Term
| ACUTE systemic inflammation signs and symptoms |
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Definition
| fever, tachycardia, hypermetabolic state, elevated WBC/C-reactive protein/amyloid A |
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Term
| CHRONIC systemic inflammation signs and symptoms |
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Definition
| low-grade fever, malaise, weight loss, anemia, elevated WBC and ESR |
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Term
| systemic factors influencing healing |
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Definition
| nutritional status (protein and vit C), psychological wellness, co-morbidities (CVD, DM, cancer) |
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Term
| what does water do in the body? |
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Definition
| provides for nutrition delivery to cells, provides for excretion of waste products, promotes energy production, promote cellular function |
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Term
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Definition
| loss of either fluid or electrolyte w/ loss of volume; excessive loss or inadequate intake, (sodium is a major ion b/c water follow sodium), can cause hypervolemia or dehydration, severe deficit can cause vascular collapse and shock |
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Term
| PT issues w/ fluid deficit |
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Definition
| 1% dec. leads to drop in exs performance and capacity; 2% dec. will drop VO2 max significantly; HR inc. 6 bpm for each 1% drop; be aware of risk factors and clinical S&S |
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Term
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Definition
| dec. CO; absent perspiration, tearing, salivation; confusion, disorientation, cognitive issues; dizziness when standing, orthostatic intolerance; loss of coordination, irritability, lethargy; headache; rapid pulse and respirations |
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Term
| PT issues w/ fluid imbalance |
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Definition
| know pt food/drink status; provide small vol. of fluid freq.; water maybe conraindicated in HF or RF pts; caffeine and alcohol are diuretics |
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Term
| Elderly risk factors for fluid imbalance... |
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Definition
| acute illness, bowel cleansing, mental status, excessive (calcium) intake, laxatives, diuretics, sodium restricted diets, voluntary fluid restriction, incontinence, obesity (low water %) |
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Term
| PT skin care implications for fluid excess |
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Definition
| edematous tissue is very fragile, skin stretch beyond normal limits, limited blood supply, heals poorly, eliminate friction, treat edema |
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Term
| PT implications for electrolyte imbalances |
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Definition
| muscle weakness and wasting, tetany, bone pain, COGNITIVE changes, skin changes, neuromuscular irritability (m. fatigue/twitching/cramping), edema, vital signs (tachycardia, orthostasis, inc. respiration) |
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Term
| Effects of sodium on the body |
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Definition
| affects osmolality, influences blood vol/MAP/interstitial fluid vol, changes ECF, linkedto forms of genetic HTN, balance linked to potassium balance, dec. in salt intake will dec. water intake, inc. in salt output will inc. urine vol |
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Term
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Definition
| muscle cramps, weakness, headache, depression, personality changes, lethargy, edema |
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Term
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Definition
| dry skin, headache, agitation, dec. reflexes, seizures, tachycardia |
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Term
| Potassium effects on the body |
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Definition
| required for normal Na/K pump, eseential for normal muscle contraction/relaxation, imbalance leads to altered muscular activity |
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Term
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Definition
| fatigue, muscle cramping, cardiac arrythmias (dizziness, palpitations), orthostatic hypotension |
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Term
| Calcium effects on the body |
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Definition
| influences cell membrane permeability, regulates neuromuscular activity, key role in cardiac cell conduction and in myocardial and vascular cell contractions, affects bone/kidney/GI tract |
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Term
|
Definition
| convulsions, memory impairment, delusions, hallucinations, paresthesia, muscle cramps, tetany |
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Term
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Definition
| drowsiness, weakness, confusion, irritability, lethargy |
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Term
| Magnesium effects on the body |
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Definition
| neuromuscular integration, stimulates PTH secretion and affects Ca++, influences skeletal muscle contraction, role in ATP production, affects musculoskeletal and cardiac systems |
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Term
| PT care for pt w/ electrolyte imbalance |
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Definition
| support adherence to dietary restrictions, encourage activity, frequent position changes, monitor vital (and ECG if possible), safety issues |
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Term
| which 3 systems act indep. to maintain normal plasma pH? |
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Definition
| blood buffer system, lungs, kidneys |
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Term
| PT implications for acid/base imbalances |
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Definition
| be aware of S&S, watch for pulmonary/CV/renal changes, burns, fever, sepsis, DM, vomiting/diarrhea-chronic, elderly & mechanically ventilated pts, help facilitate breathing (freq. turning, deep breathing tech., coughing), help pts w/ relaxation and control |
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Term
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Definition
| DEC. neural excitability, restlessness, sleepiness, headache, weakness, cyanosis, dec. pH, inc. HCO3 |
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Term
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Definition
| INC. neural excitability, dizziness, tetany, N/T, seizures, inc. pH, dec. HCO3 |
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Term
| Metabolic acidosis (kidney problem) |
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Definition
| muscle twitching, weakness, malaise, vomiting, headache, low pH, low bicarbonate |
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Term
| Metabolic alkalosis (kidney problem) |
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Definition
| nausea, confusion, irritability, agitation, twitching, cramping, convulsions, high pH, high bicarbonate |
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Term
| general causes of acute renal failure |
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Definition
| problem w/ filtering mech, tubule, or blood flow: acute shut down in renal fxn, dec. blood flow to the kidney, disruptions in the kidney structure, postrenal disruption in urine elimination |
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Term
| Acute glomerular nephritis causes (acute inflamm subsides in 2 wks) |
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Definition
| intrinsic, damage to glomerulus, ischemic or toxic origin, streptococci, antibodies reacting against kidneys, immune complexes are trapped, glomeruli blocked, inflamm. response, normal glomeruli become permeable to protein and RBC |
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Term
| Acute tubular necrosis causes |
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Definition
| destruction of tubular epithelial cells, ischemia (circ. shock, tubular cells die and slough off, nephrons plugged, no urine output), nephrotoxic drugs (Hg, lead, tetracyclines; blakc casts occur in urine), toxins from an infection, pts w/ surgery/hypovolemia/sepsis/trauma/burns |
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Term
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Definition
| emboli or atherosclerosis in renal arteries or afferent arterioles, reduced blood flow to glomerulus, red. GFR and urine output, below 20% normal blood flow to renal tubule cells cause hypoxia, may cause cell death |
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Term
| chronic renal failure disorders |
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Definition
| glomerulonephritis, pyelonephritis, benign nephrosclerosis |
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Term
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Definition
| progressive, follows SLE or acute failure, progressive thickening of basement membrane, invasion of fibrous tissue, capillary coefficient becomes reduced, reduced filtration |
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Term
|
Definition
| bacterial infection, E.Coli, obstruction of urine outflow, effects renal medulla interstitium, fxnal units lost |
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Term
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Definition
| very common, causes assoc. w/ HTN and DM, Afr. Am at inc. risk, fibrinoid deposits, occluded vessels, fibrous tissue, glomerulosclerosis, progressive dec. in blood flow and GFR, vicious cycle |
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Term
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Definition
| loss of 90% kidney fxn, GFR <5% of normal, uremia, scarring of glomeruli, atrophy and fibrosis of kidney tubules, dep. on dialysis or transplantation, caused by HTN/DM/chronic glomerulonephritis/obstruction |
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Term
| PT implications on dialysis |
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Definition
| prolonged NSAID use, weakness and fatigue, cognitive changes, anemia/weakness and red. fxnal capacity after dialysis, exercise effects on BMD, evaluate muscle strength (catabolism/anorexia), uremia (mixed sensory and motor neuropathy), measure bp in arm opposite the AV shunt for dialysis |
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Term
| Progression to ESRD (end stage renal disease) |
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Definition
1. dec. renal reserve-hypertrophy of normal nephrons; GFR 50% of normal
2. chronic renal insufficiency-azotemia (N waste in blood), anemia, HTN, GFR 20-35% of normal
3. chronic renal failure-poor vol and electrolyte regulation leading to edema, metabolic acidosis, hypercalcemia, neuro/CV/GI symptoms, GFR 20-25% of normal
4. ESRD-virtually all body systems involved |
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Term
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Definition
| have inc. protein degradation but are not hypermetabolic; energy expenditure at rest and w/ phys act is same as normal in nondialyzed and maintenance hemodialysis people |
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Term
| Clinical signs important for PTs in kidney disease pts |
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Definition
| peripheral neuropathies (LE>UE, atrophy and demyelination possibly due to uremic toxins, central problems: red. alertness, memory, red. conc.); dialysis site has a peritoneal catheter and fistula so don't put BP cuff on that arm |
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Term
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Definition
| exs during dialysis improves efficiency of dialysis but is difficult w/ the equip, circuit training recommended to inc. strength and endurance, pts can inc. exercise capacity by 20-40% and improve lipid profile and glucose metabolism |
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Term
| Exercise precautions for dialysis pts |
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Definition
| be sure pt is medically stable (K levels), monitor BP, inc. fatigue occurs after dialysis but exs is not contraindicated at this time, pt may be less stable metabolically the day before dialysis so the best day to exs is the day after, use RPE scale, red. isometric or static exs effects on BP and inc. afterload on heart by having pt breathe on exertion and use a resistance that can be completed in one smooth motion |
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Term
| Contraindications for exercise in dialysis pts |
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Definition
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Term
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Definition
| low exercise capacity (20% less VO2), autonomic dysfxn (HR response limited, use RPE for intensity); training improves VO2 max by about 40%, improves CV risk factors/QOL/autonomic dysfxn, controls BP and DM; caution: may exacerbate co-morbidity and K levels must always be stable before exercising |
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Term
| Exercise modes and prescriptions for ESRD |
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Definition
modes: bike, no swimming, resistance exs
prescription: 4-6 days/wk, low duration (2 min of exs, then 1 min rest, up to 30 min continuous), use RPE to det. intensity |
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Term
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Definition
| N/V, anorexia, constipation, dysphagia, heartburn, GI bleeding; assoc. w/ exs (diarrhea, ab cramps, belching, nausea, heartburn) |
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Term
| PT implications for GI pts |
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Definition
| postural hypotension (excessive fluid loss, caution w/ upright posture, orthostatic testing, monitor vitals); upper quadrant screening (diff. swallowing, forward head posture, disc protrusion) |
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Term
| Hiatal Hernia PT implications (lower esophogeal sphincter weakness so part of stomach rises above diaphragm) |
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Definition
| avoid flat supine pos., avoid exs req. valsalva, avoid inc. in abd and thoracic pressures, promote wt. loss, progressive exs 6-8 wks post surgery, chest tube considerations |
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Term
| Crohn's Dz and ulcerative colitis S&S |
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Definition
| constant crampy ab pain (R lower quadr), R lower quadr ab mass, low grade fever, fistula formation, small freq. stools, rectal bleeding, anorexia and wt. loss, dehydration, tachycardia |
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Term
| Medical tx for crohn's and ulcerative colitis |
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Definition
| antiinflamm drugs, antibiotics, fluids and dietary restrictions, activity limitations in acute phase, surgical resection |
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Term
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Definition
| optimize fxnal mobility, max activity tolerance and endurance, prevent p/o pulm complications via deep breathing and IS, malabsorption and anemia may be limiting factors, consult w/ nutritionist about caloric intake |
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Term
| Liver disease (cirrhosis) S&S |
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Definition
| GI symptoms, jaundice, portal hypertension, tremors, ab edema (ascites), RUQ pain, fever, GI bleeding, altered mental status, esophageal varices |
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Term
| PT implications for liver cirrhosis |
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Definition
| rest and reduce metabolic demand, resistance exs to prevent bone loss, prevent muscle loss, avoid supine and valsalva, bronchial hygiene and pulmonary PT, pain management via pos. changes, deep breathing, coughing, incision splinting, and early mob. |
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