NCMB 316 Lecture: BSN 3rd Year Final 2023 PDF

NCMB 316 LECTURE: BSN 3RD YEAR 2ND SEMESTER FINAL 2023 Medical Management Osteoporosis Drug therapy is the primary component of management for - a metabolic disease in which bone demin...

NCMB 316 LECTURE: BSN 3RD YEAR 2ND SEMESTER FINAL 2023 Medical Management Osteoporosis Drug therapy is the primary component of management for - a metabolic disease in which bone demineralization results clients with gout. Acute gouty attacks, inflamm subsides in decreased density and subsequent fractures= BONES spontaneously within 3-5 days. BECOME PROGRESSIVELY POROUS, BRITTLE & FRAGILE 1) Acute gout - Often referred as “silent disease.” …because bone loss - combination of colchicine (Colsalide, Novocolchicine) occurs without symptoms. & NSAIDs such as indomethacin (Indocin, - "You may not know that your bones have become porous Novomethacin of ibuprofen (Motrin, Amersol) (not as dense) until a sudden strain, bump, or fall causes a - IV colchicine works within 12 hrs. fracture." - client takes oral meds until inflamm subsides, usually - Most often affected bones: wrist, hip, vertebral column 4-7 days - 40-45% of a woman’s bone mass is lost during her life 2) Chronic gout span. - Uricosuric agents: Probenecid (Benemid, Benuryl)  urinary excretion of uric acid; prevents tophi formation - Allopurinol (Zyloprim) is the drug of choice when patient has or at@ risk for renal insufficiency or renal calculi ; xanthine oxidase inhibitor = interrupts the breakdown of purines before uric acid is formed ; use is limited bec of the risk for toxicity - Aspirin is avoided because it inactivates the effects of the drug- - Corticosteroids may be used in resistant cases Nursing Management - Bone density test being done at the ankle using a Patients are encouraged to restrict consumption of foods peripheral device. high in purines, esp organ meats & limit alc intake; maintain N body wt In acute episodes: pain management is essential Diet and gout Purines (specific chemical compounds found in some foods) are likely to be broken down into uric acid. - Foods to limit (very high in purines): Beef Pork Lamb Seafood - Bone density (DEXA) measurements to assess overall bone Yeast (used in beer and bread) health status. Alcoholic beverages, particularly beer - These low energy Xray tests will be used to measure the Bacon bone mineral density (BMD) of both hips, the lumbar spine Liver (both AP and lateral views). - Foods to eat occasionally (moderately high in purines, - These DEXA tests usually require 20 to 30 minutes for but may not raise your risk of gout): completion. Asparagus, cauliflower, mushrooms, peas, spinach Management: Whole-grain breads and cereals Drug Therapy: HRT (Hormone replacement therapy) Chicken, duck, ham, and turkey - has been used as a primary prevention strategy for Kidney and lima beans reducing bone loss in the postmenopausal woman - Dairy products that may lower your risk of gout: - long-term effects: high woman’s risk of breast cancer, Low-fat or skim milk cardiovascular dse & stroke Low-fat yogurt - conjugated estrogens/ medroxyprogesterone (Prempro, - Foods that are safe to eat (low in purines): Premphase) use are carefully evaluated by the health Green vegetables and tomatoes care provider & client Fruits and fruit juices PTH Breads and cereals that are not whole-grain - approved tx for both men & women Butter, buttermilk, cheese, and eggs - self-administered, daily subq injection teriparatide Chocolate and cocoa (Forteo) Coffee, tea, and carbonated beverages - stimulates new bone formation = increasing BMD Peanut butter and nuts - monitor for s/sxs of hypercalcemia: fatigue, anorexia, n&v, constipation, polyuria J.A.K.E 16 of 31  NCMB 316 LECTURE: BSN 3RD YEAR 2ND SEMESTER FINAL 2023 Calcium - Ca alone is not a tx but an impt part of a prevention program to promote bone health - OTC supplements like calcium carbonate (Tums/ Oscal) ; calcium citrate (Citracal) - Taken with foods & 6-8 ozs of water Vitamin D - for optimal Ca absorption in the intestines - 400-800 International Units/day Treatment Biphosphonates Oral supplements of vitamin D, calcium, and phosphorus - inhibit bone resorption by binding with crystal elements may be given depending on the underlying cause of the in bone, esp spongy, trabecular bone tissue disorder. - 3 BPs: alendronate (Fosamax), ibandronate (Boniva) & Larger doses of vitamin D and calcium may be needed for risedronate (actonel) are commonly used for the people with intestinal malabsorption. prevention & management of osteoporosis - side effects: not common but when it occurs, they tend Mineral calcium – calcium is essential for the formation to be serious and maintenance of bones and teeth, blood clotting, = esophagitis & esophageal ulcers esp if the tablet is normal heart beat and hormone secretion. Food sources of not completely swallowed calcium include diary products, green leafy vegetables and = s/sxs: chest pain; d/c drug & call their doctor salmon and sardines. - early AM with 8 ozs of water & wait 30 mins before Vitamin D – the body itself makes vitamin D when it is eating exposed to the sun. cheese, butter, margarine, fortified - c/i to clients with poor renal fx, gi reflux dse (GERD) cereals are food sources of vitamin D. SERMs (Selective Estrogen Receptor Modulators) - newer class of drugs designed to mimic estrogen in Infectious Disorders some parts of the body while blocking its effect Osteomyelitis elsewhere It became infected by one of 3 MODES: - raloxifene (Evista) 1) Extension of soft tissue infection (infected pressure or vascular ulcer, incisional infection) Calcitonin 2) Direct bone contamination fr bone surgery, open fracture - thyroid hormone that inhibits osteoclastic activity, thus or traumatic injury (GSW) decreasing bone loss 3) Hematogenous (bloodborne) spread fr other sited of - IM or subq salmon calcitonin (refrigerated); intranasally infection (infected tonsils, boils, infected teeth, upper resp Miacalcin = preferred bec it improves compliance, infections). Typically occurs in a bone area of trauma or minimizes side effects & is convenient ; alternate lowered resistance. nostrils to prevent s/e like nasal mucosal irritation - salmon calcitonin may  its effect are use for 2 or more years = requires holiday from this tx Diet Therapy Increase Ca & vit D intake; alcohol & caffeine discouraged If w/ fracture: protein, vit C & iron intake Exercise Plays a vital role in pain management & cardiovascular fx together with the physician , PT prescribes exercises for strengthening the abdominal and back muscles which improve posture & provide improved support for the spine, deep breathing General weight-bearing exercise program= walking for 30 mins 3x a week, swimming, biking High-impact recreational exercises (horseback riding, bowling) are avoided bec it may cause vertebral compression Osteomalacia - At high risk: - Osteomalacia is softening of the bones, caused by not Poorly nourished having enough vitamin D, or by problems with the Elderly metabolism (breakdown and use) of this vitamin. Obese - These softer bones have a normal amount of collagen that Impaired immune system gives the bones its structure, but they are lacking in w/ chronic illness (DM, RA) calcium. w/ long term steroid therapy J.A.K.E 17 of 31  NCMB 316 LECTURE: BSN 3RD YEAR 2ND SEMESTER FINAL 2023 Clinical Manifestation to prevent pathologic fracture= internal fixation or 3 MODES external supportive devices may be needed A. Extension of soft no sxs of septicemia Nursing Management tissue infection Relieving pain B. Direct bone swollen, warm, painful & tender to Improving physical mobility contamination touch Controlling infectious process C. Hematogenous onset is sudden Teaching self-care (bloodborne) sxs of septicemia: chills, high fever, Pott's Disease spread PR, general malaise - Tuberculosis (TB) of the backbone is not common, but is =systemic sxs overshadow the local sxs still seen in poor communities, especially in children. ►as infection extends into the cortex of - It is the most common form of tuberculosis of the bone. the bone - It is important to recognize and treat it early, before infected area has constant, pulsating damage to the backbone causes nerve damage and pain that intensifies w/ movt bec of paralysis. pressure of the collecting pus+ it is - Signs swollen & extremely tender It begins little by little-often without pain at first. Patient w/chronic osteomyelitis presents w/ continuously A bump develops in the backbone. This is because the draining sinus; experiences recurrent periods of pain, front part of one or more vertebrae is destroyed and inflamm, swelling & drainage = low-grade infection thrives collapses. in scar tissue bec of its reduced blood supply The child has trouble bending over to pick things up. Diagnostic test - Prevention 1) Acute consists of early diagnosis and treatment of - Early X-ray: soft tissue swelling tuberculosis, and in the fight against poverty. - After 2 wks X-ray: areas of irregular decalcification, Vaccination against TB may also help. bone necrosis, periosteal elevation & new bone - It is a presentation of extrapulmonary tuberculosis that formation affects the spine, a kind of tuberculous arthritis of the - Bone scan (isotope-labeled WBC scan) & MRI help w/ intervertebral joints. early definitive dx - It is named after Percivall Pott (1714-1788), a London - Wound & Blood culture studies: to identify appropriate surgeon. antibiotic therapy - Scientifically, it is called tuberculous spondylitis. 2) Chronic - The usual sites to be involved are the lower thoracic and - X-ray: large, irregular cavities, raised periosteum, upper lumbar vertebrae. sequestra or dense bone formations - In adults, disc disease is secondary to the spread of - Bone scan: to identify areas of infection infection from the vertebral body but in children it can be a - ESR & WBC count: N; may present w/ anemia assoc w/ primary site, as the disc is vascular in children. chronic infection - SXS: - Abscess Culture to identify infective organism & Back pain appropriate antibiotic therapy Fever Treatment Night sweating Acute: IV antibiotic therapy (Staph-sensitive to Anorexia semisynthetic penicillin & cephalosporin) RTC, continues Weight loss up to 3-6 weeks then orally for up to 3 months (taken w/o Spinal mass, sometimes assoc with numbness, tingling, food) or muscle weakness of the legs If patient did not respond to antibiotics: surgically exposed, Diagnostic Test pus & necrotic tissue removed, area is irrigated w/ sterile blood tests - elevated ESR saline soln, antibiotic-impregnated beads may be placed in tuberculin skin test the wound for 2-4 weeks, IV therapy continued radiographs of the spine Chronic: IV antibiotics + surgical debridement bone scan - SEQUESTRECTOMY-removal of enough involucrum to CT & MRI of the spine remove sequestrum bone biopsy - SAUCERIZATION-sufficient bone is removed to convert Late complications: a deep cavity into a shallow saucer closed suction irrigation system may be used to Vertebral collapse resulting in kyphosis remove debris for 7-8 days Spinal cord compression w/ large defect= cavity may be filled w/ vascularized Paraplegia (so called Pott's paraplegia) bone transfer or muscle flap J.A.K.E 18 of 31  NCMB 316 LECTURE: BSN 3RD YEAR 2ND SEMESTER FINAL 2023 Prevention: symptoms are intermittent. They will commonly occur BCG vaccination at night or when driving. Improvement of socio-economic conditions Many people will describe waking up in the night with Prevention of HIV and AIDS their hands feeling dead or numb, some say that their Patients who have a positive PPD test (but not active fingers feel like sausages. tuberculosis) may  their risk by properly taking medicines Holding the wrists bent will also bring on the problem. to prevent tuberculosis - The best way of making the diagnosis is on the history, To effectively treat tuberculosis, it is crucial that patients however sometimes that is not enough. take their medications exactly as prescribed. - There are several tests that can be done: Tinel's sign is performed by briskly tapping a nerve, the Therapy: median nerve at the wrist. (+) = results in shooting Non-operative - antituberculous drugs electric-like sensations in the distal distribution of the Analgesics nerve Immobilization of the spine region by rod (Hull) Phalen's test is performed by asking the patient to hold Surgery may be necessary, especially to drain spinal her wrist in maximum flexion. (+) = if the thumb and abscesses or to stabilize the spine finger becomes numb Carpal tunnel syndrome (CTS) Nonsurgical Treatment Activities that are causing your symptoms need to be changed or stopped: Avoid … - repetitive hand motions - heavy grasping - holding onto vibrating tools - positioning or working with your wrist bent down and out - smoking Lose weight if you are overweight. - The carpal tunnel is an opening through the wrist to the A wrist brace will sometimes decrease the symptoms in hand that is formed by the bones of the wrist on one side the early stages of CTS. A brace keeps the wrist in a resting and the transverse carpal ligament on the other. position, not bent back or bent down too far. - This opening forms the carpal tunnel. - The median nerve passes through the carpal tunnel into the hand. - It gives sensation to the thumb, index finger, long finger, and half of the ring finger. - Carpal tunnel syndrome (CTS) is a common problem affecting the hand and wrist. - Symptoms begin when the median nerve gets squeezed inside the carpal tunnel of the wrist, a medical condition known as nerve entrapment. - This syndrome has received a lot of attention in recent years because of suggestions that it may be linked with occupations that require repeated use of the hands, such as typing on a computer keyboard or doing assembly work. - Actually, many people develop this condition regardless of the type of work they do. - any condition that makes the area inside the carpal tunnel smaller or increases the size of the tissues within the tunnel = can lead to symptoms of CTS. - Example: after a wrist fracture or dislocation, the area inside the tunnel can also be reduced, if the bone pushes into the tunnel A traumatic wrist injury may cause swelling and extra pressure within the carpal tunnel - First symptoms of CTS Gradual tingling and numbness in the area J.A.K.E 19 of 31  NCMB 316 LECTURE: BSN 3RD YEAR 2ND SEMESTER FINAL 2023 EYES: ANAPHYSIO, DIAGNOSTIC TEST, AND DISORDERS Anatomy and Physiology - Protected by: bony orbits & pads of fat surrounding each eye dorsally eyelids & eyelashes which close over the eyes lacrimal apparatus/ glands lubricating & washing off foreign particles conjunctiva which lines the eyelids & covers exposed scleral surface Anti-inflammatory medications may also help common 1) The cornea is the clear surface of the outer eye which can OTC medications such as ibuprofen and aspirin oral be damaged by infections. steroid medications 2) The iris gives the eye color. High doses of vitamin B-6 3) The pupil is the black hole within the iris that lets light into the eye. It changes size in response to light levels, among Cortisone injection may help ease symptoms and can aid other things. the doctor in making a diagnosis 4) The lens is the internal focusing element of the eye, it is Open release procedure involves simply cutting the curved on both sides. The clear lens becomes cloudy when transverse carpal ligament. a cataract forms. Endoscopic carpal tunnel release 5) The conjunctiva is the thin lining of the inside of the eyelid. It extends over the front of the white part of the eye. 6) The retina is the light sensitive part of the eye. 7) The optic nerve. In glaucoma, the rise in fluid pressure in the eye damages the nerve fibers entering the optic nerve from the retina. - Wall of the eyeball is composed of 3 layers: 1) Outer fibrous protective layer - Posteriorly = sclera, the ‘white of the eye’ with firm tough connective tissue - Anteriorly = cornea, ‘window of the eye’ a forward continuation of the sclera, transparent & avascular 2) Middle vascular layer – pigmented - Hallux valgus actually describes what happens to the big - posterior = choroid toe. - anterior = ciliary body & iris the iris being the - Hallux is the medical term for big toe, and valgus is an extension of the ciliary body +pupil which anatomic term that means the deformity goes in a direction regulates the amount of light entering the interior of away from the midline of the body. the eye - “the big toe begins to point towards the outside of the foot” 3) Inner neural layer – with layers of nerve cells including: - A bunion is when your big toe points toward the second toe. photo receptors - Bunions are often caused by narrow-toed, high-heeled a) Rods shoes. - concentrated along the outer perimeter of the - These compress the big toe and push it toward the second retina toe. The condition may become painful as extra bone and a - help us to see images that come into our fluid-filled sac grow at the base of the big toe. This leads to peripheral or side vision swelling and pain. Bunions occur more frequently in - help us to see in dark and dimly lit environments women and sometimes run in families. b) Cones - If the bunion gets worse -- resulting in severe deformity or - concentrated in the macula, the center of the pain -- surgery to realign the toe and remove the bony retina bump = bunionectomy = can be effective. - allow us to perceive color - Hallux Valgus Splint – completely immobilizes the hallux for uninterrupted healing J.A.K.E 20 of 31