MS – multiple sclerosis,
- autoimmune, progressive, permanent myelin destroyed and nerve fiber breakdown, 20-40, environmental factors, relapsing/remitting most common type
- FATIGUE, weakness, vision, spas. & trem., pain w/ parasthesia, no 2 patients alike
- MRI & imunoglobin G bonded
- Mobility, no heat, urinary and bowel – embarrassing young, eye dr. often, sex dysfunction
- MEDS: Rebif, Betasteron SQqod / Avonex IMqwk / Copaxone SQqd / ßflulike symptoms / Methylprednisone for exacerbations, Mitoxarone IVq3mos (all to slow progression & reduce relapses
MG – Myasthenia Gravis
- Autoimmune, myoneural junction, antibodies get in ACH receptors, 20-40W – 60-70M, face, throat (bulbar) swallow, voice, big thymus may hold antibodies
- Tensilon test – bradycardia – Atropine
- MG crisis ¯ or late meds (respir failure) , ACH crisis meds (respir failure), always have suction available hospital and home, no sedative (hypoxia), conserve energy, energy for eating timed meds, sit to eat
- MEDS: ACHsterase inhib – Mestinon / immuno mod (¯antibodies) Prednisone, Imuron, Cyclosporin, Cytoxan / Plasmaphoresis for exacerbations / Thymectomy
GBS – Guillain Barre Syndrome
- Acute fixable myelin problem, after virus (CMV, pneum, flu) 16-25, 45-60, ASCENDING, fast
- Respiratory failure, pulmonary embolis, , autonomic dysfunction, CV instability
- In ICU, CSF will have protein, Plasmaphoresis, IVIG
- Have intubation close by, early detection, support limbs, temp pacemaker, TPN, communications before can’t talk, positive atmosphere, G-tube risk for aspiration
Parkinson
- Progressive, basal ganglia, substantial nigra, dopamine ¯ – symptoms only after 80% decrease
- ? cause – 2 out of 4 (trem, ridg, bradykensia, posture)
- tremors, dementia, micrography, suffling gait
- thalamotomy, Pallidotomy, stem cells
- exercise, rest periods, assistive devices, no rugs, OT
- MEDS: Antiparkinson –Levadopa, Carbidopa / AntiACH – Cogentin (Æ see pee spit shit) / Antiviral (¯ tremors) Symmetrel / Dopa-agonist – Parlodel, Permax, Requip, Mirapex / MAOI – Elderpryl / COMT inhibitors ( dopa) – Comtan, Tasmar / Antidepressant – Wellbutrin, Prozac Elavil
Huntington
- Chronic progressive, premature cell death basil ganglia & cortex / no treatment stops or ¯
- Intellect, emotional and mobile decline
- MEDS: Haldol, Navane – reduces involuntary movement
ALS – Lou Gerig’s
- 2 yrs to life / loss of motor neurons in anterior horn and brain stem
- Atrophy in extremities, trunk and bulbar
- No cause, no cure / death by infection, aspiration, respiratory failure
Osteoporosis
- Loss of bone mass, altered bone turnover, in small white women
- DEXA
- Diet in calcium and Vit D, walking, watch for fractures
- MEDS: biphosphonates: Fosamax, Actonel, Boniva / Calcitonin / SERMS – Evista / Forteo / Reclasp IV 1 q yr
Osteomalacia
- Deformity in long bones (bowing), low serium calcium and phosphate / due to GI, renal, thyroidism
- Treat cause / fix with lots of calcium and Vit D / watch for hypercalcemia
Osteomyelitis
- Infection of bone / due to soft tissue infection, direct bone contamination, spread from another site, mostly staphylococcus aureus
- Bloodborne – signs of sepsis, tissue – no signs of sepsis – pulsing pain, swelling, tenderness
- Round the clock IV antibiotics (lot of teaching), then oral 3 mos. / debridement
- Diet protein & vit C, hydration
RA – Rheumatoid Arthritis
- Autoimmune, synovial tissue, collagen breakdown, edema, joint pain
- Stages: Early – edu, balance exer & rest, NSAID, COX 2 – Viox, Celebrex, sm methotrexate / Moderate erosive – OT, PT, re-eval meds, cyclosporine (increases metho) / Persistent erosive – reconstructive surgery – synovectomy, arthroplasty, corticosteroids / Advanced unremitting – high methotrexate, cyclphosphamide, imuran
Osteoarthritis
- Articular cartiledge, subcondral bone, synovium / pain in morning, relieved with moving around
- Conservative ¯ weight, TENS/ surgical – osteotomy, arthroplasty, tidal irrigation
- MEDS: Tylenol, NSAID, COX 2, opiod, steroid, glucosamine and condroiton
Gout
- uric acid in blood/ cause by purines (shellfish, organ meats, asparagus, dried beans, oatmeal, alcohol), stress, illness / or secondary can be genetic
- Tophi – red and inflamed great toe, hands, ears / kidney stones
- MEDS: Colchicine, NSAID, corticosteroids, Benemid, Allopurinal – renal problems for kidney stones
Bone injuries
- Contusion – soft tissue (fall) / strain – pulled muscle (over use) / sprain – ligaments, etc (twist) / dislocation – out of joint ¬ is a medical emergency (blood flow and nerve conduction – necrosis)
- Treat with RICE – rest, ice, compression, elevation / dislocation – treatment, immobilized, closed reduction
- Fractures: incomplete-greenstick – complete: comminuted (shattered), open (compound/complex), closed (simple)
- Treat with: internal fixators or external fixators
- Pin care – don’t pick scabs, no weights on floor
- Buck can unhook and move up in bed, Thomas (balanced) cannot unhook
Bone injury complications
- Compartment syndrome
- Increased pressure with in a fascia compartment, cuts of blood supply and nerve conduction, muscle death, happens under cast or dressing often
- 5 p’s – pain, paralysis, parasthesia, pallor, pulselessness – relentless pain unrelieved by pain meds
- Medical emergency
- Remove cast, elevate, call dr, surgical decompression, stays open until swelling resolved
- Shock – caused by blood loss, replace fluid
- Fat embolism
- Often from break in upper thigh, finger/ travels and clots major organ
- S&S: hypoxic, tachycardia, Tachypnea, crackles, wheezes, fever, chest pain, coughing up yuck, ¯ BP, change in mental status
- Prevent by immobilization at accident, give oxygen,
CHILDREN
CP – Cerebral Palsy
- Most common permanent physical disability / non-progressive / extremely or very low birth weight – hypoxia during birth – kerniterous –
- no sitting by 8-12 mos – may not be diagnosed until 2 yo
- Can be: hypotonic, spastic/hypertonic, dyskinetic/athetoid, ataxic, mixed
- Goal is optimum development / AFO, orthopedic surgery / align with bolsters, pillows
- MEDS: Baclofen, Diazepam, Dantrolene (for spas), Botox (prevent contractures), Baclofen pump (intrathecal), Tegretol, Depokote (antiseizure)
MD – Muscular Distrophy
- Largest group of muscle diseases / progressive / Duchenne most common / wkness, wasting, contractures / calf & thigh / loss of ambulation by 12 y/o / progress to resp. or card. failure
- Gower sign, muscle biopsy shows fat replacing muscle fiber, creatine kinase
- Maintain indep. & function / nutrition & hydration / avoid obesity / home s/b wheelchair accessible
Downs Syndrome
- Most common chromosomal abnormality / extra chromosome, trisomy 21 / whites
- Karyotyping / congenital heart – mostly septal / URI (due to depressed nasal bridge) / dys-thyroid / risk leuk
- Otitis media / atlantoaxinal instability (C1&2) / parents greive loss / ragdoll-like infant / swaddling / infection prone-handwashing
Fragile X
- Most common cause of inherited mental impairment / males-all races / karyotyping-abnormality on x chrom / big ears, long face, prom. chin, big balls / aggressive / need routine / no cure / normal life span / MEDS: Tegretol, Prozac (for aggressiveness), Catapres ( for hyperactivity)
Major thanks for the article.Really thank you!