowsiness, lethargy and weakness

prone with pillow under hips helps to drain what

posterior basal segments

kussmaul's

deep and fast breathing; often associated with metabolic acidosis

durable poweere of attorny

lega dpcuem whci apt authroa another per so to makethei rhealth care decsion when the pt ican no logner amrhtie rown

ratio of GH to ST motion

2:1 100 GH 50 ST

endocrine vs exocrine

endo - blood exo - ducts

when are perturbations contraindicated

in patients with poor postural stability and pronounced ataxia

ovaries refers to

low back

carotid

medial aspect of the SCM in the lower half of the neck

myomettium

msuclarular outlaer of the uterus

0 pulse

no pulse

muscle test for middle deltoid

shoulder abducted to 90 degrees

moisture barriers

(i.e. ointment) designed to adhere to the skin and repel excess moisture from protected areas frequently used to protect surrounding skin from a heavily draining wound or perineal tissues from exposure to incontinence like baby ointment

stages f kidney disease accoridng to the national kindye foundaton

1 - kidney damage with normal GFR (90 or greatr) 2 - mild dcraese in GFR (60 to 89) 3 - moderate decrease in GFR (30 - 59) 4 - severe reduciotn in GFR (15-29) 5 - kidney failure (GFR less than 150

What degree of HS ROM do sci patients need and why

110 and because it allows for function in the long sitting position (ie dressing, leg management during transfers) Don't want to stretch in long sitting bc will over stretch back extensors

1 year old RR

25-35 breaths per min

ANOVA for how many comparisions

3 or more

frequency for aerobic

3-5 times a week

FIM

7 level scale of functional performance and includes 18 items on self-care, sphincter control, transfers, locomotion, communication, and social cognition

what happens to BP during and after exercise with isometrics and weight lifting

BP rises during and then falls BELOW resting levels after exercise ceases normal hemodynamic response to exercise

TMJ convex/concave

Convex on concave for first 20 degrees Concave on convex for rest of mouth opening

Old man with early stage ALS and mild Alzheimer's what is the factor that is most likely to complicate patient management

Memory impairment Problems with airway clearance, ADLs, and limited patient mobility are not characteristics of the early stage of ALS or mild AD

a lesion that affects all muscles on the left side of the face is consistent with

a LMN or peripheral nerve lesion such as bells palsy or traum to the left facial nerve

sinus arrhythmia

a sinus rhythm but with quickening and slowing of impulse formation in the SA node resulting in a slight beat-to-beat variation of the rate

bipolar

altnerating perids of depression and mania fmales at greater risk typcaly being in pts 20s

thymus

an organ located poseterio to the sternum and anteiror to the heart htat produces T cells and T lymphocyes to help combat infection

pain and temp carried thorugh

anteriolateral spinothalamic

common referral site for hip joint

anterior knee region

OA symmetrical or asymmetrical

asymmetrical Large weight bearing joints

rectocele

buldign of the antiero wall of the recti into th vafina sconary to eaken of the vlv suporting stucures

cystocele

buldign of thebladder intot he vagina

age erlaed NM and ebrosu system chagnes

decreea brain volune wiht incraes ventircular ixe decreaferoaera nfang acnditon vveli sedcarciton speed

what does nitroglyercin put an elderly person at risk for

dizziness or weakness due to postural hypotension fall risk increases

Acidemia

elevated acidity of blood (pH < 7.35)

hematoma vs tumor/bone

fluid vs solid

extrapyramidal signs

involuntary movements

perstatlis

invovlutary contaction oand lreavtion of the msucles of the intensetine which progpel food

left lower quadrant

perforated colon ileitis sigmoid divertituclis kidney stone uretral stone intenstinal obstruction (all my problems are on the LEFT)

severe heartburn meds

proton pump inhibitor PPI prilosec, nexium, prevacid

fucntional intoncenc eand at risk poplations

restricted mobilit or decterity enironeatal barried (stairs, lack ofharndail narrow dorroways not bg enough for AD) mental and psych diatbilty may not reali ethey have to omay be rconfus abot bathroom lcoaiton ohrama may take meds athat affect awrae smodbitly and decity

gallbladder

stores and releases bile into the duodenum to assist with digestion

laproscopy

surgical siganostic prodeuce usilzi fiber optic insturmpen inserted throgh the abdominal wall to view organ s

froments sign is for

ulnar nerve dysfunction

unsteady, uneven gait with veering to one side

unilateral peripheral vestibular deficiency beers to the side with the dysfunction

Intensity of 1.5 helps with what

Allows area to be treated in a reasonable time frame Increases rate of heating .5 would be very slow

What is incentive spirometry?

An incentive spirometer is a device used to help you keep your lungs healthy after surgery or when you have a lung illness, such as pneumonia. Using the incentive spirometer teaches you how to take slow deep breaths.

anal fistula

An infected tunnel between the skin and the anus.

Posterior glide is the same as

Anterior to posterior glide

Pool therapy makes what harder

Breathing w full chest immersion

Exaggerated extension synergy during gait looks like...

Extension, addiction and IR (scissoring pattern)

Diagnostic tools

Family history Physical exam Radiography Cat scan one can Stollguaiac Pap smear blood test Biopsy mammography endoscopy isotope qq

Cam or pincer deformity is associated with

Femoroacetabular impingement <20 degrees IR

Dupuytren's contracture

Flexion contractures of the fourth and fifth digits of the hand, MP, and PIP joints

chronotropic incompetence

Inability of the heart rate to increase with stress

What would a drop in BP during exercise indicate in a patient who does not take medications

Inability to maintain cardiac output at that intensity of exercise

vitmain E antioxiadn toin cell mmebrane is esp impir tin tegeri f that that ar eceom exposru to high levels of eygen such as the lunga ge RBCs bebregtab odk wehaler germ nuts and fihs sx berasdwn of RBCs this ralgei in adults toxixity decrea thryooid hormone levels n icnreaes triglcerids

..

HEP after hospital

Continue in hospital program until home care PT can make their assessment and PoC

most valid assessment of HR

60 seconds

normal adult

60 to 100

Kyphosis what muscle is stretched and should be strengthened

Lower trap

Calcaneal abduction and adduction

Medial tilt and lateral tilt Valgus and VARUS

Small intestine pain

Midabdominal (umbillicus area) Referred to back if intense

Is exertional dyspnea a early sign of right ventricular failure

No it is a result of deconditioning after a period of time with RVF

respiratory rhythm

Normal - Inspiration is half as long as expiration. I:E is 1:2 COPD - I:E ratio reflects longer exp phase; 1:3 or 1:4

calcific supraspinatus tendinitis

Often asymptomatic and found by accident on imaging If it is symptomatic, it behaves like impingement syndrome

rehab considerations for pt wth diverticualr diase a

PA assist in bowel function and is extremly impratn durin periods of remission breathing will assist in stress reucton and with breath holdin paatterns avod any increase in itnrabaomdinal prssure with exreise oracviity back pain andor referredhip pain must be exmained for pssible medical idasea

pronator teres syndrome test

Patient is sitting, elbow flexed to 90° and supported/stabilized. RESIST: forearm pronation and elbow extension simultaneously (+) TEST: Reproduces a tingling sensation or paresthesia within median nerve distribution DIFFERENT FROM CARPAL TUNNEL BC HAVE SX PROXIMAL TO THE HAND AS WELL

appendicitis can refer to

Periumbilical area or right hip

Myelopathy sign

Positive Hoffman's UMN signs Babinski Clonus Hyper reflex Ataxia Loss of strength in UEs Clumsiness Bilateral UE parenthesis

gauze and semipermeable film dressings what are they

SECONDARY dressings and offer poor conformability to deep wounds

Us 2.7mph too fast or slow for a PD patient

Too fast

Decorticate posturing

UE flexion LE extension

S/s of TOS

Wasting if the thenar area N/T of fingers Pain in shoulder and neck Ache in arm or hand Weak grip

complete LMN lesions to the right CN VII would prevent...

motor commands from reaching all ipsilateral facial muscles, resulting in facial paralysis of those muscles

cataonic schizophrenia

motor distrubanceqth rpd psrurin eisdoe consist of uncontrolledm ovement however pats wremain arwa during episode

stage I ulcer

nonblanchable erythema of intact skin

neoadjuvant

chemotehrap or aaditon iven prior to srugey conolcial internvion

heart refers to

chest and UE

paradoxical breathing

chest wall moves in with inhalation and out with exhalation; due to chest trauma or paralysis of the diaphragm

child values for rule of 9s

child under one year has 9% taken from the lower extremities and added to the head and neck each year of life, 1% is dsitribted back to the lower extremities until the age of nine when the head is considered to be the same porportion as an adult

age related changes in older person

decreased vascular and immune responses resulting in impaired healing rate of healing is considerably slower scarring is typically LESS than in a younger individual

prolactin inhib factor; dopamine

decreases the relesae of prolactin CNS and circ hormoe levels

vision

defgrees of vusla impairment will increase es i those older than 75 asoact with falls pdeion an funton delin e vsicau acutity the visl afeidl and periphr vision all decrea pisl cbomc esmaller nad are elss reposne to chagne in light aming it more dififcult iot see in the thedark odlr aults have inacre in the mosutn of time it sakes to aocmcmodate ot bright or darkin envorment loss of contacst snesiti and epth percetion can result in incra risk for fallsin when aniat stairs or uneven surafesf cmmon eyes diesra that occurs incldue catacts glaucoma macular gene and iabet retinopathy

aranoid schiozo

deli fgranderu dleion o persciotn may belthey sposes pseicl powers granduer means spesion aka they thint her mroe specuh that ntey are

best way to assess compliance

demonstrate and then watch the patient do it

ligamentous laxity is a hallmark sign of

down syndrome and can lead to atlanto-axial instabiility AAI with SC impingement MEDICAL EMERGENCY s/s include changes in strength, neck pain, limited neck motion, and hyperreflexia clonus and positive babinski may also occur

pleural friction rub

dry, crackling sound heard during both inspiration and expiration occurs when inflamed visceral and parietal pleurae rub together heard over the spot where the patient feels pleuritic pain

What is the most useful diagnostic test to determine the severity of heart failure?

echocardiography

favorable response to manual treatment to the cx spine with suspected radic

improvement in distal symptoms > improvement in neck pain

popliteal

in the popliteal space of the posterior knee

excessive compensatory hip flexion would be bc...

it would help pull the weak side into flexion due to weak hip flexors

hyperfunction agents

managem hyperactive endocrine function accompliashed throhgh negative feedback loops or thorgh hormone antagonists hyperactive or excessive endor

neck burns what position

slight extension

glomerulus

specialized tuft of cailalaries that are need for the filtation of fluid as blood passes thorugh the arterioles of thekidneys

fast vestib stimulation

spinning in a hammock and rollin/spinning on a scooter board used to increase mobility based on fast vestib stimulation

precautions/contra for ABC

splinting post op incisions to achieve adequate expiratory force bronchospasm or hyperreactive airways

balloon angioplasty

temporarily inserting a small balloon-tipped catheter into a stenotic artery and expanding the balloon at the site of bloackage to help wide a narrowed artery antioplasty is usually combined with implantation of a smallmetal coil called a stent in the narrowed artery to help prop it open and decrease the chance of restenosis

with advancing age...and the heart

the same amount of blood fills the ventricles but the pumping mechanism is less effective as a result the body compensates by increasing blood pressure in attempt to maintain homeostasis

hyperkeratosis

thickening of the outermost layer of the skin which is typcially observed with stage 3 lymphedema

PR interval

time for atrial depolarization and conduction from the SA node to the AV node normal duration is 0.12 to 0.20 seconds

QT interval

time for both ventricular depolarization and repolarization normally ranges from 0.20 to 0.40 seconds, depending on the heart rate

complete decongestive therapy

treatment ath occurs in two different phases phase 1 is the intesntive acute treatment and typically provided in an outpatient setting by a certifi ed lymphemeda theraptist for 4-6 week s phase 2 is self mamgnemnt phase and consists of long term management of sx utilziting various components of CDT pts may ned to return to pahse 1 tx whenever a sig change in sx is noted consists of manual lymph drainage compression therapy execise and skin care

concentric activity of serratus anterior does what

upward scapular motion also induces scapular abduction

dissociate disorders

when a per ucosnoiu serpate one of af tehri midn form the rest

S3/4 sound vs heart murmur

low frequency 3 - turbulence during early diastole 4 - turbulence late diastole murmur - swishing sound pericardial rub - leathery

psychpthic persnality

low moaralt por senseof resnseb no repectof rtheorhe mpusfe beahvior for imemdita gratificaiotn high russitn liitel hiud eore remofro all all aciton inabitli to alaterbheaior even with punishment exerpt liar

spleen

organ location inthe upper left quadrant of the abdomen that is posbel for the filation of RBCs as well as the production of antibidies to help fight infection

sanguineous

presents with a red color and a thin, watery consistentcy red appearance is due to the presence of blood which may become brown if allowed to dehydrate may be indicative of new blood vessel growth or the disruption of blood vessels

microchnida

part of cell responsible for energy oriduction respinsble for converting nutrient into enberyg and other spec tasksa

surgical resection of acoustic neuroma what intervention

repetition of mvmts and positions that provoke dizziness and vertigo habituation

sacral sparing

sparing of tracts to sacral segments with preservation of perianal sensation, rectal sphincter tone, active toe flexion

What impact will hyperventilation have on a patient's arterial blood gas?

What impact will hyperventilation have on a patient's arterial blood gas? lower the pH decrease the PaO2 decrease the PaCO2 increase the PaCO2 Correct Answer: decrease the PaCO2 PaCO2 is directly related to ventilation. Therefore, as the patient hyperventilates, PaCO2 will decrease as more and more carbon dioxide is expelled.

erythrocytes values

4.3 - 5.6 x10^6 / ml (male) 4.0 - 5.2 x10^6 / ml (female) x10^12 for SI units

Initial post parturition interventions

Day 1-3 Breathing, coughing and pelvic floor exercises

renal stones unique s/s

flank pain some cases can radiate to the groin depending on the location of the stone very severe pain and can cause vomiting

hip capsular pattern

flexion IR then abduction

hip burn

flexion and adduction derformity anterior hip spica, abduction splint

noncontact deceleration that produces a valgus twisting injury

i.e. athlete pivoting in the opposite direction ACL injury

MRI and CT

ideentify tumors that may be the cause of a pts lymphedema

clunk test

identifies a glenoid labrum tear

adult RR

12-20 breaths per min

hemoglobin values

13.3 - 16.2 gm/dL for males 12.0 - 15.8 gm/dL for females

regular rhythm how do you count it

15 seconds x 4

Go up stairs foot or foot is what age chid

2 Developmental milestone of this age

why cant you do percussion and shaking for airway clearance with a low platelet count

20,000 LOW increased risk for bleeding aka percussion may bcause microtrauma and increase risk

At what degree knee bend is the force at the patellofemoral joint the same as that passing through the tibiofemoral joints

25 degrees

S2 (DUB)

2nd heart sound - closure of the aortic and pulmonic (semilunar) valves at the onset of ventricular diastole high frequency sound with higher pitch and shorter duration than S1

leukocytes values

3.54 - 9.06 x10^3/mm^3 x10^9/L

newborn RR

33-45 breaths per min

Jump on one foot and stand on tip toes what age

4

Lower intensity resistance training example

50% of the one rep max more than 1 time a week

loose packed of humeroulnar joint

70 degrees flexion

Original RPE Scale

7= very, very light 9= very light 11=fairly light (11-13 upper limit in first phase of cardiac tx) 13=somewhat hard (13-14 about 70% of max HR) 15=hard 17=very hard 19=very, very hard

apgar score of what is normal

8-10 top score of 2 for all categories means HR >100, good respiration and crying, active movements, cough or sneeze, and pink color

poor reliability

<.50

ABI of what is considered a contraindication to exercsie

<.8

LDL cholesterol values

<100 optimal 100-129 near optimal 130-159 borderline 160-189 high >190 very high

3 special tests for AC joint

AC shear test (compress AC joint from front and back) Passive cross-chest adduction O'Brien test (thumb down resist flexion)

severe medial tibial rotation can damage the...

ACL

precautions and realtive contraindicaiton to complte CDT

ACUTE INFECTION CARDAIC EDEMA DIABETES HYPERTENSION MALIGNANCY RENAL INSUFFICNENT DVT

Cherry-red discoloration means

Carbon monoxide poisoning

homans sign

DVT

neural tension test to bias tibial nerve

DF and eversion

Inspiration main muscles

Diaphragm and external intercostals

Acute compartment syndrome is usually the result of

Direct trauma or tibial fracture

What causes sacral sitting with a rounded, kyphotic upper back in a w/c

Excessive leg length bc will have to slide forward in the wheelchair to reach the footplate Will results in a posterior tilt of the pelvis and sacral sitting

what motion of the GH occurs with flexion

ER

What must the tibia do in order to achieve full extension

ER so lateral condyle can make contact

CHF, CVI and lipedema have what type of swelling

Symmetrical

pulse oximeter

The concentration of oxyhemoglobin is determined by quantifying the amount of light absorbed by the solution. Pulse oximetry is used for monitoring a person's oxygen saturation.

What position do you want to avoid with TBI

Trendelenberg because would increase IC pressure

dusplasia

abnoraml develpment of cells or tsseue taht ifoetn an areal signs of neolasia

diarrhea

aboanla frwfo volue tha toftena as GI path

bambo spine

ankylosising spondylitis

crackles indicates

atelecctasis or secretions

Atelectasis vs Pneumothorax

atelectasis happens from within the lung (conditions that prevent deep breathing) pneumothorax happens when air is in the pleural space

blood pressure is directly related to ...

cardiac output and peripheral vascular resistance and therefore is an effective non-invasive performance measure of the pumping mechanism of the heart

TKA 2 weeks ago evidence of DVT what should you do

go immediately to the ED!

US can and cannot see

can - cartilage, tendons cannot - internal structure of bones bc cannot penetrate bone

phalens test

carpal tunnel opposite of praying position

neural mob with gliding and sliding and tensioners are used to

decrease adverse mechanical tension on nerves

compression garment does what

exceeds the internal tissue hydrostatic pressure

heartburn

form of indigestion

right upper quad

hepatomegaly duodenal ulcer cholecystitis penumona hepatiis bilary stones

ginkgo biloba

increa erisk of hemmoora in ts iwth antucoag

>102 cm or >40 inches means

increased risk for type 2 diabetes, dyslipidemia, hypertension, and CV disease >88 cm or >35 in in women

renal calculi

kidney stones

gait changes in PD

loss of arm swing loss of RECIPROCAL TRUNK movements shuffling gait with shorter steps festinating gait (abnormal and involuntary increase in speed of gait)

do nt ressustite

mediacl order wrirtebby a doc that docue a pt swish to not be rsusl with CPR if they breathing or heart stops the only aplppie to CPR it snot not appie t adminstrat o fmed sor other healthc are treatments

urethra

msucluar tuube for excretion of urine semem transpor tdirng ejaculation in males

elderly, fail older adult returns from 2 week hospitalization, low vision, diabetes, how should you mobilize the pt to increrase imbulation and safety

practice walking in areas of high illumination and low clutter do not open windows to let in as much light as possible because visual acuity decreases dramatically with bright glare from sunlit windows color coding stairs could help if used with strong colors and are well lit (not light colors like pastels)

autonomous stage what is a good strat

practicing consistency of performance in variable environments

measure BP for pt who is doing PT around dyalisis

pre and post activity on non shunt arm bc the shunt arm would interfere with BP

psychogenic amneia

produced by the midn with no phsyal cause forgets all aspects of the apst

pathology of the prostate

prostatisi prostate cancer

mutlple oersality

rae dissocat dioer include 2 or mroe indpend eprsalitea may or amy not mwob aout heo ther caustvi acroa are notuderoot beleive to alow a person enfage in behaot ath are against thpts noraltiy and moramly pruce guilt

rehab considerations for acid base disorders

recognize higher risk poplations such as pt siwth renal cv pulmonary brns fever sepsis pt on mechancial ventialtion dm patietns currentl vomiting with diarrhea or enteric drainainge recognize sides of edehydation in diabeteic pt injury prvention during invovlnary muscle contractions seconadry metabolic alkalosis recongpt ussing direit erhat maybe at risk for potenttium depreison reconat tah trousseas sign during blood pressure may indicat calcium deficisna and the earltstages of tetany

hyperfunction of an endocrine gland

seocnarry to overstimulation of the pituaiaty gland can also occur to due hyeplasia or neoplasia of the gland itself

boutonniere deformity

aka "buttonhole" extension of MCP and DIP flexion of PIP injury of the central extensor tendon (extensor digitorum) where it displaces palmarly (volar slippage) relative to the PIP joint the lateral bands become tight and are attached to the distal pahalnx and extend it FDP is now unopposed and it pulls the PIP into flexion

patricks test

aka FABER

rule of nines

allows for gross approx of the percentage of the body affected by a burn the rule of nines does not account for severity head and neck 9% (4.5% each side, front and back) anterior trunk 18% posterior trunk 18% bilateral anterior arm, forearm and hand 9% (4.5% each side) bilateral posterior arm, forearm and hand 9% (4.5% each side) genital region 1% bilateral anterior leg and foot 18% (9% each side) bilateral posterior leg and foot 18% (9% each side)

when do myositits ossificans happen

after hematoma benign ossifying soft tissue lesion that happens in adolesents and young adults s/s pain and tendernesss with soft tissue mass 80% are in large msucles of the proximal extremities

hormone replacement agents

agents restore normal endocrine function when endogenous production of a particular hormone is deficient or absent decrease in endogenous hormone sectreon

malignant neoplasn

aboralm uncontorlled cell growth that invasde and etsoys adacent tissue and may metasta to otehr syes and systems of the body

testosterone

target pituitary land involved in the process of spermatogeneiss and male sexual characterisitcs influenced by pituitary relase of LH

vitamin D

inceas bf level of mineral onotably calcum phoshr firtfuekd nukj fusg iiusk firtugu nargaube =faykt bi wwigh rcke ostei amalce tciity calcif atio of sift tiesu and hyerpcalemia o

main concerns for elderly pts post-op

cardiac, pulm, nero, and cognitive i.e. post op delierium interval delerium lucid interval of 1 post op day or more sx worse at night can be misdiagosed as depression BILATERAL knee replacements much higher association such a big deal where you need to contact the surgeon bc pt may not follow precautions, put self in danger and wound management

differentitated cells

cells taht have matureed from a ales efc to more speic cell tyes

L5-S1 disc buldge with no nerve root compression sx

centralized gnawing pain with loss of postural control during lifting activities (proprioception)

can you tell what bacteria is causing the infection of a wound?

no impossible without a wound culuture

dependent rubor

deep blue-red color of the lower extremities; indication of severe arterial insufficiency.

erythema

diffuse redness of the skin often reesulting from capillary dilation and congestion or inflammation

advance directive

documents that are ocmpelte by a pat priot ot thonset of an illnes tha dictate how thpt wants other end o lfie are to be arreid out Ad are impoortna since ilne s may take away apt abilty tcmmuica their wishes concet their own are as they get old duraable powr of attoryn and wlvigwill are tow types of adavec diretion

bells palsy

facial

community resources

weight watechers jenny craige take off ounds sensible TOP food addicts annymiy

convergence

hold 6 inches away and move towards nose

intelligence

inelligenc eeclice thorugh this contrus is difutcutl to sutyd due to genational different genreal integagecne btegin to decin somethei betwetn 50s and 70s crutsal ie intenligenc ehwich is th aaccuualtion og knowdl and skills has the tendency to be mainano reven improve as an invidvual ages hoevere fluid intelligenc ehwi is the spe dadn abilty to reso sand problem solve begins to decine

TMJ capsular pattern

ipsilateral opening lateral deviation to the side of restriction

bone tumor

pain is INCREASED at night, not just present

fecal diversion

suival cration of an openin of par he ocoo or amll intensetinto the surface of the skin to allow for stsoolt o exitn teh body

abrupt onset with a dry cough is consistent with

viral infection

pneumothorax vs atelectasis

A collapsed lung happens when air enters the pleural space, the area between the lung and the chest wall. If it is a total collapse, it is called pneumothorax. If only part of the lung is affected, it is called atelectasis.

What muscles should you stretch with poor posture

Pec minor Rectus capitus posterior major Upper trap Cervical paraspinal muscles Levstor scap Scalenes Suboccip muscles

Non union fractures are rare in what age group

Peds but can happen at the elbow (lateral condyle)

LMN or flaccid bladder how do you go

no reflex action emptied using the crede maneuver (manually compressing the lower abdomen) increasing intraabdominal pressure using valsalva or timed voiding

dressings from most to least moisture retentive

alginates semipermeable foams hydrocolloids hydrogels semiperm films

all limbs flexed

not typically found in comatose pt

split thickness graft

skin graft that contains only a supericial layer of the dermis in addiiton to the epidermis

precautions and contra for percussion and vib

all contraindications lsited for postural drainage plus subcuteanous emphysema recent epidural spinal infusion or spinal anesthesia recent skin grafts, or flaps on thorax burns, open wounds, and skin infection on thorax recently placed transvenous or subcutaneous pacemaker suspected pulmonary tuberculosis lung contusion bronchospasm osteomyelitis of the ribs osteoporosis complaint of chest wall pain

3rd degree AV block (complete heart block)

all impulses are blocked at the AV node and none are transmitted to the ventricles the atria and ventricles are paced independently; atrial rate > ventricular rate considered a medial EMERGENCY requiring a pacemaker if the ventricular rate is too slow, the CO drops and the patient may faint common causes include degenerative changes of the conduction systems, digitalis, heart surgery, and acute MI

articulated feet

are joined by a metal bolt or cable to the lower shank section and have rubber bumpers that absorb shock and control PF excursion

zone of conagulation

area of the brun that reviedved the msot severe injury with irreversible cell adamage

pancrea

pancratiis acute an chronci DM pancreastic cancer

semi fowelers

head elevated 30 degrees

socket aligned too posterior

hyper extension insufficient knee flexion

testes

located in the scrotum between the upper thighs secre androgens (most importantly testosterone) that regular body chagnes associated with sexuual development and support hte production of sperm

endoscopy

method od phyical examusing a lighted flexible instructn atht aaloows a phsian to exmain the insdie of teh disgesti trac t

typical hypothyroidism

myalgia PROXIMAL muscle weakness stiffness prolonged DTRs

leminiscal impingement would result in...

primarily sensory changes

lifting weights and cardiothoracic surgery

restricted to 5 to 8 lbs for the first 5 to 8 weeks mod to heavy weights are contraindicated @ 5 weeks (including 4 weeks of consistent participation in a supervised cardiac rehab endurance program) can start resistance training, do 30-40% 1RM for UE and 50-60% for hips and legs

middle, associate stage of learning what are good strats

serial practice (a practice sequence in which different skills performed are in a mixed order but in a fixed format)

promote relaxation in spastic diplegia

slow rocking on therapy ball slow vestib stimulation

depression

slower metnal and PA poor self estem immbizlifr fome everyday avitia adasne hopeles help desit to withdrae delusion in sevre cases

phase 2 cardiac rehab see 3 PVC in a row what should you do

stop the exercise and notify the physician immediately it is VENTRICULAR TACHYCARDIA rate is very rapid and, resulting in seriously compromised cardiac output potentially an emergency situation that can deteriorate into VENTRICULAR FIBRILLATION (no cardiac output) and cardiac arrest if you keep exercising then you put the patient at risk for cardiac arrest

trachesotomy

surgically created hole through the neck into the trachea below the level of the vocal cods (the hole) the term for the surgical procedure to create the opening is tracheotomy (making the hole) there are two primary indications for trachesotomy: airway obstruction at or above the level of the larynx and respiratory failure requiring prolonged mechanical ventilation the tracheostomy can be surgically closed when it is no longer needed

renal system

two kndey two yreters urianry baldder a urethra that function to form and elinate urine

rate of perceieved exertion (RPE)

used to quantify the subjects overall sense of effort during activity the reported RPE provides the therapist with an idea of the amount of strain or level of exertion the aptient is experiencing

hep B HBV

virus taht affects the lvie and its functin transmission of this virus occurs through sharing of needsle intercourse with an infected person epure to infected person blood sesm or materan l fetal expiresu 10% lead to chronic since the body cannot always rid iteslf fo HBV tx incldue hep B immuniglobulin for the unvaccinated pt with 24 hours of expusre pt should then recieve the vaccination series at on ean d 6 months if pt is already vaccinated they may requiqre another oses odo the HBV vaccine chronic hep is now being treated with interferon alfa2b provide remission for some pts

normal child

80 to 100

P Wave

atrial depolarization

listless

lacking energy or enthusiasm

emphysema GOLD

patholigic accumulation of air in the lungs found with COPD 3 classifications: centrilobular emphysema, panlobular emphysema and paraseptal emphysema results fron a long history of chronic bronchitis, recurrent alveolar inflammation or from genetic predisposition of a congenital alpha 1-antitrypsin deficiency results from a non-reversible injury and destruction of elastin protein within the alveolar walls this process causes permanent enlargement of the air spaces distal to the terminal bronchioles within the lungs anatomical changes include loss of elastic recoil, excessive airway collapse during exhalation and chronic obstruction of airflow progression of teh disease includes further destruction of the alveolar walls, collapse of the peripheral bronchiles and impaired gas exchange emphysema causes pckets of air to form between the alveolar spaces (known as blebs) and within the lung parenchyma (know as bullae) this results in an increase in dead space wtihin the lungs that diminishes gas exchange primary risk factor for development of emphysema include chronic bronchitis, lower respiratory infections, cigarette smoking and genetic predisposition enironemntal infleucne includes air polluation and other airborne toxins the risk of aquiring emphysema increases with age COPD is the SECOND leading cause of diability in indiividuals under 65 years old WORLDWIDE 2 million in US diagnosed with emphysema and another 14 mollion with some form of COPD can be asymptomatic until middle age and is most often diagnosed between 55 and 60 yersa of age centrilobular ephyemsa usually detroys the bronchios (just before the farthest part) in the upper lungs while the alveolar sacs usually remain intact panlobular destorys the air spaces of the acinus (farthest part) and is usually foundin the lower lungs paraseptal emphysema destroys the alveoli (between the bronchioles and acinus) in the lower lobes resulting in blebs along the lung periphery sx of emphysema worsen with the progression of the disae and include a persistent cough, wheezing, difficulty breathing esp with expiration and increased respitation rate advanced disease sx include increased use of accessory muscle, severe dyspnea, cor pulmonale and cyanosis XRAY is used to visally evlauate teh shape and spacing of the lungs other imaging sudies include a PLANOGRAM to detect bullae and a BRONCHOGRAM to elvauate muscus ducts and detect possible enlargement of the bronchi arterial blood gases may indicate a decreased PAO2 barrel chest increased subcostal angle rounded shoulders secondary to tight pectoralis rosy skin coloring PLB with ventilation high rates of anxiety claustrophobia insomnia depression complcaitions such as formation and rupture of bullae and blebs can lead to penumothorac cor pulmonate is a seriosou complication that can occur with advacned emphysema management = pharma, o2, PT pharma promotes bronchodilation, improved oxygenation, and venilation oral/inhaled bronchodilators, anti inflamma agents, mucolytic expectorants, mast cell stabilizers, and antihistamines may be used in the tx of emphysema preventative immunizations against influence and pneumonia are lso recommended PT may be I/M as disease progresses max functional abilities and optimize pulmonary fxn CHRONIC PROGRESSIVE DISEASE life expectancy decreases to less than 5 eyars with severe expiratory slowing measured at a rate of <1L during FEV1 similar to bronchiectasis which is an inherited or acuired disease and is characterized by chronic inflamm and dilation of bronchi and descturction of bronchial walls associated with chronic bacterial infections and is an extremem form of bronchitis incidence in the US is low brochiectasis has a hgiher risk for developement in pts with CF, sinusitis, Kartageners syndrome, and endobrochial tumors characteristics include chronic cough wtih sputum, hemoptysis, wheezing, dyspnea, and recurrent resporatory infections treatment = PT, bronchodilators and antibiottics

good reliability

>.75

hypertension SILVER

condition in whcih blood pressure is persistenly elevated primary HTN occurs without an identifiable cause and typically develps slowly over time secondary HTN occurs as a result of underlying pathology (i.e. preeclampsia, kidney disaese, congential vessel defects, atherosclerosis, stress or asa side effefct of cerain meds) force of blodo aginst the interior walls increased forces may cause daamge to the arteries, increasing the risk of more serious comorbi such as CVA or MI for pts with secondary htn structual injuries may also be linked ot the speicif cunderlying pathology AFRICAN DESCENT, MEN, POST MENOPAUSAL WOMEN, AND THOSE WITH A FAMILY HISTORY HAVE A HIGHER RISK OF DEVELOPING HTN risk increases further with AGE pregnancy diabetes and sleep apnea are associated so is obesity sedentary lifestyle stress tobacco use excessive alcohol excess dietary sodium >140 s OR >90 d over 50 ususaly show elevated systolic and normal diastolic (this is referred to as isolated sustolic hypertension ISH) sx may not be recognized until BP becomes dangeorusly high propducing headache confusion visual changes fatigue arrhythmias or tinnitus SILENT KILLER no specific labs for HTN electrocardioagram urinalysis blood cholesterol may be used to identify underlying pathologies so that medical management may be specifiall targeted management is largely focus on risk reduction through modifiable risk facors and pharma intervention pharma to decrease preload, dilate peripheral vessels or altern HR diuretics, beta blocker, calcium challeng blockers ACE inhibitors with appropriate management and controlled hypertension, most patients are able to particpate in functonal and rec activies without limitation can effectivelty mamagne morbidity and mortality are typicallt associted with poorly controlle HTN which increases the risk for metabolic syndrome, MI, HF, CVA aneurysm congnitive changes kidney dysfunction and visual impairment

abdominal obesity

men: >40 in women: >35 in

ocular pursuit

H pattern to extremes of gaze

serous

clear, light color and a thin, watery consistency serous exudate is considered to be normal in a healthy healing wound and is observed during the inflammatory and proliferative phases of healing

ST segment elevation

earliest sign of acute transmural INFARCTION can also indicate a benign early repolarization pattern in a normal heart deviations from the isoelectric baseline are expressed as ST segment elevation of 1mm, 2mm etc.

Termanilly Ill patient what should you do

1) Provide support and understanding of the grief process 2) Encourage expression of feelings and memories 3) Respect privacy, cultural or religious customs

systematic approach to analyzing ECG

1. scan rhythm strip (is the rate unusually slow or fast? does rhythm appear to be regular? are there any abnormal looking beats?) 2. determine the heart rate (regular rhythm divide 300 by the number of large squares between two consecutive P waves, if irregular then count the nmber of QRS complexes in a 6 second strip and multiply by 10) 3. evaluate the rhythm by comparing R to R intervals (regular rhythm: R to R intervals are within 0.044 seconds, if irregular is there a pattern or it is totally irregular?) 4. evaluate P waves (present vs absent, identical in shape? upright in leads I, II, and III? each P wave followed by a QRS complex?) 5. if P waves are present, measure PR interval to elvauate for conduction blocks (normal .12 to .2 seconds) 6. examine QRS complexes to determine if conduction is normal through the ventricles (normal: QRS width is 0.04 to 0.1 seconds in all leads, identical in shape?) 7. assess ST segment 0.08 seconds after the J point (is segment at isoelectric baseline, depressed or elevated?)

Recommended work interval for a non deconditioned adult performing aerobic interval training

10 min (notice that it's interval training), 5 min would be too low to increase aerobic capacity unless extremely deconditioned 3, 10 min bouts would fulfill the recommended daily exercise time of 30 min 20 min would be the minimum recommended

dietary mod

500-1000 calres rduciton per DAY usually sufficnet to prodcue a 1-2 lbs per week wight loss contned for 6 months before plateau pts think that reducing fat intake alone with repdocue tth desited weight loss but need to also reduce rcarbs and overall catoersi is equally impornatn consult bth aphysican and dietiaten to nduefn medically sfea adn neutiorn sound approad to weight loss

exercise testing and training is contraindicated at what platelet count

<50,000 WBC <3,000 hemoglobin <10 also contraindicated in significant bony metastases, severe cachexia, severe fatigue, or poor functional status

waist hip ratio

>1 in males >.085 infamels = central obesity

fasting blood glucose for metabolic syndrome

>110

hypertensive crisis what to do

A hypertensive crisis occurs when measured blood pressure is greater than 180 mm Hg and/or greater than 120 mm Hg DBP. If blood pressure is 180/120 or greater and with other associated symptoms of potential organ damage such as chest pain, shortness of breath, back pain, numbness/weakness, change in vision, or difficulty speaking then this would be considered a hypertensive emergency. This type of scenario warrants immediate medical attention including calling 911.

venography

A radiopaque dye is injected into a vein while an x-ray procedure creates an image of the vein to detect a clot or blockage.

hyperextension can damage the...

ACL

2nd degree atrioventricular block

AV conduction disturbance in which impulses between the atria and ventricles fail intermittently two major types = mobitz I - progressive prolongation of PR interval until one impulse is not conducted (generally benign) mobitz II - consecutive PR intervals are the same and normal followed by nonconduction of one or more impulses (a more serious condition). if the heart rate is slow, cardiac output will decrease with the blocked impulse. also 2nd degree AV block may progress to 3rd degree AV block

HIV ecephalopathy sx

Aka AIDs dementia Memory loss, confusion and disorientation when the disease invaded the brain Additional impairments may include unsteadiness when walking, clumsiness, shaky hands Others are personality changes, irritability, depression or apathy

eating disorders

BMI less than 18.5 to be underwight tx often recomend tin paital hozp or inpatient bc phsyical and psch factof s bulimia pinge and purse chemcia and enzye imabalces can leaed to multe organ dysfucntion major healt conduticne include herat falure due to eletcoylyte ibacle gastri rppure during prng esoah inflamm tooth deaya due to frqunt omtin dehyraon peptic ulcers pancratis andbowel irregualrity anorexia self imppsoet taraving body to eithe rslow or shut down nroal systemic prcoess heart fularure due to sloweed hrat rate and decreasde BP kidneu failrue due to heydration aosteo poros and msucle atsohy

synergies how do you discourage them

BREAK THEM UP aka do part of a flexion synergy with part of an extension synergy typical lower extremity synergies are effectively broken up using bridging (combines hip extension from the extensor synergy and knee flexion from the flexion synergy) supine hip extension with adduction and foot tapping in the sitting position are IN-SYNERGY activities

What is the reason behind eccentric exercises for tendinitis

Because there is less effort and stress placed on the contractile units than with concentric contractions at the same level of work Should be done in pain free ROM Isokinetic, isotonic and isometrics do not allow for pain free muscle contractions and can cause further inflammation of the muscle

vital sign most susceptible to change with age

Blood pressure normally increases with age. Men, in general, are more susceptible to increased blood pressure as compared to women. Heart rate and respiratory rate are unaffected by aging and the elderly are more susceptible to hypothermia.

Klumpke's palsy

C8-T1 affects intrinsic muscles of the hand (interossei, thenar, and hypothenar), flexors of the wrist and fingers (flexor carpi ulnaris and half of flexor dig profund) can also have HORNERS syndrome bc T1 affects dilation of the eyes and eyelid

CV and pumpantty

CO dcrian less toelra to aexercis decraed fuson to th perhhe tussue decre gnou sreutn artheros hol incrases sgeeo esp inatota fibroschanes iwith thmeocaariudm ath atmakse si tless conplint decf efpasote cadia ormons may sso lahbe cfrad idiis V ZYF DIFERENATION SECOSDT TO MSK CHAGNES EPXIERNA SA PER if sv cna be oaina or increase a result of exercise overal CO can be sueaeta bedis dniiseh dma HR othother chgnes hicra ebo and incread eif for potual hpitenion dcrad reinfsgn hr and increass eifk for cardia dyshthias inra myocyte coune in the vntic eneocuh on the macualt ao th my carincrea rsik fo MI due to thse CV oldra graeter risk fo rstoek ecornary artye idnase congetive HF greatthen 50% ofall odler adutls have some for aof HR sisea can maintaain SV with exeris to help make up for decreae in HR and maintain CO

Primary joint for wrist flexion

Carpal row on the radius and ulna Mobilizing the lunate in the capitates can also assist but not the primary area

metatarsalgia

Compression of the digital nerves in the forefoot results in sensory symptoms of pain and parenthesia Typically the result of excessively tight shoes Best intervention is to wear larger shoes, with a metatarsal pad placed proximal to the MT heads to elevate the transverse (anterior) arch and separate the metatarsals Custom orthotics can be molded to decrease load and wearing of high heels should be discouraged Stretching of PFs May also be helpful

Which of the following would be a criterion for terminating an exercise stress test? blood pressure of 170/80 mm Hg first-degree heart block sinus tachycardia moderate angina

Criteria for terminating a maximal exercise stress test include increasing premature ventricular complexes, ventricular tachycardia, rapid atrial arrhythmias, second or third-degree heart block, 2.0 mm of ST-segment depression, hypotensive blood pressure response, extremely elevated systolic or diastolic blood pressure, moderate to severe angina, extreme shortness of breath, dizziness, mental confusion, lack of coordination, pale and clammy skin, claudication pain, and a patient's request to stop.

DNA deoxyribonucleis acid

DOUBE HELIX MOLECUER THAT CONTAINT EH GENES THAT PROCIE THE BLUE PRINT FOR ALL OF THE STRCUTES AND FINCTIONG OA A LIIING BEING

common side effect of raloxifene (estrogenlike effects to manage osteoporosis)

DVT increases risk for stroke other sx = depressed HR, elevated BP, and altered balance reactions

lateral pterygoid

Depresses and protracts mandible and moves it from side to side Anterior head of digastric muscle and suprahyoid muscles also help with depression

Platform crutches

For patients who cannot bear weight through their hands but can bear weight through their forearms Ie fracture of left distal radius

Greatest risk for heterotopic ossification associated with an intervention

Forceful PROM especially if spasticity is present Usually occurs in soft tissues adjacent to large joints Prolonged stretching/splinting is not a risk factor

endocrine remember

HYPOTHALAMS AND PITUITARY GLAND GO BACK AND FORTH

Most common infection transmitted to health care workers

Hep B 300,000 new cases each year Transmission is through exposure to blood and blood products and infected body fluids

A common breathing pattern described by deep and fast breathing often associated with metabolic acidosis is termed: eupnea hyperpnea Kussmaul's hypopnea

Kussmaul's breathing is characterized by deep and fast breathing and is commonly referred to as "air hunger." Treatment is directed toward controlling the underlying disease.

Polyneuropathy what testing

Nerve conduction velocity testing

neural tension test to bias deep fibular

PF and inversion

Good AD for spastic diplegia

Posterior rolling walker because used to promote upright posture (eliminates the forward lean seen in use of the standard anterior walker) and the addition of wheels improves walking speed and reduced energy expenditure

if you have a lower than normal tidal volume what happens

RR increases to maintain minute ventilation (just like SV, HR and CO)

Discord lupus erythematosus tx

Red lesions to the skin Also has central atrophy of the LEs Autoimmune ROM and prevention of deformity

ovarian cyst referral

SI pain constant pain that doesnt vary much with activity no sx with MSK eval

how is LBP different from SI pain in pregnancy

SI pain from laxity LBP from added weight, poor muscle tone, increased lordosis, and loose pelvic ligaments)

ILEOCOLECTOMY

SURGIACL remveal of as ection o ht eilem and aceing colon

Hardest balance position for older person

Standing unsupported in tandem with eyes closed This is harder than standing on one foot with the eyes open

Best way to monitor intensity of exercise for a patient limited mostly by claudication?

Sustaining pain levels of at least 2 out of 4 on the claudication scale during exercise This level of blood and oxygen deprivation over time initiates the generation of collateral circulation A certain HR or RPE would not elicit claudication symptoms for all patients, different for all

delirium

TRANSISETN state of FLUCTATING cognitive abiltis memor oritneation and arusasl may all be affect commonlep after hspita post surg durin courso g euntratmed medi ontion are as a sie ffecc to fmeds sx can mini demntnai it is imprtann to consit taht thpts cog stat may chane form day to day dail retnation an docgn evalations are key ocmpnentsof skille dgetai phyca herap risk facors for derlium incdlue age greater than 7 habognna dinishe dcog stats dpessiona lochol abuse

Dyspraxia intervention

Task specific practice of familiar activities progressing from parts to whole It is the impairment of skilled learner movment (disconnect between the idea for movement and is motor execution)

Rhythmic initiation is used for what in PD

Trunk rotation Improves mobility (PNF technique) NOT stability or ROM Good activity to focus on in order to improve bed mobility

ventricular asystole

Ventricular standstill with no rhythm ecg records straight line pattern Requires immediate defibrillation or mediactions Causes include MI, ventricular rupture, cocaine use, lightning strikes and electrical shock.

Best exercise for osteoporosis that won't cause vertebral compression fractures

Weight bearing, non jarring exercises have been proven to reduce or slow bone loss without causing vertebral compression

Is medial tibial flare pressure tolerant?

Yes Also tibial and fibular shaft And the distal end of stump

Can you go sidelying with a chest tube

Yes but attend to patient comfort and chest tube positioning when doing so

Percussion and shaking in patient with severe TBI and Chest tube can you do it?

Yes the area around a chest tube is often the area in most need of airway clearance but is it important to consider pain management when doing this intervention

albuterol

a bronchodilator side effects include tremor, anxiety, nervousness, and weakness

Q wave

a characteristic marker of INFARCTION signifies the loss of positive electrical voltages due to necrosis a significant or abnormal Q wave is longer than 0.04msec and larger than 1/3 the amplitude of the R wave

egophony

a form of bronchophony in which the spoken long "E" sound changes to a long, nasal sounding "A"

nonalcoholic steatohepatitis (NASH)

a more severe form of nonalcoholic fatty liver disease. it consists of fatty accumulations plus liver-damaging inflammation. in some cases, this will progress to cirrhosis, irreversible liver scarring or liver cancer

esophagus

a musceular tube conntect teh pahrynx with the sotmach

interpretation of exercise testing

a negative test indicates a low probability of coronary artery disease, a positive test indicates a high probability of coronary artery disease prognosis can be assessed using various multivariative indices (ie. duke treadmill test score and veterans administration score) an aerobic exercise prescription can be determined from perfrmance on the exercise test

safety guidelines for the patient with angina pectoris

a rating of 1 on the agina scale is the recommended END POINT to cease activity during inpatient and outpatient cardiac rehab individuals who experience angina during activity should discontinue the acitivity immediately and rest in a sitting or recumbent position until the discomfort is resolved individuals with meds for angina should be encouraged to use the med as directed if angina is not relieved by termination of activity or by three sublingual nitroglycerin tablets (one taken every 5 min), transport the individual to the nearest emergency center the exercise target HR for aerobic exercise training should be >/=10 beats below the known ischemic or anginal threshold

to whom is it LEGAL to release PHI without pt consent

a state agency responsible for investiagting suspected abuse the insurance company that is paying for the patients tx another health care provider involved in the care of the pt

hypertophic scar

abnormal scar resulting from excessive collagen formation during healing typically raised red and firm with disorganized collagen fibers

benign neoplasm

abnralm cell growht that is usaly slow flwon ing and harmless closel resembling the compostion of adacent tissues

disutal

aboral mor sufavlssa mae passve ta form sbwwwten two internal orfans or bwtewetn two different parts of teh intestin

biotin

actin ofn mua n yne systems commonfoo toucse ocnian liver mealts milks ddeiv anemai dperson msucle pain ntoxtify

skin tear

acute wound often result from trauma to fragile skin such as bumping into an object, adhesive removal, shear or friction forces severeity of skin tear cna range from a flap like tear, that may or may not remain viable, to full thickness tissue loss

abrasion

acute wound wound caused by a combo of friction and shear forces, typically over a rough surface, resutling in the sacping away of the skins superficial layers

puncture

acute wound wound made by a sharp pointed object as it penetrates the skin and underlying tissues typically there is relatievely little tissue damage beyond the wound tract however risk of conamination and infection can be significant

povidone-iodine

adv = broad spectrum ANTIFUNGAL easily removed with water disadv = not effevtive aginst pseudomonas (bacteria from soil, water, plants) may impiar thyroid function painful application

gentamicin

adv = broad spectum may be covered or left open to air disadv = has causes resistant strains ototoxic nephrotoxic NOT PAINFUL

a lesion of the left internal capsule =

affect muscles on the lower half of the right side of the face

stoma

afttial opening in the intestnse through the amdonal wall

shunt block signs

agitation, irritible, listless, drowsy

PLB prevents

airway collapse by causing resistance that increases pressure occurs via collateral ventilation through pores of kohn and canals of lambert

phenyketonuria

aka amino acid/organic acid metabolic disorder consists of intellectual disbaility as well as behavioral and gcogitive issue seoncary to an elevation of SERUM PHENYLALANINE deficieny in the enzyme phenylalanine hydroxylase normally excessive phenyl is conerted to tyrosine bt this enzye but when this doesn happen there is an excess and the brain is the primar ogran that becoes affected children in the US are test ar bithr fro PKU and elvesl gerate the 6 rewuires osme form of tx autosomal recessive inheraited trait and is more cmmon in causcasion s/s will present within a few months of birth as the phenylalaline accumules if left untrated severe intellectual disbaility will occur these children may also exerience GAIT DISTURBANCES, HYPERACTIVITY, PSYCHOSES, ABNORMAL BODY ODOR, AND IDSPLAU FEAFURES THAT ARE LIGHT IN COLORING WHEN COMPARED TO TOTHER FAMILY MEMBERS tx = through dietary restriciton of phenylalaline thorugh the persons lifetime, adequate prevention will avoid all manifestaitons of the disease

mechanical ventilation considerations

alarm may indicate disconnected tube, coughing or change in respiratory pattern develop nonverbal means of communicating with the patient patient is at greater risk for developing contractures, skin ulcers, and deconditioning

rehab considerations for pituitary dysfunction

ambulation/exercise enoucrage wtihin 24 hours of surgery (post tumor or gland removal) must demonstrate increased awarenss for signs of hypoglycemia bilatearl CT arthris steo physa rea commone in hyper ortho hypo in hypoput bilateral hemiianoposi in hypo

wet to dry dressings

application of a moistened gauze dressing ove an area of necrotic tissue the dressing is allowed to dry compeltely and is lateral removed along with any necrotic tissue that has adhereed to the gauze most often used to debride wounds with MODERATE AMOUNTS OF EXUDATE and nectortic tissue should be used sparingly on wounds comtaining both nectortic and viable tissue since granulation tissue will be traumatized in the process removal of dry dressings from granulation tissue may cause bleeding and be extremely PAINFUL

procedure for capillary refill time

apply firm pressure over a nail bed or bony prominence (i.e. chin, forehead, or sternum) until the nail or skin lanches release the pressure observe the time for the nail or skin to regain its full color

zone of stasis

area of less severe injury that possesses reversible damage and surrounds the zone of coag

zone of hyperemia

area surroonding stasis that presetns with inflammation but will fully recover without any intevention or permanent damage

chronic adaptations to aerobic

arterovenous oxygen difference (increased at max, no change at submax) blood lactate (increased at max, decreased as submax) max voluntary ventilation increased at max plasma volume INCREASED skeletal muscle blood flow (increased at max, no change at submax) improved body heat transfer due to larger plasma volume and more responsive thermoregulatory mechanisms

what should you do if you find a cluster of moles during a pt exam

ask the pt about the history of the moles and examine them closely examine for asymmetry, border irregularities, color, and diameter >6 mm it is not uncommon to have a group of moles and they are usually benign but if there is a transformation of the nevus, then the primary care physician should be ocntacted in this situation the PT needs to establish a baseline (history and physical exam) of the moles and then determine whether there is an indication to contact the physician

obesity and wound healing

associated with numerous medical comorbidities in addition to various inherent factors that may negatively impact wound healing poor periwound skin quality is suseptible to fissuring which increases the risk of wound infection increased skin tension heightens the risk of skin tears and limits options for reapprox large skin folds create moist, warm enviroments contributing to skin maceration and bacterial growth which may lead to both the onset and perpetuation of wounds in skin crevasses

normal sinus rhythm

atrial depolaization begins in the SA node and spreads normally throughout the electrical conduction system witha heart rate between 60 and 100 bpm

COPD what do you see in exam

barrel chest (often has kyphosis associated) and decreased thoracic excursion

posterior tib

between the medial malleolus and the achilles tendon above the calcaneus

in hemipelgia what are two muscles that can be spastic in the UE

biceps scapular retractors

C5 radic weakness where

biceps, could also be the brachialis C5 radic sensory loss will be in the same area as axillary nerve sensory loss (lateral shoulder) teres minor and middle deltoid are innervated by axillary nerve

location of electrodes and lead connections for 12-lead ECG

bipolar limb leads (lead I/II/III) lead I - left arm positive, right arm negative lead II - left leg positive, right arm negative lead III - left leg positive, left arm positive augmented unipolar limb leads (aVF, aVL, aVR) aVF - left leg positive, right arm and left arm negative aVL - left arm positive, right arm and left leg negative aVR - right arm positive, left arm and left leg negative unipolar precordial leads (V1-6) positive input is where the lead is placed, negative input is the central terminal (made up of the L/R arm and L leg)

beta blocker and HR

blunts HR response

BMI underestimates..

body fat in older persons who have lost muscle measure height and weight weight kg / height (m^2) weight (lb) / height (in^2) x 703

what happens if a chest tube gets dislodged

can have a pneumothorax with the removal of the chest tube there is an increased positive pressure on the lung tissue, the lung is not able to inflate and it succumbs to the pressure and therefore collapses

carbon dioxide acidic or basic

can view it as a an acid, so when it is low then there is LESS acid

cardiac changes

cardiomthopathy abonral venti removel iei hypetoph arfirb dsyrrhthmias pumpnary asthatn obstruclspee apnea ypotenialtion sydnron e kidney dccrwaes renral perfusion gu uriant i ncontennc einertilit integ infection yperketeosis acanthosis nigricans(A skin condition characterized by dark, velvety patches in body folds and creases.) vascular increas total blood volume altered SV cardiout output hypertneison venosu insuffcueny varcosities msk ostoearthisi alteredmonilit partsn increas erpeorduciton o adipokines lepin interleukin angioteniiongen which decreases sensitivty to them so nramlyl they tell you not to aet anymore but since your not sentive you cant tll when youre full liver nonalcoholif fatty liver sieas non alco steatohepattis pancreas insulin ressitanc type 2 diabetes

kava

causes liver taoxity

pt is sore after mobilizations, what do you do

change mobilizations to gentle, low amp oscillations to reduce the joint and soft tissue irritation dont do the same with a cold pack after dont place PT on hold dont change to self stretching bc you think they dont tolerate it

restrictive ventilatory impairment

characterized by reduced lung volumes (total lung capacity, FVC, FEV1) and relatively normal expiratory flow rates inferred from spirometry when FVC is reduced and FEV1 / FVC is normal or >80% pathologies include intertital lung diease, pleural diseases, chest wall deformities, obesity, pregnancy, NM disease, and tumor

liver path

cirrhosis jaundice hep abcdeg ascites hepatic enephalopathy lvier cancer hepatomegaly

somatoform disorders

classife dbse don the physical sx presetn in each disdrof

personalti disorders

classife dby obsering apts pattenr of bevhioare dysnction av=w fo socoety level of safness ususall onogn pattern sof ddysincitona lehaorio

affective disrder

classifeid by distrubances in mood or emotoion staes of extreme happiness or aness occur and mood can alterante without cause extree motiosn can become intese or unrealistc

what type of cueing does someone with visuospatial deficits respond best to

consistent, simplified verbal cues demonstration and gestures are likely to be confusing

notice increased symmetrical swelling in ankles and they are taking lyrica for their diabetic neuropathy what should you do

contact the physician about possible development of HF bc can be a side effect of lyrica other side effects are difficulty walking long distances and lymphedema

derotation knee is for

cruciate injuries

bluish discoloration of skin as well as nail beds of the fingers and toes, palms are cold and moist, what is happening

cyanosis caused by an excess of deoxygenated hemoglobin in the blood it may be central (due to advanced lung disease, congential heart disease, abnormal hemoglobin) or peripheral (decreased blood flow, venous obstruction)

necrotic tissue

dead tissue resulting from the localized physiological and enzymatic changes associated with cell death necrotic tissue is often documented and named by the spefici type observed and may also be referred to as devitalized or nonviable tissue

differentiate dementia from delirium

delirium - fluctuating attention state (confusion with lucid intervals) sleep and wake cycles are also disturbed

best strategy for severe fluent aphasia (wernikes)

demonstrate and gesture to get the idea of the task across bc in wernikes only audtory and spontaneous speech is impaired so visual would be the best route use of a communication board is not needed in this case

phonocadiography

diagnostic test that creates a graphic record, or phonocardiogram, of the sounds produced by the heart and great vessels this supplements auscultation and improves the detection of S3 and S4 heart sounds in the diagnosis of heart failure

locking of jaw associated with

disc displacement

weakness of glut med can happen by..

disuse, superior gluteal nerve lesion or L4-L5 nerve root problems

steroid hormones

eg prostaglandins all cells crerate prostaglandins from the phospholipids of the cell membrane they are unique from other hormones since they do not circulate in the blood adn instead exertt hteir effects only where they are produced prostaglandins are capable of producing a wide variety of effects some effects as it pertains to reehab are releated to inflammation, pain mechanisms vasodilation vascocontrsitciont nutrient metabolism abd blood clotting

lymphadenomegaly

enlargement of lymph nodes which commonly occurs secondary to cancer infections and allerggic reactions

radiation burn

exposure to external beam radiation therapy DNA is altered in exposure tissue sand ischemic injury may be irreverisble complications may incldue severe blistering and desquamation, no nhealing wounds, tissue fobrosis, perm discloration and new malignancies

counternutation

extension of sacrum and anterior rotation of ilium

laxative agents

faciliate bowel evaluation and should be used sparingly promotes defeation side effects inlude ncausea bdomainl discomot cramping electrlyte inlabalce dehyration dependence with prlonged use im for PT if lax just ingest physicla discooromt may empeoratl lite patient pariticpati ni therapy inrevetions ot almay slo exprss conertab aout tx occuring in areas taht do not have asy access to resto citrucel (methycellulose) metamucil *psyllium) colace (docusate) fleet flucerin suppository (glyercin) pphillips milk of mag( mag hydroxide0 correctol (biacodly( senokot (senna)

harsh or inappropriate wound care and healing

failure to use approp technique or best practice interventions in wound care can contribute to wound healing delays vigoroous wound irrigation, aggressive debridement, prolonged whirpool expposre or the use of harsh cleansing techniques and agents can impair healing by ufurther damage to peripheral and granulating tissues

elbow burn

flexion and pronation deformity splint with ugtter splint, conforming splint, 3 point splint, air splint

anterior beck burn

flexion deformity with possible lateral flexion splint with a soft collar, molded collar, philedelphia collar

nutation

flexion of sacrum and posterior rotation of ilium

somatogonosia

impairment in body scheme

laxative

increas eaciton of the intestine or stimaution the addiotn of water to the stool to facilita bowel evaiation

lymphangitis

infeciton of the lumphasit csystem patways

neuroblastoma

initates from primirtie ectoderminal cells of enural plate and is found within the SNS primarily seen in the adrenal glands or parspinal ganglias thi is most malignat tumr seen in cildren adomainl mass chagne in persoanltiy anemia sweating pain and diarrhea surgical resection prgnosisbest with dx in first year of lfie will spntanseously regress in raer cases

asbestosis

interstitial lung disease where there are fibrotic changes within the lungs and PLB will not help

entrapment of the retrodiscal lamina

is painful literally what is behind the disc the back part of the ligament

ST segment

isoelectric period following QRS when the ventricles are depolarized

coccydynia

joint between the coccyn and sacrum can become hyper moile causing stof tussue suring th xoxoxy to beocm painful sublux durin delvity adhereence to tear or episiotomy scar (cut to help child birth) difficult sittgon on hard suface referred pain to the low back SI joint h butt groin or recutm [ pain with bowel movment dusparenunia formation of hemorrhoids HEAT external jot mob meygaical realse msucle enregy tecnique biofedback for levliloof rrealtiaons sral trianing abdomainal strengheign exercis sterghin exercise for sungoing msucles use of ucshio for siting

superficial peroneal nerve supplies

lateral and anterolateral skin of the distal leg and to the dorsum of the foot

QL action

lateral flexion of the vertebral column with ips contraction extension of the lumbar vertebral column with bilateral contraction

sidelying on the R with bed flat helps drain

lingula

hematoma

localized swelling or mass of clotted blood confined to a tissue organ or space usually caused by a break in a blood vessel

central cord syndrome

loss of spinothalamic tracts with bilateral loss of pain and temp, loss of ventral horn with bilateral loss of motor function (primarily upper extrem) preservation of proprioception and discriminatroy sense

beta-adrenergic blocking agent, what happens to HR during exercise

low at rest and rise very little with exercise (blunted repsonse) used for HTN prevent angina pectorsi and prevent certain arrhythmais i..e propranolol, inderal

osteoenia

low bone mass that is not seere rneough to wualify as osteoproos ma not have acutal bone loss but a ntaulaly low one dentiy than stablisb norms

magnetic resonance imaging (MRI)

magnetic field and radio waves create 3D images of the heart and blood vessels to assess the size and function of the chambers, thickness, and movement of the walls, extent of damage caused by myocardial infarction or heart disease structural problems in the aorta (i.e. aneuryms, dissections), and the presence of plaques and blockages in blood vessels MRI is also used to image masses located in the mediastinum, but is of limited value for imaging the lungs

urea

major nitrogen containing end prdicti of prtein metabllism noramlly cleared from the bloody bu the kidney into theurine

procedure of circumfrential measurements

measurements houdl be made on a measuring board measurements hsould be from a standard point of referce on the extmeity that is replicable (i..e every 5 to 10 cm along the exxtremity or a specific distance from a bony prominance) seven circumfreence are recommnended for the upper and lower extremtiies to deduce that the fluid has been removed and not just redistributed

comorbidities and wound healing

medical co morbidities such as CP disease, vascular conditions, and diabetes can signicantly delay wound healing often attributed to poor tissue perfsion which limits the wound ability to sustain cellular activity comorbidities which suppress or compromise the immune system an result in altered inflammatory repsonses and incrraeased risk ofinfcetion

clinical indications for inpatient and outpatient cardiac rehab

medically stable post-MI stable angina pectoris coronary artery bypass surgery percutaneous transluminal coronary angioplasty PTCA compensated heart failure crdiomyopathy heart transplant valve repair, pacemaker, etc. PAD high risk for coronary artery disease with dx of DM, dyslipidemia, HTN or obesity end-stage renal disease****

damage to suprascapular nerve how does it happen

microtrauma from "cocking" activities and follow through results in inflamm and muscle weakness of the msucles supplied

arterial insufficiency what else do you see

nail changes loss of hair pale shiny skin TROPHIC changes

vitamin B3 (niacin)

nefy of metbaolis meats hwole grain swhit lfour pellagra an GI distrub sx incldue aborlam gluc se etabl neauser boting gastic uleration epllega (dementai diarahe dermantisi)

slump test is for

neurodynamics of the spinal and peripheral nerves

hypoparathyroid

occurs to due hyposection or low level production og parathroid hormone bu the parathroudh gan s/s hypocalcemia, neuro signs such as seizures, cognitive defects, short starture, tetany, muscle pain and cramps tx of acute require rapud elevation of serum calcium levels through IV calium long term include pharama and dietyarry managment

SACH foot (solid ankle cushion heel)

often used as a temporary prothesis bc it provides good initial utility at a lower cost provides for sagittal plane motion (primarily PF) but the heel cushion is compressed and there is very limited frontal plane motion (mediolateral)

in children, >95% is considered

overweight or obese

treatment techiqnesu that are not entry levelfor pelvis floor include

perineal massage sar tissue masaafe intravaignal soft tissue massase aka Thiele massase intravaignal trigge rpoit realse and myofacia realse intravaginal self stretching using a dilator prosta massfe use for dysparenia pain ith sex, ulvoduna prostatis interivacysts painul bladder syrndone urgen cu ciga levation ani synro occofynia perineal pain from pegnagncy

autograft

permanent skin graft tkaken from a donor site on the pts own body

medicatin safety

phara consifeta in geti

prcoess meds differnly than younge rsault thereofer an awarensss of te pharmacokinetic an phar

phramcokinetics

procedure for lung sounds

place the diaphragm of the stethoscope in firm contact with the patietns unclothed chest wall start at the apices and work downward, comparing symmetrical points sequentially have the patient breathine in an dout thorugh the mouth, a little deeper than normal listen to at least one cycle of inspiration and expiration in each pulmonary segment if abnormal sounds are suspected.... compare the intensity, pitch and quality of the sounds heard on one side with sounds heard on in the same location as the other side identify the breath sounds as vesicular, bronchovesicular, bronchial or absent by the duration of inspiration and expiration and by the qaulity and pitch note the presence of absence of adventitious (extra)

ankle burn

plantar flexion deformity posterior foot drop splint, posterior ankle conforming splint, anteriore ankle conforming splint

burns over neck, anterior trunk, and shoulders what position should you stabilize them in

plastic cervical orthosis and axillary splints utilizing an airplane position (stresses abduction, flexion, and ER) CTLSO can potentially restrict breathing and does not deal with potential shoulder deformities

lumbrical grip

plate grip

premature ventricular complex PVC

premature depolarization arising in the ventricles due to an ectopic focus unifocal PVCs arise from the same ectopic focus and have the same configuration multifocal PVCs arise from different ectopic foci and have different configurations on ECG the P wave is usually ABSENT and the QRS complex has a wide and aberrant shape bigeminy - normal sinus impulse is followed by a PVC trigeminy - PVC occurs after every two normal sinus impulses common arrhythmia that occurs in healthy and diseased hearts patient may be asymptomatic or have palpitations common causes include anxiety, caffeine, stress, smoking and all forms of heart disease

heraing

progesvie oss of heraing expe is call PRESBYCUSSI hearing lo segn around the 4th deare and acleraret ein the det eath follow tendot have fiul deerentiat betwt sonds they toruble folliwnga conervatio wheehr theya er win crowded rom qhen owrin with pts wth ehralso should reude backrournosei speakd loldyl and slowly and pronount heri wods cafreuflly therapst shoulsatemt ot comucait i low oer ferwnecy range since oldera adual can isn ilower ferqwnies bette rtha nhigher eqnfi tinnitus si antoher commonhearin ipair athat is aascaote diwht increasein age

key functions of the integ system

protection sensation thermoregulation excretion of sweat vitamin D synthesis

osmotic pressure is related to

protein content

neoprene sleve

provides warmth and could be beneficial for an arthritic knee

what does a neoplasm look like on xray

ragged or may appear to have a hole in it

selective debridement

removal of only nonviable tissues from a wound slective bedridement is most often perforemed by sharp depbrid, enzymatic, or autolytic

kdineys

remove water salta dn emtabolic waste from the blood through excretion of urine contonue to hemostatuc include acid base balance, regualtn o fleectrolyte cincentration, control blod volume ad erugalr f BP thorugh the contorl of fhonrelm e secretd itn to the blood stream

biopsy

removel of sampleof tusse taken form the bdy for stus under a microsope

mode of aerobic exercise

rhythmic activities that use large muscle groups and can be performed continuously and safely (i.e. walking, hiking, running, jogging, bicycling, cross-country skiing, aerobic dance/calisthenics, rope skipping, rowing, skating, stair climbing, swimming, and various endurance game activities)

rsik facors for obestiy

sed high lglycemia deit envonrmen smoking stress hist ry of abuse meds tha increas eppetite or food varicng genentic or fmailiar predispotion underling lilne hypothroid polcuhtiic ovary syndrao mcshing parder willis cushing high cortisol

couple motions cervical

side bending and rotation occur in the same direction from C2-C7 regardless of spine position when the occiput side bends, C1 rotates in the opposite direction

AD procedure

sit upright in a chair with back support controlled breathing at 3 lung volumes = 1 - "unsticking phase" slowly breathe in through the nose at low-lung volumes followed by a two to three second breath-hold to allow collateral ventilation to get air behind the secretions, then exhale down into the expiratory reserve volume 2 - "collecting phase" breathe at tidal volume, interspersed by two to three seconds breath-holds 2 - "evacuating phase" deeper inspirations from low to mid inspiratory reserve volume, with breath holding followed by a huff exhalation through pursed lips may be used to control expiratory flow rate an average treatment is 30 to 40 min precaution/contra = requires motivation and concentration to learn

mesh graft

skini graft that is alterd to create a mesh like pattern in order to cover a larger surface area

pharmacodyanamcis

studh pf how a dreug exersi its therpa euc effecs on thebody at th cellualr or ogan gleve relation ship betwen conettaion of the durg to the ridiaul repsont oto drug illcue by age relaed pharmakine cic alterana but also a decreaei of neurotramistters and receptors when tratin ganolde ault therpa must conside taht the same dsogae amout an ditmescheudl ewill lieky produce idfferen efects with diff gae and bdoy copotiojn

zplasty

sx to eliminate a scar contracture incision in the shape of a z allows the contracture to change configuration and length the scar

norepinephrine

target CV and metabolic systems vasoconstrcition in skin, visvera, and skeletal mscles regulated by symphateic impules form the hypothalmus in stress situations

cortisol (glucocorticoid)

target GI system influence metabolism of food molecues antiimflamm effect in large amounts adrenocroticotropic hormone regualtes this

thyroxine (T4), triidothyronine (T3)

target all tissues involved with normal development; increases cellular level metabolism thyroid stimulating hormone regulates

Semi-Fowler's Position

the head of the bed is raised 30-45 degrees

cardiac catheterization

thin catheter inserted into an artery in the leg or arm is advanced to the coronary arteries where a contrast dye is injected the test can evaluate narrowing or occlusion of the coronary arteries and measure blood pressure in the heart and oxygen in the blood some treatments, such as coronary angioplasty, are performed using cardiac catheterization

LE lymph drains into

thoracic duct

heel nerve pain what nerve is damaged

tibial

capsular tightness in TMJ which way does it deviate with opening

toward the side that is tight with opening BUT lateral deviation would be limited away from the side of restriction

triggers of freezing gait include

turning, changing direction, doorways

chronic prostatitis

urgent, painful urination and pain around the base ofhis penis and behind scrotum flutates for months (in the case) but the pain is now severe, rated 7/10 pt may also experience pain after ejaculation, blood in semen, rectum pain, urinary blockage, and UTI ACUTE bacterial prostatitis have many of the same sx (this is the answer I picked) BUT comes on quickly and is typically accompanied by high fever, chills, and muscle aches chronic prostatitis or chronic pelvic pain syndrome have been linked to autoimmune disorders (chronic fatigue syndrome) and IBS

PT and behavior modification for TBI

use frequent reinforcements for all desired behaviors negative behaviors should be ignored not reprimanded

how to help with festinating gait

use of a toe wedge (would help displace the pts COG posteriorly due to their forward lean)

heavy metal comounds

used as antieoplastic agents aka platinum coordination cmpelx act as alkyating agents that inhibit DNA tarnastin and replcaiotn s epithelail malignacnies overaian testibu bladder multis stem inovlement camcerm [aom platinol (cisplatin) paraplatin (carbplatin) eloxatin (oxalliplatin)

fecal occult blood test

used to chest a stool somaple fo blood

mckenzie side glide test

utilized to determine if a disc dysfunction with nerve root involvement is present vs postural disorder This exercise is typically applied to one sided back/leg symptoms or asymmetrical symptoms that fail to central use or reduce with extension procedures including extensions done with a modified lateral starting position against wall lateral shift nonpainful side closest to the wall slide hips towards the wall if manual you pull the hips towards you

hautants test

utilized to differentiate between a vascular dysfunction in the vertebrobasilar system and a dysfunction of the vestibular system Test findings: Positive if the patient reports vertigo and dizziness, or the examiner observes drifting of one of the arms. If positive, the test is stopped immediately. Signifies compromised arterial supply to the brainstem implicating the vertebral arteries. Also consider the possibility of vestibular disease.

wound cleansers

vary from simple saline solutions to more complex compositions with cytotoxicity many wound cleansers have the potential to cause inflammation, however, this quality is produce depending wound cleansers are not typcially designed to remove nectortic tissue but rather associated wound substances such as foreign materaial exudate and dried blood

ventricular fibrillation (v-fib)

ventricles do not beat in a coordinated fashion but fibrillate or quiver asynchronously and ineffectively no cardiac output, patient becomes unconscious ECG shows characteristic fibrillatory waves with an irregular pattern that is either coarse or fine a LETHAL tachyarrhythmia requires immediate defibrillation additional measures include medications to support the circulation and intravenous antiarrhythmic agents common causes include heart disease of any type, MI, and cocaine use

QRS complex

ventricular depolarization and atrial repolarization normal duration is 0.06 to 0.10 seconds

thessaly

meniscal 1 foot 20 degrees

macronutrients

ntient tah have calcori calue th prid ebpdya with energy make up a grate rmpotion of our dsince they are need in large amountn carbs fat protein

oliguria

inadeuate urin out put in 24 hour period less than 400 ml (acute renal falrue and DM)

Gout

Typically affects 1st MT but can be seen in knee or wrist Limited to only a few joints

drop arm vs empty can

drop arm assess RC as a whole empty can more specific for supraspinatus

age and wound healing

epidermis thins and flattens as part of the aging process making it more fragile and susceptible to injury from friction and shear decreased metabolism in older adults is also correleated with a decrease in the overall rate of wound healing

femal genital system

external genitalia - mons pubis, labia majoria, labia minor, clitoris, vesibulate of vainga, bulbs of vvestible, greater vestibular (bartholins) glands skenes gland (provides procectiona n hydration of vaginal tissues and urtethra) vagina - msucuolemembranous tube connected ot the cervix (receptacle for male sperm, brth canal, excretoru duct ofr menstal fluid) uterus - hollow msucular organ (houses the fetus during devlepoement uterine tubes - extended laterally from the ovearies to the uterus (provides reanpof rthe ovum frotm th ovary for fertialzation and implantation within the uterus) overaies (alomond shaped flands suspended in the braod ligaments (produce hormones such as estogen and progesterone, storage of ooxcytes prior to ovulation)

example of an out of synergy pattern

high kneeling position (i.e. hip extension and knee flexed to 90)

opisthotonos

hyperextension of neck and spine with both LE flexed and the heels touching the butt

impotence

impairmetn with ejaculation rgams erection and or libido

medical manangemnt of obesity

imperateve weight loss

ideational apraxia

inability to perform a purposeful motor act either automatically or on demand

indirect lymphography

injection of a contrast medium water soluble just under teh skin to allow for visualzation of the smller superfial lymph vessels

assessing protective sensation

loss of protective sensation in individuals with peripheral neuopathy can sig increase the risk of tissue damage monofilament testing@ reliable method of assessing and documetning chagnes in protective sensation holdin place for 1 second with enough force to bend the filament into a C shape failure to percieve the application of a 10gm monofilament indicates a loss of protective sensation (i.e. inability to feel a small pebble in a shoe or a develpoing blister) and place a patient at increase risk for develpoing a neurpathic ulcer failure to percieve a 75 gm monofilaament indicates that an increase in INSANSATE

normal tracheal and bronchial sounds

loud, tubual sounds normally heard over the trachea inspiratory phase is SHORTER that the expiratory phase and there is a slight pause between them (bronchial sounds heard over distal airways are abnormal and represent consolidation or compression of lung tissue that facilitates transmission of sound)

urge incontinence

overactive bladder often a result of hyperreflexia and may be see in neuro disorders including stroke, parkinsons, and MS exercises may be prescribed for these pts but not as often as stress incontinence

pleuroscopy

procedure that includes examination of the lung surfaces, pleura, and pleural space using a small video camera inserted between the ribs into the pleural space a tissue sample may be taken to biopsy

coversion disorder

pshcyi comaonts of neuro basis wit ho dnerlyin caue araysis is the mots cmmonf ing other snfinf inclue deafness blindness arrestheia flreund beve this is metnal acitye trasmored into ohysica sx diagnossi can be madeon ce testign is negativ for physical aligment

schizophreia dorser

psychotic in ature pand perst iwth odisan thogh ahallc meoton anciety perceto turam geneetic hicemimabalc enron emn flue c

rehab consideration for pt with cirrhosis of liveer

recogni that acite may deveop as well asfludid accmlation in the ankle and feet report any blood loss through nose bleeds gm bleeds tarry stolls or excessive brysoiing avoid all activies that produce the valsval manuever adwaute rest is reuqir eto lvoew th demands on the lvier adn iprove cfruation a avoiid auncessary gaitgue with tehraputuc or daily activies

compression garments

reduce typertrophic scarring is typically recommended for burns requrinign greater than 14 days to heal use of sustained compression from 15 to 35 mmhf is beleived to create an envirnomental that facilataes the balance of collagenn syntheis and lysisi improved scar strucure compression is applie db custom masde garmets worn 22-23 hours per day until the scar has matured silicone or foam insets may be necesary to proived sufficient pressure over small area or concave surfaces for optiaml effect it is recommended theat the use of comproesssiongarmets begin betweent wo weeks and two monthas fter wound closrre or grafting continuenf for up to 2 years

circumfrential thoracic burn would do what to breathing

restrictive so is a rib fx

antisocal behavior

restuls from patitcualr caues ne dfro attention or invoement ina gang typcally some coner for toehrs blamdes other intta fmaily shcool for their actions sx seen ebfore 16 viatalets ther ights of otehrs lacks respornes iabiand tuonam stabilit

pt falls onto shoulder, no dislocation, no fx, AROM is 35 and PROM is nearly full with mild pain and muscle guarding, resisted abduction is weak and painful, no atrophy, what is the most likely diagnosis

rotator cuff tear would be provoked by resisted testing because it is a contractile lesion, the pt would not be able to raise the arm over head because of lack of force transmission secondary to the tear...also the mechanism of injury (trauma) can also cause a tear vs supraspinatus tear would still be able to raise overhead but would be painful and it is typically caused by overuse adhesive capsulits would only have a little more passive than active bc its the capsule axillary nerve palsy is typically caused by a DISLOCATION and would cause marked atrophy which is not this case

pt recovering from burn of leg, find local tenderness with swelling and pain on movement in the hip area WHAT IS THIS and what should you do

s/s consistent with heterotopic ossification report these findings promptly to the physician

dehiscence

separation rupture or splitting of a wound closed by primary intention may be superficial or involve dall layers of tussue

vertebral artery test if positive which artery is impacted

the opposite side of the lateral flexion and rotation

the hand is mainly innervated by what nerve

ulnar nerve "ulnar nerve dominant" bc most of the hand instrinsics are innervated by the ulnar nerve all other hand intrinsics (only 4 others) are innervated by the median nerve those 4 by the median are: abductor pollicis BREVIS opponens pollicis 1st and 2nd lumbricals

polypharmacy

ult p meds rationl and iration rational takae muslt to tratmtult medics issue or to trat ea single med where the drugs work toegtehr irration occurs when execsiv eduplate or containdaiac temd are prescito to teat e emedical condition

urinary anti infective agents

treat UTIs but are not tradition antibiots or sulfonamide agents agents can ebs sued indeent or in combo indciated in cystitsi (baldder infmal) uregeny bringin wit hurtion uti ncotura GI dsitess nausea dizzines phot sens headache contation rach do not typically interfeer with rehab cinobac (cinoxacin), furadantin (nitrofurantoin)

clinical contrainidcations for inpatient and outpatient cardiac rehab

unstable angina resting systolic pressure >200 or resting diastolic >110 orthostatic BP drop of >20 with sx critical aortic stenosis acute systemic illness or fever uncontroled artial/ventricular arrhythmias 3rd degreee AV block without pacemaker active pericarditis or myocarditis recent embolism thrombophlebitis resting ST segment depression or elevation >2mm uncompensated congestive heart failure orthoped or metabolic conditions that would prohibit exercise

antidiarrheal agents

used to slow the serious debilitation effects of dehydration associte dwith prlonge dirreah side effects is sconstipation abdomina ldicomfrot imp for PT well tolerated pt are more likleto to particpate donnagel (attapulgite) kapectolin (kaolin) peptobismol (bismuth subsalicylate) motofen (difenoxin) imodium (loperamide)

hypofuncton of an edocrine gland

usuallt seocnary to the undersimauton of the pit gland this can also ocru from conetnal or acquire disorferw

aldosterone (mineralcorticoid)

target kindeys increases reabsorption of sodium ions by the kidneys to the blood increases excretion of potassium ions by the kidney into the urine low blood sodium levesl and high blood potassium levels regulate this

Thyrotropin-releasing hormone (TRH)

target pituitary gland increases the release of thyroid stimulating hormone central nervous system feedback and cirulcating levesl of hormone

luteinizing horomone

targets ovaries and testes promotes ovulation along with estrogen/prgesterone synthesis from the corpus lutum in females promotes tesrereotn esyntheiss in males hypothalamus regulartes

infants and color

Newborns can only focus about eight to 12 inches from their face, and they see only black, white and gray. ... As their color vision begins to develop, babies will see red first - they will see the full spectrum of colors by the time they reach five months of age.

anterolateral (spinothalamic) pathway

Pain and temp

Similarity between supraspinatus tendinitis and subacromial bursitis

Painful arc from 60 to 120 degrees

scar massafe

friction massafe is advocated to loosen adhesions between cutaneous scar tissue and underlying strcutures reported benefits include decreased sensitivity and iprive pliatilt caition should be taken not to bein scar massae too soon or too affersviely due o the risk fo causing reinjry or reintiating the infalltory ohase of healing massage tehanidh should be slow and firm usnig perpendicualr parallal aicralran a or rolling strokes to mobilzie tissue layers

viatmin B12 (cobalamin)

fucntona f al cells and adis in mhempli synthesis meats whoel eegs and egg ols pernincoius anemian and psch no toity

endometrium

innter lining of the uterus taht is shed month in reposne to hormonal infleucec

fecal incontenc e

insatbialti teo reaitna stool recaitn leadkage of stoo lfrom srectum

laceration

acute wound wound or irregular tear of tissue often associated with trauma can result from shear, tension, or high force compression wiht the resultant wound characteristisc dependent on the MOI

bladder pathology

cytocele (bladder hernia or prolapse) dysurina hematuria uintersitail cystitsi (bladder pain syndrome) neurogenic bladder flaccid or spastic nocturia freq urination at night polyuria urgency frequency urinar incinten UTI

mesentery

fold of the peritoneum that carries blood vessels nad lymph gland and ataches various organs to the abdominal wall

integ injury and autonomic dysreflexia

ingrown toenails, burns, pressure ulcers, blisters, and other integ trama can trigger an episode of AD when occuring below the level of the apteitns SCI if sx do not being to resolve after the pt has been assisted into a sitting psition with catheter obstruction ruled out, the therapist should activate the emergency response system and being to assess for other potential sources of noxious stimuli

polyuria

lage colue of urine exrected at one time DM chronic renal faulreu

ulver

open sore or lesion of the skin acocompneid by slugihing or inflamed nectocit tissue

cirrhosis s/s unqiue

pain is not usually a complaint if the patient has ascites they may report discomfort but not so much pain

female hypogonadism

primaru reslts if the gonad does not produce the amout f sex sterod sufficent to suppress secreton off LH anf FSH at normal leveles the msot common cause of priamru is turner syndrome (female only born with 1 x chronomose) secondary occurs when there s a failure of the hypothtalmus or pitutary to produce the hromones taht subesetaqlt stimulate the prodction fo estrogen if a female expeirnce this prir to puberty sx will incldue gonaldoal dusfenesis a short statuere failure to proress through puberty or prmary amenorrhea and premaure goonaldal fairelu when it occurs in postpubescent, seconary amenorrhea (absence of menstraution) is thepaumry sx

supine, UE PNF lift and reverse lift patterns using rhythmic initiation can be used to improve

rolling in patients with PD

growhth hormone

target bone and msucle promotes growth and development increases the rate of protein synthesis hypothalamus regulates this

bheavioral therapy

typcialyl som epsych infleunce long term outomes imroved idivual or support gourp formations stimuls controlgoa lsetting probemk slingn social suport self monitorin of eity tinatk ean dPA if want to do bariatric surgery must particapte in some form of beahraoa coueling prior to surgery

hiatial hernia

when part of the stomach protrudes through the diaphram into the thoracic cavity

lymphoscintigraphy

injection of radioactive materal that allows for viualiztion of the lumphatc system through nucelan medial imaging traced through thre sytsem toe derein ehow effeitel lyph is being transported preferred over driect lymphography since there are fewer complications

cognitive stage what are good strategies

mental practice and breaking down the task into components

STDs that can cause swollen lymph nodes

chlamydia gonorrhea if stayed swollen for 2-3 weeks then referral to a physician would be in order

diminished pulses may be suggestive of...

chronic arterial insufficiency

mainia

contalt actie umises imemdaitel expressed nrealiz aciity elatina dn self conite disagereement with a pt may prodcue pt afferssin disorgnithrough s pseech fvery few pt sar difan wtih only amani dosorder

if the diaphragm is paralyzed what muscles should you strengthen

accessory muscles of INSPIRATION aka scalenes and SCM not the abs (TA, I/E obliques) because those are accessory for EXPIRATION which drive intra abdominal pressure up when they contract and thus push the diaphragm, raising pleural pressure which raises alveolar pressure which in turn pushes air out and they would not help with inspiration

metaplasia

change in a cell from onet ype to antoher that may be fnoram or abonral

contamination vs colonization vs infection

contam - presence of non replicating bacteria on a wound surface that causes no additional tissue injury and does not stimulate an inflammatory immune response colonization - presence of replicating bacteria on a wound surface that does not invade or futher injure tissues and does not stimulate an inflammatory immune reopnse (can delay healing, however, colonized bacteria occasionally benefit the wound by preventing more virulent organisms from proliferating in the wound bed) infection - presence of replicating bacteria that invades viable tissue beyond the wound surface causing a visible inflammatory immune response, infection will delay wound helaing significantly and if untreated can progress to sepsis, osetomyelitis, and gangrene

wheeze

continuous "musical" or whistling sound composed of a variety of pitches heard during both inspiration and/or expiration but variable from minute to minute and area to area arise from turbulent (moving unsteadily or violently) airflow and the vibrations of the walls of small airways due to narrowing by bronchospasm, edema, collapse, secretions, neoplasm, or foreign body

stridor

continuous high-pitched wheeze heard with inspiration or expiration indicates upper airway obstruction can be caused by croup or aspirations

angiotensin-convertig enzyme (ACE) inhibitor agents

decrease blood pressure and afterload by suppressing the enzyme that converts angiotensin I to angiotensin II used for hypertension, congestive heart failure side effects include hypotension, dizziness, dry cough, hyperkalemia, hyponatremia avoid sudden changes in position, patient with heart failure should avoid rapid increases in physical activity i.e. capoten (captopril), vasotec (enalapril), prinivil (lisinopril), altace (ramipril)

exercise stress testing

used to assess the patients ability to tolerate increasing intensity of exercise while ECG, BP, HR, and symptoms are monitored for evidence of myocardial ischemia, abnormal electrical conduction, or other abnormal signs and symptoms of exertion they may be used to evaluate disease severity and prognosis and to determine functional capacity, especially for exercise prescription and counseling a number of exercise protocols are avail using a treadmill, cycle ergometer, and UE ergometer

Wound with hydrocolloid dressing, PT noticed strong odor and wound drainage that is yellow, what do you do

Changed the hydrocolloid dressing (typically changed every 3-5 days or when drainage leaks out) An odor and yellowish color is to be expected as the dressing material melts

Spinotectal tract

Convey info for spinovisual reflexes

capsular pattern of GH joint

ER>ABD>IR common with diabetes mellitus

pharma

FDA approved pahrma weight loss agents for short term adjust with diet activyt hav eheorhnal mods appettie spprestna lipsase inhibior so you dot digest fats and store it? funcde felinsg of huner or incras felings of lnes not apprive d by fda but antidepres seizu rand adibets med can presbecib in short term to assist in weight oss goals

GENE

FUNDAMENTAL UNIT OF HEREDITY

What impairments can come with W sitting in a child with Down syndrome?

Femoral antetorsion and medial knee stress Because it is a stable and functional position (despite the consequences) low muscle tone children that have difficult achieving sitting are reasons why these children choose to sit in a stable W

Exaggerated flexion synergy during gait looks like...

Flexion, abduction and ER at the hip when the leg is lifted

tuberculosis BRONZE

HIGHLY CONTAGIOUS infectious diseae spread via airborne transmission primarily caused by the mycobacterium tuberculosis bacteria multiple antibiotic ressitan strains of the bacteria have been identified pts with latent strains of the bacteria have been identified pateints with latent TB are infected however they are NOT contagious and produces no sx active TB will produce sc and may develop from the latent bacteria or from a recent exposure to a contangious indidivaul typically affects the lungs, less common infection site sinclude the brain, spine and kidneys with each producing different clinical sx pts with a weakened immunse system are most likely to contract TB TB in lungs sx - fever, chills, fatigue, weight loss, decreased appetite, and night sweats are also common complaints of persistent cough for greater than 3 weeks, bloody sputum, and chest pain associated with deep breathing or coughing may be present ABNORMAL LUNG SOUNDS suggestive of pleural effusion and enlarged lymph nodes which may be tender with palpation CLUBBING of the digits may also be observed in advanced cases pts who have been on appropriate pharma regimin for AT LEAST TWO WEEKS are no longer considered contangious most recover from T without long term effects however untreated TB can spread to other areas of the body and become fatal TB is typically diagnsed based on the results of a skin test, a small amount of the substance tuberculin is injected at a forearm site and the skins reaction is then assessed 48 to 72 hours later diangostic tool is however know to produce false results esp in patietns who have preiously had a TB vaccination or have recently been infected UNIQUE RISK FACTORS = occupational exposure has ever lived or visited abroad

procedure for palpating pulses

HR and rhythm as well as the blood flow in the extremity, are assessed by palpating over the artery with the tip of the index or middle finger with enough pressure to feel the pulse but without obstructing blood flow common arteries used include brachial, carotid, dorsal pedal, femoral, popliteal, post tib, radial and temporal note the time between pulsations regular rhythms count the pulses in 15 seconds and multiply by 4 for irregular rhythms count the pulses in 60 seconds note the volume and quality of the pulse and any differences between the pulses in the two limbs

How do vitals change when using UR ergometry

Higher HR and higher systolic and diastolic BP BUT WILL HAHE LOWER MAXIMAL OXYGEN UPTAKE bc uses smaller muscle mass

CPRS early signs

Hyperalgesua allodynia and hyperpathia (increased intensity) with edema, increased swearing and thin, shiny skin Later signs stage 2 is increased pain with edema and atrophic skin and nail changes Late signs stage 3 is spreading pain, hardening of edema, cool, dry, and cyanotic skin, developing osteoporosis and ankylosis

large intestine (colon) pain

IBS Poorly localized to the mid abdominal area Pain can be referred to the sacrum

coditions assocated with diarrhea

IBS hyperthyroid electtolyte imabalcne endocrine disorder imcomplete obstruction of the bowel diverticulits certian med caffeine diet malabsorption pelic inflamm

guillain barre

LMN that produces symmetrical and ascending signs

clubbing

Lung cancer is the most common cause of clubbing. Clubbing often occurs in heart and lung diseases that reduce the amount of oxygen in the blood. Clubbing is usually seen in individuals who have coexistent pulmonary or cardiovascular diseases, such as: Lung cancer (the most common cause of clubbing) Interstitial pulmonary fibrosis Lung abscess Pulmonary tuberculosis Pulmonary lymphoma Congestive heart failure Infective endocarditis Cyanotic congenital heart disease Bronchiectasis Cystic fibrosis

most effective imaging for MS

MRI highly sensitive for detecting MS plaques int he white matter of the brain and spinal cord lesions are bright spots with increased signal activity

Mouth closing

Masseter Temporalis Medial pterygoid Lateral pterygoid

1st CMC concave in what plane

Medial/lateral

Nerve tissue

Neurons nerve fiber densities glial cells Brian nerves slincord retune Astocytoms Gloomy Nerilemma Satcoms Beurombladtoma Retinoblastoma

Does the diaphragm facilitate coughing?

No

Is percussion and shaking contraindicated in TBI?

No but important to consider it may be agitating to these patients

METABLISM

PHYSICAL AND CHEMICAL PROCESSESOF CELLS BRUNING FUEL TO PRODUCE AND USE ENERGY EXAMPLES INCCLUDE DIGESTION ELINATION OF WASTE BREATHING THERMOREGULARION MSUCAULAR CONTRACTIO NBRAIN GUNCTION AND CIRUCALTION

posterior basal segments left and right lower lobes drainage

PT is on same side pt is in prone with the foot of the bed elevated 18 inches percussion and vib are perofrmed over the lower ribs on the left and right side of the chest

right middle lobe drainage

PT on opposite side patient is turned 1/4 from supine on the left side with the foot of the bed elevated 12 inches percussion and vib are performed over the right chest bewteen the axilla and right nipple

lhermittes sign

Patient is long sitting on table. Passively flex patient's head and one hip while keeping knee in extension. Repeat this step with other hip (+) TEST: pain down the spine and into the UE or LE OCCURS MAINLY IN MS PATIENTS, can also be seen with cx tumors or myelopathy

stork standing test

Patient standing on one leg. Cue patient into trunk extension. Repeat with opposite leg on ground (+) TEST: pain in low back with ipsilateral leg on ground identifies spondylolisthesis

Foot pronation aka

Pes planus Pes valgus Flat foot Foot is in probation at the subtalar joint duringwieght bearing Associated with forefoot VARUS

Risk factors for osteoporosis and common sx

Postmenopausal Low body weight Loss of height Sedentary lifestyle Tobacco use Hyperthyroidism (graves) Severe and localized thoracic/lumbar back pain Increases pain with prolonged upright posture Decreased pain in hooklying Loss of height Kyphosis (dowagers hump) Pain is likely due to compression fractures which can be confirmed on X-ray Osteoporosis itself is confirmed with a bone density scan

enzymatic debridement

SELECTIVE refers to the topical application of an enzymatic preparation to necrotic tissue can be used on infected and non infected wounds with necrotic tissue used for wounds that have NOT responsed to autolytic debridement or in conjunction with other debridement techniques can be slow to establish a clean wound bed and should be d/c'd once devitalized tissue is removed to avoid damage to adjacent healthy tissue

sharp debridement

SELECTIVE requires the use of scalpel, scissors and or forceps to selectively remove devitalized tissue, foreign material or debris from a wound most often sued for wounds with large amounts of thick adherent necrotic tissue however it may also beused in the persence of cellulitis or sepsis sharp debridement most expedient (beneficial, efficient, convient) form of removeing necrotic tissue PTs are PERMITTED to perform sharp, selective debridement as a procedural intervention

autolytic debridement

SELECTIVE use of the bodys own mechanisms to remove the nonviable tissues common methods include the use of transparents films, hydrocolloids, hydrogels, and alginates it establishes a MOIST wound environment that rehydrates necrotic tissue and eschar, facilitating enzymatic digestion of the nonviable tissue this tpe of debridement is non invasive and pain free can be used with any amount of necrotic tissue however requires a longer healing period and SHOULD NOT BE PERFORMED ON INFECTED WOUNDS (but there are expections i.e. alginate)

cluster for SI dysfunction

SI gapping, SI compression, thigh thrust test (P4), sacral thrust, and gaenselen's test if these 5 are clustered together and 3/5 are positive, HIGH DIAGNOSTIC ACCURACY

Pancreatitis pain

Severe epigastric pain (midline or to the left) just below xiphoid Pain is referred to the middle or lower back and rarely the upper back

Yergason's Test

Tests for the integrity of transvere ligament and may also identify bicipital tendonitis "This test is used to check the ability of the transverse humeral ligament to hold the biceps tendon in the bicipital groove.

gillets test

The Stork test, also known as the Gillet Test, assesses the movement of the SIJ between the innominate and sacrum through the clinician's palpation, which may be a useful test for clinical evaluation of a subject's ability to stabilize intrapelvic motion palpate PSIS should be at level of S2 ask pt to flex hip and knee to 90 in standing and the PSIS should drop below S2 if normal

EMG is used for documenting...

The role of muscle in physical activity The different types of peripheral nerve injury (neurapraxia vs axonotmesis vs neurotmesis) Impairment of muscle recruitment in polynueopathy

Show teeth and puff cheeks what CN

VII 7 facial

Raynaud's disease

Vasospastic disorder characterized by I/M episodes of small artery construction of the digits of the fingers (rarely in toes) causing temporary pallor and cyanosis Caused by hypersensitivity of digital areas to cold (not tactile stimulation) Not associated with a loss of proprioception or tactile discrimination

ventilation and perfusion scan

Ventilation and perfusion scans are diagnostic procedures that can be used to measure gas distribution within the lungs. These scans are often indicated to rule out a pulmonary embolism. A normal ventilation scan combined with an abnormal perfusion scan is a strong indication that a pulmonary embolism may be present.

What is the approximate percentage of oxygen available for breathing at sea level?

What is the approximate percentage of oxygen available for breathing at sea level? 10 percent 15 percent 21 percent 25 percent Correct Answer: 21 percent Atmospheric air is a mixture of gases containing approximately 78% nitrogen, 21% oxygen, and 0.03% carbon dioxide.

What is the primary purpose for using an intra-aortic balloon pump? increase cardiac index facilitate cardiac output monitor left ventricle pressure administer medications

What is the primary purpose for using an intra-aortic balloon pump? increase cardiac index facilitate cardiac output monitor left ventricle pressure administer medications Correct Answer: facilitate cardiac output An intra-aortic balloon pump (IABP) is a balloon catheter placed within the aorta that inflates during diastole and deflates during systole. This results in increased coronary artery perfusion and decreased afterload. The IABP facilitates cardiac output, increases coronary artery perfusion, and decreases myocardial oxygen consumption.

lipedema (painful fat syndrome)

a chronic abnormal condition that is characterized by the accumulation of fat and fluid in the tissues just under the skin of the hips and legs Looks like lymphedema but no skin changes (no thickening) Pain and bruising are prominent features No swelling in the hands or feet

moisture and occlusion

a dry wound bed slow normal metabolic functions, impeding the healing process dry peripheral tissue are at risk for developing cracks or fissures that can become open avenues for infection conversely, prolonged excessive mosireu (i.e. from poorly managed exudate or incontinence) will cause maceration damage and erosion of intact periperal tissues in an appropriatelt moist, wound environment, macrophasges appear earlier and in greater numbers helping to reduce the risk of infection collagen synthesis and epithelaization rate are enhanced, facilitaing more rapid wound closure in exudating wounds, moisture must be well manged to prevent damage to surrounding tissues in dry wounds mosture must be added in order to maintain hydration and sustain cellularn activity maintaining an apprpo mooist wound be drewuire a delicate balance often necessitating speialized dressing to apprp manage exudate and provide some level of occulusion occlusion refers to the ability of a dressing to transmit moisture, vapor or fases between a wound be dand the atmphsere a fully occlusive substance woud be completely impermeable (i.e. latexx glvoes) whie a nonocclusive substance owuld be compelte permean (i.e. gauze pasds) wound dresing are tpically classficied accoridng to this occlusion cotumuum or b their motisure tetention porpoerties

during exercise testing, a systolic blood pressure that fails to increase or decrease with increasing workloads may signal...

a plateau or decrease in CO

lung volume reduction surgery

a portion of the lung tissue damaged by emphysema is removed, this creates extra space in the chest so that the remaining lung tissue and diaphragm work more efficicently, enabling the patient to breath more easily

hallpike-dix test can also be called

a positional test

carotid ultrasound

a procedure that uses sound waves to examine and visualize the structure and function of the carotid arteries purposes are to screen for bloackages that may indicate an increases risk of stroke and to evaluate the placement of a stent or the function of the artery after carotid endarterectomy

bronchial breath sounds

abnormal breath sounds when heard in locations where vesicular sounds are normally present pneumonia may produce these sounds

crackle (formerly rales)

abnormal, discontinuous, high-pitched popping sound heard more often during inspiration may be associated with restrictive or obstructive respiratory disorders typically represents the movement of fluid or secretions during inspirations (wet crackles) or occurs from the sudden opening of closed airways (dry crackles) crackles that occur during the latter half of inspiration typically represent atelectasis, fibrosis, pulmonary edema or pleural effusion crackles due to the movement of sectretions are usually low pitched and can be heard during inspiration and/or expiration like the sound of hairs being rubbed together between th thumb and finger pulmonary edema may produce fine crackles as air bubbles through fluid in the distal small airways often heard in the bases of lungs with interstitial lung disease, atelectasis, pneumonia, bronchiectasis, and pulmonary edema

apnea

absence of spontaneous breathing

decreased or diminished sounds

absent lung sounds may indicate pneumothorax or lung collapse

colorectal cancer

accounts for approx 15% of cancer deaths annually adenocarinoma and primaruu lyphoma account for the majority of intenstinal cancers risk factors includde increassing age hsitory of polyps ulcerative colitis chons disea afmily histr nd diet high in fat and low in fiber ss does not provide early signs of sdiseae and the msot prominent sx is a continous chagne in bowel habts bright red blood from the rectum is another prominent sign of color cancer pt may experience sx of fatigue weight loss anemia and overt rectal bleeding

ionto for the management of calcific bursitis using the acetate ion

acetate ion has a negative charge thus a negative pole will be needed to repel the drug into the tissue direct current will continuously drive the acetate into the tissue during the treatment time

mediate percussion

act of tapping the surface of teh bdoy to identify area of altered density percuss the abck with the patient sitting and the anterior chest with the patient sitting or supine facing the patient place the palmar surface of the middle finger of one hand firmly against the chest wall in the intercostal space parallel to the ribs; other fingers remains off the chest strike this finger witha quick, sharp blow using the middle finger on the other hand two or three consecutive blows are strunk in one plce, before moving the finger to antoher intercostal space compare the sounds from each space from left and right sides interpretation = percussion sounds are elevated for loudness (intensity) and pitch unilateral abnormalities are easier to identify than bilateral abnormalities because there will be a difference in the sounds from side to side the percussion sounds progress from tissues of high density to tissues of low density in the following sequence: flat or dull - sounds elicited by percussion of the thigh muscles; in the upper lung, suggests neoplasm, atelectasis or consolidation of the lung resonance - percussion sound from the normal air-filled lung hyperresonance - intermediate sounds between resonance and tympany; percussion note emitted by the emphysematous lung (hyperinflated?); suggests pulmonary emphysema or pneumothorax (complete collapse) tympany - hollow sound vaguely resembling a drumbeat, occurs almost exclusively with a large pneumothorax

hypovolemic shock situation

activate the emergency medical system lie supine with the legs elecated approz 12 inches in situations where it is tolerated control bleeding and attempt to restore blood volume (IV or blood)

psoas sign

acute appendicitis extension of the right hip with the patient lying on the left side

obturator sign

acute appendicitis internal rotation of the right hip and knee flexed to 90 this muscle may come in contact with an inflamed appendix eliciting pain which helps to substantiate (prove) a possible diagnosis of appendicicts

markles sign

acute appendicitis patient stand on his toes and drop to his heels suddenly

what are modalities and mobilization generally used for

acute pain chronic pain usually demand more long-term management (but will still probably use one of them just wont be the focus)

avulsion

acute wound aka degloving serious wound resulting from tension that causes skin to become detached from underlying structures

penetrating

acute wound results from various mechnisms and is described as a wound that enters the interior of an organ or cavity

prostate cancer

adenocarcinoma is the most common type of prostate cancer affects men over 50 yeras old it is second highest cause f dearth from cacner in mend dx is fond trhough prostate biopsy and prognosis is good with appropriate tx arpxx 10% fatality from this diagnosis risk factors inlcude incrasea ge high fat deit genetic AA epsure to camium Cadmium is a silver-white metal that is found in the earth's crust. It is extracted during the production of metals such as copper, lead, and zinc. Cadmium is found in some foods and is emitted by using fossil fuels such as coal and oil, smoking cigarettes, and burning waste. ss asymptomatic until the cancer reaches advacned stages sx include urinary obstruction, pain urgency and decreased sream or flow tx surgical inscision of prostacte galan ration hormonr thepreay can metastasize ot ht e ladder smk system lungs and lymph nodes

MRSA infection in outpatient what do you do

adhere to the precaution that an open wound must be contained within a dressing spread by contact wash hands (standard germicidal cleaning measures) PT should be gloved for any direct contact with the patients intact skin or surfaces or articles in close proximity to the patient all equipment must be clearned with an approved germicidal agent before and after use isolation in a private room is not required but in ambulatory settings, the patietn should be placed in an exam room or cubicle as soon as possible, treatment in an open gym is INAPPROPRIATE for patients with MRSA

nitrofurazone

adv = BACTERIOCIDAL broadspectrum disadv = may lead to overgrowth of fungus and psedomonas painful application

silver nitrate

adv = borad spectum non allergenic dressing application is painless disadv = poor penetration discolors making assessment difficult can cause severe electrolyte imbalances removal of dressings is painful

INITIAL intervention when pt who smokes is admitted to the hospital with signs of lung infection

airway clearance and secretion removal important to assist with secretion clearance to assist with recovery and improve gas exchange encouraging the pt to quit smoking and do inspiratory muscle training would be best timed AFTER the acute infection has resolved

pelvic diaphragm

aka alevator ani pubococcygeus puborecatlis illiococcygeus and coccygeus (ischiococygeau)

tinea pedis

aka atheletes foot superfial functonl infecton which causes epiidermatl thickening and a scaly skin appearnce fungus is opptounistics and will radily molti in a warn and bousot inven akak between toes risk facros inldudnig wearing closed toe shoes that doesn alloai ireaflow, perilong eriods of moistero owr wellntess excesive sweate posesssein gsmall nail or skin abrainsiosn contaigious thoruhg dection or when maing contact with a surface ocotnaing the tinea pediinfection s/s inteching rednes peignl skin between the teos pina odor and in more sever acases breaks in skin continutu pharma intervention incldues topical or oral antibios depending on the severity of sx may persist por reuc aomre long rem may be resu prevention in cldues throuo dryin gof feet wehen abtihn go rsweining wearn sandal around pubic ppors or shouwers chaingin socks ferqwnly poreoper hyeorhe an daocidirgn shoe ear rthah create a moitn invetment

aerobic exercise

aka cardiorespiratory endurance exercise submax, rhythmic repetitive exercise of large muscle groups during which adenosine triphosphate is synthesized primarily by the long-term energy system and the utilization of inspired oxygen indicated in reduced CR endurance primary and secondary prevention of CV disease precautions/contra = appropriate screening or health appraisal should be performed prior to beginning exercise training to identify known diseases, risk factors, for coronary artery disease, and other factors that will optimize adherence, minimize risk, and maximize benefits avoid valsavla maneuver

pressure ulcers

aka decubitus ulcers result from ssustained or prolonged pressure on tissue at levesl greater than that of CAPILLARY pressure skin covering bony prominances is particular susceptible to localized ischemia and tissue necrosis due to perssure pressure injuries to deeper tusses may initially present as bruising or purple blisters under intact skin before opening to reveal full thickness damage factors contributing to pressure ulcers include shearing forces, moisture, heat, friction, medications, muscle atrophy, malnutrition, and debilitating medical conditions valid and reliable pressure injury risk assessment tools are readily avail (braden scale, nortonscale) and typically include intervention recs based on the level of risk assessed gen recs repositioning every two hours in bed management of excess moisture off loading with pressure relieving devices inspect skin daily for signs of pressure damage limit shear, traction and friction forces over fragile skin

eczema

aka dermatitis gourp of disorders taht cause chronic skin inflammation typically do to an immune system abnormalitis alergic reaction or external irritant infants may have this and grown out of it (at higher risk when infants) geratric is also at increased risk s/s red or borwn-gray itchy lichenified (thick and leathery) skin plauqes that may be exacerbated by some tipical agents such as soaps and lotions younger popilation will also have oozing and crusting of the patchy area of irriation tx = pharma with topical or oral corticosteroids to oral antibiotics and antihistamines cold compresses and other modalities may assist with reducing the itch ing stress managenment ehcnqieus and avoidance of exrrmem temps should be employed to avoid exacerbations

rate pressure product RPP

aka double product index of myocardial oxygen consumption and coronary blood flow RPP provides an easy to measure physiologic correlate to the onset of angina pectoris or the development of ECG abnormalities in the patients with heart disease these s/s of MI generally occur at a reproducible RPP value measure SBP and HR during the same exercise workload RPP = SBP x HR RPP is usually reported as a two digit number x10^3 (i.e. if HR is 150 and SBP is 170 then RPP = 25.5 x 10^3) interpretation - in patients with fixed threshold angina = a relatively constant level of activity will precipitate angina RPP obtained during an exercise test may be used to guide the exercise prescription keeping the intensity of exercise below the RPP value will reduce the risk of developing angina

backwards trunk lean, difficulty going up ramps/stairs

aka gluteus maximus gait result of weak glut max strengthen the hip extensors can use bridges if a pt is able to do this backward lean it means they have adequate hip flexion ROM, it also means they have adequate quad strength bc the knee doesnt buckle to progress the leg must extend somewhere so that the leg moves forward instead of staying in the same spot idk

wilsons disease

aka hepatolenticular degeneration rare inherited idsorder that is most common in eartern europeans siciliand and osuthern itialains but may occur in any gourp typically appears in ppl under 40 and sx can develop in children between 4 and 6 autosomal recessvie that produces defect in the body ability to metaboiz copper copper accuulates over time with the brain liver and cornea kdiney andother tissues sx kayser-fleischer rings surrondning the risi of the eye (brown around the eye) secodary to copper desposit, dege changes in the brain esp within the basal angalia, hepatiis, cirrhsisi of liver, athetoid movement, and ataxis gait patterns emotional beaviora hange sas the copper coninteus to accumulate over ttim with severe sidisae there will be defomrities in the MSK system patholgic fx osteo malaai and msucle atrophy and ocntractures

heart rate reserve method for intensity for aerobic exercise

aka karovonen formula lower THR = [(HR max - HRrest) x40%] + HRrest higher THR = [(HRmax - HRrest) x85%] +HRrest

segmental breathing

aka localized breathing or thoracic expansion exercise intended to improve regional ventilation and prevent and treat pulmonary complications after surgery it is based on the presumption that asymmetrical chest wall motion may coincide with underlying pathology (pneumonia, pleuritic chest wall pain, retinaed secretions) and that inspired air can be directed to a particular area by facilitation or inhibition of chest wall movement through proper hand placements, verbal cues or cooridination or breathing indicated for decreased intrathoracic lung volume, decreased chest wall lung compliance, increased flow resistance from decreased lung volume, ventilation: perfusion (V:Q) mismatch no precautions or contraindications position the patient in sitting for basal atelectasis, sidelying with affected lung uppermost, postural drainage positions with affected lung uppermost to assist with secretion removal therapist applies firm pressure at the end of exhalation to the patients chest wall overlying the area to be expanded patient inhales deeply and slowly explands the rib cage under the therapists hands therapist reduces hand pressure during the patients inhalation expected outcomes... increase chest wall mobility, expand collapsed alveoli via airflow through collateral ventilation channels, assist with secretion removal

ventilation-perfusion scan

aka lung scan or V/Q scan uses small amounts of radioactive material to study airflow and blood flow within the lungs it is used most commonly in the diagnosis of pulmonary embolism

tay sachs disease

aka lysosomal storage disorder abdsence or deficiency of hexsaminidase A this produecs an accumulation of gangliosides GM2 within the brain autosoal recessvie ineherted trait and carreid primaru by the eastern ueropean (Ashkenazi_ jewish population sx at approx 6 months of age the child will start to miss developmental miles tone and will contonues to deteroirate in motor and cognitive skills as sx progress, the pt sevelops signficant intellectural disability and PARALYSIS and will ususally die by the age of 5 tx no effecteive treatment for this condition egentic testing in high risk populations to identify the carrier prior to pegnancy is impiratnt in order to avoid this disorder

strain counter strain

aka positional release. moving the body into painful position and allowing the body to relax into a non-painful position

herpes zoster infection

aka shingles acute infection caused by reactivation of the latent varicella-zoster virus (shingles) it is characterized by painful vesicular skin eruptions that follow the underlying route of a spinal (in the case below) or cranial nerve, additional sx include fever, GI distrubances, malaise and HA pain across the middle of the right chest and back clustered vesicles in a linear arc surrounding skin is hypersensitive

biotherapy

aka ummunotherapy change the rleationship ebwtn the lamignnacy and its host bio resones modife are comonly utlize for biotherpy and act to stneght a pts bio repsoe to the maugnan cells common agens us diwth treatmet include interferons inreteleukin 2 bone marrow transpkatn stem cell transpant monoclnal antibioes hrmoen therap and colonystiuatlion facors side efect incldue fever chills nasue vomtin anorezxia cnd inglamtry raciton leukopenia an fatigeu

negative pressure wound therapy (NPWT)

aka vacuum assisted closure V.A.C. is a non invasive wound care modality used to facilitate healing and manage drainage a sterile foam dressing is placed in the wound and sealing with an air tight secondary dressing which attaches via tubing to a vacuum pump with a reservoir container ' indications = acute or chronic wounds which cannot be closed by primary intention such as dehisced surgical incisions, full thickness wounds, partial thickness burns, heavily draining granular wounds, flaps, grafts, and most ulcer types contraindications = malignancy within the wound, insufficicnet vascularity to sustain wound healing, large amounts of necrotic tissue with eschar present, untreated osteomyeliti, fistulas to organs or body caviities (abnormal connection), exposures arteries or veins, uncontrolled pain advantages = provides mamagenment of wound drainage maintains a moist wound envinonment decreases interstitial edema decreases bascterail colonoization increasess cap blood flow increases granular tissue formation enhances epithelial cell migration disadvantages = requires special supplies and training treatment can be painful not reimbursed in acute or long term care settings

heterograft

aka xenograft temporary skin graft taken from another species

total parenteral nutrition, hyperlimentation devices (intravenous feeding) considerations

alarm sound indicates the fluid source is empty or the system has become unbalance disruption or disconnection may result in an air emolus shoulder motion on the side of the infusion site may be restricted primarily in flexion and abduction exercise is possible with the line but mobility may need to be restricted near the catheter insertion

RPE combines

all sensations and feelings of physical stress, effort and fatigue do not concern yourself with any one factor such as leg pain or SOB but try to focus on your total feeling of exertion dont think about the actual physical load

cancer malginancy neoplasm and tumor

all terms referring to abnormal uncontrolled cell growth within the body more than 100 different cancers malignant cancer cells are characterized by theri ablity to grow uncontollably invade other tissue reaiin udnifferentiated initated growth at at distal sties and void detection and destriction by the body immune system etilogy from environemnt to lfesytel to genetic

cholesterol test

also called a lipid panel or lipid prpfile a cholesterol test measures the amount of cholesterol and triglycerides in the blood in order to determine the risk of atherosclerosis cholesterol is carried in the circulation in association with lipoproteins a complete lipid profile includes the measurement of four types of lipids in the blood: total cholesterol high-density lipoprotein LDL triglycerides HDL is the "good" cholesterol because it helps carry away LDL and is protective against atherogenesis LDL is referred to as "bad" cholesterol because it is assocaited with the build up of fatty plaques within the arteries which reduce blood flow the body converts any calories it does not need to use right away into triglycerides, which are stroed in adipose tissue high levels of triglycerides are seen in overweight people, in those consuming too many sweets or too much alcohol, and in people with diabetes who have elevated blood sugar

erecitle dysfinctin

also known as impotence is esteimated to range form 25-85% in men with daibets which makes thi sppulation 3x mofre liket than the genreal poplaton ED in diabtes occurs 10-15 eyersa eraier than men withou diabets

auscultation of heart sounds

although considered an advanced skill, with supervised practice, the therapist should be able to differentiate normal heart sounds from blatantly abnormal sounds such as loud murmurs and gallops the bell or diaphragm of the stethoscope is held directly o the patients bare skin with enough pressure to provide a skin seal while the patient breathes quietly through the nose listen over 4 designated areas: -aortic area: 2nd intercostal space at the right sternal border -pulmonic area: 2nd intercostal space at the left sternal border -mitral area: 5th intercostal space, medial to the left midclavicular line -tricuspid area: 4th intercostal space at the left sternal border listen to the overall rate and rhythm of the heart sounds listen separately to each sounds and each pause in the cardiac cycle for as many beats as necessary to evaluate the sounds in one area before moving to the next area listen for extra sounds or murmurs while conentrating on systole and diastole

inflammatory phase and chronic wounds

an abnormal inflammatory response i.e. chronic or delayed is believed to be the msot SIGNIFICANT factor in dleayed wond healing and chroniciitty reinjury, infection, poor tissue perfusion or the bodys failure to initiate appropriate reponses may prolong the inflammatory phase inflamm that persists chronically for weeks or months interferes with the initaition of proliferative phase processes and increases the risk of infection (aka wound cannot close) anti inflam, immuno suppress, and arterial insufficiiency or conditions that alter immune responses (i.e. diabetes, alcoholism, AIDS), can limit the bodys reponse to a wound this can occur to the extent that the healing process is never truly initiated, resulting in a chronic wound differing from chronically inflammed wounds, chronic wounds show little if any of the ususaly inflammatory phase characteristics and fail to progress

chemotherapy related to ealterd blod counts

anemia thrombocytopenia and neutropenia anemia may need transfusio s may include dyspnea hreat palap dizzinezz change motions slowly rest freq anda loow full night sleep thromboctopenia petechiea peistaxis bleeidng gums alck or blody stools condult phsian befoer using ove the coutne rmeds that may fureht affect patlelets such as aspirin and ibuprogen avoid contac tworsk withi wiht or asroaun shrap obect and tight fittig cloehting or acessors neutpenia risk for infection usually asymptmatic assigned a private room with precautions to decras erisk fo exposure not in hostpai must mainta excellent hand abobody hyeive closelt selfmonitor for inefctonw aer shoes even in the home and vaovid exposreu teo potentail infection envinro corwofn literoxcbridcages fish taknls flowerand flatns stagnant water manicuper spedicure hacuuzzi hot ubs

keloid

anoral scar formation that is out of proportion to the scarring required for nomal tissue repair and is compresd of irreg distributed collagen bands typcialy exceeds the boundaties of the riginal eound appearin red thick raisea and frirm

characteristics of neuropathic ulcers

areas of the foot suseptible to pressure or shear forces during weight bearing well-defined oval or circle, callused rim, cracked periwound tissue, little to no wound bed necrosis with good granulation low to moderate exudate no pain but dysesthesia (abnormal sensations) may be reported diminished or absent pedal pulses unreliable ABI with DM normal edema decreased skin temp dry, inelastic, shiny skin, decreased or absent sweat and oil production loss of protective sensation

scar assessment

assessment devices such as a tonometer and rating scales aid in quantifying scar characteristics a number of rating scales are avail to objective document helpful for assessment and reassessment should include location, sensation ,texture pigmentation vascularity pliability and height

procedure for postural drainage and precau/contra

assume appropriate position standard positions can be modified as the patietns condition and tolerance warrant maintain each position for 2-3 min all positions are contraindicated for - ICP >20mmHg head and neck injury until stabilized active hemorrhage with hemodynamic instability recent spinal surgery or acute spinal injury active hemoptysis empyema (collection of pus in pleural space) bronchopleeural fistula pulmonary edema associated with congestive heart failure large pleural effusion PE confused or anxious patient who do not tolerate position changes rib fx with or without flail chest surgical would or healing tissue trendelenburg position contraindicated for uncontrolled hypertension distended abdomen esophageal surgery recent gross hemoptysis related to lung carcinoma treated surgically or with radiation therapy uncontrolled airway at risk for aspiration (i.e. tube feeding or recent meal)

rehab consideration for pt with peptic ulcer diseae

astmptomatic pt with hsotr of ulcer shoul db emonitor for sisngs of bleeding fatugue pallor and exercise toelraumust be montor for signs of bleedin g HEART RATE INCREASE OR BLOOD PRESSURE DECREASE MAY BE SIGNS OF BLEEDING bakc pain is a sign of a perforated ulcer location on the postero wall of the stomach and duodenum pain that radiates from the midthoracic area to the right upper quadrant and shoulder may signifcy blood and acid within the peritoneal cavity seoncdaryt o perofata and bleeding ulcer

in children, BMI between 85 and 95% is considered

at risk for becoming overweight

radial

at the wrist, lateral to the flexor carpi radialis tendon

childhood obesity

at various pts in nrmal deveopment children and adolescent are expectoed toc cayr differing poritons of body gat so be caustion not to assume all children who appear to be carrying extra weight are teruly overwigh or bese best way to dettein if appearnce o extra eweight is truly a long term heatlh is to tlak with a pedicitrian child is ocnsieerf overwigh tif their age approp BMI is between the 85 and 94 percetiles childhood obestisy is >95% erronsouly - wrongfully pader willis syndroem is an exmpal eof a condition where children are moerl ikel to become bese Prader-Willi syndrome (PWS) is a genetic disorder due to loss of function of specific genes. In newborns, symptoms include weak muscles, poor feeding, and slow development. Beginning in childhood, the person becomes constantly hungry, which often leads to obesity and type 2 diabetes.

rehab consideration for pt with GERD

avoi certain exercise seocndary to an increasein sx with acitivyt recumbenc wil induce sx rec increas indicen of head an heck dicort secondary to aperception of LUMB IN THE THRAOT LEFT SIDELYING is preferred since right sidelying may promote acid flowing in to the esophagus rec conditon such as chronic fbroncitiis asthama nd pulmoanr fibrosis may all present with ferd erc that tight lcohtin eefcise and constipation may all precicpate gerd considet certain positnin urin gpstual drainage mya enocufagae acid to move into the esophausg s

skin cancer

basal ecll carcinona is a slow growing form of skin cancer that rarely metastasizes it orginates from the epdermis and is mthe most comon tye of skin cancer sun exposure is comon cause with risk includin frequen tsun sexpore lgiht eyes anda fair si ss open sores taht can bleed or crust and remain for three or more weeks reddish patches of skin a shiny bump on the skin taht is often pink a scar like area thath as poorly defined borederes prognosis is good can routinely be cured surfical excition

metabolis and endorcinr

basal metablism decreases with age may result in the dece rin lean body mass cahgne icocut wth acid balnce alac i tebody which anhnegativ efefc to ntabolufucnton in the ndorcirn esyst there is agenral decraie n hromeond produceion an fucnton oldre adults tend to ixhibti thih blood lgllusoe levels saeocn to reucin ton the numeb afunton fobeta cells within th epancra and weal an dinincre in perhila restsan cto insulin evalted blood glcusoe i sone of the contibrutin gavo sn deloepo ment of metabllic sydnrome and ocnitiont aht is repvealti nin great han half of all older adutls loss ofboe mass occurs seocnto an icnrease i nbne resportion and has also been linke to hornoa chagnes iesp in older autl qoen decreai n insuling sensitie decra hepatic insulin relaer control decraa ssenstitei to beta adrengergiv stimuatlion hard to rela airways

why would you want to do isolated small range quad eccentric control work in standing vs exercise the quads using isokinetic ressitance at higher loads and increasing speeds for recurvatum during ambulation

bc isokinetic do not adequately address the functional demands of gait

supplemental oxygen delivery system considerations

be aware of signs of respiratory distress (dyspnea, cyanosis, cramping) monitor SaO2, PaO2, and hemodynamics prior to, during, and after physical therapy intervention exercise is possible but avoid distrubing the tubing

inpatient cardiac rehab (phase I)

begins with physician referral to cardiac rehab when the patient is medically stable consists of patient and family education, self-care evaluation, continuous monitoring of vital signs, group discussions, and low level exercise exercise activities include = AROM ambulation self-care exercise intensity is often prescribed according to heart rate and by rating on a RPE scale the trend toward early hospital discharge following a cardiac event has resulted in phase I programs averaging 3-5 days procedure = medical eval - a patient may begin rehab when considered medically stable by the referring physician (no new or recurrent chest pain in eight hours, no new signs of uncompensated heart failure i.e. dyspnea at rest with bilateral basilar crackles, no new significant abnormal heart rhythm or ECG changes in eight hours, stable creatine kinase and troponin levels) montoring and safety - ask patient to report any chest discomfort, dyspnea or faintness that occurs during activity, discontinue exercise if... HR >130 bpm or >30 above rest DBP >/=110 decrease in SBP >10 significant ventricular or artrial dysrhythmias 2nd or 3rd degree heart block s/s including angina, marked dyspnea, and ECG changes suggestive of ischemia active exercise - active upper and lower extremity exercises may begin 24 hours after bypass graft surgery and two days after infarction active exercise progress from sitting to standing (1-4 METs) upper extremity exercise should not stress the incisions of post surg patients aerobic exercise - mode: progressive, supervised level walking (2-3 METs) to walking up and down steps or treadmill walking (3-4 METs) intensity: RPE <13 (6-20 scale) post infarction heart rate <120 or <20 above resting post surgery heart rate <130 or <30 above resting duration: I/M bouts of 3-5 min progressing to 10-15 min of continuous frequency: first 3 days 3-4x per day, after 3 days two times per day with increased duration progression: activity may be progressed provided... adequate increase in HR adequate rise in systolic blood pressure (10-40 mmHg) no new dysrythmias or ST changes on ECG no cardiac sx are observed (i.e. palpitations, dyspnea, angina, excessive fatigue) expected outcomes - prevent harmful physiological and psycholigcal effects of bedrest during hospitalization walk 5 to 10 min continuously or 1000 feet x4 daily walk down and up one flight of stairs independently know safe heart rate and RPE limits for exercise recognize abnormal s/s suggesting intolerance to activity promote a more rapid and safe return to ADLs within the limits imposed by their disease prepare the patient and home support system to optimize recovery following discharge

papilloma

benign wart like skin growth that is typcally observed with stage 3 lymphedma

scouring test weird result

besides reproducing hip pain it can also result in referred pain to the knee

test to differentiate between stenosis and intermittent vascular claudication

bicycle (van gelderens) test designed to stress the LE vascular system without causing any central canal or foraminal stenosis that could be misinterpreted as I/M neurogenic claudication

when should i patient return to the clinic if they are primarily a telehealth patient

big change in POC reeval discharge maybe

H2 receptor blockers

bind specifcally to histamine recpetors to prvent the histamine activataed release of gastric activ normally stimulated during food intake dyspepsia acute anf logerm tx of petic ulcer GERD side effect headache dizziness mild GI distress tolerance, arthralgia acid rebound with disontinuation of agent imp for PT well toelrated morel eiky to particpate tagement (cimtidine) pecid (famotidine) zantac (ranitidine)

what happens if you start and stop your pee over and over

bladder complications i.e. infection and overuse

erosive gastritis (acute gastritis)

bleeding from the gastric nucosa seocnary to stress, nadis, aolchoutiziatio, biral infeciotn or direct trauma ss dyspepsia nsuase vomint hemtaesm may also be asymptomatic tx supportive with removal of the stimulta and pharama sx if bleeding continues

antihistamine agents

block the effects of histamine resulting in a decrase in nasal congestion, mucosal irritation, and symptoms of the common colds, sinuitis, conjuntivitis, and allergies used for respiratory seasonal allergies, rhinitis and sneezing from the common cold, allergic conjunctivitis, motion sickness and parkinsons disease side effects include arrhythmias, postural hypoetnsion, GI distress, dizziness, drowsiness, headache, blurred vision, fatigue, hausea, thickening or bronchial secretions increase guarding when rising from a sitting or lying position due to the risk of orthostatic hypotension closely monitor patient during exercise i.e. benadryl (diphenhydramine), allegra (fexofenadine), zyrtec (cetirizine HCL), claritin (loratadine)

sarcoidosis s/s

bone and joint involvement (most likely to impede the pts ability to participate in a walking program) can also have increased salivation, skin lesions, and liver involvement

bone mineral regulating agents

bone mineral regualtin agents attmep to enahce and maximize bone mass along with preventing bone loss or rate of bonne reabsorption typical agents can include estrogens calcium and vitamin D biphosphonates calcitonon and anabolic agents indaictions pagets disease ,osteoproosi ,hyperparathroud rickets (viatmin D) hypoparathyroid osteomalacia side effects GI distress, duspepsia (burning in tummy) dysphasia anorexia bone pain cardiac arrhythmais pt with boe min deficit are ar rsikf for fx and sdie effects ambulatong and wight to stim bone formation iei eestogens (premarin aka conjufated estrogen( calcium and vitamin D tums (caclium carbonate( calderol calciferediol biphosphnates fosamax aleddronate sodim boniva ibandronate calcitonin cibacalcin human calcitonin

ulcer

break inthe line of the stomach or int he sdudemu

diaphragmatic breathing

breathing predominantly with the diaphragm while minimizing the action of accessory muscles and motion of the upper rib cage during inspiration indicated for .... post surg patient with pain in the chest wall or abdomen or restricted mobility patient learning active cycle of breathing or autogenic drainage airway clearance techniques dyspnea at rest or with minimal activity inability to perform ADLs due to dyspnea or inefficient breathing pattern precau/contra ... moderate to severe COPD and marked hyperinflation of the lungs without diaphragmatric movement patients with paradoxical breathing patters (bc diaphragm is paralyzed and without chest movement they can't breathe), or who demonstrate increased inspiratory muscle effort, increased dyspnea duhring DB procedure ... semi-fowlers position is a good starting point sniffing can be used to facilitate contraction of the diaphragm have the patient place on ehand on the upper chest and the other just below the rib cage instruct the patient to breathe in slowly through your noseso that your stomach moves out against your hand the hand on your chest should remain as still as possible feel your abdomen gently rise into your hand exhale through pursed lips, let the hand on your abdomen descend while the hand on your upper chest remains still decreases RR decreases use of accessory muscles of inspiration increases tidal volume decrease respiratory flow rate subjecgtive improvement of dyspnea improve tolerance for activity

autogenic drainage

breathing technique that uses controlled breathing and least amount of coughing to clear secretions from your chest. It involves you hearing and feeling your secretions as you breathe out and controlling the urge to cough until secretions are high up and easily cleared with little effort.

bronchial carinoma

bronchial carcinoma or lung cancer refers to any epithelial carcinoma cocuring in the bronchopulmoanr y tree cancers are braodly divided into two main grousp small cell lung carcinomas and non small cell ung carcinomas inclduing squamos cell carinoma adenocarinoma and large cell carinoma smoking is the priamru cause of teh marjority of lung cancers but it canocur in people hwwo have never smoked or had prolonged exposure to secondhand smoke in these cases thee exat etiology is unknown ss new couhg or hcanges in a chornic ocugh coughing up blood shortness ofb rbreath weheezing weight loss bone pain sx not presetn until the disease is advacned tx surgery (wedge resection, segmental resection, lobectomy, penumonectomy) chemotherapy radiation therapy

blunted costophrenic angle

can be indicative of a pleural effusion but also seen with obstructive pulmonary disease

Immediate outpatient (phase II)

can begin immediately after hospitalization and last up to 12 weeks procedure... medical eval - exercise test with an ECG is recommended for patients entering an outpatient program and as changes in the patients condition warrant to assess: HR and rhythm s/s ST segment changes exercise capacity risk stratification target heart rate for exercise initial level of work for exercise before beginning formal physical activity, a physical exam of the patient should include: medical history CV diseaes risk profile body mass index or waist hip ratio resting ECG and blood pressure auscultation of lung sounds palation and inspection of extremities for arterial pulses, edema, and skin integrity exam of chest and leg wounds in patients after CABG or PTCA ortho and neuromuscular status (ROM, strength, posture, balance, ADLs) monitoring and safety - for low risk patients with known stable coronary artery disease, 6 to 12 sessions of ECG and BP monitoring and medical supervision are recommended to ascertain desirable exercise levels for mod to high risk patients and/or unable to self-regulate or to understand recommended activity levels, continuous ECG and BP monitoring and medical supervision are recommended until safety is established, usually >/=12 sessions d/c exercise for any of the following = plateau or decrease in HR with increase in work* SBP plateau or falls with increase in work or >250 mmHg* DBP >115 mmH* ST segment depression >1mm* 2nd or 3rd degree heart block ventrcular dsyrhythmias* angina or other sx of cardiovascular insuff aerobic exercise - mode: rhythmic activities that use large muscle groups and can be performed continuously and safely intensity: based on HR, METs, and RPE -HR (for patients without an entry exercise test, an exercise HR equal to standing resting heart rate + 20 bpm may be used with caution, a period of continuous ECG monitoring is recommended with the intensity gradually increased provided there are no sx, abrnomal hemodynamics, ventricular dysrhythmias or ECG changes indicative or MI usually a target HR (THR) is established from lower and upper heart rate limits) -METs (1 MET is the energy expended while sitting quietly (3.5 mLo2/kg/min or 1 kcal/kg/h), to establish a MET level training zone, max METs must be measured during an exercise test, lower and upper MET limits are calcuated using the same percentage training intensities as the karvonen formula lower METs = [(maxMET - restMET) x 40%] + restMET higher METs = [(maxMET - restMET) x 85%] + restMET RPE - good to use for heart transplant, beta blockers, individuals who do not have an exercise test prior to entering cardiac rehab, individuals who cannot feel their pulse, and for patients whose clinical status or medical threapy changes an RPE of 12 to 16 (somewhat hard to hard) on the 6 to 20 scale corresponds to 40-85% of max capacity RPE of 11 to 13 (fairly light to somewhat hard) is an appropriate upper limit during the initial phase of outpatient but 14 to 16 may be appropriate for higher intensity training later in cardiac rehab if there are no signs of ischemia or serious dysrhythmias RPE is specific to the mode of exercise duration - 15 to 20 min of continous or IM exercise during the first month (initial phase) 25 to 30 min during the next 3 or 4 months (improvement stage) 40 min or longer after 6 months (maintenance phase) interval training (exercise bouts of 3-5 min duration followed by equal rest) may be appropriate for patients who cannot exercise continuously as fitness improves and the patient gains confidence, increase the duration of the exercise periods frequency - 3 to 5 days a week expected outcomes of outpatient cardiac rehab... promote an active lifestyle through increased particpation in domestic, occupational, and recreational activities improved functinal capacity , msucle endurance and strength flexibility and weight management lower CV risk factors improve sx and physiological responses to physical challenges modifications of unhealthy behaviors and psychsocial characteristics improve patient understanding of safety issues during exercise

why do you have to be careful with MS patients and ankle weights

can cause excessive fatigue

BPPV what do you do

canalith repositioning treatment sx should resolve after this habituation is for CENTRAL lesions and unilateral vestibular hypofunction (UVH) gaze stability and postural stability for BVH or UVB

leukemia

cancer of the blood that ocurs when leukoctes chagen into malignant cells iimmaue cells proliferata and accumulate n bone marrow and ultiately cause the prduction of nomal cells wil spread to lymph nodes liver spleen and ithera resa of the body enironemntal chemcal or toxic egegn viral acute lymphoblastic acute myelogenous leukema abrupt onset with high fever beleding enlarge dlmph nodes and pseen progressive wakeness faituge an painul joints blood work will indicate anemia a leukocyte count greater then 500,000 and thrombocytopenia (low platelets) immunotherapy cutotoxi agents bone marrow transpkant over 90% of ps will all achievve ocmplte remssion with tx while 70-80% achieve complete remssin with treatment

BP calculation

cardiac output x total peripheral resistance to estimate systolic BP, palpate radial pulse and inflate to 200 mmHg or until you dont feel a pulse anymore, deflate until you feel a pulse, this is the estimated systolic, add 30 mmHg to that for their actual BP meauserment

cardioversion

cardioversion is performed to restore a normal heart rhythm for tachyarrhythmias that do not respond to medication electrical shocks are delivered by a defibrillator through electrodes on the chest convert any arrhythmia vs debrillation is just for lifethreatening like ventricular fibrillation or pulseless ventricular tachycardia where the pt does not have a pulse

amine hormones

catecholamins ie epinephrne and orep and dopamine synthesized from chromaffin cells within the adrenal medulla SNS stimualtion relasee the catecholamines into the blood stream ei has one of th learges effects on the sympathetic nersou sysena nd creates the right of light repsone target areas fro epi are recpetors istes in the CB andmetabolis systms other function oof catecholamines incue incraseing cardac contraction contsiction of blood veslle activatin of glycogen breakdown blocking of insulin sdecteotn increasing etabolia=c rate and dilation of airways

thermal burn

caused by conduction or convection contact from a hot liquid fire or steam are examples

undifferentiated cells

cells hwich haen ot differein n ao spect yep pie.. priarmive or emebron or hav eno special strcure of fucntion

dysmetria and dysdiadochokinesia come from damage to the...

cerebellum movement breakdown is velocity dependent

cardiac biomarkers

certain enzymes leak out of the heart cells and into the blood after an MI cardiac enzyme studies measure the levels of creatine phosphokinase (CK) and the protein troponin in the blood CK-MB is a realtively specific test for MI, it appears in blood approx 4 hours after infarction, peaks at 12-24 and declines over 48-72 hours cardiac troponin-I is also a specific marker for infarction and unlike CK-MB levels, it remains elevated for 5-7 days

hormones

certain hormoens can exacerbate or faiclitate prligeration while other hormae can attenuate articula caners typcaly used aas adjstn therapy along with other forms of tx spsecifi to malig hormoen stnetive neoplassm mtultsystem involement maculizaiton in women ot lfahs general caabol efects nolvadex (tamocigen citarate) lupron (leuorlife acetate), casodex (bicalutamine)

obstructive ventilatory impiarment

characterized by decreased expiratory flows airway narrowing during exhalation causes a disproportionate reduction of maximal air flow compared to the maximal volume displaced from the lungs FEV1 (forced expiratory volume in the first second) / FVC less than 70% is the primary indicator of an obstructive impairment pathologies include asthma, emphysema, and chronic bronchitis

psoriasis - plaque

chronic autoimmune disease of the skin and is the msot common of 5 types of psorisis t cells tigger inflammation within the skin and produce an accelraeted rate of skin cell growth skin cells accumuate in rasies red patches on the surface of the skin genetic predispotion to plaue otehr factors inldue injury to the ksin, insufficnent or excess sungliht, stress sexecivs alcoho, HIV infection smoking and certain meds s/s rd reaise bloche that typcaly presnt in blateral fadison for aeampboth both knees or elbows can appear anywahere on the body and will tend to itch and flaea cplincateion can inlude arhtieis pain severe itching seconary skin infection and sife escef secght pharam ainteventiosn tx contols th sxx a nd rpevent seocnear infection tx vareis fro topical to sstemic meds an dhtohtherapy life long ocnidtj taht can b magne aand control though various stages and exeacerabations

psoriasis

chronic skin condition characterized by skin patches covered by dry silvery scales

hemosiderin changes and increased LE edema indicates

chronic venous insufficiency hemosiderin changes due to increased iron from pooling blood

lymphoma (hodgkin and non)

classified a scancer found in the lymh system and tissues risk factors hodgin include assocation with epstein barr drug abuse mmunos upreesant obestiy chron or auto immunse diseaes a risk for nonexposrue toe benzene i.e. cig smoke auto emission and pollution ss lump that first sign and general y sx includ fever chills and fatigeu hodgkin diseae is distingished by the rpesesnce of reed sternburn cancer cell s both forms mmetastaszie one of the most curable cancers HODGKINS is chemo tadition stem cell transplant ighly active antiretroviral therapy

claudication test

claudication is a cardinal sx of PAD claidication occurs when skeletal muscle oxygen demand during exercise exceeds blood oxygen supply this results from stimulation of local sensory receptors by accululating lactate or other metabolites it is characterized by pain, aches, cramping, sense of fatigue or other discomfort in the affected muscle group which limit the ability to exercise

cataracts vs glaucoma

clouding of the lens gradual loss of vision CENTRAL is lost first then peripheral reverse for glaucoma loss of peripheral first then central then total blindness

chemo brain

cognitve chagnes are comoon in oncology pplation chemo fog misleadin gas reacrh has not deifnte connecte dimpair cognition with cemo many pts wstil peforem well onforam cog assesment adn nost do not undergo aselin ecogn testint to beginging cancer tx difficult for reaht to tuely delinate if cog chagnes are due to disear process iteslf the tx or side effects of tx depresion faitgue horonal alterd blodo cosunst stess regarless cleciton of sx assoction with chemo brain are oenl yacknowl rin ethe medical comunity and anecdotally suport by nkkons of tsp ts mst be area of anaf sensit to thse taentia lgocgia chgne sot ahte ehy maty atelra treatment intevetion and teachinig metods feeling fooggy cogitition confusein fatag elimite attention span or shorterm memory and uasual degee of difficut wth conetratin word finfd amtultitaksing and oganization

antianxiety agetns

colelcigvel target the cNS thorugh faciltain ght eeffects of GABA or tatgeting doapien and setotonin and serotonin withint he brain enzodiapoines azparioens and certain secite serotin inreutpin inhibtsior antideprsssions treat veiosu sxiety disorsr general adity OCD PTSD drisiness eation weithdarel inldud rebound anxiteyaka if you go off bezos too uckyl can have panic atackes pt coner with septaive hypnot ia gents can also implenta alternate methosd tod ecrare stes anf eit inlucing eericse and PA masafe realc and stess mangen eucaiton benzodiapazpein xanaz (alprazolam) valium (diazepam) ativan (lorazepam) azapirones buspar (buspirone) ssris akak effexor (venlafaxine) paxil (paroxetine)

semiinferous tubules

coliled tubes found which ieach lobe of the tst where speratgensois takes places

exercise guidelines for pts undergoing cancer tx

common side efect include pain, fatigue, depression, anxiety, altered body image, sleep disturbances, sleep distrub, lymphedemae, and GI distresss always check physician orders prior to treating a pt with bone metastases to verify weigh bearing status and clearance to perform mobility monitor apts blood values esp paltelet and hematocrit outns to ensure that it is safe for the pt to pariticpate in therapy acticiies exercise should be conduced at a range of 40-65% og yhr prsk park rate, herate rafer reseve adn vo2 max or beow th eanaerobic threshold during exercise percievedd exertion should nto exceed a 12 TWELVE using the borg rating of RPE (between fairly light and somewhat hard) treatment vsiits should be scheduled during the time of fayy ehen pts energy is at peak levels treartment should be modified as needed to accommodate any side effects of tx

atelectasis BRONZE

compelte or partial collapse of a lung that resuults in reduced gas exhange condiiton that prevent deep breathing and coughing incfrraese the risk fo atelectasis as the lungs are unable to fill with air in the normal manner most common cause od atelectasiss is surgial anesthesia, which reduces the normal deep breathing pattern and diminishes the urge to cough patients brathing pattern may also be distrupted secondarto to airway obstruction (i.e. mucus sectreitons, airway narrowing) or from pressure ourside of the lungs (pleural effusion, pneumothorax, chest trauma, tumor) atelectasis occurs when the alveoli within the lung become deflated and cause all or part of the lung to collapse the amount of lung tissue involed is variable if large portions are involved the pt may not be able to deliver enough oxygen to the blood if atelectasis only affects a small portion of the lung the pt may be asymptomatic larger sx = coughing fast and shallow breathing, increased HR, cyanosis, reduced oxygen saturation levels and occasionally chest pain typically diagnosed with a chest xray CT can as aid diagnosis US and bronchoscopy may be used to bettter identify the cause rule out pneumothorax, pleural effusion, and lung cancer asculation will reveal DIMINISHED OR ABSENT breath sounds

expected outcomes of paced breathing

complete activity without dyspnea decrease patients fear of becoming short of breath during activity

subdermal burn

complete descruciton of the peidermis dermis and subcutaneous tissue may invovle msucles and bone and as a reuslt often require mutiple surgeries and extensive healing time

catabolism

complex materials like protiens and lipids are broken down in the body for the purspoe of creating and releacing heat adn energy

foam dressings

comprised of a hydrophilic polyurethane base that ocntacts the wound surface and a hydrophobic outer layer allows exudate to be absorbed into the foam through the hydrophilic layer the dressins are most commonly availiblei n sheets or pads with varying degreees of thickness semipermeable foam dressings are produced in adhesive and non adhesive forms non adhesive forms require a secondary dressing indications = provide protection and absorption over partial and full thickness wounds with varying levels of exudate, they can also be used as secondary dressings over amophous hydrogelsd advantages = provides a moist environment for wound healing available in adhesive and non adhesive forms provides prophylactic PROTECTION and cushioning encourages autolytic debridement provides MODERATE ABSORPTION disadvantages = may tend to roll in areas of excessive friction adhesive form may traumatize periwound area upon removal lack of transparency makes inspection of wound difficult

genitourinary system

concists of all the reproduductive organs and the urianry organs considered together due to their common endyonic origin

intestines malabsorption syndrome

condition characterize dby a gorup of apatholiges where there is reduced intensitnal absorption and inadequat nutriotn celiac disea, dustic fibrosis pancrease carcinoma pernicious anemia AIDS chronis and addions deisease are a fwe aptolgoies tahtmay prsetn with malabsrpotions yndrome secondary to defcits in deigestion or the inability of the intestina lmucosa to sabsor the ntrent form digestad food ss prmary sx is weight loso chronic diarrhea and anemia fatigeu anomdanla bloadin steatorrhea (oil ocvered stools) abdanl cramps indigestion bone pain and excessiv gas once diagnose tx incduel avoidance of the underyling cause for the malabostiop probiotics antibioscs ditym modicaiton and nitrional support incldung vitamins mideral and eletorcy e

renal failure

condition were teh kindey expernce a decrease in glomerular fitlation rate and fail to adwautly filer toxina and wastedfromt eh bolood acute and chornic secondary to deiabets or hypertenion but can also occur form posion trama and genetics nehrons are usual amda e adnthe lose their ability to iler blood renal faluler can cbe calssife as acute damgne occurs uwickl chronic ccurs slowl yengastage neratly ototal or torall renal fualrue dialysis required

nephrolithiasis

conditon of dvep idn kdiney stones various tyeps of ccrytsl aformatisn that create stones

aciety disorder

conseta hgih tension ocersacts in cineti intance presnt with aprpehen ada chronic wrorry a acure axitey attcaks last a fwemin ind uratin excitaion of teh SoNS fear of imending doorof dath OSB hart palaptd didze neasue a initated by yncnote and internam mecains

hydrogel

consist of varying amounts of water and gel forming materals such as glycerin the dressings are typically avail in both sheet and amorphous forms indications = moisture retentive and commonly used on superficial and parital thickness wounds (i.e. abrasions blisters pressure ulcers) that have MINIMAL drainage adv = provides a mosit envonrment for wound helaing enables autolytic debridement may reduce pressure and diminish pain can be used as a coupling agent for US minimally adheres to wound some products have absorptive properties disadv = potential for dressings to dehydrate cannot be used on woudns with significant drainage typically requires secondary dressing

key functions of the endocrine system

consists of endorcinr elgands (specialized ductles landa) that secrete hormoens that travel throgh the blood stream to spignal specific target cells through the body the hornomes travel throughout the boyd to the target organs upon which they act they wil bind slectively to the receptior sites on the suraface of the receptors cells the endocrine system and nervous system both btoh function to achieve and mainatin stability of the interal enrvornmet (homeostatis) systesms are capable of working alone or inconcert with each other endocinr enad beros systems work together to reguar merablisj, reopsneto so sresss, secual blood pressure wat ean dslat abalcne as

purulent

containing pus on the basis of the yellow-green discharge

therapist called out of room with CV exercise group, PTA left alone what does he do

continue with the outlined exercise progression for that session

overflow incontinence

continuous leakage of urine that results from over distention of the bladder frequent dribbling of urine is common seen more frequently in men and may be due to an enlarged prostate, weak bladder muscles, constipation or a blockage of the urethra

rhonchi

continuous low-pitched sounds described as having a SNORING or GURGLING quality that may be heard during both inspiration and expiration caused by air passing through an airway which is obstructed by inflammatory secretions or liquid, bronchial spasm or neoplasms in the smaller (sibilant rhonchi) or larger (sonorous rhonchi) airways

invasive hemodynamic monitoring

continuous monitoring of CV status is perfoemed by intra-arterial catheters and intravenous lines that measure pressure, volume, and temperature a balloon catheter aka Swan-Ganz catheter is placed in the pulmonary artery to obtain the pulmonary artery wedge pressure and left atrial pressure a thermodiluation catheter can be used to measure cardiac output a central venous pressure CVP line measures pressure in the vena cava or right atrium

automatic implantable cardioverter-defibrillator (AICD)

continuously monitors the heart rhythm and delivers electrical shock to restore a normal heart rhythm when necessary similar to a pacemaker

piriformis sydnrome sacryn to the hip and pster thigh

contorverys over this syndromes efficacy as an accurate dignoais during pregnanacy the priformis may shorten or spasm due o tpposupostural changes and hip lateral rotaion while walking sciatic paresthesia manual techniques for correcting pelvic or sacral aligment such as msucle energy technques kotn mob self correction heat applciaiton dep tissue masasge moyogfacial reelase strain coutner strain abodminal strengheni s tretching exercise for the prios and surroundin gmsucles bdoy mechanism and pstural eduction

polyphasic potentials seen on EMG when could you see it

contracted muscle undergoing reorganization

lateral excursion is caused by what muscles of the jaw

contralateral medial and lateral pterygoids (would need to stretch these on the right side if right lateral movement was limited, just like stretching the hamstrings you are putting the leg in a stretched position not a contracted position) ipsilateral temporalis muscle

cor pulmonale BRONZE

cor pulmonae can also be called right sided heart failure it is just not congestive in nature right ventricle is unable to effectively pump blood due to the prolonged presence of pulmonary hypertension and increased right ventricular afterload results in ventricualr hypertrophy and dilation as well as changes in blood pressure cor pulmonale may be associated with conditons which cause prolonged deceased in blood oxygen levesl such as COPD cor pulmonale may also be caused by congential heart conditions through the pulmonary arteries or increase blood viscosity such as pulmonary embolism or sickle cell anemia can occur acutely due to emergency conditions like PE or acute respiratory distress syndrome ARDS in both instances the right ventricles ability to effecitvel pump blood becomes sig limited usually pts present with sx that are primarily associated with their underlying pulmonary pathology (cough, tachypnea, increased chest diameter, hyperresoanace with chest percussion, dyspnea with exertion), as the condition advanes visible signs realted more specifically to cor pulmonale may include peripheral pitting edema and jugular vein dsitension most commonly diagnosed by means of clinical findings medial history and miinimally invasive procedures such as echocardiograph labs chest xray and electrocardiography tests provide valubel info regarding etiology and severity of the condition treat the underlying cause right cardiac cath is the most accurate method of confirming cor pulmonale but is considered unnecessarily invasive

left sided neglect what should be the base of treatment

crossing midline activities are good to incorporate i.e. rolling, supine to sidelying using a PNF lift pattern symmetrical activities such as hooklying with resistance to hip abductors, sitting with both arms extended and holding, or bridging do not bring attention to the uninvolved hemiplegic side

llife style mod toa ddress bladder sx

daily fluid intake should be 2,500 or 10 cups to regulat excessivel high o low fluid intake reduce bladder irritatnts includ carobontes cafeinated and alocholic beveragea spice foods cirtic jucueia and artiici sweetneres caffere reduciton shoul db etapred slowlt to avoid sever eheacache schedule voiding for every 3-4 hours to deuce bladder distention ave person voids 6 to 8 times in a 24 hour periods a bladder diaty assits with baselin measureans and goal setting regulate bwel funtion to preventin consitatn and straining durin bowel movemn t by montorin diety fiber fluid intake and exercise avoid fluid intake 2-3 hours before bedtime smoking cesastion program may decrease the occurrance of coughing and subesebaldder laeked wight loss if moderately obese may decreas eprssure onf the pevis tissue and organs

pumonary

deceine in overall gas exhane c ches t wall become siffter ena dless ompanan and the eslataic and recoi of tlugsn also ecerase in cobo with anincrease thoracic kyphss and weaken inspira sucel these changes in a finishe msk pump decrae in the viatl capcity of the lungs as viatl caocitu decea residcual vomne iicneasde sinc tatl ung cacpity Y Oays gouhgly he smae tehr chagnes that ccours in the pularon system incldue cdecara enmbre and ize of alveiil decrei rp lof andec fliaty ifnn twpper which rinceraeik foinfeciton lpneum and ecra rsterngth effecigneess of cou

cardinal principle of manual lymphedema

decongesting the proximal portions of the limb first and working distally protein rich fluid in the extracellular space primary - developmental abnormalities, heredity, surgery, or unknown stage II - characterized by nonpitting edema with connective scar tissue and clinical fibrosis manual stroking (vodder, leduc, foldi, casley-smith pressure techniques) all techniques use cardinal principles aka proximal before distal, trunk segments before limb segments, and directing flow of the lymphatics centrally toward lymphatic ducts

taste and smell

decra nmrba isd eo as buds decre senesti to all 5 tasesr les salvia is prdue which dcra snsitiviyt decaa i ability to tet toodors also ocrs wit incraes fe combo of decreas small deimisd esrire to eat which can efe tnution

touch

decrae snstiv to avaritey of senation includ outhc pain vibration pressure propriception and temp chagnei n senatio more prone to unry burn pressure ulcers ad cecein in somatosentaio contoeute o abalcne inmpairnat ca eb execeabed de to nfelce of age related visual imparments

integ

decreain thickness of ferma ayer as dwlel as loss of elatin caus skin to wrinfle andsa ga dna mimore stron to admamg lsos sof aclalg also masek the skin more prne to dmamge feom whsra tforece presru ulcer sr more ocmmn ep sin vaula chagnes futehr ale aowund healfingn educaitona dn peeiton essential reduciton in blod vesl with thderin makes ksin appear also nparihe therparegualr ton cahgnes maer auld eauflt more proneo to hythermai and hyepthmai deceir n the nuner and steco t of swrtae galasns secea rpersipatj an drither imparit hemoregu when threrma nionfa lg aare used hreat ca must at et t mnto allff eault rotelreanc in orerot rpegent inr tan over0dr ama fepsetn witha vlundted fever fesner makig it idifiut to cidganose ertatin patholiw th elevat bdoy temp is a sx decraesd refever repsone d edecrea ttuoant mreg of ther moreg decrea vasculat hicknes and elasti cof edrmin increa pain thershold decras subst auna adpis bose tissue decrease sensoty perveton

nitrate agents

decrease ischemia through smooth muscle relaxation and dilation of peripheral vessels angina pectoris side effects include headache, dizziness, orthostatic hypotension, reflex tachycardia, nausea, vomiting patients must be educated to come to a standing position slowly to minimize risk of orthostatic hypotension sublingual adminsitration of nitroglycerin is the preferred method to treat an acute angina attack i.e. nitrostat (nitroglycerine), isordil (isosorbide dinitrate), amyl nitrite solution for inhalation

antiemetic agents

decrease sx of NV nausea associated with motin sickness anesthesia pain or oncology tx sefation dysrhymias and pain antihistamine antiemit agents frequent cause sefative efet whi can be limited to PT many other anitmetic agesnts are typcially well toelarted and should not sign interfere with therapy scopolamine (anticholinergic agent) meclizine (antihistamine agent) dolasetron (5ht3 recepto antagonist agent) phenergan (promethazine hydrocholoride)

calcium channel blocker agents

decrease the entry of calcium into vascular smooth muscle cells resulting in diminished myocardial contraction, vasodilation, and decreased oxygen demand of the heart hypertension, angina pectoris, arrhythmias, congestive heart failure side effects include dizziness, headache, hypotension, peripheral edema HR and BP response to exercise will be diminished, closely monitor patients during positional changes due to an increased risk for dizziness and or orthostatic hypotension observe the patient for s/s of congestive heart failure such as worsening peripheral edema, dyspnea or weight gain i.e. norvasc (amlodipine), procardia (nifedipine), calan (verapamil), cardizem (diltiazem)

during an US, the pt flinches and feels a strong ache should you... decrease the frequency add more tranmission medium decrease the US intensity increase the size of the tx area

decrease the intensity acoustical energy is reflected from bone into the bone tissue interface, resulting in rapid tissue temperature elevation and stimulation of the highly sensitive periosteum of the bone (which is what causes the ache if it is too rapid), if a strong ache is felt you must decrease the intenstiy frequency has to do with the depth it penetrates which doesnt effect the rate or speed at which the tissue temperature is being elevated

postpolio pt too tired to come to therapy what should you do

decrease the intensity and duration but maintain a frequency of 3x per week (1x per week would be too little to be beneficial) nonexhaustive exercise and general body conditioning is indicated

beta blocker agents (beta-adrenergic blocking agents)

decrease the myocardial oxygen demand by decreasing heart rate and contractility by blocking B-adrenergic receptors used for hypertension, angina, arrhythmias, heart failure, migraines, essential tremor side effects include bradycardia, cardiac arrhythmias, fatigue, depression, dizziness, weakness, blurred vision HR and BP response to exercsie will be diminished, rate of perceived exertion may be used to monitor exercise intensity, closely monitor patients during positional changes due to an increased risk for orthostatic hypotension i.e. tenormin (atenolol), lopressor (metoprolol), inderal (propranolol)

mucolytic agents

decrease the viscosity of mucus secretions by altering their composition and consistency, making them easier to expectorate, they are administered by a nebulizier used for viscous mucus secretions due to pneumonia, emphysema, chronic bronchitis, and cystic fibrosis side effects include pharyngitis, oral mucosa inflammation, rhinitis, chest pain therapists can exploit the effects of mucolytic agents by performing airway clearnce within one hour after drug administration patients should be instructed in the proper use and maintenance of the nebulizer and compressor system used in its delivery i.e. pulmozyme (dornase alpha), mucosil or mucomyst (acetylcysteine)

hypo vs hyperparathyroid

decreased bone resortion hypocalcemia elevated serum phosphate levels shortedn 4th nd 5th met MC (psuedohypoparathyroidism) compromised breathing due to inrercostal muscles and diaphragm spasms cardiac arrhythmias and potention HF increase NM activity that can result in tetany increased bone resorption hypercalcemia decreased serum phosphae levels osteitis fibrosa subperiostal repootpion arthritis bone defmority nephrocalcinosis renal hypetneiosn sig renal dmage gout decrease NM irritability

patient unable to open fully but can laterally deviate where is the problem

decreased flexibility in the muscles of mastication (lateral deviation will not cause significant lengthening of these muscles)

hypothyroid

decreased levesl of throid slow metaboli cprocess fatigue weakenes decraes FR weight gait ocntipation dleae uheur reattfed fgrowht and velpo common cause fo hypo are hasimootos thryoiditis or an underdeveop throud flans oral throid hormoe reaplcement therat

pneumothorax sound

decreased or none

PICA (aka Wallenberg or Lateral medullary) syndrome

decreased pain and temp in face IPSILATERAL horners syndrome IPSILATERAL nystagmus, vertigo, nausea, dysphagia pain and temp of body CONTRALATERAL PICA branch of vertebral artery involves the descending tract and nucleus of CN V, the vestibular nucleus and its connections, CN IX and CN X nuclei or nerve fibers, cuneate and gracile nuclei and spinothalamic tracts brainstem involvement vs cortical involvement (ACA or PCA)

change in skin composition with age

decreased sensitivity to touch decreased perception of pain and temp increased risk of injury inflammatory responsiveness is attenuated

gait difficulties, dragging foot and fasciculations what else would you expect to see

decreased tone and hyporeflexia LMN may also see atrophy

Cheyne-Stokes (periodic)

decreasing rate and depth of breathing with periods of apnea; can occur due to central nervous system damage

continuous inductive coil short wave diathermy what does it do and who is it good for

deep heating (will penetrate more deeply than capacitive which is electric) inductive is magnetic good for ankylosing sponylitis bc deep structures involved not good for mobidly obese bc could cause overheating not good for implanted devices which includes INSULIN PUMPS not good for pts who have open, growing epiphyses as diathermy may alter the rate of epiphyseal closure

urogential diaphragm

deep transverse perineal, urethea spinchter

PTs goal is to instruct pt in a stand pivot transfer so that he can go home this weekend on a weekend pass, pt spouse is there and will be assisting pt this weekend WHAT DO YOU DO

demonstrate the task and then practice with the patient FIRST because caregivers should only become involved after initial practice of the task with the patient and after the safety of the patient can be assured

diagatric and geniohyoid muscles do what

depress the mandible

weight loss and social withdrawl are signs of

depression also fatigue

alginates

derived from a seaweed extraction, specifically, the calcium salt component of alginic acid alginates are HIGHLY ABSORPTIVE but are also highly permeable and non occlusive as a result, they require a SECONDARY DRESSING (alginate absorbs) alginate dressings act as a hemostat (contols bleeding) and crate a hydrophilic gel through the interaction o calcium ions in the dressing and sodium ions in the wound exudate indications = PARTIAL OR FULL THICKNESS DRAINING WOUNDS such as pressure or venous insifficicency ulcers, often used on INFECTED wounds due to the likelihood of excessive drainage advantages = high absorptive capacity enables autolytic debridement offers protection from microbial contamination can be used on infected or non infected wounds nonadhereing to wound disadvantages = may require frequent dressing changes based on level of exudate requires a secondary dressing cannot be used on wounds with an exposred tendon, joint capsule or bone

growth factors

dervied from natually occuring protein factors these substances facilitate healing by stimulating the actvity of specific cell types (i.e. neurtophils, endothelial cells, fibroblasts) currently only a limited number of growth factors have been approxed by the FDA for topical wound healing applications indiactions = neuropathic ulcers extending into or through subcutaneous tissue with adeqaute circulation to sustain wound healing contraindications = wounds closed by promar intention, pts with known hypersensitivity to any component of the product of a history of neoplasm (abnormal growth) at the application site advantages = adjunct to promote wound healing environment increases growth rate of new tissue promotes cell division disadvantes = costly poor reimbursement additional research needed secondary dressing required requires refridgeration limited number of products have been approved by the FDA

uterine prolapse

descent of the uterus and cerix into the vagina bbaden-walker system is the most widespread lcassifcaiotn of prolapse using a 5 point grading system ranging form no prolapse to max descent of vaing tuss ouedie the bdoy gnetic denervation or direc mscles traum i.e labor and elvity s/s pevlic pressure that increase swith exertion rugency frew ruanri incontencne incompete baldder empying discornt vaginal dryness oriitation dspeanuia and lwoer back pai that eisr elive dby lyin down tx pevlic floor msucle trianing using biofebdcak kegal core bdoy mechainsn sx dpeendne lifestyl mod intravaginal mechans uport device called a pessary may be iniaction reconstrcot or oblterative srgery if conservativ treamtnt fails

PT role in cardiac rehab

develop a individualized exercise prescription considering mode, intensity, duration and frequency monitor HR, BP, ECG, RPE, and s/s supervise exercise and promote proper technique and breathing patterns

active cycle breathing technieu

developed under the name forced expiratory technique to assist secretion clearance in patients with asthma changed to ABC to emphasize that ABC always couples breathing exercise with the huff cough it includes 3 phases = breathing control thoracic expansion exercises forced expiratory technique

endometriosis

devleppment of endometrial tissue which normaly lines the uteraus in extrauriner locations with int he adonare an evis most common lcoation of extraueiner endometail frwoth coocurs at the UTERSOSACRAL IGAMENTS level of pain doesno talways ocrrelate with the seerity of exrautierin tissue gowth during each msntualcycle the nedo metral tssue bleeds causing susern scarring ahesions moder to sever lwoer abodmnal pelvic or lwo bal cpain before or during mental irregualr mental cucles prenmaual spotting dspeanurai pain during defation and infetiltiy tx manual thecnique such as myofacia relase, viseceral mobi and soft and deep tissue massae ot reak up scar tittus ean dadhesions mobility exeriics are perofmr to sustain elongation of tissue realxation exrecsier breathig ortee and resoptative poses are perform teo fgualt the pain cycl e tens is also indicated pahra ma ner ncadt e altera momak balcne using orag contra ceptai and antigonadorpins surgery to remvoe the rxrar tien edoe atl tissue scarrin gan dhens and a toal hyterestomt may be reomnned hen prennancy is nor longer destited

pharmacologic stress test

diagnostic procedure in which cardiovascular stress is induced by pharmacologic agents when contraindications to a routine exercise stress test exist or when the patient is unable to exercise due to injury or another debilitating condition, it is used in combo with imaging modalities such as radionuclide imaging and echocardiography pharma agents = adenosine, dipyridamole, dobutamine

computed tomography CT

diagnostic test that uses an x-ray machine that rotates around a patient lying on a table computer processes that info from the scanner and create a pic of the organ and surrounding structures pics are slices of the body called tomograms and each picture is called a computed tomograph newest models of CT allow pics of the coronary arteries to be taken without the need for catheterization

diarrhea/constipation

diarrhea is defined as an abnormal frequeny=cy or volume of stool and can cappear as a sx of certian GI patholig es constipation is defined sa the infrequent or difficult passage of stoool, secondary to an increase in the hardness of the stool and can also appear as a sx odcertin GI patholiges

diastolic and exertion, when should exercise be terminated with respect to BP change

diastolic pressure may increase or decrease a maximum of 10 mmHg due to adaptive dilation of peripheral vasculature in a typical clinical setting, the exercise session should be TERMINATED if the systolic pressure exceeds 210 mmHg or if the diastolic pressure exceeds 110mmHg

pulse pressure

difference between systolic and diastolic generally increases in direct proportion to the intensity of exercise since systolic pressure increases with exercise and diastolic tends to stay the same in a healthy adult, it is common to see a 40-50 mmHg change in systolic pressure with intense exercise excessive pulse pressure may be indicative of stiffening of the aorta secondary to atherosclerosis

angina pectoris SILVER

diminished myocardial perfusion most commonly caused by narrowing of one or more of the coronary arteries (due to embolism, atherosclerosis, inflammation), when the tissues oxygen demand is greater than that provided by the coronary arteries, myocardial ischemia results producing characterist chcest pain specific type of pain is termed angina pectoris and is most commonly associated with coronary artery disease not an independent disease process but rather a sx of myocardial ischemia risk factors include family history of HD, smoing, physcal inactivity, stress hypertension elvated cholesterol diabetes mellitus and obesity presentation = uncomfortable or painful feeling of tighness pressure fullness or squzeeing in the center of the chest sx will typically presnt on the LEFT side of the body in the back arm shoulder neck or jaw when accomapanied by radiating pain sob and unexplained fatugeu are also freqnly reported stable angina occurs predicably in response to activities taht increase the oxygen demand such as exercise, stresss cold weather, large meals, stable will not last longer than 15 min and are relieved with rest and or nitro unstable is typically considered more serious since it occurs without causes and is often unresponsive to nitro 12-lead ECG most commonly used to daignose angina pectorsi with an INVERTED T WAVE indicating myocardial ischemia in patients with a normal ECG should undergo a more provocative exercise ECG or stress test diagnosis of angina is most often confirmed by first diagnosing the underlying pathology causing the ischemia focus on the underlying pathology pharma aspirin nitrates beta blcokers statins calcium channel blockers and ACE inhibitors surgery would be to widen a coronary artery in order to improve blood flow angioplpasty, stent placement, endarterectomy and coronary artery bypass graft are common lifestylchanges nutritional management is key increased risk for developing cardiac arrhytmias or experiencing a myocardial infarction or cardiac arrest

ecchymosis

discoloration occuring below intact skin resulting from trama to underlying blood vessels and blood seeping into tissues dicolocration is typically blue-black changing in time to a greenish brown or yellow color commonly refered to as a BRUISE

filariasis

disease caused by a parasitic infeciton that is most often seen in tropical climates it is one of the msot common causes of seocnadry lymphedema worldwide

gastrostomy tube G tube considerations

distal tubing can inadvertently become caught on items such as furnature and be pulled out enteral feedings should be turned off temporarily prior to and during treatment enteral feedings can be disconnected temporarily for mobility

thomas test

distinguish between one joint and two joint hip flexor tightness with low back and sacrum flat on the table, a normal one joint hip flexor length would be with thigh flat on the table and normal two joint hip flexor length would be 80 degrees of knee flexion

antiarrhythmic agents

divided into 4 classes: class 1 - sodium channel blockers, control cardiac excitation and conduction class 2 - beta blockers, inhibit sympathetic activity by blocking B-adrenergic receptors class 3 - prolong repolarization by inhibiting both potassium and sodium channels and are often considered the most effective antiarrhythmic agent class 4 - calcium channel blockers, depress depolarization and slow conduction though the AV node for cardiac arrhythmias side effects include exacerbation of cardiac arrhythmias, dizziness and hypotension

neurogenic bladder

dmange to the cereal control that allows for urianty dusfinctio if the urine cannot be properly relase there amy be an increase in iurianry tractinfection adn kidney fdmange etiology diabtes, dimnished baldder cacpt, hyperactive detruost msucle CVA other diseae proceses infection and vnerv dmagd e frequent uunrait trac tinfectiosn laeakag eof urine inabilty to empty the bladder or loss of the urge to uriante when the pbaldder is full diagnosis shold incldue an eval by a physian xray sand urodynamtisc to assist managnmet is sdpenden on etiology goal of preventing baldder overdistention utis and renal dmamge pt eduation bladder tehcniques lower abdomianl massas temor catheteriziton phra and timed uraitn program may bindcated

goal setting in older aults

do not assume abilites can resutl in descrepancies between pts goal st hethe trpaits goagls it is impretaiv that a tharp desina ac re pan for an aolder adutl incporate relavapt goals avoid degoie genei goals iek pt willk mabuat 15 feet with rolin gwalker on elvel surface an dincrae focs on goal taht thep has aeplici itnerin in eprfon t will amubat 20 ft with tw urns using asingple pint cam ot mat their audl route of etting to thnhspaps setting oan that ap for pt NOT THERI AGE qill tnerht eh bond betwetn ther apst and pt

pts skin and eyes have yellowish hue after surgery what do you do

document findings and consult with the primary physician immediately after treatment (preferably by phone) most likely experiencing jaundice as a result of liver dysfunction NOT a common finding after sx

anaerobic metablism

doesnt need oxygen high intensity short duration

relative indications for terminating an exercise test

drop in SBP >10mm Hg from baseline depsite increase in workload WITHOUT other evidence of ischemia >2 mm ST segment depression arrhythmias other than sustained ventricular tachycardia, including multifocal PVCs, supraventricular tachycardia, heart block or bradyarrhythmias fatigue, shortness of breath, wheezing, leg cramps and claudication development of bundle branch block or intraventicular conduction delay increasing chest pain hypertensive response (SBP >250 mmHg and/or DBP >115 mmHg)

absolute indications for terminating an exercise test

drop is SBP >10 mmHg from baseline despite increase in workload with other evidence of ischemia moderately severe angina (3 out of 4) increasing nervous system symptoms (ataxia or dizziness) signs of poor perfusion (cyanosis or pallor) sustained ventricular tachycardia 1.0mm ST elevation in leads without diagnostic Q waves

chemotherapy

drugs to destory malignant cells include alkylating agents antimeetabliete seteroi dpant akltlo interfern and antitumor antibiocs most useful with widespread adn metastsi cmlaignance but also to unde remission cure or eradicate residual oral subcut intamusc iv and otravaity side effectinlue nause vomti electlyteimbalacne secual dusfntion hari los pain and decreae in paltel red adn white bcell counts

hypothyroidism produces what effects to skin

dry and cool

desiccated

drying out or dehydration of a wound desiccation often results from poor dressing selection that does not control the evaportation of wound bed moisture

referred visceral pain may minic msk pain

due to overlap in sensory and nerve pathywas sx wil often refer to soft tissue withint he dermatoe that correspond to the organs SCI innervation lefft arm or jaw pain commonl associated with MI since visceral pain is transmitted via the ANS, this is epecially true when pain is acocompanied by autonomic reposnse such as nausea vomting pallor or sweating

normal cranio-cervical flexion test

during active chin tuck, the pressure in the stabilizer is increased to 22 and the patient can hold this position for 10 seconds (during this procedure, the SCM should remain inactive) holding for 30 seconds is for the deep neck flexor ENDURANCE test, not the cranio-cervical flexion test

american college of obstetricians and hymu recs for exercise in pregnancy and postpartum

during prenancy wmen can ontineu t eecise and dreive health benfit even from mild to mod exeics erpreit reg exercsie at leat 3 x per week is preferable to intermittent avoid exerics ein supine positon after first trimester during vigorous exxericse CO will be preferentially distribed awa form splanchinic viseral organs bed (including the uterus) so avoid HIIT prolgoend perids of otionless tandin g shoudl also be avoided decrease oxygen avail for aerobic exercis eduring prengnancy modify intensit accoring to materanal sx stop exreecising ehen gatigue ad not exerciser to ehaustion weight ebaring may under some crcumastabce be ontine dat intensti simialr to thos eprior to pregnancy throughoutrevanvnay non weigh tbeainr such as cycling or swillign will minimise the risk fo injr and facilate teh contnuation of execise during pregnancy morphic chagnes in pregancny should serve as a relviate contrain t tupes of execis ein which loss of balacne cold e detrimenttal to materal or fetal well being eps in third trimester any type of potentail for even midl adboaminal truam should be avoided prenanc require a naditon 300 calires in order to mainta metablic homestoatis thus women who exercsei should be particualr to ensure an sewuate diet pregnant women who sexerics ien the first trimestt shoud augment heat dissipation by ensurainf adea a hdyaton appro clothing and ptia evoneen suroanding durin gexri man of the physiolcal and mprhoical chagnes of pregnancy persis t 4 to 6 weeks postpartum preprengan exercsie rotueins should be resued graual ybae on a owmen phsicn acapitiy

pt cannot coordinate a movement what is the most effective feedback during EARLY motor learning

during the early stage, learners benefit from seeing the whole task correctly performed dependence on visual inputs is high developing a reference of correctness (knowledge of results) is critical to ensure early skill acquisition (cognitive mapping) proprioceptive inputs in important during the middle (associative) stage of motor learning, delayed feedback may be used later on

expected outcomes of airway clearance

easier clearance of secretions and increased volume of secretions during and after treatments improved breath sounds in the lungs being treated increase in sputum production change in vital signs (moderate changes in respiration rate and or pulse rate are EXPECTED) resolution or improvement of atelectasis and localize infiltrates observed with chest x-ray improvement of arterial blood gas values or oxygen saturation

phobia disorder

ecesvie rare of obcket occura or sintauth atha tins considre out fo fapottsj riratio gearf derae didiutl in ceveeryday lief subcasificaiotn inluce aforaphorba socal ismple sime s the saer to tat may devp fro rauma texeorn cbseratlassication cition dont leave hosue in agorapphobai

example question for facet info above full side bending left full rotation left full forward flexion limited and painful extension limited and painful right side bending limited and painful right rotation what arthrokinematic motion is disrupted

either downglide of a facet on the right or upglide of a facet on the left with this case, it is the right bc the pt has pain on the right (this is how you differentiate)

hypercapnia

elevated level of co2 in the arterial blood >45 mmHg

wilms tumor

embryonal nephroblastoma dound in the kidney most caues are diagnsed betwen one and 4 autosomal dominant diese a or non inhertented with unknow etioogy abdominal mass pan hemturia fever nausea vmitng rescetion of kidne dactinomycin anti tumor properies 5 year cure rate is 75%

1973 rehab act prohibits what

employment discrimination based on disability and requries reasonable accommodation in the workplace by removing barriers unless their would be undue hardship for the employer

fats

energy esr sin body anare oruaanr fuel soruc efo rloitn etsn exeicse pa a role in suli nthte bdoy drogtection organ sn asnsiat inthe ftnasp of fatsolue viatmins fats are made up of fattay acids hwich can be acgai as aauts mono or pil astu anamal tend dot incae elvels of basd cholelstorl aka lLDL while usntarua pfats are ofund in patns and tend to inve glev sof food chosles i.e. HDL

radiacal mastectomy

entire breast pecs and axillary lmph and some skin are remvoe dusualy due to breast caner

inherited metabolic disrders

enzyne deficieny lead dsto accumulation of the substrate and subeqeen defi icney in the intended enyzme product interhieed metaoli dosrdaca can be diangosed in utero via amniocentroeis or chroioc villus sampling manu inherited matbolid dosdrsc will procie sx in a newborn inlduing lethary apnea, poor fefeing tachypnea vomitnn ghypoglucemia urine chagnes and sizuer sa sx that are immeidatela apparent indcaite a more dangeous disorder

osteogenic sarcoma

epiphyses of long bones msot commoon cause o bone cancer in chlidren witha peak incdience betwetn teh ages of 10 and 20 immunoicometea and rate of tumors profecction can metastaze wuckly ss presence of a mass paid metastates assocation pain dx throgh biopsy amutaion with proximal resection to ensureprpoer removal of affetted tissue or sur resce t and salvage limb RADIATION NOT EFFECTIVE chemo is benefitical

mononucleosis

epstein barr virus prevalent in young males but has to complain of sore throat or fatigue

vitamins

essential non caliri nutieent ath are reuqi fein small aoonts fo raceitan emabbtlu ciunfton ananot be manufafu by teh ody fat solubel or water soulbe

vaitmins A

esstniealtto ht eeys epithelai tissue noraml geowrh enad vleopomenta nad rpediciton green oragan and yellow veges lvier butuer egg olksd and fortialg marigne sx inlcud enight blidnness ogh and dry skin and rogeth failure toxicit include papetie los hari los enlgaet live ro spleen

glomerular filtation rate

estimat og the fielratccapcity of th kdiney volune of fultrat pricue per minta bu the kindye

pulse oximetry

estimate the percent of arterial oxygen saturation of hemoglobin by placing a sensor on the finger or earlobe measures the differential absorption of light by oxygenated and nonyx hemoglobin estimate is denoated as spo2 which is an indication of the patial pressure of o2 in the arterial blood

what should you document about a wound

etiology location wound type and classification clinical signs of infection area, depth, and shape of wound condition of wound margins/edges undermining or tunneling invovlement of underlying strucurres stage of healing color of base odor exudate type and volume chronicity response to previous treatment surrouding skin and scar assessment oresence of necrosis

sarcoidosis BRONZE

etiology unknown result of an abnormal immune system response to some foreign substance such as an inhaled bacterium virus chemical or allergen characterized by the growth of small, abnormal collections of inlfkammatory cells known as granulomas within the bodys organs can affect any of the organs more than others, speficially the lungs, lymph nodes, and skin when multiple granulomas form within an organ it will affect how the organ functions leading to a variety of s/s depending on the organ affected if the condition affects the heart or brain, serous complciations can occur many ppl have no s/s or only mildones when in lungs s/s include...wheezing, coughing, SOB and chest pain other sx may include fatigue, weight loss, blurry vision enlarged lymph nodes, sore or areas of disclolored skin and painful sweollen joints may present with a specific set of signs and symptoms knowns as LOFGRENS SYNDROME which is an acute form of sarcoidosis no specific test diagnosed by exclusion chest xray is often perfoemd since the large majority of patietsn with the condition will have an abnoraml chest xray bipsy may also be ordered to check for the prsence of gradulations

pulmonary edema BRONZE

excess fluid within the lungs, occurs when the L ventricle is unable to adequately pump blood to the systemic cirulation causes fluid to back up into the pulmonary ciruclation and the lungs other causes of fluid build up withiin the lungs include living at high elevations, respiratory distress syndrome, PE, adverse drug rxns, viral infections, smoke inhalation and exporesur to toxins acute pulmonary edema is considered a medical emergency!!! as the pressure in the pulmonary circulation increases, the flud moves from the lung capillaries INTO the aleveoli which makes breathing more difficult in noncardiogenic pulmonary edema, the fluid buildup in the alveoli is not caused by an increase in pressure but rather an increase in permeability of the capillaries themselves acute pulmonary edema sx - extreme SOB esp when lying down, wheezing or gasping, anxiety, a cough that produces a FROTHY SPUTUM may be tinged with BLOOD, chest pain and palpitations chronic sx - SOB that worsens with lying down or physical activity, wheezing, weight gain, lower extremity swelling, and fatigue chest xray is primary other used to determine cause i.e. blood tests, electrocardiogram and echo rule out asthma, COPD, PE

hyperpigmentation

excess of pigment that causes it to appear darker than surrounding tissues

hyperthroid

excessei nervousnes sweting weightllosos bp exophtlamos (budgling of eyes) myoathy chronci periahtisi enlgaef hyroid phrama radioactiv isoiiene and sx

hyperparathyroidism

excessive hormone production by the parathrouohd leads to disruptuon o fcalcium phsphate and bone metabbolism sx inlcude RENAL STONES and kidney damage depression memory loss msucle wasting bone defmoty andmyphathy acute tx inet=tevention that immedtae lowers calcium using direututisc or antirepositive medicatins sx is usualyl require to remove the hidsae parathyroid phamara before surgery for gor lon erm

hyperpitiitarism

excessive secretjn in pitatrau glands frequnt rowth hormes and prodces acromegaly gigantism or acromegaly hirsutism glactorreha (abnormal lactation in males or famelas) amenorrehea infertilit importence tx inlcue tumor rescetion surgery radiation and hormone suppression or replcament if the lfnf bc dysfunctional after t

swan-ganz catheters, central venous pressure cath, indwelling right atrial catheters considerations

exercise is possible with the line but mobility may need to be restricted near the catheter insertion

when will you see a higher intensity pulse

exericse and fever

pancreas1

exocrine - secrets bicarbonate and digestive enzymes into the duodenum endocrine - secretse insulin glucagon and other hormones into the blood to regualr serum glucose level

adventitious sounds

extra breath sounds that are not normally heard, such as crackles, rhonchi, wheezes, and pleural friction rubs.

thrombolytic agents

facilitate clot dissolution through conversion of plasminogen to plasmin, plasmin breaks down clots and allows occluded vessels to repoen to maintain blood flow used for acute myocardial infarction, pulmonary embolism, ischemic stroke, arterial or venous thrombosis side effects include hemorrhage (specifically intracranial in certain populations), allergic reaction, cardiac arrhythmia therapists must be careful to avoid situations that may cause trauma due to altered clotting activity i.e. kinlytic (urokinase), activase (alteplase)

Vitamin B2 (Riboflavin)

facilites selcted enymes in ovles in carvb prgorn an fat metablis milk grern leafy egs ppeanuts defin inlalm of th esont ssensit eyes scalingof sk in no toxixivty

cellulitis

fast speading inflammation that occurs as a resi to fbacterial infectio ofnt he skin and conective tissues it can develop anywhere inder the kins but will tpcialy faffect ehe xtemirie s step staph increase dafe innusupresn turam aprea wound venosu insuff s/s lcoalie red nes spera quck skin that is wamr o hot to uoch lcoala asbee or ulceration tender to palp childs fere er mallaise tx IMMEDIATE REFER to physian phrma internvetion systemic antibiotics rule out dvt and ocntac tdermnatitis pt may be wareten for wond care can lead to sepsis or ganerere if not teted

antihyperlipidemia agents

five categories most commomly used are statins which inhbit enzyme action in cholesterol synthesis, breakdown of LDL, decrease triglyceride levels, and increase HDL levels the other categories are bile acid sequestrants, nicotinic acid, cholesterol absorption inhibitors, and fibric acid derivatives used for hyperlipidemia, atherosclerosis, prevent coronary events in patients with existing coronary artery disease, diabetes or peripheral vascular diseae side effects include headache, GI distress, myalgia, and rash aerobic exercise can increase HDL and maximize the effects of drug therapy i.e. lipitor (atorvastatin), zocor (simvastatin), tricor (fenofibrate)

pitting edema

fluid accumulation that can be compression and demonstrae an indenation whith applied prssure ma be onserve din the earlty astge ao flumphema

bipolar dirsor agents

focus onteh prevnetion ofmanci indero to avoid exremm ood siwng tha follow LITHIUM certain antiseirzu and anti cphsyco meds amy assist as mod stbailzier with bcol gi stres targive dysflins afatigeh contuson atsxcia nyspanmus alether tremoe parkinsonism serizue diabertes insps toxiity coma friisk fo death know sx f toxoty of lithim lngterm use of litihum may result ni soteo pross wihci will imatc the ohsy7cal thearpy plan of care lithoibid (lithum) antipsychof clozaril clozapine rsperdal risperidone antisiez tegretol carbamazepine neurotin gabapentin

antiangiogenic therapy

focuses on the use of thalidomide and its suppresion ofblood suppply formation has had initate success in the tx of multipe meyeloma rearhs sppored blcking the process of owth as oppste teo detesciton of an already formed mass as means of inihtbi fowth of pruar lmlaignant massaes

when do you need to modify postural drainage positions

for BP or spo2 deficiencies

thrombosis

formation of a blood clot in a blood vessl

venous thrombosis BRONZE

formation of a thombus in a vein most common in LE any condition that slows or changes flow of blood within a vein can increase risk risk factors = prolonged immob recent sx pregnacy obesity cig smoking meds (i.e. birth control and hormone replacement) blood conditions like polytythemia which is "thick" blood blood clottin disorders cancer certain autoimmune s/s = swelling, redness, warmth, and pain in the affected leg most common in calf though the condition can occur without any noticable sx US most common blood tests will also be ordered to detect elevated levels of clot dissolving substances other imaging = MRI, CT and venography homans sign but has poor diagnostic value

folacin folic acid

formation of rbc and in the fucnotn of GI tarc t years tdark geren leafy whoel grian impated cel aivi alreation of retin synteh h not eoxoty

stiff pelvis which way to move on therapy ball

forward, producing posterior tilting of the pelvis

irregular rhythm how do you count it

full 60 seconds

unhappy triad what is your priority

full or partial tears of the Anterior Cruciate Ligament, the Medial Collateral Ligament and a tear of the Medial Meniscus. terminal knee extension!!! subacute phase will use closed chain to enhance functional control of the muscles surrounding the knee aka quad and hs open chain would not encourage FUNCTIONAL control

stage 4 pressure injury

full thickness skin and tissue loss with exposed or directly palpable fascia, msucles, tendon, ligament, cartilage, or bone in the ulcer slough and or eschar may be visible epibole (rolled eddges), undermining and or tunneling often occur depth varies by anatomical location if slough or eschar obscures the extent of the tissue loss it is unstageable

stage 3 pressure injury

full thickness skin loss in which adipose is visible in the ulcer and granulation tissue and epibole (rolled edges) are often present slough and or eschar may be visible the depth of tissue damage varies by anatomical location areas of sig adiposity can develop deep wounds undermining and tunneling may occur fascia, muscle, tendon, ligament, cartilage and or bone are not exposred if slough or eschar obstcures the extent of tissue loss, this is an unstageable pressure injury

stage III ulcer

full thickness skin loss with damage to or necrosis of subcutaneous tissue presents as a "crater"

stage IV ulcer

full thickness skin loss with extensive destruction, tissue necrosis, and damage to muscle, bone or supporting structures undermining or sinus tracts may also be present

6MWT good correlation with

functional abilities (submax test and function is performed at a submax work level) 6MWT does not correlate to lung disease severity 6MWT has not about a 73% correlation with VO2 max (10 meter shuffle walk test would be better test to use if correlation with VO2 is desired) and therefore it cannot document maximal exercise capacity

onychomycosis

fungal infection that primarily affects the toenails and anil beds onychomycosis is divided into subtypes but are typucally medically traeat in a similar fashion faily common rsik factors inlcud emanicures and peidcures, ossessing nailijureis or demofit, excess skin lksioture, eain closed teo dhsoes and impaired imminre repsones s/s yellow brown nail disocloration, hyperkeatosis ahd hypertophy of the nail ausie it to paritall detach from the nail bed tx = manual debridement of the nail and topical antihfunal medis ma reutne and ma have pemannent damage

elderly patient with diabetes (peripheral neuropathy) and retinopathy, difficulty with balance when ambulating at home, what is the FIRST priority

gait training with a cane to ensure safety (necessary as this patient is demonstrating complications of diabetes which are chronic and PROGRESSIVE) home environment would be the next priority in the POC

posterior thoracic pain referral

gallbladder often refers to the thorax

gallbaldder pathologies

gallstones (cholelithisasis) cholecustitis gall baldder cancer

left upper quad

gastric ulcer pperforated color pneumonia slpeen injry spleen rupture aortic aneurym (more on the left with the heart)

common pathology of stomach

gastriits peptic ulcer disease gastric cancer G hemorrhage motilita dn emptying idosrder

TENS uses what theory

gate control theory activated by the application of conventional (high rate) TENS at the spinal cord level ascending inhibition occurs after thee gate control mechanism has been activated

kdiney patholgoy

glomerulonephrisi (inflamm of tiny filters) mehprolithiasis (kidney stone) renal failure

osteopertrosis

gorup of conditionscharacterized by impaired osteoclast funtion which cauess bone to become thickened byt fragile inherited condition

neuroses disorsder

gourp of disora thate a character by niaval exhibt fear nd malalativ star ind ealing with dress ro every stimul ts with neuroses are not dleaign with pscyhos do not hav delsins andauaul ralie htey htey have aprolem

not a PRIMARY concern when evaluation home environment for fall risk

grab bars in the bathroom mounted 48 inches from the floor (should be 33 to 36) PRIMARY concerns = carpet edges, throw rugs, floorboard lighting in stairways bedrooms bathrooms nonslip surfaces in the bathtub and shower

bacterial pneumonia

gradual onset of days with a productive cough as pneumonia interferes with the transport of oxygen from the alveoli to the pulmonary capillaries, the paO2 and therefore the sao2 would be lower than expected wheezing may also occur and resound within the thorax fever is also plausible bronchial breath sound in the specific involved region of the lung is also plausible

electrocardiogram (ECG)

graphic representation of the heart's electrical activity recorded from electrodes on the surface of the body the ECG provides insight into the electrical behavior of the heart and its modification by physiologic, pharmacologic, and pathologic events a 12 lead ECG provides 12 views of the heart it is used to assess cardiac rhythm, to diagnose the location, extent, and acuteness or myocardial iscemia/infarction, and to evaluate changes with activity

best training strategy to instruct the patient in performing a wheelie

grasp the handrims posteriorly and pull the forward abruptly and forcefully if this doesnt work, the pt can throw the head back forcefully when pulling the handrims alternate technique - grasp the handrims anteriorly, pull back, and then abruptly and forecfuly reverse the direction of the pull the therapist can assist by steadying the chair at the patients balance point until the patient learns to adjust the position through the use of handrim movements fwd and back

why do you have to be careful with MS patients in the pool

have heat intolerance so can be too warm in certain scenarios (like 85 degrees is too warm)

what does a child need to possess in order to use a power w/c

head control and fine motor control age is generally not a factor bc children as young as 18 months have been found to be able to operate a w/c

secondary intention healing

healing by secondary intention permits wounds to close on their own wihtout superficial closure wound with characterisiics such as significant tissue loss or necrosis, irregular or nonviable would margins that cannot be reapproximated, infection or debris contamination typically heal by secondary intention these wounds are often associated with pathology such as diabetes, sichemi conditions, pressure damage or inflammatory disease a layer of granulation tissue will gradually fill the wound bed to the level of the surrounding skin, with closure occuring by wound CONTRACTION and scar formation wounds healing be secondary intention require ongoing wound care and have signifcantly larger scars that those helaing by primary intention (i.e. neuropathic, arterial, venous, or pressure ulcers, most full thickness wounds, and chronically inflammed wounds)

tertiary intention healing

healing by tertiary intention may also be referred to as delayed primary intension healing wonds at risk for developing complications such as sepsis or dehiscense may be temporarily left open once risk factors have been alleviated (i.e. wounds with significant edema, contamination from debris, at high risk for infection or with questionable vascular integrity) the wound is clsoed by the usual intention methods

corrhosis of the liver

healthy ltissue of liver is repalce dwith scar tissue that block sthe flow of blood through ther ogan and prevents the liver from poeroply functioning alcoholism orh hep C alcohol tend to lblock teh romal metabolis of protien fats and cafrbs this condition will normally occur aftaer a pt has been heavily drinking of rmore than a devage infalmation of the liver seconarty o hep C is also a large cauitiv evafor cirrhosois persistant inflmation ans slow adamge to the liver will resutl in cirrhosis of the liver after deverdevae of infectin otehr caues inlcude hep B and D certain drugs infection and toxins specifi ehreditayidaea and non alc and bloce dbil ducts ssfatigue decrease appeitie neasuea wekanes adoinal pain spider anigonas and weight loss aciteis (water accumulation in the abdomen secondary to decreases prouction of albumin by the luver) edema jaucneide galstones increase tiching ecchymosis bleeding increase senst o emds accuulation o ftoxins in the brain protan vein hypertension devep of vaices (enlargedblood vessels inthe stomach and esophagus) immune system dysfinciton enphalopathy and liver cancer tx cannot reverse the process or dammge but can asloow the prcoess tx is based on the cautive facor and is implementa until sx cannot be controlled a sliver transoant may be necdsary

exercise

help improve lmyph flow by increase lymph vessel contracction increasing fluid uptake in the inital lymph vessels improve msucle pump to stimulate lymph flow and increasing deep breathing which improves lyph flowin the thoracic duct bc some pts can have a negaive repsones tto exevsei they mus te monitor carefully low impact, aerobic activities are recommended at the onset isnce they are less likly o exacerbate the pts lymheda basic guidelines include starting wth TRUNK exercise followed by exremity and wrokingfrom PROXIMAL to distasl the session should fnishe dwith addiotnla trunk exercises and deep breathing to endhanc elumph flow compression bandages and garmets should be worn during exercise

compression therapy

helps to manita the reduciton in edema that is achieved with MLD help reduc elimnn siz eby improing reabsorption abilt of the capillaries and reduce the filationr of lfuis into the iniertitum also help sfoten firbtoic tiessues that may haev formed REABSORPTION REDUCE FILATIOATN INTO INTERTISI SOFTEN FIBROTIC TISSUE IN PHASE i COMPRESSION BANDAGES ARE TYPICALLY USED SHORT STRETCH BADAGES ARE USED FOR TAEATING LMPHEDEMA SICNE THEY HAVE A LOW RSETING PRSSURE AND THERFORE DO NO CNSTRICT LYMPH FLOW LIKE LONG STRETCH BANDAGES WOULD IN PHASE ii A COMBO OF OCMPROESSION GARMENTS DURING THE DAY AND COMPRESSION BDANGAGES DURING THE NIGHT COMPRESSIO GARMETS SHOULDONLY BE FITTED ONCE EDEMA ELESL HAVE plateaued BANDAFES AND GARMENTS HOULD HAVE HIGH PRESURE IN distal reggions I.E. GARDED COMPRESSION

hemiballismus vs athetosis vs chorea

hemi - sudden jerky forceful flailing involuntary movements on one side of the body athetosis - slow writhing and twisting involuntarily chorea - rapid irregular and jerky involuntary

stroke to right internal capsule, what will you see

hemiparesis of the contralateral extremities paresis of LOWER HALF of the contralateral face called supranuclear palsy which affects only the contralateral lower half of the face corticobulbar tract is the pathway that is affected which contains UMNs that project from the motor cortex to the nucleus of the facial nerve (VII) in the brainstem the muscles in the upper face are SPARED because both the right and left cerebral cortex project to the LMNs in the facial nucleus that are innervate the forehead in contrast, the LMNs that innervate the muscles of the lwoer half of the face receive input from the contralateral motor cortex only therefore, a stroke that affects the internal capsule (corticobulbar tract) prevents input from the motor cortex to the contralateral facial nucleus, causing paresis or paralysis of the muscles of the lower half of the face

2 in stage II decubitus ulcer over the left lateral malleolus is referred to PT, greenish, pungent exudate, PT wants to use e stim what is the best treatment

hi volt pulsed monophasic current with the anode over a silver dressing placed in the wound controvery in text regarding polarity and its effect on specific organisms migration towards certain poles but despite this there is strong evidence of hi volt pulsed monophasic current for the reduction of infection (aka it is NOT contraindicated for infected wounds), the promotion of granulation and epithelialization, current guideline recommend...the anode (+ pole) is used over a silver dressing IN the wound if infection is present if it is not infected, the cathode (- pole) is recommended over the wound initially to promote healing and should be continued until wound healing plateaus or degrades...if that occurs then switch polarities and continue until wound healing diminishes or there are no signs of healing in 3-7 days then switch polarity again evidence is not as strong for pulsed biphasic (totally different than above)

common pathology of esophaugs

hiatial hernia, GI refluc disease, esophageal cancer, hysphagia, esphageal varices, barretts esophaus

2/5 strength, you want to use biofeedback to assist in progressively increasing active motor recruitment, best protocol?

high detection sensitivity with recording electrodes placed far apart over the muscle belly will detect low amplitude signals generated by a small number of motor units as in a weak extensor carpi radialis longus if the patient has poor muscle control, moving the electrodes apart can help sample a larger portioon of the muscle as the pt is able to recruit more motor units the electrodes can be moved closer together to decrease potential cross talk from other motor units therapists can get the electrodes too far apart and should limit the distance to only the area they intend to sample

TBI with retained secretions what is the best mode of airway clearance?

high frequency chest wall oscillation which allows for control of inspratory and expiratory flow rates and can be used in ANY position REGARDLESS of the patients COGNITIVE STATUS active cycle of breathing, autogenic drainage, and oscillatory positive expiratory pressure PEP using a FLUTTER device require the patient to consistently follow commands and potentially complete this task alone which would be difficult for a patient in this cognitive stage of recovery

echocardiography

high frequency sound waves non-invasively to evaluate the functioning of the heart via real time images provides info on the size and function of the venticles, thickness of the septums, and function of the walls, valves and chambers of the heart transthoracic echocardiography is a ?nonivasive? procedure using a handheld US, the US is passed into the esophagus (the transducer provides a more detailed image of the heart because the esophagus lies in extemely close proximity

fast twitch exercise

high intensity short duration (<20 reps) is needed to train the highly adaptable fast twitch IIa fibers low intensity slow contraction will challenge slow twitch high intensity at long durations are contraindicated

lymphedema prevention

high risk individuals i.e. lymph node rmeoval extensive chest srugerues radiation therapy obesity can signigicant limit their risk by following thse guildelines: avoid injury to the skin to help reduce the risk of infection this may incldue trating cuts and abrainsions proerly lcaution with use of raxoers or nail clippers appling moistuzier to th eksin and avoiding skin punctures i.e. blood draws on the affecte dlimb avoid any contraiciton of the etremity this ma incldue waeraing loose fiitn glcohting and avioding having blood prssure measurements perforemd on the affected limb diet and exercise to amintain a health weight being verwirhg sign increae a pt risk for dvelipg lymphedmea when exercising carefully observe any change sin the size of the lim tp ensure that increase acitity is not cause negatie side effects ake frequent breaks during poeriods of intenstse acitivyt avoid extremem hot and cold temp eas tehy can lead to fuatuations in limbedema wear compression garments during periods of strenuous activity, when stanidn for prologned periods of time o when travleing on an iarplae

antibiotic agents

high toxity and abiltye to iner with dna and rna sysnteha dn subewen cell division mutlsystem invoelvment with midl to esvea eside effect ptent riska r eaaaent socnt ot he iagna isss of malingany SOB dsfthmias blood disorders myelosuprpession pedal edmea myelosuppresion (bone marrow suppres adriamycin (doxorubicin) mithracin (pilciamycin) cosmegen (dactinomycin)

FABER test to screen

hip and SI pathology

webers test

holding a vibrating tuning fork on the vertex of the head pt is asked which ear is louder, differentiating the unimpaired ear from the deaf ear

ambulatory electrocardiography

holter monitoring ECG electrodes are placed on the chest and attached to a small battery operated recording monitor carried in a pocket or in a small pouch around the neck ECG is recorded for 24 to 48 hours or longer to evaluate cardiac rhythm, the efficacy of medications and pacemaker function it is then correlated with a diary of the patients sx and activities

muscle test for anterior deltoid

humerus and forearm would be in neutral (not pronated and IR like for supraspinatus)

dressings from most occlusive to non occlusive

hydrocolloids hydrogels semiperm foam semiperm film impregnated gauze alginates traditional gauze

turf toe

hyperextension injury The MTP joint is surrounded by important structures that hold it in place and prevent it from dislocating. Together these structures are referred to as the "plantar complex." Plantar plate. This thick, fibrous tissue under the MTP joint prevents the big toe from bending too far (dorsiflexion). Collateral ligaments. Located on each side of the big toe, collateral ligaments connect the phalanx bone to the metatarsal and prevent the toe from going too far side-to-side. Flexor hallucis brevis. This tendon runs under the first metatarsal bone and attaches to the proximal phalanx. It provides strength and stability to the big toe during push-off motions. Sesamoids. These two small bones are enveloped in the flexor hallucis tendon, and help it to move more easily. In addition, the sesamoids provide stability to the MTP joint by helping to bear weight placed on the forefoot.

DM and exercise

hyperglycemia unaddresses can cause complciations early signs of hyper >180-200 include increased third and feequnt urination helps prevent ketoacidosis if you can recognize this which is also called a diabetic coma which most commonly occurs in DM1 LIFE THREATENING and reqiers IMMEDIATE MEDICAL ATTENTION ss of ketoacidosis is dyspnea, fruity bath, dry mouth, nausea, vomting, confusion and eventual loss of ocscisness hypoglyecemia <70 include hunger, sweating, shaking, dizzines, clumsiness and HA may lose consciousness at which point immediate medical attention is necessary hypoglyemia is often coutacteds impky y ingectin of a glucose or carb rich substance i.e. sugar honey jiuce crackers pts with sign hypo issues may be advised by their phsyican to carry a glucose source or injectable glucagon with them at all times exercise response reg exercise offtes numerous beenfits to pts with DM eight and strss managment aspcects of execiise are particularly benefitcial with regar to controllingblood glucose levesl physial and mental stressors have been show to elevated blod glucse malking long term managmene more achalenging to exercise priivdes positiv udal infecenci of aiding stress manangemen and inceasein blood glucose update byt he muscles without signifcantl inmpating ginsulin levlesl must be alter to signs of exuercsie indudeced hypogluemia which may ocurs with strenuous orrlonge dexercise stasks sx onset can be uresuce by ingestion of a carb snack prior to exercise in order to compensatte for increase dglucose demands or incusl insulin absoprion

normal vs COPD lungs

hyperlucent in COPD flat diaphragm barrel chest blunted costophrenic angle

Hyperthyroidism

hypermetabolic state associated with exercise INTOLERANCE and impaired CP function s/s include dyspnea, fatigue, tachycardia, and arrhythmia in older adults there is an increased risk of aggravating preexisting heart disease (a fib, angina, and MI) will see muscles weakness and fatigue but NOT JOINT PAIN

obesity is associated with

hypertension dyslipidemia hyperinsulinemia (type 2 diabetes) hyperglycemia

scar management

hypertophic scaring is the result of an imbalance between collagen synthesis and lysis during healing and can occur with any integumartary inury common in burns complications include contracture, adhesions, hypersensitivity, functional limitation, and poor comesis

addisons disease

hypofuntion of the adrenal coretx decrease in production of noth cortisol (glucocorticolid) and aldosterone mineralocrotiid sx incldue widespread metabolic dsfinctin secondary to cortisol defiiciten as well as flui dan elelctrolyte imbalcnes secondar to aldocersoldsfin may experience hypotension weakne anoerexia weiht tloss alere pigment and if left unteated will resutl in shock and possible death tx harama syntheti ccorticodsetoierds and mineralcortoids

therapeutic mosturizers

i.e. lotion and cream lotions are largely water based and best used to replace skin moisture that has been lost either to the air or as a result of frequent hand washing crreams are thicker water based substances with higher concentrations of solids and oils that lotions making the need for reapllication less frequent theraptuetic moisteuzers are intended to maintain the skins natural mooisture and prevent tissue cracking due to dryness but do not typically protect the skin from excessive mpsiture

froments sign

identify ulnar nerve dysfunction

what spo2 would make you stop activity and have a discussion with teh physician to consider adding O2

if <90% in acutely ill patients or <85% in patients with chronic lung disease

guieline for high risk preg

if at riskf or illness or death prevention of reterm elviety though th prescirpiton of bed rest, activity restiction and meds PT can enhane the well being andqualty of life of the pregnant womean with a high risk pereg T shoudl clseol montiro the pt during all actiie reasses afee reach treatment and devep and india execise program pt should be instructed in self monitirng tecniwu ueein actiites to aoid adeverse reacitons left sidelying is the postion of choise to reduce the pressure on the inferior vena caca maximiae carda out put to enahcne materal and fetal cirucaltion afeuc etuhe irsk fo inp,mpetetent cervic adomana execise may stimuat urine contaction the therapist should modife or discontne the exercseis keep exrecise siple slow lmooth and with minla exereiton avoid valsa bu stincontin niog exrcis ethat incfreas ein traabsomdnala pressure preiid eitnstuciotn o oerpo rbdy bmeai adn posturla instruct to intin straingin during abonala contractins encouarge maixmum jmsucles effcicieny during eah movement educathe women about cesarian delviery rehav montor and repot any utienre contraction bleeding or aminionc fluid loss

Metabolic vs respiratory acidosis/alkalosis

if it is metabolic then will see a change in the bicarbonate ion (high bicarbonate would make the body more basic bc gets rid of the acid) if the HCO3 is normal, the change will be respiratory not metabolic

Positron Emission Tomography (PET)

imaging test in which a small amount of radioactive material is injected, inhaled, or swallowed depending on the organ or tissue being studied increased radioactive material tends to accumulate in areas with high levels of chemical activity corresponding to areas of disease this presents as a different color or brighter spot on the scan useful in evaluating heart disease and cancer

dyssynergia

impairment in movement composition movements are typically performed in component parts rather than as a single, smooth activity

what would you expect to find in an elderly pt with increasing forgetfuness and some memory deficits

impairments in short term memory (i.e. recent events, why did i come in this room, who came to see me yesterday) hallucinations or delusions are common (not present in this case) immediate recall is okay (can repeat words) same for long term NOT flutuating confusion (delirium) NOT periods of agitation and wandering aka sundowning is in alzheimers type dementia but does not begin until stage II

ectopic

implantaiton of a fertilzi ocum outsid eth utera the lfalloan tube is the most common

sustained maximal inhalation with incentive spirometer

in a sustained max inspiration (SMI), a max inspiratory effort is held for 3 or more seconds at the point of maximum inspiration before exhalation many airway clearance techniques include SMI to compensate for asynchonous ventilation, to promote air passage past mucus obstructions in airways, and to maximize alveolar expansion SMI is also called incentive spirometry when using a device that provides visual or other feedback to encourage the patient to take long, slow, deep inhalations indicated for decreased intathoacic lung volume, decreased chest wall lung compliance, increased flow resistance from decreased lung volume, ventilation perfusion (V:Q) mismatch, atelectasis or risk of atelectasis due to thoracic and upper abdominal surgery, restrictive lung defect associated with quadriplegia and or dsyfunctional diaphragm precau/contra ... patient is not cooperative or is unable to understand or demonstrate proper use of the IS patient is unable to deep breathe effectively (i.e. with vital capacity less than 10mL/kg) or inspiratory capacity less than one third of predicted patient with moderate to severe COPD with increased RR and hyperinflation procedure... hold the incentive spirometer in a vertical position have the patient exhale compeltely then seal his lips around the mouth piece breathe in slowly and deeply through the mouth, raising the ball or piston of the spirometer encourage the patient to mvoe the diaphragm and expand the lower chest, NOT the upper chest hold the breath for at least three seconds and note the highest level the piston reaches perform SMI independently 5-10 breaths per hour when awake expected outcomes... absence of or improvement in signs of atelectasis decreased RR resolution of fever normal pulse rate normal chest xray improve pao2 increased froced vital capacity and peak expiratory flows

anuria

inadeuqat urin out in 23 hours period less than 100 ml (severe dehration shcok and endastag erneal disae)

increased activity

inceased acity int ehf rsit 6m month of wiehg tloss effeorst has not been shown to sig imapct wight reduciton should educate on this so dont hget frsuterated and loose motvated start with walking or dwimming perforemam at a toerlable pace target of 30 min may sprea dpe sout can pos inflence body insulin sensitivy and afastin blood glucose to a measureable degree even int he baasse of weigh tloss

hormone replacement for menopausal sx

incldue estogran adn progestin apprced byt he FDA for tx of meopausela sx and soteoproso women health intiiate trial of HRT found the beneifts for homrone replcament to be reduciotn in hot flash frwqncy severi improve in atrpphic vaginits (dry and weak leads to painful intercourse and uriantion) UTIs and preveiton of soteopororosis and fx sudies suggest women going through menopausal traition who are expeicne deprssion and memory lsos may also benefir tform HRT however this reia a contosversional claim risk icnldue PE, storke DVT gallbladder dise aand small increasein breast cancer ove the past 30 years there has been in anicnreas ein hrt for po awhp ha CVD MAY IBHIBTI PROGRESSION OF CVD but it is controversion

biolgic responset modfiers agets

include inteferons interluekin 2 and monclonal antibotes that re resonsible for enahancing the bodys oen abilty to repsonet ot neoplsatic gorwht are NOT cytotoxic but failicate the pts immunse repsonet o detroy malignant tissues particullay leukemias lymphonas kaposi sarcoma (red lesions) organ and tissue malig proleukin (aldesleukin) avastin (bevacizumab) intron A (interfereon alfa 2b)

gastroesophagea relfexu diesae GERD

incompetent LOWER esophaeal sphier that allows refluc of gastric octents bakwarsd movement of sotmach acida and contesnts can cause sopheal tissue injury over time as well as other pathgu iccurs in 20-30% of adults adn cab be found insome newbrns or infacts weakness of LES intermittent relaxation of LES irectdadmange of LES through ndsaids alcohol infections agents smoking and cetain precaitp meds ss heart urn regugigation o gastric ocntesnts belchin chest pt hoarsenes and coughing eshaigits and hemtemeisis if left unteat can delveop eshaela strictures (narrowing or tighenting of esophafu form inflamm or scarring) esophagitsi asptiation pneumoa astham barrrets esoatua sna dospafe den

antidepresion agents (tricuclic ssri maoi other)

incrase aminergic transmtion and normalize neuotramission acitivey sefationblured vision tachycarid ddry mouth insonai wieght gain sexual dusfinction hypetension or trothstatic hypotensionlook uot for must also look for any sigsn of further deression or sucual tendenciies triccleis elavil (amitriptyline) pamelor (notrilline) MAOIS nardil (phenelzine) SSRIS wellbutrin (bupropion) prozac (fluoxetine) acil (paroxetine)

hyperplastai

increaein cell numerb that may b e nroaml or abnoral depn gon addiiton chaceteis

hyperpnea

increase in depth and rate of breathing

gestational diabtes

increase in insulin resitanc etherefore nan icnrease in blood glucose levesl that occurs during preg generally dvep during the LAST TRIMESTER through that hromeons that assist ithe fetus to gow and dvelop also lead to insulin resitan occurs in about 4% of all prenancyies lareg marotiy renturn to nromal after the pregnanacy if lgucsoe intoelrae persists for more than six weeks after chilrbith the pt should be reclassificed to another form of DM babies orn to women with gestational diabetes have increase glucose levesl are at increase risk for macrosomia (ie. larger than average size) hwich makes delviery more diffcult and potential more dangerous baby may salso experience breathign difficulties jauncide and hypogluemia folliwng brith in childhood and addolecent these children are more likely to expericne insulin resitance obesity behaior health inssue such as hyperactivity disrder and delays in grocs and ine motor skillsl

expectorant agents

increase respiratory secretions which help to loosen mucus, reducing viscosity of secretions and increasing sputum volume improves the efficiency of the cough reflex and of ciliary action in removing accumulated secretions used for cough associated with respiratory tract infections and related conditions such as sinusitis, pharyngitis, bronchitis and asthma, when complicated by tenacious mucus or muscus plugs and congestion side effects include GI distress and drowsiness therapists can exploit the effects of expectorant agents by performing airway clearance interventions within one hour after drug adminsitration, therapists should encourage the patient to take the medication witha glass of water i.e. mucinex (guaifenesin), terpin hydrate

med ratle dproblems

increase risk fo expericning med ratle dproblem MRP non ahrerence cannto afford conused or ffoer fugll heaelt literacy ena deducatin may nt ucnsta inlfeuc of ailin to comply with med regimen adverse drug reaction AD seroius result fro an undestibel respone assocaite diwht the use of a drug rmintor ot lfie threanting nause vo diarheah contsipation nerveousnes soern confuso nflelserdusines THREE DRUGS INPATCIUALR ARE RESPONSIBELF RO 1/3 OFA ALL ED VISIT FOR ODER ADULTS DIGOXIN, WRFARIN INSULIN

diuretic agents

increase the excretion of sodium in urine this causes a reduction in plasma volume which decreases blood pressure, classifications include thiazide, loop, and potassium sparing agents usd for hypertension, edema associated with HF, pulmoanry edema, glaucoma side effects include dehydratin, hypotension, electrolyte imbalance, polyuria, increased low-density lipoproteins, arrhythmias positioning changes can incrase the risk of dizziness and falls due to decreased blood pressure, monitor patients closely for s/s of electrolyte imbalance and muscle weakness/cramping i.e. thiazide: diuril (chlorothiazide) loop: lasix (furosemide) potassium sparing: dyrenium (triamterene)

positive inotropic agents

increase the force and velocity of myocardial contraction, slow the HR, decrease conduction velocity through the AV node, and decrease the degree of activatin of the sympathetic nervous system used for heart failure, atrial fibrillation side effects include cardiac arrhythmias, GGI distress, dizziness, blurred vision monitor HR during activity, teach the patient and fmaily to take the patients pulse and seek health care providers advice for rates less than 60 or more than 100 i.e. lanoxin (digoxin)

normal cardioresp response to acute aerobic exercise

increased oxygen consumption due to increased cardiac output, increased blood flow, and oxygen utilization in the exercising skeletal muscles linear increase in SBP with increasing workload (8-12mmHg per MET) no change or moderate decrease in DBP increased respiratory rate and tidal volume

what happens if you position a pt in sidelying on the side that needs secretions to be drained instead of the correct way which is on the unimpaired side

increases blood flow to the impaired side and the position would worsen ventilation/perfusion matching

risk factors for cancer

increasing age tobacco use alcohol use gender virus exposure enironmental influence poor diet stress occuptional hazard ethnic background gentic inheritance sexual reproductive behavior

greatest reduction in lumbar spine compressive forces while sitting at a desk

increasing the chair backrest seat angle to between 90 and 110 using arm rests for support or adding lumbar support combo of all 3 is best a gel seat cushion would only help with pressure on the ischial seat

emetic agents

induce vominting usually afeter ingestion of a toxic substnace dehydration lectroliyin balance and upper GI eriosnoin may occur with inapproariet or prologne useage mediacl conserns associate dwith administration of an emetic agent should ne address prior t intiation or sresumptoion of therapy therapy should be deferred it a pt is acteively vomting apomorhine ipecac

viatmin C

infeciton owudn healing nevlei ent aminata of bones carialt g connetic and blood velsl cirifur toan otcanntal o aniema sowllen gsm loose teth scurvy toxogy urianty stone diarhra hypoglycemia

lymphadenitis

infection and inflammation of a lymph node which may be acute or chornic

herpes simplex

infection caused by the herpes simplex virus infections tend to occur on the face (around the mouth or nose) and sometimes are referred to as "cold sores"

gastritis

inflamation of the gastric mucosa or inner lay of the stomach ismilar to gerg howevery they tend to hav e higher intesnity erosive or noservoesbase donlevel of insy and zone

prostatis

inflammaion of the prostat eglanf bvacateiral finection of the back up of prostate secretion within the gladn acute bacterai chronic bac etai chroni pelvic pain snsero a asymtomatic inflamm prostitsi 1-4 top to bottom s/s wateray urtehtal discharge urgency frweqncy discofrmt with uration and pain with ejacualtion chronic pelvic pain sydnroem anif as pain in he perium recutn prostae penis testciella dn adomonem asyptan is prostat inlmamm without sx lifel sty mod biofeedback stretching myofascial tecniwue and bladder retaining phrama interventon sucha s antibiotas alpha blackers nonsteior santi inflam Alpha blockers — These medications relax the muscle of the prostate and bladder neck, which allows urine to flow more easily. There are at least five medications in this category: terazosin (Hytrin), doxazosin (Cardura), tamsulosin (Flomax), alfuzosin (Uroxatral), and silodosin (Rapaflo)

cholecystitis and cholelithisass

inflammation of gallbaldder that may be acute or chronic most common etiology is gallstones (cholelithisasis) that may have become inacted in the cystic duct gallstones develop fomr hypomobility of the the gallbaldder suprerstauratin of bile whtih choesterol or crysatl formation from bulrbin satls these tstones can alsoc ause infection which exercation the contiiion ss man tiems gallstones are sytmptoantic however tehy msot common sx is right upper wuaf pain if the galls tone becomes olfdhe iwht th ecutic duc thten the pt acn aexiernc many prochen incldung severer right upper uad pain with muscle guarind tenderness and rebouding pain can radiate to the intercpaular regon other sx inlcue hauncein fever nause vom anoreia and abomdinal regidity (same thing as guarding) tx is not recomende tfor thpt with asymtpatic gallstones but a low fat diet can decrease gall bladder sitmuation if mild sx are presetn if t are syptiat a lithootripsy (shocks the stone and you pass the broken pieces) prodce can be used in an attempt to break up and dissolve the stones pruamru treatment is a laprosoci cholecystecotmy to themoe eh gallbladder and the lodhge sotnes from the ducts acute cholestyt shol resolve iteslf with a aweeks iwth analygestic antibitics an dIV alimentary feeding

dermatitis

inflammatory condition of the skin characterized by eruptions (not associated with an underlying route of a nerve)

diverticulitis

inflammed or infected diverticula 20-25% of the population has it puchlike protrustion occurs in the colon aprx 10% of population over 40 develops it approx 80% of indiavual with diver are sympto matic but htos ewih sx may pexiern blading mildrmap a nd btoh diarreah anad constipation tx incldue an increase amout o d dietarry fiber 2-35 grams to aovid diveticuluts low fiber diet is cause ss abdominal pain tenerness oever the left side of the lower abdomen constpation or diaprrhea nause fever chills vomting tx det control infection lowinterncoloic pressure increase fiber intake nasogatic tube ma be reureid to give color a rest sugery for severe obstruction perfomation or necrosisi compcaition incldue bleeding infection intenstinal blocka avces perofation or tears in colon fisutal or peritonitis

intra-aortic balloon counterpulsation (IABP)

inflation and deflation of a balloon surfically palced in the aoirta provides cirulatory assistance for patients after infarction or with cardiogenic shock

lifting with breathing

inhale through the nose while standing or sitting exhale through pursed lips while bending to reach the object pause inhale through the nose while grabbing the object exhale through pursed lips while standing up

anti-inflammatory agents

inhaled corticosteroids, leukotriene modified and mast-cell stabilizers help prevent inflammatory cells, suppressing release of inflammatory mediators (cytokines, prostaglandins, leukotrienes), and reversing capillary permeability, in turn reducing airway edema used for bronchospasm, asthma side effects include... corticosteroid - decreased with inhaled form but may include damage of supporting tissues, skin breakdown, osteoporosis, decreased bone density, glaucoma, and delayed growth, local effects include nasal irritation and dryness, sneezing and bloody mucus Leukotriene modifier - liver dysfunction mast-cell stabilizer - bronchospasm, throat and nasal irritation, cough and GI distress instruct the patient in the correct use of the inhaler and to rinse their mouth with water after use to avoid irritation of local mucosa advise the patient that these agents are not bronchodilators and should not be used to treat acute episodes of asthma inform patients to contact their health care provider immeditealy if they experience s/s of liver dysfunction (i.e. fatigue, flu-like sx, jaundice, lethargy) i.e. corticosteroid (qvar aka beclomethasone dipropionate, aerobid aka flunisolide) leukotriene modifier (zyflo aka zileuton) mast-cell stabilizer (nasalcrom aka cromolyn sodium)

antithrombotic (antiplatelet) agents

inhibit platelet aggregation and clot formation used post MI, atrial fib, prevent arterial thrombus formation side effects include hemorrhage, thrombocytopenia, potential liver toxicity with the use of aspirin, GI distress a therapist must be careful to avoid injury secondary to the risk of excessive bleeding, patient education is also indicated to protect the patient i.e. bayer (aspirin), plavix (clopidogrel), persantine (dipyridamole)

anticoagulant agents

inhibit platelet aggregation and thrombus formation used for post percutaneous transluminal coronary angioplasty and coronary artery bypass graft surgery, prevention of venous thromboembolism and cardioembolic events in patients with atrial fibrillation and prosthetic heart values side effects include hemorrhage, increased risk of bleeding, gastrointestinal distress with oral medication a therapist must be careful to avoid injury secondary to the risk of excessive bleeding or bruising patient education regarding common side effects is also indicated to protect the patient i.e. heparin, coumadin (warfarin), lovenox (enoxaparin)

prpton pump inhibitors PPI

inhibit the H+/K_ -ATPase enzyme that blocks secretions of acid from gastric cells into the stomach these agents prevent erosive esiphatiis and may also psosses antibacterail effects agianga hh pylorii indications dyspepsia GERD side effects acid rebound phenomenon when dicsontined after prpolonged use imp for PT well rteralted more likely ot partipcate prevacid (lansoprazole), nexium (esomeprazole) prilosec (omeprazole), protonix (pantoprazole acidpHex (rabeprzazole)

valsava process

initially causes increase intrathoracic pressure, with an increase in BP followed by a DROP, slowing of the pulse, decreased return of blood to the heart and INCREASED venous pressure

direct lymphography

injection of a contrast medium into a lymph vessel that allows for visualzation of the entire lymph system thorugh radiography it is not commonly used dueto complciation cause by the contract medium

enema

injection of lfuid into the rectum and color toincude movembmvoeennt

contusion

injury usually caused by a blow that does not disrupt the skin characterize dby pain, edema, and discoloration which appears asa a result of blood seepage under the surface of the skin

inpatient vs outpatient cardiac rehab

inpatient has more restrictions on SBP the ones you think of like 130 in outpatient 140/80 is fine

borderline heavior

instbali in allspecifcs canifnst selfrom others usef proection denil defeni unprescsatmood beaf intesn and ucnontorleld anger chrnin cfeelings of emptins

voice sounds

int he normal lung, transmission of spoken sound is usually muffled; whispered words are faint and the syllables are not distinct, except over the main bronchi increases in loudness and distinctness indicate consolidation, atelectasis, or fibrosis, all of which improve transmission of vibrations through lung tissue whispered and spoken voice sounds are somewhat more valuable than breath sounds in detecting consolidation, infarction (when lung tissue dies) and atelectasis

deep partial thickness burn

involves complete destruction of the pidermis and the majority of the dermis invovled area may appear to be discolored with broken blisters and edema damage to nerve endings may only result in moderate levels of pain hypetophic or keloid scarring may occur in the absence of infection, healing will occur in 21-35 days

superficial burn

involves only the outer epidermis invovled areas may be red with slight edema healing occurs without peeling or ecidence of scarring in 2 to 5 days

manual lymph drainge

involves techiqnues design to move lumph around blockage in the lmph system into desriea raes wher it an be drained tx should be direct at uninvoled area to prepare those areas for new lumph flow then be directed toeads the involed aresa imorant to know the locaiton of lymph nodes since this will affect where they decide to perform manual strokes and in what direction it is also important to know if lymph nodesa re intact and fuctioning

superficial partial thickness burn

involves the epidermis and the upper portion of the dermis the involved area may be extremely pain ful and exhibit blisters healing occur with minimal to no scarring in 5-21 days

urinary incontinecen

involvunary loss of urine that i sgreat enogh to be probematic for the person and typcal occurs when bladder pressure exceeds sphincter restiance general tx incldue pevlic floor msucle training using biofeedback lifestyle mods bladder tetiaing prited vodug progmra urege suppression streg mfacia lease a viseral mob bdy emcnian abdo sterngth satefsing phrama to addess yrgency infection therapy of a "bulking agent" augment the urethral wall and increase urethral resistance to urinary flow.and suga infetione tfor uertheal and badder postuon may also be inction

full thickness burn

invovles compete destruction of epidermis and ermis alongwith partial damage to the subcutanous faty layer involved area typically preesnt swith eschar formation and minimal pain patients with full thickness burns require GRAFTS and are susceptible to infection healing time varies smaller ina matter of weks with or without grafting and larger requiing grafting anf potentially months to heal

radiation

ionizing ration or particle ration and can be delviered by tletherapy *(extenral beam bracch therap (sealed or impacte soruce) or system (unsealed course) destroys hydrogen bones between the DNA strands of malingant cells may be cuavei aduvant (suppress seoncdary) aor oalliaeive may be used prir to surgery palliativei to shrink r stusrgey to ensdur desttion of resdal maignant cells most useful with localze malignancy coon side efefcts incleu HA bone arrow suppresion skin reactiosn neurpathy visual disturb NB uraa freq diarrhea cdlayed wound heling an dinfcetin

clinical contra/precau for pulmonary rehab

ischemia cardiac disease congestive heart failure acute cor pulmonale severe pulmonary hypetension significant hepatic dysfunction metastsic cancer renal failure severe cog deficit that interferes with MEMORY and COMPLIANCE visual, hearing, or orthopedic impairments are not contraindications but may require the exercise program to be modified

intracranial monitoring considerations

isometic exercise and the valsalva maneuver should be avoided since these activities increase IC pressure avoid neck flexion, hip flexion greater than 90 degrees, and lying down in a prone position venous drainage is maximal with the head of the bed elevated 30 degrees momentary elevation of intracranial pressure is normal but sustained increases are not and therefore should be REPORTED!!!

tension test is positive when...

it reproduces the patients symptoms the response can be altered by movement of distant body parts OR there are differences when comparing the left side to the right side patients will experience symptoms even when normal neural tissue is tensioned so it is important to remember the above

anastomosis

jointin of two ducts, blood bessesl or bowel segments that allow flor form one to the other may be natural create during develip surgery or pathologic

GU system

kdineys beocme lesss effei at mtoevmoe wastes form the blood this occuts seocnato anatom and psych cahgnes iscuha s creasr blood flow few nepha dn glouer andvoer adecari n size of the kidney due to cagne GFFR decrae the kidney become less effeti at concentratin and ltain urine affec tegu osifum within with blooda well ad cleranc of cetain emd sform the bdy antehr achgne that ccur agisn is fece acacat of hte baldder with ih icnfrra lkeiood oufani frequency and nocturai a sesaton asacote with t yrinat ie s delayed or non exit in older adults hwihc incrra risk of icnotnen cetin emds such as alxerhes ideser anf parkingson sidasse resutl in detrusor muscle isntability which leavs to over active bladder anar uge inconten ceovers someolde raasult eraiur assis tantto ambul amay liea to funiton incontoen fiallt some older adults may deccrea ie aher water aintaor or hold theiri urine to litie the i eof trun wich ana leaf to UTI andspeis sif nstead men the prostattaenlage ahwich cancause isesu with voiding compketely prostate enalgement incfreaseincontenc e decfras kidney fnogn nd itlateat tea decrea dblader capcty

right lower quadrant

kidney stone uretral stone meckel diverticulum appendicits choescystisi intestinal obstruction

main symptom of PF syndrome

knee pain esp when sitting younger rec women runners moive goeers knee pain esp when going down stairs occassional buckling

anosognosia

lack of awareness of ones paralysis/deficits

lower GI again

large intestine ascenidng color transverse descning sigmoid rectum anus continues to abdors water and electrlytes stores and eliminated undigest food as feces

Lyme disease affects what joints

large joints of the body especially the knee (characterized by I/M arthritis with marked pain and swelling) permanent joint damage can occur

3+ pulse

large or bounding

varices

large swelellen veins that delvie in the espphasua or stomach fotencauing interval bleeidnn

excessive foot inset what gait deviation will you see

lateral thrust at midstance (aka knee falls into varus) varus positioning of knee into socket will cause medial knee pain because thats where the socket will hit

living will

legal doumn in which a pt dictae thaei rpeferce for heatl care treatmtnet which cbecomes espe imprtan if thetp become termially ill and can nologner exprees their ish

skin cleaners

liquid agents that typically intended for sued ont eh skin of patients are risk for break down ingredients often have a pH balancing component that is esp benefitianl for perineal cleansing in pt who are incontinent designed to be less drying to the skin and more effective than usual soap or detergent sskin products

oxygen therapy

liquid or gaseous oxygen is indicated for the treatment of acute and chronic hypoxemia in patients with a pao2 <55 or oxygen sat <88% while seated or at resk or a pao2 of 56 to 59 or oxygen sat of 89% in the presence of cor pulmonale or polycythemia a number of devices are availible to deliver the oxygen to the patient including NC, simple face mask, partial rebreathing mask, nonrebreathing mask, aerosol face mask, Venturi mask and transtracheal catheter

pancreas

located in the upper elft wuadrant of the adnominal cavity extending from the duodenum to the spleen the pancrease incldes both endocrine and exocrine tissues the islets of the langerhans are the hromone prducing cells of the pancreas alpha cells produce glucagon and beta cells produce insulin these hormones work in combo to ensure a consistent level of glucose within the bloodsteam and properly maintain stores of energy within the body

cardiac transplant from end stage heart failure what do you do different when they exercise

longer warm up and cool down

functional urianry incontence

los sof urine due to inabiltiy to unwillingness of person to use th bathrom facilites propr to nvolutary bladder realse decreased level of metnal awarensssor a decrease in mobility are the two primary caustaive facotrs rafel seen without another bladder ssue or neuo involvement imparie cognition and morbility and wil exerence inten cseocnsrt hte inabilth secucuesfll use d bathroom to voif tx with alleviate the underlying issue imprive mobiltiy modifyin clithign style increas eidpnnce iwth mbulationa nd with functon will assti wth icdc efntn incont epatient amay also require a hvheairoal toileting scheudl ero goram to dcecrea eincontenc e

attention

loss of dive datention whic is the ability t rpcoess two or more sourec eof info at the same time know asa dual tasking and a adeicit an be assoct with rgeater riskfor falls in ord adlt dcr abilt iot to wtih thei attention ebtwettneow diste ats hwioeve other fra of attntion do not show a deline usch as sustain atetniton (over tiem on one tas) and selcetiv eatteiotn (abilit t disregad soruces info that are irreelvatn tot he tasks)

anterior cord syndrome

loss of lateral corticopsinal tracts with bilateral loss of motor function loss of spinothalamic tracts with bilateral loss of pain and temp preservation of dorsla colum aka proprioception, vib sense

overflow urinary inconteine

loss of ruine when the intrabladder prssure exceeds the urethra capcity to remain closed ude to urianry retention outflow obstruction secodnaty ot narrow or obstructed rutehta taht resutls from a proplasped pelvic organ a stiricture (narrowing) an enlatge prostat e chornic osnctapation or neuro diseas diffclut initateing the urine stream steam is weak and prestnte with post void dribble sugical inetion if thereis an obstruction if ther eis weakness of the dreturs msucles double oiing is recomend for these pt as wel asother sengheign measures faure inretvention may result in IM cath Double voiding is a technique that may assist the bladder to empty more effectively when urine is left in the bladder. It involves passing urine more than once each time that you go to the toilet. This makes sure that the bladder is completely empty.

urge urianry incontence UUI

loss of urine aftera sudden intense urge to vod due to the dertrusot musce of the bladder involvuntary contactin duing bladdeer filling UUI is the most common inontence inf the GERIWTRIC population and aomong resien tin long term cafacaifilafl "urgency frequency" syndrome chagne in smoothmsucle fot he baldder increae afferent acitivy i icnreas esnesiti to fht detresot to acetchhodl and idiopathu MS, SCI, CVA and PD triggerd by certain events due to a condition relfex two of themost common triggers are keu in teh lock when arriving hoime and running water BEHAIOR MODIFICATION is thepirmary hoal biofeebcakc pelvic floor stnrehg and bladder retinraing (sceduled voidiing) are key componetns in sresovlin UUI phrama may also be warranted

hypoxia

low level of O2 in the tissue despite adequate perfusion of the tissue

what activates descending inhibition and what is it

low rate TENS, having a stronger stimulus and a longer pulse duration, activates the descending inhibition, stimulating endorphin production mechanisms

characteristics of arterial insufficiency ulcer

lower 1/3 of leg, toes, web spaces (distal toes, dorsal foot, lateral malleolus) smooth edges, well defined, lack granulation tissue, tend to be deep minimal exudate severe pain diminsihed or basent pedal pulses no edema skin temp decreased thin and shiny, hair loss, yellow nails leg elevation increases the pain

percent of HR max method for intensity for aerobic exercise

lower target heart rate = HRmax x 55% higher target heart rate = HRmax x 90%

muscles for crutches

lower trap (shoulder depression) lats (shoulder depression and extension) pec major (should adduction) also need elbow extensors

lumbar facet joint dysfunction what special test

lumbar quadrant test maximally closed position and therefore the most provocative

UE lymph drains into

lymphatic duct on either side

stemmers sign is for

lymphedema HIGHLY SPECIFIC 94-100% sensitivity 56-61% pinch and lift the skin at the base of the 2nd toe on its dorsal side a positive test is present when the skin cannot be lifted or separated from the underlying tissue the ability to pinch and lift the skin is a negative test result

intesnstines patholgies

malaboprotin syndrome appendicitis IBS crohns disease ilcerative collitis color cancer intenrstinal hernia diverticular disease

genital system consists of

male and amel gonands and associated ducts, extneral genitalia and aosasicate dhrmones that all fucntion for reproucicotn

airway clearance techniques

manage or prevent the consequences of impaired mucociliary transport of the inability to protect the airway (i.e. impaired cough) includes breathing strats, manual and mechanical techniques, and postural drainage

effective PT for long term postural changes with forward head that complains of pain and dizziness when looking up

manual therapy to provide pain relief and postural reeducation may have vertebral artery compromise at the occiput

gauze

manufactured from yarn or thread and are the most readily avail dressing used in inpatient environments can come in sheets, squares, rollls, packing strips, etc. impregnated gauze is a variation of woven gauze in which various material such as pertrolatum, zinc, or antimicrobials have been added indications = INFECTED or NONINFECTED wounds of any size can be used for wet to wet, wet to moist, or wet to dry debridement advantages = readily avail and cost effective short term dressings can be used alone or in combo with other dressings and topical agents can modify number of layers to accommodate for changing wound status can be used on infected or non infected wounds disadv = tendency to adhere to the wound be dtramatizing viable tissue on removal highly permeable requires frequent dressing chagnes prolonged use decreases cost effectiveness INCREASED INFECTION RATE compared to occlusive dressings

endocrine ydsfunction

many times it iis the hypothalamus or the pitatry gland that affets the fucnton of other endorcine glans whne they pexeence diret or inderct dusfincon

rehab consideratoions for dialysis

maoufy tx based on fluuid and elctorlyte status standarad recautions should be followe at all times for preoction recongiz epts abilites post dualysis and potential for dehytration an hypotention montor vitals signs closely however avoid pemetn of b0 cuff over fistual avoid mob activiti as they are contraindicatin DURING dialysis energy concertiaon and pacing

waist curcumference

may be better than BMI alone >40 inches >36 for women central obestiy

brain cancer

may occur as a primary tumor arising form astrocytes, meninges, nerve cells or tissues within the brain metstatc brain cancer occurs when a brain tumpr develops as a consequence of cancer in another primary area of the body most primary cancers outside of the brain metastasize to the brain during proggression of cancer ss typically progress rapidly ss inlcude headache, seizures, increased IC pressure, cognitive and motionional impairment and dcrease motor and sensory function tx surgical resection alogn with radiation or other combined therapies

complete blood count CBC

measures RBC, total WBC, WBC differential, platelets, hemoglobin, and hematocrit CBC is performed to assess health, to diagnose and monitor a medical condition and to monitor the effects of medical treatment

6MWT

measures functional status and to document treatment outcomes in patients with hear and lung disease asa well as healthy and older adults at least 100 ft (30 meters) in LENGTH pt may self administer any meds ordinarily taken before activity, may use supplemental O2 at their prescribed flow rate for exercise, and may use any AD for walking 3 walks are recommended with at least 15 min in between of rest BP, HR, RR, RPE, and O2 may be measured before and immediately after how far you can walk in 6 min you may stop and rest as much as you possibly can in 6 min i will tell you the time and i will let you know when the 6 min is up when i say 'stop' stand right where you are standard words of encouragement are provided at regular intervents i.e. youre doing well, keep up the good work, you have 3 min to go record distance and # of stops

pulmonary function testing (PFT)

measures the volume or flow of air during inhalation and exhalation the measurements include but are not limited to (forced vital capacity, and other forced expiratory flow measurements such as peak expiratory flow, the forced expiratory volume in the first second and the mid expiratory flow) procedure = while maintaining an upright posture, the subject exhales into the spirometer mouthpiece as hard and as fast as possible for six seconds until no more air can be expelled an adequate FVC test requires threeee acceptable maneuvers modern spirometers calcucate "predicted normal" values (i.e. the test value the patient should normally attain based on age, sex, height, weight, and race)

airway suctioning

mechancial aspiration of sectrions from the nasopharynx, oropharynx, and trachea using a suction catheter endotracheal suctioning refers to the mechanical aspiration of pulmonary secretions from a patient with an artificual airway in place nasotracheal suctioning refers to the insertion of a suction catheter through the nasal passage and pharynx into the trachea without a tracheal tube or tracheostomy to aspirate accumulated secretions or thickened secretions and inadequate cough the frequency of suctioning is dependent on the amount of secretion produced

great saphenous vein drains...

medial lower leg and thigh

excessive foot outset what gait deviation will you see

medial thrust at midstance (aka knee falls into valgus) valgus positioning of kneee into socket will cause lateral knee pain because thats where the socket will hit

shin splints

medial tibial stress syndrome NONfocal tenderness diffuse along the mid-distal, posteromedial tibia and LACK of edema

what to do if cant find noxious stimulus in autonomic dysreflexia

medicl management may include vasodilators to assit with symptom relief prevalence range from 48-90% in individuals with SCI at T6 or above risk increases as person moves out of spinal shock

medication and wound healing

meds from a number of pharama classes can negatively impact wound healing common classes include anti inflamm, immunosuppressive, anti coag, anti neopastic, steroid, and oral contraceptive undesirable physiologic effects may include a poor or prolonged inflamm response, reduced blood supply, delayed collagen synthesis, and decreased tensile strength of repaired tissues

memory

memors loss is themsot cmmon cigit impairmeth tah is acait ewi hafing mmeory make up of neros constus and soem of the faet of memory are affect by acit short erm merors is affect and asda reuslt ovler arults may havri fiiulty recalin gfo tha he just learned this is wxacerbated when tyrn got remvoe moer ke or lengthy meorse i working meokra laos declines in older age this the memroty epehwer indiavual use relfevant info whil in the middle of an actiey (remembering itons on a shipping liswhile shpoig ro remmebering steps in recipel) eisodic memor iei persoally epxiern eevents tne dot be affec to a great defree tan semantic (i.e mnowledge of atts ) or proecurel i.e. performance of skills

lymphedema dx thorugh

mendcal history, phsyical exam, imaging can be used to identify cause

kernigs sign

meningeal irritation resistance to knee straightening in supine is positive

osteomalacia

metabolic condition where boones become soft secondary to a calcium orphosphorus deficiency there is adequate bone matrix however ether eis insufficient calcicafation ofth ematrix calcium is typicaly lost secondary to inadequate intenstinal absopriton and the phospihrois is lost seocnadry to an increase in renal excretion a deficiency in vitamin D will also cause osteomalalcia sx include a vague presntaion of aching faitue and weight los myophaty and sensory piolyneuropathy may also occur long with periarticular tendernes and api thoraic pyhhosis demorntin adn bowing o th LE pt may also strufgle to perofrm transfers and sssume a staning positon tx inrease tnutrtin is recommendedn and pharma may in cldue vitamin D or phosphase supplemntat s

osteoporosis

metabolic ondiion that presents with a decreasein b one that that subeawrknt l incrae the risk of racture priamru affect trabecular and coritalc bone wher ethe rae of bon repoertpion accelraetea whil ethe rate of bon formation edclines declingin osteoblast function couled with theloss of caliu manhosheath salts will cause the bones to become brittle primaru can indlue idipathio cpostmenupausel or invliiotjn senil eosteopororo secondary can occur as a resl fof another prijamru condition or with use of certina meds sx include comreession another bone pfrauress low thoracci or lubar pain loss of limbar lordosis dermofnities such as kyphjsis deciesae i nheigh dowafesf hums and psjireal schange s managemen of parimar includes vitamin and phara intevention poroper nitrion assie and adpativ edic eprecscip na ndpat ecuation sx may be rewuie for fx stabiliation

pagets disease

metabolic ondition characterised by heightene dosteoclast activity excesive bone formation that lacks treu structural activity bone appears enlarged but lacks srength edue the high rutne over of bone seconary to abornal osteobclastic proliferation genetic omponennt as well as heohraphical indicen most commonly affects pts over 50 yeras old sx includd msk pain accombpaiedn by bony deformities kyphoiss coxa varus bowing of the long boxes bertebral compression skull clavival pelvis fumurs psine and tibia re common sites that sill exhibt bony changes sx of adan progession of the diaese incldue ocnonuned pain, HA vertio hearing loss mental dererorid fatigue increae CO and heart failure secondar to increawes cardia output pharama manamen using biphophonates in order to inhibi bone resportion ainimpive hte wualify o th eivnveld bone exrecise, weight control , and cardiaf finres are key compjnten toe miantain stneght and motin

ventricular assist devices (VAD)

miniature pump that is implanted in the chest to provide mechanical support to the ventricle a right ventricular device attaches to the right atrium and pulmonary artery, bypassing the right ventricle a left venticular device attaches to the left atrium, bypassing the left ventricle with a biventricular device, both ventricles are bypasses VADs are commonly used as a temporary treatment for people waiting for a heart transplant and increasingly as a permanent treatment for heart failure

visual imparimetns invettions

mitgate dthoruhg envonrmental an dhevauoral mod that cn reudce the risk of inry asocoite diwht visual dwvlie use contrastin olors to higlight rhe dofe steps thershold and tantion ares remove thorw rus fthat are not secured use DIFFUSE lighting insted o fidrect lihghthough the home use night lights formaintian low level uuilluniiotn during the night aloow for extra time when traisntion forma bright atmpspher to a dark anvce wefera to allow for accomdoatetion to the chagne mainta clear hallways and rooms inclduign remve ny aqries acrs sth waway hav handrails preferlbly two for arsria swell sboth in adnoutside the home

bariatric surgery

modibly obese last repsort BMI graeter han 40 or 35 with addiotna co morbidiites evidenc ethat other weight loss inetnetion have neen laregel unsuccessful ppre op committment to suport gourp aatenta or coulsein and somedgrees of substanweigh tloss by more tadional methods restricite malasportive combo invascie roux en Y gastic bypass combo of rrestiction and malabpsortion rus kf opost op and lognert compcaiton are high laproscopic gastir abdning oftenfer tot as a lap band has low risk compckation and cab be adust ro vremoved as needed

pain beyond 24 hours, should you modify or no

modify bc indicates possible tissue damage

adenosine triphosphate ATP

molecualr unit withi nthe body which transports the cehmical comounds for cellular meatbolism

breast cancer

most common female malignancy but also can occur in men majority of cases are classified as adenocarcinoma and it is the seocnd lading cause of female death from cancer common metastaes are ound in the lymph nodes lungs bones skin and brain if the cancer recurs, it is usll within two years of the inital diagnosis genetics gener agae mentstual history and geograph y ss presentt as a lump and is usualy found by the woman mass is typically form irrgaule and non pain ful may also presetn with signs incldue nipple dischar erythema or a change in breast shape tx surgery radaioan chemo hormonal maipulation curable if diagnosed priro to metastates survival rate decrease as the stage of cancer increases current 5 years survial rare for localized tumors is 92% this drops substantially if there i nodeal involvement

hydrotherapy

most commonly employed using a whirlpool tank with agitation directed toward a wound requiring debridement process softens and loosens adherent necrotic tissue PT must be aware of potential hydrotherapy side effects such as maceration (like when in pool for too long)` of viable tissue, edema from dependent lower extremity positioning, and systemtic effects such as hypotension

most important info for prognosis acute exacerbation

most recent pulmonary fxn tests not xray not previous history not med list

auscultation of lung sounds

movement of air in the tracheobronchial tree produces sounds that can be heart witha stethoscope auscultation of lung sounds and voice sounds is performed to assist in diagnosis and to evaluate the effects of treatment lung or breath sounds are characterized by pitch, intensity, quality, and the duration of the inspiratory and expiratory phases

graves disease

msot spefici cause of hyperthroid ism most comon in women over 20 howeever it occurs in men as awell and can affet any age group autominue diseas in which certain antibios produce bt eh immun system stimuae the thryoidj gland causing ti be voer avtve mild elnagee men GOITER haeat inelracen nerovus nerigh tmtemoroe pelatoitjan parham and remvoel radiatin or sx

considertains for pt with parathyroid

mst be familiar with all ss of parathyroi in orer to refer pts to a physican if a chagne in their status occurs reconizv sx o excessive or inadwequate pahra tteratment anf side efects of th agSNTE S AVOID TX THAT EXACETBATE CNDITIN know effeccts of hyper and hypo calcemia reoxnoge increase risk for fractures andeffedcts fro osteogeic synoits (achivels triceps and obturator tendons most affecte)

ureters

muscular tubes connecting the kidneys to the urinary bladder to transport urine

rehab considerations with metabolic bone disease

must have awareness of signs of compression fx and of pts at higher risk for al forms of fx focus on both resistance training and enduranc training to build bone density and increase strength avoid treatments taht exacerbathe the ocnition or place patients ar risk for fx i

rehab considerations for pts with inherited metabolic disorder

must have awarenss of dietary restriciton pt and family training to prevent deleterious efects from the metabolic disease apadpt tx to facilita devep menta miles wihin pt tilerance

what weird effect can statin have

myalgia cramps stiffness spasm weakness affecting exercise tolerance needs to be seen by a physician to have the dose or med changed

peripheral vascular disease GOLD

narrowing of the lumen of blood vessels causing a reduction in circulation usually secondary to atherosclerosis this can be compounded by either emboli or thrombi aka arteriosclerosis obliterans result of atherosclerosis damage can occur to the walls of both arteries and veins from fatty plaque buildup that creates hard and narrow vessels the atherosclerotic process will gradaully progress to significant or complete occlusion of medium and large arteries primary factor for developing PVD is atherosclerosis other risk factors = phlebitis, injury or surgery, autoimmunedisesae, diabetes mellitus, smoking, hyperlipidemia, inactivity, hypertension, positive family hsitory, increased age and obesity during early stages of PVD, I/M claudication may be the only manifestation sx are precipitated by walking a predictable distance and are noramally relieved by rest claudication may also present as buckling or "giving out" of the LE after a certain period of exertion other sx = tingling and numbess of the affected extremities, pain at rest and during sleep, slowed healing, changes in skin coloring, a decrease in skin temp, absence of hair on the extremity, and weak or absent pulse routine blood tests are indicated and include CBC, BUN, creatinine and electolytes doppler US are used to determine flow status MRI, angiogram, or arteriogram can also be used to assist with the diagnosis ABI rubor of dependency test transcuaneous oximetry treadmill test capillary refill also may see ischemic rest pain can occur from the combo of PVD and inadequate perfusion it is fairly common for a patient with PVD to be diagnsed with coronary artery disease or DM higher risk for complciatiosn such as DVT, thrombosis, insufficiency ulers, gangrene and amputation management = anticoag such as heparin, antiplatelet and tombolhytics pt education is PARAMOUNT reharding disease process, limb protection, foot and skin care, and risk factor reduction (smoking cessation, avoid cold exposure) walking program walk until near maximal pain then rest until pain is resolved goal is to have the patient achieve longer walking periods with less rest eventually walking 30 min continuuously nonweight bearing exercises such as swimming or stationary cycling can supplement the program after 4-6 weeks of therapy inclduing isometrics and AROM, the patient should tolerate the implementation of resistive exercise common procedures iinclude balloon angioplasty, endarterectomy, stent implantation or bypass surgery LOW CHOLESTEROL DIET for pts with pain at rest, particularly at night, the HOB should be elevated 4-6 inches which should improve their lower extremity perfusion by the effects of graity on blood flow PT is helpful in implementing a walking program that allows for the development of collateral circulation and designing an exercise program that allows the pt to gain sterngth and endurance for activities PVD can be managed and controlled through pharma, risk reduction and surgery pt with PVD are at higher risk for complications such as permanent numbess, tingling or weakness in lower extremities and or feeet, permanent sensory changes such as brugin or aching pain, hangrene and mputation also at higher risk of heart attack and stroke PVD has at least a 30% risk of death within 5 years and aprox 50% in 10 years secondary to MI or cerebrovsscualr disease similar to coronary artery disease is the narrowing or blackafge due to fatty build up withint the artery walls reducing the overall blood flow to the cardiac muscle sx include nausea, vomiting, heartburn, sob and profuse sweating electrocardiogram and angiogram used to diagnose CAD

gallstones s/s

nausea and RUQ pain which can radiate to the right scapula found more commonly in patients who are overweight or obese, female, and around the fourth decade of life more common in patients eating high fat and cholesterol meals pain becomes worse with meals

dorsalis pedis

near the center of the long axis of the foot, between the first and second metatarsal bones

chline

necnerve nfunton an lip emtablis methon which is an mino acid defen when inatka is low no rootu

hyperkeratosis

necrotic tissue aka callus typically white/gray in color and can vary in texture from firm to soggy depending on the moisture level

slough

nectoric tissue described as moist, stringy or mucinous, white/yellow tissue that tends to be loosely attached in clumps to the wound bed

gangrene

nectrotic tissue death and decay of tissue restuling from an interupption in blood flow to an area of the body some types of gangrene are also characterized by the presence of bacterial infection gangrene most commonly affects the extremities but can also occur in muscles and organs When substantial areas of tissue become necrotic due to lack of blood supply

eschar

nectrotic tissue described as hard or leathery black/brown dehydrated tissue that tends to be firmly adhered to the wound bed The eschar acts as a natural barrier to infection by keeping the bacteria from entering the wound. If the eschar becomes unstable (wet, draining, loose, boggy, edematous, red) it should be debrided according to the clinic or facility protocol.

phantom limb pain is a result of

nerves being cut nerve endins at the site continue to send pain signals to the brain that make the brain think the limb is still there sometimes the brain memory of pain is retained and is interpreted as pain regardless of signals from injured nerves

endocrine system dysfunction general s/s

neuromuscular msucle weakness periarthiris myalgia arthralgia stiffness osteoarthriis msucle atrophy adhesive capsulitis systemic polyipsia growth dysfunction skin pigmentation dysfunction polyuria increased vital sigsn hari fysfnctin n nevous or axious

couples motions lumbar/thoracic

neutral/flexion starting point - slide and rotate in opposite directions (side bend right results in segment rotating left) flexion starting point - slide and rotate in same direction

plant alkaloid agents (mitotic inhibtis)

nitrogen based and largel dervie from platns direclt target the pelciation roces prot to and durin gmgitosis to inhitn cell division litied cell divisn and cancer gowth maultsystem involvemnt oncovin (vinvristine sulfate) taxoteere (doxetaxel) taxol ( paclitaxel)

do you use desensitization for TOS

no

does external pressure have an effect on vascular permeability?

no

does profuse sweating accompany orthostatic hypotension?

no

is self correction a form of behavior modification

no

will US disrupt a cardiac pacemaker?

no

homans sign is it a good test?

no alone it is insensitive and nonspecific and cannot be relied on to confirm or exclude the diagnosis of DVT but despite the lack of specificity, a positive homans sign warrants further evaluation

would acute asthmatic exacerbation show up on xray

no and neither would chronic

other treatments for lymphedema

no medication or surgical procedures that are effecitve in the tx of lymphedema debulkking is a surgical procedure that may be done for a patient wtih lymhedea to help rmeove the exxcessie skin that forms in the latera stages of the disae however this procedure should be oerfrmed with cation as it can damfe exiting lmph vessels and fruther accelerate the course of the diseae intermittent pneumatic compression devices may be used as a part of compression therapy however ether are some concerns that exist when using these devices on pt with lymphedmea if perssure it stoo high lmphasit vessel smay be damafged and these devices often delvier pressure taht are inconisteent with the desired settings another concer is taht patent may devlep genital edema since the fluids are moved proximaly

IT band syndrome special test

noble compression test pain @ 30 degrees of knee flexion

stage 1 pressure injury

non blanchable erythema of intact skin presence of blancable erythema or changes in sensation, temperature, or firmness may precede visual changes color changes do not include purple or maroon discoloration (this may indicate deep tissue pressure injury)

benign prostatic hypertrophy

non cacnerous enlargement of the prostate that is progressive common inmales over 60 and can interfere with normal voiding

neural tension test with plantarflexion and eversion

none

enhanced extracorporeal counterpulsation (EECP)

noninvasive procedure in which inflation of pressure cuffs on the lower extremtiies compresses the veins and assists with venous return to the heart

2+ pulse

normal

interpretation of capillary refill time

normal - full color returns in <2 seconds abnormal - refill time is >2 seconds indicates capillary blood flow is compromised (i.e. artierial occlusion, hypovolemic shock, hypothermia)

character of respiration

normal breathing is quiet and effortless labored breathing is evident by the use of accessory muscles wheezes and crackles are abnormal sounds produced by changes in the airways

eucapnia

normal level of CO2 in arterial blood

eupnea

normal rate and depth of breathing

phases of normal wound healing

normal wound healing occurs as damaged tissues move through distinct yet overlapping phases of repair in chronic wounds, this progression is either interrupted or delayed causing the wound to becoe "stuck" in a particular phase of healing

soft rustling sounds

normal, vescular breath sounds

connective tissuue cancer

normally eslatic collegen fibrous striated muscel blood veslel bone carilage fat smoothmuscle sarcoma fibrosarcaoma lipsarcoma chrondosarcoma osteo sarcoma hemaniosarcoma keimyosarcoma rhabomyosacroma

epithelium cancer

normally protects aborbds and excretes ie. skin lines interal cavities mucoous membrane lining of bladder tumor calssifcation of carcinoma adenocarnoma (glandular tissue)

pitutiary gland

normally the size of a pea and is locatied at the base of the brain jus ebenethe the hypothalanus the ieoiha cotwo sepaeralglansd adenohypophyssi santioer aneurejpjsp posieoroi it flans is consdier the moset imprtan MOST IMPORTANT PART OF THE ENDOCRINE SYSTEM since it reelasel hormones that regulare several other endocrine glands MASTER GLAND inlfuenc eby fascors suchas seasonsal hangs or emotanl sterss pi gland secretes emdorhoins that act on the nervous systema nd reduce aperosna snenesti to ain it also contols ovulatin an woka sas a catalyst for the testes and ovearies to creat sex hormones

chronic compartment syndrome

not a medical emergency most often caused by athletic exertion pt will complain of bursting type of pressure and pain

sidelying on the R with foot of bed elevated 18 in

not effective then stuff goes down to the base of the lungs

hydrogel dressings are not recommended for what types of wounds

not good for wounds with heavy exudate

water soluble itamins

not store din the body in any signga outn therefore need to beincldue in dthe diet ona daily basesi less common tooxity than fat souble

modalities and palliatie care

numerous electrotheraptut ftherma and mehcan cmodalies are consnider to be contraindicat for ue with oncolgy popialtion MOST HEAT AND ELECTRO MOD ARE CONTRAINDEED for use OVER an active malignancy but are no t neccsialry contrained for use elsewhere in the body when approp seek physic guiance with physican guidenace these contraindcaion often may beoverlooked in lieu of pallative gaosl for terminaly ill pts esp tru e inhspiace where curative effort a have been discontoned and end of life is immiinent hwoever theaprist are adived to be midnful of and adhere to cntaindicaiton whci may cause a termianill ill pt addiiton discomfot (ie. the potentail for NM e stim cauisng a patholical fx in a pt with bone metasttsis)

bariatrics

obesity refers to the state of excessive edipose tisse accululation in the bdoy contributing to a variety of chornic oncitions taht neatively impact miltiple body stsme and overall health most commonly result of a prolonge imnaalnce between energer intak eanad eeery expendiru through activity and metabolic functions prevalence of oebsit reach pandemic porton s(worldwde) viewed as a chornic progressife diseaes obesity is a modifiable morbidity and moralit reisk factor second only ro smoking

how should you measure reponse to activity in pt with afib

objective measures bc can be asymptomatic

obsessive compulsive dors

obsession persitan throgh s that wil not leavea comulsion repreptai rtla hvehait that pt cannot stop erformn throght oritual thatenifeer with alt ling unable to cntorl iriration bevairo most comony begins in ounadulthood

arterial insufficiency ulcers

occur secondary to inadequate circulation of oxygenated blood (i.e. ischemia) often dur to complicating factors like atherosclerosis general recs: rest limb protection risk reduction education inspect legs and feet daily avoid using heating pads or soaking feet in hot water wear approp sized shoes with clean, seamless socks

venous insufficiency ulcers

occur seoncary to impaired functional of the venous system resulting in inadequate cirualtion and eventual tissue damage and ulceration general recs limb protection risk reduction education compression to control edema elevated legs above the heart when resting or sleeping attempt active exercise including frequent ROM wear approx sized shoes with clean seamless socks

premature atrial contractions (PAC)

occur when an ectopic focus (excitable group of cells that causes a premature heart beat) in the atrium initiates an impulse before the SA node the P wave is premature with abnormal configuration PACs are very common and generally benign but may progress to atrial flutter, tachycardia or fibrillation may occur with a normal heart (from caffeine, stress, smoking, alcohol) and any type of heart disease

T wave inversion

occurs hours or days after an MI as the result of a delay in repolarization produced by the injury may also occur with right and left bundle branch blocks, after a CVA and as a normal juvenile T wave pattern in children and some adults

type 2 DM

occurs in the pop over the age of 45 retains the ability to producec some endogenous insulin occurs seocndary to an aray of dysfinction combo of ressitance to insulin action and inadeqae insulin secteiotn characterized by hyperglucemia when the body cannot poeroply respond to unsliln obesity is ond to contrbute to insulin resitnac e ss ketoacidosis does not ooccur in type 2 bc insuline is still typically produced bc if some insulin will still be breaking down glucose and not breaking down fats and producing ketones tx include bg control through diet exercise oral meds and insulin injectiosn when necessary

chemical burn

occurs when certain chemical comounds come in contact with the body reaction will contnue until the chemical comoun is diluated at teh stie of contact compuonds that cause chemcal burns include sulfiuric acid, lye, hydrohcolic acid, and gasoline

type 1 vs type 2

onset less than 25 abrupt onset 5-10% of all cases destruction of islets of langerhan cells secondary to ppossible autoimue or viral causative factors insulin production very little or none ketoacidosis can occur tx include sinsulin inet exerise and diet noninulin dependent adult onset older than 45 gradual 90-95% of all cases ressistance at insulin receptor sties susual seocnadry to obesity ethnic prevalance insulin production variabel ketoacidosis will raretle occur tx incude weight loss orgal insuln exrcsie and diet

2 weeks post op TKA, coniderable low back pain with no previous history, bloating and passing small amounts of liquid stool which is not usual, obese lots of comorbidities, only med change is oxy...what is happening

opioid induced constipation knwon to cause constipation the diarrhea experienced in this case is caused by a fecal impaction in the rectum with overflow the impaction can press on the sacral nerve roots and lead to low back pain

malginant melaoma

originatse from melanocytese and can be classfe das superiifial sprad nodlar letigo malinga or acral lentigious melanomas peak incidence is beteen 40 and 60 years of age early diagnsis is vital to prognosis cn sperae and ematssize uqiclk brain lungs live rbonea nd skin malig risk inlud ehsotry f blistering sunbrns prior to 20 ears of age family hostry immunosppress ligth eyes fair skin and previous hostry of cancer ss lesions can be elevated n teh surface fot eh skin and appea ektatotic or scaly asymmetry irrgeular border varied clolr and aiabeter of greater thah 6mm for moles and skin 100% curable with eally dingssis excison may soley be requried with aely ytx if metastszed sx and comb may we awarreetted

oral corticosteroids and chemo, anticipated side effect

osteoporosis (with bone loss, osteoporosis and fxs common at the spine and ribs) steroid meds have major effects on the metabolism of calcium, vitamin D and bone corticosteroids can also cause HIGH BP, thinning and easy bruising and rounding of the thoracic spine (dowagers hump)

mitochonrdial disorders

over 100 differetn forms for this ytpe of idsea and eachprodices different sx result from genetically inherrited or spontaneous mutations in the dna that lead to impair function of proteins found within the mitchondria sx can include loss of msucles ocordination, muslce weaknness, visual and hearing problems, learning disabilites, heart live er and kidney ndeisae resprortao neur and GI disorder and denentia dx are relavitel newe and tx is varied trx is aimed at alleiating current sx and slwo progression

nNM and nervous sytems

overal deca ien brain sids edue to atoh of brain stse andc decera in nerve ocnuton velit ath ruesl ein oversall decrea in central cedcc result in alterat wth pts movement asl well as congintion ieorheral decra i ncorss ing afe nococets ando the rpeshreh receto decera sabilti to sensa pi decae jont propo ctida jo decera esomat ensoin impariaal ereactions afelcean finvera gait snaitl balacne is also gnega affecte sby hangesthat cocur iwihtnt he nsebbuar ss paruen ue to aloss of sesbreeoccelsl cannot reac to veo mec agne asida to psotua sbtail cobiend imsk noraml egratereisk fr falls

respiratory acidosis BRONZE

pH is abnormally LOW indicating acidemia hypoventilation prevents adequate removal of CO2 from the body causing hypercapnia as a aresult, bicarbonate HCO3- levels DECREASE altering the bodys acid-base balance common etiologies include pulmonary disease, meds, structual factors that limit lung expansion like scoliosis and morbid obesity, and conditions taht cause respiratory muscle weakness like giall barre syndrome and ALS it is not an independent disae process but rather a sx of some other underlying condition or diseae s/s are often vague and more closely related to the underlying pathology as the condition worsens, patietns may present with lethargy, confusion, altered mental stasu and cyanosis may present as a chronic or acute condition chronic - likely to beocme stable if renal function is normal and HCO3- excretion can be modulated to compensate for respiratory induced acidemia the renal ocmpensation will e reflected in lab values that typically show a near normal pH and parital pressure of Co2 meaures towards the upper limit of normal acute respiratory acidosis is considered an emergency condition due to the rapid build up of co2, this results in acidemia and paco2 levels abovee the noraml reference range labs of ABGs, metabolic panel blood analysis (serum electrolytes), and urine pH is used to idnetify abnormal acidity and differentiate between resp and metabolic acidosis

what would not help with an atelectasis

paced breathing because that just affects the rate of breathing not the DEPTH need DEEP breathing and can do this through pain control, incentive spirometry, and segmental breathing

stress fx

pain and swelling particularly with weight bearing activity tenderness or edema after a recent increase in activity or repeated activity with limited rest

mcburneys point

pain and tenderness half the distance between the ASIS and umbilicus in the right lower quadrant associated with acute appendicitis

murphys sign

pain and tenderness over the costovertebral angle acute cholecytitis or acute pylenophritis

unstable angina

pain is described as increasing in intensity angina that decreases with rest and interval training along with nitroglycerin is considered stable

postpartum thyroiditis

painfles sinflam of the throid occurring in some women after child burth presntiaon of this condition is typucally defints by two hases intiall a staetes of hyperthyroid will prestn with the first on to four months following hcild chilre follow by a shirt to hypo for 4 to 8 motnths follwing delviery heat sensitivtiy with hyper may be misterpteresa as typucal postpart um sx therag dalying diagnosis more fq diagnosed when hypo sets in dry skin hoarse voie dressio scold esnitivey and poor exercise tolerance risk facrors include hsotr of autoimmune disorders thryoid dysfunction poropr postart or family histry and thro bloodt est can confim diafnosis timely diagnosis can impact outcomes do not dismiis sx of fatigeu and irraitbil as tpcaul ostpart esp if otehr sysiigns of throid dsufntion can be itendite PT should be mindufl that phara intevention ie. beta blockers throud replacemetn hormeos may further inflence pt exrecsie tolerance and outcomes

hiipsce

palliatc are for tmeinally ill pt who have al imtied life edxpactn ath ocfuf on magnem of pan annsx aas well as accepatnc eo theri fown fl ga l is lsoow th pt s to tmerian their hoen ad they enar feath therea r inpta that prcue rhese sura as well

type 1 DM

pancreas fails to produce enough or any insuln this form is diagosed in childhood bt can occur at any age insuline dpeendent diabetes r juvenile dibaets genetic predisposition in combo with exposru tooa viral or envinormental trigger causes an immune rxn that dadamge panncras w sub failure insecetion o fendogenous insulin ss rapid onset of sx polyphagia (increase in hunger) weight loss ketoacidosis poluyuria polydipsua blurred vision dehydration and fatigue tx exogenous insulin no cure goal is to control regualtion

4/5 in quads and difficulty descending stairs how should you strengthen it

partial squats and progress to lunges not 70% of 1RM not max isometric exercise not isokinetic exercise closed chain is best for functional goals

stage II ulcer

partial thickness skin loss involving the epidermis or dermis superficial and presents clinically as an abrasion, blister, or shallow crater

stage 2 pressure injury

partial thickness skin loss with exposed dermis the wound bed is viable, pink, or red, mosoit and may also present as an intact or ruptured serum-filled blister adipose is not visible and deep tissues are not either granulation tissue, slough, and eschar are NOT present these injuries commonly result from adverse microclimate and shear over the pelvis and shear in the heel this stage should not be used to describe moisture associated skin damage (MASD) including incontinence associated dermatitis (IAD), intertriginous dermatitis (ITD), medical adhesive related skin injury (MARSI) or tramatic wounds

electrical burn

passage of electical current thorugh the body typically an enertenacne and exit wound compliations can include cardiac arrhythmias, resp arrest, renal failure, neuro famage, and fx i.e. lightning strike

S4 heart sound

pathological sound of vibration of the venticular wall with ventrcular filling and atrial contraction may be associated with hypertension, steosis, hypertensive heart disease, or MI often called an "atrial gallop" DIASTOLIC HF but occurs in late diastole

craig's test

patient prone with knee flexed to 90° palpate greater trochanter and slowly move hip through internal/external rotation. when greater trochanter feels most lateral stop, and measure the angle of leg relative to a line perpendicular with table surface Normal angle = 8°-15° hip internal rotation < 8° = retroverted hip; > 15° = anteverted hip

peripheral fat dsitribution

pear shape gluteofemoral obestiy more common in women assocaited lower relative relativ eindcien of ebsti related risk facotrs central fat akak apple shape or abdoianl obeaity is mouc more bhighgi corerlato wit sign factors usch as CV diseae and type 2 diabets hgiher percent of metaolicaltie visceral fat

astrocytoma

peds oncology 50% of ped brain tumors genetics, eniron infleu raditiaon toxin assocation with certain childhood disorders ss two tes of astrycytaom cerebellar - clumsiness, ataxic gait, headache change in personality vomintin spratentorial - headache sreizures chagne in personatltiy visal impairments and vominting surfical resection of cerebellar tumors offers a 80-90% cure rate supratentorail req sx and or radichemo

desquamation

peeling or shedding of the outer layers of the epidermis normally occurs in small scales although certain conditions, injuries and meds can case peeling in larger scales or sheets and extend to deeper layers of the skin like sun burn

3+ extensor tone what should you have on the w/c

pelvic belt to maintain the hips in flexion tilt in space best assists in keeping the patient from coming out of the chair when extensor spasms are active elevating leg rests and recliner would increase extensor tone toe loops would not adequately control for proximal tone

genitourniary systesi is support by the ....

pelvic floor consisdint of msucle fascia and aligmane t

henitourinary support structure

pelvic floor msucesl pruamr function includ ebladder bowel contral and sexual function in additon the pelvi floor support he pelvic oragns by holding the organ in postion in kcnueciton wi thligmenta na dsourninfg afcaia msucles arem madue up of two didferent ifber tep tupe 1 slow tupe 2 fast whenth epelvi lfoor msucel are weak or habe fpor enuran cdue t prenanncy truaml surgeyr erep rainign or genti hry are not able t suppor the pevli orgna leading o rgnaprplaseo affecteslmay includ eth ebladder urterus cervic intesntna and recutm may resl in uregen erenfa ralk msucle inalam durnig incrase dodmainl ressurue

male gential system

penis - extenerel genittalit that expels urine during voiding and semen durint thea act of copulation scortum - cutaneous fibromuscuar external sac for the testes, duscutus deferens, eppididymus, nerves and bloode vessles testes - prodce psern and hormoens sucha s testoerone ducuts/vas deferes - carries sperm fro teh testes to the seminal vesicle to hform the ejaculatory duct epiddmysmus - encased withint he scortum stores sperm seminal vescbles - internal tubes taht secret ea thck fluid to combine with sperm within the ejaculatory duct prostate - internal organ lying INFERIOR TO THE BLADDER produces and secretes fluid to combine with psern seminal vesl fi and bulburtethglandlduit to create semen

hematocrit (HCT)

percentage of RBC in total blood volume low hematocrit may indicate anemia, blood loss, and vitamin or mineral deficiencies high hematocrit may indicate dehydration, polycythemia vera (a condition that causes an overproduction of red blood cells)

carbs

perferrfuel source of rhigh tinet seei wihtou cabrs body wills tart to cosune protien ias its fue main sourc of nfuel for CNS cna be broenn donw into simpke anf omcpes simmple ar emade f smalle moelscu tha tincreas eblood glucoes lrapdia compre larger anebed to be ebroe theher increas egluc elevs more slowly ofer apreil ferjoi dof time glycemi inex i areus o fhow iuaca spefi cfood will raise rblodo glucose levels

coronary artery bypass graft surgery CABG

performed to treat coronary arteries that are narrow or occluded in an attempt to revascularize the myocardium in this procedure, blood is rerouted around the affected artery joining the patients own saphenous vein, internal thoracic/mammary artery or radial artery to connect the affected artery above and below the occlusion

temporary palor, cyanosis of toes and changes in skin temp suggestive of

peripheral vascular disease raynauds

deep tissue pressure injury

persistent non blancable deep red, maroon or purple discoloration intact or non intact skin with localized area of persistent non blancable deep, red, maroon purple discoloration or epidermal separation revealing a dark wound bed or blood filled blister pain and temp change often preced skin color changes discoloration may appear differently in darkly pigmented skin this forces at the bone-muscle interface the wound may evolve rapidly to reveal the actual extent of tissue injury or may resolve without tissue loss if nerotic tissue, subcutaneous tissue, granulation tissue, msucles or other underlying structures are visible this indicates a full thickness pressure injury (unstagable 3 or 4) do not use deep tissue pressure injury to describe vascular, traumatic, neuropathic, or dermatologic conditions

gastric

pertainin to the otmach

procedure for percussion and vib

place in position cover skin with shirt or towel, should be thin therapist rhythmically strikes the chest with cupped hand for 2-3 min per segment one hand on top of other or one hand on each side of the rib cage vibrate the chest as the pt exhales by tensing the muscles of the hands and arms while applying a moderate downward pressure PERFORM IN THE DIRECTION IN WHICH THE RIBS MOVE ON EXPIRATION encourage the pt to cough or huff after 2 or 3 vibrations

Phalen's test

places stress on the compartment where the median nerve passes into the hand

small intenstion

portion of the digestive tract athta firest recievsf foofs tom ethe stomach comrpesf of thdueoden jejum and ilumm

Serosanguineous

presents with a light red or pink color and a thin watery consitency considered to be normal in a healthy healing wound and is tpicall observed during the inflamm and prolif phases of healing

INITIAL plan of care for the THERAPIST after a child is burned (superficial partial-thickness)

prevention of scar contracture and preservation of chest wall mobility pain and infection management are important goals of the MEDICAL team and are typically managed by the medical team

cancer prevention

primary - screening for high risk, elimation of modifiable risk factors, use of natual agents i.e. teas and vitamins to prevent cancer, cancer vaccine secondary - early detection, selective prevenative pharma agents (tamoxifen) prevents beast cancer andalso treats it, mtilifacotral ris redcution tertiary - prevent diability that can occur seocndty to cancer and its treatment mange sx limit complciations

melahypogonadism

primary hypogonaidm is fefina as a definiceny of testosterone seconadry to failure of the testes to repsones to FSH and LH (produced by the pit an hypot) the most common cause of prmary hypo is klinefelters syndrome (two or more X chormosomes mainly infertile and small testes) secondary hypogonadism occurs whenr there is a failure of the hypthalamus or pitatary to produce the hormoens that will subsewuenyl stimulate the production of testosterone if a male experiences ths pprop to puberty sx will include sparse body hair, udnerdeveloopement of skelteal msucles and long arms and legs seocndary oto a delay inthe closure of the peiphyseal growthh plates adult onset testosterone deficieny will present with decreae libido erectile dusfinction infertility decrease cogniitave skills moods changes and sleep disturbances tx include hormone repalcement phara intevention

bronchoscopy

procedure for direct visualization of the bronchial tree performed for diagnostic and therapeutic purposes uses a bronchoscope (fiber optic instrument that transmits an image to an eyepiece or video camera and can identify tumors, bronchitis, foreign bodies, and bleeding) tissue specimens may be removed from the lungs by biopsy or bronchoalveolar lavage

heart transplantation

procedure in which a failing, diseased heart is replaced with a healthier donor heart reserved for patiens with end-stage heart failure for whom other treatments may not have been successful (i.e. cardiomyopathy, coronary artery disease, valvular disease, and congenital heart disease)

thoracentesis

procedure that includes removal of fluid from the pleural space with a needle for microbiologic and cytologic studies

demenita

proces of cog decline taht evneutal inlcude thte indivial abiltio taprticapte in dalit actiy diffiulty comorehening lagnuag impareid proble soling behagora sufsl gbane and memory deficit are alal comonly associte with dementia alxhifaen a progrssive form of demmia is lafoufn largei nin old ault incidenfe of odementia is hsow to incrae with age

title VII of the civil rights act of 1964

prohibits discrimination based on gender

pancratic cancer

prom tyep fo can with an extermely high moraltiy rate cance of the exocrine cells within the ducts is the most cmmmon willmetastzie to the liver lugs pleura coln sotmach and lspee tobacco use gender age and cholecystectomy ss vague weight loss jauncie and epgastric apin that can radaite to the thoracic reign advaned cancer may be present with severe pain that may idicat ecancer has meteastasized tx directed at relif od sx poor survival rate with a mortality rate of almost 100% surgical rescetion along with chemotherapy and radiation assist to relieve sx

chornic renal failure

prorgesive sdetoei fin renal functon DM severe hyetension glomerulathies ocbsuctive urooathy interisisal nephiirs baldder pain syndrome pilycysti kideuney diseae nausea vomtinig letheary wekaness HICCUPS anorexia ulceration within GI trac tsleep disorder HA peripheral neurahty anhemia prurutis (itchy) osteomalacia ecchymosis ulmoanr edema serizures coma tx managment of pruamr etilogy pahram durueteics nutirion support duration hemo dialysis and r transusion if appic converateive and renal replaement for chornic slows down the process adn assist body in its compensatin untrtional support hydration avoidance ofportien and phrama intevention are usuasl the periary bassi of intervention renal repclament therap incldues soe form of hemodialysi and or organ transplant peritoneal dialyis is a form of rnea lrepcament that uses the peritonal cavity ans a semi perme menber between the dialyasate fluid and blood vessels of the andomanl cavity will se ehigh protein in urine with kidney failrur

sedative hynotic agentes (benzo and non benzpO

prouce a calming andeafclitoan while hynoti cagesnts incldue sleep bezo ahve promet to erpmot sleep trogh increasien ibijhib efects at tehcns wherre GABA gamma aminobutryric acid is ound non benzoas incldue barbituates and other bdugs also privde cns depssion through inhibitory efects of GABA resucla can prcurosiness and decraes motor perofac anaterograade amneia loss of abiity tot craet new mmeorsyes toelrance dpence reouns insomina with withdral barticuate are highly adicit adnc an be fatal pteat pt hwne peak blood levsl of the agent exits toat that hte pt is cal eraedc adn can focsu however it may be prpve if pt exeprnecns drinzess mparnemnt in motnro controll risk of falling inceasses with use jfo these agesnts benzodiapazpine halcion triazolam dalmane lfu razepan non beno luminal phenobarital sonata zelaplon ambien zolpidem

2 week infant born at 27 weeks with hyaline membrane disease is referred for PT, nursing reports infant desats with handling, what is the best course of action

provide suggestions to nursing for positioning for optimal motor development (for positioning schedules, feeding, infant stimulation activities, etc) excessive handling of a premature infant can cause oxygen desaturation and it is in the best interest of the infant to LIMIT the number of handlers so we should assist nursing in this NOT put PT on hold NOT delegate to PTA for secretions (said she has no secretions) NOT perform secretion clearance

extra-articular complications of psoriatic arthitis

psoriatic skin and nail changes conjunvtivitis and iritis

initial priority after hip replacement

pt education regarding positions and motions to avoid "number 1 priority" avoid excessive flexion, IR, and ADD pts with cemented THRs should initially be weight bearing to tolerance using a walker

early intervention for foot pain reproduced with weight bearing and running on a treadmill, pt has pes planus and pain with palpation at the distal aspect of the calcaneus

pt is assumed to have plantar fascitis and apparents the focus of pt management should be on decreasing the irritation to the PF which is more effecitvely done with a RESTING NIGHT SPLINT orthotic would be necessary AFTER early management if pain persists modalities would be good if the pain was constant

respectful mamgne of escalalting pt veahiros

pts with or wothot psucha ti aidnag may ecri exclaing begjao form titme ot fie PTs shoudd pre respectul in theri descation satempst but als mindl f maintain aa sfea envonrement for every one nonverbal descaation udnreastinf that attemt to teaosn with an ecacatin pt ma make the mattse worse and that cam erasining in a thraetning in counterintuative to our own flight ro fligth successful non verbal desaebsali reuqire sth provide to maintian eself control and proective yet non threatning physcail pressecn whil efaiclaiting the descaaltion conversiosn be emphate whe setting boudaries use low cal tone of voice when peasking do not respones deficenel to pt comments offer choce option or small concessin if papriate do not foec econarct eye contact allo wthe pt to look away beresrpecfla dn ackle thepts conplants or frustion when speak wait for thept to ace rather than raeisin your ovie to be hrafd bearea of your supprigve resoise includ ghte potin to tleave the area if necessary avoid physical cntact do not turn your back on an agitate dor escaling pt do not allow an agiated roscal pt to blcyou reaexcit route maintain more spae than sual betwe touersl fna ftpt sofr safety standina t an anlge facing the pto it is seasier to sde step ifne cesary walsys stay at the same lye level as the pt iee btoh standin both sitting kee hand out of our ockets for oth self protection adn to void the appreance o concelamne ti

palpation of peripheral arterial pulses

pulse = periodic fluctuation in the flow or blood through a peripheral artery caused by the ejection of blood with each heartbeat normal pulses are strong and regular

radial artery line gets pulled what do you do as a PT

put a ****ing BP cuff on the involved extremity and inflate the cuff until the bleeding stops how stupid is that arterial bleeding needs to be stopped immediately although it is not considered a cardiac emergency you can place the cuff above the site of bleeding and inflate the cuff to above systole to stop the bleeding or place enough manual pressure on the site to stop the bleeding THEN call for help elevating the arm above the level of the heart (which is what i picked) will not be as effective bc it is an arterial bleed, as long as the heart is pumping with adequate pressure it will continue to bleed never reinsert the needle

body systems and age

rach theri geates health in theri 20s and ealrty 30s aferw age related cahgnes begn to ccur whta reusl in a deceain pyic aan ogt fucon rage cahgens relatvel consstant thorgh thept istapcal moter symtoani larera in life mah of th pshyo chagen sthat occur wiht agin also cocur wi tdecerain actethereh aexefc eexefcmay el ptp attenuate sme fo tehs canges

angiography

radiologic examination that inject a contract medium into the blood vessels coronary angiograms are part of the group of procedures known as cardiac catheterization an angiogram can show the location of plaques in the coronary arteries and the extent of occlusion

multicenter randomized controlled trial, what is it

random assignment to an experimental or control group a large multicenter RCT study with large #s of patients provides the highest level of scientific rigor and evidence

gas

rduct of idigestion that is made priamra of aodorless vaors

6 month old what is an appropriate treatment activity

reaching for a multicolored object while in an unsupported guarded sitting position

chrons disease is associated with what type of arthritis

reactive arthritis (reiters syndrome) similar to rheumatoid where the bodys immune system mistakenly attacks the joints and causes an inflammatory response, which causes joint pain and stiffness as well as deformity but unlike rhematoid reactive usually affects larger joints and can also affect the lower spine, esp SI joints

rehab considerations fpr pts with thyroid dysfunction

recogize reduced exercise capacity and faituge are typicaly avoid tx that exacerbate the condtion such as exercise in a hot quatic or gm setting due to heat intoerance (graves) avoid cv dtress to eliminate seoncdary cpmlications from hypotension goiter and graves provide close montoring of vital sigsn recognize the effects of radioiodine therapy ecognize the risk of rhabdo in hypo

rehab considerations for pt with GI disease

recognize electrolyte imabalcence from diarrhea vomit an weight loss reconige the potential for orthostaic hypotension seconadry to electrolyte imabalces increases risk for msucle cramping seconary to alteration in the sodm potantimm pumps potential for diff swalling sedonatu to disk prodtuion or esopharel patholgu back pain andhsould pain may be secondary to acute ulcer or GI bleed observation of kehrs sign indicated free air or blood within the abdomainla cavity

rehab considerations for patients with adrenal dysfunction

recognize sigsn of stess of exhaustion and avoid tx that exacerbate the ocndition notify the physiican with an sigsns of illness or increase iCP papilledema medications may need to be alterd orthostatic hypotension is common seocnday to long term cotisol thera reports leep disturbances to the physisican increased incidecne of soteooporos bone fx defen myathy tnedon reupture ataxis gait delayed wound healing may be common

elderly patient with ALS, doesnt have endurance to walk to the bathroom but refuses to use a bed pan, what do you recommend

recommend the use of a commode chair for the bedroom WHY would you do this over initiating ambulation endurance training...because ALS is a chronis progressive disorder and ambulation endurance training will not likely produce significant gains but she is also NOT a candidate for a nursing home or wheelchair at this time because she is semi functional so she should be kept that way in the HOME for as long as possible

rehab consideration for pt with malabpostion syndome

reconize increase risk fo r sotesoprois and patholic fx montior gatge level pallor bone pain and execise tolerance weight loss and abodnnal blaitng recn increase risk for msucle spasmas secndary to electrylyte inmabal ce recngna ncra errisk for genalize seewling seconadry to protein depletion

rehab consideratons with DM

reconize risk for peripheral neuropathies, small vessel angiopathy tissue schemia and uldernation imparied woudn healing tissue cnecrosis and amutaion recnogzie acute metabolic changes re tht ss of hypoglyemia consistent mangment of insulin intake diet anf PA prvide edu for proper skin scare shoe eval and shoe care

muscles that need to be stretched with forward head posture

rectus capitis posterior major and minor forward translation of the occiput in relation to the neck and trunk is assocated with extension of the occipital axial joint and flexion of the lower and mid cervical spines if its chronic then these muscles shorten and localized stretching it indicated muscles ANTERIOR to the axis for mid and lower cervical flexion and extension will be chronically overlengthened and therefore further stretching of these would not be indicated (rectus capitus anterior muscles, longus capitis and longus colli) forward head is also associated with forward scapular positioning which means that stretching of the adductors (middle trap and rhomboids) would also not be indicated

elys test

rectus femoris prone flex knee passively and positive is when ipsilateral hip flexes during knee flexion

IBS

recucuren sx of the upper an low GI system that intefere with teh noraml function of the colum coloro o large intensivne my abe snesi vto cetian foots of sterss immune stsem serotonin and bacerital infection may all bec austie factos ocurs in as many as 20% of aduts more comonly in fmfales andbegings b[rior to the age of 30 in 50% of patiesnt females have lgihl hgiher rate wihich may be triggerby good senisitives stres aciety caffeine smoking alochol or high fat in take ss abdomian pan abliadng or sdisten nv anoreia chage in form ad reqn of stol and passin go f musuc sin the stool typcialyl dianoses of exlusion from other GI change in lfesytle nutrion decrase in srres pharma adeate sleep exrecis eand pych stheapy avoid mlarge meals milk wheat rye barley alchol and caffeine also sx can be sever it does not lead to serious diseas sx can tupcial be contrlle b diet andphram and stress mangement

LE lymphedema in aquatic therapy what are the benefits

reduce effusion and assist venous return, can also induce bradycardia there is a difference between hydrostatic pressure and bouyancy (bouyancy would help to provide joint unloading active movement) hydromechanics of water molecules would increase the resistance of water as speed of movement increases

ginseng

reduce the fects of anticoaga and exagera efefcts of meds such as insulein anoral antidiabtet meds

sympathomimetic

reduces airway restriction by reducing bronchospasm (B2 receptors in the bronchiole smooth muscle) mimics the effects of stimulation of body organs and structures by the symphatetic nervous system aka albuterol (ventolin) no effect on volume or consistency of airway secretions may increase BP and cause tachycardia (through adverse effect on B1 receptors) so may result in patient monitoring exercise parameters at lower exercise workloads and reducing aerobic training effects

early intervention for osgood schlatter disease

reduction of the loading by the quads but still retaining normal LE function (forecful contrations of the quads can encourage the development of this disease, ie when a catcher stands up to throw the ball to the pitcher) modalities may improve the pain but it will not improve the underlying condition (US over an epiphyses of a 10 year old is also controversial)

gangrene (dry)

referred to as dryw when there is a loss of vaculr supply resuting in local tissue death fingers teos and limb are more often affected harded tissue is not painful however there may be sig pain at the lin eof demarcation dry gangrene typicall deveops slow and in some cases results in auto amputaion DM, artherosclerosis blood vessel disease infection is typically NOT present in dry gangrene however dry can progress to wet if an infection occurs s/s dark brown or black nonviable tissue that eventually becomes a harded mass (mummified) pt ma compain of cold or numb skin and they may present with pain tx serious medical ondiiont hat reuiqres immediate medical intevention depending on the seveirty gangrene is reaed by pharam surgeru or hyperbaric oxygen therapy

gangrene wet

referred to as wt if there is an associated bacterail infection in the affected tissue may develop as a complication of an infect untreated would swelling fromt he bacterail infection causes a sudden stoppage of blood flow can devlop after a severe burn frostbite or injury and require immediate tereatment since it tends to bread very quickly and can be FATAL there is cessation of blood flow that starts a chain of events inlding invasion by bacterai at the affected site as a reslt of the occluded blood supply the hiwt blood cells are unable to flight the infection s/s = swelling and pain at the stire of infection, change in skin color from red to brown to black, blisters that pridce pus, feve an dgenral malase tx serious medical onditin that require immediate meidcal intevention surfical deridbemet of gangrena and IV antibiotics are ytpcaly inteventions depending on the severity can trate by pharma, surgery andj hyperbaric oxygen therapy

pathologic staging

refers to staging based on the pathology findings of tissue samples obtained during surgery often surgery is performed to remove a malignant mass and or nearby lymph nodes or for an exploratory assessment and tissue sample removal in some cases the patholigic stage may differ from the clinical sage (i.e. if surgery reveals that the cancer has spread more than expected in relation to clinical staging) the patholgic stage gives the health care team more prcise info which can be use dto more definitively predict treatment respones and prognsosi

clinical staging

refers to the estimated extent of malignancy present based on the findings of a pateitsn physical examination lab values, imaging adn biopsy clincial staging is a key component in derrmining a pts optimal course of tx and also estbalish a baseline for comparisin used in asssessing the response to treatment

hyperbaric oxygen

refers to the inhalation of 100% oxygen delivered at pressures greater than 1 atmosphere hyperbaric oxygen treatment is delivered in a closed chamber tupically at pressures two to 3 times that of the atmosphere, effectively reducing edema and hyperoxygenating tissues indications = osteomyelitis, diabetic wounds, crush injuries, comparmtment syndormes, nectotizing soft tissue infection, thermal burns, radiation necrosis, and compromised flaps/grafts contraindications = terminal illness, untreated penumothorax, active malignancy, pregnancy, seizure disorder, emphysema, and use of certain chemotherapy agents advantages = antibiotic effects stimulation of firboblast production and collagnen synthesis stimulation of growth factor releases and epithelialization disadvantages = specialzied equipment not widely avail cannot be used with malignancy

what happens when you abruptly stop taking beta blockers

reflexive opposite response aka increased contractility, BP and HR (normally these sympathetic responses are blocked)

lifestyle and healing

regular PA and good nutrution facilitate woudn helaing by enhancing tissue perfusion and the availability of nutrients needed to sustain cellular actiivity in contrast, smoking dramatically impedes wound helaing by limiting the blood oxygen carrying capacity the resutign wound hypoxia slows healing and creates an ideal enviornemnt for anaerobic bacteria growth, therby increasing the risk of woundinfection

contraindication to exercise during pregnancy

relative - severe anemia unevaluated materanl cardaid dysrhythmia chronic bronchitis poorly control type 1 diatbes extreme morbid obestiy extreme udner weight BMI <12 histor of exrreemyl sed lifelsytl e intrautierin grwoth restticiotn in current prg porrly controller hypertnesion orthoei climiations poorly contorle dseizure diorse poorly contrlled hpethuroidism heavy smoker absolute - hyemodynamicall signiant hear tidseas restricive lung didsae incoempetne cervic/cerclage (opens too early multiple gestioan at risk for premature labor persistanet second or third trimester bleeding placenta previa after 26 weeks gestataion (plaenta coversl ope can cause severe bleeding) premature labor during the current pregnancy rupture mebranes preeclamspsia pregnancy induced hypertenion

bronchodilator agents

relieve bronchospasm by stimulating the receptors that cause bronchial smooth muscle relaxation or by blocking the receptors that trigger bronchoconstriction primary classifications of bronchodilators include anticholinergic sympathomimetics and and xanthine derivatives used for bronchospasm, wehezing and SOB in asthma and COPD side effects include paradoxical bronchospasm, dry bouth, GI distress, chest pain, palpitations, tremor, nervousness long acting sympathomimetics (including salmeterol) increase the risk of asthma-related death therapists should advise patients to take their bronchodilator medication as prescribed before therapy and to bring their short acting sympathomimetics (rescue medications)with them cardiac or vision abnormalities may indicate toxicity and the physician should be notified IMMEDIATELY i.e. anticholinergic - atrovent (ipratropium), spiriva (tiotropium) sympathomimetics - ventolin (albuterol), primatene mist (epinephrine), serevent (salmeterol) xanthine derivative - theo-dur (theophylline), aminophylline

overactive bladder agents

relive the sx of an overactive bladder involvetary contractions of the baldder (detrusor msucles) indicated for urency renah urge noctura side effect typcal GI distressd nauas edizznes photsens headach econstiap at pulonarty reacion PT shou be aware of adsvese effects do not typically ineere with rehab COMMUNCIATE ANY SIGNS OF PULMONAR IMPAIRMETN OR DISTRESS TO THE PHYSICIAN ditropan (oxybutynin chloride), detrol (tolterodine tartrate)

non selective debridement

removal of both viable and nonviable tissues from a wound often termed MECHANICAL DEBRIDEMENT and is most commonly performed via wet to dry dressings, wound irrigation and hydrotherapy (whirlpool)

wound irrigation

removes necrotic tissue from the wound bed using pressuized fluid pulsatile lavage is an exaple of wound irrigation that uses a pressurized stream of irrigation solution this type of debridement is most desirable for wounds that are INFECTED or have loose debris many devices permit variable pressure settings and provide suction for the removal of exudate and debris

lung transplant

reserved for patients with end-stage COPD, interstitial pulmonary fibrosis, cystic fibrosis, and other serious lung diseases, but who do not have serious comorbidities

procedure for ECG

resistance between skin and electrode is reduced by removing skin oils, and cutaneous debris with an alcohol-saturated gauze pad then abrading the skin sites to remove the superficial layer of the skin anatomic locations of limb electrodes for limb leads = right arm (RA) - infraclavicular fossa medial to the right deltoid muscle left arm (LA) - infraclavicular fossa medial to the right deltoid muscle left leg (LL) - left side of the abdomen below the rib cage right leg (RL) - right side of the abdomen (ground electrode) anatomic locations of chest electrodes for precordial (portion of the body over the heart and lower chest) leads = V1 = 4th intercostal space at the right sternal border V2 = 4th intercostal space at left sternal border V3 = midway between V2 and V4 V4 = 5th intercostal space at left midclavicular line V5 = left anterior axillary line at V4 V6 = left midaxillary line at V4 and V5 levels connect the electrodes to their corresponding lead wires to form three bipolar limb leads, three augmented unipolar limb leads and six unipolar leads

prtiens

resprn fgor goewth and aintain of the body tiseus adbua tin collagen fber which are prestn in struecues ucha s skin ligmenta adn skelts muscel aduts hsoud ocnsue 0.8 grmamsof pretin per kg of body weight if no teci afef card or fat rptein may also be sue d asa fuel coures prtie are made u o fsallsubintsi snow nas aasmin o acids 20 amin acid s9 of hich wcannt be produce by t he mbody and ms tbe ocnsute in the diet aka esstnail emoiona caids

what type of lung dysfunction is common in PD

restrictive lung function

coronary artery disease SILVER

result of atherosclerotic plaque build up within the coronary arteries develops slowly and often goes unnoticed for years beofre orpdicuing sx right and left coronary arteries are branches of the ascenidng aorta right supplies right and left supplies left as plaques develop the volume of blood available to perfuse cardiac tissue decrraeases when demand is increased diminishe dperfusion signficiantly increases the risk of myocardial ischemia and permanent cardiac damage risk factors include hypertensoin diabetes obestiy chronic kidney disease elevated cholesterll and triglycerid family hstory smoking iactivity alcohold abuse and stresss partial occlusion = exertional SOB, weakness or angina pectorsis may be first signs in some cases hwever the first sx of CAD may be as severe as a MI secondary to plaques that have compeltely occluded an artery cardiac cath with coronary angiography introduces contract dye via small catherters into the coronary arteries for xray imaging provides the most accuaret info regainf the location and severity of CAD CT scan and magnetic resonance coronary angiograms provide a less invasive means of visualizing the coronary arteis with contract dye introduced IV or via injection management = angioplasty, stent, endarectomy, and coronary artery bypsass are common nutrition is important after PT the patient should possess self management skills associated with sx recongitiion and reduction of risk factors long term effects of patients condition increased rof angina pectorsi ,HF cardaic arrhthmias cardaic arrest

non erosive gastrisis (chonri ctype b gastritis)

results of ehlicobater pylori infection hpylori sspatient usually asymptomatic but will show sx id the atritis profresses carciogen and mst be trearted affresivel oharam proton pump inihibtor and antibios

secondary gain

reward value of having a psychological or physical symptom, such as release from ordinary responsibilities described in a case where a pt reported sudden onset of back pain while trying to lift a heavy barrel, described the pain as constant, unremitting at an intensity of 10/10 over the past 3 days, and unresponsive to pain meds, the pt is unable to work but is able to drive to the clinic for treatment unaided, there is no history of back pain in the past asked what the causative factor what early degeneration herniated disc neoplastic disease secondary gain said secondary gain bc the pt was able to drive to the clinic for treatment and relates a pain of 10/10 is not providing consistent subjective data and secondary gain (in this case not working) is a likely factor pain from a disc is typically worse in the morning and will decrease (at least slightly) when the pt gets out of bed and begins to walk around neoplastic condition unlikely from traumatic onset

muscle that controls scapular abduction

rhomboids and traps if they do not eccentrically contract (and have excessive lengthening during motion) they will not adequately control scapular abduction

best intervention approach post-surgery to remove cerebellar tumor with pronounced ataxia and problems with standing balance and postural stability

rhythmic stabilization during holding in kneeling PNF technique designed to improve stability HIGH KNEELING is a GOOD position to begin with for the patient with pronounced ataxia because it is UPRIGHT, with COM LOW, degrees of freedom are reduced (foot and ankle control not required), and the BOS is increased over standing splinting and touch down support are compensatory strategies and would likely not improve recovery sidelying would not help with upright control l perturbations are CONTRAINDICATED for patients with poor postural stability and pronounced ataxia

appendix refers to

right lower quadrant

facets arthrokinematic cervical rotation

right rotation causes facets on the right to glide down and back, causing approximation of the joints on the right

naming scoliosis (i.e. "right scoliosis")

right side is CONVEX which means there is increased aeration and mobility on that side left side would have decreased aeration (decreased breath sounds and thoracic rib elevation) and shortened muscle length

breathing pattern of ASIA A C5

rising of the abdomen due to no abdominal muscle tone on the abdominal viscera abdominal muscularture provides external stability to the abdominal viscera and without it the viscera are displcaed with respiration

rehab consideration for hep

risk for contact with hep and should recieve all immuncation HBV and if expoers must recieve immun globulin therapy imemdiatel starndar dprecautions should efolloed at all times enteric precautions are required for pt with hep A and E aka must wash hands not use hand snatiizer recognize tha arthralgia may be noted eps in older pt and will nto typically repsne to rradiitonal theraputic intevention ernrgy concetaion and pacin g balance along wth periods of rest avoid prlnged bed rses and provid tp education refaing sifns o relapse or chinrinc hepatitis

if a facet on the right was restricted with downgliding (arthrokinematic restriction) then the osteokinemetic motions that would be limited are...

rotation and side bending to the RIGHT with limited extension probably will have pain on the RIGHT as well

neuropathic ulcers

secondary complciation ususally associated with a combination of ischemia and neuropathy often associated with DM but any form of peripheral neuropathy poses an uincreased risk of wound development gen recs limb protection risk reduction edu inspect legs and feet daily inpect footwear for debris propr to donning wear approp sized offloading footwear with clean cushioned seamless socks

endocrine system vs nervous system

secreting cells send hormoens throgh blood stema to sinal specifi target cells hormones diffuse into ththe blood and eravel long sdatnce to vurla very aera in the body endorcine effecotrs ocnsist of vitally all tissues regalatory effects are slow an tend to las to frolong periosd neurson secrete neurothransitter to signal nearby cells that have an apprapta reetor site neurot ranmister sent very short distances across a synapse nervos efects are limited to msucels and glandualr tissue regulartory effects appear rapidly and are often short lived

what do you examine first in an elderly pt with fall history

sensory losses and sensory organization of balance can use the clinical test for sensory integration in balance (CTSIB) or modified CTSIB

diastsisi recti

sepaton of the recut sbaodmianmucles along the linea alba that can occur during prenancy test before rrescirbing execises hat reuir use of the abdomianla s bimechan adn hromal changes in woen may cause the separtaion must note how may fingers ifit into the separtion ad mofify treatment considet to have diastatsi is fht ee SEPARATION GREATER THAN THE WIDHT OF TWO FIGNERS when the women lifts her head and shoulders off the plint stabilziation and support with adbominal streengthening exericses, postural awarenss exericse, bdoy meachaisns newborn can also have disatsi recti seconarty o inpcete develpment how ever in fants this conition resolves itself wthout inervention

perimetrium

seroius peritoneal coat of the uterus

hip and knee flexion contracture would produce what kind of gait compensation

short limb during stance so the opposite will have to circumduct, hip hike, and steppage gait to get the LE through swing it will also lead to a shorter stride lumbar spine extension can effectively compensate for hip flexion contractures up to 15 degrees but if it is >15 degrees which is common or there is limited lumbar extension ROM which is also common, the patient is forced to adpot a forward trunk tilt in terminal stance in order to complete the step with the knee flexed the quads have to work harder to maintain weight beraing through the flexed knee

exercise in hot environments

should be modified to include access to fluids, increased frequency/duration of rest breaks, and shorter exercise time moderate dehydration (loss of >/=6% of body weight) contruubutes to a drop in exercise performance and increases the risk of heat illness to maintain hydration, measure body weight before and after exercise and drink at least one pint (16 oz or 2 cups) of fluid for each pound of body weight lost wear clothing with a hgih wicking capacity to assit in evaporative heat loss, remove clothing and equipment to permit heat loss especially head gear s/s of heat-related illness: heat stroke - disorientation, dizziness, apathy, headache, nausea, vomiting hyperventilation, dry skin heat exhaustion - low BP, elevated HR and RR, wet and pale skin, weakness, dizziness heat syncope - decreased heart rate and RR, pale skin, weakness, vertigo, nausea heat cramps - localized muscle spasms progressing to debilitating muscle cramps

anterior chest and axilla burn

shoulder adduction deformity, with extension and medial rotation splint with axillary or airplane splint, shoulder abduction brace

typical pattern of spasticity in the UE of a patient recovering from stroke

shoulder adductors, forearm pronators, flexors of the elbow, wrist, and hand (antigravity muscles)

C6 slideboard transfer

shoulders ER elbows/wrist extended forearms supinated fingers flexed (to preserve tenodesis) do this bc dont have triceps and substitutes by locking the elbow strong contraction of the anterior deltoid, shoulder ERs, and clavicular portion of the pec major FLEXES and ADDUCTS the humerus causing elbow extension

normal tone of a new born in supine

shoulders are abducted/ER, elbows and fingers are flexed, hips are abducted/ER, and knees are flexed decreased flexion would occur after 1 month

incontinence and tissue injury

sig increased risk of tissue injury or delayed healing if there is an existing injury urine and feces are typically acidic in composition and can contribute to tissue irritation and erosion skin shear and friction are increased in the rpesecne of mild tomod moisture macerated skin has decreased epidermal resilience to shear and friction forces harsh cleaners, hot water and scrubbing will make delicate tissues more friable (easily crumbled) mild cleansers, warm water and min friction should be used when cleaning to minimize irritation topical agents should be employed both to maintain the skins naturla mosoture and act as a barrier to excessive mosiure from incontinence emollient ceams and oinments are typically better choices for skin moisturiares that watery lotions as they tend to have higher concentrations of solids and oils requiring less freq applciations and provided better barrier protection

combination dressings using silver and iodine

silver and iodine are elemental broad spectrum antimicrobial agents that have become valuble adjunts to wound healing interventions first used in topical applications (pwer ointment cream) these elements control microorganisms activity in wound beds without damaging viable tissue many silver and iodine-impregnated dressing also HELP TO MAINTAIN A MOIST wound healing environment absorbency and recommended frequency of dressing changes are product dependent with many requiring a secondary dressing

anabolism

simple molecules nucleic acid polysacc amino acids are COMBINED to craet the compex molecures like proteins needed for tissue and organ growth

pursed lip breathing

simple technique to reduce respiratory rate, reduce dyspnea, and maintain a small positive pressure in the bronchioles which may help prevent airway collapse in patients with emphysema ANY patient who is short of breath may use this technique indications tachypnea dyspnea precau/contra forcing exhalation procedure semi-fowlers is a good position to initiate the breathing technique intruct the patient to breathe in slowly through your nose with the mouth closed for two counts pucker or purse your lips as if you were going to whistle then gently breathe out through pursed lips as it trying to make a candle flame flicker for a FOUR count, do not blow with force expected outcomes decreased RR relieve dyspnea reduce arterial partial pressure of paCO2 improve tidal volume improve oxygen saturation prevent airway collapse in patients with emphysema increase activity tolerance

initial relearning post stroke with hemiplegia and profound visuospatial perceptual deficits

simplfy and restructure the envinronment and minimize distractions supervision is key initially bc patients tend to be impulsive and unrealistic about their residual abilities

recipient site

site that has been burned requires a graft

best intervention for multiple bouts of pneumonia for PD patient

sitting bilateral symmetrical UE PNF D2 flexion patterns using rhythmic initiation opens up the chest and enhances lung function sitting posture is a good STARTING position for a patient with postural instability

metabolic bone disease

skelteal system houses calcium and phosphorus it also contonuously balance the remodeling of the cortical and trabecular bone in order to optimize the structre of the skeleton disruption in the homeostatis of skeletal metabolic processes will result in defomriti bone loss fracture softeningof the bone arthirsi and pain

largest organ

skin consists of stratified dermal and epidermal layers, hair follicles, nails, sebaceous glands, and sweat glands the avascular epidermis is the most spperficial layer of skin the dermis, know as the true skin, is well vascularized and is characterized as elastic, flexible, and tough

sheet graft

skin graft taht is transferred directly form the unburned donor site to the prepared recicpent site

skin care

skin is more prone to damamge since the protin rich fluid impair immune sstem function allwing for bacterail and fungal fgowth infecitonc can lead to worsnin of a patietns lhmphedmea revention i prmary pnprtan limb should be inspecte and lceansdd throughly each day and patiestn should frequently apply moistiuriing lotion any soaps or moisturaers used should have a LOW or NUETRAL pH to avoid damge to the skin

maceration

skin softening and degernaetion that reuslt form prologned exposure to water or other fluids

bradypnea

slower than normal respiratory rate <12 breaths/min may be associated with neuro or electroclyte disturbance, infection or high level of cardiorespiratory fitness

lower GI

small intestine duodenum - neutralize acid in food from the stomach and mixed pancreatic and biliarty sections with food jejunum - absorsbs water, electrolytes and nutrients ileum - anrosb bile and instrinsic factors to be recycled

polyps (colon)

small non cancerous growth siont eh inner lining of the colon

1 pulse

small or reduced

prosthetic flexion during stance what is going on

socket is aligned too far forward or tilted anteriorly normally aligned in slight flexion to enhance loading on the pressure tolerant areas of the residual limb, prevent genu recurvatum and resist the tendency of the amputated limb to slide too deeply into the socket but if it TOO far anterior or excessively flexed then it will result in excessive knee flexion in early stance

maceration

softening of the tissues drained of its pigment and has a white appearance

consolidation of lung

solid lung A pulmonary consolidation is a region of normally compressible lung tissue that has filled with liquid instead of air.[1] The condition is marked by induration[2] (swelling or hardening of normally soft tissue) of a normally aerated lung.

lisfranc usually happens when...

someone steps on foot during athetics something falls on foot crush injury or landing on the foot after falling from a height

what is the valsava maneuver used to identify

space occupying lesion such as a disc herniation, tumor, etc

what else is velocity dependent and how is it different than above

spasticity slowing of movements at faster speeds

other phara therapies

sstemic ienternvtion utlize which soe tpes fo cancer which rely on a particar hormone to grow liek estrogen tpal alter the bodyes prdution or ation of specifi homrens prevetion malignant cells from using the ornam tey need t grow anti estgoren aromastae inhiitors oreogets estosn anti afno and corticosteroids more speiic than chemotehrapy attacke mtuated versn of a gene or the cells carynig mutation may ba part of the parry intevnetion or used to help maint remission

staging details by national cancer institute staging

stage 0 - early malignancy that is present only in the layer of cells in whcih it began, for most cancter this is referred to as carcinoma in situ (in original place) not all cancers have a stage 0 aka nonivasive hasnt moved, highyl treatable basically not consdiered cancer just abnormal growth stage 1 - malignancy limited to the tissue of origin with no lymph node inovlemnt or metastasis stage II - malignancy spreading into adjacent tissues, lymph nodes may show signs of micrometastases stage III - malignancy that has spread to adjaacent tissues showing signs of fixation to deeper structures the likelihood of metastatic lymph node involvement is high stage IV - malignancy that has metastasized beyond the primary site for example to bone or another organ

moist hot pack contraindicted for

stage III ducubitus ulcer infected with staph and necrotic tissue bc can accelerate bacterial growth

cervical cancer

starts in the cells on the surface of the cervix tupcailly squamos cells this precancerous condition is called dusplasia and is easily treatable annual cerical screening is recommmeded diagnosis is made thorugh a ppap test pronosis is good with timely intervention if dysplasia goes undetected, cahgesn can devleip into cervical cancer and metastatsize to the bladder, intestines, lungs and liver human papilloma virus HPV is the primary cause of cervical cancer it is slow growing risk facotrs incldue smoking, maternal use of diethylstilbestrol DES aka estrogen, african american ethnicity oral contraceptive use and certain sexually transmitted disease ss asymptomatic during the early stages however sx can include abnormal bleeding pelvic and low backpain impairmetn with bladder adn bowel function

respiratory alkalosis BRONZE

state in which pH is abnormally HIGH indicating alkalemia hyperventilation removes more CO2 from the body than can be produced causing hypocapnia as a result, hydrogen H+ levels DECREASE altering the bodys acid-base balance numerous conditions aka PE hyperthyroid sepsis, medication aka catecholamines nicotime, external influences aka high altitude, and internal influences aka cns response to trauma pain axiety fever can induce hyperventilation and subequent alkalosis not an indpendnet disease process but rather a sx of another underlying disease or condition initial s/s may be vague and are often closely realted to the underlying pathology tachypnea, tachycardia, hyperventilation and dizziness are commonly observed in severe cases a pt may develop seizures if the patient is also hypoxic, cyanosis may be observed chronic or acute chronic, lab values will reflex a partial pressure of co2 below normal and serum pH alkalemia acute will also show low co2 but serum pH willk be normal or near normal ABGs, metablic panel of blood analysis aka electrolyins urine pH

systematic approach of ABGs

step 1 - examine pH to determine acid-base balance <7.4 acidosis, >7.4alkalosis step 2 - examine the PaCO2 as an indicator of ventilatory status <30 mmHg indicates alveolar hyperventilation >50 mmHg indicates alveolar hypoventilation, ventilatory failure step 3 - interpret PaCO2 in relation to pH paco2 >45 mmHg and pH <7.4 indicates respiratory acidosis paco2 <35 mmHg and pH <7.4 indicate elimination of CO2 to compensate for metabolic acidosis paco2 <35 mmHg and pH >7.4 indicates respiratory alkalosis paco2 >45 mmHg and pH >7.4 indicates retention of CO2 to compensate for metabolic alkalosis step 4 - interpret the HCO3- in relation to pH 22-26 is normal hypo hco3- with acidic blood indicates metabolic acidosis hyper hco3- with acidic blood indicates renal compensation for respiratory acidosis hyper hco3- with basic blood indicates metabolic alkalosis hypo hco3- with basic blood indicates renal compensation for respiratory alkalosis step 5 - interpret the PaO2 and SaO2 mild hypoxia (pao2 60-79 mmHg and sao2 90-95%) moderate hypoxemia (pao2 40-59 mmHg and sao2 60-90%) severe hypoxemia (pao2 <40 mmHg and sao2 <60%) ^^all if not shift in oxyhemoglobin curve

paced breathing and exhale with effort

strategy to decrease the work of breathing and to prevent a patient from holding their breath the technique breaks any activity into one or more breaths with inhalation during the resting or less active phase of the activity and exhalation during the movement or more active phase of the activity indicated for patients with dyspnea at rest or with minimal activity, inability to perform activity due to pulmonary limitation, inefficient breathing pattern during activity precau/contra... avoid valsalva maneuver during activity procedure... perform activity at a tempo that does not exceed the patients breathing limitations find a comfortable inspiration to expiration (I:E) time to synchronize with the exertion phase of activity synchronize breathing with components of the activity do not hold breath or rush through the activity

rehab consideration with chemo and radition

strensou actiivyt should innitally be avoided follwing mpanta of radacti seend utlizin brachy theapt communcation with raiditon onologi or efering phsicn is imperateive as fureth acitity contraindicat may b acvie skin taoos are used to guide beam alignment with etern beam radiation mst be cauesion and defere intevetions whic may alter the postion of alignemtn tatots ie. taping inevetion cetain tostie isse o rmyofacia moib irrated skn requre sspecial care to prote tissue prone to erythem rahds and ry deswuation as well as pin wet dfeaftion and superficial burns desuad uper layer peal like snburn MASSAGE AND HEAT ARE CONTRAINDAICATE D VOER IRRIADIATED AREAS FOR A MINIMU OF 12 MONTHS certain chemo may cause toxity hat euwre adiotn precautions PT VOMTING DURNG THERAPY SHOULD BE REPORTED TO THE NUSR/PHYSIICAN ESP IF THE PT IS TAKING ANTIEMETIC MEDICAITON TO CONTROL NAUSEA AND VOMITNING

what do you want to do to help a downwardly rotated and adducted scapula

stretch the rhomboids and strengthen the serratus anterior

moderate evidence for what intervention for adhesive capsilitis

stretching exercises (both supervised and unsupervised) weak evidence for modalities (diathermy, US) and joint mobilization so based on the evidence stretching is best

Duchanne Muscular Dystrophy best main focus for POC

stretching hip flexors and plantar flexors main focus is to prevent contractures, maintain ADLs, energy conservation, family ed, and positioning only LOW REP AROM is considered SAFE for this population NO strengthening can cause breakdown of muscle fibers

child with difficulty releasing food from the hand to the mouth, what should the caregiver be taught to do in order to assist the child

stroke the finger extensors to facilitate opening of the hand and allow the child to release the food into the mouth stimulation of spastic finger flexors (slow stroking, quick stretch) is contraindicated passive extension of the fingers will not enhance the activity of feeding

geontology

study of aging in older adults b the eyar 2030 it ise cpect taht 20% of the USS poia;tion will be graeret than 65 yerars old eute to appxo 70 million indiavu fgeat ehant he age of 65 85 years and old expecte dot se ad ramati cincrawe int heri dmohrapi cressperstnation due to imporve in heatl hcare and the aging o fht eboabb bomer egetaion woen will outlvie men and maeu the grate percen of adults over 85 known how to provided dklled care ot anging adutl are fpsec know fo bio psych a sofial

pharmacoinetisc

study of what happens to the dutgonce it enters the human body four major parametes taht are infleuce by pahracokinetics abrostion distucit metabolis anexcretion as an iia ages th ebailti preocess af rug cange ait can fetalt in fleucne the fec to fht eme d aborpeotion refers to the mvoeme of a drug into the blood stream decrae acdidity in the stomach along with slow emetpy ing types adn cdce mobtialti can also th abartoion of the drug can repdusosa the tomatch to delveip lceaitons form antina prolnge dontat with themed striren tin med refere tot her tanpot fo th drug to vaoru ostsses ceratin dugs are liphli hydroa l ansuch athe swill inue based on th older adult body compotion cosnire older adutls demotan a eera in total body weater an dincraer in apispes tissu eand a fecrea in msucel mass cetain dugs iwll be inleuc gretr b teri teibutn cahfaretiz tahn other adional sinc ethere is apotneti ecea in serym ALBUMIN lwvel in odler adul cetaitn dyrg smay become more conetered in the bloodstema which wil reuslt in tensetifeid dug effects UNBOUND DRUGS CAUSE THE EFFECT AKAK IF THEY DONT MIND THEY HAVE A MUCH STRONGER EFFECT ALBUMIN WHEN NORMAL AVOIDS THIS STORNG EFFECT AND MEDITES IT metabolis is acmpnetn of drug lcean it cccur pramru in the live r sicne metaboli s dpend on the mass of the live szyme leve a bloof flow chanfges to the hepatis system can influe the bodys abilti to break down the drug oldera dults ate more dierspo to tside efects as the half lfie is extendd ifnal compnent of exretion prefrn b te ranl syst meds act for long bc kdiney cant excreted them as fast ar nomal (i.e increased half life_ whcih can reuslti n DRUG TOXIITY if doages are not adjsuted accordingly

barium

substance that wehn swallowed or given rectally as an enema (through the anus) makes the upper GI tract visible on xray

optimal aging

succesfula ging is defina st he absen of diase and diabtilut, high cognei and pha ncoiton an dlmaintan acrive engment with life somehwat restricitve dinftion aog afgin sicne statical there i a geare tchange of incurring a fincionlimt or dia wiht icnfreaseage erm opersmore more parpi for aheatl care proactic eto use it is defina af the capcty to fucntona cross many comainant to ones atifa and sdespin oens mdical contion def deflia aoids te imprtan of wagaing without disea nd incraes bemabend the healt caraitn that cocurs while tasll aminn a emaningful agem in a chosen lifestyle this is dferne tahn againg subpticalmy whe occurs whic and inogua does not engane in preventia eheal care and exeerou deeteroisou effecits of noral phsy agaign along with that of prevetable -athogoy i.e. pt with empahse head dif edm secondayt lifestylee

acute renal failure

sudden declin e renan la ucntion increase in BUN and creatinine oliguria (urine output below normal) hyperkalemia socum retention perenal retilgo is deoncset o a decreace in blodo flow tpcualy due to shock hemorrhag eburn or pulmoarh embolism ostrenal etiolgo is secondaty to obstruciton distal to the kidney deto neoplasm akideynstone or porsta hypertpoby intranrel etilogy is seocndary to aparua dafgam eo fen tssues due to roixn intrarenal ischema or cascular disoer

epidermis

sueprficial avasular epithelal layer of the skin that incldues flat, scale-like squamos cells, round basal cells and melanocytes which produce melanin and give skin its color

antibacterial agent effective for infection control in a thick eschar secondary to a full thickness burn

sulfamylon (penetrates through eschar and provides antibacterial control)

contact dermatitis

superficial irritation of the skin resuling from lixalized irritaion (i.e. posion ivy, latex, soap, jewlry) this condition can be acute or chronic based on the exposure to the precicpating agent very common skin disease that can occur at any age nickle, rubber, latex and topical antibioics are common preciptating agents s/s intense ithcing burnign and red skin edema and expansion of sx tx identify and remove the source topical steroid is commonly emplyed acute lesions should resolve with treatment once exposre has been removed

heartburn aggravated by

supine, prone, bridging

T5 voiding realistic outcome, they would be independent by using what method

suprapubic stroking or tapping or kneading can trigger reflex emptying (i.e. spastic or reflexive UMN bladder contracts and reflexively empties in response to a certain level of filling pressure)

empty can what muscle

supraspinatus in this position it is put in its most effective position for contraction

escharotomy

surgery that opens and removes eschar from a burn site to reduce tension on a surrounding strucutre, relieve presure from interstitail edema and subseqenly enhance circulation

colostomy

surgical creation of a opening fomr th ocol thorugh th eabomdnal wall

thoracotomy

surgical incision cutting the chest wall to access the heart, great vessels, lungs, esophagus, and diaphragm for diagnostic and therapeutic purposes the incision may be may be made under the arm (axillary thoracotomy), through the sternum (median sternotomy), from the back to the side (posterolateral thoracotomy) or under the breast (anterolateral thoracotomy)

valve replacement

surgical procedure in which a prosthetic valve is implanted in the heart to replcae a leaky or narrowed heart valve prosthetic valves may be either mechancial (ball in cage, tilting disc, bileaflet) or tissue grafts from the same patient, a cadaver or a pig

bullectomy

surgical procedure in which one or more of the large air spaces called bullae that form when the alveoli are destroyed by emphysema are removed the procedure can improve breathing

cardiac ablation

surgical procedure that uses radio frequencies or chemcial to destroy areas of the myocardium that have been identified by electrophysiologic testing to be causing cardiac arrhythmias that cannot be controlled by medication or who have arrhythmias that respond well to ablation such as wolff-parkinson-white syndrome

cardiac pacemaker

surgically implanted battery-powered device placed under the skin, usually in the left anterior chest wall standard treatment for conditions affecting the electrical conduction system including a slow heart rate and arrhythmias by preventing a slow heart rate, pacemakers can treat fatigue, lightheadedness and fainting pacemaker modes and functions are described by a 5-position format know as the NBG code

gasterectomy

suriacl produce tin which al of part of the stoamch is removed

pt on bed rest after surgery, complains of tenderness and aching in the right calf, for what clinical signs should the therapist immediately examine?

swelling in the calf or ankle > homans sign because it is just pain in the calf during squeezing and DF and is not considered reliable and lacks spec/sens so just go with the clinical signs if they are an option can do a rapid screening with doppler US color flow venous duplex scanning is the PRIMARY diagnostic test for detection of DVT may also see tachycardia and slight fever

vitamin K

syntes of at elast two ofht eprotein involev in blood clotting dark green leafy vege chees egg oylk lvier hemorrhage and defective blood cltting tcoit has not been reoted

BP and exercise cessation

systolic normally decreases promptly with the cessation of exercise, as a general guideline, the 3 min post exercise systolic BP should be less than 90% of the systolic BP at peak exercise

systolic pressure and exertion

systolic pressure increases with exertion in a linear progression 8-12 mmHg per metabolic quivalent with sustained activity, no further increase typically occurs if systolic pressure does not rise with increasing workload, it may indicate that the functional reserve capacity of the heart has been exceeded

possible ECG changes with exercise in a pt with CAD and prior MI

tachycardiac at relatively low intensity with ST segment depression (>1 mm) may also see complex ventricular arrhymias (multifocal or runs of PVCs) which would be associated with significant CAD and or a poor prognosis

epinephrine

target CV and metabolic systems increases HR and force of p=contraction incerease energy production vasodilation in skeletal muscle regulated by symphateic impules form the hypothalmus in stress situations

adrenocorticotropic hormone

target adrenal cortex increases cortisol synthesis (adrenal steroids) hypothalamus regulars

insulin

target all body systems decreased blood glucose and increase the storage of fat, protein, and carbs hyperglycemia regulates

antidiruertic hormone

target kidneys increases water resabsoportion converse water increase BP through stimulating contaction of muscles in small arteries decreased water content regualtes this

glucagon

target liver increase blood glucose by stimualting the conversion of glycogen to glucose hypoglycemia regulates

androgen

target ovarlies and testes increases masculinzation promotes rwth of pubic hair regulation inflecned by the hypthalnic productiona nd release of GnRH and luteninzing hromoone

gonadotropin realse horone

target pit gland increases the release of ltueinzing homre and follicole stimualting hormone CNS feedback and circualting leveslof hormones regulates the secretion

growth hormone releaseing hormone

target pitatoary gland increase relasef of growht hormone

thyrotropin releaseing hormone

target pitauarty gland iincrease relase of thyroid sitmulating hormone

growth hormone inhibiting hormoe

target pitauray gland decrease relaese of growth horomne CNS feedback and circualting leveslof hormones regulates the secretion

corticotropin releasing hormone

target pituitary gland increases the relase of adrenocorticotropic hormone CNS feedback and cirulating levles of hormones

prolactin releasing hormone

target pituitary gland stimulates the release of prolaction CNS and circulating levels of hormones

calcitonin

target plasma increases calcim storage in bone, decrease blood calciu, levels hypercalcemia regulates

estrogin/progesterone

target uterys and mammary glands involved in regulation of the female reproductive system and female sexual characterstics regulated through cyclical rise and fall of hormone levels

prolactin

targets mammilary glands allows for the pricess of lactation taragets the hypothalamus

follicle stimulating hormone

targets overies and testes promotes follicular development and the creation of estrogen in females promotes spermatogensis in males hypothalamus regualtes this

Exercise in High-Altitude Environments

the decreased atmospheric pressure at >/=5000 feet reduces the partial pressure of O2 in the air, resulting in decreased arterial oxygen levels, the immediate compensatory responses include increases in ventilation and HR and a decrease in performance acclimatization to altitude is the best prevention and treatment for altitude related illness staging or living at a moderate elevation for as long as one week before ascending to the final elevation, minimzing acitivty and maintaining hydration and good intake reduce risk and facilitate recovery, if severe s/s persist then descending to a lower altitude is effective s/s of altitude related illness: acute mountain sickness - headache, nausea, fatigue, poor appetite and sleep, mild swelling in hands, feet or face high altitude pulmonary edema - crackles/rales in the lungs, cyanosis of the lips and nail beds

adult patient requests to see PT progress notes in the medical record when working with a PTA, what do you do?

the law requires a health care provider, except in limited circumstances, to supply a patient, upon request, complete and current information the provider has about the patient's diagnosis, treatment, and prognosis the provider must also notify a patient of any test results in the provider's possession or requested by the provider for purposes of diagnosis, treatment, or prognosis

paracetnesis

the mremoval of accumuatled fluir from the abdomen

head jolt test

the patient is asked to quickly move their head from side to side in a horizontal plane. If there is meningeal irritation, the headache will get worse. If the headache does get worse following this movement, it is an indication for a lumbar puncture, regardless of the fact that neck stiffness may not be present.

capillary refill time

the time it takes the capillary bed to refill after it is occluded by pressure is an indicator of impaired perfusion to the extremities.

transparent film

thin membranes made from transparent polyurethane with water resistant adhesives permeable to vapor and oxygen but are largely impermeable to bacteria and water highly elastic, conform to a variety of body contours and allow easy visual inspection of the wound insce they are transparent indications = useful for superficial or partial thickness wounds with MINIMAL DRAINAGE (i.e. scalds, abraisions, lacerations) advantages = provides a moist environment for wound healing enables autolutic debridement allows visualization of the wound resistant to shearing and frictional forces cost effective over time disadv = excessive exudate accumulation can result in perwound maceration adhesive may traumatize periwound area upon removal CANNOT BE USED ON INFECTED WOUNDS

post op type II SLAP repair 1 week ago best intervention during early rehab

this lesion is characterized by a detachment of the superior labrum and the origin of the tendon of the long head of the biceps brachii that results in instability of the biceps-labral anchor (this is what is reattached during surgery), therefore you should AVOID contraction and stretching of the biceps during early rehab (aka maximum protection phase) perform careful ROM of the shoulder IRs IR ROM does not create the peel back mechanism that increases stress to the repair (where as ER does) peel back mechanism = When the shoulder is placed in a position of maximal external rotation, the rotation produces a torsional force to the base of the biceps anchor. early rehab within post op precautions correlates to a quicker overall recovery and improved outcomes

clinical indications for pulmonary rehab

to assist pt to manage and cope with dyspnea indicated in the presence of respiatory impairments including dyspnea at rest or with exertion, hypoxemia, hypercapnia, reduced exercise tolerance or a decline in the ability to perform ADLs due to chronic bronchitis emphysema asthma intersitiaal lung disease (sarcoidosis, occupational or environemental lung disease) bronchiectasis cystic fibrosis chest wall disease lung cancer NM disease (PD, ALS, MS) preop and postop lung resection, transplant or volume reduction ventilator dependency i

symphysis pubis pain

to prepare for delivty the symphsis pubis jotn become mobile in order to allow th ejoint o slightly sepearte during delvity postral addaptiaotn ligament ous laxity compcato during delvity or bith of a large infant can sult in more severe injury to the soft tssue arounnding the joint ss severe pain int he symphisis pubis and SI joint as well as blood in to tureine due to injuy to the urethraor bladder nekc phraam for pai and srugery based on degree of sepataion heat or ice IF ACUTE manual tehcniques for correcting pelvic aor sacral laigment such as muscle energy tehcnque self ocrrection eduaiton o oitosn psotual tiraning gait itinraing pelvi and lunarb stabilziation exercise and the use of a lubo pelvis brac eor binder

facets arthrokinematic side bending

to the right - right upper facet moves down and slightly anterior, left upper facet moves upward and slightly posterior (both facets move to the left)

palliative care

tpcal ptp wi th sersi ilne aims to relvie thei pan anusfer as well as adress any psych social anpsia with goal o impreove guality of life

major factor in sublux and shoulder pain in hemiplegia

traction and gravitational forces acting on a depressed, downwardly rotated scapula

adjuvant

traetment proivded in addiiton to other cure foced intervention with the p=itnetion of prevention cancer reoccurance

hep A HAV

transmisstion occurs by close personal contact with someone that has the infection or throgh thr feval oral route i.e. contaminat water and ofoot sources lfu lke ssx reprernt and acute infeciton this form does not preofess to chrnicn or cirrhosis of the liver pt susualtl recer n 6 to 10 weeks tx is suppotie an the vius is self liitied

lymphatic system genral

transport fuldi and other amterial taht arte not reabsoirbe dby th en eous system maintain fluid balacnen immune system defence lymph riintatea as a compnent of the intieristial fluid and proaru consits of water proteins fatty acis adn cullarular componentes lymph bvessel sare location anywhere that blodo suppl exits except the brain and SC inital lymph vessles - near cpailalries and are responsble for ocllectin glduif rom the intersitisum that is not picked up bu teeh venous sytem also transport amjority of proteins bc too large to be transported by the venous sytem 10-20% of the intertitial fluid while venous does 80-90 then to lymph collectors and luymph trunks main trunks are the right lympatic duct RUE and right side of the head and then the htoeaic tdcut which is the rest of th ebody vessels empty lymph directlyin to the veous ssystem viaa the subclavian veins under contrl of ANS produces cosmooth muscle contractions and muscle pump one way vales lymph nodes are aspecializ tstutes that are commonly found in the neck acilar chest abdomen and groin collect lumphh and FILTER WASTE prouct and foreetin amterail like vavteria and viruses and provide immuse sytem defence with thte use fpf T and B cells thymus bone marrow spleen tonsils an dpeyer patches in the msall intesetsn are invlevin prodiction og lmphcutes which are importan in the functionling of the inmmune system

test to identify the integrity of the C1-2 articulation

transverse ligament stress test (this ligament maintains the position of the dens of C2 with the anterior arch of C1) if you suspect instability, both the vertebral artery and max cervical compression test would be contraindicated

superficial wound

trauma to the skin with the peidermis remaining intact such as with a nonblistering subnurn a superficial wound will typically heal as part of the inflamamtory process

hemodyalysiis

treatment proces for pt with adaned an permanent kdiney failure creates excess toxic easte, increase BP retention of excess body lfuds and a adecreasein RBC production hemodalysis removes tehbood from the bdoy along with waste eess odue and fluids cleans the blood and retunr it to the body reuire sthi sprcess vo=n agerage 3x per week and each visit reuqires 3 to 5 hours to ocmepte tx side effects include anemia, renel osteodytrphy (not enough calcium and phosphae in blood creates bone diseae), prurits sleep idsorder "restless legs" and diayls reltaed amyloidosis(build u pof orpetins in the organs)

hypothalamus dysfunction

tumor (ependymomas - They form at first in your ependymal cells in the middle of your spinal cord and in the fluid-filled spaces in your brain known as ventricles aka brain tumor) inflammatory process (sacoidosis) surgical transection trauma aka skull fx

adrenal glands

two adrenal glands are located on top of each kidney the outer potion is calleed the adrenal ocrte and the inner potion is called th adrenal medulla adrenal cortex and the adrenal medullar secret diff hormones coretex produces corticosteroids that will regualrl water adn socium balance, the bodies respones to stress, the immune system and sexual developmental and function and metabloism medulla produces epinephrine taht increases HR and BP whent here is an increase in stress

elderly, frail with history of falls and mild balance instabiliy what AD should you recommend 4WW standard fixed frame two wheeled rolling walker hemi walker

two wheeled walker will provide added stability by increasing the base of support and maintaining two standard legs on the rear for increased control rolling walkers allow the user to maintain gait as a continuous movement sequence 4WW will increase the BOS but will decrease user control of the walker speed and direction

helicovater pyloir

type of bacteerium that causes infection int eh tsotmach often the cative agent in peptic ulcers

cacmer

unctonrlled clel prlieration with mitation adn spraind og abonram cells basedon tyep and claotion most comon cause in clude cig mosing diet and ntrion chemcail agesnts phycal agents envinromental caus viela nd gnentics

complimentay and alternative meds (CAM)

underreprot of CAM use is imprtnat to adders topci when taking pts history

gallstone pain

upper backunder the top of the right scapula (the pt above was at risk for this bc she is obese, female and diabetic but does not present with any typical sx) gallstones also do not alter bowel function

facets arthrokinematics extension

upper facets move downward, slightly posterior and tilt backward

nocturai

urinary freqency at night (i.e. diabetes melliwtus, cognestive HF)

disrganized schizophreni

usaly proessive an irreverisble with inpparia emoton respones mumbled talking

ulcer with dry eschar without edema, erythema, fluctuance or drainage, afebrile what do you do for pt about to start gait trianing

use an AFO with heel pressure relief, this will prevent PF contracture, give pressure relief and prevent further damage as well as promote healing based on description the ulcer is STABLE and needs to be MONITORED, NOT debrided

arterial blood pressure procedure

use appropriate cuff size the bladder inside the cuff should encircle 80% of the arm in adults and 100% of the arm in children younger than 13 if the bladder is too small = false high BP if in doubt, use a LARGER cuff brachial artery is occluded by a sphygmomanometer cuff wrapped snuggly around the upper arm and inflated to above the anticipated systolic pressure as the cuff is slowly deflated (no more than 2-3 per second) pulsatile blood flow in re-established and accompanied by soudsn taht can be detected by a stehoscope held over the artery the sounds known as korotkoff sounds, origiinate form a combo of turbulent blood flow and oscillations of the arterial wall as the pressure is reduced, the sounds change in quality and intensity phase 1 - first appearance of clear tapping sounds corresponding to the appearance of a palpable pulse SYSTOLIC phase 2 - sounds become softer and longer phase 3 - sounds become crisper and louder phase 4 - sounds be come muffled and softer phase 5 - sounds disappear completely DIASTOLIC

antacid agents

used to chemically neutralize gastric acid and increase the intragastric pH primary antacids are classified as aluminum contaiin, calcium carbonate containing, magnesium containing or soidum bicarbonate containing idnicated for episodic minor gastric indigestion or heartburn pepetic ulcer GERD acid rebound phenomen (Houston had what researchers call "acid rebound." Stomach cells that make acid multiply over several weeks of exposure to a PPI in an effort to overcome the drug's effect. When the PPI is stopped, they pour out more acid than ever. Treatment Can Make It Worse. Acid rebound is a well-known phenomenon.) constipation or diarrhea may afect metabolism of other meds electorylyte imabalcen agents are well toelrated typically no side effects that inferre with PT pt are mot lile ot parricpate in therapy with effective maagement of GI issues using these agents aluminim (basaljel (aluminum crabonate gel) caalcium carbonate containing (tums (carium carbone) milk of mag (magnesmium hydroxide) bromo setlxer (sdoium bicarboneate)

red-yellow-black system

uses a wounds surface color to direct treatment red - pink granulation tissue goals = protect wound, maintain MOIST environment yellow - moist, yellow slough goals = remove exudate and debris; ABSORB drainage black - black, thick eschar firmly adhered goals = debride nectoric tissue if unstable

autogenic drainage AD

uses controlled breathing to mobilize secretions by varying expiratory airflow without using postural drainage postiions or coughing theory is to improve airflow in small airway to facilitate the movement of mucus AD requires patience to learn so this may not be suitable for young children and patients who are not motivated or easily distracted because AD does not require the assistance of another person or equipment it can be performed anywhere and during ADLs

geriatric depression scale

valid meaure HIGH scores indicate depression >8/30

airway adjunts

variety of devices are used to maintain or protect the airway, to provide mechanical ventilation or to promote airway clearance oral pharyngeal airway - plastic tube shaped to fit the curvature of the soft palate and tongue that holds the tongue away from the abck of the throat and maintains the patency of the airway nasalpharyngeal airway - a latex or rubber tube inserted through the nose to allow for nasotracheal suctioning endotracheal tube - a plastic tube inserted in the trachea from the mouth or the nose to provide an airway and to allow for mechanical ventilation tracheostomy tube - an artificial airway inserted into the trachea from an incision in the neck below the vocal cords used in patients needing prolonged mechanical ventilation

dermis

vascular layer of skin located below the peidermis containing hari follicles, sebascous galnds, sweat glands, lymphatic and blood vessesls and nerve endings

extra-articular complications of RA

vasculitis

gold standard for DVT

venography

T wave

ventricular repolarization

UTI

very common and occur withi the gen ppulation high inciden in woen and the geriatic population uncoicnat complciatj recurrent or chonri c occur when bacteria infilatrae the urethta (urethrisi) or further into the bladder itself (cystitis) utneated this tpe ofinfection can spear and cause a kidneu infection (pyelonephrisi) diagnsis is confied with urinatlysis frewurn UTIs may reuqir eUS, IV pyelogram, and cystoscopt to futher assess teh fucntion og the balderr increase freq of voiding pain and or burngiin cloudy ruine pressure above the pubi bone in women shakiness fever back pain and faitue early tx has the best results delay in tx may allow for esrious infeciton to occur phrama antibiotics dirnk an ecess of fuids to assit with tx

acute pancreatisis unique s/s

very ill often not ambulatory severe and usually in the epigastric area radiating to the mid back N/V can occur from heavy alcohol use

S3 heart sound

vibration of the distended ventricle walls due to passive flow of blood from the atria during the rapid filling phase of diastole normal in healthy young children termed "physiologic" 3rd heart sounds abnormal in adults may be associated with heart failure, often called the "ventricular gallop" SYSTOLIC HF occurs in early diastole

CF and infection how much airway clearance

vigorously every 2 hours

hep C HCV

virus that affects the liver and its function primar etilogy for cornic liver disea nd evnetual liver failure tramision is same as hep B virus accounts for 90% of post transfusion hep cases like hep B it is often asymptomatic and the acute infection cab be mild pt with hep C hae in crease freqp of manifesting ocndtion such as HASIMOTOS thyroiidist , dDM and corneal ulceration tx include interferon alfa2b to reduce inflamm and live rdamamge but only a small percentage of pt with hep C beenfirt form med there isno vaccine to prevent his vius and no immungloblin fully effetive in treating the infection chronic hepatiis occurs in 50% of cases and 20% progress to cirrhosis of the liver

snellen eye chart

visual acuity 20 ft

cant recogonize kids what is it

visual agnosia (only knows it is his wife because of her voice)

how to test for a pure hemianopsia

visual confrontation test with a moving finger (slowly bring the finger into view and pt states when they begin to see it)

colonoscopy

visual inpection of the interior of thec olor with a fledx lgith intstuent insrerte dthough th recutm

msk and aging

voeral decrase in p ap atohy and abilit to reverat i.e. sarcopenia (loss of msucle, fialty) bth of which resutls in lsos fo strenght numerof mot r uti decraso tha eah moto neur omsut innefat a lage umer of mscue fibers reustin gin moto ruit hypetopy inceas ein fat mass ors aean ndomas idecraes inflaitaion of fat is preccot or monilai restriction begin to epx edecraeein bone mass in theri r40s and 50s a chagne that cocours due to an icnraes eein boen resportion with anequivalet inceawe in bone dpeoseition hgiher iskf or fx esp with sacroenai changes in jotns an ocnncetive itsue aricualr atialtes losles mcuh of its waer contanta nebeins to degenate leading to arthtis esp i weigh tbarin iteventatbe sidks also be lsoe the eater ocnta and decera ehigh cneiv susafsid algiten do soesnteniasbli voer reaei in ROM an feleibz chagnes can ontirebute ot hte ldevep of failty synrom who has3 out 5: ntent swght loss waekns slow aelkig speed exhausiton low PA mana fo the cagne in can be mtigageted with eecsie

urnary frewuency

voiding more than 8 times in a 24 hours period overactiv balder reuce dblader vapcity pain fullfal dsurnoe increaase uri output cause by uncontorlled DM

moderate METs (3-6)

walking at 3pmh - 3 to 4 walking 4mph - 4.5 to 7 washing windows or cars - 3 sweeping/vacuuming - 3 to 3.5 light gardening - 3 to 4 carrying, stacking wood - 5.5 power lawn mowing - 5.5 slow dancing - 3 table tennis - 4 fast dancing - 4.5 basketball shooting around - 4.5 sexual intercourse - 4 to 5 golf (walking) - 4 to 7 swimming - 4 to 8 tennis doubles - 5 bicycling (flat) at 10 to 12 mph - 6

vigorous METs (>6)

walking at 4.5 mph - 6.3 jogging at 5 mph - 8 running at 7mph - 11.5 shoveling - 7 carrying heavy loads - 7.5 heavy farm work - 8 digging ditches - 9.5 backpacking - 5 to 11 basketball game - 8 bicycling (flat) 12-14 mph - 8 bicycling (flat) 14-16 mph - 10

light METs (<3)

walking slowly at home or office - 2 toileting - 1 to 2 driving a car - 1 to 2 working at a computer or desk - 1.5 making bed, washing dishes - 2 bathing - 2 to 3 cooking - 2 to 3 playing cards, arts, and crafts - 1.5 playing muscical instrument - 2 to 2.5 fishing (sitting) - 2.5

procedure for assessing respiration

watch breathing at rest for 60 seconds (an alternate method is to place your hand over the patients upper thorax or abdomen and observe and feel movement with each respiration) document the 4 parameters

lurching is a compensation for

weak hip extensors commonly called a glut max gait leaning backwards during loading response inclines the ground reaction force vector posteriorly from its point of application at the hindfoot because the vector passes closer to the hips joint lateral axis, its moment arm is shorter and it produces a smaller hip flexor moment and when it falls behind the axis it can produce a hip extensor moment

decreased hip flexion followed by increased knee flexion on the weak side would be bc...

weak hip flexors and knee extensors

when can you sub RPE for HR

when ability to monitor HR is compromised (sensory deficit) patient begin an exercise-based rehab program without a preliminary exercise test the HR response to exercise is altered (i.e. cardiac transplant) physical activity other than cardiorespiratory endurance activity are assessed clinical status or medical therapy changes ratings can be influence by physchological state, environmental conditions, mode of exercise, and age

chest tube considerations

when ambulating, collection bottles should be kept below the level of the inserted tube location monitor the patient for changes in breath sounds before and after intervention avoid pressing directly on the chest tube during mobility activities

what do preventricular contractions look like

wide and bizzare complex, lack of P or T wave and can be upsidedown new onset indicates an abnormal response to increasing demands and high risk

pt is alzheimers what behavior should the therapist consider when forming the POC

will likely be resistant to activity training if unfamiliar activities are used (activity training is most likely done with familiar activities) they cannot be trusted to safely perform IADLs or functional mobility skills will have memory of past events retained initiaully but eventually all memory will be lost

which way does the trachea deviate when a lung collapses (or a volume loss phenomenon)

will pull the trachea towards the SAME side as the lung collapse or volume loss

when should PT begin following flexor tendon repair

within a few days after surgeyr to preserve tendon gliding early passive and active assistive exercise promote collagen remodeling to allow free tendon gliding

infection and wound healing

wound infection negatively imapcts the resortaive processes necessary for wound healing immune reponses become overwhelmed as infectious bacterial compete with the bodys own cells for available nutrients infections bacteria can also release toxins into the wound causing further tissue damage and increase the rate of cellular necrosis

wound classification by depth

wounds that are not categorized as pressure or neuopathic ulcers (i.e. skin tears, surgical wounds, venous stasis ulcers) are classififed based on the depth of tissue loss

purulent

yellow or green color and a thick, viscous consistency generally an indicator of wound infection and is always abnormal

carotenemia

yellowing of the skin that results from excess beta-carotene/vitamin A in the body different from the liver bc mainly in the palms, soles, and face (does not affect the sclerae)

can you use a lift for trendelenburg gait

yes but not the intervention of choose

pacemaker and interferential current is it contraindicated or not

yes contraindicated all e stim is contraindicated with a pacemaker consult with the referring physician

pt in outpatient cardiac rehab 10 weeks after CABG, post op course complicated by Afib which is now controlled by meds prescribed by a cardiologist...resting vitals are HR = 90 in afib, BP = 116/74, RR = 14 and spo2 is 99% on RA is a symptom linked exercise test appropriate for this patient at this time?

yes the HR is well controlled and the cardiologist is aware of the arrhythmia it is okay to be in afib and do exercise as long as this is the case (HR is between 60 and 100) "it is safe to exercise a pt who is in AF" it is a concern if the patients HR is >115-120 this is the point at which diastolic filling time is decreased which places a person in AF at risk of not maintaining their CO with increased demand

high frequency airway oscillation

• *Acapella and Flutter* are handheld devices that combine *positive expiratory pressure and high frequency airway vibrations to mobilize mucus secretions in airways* place the device in mouth with lips firmly sealed around the mouthpiece • W/ device in mouth, inhale slowly to 75% full breath; hold breath 2-3 seconds; exhale through device 3-4 seconds, repeat 10-20 breaths • Remove device and perform 2-3 coughs or huffs to raise secretions • *Precautions/Contraindications:* - Patient tolerance of increased work of breathing (acute COPD or asthma) - Intracranial pressure >20mmHg - Hemodynamic instability - Recent facial, oral, skull surgery/trauma - Acute sinusitis/nosebleed - Known or suspected tympanic membrane rupture or other middle ear pathology -Untreated pneumothorax -active hemoptysis -nausea -esophageal surgery

inspiratory muscle training (IMT)

• Attempts to strengthen diaphragm and intercostal muscles • 2 main devices: Flow resistive breathing and threshold breathing -Flow resistive: pt inspires through mouthpiece and adapter w/ adjustable diameter. Decreased diameter increases resistance to breathing, provided that breathing rate, tidal volume, and inspiratory time are kept constant -Threshold loading: Requires buildup of negative pressure before flow occurs through a valve that opens at a critical pressure. Provides consistent and specific pressure for IMT, regardless of how quickly/slowly patients breath • Used for impaired inspiratory muscle strength and/or ventilatory limitation to exercise performance • Precautions/Contraindications: - Clinical signs of inspiratory muscle fatigue (in characteristic order of appearance) tachypnea, reduced tidal volume, increased PaCO2, bradypnea and decreased minute ventilation • Measure pt's max inspiratory pressure (MIP) w/ manometer. use measured MIP to calculate training load

directed cough and huffing

• Directed cough tries to compensate for patient's physical limitations to elicit a max forced exhalation • Huffing is forced expiratory maneuver performed w/ glottis open (similar to fogging a pair of glasses with your breath) although a huff does NOT produce the same airflow as a cough, the potential for airway collapse is LESS (can be reinforced with quick adduction of the arms to self compress the chest wall) • Cough: inhale maximally, close glottic and hold breath for 2-3 seconds; contract expiratory muscles to produce increased intrathoracic pressure against glottis; cough sharply 2-3 times through slightly open mouth • Post-surgical pt may need to splint chest or abdomen by applying pressure over incision w/ a pillow or blanket roll • Huff: inhale deeply though open mouth; contract abs during a rapid exhalation w/ glottis open saying "ha, ha, ha" • Precautions/Contraindications: - Inability to control possible transmission of infection by droplets • Elevated intracranial pressure or known intracranial aneurysm • Reduced coronary artery perfusion ( e.g. acute myocardial infarction) • Acute, unstable head/neck/spine injury •Untreated pneumothorax • Osteoporosis • Flail chest (Flail chest is a life-threatening medical condition that occurs when a segment of the rib cage breaks due to trauma and becomes detached from the rest of the chest wall) • Acute abdominal pathology, abdominal aortic aneurysm, hiatal hernia, pregnancy

what do you NOT want to recommend for a pt with diabetes and risk for ulcers

"use daily hot soaks and moisturzie the skin" do not say this hot soaks are contraindicated bc of increased risk of thermal injury, pt with diabetes typically has loss of protective sensations moisturization is actually encouraged but not in combo with daily hot soaks

indications for airway clearance

*retained secretions in the central airways *prophylaxis against postoperative pulmonary complications *obtain sputum for diagnostic analysis *difficulty clearing secretions *atelectasis caused by or suspected of being caused by mucus plugging

lymphocytes values

0.20 - 0.50 20-50% SI

inflammatory phase

1 to 10 days inflammation is the immune systems initial response to a wound temporary repair mechanismsrapidly reestablish hemostasis through platelet activation and the clotting cascade, debris and necrotic tissue are removed and bacteria are killed by mast cells, neutrophils, and leukocytes processes occuring in this stage establish a CLEAN WOUND BED which signals tissue restoration and permanent repair processes to begin re-epithelialization typically begins within 24 hours at the wound borders, though visible signs are not usually observed earlier than 3 days after injury

Normal change in diastolic BP during exercise

10 above or below

duration or aerobic

20-60 min of continuous or I/M minimum of 10 min bouts accumulated through out the day lower intensity activity should be performed over a longer period of time i.e. >/=30 min higher intensity should be performed for >/=20 min moderate intensity of longer duration is recommended for adults not training for athletic compeittion due to the potential hazards and adherence problems associated with high intensity actiivty

proliferative phase

3 to 21 days formation of new tissue signals the beginning of the proliferation phase capillary buds and granulation tissue begin to fill the wound bed creating a support structure for the migration of epithelial cells keratinocytes, endothelial cells, and fibroblasts are active and the collagen matrix is formed SKIN INTEGRITY is RESTORED in the proliferation phase with wound CLOSURE occuring through epithelialization and wound contraction

Ratio of torque generation between quad and hs

65% at 60 deg/sec 69% at 180 (80/120) 71% at 300 Not used to describe function Just relative torque

bakc pain during prenancy

70% of pregnancy women minoto to sinfiacnt strucutal defmoreiietes often cause by hsyai cahgnes associte diwh tprenan icndluing weigh gain altered msucle tone increases lordosis chafe in COG and laxt tupcialyl excessive beidng lfitand wlaking can produce back pain espeina if hsit rou prorpo back pain or obesity minro can be reliev ethorugh education realteodn to body mechanis postal awaraesa nd stertching and stegngin gexercise to rvid balcne within muscular severe pain should not be dismissed as simpyl a side effect of pregannay etiology of severe back pain may incldue prenancy incduec soteporors disc disae aor heitnate disk verettbal osteoarthirsi and septic arthis pt with both minor and sefvere should be exmained to detien if the sourc e fhte paina is mechancia msucaulr joitn or discogenic

How many beats per min for PD listening device during gait

80-100 beats per min

triglycerides values

<150 desirable 150-199 borderline 200-499 high >500 very high

total cholesterol values

<200 mg/dL desirable 200-239 mg/dL borderline >240 mg/dL high

3MHz penetrates how deep

<2cm

mild lymphedema

<3 cm difference ebtween the affected and unaffected limbs

HDL cholesterol values

<40 low >60 high

sinus tachy

>100bpm

obese

>30

severe lyphedema

>5 cm difference may also use volumetric gonio mmt pain sensory skin bioelectrical impedance and gait balance Bioelectrical impedance analysis (BIA) is a commonly used method for estimating body composition, in particular body fat and muscle mass

atherectomy

surgical procedure similar to angioplasty except that the catheter has a rotating shaver to cut away plaque from the artery and increase blood flow

best intervention for stress incontinence

"kegel exercises several times a day" not a voiding schedule (does not address impairment) not biofeedback 1 hr per week (insuff frequency) not FES 3x per week (insuff frequency)

normal vesicular sounds

high pitched, breezy sounds normally heard over the distal airways in healthy lung tissue inspiratory phase is LONGER than expiratory and there is NO pause between them

wagner ulcer grade classification scale

0 no open lesion but may possess pre ulcerative lesions; healed ulcers; presence of bony deformity 1 superficial ulcer not involving subcutaneous tissue 2 deep ulcer with penetration through the subcutaneous tissues; potentially exposing bone, tendon, ligament or joint capsule 3 deep ulcer with osteitis, abscess or osteomyelitis 4 gangrene of digit 5 gangrene of foot requiring disarticulation categorizes dysvascular ulcers absed on wound depth and the rpesence of infection most commonly associated with the assessment of diabetic foot ulcers, the scale can be appropriately used to categorize most ulcers arising from neuropathic, ischemic or arterial etiology

analysis of covariance (ANCOVA)

2 or more but controls for the effects of an intervening variable

discriminative sensation what is it and what is the pathway

2 point discrim stereognosis (sense by touch) barognosis (weight) dorsal column-medial lemniscal (same as light touch which is dorsal column-lemniscal)

fat soluble viatmisn

A D E K afe rbegin abofe rby theh inrect rac the viatmins are stokere in the liver and faty tiseu rquire protein cariers to move thorugh bdy fliuid and execs are stoeor in ed theo bdoy since they are not watersolubel it is pssibl ethat the viamn may reach oxc levell s

detect pulmonary embolism

A computed tomography angiogram is used to look for a pulmonary embolism or a blood clot that may cause a pulmonary embolism.

fluoroscopy

A continuous X-ray procedure that shows the heart and lungs, because fluoroscopy involves a relatively high dose of radiation it has been largely replaced by echocardiography and other diangostic tests it is still a component of cardiac catheterization and electrophysiological testing

Brown-Sequard Syndrome

Hemi-section of the cord - ipsilateral (same side) spastic paralysis and loss of light touch and proprioception pressure and vib - contralateral (opposite side) loss of pain and thermal sense at the level of the lesion there is bilateral loss of pain and temp

Pale, washed out color means

Anemia Internal hemorrhaging Lack of sunlight exposure

Which substance facilitates endothelial vasodilation? insulin epinephrine caffeine nitric oxide

Correct Answer: nitric oxide Nitric oxide is a potent endothelial vasodilator. Nitric oxide promotes smooth muscle relaxation, however, atherosclerosis may interfere with the availability of nitric oxide and therefore result in a decreased vasodilation of the coronary arteries.

carinoma

malignancy orignatin gfrom the peithelail cells of organs carcinomas in spefici organ may be names more specifically depdndn on the cahrcteristic present large cell carcinoma, adenocarcinoma, and squamos cardina are all subset of lung carcinoma 80% of all cacners in the US are carcinomas!!!

guidelines for exercise intensity

HR usually not applicable as pts with chronic lung disease stop exercise at low heart rates due to ventilatory limits not CV limits >/= 50% of peak oxygen consumption determined from an exercise test using a dyspnea rating reported at a submax exercise level during an exercise test 60-80% of the peak work rate achieved determined from an exercise test RPE of 4 to 6 on a 0-10 scale or 12 to 16 on the 6-20 scale maintaining O2 sats GREATER than 90% meausred by pulse ox MINIMUM of 30 min of accumulated exercise per session is recommended interval training (exercise bouts of 30 seconds to 3 minutes followed by equal rest periods) may be appropriate for patients who cannot exercise continuously as fitness improves and the patient gains confidence, increase the duration of the exercise periods 3-5 days per week

adrenal insufficiency

Hyponatremia + Hyperkalemia + Hypoglycemia may have acidosis (decrease in cortisol results in an inability to regulate poassium and sodium)

Yellow color means

Jaundice Liver disease

panafil

Keratolytic enzyme used for selective debridement

ectomorphic

Lean and long with difficulty building muscle

Left Torticollis means what

Left SCM is contracted

What to consider with autoimmune disorders

Long term corticosteroid use (regular exercise should not be aggressive aka 60-80% 1RM weight training) can put at risk for osteoporosis Can do light aerobic or splints but usually not the initial priority Splints are more for arthralgia

conditionassociated with contipation

MS spincal cord tumors IBS duchenne msucualr dsytophy endoricne disorder diverticuluts inactivity bowel obstruction or facel imapction pregnancy CVA certain meds

Repair of FINGER mcp extensor tendons what can you do in 24-48 hours, they are in a dynamic splint

Passive of WRIST and finger mcp extensors (10 reps per hour) Active of finger mcp flexor tendons to 30-40 degrees via flexion block on the splint (progress as tolerated) with passive elastic recoil if the dynamic splint (10-20 reps per hour) DO NOT MAKE A FULL FIST Wrist is splinted in 40-45 degrees extension MCP in 0-20 degrees flexion IP in 0 degrees extension Avoid active extension until 4 weeks post op Need to do active flexion to prevent contracture if the extended tendons

apical segment drainage

PT behind pt is sitting leaning back 30-40 degrees percussion and vib performed above the clavicles

posterior segment of right upper lobe drainage

PT in front pt is turned 1/4 from prone on the left side with the bed horizontal and the head and shoulders raised on a pillow percussion and vib are perfomed around the medial border of the right scapula

Six P's or compartment syndrome

Pain Palpable tenderness Parenthesis Paresis Pallor Pulselessness

Child with developmental delay no shows and is late to appointments due to their parents, parents are not compliant with HEP, child is regressing and when the PT discussed this with the parents they got angry and stopped bringing the child for treatment, what is the best action?

Report the family for neglect of the child because they are withholding necessary medical care because the child is regressing and it seems that it is based on the parents behavior I put discharge the child and although that needs to be done it doesn't help the child

Rapid onset of dyspnea, sudden chest pain, and cyanosis what do you do

Stabilize the patient and contact medical services right away S/s of pulmonary embolism Emergency medical situation and cause of death in a substantial number of patients

Salter-Harris Fracture

Supracondylar humeral epiphyseal fracture Most common pediatric elbow fracture FOOSH with extended elbow Type 1 - non displaced fracture across the growth plate Type 2 - angulated and displaced across the growth plate and continuing up through the shaft of the bone Type 3 - may be displaced in three directions (posteromedial which is most common, posterolateral, or anterolateral), starts through growth plate but turns and exits through the end of the bone and into the adjacent joint Type 4 - fracture though all three elements of the bone: the growth plate, metaphysis and epiphysis, start above the growth plate, cross the growth plate and exit through the joint cartilage, these injuries can affect the joint cartilage and may impair normal growth, complete retardation or partial growth arrest may result in progressive limb length discrepancies, complete growth arrest is uncommon and depends on when the injury to the physis occurs in relation to the remaining skeletal growth potential, the younger the patient the greater is the potential for problems associated with growth, premature partial growth arrest is far more common and can appear as peripheral or central closures

Protrusion

Temporalis Medial pterygoid Lateral pterygoid

Retrusion

Temporalis Suprahyoid muscle

therapuetic modaliteis and wound healing applications

US applied at a low intensity with pulse dduty cycle has been shown to enhance all phases of wound healing during the inflammatory and prolif phases, fibroblast, endothelial and WBC activity are stimulated by US US use during these early stages f repair has been shown to enhance the strength and elasticity of scar tissue recommended treatment rotcols vary depending on the pahse ofhealing and intended outcome (restarting the inflamm phase in a chronic ulcer vs dispersing ecchymosis associated with skin tears or contusions to reduce pan and edema) high voltage pulsed current electrical stimulation has been shown to enhance healingin numerous types of wounds including chronic ulcers, burns, and donor and graft sites the application of monophasic direct dcurrent stimulates angiogenesis and epithelial migration, decreases bacterial activity and wound pain, and increases oxygen perfusion and tensile strenth HVPC is typically applied using a sensory or sub sensory intensity, tx protocols vary

ST segment depression

a depressed ST segment is a sign of subendocardial ISCHEMIA but also can be due to digitalis toxicity or hypokalemia the segment is evaluated relative to isoelectric baseline at 0.08 seconds after the J point (junction between the end of the QRS complex and the beginning or the ST segment) deviations from the isoelectric baseline are expressed as ST segment depression of 1 mm, 2 mm etc.

sample of convenience

a sample of cases from the underlying population in which the mechanism for selecting cases is not random cohort design (investigates a group of subjects without a control group)

tumr (neoplasm)

abmroam new gorhw of tissue that increase ithe overall tissue mass beign (non cancer) nalgia 9cancerous) aswell as prmr o seconay raur tymors form from cells tha belong to eh area of the tumor seocnary tumor frow form cells taht are metasitze or srepa from aoterh affected area within the dy

aneurysm BRONZE

abnormal balloon-like bulge in the wall of a blood vessel occurs when the wall of the blood vessel becomes weakneded and can no longer toelrate the pressure of the blood thus leading to bulging of the wall factors taht lead to damage or weakening of the blood vessel walls include smoking, HBP, atherosclerosis, infections, gnetic conditions such as marfan syndrome (genetic disorder of connective tissue), trauma and advanced age injury to the wall of a blood vssel tupically an ARTERY most aneyryms occur in the aorta, and are labeled thoracic aortic aneurym (TAA) or abdominal aoritic aneurym (AAA) based on the portion affected also occur in the brain specifically at the CIRCLE OF WILLIS or in any peripheral artery AAA sx = low back, abdominal or groin pain, N/V, lightheadedness, and a rapid heart rate the internal bleeding from a rupture AAA will typically lead to hypovolemic shock and is fatal in the large marjotiy of cases sx of a TAA = jaw neck back or chest pain, coughing or hoarseness, and SOB (presses on trachea?) brain aneurym may cause fatigue, loss of balance and speech/vision problems rupture brain aneurym will result in a SUBARACHNOID hemorrhage sx may include severe headache, loss of vision or double visiion, loss of consciousness, vomiting, change in mental status, and seizure THIS IS A MEDIAL EMERGENCY imaging may detect an aneurym and include... ultrasound computed tomography magnetic resonance imaging echocardiography angiography large AAA may have throbbing mass in the abdominal area if a rupture brain aneurysm is suspected, a lumbar puncture may be perforemd to detect blood within the cerebrospinal fluir

pneumothorax BRONZE

accummulation of air in the pleural cavity that results in a collapsed lung primary - occurs without a known etiology secondary - trauma, airway disease (CF, emphysema), lung infection (pneumonia, tuberculosis), lung diseaes (sarcoidosis pulmonary fib), connective tissue disease (RA, systemic sclerosis) and cancer increase in pressure in the plerual space causes collapse of the lung which results in impiared gas exhcange and decreased oxygenation of the blood if the pneumothorax is large is can cause a shirt in postion of the mediastinuum asymptomatic to life threatening sx include chest pain, SOB, hypoxemia, cyanosis, and hypotension tension penumothorax occurs when damaged tissue causes a one way valve into the chest and result in large increases in pressure, medical emergency that leads to sig impairment of respiration and circulation and requires immediate medical attension hypotension (This results in compression of the vena cava and decreased venous return or cardiac preload. The late stage of tension pneumothorax includes such signs as jugular venous distension, tracheal deviation, cyanosis, apnea, and hyperresonance on percussion.) chest xray is the FIRST imaging study performed to confirm the dx CT and US imaging can also be useful rule out PE ARDS AUSCULTATION REVEALS DECREASED BREATH SOUNDS AND DECREASED FREMITUS

cross friction massage should not be used during what stage of injury

acute

ankle brachial index ABI

aka the ankle-arm index compares systolic blood pressure at the ankle and arm to check for peripheral artery disease procedure - sustolic blood pressures are measured in both brachial arteries and both tibialis posterior arteries with a sphygomanometer and a handheld doppler US device ABI is calcualted by diving the higher of the two systolic blood pressure measurements in the ankles by the higher of the two systolic blood pressure measurements at the arms >1.3 indicates rigid arteries and the need for an US test to check for PAD (Values above 1.4 suggest a noncompressible calcified vessel. In diabetic or elderly patients, the limb vessels may be fibrotic or calcified. In this case, the vessel may be resistant to collapse by the blood pressure cuff, and a signal may be heard at high cuff pressures. The persistence of a signal at a high pressure in these individuals results in an artifactually elevated blood pressure value.) REALLY BAD 1.0 - 1.3 normal; no blockage 0.8 - 0.99 mild blockage, beginnings of PAD 0.4 - 0.79 moderate blockage; may be associated with I/M claudication during exercise <0.4 severe blockage suggesting severe PAD, may have claudication at rest REALLY BAD

atrial flutter

an ectopic, very rapid atrial tachycardia atrial rate of 250-350 bpm, ventricular rate dependent on AV node conduction saw tooth shaped P waves (also known as flutter waves) are characteristic occurs with valvular disease (especially mitral), ischemic heart disease, cardiomyopathy, hypertension, acute myocardial infarction, chronic obstructive lung disease, and pulmonary emboli) s/s include palpitations, lightheadedness, and angina due to a rapid rate stagnation of blood may predispose to thrombi in the atria

procedure of pulse oximetry

apply to earlobe or fingertip assess the strength of the waveform or pulse amplitude to assure that the oximeter is detecting adequate arterial blood flow holding the finger dependent and motionless and covering the finger sensor to occlude ambient light improve the quality of readings

desenstitzation techniques

as with osme patients status post ampuataiton, pts who hav sesutataed severe burns arse susceoible to deveoping hypernetnsi that can bfeocneof fuctnla liiting incoirotaiing densitiazation technques tinto the plan of care and apatietns self care toutine can sig improve a pts toelrance to variable tempraeture touch pressure and bibration stheraby decreaseing discofinft and inprive funcitnl abilityies include variabel texture, pressure and vib sensation aplied to the affecte area by either rubbing tapping or rolling motions the use of particle contact i.e. container of dry beans, poperocrn kernels or fluidotherapy can be benefitial in desensitizing distal extremtieis compression and TENs ahave also been show to have lclincal applciations for desnsjn golas it is recommended that desnet inteventions be oerfnrend for 5-10 minutes 3-4x DAILY each session sholud begin gwith a sesastion that is lsightl itritating but tlerable and profress to more noxisou stimula a textural progression may include feather to cotton ball to chamois cloth (sheepskin) to soft terry cloth, corduroy cloth, rough tterry cloth to wool

mortons test

assess for the presence of a stress fracture or a neuroma in the forefoot squeeze foot together from sides can also compress from top to bottom

ulnar

at the wrist, between the flexor digitorum superficialis and the flexor carpi ulnaris tendons

liver

bil is produce and is necesary tofor absrption of lipid soluble substances , assist with RCB and vitamin K production regularties serum level of carbs, proteins and fats

confirmation of a diangosis of spondylolisthesis can be made through seeing waht

bilateral pars interactircularis defects spondylolysis (break in the vertebra typically in the pars articularis) but if BILATERAL then there can be slippage

alkylating agetns

bind to th dna stand a to rpevent repliviton if dna canno unttwis then it cannot divie and repita its feticn code intiate cell dath by stir dna and relaseriea enzyen that detrosy the cell indaito forr variou s malignancies side effet by class mutl syste involve with midl to sever side efecte potenti risk are ytpicaly aearend seconty othe dx of malgnanacy mody tx basde don pt sx exterm aiue gi dis tecancer pani blodo sisord are comon provid esuport and enocuage me wtihotu psuig pt beyn dabailites mustargen (mechlurethamine, busulfex (usuflfan leukeran chloramnucil

anticholinergics

bloack the affects of acetylcholine on partietal cells in the stomach and decrease the relsaer of gastric acid indicated for gastic ulcers ss dry outh confusion consitpatio nurnarty retention PT shold be aware of side efect and response to changes in cognitnion or complaints of dry mouht constiaptio oor uranry retention gastrozepin (pirenzepine), muscarinic cholinergic antagonist

angiotensin II receptor antagonist agents

block angiotensin II receptors which limit vasoconstriction and stimulation of vascular tissue used for hypetension, congestive heart failure side effects include dizziness, back and leg pain, angina pectoris minimal implications for PT i.e. cozaar (losartan), atacand (candesartan), diovan (valsartan)

antipsychotic agents (neuroleptic agents)

block dopeamine and reduc voeravity of dopamein tpcauly ranmsitted in the area such as the limic system bnd to dopeane but witll not allwo for acitaion therea re tradion al new atypcal antipsych o gaent suse dof rshcizo and other psychosi didsorsres lorpromazine) atypical risperdal (risperidone) abiify (aripiprazone) alxiermes deics can use this increase extrapyramidal (motor) side effects trarive dyskinesia ppeusoparkinsoism akathisia efaion contpaition drynoth atypcua can prouce weigh ggain DM hypeligemda assit pts to partica bu ddecrae sx of sychossi and lalowd fo an icnreas adattenojn nspasn dimsin agiagnation an resetness aimrpve sense of realt an doveral monala bfehabior and efefct largest barre is the infleucen of extrayainal effect earl sdetedtion of these eefcstn can allwof ro rpm medican and pharm maagnmen tadion al halhol (haloperidol) thoraxine (ch

indications for xray of ankle

bone tenderness at the posterior edge or tip of the lateral malleolus bone tenderness at the posterior edge or tip of medial malleolus inability to bear weight both immediately and in the emergency department

procedure for ABC

breathing control = gentle, relaxed breathing (may be diaphragmatic breathing at patient's tidal volume and resting respiratory rate for 5 - 10 seconds or as long as the patient needs in order to prepare for the next phase) thoracic expansion exercise = three to four deep, slow, relaxed inhalations to inspiratory reserve with passive exhalation chest percussion, vibration or shaking may be combined with exhalation forced expiratory technique = one or two huffs at mid to low lung volumes with the glottis open into the expiratory reserve volume a brisk adduction of the upper arms may be added to self compress the thorax

which aphasia has good awareness of their deficit

brocas

lung cancer

cancer of the epithelium within the resp tract msot frequent cause of death from all cacners rapid metastasis can occur through the pulmonar vascular system adrenal flansd brain bne and liveer smoking envonment goegraphy occupation hazards age and family hsitroy ss cough sputum dyspnea progression may include sx of adventitous breath sounds chest pain and hemoptysis poor prognosis secondary to expedited metastasis (less than 14% for a five yar survial rate) surgical intervention along with comb therapies

pathology go the uterus

cervical cancer, endometriosis, urerin prolapse

normotrophic scar

charactered by the organized formation of collagen fibers that aling ina parallel fashoin

anterolateral leg pain after an increase in training, sx appear at the later stages of runs and presist for 2-3 hours after completion of a run, no LE paresthesias, tib anterior is tender and taut on palpation, resisted DF is strong but painful, what is this

chronic exertional pain syndrome result of transiently elevated anterior compartment pressure that restricts BF to muscles rearfoot strike running pattern may be associated with chronic exertional compartment syndrome due to increased muscle activity of the tib anterior tx may require a change in footwear, training surface or run retraining in ACUTE compartment syndrome pts frequently present with N/T in the deep fibular nerve distribution which this pt did not

lymphedmea

chronic incurable condition taht is characrreried by the accumuation of protein rich fluid i.e. lymph in the bdoy result is edema that typcally prestnts in theextremties but can occura nywher includ teh face neck kabdoen gentalia and turnk occurs eoncaryt o dangem to lyph which affectrs teh nroaml flow primary lymphedma is due to an abnormal delveop ment of the lymph system birth several years to become symptmatic aka absence of lymph vesllse decreasein number fo zie increased size which makes teh vlaaev incompetent occurs more freq in females in in the LE secondary occyrs as a resutl of some other disae or injru tramau surgyer radiation tumor growth mlti pait chrncon venous insffuen or ienfction breast facter surgery is most comon cause for secondary lymphemea bc axillary lymph node dissection and or radiation theray dynamic insufficney is the most common and occrs when ther ei secesslmyph ciruclatin ith eth elmphaiit cysts teha texceesd the tranport capcoty resutlsin in pitting edmea (chornic ven ous insuff, congestiv HF, pregnancy) mechaincal insufficncy occurs whn the ranpist acacot iis reduced due to dmamge results in mthe more protein rich lymphenema (i.e. non pitting) combined is both primary sign is swelling in the extremtieis bc the lymphatic system can no logner ahndle the volune that i snormally cexcess fluid biuld up in the INTERSTITIUM and leads to enlagement of the affected limb pt complain of achiness fullness adn heans of the affected lmn as it procresses the valves expand and become incomeonte which lead sto uther fluid accumation if the fluid statis cotinues the protein begin to degrade which leads to the devlepment of chornic inflammation and eventual yfibrrotic chagnes to the sounding tissues firbosis results in local hypoxia in the tissue which case further fhroni fnalm an increase risk for infeection

restrictive lung disease GOLD

classification of disorders caused by a pulmonary or extrpulmonary restriction that produces impairment in lung expansion and an abnrmal reduction in pulmonary ventilation can be caused by a tumor, interstitial pulmonary fibrosis, scarring within the lungs, and pneumonia extra pulmonary restrciition include pleural effusion, chest wall stiffness, strucutral abnormality, postural deformity, respiratory muscle weakness and CNS injury etiologies msk - scoliosis, pectus excavatum (fall in chest), fib fx, anklylosing spondylitis, skyphosis pulmonary - idiopathic PF, penumoia, pleural effusion, sarcooidosis (inflammed masses in tissue), hyaline membrane disease (immature lungs), tumor other - inhalation of toxic fumes, drug therapy, asbestos (scarring), rhuematoid arthritis, systemic lupus eryth, msuclular dystrophy, SCI, obestiy and other neuro causes presentation = decrease in lung and chest wall compliance, decrease in lung volumes, and increase in the work of breathing generally RLD is characterized by a reduction of lung volumes (total lung capacity, vital capacity, inspiratory reserve volume, tidal volume, expiratory reserve volume and inspiratory capacity)due to impaired lung expansion a patient with RLD will present with decreased chest mobility, decreased breath sounds, shortness of breath, hypoxemia, a rapid and shallow resp paattern (tachypnea), resp muscle weakness, ineffective cough, and increased use of accessory muscles chest radiograph evaluates lung structure and evidencec of fibrosis, infilatates,tumor, and deformity arterial blood gas analysis may indicate a decraese in pao2 PFTsting blood gas analysis = hypoxemia and hypocapnia functional ambulation profile a patient with RLD may become incapable of deep inspiration due to poor lung expansion as it progresses, resp msucle fatigue will lead to impaired alveolar ventilation and CO2 retention a pt will intially present with exertional dyspnea and progess to duspnea at rest if the resetriction progressses hypoxemia, pulmonary hypertension, cor pulmonatlle, severe decrease in oxygenation and ventialtory failure are complcaitiosn and outcomes of advacned RLD management = phama PT and potential surgery PT maximize gas exchange and obtain max functional capacoty some may get lung transplant but most eventally progress to ventilatory failure idiopathic pulmonary fibrosis is a restrictive lung disease that has a high mortality rate within four to 6 years of dx where many conditions that causes restricitve lung dusease are alleviated through appropriate management looks similar to tuberculosis - an infection and inflammatory systemic diseae that can result in restricit lugnd disea condition is a chonric pulmonary and extrapulmonary diseae that cause fibrosis within the lung it caused by mycobacterium tuberculosis (tubercle bacillus) and transmitted through infected airborne droplets that are inhaled sx = fatigue, weakness, an initial non productive cough and dypsnea with exertion the diseae also can affect other systems within the body inclduing the lymph nodes and organs pharma is the primary means of treating a patient with tuberculosis

increased work of breathing can be rectified in a pt with pnemonia by

clearing the secretions

early subacute management of ankle sprain 2 weeks ago

closed chain exercises and proprioceptive training

talipes equinovarus

club foot PF and inversion

atrial fibrillation

common arrhythmia where the atria are depolarized between 350 and 600 time/min ECG shows characteristically irregular undulations (smooth up and down) of ECG baseline without discrete P waves occurs in health hearts and in patients with coronary artery disease, hypertension, and valvular disease sx may include palpitations, fatigue, dyspnea, lightheadedness, syncope, and chest pain stagnaton of blood may predispose to thrombi in the atria

GI sytem

decra tastse and smell may effec tpts dest ot eat an loss of alveolar bne masa ad other dental isuses ato f amsticaiton more dififut to erofrn decrea salivation lead to ry moth ahwhc may fithe affect a tps appeite can resutl in manutiron and dehyataion which awilla cerasly affect all of the bdoy stsm loss of motitli beig in the eso aofcniten tn to fiest trac tni the esoharut hsi can lea to pysh ohase and gastesofrelfeuc itnesent in motitl are comon esp in large intestnsin and lead sto increaseinciden of cosntipation and diverticulosis (budlging puches) agigna los aocate wth los of control og anal spinhters inter and externa whcih increa eeeirsk fof recal intontince decreasced metanolis drecreadrug metaoli s increas risk of safve isdf eefetsf ccfomr meds ddfa aegatriac aid production decreasd bowel mobility

agre related chanteg iacitn gthe CV an dpulm systems

decrease mycoeye desity with increase myocyte volume decrease S Anode accamkker cells increase cardia aterlaod decrres nse to beat adrenergi sstim increas elacifja and fibrosis of hear vlaues incfreas evals ctne leading to increa systol BP decreas aretial elavric and compant ce cnrra muscoal thicken in bomcbo wit decfrease mucsal tranpor icnreas ephsy dead space decfrease sisn suce tnesthe fecreas FEVs incrraesriual volue following maximal epxiration

hypothyroidism vs hyper

depression and axiety, increa lethery fatigue HA slowed pseech slow metnal funtion impaired short term meroy prox msucle weakness carpal tunnel sundroem trigge rpoint malgia increase dbone sdenstiy cold interlaer parestheai dspean brachari chd repo muscles weaknss decreas oeperhe cirulatio angina inccholestero anoraxia contsinatn weight gait decaesfe aabos tpojon of food and lgucoe infertilita irrgule usenal increase menan leeding termosa heprnes nervus incesrse t meotanl ainlbailt inosnsain weaknesa stapnh chornipierati hear flshed skin hyper pig increasera hailoss trachya faif pala increaps rate increas ebp arthymais hypermatblism increase apppeti icnrea peiesasnalsi neause comitn diarrah asdphase ia pilurian infetility inrasefirst itrmesfeter miscarriage amenorrhea

peptic ulcer disease

disuption or erosion in the GI muscoa there is an imabalcne between the protective mehcanism of the stomach and the secretion of acidds with in the tomstach h pylori infection and chronic nsaid use irritatnts that increase risk ofulcer indce stress alcohol partiacualr meds foods adn smoking ss depending on the location and can inlude epigastric pain brungn go heart burn nasuea bvomin bleedin bloody stools and pain that ocm esi nave that is relieved by eatin g sx halitosis (bad breath), rosacea (acne looking redness), and lfushing hemorrhage perforation obstruction secodary to scarring and malignancy tx pahrama surgery maybe

lumbopelvic rhythm

during flexion, the spine (primarily lumbar) goes through 60 to 70 degrees of motion and then the pelvis will rotate anteriorly to allow more movement, eventually followed by flexion of the hips during extension, hips extend (if coming from a flexed position), pelvis rotates posterior, and then the spine begins to extend

fast speed isokinetics is contraindicated in people with

dysmetria bc the patient lacks speed control

pathology of the vagina

dysparenuia (painful sex), vulvodynia, vulvoagina candidiasis (yeasst infection)

dyspnea

dyspnea is a nuncomfortable awareness of breathing that may result from decreased oxygenation, hypoventilation, hyperventilation, pr increased work of breathingg due to chagnes in respiratory mechanicas or anxiety

lymphedemda tx

early intervention and onoging self care sign decrease risk of infectin and other negative sequela associated with poor sx managment coplete decongestive therapy CDT is starndard care for patients with lymphedema

palliative treatment

emphaize SYMPTOM management as oppsore to curavei effots raditaion chemo PT chirco acu alterna homeo meds ralax biofed pharama hsippcie may be provide at any time maintain confort anddginty trough appr sx mangment pallaitive can be fiernteatedin to apt suport and cargvier spport pt focues goals may incldue pain mangement meotion and spurpt suport and managn eof sx such as conusion fatigue dyspean nause ewekan bb conrercn careive suport inlcud respote aeduation assist anc wiith rapot home mangemen adn aaccessisn goscl services

rehab considerations for pt with IBS

emphasize PA to asssit with bowel functiona dn relaieve stress emphase brathing to assist with strees reuciton anf with btrath holding bpattners recnoize that biofeedback training may be beenfcial

vitamin B6 (pyridoxine)

emtabolism of pretin aminao acda cabrs anf fat liver red meat howl raing potentoes defificn preprhe nero apth culcsion depressojn tocit sensory famgna numbess atxia

penis

erectile dysfinction

electrophysiologic testing

evaluates the rhythm or electrical conduction abnormalities of the heart suing three to five catheters inserted into a blood vessel and threaded to the heart the recordings help to locate abnormal tissue that causes cardiac arrhythmias

swollen lip nodes in "sore" hip what do you look for

examine the right foot, leg and hip for injury or infection unilateral swelling of the inguinal lymph notes commonly happens bc of this caused by abrasions in sports, insect bites

pleural effusion BRONZE

excess fluid that accumulates in the space surrounding the lungs occurs secondary to a variety of medical conditions and is the result of increased fluid production, decreased fluid absorption or both some of the medical conditions that may precipitate pleural effusion include congestive heart failure, pneumonia, renal or liver disease, cancer, PE and autoimmune disorders pleural cavity is bordered by the visceral and parietal pleurae and contains a small volume of pleural fluid (about 1 mm) excess fluid accumulation in this space can impair breathiing by limiting the expansion of the lungs the exact type of fluid entering the pleural cacity is depending on the cause of the effusion and may incldue seroous fluid lymphatic or blood/pus often ASYMPTOMATIC if it is large or if inflamm is present, sx may include SOB, CP, cough and fever additional sx are more likely the reult of the underlying condition which caused the pleural effucion common tests include chest xray, CT, US imaging once it is identified a fluid sample is usually obtained via thoracentesis for furtehr testing to determine the etiology of the effusion auscultation will reveal DECREASED BREATH SOUNDS, DECREASED FREMITUS (vibration), EGOPHONY (increased sound of voice), AND PLUERAL FRICTION RUB

hypchondriassi disorder

excesve fear ofillnes bis tha tminor illness or meical proble inacta aserious life threatnin dise

exercise in cold environments

exercise in the cold may lower the angina threshold and increase the risk of death or injury in individuals with heart disease inhalation of cold air my exacerbate asthma s/s of cold related illness: frostbite - loss of feeling and a white or pale appearance in fingers, toes, ear lobes, and the tip of the nose hypothermia - body temp <97 degrees F, shivering, confusion, disorientation, incoherence, poor coordination, slurred speech hypothermia develops when heat loss exceeds hear production factors that increase the risk of developing hypothermia include water immersion, rain, wet clothing, low body fat, age >/=60 and hypoglycemia clothing should be adjusted during activity to minimize sweating and reduce sweat accumulation

stress incontinence management

exercises estim biofeedback helpful for levator ani and other pelvic muscles where increased intra-abdominal pressure results or can result in a sudden release of urine

staging

extent of the disease lymph node involvement existence of metastasis staging data it utilized in the selction of treatment interventions, to assist in goal setting and in the prediction of outcomes and prognosis for both oncological and phsical therapy interventions staging data and respones to treatment are also typically reported to a tumor registry aggregate data maintained by a tumor registry supplesi medical prodvers with info regardig treatment outcomes taht can be compared nationally numerous stagin systems exist with some used for many types and others being type specific such as for cancers of the blood or lymphatic system the TNM system is one of thmost commonly used methosd of determining tumor stage the system describes a malignancy based on the size and extent of the primary tumor (T), lymph node involvement (N), and presecne of metastasis (M) for most cancers the TNM combination will correspoond to a stage design that further defintes the severity of the disease lower numbered stages are considered to have a better overall prognosis

what causes excessive lordosis during an active SLR

fatigue weakness of the rectus abdominis and oblique muscle groups

arterial laceration to side of thigh where to you apply pressure

femoral triangle and over the wound

rehab considerations with gastritis

gastriicts secnar to chronc nsai use may be asymptmatic knowledge of blood in the stool should RESULT IN PHYSICAN REFERAL BLOOD IN STOOL educate each pt to take meds with food and avoid certain types of food and drink avoid all aspirin containing comounds

ascites

fluid n the peritoneal cavity ususlaly caising abomdinal sweling

positions to relieve dyspnea

forward leaning often provides relief of dyspnea to patients with lung disease forward leaning with arm support optimizes the length-tension relationship of the diaphragm and allows the pec minor and major to assist in elevating the rib cage during inspiration (this position may be combined with other breathing techniques) reverse trendelenburg decreases the weight of the abdominal contents on the diaphragm and reduces the resistance to movement during breathing semi fowlers 45 degrees head elevated and pillows under the knees for support and maintenance of proper lumbar curve, used for patients with congestive heart failure or other cardiac conditions

how do you want to align electrodes for LBP

four electrodes with current flow diagonal to the spinal column crosscrossed configuration is needed to create IFC

ageism

fr, pf decmation base don steotypes reagrdin afe can be firet at any age older aaltusl often aoucnr pregcj be oc mehs asteoi ftper a nawth cul eprsona nd amedical can impact abitlaf o faceatke orheatl ocroc eto id unabia sewera tis insteaf brecon motin thearpt referto oldr adulta ash oney or sweet therby infantitin ght adult adepsot good tenstninn antoehr exaoe is when aodlera dlt presetn wit PT with a fmaily meme the therap fiecte uqstion to the mfaily memrba tehrant ehnta the pt minimize thpe ts rolein rehab piental reudcin motiatn finally afesm can presetn iteslef as th eroutein delviery of care forao pts oer a spefi ineta od applying oudn epcien of cicnal decion aming reconga nheren rhersbelfia nf peduce allwos pactio vo gbekct unabia care ammeet theend o the paten

akinesia is the same as

freezing gait (no movement)

hydrocolloids

gel forming polymers (i.e. carboxymethylcellulose, gelatin, pectin) backed by a strong film or foam adhesive dressing does not attach to the wound itself but instead anchors to the intact surrounding skin the dressings absorb exudate by swelling into a gel like mass and vary in permaeability, thickness,, and transparentcy indications = hydrocolloids are usedful for partial thickness and full thickness wounds, the dressing can be used effectively with granular and necrotic wounds advantages = provides a moist environment for wound healing enables autolytic debridement offers protection from microbial contamination provides MODERATE ABSORPTION does not require a secondary dressing provides a waterproof surface disadv = may traumatize surrounding intact skin upon removal may tend to roll in areas of excessive friction CANNOT BE USED ON INFECTED WOUNDS

diabetes testing

generally performd ont wo different occasional to confirm a dianosis of DM fsting plasma glucose at lesat 8 hours after a pts last intake of foot or drink (+ if >125) normal is <100 oral glucose tolerance testing occurs 2 hours after ingestion of a sugary drink (+ if >200 or greater) normal is <140 a1c testing based on the attachment of glucose to hemoglobin that meausres to pts average blood glucose ove the apst 2-3 months (+ for DM if A1c is 6.5% or greater), noral is <5.7% dx may also be made if a pt has classif ss of DM i.e. plyppipsia polyuria along with a causl random glucose test of 200 or geater casual glucose testing can be perfrmd at any time of day without regard to food or drink intake

procedure for exercise testing

generally, the patient is required to exercise at progressively greater increments of work by varyiing the speed and grade of the treadmill or the speed and resistance to pedaling an upper extremity or cycle ergometer HR, BP, ECG, RPE and s/s are monitored before during and after the test

using the threshold inspiratory muscle trainer

have the patient place the mouthpeice in his or her mouth and inhale with enough force to open the valve adjust the spring tension by turning the control knot to adjust the pressure indicator to the prescribed setting device is marked every 2 cm h2o, the higher the setting the greater the effort needed begin training with the setting that elicits 30% to 40% of the patients MIP the patient breathes against that resistance at resting respiratory rate and tidal volume for 5-15 minutes, 2-3x a day, as tolerated resistance can be increased in small increments by adjusting the tension on the spring until the training load reaches to to 60% of MIP over a four to six week period expected outcomes... increase inspiratory muscle strength and endurance decrease dyspnea at rest and during exercise increase functional exercise capacity

decreased errors and overall endurance what should you do next

have the patient practice walking in varying environments this is the assoicative stage of learning some trial and error learning is the goal

primary intention healing

healing by primary intention most commonly occurs in acute wounds with minimal tissue loss smooth clean edges are REAPPROXIMATED and closed wuth sutures, staples or adhesives to facilitate re-epithelialization superficial partial thickness wounds such as abraisions or blisters, also heal by intention with epithelial migration over the wound bed frequently completed within 72 hours wounds heal by promary intention typically have minimal scarring and heal quickly in an uncomplicated and orderly progression (i.e. surgical incision, laceration, puncture, and superficial and parital thickness wounds)

obese pt w/c

heavy duty extra wide wheels rear axle displaced forward compared to standard to allow for more efficient arm push

primary contribution of a PT in emergency/disaster

help ppl with disabilities

active cycle of breathing technique

helps clear secretions

what temperature water would cause increased CV demands at rest and with exercise

hot water immersion >35 degrees celcius (aka more than 95 degrees F) When your body gets superheated: Your blood vessels dilate to try to help cool off the body. Blood diverts to the skin, away from the body core. Heart rate and pulse increase to counteract a drop in blood pressure. Normally, these events don't cause problems. However, if you have existing cardiovascular disease, the cascade of events could overtax your heart. This can lead to: Loss of adequate blood pressure, if your heart can't pump enough blood Increased blood pressure, if you have blood vessel disease or narrowing and hardening of the arteries Dizziness or feelings of faintness Nausea Abnormal heart rhythms Inadequate blood flow to the heart or body Heart attack

most appropriate functional goal for a 5 ear old child with a high lumbar lesion (myelomeningocele L2 level) and minimal cognitive involvement

household ambulation with a reciprocating gait orthosis RGO and lofstrand crutches child will not be a community ambulator bc of the high energy expenditure RGO is the best choice (over KAFO) because the hips are joined by metal cables that prevent inadvertent hip flexion (which would probably happen with KAFOs) during a reciprocal two or four point gait (low lumbar was the question before in the test that said they could be indepedent commuity ambulators as a primary means of functinal mobility)

pt exercising with diabetes reports feeling weak, dizzy, somewhat nauseous, sweating profusely and unsteady when standing, what is happeneing and what should you do

hypoglycemia have the patient sit down and administer orange juice once the patient is stabilized the physician should be notified emergency services are generally not needed

common side effect of nitrates, diuretics, beta blockers, or calcium antagonists

hypotension and dizziness

testes and ovaries dysfuction

in amles, the hypothalamus produces gonadotropin release hormone GnR and the pitatary responsd by producing luteinizing hormoen LH and follicle stumating formone FSH leydig cells of the testes reponse to these hormoens with the production of tetsosterone cycle normaly ocurs on a daily basis in females the hypothalams produces GnRH and thepitatary repsones by producing LH and FSH in the ovaries LH acts on theca and intertstiatll cels to produce progestins and androgens and FSH acrts on aranulosa cells to stimuate the precuros sterods to estrogen

liquid skin protectors

i.e. skin sealant applied to skin and when dry it creates a thin plastic film protecting the skin from adhesive related tissue damage this thin barried also offers soem degrees of moistur protection skin protecteact application varries slightly depending on packaging (i.e. swab wipes tube bottle) regardless once applied to the skin it should be allowed to dry fully before an adhesive product is pplie dover it

pain and swelling what do you do

ice and compression

pigmented cells cancer

ie moles classifed as malignant melanoma

when should you not do an anterior draw test

if you suspect a fracture

post-ACL surgery with knee PROM limited, marked tenderness to superficial palpation to anterior knee and posterior calf, increased temp, calf pain and discomort with weight bearing WHAT DO YOU DO

immediate referral to the surgeon may have DVT notice that the calf pain is with weight bearing

femoral

in the upper thigh, one-third of the distance from the pubis to the ASIS

functional incontinence

inability or unwillingness to go to the toilet because of impiared cognition, dementia, alzheimers, arthritis, or environmental impiarments (distance to the toilet)

narcissistic bebirs

incapa of lvng others self aborsd boseddde iqwht sucesa dnpoer unrealis percetion of self imprtnat

hypergranulation

increased thickness of the granular layer of the peidermis that exceeds the surface height of the skin

hepatitis

inflammatory process withint he liver viral heptitis is most commoon and calssifed by letters ABC are most omoone viral in naturea ther iincldue chemical reaciton drug reacito or alcohol abuse other viruses taht can acause hepatits incuce epiistein barr virus (MONO) herpsi virus 1 and 2 veraciella zotera nd measles ss fever flue sx abrupt onset of fatigue anoreixa headach ejauncide darkend urine lighter stool englaeges pseedna dnlauver and intermittent prurutis tx acute viral hepatitis usally refe swith med trartment but canbecom echronic in some cases chornic hepatits can result in need for a live transplatn

constaption

infrequent or diffcult passage of stolol seconadty to h increaein the harness of stool

climbing stairs with breathing

inhale through the nose while standing exhale through pursed lips while stepping up (or down) one or two stairs remain on the step until breathing control is restored

walking with breathing

inhale through the nose while walking two steps and then pause, exhale through pursed lips while walking four steps

too much insulin is also know as what

insulin reaction type 1 - insulin reaction caused by too much medication or too little food aka if you miss a meal and you have regular insulin, the insulin will be unopposed, or when you workout bc the body uses the glucose and then insulin is again unopposed type 2 - don't respond to insulin as well as they should and later in the disease often don't make enough insulin, i guess an insulin reaction can still happen bc they can still become hypoglycemia but it wouldnt be because of medication, it would be because of a missed meal (brain cannot store glucose so first to see effects)

calculating burn severity

like the rule of nines the lung and browder method also provides an estimated calculation of the extent of body surface area burned base don assigned percentages this methods however offers a more detailed claculation for children under the age of 7 rule of nines and lung/browder do not indcate severity or pronosis prognostic burn indexes have been developed as more through evaluative tools to do this

pbesity lipedema or both?

lipedema is a decisea with undefiend etilogy that affects the phyiscal size and dsitrubtoj of apipose cells in the body bilateral symm soft swelling most fewu apeeirn glowLE of wmoen many tukems herediatey tred inital sx rend to prestn at tiems of sign hormaonal chagne menarche aka firs tperid menopauce o during preg women affected often comment their big lges have also seem disproportional often frsuted by failreu of weigh tloss to alert general shapre and proption of their affected LEs due to failure of heaelth careproviders to recngonze liedema be if they didnt have it they would be of normal weight in obese ppe with loss is reasonel that does not postiveily impact lipemdea sx exquitie tendernes to palation in the affected sextreitie scolum like or riding breeches fat increases edema s the da progessses ongoing weight managmenent and DCT offten recommend eo ts with lipedema

thyroid gland

located on the antieor and lateral suface of he trachea immediatel below the larynx and ishpaed like abow tike or buttgly with tow lobes right and elft koint b an isthmus throid rpduce thyrozine and triiodothyroinine that act to control ther ate at which cells bur the fuel from food an increase inthyroid hormoes iwll icnreae rhte arae of the checia ractions with in the bdo y

hypocapnia

low level of co2 in the arterial blood < 35 mmHg

SI dysfunction what is most beneficial in specific quesetion

manual therapy techniques of the SI joint to provide relief of sx and therapeutic exercise to restore normal function of the pelvic girdle the hormone relaxin can cause this laxity and subsequent pain ligamentous laxity can continue for up to 3 months and leaves the pelvic area vulnerable to injury SI pain is aggravated by prolonged weight bearing and stairs would NOT mobilize this pt could use modalities but would not be the msot beneficial since they only provide temporary relief and will not promote any significant impact on healing promoting NON weight bearing and use of a lumbosacral orthosis does not allow the pt to return to normal function

elderly pt hospitalized for 3 weeks after surgical resection of carcinoma of the colon, pt is weak and is doing PT, pt complains of pain in the l shoulder that is aggravated by weight bearing when using the walker, what should you do

notify the physician immediately the risk of metastatic disease is present, the therapist should notify the physician immediately can modify or monitor the POC to reduce pain only after consulting the physician if metastatic disease is present, US is contraindicated

what limits accuracy of spo2

notion artifact abnormal hemoglobin intravascular dyes exposure of probe to ambient light during measurement poor cutaneous perfusion at the measurement site due to hypotension, hypothermia, low cardiac output or vasoconstrictor medications skin pigmentation nail polish or nail coverings

subscap tendinitis what will be painful during exam

passive GH ER bc it will be stretched also will be irritated when contracting or being resisted when the shoulder internally rotates not the primary mover for shoulder adduction thats why passive GH ER is the better answer than painful resisted shoulder adduction

after flexor tendon surgery what can you do with flexion extension

passive flexion active extension bc severe edema increases tendon drag and likelihood of rupture therefore, wait until 48-72 hours postop PRIOR to initiating ROM exercises no active for 1-3 WEEKS PASSIVE EXTENSION aka stretching of the tendon should not be done until there is adequate strength of the repair

mechanical ventilation

patients with severe pulmonary dysfunction may need assistance to breathe from a positive pressure mechancial ventilator or breathing machine positive pressure from the ventilator provides the force that delivers air into the lungs by increasing intrathoracic pressure mechanical ventilation involves an automatic cycling ventilator connected to a tracheostomy tube or mask to assist or breathe for the patient

goal for pelvic floro msucle training

patietns to be able to perofrm the contractions with functional tasks 80-100 contactins per day combining uick, long hold, an cuntional contractions quickc contractiosn are importan tot with standi ncrease dinstaabdomainl pressure ot typcally eings with 3 sets of 10 quick dholding for 2 seconds and resting for 4 seconds logn hold are endurance triangin aand are imprtna for maintian proper posture andpelvic support 3 set sof 5 daily hoilding for 5 seconds and resting for 10 radally increase the octraciton time to ten seconds make sure the pt FULLY RELAXES after each sonctraciton

caloric testing

placing cool or warm water in the ear and observing the pattern of nystagmus produced

stutter test

plica condition seated at edge of exam table with the knees flexed to 90 degrees PT palces a finger over the patellar as the patient actively extends the knee this motion should be a SMOOTH movement positive test is noted when the patella jumps or stutters between 60 and 45 degrees of knee flexion

large intenstine

poriton of the fiesti trac t may of the aaceinf trasnfer desnign sign n andppexnid largintesntis recie geht eliawuid onctents form the snlall intestin adn abdnorsbt he water and eelctrcyles from thsi liguwi to form feces o waste

stemmmers sign

posit ve if skini at sodrla base of the scond roe iner cant be esal lfieted which indicated thickend og the skin due to firbrotic chagnes

seuizure what do you do

position the pt in side-lying, check for an open airway, and immediately call for emergency assistance wait for the tonic-clonic activity to subside before initiating artificial ventilation if needed supine positioning can be life threatening if the tongue falls backward to restrict the airway

prolonged positioning is contraindicated with what type of pt

post CVA bc pt may stiffen up with excess tone

PCL tests

posterior drawer reverse lachmans stress test lmao that is not real

shortness of one joint hip flexor with normal two joint hip flexors

posterior thigh does not touch the table knee can be flexed beyond 80 degrees as the hip is flexed normally a one joint hip flexor will NOT bring the thigh off the table unless it is tight a normal two joint you see 80 degrees of knee flexion

hematuria

presecne of blodo in urine ie.. cancer fulty cath seriosu disea

somatization dsorder

priamry in women has mfmila ascait an of ten chron and lngs tandin cointa os fsx iwth no pshho basic sxmead to meca asnd medic athat alter thep pts lin resermbles hydrocnoass disord

types of dressings

primary or secondary primary comes in contact with wound a number of primary dressings include a self adhesive backing and do not require a secondary dressing secondary dreessings are placed directly over the primary dressing to provide additional protrection, absporption, occlusion and or to secure the primary dressing in place

ovaies

prodive estrogen and progesterone that contubute to the regualariotn of th emenstual cycle and prennacy estogen is secreted by the ovarian follicles and ispresopnseible for the development and maintaence of female sex characteristics such as breast development and the cycles of the femal ereprodctive system progesterone is produced by the corpus litem and fnction to maintain the liningn of the uterus ta a level necessary for pregnancy

age discrimination and employment act of 1967

prohibits employers from dscriminating against persons 40-70 years of age in any area of employment

characteristics of venous insufficiency ulcers

proximal to the medial malleolus irregular shape, shallow moderate/heavy exudate mild to moderate pain normal pulses increased edema normal skin temp flaking, dry skin, brownish discoloration leg elevation lessens the pain

if the dosage of beta blockers and calcium antagonists are too great what will happen

pt will feel extreme fatigue

alpha adrenergic antagonist agents (action, indication, side effects, implications for PT, examples)

reduce peripheral vascular tone by blocking alpha-1-adrenergic receptors this action causes dilation of arterioles and veins and decreases blood pressure used for hypertension, benign prostatic hyperplasia side effects include dizziness, palpitations, *orthostatic hypotension*, drowsiness use caution when changing position due to risk of dizziness and/or orthostatic hypotension, closely monitor patient during exercise i.e. cardura (doxazosin), minipress (prazosin), hytrin (terazosin)

spearmans rho

rank correlation coefficient nonparametric test used to correlate ordinal data

fibrillation potentials seen on EMG when would you see it

relaxed denervated muscle

pulmonary embolism BRONZE

result of VENOUS thrombi that blocks the pulmonary ARTERY in most cases, multiple thrombi must be rpesetn to create a blockage large enough to produce PE sx will cause decreased perfusion in the lung tissue suppleid by the blocked vessel tissue will become ischemic and fails to provide asequate oxygen for the body localized damage to venous structure associated with the initial thrombus frormation may occur s/s sudden onset of dyspnea, coughing, hypoxia, and chest pain which may mimic MI presents both at rest and with activity chest pain worsen with couging, eating, deep breathing or bending coughing may produce BLOOD TINGED sputum s/s unilateral LE edema, cyanosis, wheezing diaphoriesis fainting and rapid or weak pulse ventilation-perfusion scan (V-Q scan) uses nuclear imaging of inhaled and injected radioactive substance to visualize air and blood flow through the lungs and identify blockage 3D iamges produced by a spinal CT scan may be used to confirm the presence and lcoation of a PE MRI or diagnostic US may also be ordered to tule out the presence of addiotnal thombi esp in LE pulmonary angiogram is the MOST CONCLUSIVE and accurate means of identifying a PE however complciation risks are high and so it is typically used only when other diagnostic methods are inconclusive high risk ELDERLY INHERITED BLOOD ABNORMALITIES (ie fibrinogen anomalies, antithombin III deficiency) extended period of immob, recent surgery, pregnancy, eestogen replacement use, smoking and heart disease

what artery supplies the AV node

right coronary artery

torsion test

set up for a sidelying manip basically and assess for hypermobility, hypo, pain etc. positive is for rotational instability

best intervention for pt post CVA of 1 month with moderate spasticity in the L UE (predom flexor tone), minimal active movement and 1/4 inch sublux of shoulder

sitting, weight bearing on extended L upper extremity, weight shifting will help decrease flexor tone and also provide joint compression (approximation) at the shoulder which will help maintain shoulder position and stimulate stabilizing muscles quadruped would be TOO strenuous for this pt bc would be maximum weight bearing on a weak unstable UE

best intervention for colic baby that is 3 weeks old

swaddling or wrapping esp when being rocked slowly neutral warmth will also calm the baby stroking/tapping, visal stimulation, bouncing fast or rocking fast will all increase arousal and the infant is too developmentally immature for any of the other stimuli

pericarditis BRONZE

swelling and irritation of the pericardium, the sac-like membrane which surrounds the heart often cause by viral infections, though can also occur secondary to MI, systemic inflamm disorders, trauma, meds and radiation to the chest pericardium is a double lated membrane that surrounds the heart and contains a small amount of lfuid as the pericardium becomes inflamed the membrane layers rub against one another the shape chest pain flet with this condition is a reult of the friction between the membranous layers characterized by sharp chest pain that can radiate to the neck or shoulder pain can intensify with coughing, lying down, or inhaling deeply additional sx often include SOB, heart palpatiations, weakness, fatigue, fever and coughing may be acute or chornic most cases are mild and typicalyl improve on their own confirmed via medical hsitory physlca exam and auscultation characterized by the pericardial rub which is the sound heard during auscultation can also use electrocardiogram chest xray echo and CT rule out angina, MI and PE blood tests can be administered to determine if a viral infection is present

paralthyroid

ther are four paraou flafnoufnd fsitersjfj of the of the throus laeterallobes thes glanfs pr u epa raal hyhd horprodues parathyroud ormoes which functions as an antagonis tot calcitonin and is important fo rth aminatence of normal blood levels os fCALICIUM and PHOSPHATE pt hormone increases the reabsoroption of calcium and phosphate from bones to the blood secreion of the pt horome is stimuate dby hypocalcemia and ibibited by hyerpcalcemia normal clotting neuomuslsar ecitingabilit and cell membrane permeability are dpeendenr on nojraml calcium levels

pressure ulcer staging

tolerance of soft tissue to perssure and shear may also be affected by microclimate, nutrtion, perfusion and comorbidities THIS STAGING IS ONLY FOR PRESSURE ULCERS

age reltaed cahgne in msk

type IIb fibersa are denrvated and reainign motor utis hpertorhy aprx 10% decine in strengh per decae esp duringn 6 and 7 decrase msucle mass ssacropenia dca elvot of mscule contaciton decras ecnt secion area of type II muscle gibers decreas ebailit o eprofr effeoce nad altenraton movements icnreas fat inlgalta decae kels musc boen mass fater 44th decare women have lowtoe naaonare to men owme eern great lele of boen lama flfoowin menpase decea teiaurl caragkness increas eallfaestfnness due to cross lingake between ibers

chronic venous insufficiency BRONZE

typically affects the distal lower extremities and is characterized by venous incompetence and resultant venous hypertension CVI increases fluid volume within the interstitial spaces, eventially overloading the lymphatic system resulting in edema accumulation of protein rich fluid causes local inflamm, hypoxia, and fibrotic changes within the tissues changes are signfiicant factors in the developement of venous stasis ulcers and delayed healing typically the bicuspid valves prevent back flow within vessels returning blood from the periphery to the heart malfunctioning valves create venous incompetence and alow blood to pool within the vessels causing venous hypertenson at the capillary level venous hypertension alters the pressure gradient between the capillaries and interstitium impeding reabsorption and blood flow pt typically report sx more closely associated with resultant venous hypertension and stasis than the CVI itself sx include edema, feelings of heaviness and dull aching pain in the distal LE sx typically improve and may resolve fully with elevation however they reappear once dependent positioning is resumed untreated venous hypertension and statsis related sx will cause a brawny skin discoloration and hyperkeratosis chornic inflamm can lead to poor wound healing and fibrotic changes in the subcutaneous tissue diangosis will often include bidirectional or color-flow studies using venous ultrasonography to visualize structures and flow patterns and to identify reflux OBESE, prior vessel damage or who are pregnant are at great risk due to structural or tissue impedance of venosu structures ots who spend extended periods in sitting or standing are also at increased risk

facets arthrokinematics flexion

upper facets glide anteroproximally and tilt forward

interpretation

used oppostite limb for comparrision if possible a difference of 2 or 3 cm between 4 comparative circumferences on bilateral UE is evidence of lymphedema

rinnes test

used to compare bone conduction BC with airconduction AC if BC is greater than AC, the patient is experiencing conductive deafness if AC is greater than BC the patient is experiencing sensorineural deafness If the patient is not able to hear the tuning fork after it is moved from the mastoid to the pinna, it means that their bone conduction is greater than their air conduction. This indicates there is something inhibiting the passage of sound waves from the ear canal, through the middle ear apparatus and into the cochlea (i.e., there is a conductive hearing loss). In sensorineural hearing loss the ability to sense the tuning fork by both bone and air conduction is equally diminished, implying they will hear the tuning fork by air conduction after they can no longer hear it through bone conduction. This pattern is the same to what is found in people with normal hearing, but patients with sensorineural hearing loss will indicate that the sound has stopped much earlier. This can be revealed by the person administering the test (with normal hearing) placing the fork close to their own ear after the patient indicates that the sound has subsided, noting that the sound from the fork is still noticeable to a normal ear.

bunnel littler test

utilizes to determine if there is intrinsic or a joint capsule restriction present at the PIP joints

patellar stabilizing brace with lateral buttress supports what

valgus bc results in lateral displacement of patella and buttress will stop it and maintain normal tracking

facets arthrokinematic lumbar rotation

very little but clinical important because this motion causes separation and approximation of the facet joints if L3 rotates right, there is a separation at the right L3-L4 and approximation at the left L3-L4 opposite of cervical

anteroinferior dislocation what will you find in exam

weak deltoid bc of the anatomical position of the axillary nerve it can be damaged by this type of dislocation

genu recurvatum why is it happening

weak or severe spasticity of the quad

physiolgoca nad postural changes during pregnancy

weight gain between 25 adn 35 punts anemia may occur uterus ascend into the abdomanla cavity beocme an abdonala organ ribs epant to accommodate the urince ascent rest diaphragm elvates 4 cm increase dpeth of resptia tidal volume and minute vetialtion increaseoxygen consumtion 15-20% blood volume 40-50% cardiacou out apul 30-60% hypotnsion in supine during pregnancy from pressureon the inferior vena cava abdomainla become over stretch ligemnts become lax seocnary to horone chagne s honts may be comehypermobile

angina pain scales

• Grade severity of angina pectoris • 1= mild, barely noticeable • 2= moderate, bothersome • 3= moderately severe, very uncomfortable • 4= most severe or intense pain ever experienced most common

basophils values

0.00 - 0.02 0-2% SI

moderate reliability

.50-.75

staging of lymphedema

0 - latent (preclinical) stage no visible edemea though th etranpsor t capcoty of the lumph has been affected 1 - reversible lymphedema stage, pitting edema is present and increases with acitivyt or heat but will decrease with elevation and rest (dynamic) 2 - spontaneously irreversible lymphedema stage edema is now NONPITTING and does not change with elevationor rest the skin begins to deonstrate fibrotic chagnes and the risk for infection incraeses stemmers sign is positive at this stage (mechanical or combo) bc of hypoxia inflamm and icnrease risk for infection 3 - lymphostatic elephantitisis stage extensive nonpitting edme a sig fibrotic chagens to the skin and the presecne of papillomas, deep skin folds and hyperketatosis infection is common at this stage stemmers sign reamins sposive paillomas little wart like moles

Borg Dyspnea Scale

0 - no breathlessness at all 0.5 - very, very slight 1 - very slight 2 - slight breathlessness 3 - moderate 4 - somewhat severe 5 - severe breathlessness 6 - 7 - very severe breathlessness 8 - 9 - very, very severe breathlessness 10 - maximal

pt is classified as having OA if...

1 report experiencing pain 2 have either of the following (hip IR less than 15 degrees along with hip flexion less than 115 and age greater than 50 OR hip internal rotation greater than 15, along with pain during IR, morning stiffness less than 60 min, and age greater than 50)

systolic blood pressure in the legs is higher or lower than the pressure in the arms

10-20% higher this is why some cases an ABI value of greater than 1 is still considered to be normal BP readings that are lower in the legs as compared to the arms are abnormal and may be indicative of peripheral vascular disease

platelet count values

165 - 415 x10^3/mm^3 x10^9/L for SI

S1 (LUB)

1st heart sound - closure of mitral and tricuspid (AV) valves at the onset of ventricular sustole high frequency sound with lower pitch and longer duration than S2

partial thromboplastin time PTT values

26.3 - 39.4 seconds PTT/PT times measure how quickly the blood clots, the tests are commonly used to monitor oral anticoagulant therapy or to screen for selected bleeding disorders, examine all of the clotting factors of the intrinsic pathway with the exception of platelets PTT is more sensitive than PT in detecting minor deficiencies

Jump with 2 feet what age

3

ventricular tachycardia V-tach

3 or more conscutive PVCs at a ventricular rate of >150 bpm P waves are absent and QRS complexes are wide and aberrant in appearance V-tach longer than 30 seconds is a LIFE THREATENING arrhythmia and requires immediate medical intervention patients are not able to maintain an adequate blood pressure and eventually become hypotensive v-tach may degenerate into ventricular fibrillation causing cardiac arrest common causes include MI, cardimyopathy and valvular disease

moderate lymphedema

3 to 5 cm difference betweent he affected and unaffected

Pressures greater than ___ are contraindicated in stage II lymphedema

45 mmHG

The diaphragm is responsible for ______% of the air the enters the lungs during quiet breathing

45% PREDOMINANT MUSCLE FOR RESPIRATION DURING QUIET BREATHING as the diaphragm contracts, the pleural pressure drops, which lowers the alveolar pressure and draws in air down the pressure gradient from mouth to alveoli expiration during quiet breathing is predominantly a passive phenomenon, the muscles relax and the elastic lung and chest wall return passively to their resting volume

how much of the total blood volume is in the venous system

67 percent Approximately two-thirds of total blood volume is stored within the venous vasculature. Veins have a greater ability to distend compared to arteries and therefore can expand to accommodate higher volumes of blood.

which outcome measure of aerobic capacity is supported as reliable and valid functional capacity measure with reported minimal detectable change scores in patietns with HF

6MWT bruce protocol treadmill test (cardiac function), canadian aerobic fitness step test (aerobic fitness), and LE ergometer test (CV fitness) are all reliable and valid but do not have MDCs

maturation phase

7 days to 2 years aka remodeling phase initated when granulation tissue and epithelial differentiation begin to appear in the wound bed as the maturation phase progresses, mechanisms of fiber reorganization and contraction shrink and thin the scar an immature scar will appear red, raised, and rigid while a mature scar will appear pale, flat, and pliable scar tissue is remodeled and strengthened through the process of collagen lysis and synthesis newly repaired tissue have approx 15% of preinjury tensile integrity and should be protected to prevent reinjury over time, the tensile integrity may increase to as much as 80% of preinjury strength hypertrophic scarring, esp in relation to burn injuries, can significantly impact maturation phase progression**** a burn without hypertrophic scarring will typically mature within 4 to 8 weeks but burns with hypertrophic scarring may require up to 2 years to reach maturity

what condition is not likely to show up on xray

A chest radiograph, or chest x-ray, can be used to visualize the shape, size, and location of the heart, lungs, blood vessels, ribs, and bones of the spine. While it can visualize some blood vessels, an x-ray would not provide the level of detail needed to diagnose atherosclerosis within the coronary arteries. Chest x-rays can reveal fluid in the lungs or pleural space, pneumonia, emphysema, and cancer.

pt presents with T10 paraplegia, no evidence to back this up even with tests, neurologist determines that pt has functional neurologic disorder, what is the best intervention

A functional neurological disorder (FND) is a condition in which patients experience neurological symptoms such as weakness, movement disorders, sensory symptoms and blackouts. The brain of a patient with functional neurological symptom disorder is structurally normal, but functions incorrectly. "initiate functional training consistent with the level of injury" FND aka conversion disorder, represents a real loss of function for the patient, the sx are real and varied may be triggered by stress, psychological, or physical trauma PT should treat this pt the same as any pt with a SCI early intervention is crucial do not wait for psych couseling do not use FES to prove to pt that the msucles work (this is called confrontation and it is contraindicated) do not discuss the possible cause for the paralysis with the patient

Trousseau's sign

A sign of hypocalcemia . Carpal spasm caused by inflating a blood pressure cuff above the client's systolic pressure and leaving it in place for 3 minutes.

sinus arrest

A sinus rhythm, except with intermittent failure of either SA node impulse formation or AV node conduction that results in the occasional complete absence of P or QRS waves

aerobic metabolism

ATP supporte dby oxygen low inteensity and or long duration

pectus excavatum

AKA funnel chest; depression in lower sternum; compresses heart and great vessels and may cause murmurs

ALLOGRAFT

AKA homograft temp skin graft taken from abother human usually a cadaver in order to cover a large burned area

pectus carinatum

AKA pigeon chest *forward protrusion of the sternum, like the keep of a ship* marfan and ehler danlos

Common complaints of lymphedema

Aching Tightness Sensation of heaviness

What impairments from damamged area in pic

Ataxia because pointing to a hemorrhage in the cerebellum

Uncompensated forefoot supination (VARUS)

Associated with stress fracture of 5th met Stress fracture of the fibula Lateral ankle sprain Not able to absorb shock, rotate the limb, or adapt to uneven surfaces

Forefoot valgus

Associated with subtalar varus

Why does TMJ deviate towards the affected side

Because the affected condyle stops moving forward while the condyle on the other side keeps moving forward Kinda like the tongue

Myelo

Bone marrow or spinal cord

You are covering an ill coworker what do you do if you can't find the patients notes in the medical record

Briefly examine the patient and intervene appropriately If you accept an individual for PT services then it is your responsibility to examine, eval, and intervene. At least a systems review and brief plan of care should be formulated before intervening. Not appropriate to ask the patient, call the coworker (because they might not have access at home), or ask other coworkers to see if they can access the patients notes because they are not involved with the patients care

genreal s/s of cancer

CAUTION changein BB a sore that will not heal unusla bleeding/discharge thickening/lump devleops indigestion or difficulty swallowing obvious chagen in wart or mole nagging cough/hoarseness

patient seen in PT 2 days after an MVA chief complaints are headaches, dizziness, neck pain with guarding, sensation of lump in throat xrays negative what should you refer for

CT scan want to rule out an upper cervical spine fracture CT scan is still preferred for assessing cortical bone esp spinal fx MRI and myelogram are not as specific for assessing bony anatomy as the CT scan

Parkinson's patient can't walk without close supervision what should be the focus of treatment

Caregiver training for CGA during level walking and stairs Shouldn't restrict to a wheelchair Can't use a walker Manual balance perturb training would cause rigid response and discourage use of normal synergies

Cheyne-Stokes

Cheyne-Stokes The Cheyne-Stokes breathing pattern is characterized by an increasing then decreasing depth, with periods of apnea interspersed, and a somewhat regular rhythm. It is often observed with critically ill patients or patients with congestive heart failure.

Physician sends referral with wrong diagnosis, you treat what you find without telling the physician, pt dies of undiagnosed lung cancer...what is the therapist responsible for

Communicating PT examination results to the referring physician Violates the "referral relationship" need to communicate the exam, treatment plan and management CRUCIAL when the findings are inconsistent with the referrers diagnosis The therapist can not diagnose metastatic cancer but can be held responsible for not communicating with the primary physician

neural tension test to bias sural nerve

DF and inversion

Post MI what is an abnormal response that warrants immediate attention of the PT during exercise

Decrease in systolic Means cannot maintain CO of that intensity Should be immediately reduced or stopped

hypopituitarism

Decreased or absent hormonal secretion from anterior pituitary gland. Rare disorder, symptoms depend on age and deficit hormones. S&S: Short stature (Dwarfism), delayed growth and puberty, sexual and reproductive disorders, diabetes insipidus. ususlaly phrama mangement

Pt with two point discrimination deficiency, what areas of the CNS can be impaired with these findings

Dorsal column/Lemniscal pathway and somatosensory cortex Discriminative touch, proprioception sensibility and vibration sense are carried in the posterior white columns (fasoculus cuneatus for the UE and fasiculus gracilis for the LE The long ascending tracts cross the medulla (sensory decussation) and form the medial lemniscus which then travels to the thalamus (ventral posterolateral nucleus) and finally to the cortex (post central gurus) Loss of two point discrimination could result from an insult from any of these component parts Parietal lobe or internal capsule lesions are the most common sites

How to prevent delayed-onset hypoglycemia after exercise

Eat crackers or bread which are SLOWLY absorbed carbs Fruit juice or candy is rapidly absorbed Foods with saturated fats (steak) should be limited and salads or vegetables do not have major effects in preventing hypoglycemia

canadian c-spine rules

High risk people 1. age > 65 2. dangerous mechanism of injury (i.e. fall from an elevation of 3 feet or greater or 3-5 stairs or an axial load to the head like diving onto the head or a MVC at high speed aka >63 mph or with rollover or ejection) If YES then get an X RAY IF NO to Above then: low risk 0. absence of paresthesias in the extremities 1. absence of midline tenderness 2. simple rear end MVA 3. sitting position in ER 4. ambulatory at any time 5. delayed onset of neck pain these do not "mandate" an xray but if okay then proceed with ROM 1. able to rotate neck 45 degrees both ways If NO to this then XRAY If YES to this that no films needed

Clubbing is seen with (peds)

Hypertrophic osteoarthropathy

Convex/concave wrist bones

I think this picture is right

When is a rolling walker contraindicated

In patients with a forward flexed posture

nonaudible heart sound

Laminar blood flow occurs when fluid flows in parallel layers without disruption between layers. As a result, laminar blood flow is typically inaudible. The remaining options would produce an audible sound and may be indicative of cardiac pathology.

Complete lack of hip flexion, abduction and knee extension what level of spinal cord

L1

independnt community ambulation as a primary means of functional mobility is a realistic functional expectation for pts with what SCI L4-5 T9-10 T6-9 T12-L1

L4-5 locomotor training program emphasizes learning to use bilateral ankle-foot orthoses AFOs and canes all the others learn to ambulate with KAFOs and crutches but may demonstrate limited function and a high rate of orthotic rejection due to the high levels of energy expenditure during ambulation SO those pts typically choose w/c as their primary means (if they had specialized orthoses ie computerized roboti exoskeleton they can have the abiltiy to walk independently with crutches but are high cost and limited avail)

uterine prolapse characteristics

LBP and perineal discomfort aggravated by prolonged standing feelings of heaviness or pulling in the pelvis pain relieved by lying down constipation and painful bowel movement are common

ACA stroke

LE more affected than UE!!! MCA UE more than LE!!! PCA post-stroke pain syndrome and involuntary movemets internal carotid youd be dead or in a coma bc of uncal herniation from extreme edema

negative prognostic indicator with back pain

LE radicular symptoms

Emotional dysregulation

Lack of awareness, understanding, or acceptance of emotions; inability to control the intensity or duration of emotions; unwillingness to experience emotional distress as an aspect of pursuing goals; and inability to engage in goal-directed behaviors when experiencing distress.

Clicking with TMJ

Mandible can open partway without clicking because the condyle is able to push the dislocated disc in front of it until the ligaments become taut The chin deviates mike explained in the above notecard Then further opening requires the affected side to jump over the back end of the dislocated disc and onto its thin center, causing a click or pop. It occurs near wide opening because it doesn't occur until the ligaments attached to the backs of the disc become taut The closing click is softer and occurs when the jaw is more nearly closed because the disc doesn't re-dislocate until the condyle reach the depth of the socket where the disc can no longer fit In later stages of forward disc dislocation, the disc usually stops going back into place during mouth opening and the mandible cannot open past the point where it used to click

C5 complete what to do for coughing

Manual abdominal pressure provided with the assistance of a caregiver Cannot do independently but if they were advanced they could use an arm of a chair or some other external pressure to do this

Throbbing pain developed after painting kitchen, P/AROM all increase pain what diagnosis and what should you do

Manual therapy techniques and therapeutic modalities to reduce pain as the result of subdeltoid bursitis Pain with both A/PROM is characteristic of bursitis and initial interventions should focus on reducing pain and inflammation Other options like tendinopathy or tendinitis would be painful with active but not passive

Outcome and assessment information set OASIS

Measure of function in the home care setting and includes 79 core items, including sociodemographic characteristics, environmental factors, social support, health status and functional status

Best position for fraction of lumbar spine

Neutral or extended position of the spine can be prone or supine This allows for separation while preventing excessive stress on the posterior structures (flexion would our stress on the posterior structures of the disc and is inadvisable with a posterior herniation)

falling up the stairs can cause what injury

PCL knee was flexed and tibia displaced posteriorly

postural drainage, percussion and vibration

PD - positions using gravity percuss - cupping and clapping rhythmic last for several min and should NOT be painful vib - fine tremulous action on the chest wall over the lung segment being drained in the direction the ribs move during exhalation manually or with a mechanical vibrator SHOULD BE PERFORMED DURING EXHALATION

good treatment technique for dysmetria

PNF dynamic reversals can assist the patient in slowing down the movement and achieveing better control pool can also help slow down movement with resistance so can a weight cuff

1st degree antioventricular block

PR interval is longer than 0.2 seconds, but relatively constant from beat to beat no sx or significant change in cardiac function PR interval may become prolonged for many reasons including medications that suppress AV conduction

posterior segment of the left upper lobe drainage

PT in back pt is turned 1/4 from prone on the right side with the bed elevated 45 degrees and the head and shoulders raised on a pillow percussion and vib are performed around the medial border of the right scap

anterior segments right and left upper lobes drainage

PT is above pt is in supine with the bed horizontal percussion and vibration are performed below the clavicles

lateral basal segments lower lobes drainage

PT is on opposite side pt is in sidelying on the opposite side of the lobe being drained with the foot of the bed elevated 18 inches percussion and vib performed over the lower ribs

superior segments left and right lower lobes drainage

PT is on opposite side pt is prone with the bed horizontal percussion and vib are perforemd below the inferior border of the left and right scapulae

anterior basal segments left and right lower lobes drainage

PT is on opposite side pt is in supine with the foot of the bed elevated 18 inches percussion and vib are performed over the lower ribs on the left and right side

Highest compressive forces on patella in what position

Prone and flexing the knee to 110 degrees with the hip extended Over Sitting with knee at 90 or supine with hip and knee to 110 because the hip flexors are on slack and therefore there is less pull on the patellar tendon

Best position for hypo tonic Down syndrome child to activate postural extensor muscles

Prone positioning on a large gymnastic ball with the child looking up or reach up Slow repetitive rocking movements would relax the child

Proton Pump Inhibitors (PPIs)

Proton pump inhibitors (PPIs) reduce the production of acid in the wall of the stomach (that produces acid) thereby preventing ulcers and assists in the healing of ulcers that exist on the esophagus, stomach, or duodenum. ... Examples of proton pump inhibitors approved in the U.S. include: aspirin and omeprazole (Yosprala)

supine to sit test

Purpose: To assess the contribution of the sacroiliac joint to an apparent leg length discrepancy. Test Position: Supine. Performing the Test: The examiner grasps the patient's legs above the ankles and fully flexes them, then extends them. The examiner then compares the two medial malleoli to see if a difference in position is present. Have the patient sit up, while keeping the legs extended. Compare the position of the medial malleoli again to see if there is a change. If there is a posterior innominate, the leg that appeared shorter will lengthen with the sit up. If there is an anterior innominate, the leg that appeared longer will shorten with the sit up. true leg length vs SI contribution

elderly pt with diabetes post bilateral amputation trouble transferring where should he go

SNF bc requires wound care and can initiate PT when ready not home bc cant transfer custodial care (like an homemaker or aide that helps PRN) rehab too intense couldnt do 3 hrs a day

Which abnormal heart sound is associated with congestive heart failure?

S1 and S2 are normal heart sounds. S3 heard in early diastole, is associated with congestive heart failure. S3 is typically softer than S1 and S2 and is easier heard with the bell of the stethoscope. S3 is also known as ventricular gallop.

S4 why

S1 and S2 are normal heart sounds. S4 heard in late diastole is associated with myocardial infarction or hypertension. S4 is the result of an abnormally forceful contraction of the left atrium to overcome resistance caused by stiffness in the left ventricle. S4 is also known as atrial gallop

friction rims and anti tip for w/c used for mainly

SCI

interpretation for claudication test

SCORING initital claudication distance (ICD) = pain free walking distance absolute claudication distance (ACD) = max distance walked when test is terminated due to pain speed of walking GRADING grade 1 = definite discomfort or pain but only of initial or modest levels grade 2 = moderate discomfort for pain from which the patients attention can be diverted grade 3 = intense pain from which the patients attention cannot be diverted grade 4 = excruciating and unbearable pain LOCATION of sx often corresponds to the site of the most proximal stenosis pain in the buttock, hip or thighs occurs with obstruction of the aorta and iliac arteries pain the calf occurs with stenosis of the femoral and popliteal artieres pain in the ankle or foot occurs with diserae of the tibial or peroneal arteries

bony prominences associated with pressure injuries

SUPINE occiput spine of scapula inferior angle of scap vertebral spinous processes medial epicondyle of the humerus posterior iliac crest sacrum coccyx heel PRONE forehead anterior portion of acromion process anterior head of humerus sternum sternum ASIS patella dorsum of foot SIDELYING ears lateral portion of acromion process lateral head of humerus lateral epicondyle of humerus greater troch head of fibula lateral mall medial mall SITTING spine of scapula vertebral SP ischial tub

Normal BP response to progressive walking/running

Steady increase in systolic and either a slight increase or decrease in diastolic

stemmers sign

Stemmer's sign is positive for lymphedema in the presence of thickened cutaneous fold of skin over the dorsal proximal toes or fingers. There is an inability or difficulty lifting up or pinching the skin in the area. It appears in late stages of lymphedema. usually primary but can be advanced secondary

Typical presentation of juvenile rheumatoid arthritis and what do you do if you can't find specific impairments that might be contributing

Swollen, stiff, painful joints usually worse in the morning, fatigue, fever, swollen lymph nodes, and poor weight gain/slow growth Refer the patient to a physician

pacemaker malfunction s/s

Symptoms of pacemaker malfunction include dyspnea, dizziness, bradycardia, chest pain, and edema.

Teen with severe TBI and marked spasticity with strong family support how would PROM best be implemented

Taught to family members so they can participate in her care Will not increase risk of pathological fracture even though she has spasticity No need to teach RNs because they don't typically do this type of care but can teach it to rehab aids or nursing assistants

mediate percussion test q

The act of tapping the surface of the body to identify areas of altered density would happen if there were uncleared secretions in the lungs

FLUTTER device

The flutter is a simple and small device shaped like a pipe that creates a positive expiratory pressure (PEP) and high frequency oscillation as expired air passes through it. These vibrations and PEP are thought to mobilise airway secretions facilitating their clearance and improving airflow.

mean venous pressure

The mean venous pressure throughout the venous vasculature is approximately 2 mm Hg. This pressure is highest distally and lowest proximally at the junction of the vena cava and right atrium.

HRmax =

estimated with 220-age or max HR measured during graded exercise test

boyles law

The pressure within the lungs is reduced during inspiration in accordance with Boyle's Law, which states that the pressure of a given quantity of gas is inversely proportional to its volume.

scab

The term "scab" is used when a crust has formed by coagulation of blood or exudate. Scabs are found on superficial or partial-thickness wounds. Scab is the rusty brown, dry crust that forms over any injured surface on skin, within 24 hours of injury. Whenever our skin is injured due to any cut or abrasion, it starts bleeding due to blood flowing from the severed vessels. This blood containing platelets, fibrin and blood cells, soon clots to prevent further blood loss. The outer surface of this blood clot, dries up (dehydrates) to form a rusty brown crust, called a scab, which covers the underlying healing tissues like a cap. The purpose of a scab is to prevent further dehydration of the healing skin underneath, to protect it from infections, and to prevent any entry of contaminants from the external environment. Scabs generally remain firmly in place until the skin underneath has been repaired and new skin cells have appeared, after which it naturally falls off.

elderly male compplains of nausea, pain with urination, and seems to be feverish WHAT DO YOU TELL THE PHYSICIAN you think is going on

UTI ESPECIALLY evidence of fever fever is uncommon in the other choices of bladder cancer, benign prostatic hyperplasia, and renal calculi (kidney stones)

Light resistance training and PD

Would likely increase patients stiffness and rigidity

st johns waor

acclerate metholsi o some med warfarin cyclosporine and prevent numebrosu ther form treachinf therpalutc levlees

rovsings sign

acute appendicitis application of pressure

PT role in pulmonary rehab

administer a 6mwt or other appropriate exercise tests develop an individ exercise prescrition considering mode intensity duration and freq monitor hr bp dyspnea and s/s supervise exercise and promote proper technique and breathing patterns perform airway clearance and beathing exercises as needed instruct pt in energy conservation techniques looks at nutritional history, spirometry, resting artieral blood gases, sats ,,chest xray, resting ecg, exercise test (6mwt or graded exercise test), CBC, height and weight, resting bp hr and rr temperature brathing pattern ausculatate lungs auscultate breath sounds palpation and inspection of extremities for arterial puleses edmea and skin integrity ortho and neuro status functional status anxiety and depression remind patietns not ot hold their berath during exercise and exhale during the exertion phase of the activity

mafenide acetate

adv = broad spectum PENETRATES BURN ESCHAR may be used with or without occlusive dressings disadv = may cause metabolic acidosis may compromise resp function may inhibit resp function may ibihib epithelaization painful application

silver sulfadiazine

adv = can be used with or without dressings painless can be applied to owund directly broad spectum effective against YEAST disav = DOES NOT PENETRATE ESCHAR

Decerebrate posturing

all four limb in extension

waist circumference can provide

an estimate of decreased abdominal fat even in the absence of a change in BMI assesses abdominal fat before and during weight loss treatment the measurement of waist to hip provides NO advantage over waist circumference alone subject is standing snugly place measuring tape around the abdomen at the level of the iliac crest at the end of a normal exhalation it is not necessary to measure waist circumference in individuals with BMI >35 since it adds little to the predictive power of the disease risk classification of BMI

milroys disease

an inhereited type of primary lymphedema that typcually presents in infancy bilateral LE edema is the most common sx of this diseae

a line considerations

avoid applying a blood pressure cuff above the infusion site grasp the IV line suport pole so the infusion site is at heart level avoid activities that require the infusion site to be above the level of the heart for a prolonged period exercise is possible with the line but avoid disturbing the apparatus

hypopnea

decreased rate and depth of breathing

where is a person tender with MTSS

distal posteromedial tibia shin splints

calcaneocuboid syndrome

irritates the fibularis longus tendon aka cuboid syndrome

arterial ulcer location

lateral malleolus distal lower leg i.e. toes and feet anterior tibial area

pulmonary embolism situation

leading cause of hospital death in the US EMERGENCY

stomach picture

pain will be left upper quadrant

gastroscopy

procued teoer emaine the upper GI tract using an edocsope which is passted thorgh the mouth and intot he stomach

garlic

repotted to exercarbate bleedin gtissue for pts who are taking anticoag

what do you want to test before you test balance

sensory vision visual proprioception vestibular sensation primary impairments before functional impairments sensory to static balance to dynamic balance to locomotion

muscle test for upper trap

shoulder shrug

lobecomy

surgical removal of a lobe of one lung

coumadin

warfarin sodium anticlotting medication adverse effects can include increased risk of hemorrhage, which indirectly can result in lightheadedness

exercise and pregnancy

women are encourge ato contne with exercis eatitiy at a moderate rate durina low risk pregnanayc guiudele permit owmen to remaine at 50-060% of their max HR for aprox 30 min per session women must monitor their HR intermittently ot sensure theat they are maintian their target heart rate non weight beaing actiie s arepreferred due to the ocntineou change in the center of gavity and balcne loose clohting is advices to allow for dequate heaatloss and adeuate lfudi are require during exericse women should avoi vbeocm evertier dand should not exerics in the supen position after the first trimester

chest radiograph

• Visualizes location/size/shape of heart,lungs, blood vessels, ribs, bones of spine • Can also reveal fluid in lungs/pleural space, pneumonia, cancer

ST segment elevation with significant Q waves =

aneurysm or wall motion abnormality

lymphadenopathy

any disea ethat affects the size number or consistency of the lumph nodes

adhesion

fibrous bands of tusse that bind together normally separate anatomic structure

De Quervain's Tenosynovitis what special test

finkelstein for abductor pollicis longus and extensor pollicis brevis

knee burn

flexion deformity conforming splint, 3 point splints, air splint

non pitting edema

fluid acclumation that is harder and not compressible when pressure is applied observed in the lateear stages of lymphedma

urogential triagnle

fmale - bulbocavernosus ischiscav superfiical perineal male bulbo ischio supericial transverse perineal

limited flexion of knee what mob

posterior glide and internal rotation of the tibia anterior glide and ER are notions for knee extension

antibiotsic

prescirbed or h pylori facilitaing more rapdi healing o f assocaited gastric ulceration hplyori vacteria hypersenntiivei diarrhea nauseas PT awate esp of dermatolig adn resp reactions which may b associated with hypersensitivey i.e. metronidazole tetracyclein clarithromycin amociilillin

NBG pacemaker code

1 = pacing 2 = sensing 3 = inhibition 4 = programming 5 = anti-dysrhythmic functions

ST segment depression anther way to say it that indicates myocardial ischemia

downsloping ST segment depression

moderate hypoxemia

PaO2 40-59 mmHg

myocardial perfusion imaging MPI

• AKA radionuclide stress test and nuclear stress test • Shows how well heart muscle is perfused at rest and under exercise stress • Radionuclue agent injected into blood at rest and at max level of exercise • Images of heart reveal areas that have reduced blood supply due to narrowing of 1 or more coronary arteries

In patients with congestive heart failure, prolonged use of Lasix may lead to: thiamine deficiency vitamin C deficiency renal disease anemia

Correct Answer: thiamine deficiency Prolonged use of Lasix has been shown to cause thiamine deficiency in patients with congestive heart failure. Thiamine deficiency is particularly concerning in this patient population because levels of thiamine correlate to the force of myocardial contraction and cardiac performance in general.

full thickness graft

a graft that contains the epidermis and the dermis of the skin, but does not contain the subcutaneous fat

Alkalemia

aka basic decreased acidity of blood (pH > 7.45)

best dressing for a decubitus ulcer of 3 months on the lateral ankle (ankle is swollen, red, and painful with a moderate to high amount of wound drainage)

calcium alginate dressings (for wounds with mod to high exudate) bc can absorb large amount of exudate (up to 20x their weight) and form a gel, which maintains the moist environemnt whilemaintaining good permeability to oxygen

BP increases more with what type of exercise

exercises that incorporates a concentric and eccentric phase compared to isokinetic (biodex) blood pressure tends to be higher during the concentric phase of the repetition or when the valsalva maneuver is used it will continue to increase as exercise set progresses

bronchophony

increased vocal resonance with greater clarity and loudness of spoken words i.e. "99"

rehab considerations for pt with cholescystits and cholestlithiasis

must be fmailiar with all signs and sx of cholescutsi in order to REFER PT TO A PHYSICIAN if a change in status occurs post surg exreecise and ambuation are appropraite post larprospi csucha s breathing splints while coughin and moblity training

congestive heart failure GOLD

occurs when the heart can no longer meet the metabolic demands of the body, the hearts inability to pump a sufficient amount of blood occurs when there is insufficient or defective cardiac FILLING and/or impaired CONTRACTION/EMPTYING of the heart the impairment in CO causes the body to compensate for this deficit and this results in an increase in blood volume (retain fluid), cardiac filling pressure, HR and cardiac muscle mass CHF is not an independent disease process but rather a symptom of pathology within the heart muscle itself or in the cardiac valves injury can be L or R or both the abnormal retention of fluids and diminished blood flow causes further stress and injury to the cardiac system common etiologies include arrhythmia (a fib), pulmonary embolism, hypertension, valvular disease, myocarditits, unstable angina, renal failure, medication induced problems, high salt intake and severe anemia CHF occurs when there is a DECREASE in CO, abnormalities in the skeletal muscle metabolism, impaired left ventricular function or all of the above clinical presentation = initially show signs of tachycardia, other signs include venous congestion, high catecholamine levels, and finally impaired CO Catecholamines are a group of similar hormones released into the bloodstream in response to physical or emotional stress. The primary catecholamines are dopamine, epinephrine (adrenaline), and norepinephrine. as the severity of CHF increases, signs of venous congestion usually become apparent left sided HF is generally associated with signs of pulmonary venous congestion and right is associated iwith systemic venous congestion impairment to either ventricle can affect the other, leading to both systemic and pulmonary edema, nocturnal dyspnea, orthopnea, S3 gallop, dry, cough, exertional dyspnea with low level exercise, sudden weight gain, possible cyanotic extremities, cardiac hypertrophy, and shortness of breath labs = urinalysis, CBC count that includes electrolyte, thyroid stimulating hormone, blood urea nitrogen BUN, and serum creatinine levels chest xray, electrocardiogram and echocardiogram are also recommended a doppler ECHOCARDIOGRAM can determine systolic and diastolic performance and cardiac output (ejection fraction), and pulmonary artery and ventricular filling pressure framingham classification system for CHF (two major or one major/one minor) new york heart association functional capacity classification also classifies heart disease based on symptomology as it relates to physical therapy what else might you find with CHF? left ventricular infarction, aortic or mitral valve disease, and hypertension create pulmonary congestion that may result in left sided CHF over time however, fluid accumulation spreads and ankle edema, congestive hepatomegaly, ascites and pleural effusion occur which leads the patient to develop right sided CHF as well management = treated based on the root cause of the heart failure diuretics, nitrates, analgesics and angiotensin converting enzyme inhibitor agents DIGITALIS TOXICITY is something to be aware of referred to PT for generaized conditioning and mobility walking is commonly used to initiate an exercise program with cardiac patients pts can progress their overall endurance following their won heart rate and percieved exertion guidelines nutrition!!! non salt and no alcohol!! likley outcome = can live with CHF and should benefit from physical therapy in order to improve endurance and strength after a decline in function from hospitalization or bed rest PT will improve skeltal muscle function, blood flow, metabolic capacity, and overall exercise tolerance PT however will NOT CURE CHF or its cause common disorder, 4.6 million americans 500,000 new cases each year prevalence increased signifiacntly with age 1-2% 50-59 up to 10% in persons older than 75 despite the hearts compensatory mechanisms the ability of the heart to contract and relax progressively worsens and eventually fails medial survival of 3.2 years for males and 5.4 years for females after diagnosis similar to cor pulmonale which is a form of right sided heart falure but normally seen as a consequence of chronic obstructive pulmonary disease sustained hypoxia produces an increase in pulmonary artery pressure that leads to right ventricular hypertrophy and finally right sided heart failure when the right side fails the left side does not recieve adequate amounts of blood and then cannot sustain a normal CO this is not congestive in nature, however, as there is no fluid buildup within the lungs THIS right sided heart failure also does not present with an audible S3 gallop systolic HF - cant pump (S3) compliant left ventricle diastolic HF - cant fill (S4) noncompliant left ventricle

myocardial infarction GOLD

occurs when there is poor coronary artery perfusion, ischemia, and subsequent necrosis of the cardiac tissue usually due to thrombus, arterial blockage or atherosclerosis MI produces ischemia and subsequent necrosis to a portion of the myocardium the extent of damage to the myocardium is dependent on the duration of ischemia and on the thickness of the tissue involved a transmural MI involved the full thickness of the myocardium whil a nonthansmural MI involves the subendocardial area (inner third of the myocardium) the myocardium has 3 zones that form concentric cicrcles around the point of infaarct termed zones of infarct - zone of infarct zone of hypoxic injury zone of ischemia thrombosis of the ANTERIOR DESCENDING branch of the LEFT coronary artery is the most common location of infarct and affects the LEFT ventricle a right coronary artery thrombosis can result in an infarct of the posteroinferior portion of the left ventricle and can affect the right venricular myocardium primary risk factors of MI include patient or family history of heart disease, smoking, physical inactivity, stress, hypertension, elevated cholesterol, DM, and obesity the use of cocaine and aortic stenosis may also cause an MI it has been documented that an MI will occur more frequently in the morning hours and during the november to december holiday season occurs in 1.5 million individuals each year within the US mortality rate of 50,000 approx 2/3 of patients experience prodromal sx days to weeks before the event, including unstable angina, shortness of breath and fatigue a patient that is experiencing an MI will initially present with deep pain or pressure in the substernal area the may may or may not radiate to the jaw and down the left arm or to the back the patient cannot alleviate the pain with rest or nutroglycerin and the pain may lase for hours the patient is usually anxious, pale, sweating, fatigued, and may present with nausea and vomiting sx of MI frequently do not follow a typical pattern esp in females there are also instances of a silent MI where the sx are noted primary tool to detect MI is a 12 lead electrocardiogram INVERTED T WAVE indicates myocardial ischemia ELEVATED ST SEGMENT indicates acute infarction DEPRESSED ST SEGMENT indicates a pending subendocardial or transmural infarction blood serum analysis can be utilized to dettermine the level of selected cardiac enzymes CREATINE PHOSPHOKINASE (CPK) ASPARTATE TRANSFERASE (AST) LACTIC DEHYDROGENASE (LDH) can all be dramatically altered during and after an MI CBC, chest radiograph, nadionucline imaging, and amylase level may be ordered to assist with dx ASSESS MUSCLE PERFORMANCE THROUGH ACTIVE MOVEMENT ONLY, NO MMT BC OF POTENTIAL FOR VALSAVA barthel index patient status post MI is at risk for complications that include arrhythmias, hypotension, pericarditis, impaired cardiac output, pulmonary edema, congestive heart failure, pericarditis, cardiogenic shock, recurrent infarction and sudden deeath arrhythmias occur in 90% of patients post MI and are caused by ischemia, ANS impairment, electrolyte, conduction defects, and other chemical imbalances most effective management = initial medical management is to stabilize the patient and initate pharma intervention to hinder the evoluation of the MI anticoag, beta blockers, thrombolytic agents, angiotensi-converting enzyme inhibtors, vasodilators, and estrogen (in women) may be used once stable the pt is managed through cardiac rehab surgery may include = angioplasty, stenting, endarterectomy, and bypass grafting exercise testing is performed within 3 days of the MI in order to establish baseline guidelines for patients that are cleraed to exercise and do not exhibit any arrhythmias or angina likely outcome of PT goal is to resume all ADLs and recreational pursuits may be able to return to all previous activities after successful completion of a cardiac rehav program a patient must contnue to reduce the modifiable risk facors and maintain an appropriate level of exercise in order to limit a possible subsequent MI similar to angina pectoris which is a myocardial ischemic disorder that occurs when there is an oxygen defciits to the coronary arteries coronary artery disease accounts for 90% of cases of angina angina is classified as stable, post infarct, Prinzmetals, resting, unstable, nocturnal or variant sx often occur during exertion and include chest pain that may radiate rest or nitroglyercin normally provides relief of the sx treatment of the underling cause is essential to prevnt further damage to the heart

whispered pectoriloquy

recognition of whispered words "1, 2, 3"

rectum and anus pathology

rectral or anal cancer hemorrhoids anorectal fistula rectual fissue

obviates

removes the need

chi square

statistical test used to compare data in the form of frequency counts

colectomy

surgical removeal of part of all of the coon

urinary bladder

temporrary msuclar resvoir for unrine

finkelsteins test

tenosynovitis of the abductor pollicus longus and or extensor pollicis brevis

tetany

tension; prolonged, continuous muscle contraction what happend to will