Final exam material Flashcards
Exam 4
MUSCULAR DYSTROPHIES
Epidemiology: What are primary symptoms?
Primary symptoms are progressive muscle weakening and wasting of skeletal or voluntary muscle groups
MUSCULAR DYSTROPHIES
Pathophysiology: What are the two types?
Duchenne and Becker muscular dystrophies (MDs)
MUSCULAR DYSTROPHIES
Pathophysiology: Duchenne and Becker muscular dystrophies (MDs) are caused by what?
Duchenne and Becker muscular dystrophies (MDs) are caused by a mutation to the dystrophin gene
Muscular Dystrophy:
What is Dystrophin?
Dystrophin is a protein responsible for muscle repair.
What does Muscular dystrophy (MD) have? What is it caused by?
Muscular dystrophy (MD) is a disease with many different subtypes that affect certain muscle groups, are age specific in relation to presenting symptomatology, have variations in severity, and are caused by a defect in different genes.
Muscular dystrophy (MD)
What age does Muscular dystrophy occur?
Muscular dystrophy can appear at any age from infancy until middle age and beyond.
Muscular Dystrophy
What is the most well known for of muscular dystrophy and is most common in children? When is age of onset?
Duchenne muscular dystrophy (DMD) is the most well-known form and is the most common in children. Onset is 2–4 years of age
Becker muscular dystrophy (BMD): Who is it primarily present in? When does it typically occur?
Becker muscular dystrophy (BMD) is also primarily prevalent in males and typically occurs in childhood. Delayed onset, slower progression affects 5–25 years of age
Muscular Dystrophy;
What are clinical manifestations?
Progressive muscle weakness
Chronic pain, most notably in lower back and legs
Muscular Dystrophy;
How is diagnosis usually begin?
Diagnosis of MD usually begins with a preliminary review of serum muscle enzymes such as Creatine Kinase (CK), which is usually an early sign of the disease and requires frequent and close monitoring.
Muscular Dystrophy;
What is an early sign of the disease?
Creatine Kinase (CK), which is usually an early sign of the disease and requires frequent and close monitoring.
Muscular Dystrophy;
What are other diagnostic measures? What are they for exactly?
Other diagnostic studies such as:
chest x-ray,
electrocardiogram,
computed tomography (CT), and electromyography
are frequently warranted to determine the extent of muscle wasting or the presence of cardiopulmonary compromise associated with the disease.
Muscular Dystrophy;
What does medical management of MD focus on?
The medical management of MD focuses on the prevention of progressive deterioration of the disease, supportive measures to assist maximization of functional capacity, and pain management.
Muscular Dystrophy;
What is the cure or pharmacological intervention?
There is no specific cure or pharmacological intervention.
Muscular Dystrophy;
What medication can help? What do they do?
glucocorticoids such as prednisone have been shown to decrease the rate of muscle deterioration and increase restorative functional abilities.
Muscular Dystrophy;
What are severe complications of this disease?
Spinal deformity and neuromuscular deterioration causing weakness of the trunk and lower extremities are severe complications of MD.
Muscular Dystrophy;
Severe complications: What can develop with scoliosis and overall thoracic-lumbar changes?
With the development of scoliosis (curvature of the spine) and overall thoracic-lumbar changes, respiratory and cardiac compromise can develop.
Muscular Dystrophy;
Nursing interventions: What must be assessed?
Assess vital signs.
Muscular Dystrophy;
Nursing interventions: When assessing vs, what may indicate deterioration of cardiovascular and respiratory status?
Increased heart rate,
decreased blood pressure, and
decreased SpO2 may indicate deterioration of cardiovascular and respiratory status.
Muscular Dystrophy;
Nursing interventions: What must be administered?
Administer corticosteroid therapy as ordered
Muscular Dystrophy;
Nursing interventions: What must be managed? How?
Pain management—administer aspirin, ibuprofen, Tylenol as ordered for pain control.
Muscular Dystrophy;
Nursing interventions: What is the importance of managing pain?
Managing pain is essential to maintaining mobility as much as possible
Muscular Dystrophy;
Nursing interventions: What must the nurse encourage? What kind of precautions should they have?
Range-of-motion exercises.
Maximize function and decrease potential contractures
Put patient on fall precautions
What is the most common bone disease in humans and creates a major public health concern for the future?
Osteoporosis
Osteoporosis: What is it?
Osteoporosis is a chronic condition that results in deterioration of bone tissue and density, increasing a patient’s risk for fractures.
Osteoporosis:
Pathophysiology:
Some important factors to note that occur with aging are:
- a decrease in calcitonin levels
- a decrease in estrogen levels
- an increase in the parathyroid hormone
Osteoporosis:
Pathophysiology:
Some important factors to note that occur with aging are:
- A decrease in calcitonin levels- What does this lead to?
decrease in calcitonin levels a hormone that decreases osteoclastic activity;
Osteoporosis:
Pathophysiology:
Some important factors to note that occur with aging are:
- a decrease in estrogen levels- What does this lead to?
a decrease in estrogen levels, which results in the inhibition of bone formation
Osteoporosis:
Pathophysiology:
Some important factors to note that occur with aging are:
- Increase in the parathyroid hormone What does this lead to?
an increase in the parathyroid hormone, which increases osteoclastic activity and bone turnover.
Osteoporosis:
Pathophysiology:
These important factors to note that occur with aging lead to what changes?
All of these changes produce a decrease in the Bone mineral density (BMD) ;
Osteoporosis:
Pathophysiology:
What happens if there is a decrease in the Bone mineral density (BMD)?
The bones become more porous, brittle, and fragile, thereby increasing the risk for fractures
Osteoporosis:
Pathophysiology:
The risk factors of osteoporosis are defines as how?
Primary and secondary
Osteoporosis:
Pathophysiology:
Primary risk factors of osteoporosis include what?
Primary risk factors are those that are nonmodifiable, such as
age or race,
and lifestyle choices such as sedentary lifestyle,
not enough calcium intake,
or smoking.
Osteoporosis:
Pathophysiology:
Secondary risk factors of osteoporosis include what?
Secondary risk factors include other disease states that are associated with an increased risk such as
Cushing’s disease or
medication use such as steroids
Osteoporosis:
Pathophysiology:
What is osteoporosis often referred to as? Why?
Osteoporosis is also frequently referred to as the “silent disease” secondary to the fact that patients are not diagnosed until a fracture occurs after an unremarkable fall or strain.
Osteoporosis:
Pathophysiology:
Where do fragility fractures most often occur?
Fragility fractures most often occur in the spine, hip, and distal radius (part of the radius connected to the wrist joint).
Because of this, it is important to understand the risk factors of this disease.
Osteoporosis:
Pathophysiology:
What is the key modifying factor to incorporate into the medical care for patients at risk for osteoporosis?
Prevention is the key modifying factor to incorporate into the medical care for patients at risk for osteoporosis.
Osteoporosis:
Pathophysiology:
What is the gold standard assessment for osteoporosis?
The gold standard assessment for osteoporosis is Bone mineral density (BMD).
Osteoporosis:
Pathophysiology:
Who is Bone mineral density (BMD) done for?
measurements for women over the age of 65 or men over 70 and for postmenopausal women and men 50 to 69 with a high risk-factor profile.
Osteoporosis:
Pathophysiology:
How is Bone mineral density (BMD) obtained?
They are obtained through a dual-energy x-ray absorptiometry (DEXA) scan.
Osteoporosis:
Diagnosis:
What does a DEXA scan in Bone mineral density (BMD) do?
A DEXA scan gives precise measurements at clinically relevant skeletal points within the body, which highlight areas for future fracture risks.
Osteoporosis:
Diagnosis:
What tests can be done to rule out hyperthyroidism?
tests such as protein measurements can be done to rule out hyperthyroidism
Osteoporosis:
Diagnosis:
What is the most widely used tool?
The most widely used tool is the Fracture Risk Assessment Tool, or FRAX, which was developed by the World Health Organization’s Collaborating Centre for Metabolic Bone Disease.
Osteoporosis:
Diagnosis:
What is the FRAX?
The FRAX uses clinical risk factors with or without bone mineral density to assess a person’s 10-year risk for the development of fractures.
Osteoporosis:
Intervention:
What is pharmacological intervention focused on?
Pharmacological intervention is focused on preventing and slowing the progression of bone loss.
Osteoporosis:
Intervention:
What is the first line medication for prevention?
The first line of prevention is safe and inexpensive with the use of calcium and vitamin D.
Osteoporosis:
Intervention:
What other medication is used for Osteoporosis?
Fosamax
Osteoporosis:
Intervention:
How should fosamax be taken?
After getting up for the day and before taking your first food, drink, or other medicine, swallow your FOSAMAX tablet with a full glass (6-8 oz) of plain water only.
Stay upright for at least 30 minutes
What is osteomyelitis?
Osteomyelitis is bone infection
Osteomyelitis:
What is the incidence and prevalence linked to?
The incidence and prevalence for osteomyelitis are directly linked to the mechanism of infection
Osteomyelitis:
What are the mechanisms of action?
hematogenous or nonhematogenous.
Osteomyelitis:
The mechanisms of action: Nonhematogenous
Nonhematogenous, or exogenous, osteomyelitis is a result of an open fracture and/or trauma to the bone.
Osteomyelitis:
Nonhematogenous: Who is it more commonly associated with?
Nonhematogenous osteomyelitis is more commonly associated with adults and open surgical fractures or trauma.
Osteomyelitis:
The mechanisms of action: Acute hematogenous osteomyelitis
Who is this seen more in?
Acute hematogenous osteomyelitis is more commonly seen in children and those less than 1 year of age.
Osteomyelitis:
Pathophysiology:
is complex and not clearly understood
Osteomyelitis:
Pathophysiology:
Although it is complex and hard to understand, what is correlated with this disease?
principles of virulence of a bacterium (ability of a bacterium to cause disease to the host),
patient immune status, underlying patient pathology and type,
and location and vascularity of the bone are highly correlated.
Osteomyelitis:
How is osteomyelitis classified into?
Osteomyelitis is classified into one of three categories:
1) acute infection
2) subacute infection
3) a chronic infection
Osteomyelitis:
Osteomyelitis is classified into one of three categories: Acute infection
which is less than 2 weeks
Osteomyelitis:
Osteomyelitis is classified into one of three categories: Subacute infection
is from 2 weeks to 3 months
Osteomyelitis:
Osteomyelitis is classified into one of three categories: Chronic infection
Lasts longer than 3 months.
Osteomyelitis:
What are clinical manifestations of acute osteomyelitis?
Clinical manifestations of acute osteomyelitis include pain not relieved by rest, swelling, tenderness and warmth at the site, fever, nausea, chills, and a general feeling of being unwell or malaise.
Osteomyelitis:
What are clinical manifestations of chronic osteomyelitis?
Manifestations of chronic osteomyelitis include constant bone pain, edema, tenderness, erythema, and warmth at the site.
Osteomyelitis:
Why is diagnosis difficult?
Diagnosis of osteomyelitis can be difficult secondary to the fact that many serum laboratory tests are nonspecific
Also, radiographical studies often show normal function rather than pathology.
Osteomyelitis:
What does medical management require?
The medical management of osteomyelitis requires clinically appropriate antibiotic therapy and surgical debridement and incision of the infected and/or necrotic tissue and bone.
Osteomyelitis:
Medical management: What is indicated to manage pain?
Opioid analgesia is indicated to manage the pain.
Osteomyelitis:
What does nutritional support focus on?
Nutritional support focuses on a high-protein diet to support and aid in wound healing.
Supplements such as vitamin C, zinc sulfate, iron, thiamine, folic acid, and a multivitamin are recommended dependent on the patient’s baseline nutritional status.
Osteomyelitis:
What happens if there is no appropriate therapy and medical management given?
In the absence of appropriate therapy and medical management, osteomyelitis is associated with disabling and life-threatening complications such as sepsis, potentially resulting in amputation.
Osteomyelitis:
What kind of meds?
Broad spec antibiotics like vanco
Osteomyelitis:
Meds: What is a normal trough level?
10-20
If greater than 20, don’t give full dose
Osteomyelitis:
How to diagnose?
MRI can be used to detect how deep infection is within the bone
Bone Cancer aka osteosarcoma:
Epidemiology: How many new cases a year?
Approximately 750 to 900 new cases of osteosarcoma are diagnosed yearly in the United States.
Bone Cancer aka osteosarcoma:
What is the most common form of bone cancer?
Osteochondroma, a benign bone tumor, is the most common form of bone cancer
Bone Cancer aka osteosarcoma:
Osteochondroma, a benign bone tumor, is the most common form of bone cancer.
Where is it seen?
is seen at the end of a long bone, such as the knee or shoulder.
Bone Cancer aka osteosarcoma:
How common is osteosarcoma?
Osteosarcoma is rare, accounting for only 1% of all cancers diagnosed annually in the United States;
however, it is the fifth most common malignancy among adolescents and young adults.
Bone Cancer aka osteosarcoma:
Clinical manifestations of osteosarcoma are common in what kind of people?
to those of other musculoskeletal health problems, sometimes delaying diagnosis.
Bone Cancer aka osteosarcoma:
Clinical manifestations of osteosarcoma
What manifestations may be present primarily at the tumor site:
Pain worse with motion and unrelieved by rest
Pain may result in a limp
Swelling
Redness
Decreased range of motion
Fracture
Bone Cancer aka osteosarcoma:
What is the primary evaluative tool to assess osteosarcoma?
The primary evaluative tool is a comprehensive history and physical examination focusing on the musculoskeletal system.
Bone Cancer aka osteosarcoma:
What is the purpose of collecting past medical history?
The past medical history focuses on exposure to previous radiation and/or chemotherapy.
Bone Cancer aka osteosarcoma:
What are other diagnostic studies recommended?
Following the history and physical, diagnostic studies including
CT,
bone scans,
myelography,
arteriography,
MRI,
bone biopsy, are recommended.
Bone Cancer aka osteosarcoma:
What is the primary objective of medical management?
The primary objective of medical management is to destroy or remove the tumor.
Bone Cancer aka osteosarcoma:
What is another treatment option? What is the goal of this treatment?
Chemotherapy is another treatment alternative.
The goal is to reduce and/or destroy the bony tumor to prevent metastasis.
Bone Cancer aka osteosarcoma:
What is another treatment goal?
Pain control is another significant goal of treatment.
Bone Cancer aka osteosarcoma:
What is included in pain control? (What meds)
Treatment includes nonsteroidal anti-inflammatories, acetaminophen, but commonly narcotics are necessary to manage pain.
Bone Cancer aka osteosarcoma:
What does surgical management of bone cancer focus on?
Surgical management of bone cancers is focused on resection of the cancerous mass and limb salvation.
Sprains and Strains- how can they occur?
Strains and sprains consistently occur from sporting injuries in athletes of all ages, but they are also caused by accidents at home, at work, and during recreation.
Sprains and Strains:
What are the most frequently occurring orthopedic injury?
Ankle sprains are the most frequently occurring orthopedic injury and are responsible for 40% of all athletic injuries, totaling five million annually.
Sprains and Strains:
A strain is an injury to what?
A strain is an injury to muscle or tendon tissue.
Sprains and Strains:
What is a tendon?
Tendons connect muscles to bones.
Sprains and Strains:
What is a strain? What does it often result in?
A strain is the tearing or stretching of a muscle or tendon, often resulting from overextension, overexertion, or overstretching.
Sprains and Strains:
What is a sprain an injury to?
A sprain is an injury to ligaments
Sprains and Strains:
What are ligaments?
Ligaments are segments of connective tissue that secure bones to bones and bones to cartilage.
Sprains and Strains:
What is a sprain?
As in tendons, a sprain is defined as the stretching or tearing of a ligament resulting from overextension, overexertion, or overstretching.
Sprains and Strains:
How is a sprain or strain diagnosed?
The diagnosis of sprains and strains is based on a thorough history and physical examination of the affected area and is often confirmed by radiography, ultrasound, or magnetic resonance imaging (MRI).
Sprains and Strains:
What is highly effective in identifying strains and sprains?
Ultrasounds are low cost and highly effective in identifying strains and sprains, but an MRI may be more definitive in the final diagnosis.
Sprains and Strains:
What is treatment of first and second degree strains?
Treatment of first- and second-degree strains and sprains involves RICE, a common acronym referring to the treatment plan for strains and sprains:
Sprains and Strains:
Treatment of first and second degree strains:
RICE
Rest
Ice
Compression
Elevate
Sprains and Strains:
Treatment of first and second degree strains:
RICE: Rest
Rest the injured extremity for as long as 72 hours to allow the ligaments or tendon time to heal.
Sprains and Strains:
Treatment of first and second degree strains:
RICE: Ice
Ice applied for no longer than 30 minutes three to five times per day for 24 to 72 hours after injury.
Sprains and Strains:
Treatment of first and second degree strains:
RICE: Ice- What does ice promote?
This promotes vasoconstriction and decreases bleeding and fluid collection in the injured area.
Sprains and Strains:
Treatment of first and second degree strains:
RICE: Compression
Compression by means of an Ace wrap or similar compression dressing to minimize further swelling, which can delay healing.
Sprains and Strains:
Treatment of first and second degree strains:
RICE: Compression- How should the dressing be?
The dressing should be wrapped tightly but not enough to alter neurovascular function. Ensure that circulation, movement, and sensation remain intact.
Sprains and Strains:
Treatment of first and second degree strains:
RICE: Elevate
Elevate the affected area to minimize dependent swelling
Amputations:
Amputations occur for various reasons in people of all ages. They can be how?
They can be traumatic or elective in nature.
Amputations:
What are risk factors?
Risk factors for traumatic amputations include blunt force trauma obtained in motor vehicle crashes, motorcycle crashes, accidents where the patient is caught between two objects.
This accounts for 1% of all trauma patients.
Amputation: What is it?
Amputation is the severing, or removal, of part of the body, generally involving the extremities
Amputation: When does it occur?
The amputation can occur at the time of injury or is necessary immediately after injury to preserve life.
Amputation: What must be done for traumatic amputations?
How long can a tourniquet remain in place? What will happen if its on longer?
For traumatic amputations, immediately control bleeding and replace blood lost from injury.
Tourniquet can remain in place for up to 6 hours before the tissue becomes necrotic
Amputation: What are elective amputations caused by?
Elective amputations are caused by disorders that lead to ischemia and eventual cell death.
Amputation:
Elective amputations are caused by disorders that lead to ischemia and eventual cell death.
This lack of tissue perfusion causes what?
This lack of tissue perfusion prevents distribution of oxygen throughout the affected extremity.
Amputation:
What is hemorrhage in traumatic amputations caused by? What does this lead to?
Hemorrhage in traumatic amputations is caused by the destruction of large blood vessels within the extremity, leading to severe bleeding and consequent hypoperfusion.
Amputation:
Hemorrhage in traumatic amputations is caused by the destruction of large blood vessels within the extremity, leading to severe bleeding and consequent hypoperfusion.
What happens if the bleeding is not immediately controlled?
If the bleeding is not immediately controlled with a pressure dressing or tourniquet, the patient further decompensates into hypovolemic shock and death.
Amputation:
What are potential complications?
Infection
Contractures
Hemorrhage
Phantom Limb pain
Neuromas
Amputation:
Potential complications: Infection- Who do they usually occur in?
Infection in older patients with peripheral vascular disease who are undergoing elective amputations is a potential complication.
Amputation:
What is often seen in patients with lower extremity amputations?
Contractures are most often seen in patients with lower-extremity amputations .
and are manifested by lack of movement and exercise in the residual limb. These can be avoided by encouraging the patient to perform active ROM exercises and participate in physical therapy.
Amputation:
What are symptoms of contractures?
Contractures are most often seen in patients with lower-extremity amputations and are manifested by lack of movement and exercise in the residual limb.
Amputation:
How can contractures be avoided?
These can be avoided by encouraging the patient to perform active ROM exercises and participate in physical therapy.
Amputation:
Phantom limb pain: What occurs in this?
Phantom limb pain is a common complication of amputations which produces numbness, tingling, and a sharp burning pain perceived as manifesting in the removed limb or in the distal aspect of the remaining limb.
Amputation:
Phantom limb pain: How is the pain overtime?
The pain typically weakens over time but can be exacerbated by touching the residual limb.
Amputation:
Neuromas: What are they?
Neuromas are clumps of nerve axons in the distal end of the residual limb that have regenerated after surgical amputation.
Amputation:
Neuromas: Where do they typically occur?
Neuromas mostly occur in upper-extremity amputations but can develop in any residual limb.
Amputation:
Neuromas: How likely are neuromas to develop? What do the interfere with?
The development of neuromas is often inevitable and interferes with the proper fit and use of prosthetic devices, frequently requiring additional surgery for removal.
Meniscus injuries: Who do they occur in?
occur in patients of all ages and genders
Meniscus injuries: Who is more likely to sustain meniscus injury of the knees?
Men are more than twice as likely as women to sustain a meniscus injury of the knees.
Meniscus injuries:
How are medial menisci?
Medial menisci are “C” shaped and positioned on the medial aspect of the knee.
Meniscus injuries:
How is the medial menisci injured?
They are torn when excessive twisting, or rotational, force is applied to a knee that is bent.
Meniscus injuries:
Medial menisci injury compare to lateral meniscus?
The medial aspect is larger in size and more apt to tear than the lateral meniscus.
Meniscus injuries:
How is the lateral meniscus? Where is it located?
The lateral meniscus is more “U” shaped and is located on the lateral aspect of the knee joint.
What are risk factors for meniscus injuries?
Risk factors for meniscus injuries include congenital abnormalities, chronic joint diseases such as rheumatoid arthritis and osteoarthritis, ligament deficiencies, and insufficient quadriceps muscle control.
Athletes participating in football, soccer, skiing, basketball, and baseball have an increased risk of developing meniscal injuries.
Meniscus injury:
How is a diagnosis made?
The diagnosis of meniscus injuries is based on physical examination using either the McMurray’s test or Steinman’s test,
Meniscus injury:
Diagnosis: McMurray’s test
in which the knee is supported and flexed while the lower leg is rotated internally and externally
Meniscus injury:
Diagnosis: Steinman’s test
in which the knee is flexed and extended
Meniscus injury:
Diagnosis: A positive result of Steinman’s test or McMurray’s test is indicated how?
A positive result is indicated when either test reveals an audible/palpable “click,”
an inability to extend the knee,
or the presence of pain.
Meniscus injury:
Diagnosis: What is used to rule out degenerative joint diseases?
Radiography may be needed to rule out degenerative joint diseases.
An MRI can further help isolate and characterize the extent of the tear.
Meniscus injury:
Treatment: What is treatment dependent on?
What is indicated treatment for smaller tears?
Treatment of meniscus tears is dependent on the size and severity of the tear.
Smaller tears often heal within a few months and are treated with limited rest, ice, and administration of NSAIDs.
Meniscus injury:
Treatment: What are patients not recommended to do as treatment?
Total immobility and resting of the affected joint is not recommended because it may cause muscle atrophy, stiffness, and further movement problems.
Patients are encouraged to continue daily activities as tolerated.
Meniscus injury:
Treatment: What may be indicated for small tears that haven’t healed with conventional treatment or for large tears?
Surgery in the form of an arthroscopic surgical repair of meniscus tears, or meniscectomy, may be indicated for small tears that have not healed with conventional treatment or for large unstable tears.
Meniscus injury:
Treatment: What does Arthroscopic surgery for meniscus injury involve?
Arthroscopic surgery involves the insertion of small fiber-optic scopes through small incisions in the knee.
What is the most frequent compression neuropathy of the hands?
Carpal tunnel syndrome (CTS) is the most frequent compression neuropathy of the hands.
Where is the carpal tunnel located?
The carpal tunnel is an area located between the carpal bones of the wrist.
What does the carpal tunnel contain?
The tunnel contains the median nerve, tendons, and ligaments.
Carpel tunnel syndrome:
What occurs in it?
Repetitive motions of the wrist elicit inflammation of the tendons and ligaments.
Inflammation compresses the median nerve causing sharp pain, numbness, and tingling of the hand.
Carpel tunnel syndrome:
How do symptoms start?
Symptoms initially occur intermittently at night, then progress if not treated.
Carpel tunnel syndrome:
How is a diagnosis made?
Diagnosis starts with a detailed patient history.
The history includes the patient’s occupation, factors responsible for generating the wrist pain, and medical history.
Tinel’s sign
The Phalen’s test
Nerve conduction studies and electromyographies
Occasionally, MRI and ultrasound may be used to isolate the cause of CTS.
Carpel tunnel syndrome:
Phalen’s test: What is the procedure?
The Phalen’s test
aids in diagnosis of CTS and is performed by having the patient relax his or her hand in the flexed position for 60 seconds or by placing the back of the hands together while flexing both wrists.
This compresses the median nerve.
Patients with CTS experience numbness and tingling during the Phalen’s test.
Carpel tunnel syndrome:
Tinel’s sign: What is the procedure? What kind of response is positive
Tinel’s sign, tapping the median nerve over the carpal tunnel at the wrist, will also elicit paresthesia over the median nerve region of the wrist.
Carpel tunnel syndrome:
Nerve conduction studies and electromyographies are frequently ordered to do what?
Nerve conduction studies and electromyographies are frequently ordered to determine the severity of CTS and rule out any potential spinal cord lesions or tumors.
Occasionally, MRI and ultrasound may be used to isolate the cause of CTS.
Carpel tunnel syndrome:
What are treatment options? (conventional nonoperative)
Treatment of CTS can be done with conventional nonoperative measures such as modifying the work environment to eliminate repetitive motion and promote ergonomics.
Ultrasound therapy, NSAIDs, steroid injections, night splinting, and acetaminophen are other treatment options.
Carpel tunnel syndrome:
Treatment: Surgical intervention is called what?
Surgical intervention called carpal tunnel release surgery.
Carpel tunnel syndrome:
Treatment: Surgical intervention what is it for?
is often performed as an outpatient procedure to decrease pressure on the median nerve.
Carpel tunnel syndrome:
Treatment: What are the two types of surgical decompression of the median nerve?
There are two types of surgical decompression of the median nerve:
open release and endoscopic.
Imaging studies:
Bone scans: What is it for?
A bone scan is a diagnostic scan to find damage to bones, disease (such as cancer), infection, or trauma.
Imaging studies:
Bone scans: What is the procedure?
A radioactive material, a tracer, is injected IV.
The tracer travels through the body and after approximately 3 hours is absorbed into the bones.
The bone images are then completed.
Imaging studies:
Bone scans: What are results?
“cold” spots
“Hot spots”
Imaging studies:
Bone scans: How do “cold spots” show up on scan? What do “cold spots” indicate?
Areas that show little or no amount of tracer appear as dark or “cold” spots.
These areas of “cold” spots define areas with a lack of blood supply to the bone and may indicate the presence of cancer.
Imaging studies:
Bone scans: How do “hot spots” show up on scan? What do “hot spots” indicate?
“Hot spots” are areas where the tracer accumulates in the bone.
These spots are often attributed to fractures that are healing, bone infection, or diseases of bone metabolism.
Hot spots, as cold spots, may also indicate bone cancer and need further evaluation.
Breast feeding and bone scan?
If breast feeding and need bone scan. Milk made 48 hours from now should be thrown out not used or stored.
Pregnancy and bone scan?
Bone scan can tell you how deep infection is in the bone.
Pregnant people should not take care of people going for bone scan.
Imaging studies:
Arthroscopic examination — WHat kind if procedure is this?
Arthroscopy is a surgical procedure that allows a practitioner to view the inside of a joint through an instrument called an arthroscope.
Imaging studies:
Arthroscopic examination — What is this procedure for?
This procedure is used to diagnose, repair, and remove loose or foreign materials in the joint.
What is a cast?
A rigid, external immobilizing device
Casts: what are they for?
Immobilize a reduced fracture
Correct a deformity
Apply uniform pressure to soft tissues
Support to stabilize a joint
Casts: materials?
Materials: nonplaster (fiberglass), plaster
A Fasciotomy: what is it?
is a surgical procedure that involves cutting fascia, or thick connective tissue, to relieve pressure in muscle compartments.
Education Needs of the Patient With a Cast
Exercises
Do not scratch or stick anything under cast
Cushion rough edges
Signs and symptoms to report: persistent pain or swelling, changes in sensation, movement, skin color or temperature, signs of infection or pressure areas
Required follow-up care
Cast removal
Head Injury: What is it?
A broad classification that includes injury to the scalp, skull, or brain
What is the most common cause of death from trauma?
Head injury- The most common cause of death from trauma
Head injury- Who is most likely to have this?
Groups at highest risk for brain trauma include males in all age groups, adolescents ages 15 to 19 years, children younger than 4 years, and adults 65 years and older
Manifestations of head injury depend on?
Manifestations depend on the severity and location of the injury
Scalp wounds: How are they?
Tend to bleed heavily and are portals for infection
Skull fractures: How is pain?
Usually have localized, persistent pain
Fractures of the base of the skull are indicated by what?
Bleeding from nose pharynx or ears
Battle’s sign—ecchymosis behind the ear
CSF leak: halo sign—ring of fluid around the blood stain from drainage
Brain Injury: What are the different types?
Closed brain injury (blunt trauma):
Open brain injury:
Concussion:
Contusion
Brain Injury:
Closed brain injury (blunt trauma)
Closed brain injury (blunt trauma):
acceleration/deceleration injury occurs when the head accelerates and then rapidly decelerates, damaging brain tissue
Brain Injury:
Open brain injury: What is it?
object penetrates the brain or trauma is so severe that the scalp and skull are opened
Brain Injury:
Concussion: What is it?
a temporary loss of consciousness with no apparent structural damage
Brain Injury:
Contusion:
Contusion: more severe injury with possible surface hemorrhage
Manifestations of Brain Injury
Altered LOC
Pupillary abnormalities
Sudden onset of neurologic deficits and neurologic changes; changes in sense, movement, reflexes
Changes in vital signs
Headache
Seizures
Nursing and medical management of a patient with a traumatic brain injury:
Nursing and medical management of a patient with a traumatic brain injury mirrors that associated with a patient with increased intracranial pressure.
Reducing ICP is high priority in patients with brain injury.
Plan of care to reduce the risk of increasing ICP in a patient with TBI includes avoiding overstimulation.
Subdural hematoma : What is it and what are the types?
is the collection of blood between the dura and the brain.
It can be acute or subacute to chronic
Acute Subdural Hematoma: What is it?
symptoms develop over 24 to 48 hours
Subacute Subdural Hematoma: What is it?
symptoms develop over 48 hours to 2 weeks
Subdural hematoma (Acute and subacute) require what?
Requires immediate craniotomy and control of ICP
Chronic Subdural hematoma: How long does it take to develop? What can cause it?
How do symptoms occur?
Develops over weeks to months
Causative injury may be minor and forgotten
Clinical signs and symptoms may fluctuate
Chronic Subdural hematoma: What is treatment?
Treatment is evacuation of the clot
Subdural Assessment: ASSESSMENT
History
Physical assessment
Vital signs and increased intracranial pressure
Diagnostic studies
Subdural Assessment: ASSESSMENT
History- where is it best gotten from?
Best provided by the patient
Subdural Assessment: ASSESSMENT
Physical assessment
Levels of consciousness,
cranial nerves,
motor and sensory systems,
cerebellar assessment and reflexes
Subdural Assessment: ASSESSMENT
Vital signs and increased intracranial pressure
How is it regulated? What should you be monitoring?
Regulated in the brain and brainstem
Heart rate
Blood pressure
Respirations
HEADACHE: What are they referred to as?
What are the two categories??
Also referred to as cephalalgia
Primary and secondary
Headaches: What are they the result of?
Headaches are the result of the reaction of nociceptors (pain-sensitive nerve endings) to triggers, sending messages to the thalamus via the trigeminal nerve (CN V).
Headaches:
What are primary headaches?
Primary headaches are those not associated with other underlying disease or organic causes
Headaches:
What are secondary headaches?
secondary headaches are caused by an underlying structural problem such as stroke, tumor, meningitis, or encephalitis.
What are tension headaches? How do patients describe them?
Tension headaches may be episodic or chronic in nature.
Patients often describe the pain as constant pressure to the face, head, and neck, often with sensitivity to light.
Headaches: What is the treatment of tension headaches?
Treatment of tension headaches involves treating any underlying disorders or diseases.
Depression and anxiety can cause tension headaches.
Counseling and antianxiety and antidepressant medications can aid in the relief of tension headaches.
Headaches: What is a cluster headache?
Cluster headaches are considered neurovascular headaches.
Headaches:
What is the clinical presentation of cluster headaches?
The clinical presentation typically includes severe, unrelenting, unilateral pain in and around the eye.
What are the four phases of migraine headaches?
Migraine headaches are isolated into four phases.
- The premonitory phase
- Aura
- headache phase
- postdromal phase
Migraine headaches: What are symptoms?
Symptoms include Mood changes, fluid retention, increased urinary output, excessive uncontrolled yawning, food cravings, aura, confusion, exhaustion.
How to treat headaches?
Treating any underlying disorders or diseases
Depression and anxiety can cause tension headaches
NSAIDs, analgesics, and muscle relaxants
Sedatives and antidepressants
Triptan medications appear most beneficial during moderate to severe migraine pain
Headaches: Age-related considerations
Headaches in children are shorter in duration
PRIMARY BRAIN TUMORS: Where do they originate?
Originate in the brain
PRIMARY BRAIN TUMORS:
How do tumors appear?
Slow-growing, benign tumors
Highly malignant, aggressive tumors
PRIMARY BRAIN TUMORS
Pathophysiology: Oligodendrogliomas
Oligodendrogliomas slow-growing and may not spread
PRIMARY BRAIN TUMORS
Pathophysiology: Gliomas
are inclined to develop along the curved areas
PRIMARY BRAIN TUMORS
Pathophysiology: Meningiomas
Meningiomas are the most common form
PRIMARY BRAIN TUMORS
Pathophysiology: Acoustic neuromas
Acoustic neuromas are also known as schwannomas
PRIMARY BRAIN TUMORS
Clinical manifestations of brain tumors are:
Clinical manifestations of brain tumors are dependent on their location in the brain and will include
Signs/symptoms of increased ICP.
PRIMARY BRAIN TUMORS :
Management
Chemotherapy and radiation are used in place of or in conjunction with surgery, depending on the type and location of the tumor.
PRIMARY BRAIN TUMORS :
Management: What is the most common surgical procedure for all types of brain tumors?
The most common surgical procedure for all types of brain tumors is the craniotomy.
PRIMARY BRAIN TUMORS :
Management: Craniotomy- What occurs in this?
Why is this procedure done?
During this procedure, a section of the skull is removed (known as a bone flap) to provide access to the brain, this can be done to biopsy brain tissue or to excise (remove) a tumor.
PRIMARY BRAIN TUMORS :
What are complications?
Bleeding
Cerebral edema
Seizures
Venous thromboembolism
Increased intracranial pressure
Seizures:
Epidemiology
Uncontrolled, sudden, excessive discharge of electrical activity
Seizures:
Epidemiology: How do symptoms range?
Results in range of manifestations from behavior changes to loss of consciousness
The clinical presentation of seizure activity is related to the classification and can range from rhythmic jerking of all extremities and loss of consciousness as observed in generalized tonic-clonic seizures to episodes of apparent daydreaming and no loss of consciousness as observed in absence seizures.
Seizures:
Pathophysiology
No conclusive pathophysiological explanation
Genetic or developmental mutation of synapses
Ineffective activity of gamma-aminobutyric acid (GABA)
Seizures:
Diagnosis is what?
Diagnosis of seizures is made via imaging (CT, MRI) and laboratory work-up to rule out causes (lesions, tumors, metabolic, and other disorders) and through diagnostics via EEG
Seizures:
Treatments: Pharmacology- What med groups?
Pharmacological therapy is the major approach to the medical management of seizure disorders
Antiepileptic drugs (AEDs) or anticonvulsants almost always provide complete control of the seizures
SEIZURES complications
A seizure lasting more than 5 minutes is considered what?
What can seizures lasting more than 30 minutes cause?
a medical emergency
A seizure lasting longer than 5 minutes is a medical emergency, and seizures lasting longer than 30 minutes can cause respiratory failure, brain damage, and death.
Status epilepticus- What is it?
Status epilepticus, seizure activity lasting longer than 5 minutes or two or more seizures without full recovery of consciousness.
Status epilepticus- What can it be caused by?
Can be caused by head trauma, hydrocephalus, acute drug or alcohol withdrawal, or abrupt withdrawal of anticonvulsive medications.
Status epilepticus- What are treatment interventions?
Airway, breathing, circulation (ABC) interventions must be initiated immediately.
Seizures:
What is surgical management?
Vagal nerve stimulator (VNS), deep brain stimulation, and partial corpus callosotomy
Meningitis: What is it?
Inflammation of the meninges
Meningitis: How is it classified?
Acute or chronic
Meningitis:
Acute meningitis is caused by what? How long does it take for symptoms to occur?
What is acute bacterial meningitis considered?
Acute meningitis indicates a bacterial cause, with the presence of clinical manifestations occurring in hours to days.
Acute bacterial meningitis is a medical emergency.
Meningitis:
Chronic meningitis
Chronic meningitis has an onset of symptoms during weeks to months, with duration of symptoms longer than 4 weeks.
Meningitis: Epidemiology and causes?
Increased where people live in close proximity
Causes include bacterial infection, viral infection, fungal infection, and aseptic meningitis
Meningitis: Clinical manifestations
Fever, headache, and divergent degrees of altered mental status
Photophobia, chills, nausea, and vomiting
Signs of meningeal irritation (nuchal rigidity, Brudzinski, Kernig)
and opisthotonos (severe hyperextension of the head with arching of the back).
Meningitis:
What is the hallmark for the diagnosis?
Examination of CSF via lumbar puncture is the hallmark for the diagnosis of meningitis.
Meningitis: What is treatment?
Treatment for meningitis generally requires 14 to 21 days of antibiotic treatment.
LOOK at SLIDe 35
ENCEPHALITIS
Epidemiology: What causes this?
Several thousand cases of encephalitis are reported yearly and are primarily caused by enteroviruses such as herpes simplex I and II and arboviruses (transmitted via anthropoid vectors) such as rabies, Lyme disease, and West Nile virus.
Encephalitis: What is it?
Encephalitis is an acute inflammation of the brain, including the cerebrum, brainstem, and cerebellum.
Encephalitis: How does inflammation occur?
While the pathogen travels to the CNS, it invades the brain tissues and reproduces, leading to inflammation of the cerebral cortex and white matter
Encephalitis:
When the inflammation involves both the brain and spinal cord, what is it called?
it is called encephalomyelitis.
ENCEPHALITIS: What are clinical manifestations?
The clinical presentation of the patient with encephalitis includes manifestations associated with an infectious process, including fever, as well as neurological deficits associated with damage to the brain and spinal cord.
ENCEPHALITIS: What are common complaints?
Common complaints include headache, photophobia, phonophobia (fear of loud noises), and nuchal rigidity.
ENCEPHALITIS: While the infectious process develops, what forms?
While the infectious process develops, clinical manifestation of increased ICP may be present, including a change in level of consciousness (lethargy, disorientation), as well as focal signs, including muscle spasms and parasthesias.
Encephalitis: How to diagnose?
Diagnosis of encephalitis follows the procedures and protocol of meningitis, involving examination of the blood and CSF as well as the EEG, CT, and MRI scans.
Encephalitis: What is used to treat this?
Antivirals are used to treat encephalitis.
PARKINSON’S DISEASE:
Who is it most common in males or females?
What ages is usual onset?
1.5x to 2x more common in males than in females
Begins between ages of 40-70 years
PARKINSON’S DISEASE:
Pathophysiology
What kind of disease? How does it manifest? What is the primary origin?
Progressive, neurodegenerative disease of the CNS
Manifesting primarily in motor dysfunction
Primarily of idiopathic origin
PARKINSON’S DISEASE:
What are the five discernible symptoms?
resting tremors,
muscle rigidity, ‘
slowness of movement (bradykinesia)
or loss of movement (akinesia), and
postural instability (impaired balance and frequent falls).
PARKINSON’S DISEASE:
What are other clinical manifestations?
Other clinical manifestations include mood, cognitive, and behavioral alterations.
PARKINSON’S DISEASE: How to diagnose?
There are no specific diagnostic studies to confirm PD, so the presence of progressive decline in motor function accompanied by the tremors and rigidity is typically how the diagnosis is made.
Diagnosis when 2 or more cardinal symptoms with an asymmetrical presentation
PARKINSON’S DISEASE:
What is surgical management?
Stereotactic pallidotomy
PARKINSON’S DISEASE:
What is medicinal treatment? Who is it used on usually?
Why are they not used in older people?
Anticholinergics, which can reduce tremors and drooling, may be used in younger patients.
These medications are generally not used in older adults because of side effects including confusion, memory impairment, blurred vision, dry mouth, constipation, and urinary retention.
Stereotactic pallidotomy for control of the clinical manifestations associated with PD: What is the procedure?
Stereotactic pallidotomy for control of the clinical manifestations associated with PD involves the opening of the pallidum within the corpus striatum. Locating the specific site is performed via the use of multiple CTs of the head and the stereotactic head ring.
Spinal cord injury:
What does it result from?
What is it?
Spinal cord trauma may result from either direct injury to the cord or indirectly from damage to surrounding bones, tissues, and blood vessels.
Spinal cord injury is damage to the spinal cord with resulting functional loss of mobility and/or sensation.
Spinal cord injury:
What are the four types of incomplete injury?
- Central cord syndrome
- Anterior cord syndrome
- Posterior cord syndrome
- Brown-Séquard’s syndrome
Spinal cord injury:
What helps predict the part of the body that might be effected?
The level of injury helps predict what parts of the body might be affected.
Spinal Cord injuries:
Cervical injuries: What do they result in?
Cervical injuries can result in the inability to breathe (above C4) and quadriplegia.
Spinal Cord injuries:
Thoracic injuries : What do they result in?
Thoracic injuries often result in paraplegia and can include poor trunk control.
Spinal Cord injuries:
Lumbar and sacral injuries result in what?
Lumbar and sacral injuries result in decreasing control of legs, bowel and bladder function, and sexual function.
Spinal Cord injuries:
What are other effects?
Other effects include chronic pain, low blood pressure, inability to sweat below the level of injury, and decreased temperature control.
Spinal cord injury:
What is treatment in the acute stages?
During the acute stage of injury, treatment focuses on maintaining airway patency, adequate breathing and oxygenation, preventing spinal shock, restoring and maintaining blood pressure, preventing further cord damage, spinal immobilization, and avoiding possible complications.
Spinal cord injury:
What are patients monitored for in acute stages?
Patients are monitored for vital sign changes that may indicate spinal shock.
Spinal cord injury:
What do you do to control irregular heartbeat? What is used for immobilization and stabilization?
Give Medications and/or pacemaker to control irregular heartbeat
Halo traction device and Gardner-Wells tongs are used for immobilization and stabilization
Spinal cord injury:
An SCI produces a wide variety of changes in systemic physiology that can lead to a number of COMPLICATIONS
Spinal shock
Neurogenic shock
Autonomic dysreflexia
Several complications have been identified with the use of halo brace/traction devices
Myasthenia gravis: What is it?
is a motor disorder characterized by fluctuating, localized skeletal muscle weakness and fatigue. It is an acquired autoimmune disease.
MYASTHENIA GRAVIS
The course of the disease may vary from mild, with ocular symptoms of ptosis (drooping eyelids) and diplopia (double vision), to severe cases with generalized weakness and respiratory involvement. There are no known risk factors associated with developing the disease.
Ocular, bulbar, or generalized presentations
Often seek medical care for muscular weakness/fatigue
MYASTHENIA GRAVIS: How to diagnose?
Laboratory, diagnostic, serological tests
Repetitive nerve stimulations and
electromyography
Chest computed tomography
Immunotherapy
Medications
Additional therapies
Surgical management
MYASTHENIA GRAVIS: What are specific meds?
Pyridostigmine (Mestinon), Neostigmine (Prostigmin),
Immunotherapy are some medications to manage MS.
MYASTHENIA GRAVIS: A surgical approach to the management of MG:
A surgical approach to the management of MG is thymectomy (removal of the thymus gland) .
MYASTHENIA GRAVIS: What are complications?
Myasthenic crisis
Cholinergic crisis
MYASTHENIA GRAVIS:
Myasthenic crisis
Myasthenic crisis is an exacerbation of MG weakness that provokes an acute episode of respiratory failure that is often caused by a respiratory infection from viral or bacterial agents.
MYASTHENIA GRAVIS:
Cholinergic crisis
Another type of crisis that the MG patient may encounter is cholinergic crisis.
This is due to excessive anticholinesterase medication and is potentially secondary to the patient taking too much of the prescribed MG medication.
Test useful in distinguishing myasthenic from cholinergic crisis
The Tensilon (edrophonium) test is useful in distinguishing myasthenic from cholinergic crisis
Ischemic Stroke: What is it?
Disruption of the blood supply caused by an obstruction, usually a thrombus or embolism, that causes infarction of brain tissue
Ischemic Stroke: What are symptoms dependent on?
What are some symptoms?
Symptoms depend on the location and size of the affected area
Numbness or weakness of face, arm, or leg, especially on one side
Confusion or change in mental status
Trouble speaking or understanding speech
Difficulty in walking, dizziness, or loss of balance or coordination
Sudden, severe headache
Perceptual disturbances
Transient Ischemic Attack (TIA): What is it?
Temporary neurologic deficit resulting from a temporary impairment of blood flow
Transient Ischemic Attack (TIA): What is it considered?
warning of an impending stroke
Transient Ischemic Attack (TIA): What is required to treat and prevent irreversible deficit?
Diagnostic workup is required to treat and prevent irreversible deficits
ALZHEIMER’S DISEASE
No cure and confirmed diagnosis upon brain examination following death
Several medications are approved and vitamin E
MULTIPLE SCLEROSIS:
Epidemiology: Who does it affect more women or men?
women
MULTIPLE SCLEROSIS:
Numbness or weakness in limbs, partial or complete vision loss, tingling or pain, electric-shock sensations with head movements, tremor, lack of coordination, or unsteady gait, fatigue, and dizziness
MULTIPLE SCLEROSIS: common complications
Common complications
Muscle stiffness or spasms
Paralysis, often in the legs
Problems with bladder, bowel, or sexual function
Mental status changes — memory loss, problems concentrating
Depression
Seizures
GUILLAIN-BARRÉ SYNDROME
Epidemiology: what are common sources?
Respiratory or GI infections are common sources
Campylobacter jejuni is most frequent cause
Also Cytomegalovirus, Epstein-Barr virus,
Mycoplasma pneumonia, and Haemophilus influenzae
GUILLAIN-BARRÉ SYNDROME
Pathophysiology
Mediated by an immune response with acute lower extremity weakness with areflexia
GUILLAIN-BARRÉ SYNDROME
Clinical manifestations: What are they and how does it start?
Symmetrical ascending motor weakness and paralysis
Starts in feet and extends to trunk and arms
GUILLAIN-BARRÉ SYNDROME
Management: What does it focus on?
Focuses on supportive care, reducing severity, potential complications, suffering, and recovery time
GUILLAIN-BARRÉ SYNDROME
Management:
Diagnostic tests
Medications and diet
Complications
