FINAL CHRONIC

Braden scale

Assess risk for pressure injury:

• sensory perception

• moisture (ex. due to incontinence)

• activity/mobility

• nutrition

• friction/shear

Score: 6-23

• <18 → at risk MUST implement preventative measures

Psoriasis

Immune disorder causing chronic inflamm of skin

• skin cell produc. > shedding → epidermal thickness

Signs: occur anywhere → elbows, knees, palms, soles, scalp

• thick, raised red patches w/ silvery flaking scales

• painful & itchy

Lab: based on signs

• elevated CRP & ESR (serum inflamm markers)

Tx: no cure

• topicals/ointments (corticosteroid, retinoids), uv light therapy (kills cells), methotrexate

Care:

• pt are better in warmer climate → uv kills cells

Skin cancer

Cause: uv radiation

Types:

• (#1) basal cell carcinoma → usually tx b/c localized

• melanoma → harder to tx

Labs: changes in skin (size, color, sensation)

Tx: chemo, radiation

Care:

• limit sun exposure (spf 30, hats/long sleeve)

• monthly self exams

Burn injuries types

1) Superficial (sunburn)

• affect only epidermal

• signs: mild erythema/hypersensitivity

• tx: resolves in 24-72 hrs (no meds necess.)

2) superficial partial thickness

• affect epidermis & superficial

• signs: very painful b/c exposed nerve endings, wet weeping pink blisters, cap refill normal

• tx: heals in 1-2 wks

3) deep partial thickness

• affect epidermis & extend into deeper portions

• signs: appear waxy (no weepy blister), pink/cherry red, vary pain, NO cap refill

4) full thickness

• affect epidermis, dermis, subcut tissue, maybe muscle/bone

• destroy hair follicles, sweat gland, nerve ending → poor temp control & no pain

• tx: skin graft

Burn injuries

Risk: pt age & medical hx

Effects: burn shock & fluid/electrolyte imbalance secondary to massive fluid shifts

• fluids/electro leak out of intravascular space into interstitial b/c increased cap perm.

• initial: hyerK

• late: hypoK & hypoN

Burn injury stages

1) emergent

• goal: resolve immediate life threat → baseline eval, airway, fluids, prevent hypothermia, initiate wound care

• care: 100% humidified o2, place large bore iv cath (fluid resus), warming measures (ex. blanket)

2) immediate (after resus & stabilize 48-72hr later)

• goal: wound healing & closure, optimal nut., prevent infection & pain

• care: assess labs (protein, wbc, albumin), wound care, nut. (maybe feeding tube)

3) rehab (may last for years)

• goal: rehab & pyschological support

• care: community resources, teach pt how to apply pressure garment (prevents hypertrophic scarring)

  • pt w/ burn may lack sweat gland & skin graft is sensitive to light

  • increased metabolic rate & caloric need post burn

HIV

Virus that attacks body’s immune system

• targets CD4+ lymphocytes → integrate rna into host cell dna through reverse transcriptase

Cause: STI (#1), blood, breast milk

• fluid MUST come in contact w/ mucous membrane/injected into bloodstream

Lab: annual screening

• viral load & cd4 count to establish baseline

Tx: no cure → proper managment

• antiretroviral therapy (ART)

• w/o proper tx → AIDS develops

Care:

• avoid food that irritate bowel (raw fruit/veg, carbonated)

• may need enteral/parenteral nut.

• avoid high risk (use condom, reduce partners, no share needles)

• hygiene → hand wash, avoid crowds

Stages of HIV

Stage 1: acute

• develop 2-4 post exposure → very contagious

• hiv rapidly spread → increase viral load → body can still control the virus → CD4 return to normal levels (500 cells/mm3)

• signs: temporary flu like symp (fever, chills)

Stage 2: chronic

• prolonged → last several decades w/ tx or a decade w/o

• low CD4 → 200-499

• sign: asymp but STILL contagious

  • nonspecific sign → resp. tract infection, enlarged lymph

Stage 3: aids

• CD4: <200 = aids

HIV tx

Antiretroviral therapy (ART)

• interfere w/ ability of hiv to reproduc. & suppress virus

• use: confirmed case, pre/post exposure prophylaxis

• uses multiple agents & adherence is required

  • atleast 95% adherence for tx to be effective

  • eval renal & hepatic

Pneumonia

Inflamm of lung parenchyma from infection

Signs: pleuritic chest pain, cough, fever

Lab: chest x-ray

• elevated wbc, crp, positive sputum

• starts as resp. alka → later: resp. acid

Tx:

• bronchodilator: albuterol or combivent → open airway

• antibiotic → broad then specific

Care:

• SaO2 >92%

• position: good lung down, hob 30

TB

Resp. infection caused by mycobacterium tuberculosis

• spread via aerosolized droplet (NOT direct contact) → airborne precaut.

Types:

• latent → asymp. & NOT contagious

• active → abnormal chest x-ray/sputum

Signs: hemoptysis (coughing blood), weight loss, night sweat

Lab: tuberculin skin test (mantoux test) → assess induration (size/firm)

Tx: 3-9 months

• 2 phases: intensive → continuation

Asthma

Intermittent, reversible airway obstruction from inflamm → increase mucus, bronchospasm

Signs: wheezing, dyspnea, coughing, increased sputum/RR, tachy

Lab: spirometry, chest x-ray, abg

Tx: anti-inflamm (inhaled corticosteroid), bronchodilator

Care:

• maintain o2 >90%

• teach action plan, pursed lip, peak flow meter

Laryngeal cancer

Originate from squamous cells that line larynx/hypopharynx/ esophagus entry → slow develop

Risk: (#1) tabacco & alcohol

Signs: change in voice (lower, raspy, >2 wks), persistent sore throat, ear pain

Lab: laryngoscopy, barium swallow

Tx: radiation, chemo, surgery

Care: post op

• trach care/suction, pulmonary hygiene (deep breath), nut., emergency equip at bedside

Hypertension

BP that is above normal “silent killer”

Types:

• primary (#1) → multifactorial, chronic

• secondary → caused by underlying, acute

Signs: increase bp

• late → headache, chest pain, sob, vision change

Lab: >2 bp reading at SEPARATE times

Tx: slowly & cautious

• start w/ 1-2 med (LOW doses) → diuretic, beta block, ½ dose for older

HTN complications

Hypertensive crisis

• hypertensive urgency → bp very high but no sign of organ damage

• hypertensive emergency → bp >180/120 + possible damage

Coronary artery disease (CAD)

Obstruct/dysfunc of blood vessels that deliver o2 rich blood to heart muscles → ↓ perfusion of myocardial tissue

Cause: atherosclerosis (harden/narrow of arteries b/c plaque)

Risk: elevated serum lipids

• cholesterol >200, trig. >150

Sign: asymp until 40% block → angina

Lab: lipid profile

Tx: surgery (ex. stent)

• aspirin (stop aggregate)

• nitroglyercin (relief) → every 5 min x3

Care: bleeding precaut.

• diet: decrease saturated fat (meat, whole milk), increase complex carb (whole grain)

Peripheral artery disease (PAD)

Narrow/block of vessels that carry blood from heart to upper/lower extremities → deprive o2 → ischemia, necrosis

Cause: atherosclerosis

Signs: intermittent claudication (#1) → muscle pain b/c lactic acid buildup, foot pain worse w/ elevation, coolness, thin shiny skin

Lab: vascular assessment (palp, auscul, inspect), ABI

Tx: meds, angioplasty

Complications: nonhealing ulcers + gangrene → may need amputation

Venous thrombus

Blood clot in vein → potential to break off (thromboembolism)

Signs: Virchow’s triad

• stasis, endothelial injury, hyercoag.

Sign: swell, tender, redness, warmth

Lab: duplex ultrasound (confirm), D-dimer (+ test)

Tx: heparin or enoxa. (for active clot only) → transition to long term oral anticoag (warfarin (INR 2-3))

Care: watch out for bleed (bruise, petechiae, hematuria)

Venous insufficiency

Occurs when leg veins do not allow blood flow back to heart → blood flow backward & pools in leg

Sign: “heavy pain”, skin change (brown), varicose vein, venous stasis ulcer (ankles/calves)

• twisted, enlarged vein

Tx: surgery

• sclerotherapy, vein ligation & stripping

HF

Progressive disease characterized by myocardial cell dyfunc. & muscle weakening

Sign: fatigue, weight gain, tachy

• left side: sob, crackles, fatigue, cool/weak

• right: JVD, hepatomegaly, ascites, edema

Types:

• HFrEF → inability to pump forward “weak pump”

  • EF <45%

• HFpEF → unable to relax & fill “stiff, improper fill”

  • EF >45% but low CO

Lab: ecg

• troponin, BNP/NT-proBNP (released in response to high bp/fluid)

Tx: diuretic, ACE inhibitor (#1), beta block

Cancer

Uncontrolled growth of malignant cells that compromise normal cells

Risk: exposure to carcinogen → cellular mutation

Types:

• solid tumor → arise from specific organ (ex. lung)

• hematological → from cells (ex. leukemia)

Staging: TNM (tumor size, spread to lymph, metastasis)

Sign: CAUTION

Lab: biopsy

Tx: radiation, chemo, bone marrow transplant

End of life

Pt goals guide treatment

Signs: dyspnea, anorexia, delirium, depression

• late → gurgling, terminal bubbling

Care:

• suctioning, position (lateral w/ elevated head), antimuscinaric/anticholinergic to dry up secretions

Anemia

Reduction in o2 carrying capacity b/c less rbc or reduction in hemoglobin

Causes: blood loss, inadequate rbc produc, increased rbc destruct., deficiency

Types:

• iron defic. (#1) → insuff. hemoglobin to carry o2

  • sign: hypoxia, pallor, fatigue

  • lab: low serum ferritin, low H&H

  • tx: red meat, dark leafy, dried beans, fortified cereal/bread (take w/ vit C)

• vit b12 → need for func. of CNS, formation of rbc, dna reg.

  • sign: cns changes → spinal cord degen, altered mental

  • lab: b12 assay

  • tx: animal protein → meat, seafood, egg, dairy

• folic acid → need for formation of heme for rbc mature

  • sign: pallor, tachy, dizzy

  • lab: cbc

  • tx: fortification of cereal/grains → supplements for preg.

• sickle cell → cause hemoglobin to be sticky → block blood flow → hypoxic

  • sign: vassooclusion → pain swell

  • tx: o2 therapy, avoid cold

Polycythemia vera

Disorder of bone marrow → makes blood more viscous (thick) → slow circulation & o2 exchange

• increase in volume of rbc BUT still hypoxic

Cause: JAK2 gene

Sign: takes years for symp → sob, headache, risk for clot

Lab: routine blood test

Tx: therapeutic phlebotomy (remove blood)

Care:

• hydration (3L/day), elevate legs

Diabetes Insipidus (DI)

Deficiency of ADH (helps regulate h2o)

• reduce ability of kidney to collect/concentrate urine → excessive dilute urine → “DRY INSIDE”

Signs:

• polyuria, polydipsia, hemoconcentration (elevated serum sodium & hematocrit), skin tenting, dry mucous mem., weak pulse

Med:

• desmopressin or vassopressin

  • cause water reabsorption in kidneys

DI Management

Diagnostic:

• low →urine electrolytes, urine osmo. (<200), USG (<1.005)

• high → serum

• when serum osmo increases but no increase in urine osmo

Care:

• maintain adequate fluid status PO or IV

  • at risk for circulatory collapse

• mouth care → for dry mucous membranes

• watch for dehydration, hypovolemia, hypernatremia

SIADH

Excessive release of ADH

• renal reabsorption of water → water intoxic. → cellular edema → dilutional hyponatremia “SOAKED INSIDE”

Signs: volume overload + hyponatremia

• weight gain, tachy, crackles, distended neck vein, headache, personality change, hostility

SIADH Management + Tx

Diagnostic:

• low → serum

• high → urine electro., urine osmo, USG

Care:

• PO fluid restriction & increased salt intake

  • comfort measure for thirst → ice chips

Tx:

• diuretics, hypertonic sodium chloride IV

  • SLOW correction of hyponatremia (risk brain damage)

SIADH vs DI

Hypothyroidism

↓ function of thyroid → ↓ metabolism

• associated w/ iodine deficiency (needed for thyroid synth.)

Signs:

• ↓ energy, fatigue, increased sleep, weight gain, susceptible to cold temp, dry skin, thin hair, ↓CO

Diagnostic: Low T3 & T4, high TSH

Tx: levothyroxine

• taken FIRST thing in morning (1hr b/f meal or 3 hr after)

• start at low dose and increase gradual → lifelong

• side effects: weight loss, nervous, tremor, insomnia

Myxedema coma (hypothyroidsm complication)

Emergency → hypoxia and co2 retention, fluid/electro. imbalance, hypothermia

Signs:

• increased sensitivity to sedatives, analgesics, anesthetic

• ↓ CO → bradycardia, hypotension

Tx:

• IV thyroid hormone

Hyperthyroidism

Accelerated metabolism and overstim. of SNS

• usually caused by Grave’s

Signs: everything is increased

• elevated HR, heat intolerance, gastric activity (BM/D), increased app, weight loss, exophthalmos & goiter

Diagnostic: high T3 & T4, low TSH

Hyperthyroidism Tx

Meds:

• long term → antithyroid

• short term → iodine prep. (decrease blood flow through thyroid)

• beta block (slow HR, decrease palpitations)

Surgery: thyroidectomy

• for pt w/ hypersecreting tumor or tracheal compress. unresponsive to med

• establish “normal” thyroid function before surgery

• complications:

  • removal of all parathyroid tissue → hypoparathyroidism

  • laryngeal nerve damage → affect swallow/voice

Thyroid storm/thyrotoxicosis (hyperthyroidism complication)

Signs:

• tachycardia, fever, systolic hypertension, abd pain, tremors, change in LOC

Care:

• Airway + fluid resuscitation

• cooling blankets

• meds: glucocorticoids

  • ↓ conversion of T4 to more active T3

  • ↓ release of TSH

Hypoparathyroidism

Lack of parathyroid hormone → calcium not mobilized from bones/conserved in kidney/absorb in small intest. → hypocalcemia

• Cause: (#1) removal of parathyroid

Signs: ↓ Ca (Ca plays major role in membrane potential, neuronal excit., muscle contract.)

• numbness/tingling around mouth/hand/ft, tetany (severe muscle spasm → can cause laryngospasm & airway compromise), skeletal deformity, positive Chvostek sign & Trosseau

Diagnostic:

• low serum calcium, serum PTH

• high serum phosphate

Hypoparathyroidism Management + Tx

Meds: focus on raising serum calcium

• Acute: IV calcium → followed w/ oral calcium + vit D (enhance absorp.)

• Chronic: oral calcium + vit D

Care:

• adhere to med → lifelong Ca supplementation

• eat foods high in calcium BUT low in phosphorus (can bind to Ca → ↓ lvls more)

  • eat: dairy, milk, cheese, OJ, yogurt

  • avoid: beans, lentils, nuts

Hyperparathyroidism

Hypersecretion of parathyroid hormone → hypercalcemia → leads to bone breakdown & increased renal/bowel reabsorp of Ca

Signs:

• kidney stones, polyuria, abd pain, muscle weakness

• cardiac change → prolonged PR, short QT, vent. dsyrhythmis

Diagnostic:

• ↑  serum/ionized Ca, serum PTH

• ↓ serum phosphorus

Tx:

• furosemide → increase renal excretion of Ca

  • avoid thiazide diuretic (increase reabsorp)

Care:

• prevent bone injury (use lift sheets)

• if unresponsive to med → subtotal parathyroidectomy

• increase fluid to minimize renal injury

• decrease consump. of calcium containign antacid + vit D

Addison’s disease

Destruction of adrenal glands → low hormones (cortisol + aldosterone)

• mostly females

Signs: asymp until 90% of adrenal cortex destroyed

• hypoglycemia, weight loss, depression, darken bronze hyperpigment., hyponatremia (salt craving), water loss, hyerK,

Diagnostic: test hypothalamic pituitary axis & adrenal cortex, serum electro

Care:

• replacement of cortisol, fix electrolyte imbalance, maintain fluids

• take hormone replace daily

Adrenal crisis (addison’s comp.)

Severe hypovolemia & hypotension

Cause: pt who have underlying adrenal hypofunction who undergo stressful event

• Na & fluid loss, hyperK, hypogycemia

Cushing’s disease

Excessive circulating glucocorticoid (cortisol) or ACTH → excess hormones

Signs:

• hyperglycemia, thin/friable skin, moon face, male sexual characteristic develop in female (breast atrophy, voice deepen)

Diagnostic: assess cortisol, suppression test, serum electrolytes

Care:

• prevent fluid overload

• turn pt frequently/protect skin

Tx: meds that interfere w/ ACTH & glucocorticoid produc.

• monitor adrenal supress → hypoglycemia & hypona

Diabetes Mellitus

Group of disorders characterized by ↑ blood glucose lvls

Cause: insulin deficiency, resistance, both

• glucose cannot cross cell membrane to enter cell so it remains in bloodstream - insulin is the “key”

T1DM

Insulin producing beta cells of pancreas are destroyed → NO insulin

Signs: polyuria, polydipsia (increased thirst), polyphagia (increased app)

• primary cause of diabetes in children

Tx: insulin

• subcutaneously

T2DM

Defect in cell membrane → even though insulin is present, the cell “resists” it

• leads to ↑ insulin demand & beta cell failure

Signs: polyuria, polydipsia, polyphagia, poor wound heal, visual disturbance

• more common in adult

Tx: oral meds

• sulfonylureas → stim pancreas to produce insulin

• biguanides → decrease hepatic glucose output

• alpha glucosidase inhibitor → delay intestional absorp of glucose

Diagnosis for DM

Hemoglobin: 6.5% or higher

• measures amount of glucose that binds to rbc

Fasting blood glucose: >126 mg/dL

• no caloric intake for at least 8 hrs

Two-hour postprandial test: >200 mg/dL

• blood sample taken prior to consump then after at 1 hr & 2hr post

DKA (DM comp.)

Inadequate insulin for cells to obtain adequate glucose for normal metabolism

• rapid breakdown of fat stores → release fatty acids → converts to ketone → lead to metabolic acid.

• increased release of hormones (glucagon & cortisol) → severe hypergylcemia

Diagnostic:

• blood glucose >250

• blood pH <7.3

• serum bicarb <16

Signs: polyuria, kussmual, fruity acetone breath

Tx:

• administer o2

• correct electrolyte PRIOR to insulin (will make hypoK worse)

• priority: fluid → potassium → insulin

Hyperosmolar hyperglycemic syndrome (HHS)(DM comp.)

Occurs when there is enough insulin to prevent rapid fat/ketones but NOT enough to prevent hyerglycemia (>600)

• leads to osmotic diuresis → electro imbalance, neurological defect

• EXTREME dehydration

Tx: IV insulin, NaCl infusion

Seizures

Sudden burst of uncontrolled electrical activity in brain → temp disrup of normal func.

Causes: trauma, surgery, tumors, strokes, electrol.

• Chronic = epilepsy

  • Diagnosis: 2 unprovoked seizures that occur at least 24 hrs apart

Signs: *document when seizure starts, presentation, how long it last

• 4 phases

  • prodromal → precedes seizure (confusion, anxiety mood, anger)

  • aural → sensory warning leading up to seizure (flashing light, visual disturbance, smells, voices)

  • ictal → seizure itself

  • postictal → rest & recovery (5-30min until baseline)

• Other: episodes of daydreaming, unilateral muscle move., repetitive unconscious moves (lip smack, chew, swallow)

Diagnostic: CT/MRI, ECG (may need to repeat)

Tonic clonic (seizures)

Formerly “grand mal” → (#1) generalized seizure

• involves both hemispheres

2 phases

• Tonic → body stiffens, last for 10-20 sec

• Clonic → jerking of extremities, last 30-40 sec

  • cyanosis, excess saliva, tongue/cheek biting

• postictal: soreness & fatigue → pt may sleep for hours & not feel normal for hrs-days

Status epilepticus (seizure comp.)

Seizure activity lasting >5 min OR >2 seizures w/o full recovery of conciousness

Cause: head trauma, hydrocephalus, drug/alc withdrawal (anticonvulsive)

• >30 min can cause resp failure, brain damage, death

Seizure management + tx

Med:

• antiepileptic/anticonvulsants → ex. gabapentin, levetiracetam, lamotrigine, topiramate

  • do not stop abruptly → can precipate seizure

  • side effects: diplopia (blur vision), ataxia, drowsiness

Care:

• bed in lowest position, suction at bedside, do not force object in mouth, turn pt to side to prevent aspiration, do NOT restrain

• driving restrictions

Parkinson’s

Progressive neurological disorder affecting movement, balance, coordination → loss of dopamine producing brain cells

Signs:

• resting tremor, muscle rigidity, slow/loss move (bradykinesia/akinesia), postural instability (falls), shuffle & wide gait

Diagnostic: ≥2 cardinal symptoms are observed

Tx: focus on controlling symp

• (#1) dopamine receptor agonist → mimic dopamine

  • side effect: disorder of impulse control (gambling), LE edema, urinary freq

• anticholinergics → reduce tremor/drool (not used in older due to side effect)

• dopamine pre-cursor (cardidopa-levodioa) → for advanced stage

Care:

• fall risk (short, deliberate steps), psychosocial (depression)

Multiple Sclerosis

Chronic progressive neurological disorder → nerves of CNS degenerate → demyelination of nerve fiber + buildup of scar tissue/plaque

Signs: slow nerve conduction → impaired sensation, move, think

• numbness in limb, unsteady, muscle spasm, memory, vision, bladder dysfunc, speech impair

Diagnostic: no specific → ruling out other conditions (takes month-yrs)

Tx: no cure

• beta interferon, immunosuppressive → slow progession

• corticosteroid - tx attacks, inflamm

Care: collab with pt to improve ROM, increase venous return/prevent stiff

• rest period to prevent fatigue/overheat

• bowel/bladder control → self cath may be needed, increase fluid/fiber

Stroke

Occurs when there is an interruption of blood supply to the brain from ischemia or hemorrhage

• also known as “brain attack” or “cva”

Risk factors: htn, smoking, hypocholesterolemia

Signs:

• left sided strokes lead to right side deficit (& vice versa)

• swallowing, speech, receptive aphasia (loss of comprehension), excessive aphasia (loss of produc of language), global aphasia (no communication)

Diagnostic: CT/MRI

• STAT head CT → initial - looks for bleed and determine tx

Care: understand pt baseline, supportive, preventative

• monitor serum electrolytes (esp. Na)

• bedside swallow screen (NPO until cleared), tuck chin when swallow, thicken liquids, oral care, elevate paralyzed/weak limbs to prevent edema

Transient ischemic attack (TIA)

Temp episode of neurologic dysfunc caused by brief interruption of blood supply to brain

• “mini stroke”

• no cell death or perm damage, symp resolve in 24 hrs, typically not detected in brain scans

Tx:

• meds: antiplatelet & statin

• surgery: carotid endarterectomy, stent

Ischemic stroke

Inadequate blood flow to the brain from partial or complete occlusion of an artery

• (#1) stroke

Tx: TPA - reestablish blood flow through blocked artery to prevent cell death

• pt must be appropriate “candidate” and screened carefully

• must be administered within 3.4.5 hrs of symp onset

• no recent gi bleed, stroke, head trauma, no major surgery within 14 days

Hemorrhagic stroke

Bleeding within the brain caused by rupture of vessel

Cause: htn

Comp: aneurysm rebleeding, cerebral vasospasm

Tx: control bp, aneurysm clipping or coiling

• poor prognosis

Cataracts

Alteration in lens protein/chemical change → gradual clouding of lens

Risk: exposure to UV

Signs: worse w/ progression

• vision → clouded, blurred, dim, halo around light source, double vision in single eye

Diagnostic: visual acuity test & direct ophthalmoscope exam (checks opaqueness)

Tx: (#1) surgical removal of lens (replace w/ artificial)

Care:

• administer mydriatic (dilating) & cycloplegic (paralyzing) eye drops pre-op, drainage & prevent increase in IOP post-op (fluids, fiber, hob)

• maintain eye patch

Glaucoma

Characterized by increased 1) increased IOP, 2) optic nerve atrophy & damage, 3) peripheral vision loss

• Normal IOP = 11-21

Types:

• primary open angle (gradual): asymp → gradual loss of peripheral vision (both eyes) and tunnel vision (advanced)

  • IOP 22-32

• angle closure (acute): medical emerg → IOP rises very quick & signs include severe eye pain, visual disturbance, reddening

  • IOP >50

Tx: eye drops (decrease aqueous humor, drain fluids → ↓ IOP)

• surgery:

  • laser trabeculoplasty → open clogged drainage canals

  • filtering surgery → meshwork to allow aqueous humor to exit

  • drainage implants

Macular degeneration

Responsible for sharp, central vision → driving, reading, recog. faces

Types:

• Dry (#1)(can progress to wet): presence of drusen bodies (yellow deposits under retina)

• Wet: when abnormal blood vessels grow under macula → fragile & leak blood & fluid → macula raises from usual position

Signs: distorted central vision → straight lines appear disorted/wavy, difficulty recognizing faces

Diagnostic: Amsler grid, fluorescein angiogram

Tx: no cure

• supplements (vit C, E, leutin, zeaxanthin), laser surgery

Meniere’s disease

Disorder of inner ear → leads to vertigo, tinnitus, hearing loss

Cause: unknown → infection, high stress, trauma, excess endolymphatic fluid

• mainly affect females 40-60

Signs: varies → n/v/d, abd pain, uncontrollable eye move

Diagnostic: based on presentation/ruling out

Tx: no cure → goal is decrease body fluid & CNS stim.

• meds (diuretics, antiemetics, antivertigos)

• surgery for severe: vestibular nerve transection, labrynthectomy (removal) → result in total hearing loss

Care:

• avoid sudden move, bright lights, caffeine/alcohol, at least 8hr sleep, acupuncture

Osteoporosis

Chronic condition results in deterioration of bone tissue & density → risk for fracture

• #1 bone disease

• rate of bone resorption (osteoclast) > bone rebuilding (osteoblast)

Risk: aging, ↓ calcitonin, estrogen, ↑ parathyroid hormone

Diagnostic: “silent disease” not diagnosed until fracture/fall/strain

Signs: kyphosis of dorsal spine, loss of height, back pain

Tx + care: prevention & early screening are KEY → prevent/slow progression

• ↑ calcium & vit D (help w/ collagen synth & bone form.)

  • calcium: 1200 mg/day

  • vit D: 15 min/day or 800-1000 units

• meds: bisphosphonates - inhibit osteoclast, calcitonin, estrogen

Osteomyelitis

Infection of bone from direct bone contamination (open frac, trauma), extension of soft tissue infection, bloodborne spread

Signs: pain not relieved by rest, swelling/warmth/tender on site

Diagnostic: bone biopsy (#1)

Tx: antibiotic therapy (IV x4-6 weeks → then transition to PO (long term))

• surgery/debridement of infected tissue/bone, amputation for severe

Care:

• ↑ protein, vit for wound heal

• thermal therapy (hot + cold)

Fractures

Disruption or break in continuity of a bone (emergency)

• usually occur in young/old (b/c bones are porous/weak)

Diagnostic: radiography or CT

Care:

• assess neurovascular, immbolize w/ splinting, cover open frac w/ sterile dressing (do NOT attempt to reduce)

• diet: ↑ protein, calcium, vit

• pulmonary hygiene: deep breath/cough

Tx:

• nonsurgical: closed reduction (fractures are manually manipulated & realigned)

• surgical: open reduction w/ internal or external fixation (hardware)

Fracture tx

Casts: very rigid → made from fiberglass → may take 24-72 hrs to dry (handle with palms of hands)

• assess “CMS” → circulation, movement, sensation

• 5 Ps → pain, pallor, pulselessness, paresthesia, paralysis

  • notify provider if noticed

External fixation device: manage open fractures w/ soft tissue damage OR support for complicated/comminuted (crush, splintered)

• discomfort minimal → early ambulation, elevate limb, pin care

Traction: short term → pulling force to injury

• must be continuous → weights NEVER removed unless order

• ropes must be unobstructed & weight hanging freely

Amputation: removal of part of body

• DO NOT put pillow under → flat or prone instead

• wrap limb to prevent edema + better fit for prosthetic

• phantom pain common

Fracture complications

Neurovascular compromise:

• any source of ↓ blood flow and o2 to tissues

Compartment syndrome:

• ↑ pressure in compartment causing compression of nerves/blood vessels

Venous thromboembolism/fat embolism:

• clots can hinder circulation and travel to lungs

Traumatic rhabdomyolysis:

• damaged muscle tissue releases proteins and electrolytes into blood → damage heart & kidneys

Hemorrhage, hypovolemia:

• severe loss of blood

Malunion and nonunion:

• fractures fail to heal in correct alignment

Disuse syndrome:

• muscle atrophy with loss of strength

Osteoarthritis

Slow progressive disorder involving breakdown of cartilage within joint & underlying bone change “wear and tear”

• usually involve weight bearing joints → knees, hips, feet, lumbar spine

Risk: older, female (↓ estrogen)

• regular moderate exercise shown to ↓ likelihood/progress.

Signs: joints impacted ASYMMETRICALLY

• pain worse w/ activity → relieved by rest, crepitus

Diagnostic: based on signs, x-ray (may only show in advanced)

Tx: no cure

• meds: acetaminophen (not exceed 4 g daily)

  • nsaids: risk of bleed

• joint replacement: for severe

  • assess for orthostatic hypotension & dizziness

  • hip precautions (for 6-12 wks) → no flex >90 degrees, raised toilet, no crossing leg

RA

Chronic, systemic, autoimmune inflammatory disease characterized by inflamm that affect daithrodial (freely moving) joints

• commonly affect hands, wrist, knees symmetrically

Signs: SYMMETRICAL joint pain, morning stiffness >30 min

Diagnostic: combination (labs (ESR, CRP), radiograph/ultrasound, signs)

Tx:

• initial: analgesic (acetam., narcotic), nsaid, glucocorticoids

• if ineffective → methotrexate

• surgery

Care:

• keep up w/ vax (NO live vaccines)

Gout

Accumulation of uric acid crystals in joints → body attempt to get rid of them resulting in inflamm

Risk: red meat/seafood/alcohol, use of thiazide diuretic

Sign: starts w/ inflamm of great toe

Diagnostic: observing crystal in synovial fluid

Tx: avoid high purine foods

• meds:

  • acute: pain relief & inflamm (nsaid)

  • chronic: allopurinol (lower uric acid)