Jane Doe, a 22-year-old patient with no old medical history, nowadayss to the exigency section with ailment of low back hurting after stealing on a wet floor at work and falling. The patient states that the hurting is changeless hurting and radiates down both legs ( sciatica ) . The MRI shows pulled musculuss and ligaments environing the L4- L5 country. The exigency doctor provides the undermentioned discharge orders: Bed remainder with bathroom privileges for two yearss. Apply ice battalion to take down back for 20 proceedingss several times a twenty-four hours for the first 48 hours, and so get downing twenty-four hours three and on, use a warming tablet for 20 proceedingss on and 20 proceedingss off several times per twenty-four hours for the following several yearss as needed to alleviate hurting. Take 400 milligram of ibuprofen every six hours and 5 milligrams Flexeril ( Flexeril ) t.i.d. After two yearss of bed remainder, sit in chair three times per twenty-four hours for no more than 20 proceedingss. Ambulate around place and pace as tolerated, bit by bit increasing activity. Avoid distortion, bending, or making for objects. Avoid raising anything more than 5 lbs of weight for one hebdomad. See physician in one hebdomad for farther rating.
Explain the principle for the disposal of ice for 48 hours followed by the application of heat.
Explain the principle for the disposal of the isobutylphenyl propionic acid and musculus relaxer.
What are the expected patient results for the patient in this instance survey?
Case Study 2
John Tuliro, a 32-year-old patient, is admitted to the medical-surgical unit after a gunshot lesion of the right lower leg infected with staphylococci was debrided. The patient is diagnosed with osteomyelitis. The patient ‘s right lower leg is warm to touch and dropsical, and the patient states that the appendage has a changeless pulsating hurting that increases with any motion of the leg. The patient ‘s sed rate and leucocyte rates are elevated. The physician orders the followers for the patient:
Admit to medical unit with critical marks every four hours
Elevate affected leg on pillows above the degree of the bosom
Warm sterile saline soaks for 20 proceedingss t.i.d. with wet-to-dry dressing alteration
Levofloxacin ( Levaquin ) 750 milligram IVPB every twenty-four hours
Renal profile, CBC with differential in A.M.
Regular diet with high-protein addendum shingles
Vitamin C 250 milligram Po b.i.d.
Meperidine ( Demerol ) 100 milligram Po every four hours
Docusate Na ( Colace ) 100 milligram b.i.d.
The patient asks the nurse why he has to remain in bed. The nurse should supply what principle for this step?
What nursing intercessions should the nurse provide the patient?
( Individual )
DISCUSS INDIVIDUAL AND LIFESTYLE RISK FACTORS FOR OSTEOPOROSIS
The followers are the hazard factors of Osteoporosis:
Geneticss – White or Asiatic, Female, Family History, Small Frame – Predisposes to moo bone mass
Age – Postmenopause, Advanced Age, Low testosterone in work forces, decreased calcitonin – Hormones ( estrogen, calcitonin, and testosterone ) inhibit bone loss
Nutrition – Low Calcium Intake, Low Vitamin D Intake, High Phosphate Intake, Inadequate Calories – Reduces foods needed for bone remodeling
Physical Exercise – Sedentary, Lack of Weight Bearing Exercises, Low Weight and Body Mass Index – Boness needs emphasis for bone care
Lifestyle Choices – Caffeine, Alcohol, Smoking, Lack of exposure to Sunlight – Reduces osteogenesis in bone remodeling
Medicines – Cortocosteroids, antiseizure medicines, Lipo-Hepin, thyroid endocrine – affects calcium soaking up and metamorphosis
Comorbidity – Anorexia Nervosa, Hyperthyroidism, Malabsorption Syndrome. Renal Failure – Affects calcium soaking up and metablosim
Hormonal fluctuations are one of the grounds for gender differences when it comes to the development of osteoporosis. In adult females, estrogen has a function in relation to osteoporosis, while testosterone, estrogen and other endocrines in work forces besides relate to this. Besides, menopausal period in adult females histories for osteoporosis, low endogenous estrogen degrees increases the hazard.
Lifestyle factors such as smoke, imbibing intoxicant and sedentary activities, besides increases the hazard for osteoporosis.
Nutritional factors that increase the hazard, includes the undermentioned: day-to-day consumption that is less than 1000 – 1500 milligram of Ca and 400 – 600 International units of Vit. D. Eating high protein diet, imbibing caffeine, Na and P has negative consequence on Ca balance in the organic structure, hence, increasing hazard for osteoporosis.
There are certain medicines that can impact bone remodeling, and increase hazard for secondary osteoporosis.
DISCUSS THE DIFFERENCES IN MEDICAL MANAGEMENT FOR PRIMARY BONE TUMORS VERSUS METASTATIC BONE DISEASE.
Primary bone tumour ‘s end of intervention is to destruct or take the tumour. It is accomplished by surgical exersion, radiation therapy if the tumour is radiosensitive, and chemotherapy. Limb-sparing processs are used to take the tumour and next tissue. Replacement of the affected tissue is really of import. This can be done through the undermentioned: customized prosthetic device, entire joint arthroplasty or bone tissue from the patient ( autoplasty ) or from cadaver giver ( homograft ) . Surgical remotion of the affected portion may necessitate amputation.
To forestall metastasis of malignant bone tumour, chemotherapy is started before and continued after surgery, to eliminate micromestatic lesions. Alleviative direction is the intervention for metastatic bone malignant neoplastic disease. Its end is to alleviate hurting and uncomfortableness while advancing quality of life.
Structural support and stabilisation is needed to forestall break, as the bone weakens. Contraceptive internal arrested development helps beef up big castanetss with metastatic lesions.
DISCUSS CLINICAL MANIFESTATIONS OF PAGET ‘S DISEASE, AND ITS PHARMACOLOGICAL TREATMENT FOR EACH.
Paget ‘s disease are ab initio symptomless. The castanetss that are normally involved include the vertebrae, pelvic girdle, braincase, breastbone and proximal terminals of the long castanetss. Diagnosis of this disease is made by studies of bone hurting or malformation, through X ray or by sensing of elevated serum alkaline phosphate degrees found though biochemical testing.
The followers are the most common ailments of patients who are enduring from Paget ‘s disease such as hurting. Skeletal malformation, and alteration in skin temperature. Joint disfunction may ensue from harm to gristle and degenerative arthritis. Bone hurting frequently occurs at dark, which is a consequence of increased force per unit area on the periosteum or associated hyperaemia. Other manifestations that can happen include lessened mobility and unsteady pace. Neurological complications can besides happen which is caused by nervus root compaction or nervus entrapment. These constructions are next to pagetic bone near a nervus hiatuss or canal. Common clinical manifestation of Paget ‘s disease is assorted sensorineural and conductive hearing loss. Low back hurting can besides happen because of vertebral organic structure and facet expansions, loss of lumbar hollow-back, dorsal humpback, spinal encroachment and altered pace kineticss.
The short term aim in handling Paget ‘s disease is to relieve the associated bone hurting, while the long term aim, is to relieve the patterned advance of the disease. The pharmacologic therapy includes calcitonin, plimamycin, and Ga nitrate, and the biphosphonates. The chief end of this therapy is to command the disease activity, normalize biochemical parametric quantities and to better the symptoms.
LIST REHABILITATION AND HEALTH EDUCATION STRATEGIES USED FOR PATIENT WITH LOW BACK PAIN.
A comprehensive rehabilitation should include a careful rating for a specific end and interventions based on best grounds are exercising, cognitive behavioural intervention, wellness instruction and others.
We should teach the patient to avoid return of the followers:
Standing, sitting, lying and raising decently are necessary for a healthy dorsum.
Alternate periods of activity with periods of remainder.
Avoid prolonged sitting, standing and driving.
Change places and remainder at frequent intervals.
Avoid presuming tense, cramped places.
Sit in a straight-back chair with the articulatio genuss somewhat higher than the hips. Use footrest if necessary.
Flatten the hollow back by sitting with the natess tucked under. Pelvic tilt lessenings hollow-back.
Avoid articulatio genus and hip extension. When driving a auto, have the place pushed frontward as necessary for comfort. Put a shock absorber in the little of the dorsum for support.
When standing for any length of clip, rest one pes on a little stool or platform to alleviate lumbar lurdosis.
Avoid weariness, which contributes to spasm of back musculuss.
Use good organic structure mechanics when lifting and traveling approximately.
Daily exercising is of import in the bar of back jobs.
Make prescribed back exercisings twice daily strengthens back, leg, and abdominal musculuss.
Walking out-of-doorss is recommended.
Reduce weight if necessary lessenings strain on back musculuss.
IDENTIFY COMMON FOOT DISORDERS. IDENTIFY THE SPECIFIC STRUCTURE INVOLVED.
Common Foot Disorders:
Plantar Fascitis – it is a plantar heel hurting, which evolves from the bone ( list goad ) or plantar facia.
Morton ‘s Neuroma – It is the annoyance and devolution of the digital nervousnesss in the toes that produces a painful mass near the country of metatarsals.
Hallux Disorders: Valgus, Rigidus, and Sprains – Acute hurt to the ligaments and capsule of the MTP articulation. Lateral divergence of the first toe greater than the the normal angle of 15 grades between the tarsus and metatarsus This may take to a painful prominence of the medical facet of the MTP articulation. Degenerative status of the first MTP articulation taking to trouble and stiffness.
DISCUSS THE INVOLVEMENT OF VITAMIN D IN THE DEVELOPMENT OF OSTEOMALACIA. IDENTIFY TREATMENT RELATED TO CAUSE.
Vitamin D lack is the most common cause of osteomalacia. Essential for Ca and P metamorphosis is Vitamin D, it is the critical elements in mineralization of the bone. The major beginning of Vitamin D is synthesis in the tegument exposed to sunlight. Dietary alteration is needed by eating nutrient rich in Vitamin D, such as fatty fish oils, liver and egg yolks. Vitamin D addendum is besides suggested.
Develop A Plan OF CARE FOR AN ASSIGNED PATIENT WITH LOW BACK PAIN.
Nursing Intervention for Low Back Pain:
Advise patient to remain active and avoid bed remainder, in most instances.
Keep pillow between flexed articulatio genuss while in side-lying place minimizes strain on dorsum musculuss
Apply heat or ice as prescribed.
Administer or learn self-administration of hurting medicines and musculus relaxant.
Encourage ROM of all uninvolved musculus groups.
Suggest gradual addition in activities and jumping activities with remainder in semi-fowler ‘s place.
Avoid prolonged periods of sitting, standing, or lying down.
Promote patient to discourse jobs that may be lending to backache.
Promote patient to make order back exercisings. Exercise keeps postural musculuss strong, helps recondition the dorsum and abdominal muscular structure, a and serves as an mercantile establishment for emotional tenseness.
Give A TEMPLATE, COMPLETE A DISEASE MAP ON A PATIENT WITH CARPAL TUNNEL SYNDROME.
Complete A THEORETICAL CASE STUDY ON AN ACTUAL CLINICAL PATIENT WITH OSTEOMYELITIS.
hypertext transfer protocol: //www.scribd.com/doc/44830270/Osteomyelitis-Case-Study
( Web Assignments )
USING THE INTERNET, RESEARCH LITERATURE ADDRESSING MANAGEMENT OF OSTEOPOROSIS. IDENTIFY NEW MEDICATIONS ON THE Market TO TREAT THIS DISEASE.
hypertext transfer protocol: //www.ncbi.nlm.nih.gov/pmc/articles/PMC493281/
hypertext transfer protocol: //www.webmd.com/osteoporosis/news/20100602/fda-approves-prolia-for-high-risk-osteoporosis
As the basic aim of forestalling the advancement of osteoporosis to a patient is to minimise bone break, direction of osteoporosis is discussed in this article through many ways changing on the patient ‘s degree of break hazard. Prevention in a non medical therapy was described as holding good nutrition, healthy life style and autumn bar. Exercise and the assistance of vitamin D addendums can really assist in forestalling or decreasing the hazard of osteoporosis.
Medical intervention on the other manus comes in many signifiers ; as it is to be administered based on the guidelines for get downing pharmacologic therapy. Medicines for osteoporosis direction are classified in to two, the antiresorptive agents and anabolic agents, both of which moving as agents to cut down break hazard.
In the following article, a freshly approved intervention was released and approved for the direction of osteoporosis. Prolia is a biological, lab-induced intervention that is said to hold the ability to demobilize the organic structure bone ‘s breakdown mechanism. It was approved under specified types of interventions though. It can merely be administered to patients of station menopausal phase and has a high hazard of bone break caused by osteoporosis. Or to patients who already had osteoporosis interventions but had failed. Or in conclusion, to patients who ca n’t digest other osteoporosis interventions. What this intervention does is to decelerate down the procedure of bone dislocation, doing the patient less susceptible to cram break. In malice of the advantages of the said intervention though, side effects to this intervention besides has its downsides. Most common of which is the patients experiencing back, musculus, and bone strivings. It is through this ground that patients with low degrees of Ca were besides prevented to utilize this sort of intervention
Find A REASEARCH ARTICLE COMPARING PRIMARY BONE TUMORS TO METASTATIC BONE TUMORS. SUMMARIZE IN TERMS OF MANAGEMENT.
hypertext transfer protocol: //www.merckmanuals.com/professional/sec04/ch044/ch044d.html
Primary & A ; metastatic bone tumours fundamentally differ from its beginning. As primary tumour are defined as tumours which have started from the bone itself, metastatic tumours, besides known as secondary tumours are defined as tumours which have originated from another parts of the organic structure that had resulted to or affected the bone every bit good.
As primary bone tumours are treated the same as with other tumours found in the other parts of the organic structure. Patients besides undergo radiation and chemotherapy every bit good as surgery. For painful vertebral break, Kyphoplasty or vertebraplasty are besides considered as options to relieve hurting. Metastatic bone tumours on the other are treated the same as with primary bone tumours though since it has its beginning from a different country, intervention are to be considered depending on how it will impact the full organic structure of the patient or all of which that is with tumour ( chest, lung, prostate, etc. )
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