Procedures II Exam II

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Procedures II Exam II
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2011-03-30 01:38:29
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Women Health
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  1. Postpartum depression
    • 8-15% of delievering women
    • etiology and pathogenesis unknown
    • risk factors: history of major depression, PMS, abuse, low socioeconomic status, unplanned pregnancy, lifestyle stress, perinatal loss
    • 50% reoccurrence rate
  2. S/S begin 2-12 mo. post delivery and last 3-14 mo.
    Must have 5
    • Depressive mood most of time
    • diminished interest in normal or pleasurable activities
    • significant involuntart change in wt.
    • insomnia or hypersomnia
    • psychomotor agitation
    • fatigue or loss of energy
    • feelings of worthlessness or guilt
    • diminished ability to think or concentrate
    • recurrent thoughts of death
  3. Female Sexuality Includes
    • self esteem, personality
    • gender roles, relationships
    • body image and female sexual identity
    • *wt. ~excessive thinness, restrictive closths, poor footware
    • *surgeries
    • sexual orientation, sexual behavior
    • * non judgmental, objective, medical communication of the issues affecting PT
    • *same sex family and medical decisions
    • values, attitudes- social, cultural, political, spiritual
  4. Domestic Violence/Partner Abuse
    • 6-25% of pregnant women report physical or sexual abuse during pregnancy
    • Risk factors:
    • *women 17-28
    • *women- single, separated, divorced or planning separation/divorce
    • *women with h/o abuse as child or witnessed abuse as child
    • *women who use ETOH and/or drugs or partners who do so
    • *women whose partners are possessive/jealous
  5. Domestic Violece Effects on PT
    • Missed appointments
    • *cancelled by partner
    • *no transportation, child care
    • *no access to phone to call and cancel
    • *limited money for rx
    • "Therapist hopping"
    • Non compliant w/ rx
    • *unable to obtain/take medications, braces
    • *too tired or stressed to exercise
    • Partner attends PT sessions and speaks for pt
    • Partner attempts to influence PT
    • *intimidating, harassing (rude)
    • *praise PT and portraying himself as good provider
  6. Domestic Violence Screen
    • All women should be asked
    • direct questions about injuries
    • indirect questions about stress
    • assess urgency and danger in current situation
  7. Domestic Violence S/S
    • trunk injuries-throat, chest, abdomen, face
    • sprial fractures
    • injuries in various stages of recovery
    • cigarette burns, teeth marks, etc
    • somatization of pain and hypersensitivity to touch
  8. What to do and not to do
    • DO:
    • mandatory reporting- PT not mandatory reporters unless children present and witnessing the violence; stab wounds, gun shot wounds, or other serious injury
    • know local resources
    • have shelter material in women's bathroom
    • document in objective manner
    • have clear, functional goals and refer if no progress is made
    • NOT TO DO:
    • do not act too quickly- w/out communicating fully w/ pt
    • do not share personal experiences, speak in broad terms using establised stats when able
    • do not hug/touch pt w/out asking first bc may increase discomfort
    • do not approach the partner
  9. Adolescent pregnancy
    • 50% teen pregnancy results in live birth (34% abortion, 14% miscarriage)
    • Higher risks for mom and baby:
    • *higher rates of PTL and bleeding
    • *lower birth weights
    • *more physical abuse
    • *lower maternal wt. gain
    • *more smoking, drugs, ETOH use
    • *more postpartum depression
  10. Female athlete triad
    • 1. osteoporosis
    • 2. amenorrhea
    • 3. disordered eating
    • Common Pattern:
    • negative energy balance
    • external and internal pressure leads to disordered eating
    • often lean body fat <12%
    • decreads estrogen occurs
    • leading to amenorrhea and eventually osteoporosis
    • further resulting in - increased illness, increased injury, longer recovery times, decreased performance
  11. Common impairments associated w/ breast cancer rx
    • decreased should ROM
    • fatigue- chemotherapy
    • fibrosis of the tissue in the anterior chest wall- radiation
    • neural disorder-numbness, neuralgia, nerce entrapment
    • lymphedema
    • psychological effects/ body image
  12. Physiological changes during pregnancy
    • increased O2 consumption and tidal volume
    • increased efficiency to absorb O2
    • rib flare- AP and lateral direction
    • SOB
    • increased blood volume (plasma and RBC)
    • increased cardiac output (SV and resting HR)
    • decreased diastolic pressure
    • venous insufficiency
    • constipation, hemorrhoids
    • decreased peristalsis and esophageal sphincter response--> reflux
    • increased blind spot
    • change in senses
    • sagging pelvic floor and decreased bladder capacity
    • ligaments and tendons loosen
    • mm cramps
    • skin and nail changes
    • hair loss after birth
    • increased sweat production
  13. Preterm labor__ Incompetent cervix__
    Placenta previa__ Premature rupture membranes__
    Pre eclampsia__ Supine hypotension__
    Post partum depression__
    ------
    A. HA, light sensitivity, seeing sports before eyes, edema
    B. SOB, lightheaded, dizzy in supine
    C. Leakage of amniotic fluid before labor starts
    D. Rhythmical ab and LBP before 38 wks
    E. Agitation, fatigue, decreased ability to concentrate, significant involuntary wt. change, recurrent thoughts of death
    F. Usually no S/S, may have vaginal bleeding
    G. Few S/S, may have PROM or PTL
    • D
    • G
    • F
    • C
    • A
    • B
    • E
  14. Postural changes during pregnancy
    • forward shift in COG
    • starting in 2nd tri have changes in balance and postural equilibrium
    • rounded shoulders
    • Upper Xed
    • increased thoracic kyphosis and lumbar lordosis
    • anterior pelvic tilt
    • wider BOS, increased hip ER
    • recurvatum in knees
    • flattened arches of feet
  15. Predictors of LBP during pregnancy
    • previous LBP- pregnant, non, menstrual
    • low socioeconomic class
    • weak evidence: greater parity, fetal wt.
  16. Exercise recommendatoins
    • OLD: HR < 140 and temp <100
    • non- wt. bearing exercises minimize risk of injury
    • avoid supine position after 1st tri or keep < 5min
    • talk test and RPE
    • caution in hot and huid environment
    • 3x/wk for 30 min.
    • good calorie intake (extra 300kcal)
    • same guidelines for post partum 4-6wks
  17. Effects of exercise and normal pregnancy
    • placenta is larger and more efficient
    • immersion exercises eliminates problems w/ placental blood flow, elevated core temp, and possible physical discomfort
    • fetal HR increased 25-35 bpm w/ increased ex. intensity
    • fetal HR drop w/ supine ex.
    • babies may be 11 - 14 oz lighter
  18. ____first time mom
    ____more than on baby at home
    ____length of pregnancy- 280 days, 38-42 wks, 10 lunar months
    ____due date, full term if 2 wks before or after
    ____number of live births
    ____number of pregnancies regardless of outcome
    • Primigravida (primip): first time mom
    • Multigravida (multip): more than on baby at home
    • Gestation: length of pregnancy- 280 days, 38-42 wks, 10 lunar months
    • Expected date of confinement (EDC): due date, full term if 2 wks before or after
    • Parity: number of live births
    • Gravity: number of pregnancies regardless of outcome
  19. Diastasis Recti
    • More than 2 fingers is significant
    • 1st tri- 0
    • 2nd tri- 4 (27%)
    • 3rd tri- 10 (66%)
    • immediate post- 8 (53%)
    • 5 to 7 mo. post- 4 (36%)

    No DR in women who exercised previous to pregnancy
  20. stress urinary incontinence (SUI)__
    urge urinary incontinence (UUI)___
    mixed UI___ overflow incontinence___
    functional incontinence___
    underactive PFM___
    Overactive PFM___

    A. loss of uring due to in ability to reach toilet
    B. PFM unable to contract when needed
    C. Involuntary loss of uring during increased intra ab stress
    D. Concurrent SUI and UUI
    E. PRM unable to relax when needed
    F. Involuntary loss of urine with strong urge to urinate
    G. Loss of urine associated with bladder over distension
    • C
    • F
    • D
    • G
    • A
    • B
    • E
  21. Risk factors for urinary or fecal incontinence
    • vaginal delivery: forceps, abnormal presentation, prolonged active 2nd stage, birth wt. >8#, weaker collagen, 3rd degree tear
    • chronic increased intra ab pressure: obesity, chronic cough, asthma, smoking, repetitive lifting, chronic constipation
    • surgery: repair of anal fissure, hemorrhoidectomy, prolapse
  22. Hysterectomies
    • total abdominal hysterectomy: uterus and cervix removed
    • radical hysterectomy: remove uterus, cervix, cardinal ligament, upper vagina, lymph nodes
    • total vaginal: remove uterus and cervix through incision in vagina
    • supracervical: only remove uterus
    • salpingo-oophorectomy: remove fallopian tubes and ovaries
  23. Irritable bowel syndrome__ Painful BS___
    Endometriosis___ BPH___
    Coccygodynia___ Overactive PFM___
    UTI___ Vulvodynia___ Pudendal neuralgia__

    A. Hesitancy and weak urinestream, frequency of urination
    B. 5% asymptomatic
    C. constipation diarrhea, abdominal bloating, back P
    D. Pain often w/ sitting
    E. Dyspareuria, pain with sitting, obstructed void
    F. Vulvar burning often w/ posterior thigh and coccyx pain
    G. Perineal sensation of dryness, itching, pain
    H. heavy or irregular menses, LBP, ab pain
    I. urgency, frequency, ab pain associated with urination
    • C
    • I
    • H
    • A
    • D
    • E
    • B
    • F
    • G
  24. Bladder anatomy
    • Detrusor: middle layer of bladder and responsible for emptying smooth muscle
    • Trigone: specialized area of the detrusor, ureters to internal sphincter
    • Bladder neck: base of bladder, internal sphincter smooth muscle
  25. Info on bladder
    • reservoir stores 400-600 ml urine, 13-20 oz
    • 1st void sensation approx. 1/2 full
    • no more than 67 oz or 2 liters
  26. Neurological Pathways
    • Somatic: pudendal n. and n. to levator ani; S2-4; sensory and motor to PFM
    • Sympathetic: hypogastric n.; T11-L2; bladder relax sphincter contract
    • Parasympathetic: plevic n.; S2-4; bladder contract sphinter relax

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