Other topics - Semi-Finals

Responses to Altered Perception

Neurological Disturbance
a. degenerative:
 -Multiple Sclerosis
 -Parkinson’s Disease
 -Myasthenia Gravis
 MULTIPLE
SCLEROSIS
 Multiple Sclerosis

Sclerosis - ?
 Multiple Sclerosis
Sclerosis - in medicine it refers
to the stiffening or hardening of
a tissue or anatomical feature,
often caused by the replacement
of normal tissue with scar-like
connective tissue
 Multiple Sclerosis
MS) is a chronic condition
unpredictable disease of the central
nervous system where the immune
system mistakenly attacks nerve
fibers' protective covering myelin
sheath), leading to various
neurological symptoms.
 Multiple Sclerosis
MS is an autoimmune disease that
affects the Myelin Sheath of the
neurons nerves) in the CNS brain
and spinal cord)
 Multiple Sclerosis - pathophysiology

The neuron which is attack

become inflamed and result to
scarring of the neuron
 Multiple Sclerosis - pathophysiology

Inflamed neurons will result in a

decrease in nerve signal
transmission
This will lead to motor and
sensory symptoms
 Multiple Sclerosis - facts
Immune related – immune cells
going to the CNS and attack the
myelin sheath
Note: myelin sheath protects the
axons in our neurons and axons are
responsible for the transmission of
electrical signals to other neurons
 Multiple Sclerosis - facts
Symptoms vary – this is so
because of its effects in the CNS
Example: cerebellar area: Sx are
tremors, dysarthria issues in
articulating speech), ataxia
balance), cognitive
 Multiple Sclerosis - facts
Different forms
Relapsing-remitting MS most
common)
 on and off
Affects women 20-40 yrs.
 Multiple Sclerosis – cause & cure and
management
Unknown
No cure
Can be managed by:
1. improved lifestyle like exercise
2. Medications prescribed) to
improve symptoms
 Multiple Sclerosis – diagnosis
How to diagnose?
Diagnosing takes time
Neurologist has to assess various
things.
The signs and symptoms should
rule out other diseases
 Multiple Sclerosis – diagnosis
2. MRI magnetic resonance
imaging) of the brain and spinal
cord; to look for inflammation and
scarring of the neuron
3. Lumbar puncture
 Multiple Sclerosis – diagnosis
3. Lumbar puncture – CSF
 to look for the presence of
oligoclonal bands OCBs), specifically
IgG oligoclonal bands IgG OCBs), in
the cerebrospinal fluid CSF)
- a significant indicator, detected in
nearly 90% of MS patients
– which explains of inflammation in the
CNS
 Multiple Sclerosis – diagnosis
4. Evoked potential study
 measures electrical activity in the
brain in response to stimulation of
sight, sound, or touch.
When the brain is stimulated by
sight, sound, or touch, signals
travel along the nerves to the brain.
 Multiple Sclerosis – diagnosis
Difference between Evoked
potential study and EEG
electroencephalogram)
 EEG measures and records our
brain's electrical signals as they
naturally happen. While
Evoked potential tests measure
how quickly your nerves respond to
certain stimulation.
 Multiple Sclerosis – signs and symptoms
Emotion and cognitive
Drained fatigued)
Depressed
Speech issues dysarthria)
Dysphagia
Mood swings 9easily be happy and
switch to sadness)
Trouble – thinking focus, problem
solving
 Multiple Sclerosis – signs and symptoms
sensation
Tremors
Spasm - very painful)
Clumsy
Numbness tingling sensation)
in the face and extremities
 Dizziness, vertigo
 Multiple Sclerosis – signs and symptoms

sensation
Coordination issues
Romberg’s sign balance while
standing with feet together and
eyes closed)
 Multiple Sclerosis – signs and symptoms

Lhermitte’s sign
As the patients move the head
in various motions, they can
experience an electric shock
sensation in their body
 Multiple Sclerosis – signs and symptoms
vision
Nystagmus - involuntary movement of
the eyes
Optic neuritis – inflamed optic nerve
- Double vision
- Blurry
- Dull/gray vision
- Pain in moving the eyes
- Dark spots vision
 Multiple Sclerosis – signs and symptoms
elimination
Can’t hold urine
-Nocturia
- Overactive bladder
Problems with contracting to void
– retention
Bowel – constipation or diarrhea
Can’t hold stool
 Multiple Sclerosis – signs and symptoms

Uhthoff’s sign
Heat makes the signs and
symptoms worse
 Multiple Sclerosis – nursing interventions

Safety
Issues in vision, coordination,
decreased perception of pain,
bowel/bladder how to educate),
RRMS prevention, meds
 Multiple Sclerosis – nursing interventions
Safety
Prevention of RRMS Relapsing-
remitting multiple sclerosis with
common issues:
 Fatigue, numbness or tingling, vision
problems, difficulty with balance and
coordination, and cognitive
difficulties, often occurring in relapses
followed by period of remission
 Multiple Sclerosis – nursing interventions

Safety
medication
 Multiple Sclerosis – nursing interventions

Prevent increase in S/Sx

 avoid exposure to too much
heat
Avoid stress
Protect from infection
Avoid overexertion
 Multiple Sclerosis – nursing interventions

Prevent increase in S/Sx

Avoid overexertion
Exercise is very important to
increase energy and decrease
depression, but do not overdo it
 Multiple Sclerosis – nursing interventions

Assistive devises
Like shower chair
 Clutter-free environment
Scanning the environment
before walking or getting out of
bed
 Multiple Sclerosis – nursing interventions

Sppech language pathologist and

physiotherapies & support groups
 Multiple Sclerosis – nursing interventions
Easy access to the bathroom
Self-catheterization
1-2 L fluid
Skin care
Increase fiber
Stool softener
Skin care
 Multiple Sclerosis – medications
Beta interferon – decreases the
number of relapses of symptoms by
decreasing the inflammation and
the immune response
Risk of infection because it
decreases WBCs
- Drugs: Avonex interferon beta 1a),
Rebif, Betaferon
 Multiple Sclerosis – medications

Corticosteroids – for relapses of

MS symptoms
- Decease MS symptoms
- Drugs: methylprednisolone,
prednisone
 Multiple Sclerosis – medications

Bladder issues
Drugs:
Oxybutynin – an anticholinergic
that helps with overactive
bladder by relaxing the bladder
muscle to prevent contraction
 Multiple Sclerosis – medications

Bladder issues
Drugs:
bethanechol–cholinergic that
helps with emptying the bladder
by helping with bladder
contraction
 Multiple Sclerosis – medications

Fatigue
Drugs:
Amanthadine – antiviral &
antiparkinsonian) has CNS
effects that helps improve fatigue
in patients with MS
 Multiple Sclerosis – medications

Fatigue
Drugs:
Modafinil – CNS stimulant
 Multiple Sclerosis – medications

Spasm
Drugs:
baclofen– skeletal muscle
relaxant that acts centrally
 Multiple Sclerosis – medications

Spasm
Drugs:
Diazepam
 Multiple Sclerosis – medications

tremors
Drugs:
Propranolol – beta blocker
Isoniazid – an antibiotic used for
infections, especially TB
- Helps certain tremors
PAR K I N S O N
DI S E A S E
 PARKINSON DISEASE

•IS A DISEASE THAT AFFECTS

MOVEMENT
 PARKINSON DISEASE - PATHO
•THE DOPAMINERGIC NEURON STARTS
TO DIE IN THE SUBSTANCIA NIGRA
WHICH IS LOCATED IN THE GANGLIA OF
THE BRAIN (PART OF THE BRAIN STEM)
THAT CONTROLS OUR MOVEMENT
•THE DOPAMINERGIC NEURONS RELEASE
THE NEUROTRANSMITTER DOPAMINE
PARKINSON DISEASE - PATHO
•NOTE: THE DOPAMINERGIC NEURONS
RELEASE THE NEUROTRANSMITTER
DOPAMINE
•SO IF THE DOPAMINERGIC NEURONS
STARTED TO DIE , THERE IS LESS RELEASE
OF DOPAMINE
 PARKINSON DISEASE - PATHO
•NOTE: THE DOPAMINE
NEUROTRANSMITTER PROVIDES
US WITH ACCURACY WITH
MOVEMENT
 PARKINSON DISEASE - PATHO
• NOTE: WHAT HAPPENING IS IN PARKINSON?
• ACETYLCHOLINE (EXCITATORY NEUROTRANSMITTER
THAT CAUSES CHOLINERGIC ACTIVITY – THE
SYMPATHETIC VS PARASYMPATHETIC ACTIVITY) AND
DOPAMINE(HAS AN INHIBITORY PROPERTY )
• IF DOPAMINE IS LESS, THE BALANCE
OF THE BODY’S
MOVEMENT IS AFFECTED. THERE IS NOW THE
OVERSTIMULATION OF THE NEURONS THAT CAUSES
TREMORS, RIGIDITY
PARKINSON DISEASE - PATHO
•NOTE: WHAT IS HAPPENING IN
PARKINSON?
•
IF DOPAMINE IS LESS, THE BALANCE OF
THE BODY’S MOVEMENT IS AFFECTED.
THERE IS NOW THE OVERSTIMULATION OF
THE NEURONS THAT CAUSES TREMORS,
RIGIDITY
 PARKINSON DISEASE – RISK
FACTOR AND CURE
•AGE-RELATED – 65 AND ABOVE BUT CAN
ALSO AFFECT YOUNG PEOPLE
•GENETIC ISSUES – NOT CLEAR
•
NO CURE, BUT MEDICATIONS LIKE
CHOLINERGIC DRUGS ARE PRESCRIBED
TO DECREASE SIGNS AND SYMPTOMS
 PARKINSON DISEASE – SIGNS
AND SYMPTOMS
• SUBTLE AND VARY FROM PATIENT TO
PATIENT
•
AS TIME GOES ON, THE S/SX BECOME WORSE
OVER TIME
•
MAY START IN ONE SIDE OF THE BODY AND
ONE EXTREMITY AND AS TIME GOES ON S/SX
PROGRESSES
 PARKINSON DISEASE – SIGNS
AND SYMPTOMS CAUSES
COMMON S/SX EXPERIENCED WITH THE DISEASE:
•TREMORS THAT OCCUR AT REST. THEY CAN
OCCUR AT THE HANDS, ARMS, LEGS, LIPS,
TONGUE
•TREMORS OF FINGERS AND HAND ARE CALLED
PILL-ROLLING (LIKE ROLLING A PILL WITH THE
FINGER)
 PARKINSON DISEASE – SIGNS
AND SYMPTOMS CAUSES
• TREMORS TEND TO IMPROVE WITH
PURPOSEFUL MOVEMENT AND ARE
WORSE WHEN RESTING
•
STIFFNESS OF EXTREMITIES.
- WHEN WALKING THE ARMS DO NOT
SWAY BUT STAY AT SIDES
 PARKINSON DISEASE – SIGNS
AND SYMPTOMS CAUSES
• AKINESIA – LOSS THE ABILITY TO DO
MUSCLE MOVEMENT VOLUNTARILY
* THEY CAN BE WALKING AND SUDDENLY
FREEZE UP; FEELS LIKE THEIR FEET ARE
STUCK ON THE GROUND, AND THEY CANNOT
MOVE
 PARKINSON DISEASE – SIGNS
AND SYMPTOMS CAUSES
• STIFFNESS OF EXTREMITIES CAUSES SHUFFLING
OF GAIT – PATIENTS DO NOT PICK UP THEIR FEET
WELL AS THEY WALK. AS THEY WALK, THEY
BEND A LITTLE BIT FORWARD
• COGWHEEL RIGIDITY – MOVING ARMS PASSIVELY
TOWARD THE BODY
 PARKINSON DISEASE – SIGNS
AND SYMPTOMS CAUSES
• STIFFNESS OF EXTREMITIES CAUSES SHUFFLING
OF GAIT – PATIENTS DO NOT PICK UP THEIR FEET
WELL AS THEY WALK. AS THEY WALK, THEY
BEND A LITTLE BIT FORWARD
• COGWHEEL RIGIDITY – MOVING ARMS PASSIVELY
TOWARD THE BODY
 PARKINSON DISEASE – SIGNS
AND SYMPTOMS CAUSES
• BRADYKINESIA –SLOW
* SWALLOWING ISSUES: DROOLING
* EXPRESSIONLESS FACE – “MASK-LIKE
*CHEWING ISSUES
* SPEECH – SOFT/SLURRED
 8 BASIC PATHOLOGIC GAITS
1. HEMIPLEGIC,
2. SPASTIC DIPLEGIC,
3. NEUROPATHIC,
4. MYOPATHIC, ATTRIBUTED TO
5. PARKINSONIAN,
NEUROLOGICAL
CONDITIONS
6. CHOREIFORM,
7. ATAXIC (CEREBELLAR)
8. SENSORY.
 TYPES OF ABNORMAL GAITS
1. ANTALGIC GAIT
2. ATAXIC GAIT
3. NEUROPATHIC GAIT
4. STEPPAGE GAIT
5. SPASTIC GAIT
6. SCISSOR GAIT
7. PARKINSONIAN GAIT
8. TRENDELENBURG GAIT
1. WADDLING GAIT TYPES OF ABNORMAL
2. BIZARRE GAIT
GAITS
3. DIPLEGIC GAIT
4. MYOPATHIC GAIT
5. PROPULSIVE GAIT
6. LIMP
7. LURCHING GAIT
8. STIFF GAIT
9. HYPERKINETIC GAIT
10.PARAPARETIC GAIT
 PARKINSON DISEASE – SIGNS
AND SYMPTOMS CAUSES
• COORDINATION PROBLEMS: THEY STOOP TO
COMPENSATE
• NON-MOTOR S/SX :
*LOSS OF SMELL,
*CONSTIPATION,
*DEPRESSION
PARKINSON DISEASE – NURSING
INTERVENTIONS
AREAS OF FOCUS:
•SAFETY:
•PSYCHOSOCIAL:
•DIGESTION/NUTRITION
•MEDICATION SIDE EFFECTS AND EDUCATION
 PARKINSON DISEASE – NURSING
INTERVENTIONS
AREAS OF FOCUS:
•SAFETY:
BECAUSE OF BALANCE IN
MOVEMENT ISSUES
PARKINSON’S DISEASE – NURSING INTERVENTIONS
AREAS OF FOCUS:
•PSYCHOSOCIAL: CHALLENGES
 DISRUPTED RELATIONSHIPS,
 STIGMA,
 LONELINESS, AND MENTAL HEALTH
SEQUELAE, SUCH AS: ANXIETY,
DEPRESSION, AND DEMORALIZATION.
PARKINSON’S DISEASE – NURSING INTERVENTIONS
AREAS OF FOCUS:
• DIGESTIVE SYSTEM :
THE INVOLVEMENT OF THE AUTONOMIC NERVOUS
SYSTEM IN PARKINSON'S DISEASE CAUSES MANY
NON-MOTOR SYMPTOMS:
GASTROINTESTINAL COMPLAINTS ARE
PROMINENT:
 DROOLING (SALIVA FLOWING OUT OF YOUR
MOUTH UNINTENTIONALLY)
 PARKINSON’S DISEASE – NURSING INTERVENTIONS
AREAS OF FOCUS:
• DIGESTIVE SYSTEM :
GASTROINTESTINAL COMPLAINTS ARE PROMINENT:
DYSPEPSIA (PAIN OR BURNING IN THE STOMACH, BLOATING,
EXCESSIVE BELCHING OR NAUSEA AFTER EATING. AN EARLY
FEELING OF FULLNESS WHEN EATING
CONSTIPATION,
ABDOMINAL PAIN AND FECAL INCONTINENCE (INVOLUNTARY
LEAKAGE OF STOOL), WHICH IS ALSO DUE TO DISTRESS)
PARKINSON’S DISEASE – NURSING INTERVENTIONS

AREAS OF FOCUS:
• NUTRITION:
RESEARCH SUGGESTS THAT PEOPLE WITH PD
LACK COQ10, GLUTATHIONE, AND VITAMINS C
AND D.
 COENZYME Q10 AT DOSAGES OF 300–1,200 MG
DAILY MAY HAVE A POSITIVE IMPACT ON MOTOR
NEURON SYMPTOMS, FINGER DEXTERITY, VISUAL
COLOR ACUITY, AND INFLAMMATION.
PARKINSON’S DISEASE – NURSING INTERVENTIONS

COENZYME Q10 (COQ10) IS AN

ANTIOXIDANT THAT YOUR BODY
PRODUCES NATURALLY.
 YOUR CELLS USE COQ10 FOR
GROWTH AND MAINTENANCE.
 LEVELS OF COQ10 IN YOUR BODY
DECREASE AS YOU AGE.
PARKINSON’S DISEASE – NURSING INTERVENTIONS
FOODS HIGH IN COQ10:
ORGAN MEATS: KIDNEY, LIVER.
FATTY FISH: SARDINES, SALMON, TROUT, MACKEREL.
MEATS: CHICKEN, BEEF, PORK.
VEGETABLES: SPINACH, BROCCOLI, CAULIFLOWER.
FRUITS: STRAWBERRIES, ORANGES.
OILS: SOYBEAN AND CANOLA OILS.
LEGUMES: SOYBEANS, LENTILS, PEANUTS.
NUTS AND SEEDS: PISTACHIO, SESAME SEEDS.
MYASTHENIA
GRAVIS
 Myasthenia gravis (MG)

• is a chronic autoimmune disorder

in which antibodies destroy the
communication between nerves
and muscle, resulting in weakness
of the skeletal muscles
 Myasthenia gravis (MG)

- affects the voluntary muscles of

the body, especially those that
control the eyes, mouth, throat,
and limbs.
 Myasthenia gravis (MG) – RISK
FACTORS
- strikes anyone at any age,
- more frequently seen in young
women (age 20 and 30) and men
aged 50 and older.
 Myasthenia gravis (MG) – cause & cure

- The cause is unknown

- not inherited, and it is not contagious.
- There is no cure,
- Early detection and prompt medical
management can help people live
longer, more functional lives.
 Myasthenia gravis (MG) – cause & cure

- A temporary form of myasthenia

gravis may develop in the fetus
when a woman with myasthenia
gravis passes the antibodies to the
fetus. Generally, it resolves in 2 to 3
months.
 Myasthenia gravis (MG) –
pathophysiology
- It generally develops later in life
when antibodies in the body attack
normal receptors on muscle.
- This blocks a chemical needed to
stimulate muscle contraction.
 Myasthenia gravis (MG) – Sign &
symptoms
- involve difficulty in swallowing
or breathing.
 Myasthenia gravis (MG) – Sign &
symptoms
- Visual problems, including drooping
eyelids (ptosis) and double vision
(diplopia)
- Muscle weakness and fatigue may vary
rapidly in intensity over days or even
hours and worsen as muscles are used
(early fatigue)
PTOSIS
 Myasthenia gravis (MG) – Sign &
symptoms
- Facial muscle involvement causing a
mask-like appearance; a smile may
appear more like a snarl
- Trouble swallowing or pronouncing
words
- Weakness of the neck or limbs
 Mask-like appearance of the face
- a reduced degree of facial
expression
 Myasthenia gravis (MG) – diagnostic
test
1. To test how the patient respond to
certain medicines.
Muscle weakness often dramatically
improves for a brief time when the
patient is given an anticholinesterase
medicine. If there is a response to the
medicine, it confirms myasthenia
gravis.
 Myasthenia gravis (MG) – diagnostic
test
2. Blood tests.
These tests look for antibodies that
may be present in people with
myasthenia gravis.
 Myasthenia gravis (MG) – diagnostic
test
3. Genetic tests
. These tests are done to check for
conditions that run in families.
4. Nerve conduction studies. A test
called repetitive nerve stimulation is
used to diagnose myasthenia gravis.
 Myasthenia gravis (MG) – diagnostic
test
5. Electromyogram (EMG).
A test that measures the electrical
activity of a muscle. An EMG can
detect abnormal electrical muscle
activity due to diseases and
neuromuscular conditions
 Myasthenia gravis (MG) – treatment
basis
Age of the patient
Overall health and medical history
How sick the patient is
 Myasthenia gravis (MG) – treatment
basis

How well patient can handle specific

medicines, procedures, or therapies
How long the condition is expected to
last
Patient opinion or preference
 Myasthenia gravis (MG) – treatment
There is no cure for myasthenia
 Symptoms can often be controlled.
a lifelong medical condition.
Early detection is the key to
managing the condition.
 Myasthenia gravis (MG) – treatment
There is no cure for myasthenia
 Symptoms can often be controlled.
a lifelong medical condition.
Early detection is the key to
managing the condition.
 Myasthenia gravis (MG) – treatment
goal
goal of treatment is to increase
muscle function and prevent
swallowing and breathing problems.
 Myasthenia gravis (MG) – nursing
management
aim to improve muscle strength,
manage symptoms, and prevent
complications.
 Myasthenia gravis (MG) – nursing
management
Key areas of care :
monitoring muscle strength,
respiratory function, and swallowing
ability,
providing nutritional support, and
educating patients and their families on
medication management
crisis prevention
 Myasthenia gravis (MG) – nursing
management
Assessment and Monitoring:
Muscle Strength:
Regularly assess muscle strength, including the
onset, duration, and frequency of weakness, and
document any changes.
Respiratory Function:
Monitor respiratory rate, depth, effort, breathing
pattern, breath sounds, and oxygen saturation,
reporting any concerning findings like respiratory
distress or hypoxemia.
 Myasthenia gravis (MG) – nursing
management
Assessment and Monitoring:
Swallowing Ability:
Assess swallowing ability and
implement aspiration precautions, as
dysphagia is common in MG.
 Myasthenia gravis (MG) – nursing
management
Assessment and Monitoring:
Fatigue:
Recognize and address fatigue, as it
can exacerbate symptoms and
potentially lead to crises.
 Myasthenia gravis (MG) – nursing
management
Interventions:
Nutritional Support:
Provide small, frequent meals; soft
foods; and high-calorie snacks to
manage dysphagia and maintain
adequate nutrition.
 Myasthenia gravis (MG) – nursing
management
Interventions:
Respiratory Support:
Ensure access to suctioning and emergency
equipment, as respiratory failure is a potential
complication.
Medication Management:
Administer prescribed medications, including
anticholinesterase drugs, as per the doctor's
orders and monitor for potential side effects.
 Myasthenia gravis (MG) – nursing
management
Interventions:
Activity Management:
Encourage rest to reduce fatigue and prevent crises,
while planning short activities that coincide with
times of maximal muscle strength.
Crisis Management:
Be prepared to manage both myasthenic and
cholinergic crises, recognizing the signs and
symptoms of each and taking appropriate actions.
 Myasthenia gravis (MG) – nursing
management
Interventions:
Patient Education:
Educate patients and families about MG, its
management, medication compliance, potential
triggers (infections, stress), and how to recognize
and prevent crises.
Support:
Offer emotional support to patients and their
families, as living with a chronic condition can be
challenging.
 Myasthenia gravis (MG) – nursing
management
Interventions:
Eye Care:
Provide artificial tears during the day and consider using
an eye patch to prevent corneal damage if ptosis
(drooping eyelid) or other eye problems are present.
Thymectomy:
If the patient is undergoing or has undergone
thymectomy (removal of the thymus gland), be prepared
for potential temporary exacerbation of MG symptoms.
 Myasthenia gravis (MG) –
The thymus gland is significantly related to
myasthenia gravis (MG), an autoimmune disorder
affecting neuromuscular transmission.
In many individuals with MG, the thymus exhibits
abnormalities, including hyperplasia (overgrowth) or
the presence of thymomas (tumors), which can trigger
or maintain the production of autoantibodies that
attack the acetylcholine receptors at the
neuromuscular junction, leading to muscle weakness.
Responses to Altered
Coordination
1. Injuries
- Fracture
- Motor Vehicle Collision
- Sports Injury
2. Joint Disorders
- osteoarthritis
- gout
- carpal tunnel syndrome
- low back pain
3. Degenerative
- osteoporosis
 BONE FRACTURE

• A fracture is a partial or
complete break in the bone.
 BONE FRACTURE – Types depending on
criteria
• Pattern: A fracture pattern is the
medical term for the shape of a
break or what it looks like.
• Cause: Some fractures are classified
by how they happen.
• Body part: Where in your body your
broke a bone.
 BONE FRACTURE – Types depending on
criteria
Fractures that have a single straight-line
break include:
• Oblique fractures.
• Transverse fractures.
• Longitudinal fractures (breaks that
happen along the length of the bone).
• Fracture patterns that don’t break your
bone in a single straight line include:
 BONE FRACTURE – Types depending on
criteria
Fracture patterns that don’t break
your bone in a single straight line
include:
• Greenstick fractures.
• Comminuted fractures.
• Segmental fractures.
• Spiral fractures.
 BONE FRACTURE – Types depending on
criteria
Fractures diagnosed by cause:
• Stress fractures (a fatigue-induced
bone fracture caused by repeated
stress over time).
• often occur in the foot after training
for basketball, running, and other
sports.
 BONE FRACTURE – Types depending on
criteria
Fractures diagnosed by cause:
• Avulsion fractures.(A piece of bone
attached to a ligament or tendon
breaks away from the main part of
the bone)
bones that are most at-risk of an
avulsion fracture include:
 BONE FRACTURE – Types depending on
criteria
Bones that are most at-risk of an
avulsion fracture include:
 Elbow bones.
 Ankle and foot bones.
 Knee bones.
 Finger and wrist bones.
 Pelvis and hip bones.
 Spine bones.
avulsion
 BONE FRACTURE – Types depending on
criteria
Fractures diagnosed by cause:
• Buckle fractures (sometimes referred
to as torus or impacted fractures).
 BONE FRACTURE – Types depending on
criteria
Fractures that affect people’s chest, arms,
and upper body include:
Clavicle fractures (broken collarbones).
Shoulder fractures.
Humerus (upper arm bone) fractures.
Elbow fractures.
Rib fractures.
Compression fractures.
Facial fractures.
 BONE FRACTURE – Types depending on
criteria
Fractures that damage the bones in your lower
body and legs include:
Pelvic fractures.
Acetabular fractures.
Hip fractures.
Femur fractures.
Patella fractures.
Growth plate fractures.
Tibia (your shin bone) and fibula (your calf bone)
fractures.
 BONE FRACTURE – Types depending on
Fractures that affectcriteria
your feet and ankles are
more likely to have complications like nonunion.
They include:
Calcaneal stress fractures.
Fifth metatarsal fractures.
Jones fractures.
Lisfranc fractures.
Talus fractures.
Trimalleolar fractures.
Pilon fractures.
Open vs. closed fractures
 BONE FRACTURE - CAUSES
• falls
• Injuries like sports injuries and accidents
• because of a direct hit or kick to the body.
• Overuse or repetitive motions that cause
stress fractures
• diseases that weaken the bone
(osteoporosis)
 BONE FRACTURE - symptoms
• Pain.
• Swelling.
• Tenderness.
• Inability to move a part of your body like
you usually can.
• Bruising or discoloration.
• A deformity or bump that’s not usually
on your body.
 BONE FRACTURE - complications
1. Infection:
• Monitor for signs and symptoms of
infection (fever, redness, swelling,
pain, purulent drainage) and
administer antibiotics as prescribed.
 BONE FRACTURE - complications
2. Neurovascular Compromise:
• Regularly assess circulation and
sensation in the affected limb to
detect any signs of nerve or blood
vessel damage.
 BONE FRACTURE - complications
3. Deep Vein Thrombosis (DVT):
• Encourage early mobilization and
administer anti-coagulants as
prescribed to prevent DVTs.
 BONE FRACTURE – diagnostic test
• X-rays: An X-ray will confirm any fractures
and show how damaged your bones are.
• Magnetic Resonance Imaging (MRI): to get
a complete picture of the damage to the
bones and the area around them. An MRI
will show tissue like cartilage and
ligaments around the bones, too.
• CT scan: gives a more detailed picture of
the bones and the surrounding tissue than
an X-ray.
 BONE FRACTURE – management and
treatment
1. Immobilization with
 splint,
cast,
For 3-8 weeks
 BONE FRACTURE – management and
treatment
2. Closed reduction
For more severe breaks to set
(realign) your bones.
During this non-surgical procedure,
the surgeon will physically push and
pull the body on the outside to line up
your broken bones inside.
 BONE FRACTURE – management and
treatment
2. Closed reduction
Management during the procedure:
a. Local anesthetic to numb the area around
the fracture.
b. Sedatives to relax your whole body.
c. General anesthesia to make you sleep
through the procedure.
d. Post-care: splint & cast
 BONE FRACTURE – management and treatment
3. Bone fracture surgery
a. Internal fixation – (the surgeon inserts pieces of
metal into the bone to hold it in place while it heals).
 The technique includes:ORIF (Open Reduction and Internal
Fixation)
Rods: A rod inserted through the center of the bone
that runs from top-to-bottom.
 Plates and screws: Metal plates screwed into your bone to hold
the pieces together in place.
 Pins and wires: Pins and wires hold pieces of bone in place that
are too small for other fasteners. They’re typically used at the
same time as either rods or plates.
 BONE FRACTURE – management and treatment
3. Bone fracture surgery
b. External fixation – the surgeon will put
screws in the bone on either side of the
fracture inside the body then connect
them to a brace or bracket around the
bone outside the body.
This is usually a temporary way to
stabilize the fracture and give it time to
begin healing before the internal fixation.
 BONE FRACTURE – management and treatment
3. Bone fracture surgery
c. Arthroplasty– the surgeon will remove
the damaged joint and replace it with an
artificial joint.
The artificial joint (prosthesis) can be
metal, ceramic, or heavy-duty plastic.
The new joint will look like the natural
joint and move similarly.
 BONE FRACTURE – management and treatment
3. Bone fracture surgery
d. Bone grafting– the surgeon will
insert additional bone tissue to rejoin
the fractured bone. Done in severely
displaced bone or when sn’t healing
back together as well as it should.
 BONE FRACTURE – management and treatment
3. Bone fracture surgery
d. Bone graft sources:
Internally from somewhere else in
the body — usually the top of the hip
bone.
An external donor.
An artificial replacement piece.
 BONE FRACTURE – management and treatment
4. pharmacological
NSAIDs
 Side effects:
Bleeding.
Ulcers.
Stomach pain
Bowel complications.
 Complications of bone fracture treatment
Acute compartment syndrome (ACS): A
build-up of pressure in the muscles may
stop blood from getting to tissue, which can
cause permanent muscle and nerve
damage.
Malunion: This happens when your broken
bones don’t line up correctly while they
heal.
Nonunion: Your bones may not grow back
together fully or at all.
 Complications of bone fracture treatment
Bone infection (osteomyelitis): open
fracture (the bone breaks through the
skin) causes an increased risk of
bacterial infection.
Other internal damage: Fractures can
damage the area around the injury
including the muscles, nerves, blood
vessels, tendons, and ligaments.
 BONE FRACTURE - main goal of
treatment
• to put the pieces of bone back in place
so the bone can heal.
• This can be done with:
 splint,
cast,
surgery, or
traction.
 BONE FRACTURE – nursing assessment
Pain Assessment:
1. Regularly assess the patient's pain
level and administer pain medication as
prescribed.
2. "5 P's" (pain, pulse, pallor,
paresthesia, and paralysis), check level
of consciousness and temperature, and
ensure proper fit and function of casts,
splints, and traction equipment.
BONE FRACTURE – nursing assessment
2. Neurovascular Assessment:
Monitor for signs of neurovascular
compromise, such as:
 decreased pulses,
numbness,
tingling,
coolness, especially distal to the
fracture.
BONE FRACTURE – nursing assessment
3. Fracture Assessment: Check the
immobilization device (cast, splint,
traction) for proper placement and
alignment, and monitor for signs of
pressure or irritation.
4. Infection Assessment: Monitor for
signs of infection, such as redness,
swelling, warmth, pain, or drainage,
especially with open fractures.
BONE FRACTURE – nursing assessment

5. Psychosocial Assessment: Assess

the patient's anxiety, fear, and coping
mechanisms, and provide support and
education.
 BONE FRACTURE – nursing interventions
2. Immobilization:
Maintain the fracture immobilization
device as prescribed, and educate
the patient on proper care. ,
 BONE FRACTURE – nursing interventions
3. Prevent Complications:
a. Infection:
Monitor for signs of infection.
Provide wound care as needed for
open fractures.
administer antibiotics as prescribed.
 BONE FRACTURE – nursing interventions
3. Prevent Complications:
b. Thromboembolism:
Encourage early ambulation and
movement
administer anticoagulants as
prescribed to prevent blood clots.
 BONE FRACTURE – nursing interventions
3. Prevent Complications:
c. Pressure Ulcers: Monitor skin
integrity and perform skin care,
especially in immobilized patients.
d. Muscle Atrophy: Encourage
isometric exercises and physical
therapy as prescribed to prevent
muscle weakness.
 BONE FRACTURE – nursing interventions
4. Promote Healing:
a. Nutrition: Provide a high-protein diet to
support bone healing.
b. Hydration: Encourage adequate fluid
intake to prevent constipation.
c. Rest and Activity: Balance rest with
appropriate activity to promote healing
and prevent complications.
 BONE FRACTURE – nursing interventions
5. Psychosocial Support: Provide
emotional support, education, and
referrals as needed to address anxiety,
fear, and coping mechanisms.
6. Patient Education:
Fracture Care: Educate the patient on
proper care of the fracture immobilization
device, wound care (if applicable), and
signs of complications.
 nursing interventions: Fracture Care:
a. Medications: Explain the purpose, dosage,
and potential side effects of medications.
b. Activity Restrictions: Explain activity
restrictions and the importance of avoiding
activities that could cause further injury.
c. Rehabilitation: Educate the patient on the
importance of physical therapy and
rehabilitation exercises to regain function
and mobility.
 nursing interventions: Fracture Care:
Rib Fractures:
Monitor respiratory status, encourage
coughing and deep breathing
exercises, and provide pain
management to prevent complications
like pneumonia.
 nursing interventions: Fracture Care:
Ankle Fractures:
Provide education on proper fitting of
casts or splints, and monitor for signs
of compartment syndrome.
 nursing interventions: Fracture Care:
Hip Fractures:
Address potential complications such
as DVT, infection, and pneumonia, and
provide education on mobility and
assistive devices.
 nursing interventions: Fracture Care:
Pediatric Fractures:
Use age-appropriate explanations and
techniques, and involve parents or
caregivers in the care plan.
BONE FRACTURE – nursing interventions to
prevent fracures
1. EDUCATION:
• Always wear a seatbelt.
• Wear the right protective equipment for all
activities and sports.
• Make sure the home and workspace are
free from clutter that could trip you or
others.
• Use a cane or walker for difficulty in
walking or have an increased risk for falls.
 BONE FRACTURE – nursing management
1. EDUCATION:
• Always use the proper tools or equipment at
home to reach things. Never stand on
chairs, tables, or countertops.
• Follow a diet and exercise plan that will
help you maintain good bone health.
• Submit for a bone density test for ages 50
and above or if you have a family history of
osteoporosis.
 BONE FRACTURE – nursing management
2. Focus on pain relief,
3. Ensure proper immobilization,
4. Prevent complications like
infection, and
5. promote healing through adequate
nutrition and rehabilitation.
 ASSISTIVE DEVICES
• Assistive devices for fractures primarily focus on
weight-bearing support, balance, and stability to
aid in mobility during recovery.
• Common devices include crutches, canes, and
walkers. These devices help reduce stress on
the injured limb and assist with activities of daily
living
 Types of Assistive Devices for Fractures:
Crutches:
• Provide support and weight-bearing assistance,
especially for lower limb fractures
Canes:
• Offer a smaller level of support than crutches,
primarily for balance and stability
 Types of Assistive Devices for Fractures:
Walkers:
 Provide more stability than canes and are often
recommended for individuals with significant balance
issues or lower limb weakness.
Wheelchairs:
 Used for individuals with limited mobility or inability to
walk, especially for extended recovery periods.
 Types of Assistive Devices for Fractures:
Forearm Crutches:
 Offer increased freedom of movement compared
to traditional crutches, often preferred for long-
term use.
 Purpose of Assistive Devices:
Weight Bearing: - Reduce stress on the injured
limb during weight-bearing activities.
Balance and Stability: - Improve balance and
reduce the risk of falls.
Mobility and Independence: - Enable individuals to
perform daily activities more safely and
independently.
Assistive Devices:
 carpal tunnel
syndrome
 Carpal tunnel syndrome

• is a condition caused by compression of the

median nerve as it passes through the carpal
tunnel in the wrist.
• This compression can lead to pain, numbness,
tingling, and sometimes weakness in the hand
and fingers, particularly the thumb, index, and
middle fingers.
 Carpal tunnel syndrome - causes
• Swelling or inflammation.
• Repetitive strain:
• Repeated wrist movements or awkward hand
positions
• Underlying medical conditions - Conditions like
arthritis, diabetes, and thyroid problems
• Trauma - Injuries to the wrist, such as fractures or
dislocations,
 signs & Symptoms
• Numbness and tingling: Often felt in the fingers,
particularly the thumb, index, and middle fingers.
• Pain: May be felt in the wrist, hand, or fingers,
and can sometimes radiate up the forearm.
• Weakness: May make it difficult to hold or grip
objects.
• Nighttime symptoms: Symptoms are often worse
at night and can wake people up.
 carpal tunnel syndrome -Diagnosing

physical examination
nerve conduction studies,
 Carpal tunnel syndrome – management &
treatment
Non-surgical:
 Wrist splints: Can help keep the wrist in a neutral position
and reduce pressure on the nerve.
 Pain relievers: Over-the-counter or prescription pain
medications can help manage pain.
 Corticosteroid injections: Can reduce inflammation and pain.
 Physical therapy: Exercises and stretches can help improve
wrist and hand strength and flexibility.
 Lifestyle modifications: Adjusting activities, ergonomics, and
hand positions can help reduce pressure on the nerve.
 Carpal tunnel syndrome – management &
treatment
Surgical
Carpal tunnel release: Surgical procedure to relieve
pressure on the median nerve by cutting the
transverse carpal ligament.
 nursing management

Diet – low purine diet

Exercises
Pain management
gout
 GOUT
• Gout is a common and complex form of arthritis.
• It's characterized by sudden, severe attacks of pain,
swelling, redness and tenderness in one or more
joints, most often in the big toe.
• An attack of gout can occur suddenly, often causing
the client to wake up in the middle of the night with
the sensation that the big toe is on fire.
• The affected joint is hot, swollen, and so tender that
even the weight of the bedsheet on it may seem
intolerable.
 GOUT

• Gout occurs when urate crystals accumulate in

the joint, causing the inflammation and intense
pain of a gout attack.
• Urate crystals can form when there is a high levels
of uric acid in the blood.
• The body produces uric acid when it breaks down
purines — substances that are found naturally in
your body.
 Sources of purine

• red meat and organ meats, such as liver.

• seafood includes anchovies, sardines, mussels,
scallops, trout and tuna.
• Alcoholic beverages, especially beer, and drinks
sweetened with fruit sugar (fructose) promote
higher levels of uric acid.
 Gout - pathophysiology
• Normally, uric acid dissolves in the blood and
passes through your kidneys into the urine.
• But sometimes either the body produces too
much uric acid or the kidneys excrete too little
uric acid.
• When this happens, uric acid can build up,
forming sharp, needlelike urate crystals in a joint
or surrounding tissue that cause pain,
inflammation, and swelling
 Gout – signs & Symptoms
• Intense joint pain.- usually affects the big toe, but it
can occur in any joint which include the ankles, knees,
elbows, wrists and fingers. The pain is likely to be
most severe within the first four to 12 hours after it
begins.
• Lingering discomfort. After the most severe pain
subsides, some joint discomfort may last from a few
days to a few weeks. Later attacks are likely to last
longer and affect more joints.
• Inflammation and redness. The affected joint or joints
become swollen, tender, warm and red.
 Gout- risk factors

Diet - diet rich in red meat and shellfish and

drinking beverages sweetened with fruit sugar
(fructose), Alcohol consumption, especially of
beer,
Weight - overweight, where the body produces
more uric acid, and the kidneys have a more
difficult time eliminating uric acid.
 Gout- risk factors
Medical conditions - untreated high blood
pressure and chronic conditions such as diabetes,
obesity, metabolic syndrome, and heart and
kidney diseases.
Certain medications - Low-dose aspirin and some
medications used to control hypertension —
including thiazide diuretics, angiotensin-
converting enzyme (ACE) inhibitors and beta
blockers
 Gout- risk factors
 Family history of gout
 Age and sex - occurs more often in men, primarily
because women tend to have lower uric acid levels. After
menopause, however, women's uric acid levels approach
those of men.
Men are also more likely to develop gout earlier — usually
between the ages of 30 and 50 — whereas women
generally develop signs and symptoms after menopause.
 Recent surgery or trauma. Experiencing recent surgery or
trauma can sometimes trigger a gout attack. In some
people, receiving a vaccination can trigger a gout flare.
 Gout- Complications
Recurrent gout.
Advanced gout - Untreated gout may cause
deposits of urate crystals to form under the skin
in nodules called tophi (TOE-fie).
Tophi can develop in several areas, such as your
fingers, hands, feet, elbows or Achilles tendons
along the backs of your ankles. Tophi usually
aren't painful, but they can become swollen and
tender during gout attacks.
Kidney stones.
 Osteoarthritis – Diagnosing

physical examination
serum uric acid test
 Osteoarthritis – nursing management

Diet – low purine diet

Exercises
Pain management
Safety,
Security and
Emergency
Preparedness
Safety, security, and emergency preparedness
involve taking proactive steps to protect individuals
and communities from harm before, during, and after
emergencies.
This includes planning for potential disasters,
developing response protocols, and ensuring
resources are available for timely and effective
assistance.
Safety, security, and emergency preparedness
are crucial for protecting individuals,
communities, and organizations from
harm. Safety focuses on preventing accidents
and hazards, while security focuses on protecting
assets and individuals from threats. Emergency
preparedness involves planning and taking steps
to minimize the impact of emergencies and
disasters.
Emergency preparedness and safety
management involves proactive measures
taken to prepare for and respond to potential
disasters, ensuring the safety and well-being of
individuals and communities.
It encompasses a range of activities, including
risk assessment, developing emergency plans,
conducting drills, and providing training.
 SAFETY
 Hazard Identification:

Identifying potential hazards in the

environment, both physical and social, is a
key step in ensuring safety.

Risk Assessment:
Evaluating the likelihood and severity
of potential hazards helps prioritize
safety efforts.

Prevention and Mitigation:
Implementing measures to prevent
accidents and reduce the impact of
hazards is essential.

Training and Education:
Educating individuals on safety
procedures and practices is vital for
fostering a safety-conscious culture.

Situational Awareness:
Being aware of your surroundings and
potential dangers helps individuals make
informed decisions and take appropriate
actions.
 SECURITY

Threat Assessment:
Identifying potential threats to individuals,
assets, and infrastructure is crucial for
security.

Access Control:
Implementing measures to restrict access
to sensitive areas and resources is a key
security function.

Surveillance and Monitoring:
Utilizing technology and personnel to
monitor activity and detect potential threats
helps enhance security.

Response Protocols:
Developing clear protocols for responding
to security incidents, such as active
shooter situations, is essential.

Physical Security:
Protecting physical infrastructure and
assets through measures like fencing,
alarms, and security personnel.
EMERGENCY PREPAREDNESS
Planning:
Developing comprehensive plans for
responding to various emergencies,
including natural disasters and man-
made incidents.

Training and Drills:
Conducting drills and training exercises
helps individuals and organizations
prepare for emergencies.

Communication:
Establishing clear communication
channels to disseminate information and
coordinate responses during an
emergency.

Resource Mobilization:
Having access to necessary resources,
such as emergency kits, first aid supplies,
and evacuation plans.

Recovery:
Developing plans for restoring normalcy
after an emergency, including damage
assessment and repair.

Specific Hazards:
Consider hazards like typhoons, floods,
earthquakes, fire, and potential terrorist
threats.
 Community Preparedness:


Participate in local emergency

preparedness programs and drills.

Individual Responsibility:
Develop a family emergency plan, have an
emergency kit, and know how to respond
to different emergencies.


Local Resources:
Familiarize yourself with local emergency
response systems and services.

Stay Informed:
Follow local news and emergency alerts
for up-to-date information.
Key Components of Emergency Preparedness
and Safety Management:
•Risk Assessment:
Identifying potential hazards and vulnerabilities within a
specific area or organization.
•Emergency Planning:
Developing detailed procedures for responding to
different types of emergencies, including
communication protocols, evacuation routes, and
resource allocation.
Key Components of Emergency Preparedness
And Safety Management:
•Training and Drills:
Equipping individuals with the knowledge and skills
needed to respond effectively to emergencies, and
practicing these plans through simulated exercises.
•Communication:
Establishing clear communication channels to inform
the public and emergency responders about potential
hazards, emergency alerts, and safety instructions.
Key Components of Emergency Preparedness
And Safety Management:
•Resource Management:
Identifying and securing the necessary resources to
support emergency response, including supplies,
equipment, and personnel.
•Mitigation:
Implementing measures to reduce the potential impact
of emergencies, such as strengthening buildings,
improving infrastructure, or implementing early warning
systems.
Key Components of Emergency Preparedness
And Safety Management:
•Response:
Actively responding to an emergency event, following
established plans and procedures, and coordinating
with other agencies and responders.
•Recovery:
Assisting individuals and communities affected by an
emergency event, restoring essential services, and
rebuilding infrastructure.
Key Components of Emergency Preparedness
And Safety Management:
Examples of Emergency Scenarios:
Natural disasters (earthquakes, floods, hurricanes, wildfires).
Man-made disasters (chemical spills, industrial accidents, acts of
terrorism).
Public health emergencies (epidemics, pandemics).
Importance of Emergency Preparedness:
Protecting lives: Minimizing casualties and injuries during
emergencies.
Saving resources: Reducing property damage and economic losses.
Restoring normalcy: Facilitating a swift and effective recovery
process.
Building resilience: Strengthening communities' ability to withstand
future crises.
Types of Emergencies
 Bomb Threats
 Earthquake
 Fire
 Hurricane
 Medical Emergency
 Power Outages
 Suspicious Person
 Tornado
 Violent Incident
 Winter Storm/Inclement Weather
 Other Emergencies
1. Planning:
Developing comprehensive plans that
outline roles, responsibilities,
communication protocols, and resource
allocation in case of an emergency.
2. Mitigation:
Implementing measures to reduce the risk
of emergencies, such as building codes,
land use planning, and early warning
systems.
3. Preparedness:
Having the necessary resources and
training to respond effectively to
emergencies, including emergency kits,
evacuation plans, and drills.
4. Response:
Implementing the emergency plan and
coordinating resources to provide
assistance during an emergency.
5. Recovery:
Addressing the long-term impacts of an
emergency and working to restore
normalcy, including providing mental
health support and rebuilding
infrastructure.
1. Fire Safety:
Installing smoke detectors, having fire
extinguishers available, and practicing
evacuation drills.
2. Security Measures:
Implementing access control systems,
security patrols, and surveillance
equipment.
3. Emergency Communication:
Establishing clear communication
channels and having backup
communication systems.
4. First Aid Training:
Providing training on basic first aid skills
to ensure individuals can provide
assistance during an emergency.
Emergency Kits:
Containing essential supplies for survival, such as
food, water, first aid supplies, and a flashlight.
Emergency Plans:
Outlining procedures for responding to specific
types of emergencies, such as floods,
earthquakes, or fires.
Emergency Contact information:
Having a list of emergency contacts, including local
authorities, emergency services, and family
members.
Training and Drills:
Participating in emergency drills and training
programs to improve preparedness and response
skills.
.gov
https://www.google.com-Emergency+preparedness+and+Safety+management
osteoarthritis
- gout
- carpal tunnel
syndromes
- low back pain
 osteoarthritis

• is a degenerative joint disease, which involves

cartilage and bone breakdown within a joint.
• It's the most common type of arthritis and is
characterized by pain, stiffness, and swelling,
impacting a person's ability to move freely.
• While damage to the joints cannot be reversed,
symptoms can often be managed through lifestyle
changes and treatments.
 Osteoarthritis – causes & risk factors

• The primary cause is the breakdown of cartilage,

which acts as a cushion between bones.
RISK FACTORS
• Age, injury, and overuse of the extremities where
joints are involved
 Osteoarthritis – affected joints

Affected Joints:
• hands, knees, hips, and spine
 Osteoarthritis – Management and Treatment

Lifestyle Changes:
Maintaining a healthy weight,
exercising regularly, and
 Engaging in activities that build strength and
flexibility
Medications:
Pain relievers and anti-inflammatory drugs to
reduce pain and inflammation.
 Osteoarthritis – Diagnosing

physical examination - assess pain, stiffness, and

range of motion, along with medical history and
potential imaging like X-rays.
X-rays - show loss of joint space, bone damage,
and bone spurs,
but early joint damage may not be visible on X-
rays.
 Osteoarthritis – nursing management

NOTE: Osteoarthritis is a leading cause of chronic

disability, particularly in older adults.
While symptoms can be managed, the damage to
the joints cannot be reversed.
 Osteoarthritis – nursing management

Provide the client with the opportunity to Stay

active and maintain a healthy weight to slow the
progression of the disease and improve joint
function.
While in the hospital, do the following:
Passive or active ROM exercises
Deep breathing exercises
Assist in ADL