OT 524 Conditions Exam 1 (Weeks 1-4)

Acute Pain

Sudden response to trauma that resolves during tissue healing process-- systems protective response

Lasts less than 30 days

Chronic Pain

Uncontrollable, persistent and progressive pain

Lasts longer than 3 months

Referred Pain

Felt in an area other than its origin

Usually follows a specific pattern

Ex: heart attack felt in right arm

Central Neuropathic Pain

caused by lesion or dysfunction in brain or spinal cord

pain is difficult to describe

Nociceptive Pain

damage to superficial or deep tissue that elicits a body response through nociceptors (pain) receptors

Serves as a warning or a threat

Neuropathic pain

Damage to a nerve

felt as burning, stabbing, radiating, numbness, decreased pain & temperature, paresthesia

What is Down Syndome? What is the cause? (Etiology)

A chromosomal genetic disorder of Trisomy 21-- caused by an extra chromosome

Brain abnormalities seen in cerebellum, limbic system and cortex. Also involves extra brain cells which leads to a heavier brain

Signs and Symptoms of Down Syndrome

Signs from birth

- stereotypical facial features

- flat nasal bridge

- small mouth

- excessive skin at nape of neck

- single transverse palmar crease

Intellectual deficits, communication deficits, social deficits

50% will never develop speech or use it in a meaningful way

Repetitive, patterned and unproductive behaviors

Distress at small changes or transitions

Unusual response to sensory input

Functional Deficits of Down Syndrome

Emotional and behavioral difficulties

- Anxious

- Agitated

- Withdrawn from social interaction

Increased risk of abnormalities of almost every organ

Congenital heart defect

Sensory impairments (vision & hearing)

Endocrine (hormone) abnormalities

Musculoskeletal abnormalities

Obesity (short stature)

Orthopedic conditions

- Subclinical atlantoaxial subluxation (barely noticeable but there-- so you should be careful with their necks)

- Symptomatic atlantoaxial subluxation (difficulty walking, abnormal gait, neck pain, fatigue quickly)

Prognosis of Down Syndrome

Will have medical conditions ACROSS ENTIRE LIFESPAN including:

- Dental

- Gastrointestinal malformations

- Celiac disease

- Epilepsy

- Leukemia

- Skin conditions

- Alzheimer's

Increased stress on families is common

Early Intervention can help prevent need for disability income later in life

Treatments for Down Syndrome

Early intervention

Behavior interventions/modifications

Sensory Integration

Vitamins and Special diets

What is Prader-Willi syndrome? What is the cause (etiology)?

Caused by an absence of expression of imprinted genes on chromosome 15

*Most common cause of obesity and intellectual disability*

Signs and Symptoms of Prader-Willi Syndrome

Infancy: poor feeding, low muscle tone (floppy), failure to thrive

BUT THEN

Childhood: overeating (always hungry), ID, low sex hormones

lack of satiation after meal

high rates of tantrum

Round face

Narrow palpebral fissures

Short stature

Small genitals

Short fingers and toes

Functional Deficits of PWS

Mild intellectual disability (ID)

Poor attention

Obsessive behavior particularly around food (food hoarding and stealing are common)

Excessive skin picking

Prognosis of PWS

Due to obesity:

Type 2 diabetes bc of overeating & heart failure

and

Obstructive sleep apnea

What is Fragile-X syndrome? What is the cause (etiology)?

Genetic disorder

Mutation of FMR1 resulting from deficiency of FMR1 protein (FMRP) which affects the translation of genes

Most common inherited cause of Intellectual Disability and Autism spectrum disorder

What are the signs and symptoms of Fragile-X Syndrome?

Long face

Prominent ears

Hyperextensible finger joints and flat feet

Behavioral: hand flapping, Hyperactivity

What are the functional deficits of Fragile-X Syndrome?

Attention problems

Poor eye contact

Anxiety

Hyperarousal (body suddenly kicks into high alert and cannot calm down)

Lack of habituation to sensory stimuli

Intellectual disability

Delayed speech and motor development

Prognosis of Fragile-X

Comorbidities:

Autism

ADHD

Seizure Disorder

Can live a normal life span

What is Angelman Syndome? What is the cause (etiology)?

SEVERE Neurogenetic disorder caused by

Genetic mutation on chromosome 15 maternal

What are the signs and symptoms of Angelman Syndrome?

Infants 0-24 months:

-Lack of cooing or babbling

-Inability to support one's head

-Pull oneself up to stand

-Delayed motor skills

Young Children:

-Lack of speech

-Delayed ability to walk

-Unable to gait or balance issues

-Ataxia; tremor

-Increased anxiety

Babies will start off being SUPER inconsolable and crying all the time and then all of the sudden will switch to extremely happy demeanor, laughing all the time

What are the functional Deficits of Angelman Syndrome?

Variety of developmental delays throughout life-- most ADL's are compromised

Seizures during childhood but decrease in adolescence

Sleep disorders

Abnormal EEG (electrical activity in brain)

What is the prognosis of Angelman Syndrome?

No cure

Preterm birth Apnea

pause in breathing for about 15-20 seconds

usually paired with bradycardia

Preterm Bronchopulmonary Dysplasia (BPD)

Lung Infection due to poor development

Preterm Respiratory Distress Syndrome (RDS)

Collapsed lung sac due to insufficient amount of surfactant

SUID

Sudden Unexpected Infant Death

Death attributed to accidental suffocation, asphyxia, infection, arrythmias....

includes SIDS (sudden infant death syndrome)(SIDS cannot be explained through investigation or autopsy)

SUID/SIDS Precaution

There has been a decrease in SUID and SIDS because of our awareness

Don't put babies on bellies, or in a crib with blankets and STUFF because they don't have the motor skills to move themselves (other than arms and legs which can put a blanket on their heads by accident) and they can suffocate

Don't bring baby in bed with parents

Important to EDUCATE parents - cultural consideration, but education is still necessary

Even though we are not 100% sure what is causing the suffocation, still important to take those precautions

Congenital Heart Disease

Abnormalities of cardiovascular system before birth - causes largely unknown

general symptoms: Dyspnea, palpitations, fatigue, cyanosis, pulmonary edema, limited exercise tolerance

risk factors: Genetic abnormalities (ex. Down syndrome)

Medications/alcohol/drug use during pregnancy

Rubella infection—why it's important to get MMR vaccine

Parent or sibling with CHD

Patent Ductus Arteriosus (PDA) Etiology

CHD

Every baby is born w/ ductus arteriosus - fetal artery that connects Aorta and pulmonary artery (detour away from lungs)

PDA occurs when the ductus arteriosus doesn't close

PDA signs and symptoms

extra blood from aorta will be pumped into pulmonary arteries causing the lungs to be congested

minor cases will be picked up as a heart murmur

other symptoms:

poor urine output, clinical deterioration, abdominal distention

PDA Prognosis

early diagnosis: minimal damage

late diagnosis: can lead to heart and lung failure, endocarditis & worse

surgery needed to close arteriosus ductus

Atrial Septal Defect (ASD) Etiology

CHD

Hole in interatrial septum - oxygenated and deoxygenated blood mixes

ASD signs and symptoms

Shortness of breath. fatigue, right side heart failure, UE edema

Arrhythmias

Systolic murmur when listening to heart

ASD Prognosis

Can live life without knowing you have one (present with symptoms later in life)

BUT Clot can form and go through hole up to brain & cause stroke

Treated with Cardiac catheterization

Atrioventricular Septal Defect (combined ASD and VSD) Etiology

CHD

Mitral and tricuspid valves combined into common AV valve

Lungs get more blood than normal due to ASD and VSD

Heart works harder to pump more blood

AVSD signs and symptoms

Fast breathing, poor weight gain

AVSD Prognosis

Treatment (Surgery) ASAP has better prognosis

Coarctation of the Aorta Etiology

CHD

Narrowing of the aorta - causes left ventricle hypertrophy or narrowing and dilation of the aorta

Coarctation of the Aorta Signs and Symptoms

Could present with heart failure as newborn - symptoms not normally present in children, especially if obstruction is mild

*Abnormally high blood pressure (for younger person especially)*

Coarctation of the Aorta Prognosis

Degree of narrowing determines how severe/ how needed intervention is -- surgery will be needed if it is severe enough

Often found in first few weeks of life

Less severe could go undiscovered for years

Tetrology of Fallot (TOF)

CHD

4 defects:

Pulmonary stenosis - narrowing of pulmonary valve and main pulmonary artery, limits blood flow to lungs

Ventricular septal defect —hole in wall between 2 lower ventricles, oxygenated blood pouring into left ventricle

Overriding Aorta- aortic valve is enlarged and opens both ventricles instead of just left ventricles

Right ventricular hypertrophy - muscular wall of right ventricle thicker than normal

TOF signs and Symptoms

Small opening wouldn't cause symptoms

Large opening: increase in respiration, infants will have issue w/ feeding

May have abnormal heart murmur

**Symptoms could be delayed until weeks after birth

TOF Prognosis

In 95% of cases ToF diagnosed and repaired in first year of life through surgery

if not caught, can lead to high pressure in lung blood vessels can cause permanent damage to them

Coronary Artery Disease

Secondary to atherosclerosis

(narrowing of coronary arteries from fatty/plaque deposits)

Risk Factors: Unhealthy diet

Coronary Artery Disease signs and symptoms

Angina, arrhythmias, heart failure and sudden death (vessel wall can become completely blocked - no blood into heart)

CAD Prognosis

BAD

One of the leading causes of death because it is often undiagnosed

Treatment:

-angioplasty: putting balloon or stent to widen the artery and improve blood flow (most common)

-Coronary artery bypass graft (CABG) - used to be most common surgery, vein or artery from another part of body used to replace or bypass the blocked artery to improve blood flow

Angina

Inadequate blood flow to heart - block or narrowing of coronary artery

Stable - happens during an activity, resolves within minutes

Unstable - no pattern, not triggered by specific activity; usually caused by rupture of plaque

Angina signs and symptoms

Chest pain: pressure, tightness, squeezing

Can also have pain in jaw, neck or left arm (similar to heart attack)

Angina Prognosis

Stable angina often managed

Unstable can lead to heart attack

Stable resolved with rest or nitroglycerin (medication)

Unstable not resolved w/ rest or medication - needs emergency attention

Myocardial Infarction (MI)

HEART ATTACK

a result of unstable angina, reduced blood flow and oxygen to the heart

Coronary artery is blocked by blood vessel plaque, rupture, or thrombus

MI Signs and symptoms

Pain or no pain - intermittent and people ignore it

Crushing sensation in chest, jaw, down left arm, scapula

Fatigue, shortness of breath, sweaty, cool or clammy skin

Anxiety or restlessness

*Women can have symptoms for a couple days or few weeks before getting medical attention (higher threshold for symptoms)

MI Prognosis

The longer blood flow is restricted to heart, the greater chance of tissue death (necrosis)

Better prognosis w/ quick emergency attention

Complications: arrhythmias, cardiogenic shock (heart can't pump enough blood), pericarditis, clots, chronic heart failure, sudden death

Diagnosed with: blood test (creatine, kinase or troponin elevated)

Cardiomyopathy

disease of the heart muscle

heart will become thicker and enlarge which impairs heart conductivity

GENETIC ETIOLOGY

Cardiomyopathy signs and symptoms

decreased cardiac output

Cardiomyopathy Prognosis

Ventricular hypertrophy or dilation - left ventricle specifically cannot contract, becomes weak and doesn't pump well out to systemic circulation

May cause low heart muscle tone

Can be treated with lifestyle changes/medicine

if severe a heart transplant

Endocarditis

Caused by bacterial infection of endocardium and heart values

Endocarditis Signs and Symptoms

Fever, fatigue, dyspnea, weight loss, night sweats, joint pain, UE and LE numbness

Risk factors: UTI and drug use

Endocarditis Prognosis

Treated with Antibiotics, bed rest, fluids and/or surgery

Myocarditis

Some form of infection of the heart muscle (viral, bacterial, parasitic or fungal infection)

can be caused by Allergic reactions, exposure to certain chemicals, systematic diseases

Myocarditis Signs and symptoms

Dyspnea, orthopnea, fatigue, chest pain, cardiac arrythmias, fluid retention, fever (feels like a cold)

Myocarditis Prognosis

Can lead to dilated cardiomyopathy or sudden death

bacterial: antibiotics

viral: steroids and diuretics

Pericarditis

inflammation of the sac surrounding the heart

Result of heart attack, open heart surgery, immunologic condition, kidney failure or infection

Pericarditis Signs and symptoms

Chest pain, fever, dry cough, fatigue

Pericarditis Prognosis/Treatment

Nonsteroidal, anti-inflammatory drugs, steroids, antibiotics, pericardiocentesis or surgery

Valvular Heart Disease (VHD)

Could be caused by endocarditic, rheumatic fever, congenital heart disease, cardiomyopathy, atherosclerotic heart disease

Three Categories:

Stenosis - valves don't open properly, restrict blood flow

Regurgitation or insufficiency - valve doesn't close properly, constant opening and blood going back in

Prolapse—valves leaflets don't close properly

Stenosis VHD

can lead to back up of blood into lungs (lung congestion)

Regurgitation VHD

more serious condition, worse prognosis

Prolapse VHD

not normally serious but can lead to more serious conditions: regurgitation, bacterial endocarditis, death

Treatments for all VHD

medication, surgical repair or valve or replacement of valve

Aortic Aneurysms

A weakness in the wall of the aorta that makes it susceptible to rupture.

caused by heredity, atherosclerosis, hypertension

Aortic Aneurysm signs and symptoms

Syncope (fainting), radiating severe chest or back pain

CAN GO UNNOTICED

Aortic Aneurysm Prognosis

Can lead to aortic dissection or rupture - causes bleeding, comprised vital functions

Can lead to stroke and/or death

Treated through surgery

Congestive Heart Failure

Progressive weakened heart disease - heart inefficiently pumps blood to meet body's metabolic need

caused from hypertension, damaged heart tissue from MI, cardiomyopathy, congenital heart defects

Congestive Heart Failure signs and symptoms

Dyspnea, orthopnea, fatigue, exercise intolerance, coughing, weight gain, LE edema

Congestive Heart Failure Prognosis

Overall poor prognosis

Right and/or left side heart failure

Heart chamber enlargement

Backup of blood into venous system -overload of fluid in tissue is what causes mostly LE edema but also UE

can be treated slowly through lifestyle changes and medications

Hypertension

Elevated blood pressure 140+/90+ mmHg

caused by Genetics, poor diet, depression, poor stress coping mechanisms

Hypertension signs and symptoms

Fatigue, confusion, chest pain, vision changes (could also be asymptomatic)

Hypertension Prognosis

Early detection will help

can lead to chronic heart failure, CVA (stroke), renal disease

can be treated with meal plan changes, Beta blockers & Calcium channel blockers (lower BP)

Hypotension

Low blood pressure-- a decreased venous return and cardiac output

Types:

Orthostatic = change in position

Postprandial = after eating

Neutrally mediated = standing too long

Caused by aging, medical conditions like Parkinson's, spinal cord injuries

Hypotension signs and symptoms

Weakness, sleepiness, blurred vision, confusion, syncope (fainting), light headedness

Hypotension treatment

Change in medications, meds to increase BP

Peripheral Vascular Disease (PVD)

Lack of blood supply to the LE due to stenosis or blockage within the arteries

caused by Diabetes, smoking, hypertension, high cholesterol, obesity, heart attack, stroke

Age, gender, family hx

PVD signs and symptoms

Complaining of cold and/or aching extremities, numbness/tingling, absence of hair, ulcers, brown/gray tint to skin, itching, ischemia

PVD Prognosis

Combined risk factors lead to worse prognosis (ex. Someone who is diabetic and smokes and has high cholesterol)

lifestyle changes are needed to treat, also medications

Venous Stasis

LE blood flow compromised which leads to thrombosis-- happens because of immobilization

DVT and Phlebitis

Treated with Anticoagulant (blood thinner)

Deep Vein Thrombosis

swelling, pain, warmth of affected area

Phlebitis

superficial blood clot

Pulmonary Embolism

Caused by deep vein thrombosis that breaks loose (embolus) and travels to lungs

Blocks blood flow from right side of heart to the lungs

other risk factors include: Pacemakers, fat emboli from trauma, surgery, infection

Pulmonary Emolism signs and symptoms

Sudden dyspnea, tachycardia, tachypnea, chest pain, syncope, cyanosis, low grade fever

PE Prognosis

Positive prognosis with changes in diet, medications

Avoiding certain foods like vitamin K—alters anticoagulant effectiveness

Atherosclerosis

condition in which fatty deposits called plaque build up on the inner walls of the arteries

Chronic Obstructive Pulmonary Disease (COPD)

Pulmonary Condition

Chronic airflow limitation caused by inflammation, loss of elastic recoil, restricted airway

COPD signs and symptoms

Fatigue and dyspnea

COPD Prognosis

Decreased pulmonary function

3rd leading cause of death in US

Emphysema is EVEN MORE SERIOUS

Treatment is mostly management of symptoms, slowing progression - antibiotics, steroids, oxygen tank use, bronchodilators

Emphysema (COPD)

common type of COPD - recurrent inflammation destroys alveoli causes air "trapping", loss of recoil, hyperinflation of lungs and decreased O2

Emphysema signs and symptoms

dyspnea on exertion, wheezing, rapid shallow breathing

malnutrition, weight loss, muscle wasting, clubbing digits

Cystic Fibrosis (CF) Etiology

GENETIC-- both parents must be carriers

Defective cells produce mucus, sweat and digestive juices that are thick and sticky

CF Signs and symptoms

affects bowel—abdominal pain, constipation, gas, bloating, nausea

Pulmonary: cough, increased mucus, fatigue, nasal congestion, shortness of breath

Reproductive: males have infertility

Endocrine: inflammation of pancreas

Soft tissue: clubbed fingers

CF Prognosis

Comorbidities: chronic respiratory failure, right sided heart failure, diabetes, liver disease

No cure but treatments like expectorants, bronchodilators, nutritional support, and other holistic methods can manage symptoms