DnD 2 Exam 1 Study Guide

Body Function

Physiological functions of body system

Body Structure

Anatomical parts of the body such as organs, limbs, and their components

Activtity

Execution of a task or action by an individual (daily activities and changes in routine)

Communication

Delivering and receiving verbal and nonverbal communication

Mobility

Changing body position or location by transferring from one place to another

Participation

Involvement in everyday life situations; has 5 areas

5 areas of participation

Self care, domestic life, interpersonal interactions and relationships, major life areas (education, employment), and community & civic life

Areas of participation restriction

Environmental factors: natural/ built environment, supports & relationships, attitudes, services, systems, policies

Personal factors

MS (multiple sclerosis)

A neurological, autoimmune disease in which deterioration of myelin occurs

Epidemiology of MS

Age: 20-50

Gender: 3x more females than males

Race: most common in whites, not common in some populations

Difficult to diagnose due to different symptoms

MS Symptoms

Fatigue (most common), heat sensitivity, discomfort (numbness, tingling, sudden pain), visual difficulty (inflammation of optic nerve, double vision, vision loss, nystagmus), muscle weakness (spasticity and spasms), balance issues, dysphagia (swallowing), dysarthria (speaking), dysphonia (voice quality), cognitive issues (34-65%), loss of bowel and bladder control, sexual dysfunction

Central Nervous System (CNS)

Brain and spinal cord. The CNS is the body's processing centre. The brain controls most of the functions of the body, including awareness, movement, thinking, speech, and the 5 senses.

Myelin

Consists of lipids and proteins, nerve insulation, coats and protects axons in CNS & PNS, provide efficient impulse transmission, formed by oligodendrocytes

Demyelination

Loss of myelin with preservation of axons

Plaques

Multiple focal areas of myelin loss within the CNS

Exacerbation

Symptoms become worse for at least 24 hours, not due to infection or other cause

Relapse

Sudden deterioration after a period of improvement, slip back into former state

Remission

Symptoms disappear or lessen in intensity for an indefinite time

Causes of MS

Damage to brain and spinal cord, genetic predisposition, environmental, viral

Diagnosis of MS

Use of MRI to “rule out” other diseases, evoked potentials, lumbar puncture, blood tests

Clinically isolated syndrome

One of the four MS clinical courses. Newer MS category, single demyelinating attack, experience neurological symptoms that may or may not return later

Relapsing-Remitting

One of the four MS clinical courses. 85% of MS population, exacerbation followed by remission, symptoms subside or recovery to baseline, may have disease progression between attacks

Primary progressive

One of the four MS clinical courses. 15% of MS population, manifest in ppl 30-40, gradual but steady disease progression, no clear relapses or remissions

Secondary progressive

One of the four MS clinical courses. Evolves from relapsing-remitting over time (90% of people with R-R). Progressive course of disease in which symptoms gradually worsen. May or may not have relapses.

Treatment of MS

Drugs to stop exacerbations and to help maintain function. Ppl with R-R & PP able to work 25 years past onset, avoid hot temperatures, conserve energy

Exercise with MS

Non-fatiguing (can worsen symptoms), light resistance, maintain range of motion. Swimming in pool is good option.

PLISSIT Model

Used as framework for caregivers to provide assistance in order to treat sexual problems

Diabetes

Improper processing of sugar, high blood sugar disorder with defects in insulin secretion, insulin action of both, imbalance of supply and demand for insulin, and insidious as it affects every body system

Ductless gland

Mechanism of endocrine system. provide regulatory function, maintain homeostasis, secrete specific hormones, communication amongst the systems

Insulin

Mechanism of endocrine system. Produced by the beta cells of pancreatic islets, regulates carbohydrate metabolism

Glucagon

Mechanism of endocrine system. Produced by the pancreas alpha cells, stimulates liver to release glucose when levels are low

Types 1 Diabetes

Insulin dependent, autoimmune, stomach converts food to glucose, glucose enters bloodstream, pancreas produces little to no insulin, glucose unable to enter body efficiently

Type 2 Diabetes

Non-insulin dependent, insulin resistance, insulin is being produced but the insulin in the glucose is just hanging out in the bloodstream

Gestational Diabetes

Affects pregnant mother late in pregnancy, occurs in 5-7% of all pregnancies. Screening often conducted during pregnancy

Prediabetes

Higher than normal blood glucose level, doesn’t yet meet diabetes diagnosis, known as impaired glucose tolerance, fasting blood sugar

Normal

70-100 mg/dL

Above normal

>100 mg/dL

Fasting blood glucose

Nothing by mouth for 8 hours prior, usually first step before other testing, normal: 70-100 mg/dL

A1cTest

Measures average blood sugar level for past 2-3 months

Glucose Tolerance Test

Undergo fasting test and then drink sugary solution, 2 hours post have another blood test

Role of insulin in treatment management

Keep blood sugar levels under control

Treatments/lifestyle changes/management strategies of diabetes

Weight control, healthy nutrition, exercise, oral medications, work accommodations

Hyperglycemia

High glucose due to little insulin or insufficient use of insulin, high levels of sugar in urine, frequent urination, increased thirst

Hypoglycemia

Low blood sugar, fast heartbeat, confusion, hunger, shakiness, nervous, irritability, clammy

Systems/organs at risk from poor blood glucose control

Skin, teeth and gums, eyes, peripheral neuropathy, kidney disease, amputation

Complication of Diabetes

Blindness, end-stage renal disease, HTN/stroke, heart disease, non-traumatic amputation, peripheral neuropathy, erectile dysfunction, delayed skin healing

Epidemiology of HIV

~38 million people currently living with HIV, Sub-Sarahan Africa most affected by HIV and AIDS (61%), Gay and bisexual men (83%)

Key populations affected by HIV

Gay & bisexual men, heterosexuals, African Americans, Hispanic/latinos, South of U.S., Sub-Saharan Africa

Etiology

HIV impairs immune system cells leading to immunodeficiency, transmission through: bodily fluids, vaginal or anal intercourse, oral sex, sharing needles, passing virus from mother to fetus, accidental contamination with infected blood

Symptoms of HIV

Unexplained persistent fatigue, fever, chills, night sweats, unexplained weight loss, swollen lymph nodes, pink, red, purple, or brown blotches

Stage 1: Acute HIV infection

2-4 weeks of becoming infected, large viral load: infectious, flu-like symptoms OR may have no symptoms

Stage 2: Clinical latency - asymptomatic or chronic HIV infection, less likely

HIV is active but reproduces at low levels, clinical latency - may not have symptoms or feel sick, can transmit disease, at end of this phase if not taking meds, viral load increases while CD4 count decreases

Stage 3: Acquired immunodeficiency syndrome: viral load up, “opportunistic infections”

Last and most severe stage, ripe for opportunistic infections, opportunistic infections, can affect all body systems, pathogens can run amok, cause severe illness, occur when CD4 count is less than 200 cells per milliliter of blood. High viral load and infectious, no treatment means survival of ~3 years at the particular stage of disease

HIV Testing

Antibody tests, combination/fourth generation test, nucleic acid tests (NAT), rapid testing is expensive

ART changed disease from fatal to a chronic condition

Daily regimen, prevents HIV from multiplying, “undetectable viral load”, reduces risk of transmitting HIV, broadly neutralizing antibodies, PrEP

Short term effects of HIV

Fatigue, nausea, vomiting, diarrhea, headache, fever, muscle pain, occasional dizziness, insomnia

Long term effects of HIV

Kidney failure, liver damage, heart disease, diabetes/insulin resistance, hyperlipidemia, lipodystrophy, osteoporosis, peripheral neuropathy, depression suicidal thoughts

Prevention

Get tested, use condoms, limit sexual partners, get tested for STDS, don’t inject drugs

Harm reduction

Application of additional measures to reduce risk of harm on an inherently dangerous activity

Resistance in using approach

Diverting clinical resources, potentially reducing treatment incentive, encouraging

Epilepsy

A group underlying neurological condition causing disruption of electrical activity in the brain (changes in electrical system)

Focal/partial seizures

Type of seizure involved with smaller, localized areas of the brain

Simple focal

Type of seizure with subtle changes in sensation and emotions, twitching

Complex focal

Type of seizure with uncharacteristic repetitive movements such as twitching, mouth movement, walking in circle, actions that may seem purposeful, and other automatisms

Tonic

stiffening of muscles (back, legs, arms)

Atonic

loss of normal muscle tone, head drooping, may fall down, muscle relax

Clonic

jerking or shaking movements of muscles on both sides of the body

Myoclonic

short jerking movements in parts of the body

Automatisms

Actions performed without conscious thought or intention

Absence seizures

Rapid blinking, staring into space

Generalized tonic-clonic

Loss of consciousness, muscle rigidity, and muscle jerks, May cry out, fall to the ground, last for minutes, followed by confusion and fatigue

Difference between epilepsy & seizure

Epilepsy is a disorder of the brain characterized by repeated seizure, a seizure is sudden alteration of behavior due to a temporary change in the electrical functioning of the brain

Sudden Unexpected Death in Epilepsy (SUDEP)

Leading cause of death in those with uncontrolled seizures (prone position is major risk factor in people 40 and younger), similar mechanism to (SIDS), recovery position

Diagnosis of epiplepsy

Physical and neurological exam, bloodwork, EEG, MRI, CT, PET

Treatment of epilepsy

Ketogenic diet, vagus nerve stimulation, surgical intervention, medications (anti-convuslants & anti-epileptics) - may side effects especially with long term use

Possible participation restriction

Operating heavy machinery, piloting planes, various sports/recreational activities, driving a car

Huntington’s Disease

Progressive, genetic condition of central nervous system, HTT gene, Neurons in basal ganglia of brain deteriorate, systems develop between ages 30-50, leads to total disability and death after 15-20 years

Psychiatric symptoms of Huntington’s as well as physical

Irritability, depression, small involuntary movements, poor coordination, trouble learning, new info and making decisions, decline in thinking and reasoning, difficulty walking, speaking, & swallowing, behavioral and personality changes

Diagnosis of Huntington’s

Clinical findings, family history - confirmed by genetic testing via blood test

ALS (Amyotrophic lateral sclerosis)

Chronic disease affecting voluntary motor pathways of central nervous system, symptoms usually begin after 40, clinical course is rapidly progressive

Body function & structure affected by ALS

Voluntary motor pathways CNS affected, fasciculations (involuntary twitching of muscle fibers), onset mid to late adulthood, 2-5 years living after diagnosis for 50% of people, cause: genetic or environmental exposure

Symptoms of ALS

Muscle weakness, gait disturbance, fatigue, usually cognitive function, muscle weakness, fasciculations (involuntary contraction or twitching of muscle fibers), begins with muscle atrophy, gait abnormalities, arm function deficits, impaired speech & swallowing, respiratory muscle weakness, intellectual function are not affected

Functional disabilities and treatment of ALS

Gait difficulties, loss of arm muscle power, fatigue, rapidly becomes dependent on caregiver due to progression to complete loss of functional independence

Sporadic ALS

Type of ALS affecting both genders, all races, 95% of all cases, can affect people of any race, ethnicity, gender, most common form in the US, 90-95% of all cases

Familial ALS

Type of ALS occurring more than once in a family, genetic dominant inheritance, 50% chance offspring will inherit gene mutation, small number of cases in US (5-10%)

Guamian ALS

Type of ALS with a high incidence in Guam (50 to 100 times greater), possibly due to exposure to toxin from cycad nut

Secondary ALS

ALS symptoms associated with syphilis, hypoglycemia, plasma cell disorders

Assitive devices for ALS

Requires a variety of assistive devices to maintain posture and assist in function such as lower extremity braces, upper extremity splints, cane, walker, wheelchair

Treatment for ALS

Drug treatment to slow progression, but no cure

Neoplasm

New growth (tumor)

Metastasis

Spread of cancer from primary site to other areas

Carcinoma

Cancer of epithelial cells (skin, organ lining, glandular tissue)

Sarcoma

Cancer of bone, muscle, connective tissue

Lymphoma

Cancer of lymphatic system

Leukemia

Cancer of endothelial cells

Melanoma

Cancer of pigment producing cells of the skin

Carcinogen

Chemical or substances that may cause cancer

Mutation

Changes in the DNA by deletion, insertion, or rearrangement of genes

Primary site

Original place where cells mutated

Secondary site

Other areas that are impacted from the spread of the originally mutated cells