NPTE: Non/Other Systems

ethic question

answer C (call 911)

Contact vs droplet vs airborne

o Airborne

§ Measles

§ TB

§ Varicella

o Droplet

§ Sepsis/scarlet fever/strep

§ Parvovrisu B19/pneumonia/pertussis

§ Influenza

§ Diphtheria (pharyngeal)

§ Epiglottis

§ Rubella

§ Mumps/meninigitis/myocoplasma/meningeal/pneumonia

§ Adenovirus

o Contact

§ Multi drug resistant organism

§ Respiratory infection

§ Skin infections

§ Wound infections

§ Enteric (C DIFF)

§ Eye infection (conjunctivitis)

Donning and doffing

Workstation ergonomics

CPR do's and don'ts

-chest compressions at a rate of 100-120/min

-compress chest at least 2 in/5 cm (baby is 1.5 in)

-allow full chest recoil between compression

-minimize pause during compressions

-2 breaths per 30 compressions

-allow chest to rise fully with breaths

Hickman catheter

-central line tunneled under the skin

-provides antibiotics, nutritional solutions and blood samples

Swan ganz catheter

-balloon flotation device inserted through the internal jugular vein or femoral vein into the pulmonary artery

-monitors blood flow and the function of the heart

Colostomy bag

-exits the colon to the abdomen (stoma) when a part of the colon or large intestine has been removed

-seen with colon cancer

-focus on early mobility and beware of gait belt!! (if you use one place it above)

Central venous pressure catheter

measures blood pressure directly from right atrium and superior vena cava

Arterial line

monitor arterial blood gases

-if dislodged, apply firm pressure and alert nursing immediately

Chest drainage tube

- Inserted through an incision in the chest and may be

connected to a mechanical or gravity-based suction

system

- Used to remove air, blood, purulent matter from the

patient's chest or pleural cavity

if dislodged, have the patient exhale, place gauze or a gloved hand over the area and call nursing staff, keep collection bottle below tube

IV lines cautions

arms should not be held above head for extended periods, alert staff if fluid is low due to air bubbles

femoral line cautions

avoid repetitive hip flexion and hip flexion >45 degrees

Catheters cautions

hang below level of bladder, do not empty bag if output is being monitored, empty or alert staff if overfilled

A clinician is preparing to ambulate with a patient with pleural effusion and a chest tube. Which of the following procedures is most important to consider?

collection bottle should be kept below the level of the inserted tube

3 multiple choice options

Wheelchair measurements

Wheelchair axle positioning

-normal is in line with the shoulder or slightly posterior

-bariatric patients then move the rear wheel axle forward

-bilateral transfemoral amputation then move the rear wheel axle behind the patient's shoulders

How to teach a wheelchair wheelie

lean forward, gait belt to rear axle

-patient places hands back on the hand rims, then push them forward abruptly and forcefully

Ascending and descending curb

Posterior vs anterior hip replacement precautions

posterior: no flex >90, no adduction, no IR

anterior: no flex>90, no adduction, no ER, no extension past neutral, in combination cannot FABER (AAAA AVOID PIVOTING AWAY (ER)

Which of the following is most likely to be included while educating a patient on prevention of hip dislocation? they had an anterior THA

avoid standing activities that involve rotating the body away from the operated extremity

Do you transfer to strong or weak side?

strong

Gait pattern for anterior THA

front wheeled walker and step to gait pattern (cannot do step thru because NO HIP EXT can be done)

Standard crutches vs forearm crutches vs cane fitting

Nerve for crutch palsy

radial nerve or brachial plexus

Longitudinal arch and UCBL orthosis

Posterior leaf spring vs klenzak joint vs plantarflexion stop

What will excessive height of medial vs lateral upright KAFO cause?

medial: lateral trunk lean

lateral: medial trunk lean

A review of the patient's chart shows BP 169/90 mmHg, triglyceride level of 160 mg/dL and a fasting blood glucose of 115 mg/dL. patients body mass index is 40 kgg/m and their waistline is 54 in. What are these findings suggestive of?

metabolic syndrome

3 multiple choice options

Metabolic syndrome

consists of signs and symptoms that are risk factors and are strongly linked to type 2 diabetes, cardiovascular disease and stroke

Anterior vs posterior pituitary

frogs practically like all things green for anterior pituitary

FSH

TSH

LH

ACTH

GH

Glands of the endocrine: hypothalamus, pituitary, thyroid, parathyroid, adrenal

What does cortisol do?

blood pressure, gluconeogensis, regulate stress, decrease inflammation

What does aldosterone do?

retains Na and water, kicks out K+

Addison's disease

Mrs. Addison is a brown old petite lady walking with a stick

Secondary adrenal insufficiency

● Lack of pituitary ACTH because of insufficient stimulation of adrenal cortex

● Causes: removal of pituitary gland, rapid withdrawal of drugs, hypothalamic or pituitary tumors

Cushing's disease

Mr. Cushings is a white chubby boy (ruddy appearance) who loves chugging beer or santa clause

Cushing disease vs syndrome

Hyperthyroidism

graves and exophthalmos

(blood pressure decreases; osteoporosis risk)

Hypothyroidism

myxedema (puffiness and swelling in hands, feet, and face BAD), hashimotos

lazy person laying on the couch all day in sidelying

When are goiters usually seen?

hyperthyroidism (deficiency of iodine)

Hyperparathyroidism vs hypoparaythyroidism

directly related to calcium and inversely related to phosphate

-hyperparathyroidism: bones, stones, groans, moans, sensory

-hypoparathyroidism: analogy - cats are numb (trosseau sign is carpopedal spasm; chovsteak is tingling numbness in the facial nerve)

Hyperparathyroidism bones, stones, groans, moans, sensory

Type 1 vs type 2 diabetes

type 1: insulin dependent

type 2: insulin resistant

(ketoacidosis is fruity odor breath and is emergency!!)

Secondary diabetes

associated with other conditions

➤ Pancreatic disease or removal of pancreatic tissue

➤ Endocrine disease: acromegaly, Cushing syndrome

➤ Drugs: some diuretics, glucocorticoids, levodopa

➤ Chemical agents

Gestational diabetes

high blood sugar during third trimester of pregnancy

Prediabetes

impaired glucose tolerance (IGT) with abnormal response to oral glucose

Kussmaul breathing

sign of diabetic ketoacidosis (DKA)

S/S of diabetes

● Hyperglycemia: elevated blood sugar (fasting glucose level of > 126 mg/dL)

● Glycosuria: elevated glucose level in urine

● Polyuria: excessive urination

● Polydipsia: excessive thirst

● Polyphagia: excessive hunger

● Glycated hemoglobin (A1C) level: ≥ 6.5%

● Ketonuria

● Unexplained weight loss

● Fatigue and weakness

● Irritability

● Blurred vision

● Recurring skin, gum, bladder, vaginal, or other infections

● Numbness or tingling in hands and feet

● Cuts and bruises heal with difficulty

Complications of diabetes

- microvascular disease (retinopathy, diabetic neuropathy, peripheral neuropathy)

- macrovascular disease (heart, brain and lower extremity arteries are effected), atherosclerosis, coronary artery disease, peripheral vascular disease

- integumentary impairments (degenerative changes in connective tissues, skin infections)

- musculoskeletal impairments (adhesive capsulitis, hand stiffness)

- neuromuscular impairments (diabetic polyneuropathy)

- diabetic autonomic neuropathy

- kidney failure

-vision impairments

- fatty liver disease

Diabetes diagnostic criteria

Post exercise hypoglycemia may last as long as ___ hours

12

Signs and symptoms of hypoglycemia and hyperglycemia

Sympathetic cardiovascular changes in patients with long standing type 1 diabetes

heart rate becomes fixed

Fasting blood glucose vs random blood glucose level vs HbA1C diagnosis of DM

fasting: >126 mg/dL

random blood glucose level: > 200 mg/dL

HbA1C: >10 is immediate insulin therapy and 4-6% is normal; 3 month average of amount of glucose that is attached to your hb

Hypoglycemia vs hyperglycemia

hypoglycemia:

Tachy

Irritable

Restless

Excessive hunger

Dizziness

cold and clammy give them a candy

hyperglycemia: hot and cry sugar high

How does exercise impact diabetes/when can you exercise?

NO exercise: <70 or >300

safe is 100-250

Diabetic foot care

-foot should undergo screening

-wash (do not soak) feet daily in warm water

-toe nails cut

-clean white socks without wrinkles

-alternate shoes

-snug fit with laces or velcro

DM FITT principles

Lateral wall of the pelvic cavity is formed by _______________ and ___________

piriformis and obturator internus

What makes up the pelvic diaphragm (primary muscular support)

What is the perfect scheme?

a method of examination of the pelvic floor muscles that looks at

Power - Modified Oxford Scale

Endurance - How long can they hold a maximal voluntary contraction (up to 10sec)

Repetitions - How many maximal voluntary contractions they hold with a rest between them, up

to 10 reps (eg 10 repetitions of a 10-second hold)

Fast- The number of 1-second maximal voluntary contractions they can perform in a row (up to

10)

Every Contraction Timed - a reminder to time every contraction

Stress incontinence

involuntary leakage of urine during couch, sneezing or exertion;

-can be seen in postpartum, pelvic floor muscle weakness (levator ani muscles which are puboccygeus, ilioccygeus, pubo rectalis)

tx: strengthen pelvic floor muscles

Urge incontinence

involuntary contraction the detrusor muscle with a strong desire to void (urgency)

-can be seen with infections, parkinsons, UMN lesions

tx: treat infections and voiding schedule

Overflow incontinence

incontinence caused by an acontractile or underactive detrusor muscle; bladder is overdistended, can not empty completely and urine dribbles or leaks out

-can be seen with benign prostatic hyperplasia, DM

tx: behavioral modification like double voiding, medication and catherization

Functional incontinence

incontinence due to mobility, dexterity, or cognitive deficits

-can be seen with dementia, lower extremity weakness

tx: clear clutter, improve accessibility, and prompted voiding

Changes with pregnancy weight gain and MSK system postural changes

-25 to 35 lbs essential for baby's nourishment

-postural changes: forward head, kyphosis, increased lordosis, anterior pelvic tilt

-postural stress continues even postpartum due to lifting and carrying of baby

Blood pressure and heart rate changes in pregnancy and positional consideration

-blood pressure is low in first and second trimester increases in last trimester (CO increases)

-resting heart rate increases by 10-20 bpm (heart rate will not proportionally increase with exercise, max heart rate)

Lay on your ______ side when pregnant

left

_________ incontinence is most common during pregnancy

stress (80% of the time)

Respiratory changes during pregnancy

➤ Depth of respiration increases

➤ Tidal volume and minute ventilation increase, whereas total lung capacity is unchanged or decreases slightly

➤ Natural state of hyperventilation exists during pregnancy to meet the increased oxygen demands during pregnancy

➤ Diaphragm is elevated and thoracic cage widens → hyperventilation, with mild exercise

Metabolic changes during pregnancy

➤ Increased basal metabolic rate and heat production

➤ Lower fasting blood glucose levels

➤ Body requires an additional 300 kcal per day to maintain homeostasis

➤ Stroke volume (SV) and CO increase with exercise

FITT for pregnancy

➤ Postural education and exercises

Stretch and strengthen appropriate muscles

➤ Pelvic stabilization exercises

➤ Pelvic floor muscle exercises

➤ Focus on strengthening trunk flexors, hip extensors, and pelvic floor muscle

➤ Ankle pumps for late-stage pregnancy; elevate legs to assist in venous return

➤ Progress from gravity-assisted to standing positions as strength and awareness increase

Postcesarean 1-3 days post vs later exercises

● 1 to 3 days post: breathing exercises, coughing or huffing to loosen phlegm, and pelvic floor exercises

● Later: gentle partial sit-ups and head lifts, low-intensity aerobic exercises, pelvic tilts in quadruped position

Premature rupture of membranes

anmoitic sac breaks and amniotic fluid is lost before the onset of labor (requires immediate medical attention)

Incompetent cervix

painless dilation of cervix in 2nd trimester (after 16 weeks gestation) or early 3rd trimester

- May use stitches to keep cervix closed (cerclage)

- Without timely intervention, may lead to continued dilation of the cervix → rupture of membranes → delivery of fetus

Placenta previa

placenta attaches too low on the uterus → as the cervix dilates, the placenta begins to separate from the uterus and may present before the fetus

- Life threatening to the fetus

- Bleeding is the primary symptom

Contraindications for pregnancy

-prolonged periods of motionless standing

-avoid valsalva

Absolute contraindications

-Preeclampsia

-severe anemia

-restrictive lung disease

-type 1 diabetes

Precautions to observe for during pregnancy

● Vaginal bleeding

● Persistent pain: chest, pelvic girdle, low back

● Leakage of amniotic fluid

● Painful contractions that persist beyond exercise session

● Shortness of breath

● Tachycardia

● Headache, dizziness

● Swelling and/or pain in calf

Premature onset of labor is before

37 weeks

Preterm rupture of membranes

amniotic sac breaks and amniotic fluid is lost

before the onset of labor; Requires immediate medical attention

Incompetent cervix

painless dilation of cervix in 2nd trimester (after 16 weeks'

gestation) or early 3rd trimester

May use stitches to keep cervix closed (cerclage)

Without timely intervention, may lead to continued dilation of the cervix → rupture of membranes → delivery of fetus

Placenta previa

placenta attaches too low on the uterus → as the cervix dilates,

the placenta begins to separate from the uterus and may present before the fetus

-life threatening to fetus

-bleeding is primary symptom

Preeclampsia

starts in 3rd trimester and disappears postpartum

- Pregnancy-induced acute HTN

- BP > 140/90 (measured 2 times within 4 h) → medical emergency

- S/S: HTN, protein in urine, severe fluid retention

- Complications: maternal convulsions, coma, and death

Ectopic pregnancy

 tubal pregnancy

-Fertilized egg is implanted outside the uterine cavity (mainly in the fallopian tube)

-Medical emergency

S/S

⚬ Sudden onset of sharp pain on one side of the lower abdomen or pelvis

lasting more than a few hours

⚬ Referred pain to shoulder

⚬ Amenorrhea, irregular bleeding, and spotting

⚬ Dizziness, fainting, paleness, and shock

-Treatment: pain management, surgery

Pelvic inflammatory disease

Cystocele vs rectocele vs uterine prolapse

Uterine Prolapse- bulging uterus into the vagina

Signs & symptoms:

• Pelvic pressure, perineal heaviness, backache

• Symptoms relieved by lying down

• Symptoms made worse by prolonged standing, walking, coughing, or straining

Cystocele Prolapse- herniation of bladder into the vagina

Signs & symptoms:

• Urinary frequency and urgency

• In advanced stages, difficulty emptying the bladder

• Cystitis (bladder infection)

• Bulge or pressure sensation in the perineal area

• Urinary incontinence

Rectocele Prolapse- herniation of rectum into the vagina

Signs & symptoms:

• Perineal pressure and bulge

• Straining to defecate

• Feeling of incomplete rectal emptying

• Constipation

Pelvic floor prolapse treatment

• Kegel's exercise -Start in lying (gravity elimination position) and progress to upright postures,

sitting, and standing while performing activities. This improves control of the pelvic muscles and

helps in treating incontinence. Examples are gravity assisted (Inverted hook lying), gravity

eliminated (supine, prone, side-lying), resisted (standing, lunges, squat)

• Vaginal weight training (using vaginal cones)

• Biofeedback, postural reeducation, pelvic mobilization

• Electrical stimulation

• Teach splinted coughing, and huffing as a patient will not be able to bear down

Coccydynia

pain in region of coccyx

-joint becomes hypermobile and causes coccyx pain

-causes: trauma, events associated with childbirth

Sacroiliaic joint dysfunction

➤ Due to postural changes, ligament laxity

➤ Pain in the posterior pelvis and buttock that may radiate into the posterior thigh and knee

Nerve supply to pelvic floor

pudenal nerve

Precalmpsia

-pregnancy induced acute hypertension after the 20th week of gestation

-increase in protein in urine, hyperreflexia, edema, headache, sudden weight gain

-a blood pressure more than 140/90 mmHg; second abnormal BP reading four hours after the first confirms the diagnosis

EMERGENCY!

Eclampsia

after birth and has seizures due to high BP after childbirth, headache and visual disturbances (preclampsia does not have seizures!)

Multiple gestation

more than 1 fetus

Contraindications to exercise for pregnant women

*uncontrolled maternal type I diabetes or any of these that are currently symptomatic

Treatment for diastasis recti and how much is considered diastasis recti

>2 cm (don't do any aggressive...avoid curl ups, leg lifts, fire hydrants)

Gerd symptoms and complications

problem with the lower esophageal sphincter; reflux of gastric content of the gastroduodenal contents into the esophagus

GERD treatment

-maintain upright positions

-eat meals at least 3-4 hours before sleep

-avoid supine b/c 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