neuro/musculoskeletal by diana blum rn msn metropolitan community college

121
NEURO/MUSCULOSKELETAL BY DIANA BLUM RN MSN METROPOLITAN COMMUNITY COLLEGE

Upload: korey-wheeley

Post on 16-Dec-2015

216 views

Category:

Documents


1 download

TRANSCRIPT

NEURO/M

USCULOSK

ELETA

L

B Y D I A N A B L U M R N M S N

M E T R O P O L I T A N C O M M U N I T Y C O L L E G E

SELECTIVE ANATOMY

12 cranial nerves 31 spinal nerves

Neuron transmits impulses to facilitate movement or sensation

Meninges serve as protection of the brain and spinal cord

Bronca’s area in frontal lobe forms speech

Hypothalamus regulates water, appetite, temp

CSF: surrounds and cushions brain and cord

MENTAL STATUS

Does not decline with age

Caused by drugs or lack of o2 to the brain

As we age LTM is better then STM

FUNCTIONAL ASSESSMENT

Appearance

Speech

Motor function

Family history

Ethnicity

Diet

ADLs

Right handed or left handed◦ Brain injury is more pronounced in dominant hemisphere

PHYSICAL ASSESSMENT

Orientation

LOC

Memory◦ LTM (DOB)◦ STM (mode of transportation to hospital)◦ Immediate memory (repeat 3 words after 5 minutes)

Attention◦ Serial 7 test

Language/copying◦ Follows simple commands

Cognition ◦ Current events

SENSORY ASSESSMENT

Pain and temp◦ Cotton ball vs paper clip◦ Cold vs warm

Touch◦ Pt closes eyes and you touch hand etc and then have them touch

where you touchedABNORMAL FINDINGS

Propioception-position sense below injury Contralateral- loss of sensation in opposite side of body

affected

MOTOR ASSESSMENT

Hand grasps

Foot strength

Arm drift

Coordination

Gait

Balance

Reflexes

ABNORMAL FINDINGS

tremors, weakness, paralysis, jerking muscles

RAPID ASSESSMENT

Glascow coma scale: eye opening, motor response, and verbal response◦ painful stimuli

Supraorbital pressure Sternal rub Mandibular pressure Trapezius squeeze

◦ LOC Decortication-hands/arms turned in Decerebration- hands/ arms turned out

◦ Pupil assess Response to light

The GCS is scored between 3 and 15, 3 being the worst score, and 15 the best.

It is composed of three parts: Best Eye Response, Best Verbal Response, Best Motor Response

When doing a neuro assessment it is important to watch for trends indicating a decreasing LOC.

Keep in mind that when patients have ingested alcohol,

mind altering drugs, have hypoglycemia or shock with a systolic BP <80, the GCS may be invalid.

9 to 12 is a moderate injury

8 or less is a severe brain injury.

  7 or less = Coma

A client has a 5 on the Glasgow Coma Scale. When assessing this client, the nurse would expect what level of consciousness?

Sleepy or drowsy

Stuporous

Fully alert and oriented

Comatose

Comatose

A score of 7 or less indicates a comatose client. Above that are varying degrees of consciousness.

Coma: No eye opening, no ability to follow commands, no word verbalizations (3-8)

DIAGNOSTICS Blood cultures to find

infection Xray for fx, erosion,

etcPET◦ Evaluates drug metabolism◦ Detects alzheimer’s,

epilepsy, etc◦ No caffeine, alcohol, or

tobacco 24 hrs before test◦ NPO 6-12 hours prior◦ No insulin prior◦ Takes 2-3 hrs◦ No special follow-up

Angiography for circulation check◦ NPO for 4-6 hrs prior◦ Preop checklist◦ Remove jewelry and

hairpins◦ Neuro check and vs◦ Empty bladder before◦ After- monitor pulses, cap

refill, color, and vs

MRI Signed consent No food or fluid restrictions Inform of noise and offer ear

plugs Check for hx of pins,

pacemaker, metal objects

Lumbar puncture Needle in subarachnoid

space to obtain CSF for analysis

Signed consent Empty bladder Explain procedure Lie in fetal position for test Bedrest 4-8 hours post Increase fluid for 24 hours

to prevent spinal headache (3000ml)

DIAGNOSTICS CONTINUED

CT◦ No food 4-6 hrs

prior◦ Fluids okay◦ Remove jewelry

and hairpins◦ Monitor for rx to

dye◦ Monitor I/O

EEG◦ Determines brain

activity◦ Determines origin of

seizures◦ Dx of sleep disorders◦ Determines brain death◦ Explain procedure◦ No coffee , tea, or

stimulants◦ May be ordered as

speep deprived◦ Hair should not have

product on it◦ Takes about 1 hour◦ When done remove gel

with acetone

DIAGNOSTICS CONTINUED

EMG◦ Looks at muscle

activity

BRAIN SCAN◦ Locates tumors and

aneurysms◦ Explain the test◦ May need consent◦ 2 hour delay so brain

absorbs isotope◦ Must be still for

duration of test◦ 1-2 hour exam◦ f/u is to increase

fluids to promote elimination of isotope

TRAUMATIC BRAIN INJURY(TBI)

HEAD INJURY CLASSIFICATION:

Severe Head Injury----GCS score of 8 or less

Moderate Head Injury----GCS score of 9 to 12

Mild Head Injury----GCS score of 13 to 15

(Adapted from: Advanced Trauma Life Support: Course for Physicians, American College of Surgeons, 1993).

SUPERFICIAL INJURIES

Common

Abrasions

“Goose Eggs”

Lacerations Scalp is very vascular

Xray if suspect skull fracture

SKULL FRACTURES

Categorized according to type and severity

Frequently seen in conjunction with brain injuries

Linear skull fractures

Comminuted skull fractures

Basal skull fractures

Possible associated cranial nerve deficits

OPEN SKULL FRACTURESLinear- simple clean break

Depressed - bone pressed in towards tissue

Open -lacerated scalp that creates opening to brain tissue

Comminuted - bone fragments and depresses into brain tissue

Basilar- unique fx at base of skull with CSF leaking though the ear or nose

Racoon eyes/Battles sign

http://www.pearlau.com.au/jpg/raccoon%2520eyes%

http://www.pearlau.com.au/jpg/raccoon%2520eyes

CLOSED SKULL FRACTURES

Closed- blunt trauma Mild concussion-brief LOCDiffuse axonal injury- usually from MVA May go into coma

Contusion-bruising of brainSite of impact (coupe)Opposite side of impact (contrecoupe)

INTRACRANIAL HEMATOMAS

Epidural- bleed b/w skull and dura Laceration of artery or vien

Subdural-bleed below dura and arachoid layers Acute, subacute, chronic

Intracerebral-accumulation of blood in brain tissue Blunt trauma Penetrating wounds Acceleration/deceleration injuries

INCREASED INTRACRANIAL PRESSURE(ICP)

Increase is caused by an increase in the volume of any of the intracranial components

Drivers of increased ICP Hypoxia – triggers the vasodilatory cascade Ischemia in acute brain injury

INCREASED ICP

Normal ICP 10-15mmHg

Normal increases occur with coughing, sneezing, defecation

Leading cause of death for head trauma

As ICP increases cerebral perfusion decreases causing tissue hypoxia, decrease serum pH, and increase in CO2

ICP CONTINUED

3 types of edema Vasogenic: increase in brain tissue volume Cytotoxic: result of hypoxia Interstitial: occurs with brain swelling

ASSESSMENT

HYDROCEPHALUS

abnormal increase in CSF volume

Causes: impaired reabsorption from subarachnoid hemorrhage or menengitis

BRAIN HERNIATION

Increased ICP will shift and move brain tissue downward

Central HerniationDownward shift to brainstem

S/S Cheyne stokes , pinpoint pupils, hemodynamic instability

The most life threatening is Uncal because it causes pressure on the 3rd cranial nerve

S/S Dilated, nonreactive pupils, ptosis, rapidly decreased

LOC

HERNIATION SYNDROMES.

THE BRAIN

Headaches◦ 3 MAIN types

Migraine-genetic predisposition s/s: sensitive scalp, anorexia, photophobia, N/V Spasming of arteries at the base of the brain causing arterial

constriction, decrease cerebral blood flow, platelets clump, and serotonin released. Other ateries release prostoglandins that cause swelling and inflammation

With aura- sensation that signals onset Most are without aura Atypical- less common Tx: tylenol, migraine medicine, beta blocker, yoga,

meditation, relaxation, etc.

CLUSTER HEADACHE

one sided headache usually felt deep around eye. They come and go

Onset is associated with relaxation, napping or REM sleep

s/s: ipsilateral (one side) tearing of the eye, rhinorrhea(runny nose), ptosis(droopy), eyelid edema, facial sweating, miosis (abn. Constriction of eye). There may be bradycardia, pallor, increased temp.

Tx: same as migraine, wear sunglasses, O2 for 15 minutes, surgery

TENSION HEADACHE

Muscle and shoulder tenderness, base of skull and forehead pain. Similar s/s to migraines

Classic s/s:N/V, photophobia, phonophobia, aggravates with activity

Tx: NSAIDS,muscle relaxers

SEIZURES/EPILEPSY

Seizure: abnormal sudden, excessive, uncontrollable electrical d/c of neurons w/in the brain that may result in altered LOC, motor/sensory ability, and/or behavior.

No known cause but may be from tumors

TYPES OF SEIZURES

Tonic-Clonic: lasts 2-5 minutes Rigidity/stiffening arms/legs and Loss of ConsciousnessTonic: loss of consciousness, muscle contraction and relaxationClonic: rhythmic jerking, may bite tongue, incontinence Post seizure lethargyAbsence: more common in kids, runs in families, blank staring, loss

of consciousness (resembles daydreaming)Myoclonic: brief jerking or stiffening, symmetric or assymetric

movementAtonic (akinetic): sudden loss of muscle tone, lasts for few seconds

confusion after seizure.Partial: begin in one part of cerebral hemisphere, most often in

adults and are less responsive to medical treatmentComplex Partial: blacks out for 1-3 minutes and automatisms

present (lip smacking, picking), amnesia after seizure,temporal lobe most affected

Simple partial: remains conscious, senses unusual sensation, smell, or pain before (déjà vu). Unilateral movement during seizure, and may have tachycardia, flushing, or psychic symptoms

Idopathic: account for ½ of seizures, no known cause

CAUSES

Metabolic disorders

ETOH withdrawl

Electrolyte disturbances

Heart disease

Altered gene function

Defective genes for channels that regulate ions in/out of cell

Myoclonus clients are missing cystain B protein

Etc.

Triggers Physical activity Stress Fatigue Alcohol or caffeine Certain foods

EPILEPSY

Def: chronic disorder characterized by recurrent unprovoked seizure activity.

May be caused from abnormality in electrical neuronal activity, abnormal transmitters, or both.

Approximately 2 million people in the USA with epilepsy

can be defined as abnormal, uncontrolled electrical activity in brain cells.

Nerve cells transmit signals to and from the brain in two ways by

(1) altering the concentrations of salts (sodium, potassium, calcium) within the cell

(2) releasing chemicals called neurotransmitters (gamma aminobutyric acid). The change in salt concentration conducts the impulse from one end of the nerve cell to the other.

TYPES OF EPILEPSY

Primary or idopathicNot associated with identifiable brain lesion

Secondary Most common cause is brain lesion, tumor or trauma

Status epilepticusProlonged seizures that last greater than 5 minutes or repeated seizures over the course of thirty minutes. Causes:

Med withdrawl Infection Acute alcohol withdrawl Head trauma Cerebral edema Metabolic disturbances

CONVULSIVE STATUS EPIEPTICUS IS A NEUROLOGICAL EMERGENCY AND MUST BE TREATED PROMPTLY AND AGGRESSIVELY.

Call 911or staff emergencyGet airway established if needed by RT, Anesthesia O2 as neededEstablish large bore IV accessStart NSGet ABGsTransfer to ICU

EDUCATION OF SEIZURE/EPILEPSY PATIENTTeach importance of taking meds as prescribed

Promote balanced diet, rest, and stress reduction techniques

Instruct pt. to keep a seizure diary to identify causative factors

PHASES OF SEIZURESPreicteral phase: aura present.. The first phase involves

alterations in smell, taste, visual perception, hearing, and emotional state. This is known as an aura, which is actually a small partial seizure that is often followed by a larger event.

Ictus: The seizure.. There are two major types of seizure: partial and generalized. What happens to the person during the seizure depends on where in the brain the disruption of neural activity occurs.

Postictal state: The period in which the brain recovers from the insult it

has experienced. Drowsiness and confusion are commonly experienced during this phase. the period in which the brain recovers from the insult it has experienced

TREATMENT

Nonsurgical Antiepileptic drugs Seizure precautions

During: Protect the client from

injury Do not force anything into

mouth Turn client to side Loosen restrictive clothes Do not restrain

After Take vitals Perform neuro checks Keep on side Allow rest document

Teach family Info about disease Info about medication Support groups available Teach about alcohol

avoidance To investigate state laws

pertaining to driving and working with machinery

Care of seizure client

SURGICAL TREATMENT

Vagal nerve stimulationFor simple or complex partial seizuresStimulating device is surgically placed in the left chest wall with a lead wire on the vagus nerve

Activates with hand held magnet

CorpuscalostomyUsed for tonic-clonic seizuresFor those not candidates for other surgical procedures

Sections of the anterior and 2/3 of the corpus collosum are created to prevent neural discharges

NURSING DIAGNOSIS

Risk for falls

Ineffective coping

Risk for ineffective breathing

PARKINSON’S

http://www.youtube.com/watch?v=TtM-aP9Gr28

ALZHEIMER’S DISEASE

http://www.youtube.com/watch?v=Z6lA1P2tF0o&feature=related

STAGES

Early mild

Middle moderate

Late severe

S/S

Aggressive

Rapid mood swings

Increased confusion at nite (sundowner’s)

Decrease interest in personal appearance

Inappropriate clothing selection

Loss of bowel/bladder

Decreased appetite

DIAGNOSIS

CBC

BMP

Folate level checked

Thyroid and liver function test

Test for syphilis

Drug tox screening (OTC)

Alcohol screening

CT

MRI

PET

EEG

NURSING DIAGNOSIS

Chronic confusion

Risk for injury

Disturbed sleep pattern

TX

Meds

Prevent overstimulation

Be consistent

Reorient

Promote independence

Bowel/bladder training

Promote facial recognition

Speech therapy

Safety precautions

Minimize agitations

SPINAL CORD INJURY(SCI)

CAUSES OF SCIPrimary Hyperflexion (moved forward excessively) Hyperextension (MVA) Axial loading (blow at top of head causes shattering) Excessive rotation (turning beyond normal range) Penetrating (knife, bullet)Secondary Neurogenic shock Vascular insult Hemorrhage Ischemia Electrolyte imbalance

TYPES

Complete: spinal cord severed and no nerve impulses below level of injury

Cervical/Thoracic

Incomplete: allow some function and movement below level of injury

Includes: Central cord syndrome Anterior cord syndrome Brown-Séquard syndrome

COMPLETE

Tetraplegia (quadriplegia): paralysis from neck down Loss of bowel and bladder control Loss of motor function Loss of reflex activity Loss of sensation Coping issues*Christopher Reeve is example of this injury*

INCOMPLETE

Central Cord Syndrome Hyperextension damage to center of spinal cord Greater loss of function in upper extremities

Anterior Cord Syndrome Cause: Direct injury to anterior spinal cord or disrupted anterior spinal

artery Paralysis, loss of pain and temperature sensation Light touch, vibration, proprioception preserved Prognosis for recovery is variable

INCOMPLETEPosterior cord lesion Damage to posterior white and gray matter Motor function intact, but loss of vibratory sense, crude touch, and

position sensation

Brown Sequard syndrome Result of penetrating injury that causes hemisection of spinal cord. Motor function , proprioception, vibration, and deep touch are lost on

the same side as injury (ipsilateral) On the other side (contralateral) the sensation of pain, temperature

and light touch are affected

ASSESSMENT

1st -respiratory status

2nd - intra-abdominal hemorrhage (hypotension, tachycardia, weak and thready pulse)

3rd assess motor function C4-5 apply downward pressure while the client shrugs C5-6 apply resistance while client pulls up arms C7 apply resistance while pt straightens flexed arms C8 check hand grasp L2-4 apply resistance while the client lifts legs from

bed L5 apply resistance while client dorsiflexes feet S1 apply resistance while client plantar flexes feet

COMPLICATIONS

Cerebral ischemia

DVT/PE

Pneumonia/Atelectasis

Vomiting and Aspiration

GI stress ulcers

Constipation

UTI

Pressure Ulcers

AUTONOMIC DYSREFLEXIA

Severe HTN, bradycardia, sever headache, nasal stuffiness, and flushing

Caused by noxious stimuli like distended bladder or constipation

Immediate interventions Place in sitting position Call doctor Loosen tight clothes Check foley tubing if present Check for impaction Check room temp Monitor BP q10-15 minutes Give nitrates or hydralazine per md order

TREATMENTImmobilize fx- C-collarProper body alignmentTraction is possibleMonitor VS q4 hr and prnNeuro checks q4 hr and prnMonitor for neurogenic shock

(hypotension and bradycardia)Prepare for possible surgeryTeach skin care, ADLs, wound

prevention techniques, bowel and bladder training, medications, and sexuality

NRSG DX FOR SCI

Ineffective tissue perfusion r/t interruption of arterial flow

Ineffective airway clearance r/t SCI

Ineffective breathing pattern r/t SCI

Impaired gas exchange r/t SCI

HUNTINGTON’S DISEASE

Formerly huntington’s chorea

Hereditary

Transmitted as an autosomal dominant trait at time of conception

25000 people in usa have

2 main symptoms are progressive mental status changes and choreiform movements (rapid, jerky) in the limbs trunk and face

No known cause

No known treatment

Only prevention is to not have children

Antipsychotics and monoamine depleting agents used to manage movement

TX: PT, OT, speech therapy, meal planning by dietician, HHC, social work to line up community resources

OSTEOPOROSIS

Metabolic condition

Bone demineralizes

Easy to fracture

Wrist, hip, and vertebrae are most affected

Osteopenia: low bone mass

Osteoclasic: bone resorption

Decreased bone mineral density

40-45% loss in women throughout lifespan

Trebecular (Spongy bone) is lost first

Then Cortical (compact bone) lost 2nd

Pathophysiology is unknown

CLASSES

Generalized:involves many structures Primary: more common

Post menopausal women Men in 60s-70s

seconday

Regional: limb involved r/t fx, injury, paralysis, joint inflammation Immobilization greater than 8-12 weeks Weightless environment (astronauts)

HEALTH PREVENTION

Teach about exercise

Teach about diet rich in calcium

Teach about bone health

Teach about safety

ASSESSMENT

Risk for falls

Head to toe assessment Inspect and palpate vertebrae

Assess pain

Assess for fallophobia

No definitive lab tests

Bone scan to check density

NURSING DIAGNOSIS

Risk for falls

Impaired physical mobility

Acute or chronic pain

INTERVENTIONS

Client education is #1

Hormone replacements

Calcium supplements

Multivitamins

Diet

Fall prevention

Exercise

Pain management

Braces

OSTEOMALACIA

Softening of the bone tissue

Inadequate mineralization of osteoid (mature compact and spongy bone)

Vitamin D deficiency is a key player

Similar characteristics with osteoporosis

Rare in USA

Prevent with vitamin D, sun exposure, and diet

s/s: early stages : nonspecific Muscle weakness Bone pain Hypophosphatemia Hypocalcemia Generalized bone tenderness

PAGET’S DISEASE

Metabolic disorder of bone remodeling

Bone deposits that are weak, enlarged, and disorganized

Phases:Active increased osteoclasts cause massive bone destruction Osteoclasts are multinuclear

Mixed Inactive 2nd phase

New bone becomes sclerotic and very hard Osteoclasts return to normal amount

2nd most common bone disease

Most common sites are vertebrae, femur, skull, sternum, and pelvis

Unknown cause

ASSESSMENT 80% asymptomatic

Assess past history of fractures, skin color and temp, gout, hyperparathyroidism, lethargy, hyperuricemia

Pain that is aching, deep, poor description

Pain worsens with weight bearing and pressure

Pain most noticeable at nite or at rest

Arthritis at infected joints

Assess posture, gait, and balance

Assess vision, speech, and swallowing, hydrocephalus,

Neoplasm is the dreaded complication

DIAGNOSTICS

Serum alk phosphate Those treated for paget’s need ALP drawn 3-4 times/year

Urine hydroxyproline Shows bone collagen turnover and degree of severity

Calcium levels are normal or elevated

Increase noted in uric acid May initially be thought to be gout

X-rays, CT, MRI, bone biopsy

TREATMENT

Drugs for pain relief

Drugs to decrease bone resorption

Calcitonin (thyroid hormone)

Mithramycin (antineoplastic)

Biphosphanates

Heat therapy

Gentle massage

Exercise

PT

Diet

Osteotomy or joint replacement

OSTEOMYLELITIS

Inflammatory process

Increase in vascularity and edema

Vessel becomes thrombosed once inflamed

Ischemia is next

Then necrosis

Sequestrium forms and retards bone healing

CATEGORIES

Exogenous: infection enters from outside

Endogenous: infection enters from inside

Contiguous: results from skin infection

The most common offending organism is pseudomonas aeruginosa

Staph, salmonella are aslo culprits

S/S AND ASSESSMENT

Pain

Fever

Erythema

Heat

Swelling

Assess circulation

Assess for septic shock

TREATMENT

Contact precautions

IV antibx therapy

PICC line

Use sterile techniques

Pain meds

Hyperbaric oxygen therapy

Bone grafts

Muscle flaps

Amputations

CHONDROGENIC

Osteochondroma: most common, benign, tumor…onsets in childhood, grows until skeletal maturity..has a bony stalk like appearance..may become malignant

Chondroma: lesion of mature hyaline cartilage of the hand and feet. Ribs, sternum, spine, and long bones can also be affected…can get at any age or gender

OSTEOGENIC

Osteoid osteoma: pinkish granular appearance..any bone affected..femur and tibia most affected

Osteoblastoma: affects vertebrae and long bones..large in size and lies in spongy bone..reddish granular appearance

Giant cell tumor: origin unknown..aggressive and extensive..affects women 20s-30s

ASSESSMENT/ TX

Assess pain

Palpate involved area

CT scan and MRI done for diagnosis

Interventions Meds and surgery combination Pain meds Meds taken with meals or milk

MALIGNANT BONE TUMORSPrimary: originate in bone / 2nd ary: mets to bone Primary

Osteosarcoma: most common Large lesion, pain and swelling of short duration, warm site, central portion is

sclerotic, usually mets to lung in 2 yrs then death

Ewing’s sarcoma: most malignant Pain and swelling, fever, anemia, leukocytosis, pelvis and lower extremities most

affected, any age..but kids and young adults age 20s more Pelvic yields poor prognosis

Chondrosarcoma: dull pain, swelling for long period.. pelvis and femur fore affected Destroys bone and often calcifies Affect middle age to elders and more in men

Fibrosarcoma: from fibrous tissue; most common in long bones of legs and mets to lungs

Histiocytoma is most malignant type Local tenderness, with or w/o mass palpated

BONE METS

Primary tumors are in prostate, breast, kidney, thyroid, and lung

Fractures are major problem with management Femur and acetabulum

Primarily affects those under 40

ASSESS/ DIAGNOSTICS

Assess pain, swelling, palpate for masses

Monitor vs

Assess ADLs

Assess support structures

Assess coping skills

Check ALP levels for elevation

CT scan

Stage tumor

NURSING DIAGNOSIS/TX

Pain

Anticipatory grieving

Disturbed body image

Fear

Anxiety

Tx Pain management, chemo, radiation, surgery, dressing changes, be

active listener, establish goals, safety precautions, HHC

CARPAL TUNNEL

EDUCATION

Use ergonomic work stations

Teach client to take regular breaks

s/s Parathesia in hands Weak pinch, clumsiness, weakness Hand activity worsens symtoms Swelling may occur

Tx: nsaids, surgery

DUPUYTREN’S CONTRACTURES

Slow progressive contracture

Common problem

Affects 4th or 5th digit of the hand

Trigger finger release surgery performed to fix

DISORDERS OF THE FOOT

Hammertoe: fix with surgery

Tarsal tunnel syndrome: ankle version of carpal tunnel

Plantar fasciitis: inflammation of the plantar fascia located in the arch of the foot

s/s: pain in arch, pain worsens w/ wt bearing Tx: ice, rest, stretches, strapping, nsaids, surgery

Hallux valgus: aka bunion

RHEUMATOID ARTHRITIS

Most common connective tissue disorders

Most destructive to joints

RA factors looked for in lab

Assess sedrate

Assess immunoglobins

MRIs performed

EMGs are performed to measure function

ASSESSMENT/ S/S CONTINUED

Joint stiffness

Swelling

Pain

Fatigue

Weight loss

Reddened joints

Deformity of joints

Baker’s cysts may occur and cause pain

Dry eyes, dry mouth, dry vagina

Assess ADLs, coping, pain

INTERVENTIONS

Nsaids

Immunosuppressive drug

Rest

Proper positioning

Pain management

Ice

Heart parafin wax

Plasmapheresis

Fish oil tablets

LUPUS

Characteristic sign is butterfly rash

Also alopecia is common

Autoimmune disorder

May have kidney involvement

Women b/w 15-40

African american more than caucasian

GOUT

Type of arthritis

Urate crystals deposit in joints

Primary gout is most common

Inflammation is key sign

2nd ary is when too much uric acid in blood

Can affect kidneys

Meds to treat

Pain management

MARFAN SYNDROME

Inherited, dominant autosomal trait

s/s: excessively tall and lanky with elongated hands and feet, scoliosis, funnel shaped chest, glaucoma

Avg life span is 32 years

Mitral valve prolapse and AAA are common

Tx is palliative and preventitive

FIBROMYALGIA

Chronic pain syndrome

Pain is burning or gnawing

Headache and jaw pain are also common

Chest pain is common

Pain control is the key Muscle relaxers, nsaids, antidepressants

GLAUCOMA

2 types Primary open angle: most common Angle closure: less common..emergency

S/S

Open angle: small cresent shaped defect

Angle closure: visual fields quickly decrease, severe pain around eye, headache, n/v, halos, blurred vision

MACULAR DEGENERATION

Central vision declines

Mild blurring or distortion

More rapid to produce in smokers

MUSCULAR DISTROPHIES

9 types

Progression is slow or fast

Most common is severe X linked recessive

Diagnosis is difficult

Comfort is key

Treat symptoms