NUR 212 Unit 2 Part 2 Hand & Foot Disorders PDF

NUR 212 Unit 2 Part 2 Hand & Foot Disorders Muscular Dystrophy Osteomalacia Cortney Maffett, MSN, FNP-BC Hand & Foot Disorders 1. Dupuytren’s Contracture 2. Ganglion Cyst 3. Hallux Valgus 4. Hammer Toe 5. Plantar Fasciitis 6. Carpal Tunnel Syndrome Dupuytren’s Contracture A gradu...

NUR 212 Unit 2 Part 2 Hand & Foot Disorders Muscular Dystrophy Osteomalacia Cortney Maffett, MSN, FNP-BC Hand & Foot Disorders 1. Dupuytren’s Contracture 2. Ganglion Cyst 3. Hallux Valgus 4. Hammer Toe 5. Plantar Fasciitis 6. Carpal Tunnel Syndrome Dupuytren’s Contracture A gradual thickening and tightening of tissue under the skin in the hand Ganglion Cyst Small, round, fluid-filled sac growing out of the tissues surrounding a joint Hallux Valgus (Bunion) Great toe drifts laterally and the first metatarsal head becomes enlarged Hammer Toe Dorsiflexion of metatarsophalangeal (MTP) joint with plantar flexion of the proximal interphalangeal (PIP) joint next to it Plantar Fasciitis Inflammation of plantar fascia Carpal Tunnel Syndrome (CTS) Very common Median nerve compression Loss of grip strength Chronic presentation Associated with RA Repetitive stress injury Genetics CTS – Assessment & Diagnostics Pain Numbness Paresthesia Motor changes Inspection Palpation Phalen Maneuver Tinel’s Sign X-ray, MRI, Ultrasound Nerve conduction study CTS - Treatment Goal: Relieve nerve compression Medication ○ NSAIDS ○ Steroids ○ Diuretics Immobilization Surgery ○ Endoscopic carpal tunnel release (ECTR) ○ Open carpal tunnel release (OCTR) ○ Synovectomy Carpal Tunnel Release Post-op Care Monitor VS Monitor dressing Elevate extremity NV checks q hour Pain relief Wrist splint Lifting restrictions Home care  Muscular Dystrophies Muscular Dystrophy (MD) A group of genetic diseases that cause progressive weakness and loss of muscle mass Different Types: ○ Duchenne ○ Becker ○ Limb-Girdle ○ Facioscapulohumeral ○ Myotonic ○ Congenital ○ Distal ○ Emery-Dreifuss ○ Oculopharyngeal  Duchenne & Becker MD X-linked disorders that differ only in severity Dystrophin gene Usually limited to males Symptoms: may be masked early; muscle weakness when learning to walk, ride a bike, climb stairs; frequent falls; waddling gait; lordosis; Gower sign; pseudohypertrophy; cardiomyopathy; cognitive impairment Duchenne ○ Most severe ○ Onset 2-6 yo ○ Loss of mobilization by age 12 ○ Survival past 20 years old is rare Becker ○ Less severe than DMD ○ Onset adolescent or early adulthood Gower’s Sign  Review MD chart PDF located on Blackboard MD - Diagnosis Physical exam Genetic Testing DNA Testing Muscle Biopsy Neurological tests Serum creatine kinase Myoglobulin MD - Treatment No cure Many current clinical trials Primary goal: Maintain optimal functioning Secondary goal: Prevent contractures Physical therapy Corticosteroids Stretching, strength & muscle training, breathing exercises, ROM exercises Surgery Resp and Cardiac Problems ○ Palliative care ○ Noninvasive ventilation (BiPAP, CPAP) ○ Trach ○ MIE ○ Extensive cardiac evaluation Osteomalacia Osteomalacia Softening of bones r/t deficiency in or malabsorption of Vitamin D Called “Rickets” in children Risk Factors: Decreased sunlight to skin exposure Dietary deficiency in Vit D Malabsorptive syndromes Dark skin Obesity Elderly Medications that may precipitate vitamin D deficiency Renal or hepatic disease Osteomalacia – Clinical Manifestations Hypocalcemia Pain, esp in arms, legs and spine Pain worse at night Waddling Decreased muscle tone Fractures Bowlegs Pigeon chest Restless at night Fever Osteomalacia - Diagnostics X-ray Bone mineral density scan Labs ○Blood tests ○Urine tests Osteomalacia - Treatment Supplements (Vitamin D, Calcium, Phosphorous) Increase sunlight exposure Increase dietary intake of Vitamin D Corrective braces Surgery to correct bone deformities Routine lab draws  Osteoporosis Osteomalacia Decreased bone mass Bone softening Lack of calcium and Lack of vitamin D hormones Fractures Fractures Calcium level < 8.5 Calcium level- Low-WNL mg/dL Phosphate WNL Phosphate Low < 1.0 PTH WNL mg/dL ALP-WNL PTH > 330 pg/mL ALP >85 IU/L THANKS!