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NEURO/MUSCULOSKELETAL BY DIANA BLUM RN MSN METROPOLITAN COMMUNITY COLLEGE.

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Presentation on theme: "NEURO/MUSCULOSKELETAL BY DIANA BLUM RN MSN METROPOLITAN COMMUNITY COLLEGE."— Presentation transcript:

1 NEURO/MUSCULOSKELETAL BY DIANA BLUM RN MSN METROPOLITAN COMMUNITY COLLEGE

2 SELECTIVE ANATOMY 12 cranial nerves 31 spinal nerves Neuron transmits impulses to facilitate movement or sensation Meninges serve as protection of the brain and spinal cord Bronca’s area in frontal lobe forms speech Hypothalamus regulates water, appetite, temp CSF: surrounds and cushions brain and cord

3 MENTAL STATUS Does not decline with age Caused by drugs or lack of o2 to the brain As we age LTM is better then STM

4 FUNCTIONAL ASSESSMENT Appearance Speech Motor function Family history Ethnicity Diet ADLs Right handed or left handed ◦ Brain injury is more pronounced in dominant hemisphere

5 PHYSICAL ASSESSMENT Orientation LOC Memory ◦ LTM (DOB) ◦ STM (mode of transportation to hospital) ◦ Immediate memory (repeat 3 words after 5 minutes) Attention ◦ Serial 7 test Language/copying ◦ Follows simple commands Cognition ◦ Current events

6 SENSORY ASSESSMENT Pain and temp ◦ Cotton ball vs paper clip ◦ Cold vs warm Touch ◦ Pt closes eyes and you touch hand etc and then have them touch where you touched ABNORMAL FINDINGS  Propioception-position sense below injury  Contralateral- loss of sensation in opposite side of body affected

7 MOTOR ASSESSMENT Hand grasps Foot strength Arm drift Coordination Gait Balance Reflexes ABNORMAL FINDINGS tremors, weakness, paralysis, jerking muscles

8 RAPID ASSESSMENT Glascow coma scale: eye opening, motor response, and verbal response ◦ painful stimuli  Supraorbital pressure  Sternal rub  Mandibular pressure  Trapezius squeeze ◦ LOC  Decortication-hands/arms turned in  Decerebration- hands/ arms turned out ◦ Pupil assess  Response to light

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10 The GCS is scored between 3 and 15, 3 being the worst score, and 15 the best. It is composed of three parts: Best Eye Response, Best Verbal Response, Best Motor Response When doing a neuro assessment it is important to watch for trends indicating a decreasing LOC. Keep in mind that when patients have ingested alcohol, mind altering drugs, have hypoglycemia or shock with a systolic BP <80, the GCS may be invalid. 9 to 12 is a moderate injury 8 or less is a severe brain injury. 7 or less = Coma

11 A client has a 5 on the Glasgow Coma Scale. When assessing this client, the nurse would expect what level of consciousness? Sleepy or drowsy Stuporous Fully alert and oriented Comatose

12 A score of 7 or less indicates a comatose client. Above that are varying degrees of consciousness.

13 Coma: No eye opening, no ability to follow commands, no word verbalizations (3-8)

14 DIAGNOSTICS Blood cultures to find infection Xray for fx, erosion, etcPET ◦ Evaluates drug metabolism ◦ Detects alzheimer’s, epilepsy, etc ◦ No caffeine, alcohol, or tobacco 24 hrs before test ◦ NPO 6-12 hours prior ◦ No insulin prior ◦ Takes 2-3 hrs ◦ No special follow-up Angiography for circulation check ◦ NPO for 4-6 hrs prior ◦ Preop checklist ◦ Remove jewelry and hairpins ◦ Neuro check and vs ◦ Empty bladder before ◦ After- monitor pulses, cap refill, color, and vs MRI  Signed consent  No food or fluid restrictions  Inform of noise and offer ear plugs  Check for hx of pins, pacemaker, metal objects Lumbar puncture  Needle in subarachnoid space to obtain CSF for analysis  Signed consent  Empty bladder  Explain procedure  Lie in fetal position for test  Bedrest 4-8 hours post  Increase fluid for 24 hours to prevent spinal headache (3000ml)

15 DIAGNOSTICS CONTINUED CT ◦ No food 4-6 hrs prior ◦ Fluids okay ◦ Remove jewelry and hairpins ◦ Monitor for rx to dye ◦ Monitor I/O EEG ◦ Determines brain activity ◦ Determines origin of seizures ◦ Dx of sleep disorders ◦ Determines brain death ◦ Explain procedure ◦ No coffee, tea, or stimulants ◦ May be ordered as speep deprived ◦ Hair should not have product on it ◦ Takes about 1 hour ◦ When done remove gel with acetone

16 DIAGNOSTICS CONTINUED EMG ◦ Looks at muscle activity BRAIN SCAN ◦ Locates tumors and aneurysms ◦ Explain the test ◦ May need consent ◦ 2 hour delay so brain absorbs isotope ◦ Must be still for duration of test ◦ 1-2 hour exam ◦ f/u is to increase fluids to promote elimination of isotope

17 TRAUMATIC BRAIN INJURY (TBI)

18 HEAD INJURY CLASSIFICATION: Severe Head Injury----GCS score of 8 or less Moderate Head Injury----GCS score of 9 to 12 Mild Head Injury----GCS score of 13 to 15 (Adapted from: Advanced Trauma Life Support: Course for Physicians, American College of Surgeons, 1993).

19 SUPERFICIAL INJURIES Common Abrasions “Goose Eggs” Lacerations  Scalp is very vascular Xray if suspect skull fracture

20 SKULL FRACTURES Categorized according to type and severity Frequently seen in conjunction with brain injuries Linear skull fractures Comminuted skull fractures Basal skull fractures Possible associated cranial nerve deficits

21 OPEN SKULL FRACTURES Linear- simple clean break Depressed - bone pressed in towards tissue Open -lacerated scalp that creates opening to brain tissue Comminuted - bone fragments and depresses into brain tissue Basilar- unique fx at base of skull with CSF leaking though the ear or nose  Racoon eyes/Battles sign

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24 CLOSED SKULL FRACTURES Closed- blunt trauma  Mild concussion-brief LOC  Diffuse axonal injury- usually from MVA  May go into coma  Contusion-bruising of brain  Site of impact (coupe)  Opposite side of impact (contrecoupe)

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26 INTRACRANIAL HEMATOMAS Epidural- bleed b/w skull and dura  Laceration of artery or vien Subdural-bleed below dura and arachoid layers  Acute, subacute, chronic Intracerebral-accumulation of blood in brain tissue  Blunt trauma  Penetrating wounds  Acceleration/deceleration injuries

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28 INCREASED INTRACRANIAL PRESSURE (ICP)

29 Increase is caused by an increase in the volume of any of the intracranial components Drivers of increased ICP  Hypoxia – triggers the vasodilatory cascade  Ischemia in acute brain injury

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31 INCREASED ICP Normal ICP 10-15mmHg Normal increases occur with coughing, sneezing, defecation Leading cause of death for head trauma As ICP increases cerebral perfusion decreases causing tissue hypoxia, decrease serum pH, and increase in CO2

32 ICP CONTINUED 3 types of edema  Vasogenic: increase in brain tissue volume  Cytotoxic: result of hypoxia  Interstitial: occurs with brain swelling

33 ASSESSMENT

34 HYDROCEPHALUS abnormal increase in CSF volume Causes: impaired reabsorption from subarachnoid hemorrhage or menengitis

35 BRAIN HERNIATION Increased ICP will shift and move brain tissue downward Central Herniation  Downward shift to brainstem  S/S  Cheyne stokes, pinpoint pupils, hemodynamic instability The most life threatening is Uncal because it causes pressure on the 3 rd cranial nerve  S/S  Dilated, nonreactive pupils, ptosis, rapidly decreased LOC

36 HERNIATION SYNDROMES. HERNIATION SYNDROMES.

37 THE BRAIN Headaches ◦ 3 MAIN types  Migraine-genetic predisposition  s/s: sensitive scalp, anorexia, photophobia, N/V  Spasming of arteries at the base of the brain causing arterial constriction, decrease cerebral blood flow, platelets clump, and serotonin released. Other ateries release prostoglandins that cause swelling and inflammation  With aura- sensation that signals onset  Most are without aura  Atypical- less common  Tx: tylenol, migraine medicine, beta blocker, yoga, meditation, relaxation, etc.

38 CLUSTER HEADACHE one sided headache usually felt deep around eye. They come and go Onset is associated with relaxation, napping or REM sleep s/s: ipsilateral (one side) tearing of the eye, rhinorrhea(runny nose), ptosis(droopy), eyelid edema, facial sweating, miosis (abn. Constriction of eye). There may be bradycardia, pallor, increased temp. Tx: same as migraine, wear sunglasses, O2 for 15 minutes, surgery

39 TENSION HEADACHE Muscle and shoulder tenderness, base of skull and forehead pain. Similar s/s to migraines Classic s/s:N/V, photophobia, phonophobia, aggravates with activity Tx: NSAIDS,muscle relaxers

40 SEIZURES/EPILEPSY Seizure: abnormal sudden, excessive, uncontrollable electrical d/c of neurons w/in the brain that may result in altered LOC, motor/sensory ability, and/or behavior.  No known cause but may be from tumors

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43 TYPES OF SEIZURES Tonic-Clonic: lasts 2-5 minutes  Rigidity/stiffening arms/legs and Loss of Consciousness Tonic: loss of consciousness, muscle contraction and relaxation Clonic: rhythmic jerking, may bite tongue, incontinence  Post seizure lethargy Absence: more common in kids, runs in families, blank staring, loss of consciousness (resembles daydreaming) Myoclonic: brief jerking or stiffening, symmetric or assymetric movement Atonic (akinetic): sudden loss of muscle tone, lasts for few seconds confusion after seizure. Partial: begin in one part of cerebral hemisphere, most often in adults and are less responsive to medical treatment Complex Partial: blacks out for 1-3 minutes and automatisms present (lip smacking, picking), amnesia after seizure,temporal lobe most affected Simple partial: remains conscious, senses unusual sensation, smell, or pain before (déjà vu). Unilateral movement during seizure, and may have tachycardia, flushing, or psychic symptoms Idopathic: account for ½ of seizures, no known cause

44 CAUSES Metabolic disorders ETOH withdrawl Electrolyte disturbances Heart disease Altered gene function  Defective genes for channels that regulate ions in/out of cell  Myoclonus clients are missing cystain B protein  Etc. Triggers  Physical activity  Stress  Fatigue  Alcohol or caffeine  Certain foods

45 EPILEPSY Def: chronic disorder characterized by recurrent unprovoked seizure activity.  May be caused from abnormality in electrical neuronal activity, abnormal transmitters, or both. Approximately 2 million people in the USA with epilepsy

46 can be defined as abnormal, uncontrolled electrical activity in brain cells. Nerve cells transmit signals to and from the brain in two ways by  (1) altering the concentrations of salts (sodium, potassium, calcium) within the cell  (2) releasing chemicals called neurotransmitters (gamma aminobutyric acid). The change in salt concentration conducts the impulse from one end of the nerve cell to the other.

47 TYPES OF EPILEPSY Primary or idopathic  Not associated with identifiable brain lesion Secondary  Most common cause is brain lesion, tumor or trauma Status epilepticus  Prolonged seizures that last greater than 5 minutes or repeated seizures over the course of thirty minutes.  Causes:  Med withdrawl  Infection  Acute alcohol withdrawl  Head trauma  Cerebral edema  Metabolic disturbances

48 CONVULSIVE STATUS EPIEPTICUS IS A NEUROLOGICAL EMERGENCY AND MUST BE TREATED PROMPTLY AND AGGRESSIVELY.  Call 911or staff emergency  Get airway established if needed by RT, Anesthesia  O2 as needed  Establish large bore IV access  Start NS  Get ABGs  Transfer to ICU

49 EDUCATION OF SEIZURE/EPILEPSY PATIENT Teach importance of taking meds as prescribed Promote balanced diet, rest, and stress reduction techniques Instruct pt. to keep a seizure diary to identify causative factors

50 PHASES OF SEIZURES Preicteral phase: aura present.. The first phase involves alterations in smell, taste, visual perception, hearing, and emotional state. This is known as an aura, which is actually a small partial seizure that is often followed by a larger event. Ictus: The seizure.. There are two major types of seizure: partial and generalized. What happens to the person during the seizure depends on where in the brain the disruption of neural activity occurs. Postictal state: The period in which the brain recovers from the insult it has experienced. Drowsiness and confusion are commonly experienced during this phase. the period in which the brain recovers from the insult it has experienced

51 TREATMENT Nonsurgical  Antiepileptic drugs  Seizure precautions  During:  Protect the client from injury  Do not force anything into mouth  Turn client to side  Loosen restrictive clothes  Do not restrain  After  Take vitals  Perform neuro checks  Keep on side  Allow rest  document Teach family  Info about disease  Info about medication  Support groups available  Teach about alcohol avoidance  To investigate state laws pertaining to driving and working with machinery  Care of seizure client

52 SURGICAL TREATMENT Vagal nerve stimulation  For simple or complex partial seizures  Stimulating device is surgically placed in the left chest wall with a lead wire on the vagus nerve  Activates with hand held magnet Corpuscalostomy  Used for tonic-clonic seizures  For those not candidates for other surgical procedures  Sections of the anterior and 2/3 of the corpus collosum are created to prevent neural discharges

53 NURSING DIAGNOSIS Risk for falls Ineffective coping Risk for ineffective breathing

54 PARKINSON’S

55 ALZHEIMER’S DISEASE

56 STAGES Early  mild Middle  moderate Late  severe

57 S/S Aggressive Rapid mood swings Increased confusion at nite (sundowner’s) Decrease interest in personal appearance Inappropriate clothing selection Loss of bowel/bladder Decreased appetite

58 DIAGNOSIS CBC BMP Folate level checked Thyroid and liver function test Test for syphilis Drug tox screening (OTC) Alcohol screening CT MRI PET EEG

59 NURSING DIAGNOSIS Chronic confusion Risk for injury Disturbed sleep pattern

60 TX Meds Prevent overstimulation Be consistent Reorient Promote independence Bowel/bladder training Promote facial recognition Speech therapy Safety precautions Minimize agitations

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62 gXI

63 SPINAL CORD INJURY (SCI)

64 CAUSES OF SCI Primary  Hyperflexion (moved forward excessively)  Hyperextension (MVA)  Axial loading (blow at top of head causes shattering)  Excessive rotation (turning beyond normal range)  Penetrating (knife, bullet) Secondary  Neurogenic shock  Vascular insult  Hemorrhage  Ischemia  Electrolyte imbalance

65 TYPES Complete: spinal cord severed and no nerve impulses below level of injury  Cervical/Thoracic Incomplete: allow some function and movement below level of injury  Includes:  Central cord syndrome  Anterior cord syndrome  Brown-Séquard syndrome

66 COMPLETE Tetraplegia (quadriplegia): paralysis from neck down  Loss of bowel and bladder control  Loss of motor function  Loss of reflex activity  Loss of sensation  Coping issues *Christopher Reeve is example of this injury*

67 INCOMPLETE Central Cord Syndrome  Hyperextension damage to center of spinal cord  Greater loss of function in upper extremities Anterior Cord Syndrome  Cause: Direct injury to anterior spinal cord or disrupted anterior spinal artery  Paralysis, loss of pain and temperature sensation  Light touch, vibration, proprioception preserved  Prognosis for recovery is variable

68 INCOMPLETE Posterior cord lesion  Damage to posterior white and gray matter  Motor function intact, but loss of vibratory sense, crude touch, and position sensation Brown Sequard syndrome  Result of penetrating injury that causes hemisection of spinal cord.  Motor function, proprioception, vibration, and deep touch are lost on the same side as injury (ipsilateral)  On the other side (contralateral) the sensation of pain, temperature and light touch are affected

69 ASSESSMENT 1 st -respiratory status 2 nd - intra-abdominal hemorrhage (hypotension, tachycardia, weak and thready pulse) 3 rd assess motor function  C4-5 apply downward pressure while the client shrugs  C5-6 apply resistance while client pulls up arms  C7 apply resistance while pt straightens flexed arms  C8 check hand grasp  L2-4 apply resistance while the client lifts legs from bed  L5 apply resistance while client dorsiflexes feet  S1 apply resistance while client plantar flexes feet

70 COMPLICATIONS Cerebral ischemia DVT/PE Pneumonia/Atelectasis Vomiting and Aspiration GI stress ulcers Constipation UTI Pressure Ulcers

71 AUTONOMIC DYSREFLEXIA Severe HTN, bradycardia, sever headache, nasal stuffiness, and flushing  Caused by noxious stimuli like distended bladder or constipation Immediate interventions  Place in sitting position  Call doctor  Loosen tight clothes  Check foley tubing if present  Check for impaction  Check room temp  Monitor BP q10-15 minutes  Give nitrates or hydralazine per md order

72 TREATMENT Immobilize fx- C-collar Proper body alignment  Traction is possible Monitor VS q4 hr and prn Neuro checks q4 hr and prn Monitor for neurogenic shock (hypotension and bradycardia) Prepare for possible surgery Teach skin care, ADLs, wound prevention techniques, bowel and bladder training, medications, and sexuality

73 NRSG DX FOR SCI Ineffective tissue perfusion r/t interruption of arterial flow Ineffective airway clearance r/t SCI Ineffective breathing pattern r/t SCI Impaired gas exchange r/t SCI

74 HUNTINGTON’S DISEASE Formerly huntington’s chorea Hereditary Transmitted as an autosomal dominant trait at time of conception people in usa have 2 main symptoms are progressive mental status changes and choreiform movements (rapid, jerky) in the limbs trunk and face

75 No known cause No known treatment Only prevention is to not have children Antipsychotics and monoamine depleting agents used to manage movement TX: PT, OT, speech therapy, meal planning by dietician, HHC, social work to line up community resources

76 OSTEOPOROSIS

77 Metabolic condition Bone demineralizes Easy to fracture Wrist, hip, and vertebrae are most affected

78 Osteopenia: low bone mass Osteoclasic: bone resorption Decreased bone mineral density 40-45% loss in women throughout lifespan Trebecular (Spongy bone) is lost first Then Cortical (compact bone) lost 2 nd Pathophysiology is unknown

79 CLASSES Generalized:involves many structures  Primary: more common  Post menopausal women  Men in 60s-70s  seconday Regional: limb involved  r/t fx, injury, paralysis, joint inflammation  Immobilization greater than 8-12 weeks  Weightless environment (astronauts)

80 HEALTH PREVENTION Teach about exercise Teach about diet rich in calcium Teach about bone health Teach about safety

81 ASSESSMENT Risk for falls Head to toe assessment  Inspect and palpate vertebrae Assess pain Assess for fallophobia No definitive lab tests Bone scan to check density

82 NURSING DIAGNOSIS Risk for falls Impaired physical mobility Acute or chronic pain

83 INTERVENTIONS Client education is #1 Hormone replacements Calcium supplements Multivitamins Diet Fall prevention Exercise Pain management Braces

84 OSTEOMALACIA Softening of the bone tissue Inadequate mineralization of osteoid (mature compact and spongy bone) Vitamin D deficiency is a key player Similar characteristics with osteoporosis Rare in USA Prevent with vitamin D, sun exposure, and diet

85 s/s: early stages : nonspecific  Muscle weakness  Bone pain  Hypophosphatemia  Hypocalcemia  Generalized bone tenderness

86 PAGET’S DISEASE

87 Metabolic disorder of bone remodeling Bone deposits that are weak, enlarged, and disorganized Phases:  Active  increased osteoclasts cause massive bone destruction  Osteoclasts are multinuclear  Mixed  Inactive  2 nd phase  New bone becomes sclerotic and very hard  Osteoclasts return to normal amount 2 nd most common bone disease Most common sites are vertebrae, femur, skull, sternum, and pelvis Unknown cause

88 ASSESSMENT 80% asymptomatic Assess past history of fractures, skin color and temp, gout, hyperparathyroidism, lethargy, hyperuricemia Pain that is aching, deep, poor description Pain worsens with weight bearing and pressure Pain most noticeable at nite or at rest Arthritis at infected joints Assess posture, gait, and balance Assess vision, speech, and swallowing, hydrocephalus, Neoplasm is the dreaded complication

89 DIAGNOSTICS Serum alk phosphate  Those treated for paget’s need ALP drawn 3-4 times/year Urine hydroxyproline  Shows bone collagen turnover and degree of severity Calcium levels are normal or elevated Increase noted in uric acid  May initially be thought to be gout X-rays, CT, MRI, bone biopsy

90 TREATMENT Drugs for pain relief Drugs to decrease bone resorption Calcitonin (thyroid hormone) Mithramycin (antineoplastic) Biphosphanates Heat therapy Gentle massage Exercise PT Diet Osteotomy or joint replacement

91 OSTEOMYLELITIS

92 Inflammatory process Increase in vascularity and edema Vessel becomes thrombosed once inflamed Ischemia is next Then necrosis Sequestrium forms and retards bone healing

93 CATEGORIES Exogenous: infection enters from outside Endogenous: infection enters from inside Contiguous: results from skin infection The most common offending organism is pseudomonas aeruginosa Staph, salmonella are aslo culprits

94 S/S AND ASSESSMENT Pain Fever Erythema Heat Swelling Assess circulation Assess for septic shock

95 TREATMENT Contact precautions IV antibx therapy PICC line Use sterile techniques Pain meds Hyperbaric oxygen therapy Bone grafts Muscle flaps Amputations

96 BONE TUMORS

97 CHONDROGENIC Osteochondroma: most common, benign, tumor…onsets in childhood, grows until skeletal maturity..has a bony stalk like appearance..may become malignant Chondroma: lesion of mature hyaline cartilage of the hand and feet. Ribs, sternum, spine, and long bones can also be affected…can get at any age or gender

98 OSTEOGENIC Osteoid osteoma: pinkish granular appearance..any bone affected..femur and tibia most affected Osteoblastoma: affects vertebrae and long bones..large in size and lies in spongy bone..reddish granular appearance Giant cell tumor: origin unknown..aggressive and extensive..affects women 20s-30s

99 ASSESSMENT/ TX Assess pain Palpate involved area CT scan and MRI done for diagnosis Interventions  Meds and surgery combination  Pain meds  Meds taken with meals or milk 

100 MALIGNANT BONE TUMORS Primary: originate in bone / 2 nd ary: mets to bone  Primary Osteosarcoma: most common  Large lesion, pain and swelling of short duration, warm site, central portion is sclerotic, usually mets to lung in 2 yrs then death Ewing’s sarcoma: most malignant  Pain and swelling, fever, anemia, leukocytosis, pelvis and lower extremities most affected, any age..but kids and young adults age 20s more  Pelvic yields poor prognosis Chondrosarcoma: dull pain, swelling for long period..  pelvis and femur fore affected  Destroys bone and often calcifies  Affect middle age to elders and more in men Fibrosarcoma: from fibrous tissue; most common in long bones of legs and mets to lungs  Histiocytoma is most malignant type  Local tenderness, with or w/o mass palpated

101 BONE METS Primary tumors are in prostate, breast, kidney, thyroid, and lung Fractures are major problem with management  Femur and acetabulum Primarily affects those under 40

102 ASSESS/ DIAGNOSTICS Assess pain, swelling, palpate for masses Monitor vs Assess ADLs Assess support structures Assess coping skills Check ALP levels for elevation CT scan Stage tumor

103 NURSING DIAGNOSIS/TX Pain Anticipatory grieving Disturbed body image Fear Anxiety Tx  Pain management, chemo, radiation, surgery, dressing changes, be active listener, establish goals, safety precautions, HHC

104 CARPAL TUNNEL

105 EDUCATION Use ergonomic work stations Teach client to take regular breaks s/s  Parathesia in hands  Weak pinch, clumsiness, weakness  Hand activity worsens symtoms  Swelling may occur Tx: nsaids, surgery

106 DUPUYTREN’S CONTRACTURES Slow progressive contracture Common problem Affects 4 th or 5 th digit of the hand Trigger finger release surgery performed to fix

107 DISORDERS OF THE FOOT Hammertoe: fix with surgery Tarsal tunnel syndrome: ankle version of carpal tunnel Plantar fasciitis: inflammation of the plantar fascia located in the arch of the foot  s/s: pain in arch, pain worsens w/ wt bearing  Tx: ice, rest, stretches, strapping, nsaids, surgery Hallux valgus: aka bunion

108 RHEUMATOID ARTHRITIS

109 Most common connective tissue disorders Most destructive to joints RA factors looked for in lab Assess sedrate Assess immunoglobins MRIs performed EMGs are performed to measure function

110 ASSESSMENT/ S/S CONTINUED Joint stiffness Swelling Pain Fatigue Weight loss Reddened joints Deformity of joints Baker’s cysts may occur and cause pain Dry eyes, dry mouth, dry vagina Assess ADLs, coping, pain

111 INTERVENTIONS Nsaids Immunosuppressive drug Rest Proper positioning Pain management Ice Heart parafin wax Plasmapheresis Fish oil tablets

112 LUPUS Characteristic sign is butterfly rash Also alopecia is common Autoimmune disorder May have kidney involvement Women b/w African american more than caucasian

113 GOUT Type of arthritis Urate crystals deposit in joints Primary gout is most common Inflammation is key sign 2 nd ary is when too much uric acid in blood Can affect kidneys Meds to treat Pain management

114 MARFAN SYNDROME Inherited, dominant autosomal trait s/s: excessively tall and lanky with elongated hands and feet, scoliosis, funnel shaped chest, glaucoma Avg life span is 32 years Mitral valve prolapse and AAA are common Tx is palliative and preventitive

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116 FIBROMYALGIA Chronic pain syndrome Pain is burning or gnawing Headache and jaw pain are also common Chest pain is common Pain control is the key  Muscle relaxers, nsaids, antidepressants

117 GLAUCOMA 2 types  Primary open angle: most common  Angle closure: less common..emergency

118 S/S Open angle: small cresent shaped defect Angle closure: visual fields quickly decrease, severe pain around eye, headache, n/v, halos, blurred vision

119 MACULAR DEGENERATION Central vision declines Mild blurring or distortion More rapid to produce in smokers

120 MUSCULAR DISTROPHIES 9 types Progression is slow or fast Most common is severe X linked recessive Diagnosis is difficult Comfort is key Treat symptoms

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