Immunological Dx

Question 1

Scleroderma & 3 main comps

Answer 1

Rheumatic, conn tissue dx associated w impaired immune responses; Vascular: Raynauds, constant recurrent restriction of BVs=pulm HTN & decreased esophageal motility. Fibrotic: thick/burning skin, restrictive lung disease. Autoimm: B-cell prod antibodies > genetic/environmentallty induced; most often women

Question 2

Limited Scleroderma

Answer 2

Skin involvement w good prognosis & linear scleroderma=bands of thicker skin w good prognosis

Question 3

Systemic Scleroderma

Answer 3

Of internal organs=life threatening; CREST syndrome w good prognosis: Calcinosis, Raynauds, Esophageal dysfun; Sclerodactyly of fingers/toes & Telangiectasis or red spots covering hands/feet/forearms/face/hips

Question 4

Tx for Raynauds (Scleroderma)

Answer 4

Dress in layers - clothing modification (fingers/toes); Biofeedback - guided imagery to focus on distal circulation; Edu on skin inspection; Activity mod to prevent trauma to fingers/toes

Question 5

Tx for Contractures rel to Scleroderma

Answer 5

Splint at optimal resting length for hands/wrists to slow development; Silicone gel in plams; Electrical/mechanical muffled vibration to stim rapidly adapting A-type nerve fibers & decrease burning sensation

Question 6

Gen tx for Scleroderma

Answer 6

Nasal O for pulmonary artery probs, diet mods for Gi probs, cessation of exercise if myositis, protective gloves(cotton, insulated, mildly compressive) if fibrosis skin probs

Question 7

AIDs: Acquired Immunodeficiency Disease

Answer 7

Acquired through unprotected sex/blood or body fluids.

Question 8

HIV: Human Immunodeficiency Disease

Answer 8

Retrovirus (DNA); Attacks lymphatic system (immunity system) - T cells/CD4 attack body

Question 9

4 Stages of HIV Infection

Answer 9

Acute: flu-like. Asymptomatic: HIV replicated and affects imm system but does not show signs other than blood abnormalities. Symptomatic: signs/symptoms appear. Advanced: severely compromised immunity; CD5 (T cell) levels drop

Question 10

HIV Symptoms

Answer 10

Enlarged lymph nodes, fatigue, weight loss/malabsorption of nutrients, fever, diarrhea, decreased act tol, neurolog impairment: cog, affective, sensory, ADL impairments, myelopathy, peripheral neuropathy, visual impairment

Question 11

Hep A/B

Answer 11

Viral infections. A= contaminated seafood/protective imm possible. B/C/Others= body or blood borne exposure/protective imm possible for B. HC workers are most susceptible to B. Fever, fatigue, decreased act tol & cirrhosis (liver degen)

Question 12

Methicillin-Resistant Staphylococcus Aureus: MRSA

Answer 12

Usually mild infections (pimps/boils) > can be more serious including in surgical wounds. Can be local or systemic thru bloodstream affecting lungs or urinary tract. Risks: Weakened immune system, hosp confinement, close quarter living, direct contact (sports) or secondary (towels). Resists most antiboticis

Question 13

MRSA Signs/Symptoms

Answer 13

Red/swelling/pain at wound, drainage, fever, skin abscess, chest pain, cough, fatigue, head/mus ache, rash, SOB - chance of reoccurring in future

Question 14

Tx for Acute Hosp of Imm System Disorders

Answer 14

Early mobilization, preservation of function, positioning, psychological/emo support, prevent LT disability

Question 15

Tx for In Pt Rehab of Imm System Disorders

Answer 15

Eval/restoration of fx’al abilities: ADL, IADL, econ, work simp, restoration of activity/ex tol, achievement /maintenance of QOL, role adjustment intervention, plan comm re-integ

Question 16

Home Care for Imm System Disorders

Answer 16

Collab assessment (COPM) to set goals, eval/restore of fx’al ability, restore act/ex tol, comm mobility

Question 17

Type 1 Diabetes

Answer 17

Insulin-dependent (only 5-10%); Autoimmune, genetic & environmental factors contribute

Question 18

Type 2 Diabetes

Answer 18

Non-insulin dependent (90%); Older age, obesity, fam hx, prior hx of gestational dx, impaired glucose tolerance, physical inactivity, race

Question 19

Other Diabetes

Answer 19

Gestational (2-5% of all pregs-40% may develop Type 2): usually resolves after preg, obesity/race are risk factors. Genetic syndromes, surgery, drugs, malnut, infections.

Question 20

Signs/Symptoms of Diabetes

Answer 20

Frequent urination, excessive thirst, unexplained weight loss, extreme hunger, visual changes, sensory changes in hands/feet, fatigue, very dry skin, slow healing wounds, increased rate of infections > Hypoglycemia: vagueness, dizzy, tachycardia, pallor, weakness, diaphoresis, seizures and/or coma

Question 21

Hyperglycemic Crisis

Answer 21

Ketoacidosis: dehydration, rapid/weak pulse, acetone breath. Hyperosmolar coma: stupor thirst, polyuria, neurolog abnorms. IV fluids/insulin req - call 991

Question 22

Tx for Diabetes

Answer 22

Preventative ther ex, edu on compliance/med mngt for condition, psychosoc/emo support, lifestyle mod to complications, protective issues regarding peripheral neuropathy, early attn to wound mngt, edu on how to notice fx’al changes and edu on what to do

Question 23

BMI: Body Mass Index

Answer 23

Calc by dividing weight in kilos by square of persons height in m. Overweight BMI=25-29.9, obesity=>30, morbidly obese=>40.

Question 24

Health Risks Associated w Obesity

Answer 24

Metabolic syndrome, HTN, HLD, Type 2 DM, cardiovas disease, stroke, glucose intol, sleep apnea, gallbladder disease, menstrual irregs/infertility, Ca, and chronic LBP

Question 25

Tx for Obesity

Answer 25

Lifestyle redesign, activity focused ex program, self monitoring ex responses, supportive coaching/counseling,, AT to max participation

Question 26

Co-morbidities w Obesity

Answer 26

Cardiopulmonary: angina, SOB, increased BP, joint pain/altered biomechanics, increase risk of pressure ulcers d/t shear forces, increased occurrence of lymphedema, cellulitis, skin fold dermatitis/other skin infections, increased heat intol=risk of hyperthermia/heat exhaustion & increased risk of th. injury when using body mechanics

Question 27

Symptoms of Lyme Disease

Answer 27

Fatigue, headache, chills/fever, mus/joint pain, swollen lymph nodes, rash, arthritis, numb, pain, bells palsy=weak on one side of face, meningitis

Question 28

Tx of Lyme

Answer 28

Edu on arthritic flares, rest, anti-inflams, splinting/wrapping to protect/prevent overstretching, energy conservation, work simplification, safety assessment, coping w chronic pain, PAMs to reduce pain, stress mngt techs, neutral warmth, adaptive techs to avoid tigger mvmts, facial splint, e-stim to stim denervated mus, edu on using fingers to help close mouth, counseling on body image, pluse-ox

Question 29

Conditions that Predispose pt to Decubitus Ulcers

Answer 29

Immobility/altered mobility, weight less, edema, incont, sensory deficiencies, circulation abnorms, dehydration, inadequate nutrition, obesity, patholog conditions/multiple co-morbidities and/or age related skin changes

Question 30

Suspected Deep Tissue Injury

Answer 30

Localized discoloration of intact skin or blood blister resulting from damage of underlying soft tissue - could evolve, rapidly

Question 31

Stage 1 Pressure Ulcer

Answer 31

Skin in tact w visible nonblanchable redness over localized area (bony prom), may be softer/firm or cooler/warmer than surrounding area, area may be painful/itchy, may be "at risk" but difficult to detect

Question 32

Stage 2 Pressure Ulcer

Answer 32

Involves dermis w partial thickness loss which presents as a shallow, open ulcer that is shiny or dry or as a blister. Wound bed is red-pink w/o slough or bruising

Question 33

Stage 3 Pressure Ulcer

Answer 33

Involves full thickness tissue loss w subcutaneous fat possible visible, Slough (dead matter) may be present, bone/tendon/mus not exposed, can range from shallow to very deep depending on location

Question 34

Stage 4 Pressure Ulcer

Answer 34

Full thickness tissue loss w bone/tendon/mus visible or directly palpable. Can range from shallow to very deep depending on location.

Question 35

Unstageable Pressure Ulcers

Answer 35

Invloves full thickness loss which the wound bed has slough and or eschar (scab/dark crusted ulcer) which covers base of ulcers

Question 36

Tx for Pressure Ulcers

Answer 36

Prevention is most effective. Group 1: cushions/mattresses w non-elec means (air, foam, gel or h20), Group 2: dynamic, elec-powered devices (alternatinf and low air loss mattresses) for full thick/mod-high risk ulcers & Group 3: dynamic, elec-powered devices (air-fluidize beds) for pts w nonhealing, full thick ulcers, weight shifting and skin care

Question 37

Heat Exhaustion is Characterized By

Answer 37

Rapid pulse, decreased BP, nausea, vom, cool pallid skin, mental confusion, headache and/or giddiness but no fever

Question 38

Heat Stoke is Characterized By | *med emergency

Answer 38

Hot, dry, red skin; body temp higher than 104; slow deep respiration; tachycardia; dilated pupils; confusion > seizures/LOC