FF - UE and LE Nerves

How much weight gain is expected during pregnancy?

25-35 lb

What happens to posture during pregnancy?

Forward head

Kyphosis

Increased lordosis

Anterior pelvic tilt

What muscles do you want to stretch for postural correction?

SCM, scalenes, traps, LS, pecs, sub occ, hip flexors, lumbar ext

What muscles do you want to strengthen for postural correction?

Deep neck flexors, abs, glute max

What happens to blood pressure during the 1st and 2nd trimesters?

Dec

What happens to blood pressure during the last trimester?

Inc

Why should supine lying be avoided during pregnancy?

The uterus can compress the inferior vena cava, decreasing cardiac output

What can result from compression of the inferior vena cava while supine?

Supine hypotensive syndrome

What happens to cardiac output when the inferior vena cava is compressed?

Dec

How much does resting heart rate increase during pregnancy?

10-20 beats/min

What is the best side-lying position during pregnancy?

L side-lying

Why is L side-lying considered the best?

Decreases compression of inferior vena cava, maximizes cardiac output, decreases GERD as internal organs are relaxed and improves NPTE Final Frontier maternal and fetal circulation

Does HR proportionally inc with exercise?

NO

How does RR change in pregnancy?

Unchanged, depth of respiration increases

How does metabolic rate and heat production change in pregnancy?

Inc

How does normal fasting blood glucose levels change in pregnancy?

Lower

Pregnancy induced acute hypertension after the 20th week of gestation

Preeclampsia

What is the blood pressure cutoff for pregnancy-induced hypertension?

>140/90 mmHg, second abnormal BP reading 4 hours later confirms diagnosis

Contraindications to Exercise

Hemodynamically significant heart disease

Restrictive lung disease

Incompetent cervix: Early dilation of the cervix before full term

Vaginal bleeding, especially second or third trimester

Placenta previa after 26 weeks gestation: placenta is located on the uterus position in which it may detach before the baby is delivered

Preeclampsia or pregnancy-induced hypertension

Rupture of membranes: Loss of amniotic fluid before the onset of labor

Premature labor: Labor beginning before the 37th week of pregnancy

Maternal type I diabetes

Severe anemia

Diastasis Recti

Separation of rectus abdominus from linea alba

Anything greater than __________ is positive to have diastasis recti.

2 cm or 2 finger width

Treatment for Diastasis Recti

Head lift -> progress to head lift with pelvic tilt (>2)

Abdominal bracing and breathing exercises (>4)

>6 refer them out

*Perform all abdominal contractions with an exhalation to minimize intra-abdominal pressure

Reflux of gastric content of the gastroduodenal contents into the esophagus

GERD

Symptoms of GERD

• Heart Burn- 30 minutes after eating and at night lying down

• Dysphagia

• Sour Taste- from regurgitation of acids

• Hoarseness of voice

• Atypical pain of the head and neck

Complications of GERD

Aspiration pneumonia, asthma

Esophagitis

Treatment of GERD

• Maintain upright positions

• Eat meals at least 3-4 hours before sleep

• Avoid SUPINE- tends to straighten the esophagus

• Sleep on left side preventing nocturnal reflex

• Exercise must be completed 2-3 hours after eating or before meals

• AVOID spicy, chocolate, fatty food, peppermint

• Drugs ̶Antacids ̶H2 receptor blockers ̶Proton pump inhibitors

What organs can refer pain to the mid-back/scapular region?

Esophagus, gallbladder, stomach, and pancreas

What organs can refer pain to the left shoulder?

Heart, diaphragm, spleen, and tail of the pancreas

What organs can refer pain to the right shoulder?

Gallbladder, liver, and head of the pancreas

What organs can refer pain to the pelvis, low back, or sacrum?

Colon, appendix, and pelvic viscera

What is a Pancoast tumor?

Upper lung tumor

What nerve distribution can pain from a Pancoast tumor follow?

C8-T2 nerve distribution

What condition can a Pancoast tumor mimic?

TOS

Where is pain commonly felt with a Pancoast tumor?

Top of shoulder

Is Pancoast tumor pain typically ipsilateral or contralateral to the tumor?

Ipsilateral

What conditions are commonly associated with RUQ pain?

Peptic ulcers, gallbladder pathology, and head of the pancreas

What conditions are commonly associated with RLQ pain?

Appendix and Crohn's disease

What conditions are commonly associated with LLQ pain?

Diverticulitis, ulcerative colitis, and IBS

What conditions are commonly associated with LUQ pain?

Tail of the pancreas and spleen pathology

What is Kehr's sign?

A clinical indication of referred pain to the L shoulder, often due to poor blood or air in peritoneal cavity, typically from a ruptured spleen

A hiatal hernia causes what type of pain?

Shoulder pain

A femoral hernia causes what type of pain?

Lateral pelvic wall pain and groin pain

An inguinal hernia causes what type of pain?

Groin pain

Umbilical hernia causes what type of pain?

Pain around the umbilical ring in the mid to lower abdomen

Blockage or impaction of gallstones in the cystic duct resulting in inflammation of the gallbladder

Cholecystitis

Where can gallbladder pain radiate?

R scapula

What special test is used to assess gallbladder pathology?

Murphy's Sign - Palpate near the right subcostal margin while the patient takes a deep breath

Ulcerative lesions in the stomach caused by chronic use of NSAIDS, stress, anxiety, H. pylori bacteria

Gastric (Stomach) Ulcers

Ulcerative lesions in the duodenum caused mainly by H. pylori infection

Duodenal Ulcers

When does gastric ulcer pain increase?

With the presence of food due to acid secretion; typically after eating

When does duodenal ulcer pain increase?

With the absence of food, especially early morning and between meals

What relieves gastric ulcer pain?

Antacids and medical treatment of H. pylori infection

What relieves duodenal ulcer pain?

Medical treatment of the H. pylori infection

Where can gastric ulcer pain refer?

R shoulder

Characteristic of peptic ulcer disease

Coffee ground emesis and melena (dark) tarry stools

Melena is mainly for which ulcer?

Duodenal ulcers

*think duodENAl = melENA

Ulcerative Colitis vs Crohn's Disease: Which only affects the large intestine and rectum?

Ulcerative Colitis

Ulcerative Colitis vs Crohn's Disease: Which has continuous lesions?

Ulcerative Colitis

What are some symptoms of Ulcerative Colitis?

Rectal pain, bleeding, bloody diarrhea with mucus/pus, fecal urgency, weight loss, LBP

What are some symptoms of Crohn's Disease?

Pain relieved by passing gas, abdominal pain, weight loss, joint arthritis

Where can Crohns Disease occur in the body?

Anywhere in GI tract

Where is pain located in Crohns Disease?

Right lower quadrant

Where is pain located in Ulcerative Colitis?

L lower quadrant

Spastic, nervous or irritable colon

Irritable Bowel Syndrome (IBS)

What can trigger IBS?

Emotional stress, anxiety, high-fat foods, and lactose-containing foods

What typically relieves IBS pain?

Defecation (having a bowel movement)

What type of stools may occur with IBS?

Ribbon-like

Where is pain commonly located with IBS?

LLQ

Inflammation of the vermiform appendix

Appendicitis

S/S of Appendicitis

̶Pain in right lower quadrant, comes in waves progressing to steady

̶Anorexia, Nausea, Vomiting, elevated temperature, leukocytosis, fever

̶Tender at McBurney's point, Rovsing's sign for pain migration, Blumberg's sign for rebound tenderness

PROM- IR of flexed thigh

Obturator sign

PROMExtension of thigh

Psoas sign

Rebound tenderness

Blumberg's sign

Hopping on right side- pain

Single hop test

Heel drops- pain on right

Markels sign