S/Sx: Hyperactivity, Sensitive to heat, weight loss, diarrhea, tachycardia, exophthalmus, fine, soft hair
Tx: Antithyroid drugs (SSRI methimazole, propylthiouracil), Irradiation, surgery.
Decreased BMR, T3,T4, increased TSH
Restrict use of soaps and apply lanolin or creams to skin
High-protein, low-calorie diet
Prevent constipation: high-fiber, high-cellulose foods, stool softeners
Explain Sx are reversible with Tx
Administer drug replacement therapy (synthroid, Cytomel [Liothyronine Sodium]).
Administer sedatives carefully - risk of respiratory depression
Instruct about causes of myxedema coma (acute illness, surgery, chemotherapy, discontinuation of medication).
Increaseed Temp and pulse, HTN.
Tx: hypothermia blanket, O2, sodium iodine, propylthiouracil (PTU), Inderal, hydrocortisone, Tylenol; also caused by trauma, infection, palpation, RAI (radioactive Iodine) therapy.
What is it? A break in continuity of bone
Types of fractures:
--Complete: Break across entire cross-section of bone
--Incomplete: Break through portion of bone
--Closed: No external communication
--Open: Extends through skin
S/S: Swelling, pallor, ecchymosis, loss of sensation, deformity, pain & acute tenderness, muscle spasms, loss of function, abnormal mobility, crepitus, shortening of affected limb, decreased or absent distal pulses, extremity is colder
--Provide emergency care
--Splinting & Surgery
Assessment: pain muscle tone, poor body mechanics/posture
Treatment: Meds (NSAIDs , muscle relaxers), traction, TENS
DX test: CT, MRI
Post op care: positioning log rolling, firm mattress, make sure they have proper body alignment, assess stimulation in lower extremities, proper body alignment, erect posture, avoid prolonged sitting and standing
Occurs in postmenopausal women
Assessment: reduction in bone mass, decreased height, low back pain, kyphosis
Risk factors: over 60 years old, small frame, caucasian or asian, postmenopausal, use of alcohol, smoking, sedentary lifestyle d/t lack of weight bearing on the bones
Implementation: diet high in calcium, protein, vitamin D, estrogen replacement therapy, med: FOSAMAX, safety precautions to prevent fractures
Assessment: deficiency of dopamine, tremors (pill-rolling) , akinesia (loss of automation) rigidity, "motorized" propulsive gait, slurred monotonus speech, dysohagia, salivation, mask-like expression, drooling, constipation, depression, dementia
Implementation: Teach ambulation modification, ROM exercises
Medications: Artane, Cogentin, L-Dopa, Parlodel, Sinement, Symmetrel
Assessment: deficiency of acetylcholine, muscular weakness produced by repeated movement, dyphagia, respiratory distress, diplopia, ptosis (eyelid drooping), impaired speech, dysphagia. (MG crisis affects pt's airway, emergency!)
Implementation: Good eye care, restful environment
Medications: anticholinesterases, corticosteroids, immunosuppressants
provides rigid immobilization of the affected area, provides stability and support to help with healing, may be plaster or fiberglass, diminishes skin problems, does not soften when wet
Immediate Care: don't cover until dry, handle with palms of hands, don't rest on hard surface, keep above level of heart, check pulses, color and sensation. Watch for blueness, paleness, pain numbness or tingling sensation
Intermediate care: When cast is dry pt should be mobilized
After cast care: elevate limb
Joint pain, swelling, and limitation of movement.
Nodules over bony prominences
High fever and rheumatoid rash (seen in JRA)
Salmon-pink macular rash (small, flat red dots) on chest, thighs, and upper arms.
Diagnose: Systemic disease, remissions and exacerbations, bony ankylosis, progressive
Rheumatoid factor (autoantibody), C-reactive protein, ESR (sed-rate), ANA (in JRA), Aspirationof synovial fluid, X-Rays.
Breakdown of bone tissue
Data:Pain, Bowed legs/decreased height, Shortened trunk with long-appearing arms, Enlarged skull, labored/waddling gait, Kyphosis (hump back), Pathologic fractures
Diagnose: Unknown etiology, excessive bone resorption (loss), Occurs more in older adults.
1. Administer analgesics,
2. Encourage rest
3. Prevent Pathological Fractures
4. Administer meds: Calcitonin (Miacalcin), biphosphonates ex. Alendronate (Fosamax); pamidronate (Aredia)
Data:Pain due to inflammation
Decreased mobility, especially on abduction.
Diagnose:Inflammation of connective tissue sac between muscles, tendons, and bone, particularly affecting shoulder, elbow, and knee.
2. Immobilize affected joint with pillows, splints, slings.
3. Administer pain medication, muscle relaxants (Valum), steroids.
4. Apply heat/cold packs to decrease swelling.
5. Promote exercise (ROM)
6. Assist in performance of ADL (Activities of Daily Living) by modifying activities relative to limitations.
7. Assist with cortisone injection, draining of bursae.
Softening of the bones due to a lack of vitamin D or a problem with the body's ability to break down and use this vitamin.
Data: Bone pain and tenderness, Muscle weakness, bowed legs, Kyphosis, X-ray (porous bones).
Decalcification of bones due to inadequate intake of Vit D, absence of exposure to sunlight, or intestinal malabsorption, chronic kidney disease/
1. Administeration of analgesics
2. Increase sun exposure
3. Reinforce about Vit D foods (milk, eggs, Vitamin D enriched cereal/bread)
4. Administer Vitamin D, calcium, and expose to sunlight and/or ultraviolet irradiation.
5. Assist with performance of ADL to prevent pathological fractures.
Occulta: no Tx
Meningocele/myelomeningocele: Surgical repair at 24-48 hours.
Observe for irritation, CSF leakage and signs of infection, hydrocephalus.
Maintain optimum asepsis; cover lesion with MOIST sterile dressing.
Position patient on ABD or semiprone (on side, top knee up) with sandbags.
Provide optimum skin care, especially to perineal area.
Check for ABN movement of extremities, absent or ABN reflexes, incontinence, fecal impction, flaccid paralysis of lower extremities.
Observe for increased intracranial pressure (h/a, changes of LOC, motor functions, and vital signs).
Observe for symptoms of meningeal irritation or meningitis.
Provide frequent sources of stimulation appropriate for child's age level.
Provide postoperative care - vertebral fusion or surgical repair.
Focus postoperative observation on detecting signs of meningitis, shock, increased intracranial pressure, and respiratory difficulty.
Foster parental bonding.
Reinforce family teaching on how to care for child at home.
Discuss with family referral for PT, orthopedic procedures, bladder and bowel management.
*a loss or deficiency of motor control with involuntary spasms caused by permanent brain damage present at birth; poor control over muscles due to brain damage (cord wrapped around neck)
Athetosis (twisting movements), spasticity, rigidity, ataxia, atonicity; repetitive, involuntary, slow, gross movements.
Neonate:cannot hold head up, feeble cry, inablility to feed, body noticeably arched or limp.
Infant: failure-to-thrive syndrome.
Toddler/preschooler: mental retardation, delayed physical development.
Voluntary muscles poorly controlled due to brain damage.
Predisposition:prematurity, existing prenatal brain abnormalities, trauma, axnoia, or infection at time of birth.
Tx: Ambulation devices, surgical lengthening of heel cord to promote stability and function. Assist with feeding, place food at back of mouth or on either side of tongue toward cheek, apply slight downward pressure with the spoon. NEVER TILT HEAD BACKWARD WHEN FEEDING, High calorie diet.
Medications:muscle relaxants, tranquilizers, anticonvulsants, baclofen (lioresal) intrathecal pump.
A chronic progressive nervous disorder involving loss of myelin sheath around certain nerve fibers.
Analysis: Demyelination of white matter throughout brain and spinal cord.
Chronic and Progressive
Leads to paraplegia or complete paralysis
Early: Vision, motor sensation changes
Late: Cognitive and bowel changes, muscular incoordination, ataxia, spasticity, intention tremors, nystagmus, chewing and swallowing difficulties, impaires speech. Incontinence, emotional instability, sexual dysfunction.
Tongue fatigue, atrophy with fasciculation (brief muscle twitching)
Nasal quality to speech, dysarthria (difficulty saying words), Dysphagia, aspiration
Progressive muscular wasting, atrophy, spasticity, weakness -usually begins in upper extremities, distal portion affected first, fasciculations.
Emotional lability (b/c death is outcome), cognitive dysfunction
Respiratory insufficiency (usual cause of death)
No alteration in autonomic, sensory, or mental function.
hyperoxygenate, deep breath, suction trach tube, remove dressing, open kit, sterile gloves, remove inner canula, clean canula withperoxide, rinse sterile H2O, change ties, keep old in place, sterile dressing depression/temper outbursts; Choreiform movts, restlessness, facial grimacing, arm movts, irrefular leg movts, twisting, turning, tongue movts., person is in constant motion by end of disease progression. Paranoia, demanding, memory loss, dementia, psychosis seen at end stage