Medical Surgical Nursing PDF

MEDICAL SURGICAL NURSING- DR. JOSIE Q. UDAN CONCEPTS MS CRITICAL THINKING DRILLS hepatomegaly the venous blood to be transported by the portal vein cannot be CONGESTIVE HEART FAILURE...

MEDICAL SURGICAL NURSING- DR. JOSIE Q. UDAN CONCEPTS MS CRITICAL THINKING DRILLS hepatomegaly the venous blood to be transported by the portal vein cannot be CONGESTIVE HEART FAILURE E accepted by the liver, accumulation of One of the complications of myocardial blood in the portal vein is called portal infarction hypertension, on of the branches of the It happens when the ventricles are unable to portal vein is the splenic vein, it will empty or eject blood as fast blood returns into the atria. transport to the venous blood from the It is the ventricles which are in failure in spleen to the portal circulation. However, congestive heart failure. there is portal hypertension, so blood will In adults left sided congestive heart failure accumulate in the spleen thus occurs first because the left side of the heart has splenomegaly. If there is hepatomegaly, far greater workload than the right side. splenomegaly follows. As there is accumulation of blood in the liver, and the Left side of the heart ejects 5 to 6 liters of blood portal vein increase hydrostatic pressure will per minute, the cardiac output. push the plasma out, and this is the abdominal cavity, accumulation of fluids or Right Sided CHF (Backward failure) plasma in the abdominal cavity is ascites. “Venous Back-Up” One of the functions of the spleen is “Systemic Manifestations” hemolysis, it destroys old blood cells, RBC, platelets, WBC. The spleen normally destroys Left Sided CHF (Forward failure) old blood cells only. However, if there is “Left-lungs” splenomegaly, even young blood cells are “Cellular Hypoxia” trapped and they will be included in the “RAAS Activation” (HPN, HypoK+) hemolysis. Thus, hemolytic anemia, severe anemia, if there is splenomegaly there is RSCHF hemolytic anemia, the signs and symptoms - When the right ventricle is unable to eject take place below the chest, that is in the blood as fast as blood returns into the right body, continue down the legs but they are atrium, congestion of the heart will eject, occur in the body called as the systemic wherein in the super vena cava, inferior manifestations. vena cava, when blood accumulates, in superior vena cava and inferior vena cava LSCHF it follows the venous blood, example coming - Happens when the left ventricle is unable to from the upper parts of the body, it will not eject as fast as blood returns to the left re-enter the heart. atrium. If there is congestion in the left side of the heart, the oxygenated blood from the Manifestations: lungs could not go back to the left atrium Jugular vein distention or distending adequately, so blood accumulates in the veins pulmonary capillaries, the capillaries Hepatomegaly become distended, there is increase Portal vein hypertension hydrostatic pressure, pushing the blood into the intra-alveolar and interalveolar spaces, Ascites called as pulmonary edema, whenever Splenomegaly there is left sided heart failure it pertains to Hepatomegaly the lungs. Notably, most of the oxygenated Hemolytic anemia blood remained in the lungs, very little can go back to the heart, the problem is the left sided of the heart is unable to eject - What happens to the lower parts of the adequate oxygenated blood to the body if the inferior vena cava is congested systemic circulation, thus hypoxia, the blood that is supposed to be transported whenever the lungs are affected, one by the liver could not be accommodated, problem will be hypoxia. One of the natural as the blood accumulates in the liver, there responses of the body to chronic hypoxia is will be hepatomegaly, when there is Page 1 of 11 NOTES BY: JOMY MICHA DEL PILAR  MEDICAL SURGICAL NURSING- DR. JOSIE Q. UDAN CONCEPTS RAAS (Renin-angiotensin-aldosterone RENIN-ANGIOTENSIN ALDOSTERONE SYSTEM M system) activation. - If there is chronic hypoxia the kidney secretes the hormone ‘Renin’, once the renin is secreted the liver will respond, it will produce ‘Angiotensinogen’, once angiotensinogen is produced by liver, the lungs will respond by producing ACE ‘Angiotensin- converting enzyme’, angiotensinogen becomes ‘Angiotensin I’ which is a vasoconstrictor, the ACE will convert into ‘Angiotensin II’. There are two major effects of angiotensin II, one it causes arteriolar vasoconstriction, second it will stimulate the adrenal cortex, the adrenal cortex will increase the aldosterone secretions, the effect of increasing the potassium excretion, and therefore RAAS SIGNS/ SYMPTOMS OF CHF will cause hypokalemia, the arteriolar vasoconstriction will increase the blood RIGHT SIDED CHF LEFT SIDED CHF pressure. - Jugular Vein - Need 3 pillows for Distention sleeping (Orthopnea) 2 RAAS Manifestations: - Leg edema +3 - Rales/ crackles - Hypokalemia - Portal - Hypokalemia (RAAS) - Increase blood pressure hypertension - BP 150/100mmHg - Severe anemia (because of RAAS (Hemolytic activation) anemia cause - Polycythemia (increase by RBC due to hypoxia, the splenomegaly) kidney will secrete the - Hepatomegaly hormone erythropoietin, (systemic) it stimulates the bone - Splenomegaly marrow to increase RBC (systemic) in an attempt to - Central venous increase the oxygen pressure= supply) 15cm H20 - Clubbing of fingers - Yellowish - Anorexia, weight loss, sclerae weakness due to (jaundice, decreased metabolism affected liver, (we need oxygen to systemic) digest food, hypoxia has - Internal weight loss) hemorrhoids - Pulmonary artery DIFFERENT TYPES OF ANEMIA M (congested pressure = 25mmHg - Inadequate availability of oxygen to tissues. veins) (Normal is 4-12mmHg) - Hemoptysis (came from IRON DEFICIENCY ANEMIA lungs) FOLATE DEFICIENCY ANEMIA - Oxygen saturation of PERNICIOUS ANEMIA 90% APLASTIC ANEMIA - Faintness THALASSEMIA Page 2 of 11 NOTES BY: JOMY MICHA DEL PILAR  MEDICAL SURGICAL NURSING- DR. JOSIE Q. UDAN CONCEPTS IRON - Microcytic/ hypochromic - Lowering of legs - Calf pain DEFICIENCY anemia improves blood ((homan’s sign) ANEMIA - Cheilosis (crack on the side flow accumulation of of the lips) - Gangrene unoxygenated - Koilonychia (spoon shaped develops blood in the legs) finger nails) - Intermittent - Thrombophlebitis - Vinson-plummer’s syndrome claudication (group of manifestations: (relieved by rest) stomatitis, dysphagia, - Raynaud’s disease atrophic glossitis) (vaso-spasm of FOLATE - Macrocytic, normochromic small and medium DEFICIENCY anemia (big RBC) sized arteries ANEMIA usually in the digits) PERNICIOUS - Macrocytic, normochromic people who are ANEMIA anemia (big RBC) exposed in the - Beefy red tongue very cold - Intrinsic factor deficiency environment or (Vitamin b12) even workplace, - Cyanocobalamin deficiency we have (B12) Raynaud’s in the APLASTIC - Pancytopenia country; e.g. staff ANEMIA in frozen meat THALASSEMIA - Abnormal hgb, short lifespan section. of RBC - Aneurysm - Iron overload (because of the rapid destruction of the RBC, the iron component is released in the circulation. DIFFERENT BREATH SOUNDS M Vesicular - Rustling like sound of wind in the ARTERIAL & VENOUS INSUFFICIENCY M trees Arterial insufficiency: carries oxygenated - Inspiration longer than blood away from the heart expiration “Low/ No oxygen in the legs” - Heard at the periphery, apex, and base of the lungs. Venous insufficiency: carries Broncho- - Heard over mainstem bronchi unoxygenated blood back to the heart vesicular - Inspiration equals expiration “Blood pooling in the legs” Bronchial - Harsh, hollow, tubular ARTERIAL VENOUS - Heard over trachea INSUFFICIENCY INSUFFICIENCY - Inspiration shorter than - Absence of pulse - Elevation of legs expiration - Thin, shiny, relieves edema Wheeze - High-pitched hissing/musical hypopigmented - Thickened, sound on expiration - Ulcers in the toes hyperpigmentation Crackles - Burst of popping bubbles - Cold, cyanotic skin in the legs in leg - Edema Rhonchi - Low-pitched musical sound on - Leg pain on - Ulcers in the ankle inspiration walking - Warm, reddish skin Stridor - Musical wheeze over trachea (intermittent in the leg claudication) - Leg pain relieved Pleural - Sounds like 2 pieces of by walking Friction sandpaper rubbing together Rub Page 3 of 11 NOTES BY: JOMY MICHA DEL PILAR  MEDICAL SURGICAL NURSING- DR. JOSIE Q. UDAN CONCEPTS SIADH & DIABETES INSIPIDUS M Blood: Urine (opposite direction) SIADH (Syndrome of Inappropriate ADH) Dilute Concentrated “Water Retention” “Low Serum Sodium” (Dilutional HypoNa+) Concentrated Dilute D.I. (Diabetes Insipidus) Water in blood is water retention “Water loss” Water in the urine is water loss ADH (VASOPRESSIN)- exerts its action in the distal convoluted tubules and collecting tubules. Urine Specific Gravity (1.010-1.025) Functions: High specific gravity- Urine is concentrated - Retains water in the renal tubules - (1.03 and above) - Vasoconstriction Low specific gravity- Urine is dilute Hypersecretion: SIADH - (1.001 and above) Dilutional hyponatremia is caused by ADH Hypersecretion: Hyposecretion: DI exerts its action in the distal convoluted tubules SIADH and collecting tubules, far from the renal - Highly- colored - Urine output +4 to tubules, there’s no need to retain electrolytes urine 6L/day anymore just water, if compared with - Urine specific - Weight loss Aldosterone, the site of action of all the gravity = 1.050 - Dehydration aldosterone is from proximal convoluted tubules (Urine - Constipation up to distal, along the way from proximal concentrated the - Fluid intake = 4L/day convoluted tubules the kidneys will still retain blood is dilute = - Low urine specific some necessary electrolytes, if its aldosterone water retention) gravity retained sodium and water, but ADH retrains - Weight gain - Hemoconcentration water only, even sodium level is normal initially - Serum sodium = - Polydipsia because of too much water retention the 120 mEq/L - Water-like urine sodium level will appear low in relation to the - Low hematocrit - Growth retardation amount of water retention called as low serum (water retention) (low water) sodium. - Hypertension - Urine specific gravity - Pulmonary edema =1.004 Hyposecretion: DI - Decreased blood Diabetes insipidus is where the kidneys are osmolarity unable to retain water causes the water loss. - Water intoxication Osmolarity- it means concentration of fluids, it can be applied to both urine and blood, when HYPERTHYROIDISM & HYPOTHYROIDISM M there is high osmolarity the fluid is concentrated, it is viscous; low osmolarity, the fluid is dilute. When there is a problem with ADH Hyperthyroidism Concentration of fluids “Everything is high, fast, and wet “Hypocalcemia” - High osmolarity- concentrated (less “Eye manifestations” water) - Low osmolarity- dilute (more water) Hypothyroidism “Everything is low, slow, and dry” “Hypercalcemia” Page 4 of 11 NOTES BY: JOMY MICHA DEL PILAR  MEDICAL SURGICAL NURSING- DR. JOSIE Q. UDAN CONCEPTS Thyroid Gland HYPERTHYROIDISM - Exophthalmos (can happen at early or 1. T3 (triiodothyronine) late stage, it is irreversible) - Metabolism & growth - Von Graefe’s sign (lid lag)- like eyes of 2. T4 (thyroxine) Garfield - Catabolism, body heat production Patient looks down-long and deep palpebral 3. Thyrocalcitonin fissure - Jeffrey’s sign - Regulates serum calcium levels Patient looks up, forehead remains smooth - Dalrymple’s sign (thyroid stare)-infrequent - increase serum blinking of the eyes Serum Calcium calcium level will try to bring it back to BMR (BASAL METABOLIC RATE) Thyrocalcitonin normal by the thyroid - Normal (euthyroid) gland by secreting +20% to – 20% the hormone - + 20% hyperthyroidism Deposits calcium into the bones thyrocalcitonin, the - - 20% hypothyroidism action of THYROID DRUGS thyrocalcitonin will ANTI-THYROID THYROID deposits serum PREPARATIONS Serum calcium levels calcium into the - Tapazole - Synthroid bones, the calcium - PTU - Cytomel levels in the blood will decrease. - Lugol’s Taken on empty Thyrocalcitonin do is to lower serum solution stomach (fast calcium levels, deposit calcium in the Taken on full adequate absorption) stomach (prevent Start with LOW dose, bones. GI irritation), start then gradually Thyrocalcitonin: Serum Calcium (opposite with HIGH dose increase (prevent then gradually thyroid crisis), check direction) taper. pulse rate and BP before administration (it can cause Hyperthyroidism HypoCa+ tachycardia and hypertension) Hypothyroidism HyperCa+ SIGNS AND SYMPTOMS HYPERTHYROIDISM HYPOTHYROIDISM - Diarrhea - Anorexia - Exophthalmos - Cold intolerance Hyperthyroidism - Thin - Fatigue (initial - Restlessness/ manifestation) T3 - metabolism nervousness - Obesity T4 - body heat production - Fine, oily hair - Dry, sparse hair - Serum calcium - Serum calcium Thyrocalcitonin - hypocalcemia +3.5 mEq/L +12mg/Dl - Fine tremors - Serum cholesterol *Everything is HIGH, FAST, and WET - Lid lag =280 mg/Dl *Eye manifestations - BP= 140/90 TO - Pulse rate =55 to 60 *Hypocalcemia 159/94 mmHg bpm Hypothyroidism - Diarrhea - Thickened, - Sweaty skin hyperpigmentation T3 - metabolism - Tachycardia skin in the pretibial T4 - body heat production - Elevated body area temperature - Dry, scaly skin Thyrocalcitonin - hypercalcemia - treated with - Slow physical and tapazole mental reaction *Everything is LOW, SLOW and DRY - treated with PTU - Hypercalcemia *Hypercalcemia - Treated with - BMR= (-) 30% Lugol’s solution - Treated with - Exophthalmos Synthroid Page 5 of 11 NOTES BY: JOMY MICHA DEL PILAR  MEDICAL SURGICAL NURSING- DR. JOSIE Q. UDAN CONCEPTS - Von Graefe’s sign - Dull look boundary between the cell and the - Jeffrey’s sign - Treated with blood vessels and the cell membrane. - Dalrymple’s sign Cytomel - Permeability is the ability to allow - Requires high - Requires warm calorie diet environment during - Requires low fiber cold climate diet - Tendon of Achilles - Requires cool, reflex (=1) quiet environment HYPERPARATHYROIDISM & HYPOPARATHYROIDISM Hyperparathyroidism substances to pass through. “Everything is LOW and SLOW EXCEPT The muscle will relax if the sodium is OUTSIDE BP” (BP is high) the cells and the potassium is INSIDE the cells. “Hypercalcemia 99% of calcium are found in the bones and Hypophosphatemia” teeth, only 1% remains in the blood, and some of that 1% is in the cell membrane. Hypoparathyroidism Calcium regulates cell membrane, permeability. “Everything is HIGH and FAST EXCEPT BP” (BP is low) “Hypocalcemia, Hyperphosphatemia” Parathyroid Gland PTH (Parathormone) Serum Calcium PTH release The muscle will contract when the sodium goes inside the cells and the potassium goes Withdraws Calcium from the out of cell, so muscle will contract if the bones sodium and potassium exchange places, to exchange places will depend on the cell membrane, permeability. Serum calcium levels Calcium = security guard Parathormone: Serum Calcium (same direction) Hyperparathyroidism HyperCa+ Hypothyroidism HypoCa+ Role of Calcium: If low potassium in the cell membrane, there - Regulates cell membrane permeability, will be fast pass through of sodium and the cell membrane is located in the potassium. In hypocalcemia, sodium and potassium can easily exchange places. Page 6 of 11 NOTES BY: JOMY MICHA DEL PILAR  MEDICAL SURGICAL NURSING- DR. JOSIE Q. UDAN CONCEPTS HYPERCALCEMIA - Polyuria – polydipsia - Dehydration - Urinary stones - fracture Calcium exerts high osmotic pressure in the renal tubules causing polyuria. If there is polyuria, you’ll lose a lot of water causes to have excessive thirst. Too much polyuria can cause dehydration, too much calcium can cause urinary stones, there is too much calcium because there was too much Increased neuromuscular irritability means withdrawal of calcium from the bones, increase muscle contractility, hypocalcemia is that’s why bones become weak and brittle, a characteristic of hypoparathyroidism. Blood they are at risk for fracture. pressure is low because calcium is necessary for vasoconstriction, if inadequate calcium there Similar manifestations: will be weak vasoconstriction causes bp to HYPOTHYROIDISM HYPOPARATHYROIDISM become low. ✓ Dry skin ✓ Dry hair ✓ Brittle nails HYPERPARATHYROIDISM HYPOPARATHYROIDISM - Hypercalcemia - Hypocalcemia - Muscle cramps - Dry, scaly skin (because of - Dry brittle hair and hypocalcemia nails there are few - Muscle weakness calcium in the cell - Low BP membrane) - Seizures - Hypophosphatemia - Tingling lips, fingers, - Increased urine toes output - + Chvostek’s - Polydipsia - + Trousseau’s - Fracture of long - Laryngospasm In hypercalcemia there is decreased cell bones membrane permeability and decreased - Hypertension neuromuscular irritability. DIABETES MELLITUS TYPE I & II M DM TYPE I DM TYPE II - Thin - Non- insulin - Lifelong insulin dependent therapy - Associated with - Brittle DM, obesity unstable DM, - Prone to HHNC Juvenile DM - Onset after age of - Occurs among 30 years children - Associated with Hypercalcemia is a manifestation of - Absence of Islets hereditary (DM II is hyperparathyroidism. Calcium is stronger, of Langerhans more associated there will be strong vasoconstriction causes - Onset before the esp. if the mother the blood pressure to become high. In age of 30 years has DMII) hyperparathyroidism there is hypersecretion - Associated with - Pancreas secretes of PTH, hypercalcemia, hypophosphatemia. autoimmune insulin but demands disorders (children are increased are prone to viral - Ketosis- resistant infections that - Obese Page 7 of 11 NOTES BY: JOMY MICHA DEL PILAR  MEDICAL SURGICAL NURSING- DR. JOSIE Q. UDAN CONCEPTS triggers - Treated with oral ADDISON’S & CUSHING’S DISEASE M autoimmune) hypoglycemic - Insulin- agents (OHA) Addison’s disease dependent DM “Everything is LOW EXCEPT K+, - Best managed Ca+, PULSE RATE” with diet, activity, “Dark skin” exercise and insulin. Cushing’s disease - Prone to DKA “Everything is HIGH EXCEPT K+, (because they do Ca+, PULSE RATE” not obtain glucose from Addison is hyposecretion of adrenal cortex, carbohydrates everything is low except potassium, calcium causes of and pulse rate, because if the aldosterone breakdown of secretions lower potassium is retained, it goes fats, sources of up, except calcium because if there is glucose cause hyposecretion in adrenal cortex there is the release of decreased protein breakdown, protein in blood ketones) increases, protein will absorb calcium, that’s why calcium increases, in Addison’s BP goes Hypoglycemia down, inversely the body response increasingly “Decreased glucose supply to the pulse rate. brain” “SNS stimulation” – activated Cushing’s is hypersecretion of adrenal cortex, if during fight or flight adrenal cortex goes up potassium is excreted so “Feeling hungry” its potassium goes down, except calcium because of increased breakdown of protein so Hyperglycemia there is decreased absorption of calcium, “3P’s (Polyuria, polydipsia, except pulse rate because when BP increases polyphagia) slowdowns the pulse rate. “Dehydration” “ketoacidosis” HYPOGYLCEMIA HYPERGYLCEMIA - Blurred vison - Urine output - Headache, 300ml/hr dizziness - Acetone breath - Pallor, diaphoresis - Fluid intake 4L/day - Cold, clammy skin - Kussmaul’s - Restlessness breathing - Weakness, (compensatory shakiness mechanism for - Faintness ketoacidosis) - Hunger pangs - Sunken eyeballs Glucocorticoid- regulates the sugar by - Yawning - Excessive hunger elevating the blood sugar by gluconeogenesis, - Blood glucose =50 - Urine (+) for glucose it breaks down fats and proteins into glucose, mg/dl and ketones neo because these are new sources of glucose, - Inability to - Ph =7.31(acidosis), the primary source of glucose is carbohydrates, concentrate HCO3= 18 (acidosis) break down of fats and proteins into glucose is - Needs glucose - Warm, flushed, dry gluconeogenesis, then glycogenolysis is when - Memory lapses skin there increases glucose in the blood it will be - Hypokalemia (there converted into glycogen and stored in the liver, is polyuria leads to the body needs additional glucose, so the hypokalemia) glycogen stored in the liver will be converted - Needs insulin back into glucose. - Urine (+) for glucose and ketones Mineralocorticoid- regulates salt, the most - Fruity odor of breath important human mineralocorticoid is - Polydipsia aldosterone. - Polyphagia Page 8 of 11 NOTES BY: JOMY MICHA DEL PILAR  MEDICAL SURGICAL NURSING- DR. JOSIE Q. UDAN CONCEPTS Sex hormones- estrogen & testosterone, even - Thinning of hair scalps the female patient underwent hysterectomy or in females oophorectomy they can still get sex hormones - Acne from the adrenal cortex; both males and females have estrogen and testosterone. CRANIAL NERVES M HYPOKALEMIA/ HYPERKALEMIA/ CUSHING’S ADDISON’S ✓ Anorexia ✓ Nausea and vomiting ✓ Muscle weakness ✓ Fatigue ✓ Paralysis ✓ Dysrhythmias ✓ Renal damage *Effects of Adrenal Cortex hormones/ signs and symptoms of Cushing’s disease/ side effects of steroids ADDISON’S CUSHING’S - Hypotension - Moon face - Hyponatremia - Hyperglycemia - Eternal tan skin - Edema - Dehydration - Hypertension - Hyperkalemia - Delayed wound - Hypoglycemia healing - Loss of appetite - Thinning of scalp hair to eat - Osteoporosis - Fatigue - Bradycardia - Nausea and - Hirsutism vomiting - Obese trunk, thin - Depression arms, and legs - Hyponatremia - Purple striae on the - Weight loss abdomen - Muscle weakness - Hirsutism in females - Loss of appetite to eat - Hypocalcemia Oh 1. Olfactory Loss of sense of smell - Fatigue oh 2. Optic Blurred vision - Nasea and vomiting Papilledema - Poor wound healing Scotoma (Blind spots - Gynecomastia in in the visual field) oh 3. Oculomotor Unequal pupils males - Buffalo hump Rolling of the eyeballs To 4. Trochlear Loss of hearing - Hypernatremia - Muscle weakness Touch 5. Trigeminal Tic douloureux And 6. Abducens Ptosis of the eyelids, - Increased virilism in females (macho) diplopia Feel 7. Facial Loss of sense of taste, - Hypokalemia - GI Irritation anterior 2/3 of the - Immunosuppress Tongue (ageusia) (prone for infection Bell’s palsy esp. fungal infection) Inability to smile and - Capillary fragility show the teeth (easy bruising’s) A 8. Acoustic/ Vertigo - Decreased libido in Vestibul males ar - Impotence in males Good 9. Glosso Protrusion of the - Masculinization in pharyng tongue females eal Page 9 of 11 NOTES BY: JOMY MICHA DEL PILAR  MEDICAL SURGICAL NURSING- DR. JOSIE Q. UDAN CONCEPTS Dysphonia (altered - Treated with Baclofen volume & pitch of - Bladder and bowel voice) dysfunction Loss of gag reflex - Charcot’s triad (scanning Velvet 10. Vagus Parasympathetic speech, intention tremors, nerve stimulation nystagmus) Loss of gag reflex - Slowing and slurring of - Lhermitte’s sign (flexing of speech (dysarthria) neck then there is sudden So 11. Spinal Inability to shrug electric sensation) accessor shoulders GUILLAIN - Ascending paralysis y BARRE - Associated with swine flu heave 12. Hypogloss Inability to stick out the vaccine n al tongue DIFFERENT TYPES OF ARTHRITIS M NEUROMASCULAR DISORDERS M Parkinson’s disease “Tremors, rigidity” Myasthenia gravis (MG) “Muscle weakness” Multiple sclerosis (MS) “Demyelination of CNS” Guilain Barre’ syndrome (GBS) “Demyelination of the peripheral nervous system PARKINSONS - Pill rolling tremors - Tiptoe walking (starts with slow phase and keeps on increasing until running phase) - Shuffling gait - Treated with Levodopa - Treated with Cogentin - Bradykinesia Cogwheel rigidity Decreased dopamine production receptor sites - Resting tremors - Sticky skin - Soft, monotonous voice (rigid throat muscles) - Treated with anticholinergic - Flattened affect (mask like appearance) - Stooped posture - Small, shaky handwriting - Absence of arm swing when walking MYASTHENIA - Muscle weakness associated GRAVIS with activity RHEUMATOID Autoimmune disorder - Ptosis (first manifestations), ARTHRITIS Females more commonly strabismus, diplopia affected - Treated with Mestinon Subcutaneous nodules - Decreased acetylcholine Localized inflammation - Positive Tensilon test Synovial membrane - Treated with cholinergic affected MULTIPLE - Ataxic gait Weight- bearing joints most SCLEROSIS - Intention tremors commonly affected - Scanning speech (first words Ulnar drift of the hand keep repeating) Cock- up toe Morning stiffness Page 10 of 11 NOTES BY: JOMY MICHA DEL PILAR  MEDICAL SURGICAL NURSING- DR. JOSIE Q. UDAN CONCEPTS Pain-on-nonuse of joints Excessive dryness of eyes, mouth, and vagina (Sjogren’s syndrome) Leukopenia, splenomegaly (Felty’s syndrome) Hemolytic anemia Inflammation affects both side of the body OSTEOARTHRITIS Degenerative disorder Obese elderly commonly affected Localized inflammation Cartilage of joints wear off Joints of fingers commonly affected Bouchard’s nodes Heberden’s nodes Crepitus Pain-on-use of joints Unilateral affectation of joints GOUTY Metabolic disorder ARTHRITIS Males more commonly affected Big toe commonly affected Tophi Elevated urine and serum uric acid Unilateral affectation of joints Page 11 of 11 NOTES BY: JOMY MICHA DEL PILAR