This document discusses assessment and management of patients with chronic musculoskeletal system disorders. It provides details on rheumatoid arthritis, gouty arthritis, osteomyelitis, osteoporosis, and osteomalacia. For each condition, it describes etiology, clinical manifestations, diagnostic tests, and pharmacological and non-pharmacological treatment approaches. The overall goal is to educate students on identifying these joint, connective tissue, and bone disorders and implementing appropriate nursing care plans.
Osteoporosis is a skeletal disorder in association with compromised bone strength predisposing individuals to an increased fracture risk.
Osteoporosis occurs when there is imbalance between resorption and formation of bone, if resorption is often quicker and formation is slower, or for both reasons. This presentation includes definition, classification, diagnosis, treatment prevention and complications associated with osteoporosis.Osteoporosis can be prevented by properly awarening people about the facts of it. If etiological factors are minimized then the condition can be well regulated. Lifestyle changes like advising physical activities, prohibiting addictions like tobacco, smoking, alcohol, proper diet which in rich in calcium, phosphorus, salt restriction, getting exposure to sunlight. Intrinsic factors including poor vision, musculoskeletal and neurological disease and medications, whereas extrinsic or environmental factors including trailing wires, loose carpets, and ill fitting footwear assessment should be done for reducing fall complication risks.if dietary intake of calcium cannot be achieved then calcium supplementation should be provided. Caffeine intake should be properly regulated since it plays role in calcium excretion. Weight-bearing aerobic and strengthening exercises can decrease the risk of falls and fractures by improving muscle strength, coordination, balance, and mobility.
Osteomalacia is the softening of the bones caused by defective bone mineralization secondary to inadequate levels of available phosphate and calcium.
The true prevalence of osteomalacia across the globe remains unknown.
Osteoporosis is a chronic, progressive skeletal disease characterized by low bone mass, microarchitecture deterioration of bone tissue, bone fragility, and a consequent increase in fracture risk.
Multiple atraumatic osteoporotic vertebral fractures: Unusual cause of pain i...Apollo Hospitals
Secondary osteoporosis may not be detected early, and thus the condition remains clinically silent until the patient presents with multiple atraumatic compression fractures. It is devastating for a young patient to develop multiple vertebral fractures in view of the associated morbidity and mortality. To decrease the risk of additional fractures and preserve the quality of life in these patients, interventions should be initiated early. Hence, it is important to consider multiple osteoporotic vertebral fractures as a complication in any patient on prolonged steroid therapy.
Osteoporosis is a skeletal disorder in association with compromised bone strength predisposing individuals to an increased fracture risk.
Osteoporosis occurs when there is imbalance between resorption and formation of bone, if resorption is often quicker and formation is slower, or for both reasons. This presentation includes definition, classification, diagnosis, treatment prevention and complications associated with osteoporosis.Osteoporosis can be prevented by properly awarening people about the facts of it. If etiological factors are minimized then the condition can be well regulated. Lifestyle changes like advising physical activities, prohibiting addictions like tobacco, smoking, alcohol, proper diet which in rich in calcium, phosphorus, salt restriction, getting exposure to sunlight. Intrinsic factors including poor vision, musculoskeletal and neurological disease and medications, whereas extrinsic or environmental factors including trailing wires, loose carpets, and ill fitting footwear assessment should be done for reducing fall complication risks.if dietary intake of calcium cannot be achieved then calcium supplementation should be provided. Caffeine intake should be properly regulated since it plays role in calcium excretion. Weight-bearing aerobic and strengthening exercises can decrease the risk of falls and fractures by improving muscle strength, coordination, balance, and mobility.
Osteomalacia is the softening of the bones caused by defective bone mineralization secondary to inadequate levels of available phosphate and calcium.
The true prevalence of osteomalacia across the globe remains unknown.
Osteoporosis is a chronic, progressive skeletal disease characterized by low bone mass, microarchitecture deterioration of bone tissue, bone fragility, and a consequent increase in fracture risk.
Multiple atraumatic osteoporotic vertebral fractures: Unusual cause of pain i...Apollo Hospitals
Secondary osteoporosis may not be detected early, and thus the condition remains clinically silent until the patient presents with multiple atraumatic compression fractures. It is devastating for a young patient to develop multiple vertebral fractures in view of the associated morbidity and mortality. To decrease the risk of additional fractures and preserve the quality of life in these patients, interventions should be initiated early. Hence, it is important to consider multiple osteoporotic vertebral fractures as a complication in any patient on prolonged steroid therapy.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
2. Session objectives
Upon completion of this System, the students should
be able to:
– Identify joint and connective tissue disorders with
their respective causes, c/m, pp and management
– Describe metabolic bone disorders
– Implement nursing process for all disorders
2
4. Rheumatoid Arthritis
A chronic systemic disease characterized by recurrent
inflammation of diarthrodial joints and related structures
Onset can be acute or insidious
Characterized by periods of remissions and exacerbation.
4
8. Rheumatoid Arthritis (Lab Dx)
Elevated Erythrocyte Sedimentation Rate (ESR)
– reflects inflammatory activity
Elevated Rheumatoid Factor (RF)
– Measures the presence of unusual IgG and IgM.
Anemia (Decreased RBC)
C-Reactive protein (CRP) and antinuclear antibody (ANA) may
also be positive
Arthrocentesis
– Needle aspiration of synovial fluid: fluid is cloudy, milky, or
dark yellow, containing WBCs
8
9. Rheumatoid Arthritis (Management)
Pharmacologic Therapy (Disease modifying drugs)
– Methotrexate, 7.5mg P.O., once per week. Increase dose gradually
to a maximum of 25mg per week. Plus
– Folic acid 5mg P.O., per week with methotrexate at least 24 hours
after the methotrexate dose. OR/Plus
– ChloroQuine phosphate, 150mg P.O., (as base) daily for 5 days of
each week for 2–3 months. OR
– SulfasalaZine, 500mg P.O., 12 hourly.
Oral corticosteroids:
– Prednisolone, 40mg P.O., daily for 2 weeks during acute flares
9
10. Rheumatoid Arthritis (Management)
NSAIDs:
– Ibuprofen, 800mg, P.O.,TID with meals. Or
– Diclofenac, Immediate or delayed release tablet: 150-
200mg/day P.O., in 2-4 divided doses.
– Indomethacin, 25-50mg P.O., BID TO TID; maximum
dose: 200mg/day.
Nutritional: weight control,
Reconstructive Surgery
10
11. Rheumatoid Arthritis (Management)
Rest and Activity
– Naps, avoid over-exertion
– Avoid positions of flexion
– Energy conservation
– Exercise therapy – for flexibility, strength, endurance, to
maintain joint mobility/function
Joint protection
– Splints for acutely inflamed joints
Cold therapy – for inflammation during flare-ups
Heat therapy – for chronic stiffness
11
12. Gouty Arthritis
Most common inflammatory arthritis in elderly
– Increasing prevalence with age (75-85 years high)
– Men > women, (for < 65years)
Deposition of urate crystals in tissue
Gout in women
– Usually > 65 years.
– Loss of estrogens induced uricosuric effect
12
16. Gouty Arthritis (Management)
NSAIDs:
Aspirin up to 500mg
Ibuprofen up to 800mg
Indomethacin 25-50mg
Corticosteroids:
prednisone 30-40 mg/d for 5 days
Prednisolone 5mg
Bethamethasone 6mg/ml
Methylprednisolone 16-32 mg
16
17. Osteomyelitis
Is an infection of the bone that becomes
infected by one of the three modes.
– Extension of soft tissue infection (e.g. Vascular
ulcer, incisional infection)
– Direct bone contamination from bone surgery, or
traumatic injury (e.g gun shot)
– Hematogenous spread from other sites of infection
(e.g. upper respiratory infections).
17
19. Osteomyelitis (C/M)
painful,
swollen and
extremely tender
Osteomyelitis (lab Diagnosis)
Elevated leukocyte levels and elevated sedimentation
rate.
Wound and blood culture studies
Standard x-ray studies
19
20. Osteomyelitis (Management)
Antibiotic therapy for 3-6 weeks.
– Amoxicillin-clavulanate 875 mg/125 mg PO Q12h or.
– Ciprofloxacin 750 mg PO Q12h plus clindamycin 300-450 mg PO
Q6h or.
– Levofloxacin 750 mg PO daily plus clindamycin 300-450 mg PO
q6h.
Supportive measures such as hydration, high protein & vitamins.
Immobilize the affected area to prevent pathogenic fracture.
Internal fixation or external supportive device may be need.
20
26. Osteoporosis (Classification)
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26
Generalized osteoporosis occurs most commonly in
postmenopausal women and men in their 60s and
70s……primary osteoporosis (because of
inadequate intake or absorption of calcium, estrogen
deficiency, and sedentary life)
Secondary osteoporosis results from an associated
medical condition such as hyperparathyroidism,
long-term drug therapy, long-term immobility.
Regional osteoporosis occurs when a limb is
immobilized.
28. Osteoporosis (Management)
10/3/2023
28
There is no cure! But as a supportive
management:
Calcium.. … to enhance bone strength
Vitamin D … to support bone metabolism
Estrogen replacement… to decrease bone resorption
Estrogen with progestin …
SERM (Selective Estrogen Receptor Modulator) with anti-
estrogens
29. Osteoporosis (Management)
Exercise
Avoid caffeine intake
Improve protein, K,..intake
Providing hazard free environment to avoid fall
Safety for pathologic fracture (Health education)
29
31. Osteomalacia
10/3/2023
31
Softening of the bone tissue characterized by
inadequate mineralization of osteoid.
Causes:
Lack of activated Vitamin D (this results in poor
utilization of calcium and phosphorous)
Hyperparathyroidism leads to skeletal decalcification
and thus to osteomalacia by increasing phosphate
excretion in the urine.
Prolonged use of antiseizure medication (phenytoin,
phenobarbital) poses a risk for osteomalacia, as does
insufficient vitamin D (dietary, sunlight).
32. Osteomalacia
Osteomalacia may result from failed calcium absorption
(malabsorption syndrome) or from excessive loss of
calcium from the body.
Gastrointestinal disorders (eg, celiac disease, chronic
biliary tract obstruction, chronic pancreatitis, small bowel
resection) in which fats are inadequately absorbed
In addition, liver and kidney diseases can produce a lack
of vitamin D because these are the organs that convert
vitamin D to its active form.
32
33. Diagnosis method of osteomalacia
X-rays
CT – scans
Serum calcium, phosphorous and alkaline
phosphatase levels,
33
34. Osteomalacia
C/M: easily breakable bones,
Management:
vitamin D from exposure to sunlight
Nutritional / proteins, minerals/
Physical, psychological, and pharmaceutical
measures are used to reduce the patient’s
discomfort and pain.
34