NOTES for PTA

Musculoskeletal System

MMT
Supine
Abdominals Anterior Deltoid Biceps
Brachioradialis Finger flexors Finger extensors
Iliopsoas Infraspinatus Lateral rotators of shld
Medial rotators of shld Neck flexors Pec Major
Pronators Sartorius Pec Minor
Supinators TFL Teres Minor
Thumb muscles Tibialis Ant Tibialis Post
Toe extensors Toe flexors Serratus Anterior
Wrist extenors Wrist flexors Triceps

Sidelying
Gluteus Medius Gluteus Minimus
Hip adductors Lateral abdominals

Prone
Back extensors Gastroc Glut Max
Hamstrings Lateral rotators of shld Lat Dorsi
Middle and Lower Trap Medial rotators of shld Neck extensors
Post Deltoid Quadratus Lumborum Rhomboids
Soleus Teres Major Triceps

Sitting
Coracobrachialis Deltoid
Hip flexors Lateral rotators of hip
Medial rotators of hip Quads
Upper trap Serratus Anterior

Standing
Plantar flexors Serratus Anterior
Upper Limb tension tests

Ligament Tears
Grade I Partial tear, no joint instability
Grade II Partial tear, some joint instability
Grade III Full thickness tear, causing significant joint instability
Healing: acute inflammation, localized pain
Healthy tissue is replaced with scar tss, not regenerated lg tss
Medical management: arthroscopic surgery for lg repair or grafting
PT: mobs for alignment of scar tss for tensile strength and stiffness
Ice for edema, low-load exercise to improve tensile strength

Congenital Musculoskeletal Disorders

Hip dysplasia Legg-Calve-Perthes Disease
Muscular dystrophy Osteogenesis Imperfecta
Torticollis Clubfoot
Scoliosis

Musculoskeletal Pathology
Achilles Tendonitis/Tear Osgood-Schlatter Disease
Adhesive Capsulitis (DM!) OA
ACL Sprain RA
MCL Sprain (with ACL and Medial JRA
Meniscus tear) PFPS
Shoulder Impingement Plantar Fasciitis
 Talipes Equinovirus
Lateral (tennis elbow) and Medial
(golfer’s elbow) Epicondylitis
Musculoskeletal Characteristics
D/O
Adhesive Loss of AROM and PROM,
Capsulitis adhesive fibrosis and
scarring in capsule, RTC,
subacromial bursa,
deltoid
Impingement Throwing, swimming,
Syndrome racquet sports; humeral
head and RTC moving
prox and becoming
impinged under acromion
and coracoacromial LG
Lateral Inflammation from
Epicondylitis eccentric loading of
common extensor mss,
racquet sports or
throwing
RTC Tear Impaired blood supply to
tendon, microtrauma,
resulting in degeneration
Achilles Repetitive overuse D/O,
Tendonitis in pts with limited
flexibility, weak, pronated
foot, runners, bball,
gymnasts, dancers
Plantar Fasciitis Inflammation of plantar
fascia at calcaneus. Acute
injury from excessive
loading of the foot or
excessive pronation
GH Instability (Multidirectional,
Subluxation, Bankhart [TUBS], Hill-
Sachs, SLAP)
PT/Tx
40-60 y/o, females, Increase ROM with
DM, self-limiting, GH mobs, may need
resolves on its own closed manip under
Capsular pattern loss anesthesia
Painful arc of motion RICE, NSAIDs, RTC
70-120* strengthening, scap
Special tests stability, improved
biomechanics
Poor mechanics or RICE, NSAIDs,
faulty equipment, increase strength,
30-50 y/o flexibility and
Special tests endurance of wrist
ext, may use strap
Arm positioned in IR RICE, NSAIDs,
and ADD, point prevent AC,
tenderness at GTand strengthen UE mss,
acromion. Limitation PROM à AAROM à
of flex and abd AROM, isometrics,
Special tests return to fxnal
activities requiring
dynamic overhead
motion in 9-12 mo
Aching or burning in RICE, heel lift, cross
heel, tenderness of training, heel cord
AT, morning stiffness stretching, eccentric
-Itis can lead to strengthening of
rupture gastroc-soleus
Heel pain, heel spur, RICE, NSAIDs, heel
morning pain, pain cup, massage using
post activity, pain tennis ball, medial
when walking longitudinal arch
barefoot

ACL Sprain Noncontact twisting
injury associated with
hyperextension +
varus/valgus stress
MCL Sprain A contact or noncontact,
fixed foot, tibial rotation
injury associated with
valgus force and ext tibial
rot.
Football, skiing, soccer
PCL Sprain Landing on the tibia with
a flexed knee, hitting a
dashboard with a flexed
knee
Meniscus Tear Fixed foot rotations while
WBing on a flexed knee,
dx with arthroscopy and
MRI
PFPS Pain or discomfort in the
anterior knee, decreased
quads, decreased LE
flexibility, increased tibial
torsion or anteversion
Osteoarthritis Chronic degeneration of
(OA) articular cartilage, in
WBing jts. Thickening of
subchondral bone.
Affects: hands, hips,
knees
Rheumatoid Systemic autoimmune
Arthritis (RA) D/O – chronic
inflammation, common in
small jts of hand, foot,
wrist, ankle; blood
taping, heel cord
stretching
Knee buckles, pops, RICE, NSAIDs,
positive special tests strengthen quads
and hams, derotation
brace, mini squats
Swelling, antalgic RICE, NSAIDs,
gait, decreased ROM, progressive
instability strengthening,
Special tests increase ROM
Involve ACL, MCL, RICE, NSAIDs, LE
LCL, menisci strengthening, NO
Special tests hamstring exer
Outer edges = RICE, NSAIDs, partial
vascularized meniscectomy,
Special tests meniscal repair
Females, growth Modalities, medial
spurt, runners, patella glides, patella
overweight taping, strengthen
quads/vastus
medialis oblique
Middle age – 70+, Reduce pain,
overweight, fx, jt promote jt fxn,
injuries, occupation protect jt, NSAIDs,
or athletic overuse. improve lubrication
Gradual onset of in knee, PROM,
pain, pain post exer, AROM, TENS, energy
weather related conservation, weigh
pain, Heberden’s loss, bracing
nodes, Bouchard’s
nodes, use xray dx
40-60 y/o, females, Reduce inflammation
symmetrical and pain, promote jt
involvement, pain fxn, DMARDs, PROM,
and tenderness, AROM,
morning stiffness, heating/cooling,
warm jts, decrease in
 rheumatoid factor and appetite, swan neck splinting, body
radiograph and boutonniere mechanics
deformities

MS D/O Characteristics PT/Tx

Congenital Hip Developmental Asymmetrical hip Harness, splinting,
Dysplasia dysplasia, abduction with traction, bracing.
malalignment of the tightness, apparent Open reduction with
femoral head within femoral shortening hip splica cast.
acetabulum Tests: Ortolani, Barlow, Stretching,
US strengthening
Congenital Wry neck. SCM Malpositioning in utero, Stretching, AROM,
Torticollis contracture within first birth trauma. Ipsi lateral positioning, massage,
2 mo of life. cervical flexion, contra surgical release
rotation
Juvenile Inflammation of jts and Symmetrical joint NSAIDs, PROM,
Rheumatoid connective tss. involvement in Poly; AROM, positioning,
Arthritis Systemic, polyarticular, Oligo/pauci – less than splinting,
oligoarticular. 5 jts with asymmetrical strengthening,
jts endurance, postural
training, paraffin, US,
cryotherapy
Legg-Calve- Avascular Necrosis - Antalgic gait, positive Maintain femoral
Perthes Disease Degeneration of the Trendelenburg sign head in position,
femoral head stretching, splinting,
crutches, aquatic
therapy, traction
Osgood- Traction apophysitis – May result in a small Icing, flexibility exer,
Schlatter from repetitive traction avulsion of the eliminating strain on
Disease on the tibial tuberosity tuberosity and swelling patella tendon:
apophysis squatting, running,
jumping
Osteogenesis Connective tss D/O that Pathological fractures, Handling techniques,
Imperfercta affects formation of OP, hypermobile jts, AROM, emphasize
collagen during bone bowing of long bones, symmetrical
development, genetic – scoliosis, impaired resp movement, use
autosomal recessive fxn orthotics, w/c
Talipes Clubfoot, Adduction of In utero positioning. Splinting and serial
Equinovarus forefoot, Varus of casting, restore
hindfoot, PF at ankle proper positioning
 Interventions
Soft tissue/myofascial techniques
Articulatory techniques (jt mobs)
Neural tissue mobilization
Therex
Training Programs
Dry needling (breaks up trigger pts in myofascial pain syndrome)

Resistance Training/Strength Training

Relative Outcome % 1 RM Repetition # of Sets Rest between
Loading Range sets
Light Muscular <70 12-20 1-3 20-30 sec
endurance
Moderate Hypertrophy & 70-80 8-12 1-6 30 sec – 2 min
Strength
Heavy Maximum 80-100 1-8 1-5+ 2-5 mins
Strength

Surgery
Hand: flexor Distal extremity immobilization 3-4 weeks: protective splint,
tendon repairs rubber band traction, IP jts in 30-50 flex
AROM at 4 wks, begin with ext, then flex
Hand: extensor Distal DIPs immob in neutral for 6-8 wks; AROM at 6 wks with PIP
tendon repairs in neutral, begin with ext
Proximal IPs: immob with wrist and digits in ext for 4 wks
AROM/PROM in flex with MCP jt in ext
Full AROM at 6 wks
THR Cemented Uncemented
NO IR, Add, Flex beyond 90 for NO IR, Add, Flex beyond 90 for
3-6 mo 3-6 mo
PWB for 3 wks WBAT:
Amb with cane at 4 wks PWB for 3 wks
FWB at 5 wks Amb with cane at 4 wks
FWB at 6 wks
Toe Touch WB:
Resisted Exer: week 4 1/3 WB at wk 6
2/3 WB at wk 8
FWB with walker at wk 10
 TKR Cemented Uncemented
0-90 within 2 wks 0-90 within 2 wks
0-120 within 3-4 wks 0-120 within 3-4 wks
WBAT with walker WBAT:
With cane at wk 3 WBAT with walker
FWB at wk 4 With cane at wk 5-6
FWB at wk 6
TTWB:
Resisted exer: week 2-3 TTWB immediately
WBAT with walker at wk 6
Cane at 8-10 wks
FWB at week 10
ACL NWB at wk 1
Immediately postop: CPM 0-70 flex
Week 6: CPM 0-120
Hinged brace: 20-70 – wean off around wks 2-4
Weakest at week 6
Meniscus – Partial Day 1: AROM
Meniscectomy Day 3: isotonic and isokinetic strengthening
Meniscus Repair NWB 3-6 wks
Joint mobs

Neuromuscular and Nervous System

Neuromuscular and Nervous System Pathology

Alzheimer’s Disease Multiple Sclerosis
ALS Myasthenia Gravis
Bell’s Palsy Parkinson’s Disease
CTS Post Polio Syndrome
Diabetic Neuropathy CVA
Epilepsy TBI
Guillian-Barre Syndrome SCI
Huntington’s Disease

Cranial Nerve Disorders Central Nerve Disorders

Trigeminal Neuralgia (tic douloureux) Multiple Sclerosis
Bell’s Palsy (VII Facial Nerve) Parkinson’s Disease
Bulbar Palsy
NMJ Disorder: Myastenia Gravis
Neuromuscular Characteristics PT/Tx
Disease
Alzheimer’s ACh deterioration Memory and Maximize function,
Disease within cerebral concentration probs, meds to inhibit
cortex and rigidity, bradykinesia, acetlycholinesterase
subcortical areas. shuffling gait, PH: Cholinergic agents
Amyloid plaques and intellectual and
neurofibrillary physical destruction
tangles
ALS (ALL) UMN & LMN; Distal to Prox loss, Focus on quality of life
demyelination of asymmetric mss
corticospinal tract & weakness
loss of anterior horn
cells
Guillain-Barre Acute Distal to Prox, mss Pulm rehab,
Syndrome polyneuropathy, weakness, sensory strengthen, mobility
demyelination of impairment, resp training, w/c,
peripheral myelin paralysis orthotics
sheaths, LMN
Huntington’s Degen of basal 35-55 y/o. Maximize endurance,
Disease ganglia and cerebral involuntary chorea strength, balance,
cortex, NTs are mvmts, personality postural control,
deficient – unable to changes, ataxia with functional mobility,
modulate movement choreoathetoid meds for choreiform
mvmts, dysphagia, mvmts
rigidity
Multiple Demyelination of 20-35 y/o. weakness, Energy conservation,
Sclerosis myelin sheaths, ataxia, balance tone normalization,
decreases nerve dysfxn, fatigue; gait training, core
impulses, plaque exacerbations and stab, AD training
development remissions
Myasthenia NMJ pathology, Extreme fatigue, mss Obtain resp baseline,
Gravis antibodies block or weakness, ocular mss energy conservation,
destroy ACh affected, dysphagia isometric
receptors – prevents (sustained test, strengthening,
mss contraction looking at the roof) steroids
Parkinson’s Decreased 50-79 y/o. resting Maximize endurance,
Disease production of tremor (pill rolling), strength, function,
Dopamine in corpus akinesia, stooped energy conservation
 striatum in Basal posture, PH: Dopamine
ganglia bradykinesia, replacement agents:
festinating and Levadopa, Sinemet
shuffling gait,
cogwheel/leadpipe

Types of SCIs
SCI Syndrome MOI Signs and Symptoms
Anterior Cord Syndrome Hyperflexion injury Loss of pain and temperature, loss
of motor function
Central Cord Syndrome Hyper extension injury UE>LE, motor>sensory, tracts
affected: spinothalamic,
corticospinal, dorsal columns
Brown-Sequard’s Stab wound, gun shot Contralateral loss of pain and
Syndrome temperature, ipsilateral loss of
vibration, position sense, motor
function (paralysis)
Cauda Equina Syndrome Injury below L1 Peripheral nerve injury, flaccidity,
areflexia, bowel and bladder
dysfunction
Posterior Cord Syndrome Compression of Loss of pain perception,
(sensory) Posterior Spinal Artery proprioception, 2 pt discrimination,
RARE stereognosis
Motor is preserved!

Types of CVAs
Artery Affected Area of Brain Affected Signs and Symptoms
Anterior Cerebral Artery Anterior frontal lobe, Contralateral loss of LE motor and
medial surface of frontal sensory, loss of bowel and
lobe, medial surface of bladder, aphasia, apraxia,
parietal lobe agraphia, akinetic mutism
[ABC]
 Middle Cerebral Artery
Posterior Cerebral Artery
Vertebral Basilar Artery
Cerebrum, Basal Ganglia UE more affected, contralateral
weakness and sensory loss of face,
Wernicke’s aphasia, apraxia,
anosognosia, homonymous
hemianopsia
Occipital Lobe, Contralateral hemiplegia,
Midbrain, Thalamus contralateral loss of pain and
temperature, prosopagnosia
Cerebellum, Medulla, Hemi-tetraplegia, dysphagia,
Pons dysarthria, ataxia, loss of
consciousness, Locked-In
syndrome

Glascow Coma Scale

Eye opening Score
No eye opening 1
To pain 2
To speech 3
Spontaneous 4

Motor Response Score

No response 1
Decerebrate posture 2
Decorticate posture 3
Withdraw from pain 4
Localized(moves a limb to remove stimulus) 5
Obeys commands 6

Verbal Response Score

No response 1
Incomprehensible and unintelligible sounds 2
Inappropriate; speech is intelligible but 3
conversation is not possible
Conversationally confused 4
Oriented 5

Score Represents
3-8 Severe brain injury, Comatose
9-12 Moderate brain injury
13-15 Mild brain injury
Ranchos Los Amigos Levels of Cognitive Functioning
Level
I. No Response
II. Generalized Response
III. Localized Response
IV. Confused-Agitated
V. Confused-Inappropriate
VI. Confused-Appropriate
VII. Automatic-Appropriate
VIII. Purposeful-Appropriate Standby assistance, oriented, recalls and integrate past
Description
Total assistance
Total assistance, inconsistent and nonpurposeful response to
stimuli; responses may be physiological changes, gross body
movements, or vocalizations
Total assistance, specific but inconsistent, responses are
related to type of stimuli presented, follows simple
commands such as closing eyes or squeezing hand
Max assistance, heightened state of activity with bizarre,
nonpurposeful behavior. Indiscriminate among people and
objects; unable to cooperate directly with tx. Verbalizations
are incoherent and confabulatory. Gross attention is limited,
lacks short and long term recall
Max assistance, responds to simple commands fairly
consistently; if commands are complex – responses are
nonpurposeful or random. Highly distractible, verbalization is
inappropriate and confabulatory, inappropriate use of
objects, performs previously learned tasks with structure
Moderate assistance, goal directed behavior dependent upon
external input or direction follows simple direction and
shows carryover. Responses may be incorrect due to
memory, but appropriate. Past memory better than recent
Minimal assistance, appropriate and oriented, goes through
daily routine automatically but robot-like. Shows carryover
for learning, needs structure for social activities, judgment is
impaired
events, completes familiar tasks, over- or under-estimates
abilities, shows a decreased ability compared to premorbid
state, abstract reasoning, tolerance for stress, judgment
Brunnstrom’s Stages of Recovery
Stage Spasticity
1 None, Flaccid
2 Beginning
3 Peak Spasticity
4 Decreasing
5 Decreasing
6 Minimal except during rapid
movements
7 Normal
Synergy
None
Beginning, weak associated movements
Perform synergy voluntarily, mass synergy
movement patterns
Begin out of synergy movements
Independent out of synergy, nearly clear
of synergy
Free of synergy, awkward, isolated joint
movements with coordination
Normal

Cranial Nerves
Nerve Motor/Sensory Action/Test
I. Olfactory Sensory Identify familiar odors with eyes closed
II. Optic Sensory Test visual fields
III. Oculomotor Motor Upward, downward, and medial gaze
IV. Trochlear Motor Downward and lateral gaze
V. Trigeminal Both Sensation of face, mss of mastication, corneal reflex,
jaw reflex
VI. Abducens Motor Lateral gaze
VII. Facial Both Mss of facial expression, taste to anterior 1/3 of
tongue – identify familiar tastes, close eyes tight,
smile with teeth, puff cheeks
VIII. Vestibulo- Sensory Hearing tests, balance and coordination tests: finger
cochlear to nose
IX. Glosso- Both Taste to posterior 1/3 of tongue, gag reflex, ability to
pharyngeal swallow
X. Vagus Both Gag reflex, ability to swallow, say “ahh”, rise of uvula
when stroked
XI. Spinal Motor Resisted shoulder shrug
Accessory
 XII. Hypoglossal Motor Tongue protrusion – if injured, will deviate toward
lesion

UMN Lesion LMN Lesion

CNS PNS
Hyperreflexia Hyporeflexia
Hypertonia Hypotonia
Spastic Flaccid
Positive Babinski Fasciculations
Clonus Muscle atrophy

Motor Control/Motor Learning

Stage of Motor Learning Training Strategies
Cognitive Stage: Feedback after every trial, knowledge of performance and
Learner develops results, practice in stress-controlled environment,
understanding of task, distributed practice or blocked practice
structures motor
program, “what to do”
Associated Stage: Provide KP and KR, provide variable feedback and after
Learner practices errors, assist self eval, encourage consistency, variable
movement, refines motor practice, progress towards changing environment
program, decreases
errors, uses
proprioceptive feedback,
“how to do”
Autonomous Stage: Decision making skills apparent, occasional feedback when
Learner practices error- errors present, massed practice, vary environment
free mvmt, “how to
succeed”

Cardiovascular/Pulmonary/Lymphatic Systems

Blood Pressure
Blood pressure is the force of blood against the walls of arteries. Blood pressure is recorded as
two numbers—the systolic pressure (as the heart beats/contracts) over the diastolic pressure
(as the heart relaxes between beats).
Orthostatic Hypotension is a decrease in BP (systolic greater than diastolic) as the patient
assumes a more upright position; sx: dizzy, lightheadedness

Ankle-Brachial Index
ABI = Ankle Systolic Pressure/Brachial Systolic Pressure
Value Significance
>1.0 Normal, ankle systolic pressure is as high as brachial pressure
0.8-1.0 Mild peripheral artery disease
Compression therapy with caution
0.5-0.8 Moderate PAD, intermittent claudication
NO Compression therapy
<0.5 Severe PAD, critical limb ischemia
Resting pain
NO Compression therapy
1.0-1.4 PAD, calcification of arteries

Cardiovascular Characteristics
Disease
Atherosclerosis Plaques affecting moderate
and large arteries;
thickening and narrowing of
blood vessel wall
CAD Angina, infarction, sudden
cardiac death; decrease in
myocardial oxygen supply
resulting in ischemic chest
pain
MI Prolonged ischemia, injury,
death of area of
myocardium caused by
occlusion of coronary
arteries
Risk factors: atherosclerotic
heart disease with
Risk factors: smoking, age, male, high LDL
levels, stress, high BP, obesity, sedentary life,
DM
Stable angina: exercise induced, relieved with
rest or nitro
Unstable: coronary insufficiency at rest,
increases risk for MI or lethal arrhythmia;
difficult to control
Variant (Prinzmetal’s): caused by vasospasm
of coronary arteries, responds well to nitro or
Ca2+ channel blocker
Zones of infarction: central zone, zone of
injury, zone of ischemia
 thrombus, coronary
vasospasm, or embolism

Heart Failure Heart is unable to maintain Left sided heart failure vs Right sided heart
adequate circulation of the failure – See Below
blood o meet the metabolic
needs of the body
Occlusive PAD: result of peripheral atherosclerosis; HTN, CAD, DM, metabolic
syndrome, smoking; pale on elevation/dusky red on dependency;
PVD: Arterial intermittent claudication
Disease Thomboangiitis obliterans (Buerger’s disease): inflammatory vascular
occlusive dz of small veins
Diabetic angiopathy: elevation of blood glucose levels and accelerated
atherosclerosis
Raynaud’s disease: spasm of small arteries, exacerbated by cold or stress
PVD: Venous Varicose veins: distended, swollen superficial veins
Disease Superficial vein thrombophlebitis: clot formation and acute inflammation in a
superficial vein
DVT: clot formation and acute inflammation in a deep vein
Chronic venous stasis/incompetence: chronic leg edema, venous valvular
insufficiency
Congenital Heart Atrial Septal Defect: hole between two atria
Defects Coarctation of the aorta: aorta is narrowed near ductus arteriosus
Patent ductus arteriosus: ductus arteriosus from pulm artery to descending
aorta does not close after birth
Ventricular septal defect: hole between two ventricles
Tetralogy of fallot: VSD+pulm stenosis+RV hypertrophy+aorta overriding VSD

Left Sided Heart Failure Right Sided Heart Failure

Congestive Heart Failure
Pulmonary Congestion: dyspnea, dry cough,
orthopnea, paraoxysmal nocturnal dyspnea,
pulmonary rales, wheezing
Edema, low cardiac output due to backup of
blood from LV
From LV failure, mitral valve disease, cor
pulmonale
Jugular distention, peripheral edema
(dependent edema), weight gain, ascites,
hepatomegaly
Anorexia, nausea, bloating, cyanosis, RUQ
pain
Excessive workload of heart: HTN, valvular Right sided S3 sounds
disease, congenital defects
Signs and symptoms: hypotension, Murmurs of pulmonary or tricuspid
tachycardia, lightheadedness, dizziness, insufficiency
cerebral hypoxia, fatigue, weakness, S3,
maybe S4, murmurs of mitral or tricuspid

Pulmonary Disease Characteristics

Asthma Chronic inflammation of
airways caused by increased
hypersensitivity
Atelectasis Areas of lungs collapse or do
not inflate properly
Bronchiectasis Progressive obstructive lung
disease that produces an
abnormal dilation of bronchus;
bronchial walls weaken and
allow for permanent dilation of
bronchi
Bronchitis Inflammation of the bronchi,
hypertrophy of mucus secreting
glands, insufficient oxygen
Productive cough for 3 months
for 2 years, increased used of
accessory mss, dyspnea,
cyanosis, resp infections
COPD Group of lung diseases that
block airways due to narrowing
of the bronchial tree
Cystic Fibrosis Autosomal recessive genetic
disease of the exocrine glands – productive cough , frequent
affects lungs, pancreas, liver, lung infections, wheezing, SOB,
intestines, sinuses, sex organs. poor growth
PH: anti inflammatory,
bronchodilators
PT: airway clearance, breathing
exercises, relaxation,
endurance and strength
training
Tx: deep breathing, changing
positions, airway clearance
Consistent productive cough,
hemoptysis weight loss,
anemia, crackles, wheezes, loud
breath sounds
Abx, anti inflammatory,
bronchodilators, smoking
cessation, airway clearance,
endurance, strength training
Emphysema, chronic bronchitis
Excessive mucus production,
chronic productive cough,
wheezing, SOB, fatigue,
reduced exercise capacity
Sx: salty skin, persistent

Emphysema Alveolar walls are gradually
destroyed and the alveoli are
turned into large, irregular
pockets with holes in the walls.
Pleural Effusion Buildup of fluid in pleural space
between lungs and chest cavity.
Excess fluid pushes on fluid and
makes it difficult to breathe,
can cause atelectasis
Pulmonary Edema Fluid collects in alveoli, causing
difficulty breathing
Pulmonary Embolism Arteries in lungs are blocked.
(PE) Blood clots from LEs travel up
to lungs.
Lymphatic Disease Characteristics
Lymphadenopathy Enlargement of nodes, with
or without tenderness
Lymphedema Chronic D/O with excessive
accumulation of fluid due to
obstruction of lymphatics,
mechanical insufficiency
Acute lymphangitis Acute bacterial infection
spreading through lymph
Pharmacology Action Indications Side Effects
PT: airway clearance, breathing
techniques, assisted cough,
ventilatory mss training
SOB, wheezing, chronic cough,
barrel chest, use of accessory
mss, increased RR, fatigue
If fluid gets infected and turns
to abscess = empyema
Left ventricle is unable to pump
blood adequately (left sided
heart failure)
Sudden onset of SOB, deep
breathing chest pain,
hemoptysis, excessive
sweating, rapid pulse
Swelling of soft tss is UEs and
LEs.
Due to congenital condition,
sx (mastectomy, bypass,
lymph node removal),
tumors, trauma, infection,
radiation therapy, venous
insufficiency
Usually streptococcal
PT Examples
Alpha Reduce HTN Dizziness, Caution -osin
Adrenergic peripheral palpitations, when
Antagonist vascular tone, OH rising due
causing dilation to OH
of arteries and
veins, decreases
BP
ACE Inhibitors Decrease BP and HTN, CHF Hypotension, Avoid -pril
afterload by dizziness, dry sudden prinivil,
suppressing cough, postural altace
converting hyperkalemia, changes
enzyme hyponatremia
Angiotensin II Block angio II HTN, CHF Dizziness, Minimal -sartan
Receptor receptors, limit back and leg Cozaar,
Antagonists vasoconstriction pain, angina Diovan
pectoris
Antiarrhythmic Class I: Sodium channel blocker
Class II: Beta Blockers
Class III: inhibit sodium and potassium channels
Class IV: Calcium channel blockers
Beta Blockers Decrease HTN, angina, Bradycardia, HR and BP -olol
myocardial arrhythmias, cardiac response atenolol,
oxygen demand heart failure, arrhythmias, to exer will metoprolol
by decreasing migraines, fatigue, be Lopressor
HR and essential depression diminished
contractility by tumors *Use RPE
blocking beta
adrenergic
receptors
Calcium Decrease entry HTN, angina HA, HR and BP Procardia,
Channel of calcium into pectoris, hypotension, response Norvasc,
Blockers vascular smooth CHF peripheral to exer will Cardizem
mss, resulting in edema be
diminished diminished
myocardial *Use RPE
contraction, Watch for
vasodilation, OH, CHF,
decreased peri
oxygen demand edema,
dyspnea,
 weight
gain

Diuretics Increase HTN, edema Dehydration, Position Lasix, Diuril

excretion of associated hypotension, changes (chloro-
sodium and with heart electrolyte lead to thiazide)
urine, causes a failure, pulm imbalance, decreased
reduction in edema, polyuria BP,
plasma volume glaucoma monitor
and decreased for
BP electrolyte
imbalance,
mss
weakness,
cramps