Jane Doe, a 22-year-old patient without previous medical history, reveals to the crisis department with complaint of low back again pain after sliding on a wet floor at the job and falling. The patient areas that the pain is frequent aching and radiates down both lower limbs (sciatica). The MRI shows taken muscles and ligaments encircling the L4- L5 area. The disaster physician supplies the following discharge requests: Bed recovery with bathroom privileges for two days. Apply glaciers pack to lower back again for 20 minutes many times per day for the first 48 hours, and then starting day three and on, apply a heating pad for 20 minutes on and 20 minutes off many times per day for another several days as needed to decrease pain. Take 400 mg of ibuprofen every six hours and 5 mg cyclobenzaprine (Flexeril) t. i. d. After two days and nights of bed rest, sit in couch three times per day for only 20 minutes. Ambulate around home and lawn as tolerated, gradually increasing activity. Avoid twisting, bending, or attaining for objects. Avoid lifting any other thing more than 5 pounds of weight for one week. See doctor in one week for even more evaluation.
Explain the rationale for the supervision of glaciers for 48 hours followed by the use of heat.
Explain the explanation for the supervision of the ibuprofen and muscle relaxer.
What will be the expected patient outcomes for the individual in this case study?
Case Analysis 2
John Tuliro, a 32-year-old patient, is accepted to the medical-surgical device following a gunshot wound of the right lower leg contaminated with staphylococcus was debrided. The patient is diagnosed with osteomyelitis. The patient's right lower knee is warm to touch and edematous, and the patient says that the extremity has a frequent pulsating pain that boosts with any movements of the lower leg. The patient's sed rate and leukocyte rates are enhanced. The physician orders the next for the patient:
Admit to medical unit with vital signals every four hours
Bed rest
Elevate affected lower leg on pillows above the amount of the heart
Warm sterile saline soaks for 20 minutes t. i. d. with wet-to-dry dressing change
Levofloxacin (Levaquin) 750 mg IVPB every day
Renal account, CBC with differential inside a. M.
Regular diet with high-protein health supplement shakes
Vitamin C 250 mg po b. i. d.
Meperidine (Demerol) 100 mg po every four hours
Docusate sodium (Colace) 100 mg b. i. d.
The patient asks the nurse why he has to stay in bed. The nurse should provide what rationale for this measure?
What medical interventions if the nurse supply the patient?
(Individual)
DISCUSS INDIVIDUAL AND LIFESTYLE RISK FACTORS FOR OSTEOPOROSIS
The following are the risk factors of Osteoporosis:
Genetics - Caucasian or Asian, Woman, Family History, Small Framework - Predisposes to low bone mass
Age - Postmenopause, Advanced Age group, Low testosterone in men, decreased calcitonin - Hormones (estrogen, calcitonin, and testosterone) inhibit bone loss
Nutrition - Low Calcium mineral Intake, Low Supplement D Absorption, High Phosphate Absorption, Inadequate Energy - Reduces nutrition necessary for bone remodeling
Physical Exercise - Sedentary, Insufficient Weight Bearing Exercises, Low Weight and Body Mass Index - Bones needs stress for bone maintenance
Lifestyle Options - Levels of caffeine, Alcohol, Smoking, Insufficient exposure to Natural light - Reduces osteogenesis in bone remodeling
Medications - Cortocosteroids, antiseizure medications, heparin, thyroid hormone - impacts calcium mineral absorption and metabolism
Comorbidity - Anorexia Nervosa, Hyperthyroidism, Malabsorption Syndrome. Renal Failing - Affects calcium absorption and metablosim
Hormonal versions are one of the reason why for gender dissimilarities as it pertains to the introduction of osteoporosis. In women, estrogen has a role with regards to osteoporosis, while testosterone, estrogen and other hormones in men also relate with this. Also, menopausal period in women accounts for osteoporosis, low endogenous estrogen levels increases the risk.
Lifestyle factors such as smoking, alcohol consumption and sedentary activities, also increases the risk for osteoporosis.
Nutritional factors that increase the risk, includes the following: daily intake that is significantly less than 1000 - 1500 mg of calcium and 400 - 600 International units of Vit. D. Eating high necessary protein diet, drinking caffeine, sodium and phosphorus has negative effect on calcium balance in the torso, therefore, increasing risk for osteoporosis.
There are certain medications that make a difference bone remodeling, and increase risk for supplementary osteoporosis.
DISCUSS THE Dissimilarities IN MEDICAL MANAGEMENT FOR PRIMARY BONE TUMORS VERSUS METASTATIC BONE DISEASE.
Primary bone tumor's goal of treatment is to eliminate or take away the tumor. It is accomplished by surgical exersion, radiation therapy if the tumor is radiosensitive, and chemotherapy. Limb-sparing strategies are used to eliminate the tumor and adjacent tissues. Replacement of the damaged tissue is very important. This can be done through the following: custom-made prosthesis, total joint arthroplasty or bone muscle from the individual (autograft) or from cadaver donor (allograft). Surgery of the damaged part may require amputation.
To prevent metastasis of malignant bone tumor, chemotherapy is began before and prolonged after surgery, to eliminate micromestatic lesions. Palliative management is the procedure for metastatic bone cancer tumor. Its goal is to alleviate pain and discomfort while promoting standard of living.
Structural support and stabilization is needed to prevent fracture, as the bone weakens. Prophylactic inside fixation helps improve large bones with metastatic lesions.
DISCUSS CLINICAL MANIFESTATIONS OF PAGET'S DISEASE, AND ITS OWN PHARMACOLOGICAL TREATMENT FOR EACH.
Paget's disease are in the beginning asymptomatic. The bones that are commonly involved include the vertebrae, pelvis, cranium, sternum and proximal ends of the long bones. Analysis of the disease is made by information of bone pain or deformity, through X-ray or by diagnosis of increased serum alkaline phosphate levels found though biochemical evaluation.
The following are the most typical problems of patients who are suffering from Paget's disease such as pain. Skeletal deformity, and change in skin temperature. Joint dysfunction may result from damage to cartilage and osteoarthritis. Bone pain often occurs during the night, which really is a result of increased pressure on the periosteum or associated hyperemia. Other manifestations that can occur include diminished flexibility and unsteady gait. Neurologic complications can also occur which is caused by nerve main compression or nerve entrapment. These buildings are next to pagetic bone near a nerve foramen or canal. Common professional medical manifestation of Paget's disease is merged sensorineural and conductive ability to hear loss. Low back again pain can also occur because of vertebral body and facet enlargements, loss of lumbar lordosis, dorsal kyphosis, vertebral impingement and changed gait dynamics.
The short-term aim in treating Paget's disease is to ease the associated bone pain, as the long term target, is to alleviate the development of the disease. The pharmacologic therapy includes calcitonin, plimamycin, and gallium nitrate, and the biphosphonates. The primary goal of this therapy is to regulate the condition activity, normalize biochemical variables and to enhance the symptoms.
LIST REHABILITATION AND HEALTH EDUCATION STRATEGIES UTILIZED FOR PATIENT WITH LOW BACK PAIN.
A comprehensive rehabilitation should include a careful analysis for a specific goal and treatments based on best research are exercise, cognitive behavioral treatment, health education among others.
We should instruct the patient to avoid recurrence of the next:
Standing, sitting, lying down and raising properly are essential for a wholesome back.
Alternate durations of activity with cycles of break.
Avoid prolonged sitting, standing and driving a vehicle.
Change positions and slumber at repeated intervals.
Avoid presuming tense, cramped positions.
Sit in a straight-back chair with the legs slightly greater than the sides. Use footstool if necessary.
Flatten the hollow rear by sitting with the buttocks tucked under. Pelvic tilt lessens lordosis.
Avoid knee and hip extension. When driving a car, have the chair pushed forwards as essential for comfort. Place a pillow in the tiny of the back for support.
When standing for just about any length of time, rest one ft. on a tiny stool or platform to relieve lumbar lurdosis.
Avoid exhaustion, which plays a part in spasm of back again muscles.
Use good body technicians when lifting and moving about.
Daily exercise is important in preventing backside problems.
Do prescribed again exercises twice daily strengthens back, leg, and stomach muscles.
Walking outdoors is preferred.
Reduce weight if possible decreases strain on backside muscles.
IDENTIFY COMMON FOOT DISORDERS. IDENTIFY THE PRECISE Composition INVOLVED.
Common Ft. Disorders:
Plantar Fascitis - this is a plantar heel pain, which evolves from the bone (heel spur) or plantar fascia.
Morton's Neuroma - It is the soreness and degeneration of the digital nerves in the toes that produces an agonizing mass nearby the section of metatarsals.
Hallux Disorders: Valgus, Rigidus, and Sprains - Severe injury to the ligaments and capsule of the MTP joint. Lateral deviation of the first bottom higher than the the standard position of 15 levels between the tarsus and metatarsus This might lead to a painful prominence of the medical facet of the MTP joint. Degenerative condition of the first MTP joint resulting in pain and tightness.
DISCUSS THE Participation OF Vitamin supplements D WITHIN THE DEVELOPMENT OF OSTEOMALACIA. IDENTIFY TREATMENT RELATED TO CAUSE.
Vitamin D insufficiency is the most frequent reason behind osteomalacia. Essential for calcium and phosphorus metabolism is Supplement D, it is the critical elements in mineralization of the bone. The major source of Vitamin D is synthesis in your skin subjected to sunlight. Dietary changes is needed by eating food abundant with Vitamin D, such as fatty fish natural oils, liver and egg yolks. Supplement D supplementation is also suggested.
DEVELOP AN IDEA OF LOOK AFTER AN ASSIGNED PATIENT WITH LOW Back again PAIN.
Nursing Treatment for Low Back Pain:
Relieving Pain
Advise patient to stay active and avoid bed rest, generally.
Keep cushion between flexed legs while in side-lying position minimizes strain on back again muscles
Apply heating or ice as approved.
Administer or coach self-administration of pain medications and muscle relaxant.
Promoting Mobility
Encourage ROM of most uninvolved muscles.
Suggest gradual increase in activities and alternating activities with break in semi-fowler's position.
Avoid prolonged intervals of sitting, ranking, or prone.
Encourage patient to go over issues that may be adding to backache.
Encourage patient to do approved again exercises. Exercise keeps postural muscles strong, helps recondition the trunk and abdominal musculature, a and functions as an shop for emotional stress.
GIVEN A TEMPLATE, COMPLETE AN ILLNESS MAP ON A PATIENT WITH CARPAL TUNNEL SYNDROME.
Picture1. png
COMPLETE A THEORETICAL RESEARCH STUDY ON A GENUINE CLINICAL PATIENT WITH OSTEOMYELITIS.
http://www. scribd. com/doc/44830270/Osteomyelitis-Case-Study
(Web Projects)
USING THE INTERNET, RESEARCH LITERATURE ADDRESSING MANAGEMENT OF OSTEOPOROSIS. IDENTIFY NEW MEDICATIONS AVAILABLE ON THE MARKET TO TREAT THIS DISEASE.
Links:
http://www. ncbi. nlm. nih. gov/pmc/articles/PMC493281/
http://www. webmd. com/osteoporosis/news/20100602/fda-approves-prolia-for-high-risk-osteoporosis
As the basic objective of avoiding the progress of osteoporosis to a patient is to reduce bone fracture, management of osteoporosis is discussed in this specific article through many ways varying on the patient's level of fracture risk. Elimination in a non medical therapy was described as having good nourishment, healthy lifestyle and fall elimination. Exercise and aid from vitamin supplements D supplements can actually help in preventing or lessening the chance of osteoporosis.
Medical treatment on the other hands will come in many forms; as it is to be administered based on the guidelines for commencing pharmacologic therapy. Medications for osteoporosis management are categorized directly into two, the antiresorptive providers and anabolic agents, both which acting as brokers to reduce fracture risk.
In the next article, a newly approved treatment was released and approved for the management of osteoporosis. Prolia is a biological, lab-induced treatment that is said to have the ability to inactivate your body bone's breakdown mechanism. It had been approved under given programs though. It could only be implemented to patients of post menopausal stage and has a high risk of bone fracture caused by osteoporosis. Or even to patients who already got osteoporosis treatments but experienced failed. Or finally, to patients who can't withstand other osteoporosis treatments. What this treatment does indeed is to decelerate the procedure of bone breakdown, making the patient less vunerable to bone fracture. Regardless of the features of the said treatment though, side effects to the treatment also offers its downsides. Most usual of which is the patients feeling again, muscle, and bone pains. It is through this reason that patients with low levels of calcium were also prevented to use this kind of treatment
FIND A REASEARCH ARTICLE Looking at Key BONE TUMORS TO METASTATIC BONE TUMORS. SUMMARIZE WITH REGARDS TO MANAGEMENT.
http://www. merckmanuals. com/professional/sec04/ch044/ch044d. html
Primary & metastatic bone tumors fundamentally change from its origins. As major tumor are thought as tumors which have began from the bone itself, metastatic tumors, also called secondary tumors are defined as tumors that have comes from another areas of the body that possessed resulted to or affected the bone as well.
As key bone tumors are cured exactly like with other tumors within the other areas of the body. Patients also go through radiation and chemotherapy as well as surgery. For agonizing vertebral fracture, Kyphoplasty or vertebraplasty are also considered as options to ease pain. Metastatic bone tumors on the other are cured exactly like with key bone tumors though since they have its origins from another area, treatment should be considered depending about how it will impact the entire body of the patient or which that is with tumor (breasts, lung, prostate, etc. )
