Lecture Notes on Hypertension, Diabetes, Amputations, Geriatrics, Burns, and Hand Injuries

Flashcards covering key concepts from lecture notes on hypertension, diabetes, amputations, geriatrics, burns, and hand injuries

What is considered normal blood pressure (BP) in mmHg?

Normal BP is 120/80 mmHg.

What is the definition of hypertension based on systolic and diastolic blood pressure readings?

Hypertension is defined as a systolic BP (SBP) of ≥ 140 mmHg or a diastolic BP (DBP) of ≥ 90 mmHg, or both.

What percentage of hypertension cases are classified as 'essential hypertension'?

90% of hypertension cases are 'essential hypertension' (no known cause).

List at least three risk factors or causes associated with hypertension.

Family history of hypertension, ethnic groups (black African population), age (older people), gender (male > female), smoking, obesity, unhealthy diet, chronic alcohol abuse, physical inactivity, stress, pregnancy (pre-eclampsia), diabetes, kidney/heart disease/CVA history, hyper/hypothyroidism, certain medications, ↓ Erythropoietin (EPO).

List at least three common signs and symptoms of hypertension.

Fatigue, blurred vision, morning headache, facial flushing, dizziness, confusion, ear noise, nosebleed, nausea/vomiting, swelling legs/ankles, chest pain, respiratory distress, blood in urine, irregular heartbeat.

What is a potential consequence of atherosclerosis resulting from hypertension?

CVA/Stroke: Arteries to brain blocked or damage to blood vessels.

How does hypertension contribute to organ damage, specifically affecting the kidneys?

Damaged blood vessels in kidneys lead to decreased or blocked blood flow, starving the organ of blood, O2, and nutrients.

What condition may arise when sufficient blood supply cannot reach the heart due to hypertension?

Angina (chest pain), potentially leading to heart attacks or failure.

Define Neuropathy and its relation to hypertension.

Microvascular injury causing damage to small blood vessels that supply nerves, which leads to weakness and/or paralysis.

What vision-related issue can arise from damaged blood vessels in the eyes due to hypertension?

Retinopathy leading to vision changes due to damaged retina.

How does hypertension affect the heart muscle, and what can this lead to?

Hypertension causes the heart to pump harder, thickening the heart wall and potentially leading to coronary heart disease or congestive heart failure.

What breathing problems may occur due to hypertension and weakened heart function?

Dyspnoea (shortness of breath, SOB) and/or tachypnoea (↑ RR).

Describe how blood pressure is measured using a sphygmomanometer and provide key points for accurate measurement.

Patient seated with back support, feet flat, arms bared and supported at heart level, resting 5 minutes before readings. Avoid stimulants 30 minutes prior. Cuff size important, bladder should circle at least 80% of arm. Measure both arms initially; use the arm with the highest reading thereafter. Take two or more readings, separated by 2 minutes.

Name at least two non-pharmacological management strategies for hypertension.

Dietary changes (less salt, limited fat, plant oils), limiting alcohol intake, stop smoking , exercise (30 min, 3x/week).

Describe the action of diuretics in managing hypertension.

Increases sodium (salt) and water excretion, decreasing fluid volume in bloodstream and lowering blood pressure.

What is the main side effect of diuretics, and what dietary advice should be given to patients taking them?

Increased frequency of urination and increased excretion of potassium. Encourage eating potassium-rich foods like bananas or taking a potassium supplement.

How do beta-blockers lower blood pressure, and what are potential side effects?

Decreases the vigor of heart’s contractions, lowering BP. Potential side effects include excessively slowed heart rate and worsening heart failure.

What is the mechanism of action of calcium channel blockers in hypertension management?

Lowers BP by decreasing the force with which blood is pumped through arteries and dilates arteries, decreasing resistance to blood flow.

How do ACE inhibitors work to manage hypertension, and what is a potential side effect?

Dilates arteries, decreasing resistance to blood flow and lowering BP. Potential side effect is chronic non-productive coughing. Rarely can cause sudden swelling of lips, face, and cheek areas in an allergic reaction.

Define Diabetes Mellitus

Diseases where high blood glucose levels are due to defects in insulin secretion and action, characterized by impaired carbohydrate, fat and protein metabolism.

What are the normal levels of glucose in blood?

3,3 – 5,9 mmol/ℓ

What are common chronic illnesses associated with diabetes?

Coronary heart disease, Peripheral vascular disease, Cerebrovascular disease, Retinopathy, Neuropathy, Nephropathy, Gastro-intestinal paresis.

What is Type 1 Diabetes?

Condition in which the pancreas ceases to produce insulin, a chemical messenger (hormone) which lowers blood glucose. Results in hyperglycaemia (high blood glucose levels).

What are some signs and symptoms of Type 1 Diabetes?

People < 30 years, Polyuria, Polydipsia, Polyphagia, Unexplained weight loss, Tiredness, Younger in age and slim build, Lack of family history of diabetes, ketones in urine & *positive tests for antibodies against enzymes in pancreas.

What is a major complication of Type 1 Diabetes?

Diabetic ketoacidosis (DKA): Results from an acute lack of insulin = high levels of glucose (hyperglycaemia)

What are signs and Symptoms of Diabetic ketoacidosis (DKA)?

ketones in urine, Abdominal pain, Warm dry skin, Fruity smelling breath, Nausea, Vomiting, Laboured breathing (Kussmaul respiration), Drowsiness, loss of consciousness

How do you treat Type 1 Diabetes?

Subcutaneous administration of insulin for life, Dietary control (carbohydrate tracking), Pancreas and kidney transplants as last resort.

What is Type 2 Diabetes?

Insulin resistance is the main metabolic abnormality leading to development of Type 2 diabetes. Caused by obesity.

What are the 3 stages in development of Type 2 DM ?

Insulin resistance, eventually pancreas unable to produce enough insulin to compensate for insulin resistance. = impaired glucose tolerance, eventually less insulin is produced as the disease progresses.

How is Type 2 diabtes Daignosed?

Usually older than 30 years, Overweight or obese, Physically inactive, Family history of diabetes mellitus, Polyuria, Polydipsia, Loss of weight, Fatigue, Poor wound healing, Greater susceptibility to illness, Fasting blood glucose > 6,7 mmol/ℓ on two occasions, Random blood glucose > 10 mmol/ℓ, Oral glucose tolerance test > 11 mmol/ℓ 2 hours later

How is Type 2 Diabetes treated?

LIFESTYLE CHANGE, weight loss, no smoking, exercise programme and low-fat diet low. Oral hypoglycemic medication.

List some Dangers of Hypoglycemia.

May precipitate strokes or heart attacks if artherosclerosis present.

What are some sign and symptoms of Hypoglycemia?

hunger, irritability, headache, shakiness, sweating, altered neurologic status ranging from drowsiness to unconsciousness, convulsions

How do you cope with Acute Illness?

Notify doctor if unable to retain food and fluids for 4 hours or more., Check blood glucose and urine ketone levels, every 2-4 hours, Consume 10-15 gram carbohydrate every 1- 2 hours. Vomiting, diarrhea or fever = liquids every 15 – 30 minutes to prevent dehydration, replace electrolytes and provide energy.

What are some causes for Amputations?

Peripheral vascular disease, Diabetes mellitus, Tumours / cancer, Leprosy, Trauma, Congenital deformities

What are Esquenazi’s 9 phases of amputation recovery?

Pre-operative, Amputation surgery, Acute post- surgical, Pre-prosthetic training, Prosthetic prescription, Prosthetic training, Community integration, Vocational rehabilitation, Follow-up

What is initial management for amputation?

Pre-op counselling, education, prosthetics, cardiovasc conditioning. Advice of stump positioning in bed. Reduce / prevent oedema of residual limb. Bed exercises: ROM, Strengthening and stretching

List some Prevention of complications of amp surgery.

Wound infection, Delayed wound healing, Protruding bone, Neuromas, Contractures, Falling.

What are some Complications of prosthetic use?

Stump skin breakdown, Educate caregiver / patient stump lubrication / hygiene / scar mobilisation, Skin ulcers due to socket friction / sweating, Stump oedema,Phantom limb pain.

List some post operative management for amputations.

Prevention of hip and knee flexion. Strengthening of hip extensors and abductors. Mobilising patient. Stump conditioning for prosthetic fitting.Pain management

List factors for Psychological adjustment/treatment regarding amputations.

Grieving process ,Family , Psychological counselling and medication

What are the purposes of a Multidisciplinary team for amputations?

to perform Surgeon, medical care with Physician, post op care / dressing with Nursing staff, counselling with Psychologist, rehabilitation with Physio, with Prosthetist, home and work environment with OT

List the K-levels for prosthetic rehabilitation?

K 0, K 1, K 2, K 3, K 4

List both Subjective and Objective Assessments of person with a lower limb amputation.

Subjective; What is different?, Objective; UL muscle strength, Sitting balance

What are some treatment techniques for amputations?

Oedema massage, Scar massage , Skin desensitization , Mirror box therapy for phantom pain

What is the definition of Geriatrics?

specialty that focuses on elderly health care (>75 y.o.). promote health by preventing and treating diseases and disabilities in older adults.

What are some Significant diseases in elderly?

Dementia / Alzheimer’s disease, Delirium , Arthritis, Osteoporosis, Rheumatoid Arthritis, Parkinson’s disease, Atherosclerosis, Heart Disease, High Blood Pressure, High Cholesterol

What are some Major impairments in elderly?

Joint disorders, Impaired hearing, Impaired vision, Malnutrition, Incontinence, Impaired intellect/memory, increase complexity, Depression

What are the three dimension that geriatrics should be seen?

Psychologically, old age dementia; Socially, living conditions, poverty, the community; Biologically, physiological changes and ↓ in function.

What are some aspects that should be addressed during geriatric rehabilitation?

Functional ROM, Musculoskeletal rehabilitation, Cardiopulmonary rehabilitation, Functional rehabilitation / ADLs

What are primary, Secondary, and Tertiary prevention for geriatrics?

Primary: Promote a healthy lifestyle, Secondary: Early detection of a disease, Tertiary: Correct treatment when a person has lost function: provide rehabilitation.

Define Falls

Some part of person comes to rest on the ground / lower level (below waist). Unexpected and unintentional, Circumstances not such that a fit person would have fallen

What are some Reasons for falling?

Chronic predisposing intrinsic factors --- diseases, Situational factors --- CVA / stress, Intrinsic + extrinsic factors --- disease + slippery floor, Activity engaged --- stone / uneven ground walking

What are the classifications of fallers?

At risk, Occasional, Intermittent, Recurrent

What are the goals of physio for geriatrics?

Improve ability to withstand threats to balance, Improve safety of environment, Prevent suffering consequences of a long lie post fall, Restore confidence in ability to move abut safely + effectively in environmt

What is a Burn?

Injury to skin and underlying structures caused by heat, corrosive chemical action, or physical agents (electricity) leading to destruction of tissue.

What are the Types of burns?

Superficial, Deep, Thermal, Chemical, Electrical, Radiation

What is the function of the skin?

Regulation of body temp, Protection of body integrity, Excretion, Vitamin D synthesis, Immunity, Secretion of oils that lubricate the skin

What are the phases of Healing of wound?

Inflammatory phase, Fibroblastic phase, Remodelling phase

What is the Immediate first aid for burns?

Remove cause of burn, Apply running water for min 30 min, Roll on ground or in blanket, Burning clothes, Clear airway

What are the Signs and symptoms of a Superficial burn?

1st degree – epidermis only, Can have blistering.Red, oedematous, and painful, May have peeling within 2-3 days. Spontaneous healing within 5-10 days

What are the Signs and symptoms of a Superficial partial thickness burn?

2nd degree – damage to epidermis and upper layers of dermis, May have blistering.Red, oedematous, and painful Sensitive to light touch.Heals within 7-10 days. After healing skin has slight colour change

What are the Signs and symptoms of a Deep partial thickness burn?

2nd and 3rd degree destruction of epidermis and most of dermis. Hair follicles and sweat glands spared. Marble white appearance and oedematous.Healing may occur spontaneously skin graft if not healed by day 21

What are the Signs and symptoms of a Full thickness burn?

3rd to 4th degree all layers of epidermis, dermis, and skin appendages. May affect fascia, muscle, and bone. No squamous epithelium remaining, In acute stage area is painless and insensitive, Always requires grafting

What is involved with post burn Airway obstruction?

Patient will suffer from resp distress, pulmonary oedema, and pneumonia., Can damage to skin in oropharynx – oedema and airway obstruction may require intubation Signs = lips and mouth burned, hoarse voice

What are common General post burn complications?

Swelling, Sepsis, Ischaemia, Scarring of skin, tendons, or joints, contracture

List some points form General assessment.

Date of burn, Any first aid, Type of burn, Size of burn, Depth of burn, Age of patient Area of burn, Physio role and assessment

What is involved in Wound infection control for burns?

Strict hand washing before and after handling, Sterile procedures: wound care daily with bioscrub, removal of dead tissue, dressings bi-daily, Topical antimicrobial creams and sterile moist gauze, Isolation and barrier nursing, Early nutritional support, Antibiotics where needed

Name the two categories for Surgical management of burns.

Surficial and partial thickness burns and Full thickness burns

Describe the factors needed for graft to take.

No mechanical trauma and haematoma formation, Adequate excision of necrotic tissue, Adequate circulation

List steps for grafting priorities.

Large areas, Hands, face, neck, Skin over joints

What are some Aims of Burn treatment and Physio role and objective Assessment methods?

Aims of Rx: management of resp complications and oedema. Objective: Position and posture, Wounds and dressings, Inhalation burn – chest assessment.

List Methods of treatment for burn care.

Chest physio, Correct positioning and splinting,Exercise programme, Circulatory exercises

What is the definition of Hand Anatomy?

Skin – dorsal and palmar & nail, Fascia and Retinacula, Articular anatomy – bones; finger and wrist joints, Neurovascular supply, Muscles and tendons

Describe General Management (Holistic!!) for Hand injures.

Pre- operatively-Stabilization of the patient Check for infection. If SURGERY is required-Referral to Work Assessment Unit for employment PT provides necessary splinting.

List Equipment for a Hand Assessment.

Tape measure, Finger goniometer, Normal goniometer for wrist and elbow, Squeeze measurer, Pin, Hot and cold test tubes, Variety of objects to pick up

Describe types of a Hand Assessment.。

Posture, Swelling, Skin condition, Wound. Muscle wasting, Deformities + contractures, Active ROM, Passive ROM, functional test, muscle power

Describe Education regarding Hand injures.

pre-cautions and contra-indications of exercises; HEP Functional activities

Describe the injury Carpal Tunnel Syndrome.

Compression of the median nerve, Causes: fluid retention in pregnancy; overuse

Describe the treatment for Carpal Tunnel Syndrome.

First try steroid injection to ↓ inflammation and swelling and resting splint for two weeks.Surgery

Describe the injury De Quervains Tendonitis.

Abductors and extensors of thumb become stuck in sheath. Causes: Overuse/ ergonomics

Describe the treatment for De Quervains Tendonitis.

First try steroid injection to ↓ inflammation and swelling and a dorsal thumb splint for two weeks. Surgery

Relate what needs to be treated forCrushed hands.

Vigorous Rx is needed, Requires emergency surgery = FASCIOTOMY for decompression to prevent infection

Describe the 3 sources of nutrition for Tendon.

The proximal palmar vessels at the muscle-tendon junction, The vinculum longum and vincula brevia, The distal bony tendinous insertion Each tendon has a longitudinally running chief artery

What are the Postoperative Management aims for Flexiton Tendons.

minimize joint stiffness, minimize adhesions. Varies from unit to unit, Management ranges from conservative . Specific instruction rests with attending hand surgeon site of repair.

Describe treatment from Day 1 - 3 to Day 3 - week 2 for Flexiton Tendons.

Day 1-3 - oedema = cold therapy With special attention to internal rotation, Hand in sling while in bed. Day3- week 2 - Exercises carried out twice daily Wrist in neutral, MCP joints held in 90 degrees flexion and Passive flexion performed within limits of pain .

Describe treatment from Week 2 - 3 to Week 3 - 4 for Flexiton Tendons.

Week 2 - 3, Sutures removed on day 14. Warm water bath prior to treatment to cleanse wound. Passive flexion and active resisted IP extension exercises are maintained on a basis of 10-15 movements 2-hourly. Week 3 - 4 Gentle active wrist flexion exercises commenced. Active stabilised PIP and DIP flexion exercises begun to ensure specific glide of FDS and flexor digitorum profundus with 10-15 glides per tendon 2-hourlyfollowed by gross gentle flexion.

Describe phases for treatment from Week 4 - 6 to Week 6 - 8 for Flexiton Tendons.

Week 4- 6 Full digital extension gained gradually without tension on repair. Un-resisted active wrist extension commenced, initially with fingers flexed, End of 5th week gentle resistance applied to stabilised PIP and IP flexion exercises. Week 6 - 8 Protective splint used for travelling and sleeping until 8th week In , gentle slow flexion against resistance of band adjunct to therapy and splint worn for 2 hours on and 2 hours off during day, and all night.

Describe phases for treatment from Week 8 to 12 for Flexiton Tendons.

Splint discarded,except in schoolchildren. Resisted exercises and activities upgraded Pinch and power grip strengths recorded in last few weeks of treatment to assess progress. .Stabilised flexion exercises maintained for months following discharge from therapy.

Describe types of Extensor tendons.

tendons are para-tendon tendons and in loose areolar tissue in the dorsum of the hand. and thin and flat horizontal mattress sutures are used

Describe a scenario for Zones of extensor tendon injury and surgery: Zone 1

Injuries to extensor tendon over DIP joint. Closed injuries treated by dorsal / volar finger ext splint for 6 weeks Open wounds treated by repair , Oedema in distal part of digit common after repair. Post-operative - Active PIP flexion exercises are started together with, Sutures are removed meanwhile. . Active DIP flexion and intrinsic extension exercises started and Splin

Describe a scenario for Zones of extensor tendon injury and surgery: Zone 2

Between level of MCP joints and is Closed / open injuries over PIP joint. Suspected closed injuries of central slip treated with dorsal finger extension splint over PIP joint, leaving DIP joint free.Early DIP exercises. Post-operative - If significant oedema, finger immobilised in splint in POSI.PIP joint held in full extension and active DIP flexion exercises are practised.

Describe a scenario for Zones of extensor tendon injury and surgery: Zone 3

Between level of MCP joints. Closed injuries of sagittal hood system occur. requiring surgery and common complications:. 6 Splint, post-operative active range.

Describe types of Burnt Hands.

Most commonly due to heat and may be: frictional, electrical, chemical and radiation burns

List the three Pathological classifications (based on depth of injury) on a burnt hand.

Superficial, deep and mixed

Elaborate on Pathophysiology of a burnt hand.

Hand has relatively large surface area = rapid heat gain in dermal and subdermal layers, congestion and oedema = damage to skin , infection and fibrosis.

Describe complications for a burnt hand.

Swelling, Sepsis, Ischaemia,

Summarize Treatment methods and measures for superficial burns.

allows patient to exercise and use hand during day for light self-care - warm Lux baths Hand is splinted in the POSI position Oedema -Encourage early functional use,adaptation.Once skin has epithelialized - no open areas - new skin is fragile - lubricate it, protect skin from friction

Outline Treatment for deep and/or mixed burns.

deep and/or mixed burns require excision of devitalized tissue - skin grafted, deformity specific to deep dorsal burns. , active exercises, gross flexion, extensor tendon damage, volare or dorsal - healing = soft tissue tightness

List some Equipment used for REHABILITATION ACTIVITIES with fine and gross motor activities

Power webDigi-flex hand exerciser