NSG 554 Exam 4

findings of bursitis

redness, warmrth, tenderness, pain

Treatment of bursitis

Rest, NSAIDs, steroid and anesthetic injection around tendon

symptoms of achilles rupture

-immediate pain

-difficulty walking

-audible "snap"

-swelling

-palpable defect

Thompson Test

compression of the calf muscle while observing for plantar flexion to assess the stability of the Achilles tendon

symptoms of carpal tunnel syndrome

numbness, pain, tingling in the thumb, index, and middle fingers

diagnostics of carpal tunnel syndrome

X-ray if fracture is suspected

EMG = no response to conservative tx in 6-8 wks

treatment of carpal tunnel syndrome

anti-inflammatory drugs, immobilization of the wrist, and sometimes surgery to remove part or all of flexor retinaculum

plantar fasciitis symptoms

-Heel pain

-Worse with dorsiflexion of toes

-Worse in morning

ACL vs Meniscus

dsm 5 criteria for anorexia

Criteria A: restriction of energy intake leading to a significantly low body weight (BMI 17)

Criteria B: intense fear of gaining weight or behaviours stopping the gaining of weight (compensatory behaviours)

Criteria C: disturbance in the way in which one's body weight or shape is experienced + lack of recognition of seriousness

symptoms of bulimia

Eating large amounts of food uncontrollably (binging)

Vomiting, using laxatives, or using other methods to eliminate food (purging)

Excessive concern about body weight

Depression or changes in mood

Irregular menstrual periods

Unusual dental problems, swollen cheeks or glands, heartburn, or bloating (swelling of the stomach)

causes of hyperkalemia include

potassium supplements, ace inhibitors, renal failure, excessive loss from cells, potassium-sparing diuretics, burns, trauma, metabolic acidosis, infections

Symptoms of hyperkalemia include?

muscle weakness, bradycardia, fatal arrhythmias

EKG with hyperkalemia

Peaked T waves

medications that cause hyperkalemia

potassium-sparing diuetics

- amiloride (Midamor)

- spironolactone (Aldactone)

- triamterene (Dyrenium)

interactions with potassium-sparing diuretics

- ACE inhibitors (-pril)

- ARBs (-sartan)

combination diuretics

•Amiloride/hydrochlorothiazide (Moduretic)

•Spironolactone/hydrochlorothiazide (Aldactazide)

•Triamterene/hydrochlorothiazide (Dyazide, Maxzide)

causes of hypernatremia

Excess aldosterone secretion, water deprivation or increased water loss.

Pheochromocytoma

hypersecretion of epi/norepi. persistent HTN, increased HR, hyperglycemia, diaphoresis, tremor, pounding HA; avoid stress, frequent bathing and rest breaks, avoid cold and stimulating foods (surgery to remove tumor)

Symptoms of PCOS

irregular menstrual cycles, elevated hormone levels, multiple cysts on ovaries

Diagnostics of PCOS

Treatment of PCOS

• Weight loss

• OCPs

• Spironolactone (hirsutism)

• Metformin (insulin resistance)

• Clomiphene (infertility)

Addisonian crisis

N/V confusion, abdominal pain, extreme weakness, hypoglycemia, dehydration, decreased BP

Cushing's disease symptoms

Buffalo hump

Hyperglycemia

Hypertension

Moon face

Purple straie

Thin-fragile skin

truncal obesity

Weight gain

Diagnostics of Cushing's disease

elevated cortisol

hyperparathyroidism s/s

-hypercalcemia

-muscle weakness, atrophy, GI pain, nausea, low back pain, renal calculi (kidney stones), easy fracturing of bones

Causes of hyperparathyroidism

tumors, hyperplasia, and chronic hypocalcemia (renal failure)

sprain vs strain

Sprain: overstretching/damaging ligaments

STrain: T for TENDON, overstretching/damaging tendon.

lifestyle choices that increase risk of fractures

alcohol

smoking

Causes of hypoparathyroidism

-Tumor

-Congenital lack of parathyroid

-Surgery or radiation in neck region

-Autoimmune disease

Trousseau's sign

arm/carpal spasm associated with hypocalcemia

Causes of hypothyroidism

1 subtotal lobectomy of thyroid

2 goiter

3 autoimmune dz (myxedema)

4 radiation therapy of thyroid

Symptoms of DeQuervain's Tenosynovitis:

•Swelling and pain over radial styloid

•Pain with resisted thumb extension or abduction

•Pain with resisted thumb MCP flexion and adduction

Pain can radiate down forearm

ADLs affected: wringing out dishrags, using scissors, typing, closing/opening jars, knitting, racquet sports

symptoms of medial epicondylitis

• Pain with wrist flexion.

• Pain upon palpation of the medial epicondyle.

• Pain that may radiate down the forearm.

• Pain radiation may be caused by ulnar nerve compression.

symptoms of lateral epicondylitis

pain at lateral epicondyle

radiate distally into below

pain described as an ache with episodes of sharp pain

onset may be gradual or acute

signs for carpal tunnel syndrome

+tinels - tapping

+phalens

treatment of plantar fasciitis

Stretching exercises

RICE

NSAIDs

Orthotics

Drop Arm Test

identifies tear and/or full rupture of rotator cuff

meniscus vs ACL tear symptoms

ACL - popping, giving way with weight-bearing

Meniscus - knee pain stiffness, difficulty straightening the leg

treatment of ACL

surgical reconstruction

treatment of meniscus

surgery for larger tears

Lachman's Test

ACL

diagnostics of concussion

Treatment of concussion

-For mild injuries, discharge and observation with normal CT, neurologic function

-For moderate to severe - intubation, ventilation, control intracranial pressure

DSM 5 for generalized anxiety disorder (GAD)

first line treatment for generalized anxiety disorder

lexapro

duloxetine

venlafaxine

screening tool for depression

PHQ-9

dsm 5 criteria for depression

5 or more symptoms during 2 week period and represent change of previous functioning. One of the symptoms must be depressed mood or loss of interest of pleasure.

blackbox warning for adolescents and MDD treatment

in anyone less than 25

MAY HAVE INCREASED RISK OF SUICIDAL THOUGHTS

symptoms of substance abuse

• D: dangerous use of substance

• RI: Role Impairment

• N: No respect for the law

• K: keeps drinking in spite of social/interpersonal problems

drugs to not use in the elderly

benzos

TCAs

paxil

treatment of hyperparathyroidism

Surgical removal of parathyroid gland

Medical management includes hydration and ambulation to maintain bone density

For hypercalcemic crisis, rapid volume expansion with 0.9% NS to treat dehydration and improve glomerular filtration rate; diuretics to increase calcium excretion by the kidneys

symptoms of hyperparathyroidism

stones, bones, and groans:

hypercalcemia and hypercalciuria (renal stones)

bone resorption and increased alkaline phosphatase (bones)

weakness and constipation (groans)

Causes of hyperthyroidism

1. Graves' disease is the most common cause.

2. Autoimmune antibodies result in hypersecretion of thyroid hormones.

3. Autosomal recessive trait passed to females.

4. Toxic nodular goiter, a less common form of [TERM], is caused by the overproduction of thyroid hormone due to the presence of thyroid nodules.

5. Exogenous hyperthyroidism is caused by excessive dosages of thyroid hormone

Treatment of hyperthyroidism

-Surgery

-Medications to suppress thyroid activity

-Administration of radioactive iodine

-Clinical mismanagement of hyperthyroidism may lead to hypothyroidism

diagnostic of hirsutism

elevated testosterone

GCS

NEXUS criteria

- Absence of tenderness in posterior midline

- No evidence of intoxication

- Normal mental status

- Absence of a neurological deficit

- No painful distracting injuries

McMurray Test

compression of the meniscus of the knee combined with internal and external rotation while the patient is face-up to assess the integrity of the meniscus

red flag symptoms of neck pain

pain radiating

loss of bowel or bladder

loss of sensation

treatment for neck pain

ice

NSAIDs, acetamin

physical therapy

cervical collar for period of time

diagnostics for syncope

ekg

echo

carotids

BP

Causes of hyponatremia include

GI suctioning, vomiting, diarrhea, increase blood sugar, congestive heart failure, renal disease, adrenal insufficiency, oxytocin, excessive infusion of DW5 IV fluid

Labs in Addison's disease

low sodium + cortisol, high potassium + ACTH

Treatment of Addison's Disease

corticosteroid replacement therapy

McMurray Test

compression of the meniscus of the knee combined with internal and external rotation while the patient is face-up to assess the integrity of the meniscus

Shoulder Impingement Syndrome

subacromial bursitis and rotator cuff tendonitis

older ppl, on raising arms

early Sx- mild pain, front to lateral arm, sudden when reaching/lifting

late Sx - pain at night, restricted motion, loss of strength, difficult hand placement on back

Finkelstein's test

stretching or lengthening of the thumb tendon to assess the possibility of de Quervain's disease, or tenosynovitis of the thumb tendon

BP in Addisons

low

BP in Cushing's

high