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Medical Conditions



Acquired Immunodeficiency Syndrome (AIDS)



HIV stands for human immunodeficiency virus. It can lead to acquired immunodeficiency syndrome or AIDS if not treated. AIDS is a syndrome, or range of symptoms. A person can have HIV without developing AIDS, but it is not possible to have AIDS without first having HIV.

HIV attacks the body’s immune system, specifically the CD4 cells (T cells), which help the immune system fight off infections. Untreated, HIV reduces the number of CD4 cells (T cells) in the body, making the person more likely to get other infections or infection-related cancers.

No effective cure currently exists, but with proper medical care, HIV can be controlled. The medicine used to treat HIV is called antiretroviral therapy or ART.

There are three stages of HIV infection:

Stage 1: Acute HIV Infection
Within 2 to 4 weeks after infection with HIV, about two-thirds of people will have a flu-like illness. This is the body’s natural response to HIV infection. Some people do not have any symptoms at all during this early stage of HIV.

Stage 2: Clinical Latency
In this stage, the virus still multiplies, but at very low levels. People in this stage may not feel sick or have any symptoms. This stage is also called chronic HIV infection.

Stage 3: AIDS
If you have HIV and you are not on HIV treatment, eventually the virus will weaken your body’s immune system and you will progress to AIDS (acquired immunodeficiency syndrome). This is the final stage of HIV infection.

Symptoms of AIDS can include:
• Rapid weight loss
• Recurring fever or profuse night sweats
• Extreme and unexplained tiredness
• Prolonged swelling of the lymph glands in the armpits, groin, or neck
• Diarrhea that lasts for more than a week
• Sores of the mouth, anus, or genitals
• Pneumonia
• Red, brown, pink, or purplish blotches on or under the skin or inside the mouth, nose, or eyelids
• Memory loss, depression, and other neurologic disorders
• Each of these symptoms can also be related to other illnesses.

Socialization and support groups.





Cancer refers to any one of a large number of diseases characterized by the development of abnormal cells that divide uncontrollably and have the ability to infiltrate and destroy normal body tissue. Cancer often has the ability to spread throughout your body. Doctors use the TNM description to assign an overall stage from 0 to 4 for many types of cancer.
** TNM T stands for tumor. N stands for lymph nodes. M stands for metastasis.
Stage 0 – carcinoma in situ, a precancerous change
Stage 1 – the tumor is usually small and hasn’t grown outside of the organ it started in
Stages 2 and 3 – the tumor is larger or has grown outside of the organ it started in to nearby tissue
Stage 4 – the cancer has spread through the blood or lymphatic system to a distant site in the body (metastatic spread)Medical treatment: surgery, chemotherapy, radiation, immunotherapy, hormonal therapy, transplant
Cancer and its treatment can cause several complications, including:
•Pain which can be caused by cancer or by cancer treatment, though not all cancer is painful.
•Fatigue which has many causes, but it can often be managed. Fatigue associated with chemotherapy or radiation therapy treatments is common, but it’s usually temporary.
•Difficulty breathing.
Cancer or cancer treatment may cause a feeling of being short of breath.

•Nausea. Certain cancers and cancer treatments can cause nausea.
•Diarrhea or constipation. Cancer and cancer treatment can affect your bowels and cause diarrhea or constipation.
•Weight loss. Cancer and cancer treatment may cause weight loss. Cancer “steals” food from normal cells and deprives them of nutrients. This is often not affected by how many calories or what kind of food is eaten; it’s difficult to treat. In most cases, using artificial nutrition through tubes into the stomach or vein does not help change the weight loss.
•Chemical changes in your body. Cancer can upset the normal chemical balance in your body and increase your risk of serious complications. Signs and symptoms of chemical imbalances might include excessive thirst, frequent urination, constipation and confusion.
•Effects on brain and nervous system. Cancer can press on nearby nerves and cause pain and loss of function of one part of your body. Cancer that involves the brain can cause headaches and stroke-like signs and symptoms, such as weakness on one side of your body.
•Unusual immune system reactions to cancer. In some cases, the body’s immune system may react to the presence of cancer by attacking healthy cells. Called paraneoplastic syndrome, these very rare reactions can lead to a variety of signs and symptoms, such as difficulty walking and seizures.
Post-op/ Convalescence: rehab of motor, sensory, cognitive, psychological impairment.
• consider body image, occupational role and social support.

Palliative care: prevent and relieve suffering.
• enhance quality of life by engaging in meaningful occupations
• modify/alter environmental/contextual factors
• collaborate with family
• caregiver training

End-of-life care (hospice): support quality of life.
• empower life celebration- journaling, scrapbooks, phone calls contact, letter writing
Diabetes Mellitus


Diabetes mellitus refers to a group of diseases that affect how your body uses glucose. Glucose is vital to your health because it’s an important source of energy for the cells and is also your brain’s main source of fuel.
Chronic diabetes conditions include type 1 diabetes and type 2 diabetes. Potentially reversible diabetes conditions include prediabetes and gestational diabetes.

Type 1: is the result of the human immune system mistaking the body’s beta cells, which produce insulin, for foreign cells and causing their destruction.
insulin-dependent, autoimmune, genetic & environmental factors.

Type 2: Patients with type 2 diabetes make insulin, but the cells in the body cannot respond to it adequately so they cannot take up glucose. Later on, especially when treatment fails, type 2 diabetes is aggravated by exhausted beta cells, decreasing their insulin production resulting in further increases in blood sugar levels.
non-insulin dependent, old age, obesity, family history, glucose
•Increased thirst
• Frequent urination
• Extreme hunger
• Unexplained weight loss
• Presence of ketones in the urine (ketones are a byproduct of the breakdown of muscle and fat that happens when there’s not enough available insulin)
• Fatigue
• Irritability
• Blurred vision
• Slow-healing sores
• Frequent infections, such as gums or skin infections and vaginal infections
HYPOglycemic episode- offer carbohydrates (candy, fruit, juice, honey)

HYPERglycemia episode- may need insulin & IV intervention

Patients @ risk- promote healthy lifestyle

• Vision – adaptations for low vision, safety assessment, physical adaptations to home
• Function- educate on recognizing changes in functional status
• Peripheral neuropathy- adaptation for peripheral neuropathy, safety adjustments, education, skin care, & pain management
• Education regarding diet, med compliance, early attention to wound management using skin care inspection

Supportemotional support




Dysphagia is the medical term used to describe difficulty swallowing. Dysphagia includes difficulty starting a swallow (called oropharyngeal dysphagia) and the sensation of food being stuck in the neck or chest (called esophageal dysphagia). Oropharyngeal dysphagia can result from abnormal functioning of the nerves and muscles of the mouth, pharynx and upper esophageal sphincter. Diseases that involve the esophagus can cause esophageal dysphagia. When a patient is being evaluated for dysphagia, it is important for the doctor to determine which type of dysphagia is more likely, oropharyngeal or esophageal, as different tests are ordered for each type.

Dysphagia needs to be distinguished from odynophagia, which is defined as pain during swallowing. This can arise from infection or inflammation in the esophagus. Dysphagia also needs to be distinguished from globus sensation. This is a constant sensation of something being stuck at the back of the throat, which does not typically make swallowing difficult. Globus can sometimes be seen in acid reflux disease, but more often, it is due to increased sensitivity in the throat or esophagus.

Signs and symptoms associated with dysphagia may include:
• Having pain while swallowing (odynophagia)
• Being unable to swallow
• Having the sensation of food getting stuck in your throat or chest or behind your breastbone (sternum)
• Drooling
• Being hoarse
• Regurgitation
• Having frequent heartburn
• Having food or stomach acid back up into your throat
• Unexpectedly losing weight
• Coughing or gagging when swallowing – Patient may demo: coughing after drinking, changes in face color (flushed/ashy), gasping for breath, losing consciousness
• Modified diet textures to ensure safe swallowing and eliminate or minimize the risk of aspiration.
• Adapted mealtime environments
• Preparatory exercises prior to a meal to facilitate the oral and pharyngeal motions required for eating.
• Positioning of the body to facilitate safe eating
• Adapted swallowing techniques
• Training for caregivers in individualized feeding and swallowing strategies


Gastroesophageal reflux disease (GERD) occurs when stomach acid frequently flows back into the esophagus. This backwash (acid reflux) can irritate the lining of your esophagus. Many people experience acid reflux from time to time. GERD is mild acid reflux that occurs at least twice a week, or moderate to severe acid reflux that occurs at least once a week.
Most people can manage the discomfort of GERD with lifestyle changes and over-the-counter medications. But some people with GERD may need stronger medications or surgery to ease symptoms.
Common signs and symptoms of GERD include:
• A burning sensation in your chest (heartburn), usually after eating, which might be worse at night
• Chest pain
• Difficulty swallowing
• Regurgitation of food or sour liquid
• Sensation of a lump in your throat If you have nighttime acid reflux, you might also experience:
• Chronic cough
• Laryngitis
• New or worsening asthma
• Disrupted sleep
• Sleeping with multiple pillows/ elevated head.
• Diet modifications: less spice, less alcohol, small meals more frequently.
• Stress Management.


Hepatitis is an inflammation of the liver. It may be caused by drugs, alcohol use, or certain medical conditions. But in most cases, it’s caused by a virus. This is known as viral hepatitis.

There are 5 main hepatitis viruses, referred to as types A, B, C, D and E.

Type A:present in the faeces of infected persons and is most often transmitted through consumption of contaminated water or food.
Type B: transmitted through exposure to infective blood, semen, and other body fluids.
Type C: mostly transmitted through exposure to infective blood.

Types B and C lead to chronic disease.

Hepatitis A and E are typically caused by ingestion of contaminated food or water.

Hepatitis B, C and D usually occur as a result of parenteral contact with infected body fluids.

Common modes of transmission for these viruses include contaminated blood or blood products, invasive medical procedures using contaminated equipment and for hepatitis B transmission from mother to baby at birth, from family member to child, and also by sexual contact.

Health care workers most susceptible to B.

The initial phase of hepatitis is called the acute phase. The symptoms are similar to mild flu, and may include:
• Diarrhea
• Fatigue
• Loss of appetite
• Mild fever
• Muscle or joint aches
• Nausea
• slight abdominal pain
• vomiting
• weight loss
• jaundice
As the disease progresses, chronic hepatitis can lead to progressive liver failure, resulting in jaundice, swelling of the lower extremities, confusion, and blood in the feces or vomit.
Energy conservation training



Lyme Disease


Lyme disease is caused by the bacteria, Borrelia Lyme disease is transmitted by the bite of an infected black-legged tick, commonly known as a deer tick. Early signs and symptoms of Lyme disease may include:
• Rash, sometimes shaped like a bull’s eye (Erythema migrans (EM rash))
• Fever
• Chills
• Headache
• Fatigue
• Muscle and joint aches
• Swollen lymph nodes
If left untreated, more severe symptoms may occur and can last from months to years. Severe symptoms may include:
• Severe headaches
• Additional EM skin rashes
• Facial paralysis (i.e. Bell’s palsy)
• Intermittent muscle, joint, tendon and bone aches
• Heart disorders (heart palpitations, abnormal heartbeat), known as Lyme carditis
• Neurological disorders (dizziness, mental confusion or inability to think clearly, and memory loss, inflammation of the brain and spinal cord, nerve pain, numbness or tingling in the hands or feet)
• Arthritis with severe joint pain and swelling, particularly the knees and less commonly in other joints such as the ankle, elbow and wrists.

Treat joint pain & swelling
• Educate about acute arthritic flares
• Splinting to protect inflamed joint & prevent overstretching
• Energy conservation

Impact on nervous system
• Safety assessment & intervention to prevent injury
• Management of aesthesias that are perceived as painful.
• Occupation based interventions to encourage & preserve function
• Chronic pain management



Methicillin- Resistant Staphylococcus aureus (MRSA)


Methicillin-resistant Staphylococcus aureus (MRSA) infection is caused by a type of staph bacteria that’s become resistant to many of the antibiotics used to treat ordinary staph infections.

Most MRSA infections occur in people who’ve been in hospitals or other health care settings, such as nursing homes and dialysis centers. When it occurs in these settings, it’s known as health care-associated MRSA (HA-MRSA).

Staph skin infections, including MRSA, generally start as swollen, painful red bumps that might resemble pimples or spider bites. The affected area might be:
• Warm to the touch
• Full of pus or other drainage
• Accompanied by a fever
These can quickly turn into deep, painful abscesses that require surgical draining. Sometimes the bacteria remain confined to the skin. But they can also burrow deep into the body, causing potentially life-threatening infections in bones, joints, surgical wounds, the bloodstream, heart valves and lungs.
* Prevention of MRSA very important in hospital setting. Hand washing, avoid sharing personal items, keep wounds covered, avoid communal bathing/swimming, assure facilities are clean.


Obesity/Bariatric Issues


The fundamental basis for bariatric surgery for the purpose of accomplishing weight loss is the determination that severe obesity is a disease associated with multiple adverse effects on health which can be reversed or improved by successful weight loss in patients who have been unable to sustain weight loss by non-surgical means. People with obesity are more likely to develop a number of potentially serious health problems, including:

• Heart disease and strokes. Obesity makes you more likely to have high blood pressure and abnormal cholesterol levels, which are risk factors for heart disease and strokes.
• Type 2 diabetes. Obesity can affect the way your body uses insulin to control blood sugar levels. This raises your risk of insulin resistance and diabetes.
• Certain cancers. Obesity may increase your risk of cancer of the uterus, cervix, endometrium, ovary, breast, colon, rectum, esophagus, liver, gallbladder, pancreas, kidney and prostate.
• Digestive problems. Obesity increases the likelihood that you’ll develop heartburn, gallbladder disease and liver problems.
• Gynecological and sexual problems. Obesity may cause infertility and irregular periods in women. Obesity also can cause erectile dysfunction in men.
• Sleep apnea. People with obesity are more likely to have sleep apnea, a potentially serious disorder in which breathing repeatedly stops and starts during sleep.
• Obesity increases the stress placed on weight-bearing joints, in addition to promoting inflammation within the body. These factors may lead to complications such as osteoarthritis.
• Quality of life. Obesity can diminish your overall quality of life. People with obesity may even encounter discrimination, depression, social isolation.


Education – community-driven group intervention
Lifestyle redesign: create personal plan to change unhealthy habits, activity-focused exercise, education on activity monitors, supportive coaching to make long-term changes

Mobility devices and equipment to facilitate ADL participation.






Scleroderma is a group of rare diseases that involve the hardening and tightening of the skin and connective tissues. Scleroderma results from an overproduction and accumulation of collagen in body tissues. There are many different types of scleroderma. There are two types of scleroderma – localized and systemic (sometimes called systemic sclerosis).

1. Localized scleroderma can be further divided into morphea and linear forms.
• With the morphea form of localized scleroderma, hard round or oval patches develop on the skin. These patches tend to be white with a reddish area around them. They may occur on your chest, stomach, face, arms, legs or other parts of your body.• With the linear form of localized scleroderma, a line of thickened skin may occur in areas such as your face (often the forehead), arms or legs. This line of hard skin extends deep down into the skin, bones and muscles, and may alter growth of the affected part.

2. Systemic sclerosis can be further divided into limited and diffuse forms.
• With limited scleroderma, your skin hardening may be widespread, but not everywhere on your body, and it will not appear on your trunk. Often with this form the heart and kidneys are not involved, but heartburn from involvement of the esophagus is a common symptom. A range of conditions (and therefore symptoms) can be associated with limited scleroderma.
• Calcinosis (calcium deposits in the skin).
• Raynaud’s phenomenon (fingers and/or toes become white or bluish and cold or numb).
• Esophageal dysmotility (difficulty swallowing).
• Sclerodactyly (tight skin on the fingers).
• Telangiectasias (red spots on the skin).• With diffuse scleroderma, you may have widespread thickening of the skin on your arms, legs, face, chest and stomach. These skin changes can occur quite rapidly, though progress of this form of the disease varies widely from person to person. In addition, lungs, kidneys, heart, blood vessels, bowel, esophagus, joints, and connective tissues such as tendons and ligaments are frequently involved. Diffuse scleroderma can become very severe, even life threatening.

• keep digits warm
• guided imagery to improve circulation
• education to encourage skin inspection
• modification of activities to protect fingers/toes

• splinting to slow progressive development of contractures (optimal resting length), silicone gel in palms of hands
• electrical/mechanical vibration to decrease burning sensation (A fibers)

Body image issues
• support groups, adaptations/accessories to facilitate adjustment to image

Stroke like symptoms from lesions in brain
• rehab for functional deficits

Thoracic spinal lesions – mobility and ADL difficulties
• neuro & biomechanical rehab

Fibrosis of skin
• protective/compressive gloves

Gastrointestinal problems
• educate on soft diet, avoiding alcohol & spicy foods

Myositis (inflammation in muscles)
• no exercise