Conditions Exam 2 PDF

Explain the role of normal (lines of) defenses in preventing disease; generally describe the components of the immune system Physical and chemical barriers: ○ Includes skin, mucosa of respiratory and digestive tracts ○ Mucus, tears, urine, nose hairs, ear wax, saliva Non-specif...

Explain the role of normal (lines of) defenses in preventing disease; generally describe the components of the immune system Physical and chemical barriers: ○ Includes skin, mucosa of respiratory and digestive tracts ○ Mucus, tears, urine, nose hairs, ear wax, saliva Non-specific innate responses: ○ Immune cell response to agents which penetrate the physical barrier ○ Inflammatory response leads to redness, swelling, and pain at site Specific adaptive responses: ○ Targets and removes pathogens to which the body has been previously exposed ○ When we think acquired immunity, this process comes to mind Define inflammation and differentiate between acute and chronic inflammation The normal defense mechanism in which the intention is to localize and remove an injurious agent ○ Typically presents with redness, warmth, swelling, and pain Acute: Sudden, short term response to an injury or infection that usually lasts a few days Chronic: Long-term response that can last months or years. Can be caused by environmental factors or an overactive immune system. Describe the local and systemic effects of inflammation Local: Occurs in the area affected by an injury or irritation, such as redness and swelling at the site of a cut or sprained ankle Systemic: Occurs when the immune system is constantly defending the body, such as when inflamed joints occur throughout the body. Describe the types of healing: Resolution: Damage cells recover and tissue repairs quickly(mild sunburn) Regeneration: damaged tissue is replaced with identical tissue(liver) Replacement: Connective tissue forms where there is significant damage(scars) Define and differentiate between contracture, adhesion, hypertrophic scar/keloids, wound dehiscence, and ulceration: Contracture: Fixation and deformity of a joint due to scar tissue or high muscle tone Adhesion: Scar tissue which bonds two surfaces which are normally separated Hypertrophic scar tissue/keloid: Overgrowth of fibrous tissue which can lead to contractures Ulceration: Open sore which is caused by poor blood flow Wound dehiscence: Tearing apart of wound edges due to improper healing Identify and describe the three layers of the skin: Epidermis: outermost layer which protects body from external environment Dermis: layer where the sweat glands, hair, hair follicles, muscles, sensory neurons, and blood Hypodermis: Layer of adipose tissue Define burn; identify and differentiate between the various types, or mechanisms, of burns Burn: Thermal(heat) or nonthermal(chemical or electrical) injury to the body leading to acute inflammation and destruction of tissue. Types: heat, chemicals, radiation, electricity, light, friction Describe and differentiate between the classification of burns: First-degree burns: Superficial, damaging to epidermis. Typically red and painful, heals without scarring. Ex: sunburn and mild scalding Second-degree burns: Partial thickness, destruction of epidermis and part of dermis. Typically red, swollen, and blistered. High risk of infection. May require skin grafts. Third degree burns: Full-thickness, destruction of all skin layers. May be initially painless due to nerve damage. Will require skin grafts. Define and differentiate between eschar and exudate: Eschar: Dead tissue which forms over healthy tissue and then sloughs off. Exudate: Collection of interstitial fluid which forms in the area of inflammation Define TBSA and discuss use or purpose in the assessment of a burn—describe the Rule of Nines and the Lund Browder: TBSA: total body surface area. It is a measurement used to assess the extent of a burn injury and is expressed as a percentage of a patients total body area. It is important for estimating fluid resuscitation needs and determining a patients outcome. Rule of nine: A method for estimating the total body surface area of a burn by dividing the body into percentages: head:9%, each arm: 9%, anterior and posterior chest and abdomen: 18% each, Each leg: 18%, Perineum:1% Lund Browder: considered most accurate, is a burn assessment technique that uses a chart to calculate the TBSA affected by burns. ○ Identify age, Outline burn, calculate %, Calculate TBSA Differentiate between edema, pitting edema, and third-spacing (Gould, pg. 16-21) Edema: Excessive amount of fluid in skin Pitting Edema: Leaves indentation when pressed Dehydration: insufficient body fluid due to inadequate intake or loss of fluids  Third-spacing: Fluid shifts out of the blood into a body cavity and is no longer available to circulate Generally, describe the systemic affect from a burn—shock, respiratory issues, infection, pain, and metabolic needs Shock: condition caused by a rapid loss of fluid, which can lead to decreased cardiac output, hypovolemia, and hypoperfusion. This can be managed with fluid resuscitation, can be fatal Respiratory issue: Can occur due to burning of lung tissue and effects of toxic fumes Infection: high risk Pain: very Metabolic need: increase need for healing Generally, discuss the types of permanent wound coverings and temporary wound coverings Discuss the role of splinting and protective positioning in burn care; identify the appropriate splint/position for burns at the following joints: neck, axilla, elbow, wrist, and hand: Used for: edema prevention, skin contracture prevention, maintaining or increasing range of motion, keloids scar prevention, protect skin graft, immobilize extremity Neck: position in midline with 0-15 degrees of extension Axilla: 90 degrees of shoulder abduction Wrist: full pronation Elbow: full extension Hand: resting hand with fingers and thumb extended Define and generally differentiate between the types common microorganisms Nonpathogenic: Do not cause disease and may be beneficial Pathogenic: disease-causing microbes/ “germs” Bacteria: single cell organisms that do not require living tissue to survive ○ Ex: staphylococcus aureus Fungi: single cell or chain of cells ○ Athletes foot, candida Viruses: small intracellular parasite which requires a living host to replicate ○ Influenza, covid-19. HIV Protozoa: parasites ○ malaria Differentiate between the modes of transmission for infectious organisms—direct contact, indirect contact, droplet, aerosol, and vector-borne:  Direct contact: no intermediary Indirect contact: Uses intermediary such as hand, food, or object to spread Droplet: Respiratory or salivary secretions spread organisms Aerosol: particles from the respiratory tract Vector-borne: insect or animal carries disease Describe standard precautions guidelines for infection control: Hand hygiene Use of ppe(gloves, gowns, mask, eyewear) Respiratory hygiene/cough etiquette Sharps safety(engineering and work practice control) Safe injection practices Sterile instruments and devices Clean and disinfected environmental surfaces Describe appropriate respiratory hygiene and cough etiquette for health professionals: Cover mouth and nose with tissue when you cough or sneeze Throw used tissue in trash Wash hands with soap and water Reflecting on methods of infectious disease transmission, discuss the purpose and procedures for the following precautions, including personal protective equipment (PPE): contact precautions, droplet precautions, and airborne precautions: Use of gloves in situations involving possible contact with blood or body fluids, mucous membranes, non-intact skin Use of protective clothing to protect skin and clothing during procedures or activities where contact with blood or body fluids is anticipated Use of mouth, nose, and eye protection during procedures that are likely to generate splashes or sprays of blood or other body fluids Define multidrug resistant organisms (MDROs), discuss transmission, whom is at risk: MDRO’s: bacteria of fungi which are resistant to antimicrobial or antifungal medication ○ Patients with low immune resistance or who are immunocompromised are especially susceptible to these infections ○ Patients with neutropenia, due to cancer chemotherapy, are at a higher risk for infection Review neutropenia and neutropenic precautions:  Neutropenia: condition where there are low levels of neutrophils in the blood which can increase the risk of serious infections Neutropenic: instructions that can help reduce the risk of infection in people with neutropenia Describe the mechanism of autoimmune disorders and the cause and effects of immunodeficiency: Autoimmune disorder occurs when the immune system mistakenly attacks the bodys own tissues, perceiving them as foreign invaders, leading to inflammation and tissue damage, while immunodeficiency refers to a weakened immune system, making the body highly susceptible to infections due to a lack of proper immune response. Understand the etiology, general epidemiology, affected body structuresand functions, and identify the possible barriers to occupational performance (impact of condition on client factors) as a result of the following conditions: superficial, partial-thickness, and full-thickness burns; nosocomial infections; septicemia; methicillin-resistant staphylococcus aureus (MRSA); clostridium difficile (c-diff); mycobacterium tuberculosis (TB); and, vancomycin-resistant enterococci (VRE); HIV/AIDS; hospital-acquired pneumonias (PNA) Superficial: due to heat source causing tissue cell death or charring. Affects epidermis Partial thickness: affects epidermis and dermis Full thickness burns:cold, radiation, chemicals, electricity, heat. Affects skin, subcutaneous tissue, underlyin structures, nerves Physical abilities: Physical abilities can remain a barrier to returning to work for up to a year. Working conditions: Temperature, humidity, and safety of the workplace can be barriers. Psychosocial factors: Nightmares, flashbacks, and appearance concerns can be barriers. Returning to the same place of injury: If the injury occurred at work, returning to the same place or doing the same tasks can cause anxiety or fear. Nosocomial infections: hospital acquired, caused by bacteria, viruses and fungi. more than 100 million each year. Can affect lungs, skin, urinary tract, bloodstream, surgical sites, organs, and surgical implants Lack of knowledge: Patients and staff may not understand the causes of nosocomial infections. Inadequate supplies: Hospitals may not have enough personal protective equipment (PPE), such as gloves, masks, gowns, and goggles. They may also lack other supplies, such as soap dispensers, hand sanitizer, and waste disposal bins.  Poor hand hygiene: Staff may not wash their hands properly or often enough. Inadequate training: Staff may not be adequately trained in infection prevention and control (IPC) practices. Staff turnover: High rates of nursing staff turnover can make it difficult to maintain an experienced staff. Heavy workloads: Clinical workloads can make it difficult for staff to prioritize infection control. Inadequate infrastructure: Hospitals may not have enough isolation rooms, or wards may be cramped and not well-equipped. Antibiotic resistance: Pathogens may evolve and become resistant to antibiotics, making infections harder to treat. Septicemia: bacterial infection, can be caused by viral or fungal or noninfectious. 15 per 1000. Can affect bloodstream, kidneys, lungs, skin, central nervous system, gi tract, liver, cardiovascular system, and genitourinary tract Lack of knowledge and training Nurses may lack knowledge of sepsis protocols, or have poor attitudes towards blood culture techniques. Understaffing Emergency departments may be understaffed, which can make it difficult to provide appropriate fluid management. Overcrowding Overcrowded medical wards can make it difficult to provide appropriate care. Poor teamwork and communication Poor teamwork and communication can make it difficult to implement sepsis care. Resource concerns Hospitals may not have adequate resources to provide sepsis care. Poor facility condition Facilities may be in poor condition, with inadequate sanitation, ventilation, electrical supply, or lighting. MRSA: caused by unnecessary antibiotic use. 2% of people carry it. Affects bones, joints, blood, organs. C-diff: caused by contact with contaminated surfaces, antibiotic use, length of stay in a healthcare facility. 500k people per year. Affects large intestine or colon, and rectum TB: caused by the bacteria Mycobacterium tuberculosis. 10.6 Million people. Can affect lungs, brain, kidneys, spine, amd skin VRE: Contact with contaminated surfaces, person to person contact, and medical equipment. 20k a year become infected in the US. can cause infections of urinary tract, bloodstream, wounds associated with catheters or surggical procedures, or other body sites. HIV/AIDS: Caused by a virus spread through sexual contact, shooting of drugs or use of shared needles, or contact with infected blood. 88.4 million people have been infected. Can affect brain, kidneys, heart, genital organs, nervous system, gastrointestinal tract, musculoskeletal system, oral cavity, skin PNA: caused by bacteria, viruses, fungi, parasites, or exposure to chemicals or pollutants. 24.8 cases per 10,000 adults. Inflames air sacs in one or both lungs. Generally, describe the structures and function of the pulmonary system including the protective (defense) mechanisms Upper respirtory tract: Nose: entry point for air, filters large particles Nasal cavity: air is warmed and humidifed here Pharynx(throat): passageway for air to travel to the trachea Larynx (voice box): contains vocal cords, responsible for sound production Lower respiratory tract: Trachea(windpipe): large tube that carries air to the bronchi Bronchi: divide into smaller airways, further branching into bronchioles Bronchioles: tiny tubes that lead to the alveoli where gas exchange occurs Alveoli: small air sacs within the lungs where oxygen is transferred to the bloodstream and carbon dioxide is released Define and differentiate between ventilation and perfusion Ventilation Noninvasive: administered without using an invasive artificial airway; mask or similar device Invasive: admin of breathing support; tracheal intubations, ventilator Describe the diagnostic tests and tools related to COPD you may see in medical record reviews—spirometry-pulmonary function test, bronchoscopy, pulse oximetry, and cultures Spirometry test: measures how much air you can inhale and exhale along with how efficiency and fast you can blow the air Pulmonary function test: measure lung volume, capacity, air flow rates, and gas exchange  Bronchoscopy: examines air passages through the use of a small camera connected to a tube Pulse oximetry: measures oxygen saturation and heart rate Cultures: used to determine type of infection in lung Identify and define the common symptoms of pulmonary disorders—cough, wheezing, stridor, rales, bronchi, dyspnea, cyanosis, clubbing, mucous secretions, Cough: expel air from the lung with a sudden sharp sound Wheezing: breathing with a whistling or ratting sound in the chest Stridor: high-pitched, abnormal breathing sound that occur when there is a blockage or narrowing in the airway Rales: an abnormal rattling sound heard when examining unhealthy lungs with a stethoscope Bronchi: Large tubes that connect to your trachea and direct the air you breathe to your lungs Dyspnea: shortness of breath, is the subjective feeling of difficulty breathing Cyanosis: a bluish discoloration of the skin resulting from poor circulation or inadequate oxygenation of the blood Clubbing: physical sign of enlarged, bulbous ends on the fingers or toes Mucous secretions: the production and release of a fluid called mucus by specialized cell in the body Define and differentiate between the following terms: anoxia; hypoxemia; hypoxia; respiratory arrest; and, respiratory failure Anoxia: total depletion in the level of oxygen Hypoxemia: low level of oxygen in the blood ○ Can caused lung disease (COPD), heart failure, anemai Hypoxia: body’s tissues don’t receive enough oxygen Respiratory arrest: condition that exists at any point a patients stops breathing or is ineffectively breathing Respiratory failure: condition that makes it difficult to breathe on your own. ○ Develops when the lungs can’t get enough oxygen Differentiate between obstructive and restrictive lung disease Obstructuve lung disease: problems with exhalation; exhalations can be slow and shallow ○ Chronic bronchitis, COPD, CF, and asthma Restrictive lung disease: problems with inhalation  ○ Pneumonia, TB, and sarcoidosis Identify and differentiate between the modes of supplemental oxygen delivery; differentiate between invasive and noninvasive mechanical ventilation Nasal cannula: most commonly used (noninvasive) Face mask: used if higher levels of oxygen are needed or if person cannot tolerate nasal cannula (noninvasive) Portable oxygen tanks (noninvasive) Oxygen concentrator (noninvasive) Liquid oxygen: use caution regarding cold temperature when filling (noninvasive) Humidifier: required for oxygen flow over 4 liters (noninvasive) Generally, describe the features of pulmonary rehabilitation Medical program used to assist people with lung problems in breathing and living better ○ Baseline vital are typically taken via stress test, 6-minutes walk test, or similar assessment ○ Education is provided on breathing techniques, nutrition, and exercise, along with opportunities for psychological counseling ○ Additional education/ support provided on smoking cessation, energy conservation, and managing daily activites Discuss the purposes of dyspnea control postures, pursed lip breathing, diaphragmatic breathing, and effective coughing Dyspnea control postures: Help reduce shortness of breath in conjunction with pursed lip breathing and diaphragmatic breathing Pursed lip breathing: Simplest ways to control shortness of breath. It provides a quick and easy way to slow your breathing pace, making each breath more effective. It also helps you get more oxygen into your lungs. Diaphragm breathing: use the diaphragm correctly while breathing. This breathing technique offers several benefits to your body including reducing your BP and HR and improving relaxation Effective coughing: maneuver that can help clear mucus from the lungs Understand the etiology, general epidemiology, affected body structuresand functions, and identify the possible barriers to occupational performance (impact of condition on client factors) as a result of the following conditions: congestive heart failure (CHF); chronic obstructive pulmonary disease (COPD); emphysema; chronic bronchitis; asthma; bronchiectasis; cystic fibrosis (CF); atelectasis; acute respiratory distress syndrome (ARDS); pneumonia types; pulmonary edema; pulmonary hypertension; pulmonary embolism; pneumothorax; pleural effusion; tuberculosis; sarcoidosis; sleep apnea Congestive heart failure (CHF):  Etiology: coronary artery disease, high blood pressure, valvular heart disease Epidemiology: prevalence 1.9-2.6% of gen pop in US, more likely in men; incidence 1-5 per 1,000 under 65 years old Affected body structures: heart, lungs, liver, kidneys, and limbs Barriers to Occupational Performance: fatigue and shortness of breath (climbing stairs, cooking); cognitive impairment (driving, meal preparation) Chronic obstructive pulmonary disease (COPD): block airflow making it difficult to breath Etiology: long-term exposure to harmful particles or gases that damage the lungs and airways Epidemiology: prevalence affects more than 14 million adults Affected body structures: lungs, accessory muscles, skeletal muscles Barrier to occupational performance: shortness of breath, coughing, and increased mucus makes it difficult to perform daily tasks. Emphysema: shortness of breath and chronic cough Etiology: long-term exposure to irritants that damage the lungs; main causes is cigarette smoking ○ Environmental exposure - air pollution, chemcial fumes, dust, vapors ○ Genetic conditions Epidemiology: prevalence 14 million people in US- higher in men and areas w/higher environmnetal polluation ○ Mortality- third leading cause of death worldwide Affected body structures: damages the air sacs and airways in the lungs - alveoli Barrier to occupational performance: difficulty breathing making it difficult to perform daily activities, exercise intolerance, poorer work productivity, anxiety and fatigue Chronic Bonchitis: cough that produces mucus and makes it hard to breath Etiology: caused by progressive and irreversable damage to the bronchi due to irritation from smoking or industrial pollution Epidemiology: 10 million people in the US, prevalence of CB increases with age and more prevalent in non-hispanic white and non-hispanic black individuals compared to hispanics; more prevalent in patients with chronic obstructive pulmonary disease Affected body structures: bronchial tubes, lungs, heart Barrier to occupational performance: shortness of breath, wheezing, chest tightness, and cough can make it difficult to engage in everyday activities, lead to poorer work productivity, anxiety and fatigue, financial burden Asthma: airways become narrow and swell, inflamed, and extra mucus Etiology: caused by both genetic and environmnetal factors  Epidemiology: 1 in 12 people have asthma (28 million people) higher in adults than children and females; 3,500 people die from asthma each year in US Affected body structures: the bronchial tree: bronchi, bronchioles, airway linings Barrier to occupational performance: decrease motivation Bronchiectasis: airway becomes damage making is difficult to clear liquid or mucus Etiology: thickening of walls of the bronchi due to inflammation or infection Epidemiology: prevalence increases with age and more common in women; incidence 29 cases per 100,000 people Affected body structures: bronchi, heart, bloof vessels Barrier to occupational performance: shortness of breath when performing activities, muscle weakness affecting mobility, balance, and posture Cystic fibrosis (CF): life threatening condition that effects lungs and digestive system Etiology: genetic mutation in the cystic fibrosis transmembrane conductance regulator gene Epidemiology: most common in white newborns; incidence about 1,000 new cases of CF are diagnosed each year in US Affected body structures: lungs, pancreas (mucus can clog ducts of pancreas), intestines, sweat glands, males reproductive system, lack of oxygen to fingures and toes Barrier to occupational performance: present with decreased activity tolerance and endurance which impacts ADL and work performance Atelectasis: complete or partial collapse of a lung or section of lung Etiology: blockage in air passages, pressure on the outside of the lungs, shallow breathing or poor inspiratory effort, underlying condition: lung disease, COPD, Epidemiology: common in children under 10 because their airways are narrower, risk is high after surgery, obesity and pregnancy increase the risk of atelectasis because the disphragm is displaced upwards Affected body structures: Lobe of the lung and alveoli Barrier to occupational performance: present with decreased activity tolerance and endurance which impacts ADL and work performance Acute respiratory distress syndrome (ARDS): fluid collections in air sacs, depriving organs of oxygen Etiology: lung injury that damages the air sacs (alveoli) in the lungs: pulmonary risk factos- pneumonia, arpiration; extrapulmonary risk factors- sepsis, pancreatitis, trauma to the head, chest, or other areas of the body ○ Illness or injury Epidemiology: can effect people of any age; about 190,000 americans are diagnosed with ARDS each year Affected body structures: lungs, blood vessels, heart, liver, or kidneys  Barrier to occupational performance: sever shortness of breaking: walking, talking, eating challenging- reduced physical activity levels Pneumonia types Pneumococcus infection of one or more lobes of lung ○ Present with sudden onset, high fever, chills, pain with breathing, and a productive cough ○ Treatment is antibiotics ○ Vaccine available for older adults Bronchopneumonia infection of alveoli which impairs oxygen diffusion ○ Insidious in onset ○ Immobolized patients are at higher risk ○ Present with moderate fever, cough, and rales (crackles- abnormal sounds in the lungs that are heard when a person inhales) Pulmonary edema: abnormal buildup of fluid in the lungs Etiology: heart conditions (heart can’t pump efficiently), injury to lungs (pneumonia), acture central nervous system injury Epidemiology: life-threatening condition, common finding in acute heart failure, sudden and severe high BP can cause pulmonary edema Affected body structures: alveoli and interstitium (an extravascular space in the lungs) Barrier to occupational performance:breathing difficult - decrease in activity Pulmonary hypertension: high blood pressure Etiology:occurs when the small arteries in the lungs narrow, making it difficult for the heart to pump blood through the lungs Epidemiology: rare disease 15-50 cases per million people, prevalence increases with age, women are more liekly to have it Affected body structures: heart, lungs, liver, kidneys, brain Barrier to occupational performance: exercise is difficult or even dangerous, climbing stairs, bending over, grocery shopping Pulmonary embolism: one or more arteries in the lungs become blocked by blood clot Etiology: caused by blood clots that breaks off from a deep vein in the leg or pelvis and travels to the lungs, blocking an artery ○ Also called deep vein thrombosis Epidemiology: significant cause or morbidity and mortality worldwide, rare in children more common after age 75 Affected body structures: lungs, heart - low blood oxygen levels Occupational barriers: Pneumothorax: a collapsed lung  Etiology: can occur for numerous reasons: blunt or penetrating trauma to chest wall, during menstrual period (endometriosis), a rupture of blebs in the lung can air to leak into the pleural space ○ Chest unjury, medical procedures, or underlying lung disease Epidemiology: higher in males than females in US Affected body structures: chest wall and lung (pleural space) Occupational barriers: should wait at lest three weeks to fly, avoid high elevations or scuba diving Pleural effusion: buildup of fluid between the tissues that line the lungs and the chest Etiology: fluid around the lungs that is caused by heart failure, liver cirrhosis, pneumonia, cancer, or pulmonary embolism Epidemiology: common condition, 1.5 million people are diagnosed ed in the US each year, conditions occurrence rate appears differently geographically Affected body structures: respiratory system function Occupational barriers: decrease exercise- difficulty breaking when doing anything other then sitting or standing Tuberculosis: bacterial disease that effects the lungs Etiology: caused by the bacterium mycobacterium tuberculosis epidemiology: increases rapidly during adolescence Affected body structures: lungs, lymph nodes, bones and joint, CNS, abdomen Occupational barriers: decreased activities Sarcoidosis:the growth of tiny collections of inflammatory cells in different parts of the body Etiology: exact cause of sarcoidosis is unknown, but it appears to have both genetic and environmental compnents Epidemiology: incidence changes by region, age-associated incidence peaks at 30-39 - mean age increases over time, when are more likely to have sarcoidosis Affected body structures: lymph nodes, eyes, and skin Occupational barriers: exercise, work, fatigue, pain, reduced muscle strength Sleep apnea: breathing repeatedly stops and starts Etiology: obesity, smoking, genetics, hormones, age (getting older) Epidemiology: globally 936 million adults have mild to severe and 425 million have moderate to severe Affected body stuctures: respiratory, endocrine system, digestive system, cardiovascular system, nervous system, brain Describe the purpose of the diagnostic tests and tools related to cardiac conditions you may see in medical record reviews: electrocardiogram (ECG or EKG), echocardiogram, stress test, cardiac catheterization, angiography, troponin test, arterial blood gas, and serum lipid levels ECG: Monitors the conduction system of the heart and detects abnormalities such as arrhythmias, MI, infections, and pericarditis EKG: Ultrasound used to record image of the heart and detect valvular abnormalities, congenital defects,and changes in structure or function Stress test: Exercise test used for assessment of cardiovascular function, exercise induce conditions, and checking for arrhythmias Cardiac catheterization: Used to visualize inside the heart, measure pressures and assess functioning of valves and heart Angiography: Used to visualize blood flow in coronary arteries Troponin test: measures levels of blood proteins. High levels = heart damage Arterial blood gas: measures current oxygen level and acid base balance in patients with MI or shock Serum Lipid Levels: Measure used for predicting cardiovascular risk(total cholesterol, HDL cholesterol, LDL cholesterol and triglycerides Describe two ways an artery can become totally obstructed: Atherosclerosis: presence of plaque which forms inside vessel walls Plaque rupture that causes a blood clot to form Describe the dietary and lifestyle changes and the general purpose of the following cardiac medications: vasodilators, beta-blockers, calcium channel blockers, digoxin, diuretics, ACE inhibitors, anticoagulants, and statins. Lots of fruits veggies and whole grain Vasodilators:opens blood vessels to increase blood flow Beta-blockers: blocking action of adrenaline Calcium channel blockers: prevent calcium from entering the heart and blood vessels Digoxin:treat heart failure and heart rhythmic problems ACE inhibitors:treat high blood pressure, heart failure… Anticoagulants: prevent or reduce clotting Statins: lower cholesterol-> lower risk of MI or stroke ;Discuss the various medical interventions for heart disease/conditions including any implications and/or contraindications for therapy: coronary artery bypass (CABG); percutaneous coronary intervention including angioplasty and stenting; ablation; pacemaker; cardioversion; and, VAD  coronary artery bypass (CABG): improves blood flow to heart by rerouting blood around blockage ○ Implications: significant blockage of arteries ○ Contradictions: non-symptomatic, 85+, obesity Angioplasty: minimally invasive surgery that widens, narrowed or blocked arteries with a catheter ○ Implications: activity restriction, cardiac rehab ○ Contradictions:small vessel size, occlusion,hematoma of vessel Stenting: minimally invasive surgery placing a small tube in narrow or blocked passage to help the body to open it ○ Implications: antiplatelet therapy, self care ○ Contraindications: bleeding disorders, blood clotting disorders Ablation: medical procedure that destroys or removes tissue or a body part ○ Implications: cancer AFib ○ Contraindications bleeding diatheses Pacemaker: small surgically place device in chest to help regulate the heart’s rhythm ○ Implications: ○ Contraindications: infection, swelling, bleeding cardioversion: restores a normal heart rhythm when it is beating to fast or to slow ○ Implications ○ Contraindications VAD: ventricular assistive device: medical pump that helps pump blood when the heart is failing’s ○ Implications ○ Contraindications: Identify the psychosocial considerations for those with heart disease Lack of social support Work stress and/or family stress Depression Anxiety disorders Low socioeconomic status Define blood pressure and differentiate between: diastolic and systolic; hypotension; orthostatic hypotension; primary, secondary, and malignant hypertension Blood pressure: measures the pressure of blood against the wall of the arteries Systolic: measures pressure inside of arteries while the heart is beating  Diastolic: measures pressure inside the arteries between heartbeats Orthostatic hypotension: blood pressure drops with position change from sitting to standing Primary hypertension: Idiopathic- high BP Secondary hypertension: due to renal or endocrine disease or tumor of adrenal medulla Malignant hypertension: Emergency level HTN which results in organ damage Describe the general precautions in working with clients with heart diseases and vascular disorders: Monitor vitals at baseline and during activities Oxyggen saturation should be 95 to 100% Do not engage in aggressively active rehabilitation treatment or intervention Constantly ask patient how they are feeling Allow for rest break Describe and differentiate between the following conditions—including signs and symptoms: CAD-arteriosclerosis and atherosclerosis; angina pectoris and myocardial infarct; cardiac arrhythmias—PVCs, atrial flutter, atrial fibrillation, and total heart block; congestive heart failure; endocarditis and pericarditis; peripheral vascular disease; and shock Cad- CAD stands for coronary artery disease, a condition that occurs when the coronary arteries that supply blood and oxygen to the heart become blocked or narrowed. This blockage is usually caused by a buildup of plaque, which is made up of cholesterol, fatty substances, and other materials chest pain, shortness of breath, pain in arm shoulder or jaw, weakness, light headedness, nausea, cold sweats, heart palpitations, swelling in hands/feet. Dizziness Atherosclerosis: is a general term for a vascular disease that causes arteries to thicken and stiffen, which can restrict blood flow.CHest pain, pain in arms/legs, abdominal or back pain, TIA, erectile dysfunction, dizziness, loss of balance, confusion, diff talking, vision probs, nausea, cold sweats, fatigue Angina pectoris: medical term for chest pain or discomfort that occurs when the heart muscle doesn't receive enough blood and oxygen. A pressing, crushing pain under breastbone, pain in upper back, both arms, neck, or ear lobes, chest pain that spreads to arms jaw neck or back, shortness of breath, weakness MI: stands for myocardial infarction, which is a medical emergency also known as a heart attack. It occurs when blood flow to the heart  muscle is reduced or stops, which can lead to permanent damage to the heart. chest pain, cold sweat, fatigue, heartburn, dizziness, nausea, shortness of breath Cardiac arrhythmias: a condition where the heart's rhythm or rate is abnormal: Fatigue, dizziness, fainting, rapid heartbeat, shortness of breath or anxiety, chest pain, alternating heart beat, sweating PVC’s: Premature ventricular contractions (PVCs) are extra heartbeats that occur when the heart's lower chambers, the ventricles, contract too early. This disrupts the heart's normal rhythm and can cause a fluttering or skipped beat in the chest. PVCs are a common type of irregular heartbeat, also known as an arrhythmia.skipped heartbeat, lightheaded, short of breath, chest pain Atrial flutter: a heart rhythm abnormality that causes the upper chambers of the heart (atria) to beat too quickly and in a regular pattern: shortness of breath, fatigue, chest pain, fluttering heartbeats, light headed, fainint, swelling in feet and legs Atrial fibrillation: a heart condition that causes an irregular heartbeat in the upper chambers of the heart. fast, fluttering, pounding heartbeat, chest pain, dizziness, fatigue, light headed, reduced ability to exercise, shortness of breath, weakness Total heart block:a medical condition that occurs when the electrical signals in the heart are disrupted, preventing the heart's upper and lower chambers from beating in sync. dizziness, palpitations, fatigue, chest pressure or pain, short of breath, fainting spells Congestive heart failure: is a chronic condition that occurs when the heart is unable to pump blood efficiently, causing fluid to build up in the body.short of breath, fatigue, swelling, coughing, weight gain, rapid heartbeat, blush color, trouble sleeping, dizziness, frequent urination Endocarditis:Endocarditis is a rare but life-threatening condition that causes inflammation of the heart's inner lining and valves: aching joints and muscles, chest pain when breathing, fatigue, flu like fever and chills, night sweats, short of breath, swelling leg feet or belly, heart murmur Pericarditis:a medical condition that involves inflammation of the pericardium, the sac that surrounds the heart: chest pain, short of breath, fever, swelling, heart palps, cough, fatigue, anxiety, pain in neck and shoulders  Periperal vascular disease: is a circulatory condition that occurs when blood vessels outside of the brain and heart narrow, spasm, or become blocked. pain like cramps, aches, burning in leg and feet esp during activity, skin changes, wounds, hari loss on legs, coldness, numbness, weakness, heavy legs and feet,ED, pulses weak or absent in feet and legs, toenails brittle or slow growing, gangrene Shock: a life-threatening condition that occurs when the body's circulatory system fails to deliver enough blood and oxygen to the body's tissues and organs. pale, cold, clammy skin, shallow rapid breathing, diff breathing, anxiety, rapid heartbeat, heart irreggularities or palps, thirst or dry mouth, low urine or dark output Differentiate between the various types of brain injuries—primary vs secondary; concussion; closed, open, and contrecoup; traumatic vs nontraumatic; postconcussive syndrome Primary Brain Injury: when an injury to the brain is caused by the primary onset (impact, penetration, fall, car accident) Secondary brain injury: additional damage to the brain that is the result of the effects of the primary brain injury (blood-brain barrier breakdown, increased intracranial pressure, meningitis) Concussion (mild TBI): traumatic brain injury caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth Open head injury: skill is penetrated or damaged Closed head injury: damage happens internally, but skill is not broken Contrecoup head injury: damage occurs at sites of the brain from the point of impact (often a contusion that develops on the opposite side of the brain from the point of impact) Traumatic: caused by an external force, such as a fall, assault, or motor vehicle accident Non-traumatic: acquired brain injury, caused by internal factors, such as a lack of oxygen, exposure to toxins, or a stroke Generally, discuss the various medical interventions: tissue plasminogen activator (tPA), burr hole, craniotomy, clipping, carotid endarterectomy, and evacuation Tissue plasminogen activator (tPA) medication given (by IV) that dissolves blood clots impeding blood flow and oxygen to the brain - if administered fast enough it can reduce the impact/damage of the blood clot  Burr hole: small holes made in the skull to relieve intracranial pressure cuased by fluid buildup such as blood Craniotomy: surgical removal of part of the skull in order to get access to the brain Clipping: surgical procedure to clip and aneurysm Carotid endarterectomy: surgical procedure to remove plaque buildup in the common carotid and internal carotid arteries Evacuation: surgical procedure to remove blood from the brain (treats subdural hematoma) Describe various types of strokes including TIAs (Gould, Table 14.8); aneurysm; arteriovenous malformation; anoxia; contusion, subdural, epidural, and intracerebral hematomas; generalized seizures and partial seizures Generally, discuss the circulatory system of the brain including the blood brain barrier and the Circle of Willis. ○ Types of strokes Thrombus: results of arthosclerosis (build up of protein, fatty material, plaque) in cerebral artery ○ Gradual onset which may be precipitated by transient ischemic attaches (TIA) ○ Often happen at rest, temporary blockage but then clears up Embrolus: results of atherosclerosis in carotid artery or heart ○ Sudden on set ○ Can be active/athletic all life and still get it Hemorrhage: results of hypertension due to atherosclerosis ○ Sudden onset which often occurs with activity ○ High intracranial pressure, often fatal Aneurysm Cerebral aneurysm: caused by localized dilation of an artery ○ Greater risk for rupting as it enlarges over time ○ Can be treated with clipping of the bulge Arteriovenous malformation (AVM): an abnormal tangle of blood vessels that connect artieres and veins in the brain (thicker) It can occur in the brain or spinal cord At risk for rupturing, leading to bleeding in the brain Can be repaired by surgery Anoxia: complete oxygen deprivation to organ or tissues In the brain, it can lead to anoxic brain injury Damage all over the brain-anywhere the blood supply go cut off to Contusion: medical term for a bruise; result of a direct blow or an impact ->fall Hematomas Extradural or epidural hematoma: blood fills space between dura and bone due to tear or the middle meningeal artery Subdural hematoma: blood fills space between the dura and arachnoid which typically accumulates slowly due to a vein tear Intracerbral hematoma: results from contusion or shearing injuries Seizures Generalized seizures: multiple origins in the brain that leads to unconsciousness ○ Multiple serizures can happen in a row or several times a day, caused by abnormal electrical activity in both sides on the brain Parietal seizures: single origin in the brain which may alter consciouness Circle of Willis: a ring of blood vessels connecting the anterior and posterior circulations of the brain Keeps the front and back of the brain oxygenated Blood brain barrier: regulates transfer, solutions, and chemicals from the circulatory system to the CNS Protects the brain from harmful substances Define and differentiate between levels of consciousness including: coma, vegetative state, and locked-in syndrome Coma: state of appearing asleep, but not able to wake due to a prolonged loss of consciousness Vegetative state: appearing akway, but not interacting with the environment -> no visual tracking Locked-in syndrome: state of paralysis, with exception to the eye muscles, where the person is aware (can think and reason). But cannot move or speak. Define and describe the signs of increased intracranial pressure; describe brain herniation Intracranial pressure: the pressure within the cranispinal compartment. This can increase as result of brain injury, which puts additional brain tissue at risk of damage ○ Signs include headache, blurred vision, and emesis (vomiting) ○ Can cause brain herniation or displacement of brain tissue which causes further damge Generally, describe seizure precautions and actions occupational therapists should take during a seizure Seizure precautions include minimization of flashing lights and rapid and rotational movements If a seizure happens: make sure airway remains open so that breathing is unimpeded Describe the purpose of the neuroimaging diagnostic tests and tools you may see in medical record reviews: computerized tomography (CT) scan, magnetic resonance imaging (MRI), electroencephalogram (EEG), and positron emission tomography (PET) computerized tomography(CT): computerized X-ray imaging used to build a 3D image of the brain magnetic resonance imaging(MRI): magnetic field imagery used to take pictures of the inside of the body Electroencephalogram (EEG):measures the electrical activity in the brain Positron emission tomography (PET): imaging test that uses radioactive “tracer” to evaluate typical or atypical metabolic activity: disease can be detected before showing up on CT or MRI Describe the general effects of neurologic dysfunction Effects movement, including paralysis, weakness, loss of muscle, control, increase muscle tone, loss of muscle tone, or tremor Differentiate between the following muscle tone disorders: hypotonia, hypertonia, flaccidity, spasticity, rigidity, cogwheel, and clonus Hypotonia: low muscle tone (may appear floppy or present with flaccidity) Hypertonia: high muscle tone (may appear stiff or present with spasticity) Cogwheel rigidity: muscle jerks through movement (associated with Parkinson's) Clonus: abnormal reflex that presents as rhythmic and involuntary motor contractions (associated with upper motor neuron lesion which is damage to brain or spinal cord) ○ Leg jumping and they do not mean for it to do so Define and differentiate between the following: paralysis, paresis, hemiplegia, hemiparesis, tremor, and ataxia. Paralysis: loss of muscle function to part of the body Paresis: onset of muscle weakness in part of the body Hemiplegia: loss of muscle function to one side of the body Hemiparesis: weakness on one side of the body Tremor: involuntary rhythmic shaking Ataxia: difficulty with coordination due to loss of muscle function Differentiate between decorticate and decerebrate posturing (Gould, Fig. 14.6) Decorticate posturing: flexion of arms, wrist, and fingers with adduction of upper extremities Decerebrate posturing: extremities are rigid with hyperpronation of forearms and plantar flexion of feet ○ Very small likelihood of survival ○ If found do not move and call 911 Define, differentiate, and provide an example of the following: neglect, agraphia, agnosia, dysarthria, aphasias (Gould, Table 14.6), homonymous hemianopsia, field cut, apraxia, dysphagia, stereognosis, spatial relations, form constancy, figure ground, visual discrimination, visual closure, and visual memory Neglect: Loss of awarness of things to one side of the body due to the brain not processing information. Ex: leaving food on one side of the plate Agraphia: impaired ability to write Agnosia: loss of recognition. Ex: they know what a cat is, can see the cat, but cant tell you that its a cat Dysarthria: difficulty with articulation EX: slurring or mumble Aphasias: ○ Expressive (Broca’s): difficulty producing speech. Ex: leaving out words like “is” or “the”, Using the wrong word like car instead of truck, repeating words or phrases, choppy speech, using short phrases like I walk dog ○ Receptive(wernickes): inability to understand speech. Ex: using word salad like speaking in a way that sounds like a sentence but isnt, using the wrong words like calling a fork a gleeble, adding unnecessary words, creating words, trouble repeating words back ○ Global: combo of expressive and receptive. EX: Limited speech like yes or no, Automatic phrases such as thank you or excuse me Homonymous hemianopsia: Loss of half of visual field in each eye, a right HH affects the right visual space of each eye Field cut: loss of parts of field of vision Apraxia: Difficulty with motor planning. Ex: may be unable to tie shoelaces or button shirt Dysphagia: Difficulty with swallowing ex: drooling Stereognosis: Ability to identify objects by touch Spatial relations: ability to tell proximity of objects Form constancy: Objects stay the same irrespective of size Figure ground: Ability to pick out an item from a jumbled background Visual discrimination: ability to detect differences Visual closure: Ability to fill in missing parts of objects Visual memory: Ability to memorize detail Identify the spinal cord anatomy; describe the general functions (Gould Figure 14.4) Cervical: 8 ; head and neck, diaphragm, triceps, wrist, hand Thoracic: 12; chest and abdominal muscles Lumbar: 5; leg muscles Sacral: 5; bowl/bladder and sexual function Differentiate between upper motor neuron and lower motor neuron lesions in the central nervous system Upper motor neuron: encompasses area of the cerebral cortex to brain stem or spinal cord ○ Lesions present as hypertonia and spastic paralysis Lower motor neuron: encompasses area of spinal cord to muscle ○ Lesions present as hypotonia and flaccid paralysis Define and differentiate between the following: paraplegia, quadriparesis, quadriplegia, tetraplegia, tremor, and ataxia. Paralysis: loss of muscle function to part of the body Paresis: onset of muscle weakness in part of the body Paraplegia: paralysis of the lower half of body Quadriplegia/tetraplegia: paralysis if the whole body Tremor: involuntary rhythmic shaking Ataxia: difficulty with coordination due to loss of muscle function Identify the symptoms and differentiate between the following: spinal shock, autonomic dysreflexia, postural hypotension, and neurogenic bowel and bladder Spinal shock: motor and sensory function shut down temporarily post-injury ○ Symptoms: loss of sensation, motor activity, and spinal reflexes below the level of the injruy Autonomic dysreflexia: noxious stimuli lead to rapid rise in BP ○ Symptoms: headache, skin changes, sweating, HR slows, blurred vision, nasal stiffness, nause Postural hypotension/orthostatic hypotension: BP drops with upright position change ○ Symptoms: dizziness or lightheadedness, feeling faint, passing out, falling, headaches, blurry or tunnel vision, mental confusion Neurogenic bowel and bladder: dysfunction caused by damage to the spinal cord ○ Symptoms: constipation and stool leakage or incontinence Describe the objective of the ASIA Standard Neurological Classification of Spinal Cord Injury; Standardinzing documentation, guiding treatment, determining injury completeness, aiding research differentiate between a complete and incomplete spinal cord injury Understand the etiology, general epidemiology, affected body structures and functions, and identify the possible barriers to occupational performance (impact of condition on client factors) as a result of the following conditions: Bell’s Palsy; amyotrophic lateral sclerosis; Guillain-Barré syndrome; multiple sclerosis;transverse myelitis; Brown-Sequard; Parkinson’s; anterior cord syndrome; central cord syndrome and post-polio syndrome.  Complete: all sensory and motor functions below the site of the injury are absent Incomplete: some sensory and/or motor control remains below the sire of injury Bell’s Palsy: weakness in the muscles on one side of the face ○ It can be misdiagnosed as a stroke ○ Has to do with a nerve - not so much the brain ○ Etiology- exact cause unknown; sudden onset of facial muscle weakness or paralysis ○ Epidemiology: more common in individuals aged 15-60, with slight predomiance in women and pregnat individuals ○ Affected body structures: facial nerve ○ Barriers to occupation performance: challenges with eating and drinking - difficulty with facial expression and communication Amyotrophic lateral sclerosis (ALS): progressive neurological disease in loss of motor movement and eventually death ○ Etiology: exact cause is largely unknown; some cases have genetic links ○ Epidemiology: typically diagnosed between ages 40-70; slightly more common in men ○ Affected body structures: muscle weakness, atrophy, and spasticity Speech,swallowing, and breathing difficulties ○ Barriers to occupational performance: limitations in mobility and self-care, difficulties in communication Guillain barre syndrome: The immune system attacks the peripheral nervous system which impacts muscle function ○ Often attacks the myelin sheaths ○ Close to full recovery ○ Etiology: autoimmune response often triggered by infection ○ Epidemiology: incidence of about 1-2 per 100,000; most common in adults and slight more in males ○ Affected BOdy structures: PNC- muscle weakness, sensory changes, and sometimes paralysis; respiratory issues if those muscles are affected ○ Barriers to occupational performance: sudden onset of weakness can disrupt daily activities and employment; fatigue Multiple sclerosis: progressive demyelination of neurons of the brain, spinal cord, and cranial nerves ○ Etiology: chronic autoimmune disorder; combination of genetic and enviornmnetal factors ○ Epidemiology: more prevalent in women and often diagnosed between ages 20-50 ○ Affected body structures: impacts brain and spinal cord function ○ Barriers to occupational performance: fatigue, limit engagement in work. Memory, attention, problem-solving, depression and anxiety Transverse myelitis: inflammation of the spinal cord resulting which impacts nerve conduction to the rest of the body ○ Delayed/slowed motor movements  ○ Etilogy: exact reason for transverse myelitis is unknown; bacterial and fungal infections affecting the SCI may cause transverse myelitis - inflammatory appears after recovery from infection ○ Epidemiology: 1-8 new cases per million per year ○ Affected body structures: weakness of the legs and arms- can cause pain, paralysis, sensory problems, or bladder and bowel dysfunction ○ Barriers to occupational performance: difficulty with dressing, bathing, grooming, and eating Brown-sequard syndrome: lesion in the spinal cord that results in a loss of sensation on one side of the body and weakness or paralysis on the opposite side ○ Movement fine but not a good sensation ○ Hot and cold sensation ○ Etiology: caused by spinal cord tumor, traum, inadequate or blocked blood flow through a blood vessel to a part of the body, TB, or MS ○ Epidemiology: approximately 2-4 % of SCI annualy ○ Affected body structures: spincal cord ○ Barrier to occupational performance: balance, walking, and most ADLs Parkinson's disease: caused by degeneration of nerve cells in the brain that produce dopamine. Presents as uncontrolled movements, shuffling gait, soft voice, limb rigidity ○ Work on trying to make larger movements ○ Etiology: The cause of Parkinson’s is unknown, but several factors appear to play a role, including genes and environmental triggers ○ Epidemiology: second most common neurdenerative disease (90,000 people in US); incidence increases with age, most diagnosed around 60 (men are 1.5 times more likely to develop it) ○ Affected structures: urinary problems or constipation, diminished coordination and balance, difficulty swallowing, chewing, and speaking ○ Barriers to occupational performance: difficulty with independently completing ADLs due to tremors and muscle stiffness; decreased socialization due to increased difficulty in leaving the house and difficulty with speaking and swallowing Anterior cord syndrome: cord syndrome that impacts the anterior ⅔ of the spinal cord resulting in complete loss of movement, and pain and temperature loss, but it preserves light touch sensations ○ Etiology: reduce blood flow to the front 2/3s of the spinal cord ○ Epidemiology: rare with around 40 cases per million people in US ○ Affected structures: spinocerebellar and spinothalamic tracts ○ Barriers to occupational performance: Posterior cord syndrome: cord syndrome which impacts the posterior spinal cord resulting in loss of light tough sensation, but movement, pain, and temperature sensation are preserved ○ Etiology: trama, tumors, herniated disc, vitamin B12 deficiency, MS ○ Epidemiology: 2% with an average age of 62 ○ Affected structures: posterior columns and dorsal horns of the spinal cord ○ Barriers to occupational performance: difficulties walking, medication