rehab: final

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Motion and weight bearing can produce

"Extra noise" that interferes with pulse ox signal

indications to terminate exercise or physical activity for other signs such as..

-cyanosis -diaphoresis -bilateral edema in pt with CHF -pallor -abnormal change in breath sounds or heart sounds -ataxia (impaired coordination)

sx's of CHF: STAGE 1

-feel tired easily -SOB when more active -palpitations -feel weak, tired or dizzy (sx's can come & go in this stage)

indications to terminate exercise or physical activity pertaining to SBP

-greater than 200mmHg -decreases to less than 90 mmHg -drop greater than 10 mmHg from resting or with increasing exercise

sx's of COPD - early stage

-have a cough that produces mucous or lasts a long time -SOB easily (esp with activity) -have a tight feeling in the chest -have 'wheezing' , 'rattling' , or 'whistle' in chest when you breathe

indications to terminate exercise or physical activity pertaining to symptoms such as..

-SOB -angina -dizziness -severe headache -sudden onset of numbness or weakness

sx's of CHF: STAGE 2

-SOB, even @ rest -swelling (esp in legs, ankles, feet) -weight gain (may happen in 1-2 days or more slowly) -cough or wheeze (esp when lying down) -need to urinate more @ night -feel bloated or sick to stomach

two disease-specific measures have been developed to assess QOL in pts with heart failure

-minnesota living with heart failure questionnaire (LHFQ) & -kansas city cardiomyopathy questionnaire (KCCQ)

ADVANCED STAGE of sx's of COPD

-mms do not work as well as they previously did -weight loss -difficulty catching breath w/ any activity (even just walking) -lips & nail beds turn grey or blue in color -experience swelling in your legs, feet, or ankles -HB is fast -frequently experience colds &/or flu

new york heart association (NYHA) classifies patients with heart failure into

-one of four classes according to their degree of sx's @ rest & with activity -4 classifications based on their self-report of sx's in response to activity

indications to terminate exercise or physical activity pertaining to HR

-sudden drop less than 15 bpm -change from regular to irregular rhythm -or excess HR maximum (200)

heart failure is generally classified by whether it most affects

-systolic (ejection of blood from heart) heart function or -diastolic (filling of the heart with blood) heart function

Balance Evaluation Systems Test (BESTest) categories

36 item assessment across 6 postural control contexts Biomechanical constraints Stability limits Anticipatory postural adjustments Postural responses Sensory orientation Stability in gait

RA affects how many

2.1M Americans

Consequences of falls for elderly

20% who fall and sustain a medical injury are admitted to hospital 1% die as a result of the injury Most serious fall injuries -- head trauma and/or fractures (wrist, vertebrae, and hip) Women (especially over 80yo) are more likely to be injured Falls are the most common cause of accidental death (48.8% within age 60-69 and 65.9% above 70yo) **EXCEPTION: patient fell while putting away TENS unit, reports back felt "better" after fall, assuming back was stiff and she was afraid to move it and the fall helped loosen things up

RA occurs between the ages

20-40yo

BKA saves ___ of tibial length

20-50%

dilated cardiomyopathy affects

20-60 YO males>females

RBCs stay in circulation for

120 days

Left upper lobe lingular segment

16in table, sidelying on right and turned 1/4 backwards onto pillow Percussion over left nipple area (for females -- heel of hand under armpit and fingers beneath breast)

Do NOT exercise body part of insulin injection

60-90min following injection **Because metabolizes more quickly

General goal for 30sec Sit to Stand

9-10 reps (varies depending on age and gender)

Thigh corset suspension is commonly used in

1950s NOT common today

Wearing schedule for orthosis

1st day -- 30min on/30min off 2nd day -- 60min on/60min off 3rd day -- increase incrementally After 1 week -- should be tolerating 1/2 day to full day

Sustained maximal breathing exercises AKA rhythmic breathing

A maximal inspiration is sustained for about 3sec, then air is exhaled Associated with improved oxygenation and slowing breathing rate

Pulse ox values are critical to assess and determine

A patient's oxygen needs at rest and with activity

A in CAUTION stands for

A sore that does not heal

OA affects how many

20.7M Americans

Lower lobe posterior basal segment

20in table, prone with pillow under hips Percussion over lower ribs (below scapula) fingers pointed towards spine

Lower lobe lateral basal segment

20in table, sidelying and turned 1/4 frontwards onto pillow with bottom leg straight and top arm extended over head Percussion over upmost portion of lower ribs (on side, next to breast) fingers of hand are pointed towards pt's toes

Lower lobe anterior basal segment

20in table, sidelying with pillow between knees and top arm extended over head Percussion over lower ribs (beneath breast) hand is diagonal; fingers pointing towards toes

Other diabetic medications

22-31% of people with diabetes use dietary supplements Certain ethnic groups use supplements more than others

Troponin T (Trop T) usually peaks

24-36hrs after MI then starts to fall

to be dx with chronic bronchitis (blue bloater) you must have a productive cough lasting

3 months out of a year for 2 consecutive years

Time needed for Oswetry Disability Index (ODI)

3-6min

cardiopulmonary test & measures: abnormal heart rhythms (arrhythmias) cause approximately

50% of deaths in patients with heart failure therefore it is important for therapists to monitor vitals, on telemetry if available, at baseline, as well as during & after interventions

MHR intensity for diabetic patient exercise

50-75%

Age of onset for FTD

57-63yo (average is 57yo)

Fibromyalgia syndrome affects how many

3.7M Americans

Alignment of knee joint

3/4in above medial tibial plateau Weight line falls anterior to offset joint, hinge is placed posterior to midline of leg which helps in ambulation

Polyarticular arthritis affects how many

30-40% of all JRA patients Most common

AKA saves ___ of femoral length

30-60%

Time to complete for 30sec Sit to Stand

30-60sec

JRA affects how many

300,000 children nationally 6,000 in Minnesota

Duration and frequency of exercise for diabetic exercise prescription

30min 5x/week (150min total) **May need to start at a deconditioning level

If AKA, actively ___ residual limb

ADDuct

Dealing with hip replacement precautions

ADDuction wedge Knee immobilizer Spaced retrieval memory training Memory notebook or cues

Example of orthosis that increase function

AFO to address toe drag

Orthosis that reduce tone

AFOs Wrist brace where thrumb is ABDucted (key to breaking tone is getting thumb out, then hand relaxes)

Clinical Test of Sensory Integration and Balance (CTSIB)

AKA "foam and dome" Similar to SOT but requires less equipment

platelet count of less than 20,000/mm3

AROM, maybe walking

Bony landmarks of pelvis

ASIS PSIS Ischial tuberosity Iliac crests Pubic symphysis

Sternal precautions

AVOID pushing, pulling, or lifting over 5lbs (or 10lbs for some facilities) for 6-8wks Some facilities restrict shoulder flexion and ABDuction to 90', others include full shoulder AROM as part of rehab Little evidence to base sternal precautions on

Arterial line AKA A-line precautions

AVOID tension and AROM at catheter insertion site Apply pressure immediately at insertion site if catheter is pulled out and notify nurse If a LE artery is used, check facility policy regarding mobilizing patient

Balance Evaluation Systems Test

Abbreviated to BESTest Shortened to mini-BESTest and brief BESTest 69% differentiated fallers from nonfallers in the general population

Balance (def.)

Ability to locate and maintain one's center of gravity (CoG) within or over one's base of support (BoS)

Hammer toe

Abnormal bend in the middle joint of the toe

Scoliosis (def.)

Abnormal lateral s-curve of spine

Systolic BP should not be ___ during exercise

Above 180mmHg

Blood glucose ___ is a contraindication to exercise

Above 240-300mg/dL (ESPECIALLY if fasting)

AKA or AK (abbrev.)

Above knee amputee

BPPV symptoms onset ___ and ___

Abrupt Frightening

Apnea (def.)

Absence of ventilation

Atrial fibrillation

Absent P waves

4 progressive stages of pharmacokinetics

Absorption Disruption Biotransformation Excretion

Alpha-glucosidase inhibitor medications

Acarbose (Precose) Miglitol (Glyset)

Adaptive reconciliation

Acceptance

Advantages of multi-axis foot

Accommodates to uneven ground

Cancer patients canNOT take herbal home remedies because can

Affect absorption of vitamins and minerals Contains cancer causing agents Increase tumor growth Increase risk of bleeding Cause depression Decreased efficacy Decrease effectiveness of chemo

Claw toe AKA mallet toe

Affects joint nearest the toenail **Usually occurs to 2nd toe

Results of great toe transphalangeal amputations

Affects push off, running and walking quickly

Charcot's joint/charcot foot

Affects small joints of foot Degeneration of bone

Postural awareness training

Allows body to maintain upright alignment Permits efficient movement patterns Allows joints to be loaded smmetrically Decreases/distributes load on ligaments, muscle, cartilage, and bone

Joints in orthosis provide

An axis for movement to occur

Clinical notes on factors that influence SpO2 including

Anemia, and low perfusion Errors including wrong probe, wrong position, and "noise" interference

Foot complications with diabetes

Angiopathy (macrovascular and microvascular disease) Neuropathy (autonomic, sensory, motor) End result is amputation

If cardiac patient is on vent and PT is not on hold, treatment consists of

Ankle pumps Heel slides Hugs (bilateral D1 flexion) Cheer (bilateral D2 extension) -- unless Swan-Ganz then only go to 90'

GI side effects of chemotherapy include

Anorexia Nausea/vomiting (N/V) Diarrhea Ulcers Hemorrhage

Weight relief surfaces with PTB socket

Anterior tibial crest Head and distal end of fibula Lateral tibial condyle Anterior distal end of tibia

2nd course of JRA medical treatment

Anti-rheumatics Gold salts, anti-malarial drugs

Choice of socket depends on patient's

Anticipated activity level Co-morbidities Residual limb condition

Medical treatment for labyrinthitis

Antiviral medications or anti-inflammatory medications or cortisone-like drugs Symptomatic medications for vertigo or nausea such as Meclizine or Antivert Sedative medications are best avoided

Initial shock felt after amputation

Anxiety, fear, anger

Disability (def.) in WHO 1980 disablement model

Any limitation or function loss deriving from impairment that prevents the performance of an activity in the time-lapse considered normal for a human being

Abnormal GHb AKA Hgb A1C

Anything over 6% warrants intervention via diet and exercise

Blood vessel changes as pregnancy progresses

Aorta partially obstructed in supine Vena cava compression in supine

Coronary Artery Bypass Graft (CABG) is AKA

AortoCoronary Bypass (ACB)

Disadvantages of IPOP

Application Does NOT allow for daily wound inspection and dressing changes If patient can NOT control weight bearing then early ambulation is a detriment

Rocker feet

Arch disappears and becomes the primary weight bearing surface of foot

Old terminology for foot orthotics

Arch supports

HypOmagnesemia (low magnesium) can cause

Arrhythmias

Surgical management for severe JRA

Arthroplasty Arthroscopy Carpel tunnel release Fusion Synovectomy

Hip/ankle/stepping strategies

Arutomatic Occur 85-90msec after the perception of instability is realized

Alzhemier's disease (AD) was first identified

As early as 1907 as a distinct clinical and pathological entity

If AKA, get up and ambulate

As soon as possible

Assisted joints

Assist in motion in one direction via spring load mechanism

Basis of geriatric rehab

Assist the disabled aged in recovering lost physical, psycholocal, or social skills, so that they may become more independent, live personally satisfyinng environments, and maintain meaningful social interactions

Gait training with/without prosthesis

Assistive device used Ability to donn/doff prosthesis Functionality of the joint just proximal to amputation (if maintaining a position that causes gait abnormality) Weight shift/weightbearing Gait pattern Wheelchair mobility and adaptations Management of architectural barriers

Adapting the environemnt to lessen the likelihood of falls

Assistive walking devices -- correct choices Adaptive ADL equipment Handrails in bathroom/bedside commode Opportunities to enhance communication (i.e. LifeAlert, keeping phone on person) Increased illumination Large pattern design and bright contrasting colors in upholstry and textiles Higher, reasonably firm, supportive and comfortable chairs with high backs and wide arms rests Reduce clutter and excessive furniture Omit or clearly define stairs and more unsafe areas

In constrast with unilateral loss of labyrinthine function, bilateral loss of labyrinthine function patients have no

Asymmetry of activity from the labyrinthines with the head still They do not have symptoms until they move Some patients who lose vestibular function, for example from the toxic effects of some antibiotics that must be used to treat severe infections are so sick and are not moving anyway so until they get better and start moving around they are unaware of deficits

P wave

Atrial contraction (depolarization) (systole) Rounded deflection before QRS complex

Saw toothed

Atrial flutter

Characteristics of Menieres disease

Attacks last a few hours to a few days Patients usually return to normal between attacks Usually only affects one ear initially In about 1/3 of patients, both ears eventually become involved In more chronic cases, drop in hearing may not recover between attacks and becomes permanent

Acetylcholine purpose

Autonomic nervous system regulation Nerve to muscle transmission Memory formation

Waist belt suspension is indicated for

Auxiliary suspension

Disability of the Arm, Shoulder, and Hand (DASH)

Available in short form known as the QuickDASH

Thiazolidinedione medications

Avandia Actos

Goal of phase 1 (inpatient) cardiac rehab

Avoid deleterious (damaging) effects of bed rest Maintain ROM and muscle strength

Precautions for postural drainage (if side-lying position) **From handout provided

Axillofemoral bypass graft Arthritis Recent rib fracture Shoulder bursitis or tendinitis Any condition that would make postural drainage positioning uncomfortable

Warning signs of cancer

CAUTION acronym

PTB socket is more common with

BKAs

Plaques and tangles in AD brain

BOTH are present in brains that display symptoms Overproduction/overabundance of these in AD brains

Women lose bone density from which location

BOTH femoral neck and vertebra Lose at faster rate than men, starting at 25yo

Regardless of mode of exercise, need to monitor

BP and HR in diabetic patients with cardiovascular problems

How to treat and improve gait

Backwards gait Gait with saccades Gait with head turn Gait with head movement up and down Gait with mental exercises such as counting backwards Reaching, weight shifting activities such as tossing a ball Sudden turns Head circles seated and standing Walking in circles Sudden change in direction with gait

Intrinisic factors contributing to fall risks

Balance and strength problems: Dizziness Protective sensation

Task-specific training (locomotion) with falls

Balance during gait can be made more challenging by increasing its speed, number of stops and starts, variation of surfaces, and closing the eyes

Vestibular therapy interventions include

Balance retraining Oculor motor exercises Repositioning/redistribution techniques

Trunk strengthening after amputation

Balance, isometric, isotonic Functional activities

Standardized testing

Balance/gait LE strength/endurance Low back pain UE disability

Insulin pump mimics pancreas by offering insulin delivery in two ways

Basal dose: helps control blood sugar between meals and during sleep Bolus dose: controls blood sugar from meals (released in a burst)

Treatment for Menieres disease

Based upon both treating symptoms AND preventing the attacks Medications that ease nausea and vomiting or mild sedatives Modify diet AVOID foods that trigger symptoms (MSGs or caffeine) AVOID nicotine Use of a diuretic to excrete excess endolymph fluid Diamox or Acetazolamide to decrease production of endolymph fluid and reduce inner ear pressure Gentamicin injections through the ear drum into the middle ear for recurrent, incapacitating attacks of vertigo which partially destroys labyrinthine function so decreases severity Removing the labrinthine when hearing is already lost Cutting the vestibualr nerve to the part of the labyrinth that relays vestibular sensation to the brain

Three levels of ADLs

Basic Instrumental Mobility

Basic ADLs include

Bathing Dressing Toileting Continence Feeding

Education for prevention and early diagnosis

Be familiar with American Caner Society warning signs of cancer Encourage patients to seek further medical care if signs and symptoms present

ADLs to learn after amputation

Bed mobility, transfer Dressing (including donning/doffing prosthesis) Eating/food prep Cleaning Toileting Overall ability to function throughout the patient's day Care of shrinkers and ace wraps Donn/doff shrinkers and ace wraps

Treatment during bedrest

Bedrest with bathroom privileges after contractions are under control Sometimes placed in trendelenberg (upsidedown position) Tocolytic therapy given to decrease uterine contractions Modalities for pain, positioning, bed mobility,and exercise to prevent muscle atrophy

Environmental fall risk factors

Bedroom (i.e. stepstool needed for high bed, bedside commode) Available devices Bathroom (i.e. shower chair, long handed reacher) Outside (i.e. ramps and stairs, yard hazards) Lighting (i.e. brightness, keeping a light on)

Insulin pump

Beeper-sized device that delivers insulin through a flexible plastic tube attached to the body

Although dementia is viewed as a disorder of cognition, non-cognitive symptoms include

Behavioral symptoms that may precede any clinical evidence of changes in cognition Include changes in mood, manifestations of agitation, and psychotic symptoms

Patient behavior warranting a mental health consultation

Behaviors produce clinically significant distress and/or significant impairment to personal and interpersonal functioning Regression Disorientation Delusional thinking Inaccurate interpretation of environment Inappropriate affect Hypo- or hyhper-vigilance Mood swings Self-destructive behavior Normal behaviors taken to extreme

BKA or BK (abbrev.)

Below knee amputee

Peripheral vestibular dysfunctions

Benign Paroxysmal Positional Vertigo (BPPV) Bilateral Loss of Labyrinthine Function (AKA Disequilibrium of Aging) Unilateral Loss of Labyrinthine Function (AKA Labyrinthinitis) Menieres Migraines

PT management in chest care

Breathing techniques Cough facilitation (ABCT) Postures to increase breathing Relaxation techniques Functional training Bronchial drainage Percussion/vibration

Exercises that put too much pressure on chest and ribcage

Bridge and partial sit-ups (do NOT perform these exercises)

What to do when patient continues to wander from session

Bring session to them and set up stations along wandering path

Amyloid (def.)

Bunch of proteins that fold into abnormal shape (fibrils) disrupting normal healthy tissue function

Glucagon is released by pancreas as a response to

Decreased blood sugar

Changes in GI tract contributing to more medication being absorbed

Decreased intestinal blood flow Increased time to empty gastric contents Increased time for mucosal cell absorption

Prognosis of transmetatarsal (mid foot/Chopart's) amputation

Decreased morbidity rate compared to AKA or BKA

Results of knee disarticulation

Decreased morbidity than amputation that transects a bone

Neuronal changes with age

Decreased myelin sheath and axon diameter

Impaired wound healing in diabetics is due to

Decreased oxygen in tissues Catabolism of proteins Growth of microorganisms

Age-related changes in vision

Decreased peripheral vision Changes in accuracy to judge horizontal and vertical orientation

Advantages of una boot dressing

Decreased post-op edema Self suspension Changes easily if needed Conforms to shape of residual limb Light weight

Average cancer survival rate with weight loss is decreased by 30% and show

Decreased response to chemotherapy

Symptoms of ANS neuropathy with diabetes

Decreased temperature regulation Decreased ability to sweat Cardiac neuropathy Gastroparesis

Age-related changes to muscle

Decreased torque Decreased cross-section area Decreased muscle fibers (fast phasic) Decreased muscle size Muscle is replaced with fat cells

Age-related intrinsic fall risk factors

Decreased type II (fast twitch) muscle fiber function Loss of tissue extensibility (decreased ROM, esp. ankle DF) Loss of function in spine and LEs due to strength/ROM changed Decreased capillary function) increased risk of orthostatic hypertension

Prognosis for hip disarticulation

Decreased use of prosthesis Wound healing problems can occur Many are functional even with driving with/without prosthesis

Advantages of CET

Decreases edema Decreases pain (subjective) Increases wound healing environment Allows active exercise secondary to flexibility (need 60' knee flexion) Allows observation of wound

Foot orthotics (FO)

Decreases pain because transfers weightbearing strsses to pressure tolerant sites Protects painful areas from contact with show Improve foot balance

Advantages of waist belt suspension

Decreases pistoning (which decreases friction)

Pads are used to control ___ and provide ___

Deformity Support

Sarcopenia

Degenerative loss of muscle mass 0.5-1% loss each year after 25yo Increases with each decade Increases to 1-2% each year after menopause in women

Residual limb pain causes

Delayed healing, ulceration, gangrene

PPD will see deterioration on tasks of

Delayed recall Semantic knowledge Frontal-executive functions Speech and language Visuospatial functions

Memory loss is not always the first sign of ___ and is not always a progressive condition

Dementia

Normal pressure hydrocephalus is seen with clinical triad of

Dementia Slow shuffling gait Urinary incontinence

Grieving

Denial or problem/severity Obsession with past or pre-loss state Obsession with guilt related to loss Regression Difficulty concentrating Loss of interest in activities and events Liability of mood Inability to discuss loss Fear of being left alone Acting out (i.e. tantrums, promiscuity, suicidal behaviors) Angry stance

Prognosis of transphalangeal (toe) amputations

Depends if 1 toe or multiple toes amputated and if both feet are affected

Prognosis of knee disarticulation

Depends on patient Requires increased O2 demand Depends on the scar free padding left for weight bearing

Atherosclerosis (def.)

Deposits of plaques of fatty material on the inner walls of the arteries

Dementia may not be the culprit of memory loss, other diagnoses could be

Depression Anxiety Delirium Medication-induced problems

Hightened possibility of suicide

Depression Giving away possessions Hoarding or hiding medication or potential weapons Writing suicide note Updating will Verbalizing loneliness or hopelessness Statements regarding benefit of release of pain, absence, etc. Intrusiveness of such thoughts

Grief reaction

Depression Mourning Self-blame Needs to be resolved before the patient can move on

Acknowledgement after amputation includes

Depression, mourning, hostility

Imbalance can occur when a patient is

Deprived of other sensory cues such as vision or the sense of touch that are typically used o compensate for loss of labyrinthine function Walking in the dark can become treacherous Walking in sand or even a soft surface such as well padded carpet can be difficult because sensations from the feet cannot be used to determine exactly where one's are relative to the stable ground For this reason, one should not swim alone on a dark day because one can't rely on vision or other sensory cues to know up from down

Reciprocating gait orthosis (RGO)

Derivative of the HKAFO but incorporated a cable system to assist with advancement of lower extremities during gait When patient shifts weight on right extremity cable system will advance left extremity

Craig Scott KAFO

Designed for paraplegics Design allows a person to stand with a posterior lean of the trunk

Dementia (def.)

Deterioration in cognitive functioning that renders a person unable to meet the diverse intellectual demands of everyday life

Distribution (def.)

Determines the concentration of a drug at its target site Nature of drug has an affinity for certain body components (H2O, fat, protein)

Characteristics of type II (NIDDM) diabetes

Develops over 35yo (called "adult onset") Gradual onset 90% of all diabetes cases Ketoacidosis is unlikely Usually obese Managed by diet, exercise, oral medication, and insulin Obesity-related or hereditary etiology

Characteristics of type I (IDDM) diabetes

Develops under 30yo (called "juvenile onset") Abrupt onset 10% of all diabetes cases Ketoacidosis may occur Normal body weight Managed by diet/exercise and insulin Viral, autoimmune, or hereditary etiology

Microvascular changes result in

Diabetic neuropathy Retinopathy

Performing active cycle of breathing technique (ACBT)

Diaphragmatic breathing then thoracic expansion then FES/huff

Chest excursion (def.)

Difference in chest circumference from maximal expiration to maximal inspiration

Work balance tasks in increasing ___

Difficulty (i.e. seated to standing to walking, moving to narrower base of support)

Orthopnea (def.)

Difficulty breathing in postures other than erect

DRE (abbrev.)

Digital rectal exam

Normal pressure hydrocephalus (def.)

Dilation of ventricles affects surrounding brain tissue that controls lower extremity movement and bladder function

How ankylating agents work

Directly damage DNA to keep the cell from reproducing

DMARDs

Disease modifying medications Include GOLD, methotrexate, leflunomide Arthritis patients can also take azathioprine or cyclosporine (immumosuppressants), or hydroxychloroquine (anti-malarial drugs)

Pre-op patient education

Disease process Benefits of exercise Extremity hygiene Methods of edema control Information on phantom limb pain/sensation, donning/doffing prosthesis, gait training

Heart blocks (def.)

Disease where electrical system of heart does not work

Immunotherapy is given to people with cancer to

Encourage their own cells to attack the cancer cells Example: approved vaccine for advanced prostate cancer

Diabetic neuropathy may affect what nerves

CNS (including cranial nerves), PNS (most common), or ANS

Deep thermal modalities (US, diathermy, etc.) with cancer

CONTRAINDICATED over or near a malignancy

Deep heat for arthritis

CONTRAINDICATED with RA Stimulates collagenase activity in the joint furthering its destruction It may effect viscoelastic properties of collagen and increase the plastic stretch of ligaments Include ultrasound

Symes amputation

Calcaneous is dissected from talus Tibia/fibula malleoli are shaved or removed Flap made from preserved heel fat pad

Examples of topoisomerase inhibitors

Camptothecin alkaloids, pododphyllotoxin derivatives, anthracycline antibiotics and anthracenediones

Ventricular tachycardia

Can be very dangerous (leads to v-fib and death) If sustained, then crash cart and staff will be in room If recent episode of unsustained (shorter than 30sec), defer PT until after cardiology assessement

Main concern of anti-tumor antibiotics

Can cause permanent damage to heart if given in high doses

Goals of breathing exercises

Can decrease the risk of lung complications following surgery Get more O2 to body's cells Can also be beneficial to individuals who are susceptible to pulmonary or respiratory problems Work to clear muscus and allow moist air to enter the airways

Cause of Menieres disease

Can follow other diseases of the inner ear including: Head trauma Inner ear infections of them in the distant past Auto-immunity Allergy Viral infections

Disadvantages of una boot dressing

Can loosen up allowing edema Frequently changing Does not protect residual limb well

Advantages of ENDOskeletal shanks

Can make adjustments Components can be exchanged Improved cosmetic appearance

Denial

Can mask depression or anxiety

When you can change supplemental oxygen orders

Can only change in urgent need and must contact PT PT will need to get order to modify O2 prescription during therapy

Exercise based on stage of arthritis

Can only do PROM and gentle isometrics in acute stage Must do PROM/stretching regardless of flare up or not When NOT in acute phase, movement and strengthening are key to recovery Energy conservation (differs from joint protection) -- sitting v. standing to perform a task

Treatment after Four Square Step Test (FSST)

Can perform FSST multiple times Forward/backward and lateral stepping

Results of symes amputation

Can provide durable end-bearing stump Can ambulate short distances without prosthetic or AD

Testing for protective sensation

Can their feet touch the floor? More common problems in diabetics Test with 5.07 monofilament (great toe, 4th toe, 1/3/5 metatarsal heads)

Differentiating agents attack

Cancer cells and help them mature into normal cells

Abnormal potassium (K+) levels can cause

Cardiac arrhythmias

Beta blockers (Metoprolol) is used with

Cardiac arrhythmias Cardiac protection after MI HypERtension (HTN) Congestive heart failure (CHF)

Troponin (Trop T) shows evidence of

Cardiac muscle injury

Exercise physiology educated patients on

Cardiac rehab phase II (outpatient) before discharge

Other problems that futher affect pharmacokinetics

Cardiac, kidney and liver disease

Common musculoskeletal complications during pregnancy

Carpal tunnel syndome (CTS) Thoracic outlet syndome (TOS) Femoral nerve compression Diastasis recti

Multiple gestation (def.)

Carrying more than one baby (i.e. twins, triplets, quadruplets, etc.)

Osteoarthritis (OA)

Cartilage degenerates Loss of joint integrity

Ethnicity and bone density changes

Caucasian and Asian are more at risk than African Americans

Meglitinides are unlike sulfonylureas because they do NOT

Cause an increase in insulin release regardless of glucose levels Can lead to hypOglycemia

Age-related GI system changes

Changes begin before 50 Increased tooth decay Decreased taste buds and smell Decrease in gastric motility (proteins, fats, and minerals are absorbed more slowly) Decreased gastric acid Decreased absorption of iron and vitamin B12 Bowel and bladder function is decreased

Age-related changes in vestibular system

Changes in neurotransmission with overall decrease

Crisis points in the rehabilitative process

Changes in the phases of heath care (i.e. acute care vs IP vs OP clinic) Changing status of other patients (i.e death, discharge, or new admittance) Patients discharge or termination form service raises awareness of loss of security and safe environment Patient must confront physical and social differences in a non-hospitalized or non-injured population

Results of all age-related changes on pharmacokinetics

Changes make the elderly more susceptible to toxicity and more prone to side effects

Parkinson's disease (PD)

Characterized by tremors, rigidity, flexed or forward posture, slowing of movements, or bradykinesia

Temporary pacemaker

Check with ICU nurse before seeing patient Not unusual to see post-CABG Do NOT change setting accidentally when mobilizing patient AVOID tension on wires NO restrictions to mobilizing patient if he/she is stable

High PT/INR (above 5)

Check with PT to see if high risk of bleeding Fall precautions

If troponin T (Trop T) levels are still rising

Check with PT, consider holding exercise If exercise, keep patient on telemetry

Percussion

Chest clapping (manual v. mechanical) Both loosen secretions Increased pulmonary function with manual

Chest wall mobility can be measured by

Chest excursion

Pulse ox errors due to machine maintenance

Clean with minimal amount of alcohol, harsh chemicals cause corrosion or damage to the unit Use bleach solution or alcohol with slightly wet cloth (water only) to minimize corrosion Put monitor in clear glove or baggie for use in isolation areas If rubber boot available, use it to prevent damage if dropped Wrapping cable/wire around unit causes wire to break and cable quit working

Postural draininge (def.)

Clears airway of seretions by placing patient in position where gravity can assist with removing secretions

CBE (abbrev.)

Clinical breast exam

Gastroparesis (def.)

Condition that reduces the ability of the stomach to empty its contents **Stomach muscle doesn't function normally but NOT due to blockage

Geriatric perspectives with amputation

Confusion/disorientation Agitation Forgetfulness Becomes fearful Feelings of isolation Concentration difficulties Withdrawl Depression

Brain natriuretic peptide (BNP) AKA B-type natriuretic peptide or GC-B is elevated with which diagnosis

Congestive heart failure (CHF)

Precautions for postural drainage (if Trendelenburg position) **From handout provided

Congestive heart failure (CHF) HypERtension Pulmonary edema Shortness of breath (SOB) made worse with Trendelenberg Obesity Abdominal distention Hiatal hernia Nausea Recent food consumption

Troponin T (Trop T) levels can be elevated with which diagnoses

Congestive heart failure (CHF) Post heart surgery Chronic ischemia

If awaiting bolus of potassium (K+) to correct low levels

Consider deferring PT

Guidelines when looking at common labs for cardiac rehab

Consider the numbers as one piece of the whole clinical puzzle Treat the patient, NOT the numbers No exercise does not necessarily equal complete bed rest

Medical treatment of JRA

Consists of 4 courses Keep MD informed of what's working and what's not

Many patients have a mild degree of ___ during periods where they are having the recurrent attacks of BPPV

Constant unsteadiness

Purpose of socket

Contain support and residual limb

Types of supplemental oxygen

Continuous flow Pulsed flow Resevoir

P wave on EKG

Contraction of atria by electrical current from SA node Depolarization occurs here

CET (abbrev.)

Controlled environment treatment

Cardiac rehab should consist of

Coordinated, multifaceted interventions designed to optimize a cardiac patient's physical, psychological, and social functioning. In addition to stabilizing, slowing, or even reversing the progression of the underlying atherosclerotic processes, thereby reducing morbidity and mortality.

Emotional adjustment following amputation

Coping with loss and grief dependent on pre-amputation behavior and personality - Initial shock - Defensive retreat - Acknowledgement - Adaptation

Purpose of heel spur cushions

Corrects abnormal functioning (i.e. forefoot ABDuction)

3rd course of JRA medical treatment

Corticosteroids Prednisone

Non-prosthetic management

Cost of prosthesis prohibitive Energy cost is too high for patient NOT ambulatory before surgery Poor balance, strength, paralysis, coordination Severe contractures Chemotherapy or radiation (b/c may complicate wound healing) Bilateral amputations (especially AKAs)

Hemotysis (def.)

Coughing up blood

Primary benefits of pulmonary strength training

Counteract systemic effects of COPD resulting in peripheral and ventilatory muscle weakness Strength of both UEs and LEs improve

If AKA, want to strengthen ADDuctors to

Counteract typical contracture formation

Two PVCs together

Couplet Arrhymia

Rhonchi breath sound

Course rattles or popping sounds the sound like snoring usually heard on expiration Indicate congestion in proximal (large) airways that typically clear with an effective cough

Nagi disablement model

Created in early 1980s Similar to WHO's 1980 model but includes functional limitations

Otoconia with BPPV

Crystals become disloged from the utricle If formed, a clump can migrate to the lowest part of the inner ear, the posterior semicircular canal Once in the semicircular canal, they may still move whe the head changes position, leading to false sense that head and body are spinning

Lifestyle factors that influence health

Cultural influences (i.e. generational demographics, socioeconomic status, adverse childhood experience, etc.) Physical activity Nutrition Obesity Smoking/tobacco use/alcohol/other drugs Domestic violence

Nurture

Cultural, ethnic, and social adaptations to adjustments

Sick role

Culture supports helplessness and dependency Secondary gains from being ill

Disadvantages of waist belt suspension

Cumbersome Poor cosmetic appearance Hygiene problems

How to treat and improve balance

Cushion drills Open eyes and closed eyes Perturbations Head turns Sacaddes and vestibular occular reflex (VOR) exercises (i.e. gaze stabilization) from seated static to bouncing on an exercise ball CTSIB (foam and dome) Head motions

Purpose of metatarsal pad

Cushions

BPPV in anterior canal

Exceedingly rare because debris in the canal is located at the top of the inner ear easily falls out on its own

Prognosis of oligoarticular JRA with early diagnosis in kids

Excellent

Polyphagia (def.)

Excessive hunger

Polydipsia (def.)

Excessive thirst **Initial symptom of diabetes

Polyuria (def.)

Excessive urination

Second degree heart block: Mobitz type II (AV block)

Excitation completely fails to pass to AV node so you get repeated P waves

How to establish correct vestibular migrane diagnosis

Exclude other conditions that can cause similar symptoms: BPPV Menieres disease TIAs (mini strokes) Fluid leaks in the inner ear Vestibular nerve irritation

Weakness/debility

Exercises in early stage Cueing each repetition or after 5 or 6 reps, may be needed Group volleyball beneficial (parachute game, balloon volleyball) Use activities as a modality Can grade the activity with weight cuffs or number of minutes standing or required reaching

Typical cardiac patient

Expect multiple diagnoses (i.e. MI with CHF that is S?P CABG) PT may not be ordered for all cardiac cases, more MDs recognize early mobility after surgery is important

Physiological symptoms that dementia patient may exhibit

Experiencing pain Distracted by basic urges (hunger, thirst, bathroom urge) Refusing to participate in therapy Drifting off task NOT sustaining a behavior

If AKA, work on ___ while flexing other leg

Extension of residual limb

Orthosis (def.)

External device work on the body to improve mobility, increase stability, increase function, restrict motion, enhance motion, reduce load

Oscillopsia (def.)

FIRST major symptom of bilateral loss of labyrinthine function is the illusion that the environment is moving when we move our heads Characteristic visual symptom when vestibular function is lost

Step strategy is used to prevent a

Fall

Patient history in typical examination findings

Fall history, including number, time, and circumstances of any falls Type and overall number of medications Number of targeted, standardized, self-report questionnaires concerning balance and fall history Complaints of imbalance, dizziness, vertigo, oscillopsia, nausea and/or vomiting, diminished strength, sensation changes, hearing loss, tinnitus, or vision changes

Listen to ___ because they can tell you key information

Family members

Procedure for fasting plasma glucose test

Fast for at least 8hrs One sample of blood is drawn for glucose levels

Prolonged expiration (def.)

Fast inspiration, slow and prolonged expiration yet normal rate, depth, regular rhythm Associated with obstructive lung disease

Hip strategy is used when perturbation is

Fast or large amplitude

Hyperventilation (def.)

Fast rate, increased depth, regular rhythm Results in decreased arterial carbon dioxide and tension Associated with CNS disorders such as encephalitis

Tachypnea (def.)

Fast rate, shallow depth, regular rhythm Associated with restrictive lung disease

Types of intensive conventional insulin treatment

Fast-acting (regular) Intermediate (LPH, Lente) Prolonged (Ultralente)

Ways to monitor blood sugar

Fasting blood sugar Glycosylated hemoglobin (GHb) AKA Hgb A1C

Diagnostic tests for diabetes

Fasting plasma glucose Random plasma glucose (AKA "non-fasting") Oral glucose tolerance test

Presyncope

Feeling faint More cardiovascular

Diabetic patients are prone to injury during exercise, especially on the

Feet

Men lose bone density from which location

Femoral neck > vertebra

Hip disarticulation excises the ___ but saves the ___

Femur Pelvis

Side effects of biotherapy (interferons) cancer treatment

Fever Chills Nausea/vomiting (N/V) Anorexia Fatigue Fluid retention CNS effects

Clinical features of JRA

Fever (if systemic) Rash Symmetrical joint inflammation Swelling Malaise ROM limitations Pain with palpation or movement Same as adult RA Cold will aggravate symptoms Heat relieves symptoms Exacerbations and remissions

Rales AKA crackes breath sound

Fine crackling sounds, usually high pitched Sounds like hair rubbing between fingers or rustling of cellophane

Placement of pulse ox probe

Fingertip (transmission) sensor Forehead (reflectance) sensor Nasal sensory Earlobe sensor Foot style sensors

Contact surface with ankle strategy

Firm, wide and longer than foot

Timeframe for phase 1 (inpatient) cardiac rehab

First 3-5 days after MI

Depression

Flat affect Low energy levels Manic energy or behavior Psychomotor retardation -- slow movements Ruminating about negative thoughts Change in eating/sleeping patterns Regression Social withdrawl Self-destructive behaviors Loss of interest in environment, people, and events Self blame and criticism

Upper lobe posterior segment

Flat table or backless chair, sitting leaned forward/over on pillows 30' Percussion over upper back (on top of scapula)

Lower lobe superior segment

Flat table, prone with superior segment Percussion over middle of back at top of scapula fingers pointed towards spine or head

Upper lobe apical segment

Flat table, sitting leaned back 30' on pillows with therapist leaning on wedge Percussion between clavicle and top of scapula

Upper lobe anterior segment

Flat table, supine with pillow under knees Percussion between clavicle and nipple fingers pointed towards toes

PT intervention for falls

Flexibility exercises Strength training Sensory training or retraining Perceptual training Postural awareness training Task-specific training (locomotion) Vestibular rehabilitation Progression of gaze stabilization exercises Multidimensional or multifactoral training Patient or client related instruction (education and safety) Injury prevention or reduction

Other dizziness

Floating, lightheaded, feelings of nausea May be lots of other things

Perceptual training with falls

Focuses on integrating all sensory information relevant to certain environmental conditions, particularly vertical orientation relative to gravity and surface orientation relative to the base of support

Diabetic foot ulcer stats

Foot ulcers are key cause to morbidity in diabetes mellitus 45% of all non-traumatic amputations

Frequent dependence of compliance

For asthmatics and COPD patients who have compromised airway resistance, the slower you breathe, the better you breathe

Microtubules

Form skeleton of nerve cell Function as a conduit for materials to flow within the cell **If microtubules tanged up then cell cannot get its needed nutrition and dies **If skeleton is tangled, cell structure collapses

Purpose of tau

Forms microtubules

Glycosylated hemoglobin (GHb) AKA Hgb A1C

Forms when glucose in the blood attaches to hemoglobin

Center of gravity is shifted ___ creating balance issues

Forward

Two types of joints

Free Assisted

Q wave

Frist deflection downward of EKG Beginning of QRS complex

Berg balance test

Functionally oriented balance, transfer and gait assessment Detailed test that requires more time

Soft dressings

Gauze and an ace wrap Oldest method

Polyneuropathy (def.)

General degeneration of peripheral nerves that spreads toward the center of the body

Allow for as much self pacing as possible