Pathophysiology D069

Open or Compound Fracture

A break in bone with open wound on the fracture site. Piece of broken bone protruding through the skin.

Greenstick Fracture

A break in the bone that is partiallly bent and split, a green stick or twig does when bent, common on children w/Rickets or adults with soft bones. S/S: Pain, deformity, swelling, discoloration, loss of limb function, muscle spasm, hemorrhage and shock. Dx: Xrays, Scintiscan for hairline fractures. Tx: immobilization, Open reduction (screw, rods, metal plates placements) or closed reduction (Casting), Traction, pain meds, muscle relaxants, Rib fractures (no tx).

Vitiligo

A disorder in which melanocytes, pigment-producing cells of skin are destroyed or cease producing melanin. Depigmentation or white patches on the skin and mucous membranes Risk: Dark skin tones, autoimmune disorder, hyperthyroidism, adrenocortical insufficiency, pernicious anemia S/S: Depigmentation or White spots. Exposed to sunlight, white patches in the armpits, naval, groin, genital and rectal areas. 3 patterns: 1) Focal pattern: limnited in one or two areas. 2) Segmental pattern: one side of the body 3) Generalized pattern: Symmetrical on both sides of the body. (Gray hair on scalp, facial hair, eyebrows, and eyelashes.) Dx: PE, Blood tests check fo anemia, thyroid functionm, CBC. Tx: Repigment the white areas, Topical corticosteroids, Psoralen, Ultraviolet A therapy, Monobenzone (50% depigmentation), Skin grafts, Micropigmentation and tatooing. Therapy: Ginko biloba (monitor w/ anticoagulant)

AGE-RELATED MACULAR DEGENERATION

A slowly progressive disease that produces changes in the pigmented cells of the retina and macula. Risk: Aging. Hyperopia, light iris color, positive family history, hypertension, cigarette smoking, and obesity. S/S: Dry Macular Degeneration starts with the appearance of spots on the retina called Drusen. Dx: · Amsler chart or grid is used to detect small changes in vision when they first appear. Flourescein Angiography Tx: Nutritional intervention. No drug. Laser Therapy.

GLAUCOMA

Accumulating fluid pressure within the eye damages the retina and optic nerve. Blindness. Obstruction of passages within the eye that form the trabecular meshwork, which drains the aqueous humor into the lymphatic system. Risk: Idiopatic. Unknbown genetic. Induced by certain drugs or toxins. S/S: Asymptomatically. · Mild aching in the eyes and visual disturbances. Seeing halos around lights or loss of peripheral vision. Dx: Tonometer. Ophthalmoscopic inspection of the retinal surface. Vision-field testing. Tx: Eye Drops, Laser Surgery or microsurgery. · Trabeculectomy-a new channel is created to drain the fluid, reducing the intraocular pressure that causes glaucoma. Early laser surgery or microsurgery.

OTITIS MEDIA

Accumulation of fluid within the middle ear. Risk: adenoidal tissue or chronic sinus infections. Caused by the introduction of pyogenic microorganisms into the middle ear, usually Haemophilus influenzae, S. pneumoniae, or Moraxella catarrhalis. Narrowing or constriction of Eustachian Tubes. S/S: Hearing impairment, fevers and chills, dizziness. Dx: Otoscope reveals bulging of the eardrum. Decongestants. Needle aspiration called Myringotomy. Tympanoplasty correct eardrums.

Osteomyelitis

Acute or chronic infection of the bone forming tissue Risk: Trauma resulting in hematoma formation and bacterial infection, (Staphylococcus aureus), virus, and fungi that may reach bone marrow through blood or tissues. Common infection affects the long bones of arms and legs, DM, prostetic hardwares, patients in dialysis, removed spleen, inject illegal drugs S/S: Spreads/virulence to affecting bones. Fever, chills, malaise, sweating, pain and tenderness. Acute: fever, irritibaility and fatigue (Children) Chronic: drainage or seeping from open wound, fever and fatigue. Dx: x-rays, bone scans, MRI, blood cultures, or aspiration of fluid on infection site. Tx: Bed rest, antibiotics, surgical draining to remove pus and dead bone, tissue grafts, immobilization and pain meds.

Atopic Dermatitis

An inflammation of the skin accompanied by intense itching, of unknown etiology. Risk, Allergic Rhinitis, Ashtma, Asians and Whites. S/S: Pruritis, leathery vesicles and exudative eruptions. Dx: Medical History, Elevated Serum IgE Tx: Local and sytemic agents, moisturizers, topical corticosteroids cream and ointments, Phototherapy, High humidifier Therapy: No milk, aloe vera gel, calendula lotion.

Cataracts

An opacity, or clouding, of the crystalline lens of the eye or its surrounding membrane. Develops slowly, affecting visual acuity. Risk: Aging (senile cataracts), eye injuries (traumatic cataracts), certain diseases (secondary cataracts), and genetic diseases such as myotonic dystrophy, neurofibromatosis, or birth defects (congenital cataracts). S/S: Tonometry is used to measure fluid pressure inside the eye. Loss or blurring of vision. Colors appears faded. Seeing halos around lights. · Pupil of the eye may appear white to an observer. The condition is painless. Tx: · Surgical extraction of the defective lens is followed by refractive correction using eyeglasses, contact lenses, or surgically implanted artificial lenses called intraocular lenses (IOLs). Ultrasonic device.

PERNICIOUS ANEMIA

Appearance by the large, abnormal RBCs, which form when there are inadequate levels of vitamin B12 in the body. Risk: Intrinsic Factor: failure of certain cells in the gastric mucosa to secrete adequate levels of a protein. Chron disease. Insufficient Vitamin B12. S/S: Fatigue, dyspnea, palpitations, sore and bright red tongue, and numbness and tingling of the extremities—the damage can be severe. Weakness, nausea, vomiting, neuritis (inflammation of nerves), impaired coordination, altered vision, light-headedness, and tachycardia. Dx: CBC, Labs: Hemoglobin, Folic acid, Serum Levels of B12. Bone Marrow aspiration and gastric analysis. Tx: Vitamin B 12 Inj.

Atopic dermatitis

Appears to have allergic or hereditary components

REFRACTIVE ERRORS Hyperopia:

Are defects in visual acuity. Inability of the eye to focus light on the surface of the retina. Hyperopia: Occurs when light entering the eye comes to a focus behind the retina so that vision is better for distant objects. Farsightedness: difficulties in seeing objects that are close. Hyperopia often results when the globe of the eye is abnormally short in length from front to back. Risk Genetics. Age. S/S: Squinting, headaches and frequent rubbing of the eyes. Halos around bright lights. Dx: Snellen Eye Chart. Dilation for Ophthalmoscopic Exam. Tx: Eye glasses; Contact lenses. Lasix Surgery (Laser-assisted in situ keratomileusis. Photorefractive keratectomy (PRK) to treat myopia, hyperopia, astigmatism.

Squamous cell carcinomas:

Arise from epidermal layers abve the basal layers Keritanize and slough off that continue to grow outwards Tendency to Metastasize. Risk: Overexposures to the sun ultraviolet rays. Radiation exposure, chronic skin irritations and inflammations and exposure to carcinogens Dx: Biopsy of skin lesions S/S: painless Noduloulcerative lesions, superficial basal cell, sclerosing basal cell, superficial basal cell, sclerosing casal cell. Tx: Surgery, Radiation therapy, curettage, cryosurgery, laser therapy and electrodesiccation and Mohs micrographic surgery. Chemotherapeutic agents.

Basal cell carcinomas:

Arise from the basal cell layers of the epidermis or hair follicles, are slow-growing and destructive, not metastasize. Risk: Overexposures to the sun ultraviolet rays. Radiation exposure, chronic skin irritations and inflammations and exposure to carcinogens Dx: Biopsy of skin lesions S/S: painless Noduloulcerative lesions, superficial basal cell, sclerosing basal cell, superficial basal cell, sclerosing casal cell. Tx: Surgery, Radiation therapy, curettage, cryosurgery, laser therapy and electrodesiccation and Mohs micrographic surgery. Chemotherapeutic agents.

Tumors of the Brain

Benign or malignant neoplasm spread from the lung, breast or others. Neurological deterioration by replacing healthy brain tissue, by compressing brain tissue or by blocking the blood supply or the flow of CSF to a portion of the brain. S/S: Difficult to diagnose because of vague symptoms and their slow onset. Headache, vomiting, defective memory, mood changes, seizures, visual distubances, motor impairement and personality changes. Dx: PE, Skull xrays, lumbar puncture for CSF, Cranial CT scans and MRI, Biopsy of the lesions Tx: Treatment is dependent on the stage and type of brain tumor. Surgery, radiation therapy, or chemotherapy. Medications may be ordered for symptomatic tx of seizures, edema, headaches.

Closed Simple Fracture

Break in the bone without an external wound to the skin.

Contact dermatitis

Causes erythema and small skin vesicles

Psoriasis

Characterized by high rate of skin cell turnover

Dermatophytosis

Chronic, fungal infection in scalp (Tinea Capitis) , body (Tinea corporis), nails (tinea unquium), feet (tinea pedis) or groin (tinea cruris) Risk: Direct contact with fungus and spores. Traumatized skin, infection causing fomites, inanimate objects. Towels or shoes, poor hygeine, fungal infection S/S: Tinea Capitis: persistent, contagious, asymptomatic or have itchiness. Lesions are round, gray and scaly. Tinea Unguium: Asymtpomatic. Hypertrophic, brittle lusterless nails. Tinea Pedis (Athlete foots) Itchiness, burning stinging and main. Tinea cruris: Jock Itch. red, raised, sharply defined, itching lesions in the groin

Retinal Detachment

Complete or partial separation of the retina from the choroid layer of the eye; it leads to the loss of retinal function and blindness. · A hole or break in the retina that allows vitreous humor to accumulate between the two layers. Risk: Head trauma. Hemorrhages or tumors. DM, Retinal Detachments. S/S: Cobwebs, floating spots, flashes of light, or the sensation of a shade coming across the eye. Dark shadow extending from the periphery inward. Retina detaches from the choroid surface, progressive loss of vision. Dx: ophthalmoscopic Exams. Tx: Laser Surgery the small holes. Cryopexy, laser surgery. Synthetic Bands around the eyeballs. Vitrectomy. Gas or silicone.

Impetigo

Contagious bacterial skin infection forming vesicles (small, fluid-filled blister), bulla (a large, fluid-filled blister_ that becomes pustural, ruptures and forms a yellow crust. Risk: Poor hygiene, malnutrition, anemia, Streptococcal or staphylococcal bacteria, warm climates. S/S: Macules, vesicles and pustules then Pruritis. Lesions ruptures, honey colored serous fluid. The lesions hardens, and a thick, yellow crust eventually forms in the infected sites. Satellite lesions appear in autoinocculation. Erythema w/ulcerations and scarring. Dx: Gram stain Tx: Topical and oral Antibiotics. Cleansing 2 to 3 x a day. Soaking in White Vinegar.

Polymyositis

Disease of connective tissue characterized by edema, inflammation, degeneration of skeletal muscles. Dermatomyositis if skin is involved (Telltale lilac-colored rash on the eyelids, edema around the eye sockets, bridge of the nose, the cheeks, forehead, chest, elbow & knees). Caused by Viral, parasitic, and bacterial infection, RA, SLE, malignancies of lung and breast. S/S: Muscle weakness (hips and thighs), difficulty getting up, sitting down & kneeling down. Dysphagia, respiratory difficulties. Dx: Muscle biopsy, serum levels of creatinine kinase, enzymes, ESR. Tx: High dose of Steroids, Cytotoxic drugs, immunoglobulins, beds rest, physiotherapy, and PT.

Epilepsy

Disruption of the normal pattern of electrical activity in the brain. Neurons within the brain discharge in a random, intense manner. Recurring attacks of abnormal sensory, motor, and psychological activity. Seizures generally are categorized as partial or generalized. Partial seizures: are focal in origin—that is, they affect only one part of the brain and cause specific symptoms. Generalized seizures: are nonfocal in origin and may affect the entire brain.

Traumatic Brain Injuries:

Dx: CT Scans and MRI Glascow Coma Scale, test for mental health alertness, blink eyes and move extremities, and speech coherence. Drain Excess fluid Tx: Mild TBI: Analgesic, bed rest and mild analgesics Severe TBI: Requires ICU. Diuretics by IV to reduce fluid tissue and anti-seizure. Coma Inducing Medication. Surgery to remove blood clot, repair skull fracture, create an opening for drainage.

BLEPHARITIS

Dx: External exam. Lid margins, eyelashes and meibomian gland openings using bright light and magnification. Staphylococcal Blepharitis: mild sticking together of the lids, Seborrheic Blepharitis: appears as greasy flakes or scales at the base of eyelashes and some eyelid redness. Ulcerative blepharitis: matted, hard crusts around the eyelashes that, when removed, leave small sores that ooze and bleed.· Cornea may also become inflamed. Tx: · Warm compresses · Don't use eye makeup. · Staphylococcal blepharitis requires antibiotic treatment. · Artificial tear solutions or lubricating ointments may be prescribed. Discontinue Contact lens

Leukemia

Dx: Labs, Biopsy Bone marrow, Labs: reveal · thrombocytopenia, leukocytosis, anemia, and neutropenia (the presence of abnormally small numbers of neutrophils in the circulating blood). · Chromosome cells from samples of peripheral blood, bone marrow, or lymph nodes. · Philadelphia chromosome can be detected. A spinal tap and chest x-rays may be ordered. Tx: Chemotherapy, radiation therapy, or bone marrow transplant. Biological therapy uses substances known as biological response modifiers (BRMs). · Radiation therapy may be specifically focused or consist of total body radiation. · Stem cell transplant allows clients to be treated with high doses of drugs, radiation, or both. · The high doses of the treatment kill normal blood cells and the leukemia cells in the bone marrow.

Eplepsy

Dx: PE, History of head trauma, illness, CNS infection or CVA. Electroencephalograms-detect abnormalities in brain-wave patterns Cranial CT scans: pinpointing brain lesions that may be triggering seizures MRI helps to diagnose epilepsy. Tx: Anticonvulsant drugs, PCP will engage in trial by error before setting on one drug. Neurosurgery, Education about the disease.

Dermatophytosis

Dx: Suspected leasions may be cultured to isolate the fungus. Sensitive to topical and oral antifungal agents. Potassium Hyroxide (KOH) exam, Tx: Topical Fungicidal medication, Keep skin dry and clean, wear lose fitting clotes, limit exercise and activity to prevent prespiration. Therapy: Garlic (antifungal agent), tea tree oil, grapefruit seed extract

Rickets

Greenstick fracture: a break in which the bone is partially bent and split, as a green stick or twig does when bent; this type of fracture occurs most frequently in children, especially those who have rickets, or among adults with soft bones

Keratosis Pilaris

Hyperkeratinization of the stratum corneaum Excess skin is slow to shed and clogs the hair follicles, forming skin-colored plugs that are inflamed Papules are mistaken for acne vulgaris Dx: Cosmetic condition Tx: Remove the keratin, lotion, creams or ointments that has ammonium lactate, alpha hydroxy acid, urea, glycolic acid, salicylic acide to exfoliate the skin. Retinoids, laser therapy.

IRON-DEFICIENCY ANEMIA

Inadequate reserves of iron in the body and the formation of unusually small, hemoglobin-poor RBCs. Risk: GI Bleed, Overuse of NSAIDS, Low Iron levels. S/S: extreme fatigue, pallor, headache, cold hands and feet, and irritability. Brittle Nails. Dx: Blood tests: HCT/HGB. Levels of serum iron and serum ferritin. RBC. Endoscopy r/o GI Bleeding. Colonoscopy for tumors. Bone Marrow Aspiration. Tx: · Oral or parenteral (intramuscular or intravenous) iron supplements. Dietary modifications are often sufficient to restore lost bodily iron reserves.

Bursitis

Inflammation of brusa, a thin-walled sac lined with synovial tissue and filled with viscous fluid/synovial fluid. Burase is a cushion between bones and joints and helps the tendons and muscles move. Subacromial (shoulder), subdeltoid (arm), olecranon (elbow). Miners or tennis elbow, prepatellar (housemaids knee), ischial (pelvis-weavers button). Caused by excessive forces, trauma and systemic disease (RA or Gout or infection). S/S: Fluid accumulation causes inflammation, Dull aching pain, irritation. Dx: Xrays (shows calcific deposits), CT scans, MRI S/S: Dull aching pain Dx: Xrays (shows calcific deposits), CT scans, MRI Tx: Cold or Heat, immobilization, NSAIDS, steroid injections, Active mobilization may improve adhesions and improve pain. Hydrotherapy and PT.

Rosacea

Inflammation of skin that causes flushing or redness (erythema) and red pustules on face. Often gets mistaken w/ Acne Vulgares. Risk: Sunlight, stress, spicy food, hot or cold temps, wind, corticosteroids, alcohol and drugs that dilate blood vesses. S/S: Flushing cheeks, forehead, nose or chin, Rhinophyma (enlarged nose). Eye redness, burning, dryness and excessive tearing. 3 phases: 1) Pre-Rosacea (blush or flush) 2) Vacular Rosacea: sensitive cheeks and nose swelling. 3) Inflammatory Rosacea: red pustules on cheeks, nose, forehead and chin. Dx: Medical History Tx: Topical creams or lotions: Retinoids, Tretinoin, Benzoyl Peroxide, Azelaic Acid. Antibiotics: Tetracycline, Erythromycin, Minocycline. Laser Surgery

Osteoarthritis

Inflammation of the bone and joints Risk: Chemical, genetic, metabolic, mechanical, and may be autoimmune factors, secondary to trauma, congenital abnormality, dysplasia and obesity. S/S: Insidious/Gradual, deep, aching joint pain, swelling, crepitation, crackling sound due to grafting of bones or movement, defornmity Dx: Xrays, bone scans and MRI Tx: Minimize pain and inflammation w/NSAIDS, heat, exercise, artificial joints can be injected. Surgeries: debridement of lose or torn cartilage, bone realighnment, bone fusion or joint or prothetic replacements

BLEPHARITIS

Inflammation of the edges of the eyelids that is commonly ulcerative or nonulcerative, involving hair follicles and glands that open onto the surface. · Anterior blepharitis appears on the outside front edge of the eyelid where eyelashes attach. · Posterior blepharitis appears at the inner edge of the eyelid that is in contact with the eye. Risk: Staphylococcal Bacteria Allergy or exposure to smoke, heat or chemical. May be secondary to sebeceous secretion (seborrhea) of the eyelids or pediculosis of the eyelashes or eyebrows. S/S: Burning and itching. Eyes usually appear red-rimmed. Minor irritation and itching. Such as blurring of vision, missing eyelashes, and inflammation of other eye tissue, particularly the cornea.

Rheumatoid Arthritis

Inflammation of the synovial joints. Autoimmune disorder that destroy cartilage, erode bone and deform joints. S/S: Spreads to joints, malaise, low grade fever, fatigue, weight loss, joint pain, stiffness. Advance cases: Affects interphalngeal joints, swelling and edema. Dx: Positive RA factor, Serum protein electrophoresis, ESR, CBC, Synovial fluid Analysis, Xrays, MRI, CT. Tx: NSAIDS, DMARDS (Antirheumatic Drugs, Hydroxycholorquine (Plaquenil), Methotrexate, Etenercept, Adalimumab (Hunmera), Tumor necrosis factor alpha inhibitors, corticosteroids. Advance RA: Surgery repair

Acne vulgaris

Inflammatory disease of sebaceous glands and hair follicles

Urticaria

Inflammatory reaction of the capillaries beneath a localized area of the skin. Risk: Eating certain foods, shellfish, nuts, soy, wheat, eggs. Allergic reactions, heat, cold, water and sunlight. S/S: Eruption of pale, raised wheals of skin, erythema, vascular reaction, intense itching. Dx: Review medical history on medications used, food, environmental factors and psych status. Tx: Antihistamines, Epinephrine, hydrocortisone cream and lotions.

TRANSIENT ISCHEMIC ATTACKS

Insufficient blood flow to a part of the brain. Little strokes or little brain attacks Brain Attaches may be severe warning of CVA Risk: Cerebral arterioles by small emboli or by ischemia brain tissue due to arterial narrowing. Results of Atherosclerotic Dx. S/S: Muscle weakness in the arm, leg, feet, diplopia, speech deficit, dizziness, staggering or uncoordinated gait. Do not result in unconsciousness. Dx: PE and neurological exam. Carotid ultrasound, cranial CT scans, Cranial MRI Tx: Prevent future brain attack. Antiplatelet agents and aspirin or anticoagulants drug. Surgery to improve blood flow.

APLASTIC ANEMIA

Insufficient or totally absent RBC production. Bone marrow stops producing WBC, RBC and platelets. Risk: · Medications used to threat rheumatoid arthritis, autoimmune disorders, and viral infections such as HIV and hepatitis may cause aplastic anemia. S/S: Fatigue, pallor, shortness of breath upon exertion, irregular heart rate, purpura, nosebleeds and bleeding gums, infections, headache, and dizziness. Pancytopenia-decrease in all cellular components of the blood in the bone marrow. Dx: · Blood tests will show the RBC, WBC, and reticulocyte (immature form of RBCs) counts are low in the majority of cases. Bone marrow studies. Tx: · Exposure to any known cause must be discontinued. Bone marrow or peripheral stem cell transplant. Immunosuppressive therapy. Transfusion of RBCs and platelets.

Lordosis

Inward curvature of the lumbar or lower spine. "Swayback" Risk: Obesity and osteoporosis Spinal deformities may be caused by: tumors, trauma, infection, OA, tuberculosis, Cushing's, prolonged steroid therapy, and degeneration of the spine S/S: chronic fatigue and backache Dx: Physical Exam, Anterior/Posterior xrays, MRI if tumor or infection is present Treatment: PT, Exercise, back brace, surgery if curvature interferes w/ mobility or breathing, spinal fusion, bone grafts, pain meds

Systemic Lupus Erythenmatosus

Is a chronic, inflammatory connective tissues disorder in which cells and tissues are damaged by autoantibodies and immune complexes Risk: Gentics, environmental, hormonal, stress, overexpsoure to UV light, Immunization reaction, pregnancy. S/S: Weight loss, fatigue, fever, butterfly rash, photosensitivity of skin, pain, joint deformities, nausea, vomiting, diarrhea, nasopharyngeal ulcerations, patchy alopecia, pleuritis or pericarditis, Raynaud phenomenon. Intermittent interruptions of blood supply to fingers and toes. Dx: CBC w/Diff: ESR, Serum electrophoresis, Antinuclear antibody, Anti-DNA, lupus tests, LE cells (polymorphonuclear leukocytes) in bone marrow. Tx: Aspirin, Corticosteroids drugs and cream for skin, sunscreen Avoid milk. Increase veges, fish oil, flaxseeds. Vitamin B12, B5 and C. Low sodium, low protein diet. Heat packs.

CONJUNCTIVITIS

Is inflammation of the conjunctiva. ·Causes small blood vessels in the conjunctiva to become more prominent, giving a pink cast to the whites of the eyes, hence the term pinkeye. Risk: Infection from virus or bacteria. Contagious. Irritation to UV light, heat, cold, chemicals and allergies. S/S: Red, swollen conjunctivae, which may itch, burn, or cause pain, especially when blinking. Dx: PE, Steined smears to reveal monocytes, polymorphonuclear leukocytes and macrophages. Culture and sensitivity tests. Tx: Antibiotics, eye drops or systemic medication.

KERATITIS

Is inflammation of the cornea that usually occurs unilaterally. Risk: · Due to infection of the cornea by herpes simplex virus (HSV); by certain bacteria, such as Staphylococcus pneumoniae and Pseudomonas aeruginosa; or by fungi. Secondary to syphillis. S/S: Irritation, tearing and photophobia. Dx: Slit-lamp examination, fluorescein (dendritic ulcer of HSV infection) and vision testing. Tx: Topical eye cream. Antibiotic, Antifungal or antiviral meds, eye patch.

Decubitus Ulcer

Localized breakdown and ulceration of skin due to interference with its blood supply, usually due to constant pressure in a bony area. Also known as a bedsore. Risk: Prolonged immobilization, weak circulation S/S: Stage 1: Early signs include shiny, reddened skin, usually appearing over a bony prominence Stage 2: If not treated quickly, the ulcer may skin become swollen and shows a blister Stage 3: A craterlike ulcer that goes deeper into the skin Stage 4: A deep ulcer that goes into fat, muscle, or bone If the ulcer becomes infected, it will be foul-smelling and purulent. Dx: Visual exam, wound culture and sensitivy testing Tx: Alleviate skin pressure, keep it clean and ry, Topical Antibiotics, honey preparations, hyperbaric oxygen, chemicals. Complementary therapy: Vitamin E oil, zinc oxide, and goldenseal powder to the affected area. Aloe vera and exposure to sufficient natural light

Dislocations

Luxation: occurs when a bone is separated from a joint. Subluxation: Partial dislocation Dislocated Shoulder and vertebral . Occurs impact to joints, falls, sports injuries, auto crashes, obesity, poor sleeping postures, repetitive movement, Pagets, Arthritis. S/S: Bone may be deformed or out of alignment. Bruising, swelling, pain. Ligaments, muscle and nerves may be affected. Nerve impairment (Pinched nerve), inihibits conduction of impulses. Shoulder dislocation may involve tear of cartilage and rotator cuff muscles. Dx: Visual Exam, PE, Xrays, MRI Tx: Surgical reduction, pain meds, muscle relaxant, immobilization and PT.

Osteoporosis

Manifestation of prolonged steroid therapy, alcoholism, lactose intolerance and hypothyroidism Risk: Low intake of Calcium, a diet high in protein and fat, sedentary lifestyle, poor adrenal function, estrogen deficiency, Vitamin D deficiency; smoking, amenorrhea. Men: low testosterone, smokers S/S: Silent Disease, fractures d/t trauma, bone pain, weight-bearing bones, bones susceptible to fractures Dx: DEXA, Blood tests for phosphorus, alk phosphate, total protein, albumin and creatinine. U/A for calcium, phosphate, creatinine & hydroxyproline, Scintiscan, bone biopsy, CT. Not xrays. Tx: Prevent fractures and pain, Calcium, D3, and Drugs to restore bones and reduce the risk of fractures.

Gout

Metabolic gout: body produces more uric acid that can be cleared by kidneys into the urine. Renal gout: renal dysfunction. The body may produce normal uric acid but the kidneys cannot clear the compound from the blood. Risk: Genetic factors, obesity, mod to high alcohol use, aspirin and low thyroid function. S/S: Joint pain (big toe, feet, ankles knees), fever, chills, tophi may appear around the joints. Dx: Identify Urate crystals in joint fluid, Urinalysis, ESR and differential count (WBC), uric acide levels are low, Skeletal xrays to identify damaged joints. Tx: Bed rest, immobilization, NSAIDs, Corticosteroids, Colchicine, low purine diet, avoid sweetbreads, liver, kidney, poultry, fish, alcohol, rich pastries and fried foods. Antihyperuricemic Agents (Allopurinol)

OTOSCLEROSIS

Metabolic imbalance that causes new bone to grow over the end of stapes. The bone becomes fixed and no vibration occurs, eliminating the transfer of sound to the inner ear and causing permanent hearing loss. Risk: Pregnancy and genetic factors. S/S: B/L hearing loss of low tones and soft sounds. Tinnitis Dx: Hearing tests: Tuning fork. Conductive hearing loss. Rinne Tests. Weber tests. Tx: Hearing aids. Sodium fluoride tablets. Stapedectomy, and a prosthesis will be inserted.

CEREBROVASCULAR ACCIDENT (STROKE OR BRAIN ATTACK)

Occlusion or hemorrhaging of blood vessels in the brain. Brain is deprived of blood supply that becomes necrotic known as stroke or brain attack. 2 types of stroke: Ischemic: Interruption of blood flow in the cerebral vessel. Thrombosis or Emboli Hemorrhagic: Brain ruptured and bleeds in the subarachnoid spacing cause of HTN, Aneurysm, head injury, AV malfunction, blood disease. S/S: Strokes caused by an embolus or hemorrhage Cheyne Stokes respiration, full and slow pulse, Hemiparesis, Stupor to coma, Apnea 10 to 60, Loss of balance and coordination, speech impairment, numbness, sensory disturbances, double vision, poor coordination, confusion, headaches and dizziness. Dx: PE, Neurological work up, Cerebral Angiogram, CTA, MRI and magnetic resonance angiography (MRA), Carotid Ultrasonography of neck, Transcranial Doppler (TCD) test shows blood flow. Tx: Goal of treatment is to salvage damaged brain tissue and minimize disability. Control the brain edema. Anticoagulants, antiplatelets and surgery (Carotid Endarterectomy or Cerebral Angioplasty. Physical Rehab.

REFRACTIVE ERRORS: Astigmatism

Occurs when light entering the eye is focused unevenly or diffusely across the retina so that some of the visual field appears properly focused while some does not. The condition is caused by variations in the curvature over certain portions of the lens or cornea of the eye, creating out-of-focus vision. S/S: Squinting, headaches and frequent rubbing of the eyes. Halos around bright lights. Dx: Snellen Eye Chart. Dilation for Ophthalmoscopic Exam. Tx: Eye glasses; Contact lenses. Lasix Surgery (Laser-assisted in situ keratomileusis. Photorefractive keratectomy (PRK) to treat myopia, hyperopia, astigmatism. Astigmatic keratectomy:

Khyposis

Outward curvatures of upper thoracic vertebrae "Humback" Risk: Hx of neuromuscular condition, poor posture, degenerative arthritis S/S: Chronic fatigue and backache Dx: Physical Exam, Anterior/Posterior xrays, MRI if tumor or infection is present Treatment: PT, Exercise, back brace, surgery if curvature interferes w/ mobility or breathing, spinal fusion, bone grafts, pain meds

Fibromyalgia

Pain in the muscles, ligaments and tendons; chronic fatigue and muscle tenderness. Risk: Genetic, nerve stimulation causes the nuerotransmitters to increase pain receptors, emotional distress, trauma, illness S/S: Dull muscle ache, pain in tender points, Spots in the head, top of the shoulders, outer elbows, hips and inner knees, exhaustion, Cognitive difficulties "fibro fog". Coexisting conditions: SLE, Osteoarthritis, PTSD, Restless leg syndrome and depression. Dx: PE both sides of the body and waist, Blood work: CBC, ESR and Thyroid function Tx: Reduce pain and improve sleep, pain meds, antidepressants, Cymbalta, antiseizure drugs to reduce pain and improve sleep, Milnacipran (Savella), stress management and PT.

Acute and Chronic Headaches:

Primary headaches, which include tension, migraine, and cluster headaches. Secondary headaches, which occur because of some underlying structural problem S/S: Headache pain, dull and aching or acute or pounding. Front, side or back of the head. Dx: medical history reveals a pattern of recurrent or unusually severe headaches Tx: Analgesic, OTC, muscle relaxants Complimental therapies: Massage, acupressure, meditation, yoga, biofeedback, hydrotherapy

Seborrheic dermatitis

Produces dry, moist, or greasy scaling

Epilepsy

Risk: Birth trauma, congenital malformations of the brain, head trauma, fever, metabolic and nutritional disorders, CVA, CNS infection; meningitis or neoplasm. S/S: Warning or aura of seizure. Simple uncontrollable twitch of finger, hand or mouth. Dizzy with unusual or unpleasant sights, sounds or odeors. Sudden loss of consciousness and intense rigidity Cyanosis, inhibited respiration, incontinence, chewing of the tongue. Amnesia, Headaches, Drowsiness, sleep for hours after a seizure.

Alzheimer's disease

S/S: Early stages: Difficulties at work or in social setting with memory loss. Loss of function. Depression and anxiety Mental Impairment: Short term memory, inability to learn new task, subtle changes, forgetfulness, agitation, irritability, restlessness, Person retell same stories. Dx: r/o degenerative brain disease, PE, CT, MRI, Positron Emission Tomography (PET), Depression scale and cognitive functioning tests, Labs: Urine and blood. Tx: Cholinesterase Inhibitors breaks down acetylcholine Memantine. Palliative, Focus on client safety, hydration and nutrition.

Seborrheic Dermatitis

Sebaceous glands marked by an increase in the amount and often alteration in the quality of the sebaceous secretion. Risk: Individuals that have nervous system, Parkinson disease, Stress S/S: Skin eruptions on (scalp, eyelids, cheeks, beard, chest, axillae, groin, or trunk that is dry, moist or greasy scales. Brown-yellow or red. Dandruff. Dx: Medical history Tx: Use Salicylic Acid, Zinc Pyrithione, Hydrocortisone cream.

RESTLESS LEG SYNDROME

Sensations in the leg create an uncontrollable urge to move the leg when at rest. Trying to relax the leg only makes it worse. Risk: Heredity, pregnancy, stress, and related disorders. Iron deficiency, diabetes, and Parkinson disease can cause or worsen RLS. S/S: Restless or unpleasant sensation in legs. Creeping, Tingling, Burning, crawling, and inactive worsens at night. Dx: Often undiagnosed. PE, r/o any other disorders., Sleep study or nocturnal polysomnography. Blood tests to r/o iron and vitamin deficiency. Tx: Controlling RLS, OTC pain relief, warm baths, relaxation techniques, yoga and regular exercise.

Scoliosis

Sideward curvatures of the spine to either left or right. Rotaion of vertebral column Combination with kyphosis and lordosis S/S: Clothing seems longer on one side than the other. Uneven shoulders Dx: Physical Exam, Anterior/Posterior xrays, MRI if tumor or infection is present Treatment: PT, Exercise, back brace, surgery if curvature interferes w/ mobility or breathing, spinal fusion, bone grafts, pain meds

Cold sores and fever blisters

Skin eruptions occurring around the perimeter of the mouth, lips, and nose or on the mucous membranes in the mouth. Herpes Simplex Virus Type (HSV-1) Virus may be dormant and reactivate during times of stress. Cold sores erupt during colds or mentruation. S/S: Lesions are small, pale vesicles in clusters in lips or mouth. Burning and sting, forming ulcers or crusts. Dx: Diagnosis is made on individual characteristic lesions. Tx: Symptomatic, Valacyclovir, Dry and clean, Topical analgesics or ointments docosanol or benzalkonium chloride for burning and itching, Antibiotic ointment. Therapy: L-lysine 500 mg, amino acid and Vitamin E oil.

Scabies

Skin infection resulting in Itch mite or sarcoptic mange (Sarcoptes Scabiei var. Hominis) causing infection. S/S: Itching intensifies at night. Spreads on fingers, on wrists, on elbows, armpit, waste, nipples and buttocks. Dx: Visual Exams, Mineral Oil, Microscope Tx: Peduculicide, Permethrine, Lindane Cream, Crotamiton, Antipuritics, antihistamines.

Tendonitis

Tendonitis: inflammation of tendon or fibrous band of tissues (shoulders rotator cuff, hip, achilles tendon or hamstring). Overuse, another musculoskeletal disease such as RA, postural misalignment, or hypermobility. S/S: Dull aching pain Dx: Xrays (shows calcific deposits), CT scans, MRI Tx: Cold or Heat, immobilization, NSAIDS, steroid injections, Active mobilization may improve adhesions and improve pain. Hydrotherapy and PT.

CEREBRAL ANEURYSM

There is a bulging outward of an artery in the brain. Artery walls become thin, vessel can balloon and weaker in the junction. Risk: Congenital disease, close relative with brain aneurysm, smoking, HTN, High cholesterol, alcohol consumption or cocaine use. S/S: Ruptured Cerebral Aneuryms: Headaches, dilated pupils, blurred or double vision, neck pain, nausea, sensitivity to light, loss of sensation . Rupture occurs: Speech problems, diminished thought processes, loss of balance and coordination and vision deficits. Dx: Aneurysm Ruptures: shows in CT scan Lumbar puncture to reveal blood in CSF. Cerebral Angiography to identify where and size of aneurysm Electroencephalogram (EEG) and MRI Tx: Endovascular coiling-catheter in femoral artery to find navigated toward the aneurysm. Craniotomy

REFRACTIVE ERRORS: Myopia

This condition occurs when light entering the eye comes to a focus in front of the retina so that vision is better for nearby objects. Nearsightedness: close objects are seen clearly, but objects farther away appear blurred. S/S: Squinting, headaches and frequent rubbing of the eyes. Halos around bright lights. Dx: Snellen Eye Chart. Dilation for Ophthalmoscopic Exam. Tx: Eye glasses; Contact lenses. Lasix Surgery (Laser-assisted in situ keratomileusis. Photorefractive keratectomy (PRK) to treat myopia, hyperopia, astigmatism. • Intrastromal corneal rings: In this procedure, clear, thin polymer inlays are used to correct low myopia only. Two ultrathin arcs are surgically implanted in the peripheral area of the cornea.

REFRACTIVE ERRORS: Presbyopia:

This refractive error is a form of farsightedness that causes the eye to lose its ability to focus. Results from loss of elasticity in the crystalline lens of the eye., · When the eye focuses on a distant object, muscles encircling the lens contract, stretch, or flatten it. When the eye focuses on a nearby object, the muscles relax, allowing the lens to resume a more spherical shape S/S: Squinting, headaches and frequent rubbing of the eyes. Halos around bright lights. Dx: Snellen Eye Chart. Dilation for Ophthalmoscopic Exam. Tx: Eye glasses; Contact lenses. Lasix Surgery (Laser-assisted in situ keratomileusis. Photorefractive keratectomy (PRK) to treat myopia, hyperopia, astigmatism.

Warts

Verrucae: benign, elevated skin lesions resulting from hypertrophy or the epidermis. Solitary, clustered. Type of warts: Common warts: Rough, shapled like dome, gray brown color. Plantar warts: thick patches pain causes when walking Flat Warts: appears in face, arms legs, smaller than erasiers are flat, pink, brown or yello. Filiform Warts: appears in nose, head same color as skin Periungual warts: grows in toenails and fingernails. Risk: Papillomaviruses, spreads direct contact or autoinfection. S/S: Asymptomatic, tenderness or itchiness. Tx: Carbon Dx, laser therapy, salicylic acide plaster, surgical excision, cryosurgery, keratolytic (peeling) agents, immunotherapy.

Paget's Disease

Viral infection causes a dormant skeletal infection that erupts years later. Chronic metabolic skeletal disease. Reabsorbed and replaced with bone of a coarse, irregular consistency. Later phase: Replacement of normal bone marrow with high vascular fibrous tissue. S/S: Asymtomatic. Gradual pain. Pinched nerves by enlarged bones, tingling or numbness, warm to touch, headaches and vision loss. Dx: Bone Scintiscans, xrays, bone marrowbiopsies, Blood analysis and urnalysis (alkaline phosphatase and high levels of hydroxyproline in urine). Tx: PT, Bisphosphonates (reduces osteoclast), Analgesics, NSAIDS, Tylenol, Calcitonin (used if Bisphosphnates does not work). Surgery to repair fractures or knee/hip replacements. Surgery,

Myasthenia gravis

Weakness of voluntary muscles. Antibodies produced by the thymus gland destroy the acetylcholine receptors. Motor nerves nor the muscles are not affected. S/S: Muscle weakness, fatigue, drooping eyelids and double vision. Face, lips, tongue, neck and throat muscles affected, a blank expression, nasal regurgitation of fluids, dysphagia, blepharoptosis (drooping of eyelid), dysphasia, bobbing head. Most muscles are affected until paralysis. Menses, stress, sunlight, and the cold increases symptoms. Respiratory muscles weakness Dx: Anticholinesterase, Neuro exam, Electromyography, MRI, CT, ice pack on the eyelid. Confirms MG: Improved muscle function after an IV injection of edrophonium and neostigmine. Tx: Anticholinesterase drugs, Thymectomy, Corticosteroids, Antibody therapies (plasmapheresis).

Dermatomyositis

When the polymyositis disease develops as dermatomyositis, symptoms are accompanied by the appearance of a telltale lilac-colored rash on the eyelids, bridge of the nose, the cheeks, forehead, chest, elbows, and knees. The rash-covered portions of the body may itch severely. May be accompanied by edema around the eye sockets.

Incomplete partial fracture

a break in which the fraction line does not include the whole bone (stress fracture) S/S: Pain, deformity, swelling, discoloration, loss of limb function, muscle spasm, hemorrhage and shock. Dx: Xrays, Scintiscan for hairline fractures. Tx: immobilization, Open reduction (screw, rods, metal plates placements) or closed reduction (Casting), Traction, pain meds, muscle relaxants, Rib fractures (no tx).

Parkinson's disease

a progressive disease that destroys brain cells and is identified by muscular tremors, slowing of movement, and partial facial paralysis. progressive muscle rigidity and involuntary tremors. Risk: Loss of brain cells that make the neurotransmitter chemical Dopamine. S/S: Bradykinesia, Rigidity, and "pill-rolling" tremors beginning in the fingers. Difficulty with balance, a shuffling walk, and muffled speech. Fixed facial expressions. • Stress, fatigue, and anxiety tend to aggravate the tremors, whereas purposeful movement and sleep decrease the tremors due to increase fluid on the brain. Dx: PE, Neuro exam. Blood tests and MRI. Tx: Levodopa, Anticholinergics, PT, Deep brain stimulation.

Herniated Disk

a sac like cushion of cartilage slipped or ruptured disk in the 4th and 5th lumbar and vertebrae and 1st sacral vertebrae nucleus pulposus protrudes through the wall of the disk and into the spinal canal, where it presses on spinal nerves and causes pain and disability Risk: Caused by spinal trauma, fall, straining or heavy lifting S/S: back pain, sensation of numbness, prickling, tingling, paresthesia, coughing, sneezing, bending can intesify pain, Sciatic nerve pain, bad leg cramp. Dx: Straight leg raising tests, Spinal xrays, CT scans, MRI, Myelography (shos oint of compression) Tx: Bed rest, Analgesics, Muscle relaxants, traction, Laminectomy, Endoscopic microdiscectomy, Spinal fusion.

CARBUNCLES

a severe abscess or multiple boil in the skin, typically infected with staphylococcus bacteria. Risk: Infection by staphylococcal bacterial Predisposing factor diabetes, nephritis, hematologic malignancy, debilitation, and infected wound. Common in hot climates. S/S: Tender, painfull and swollen, abscess, erythema, edema. Dx: CBC, Gram Stain of purulent will reveal the causative organism. Tx: Do not squeeze the boil Soap and water, hot and cold compresses, antibiotics agents, surgical incision and drainage, bed rest if buttock is affective.

Peripheral neuropathy:

also called multiple neuritis, polyneuritis, and peripheral neuritis • is a degeneration of the nerves carrying impulses to and from the brain and spinal cord. The syndrome causes loss of sensation and pain as well as the inability to control muscles Risk: Deficient in B12, alcohol intoxicfication, uremia, Toxicity from poison, drugs, metals. Hepatitis, HIV, RA, Lupus, DM Neuropathy S/S: Pain and loss of sensation, tingling, prickling, burning or freezing, muscular weakness, loss of dexterity, tenderness, physical wasting, loss of reflexes, clumsiness. Blurred vision, dizziness, abdominal bloatingm, constipation or diarrhea, urinary hesistance, inconsistence and heat tolerance Dx: Neuro work up, H& P, Electromyography, Blood tests, CT scan and MRI, Nerve conduction studys, lumbar puncture, Tx: Neutralize the toxins, treat infections and metabolic and nutritional deficiencies. Low dose of anticonvulsants, antidepressants, lidocaine patch, PT, OT, Orthopedic interventions, elastic support stockings, sleeping with the head elevated

Alzheimer's disease

an irreversible, progressive brain disorder, characterized by the deterioration of memory, language, and eventually, physical functioning • The result is neurofibrillary tangles, a tangled mass of nonfunctioning neurons, and their replacement by microscopic senile or neurotic "plaques." Biochemically, acetylcholine production, used for memory processing, is reduced, resulting in progressive memory impairment followed by gradual deterioration of judgment, reasoning ability, verbal fluency, and other cognitive skills. Risk: Heridetary, autoimmune reactions, advance aging, history of head trauma.

FOLIC ACID DEFICIENCY ANEMIA

appearance of large abnormal red blood cells (megaloblasts), which form when there are inadequate stores of folic acid. Risk: Low folic acid. Poor diet or alcoholism. S/S: Weakness, fatigue, anorexia, pallor, forgetfulness, irritability, and diarrhea. Dx: PE, CBC (to reveal megaloblast). Decreased Serum folate and Vitamin B12. Bone marrow studies. Tx: · Folic acid supplements administered parenterally. A diet high in folic acid is prescribed.

Furnuncles

boil, is an abscess involving the entire hair follicle and adjacent subcutaneous tissue. Risk: Infection by staphylococcal bacterial Predisposing factor diabetes, nephritis, hematologic malignancy, debilitation, and infected wound. Common in hot climates. S/S: Tender, painfull and swollen, abscess, erythema, edema. Dx: CBC, Gram Stain of purulent will reveal the causative organism. Tx: Do not squeeze the boil Soap and water, hot and cold compresses, antibiotics agents, surgical incision and drainage, bed rest if buttock is affective.

Impacted Fracutre

bone is broken with one end forced into the interior S/S: Pain, deformity, swelling, discoloration, loss of limb function, muscle spasm, hemorrhage and shock. Dx: Xrays, Scintiscan for hairline fractures. Tx: Immobilization, Open reduction (screw, rods, metal plates placements) or closed reduction (Casting), Traction, pain meds, muscle relaxants, Rib fractures (no tx).

Traumatic Brain Injuries:

caused by sudden, violent blows to the head that bruise the brain. • Military conflicts, serious assaults, bullet wounds, serious vehicular crashes, catastrophic events (e.g., earthquake, building/bridge collapse), and severe sports injuries are major causes of TBIs. S/S: Mild: Unconsciousness, amnesia, headache, confusion, problems concentrating, balance problems, blurred vision, ringing in the ears, bad taste in the mouths and mood changes. Serious symptoms: persistent headache, vomiting or nausea, convulsions or seizures, slurred speech, numbness in extremities, agitation and combativeness, and the inability to be awakened from sleep.

MULTIPLE SCLEROSIS

destruction of the myelin sheath—the lipid and protein layer that insulates and protects the axons of certain nerve cells. Risk: Genetics. Immune system attacks it's own tissue. Higher incidents if living farther away from the equator d/t lack of vitamin d. s/s: Sudden motor and sensory disturbances, muscle weakness, paralysis incontinence, fatigue, balance problems, numbness and mood swings. Initial onset of symptoms, and later relapses: acute infection, trauma, serum injections, pregnancy, or stress. Dx: No definitive tests. Neuro exam. Periodic testing and observations. Tx: No cure. Interferon Beta Products, Corticosteroids. Rehab and psychological approaches.

MIGRAINE HEADACHE

incapacitating head aches. Risk: changes in the cerebral blood flow, presumably due to vasoconstriction and subsequent vasodilation of cerebrocranial arterioles. Trigeminal cranial nerve releases neuropeptides when serotonin levels fall, usually the result of a chemical imbalance. S/S: Flashing lights, photophobia, tinnitus, ringing in the ear. Migraine attack: Premonitory symptoms: Aura,. vomiting, nausea and photophobia. Patients can have a stroke. Dx: Recurrent pattern of headaches. CT scan or MRI. Tx: NSAIDS, Triptans Imitrex, ergot prep, antinausea, opiates, Antidepressants, botulinum toxin type A.

Carpal Tunnel Syndrome

inflammation and swelling or fibrosis of tendon sheaths that passes through carpal tunnel. S/S: Pain, burning, weakness, numbness or tingling in hands, unable to clench fist. Decreased sensation to light touch or pinpricks of tingers Dx: Postivie of Tinel Sing, Electromyogram, Nerve conduction study Tx: Rest the wrist, splint, use Ergonomic, NSAIDs, surgical decompression of nerve, resection of ligament.

Otitis Media

inflammation of middle ear. Fluid is the product of pus-producing bacteria. accumulation of fluid in the middle ear. Risk: Upper respiratory tract infection. Pressure in the ear caused by Haemophilus influenzai, S. Pneumoniae, Moraxela Catarrhalis in the middle ear. Often comes with flu, cold, swimming in contaminated water in the middle ear. Narrowing or constriction of the eustachian tubes. S/S: Sensation of fullness or pressure of the affected ear. Fever and chills, dizziness. Dx: Otoscope reveals bulging or eardrums. Cherry red Discoloration. Fluid Bubbles. Elevated WBC count Tx: Antibiotics and analgesics. Decongestants may be ordered to promote drainage. Myringotomy, Drainage by needle aspiration · Tympanoplasty correct the eardrum.

EXTERNAL OTITIS (SWIMMER'S EAR)

inflammation of the external ear canal. Risk: Caused by a bacterial or fungal infection such as seborrhea or psoriasis. · The most common bacterial infections are caused by Staphylococcus aureus and Pseudomonas species. · Aspergillus is the most common fungus to cause external otitis. S/S: · Pain, pruritus, and a red, swollen ear canal are common presenting symptoms. Foul-smelling drainage. Dx: Otologic Exam. WBC. Bacterial culture of ear canal scrapings, as well as sensitivity tests. Tx: Antibiotics and analgesics. Eardrops or ointments. Heat compresses. Keep ear dry and clean.

Acne Vulgaris

inflammatory of sebaceous glands and hair follicles. Appearance of Comedo (blackheads or whiteheads), papules (solid elevation less than 1 cm) and pustules (small, raised areas of skin-filled pus), Risk: Genetic disposition. Inherited in autosomal dominant pattern. Follicular occlusion and androgen-stimulated sebum production. Hormonal balances affecting sebacious glands. Endocrine disorders, use of steroids, psychogenic factors. S/S: Acne plug often appears first as an open comedo (blackhead) or closed comedo (whitehead). Blackhead is caused by melanin produced by hair follicles, not by dirt. Enlarged plug may rupture or leak. Pustules or papules Dx: Medical history Tx: Goa is to reduce bacterial count, decrease sebaceous gland activity, prevent the follicle from being inflamed. Topical antibacterial Treatment, Antibiotics, peeling agents, keratolytic agents

Psoriasis

inflammatory skin disease marked by the appearance of discrete pink or red lesions surmounted by a characteristic silvery scaling s/s: high rate of skin cell turnover produces the thick, flaky scaling that is characteristic of psoriasis. Pruritus. Dx: Observation of the skin, a careful medical history, or a skin biopsy Tx: Soften the scales with petroleum jelly Exposure to ultraviolet (UV) A or UV-B light, Corticosteroids cream, non-steroidal cream, low dosage antihistamines, oatmeal bath, coal tar preparations, Biological agents: Alefacepts (Amevive, suppresses the immune systme), Enbrel, Intralesional therapy: Triamcinolone Acetonide.

Plantar Fasciitis

irritation of ligament on the bottom of feet Risk: Repetitive straining ad tearing, Straining of ligaments, age, often stands or walks, high arches, obesity, pregnancy, walking, standing or running for long periods of time, poorly fitting shoes, excessive pronation, tight Achilles tendons. S/S: Pain, stiffness Dx: PE, xrays Tx: NSAIDs, ice and rest, night splints, corticosteroid injection, extracorporeal shock wave therapy. if treatment fails, surgery to release fascia.

ACUTE MYELOID LEUKEMIA

is a neoplasm characterized by the hyperproliferation of abnormal, immature white cell precursors called blasts. Abnormal cells accumulate in the bone marrow, blood, and body tissues. The white cells are immature, so there is rapid accumulation of myeloid precursors called myeloblasts. Risk: · Exposure to high levels of certain chemicals, such as formaldehyde or benzene. Chemotherapy, especially in those with cancer who are treated with alkylating agents. Radiation treatments may be another source of high-level exposure. · Human T-cell leukemia virus-1 can cause a rare type of leukemia. Myelodysplastic syndrome. S/S: · fever or night sweats; frequent infections; feeling weak or tired; headache; bleeding, especially bleeding gums, and easy bruising; purplish patches in the skin; petechiae, or tiny red spots on the skin; pain in the bone or joints; swelling or discomfort in the abdomen from an enlarged spleen; swollen lymph nodes, especially in the neck or armpit; and weight loss. Include prolonged menses, anorexia, vomiting, confusion, loss of muscle control, and seizures. · tachycardia, palpitations, and increased incidence of infection are common.

Amyotrophic lateral sclerosis (ALS), commonly known as Lou Gehrig disease

is a progressive neurological disorder that damages nerve cells and causes the brain to no longer be able to control muscle movement. The disease affects both upper motor neurons, which send messages from the brain to the spinal cord, and lower motor neurons, or those that run through the spinal cord and connect to the muscles. S/S: Involuntary muscle contractions and muscular atrophy, weakness, and twitching. The individual may have problems with speech, chewing, swallowing, and even breathing if the brain stem is affected. There is no sensory nerve involvement. Person in the later stages of the disease becomes totally paralyzed. Dx: Electromyography, Nerve conduction tests, Muscle Biopsy, MRI. R/o similar symptoms, such as MS, spinal cord neoplasm, and myasthenia gravis. Tx: No effective tx. Emotional and physical support. Use of wheelchair or bed. Teach patient to suction themselves to prevent from choking. Antiglutamate Drug (Riluzole/Rilutek).

MÉNIÈRE DISEASE

is an inner ear problem that can cause dizzy spells, also called vertigo, and hearing loss. Most of the time, Meniere's disease affects only one ear. Risk: Destroys the hair cells within the cochlea. Rupture of the membranous labyrinth allows the endolymph to mix with perilymph. Noise pollution and viral infections. S/S: Severe vertigo, tinnitus, and sensorineural hearing loss. Acute attack of vertigo may cause nausea, vomting, sweating and loss of balance. Dx: Audiometry and radiographs of the internal meatus of the ear. MRI to r/o of brain. Accurate measurement and characterization of hearing loss are of critical. Tx: No cure. Ototoxic antibiotic gentamicin. A salt-free diet, diuretics, antihistamines, and mild sedatives. Control allergies or improve blood circulation in the inner ear may help. Eliminating tobacco use and reducing stress levels. Labyrinthectomy (removal of the inner ear sense organ). Vestibular neurectomy.

Chronic lymphocytic (lymphoblastic) leukemia (CLL)

is characterized by the accumulation of immature, immunologically ineffective B lymphocytes. These cells accumulate to an enormous extent in the lymphoid tissue, blood, and bone marrow. Risk: · Exposure to high levels of certain chemicals, such as formaldehyde or benzene. Chemotherapy, especially in those with cancer who are treated with alkylating agents. Radiation treatments may be another source of high-level exposure. Human T-cell leukemia virus-1 can cause a rare type of leukemia. Myelodysplastic syndrome. S/S: · fever or night sweats; frequent infections; feeling weak or tired; headache; bleeding, especially bleeding gums, and easy bruising; purplish patches in the skin; petechiae, or tiny red spots on the skin; pain in the bone or joints; swelling or discomfort in the abdomen from an enlarged spleen; swollen lymph nodes, especially in the neck or armpit; and weight loss. Include prolonged menses, anorexia, vomiting, confusion, loss of muscle control, and seizures. · tachycardia, palpitations, and increased incidence of infection are common.

Chronic myeloid (myelogenous) leukemia (CML)

is characterized by the proliferation of abnormal white cell precursors called granulocytes in the bone marrow. These granulocytes later enter the blood and invade other body tissues. Risk: · Exposure to high levels of certain chemicals, such as formaldehyde or benzene. Chemotherapy, especially in those with cancer who are treated with alkylating agents. Radiation treatments may be another source of high-level exposure. · Human T-cell leukemia virus-1 can cause a rare type of leukemia. Myelodysplastic syndrome. S/S: · fever or night sweats; frequent infections; feeling weak or tired; headache; bleeding, especially bleeding gums, and easy bruising; purplish patches in the skin; petechiae, or tiny red spots on the skin; pain in the bone or joints; swelling or discomfort in the abdomen from an enlarged spleen; swollen lymph nodes, especially in the neck or armpit; and weight loss. Include prolonged menses, anorexia, vomiting, confusion, loss of muscle control, and seizures. · tachycardia, palpitations, and increased incidence of infection are common.

UVEITIS

is inflammation of the uvea, the pigmented layer of the eye between the inner retina and the outer fibrous layer composed of the sclera and cornea. Risk: Autoimmune Disorders. Microbial infections, AIDS, Tuberculosis, Herpes Zoster, Histoplasmosis, improperly healed corneal abrasions. Allergies, chemicals, trauma or surgery. S/S: · intense, unusual intolerance of light (photophobia); blurred vision; redness; and dark, floating spots in the vision. Severe ciliary congestion, tearing, and a pupil that is nonreactive when exposed to light. Dx: Ophthalmic exam and medical history. Tx: Wearing dark glasses, using eyedrops to dilate the pupil and relieve pain, or using steroid eyedrops or ointment. Atorpine, anticholinergic agent, corticosteroids and analgesics.

Acute lymphocytic (lymphoblastic) leukemia (ALL)

is similar to AML except that there is abnormal growth of lymphocyte precursors called lymphoblasts. Risk: · Certain genetic diseases caused by abnormal chromosomes such as Down syndrome. Chromosomal alterations are often evidenced in ALL. Risk: · Exposure to high levels of certain chemicals, such as formaldehyde or benzene. Chemotherapy, especially in those with cancer who are treated with alkylating agents. Radiation treatments may be another source of high-level exposure. · Human T-cell leukemia virus-1 can cause a rare type of leukemia. Myelodysplastic syndrome S/S: · fever or night sweats; frequent infections; feeling weak or tired; headache; bleeding, especially bleeding gums, and easy bruising; purplish patches in the skin; petechiae, or tiny red spots on the skin; pain in the bone or joints; swelling or discomfort in the abdomen from an enlarged spleen; swollen lymph nodes, especially in the neck or armpit; and weight loss. Include prolonged menses, anorexia, vomiting, confusion, loss of muscle control, and seizures. · tachycardia, palpitations, and increased incidence of infection are common.

Comminuted Fracture

the bone is broken or shattered into peices, with fragments stuck in the surrounding tissues S/S: Pain, deformity, swelling, discoloration, loss of limb function, muscle spasm, hemorrhage and shock. Dx: Xrays, Scintiscan for hairline fractures. Tx: Immobilization, Open reduction (screw, rods, metal plates placements) or closed reduction (Casting), Traction, pain meds, muscle relaxants, Rib fractures (no tx).

Simple fracture

the rib is broken two parts caused by a direct blo or shock to the thorax

HEARING LOSS AND DEAFNESS

· Affects elderly people and is part of the aging process. Risk: Congenital. D/t trauma, infection during pregnancy or delivery. Otitis media, meningitis, and Down syndrome. S/S: Hearing loss. Ototoxic Drugs, Exposure noise, tumors, trauma and aging process. It can result in · Ménière disease, or a sensorineural loss with damage to the cochlear or vestibulocochlear nerve. S/S: Turn up the television. Safety, Does not notice the loss; family members and friends usually bring it to their attention. Dx: Weber and Rinne tuning fork tests. An audiological examination. CT or MRI Scan. Tx: · Conductive hearing losses can be treated surgically. · Sensorineural hearing losses are permanent. · Tympanoplasty or stapedectomy. · Hearing aids may be ordered. Cochlear implants. Prostheses convert sound energy to electrical energy

sprain vs strain

·A sprain is the tearing or stretching of a ligament surrounding a joint that usually follows a sharp twist. A strain is a tearing or overstretching of a tendon or a muscle. Both usually heal without surgery. S/S: Pain, inflammation, bruising, loss of mobility, overuse of ligament, muscles, tendon stiffness, soreness, tenderness, sharp pain Dx: Xrays (determine the fracture) and MRI (extent of the injury) Tx: Elevation and rest, cold compress, immobilization, analgesics, NSAIDS, surgery repair.

Bell palsy

• A disruption of the seventh cranial facial nerve's message sent from the brain to facial muscles, causing paralysis of the muscles on one side of the face. Risk: Viral infection, tumors, vascular ischemia, autoimmune disease, lyme disease, trauma to 7th CN, High blood pressure, DM, Viral disease, viral meningitis, common cold sore. S/S: Facial weakness, drooping mouth w/ saliva drooling. Pain in the jaw, behind ear, headaches, Bell phenomenon: eye cannot close completely, eyeballs rolls upward and tear excessively. Dx: Neurological exam to check nerve function. Must tell the difference between CVA. Electromyography. Tx: Antiviral Medications. Electrical stimulation, warm moist heat, analgesia, corticoid drugs to reduce edema.