Various Systems Disorders

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Various Systems Disorders
2015-08-11 23:23:10
NBCOT exam review
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  1. Gastrointestinal system
    Dysphagia and swallowing disorders
    • oral facial musculature
    • pharyngeal and laryngeal structures
    • Piriform sinuses
    • vocal folds
    • bronchioles/bronchi
    • lungs
    • esophagus

    facial paralyis--> incomplete closyure of the mouth; loss of bolus out of the front of oral cavity

    praxis/motor planning difficulties--> inability to effectively chew and coordinate tongue movements to propel the bolus toward the base of the tongue; residual food centrally located in the oral cavity; difficulty forming a bolus with smoother consistencies

    sensory impairments--> lack of awareness of residual food on the side of the mouth with decreased sensation; pocketing of food; spillage of residual good into the airway at time when vocal cords are open; timing of swallowing sequence is off.

    weakness of tongue/base of tongue structures--> inefficient propulsion of the bolus at an efficient rate of speed past the base of the tongue into the pharyngeal cavity;lack of closure at the cricopharyngeal junction causing suboptimal propulsion of the bolus, interference with the timing of swallowing, and failure to close the vocal cords leading to aspiration

    weakness of the elevation of the pharynx dduring swallowing(incomplete triggering of the pharyngeal phase of swallowing

    vocal cord paralysis: inefficient closure of the vocal cords during the pharyngeal phase of swallowing which may lead to aspiration.

    • Penetration of the bronchioles/bronchi by the bolus when aspiration occurs:
    • food enters the lung: true aspiration occurs
    • bacteria can cause pneumonia (aspiration pneumonia); person may or may not fight it off/experience pneumonia)

    • clinical aspiration
    • Food enters the airway
    • person can clear airway by coughing (reflex intact)
    • Person silently aspirates (bolus enters ling and person does not react; person experiences respiratory distress without a cough; person cough s too weakly to raise the bolus in order to expel it).

    • diminished esophageal motility:
    • bolus sits in the esophagus and can slowy move toward the stomach or up toward the pharynx; person may feel food is stuck in the esophagus; person aspirates when food propels upwards and he/she cannot swallow it.
  2. Clinical exams and functional findings of swallowing disorders
    • person coughs during or after drinking water or other thin liquid
    • person's face changes color during or after eating
    • person gasps for breath but has a partial or complete airway obstruction

    • Bedside swallowing eval
    • assess level of alertness, ability to follow directions, level of awareness of impairment, orientation to activity
    • assess motor and sensory components of swallowing
    • assess ability to manage own secretions
    • clinical obseravtions
    • assess swallowing function using trial boluses (suggest diet modification, as indicated; recommend further testing if needed)

    swallow studies can also be conducted with barium; record swallowing to see if a person is aspirating

    • relating swallowing dysfunction to occupation
    • disruptionof apersons role relative to his/her family unit/decreased ability to comfortably wat at the dinner table; modified diet could be infantilizing; person may not be comfortable eating out; alteration of self-concept

    • intervention
    • provide family centered intervention to determine an acceptable dinner table alternative to interaction
    • work with person toward developing new roles and occupations
    • provide ongoing education and information to family regarding persons feeding/nutrition.
  3. Gastric Esophageal Reflux Disease (GERD)
    • Structures involved include the lower esophageal sphincter and gastric sphincter:
    • Food enters stomach and mixed with stomach acid/digestive juices
  4. Gastric Esophageal Reflux Disease
    structures involved include the lower esophageal sphincter and the gastric sphincter

    food enters the stomach and  mixes with stomach acid; lower esophageal sphincter closes inefficiently and the stomach contraction propels acid/acidic bolus back into the esophagus.

    frequent complaints of people with GERDinclude heartburn, indigestion, chest pain, sensation of something stuck in esophagus, regurgitation after swallowing

    • tests:
    • barium swallowing (observing below the pharynx); flexible endoscopy (observing at the pharynx)

    • Intervention
    • Sleeping with more than one pillow (elevating the head to discourage regurgitation associated with body posture)
    • keep head elevated above the stomach when a person is reclined in order to discourage upward retropulsion of the bolus from the stomach
    • drug therapy

    diet modification (less spice, small meals on a more frequent basis, lower alcohol intake

    stress management
  5. Small bowel obstruction
    etiology- secondary to scar tissue and/or radiation to the abdomen, result of tumor obstruction

    • surgical treatment
    • resection with open stoma (colostomy); closed abdominal surgery

    • rehab issues:
    • self-care aspects of stoma care must be addressed for persons with decreased FM skills
    • decreased mobility of GM movements that cause traction on the healing scar (bending, stooping, foot/LE related self-care such as dressing, bathing, nail and foot care)
    • altered appetite in post-operative phase
  6. Neurogenic Bowel
    etiology- sympathetic nerve impairment, generally occuring in persons who have SCI above T6

    loss of control of the anal sphincter; sensory loss resulting in lack of awareness of feces in the bowel

    flaccidity of muscles results in incontinence

    autonomic dysreflexia (an extreme rise in BP can result leading to an emergency if not reveresed)
  7. Renal Genitourinary System
    kidney disease
    risk factors:diabetes, HTN, systemic lupus erythematosus

    • treatment for renal disease:
    • prevention, early intervention and control of HTN (diet, exercise, medication, stress reduction, smoking cessation); prevention, early intervention and control of diabetes.

    treat with diuretics and medications to prevent fluid accumulation

    • acute renal failure treatment:
    • drug control, acute dialysis

    medical treatment of end stage renal failure: dialysis to stay alive; transplantation (cadaver, living related/unrelated)

    • Impact on function:
    • Motor dysfunction (fatigue, muscle pain, edema limiting mobility, weakness)
    • sensory system function (neuropathy, vision loss)
    • cognitive dysfunction (alteration of body image, delusions, dementia)
    • perceptual/neurobehavioral dysfunction (demetia/infarct related or stroke related)
    • psychosocial dysfunction (anxiety, depression, mood/adjustment disorder, poor coping,drug therapy and counseling may be helpful)

    • Impact on performance
    • self care (alteration in urine, need for meticulus sanitary technique with self dialysis)
    • strict adherence to a disease
    • alteration in sexuality (impotence, alteration of self esteem, feeling less desirable)
    • need for adaptive devices (tub/toilet benches, build ups, reaching devices, fine motor assistive devices
    • energy conservation
    • alterered mobility

    IADL adaptations
  8. Cancer
    risk factors- heredity, environment, habitat

    prevention and early detection: mammograms for women 40+ years; prostate and testicular exams for all adults (PSA); skin checks;pap smears; blood tests/ultrasounds; avoid environmental contributions (lead paint,chemical contaminants);avoid contributory habits( i.e. smoking)
  9. Diagnostic staging of Cancer
    • Stage 1- tumor present, no perceived spread of disease
    • stage 2- localized spread of the tumor
    • Stage 3- extensive of a

    • primary tumor that has spread to other organs in the body
    • stage 4- inoperable primary lesions;multiple metastises
  10. Treatment/rehab of cancer
    medical treatment- surgery, chemotherapy, radiation, immunotherapy

    • rehabilitation:
    • preoperative- preoperative functional assessements and preparation of the client for postoperative phase and care; client and caregiver education concerning recovery and follow up care/functional expectations.
    • post-operative- intervention planning based on a client's medical status

    • convalescence-
    • motor impairments, sensory impairments, cognitive impairments, neurobehavioral impairments, psychological support (liminality-self recognition of vulnerability and self sense of mortality), development of health supportive behaviors.

    palliative care- prevent and relieve suffering, address physical,psychosocial,enhance qol, consider environment

    End of life care (hospice)- support QOL, provide client with as much control as they can, ecourage planning for death, empower life celebration, refer for legal support.
  11. Scleroderma
    rheumatic,connective tissue disease associated with impaired immune response

    • three main components
    • vascular (raynaud's phenomenon; constant recurrent constriction of small blood vessels leading to pulmonary hypertension; decreased esophageal motility)
    • fibrotic- scar tissue resulting from excess collagen (fiber) causing thickness of skin and burning sensation in the skin; fibrosis of the lungs causes restrictive lung disease
    • Autoimmunity- B cell produced antibodies

    • twobasic types of the disease
    • limited: skin involvement (with good prognosis) and linear scleroderma (bands of thicker skin)
    • systemic: involvement of organs (life threatening); CREST Syndrome (calcinosis or calcium is skin, Raynaud's, Esophageal dysfunction,Sclerodactyly, Telangiectastsor red spots covering the hands,feet,forearms, face and hips.

    risk factors- genetic and environment

    • Intervention
    • Raynaud's- keep fingers and toes warm, dress in layers, drug therapy (vasodilators),biofeedback

    pulmonary artery problems- drug therapy, medication

    gastrointestinal problems- drugs, dietary modifications (soft diet, avoid alcohol and spicy foods, treatment of infection

    fibrosis of skin- durg therapy,protective gloves

    myositis- inflammatory disease, cessation of exercise, durg therapy

    fribrosis of lungs- drug therapy

    • Raynaud's
    • dress in layers, guided imagery to concentrate on improving distal circulation, education to encourage skin inspection, activity to prevent trauma to fingers and toes

    • Contractures
    • splinting at optimal resting length for hands/wrists to attempt to slow progressive development of contractures; use of silicone gel in the palm of hands; use of electrical/mechanical vibration to decrease burning sensation in hands

    facial disfigurement- look good/feel better programs,  support groups

    thoracic spinal lesions can result in nuerogenic bowel/bladder, altered mobility,  and altered activities of daily living

    space occupying lesions in the brain produce stroke-like symptoms(rehab for functional tasks)
  12. Rehab for immunological system disorders
    overall goals and approaches can be preventative, restorative, supportive, and/or palliative depending on treatment setting, diagnosis, stage of illness,expected outcomes

    • interventions for impairment level problems:
    • cousel people to be compliant with screening and treatment regimens
    • set personal goals to invest behaviorally in ones health
    • provide support
    • social support
    • refer to physcian for durg therapy

    • interventions for activity level problems
    • adaptations and training to do self care tasks with greatest ease while conserving energy; alter grasp/pinch patterns and level of demand of the UE;alter size of feeding utensils, and tooth brushes to accommodate decreased ability to open mouth; prevent shearing forces on skin
    • WORK
    • work capacity evaluations; modifications to work site to allow participation
    • modify specific tasks and acivities;evaluate skills and interests to introduce new leisure or sports activities
    • REST
    • monitor and intervene to maximize the ability to be well positioned during sleep; monitor sleep habits and patterns and intervene when strategies are needed to relax and unwind

    • Interventions for participation problems
    • needs assessment to determine individual issues the person has with mobility, social orpolitical access to their home, or community environments
  13. Phases of rehab
    • Acute hospitalization phase-
    • early mobilization, preservation of function, positioning, psychological/emotional support, prevention of LTD

    • inpatient rehabiliation-
    • evaluation and restoration of functional abilities (selfcare, IADL, energy conservation, and work simplification), restoration of activity, achievement/maintenance of QOL, role readjustment, plannin return to community

    • Home care
    • Collaborative assessment (COPM), evaluation and resortation of functional activity, restoration of activity/exercise tolerance, community mobility,

    • Community based care
    • school related- transitioning from homeschooling back to school
    • work related- participatory as per ADA
    • population related
  14. Diabetes
    • type 1
    • insulin dependent, autoimmune, genetic, environmental factors

    • type 2
    • noninsulin dependent (90-95% of all cases)
    • (older age, obesity, family hx, race)

    gestational diabetes (2-5% of all pregnances) usually resolves after pregnancy

    • signs/symptoms
    • frequent urination, excessive thirst, unexplained wt loss, extreme hunger, visual changes, sensory changes, fatigue, very dry skin, slow healing wounds, increaed rate of infection)

    prevention (regulary physical activity can prevent diabetestype 2

    • sequalae/complications
    • fatigue/decreased activity tolerance
    • urinary disturbance
    • visual loss, low vision, blindness
    • peripheral neuropathy (amputations)
    • popenisty to develop wounds
    • poor general health/increased rate of infections

    hypoglycemia (dizziness, tachycardia, pallor, weakness, diaphoresis (sweating), seizures and or coma; if person is concouse, provide carbs in the form of hard candy , fruit, juice or honey***

    • hyperglycemic crisis
    • ketoacidosis- signed include dehydration, rapid and weak pulse and acetone breath
    • hyperosmolar coma- signs include stupor,thirst,polyuria,and neurological abnormalities; call for emergency medical services

    • Rehabilitation
    • preventative exercise
    • education concerning compliance
    • psychosocial support
    • lifestyleredadjustment
    • protective issues regarding peripheral neuropathy (safety assessment)
    • skin care
    • pain management
    • adapted techniques/equipment
    • attention to wound management
  15. Obesity
    • Prevention
    • education(raising awareness of behavioral factors contributing to obesity such as sedentary lifestyle; community driven group intervention)
    • habit intervention with occupations and activities that contribute to obesity

    • Sequelae
    • decreased ability in performance areas of occupations (BADL,IADL, mobility, social participation), symptamology related to larger body size (musculoskeletal pain, limited mobility, lower activity tolerance)

    • Rehabilitation
    • lifestyle redesign (personalized plan, activity-focused exercise program, self-monitoring of exercise responses, supportive coaching to improve compliance)

    • inpatient rehab tertiary care
    • assesdevicesto mazimize participation; relearn lifestyle modifications

    • co-morbidities
    • cardiopulmonary comprise is typically exhibited, altered biomechanics affects hips, knees, ankles, foot, back, and joint pain
    • inreased risk of pressure ulcers due to shear forces
    • increased occurrance of lymphedema, cellulitis, skin fold dermatisitand other skin infections
    • increase heat intolerance
    • increased risk of practittioner injury when using poor body mechanics or inadequate assistance during transfers and lifts.
  16. Lyme disease
    etiology- tick bites

    • sequelae and symptoms
    • impairs immune response and affects the neurological and orthopedic systems

    • early symptoms
    • fatigue, headache, chills and fever, muscle and joint pain, swollen lymph nodes, rahs,erythema migrains (circular red patch occuring 3 days to one month after the bite; center of the rash may clear resembling a bulls eye)

    • late sympoms
    • arthritis- brief bouts of pain and swelling in one or more of the large joints (knees most commonly affected joints)
    • nervous system abnormalities (numbness, pain, bell's palsy, meningitis)
    • hear rate irregularities

    • medical treatment
    • anibiotics,management of joint related symptoms

    • rehabilitation
    • treat joint pain and swelling (eduaction regaring acute arthritic flares,rest, splinting or wrapping, energy conservation)
    • treat nervous system abnormalities (numbness- safety assessment)
    • pain (physical agent modalities,stress management, adapted techniques)
    • Bell's Palsy (facial splint, electrical stimulaion, using fingers to assist with mouth closure)
    • Meningitis (acutecare- positioning, splinting, supportivecare)
    • heart rate irregularities (pulseoxmeasurements, work simplification and modification)
  17. Pressure/decubitis ulcer
    pressure that interrupts normal circulation causing localized areas of cellular necrosis

    greates risk is over bony prominences; intensity and duration of of the pressure determines the severity of the decubiti

    condition predisposing to ulcers- immobility, weight loss, edema, incontinence, sensory deficiences, circulatory abnormalities, dehydration, inadequate nutrition, obesity

    • stage I: skin intacts with visible redness over a localized area (typically over a bony prominence); area may be soft or firm; area may be painful or itchy
    • stage II: involves the dermis with partial thickness loss which presents asashallowopen ulcer that canbe shiny or dry; can also present as a blister
    • stage III: full thickness tissue loss with subcutaneous fat possibly visible
    • STAge IV: full thickness tissue loss with bone, tendor or muscle visual or directly palpable

    • evaluation
    • presence of risk factors should be identified; caregiver training to check skin

    • intervention
    • using wheel chair cushion,pressure relief bed aids to distribute pressure
    • train individual in positioning and weight shifting techiques (push ups, full weight shifts
    • train in proper skin care (keep skin free of excessive moisture, dryness, and heat--- check skin at least 2x/dayfor evidence of breakdown).
    • encourage adequate intake  of fluids to maintain nutrition, promote healing, andachieve recommended body weight.