Therapy ED Other Systems NPTE

True or False

CFS (Chronic Fatigue Syndrome) is associated with hypothyroidism.

False

hyperthyroidism via increases hormone production (substance P, etc)

list the different types of immune cells

1. antigen (immunogen)

2. lymphocytes (T and B)

3. macrophages

4. cytokines

5. CD molecules (i.e. CD4 helper cells)

6. major histocompatibility complex (MHC) membrane molecule

CALM CD-M

(fully developed at birth) Primary central gland of the immune system located behind the sternum and above the heart

thymus

S&S of

AIDS-related complex (ARC),

Precurser to full-blown AIDS

Recurrent fever

chills

night sweats

swollen lymph glands

loss of appetite

weight loss

diarrhea

persistent fatigue

infections

apathy

depression.

Febrile S&S & GI S&S

HIV-AIDS symptoms (middle to late stage of disease)

All/some ARC symptoms and:

HA

Blurred vision

Dyspnea

Dry cough

Oral/skin lesions

Dysphagia

Dementia

Seizures

Focal neurological signs

AIDS: Adverse effects of anti-viral therapy

Rash

Nausea

Headaches

Dizziness

Muscle pain

Weakness

Fatigue

Difficulty sleeping

With hepatotoxicity signs of CARPAL TUNNEL may be seen

Chronic Fatigue Syndrome (CFS): Major criteria (3 things)

1. New onset of persistent or relapsing fatigue

2. Must be present for at least 6 months

3. Does not resolve with rest and reduces daily activity by at least 50%

Exclusion of other chronic conditions

Chronic Fatigue Syndrome (CFS): Symptoms

1. Inability to recover from normal exercise

2. Low-grade fever or chills

3. Sore throat: Non-exudative pharyngitis

4. Lymph node pain and tenderness

5. Muscle weakness

6. Muscle discomfort or myalgia

7. Sleep disturbances (insomnia or hypersomnia)

8. Headaches

9. Migratory arthralgias without joint swelling or redness

10. Cognitive impairments: Photophobia, inability to concentrate, irritability, confusion

Treatment of Chronic Fatigue Syndrome

Examine exercise tolerance - may show fluctuations in HR, BP, orthostatic hypotension is common

If decondition - dyspnea with exercise

Modified fatigue impact scale

Treatment:

Reduce activities when fatigue is maximal - avoid overexertion

BEDREST CONTRAINDICATED other than for sleep

Graded ex program - short duration, gradually increasing intensity

Activity pacing, energy conservation

Address posture

Teach stress management

Support group

Fibromyalgia syndrome (FMS) and Sxs (what temperature intolerance?)

Chronic pain syndrome affecting muscles and soft tissues

SXS: Myalgia, generalized aching, persistent fatigue, sleep disturbances, generalized morning stiffness, trigger points

Visual problems, mental/physical fatigue, spasm, cold intolerance, headaches, irritable bladder or bowel, cognitive problems (impaired memory, decreased concentration), restless legs, atypical patterns of numbness and tingling (sensitivity amplification)

Women>men

PT Treatment for Fibromyalgia syndrome (FMS)

Pt typically demonstrates exercise intolerance

Daily exercise is important

Protection strategies to avoid overuse syndromes

Focus on aerobic training, mild-moderate intensities

Aquatic therapy ideal to decrease pain and increase cardiovascular conditioning and strength

stachylococcal infections

-localized bacterial infection that enters through the skin (wounds, ulcers, burns)

-spreads through the blood stream or lymphatic system to almost any body location

-infection produced suppurations (pus) and abscess

-can develop into antibiotic resistant strains

Medical management for staphylococcal infections

-antibiotic therapy

-drainage of abscesses

-skin infections that are untreated can become systemic; septic; lethal

Methicillin-resistant stachylococcal aureus (MRSA) - precautions

-MRSA resistant to all penicillins

-hospital patients with MRSA infections are isolated and standard mask-gown gloves precautions required

Which is acute liver inflammation that is mostly transmitted via fecal -oral route

HEP A

HEP B

HEP C

HEP D

HEP A (A =acute)

HEP B= chronic, transmitted bodily fluid via STD

HEP C = most common; transmitted bodily fluid via STD (no vaccine)

HEP A

Transmitted primarily through fecal-oral route or close personal contact

Contracted through contaminated food or water, infected food-handlers

Acute infection with flu-like symptoms, does not progress to chronic disease or cirrhosis. Pts usually recover in 6-10 weeks.

HEP B

Transmission from blood, body fluids or body tissues

Rx: Hepatitis immunoglobulin (HBIG) for unvaccinated pt within 24 hrs of exposure. Pt should then receive vaccination series.

HEP C

Transmission from blood, body fluids or body tissues

One of the primary causes of chronic liver disease and eventual liver failure. Accounts for 90% of hepatitis post transfusion.

No vaccine

Tuberculosis (TB) - signs & sxs, precautions

Airborn infection

Most commonly affects respiratory system

Sxs: Fatigue, low-grade fever, night sweats, anorexia, weight loss

-Cough, rales, dyspnea

Respiratory droplets or sputum - use tissues to cover nose/mouth when coughing/sneezing; disposable containers for sputum and tissues

If a pt is in Shock should he/she be placed in semi fowler/reclining position or supine/trendelenburg position?

Shock = Inadequate blood flow to body tissues

Associated with hypotension, inadequate CO, changes in peripheral blood flow and resistance

Vital functions must be carefully monitored and restored as quickly as possible

Patient should be placed supine or in a modified Trendelenburg position to aid venous return

List the types of hematological disorders

1. Anemia

2. Sickle cell disease

3. Hemophilia

Anemia signs/sxs

Fatigue

weakness

dyspnea on exertion

yellow skin, tachycardia, bleeding of the gums

Severe: hypoxic damage to the liver and kidneys

What are the signs and symptoms of a sickle cell anemia crisis?

-Acute abdominal pain from visceral hypoxia

- painful swelling of soft tissues of the hands and feet

-persistent headache dizziness confusion

-nystagmus, coughing

What PT modality is contraindicated for sickle cell disease tx?

Cold is contraindicated because it increases vasoconstriction

Cancer: Malignant tumor: Connective tissues

General: Sarcoma

Blood vessels: Hemangiosarcoma

Bone: Osteosarcoma

Fat: Liposarcoma

SMC: Leiomyosarcoma

Fibroblasts: Fibrosarcoma

Originates in connective and mesodermal tissues (muscle, bone, fat)

Cancer: Malignant tumor: Hematopietic tissues (4)

What is Leukemia?

What is Myelodysplasia?

What is polycythemia?

What is myeloma?

Myleo = marrow

Leukemia: Blood/bone marrow, abnormal increase in immature cells (usually leukocytes), crowding, unable to make healthy cells

Myelodysplasia: Group of marrow diseases. Poorly formed/dysfunctional blood cells, underproduction.

polycythemia: Increased cellular proliferation of one or more cell types, increased fibrous marrow tissue that an result in scarring and underproduction of cells.

Multiple myeloma: Cancer of plasma cells in marrow - increased growth, tumor, decreased RBCs/WBCs/platelets

Cancer: Malignant tumor: Staging

What does T stand for ?

What does N stand for ?

What does M stand for ?

Primary tumor (T)

Regional lymph node involvement (N)

Metastasis (M)

Numbers used to denote extent (stage 0-IV)

Cancer Stages (0-4)

stage 0 = early malignancy in layer of cells

1 = Limited to tissue origin (no metastasis)

2 = spread to adjacent tissue (maybe metastasis)

3 = likelihood of lymph metastasis

4 = bones and other organs

Cancer: Radiation therapy adverse effects

Radiation sickness, immunosupression, fibrosis, burns, delayed wounds healing, edema, hair loss, CNS effects.

Cancer pain syndrome

Nerve/nerve root compression

Ischemic response to blockage of blood supply

Bone pain

Mod-severe pain may be accompanied by tachycardia, HTN, tachypnea, nausea, vomiting

Pain at side distal to initial site may suggest metastasis

Iatrogenic pain may result from surgery, radiation or chemo

Adverse side-effects of CA treatment

MSK symptoms

Muscle atrophy and weakness (high steroid doses in many chemo protocols)

Weakness from disuse/tumor compression.invasion

ROM deficits (radiation)

Hematological symptoms

Decreased WBCs (leukopenia), increased susceptability to infection

Platelet suppression (thrombocytopenia) increased bleeding

RBC supression (anemia) diminished aerobic capacity

Cancer: PT precautions- low platelet counts (<20,000), bony metastases, osteoporosis

AROM, ADL only

Weight bearing may be restricted - provide aids/orthoses

High risk of vertebral/other compression #'s - light ex only

Cancer: Thermal agent contraindications

Do not use:

Directly over tumor

Over dysvascular tissue

Over tissue exposed to radiation therapy

Increased bleeding/hemorrhage (corticosteroids)

Cancer: Cryotherapy red flags

Do not use:

Insensitive to cold

Delayed wound healing

Dysvascular tissue

Tissue exposed to radiation therapy

Cancer: Hydrotherapy with agitation red flags

Do not use:

Dysvascular tissue

Tissue exposed to radiation therapy

Decreased temp sensitivity

Pain in affected area

Areas of increased bleedingg/hemorrhage/open wounds

Risk of cross infection is high with immunosupressed pts

Early signs of pancreatic cancer

vague during the initial stages of the disease which often results in delayed diagnosis

common symptoms include weight-loss, jaundice and epigastric pain that can radiate to thoracic region

Cancer: describe basal cell carcinoma vs squamous cell

Basal Cell

- Raised

-Low growing form of skin cancer that rarely metastasizes

-most common form of skin cancer

-prognosis is good

SquamousCell

-Flat

-Uneven edges

-malignant

-various colors (dark)

Function of GI gland organs

Gall bladder (RU):

Liver (RU):

Pancreas (LU/RU):

Gall bladder (RU): Stores and releases bile into the duodenum

Liver (RU): Produces bile, assists with RBC and vit K production, regulates serum level of carbs, proteins and fats

Pancreas (LU/RU): Exocrine secretes bicarbonate and digestive enzymes into duodenum; Endocrine secretes insulin, glucagon and other hormones into blood (Balance PH)

Esophageal varices

-Abnormal enlargement of veins in the lower part of the esophagus (most often follows serious liver disease)

-esophageal varices develop when blood flow to liver is obstructed by scar tissue and blood flows into smaller blood vessels that are not designed to carry large volumes of blood

Pain referral pattern for the liver, diaphragm, pericardium

Shoulder

Pain referral pattern - Gall bladder, stomach, pancreas, small intestine

Mid-back

Scapular region

Pain referral patterns - Colon, appendix, pelvic viscera

Pelvis

Low back

Sacrum (Colon)

GERD - PT

Positional changes from full supine to modified, more upright positions is indicated

Recumbency (lying down) will induce symptoms

Left-sidelying is preferred (R sidelying may promote acid flowing into esophagus)

VALSALVA CONTRAINDICATED

GI disorders: Peptic ulcer

Disruption/errosion in GI mucosa. Imbalance between protective mechanisms of the stomach and the secretion of acids within the stomach. Many ulcers are caused by H. Pylori and chronic NSAID use. Irritants which increase risk include alcohol, stress, particular meds, foods and smoking.

Complications: Hemorrhage, perforation, obstruction (secondary to scarring), malignancy.

ULCER AT POSTERIOR WALL CAN PRESENT AS RADIATING BACK PAIN/RIGHT SHOULDER PAIN

GI disorders: IBS symptoms

Persistent/recurrent abdo pain relieved by defecation

Constipation/diarrhea, vomiting

Bloating

Abdo cramps

Flatulence

Nausea

Anorexia

Changes in form of stool, passing of mucus in stool

IBS rehab considerations

Physical activity assists bowel function and can relieve stress

Breathing techniques will assist in stress reduction and with breath-holding patterns

Biofeedback training may be beneficial

GI disorders: describe Diverticulitis symptoms

Inflamed/infected diverticuli

Pain and cramping in lower left quadrant (primary symptom), Nausea, Vomiting, Slight fever, Elevated WBC, constipation, chills, vomiting

Complications: Bleeding, infections, intestinal blockage, abscess, perforation, tears in colon, fistulas, peritonitis

GI disorders: Appendicitis symptoms

Abrupt onset pain in epigastric/periumbilical area

Increases in intensity over time

Rebound tenderness (Blumberg's sign)

Point tenderness at McBurney's point (site of the appendix located 1.5-2" above ASIS in right lower quadrant

GI disorders: Peritonitis signs and Symptoms

Inflammation of inner lining of stomach

Abdominal distension

Severe abdominal pain

Rigidity from reflex guarding

Rebound tenderness

Decreased/absent bowel sounds

Nausea and vomiting

Tachycardia

Elevated WBC count

Electrolyte imbalance

Fever

Hypotension

Peritonitis is a serious medical condition that can lead to toxemia and shock, circulatory failure, respiratory distress. Requires immediate medical attention

-What is cholecystitis?

-What are Cholelithiasis?

What type of diet is associate with Cholelithiasis?

cholecystitis a: refers to inflammation of the gallbladder that may be acute or chronic

cholelithiasis: are otherwise known as gallstones, -gallstones develop from hypomobility of the gallbladder supersaturation of the bile with cholesterol or crystal formation from BiliRubin salts

High fat Treatment: low-fat diet can decrease gallbladder stimulation

Genitourinary system: describe muscles of the pelvic diaphragm

Levator ani: pubococcygeus, puborectalis, iliococcygeus, and coccygeus

genitourinary system: Symptoms of pelvic floor weakness

Does pelvic floor weakness cause pain to radiate down the anterior or posterior thigh?

Pelvic pain (perivaginal, perirectal, lower abdo quadrant)

Urinary incontinence

Pain on sexual intercourse

Can radiate down posterior thigh

Post-cesarean section PT

TENS (electrodes parallel to incision)

Prevent post-op pulmonary complications (assist breathing, coughing)

Exercises:

Gentle ab exercises - incisional support with pillow

Pelvic floor exercises

Postural exercises (precautions about heavy lifting for 4-6 weeks)

Ambulation

Prevent incisional adhesions (friction massage)

Genitourinary system: uterus: describe endometriosis

Endometrial growth that occurs at the uterosacral ligament is most common

-moderate to severe lower abdominal pelvic or low back pain before or during menstruation

Genitourinary system: uterus: describe uterine prolapse

-The dissent of the uterus and cervix into the vagina

-S&S: pelvic pressure that increases with exertion frequency of urination discomfort and vaginal dryness

-pelvic floor muscle training using biofeedback Keagle exercises core strengthening exercises and lifestyle modifications

Genitourinary system: What is the function of the Kidney?

Regulate:

pH

Fluid composition

Mineral and water balance

BP (via renin-angiotensin-aldosterone & salt/water regulation)

Metabolic waste elimination

Bone metabolic function (via PO4- regulation & vit D activation)

RBC production in marrow (via erythropoietin production)

metabolic system: Metabolic acidosis causes, S&S, Rx

Acid gain/bicarbonate loss

Causes - diabetic/alcoholic ketoacidosis, renal insufficiency/failure, severe diarrhea, lactic acidosis, starvation,

S&Sxs: Compensatory hyperventilation (decrease CO2), Deep respirations, Weakness, Muscular twitching, Malaise, Nausea, Vomiting, Diarrhea, Headache, Dry skin and mucous membranes, Poor skin turgor, arrhythmias. Left untreated can induce coma and death

Rx: Manage underlying cause, correct any coexisting electrolyte imbalances, administer NaCO3

metabolic system: Metabolic alkalosis causes, S&S, Rx (Think too many metabolic salts so lost via diarrhea, vomiting, diuretics, etc)

Causes: Excess vomiting, excess diuretics, hypokalemia, peptic ulcer, excessive intake of antacids, nasogastric suctioning

Compensatory hypoventilation, Depressed respirations, Dysrhthymias, Prolonged vomiting, Diarrhea, Weakness, nausea, Muscle fasciculations/cramping, neuromuscular excitability, paresthesias, Irritability, Agitation, confusion, Convulsions, coma, death

Rx: Manage underlying cause, correct coexisting electrolye imbalances, administer potassium chloride

Respiratory acidosis

(CO2 retention, impaired alveolar ventilation)

Causes: hypoventilation, drugs/over-sedation, chronic pulmonary disease, hypermetabolism (sepsis, burns)

Dyspnea

Hyperventilation

Cyanosis

Restlessness

Headache

Respiratory alkalosis causes S&S

(diminished CO2, alveolar hyperventilation)

Causes: Anxiety attack with hyperventilation, hypoxia (emphysema, pneumonia), impaired lung expansion, CHF, pulmonary embolism, diffuse liver or CNS disease, salicylate poisoning, extreme stress (stimulation of respiratory center)

Tachypnea

Dizziness

Anxiety

Difficulty concentrating

Numbness and tingling

Blurred vision

Diaphoresis

Muscle cramps

Twitching/tetany

Weakness

Arrythmias

Convulsions

metabolic system: Renal failure

Usually occurs due to DM or HTN

Acute: Sudden loss of renal function with resulting elevation in BUN and creatinine, oliguria, hyperkalemia, Na retention

Chronic

Progressive loss of kidney function leading to end-stage failure

DM, severe HTN, SLE and others

metabolic system: Renal failure S&S

Nausea, vomiting, lethargy, weakness, hiccups, anorexia, GI ulceration, sleep disorders, headache, peripheral neuropathy, anemia, pruritus, osteomalacia, ecchymosis, HTN, dyspnea on exertion, HF, dizziness, pulmonary/peripheral edema, anxiety, inability to concentrate, convulsions, seizures, coma.

Chronic pain: Ischemic leg pain, painful cramps

Muscle weakness: Peripheral neuropathy, cramping, restless legs

Skeletal: Osteomalacia, osteoporosis, bone pain, fracture

Skin: Pallor, ecchymosis, pruritis, dry skin

Anemia, tendency to bleed easily

Decreased endurance, functional losses

Autonomic nervous system dysfunction: decreased HR, BP, orthostatic hypotension

Adrenal cortex

Mineral corticosteroids vs Glucocorticoids vs Adrenal androgens

Mineral corticosteroids (aldosterone): Kidneys - Increases reabsorption of Na ions from kidneys into the blood, increases excretion of K ions by the kidney into the urine

Glucocorticoids (cortisole): GI system - Influences metabolism of food, anti-inflammatory effect in large amounts

Adrenal androgens (dehydroepiandrosterone, androstenedione): Ovaries/testes - Increases masculinization, promotes growth of pubic hair in males and females

Adrenal medulla

Epinephrine vs Norepinephrine

Epinephrine: Cardiovascular and metabolic systems - Increases heart rate, contractility, energy production, vasodilation in skeletal muscle

Norepinephrine: Cardiovascular and metabolic systems - Vasoconstriction in skin, organs and skeletal muscles

Thyroid

Triiodothyronine, Thyroxine: All tissues - Involved with normal cellular development, increases cellular metabolism

Calcitonin: Plasma - Increases Ca storage in bone, decreases blood Ca

Endocrine system: signs and symptoms of endocrine dysfunction

Neuromuscular: muscle weakness, myalgia, arthralgia stiffness, arthritis, muscle atrophy, and adhesive capsulitis

Systemic: growth dysfunction, skin pigmentation dysfunction, polyurea, increased vital signs, hair dysfunction, and nervousness or anxiety

Signs of low blood sugar

Rapid onset (minutes)

Glucose <60mg/dL

CNS changes: Labile, irritable, headache, blurred vision, slurred speech, decreased concentration, confusion, incoordination

Sympathetic changes: Diaphoresis, pallor, piloerection, tachycardia, heart palpitations, nervousness and irritability, weakness, shakiness/trembling, hunger

Hypoglycemic coma: Loss of consciousness that results from abnormally low blood sugar levels

IF PATIENT AWAKE GIVE SUGAR

IF UNRESPONSIVE CALL FOR HELP - IV GLUCOSE REQUIRED

Signs of high blood sugar.

What is the glucose level?

Gradual onset (days)

Glucose >250 mg/dL

Results from untreated DM

CNS changes: Dulled senses, confused, diminished reflexes, paresthesias

Fruity breath odor

Thirst/dehydration

Flushed

Nausea/vomiting

Abdo pain

Deep, rapid respirations

Rapid, weak pulse

Hyperglycemic coma: Caused by hyperosmolarity of ECF and dehydration - can lead to death

Rehabilitation considerations for DM (when not to exercise)

ETT prior to exercise due increased cardiovascular risk

Do not inject short-acting insulin into exercising muscles or sites close to them

DO NOT EXERCISE:

-Without eating at least 2 hours before

-Uncontrolled glucose levels (>250mg/dl)

-Urine test positive for ketones

-Poorly controlled complications (cardio, HTN, retina, renal, neural)

Addison's disease

Adrenal disorder - hypofunctioning - decreased production of cortisol and aldosterone

Sxs -

1. Hypotension

2. Weakness

3. Anorexia

4. Weight loss

5. Altered pigmentation (bronze skin)

6. If left untreated, will result in shock and possible death

Hypoparathyroidism versus hyper parathyroidism

Parathyroid regulates calcium

Hyper: increased bone reabsorption hypercalcemia, gout, hypertension and significant renal damage, decrease neuromuscular irritability

Hypo: decreased bone reabsorption, hypocalcemia cardiac arrhythmias potential heart failure increase neuromuscular activity

Rehab for Thyroid Dysfunction

Are hot environment's tolerable?

NO!!

1. Recognize reduced exercise capacity and fatigue are typical

2. Avoid treatment that exacerbates symptoms

-hot aquatic, hot gym setting

3. Avoid Cardiovascular stress

-due to complications with graves disease and hypotension, goiter

4. Close monitoring of vital signs

Psychological disorders: Side effects of tricyclic antidepressants

Disturbed balance

Postural hypotension

Falls and fractures

Increased HR

Dysrhythmias

Ataxia

Seizures

Tay-Sachs Disease

Inherited Metabolic Disorder

At ~ 6 mos. pt will start to miss developmental milestone and will continue to deteriorate in motor and cognitive skills. Will develop significant mental retardation, paralysis and will usually die by age 5.

Currently no effective treatment

Wilson's disease

Defect in the body's ability to metabolize copper - copper accumulates in brain (esp the BG), liver, cornea, kidneys and other tissues.

Symptoms begin ~ 6 yrs: hepatitis, liver cirrhosis, athetoid movements, ataxic gait patterns, may be emotional/behavioral changes as copper accumulates. Over time there will be musculoskeletal deformities, pathological fractures, osteomalacia, muscle atrophy, contractors.

Osteomalacia

Bones become soft due to calcium or phosphorus deficiency

S&S: Vague presentation of aching, fatigue, weight loss. Myopathy & sensory polyneuropathy may also occur along with periarticular tenderness and pain, thoracic kyphosis deformity and bowing of the LLs. Pt may struggle with transfers and STS

Paget's disease

Excessive bone formation without structural integrity. Bone is enlarged and lacks strength

S&S: Musculo pain, bony deformity, vertigo, hearing loss, mental deterioration, increased CO leading to HF.

Describe hydrocolloids

-gel-formed polymers (carboxymethylcellulose, gelatin, pectin)

-film or foam adhesive

-does not attach to wound but anchors to the intact surrounding skin

-dressing absorbs excudate by swelling into a gel-like mass

-used for partial thickness wounds, full-thickness wounds, and granular or necrotic tissue

Describe hydrogels

-water and gel-forming materials such as glycerin

-commonly used on superficial and partial thickness wounds (abrasions, blisters,. pressure ulcers) that have MINIMAL DRAINAGE

Describe foam dressings

-hydrophilic polyurethane base that contacts the wound surface and a hydrophobic outer layer

-allows exudate to be absorbed into the foam through the hydrophilic layer

-most commonly available in sheets and pads with varying degrees of thickness

Describe transparent film

-thin membrane from transparent polyurethane with water-resistant adhesives.

-permeable to vapor and oxygen

-impermeable to bacteria and water

-highly elastic

-easy to visually inspect

-used for superficial and partial thickness wounds with minimal drainage

Describe gauze

-manufactured from yard or thread and are the most readily available dressing used in inpatient

-many shapes and sizes

-used for infected and non-infected wounds of any size

Describe alginates

-dressing derived from seaweed extraction specifically the calcium salt component of alginic acid.

-highly absorptive but highly permeable and non-occlusive

-used for partial and full thickness draining wounds such as pressure or venous insufficiency ulcers or infected wounds with EXCESSIVE DRAINAGE

Define occlusion

ability of a dressing to transmit moisture vapor or gases between a wound bed and the atmosphere

Splinting type for burns to the elbow

-gutter splint

-conforming splint

-three-point splint

-air splint

Hypokalemia

refers to abnormally low potassium levels in blood. This condition can be caused by vomiting, diarrhea, burns, uncontrolled DM, diuretic therapy and steroid therapy.

Hyperkalemia

Grave's disease

Excess secretion of thyroid hormone (hyperthyroidism).

Classic signs include difficulty eating, mild facial edema, and abnormal protrusion of eyes.

Other symptoms include heat intolerance, weight loss, nervousness, muscle weakness/fatigue, tremor and palpations.

Increased DTRs

Hypovolemic shock

Dehydration, pulse and respirations are increased; BP may decline. Restlessness, anxiety and confusion may all be present.

Caused by hemorrhage, vomiting, diarrhea

OCCURS IN: Addison's disease, burns, pancreatitis, peritonitis

Diabetic ketoacidosis

Production of excess ketones by the liver

S/S

-Altered GI: (anorexia, nausea, vomiting, abdominal pain),

-neural function (weakness, lethargy, malaise, confusion, stupor, coma, depression of vital functions)

-CV function (peripheral vasoildation, decreased HR, cardiac dysrhythmias, skin (warm and flushed); and increased rate and depth of respiration.

Cushing's syndrome

Adrenal disorder - TOO MUCH cortisol

Causes hyperglycemia, hypokalemia, HTN, muscle weakness and wasting.

S&S: Evolve over years and include hyperglycemia, round "moon face", weakness, acne, HTN obesity (fat pads on chest, abdomen, buffalo hump), depression, poor concentration, memory loss

Metabolic syndrome w/ multiple CV disease risk factors, initial exercise prescription should be

AKA DM

Moderate intensity (40-60%), exercise 30 min per day, most days of the week.

Inherited Metabolic Disorders: Phenylketonuria (amino acid metabolic disorders)

Autosomal recessive trait

Consists of mental retardation as well as behavioral and cognitive issues as a result of elevation of serum phenylalanine

Presents within a few months of birth

Shows signs of gait disturbances and hyperactivity

Parathyroid dysfunction

Hyper: Excessive levels of horomone production

leading to distribution of calcium, phosphate, and bone metabolism.

Symptoms: Renal stones, kidney damage, memory loss, bone deformity,

Hypo: Symptoms include hypocalcemia , neurological symptoms such as seizures, cognitive defects, muscle pain, cramps

Thyroid Dysfunction: Hypothyroidism - Signs & Symptoms

1. Fatigue

2. Weakness

3. Decreased Heart Rate

4. Weight Gain

5. Constipation

6. Delayed Puberty

7. Retarded Growth and Development

Thyroid Dysfunction - What is Hyperthyroidism?

Occurs when there are excessive levels of thyroid hormones in the bloodstream.

Hyperthyroidism - Signs & Symptoms

Think ^ metabolism - Grave's Disease

1. Increase in nervousness

2. Excessive sweating

3. Weight loss

4. Increase in blood pressure

5. Exophthalmos (bug eyes, eyes protrude)

6. Myopathy

7. Chronic peri-arthritis (frozen shoulder)

8. Enlarged thyroid gland

A physical therapist observes that a patient with end-stage renal disease has significant exercise intolerance. Which factor is the MOST likely cause of the exercise intolerance?

Anemia - kidneys no longer releasing EPO to stimulate RBC production (which carry O2)

Persons with end-stage renal disease have limitations to exercise due to reduced oxygen-carrying capacity associated with anemia.

A patient who has been receiving corticosteroids over the past 3 months is MOST likely to experience which side effects?

Increased risk of infection

The risk of infection is increased because cortisol or corticosteroids dampen the body's inflammatory response

Herpes Zoster

(shingles) Acute viral infection; painful vesicular eruptions on the skin following along the nerve pathways of underlying spinal or cranial nerves.

usually has a symptom distribution in the nerve root pattern