DND Exam 2 Study Guide
HSC 4558 Exam Study Guide Part B- 2024
Content covered on the exam will be from the assigned chapters, videos, and in-class assignments for weeks 9-14. Consider themes such as risk factors, symptoms, diagnosis, assessment & treatment, vocational implications/accommodations, medical terminology. Additionally, be able to compare and contrast diseases, recommend proper exercise and secondary prevention techniques, understand any relevant historical perspectives. Identify diseases that commonly combine with others or predict greater risk of development. You can expect 2 questions from each “On Location” video- consider what caused the disease, how/when diagnosed, any complications, treatment, advice to health professionals.
Cardiovascular Disease
Structures of heart and vessels
Heart Layers
Pericardium: Outer sac
Myocardium: Heart muscle, site of necrosis
Endocardium: Inner/ valves
Circulation
Atria on top and ventricles on bottom
Deoxygenated comes in from right and takes it to left and pumps it to the rest of the body
Artery takes blood away and vein takes blood towards the heart
Heart Valves
Bicuspid (mitral) valve
Risk factors of heart disease
Prolonged hypertension
High LDL cholesterol
Diabetes
Smoking
Obesity
Diet and inactivity
Identify terms:
Atherosclerosis:
Build up of fats, cholesterol, and other substances in the artery
Chronic inflammatory response
Common cause of heart conditions/stroke
Associated with hyperlipidemia
Varies due to level of stenosis
Severe stenosis: Heart attack
**All people with atherosclerosis have arteriosclerosis (not vice versa)
Arteriosclerosis: is result of old age- Lack of elasticity of the blood vessel- Does not necessarily produce symptoms- No specific treatment
Sometimes used interchangeably with Atherosclerosis
Angina: A type of chest pain caused by reduced blood flow to the heart
Stable
Predictable
Triggered by activity
Unstable
Occurs at rest
More severe and frequent
Relief with nitroglycerin
Dilates the coronary arteries
Arrhythmia: An irregular heartbeat
Various medical conditions
Idiopathic
Range from minor to life threatening
Sinus bradycardia
Ventricular fibrillation
Atrial fibrillation
Severe: sudden cardiac arrest
Cardiac arrest: When the heart suddenly stops beating, preventing blood from circulating throughout the body
Symptoms may include
Loss of consciousness
Abnormal or no breathing
Sudden cessation of heart function
Common cause of CAD
Often fatal unless
CPR successfully performed
Defibrillator successfully used
Within 5-8 minutes
Describe differences between cardiac arrest and myocardial infarction
Myocardial Infarction:
Myocardium sustains anoxia and necrosis
Symptoms include prolonged chest pain, pressure that radiates to arm (particularly left), neck, back, accompanied by nausea, dyspnea, diaphoresis
Symptoms may be less dramatic and involve indigestion and feelings of doom
Emergency situation:
Admission to CCU
Initiate electrical stability
Cardiac Arrest:
Symptoms may include
Loss of consciousness
Abnormal or no breathing
Sudden cessation of heart function
Common cause of CAD
Often fatal unless
CPR successfully performed
Defibrillator successfully used
Within 5-8 minutes
Know “normal”/abnormal levels:
Blood pressure: Normal 120-180 mm/Hg
Cholesterol: 200 mg/dL and below
HDL: 60 mg/DL and higher
LDL: less than 100 mg/dL
Ratio: Less than 4:1
Blood sugar: Normal 70-99 mg/dL
Heart rate: Normal: 60-100 BPM
Know differences between CAD, heart failure, atrial fibrillation
CAD (Coronary Artery Disease)
Inadequate blood supply to heart
Diminished oxygen supply
May lead to blockage (ischemia)
Unstable angina pectoris
Myocardial infarction (MI)- Acute coronary syndrome
Atherosclerosis
Thrombus
Embolus
Heart Failure
Heart Failure: Left-sided
Damaged organ becomes ineffective
Blood backs up into atria
Pulmonary edema
Symptoms
Unexpected weight gain
Orthopnea
Lower extremity edema
Paroxysmal nocturnal dyspnea
Fatigue and weakness
Cognitive deficits
Heart Failure: Right-sided
Right sided ventricle pumps blood to lungs
Resulting leg, ankle, abdomen swelling**
Nocturia
Dyspnea
Gaining weight from excess fluid
Confusion
Fatigue
May be triggered by left sided failure
Atrial fibrillation
Irregular rate of atrial contraction
Most common of the arrhythmias
Increases risk of stroke by 5X
Symptoms include:
Quivering/ fluttering of heart
General fatigue
Chest pain
Exertional dyspnea
Syncope
CPR changes (emphasis on compressions)
Importance of compression rate and depth
Quality over quantity
Use of defibrillator
Defibrillator is a medical device used to send an electrical shock to the heart in certain life threatening situations, particularly when a person is experiencing a cardiac arrest
Cardiac assessments and their utility:
EKG
Records heart’s electrical activity
Records strength and timing of electrical signals
Can show signs of heart damage/ precious or current heart attack
P wave: Initial bump
QRS: spike
T wave: relaxation
Holter monitor
Portable device
Provides numerous data points
Generally 24 hours/ also 14 day
Diary entries
METS table
Metabolic Equivalents; Measure used to quantify the energy expenditure of physical activities
1 MEt is at rest
Higher MET > higher activity
Event monitor
Variety of different forms
Designed to detect transient/ intermittent episodes
Worn for up to 30 days
Stress test
Used to see condition of heart
Walking on treadmill
Create situation in which heart needs work hard and beat fast
Treadmill
Stationary bike
Pharmacological
Measures taken:
HR
BP
EKG
Cardiac catheterization
Usually go into the groin all the way up
Catheter threaded into a coronary artery (via arm, groin, or neck)
Dye injected into the catheter to determine any blockages
CT scan
Another way of seeing what is going on
Telemetry
Common in hospital
Monitored and set up to have their RR, BP measured
Blood tests and chest x-ray
Heart and location
Problems with chest
Blood tests for cardiac enzymes in blood (indicative of heart attack)
Surgical and minimally invasive interventions for heart conditions:
Angioplasty:
Minimally invasive
Catheter insertion to occluded artery
Balloon
Stent
CABG (Coronary Artery Bypass Graft (CABG): Severe heart disease
Commonly attached to the end of where blockage is
3-6 hour operation (general anesthesia)
Graft: Typically saphenous vein/ may be multiple vessels grafted (eg. left internal mammary artery)
Incision in center of chest (sternotomy)
Medicine to stop heart- placed on heart-lung machine
Heart Transplant:
Rule out if person has
HIV, Active cancer, Severe psychiatric condition, Unable to adhere to complex management plan
Heart Transplant Recipient
Body size
Heart size
Blood type
Organ preservation time: 4 hours
Post-transplant immunosuppressant therapy
Prone to infection
Mitral valve Repair:
Surgical procedure to correct abnormalities or damage to mitral valve
Restores proper functioning of valve, allowing it to control blood flow and prevent blood from leaking backward
Ablation:
Destroys or removes abnormal tissue in the body
Commonly used in the treatment of arrhythmias
Lifestyle modifications to prevent and combat heart disease progression
Decrease stress
Proper body weight
Reduce alcohol/ smoking cessation
Diet high in lean protein, low fat dairy, whole grains, fruits and vegetables
Decrease sodium, saturated fats, sugars, carbs
Get sufficient rest
When not sufficient, take medications
Antihypertensives
List modifiable and non-modifiable factors
Modifiable
Decrease stress, proper body weight, reduce alcohol/ smoking, diet, rest
AHA: Life’s Simple 7
Not smoking
Physical Activity
Healthy Activity
Healthy diet
Healthy body weight
Cholesterol controlled
BP controlled
Blood sugar controlled
Non-modifiable factors
Age
gender
Family history
Practice Questions:
Which condition(s) can result in sudden death?
aneurysm
cardiac arrest
ventricular fibrillation
all of the above
A primary prevention for reducing a female patient's risk of developing coronary heart disease is to:
Avoid excessive weight gain during pregnancy.
Enroll in a cardiac rehabilitation program.
Take 81 mg of aspirin daily. (wise to do this to counteract any possible things, in this case this could be a primary prevention)
Take nitroglycerin at the onset of chest pain.
Which of the following best reflects the evidence on physical activity for primary prevention of cardiovascular disease?
People who are physically active experience about a 30%–50% reduction in relative risk of coronary heart disease compared with people who are sedentary after adjustment for other risk factors
Physical activity is associated with reduced risk of coronary heart disease but not of stroke
There is a high absolute risk of sudden death after strenuous activity
Which lifestyle changes should a client diagnosed with coronary artery disease consider?
Smoking cessation
Establishing a regular exercise routine
Salt intake reduction
All of the Above
A patient reports during a routine check-up that he is experiencing chest pain and shortness of breath while performing activities. He states the pain goes away when he rests. This is known as:
Unstable angina (means it is going to happen at different times)
Hypostatic pressure
Exercise-induced hypoxemia
Stable angina (you know what the trigger is, easier to treat)
Keeping the patient in previous question in mind: What type of diagnostic tests will a physician most likely order (at first) for this patient to evaluate the cause of the patient’s symptoms? Select-all-that-apply:
EKG
Stress test
Heart catheterization
Balloon angioplasty
Pulmonary Disease
Pulmonary System components (lobes, bronchioles, alveoli, etc.)
Diaphragm: muscle that assists with inhaling and exhaling
Nose: humidifies, warms, and filters air before it enters the respiratory tract
Trachea: allows passage of air into and out of the lungs
Bronchi: carry air into and out of lungs, also create mucus to humidify air
Bronchioles: deliver air to the vast network of alveoli in the lungs
Alveoli: where the lungs exchange oxygen and CO2 with blood
Symptoms of chronic obstructive pulmonary disease (includes emphysema & chronic bronchitis)- subtle at first
Obstruction of lung due to pressure on alveoli; inadequate gas transfer
Shortness of breath, chronic cough, sputum (mixture of saliva and mucus) production, decline in activity level
Chronic bronchitis
Inflammation or irritation of airways in the lungs
Fibrosis (scarring) of bronchioles → narrowing of airway
Excessive, thick mucus → compromises breathing
Emphysema
Large cavities of alveoli have coalesced and cannot adequately perform gas transfer
Can be a result of obstruction from bronchitis
Epidemiology:
older than 65, females, history of asthma, current or former smoker (8 in 10 COPD deaths due to smoking)
Global disease
COPD is the 3rd leading cause of death globally behind ischaemic heart disease and stroke
Testing: Pulmonary Function Testing (spirometry)
Spirometry determines severity of COPD and differentiates it from asthma
Treatment: self-management, bronchodilators, inhaled corticosteroids, pulmonary rehab; more severe cases: oxygen, surgery
Best treated with early detection and early treatment
Requires aggressive management
Smoking cessation
Adequate fluid intake, use of expectorants, bronchodilators, inhaled corticosteroids, oxygen therapy
Physical therapy
Learn to expel mucus from respiratory tract, breathing exercises and techniques, exercise reconditioning to increase endurance and work capacity
Participation restrictions due to COPD
Most limiting factor is dyspnea (shortness of breath), but manifests itself slowly
sedentary activities may be accomplished easily initially, but become more difficult with time
May limit one’s ability to drive or walk limited distances
1 in 4 unable to work
May require work accommodations like closer parking spots, workstations close to the entrance, rules against smoking and perfumes, air purifier at workstation, and ability to work from home and around medical appointments
May have difficulty in walking upstairs or require the use of special equipment
Poliomyelitis (infectious disease due to poliovirus): Polio epidemic (history of disease: FDR & iron lung)
Vaccination effective in 1950s in US- not totally eradicated but extremely effective
Decades later those with polio experienced Post-Polio Syndrome (PPS)
Symptoms: fatigue, pain, breathing/swallowing problems, weakness
Severity of poliomyelitis is associated with higher risk of developing PPS
Exercise prescription- participation limitations due to fatigue
Difficulty standing, walking, lifting, and breathing
Post-polio management
Non pharmaceutical treatments but can manage with non-fatiguing exercises to improve muscle strength and reduce fatigue
Make use of mobility aids and ventilation equipment
Modify ADLs and avoid activities that cause pain/fatigue
Practice Questions:
You are a 53 year old smoker (3 pack a day) with SOB, cough with sputum, fatigue, limitations in ability to inspire and expire air. You are anxious about your symptoms. What diagnosis/diagnoses is/are a possibility?
Post-polio syndrome
COPD
Asthma
Emphysema
True or False: COPD is reversible and tends to happen gradually.
True
False
Which of the following diseases is included in the umbrella term COPD?
Emphysema
Chronic bronchitis
Lung cancer
A and B
*Acute bronchitis would not be under COPD because it can go away
Respiratory infections are major health risks for someone with COPD. Which of the following steps helps prevent these infections?
Annual flu shot
Pneumonia shot, as advised by your healthcare provider
Avoid cold weather
A and B
How is COPD treated?
Bronchodilators
Inhaled corticosteroids
Supplemental oxygen
pulmonary rehabilitation
All of the above
Alzheimer’s Disease and dementia
Define Dementia and its symptoms (characteristics)
Cognitive: memory loss; difficulty communicating, problem-solving, handling complex-tasks, planning, organization, and with coordination; confusion
Psychological: personality changes, depression, anxiety, inappropriate behavior, paranoia, agitation, hallucinations
Several types- a general term: vascular; mixed; dementia-like symptoms
Vascular: reduced blood supply to brain
Mixed: combination of types
Dementia-like symptoms can be caused by: depression, drug interaction, thyroid problems, excess alcohol use, and vitamin deficiencies
Alzheimer’s Disease (most common form of dementia): Typically after age 60; late and early onset
Irreversible, progressive disease that causes problems with memory, thinking, language, and behavior
60 - 80% of dementia cases
Late-onset: signs appear in mid-60s, most common type, may involve APOE 4 gene
Early-onset: signs appear between 30s to mid-60s, very rare, caused by gene changes passed down from parent to child (FAD)
Brain changes: amyloid plaques & neurofibrillary tangles; brain shrinkage
Amyloid plaques: amyloid B-protein clumps together in plaques → disrupts cell function
Neurofibrillary tangles: abnormal accumulation of protein tau → block neuron’s transport system
Widespread brain damage causes neurons to stop functioning, loss of connections, and death of neurons
Changes in entorhinal cortex and hippocampus cause memory problems
Changes in the cerebral cortex cause problems with language, reasoning, and social behavior
Etiology- unclear; epidemiology: 1 in 10 people over 65 have AD and it increases with age/ expected to greatly increase with people living longer
Combination of genetic and environmental factors
Disproportionately affects African Americans, Hispanics, and females
Diagnosis: interview, memory & problem solving (mini-cog, MMSE, MoCA), brain scans
Diagnosis
Medical interview
Tests of memory, problem solving, attention
Standard medical tests
Identify other possible causes
Brain scans
Computed tomography (CT)
Magnetic resonance imaging (MRI)
Positron emission tomography (PET)
Rule out other possible causes
Screening
Mini Cog test
Remember and few minutes later repeat, names of three common objects
Draw the face of a clock showing 12 numbers in correct places in specified time
Mini mental status examination (MMSE)
Dementia screening tool
Measure decline and recovery
Health professional asks patient questions
Range of everyday mental skills
MMSE: Scoring
Mild dementia: 20- 24
Moderate: 13-20
Severe: < 12
Average decline 2 to 4 points/ year
MMSE evidence
Mixed results
Is effective in public health settings
Less effective distinguishing MCI from depression
Insufficient evidence for predicting conversion MCI > dementia
Stages of Alzheimer’s: Pre-clinical AD, mild cognitive impairment, mild dementia due to AD, moderate dementia due to AD (safety issues- wandering), severe dementia due to AD (lose ability to communicate, decline in physical function)
Pre-clinical: before symptoms begin, but brain changes are occurring
Mild cognitive impairment: mild changes in cognitive impairment like memory lapses, but does not impact work/relationships
Mild dementia: memory loss of recent events, difficulty problem solving, poor judgment, personality changes, difficulty organizing/expressing thoughts, friends/family may start to notice
Moderate dementia: increasingly confused, poor judgment, wandering, require help with ADLs, significant personality changes, unfounded suspicions
Severe dementia: lose ability to communicate, require total assistance for ADLs, decline in physical function, lose ability to swallow, loss of bladder/bowel control
Mortality causes:
Pneumonia, dehydration, malnutrition, falls
Residential housing options:
Nursing home
memory units
assisted living
Healthy aging strategies to reduce AD risk
Caregiving challenges:
Needs of patients
Taking care of the caregiver
Practice Questions:
1. Mike, a 74-year-old male, has recently been to the doctor and has been expressing some concern about increasingly frequent memory problems. He mentions, for example, that he keeps getting late penalties on his credit cards and his utility bills despite having prided himself on always being on time in his life. He also describes getting lost when he is in places he doesn’t know as well. What would you be concerned about with Mike?
Early-stage Alzheimer’s
Vascular dementia
Late-stage Alzheimer’s
Parkinson’s
Depression
Which of the following are used to determine an Alzheimer’s diagnosis?
The Consortium to Establish a Registry for Alzheimer’s Disease (CERAD) test
B. The Mini-Mental State Exam (MMSE)
Blood tests
A Medical Interview/examination of the patient’s family health history
Lipid panel
None of the above
True or False: Alzheimer’s and Vascular Dementia are reversible.
True
False
Which of the following can help slow the progression of Alzheimer’s?
Diet
Exercise
Attitude
Doing activities in groups
encouraging relationships with friends/family/caregivers
crosswords/puzzles/word find/ WORDLE/games
learning music or another language/ reading the news
Renal Disease & Kidney Transplant
Body function and structure—kidneys, nephrons & glomeruli
Kidneys: eliminate byproducts, waste, foreign chemicals
regulates body fluids, electrolyte balance, hormone secretion, recover or reabsorb essential substances
Nephrons: filtering unit of the kidney
includes the site of filtration, site of secretion and absorption, and site of urine formation
Glomeruli: cluster of nerve endings/small blood vessels where waste products are filtered from the blood
Terminology regarding urine:
dysuria: Stinging/burning of urethra associated with urination
pyuria= urine overproduction
hematuria= blood in the urine
bacteriuria= bacteria in the urine
nocturia= wake up more than one time each night to go to the bathroom
oliguria= scanty, decreased urine production
albuminuria= too much albumin (protein in blood) in the urine
uremia= build up of waste products in your blood
micturate/void = to urinate
Function of electrolytes and what leads to their imbalance
Abstained by eating and drinking
Found in urine, blood and sweat
Lose partially through exercise, sweating, voiding, and evacuating
Chemicals regulating nerve and muscle function
Hydrate the body
Balance body acidity and pressure
Assist in rebuilding damaged tissue
Move within, outside and between cells
Electrolyte imbalance due to kidney disease
High sodium= hypernatremia: fluid retention which leads to edema and perhaps hypertension
Fluid overload causes weight gain, edema, dyspnea
High potassium= hyperkalemia: affects heart (irregular heartbeat, palpitations) weakness
High phosphorus= combines with calcium to keep bones strong- ratio of calcium & phosphorus is not kept constant
Low calcium= calcium loss from bone-osteoporosis = bone weakness with
Kidney function tests: imaging; IVP; urinalysis; culture & sensitivity; blood work
IVP (intravenous pyelogram):
x-ray exam that uses an injection of contrast material to evaluate your kidneys, ureters, and bladder
Tests
Cystoscopy
CT urogram scan
MRI
X-rays (IVP)
IVP = intravenous pyelogram
Kidney biopsy
Blood
Creatinine
Urine
Proteinuria
Urinalysis:
Checking for blood and protein
Checking for electrolytes
Checking for bacteria
Checking color and odor
Culture & Sensitivity:
A culture is a test to find germs that can cause infection
Sensitivity test checks to see what kind of medicine will work best to treat the illness or infection
Blood work:
Creatinine
Glomerular filtration rate (GFR)
160 is a good rate for our age (Said 116 in class)
60 - 120 is a good range
Under 60 not good for kidney function
Measures amount of creatine
High level= kidneys not working properly
Urea nitrogen- BUN
Waste product in blood increases as kidney filtration decreases
ACR: Albumin to creatinine ratio
Types of renal diseases:
UTI:
Common
Most common in females
Enlarged prostate in males
Usually bacterial infection of kidneys, ureters, bladder, urethra
Symptoms include
Burning sensation, pain, cloudy/dark/strange, strong smelling urine, fatigue
Antibiotics used to fight bacteria
Complete entire course of medication
Drink water
Prevention
Drink good amount of fluids to flush the system
Be aware of bathroom habits
Void when you get signals
Establish good personal cleaning hygiene
Urinate shortly after sex to flush away urethral bacteria
Switch birth control methods of sustaining repeat bladder infections
cystitis: a UTI that affects the bladder
May be serious in people with chronic health issues
Catheters can predispose
May be due to structural anatomy issues or poor hygiene
If not managed, may lead to pyelonephritis
Look for dysuria, urgency, pyuria (pus in urine), hematuria (blood in urine), bacteriuria
Antibiotics used
acute & chronic pyelonephritis= bacterial infection causing inflammation of the kidneys
Acute:
Signs and symptoms include fever, chills, abdominal pain, nausea and vomiting
Chronic Pyelonephritis:
May affect one or both kidneys
Irreversible degenerative kidney damage
Scarring of tissue
Vesicoureteral reflux (VUR)= bladder is full and can’t do its job, urine can go back up the ureters and into the kidneys
Obstructions
May lead to kidney failure
Sepsis
Treat with antibiotics
Treat surgically if obstruction present
glomerulonephritis= inflammation of the glomerulus
Post strep infection; diabetes
Inflammation of glomerulus
May lead to hypertension
Can’t get rid of waste (decreased filtration)
S and S lack of appetite, fatigue, mild edema, frequent nocturia, bubbly/foamy urine
Damage to capillaries
RBCs and protein (mild amount) are leaked
Chronic form may be insidious
May lead to CKD
Tx: antihypertensives, diuretics, plasmapheresis low salt and potassium diet
nephrotic syndrome
Changes to glomerulus
From infections, medication effects, DM, SLE, SCD
Leaking of massive proteins
Albuminuria
Regulates water
Edema: face, extremities, abdomen
Hyperlipidemia
Tx: diuretics, IV albumin, corticosteroids, low salt diet
hydronephrosis= increased serum and electrolyte imbalances
Severe long-standing hydronephrosis→ nephron destruction→increased serum creatinine and electrolyte imbalances
Symptoms
Pain, nausea, fever, incomplete voiding and pain
Treatment
Urine drainage
Ureteric stent
Nephrolithotripsy
polycystic disease
Hereditary
Autosomal dominant polycystic kidney disease - 90%
10% of those with ESRD (end stage renal disease)
Numerous fluid filled cysts
Develops slowly
Nocturia, low back pain, hematuria, HTN
Diagnosis with
Ultrasound
MRI= measures volume/growth of cysts
Tx
No cure
Drink water throughout the day and avoid caffeine
kidney stones
nephrolithiasis= stone forming in the kidney
urolithiasis= stone forming in the urinary tract
Ureterolithiasis=stone in the ureter
Risk factors for formation
Dietary factors
Dehydration***
Hereditary factors
Most often 20-49 years of age
Infection in the urinary tract
Obesity and gastric bypass surgery
Certain medical conditions
Gout
Hypercalciuria
Hyperparathyroidism
DIABETES and HYPERTENSION
Signs and symptoms
Severe pain
Nausea and vomiting
Hematuria
Urgency but unable to void
Asymptomatic for some
Prevention
Calcium oxalate stones (most common)
AVOID spinach, tea, rhubarb, nuts, seeds, beats
Drink lemon juice/cranberry juice??
Drink plenty of water—stay hydrated
Limit salt and animal protein
DASH diet (dietary approaches to stop hypertension)
acute renal failure= when your kidneys become unable to filter waste products from your blood
Sudden onset due to surgery, health conditions or trauma
Signs:
Hypovolemia (decreased blood volume)
Hypotension
Septicemia
Urinary tract obstruction
Nephrotoxins (drugs, solvents, metals)
Immediate management: correct the problem
Dialysis as temporary measure
chronic kidney disease/failure:
Majority of time due to diabetes and hypertension
May span over years
Signs and symptoms
Fatigue
Proteinuria
RBC decrease
Anemia contributes to cardiomyopathy
Uremia – toxic condition
Loss of appetite
Nausea and vomiting
Swelling from fluid build-up
Change in sleep patterns
Change in mental function
Pruritus – overall itchiness
Management:
Diet
Medications
Antihypertensives
Vasodilators
Diuretics
Iron supplement injections
Stage 1 (mildest form of kidney disease): Kidney damage with normal infection
Stage 2: Kidney damage with mild loss of function
Stage 3: Mild to severe loss of kidney function
Stage 4: Severe loss of kidney function
Stage 5: Kidney failure requiring dialysis or transplant aka end-stage renal disease (ESRD)
Treatment and management of all of the above:
plasmapheresis= a machine used to separate the plasma from blood cells
Filters blood
Removes harmful antibodies
Similar to dialysis
hemodialysis= filters wastes, salts and fluid from your blood when your kidneys are no longer healthy enough to do this work adequately (ESRD)
3x week/3-4 sessions
Blood removed/circulated through dialyzer and then returned
typically in arm
CAPD(continuous ambulatory peritoneal dialysis):
Intermittent peritoneal dialysis
Not common- performed 3x/week at night for 10 hours
Continuous cycling peritoneal dialysis
Performed nightly
Cycler machine 25lbs, fits into suitcase
ESRD
Peritoneum membrane lining abdominal cavity
Dialysate drained into catheter (exchange)
Performed 4-5 times daily (30-40 min sessions)
Types of peritoneal dialysis
Continuous ambulatory peritoneal dialysis (CAPD)
Intermittent peritoneal dialysis
Not common
Performed at night for 10 hours
Continuous cycling peritoneal dialysis
Performed nightly
Cycler machine
Possible issues
Vascular disease
Increased risk of infection
Catheter displacement
Hernia
Pain
Loss of membrane function
peritoneal dialysis:
Peritoneum membrane lining abdominal cavity
Dialysate drained into catheter (exchange)
Performed 4-5x daily 30-40 min sessions
Issues from peritoneal disease
vascular disease, increased risk of infection, catheter displacement, hernia, pain, loss of membrane function
lithotripsy= procedure used for kidney stones that don’t pass on their own
high energy shock waves passed through the body to break stones into pieces as small as grains of sand
kidney transplant=
intervention= NOT A CURE
may effectively manage the condition
leave diseased kidney in place unless:
uncontrolled infection
uncontrolled HBP
space limitation
challenging to find a match
rejection (acute and chronic)
typically within 3-6 months
places on immunosuppressants (anti-rejection)
Kidney post-transplant
Immunosuppressants
Increase susceptibility to infection
HBP
Cataract formation
Degeneration of bone
Increased risk for developing skin cancer
Return to work average for patient 6-8 weeks
Return for donor 4-6 weeks
Psychological issues
Transplant may fail
May have strong feelings where organ originated
May re-evaluate life
Possible cognitive deficits from kidney disease (e.g., UTIs, CKD)
Post-transplant issues
6-8 weeks until able to return to work for recipient
4-6 weeks for donor
Transport may fail, may have strong feelings regarding where organ originated, may re-evaluate life
CKD (chronic kidney disease) is a strong risk factor for…
Mild cognitive impairments (cognitive impairments beyond those expected based on an individual's age and education but which are not significant enough to interfere with instrumental ADLs)
Dementia
UTIs are also common from kidney disease, which can lead to cognitive decline, increased confusion, and memory deficits
CKD
Strong risk factor for mild cognitive impairment (MCI) and dementia
UTIs can cause sudden confusion (delirium) in older people and people with dementia
Agitation and withdrawal
Depression and anxiety
Risk factors for stone formation:
Dietary factors
Dehydration
Hereditary factors
Most often 20-49 years of age
Infection in the urinary tract
Obesity and gastric bypass sx
Certain medical conditions
Gout, hypercalciuria
Hyperparathyroidism- has to do with Ca
Diabetes and hypertension
Stone prevention strategies:
calcium oxalate stones (most common)
avoid spinach, tea, rhubarb, nuts, seeds, beets
drink lemon juice/cranberry juice???
drink plenty of water
limit salt and animal protein
DASH diet (dietary approaches stop hypertension)
Black market for organs- issues with demand/supply
Practice Questions:
What Functions do the Kidneys serve?
Eliminate byproducts, waste, foreign chemicals
Regulate body fluids
Recover/absorb essential substances
Absorption of Bilirubin
Production of bile
None of the above
2. What are symptoms of electrolyte imbalance caused by kidney disease?
High sodium (hypernatremia): fluid retention
edema
dyspnea= trouble breathing
High potassium (hyperkalemia): affects heart (irregular heartbeat, palpitations),
High phosphorus: Combines with calcium to keep bones strong- ratio of calcium & phosphorus is not kept constant
Low calcium- calcium loss from bone-osteoporosis (bone weakens with increased risk of fracture
All of the above
What are some risk factors for developing kidney stones?
Drinking too much water
Most often 20-99 years of age
Infection in the Urinary Tract
Gout= Uric acid build up= stone buildup
Hypercalciuria= build up of calcium
What are the stages of Chronic Kidney Disease? (Name the stage, what the describes)
Stage 1:
Stage 2:
Stage 3:
Stage 4:
Stage 5:
All of the people below have ESRD. Who would be the best candidate for peritoneal dialysis?
a homeless person who doesn't have regular access to a washroom
a person with moderate dementia
a person with a scarred abdomen due to burns and multiple surgeries
a person with obsessive tendencies to be clean
You have a glomerular filtration rate of 90. Which statement is true about your kidney health?
Kidneys are functioning adequately- no problems
Will need to be on dialysis
Will need to restrict salt and protein in the diet
Will need to be on a waitlist for a kidney
Avg- 116 for our age groups
Rheumatoid Arthritis/ Osteoarthritis
Differentiate symptoms between RA, OA and JIA (Juvenile Idiopathic Arthritis)
Rheumatoid Arthritis (autoimmune) | Osteoarthritis | Juvenile Idiopathic Arthritis (under 17) |
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Risk factors and problems associated with RA & OA
Issue of exacerbation (flares)- primarily in RA
Risk factors RA
30-60 years old
More likely if smoker
genetic risk triggered by particular infection
not understood definitively
more common in women
disruption in hormone balance
Risk factors for OA
older age
female
obesity
joint injuries
certain occupations
genetics
bone deformities
OA variability
Debilitation vs. intermittent aggravation
Few symptoms vs. dramatic x-ray degenerative changes
Constant pain vs. pain-free intervals
Conservative measures vs. multiple meds
Genetics vs. trauma
Differences in joint morphology between the normal, RA, OA joint
RA vs. OA
RA —-----------------------------------------------
More severe than OA
Caused by the immune system attacking the body
Can affect people of any age, but most commonly affects those between ages 20 and 60 years old
Symptoms can be felt throughout the entire body
Affects more women than men
OA—--------------------------------------------------------------------------
Joint destruction
Generally less severe than RA
Caused by wear and tear on the body
Generally affects people over the age of 40
Usually only affects the joints
Commonly found in both men and women
Types of blood tests, imaging and surgical procedures used in RA & OA
Blood tests
Rheumatoid factor, anticitrullinated protein antibody (anti-CCP)
Antinuclear antibody
Erythrocyte sedimentation rate
C-reactive protein
C-reactive proteins
Substance produced by liver in response to inflammation
High level of CRP signifies conditions from infections to cancers
CRP test is nonspecific
COPD, heart disease, lupus, inflammatory bowel disease, RA
Imagins
X-ray, MRI, ultrasound
Treatment of RA, OA
RA:
medication, exercise, assistive devices, surgery, pain control, energy conservation/rest & relaxation, diet
OA:
stay mobile= engage in activity, aerobics, stretching, strength training
Acupuncture, Massage, Heating pads/ice packs, Surgical procedures , stay mobile, pain management
Blood tests | Imaging | Surgical Procedures | |
|---|---|---|---|
Rheumatoid Arthritis |
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Osteoarthritis |
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Specific splints/assistive devices commonly recommended for RA & OA
resting hand splints, wrist supports, finger splints, and special shoes, shoe inserts
Strategies to deal with RA & OA
RA:
Movement
ROM dance, Tai Chi, yoga, mild weights, low impact aerobics
NSAIDs = pain relief
ibuprofen, aspirin, naproxen
DMARDs- slow progression of the disease
methotrexate, janus kinase inhibitors (xeljanz)
Corticosteroids= short term use
Static splits
silver rings, blocks, dynamic splints (tension for exercise)
Thermal agents
hydrotherapy, paraffin baths, fluidotherapy, hot packs, frozen water bottle/ ice packs/ cool mattress, heating pad, icy hot
Energy conservation
planning and prioritizing, pacing simplifying tasks, utilizing good body mechanics
Diet
fiber, beans, green tea (antioxidants), omega-3 fatty acids (salmon, tofu, walnuts), avoid high saturated fats, gluten-free, avoid nightshades?? (tomatoes/peppers, citrus, white potatoes)
Self care= chocolate treat, warm drink, social media unplugged, hair cut, warm bath, good book
OA:
Splinting/bracing
Assistive devices
Pain and control
Rest and relaxation
Pain expression/management
RA:
OA:
prescription opioids- short term, aspirin, naproxen, topical analgesics, corticosteroid/hyaluronic injection, lose weight
acupuncture, massage, heating pads/ice packs, surgical procedures
Thermal agents
Hydrotherapy
Paraffin baths
Fluidotherapy
Hot packs
Frozen water bottle/ice packs/ cool mattress
Heating pad and icy hot
Osteoarthritis is best defined as…
A systemic condition characterized by inflammation
A local joint condition characterized by pain and functional loss
Reduced bone mass
A break in which ends of the bones are pressed against each other
Rheumatoid arthritis is best defined as…
a progressive, chronic, systemic inflammatory auto–immune disease distinguished by joint tenderness and swelling.
an auto-immune condition that produces inflammation and structural changes in multiple organs and organ systems in the body.
an uncomplicated break of a bone with no breaking of skin
None of the above
A patient comes in with complaining of extreme knee pain. Over the course of the visit, the patient reveals that he has always had a “nagging” feeling in the affected knee and that he thinks it is related to an injury he had while playing soccer when he was much younger. Which of the following conditions do you think might explain his pain?
Lupus
Rheumatoid arthritis
Osteoarthritis
Incomplete fracture
Worn away cartilage
Parkinson’s Disease
Causes, symptoms and risk factors
Neurodegenerative disease
Progressive deterioration
Basal ganglia changes
Loss of dopamine
Cause of PD
Unknown
Genetics
Environmental triggers
Presence of Lewy bodies in substantia nigra
Abnormal aggregates of protein
Location is critical
Risk factors
Usually 60 and older
Hereditary
Male
Exposure to toxins
Herbicides, pesticides, agent orange (herbicide used in vietnam)
Cardinal symptoms
Tremors
Bradykinesia
Postural instability
Rigidity
Role of dopamine
Control movement
Emotions
Thinking
Memory
Differentiate PD from young onset and secondary parkinsonism diagnosis
Young onset PD
21-50 years
Similar symptoms
More frequently have a family history
Typically experience
Slower progression of symptoms
More side effects from meds
More frequent dystonias
Primary parkinsonism
75-80% of PD cases
Classic idiopathic PD
Sporadic (caused by environmental factors)
Familial (heritable)
Secondary Parkinsonism
Drug ingestion
Toxic exposure
CO
Chemicals
Alzheimer’s
Encephalitis
Brain tumor
Head trauma
Huntington’s
Methods to classify PD severity
Diagnosis
No specific definitive test
Medical history
Signs and symptoms
Neuro exam
SPECT = specific single photon emission computerized tomography – dopamine transport scan
Radiopharmaceutical
Blood tests
Imaging tests
PD stages
Stage 1: mild symptoms: some tremor, loss of erect posture, diminished facial expressions- may be only one side effected
2: tremors, some body rigidity, walking/posture problems are apparent
3: loss of balance, bradykinesia, falls are common
4: symptoms are severe and limiting-needing assistance to stand
5: most advanced stage – difficult to stand or walk – uses wheelchair for mobility; may experience hallucinations and delusions
Modified Hoehn and Yahr scale
Stages 0-5
Includes stages for unilateral/bilateral disease
Simple rating scale
0: unilateral involvement only
1: unilateral and axial involvement
2: bilateral involvement without impairment of balance
3: mild bilateral disease with recovery on pull test
4: mild to moderate bilateral disease; some postural instability; physically independent
5: severe disability; still able to walk or stand unassisted; wheelchair bound or bedridden unless aided
Unified PD rating scale
More comprehensive tool
Addresses motor and non-motor symptoms
Questionnaire
Behavior/mood
ADLs
Motor abilities
Complications of therapy
Complications of PD
PD complications: motor/non-motor (***nonmotor)
Depression
Bladder problems
constipation***
Sleep disorders ***
BP changes
Hyposmia (smell dysfunction) *** (***nonmotor)
Fatigue
Sexual dysfunction
swallowing/chewing
Writing (micrographia)
Thinking (later stages)
Worsening of symptoms
Though a progressive disease, symptoms are slow to present
Symptoms may intensify due to
Medication changes
Infection (UTI common)
Dehydration
Sleep deprivation
Recent surgery
Stress
Gait/balance/posture
Shuffling
Difficult to initiate stepping
Stooped posture
Arms don’t swing when walking
FALLS
Speech and swallowing
Dysphagia
Aspiration (#1 reason why people with PD die), pneumonia, drooling
Hypophonia= soft speech
Decreased volume, no infection, sometimes hoarse
Rigidity
Mask-like face
Facial masking
Movement is stiff
Freezing, interferes with sleep
Bradykinesia
Often unpredictable
Slowness of movement
Lose automaticity of movement
Blinking
Arm swing while walking
Swallowing
Difficult to initiate movement
Interferes with ADLs
Dyskinesia
Involuntary, erratic, writhing movement
Face, arms, legs, trunk
Complication from medication
Levodopa-induced dyskinesia
Usually occurs after a few years of levodopa treatment
Can manage dyskinesias with amantadine
Seen as preferable to parkinson’s symptoms
May be mild→severe
Tremor: involuntary, rhythmic shaking
Essential
When using limb (active)
Variety of conditions- not typically PD
Resting
Found in people with PD
Frequently seen as pill-rolling
Besides hand, lower lip, jaw, leg
Internal tremor (chest)
Difficulty with handwriting, using tools
May be intermittent or constant
Usually one-side of body
Tremor
Starts usually with one hand
Pill rolling
Wrist
Head (yes or no shaking)
Mood: affects health
Depression
Anxiety
Cognitive
At later stages- dementia
Possible after 10 years
Treatment/management strategies
Remain active
Simplify daily tasks
Use assistive devices
Remove clutter/organize
Choose healthy foods
avoid/manage stress
Avoid cold environment
Avoid alcohol/smoking/caffeine
Nutrition
Dietary elements: whole grains, nuts, fish, mediterranean diet
Ginger for nausea
Green tea (caution: caffeine)
Antioxidants
Herbs and supplements
Not rigorously studied
USFDA does not strictly regulate
No guarantee of safety, strength or purity
Assistive Equipment
Wrist weights
Rolling walker
Handwriting aid
Grab bars
Clear environment
Liftware: designed for tremors
Depression and anxiety
Cognitive behavioral therapy (CBT)
Psychotherapy
Relationship between thoughts, feelings, behaviors
Collaborative approach to deal with life’s difficulties
Guided imagery/relaxation
Exercise
Yoga
Acupuncture
Medications
Carbidopa- levodopa
Routed as most effective
Benefit wears off over time
High doses lead to dyskinesia (involuntary movement)
Amantadine (early/mild symptoms)
Dopamine agonists
Mao B inhibitors
Anticholinergics
Levodopa
Needs to be taken on time
Don’t wait until it has worn off (on-off periods)
Improves quality of life
Doesn’t treat all symptoms
Dramatically helps with most disabling motor symptoms
Other considerations
Support groups/counseling
Home evaluation
Check safety
Assess equipment needs
Driving evaluation
Evaluate driving skills
Prescribe devices
Exercise specifics for PD
Exercise
Flexibility
Aerobic
Resistance training
Exercise ideas
Practice large, rhythmical movement
Practice handwriting
Engage in forced use
Change tempo of movement
Change direction of movement (balance)
Challenge motor planning
Add cognitive component to aerobic activity
Counting reps (assists vocal cords)
Exercise benefits
Consensus from researchers
2.5 hours per week
Improvement in
Gait, balance, decreased tremor, flexibility, cognition, depression, fatigue
Deep Brain Stimulation (DBS): pros and cons
Electrical impulses interfere and block symptoms that cause PD symptoms
Not a cure
Lasts about 5 years
1997- reduce tremor
2002- advanced cases
2016- earlier stages
Diagnosis 4 years or more
Symptoms uncontrolled
Possible candidates for deep brain stimulations
Good response to individual doses of levodopa
Good general health
Good family support
Typical PD with tremor
Wearing off spells
NOT recommended if medication controls disease
Deep brain stimulation (DBS) = electrical impulses interfere and block signals that cause PD symptoms
NOT A CURE
Does not slow progression
Lasts about 5 years
Possible candidates
Good response to individual doses of levodopa
Good general health
Good family support
Typical PD with tremor
Wearing-off spells
NOT RECOMMENDED if medication controls the disease
Pros of DBS:
symptom reduction
little to no damage of brain and no removal of nerve cells
decreased medication needs
Cons of DBS:
invasive and awake during procedure
symptoms that respond to levodopa generally unaffected
risk of stroke, infection, bleeding, accumulating fluid in the brain
expensive
results are not immediate
Association between dementia and Parkinson’s Disease
Dementia often developed in later stages of PD
Possible after 10 years
Lewy bodies
Up to 80% of people with PD eventually develop dementia. The average time from onset of movement problems to the development of dementia is about 10 years. (google)
On location video: Keith Teller’s parkinson’s class at Gainesville Dojo
Keith Diagnosed at 58 with PD
Not going to die from it but going to die with it
Guy came to him and asked if he could learn boxing and then 6 months later 10 ppl then 45 people on roster
Average 15-20 ppl a class
One guy’s problem was balance, strength, coordination
Stiffness an issue with PD
One man had PD for 14 years
Involved in boxing 2x a week 1 hour each
Dr says that their symptoms are decreasing
Some people decreasing amount of medicine taking from exercise
Women are usually stronger than men - men intimidated by women
Rhythmic movement helps people with PD
Swimming, walking, stair steppers
Parkinsonism describes a condition where 4 main manifestations happen. What are they?
Tremor, postural instability, Rigidity, and dyskinesia (side effect of medicine)
Rigidity, Tremor, Akinesia(difficulty with movement but doesn’t say the type of parkinson’s)= bradykinesia is the PD type, Postural Disturbance
Tremor, Rigidity, Confusion, falling
None of the above
What can cause secondary Parkinsonism?
Alzheimer’s
Encephalitis
Brain Tumor
Head Trauma
Huntington’s- writhing
Drugs
What does “poverty of spontaneous movement” refer to? (select all that apply)
Difficulty fleeing from a situation
Blinking less frequently
Mask-like, expressionless face
Dysphagia= trouble swallowing
None of the above