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Nursing of Adult Patients with Medical & Surgical Conditions

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Presentation on theme: "Nursing of Adult Patients with Medical & Surgical Conditions"— Presentation transcript:

1 Nursing of Adult Patients with Medical & Surgical Conditions
Musculoskeletal Disorders

2 Assessment Scoliosis Lateral curvature of the spine

3 Assessment Kyphosis A rounding of the thoracic spine
Hump-backed appearance

4 Assessment Loradosis An increase in the curve at the lumbar region

5 Assessment Blanching Test Capillary nail refill
Signals circulation status Compress each fingernail or toenail, release the pressure, and note how quickly the pink color returns to the nail bed. Should return to normal color within 2 seconds

6 Diagnostic Tests Myelogram
Injection of a radiopaque dye into the subarachnoid space at the lumbar spine to determine the presence of herniated disk or tumors. Assess for allergies to iodine and seafood Oil-based dye Removed to prevent meningeal irritation Flat for 12 hours (keeps air space in lower spine) Water-soluble dye Not removed; absorbed by body Semi-fowler’s position for 8 hours (keeps dye in lower spine) Encourage fluids to assist with absorption of dye

7 Diagnostic Tests Nuclear Scanning
Given a low dosage of radioactive isotopes Scanner or camera detector is used to record images Nursing Measures Written consent Informing the patient about radioacive isotopes; will not affect others Follow instrucitions by nuclear medicine dept.

8 Diagnostic Tests Magnetic Resonance Imaging
Involves the use of magnetism and radio waves to make images of cross sections of the body Gives detailed picture of fluid filled soft tissue and blood vessels Patient must remove any metal objects patients with metal prosthesis (heart valves, othopedic screws) cannot undergo and MRI Sedatives may be given for anxiety due to claustrophobia

9 Diagnostic Tests Computer Axial Tomography (CAT scan)
3-D picture of the structure (Soft tissue & bones) More sensitive than standard x-rays Iodine contrast may be used Nursing Measures Written consent Ask about allergies to iodine and seafood NPO 3-4 hours before test Baseline vital signs Remove jewelry, etc. Teach pt. about procedure

10 Computer Axial Tomography (CAT scan)

11 Diagnostic Tests Bone Scan
Detects metastatic and inflammatory bone disease Radioisotopes administered IV 2-3 hours before test Encourage fluids A scanning camera is used to reveal the degree of uptake Areas of uptake may indicate a tumor or other abnormality

12 Diagnostic Tests Arthroscopy Direct visualization of a joint
exploration of joint drainage of fluid from the joint removal of damaged tissue or foreign bodies Involves insertion of a large-bore needle into the suprapatellar pouch. Patient may be given a general or local anesthetic Activities may be limited for several days

13 Diagnostic Tests Synovial Fluid Aspiration
The puncture of a joint with a needle and the withdrawal of synovial fluid Used for diagnosis of trauma, systemic lupus, gout, osteoarthritis, and rheumatoid arthritis Normally straw colored, clear, or slightly cloudy After procedure support extremity joint rest for 12 hours ice to joint for hours assess for s/s of infection

14 Diagnostic Tests Electromyogram (EMG)
Insertion of needle electrodes into the skeletal muscles to record the electrical activity Muscles do not produce electrical charge at rest Unusual patterns may be observed for neuropathy and myopathy

15 Rheumatoid Arthritis Etiology/Pathophysiology
Most serious form of arthritis Chronic, systemic disease Most common in women of childbearing age Autoimmune disorder, but may also be genetic Agents that should protect the body attack joint tissues Can affect lungs, heart, blood vessels, muscles, eyes and skin Chronic inflammation of the synovial membrane of the diarthrodial joints (movable)

16 Rheumatoid Arthritis Signs & Symptoms
Characterized by periods of remission and exacerbation Malaise Muscle weakness Loss of appetite Generalized aching Edema & tenderness of joints Limited range of motion (morning stiffness)

17 Rheumatoid Arthritis

18 Rheumatoid Arthritis Diagnostic Tests
Radiography studies show loss of articular cartilage and change in bone structure Laboratory Tests Erythrocyte Sedimentation Rate (ESR) increase indicates inflammation Rheumatoid Factor (RF) elevation indicates abnormal serum protein concentration Latex agglutination test detects presence of IgM version of rheumatoid factor (anti-IgG antibodies) Synovial fluid aspiration fluid is cloudy, yellow, less viscous and increased protein

19 Rheumatoid Arthritis Treatment Medications Salicylates (Aspirin)
Nonsteroidal Anitinflammatory Drugs (NSAID’s) indomethacin (Indocin) ibuprofen (Motrin) naproxen (Naprosyn) piroxicam (Feldene) nabumetone (Relafen) Potent Antiinflammatory Agents adrenocorticosteroids (prdnisone) phenylbutazone (Butazolidin) Slow-Acting Antiinflammatory Agents (6-12 mo.) hydroxychloroquine (Plaquenil)

20 Rheumatoid Arthritis Rest Exercise Heat Rehabilitation
8-10 hours of sleep a night; 2 hour nap during day Exercise Range of motion 2-3 times per day prevents joints from “freezing” and muscles from weakening Heat Hot packs, heat lamp, and/or hot paraffin Relaxes and soothes muscles Rehabilitation Help pt. to adapt to physical limitaions and promoting normal daily activities

21 Rheumatoid Arthritis Prognosis Remissions and exacerbations are common
Disease normally progresses to include joint deformity, extensive muscle atrophy, soft tissue lesions, bone and cartilage destruction, and fibrous or bony ankylosis (fixed joints)

22 Ankylosing Spondylitis
Etiology/Pathophysiology Chronic, progressive disorder of the sacroiliac and hip joints, the synovial joints of the spine, and the adjacent soft tissues. Most common in young men Strong hereditary tendency

23 Ankylosing Spondylitis
Signs & Symptoms Low back pain and stiffness “sciatica pain” lasts for a few days then subsides worse when standing May also affect joints in the neck, jaw, shoulders, knees, and hips Decreased ROM Elevated temperature Tachycardia Hyperpnea

24 Ankylosing Spondylitis

25 Ankylosing Spondylitis
Diagnostic Tests Hemoglobin and Hematocrit Low due to anemia ESR elevated due to inflammation Serum alkaline phosphatase elevated due to immobilization Radiographic reveals sacroiliac joint and intervertebral disk inflammation with bony erosion and joint space fusion

26 Ankylosing Spondylitis
Treatment Analgesics NSAID’s Exercise program swimming and walking Surgery replace fused joints Maintain spine alignment firm mattress bed board back brace Breathing exercises Turn and position every 2 hours

27 Ankylosing Spondylitis
Prognosis Chronic disease Lasts about 20 years leaving permanent damage

28 Degenerative Joint Disease (Osteoarthritis)
Etiology/Pathophysiology Nonsystemic, noninflammatory disorder that progressively causes bones and joints to degenerate Primary Cause is unknown Secondary Caused by trauma, infections, previous fractures, rheumatoid arthritis, stress on weight-bearing joints.

29 Degenerative Joint Disease (Osteoarthritis)

30 Degenerative Joint Disease (Osteoarthritis)
Signs & Symptoms Joint edema, tenderness, instability, and deformity Heberden’s Nodes nodules on the sides of the distal joints of fingers Bouchard’s Nodes nodules on the proximal joints of fingers

31 Degenerative Joint Disease (Osteoarthritis)

32 Degenerative Joint Disease (Osteoarthritis)
Diagnostic Tests Radiographic studies Arthroscopy Synovial fluid examination Bone scans

33 Degenerative Joint Disease (Osteoarthritis)
Treatment Exercise balanced with rest Heat applications Gait enhancers (canes, walkers, etc.) Medications Salicylates (aspirin) NSAID’s (Motrin) Steriods (cortisone) Surgery Osteotomy Joint replacement

34 Degenerative Joint Disease (Osteoarthritis)
Prognosis Chronic disease that ultimately causes permanent destruction of affected cartilage and underlying bone.

35 Gout (Gouty Arthritis)
Etiology/Pathophysiology Metabolic disease resulting from an accumulation of uric acid in the blood Caused by an ineffective metabolism of purines Primary hereditary factors Secondary use of certain drugs, complication of other diseases, or idiopathic Affects men more frequently than women Does not occur before puberty in the male or before menopause in the female

36 Gout (Gouty Arthritis)
Signs & Symptoms Excruciating pain Edema Inflammation Most common in the great toe Tophi calculi deposits

37 Gout (Gouty Arthritis)

38 Gout (Gouty Arthritis)
Diagnostic Tests Serum and uric acid levels Complete blood count ESR Radiography studies reveal cysts Synovial fluid aspiration contain urate crystals

39 Gout (Gouty Arthritis)
Treatment Medications colchicine decreases uric acid phenylbutazone (Butazolidin) indomethacin (Indocin) antiinflammatory corticosteroids allopurinol (Zyloprim) decreased the production of uric acid sulfinpyrazone (Anturane) increases secretion of uric acid by the kidneys

40 Gout (Gouty Arthritis)
Encourage fluid intake at least 2000 cc/day Monitor intake and output Bed rest and joint immobilization Diet Avoid high purine foods organ meats anchovies yeast herring mackerel scallops

41 Gout (Gouty Arthritis)
Prognosis Signs and symptoms are usually recurrent Can progress to destructive joint changes

42 Osteoporosis Etiology/Pathophysiology Reduction of bone mass
Most common in women ages 55-65 possibly related to lack of estrogen Contributing Factors Immobilization Use of steroids High intake of caffeine Diet low in calcium Smoking Excessive protein in diet Sedentary lifestyle

43 Osteoporosis Magnification of: Healthy Bone Bone with Osteoporosis

44 Osteoporosis Signs & Symptoms Backache Bones porous and brittle
especially in the thoracic and lumbar regions worse with sitting, standing, coughing, sneezing, and straining Bones porous and brittle pathological or spontaneous fractures Dowager’s hump spinal deformity and height loss that develop from repeated spinal vertebral fractures

45 Osteoporosis Diagnostic Tests CBC Serum calcium Phosphorus
Alkaline phosphatase Blood urea nitrogen Creatinine level Urinalysis Liver and thyroid function tests Radiography studies

46 Osteoporosis Treatment Calcium supplements Vitamin D
1000 mg for men 1500 mg for women Vitamin D Weight-bearing exercises Estrogen alendronate (Fosamax) absorbs calcium phosphate crystal in bone Diet Milk and dairy products provide the most calcium Limit caffeine

47 Osteoporosis Prognosis Chronic disorder
Prevention should begin before bone loss occurs

48 Osteomyelitis Etiology/Pathophysiology
Local or generalized infection of the bone and bone marrow Staphylococci most common cause Introduced through trauma (injury or surgery) or by the bloodstream from another site in the body to the bone Bacteria invade the bone and degeneration of bone occurs

49 Osteomyelitis Signs & Symptoms
Persistent, severe, and increasing bone pain Wound draining purulent fluid S/S of infection temperature, tachycardia, and tachypnea Edema of affected area

50 Osteomyelitis Diagnostic Tests Radiography studies Bone scan
CBC (esp WBC) ESR Cultures of blood and drainage

51 Osteomyelitis Treatment Antibiotic therapy Surgery
broad-spectrum antibiotic Keflin (cephalothin) IV for several weeks Surgery removal of necrotic bone Absolute rest of affected extremity Wound Care irrigate with hydrogen peroxide or antibiotic solution cover with sterile dressing Drainage and secretion precautions Diet high in calories, protein, and vitamins

52 Osteomyelitis Prognosis Acute Chronic
usually responds to treatment after several weeks Chronic may persist for years with exacerbations and remissions

53 Herniation of Intervertebral Disk (Herniated Nucleus Pulposus)
Etiology/Pathophysiology Rupture of the fibrocatrilage surrounding an intervertebral disk, releasing the nucleus pulposus that cushions the vertebrae above and below Lumbar and cervical herniations are most common May occur from lifting, twisting, trauma, or degenerative changes.

54 Herniation of Intervertebral Disk (Herniated Nucleus Pulposus)

55 Herniation of Intervertebral Disk (Herniated Nucleus Pulposus)
Signs & Symptoms Lumbar low back pain that radiates over the buttock and down the leg numbness and tingling in affected leg Cervical neck pain, headache, and neck rigidity

56 Herniation of Intervertebral Disk (Herniated Nucleus Pulposus)
Diagnostic Tests Radiography studies CT Myelogram Electromyelography (EMG)

57 Herniation of Intervertebral Disk (Herniated Nucleus Pulposus)
Treatment Bed rest Pain medication Muscle relaxants Physical therapy muscle strengthening ultasound heat - cold application Traction pelvic or cervical

58 Herniation of Intervertebral Disk (Herniated Nucleus Pulposus)
Surgery Laminectomy Removal of the bony arches or vertebrae Removal of displaced vertebral disk Spinal Fusion Immobilization of joint Remove disk and fuse vertebrae; may use bone from iliac crest Diskectomy Removal of extruded disk material Chemonucleolysis Injection of chymopapain to dissolve the nucleus pulposus

59 Tumors of the Bone Etiology/Pathophysiology
May be primary or secondary Benign or Malignant Osteogenic sarcoma primary malignant bone tumor seen most often in male ages 10-25 can metastasize via bloodstream fast-growing and aggressive Osteochondroma benign tumor seen most often in males ages 10-30 may be a single tumor or muliple tumors

60 Tumors of the Bone Signs & Symptoms Spontaneous fractures Anemia
Pain esp. with weight bearing Edema and discoloration of skin at site

61 Tumors of the Bone Diagnostic Tests Radiography studies Bone Scan
Bone biopsy CBC Platelet count Serum protein levels serum alkaline phosphatase level

62 Tumors of the Bone Treatment Surgery Chemotherapy and Radiation
Depends on tumor size, location and extent of tissue involvement Wide excision or resection Bone curettage Leg or arm amputation Chemotherapy and Radiation Decrease size or tissue involvement before surgery Limb-salvage procedure

63 Tumors of the Bone Prognosis
Survival rates with aggressive treatment are approximately 50% at 5 years

64 Traumatic Injuries Contusions
An injury from a blow or blunt force which causes local bleeding under the skin Treatment Cold compresses for minutes intermittently for 12 to 36 hours Elevate involved extremity

65 Traumatic Injuries Sprains
Results from a wrenching or hyperextension of a joint, tearing the capsule and ligaments May involve bleeding into the joint (hemarthrosis) Treatment Cold compresses for minutes intermittently for 12 to 36 hours Elevate involved extremity

66 Traumatic Injuries Whiplash
Injury at cervical spine caused by hyperextension Usually caused by violent back-and-forth movements of the head and neck Symptoms Pain in the cervical area; may radiate down the arm Headache, blurred vision, weakened hand grip Treatment Analgesics Muscle relaxants Cervical traction (neck brace)

67 Traumatic Injuries Ankle Sprains
Caused by a wrenching or twisting of the foot and ankle Signs & Symptoms Edema of the ankle Pain with movement of ankle Treatment Elevate injured area Cold compresses for minutes intermittently for hours Warm compresses for minutes four times a day after 24 hours Compressive dressings and splint Surgery may be necessary for torn ligaments

68 Traumatic Injuries Strains
Microscopic muscle tears as a result of overstretching muscles and tendons Signs & Symptoms Sudden & severe pain in affected muscle Ecchymosis and edema over area Treatment Analgesics Exercise legs Cold compresses minutes for hours then warm compresses minutes after 24 hours Surgery may be required if muscle is completely ruptured

69 Traumatic Injuries Dislocations Etiology/Pathophysiology
Temporary displacement of bones from their normal position May be caused by: congenital disease process trauma

70 Traumatic Injuries Signs & Symptoms Erythema Discoloration Edema Pain
Limitation of movement Deformity or shortening of the extremity

71 Traumatic Injuries Treatment Closed reduction Open reduction
Cold compresses first 24 hours and warm compresses after 24 hours Elevate injured extremity Elastic bandage Immobilze splint sling Analgesics Demerol, Morphine Motrin, Tylenol

72 Carpal Tunnel Syndrome
Etiology/Pathophysiology Compression of the median nerve between the carpal ligament and other structures in the carpal tunnel

73 Carpal Tunnel Syndrome
Predisposing Factors Obese, middle aged women Employment in occupations involving repetitious motions of the fingers and hands computer usage basket weaving meat carving typing

74 Carpal Tunnel Syndrome
Signs & Symptoms Paresthesia sensation of pricks of pins and needles Hypoesthisia decrease in sensation in response to stimulation Burning pain or tingling in the hands may be intermittent or constant Inability to grasp or hold small objects Edema of the hand, wrist, or fingers Muscle atrophy Depressed appearance at the base of the thumb on the palmer side

75 Carpal Tunnel Syndrome
Diagnostic Tests Physical exam Tinel’s sign increased tingling with gentle tap over tendon sheath on ventral surface of central wrist Electromyogram MRI

76 Carpal Tunnel Syndrome
Treatment Immobilizer cock-up splint Elevate extremity ROM exercises Surgery Release carpal ligament Post-op Interventions Elevate the hand and arm for 24 hours Needs to be elevated as high as possible ROM to thumb and fingers Analgesics Monitor vital signs Assess fingers for circulation, sensation, and movement every 1-2 hours for 24 hours

77 Carpal Tunnel Syndrome
Prognosis Mild symptoms may be relieved by nonsurgical treatment Severe symptoms may be relieved by surgical treatment Pregnancy induced usually subside after delivery

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