Today my contribution will be about casts. • Observe for the following:
• Increased pain and swelling which is not controlled with ice, elevation, and/or pain medication.
• A feeling that the splint or cast is too tight.
• Numbness and tingling in your hand or foot.
• Burning and stinging.
• Excessive swelling below the cast.
• Loss of active movement of toes or fingers, which requires an urgent evaluation by your doctor.
• A feeling of a blister developing in your cast.
• A feeling that that the calf is becoming swollen, tight and painful inside the cast.
• Notice any unusual odor coming from inside the cast.
• If the cast breaks or becomes too loose.
• If the cast edges are causing skin problems.
• If a fever develops.

Mrs. Walsh RN

Carpel tunnel syndrome is possibly the most common nerve disorder experienced today. The carpal tunnel is located at the wrist on the palm side of the hand. The carpal tunnel area is composed of soft tissues, consisting mainly of a ligament called the transverse carpal ligament. Within the carpal tunnel a nerve called the median nerve are passed through the carpal tunnel. When this median nerve in the wrist is compressed it slows or blocks nerve impulses from traveling through the nerve.
The results of this nerve blockage are numbness to hand, weakness, loss of feeling and loss of hand function. I addition to numbness, those with the syndrome may experience tingling, pins and needle sensation or burning of the hand occasionally extending up to the forearm. numbness and tingling may be mild and occur only as a periodic episode, many do not seek medical help. However, the disease can progress to more persistent numbness and burning. In some severe and chronic cases of carpal tunnel syndrome, loss of muscle mass (atrophy) occurs at the base of the thumb on the palm side of the hand. In these instances, especially in untreated cases, some weakness or impaired use of the hand as well as loss of sensation can occur with nerve and muscle damage that can’t be reversed by treatment.
Symptoms of carpal tunnel surface in the morning upon awakening, or may cause
waking during the night. Symptoms can occur with certain activities such as driving, holding a book or other repetitive activity with the hands, especially those requiring long grasping or flexing of the wrist. _____________________________SOniaSVN
.

American College of Rheumatology
Treatment for Carpal Tunnel

Treatment can come in both drug and non-drug styles. A non-drug type of treatment would be to splint the wrist. This can be done using a brace. Typically this is done during the night so that the client does not bend the wrist in a harmful direction during sleep. During the day, the client’s elbow can be extended to a 45 degree angle. Underneath the elbow, place a pad (elbow pads work fine). Surgical decompression can also be done to help should the situation not be fixed by the splint and elbow padding. Cool ice packs can also be used.

Medicine treatments primarily include NSAIDS, corticosteroids, and mild analgesics. Mild analgesics are primarily used, such as acetaminophen. NSAID’s are also commonly used, such as ibuprofen. Corticosteroids such as prednisone can be used to reduce swelling and pressure on the median nerve.

Nursing Interventions for Carpal Tunnel

Most nursing interventions on carpal tunnel are focused on prevention and management. One intervention is to teach the client about exercises that prevent the occurrence of carpal tunnel, such as doing “wrist circles” in which the client rotates the wrist in a circular motion. Teaching the client about the medications and when to take them is also important. Also, you can teach the client how to wear a splint (at night) to prevent further injury. _____________________________________AShererSVN

National Institute of Neurological Disorders and Stroke

I would like to contribute to this study guide by adding more about this repetitive stress injury by talking about a common surgical procedure. Open-release surgery allows the surgeon to view the carpal tunnel directly, without the aid of a camera. This is an out-patient procedure that will allow the patient to go home later that same day. This is preferred by surgeons because it is simple, safe and effective. The doctor will use Local anesthesia to numb the area with an injection. The doctor will make an incision up to 2 inches in the wrist and then cut the carpal ligament to enlarge the carpal tunnel. Recover time for this procedure is usually a couple of months. The patient is required to wear a splint and restrict many activities during this time. Most people are off work for at least a month after open-release surgery.
———————————— Emily V. Hollandsworth

A hammer toe is a deformity of the second, third or fourth toes. In this condition, the toe is bent at the middle joint, so that it resembles a hammer. Initially, hammer toes are flexible and can be corrected with simple measures but, if left untreated, they can become fixed and require surgery.
People with hammer toe may have corns or calluses on the top of the middle joint of the toe or on the tip of the toe. They may also feel pain in their toes or feet and have difficulty finding comfortable shoes.

Treatment for hammer toes
Conservative treatment starts with new shoes that have soft, roomy toe boxes. Shoes should be one-half inch longer than your longest toe. (Note: For many people, the second toe is longer than the big toe.) Avoid wearing tight, narrow, high-heeled shoes. You may also be able to find a shoe with a deep toe box that accommodates the hammer toe. Or, a shoe repair shop may be able to stretch the toe box so that it bulges out around the toe. Sandals may help, as long as they do not pinch or rub other areas of the foot.
Your doctor may also prescribe some toe exercises that you can do at home to stretch and strengthen the muscles. For example, you can gently stretch the toes manually. You can use your toes to pick things up off the floor. While you watch television or read, you can put a towel flat under your feet and use your toes to crumple it.
Finally, your doctor may recommend that you use commercially available straps, cushions or nonmedicated corn pads to relieve symptoms. If you have diabetes, poor circulation or a lack of feeling in your feet, talk to your doctor before attempting any self-treatment.
Hammer toe can be corrected by surgery if conservative measures fail. Usually, surgery is done on an outpatient basis with a local anesthetic. The actual procedure will depend on the type and extent of the deformity. After the surgery, there may be some stiffness, swelling and redness and the toe may be slightly longer or shorter than before. You will be able to walk, but should not plan any long hikes while the toe heals, and should keep your foot elevated as much as possible.
A bunion is essentially a shift of the toe bones into the improper position causing pain and loss of function. The deformity involves the big toe and the long bone behind the big toe, the 1st metatarsal. Over time, the 1st metatarsal will begin to move towards the other foot (medial) while the big toe will move out of joint towards the 2nd toe (lateral). Now that the end of the 1st metatarsal bone is sticking out, it will be under pressure from shoes and the ground. This constant pressure and friction will cause extra bone formation, leading to the bump that is seen on the side of the foot. The big toe will continue to shift towards the second toe causing an unbalanced big toe joint. Over time arthritis can develop in the joint due to the mal-positioned joint. A bunion deformity is always progressive. It will always get worse over time.

A bunion deformity does not always have to be associated with pain. Some patients have a very severe deformity and no pain, while others with a mild deformity have severe pain. Patients usually will have pain right over the bump with continued irritation and bruising to the bone from shoe gear and the ground forces. As the deformity progresses, pain will then be noticed in the joint itself when the big toe is moving. The big toe is very important during the gait cycle for pushing off the ground. With this imbalance of the joint there is a loss of the proper range of motion of the big toe joint leading to an inefficient gait. Over time arthritis will develop in the joint as the cartilage is scraped away each time the joint moves. The pain can be of different degrees depending on the degree of deformity, shoe gear, and activity level.

Conservative treatments for bunions are limited. Wider shoe gear and accommodation for the deformity can be used to take the pressure off the area. Bracing and spacers are often used to brace the big toe back into position and can take some of the pressure of the big toe. However, this does not address the deformity and shift in the metatarsal bone. Furthermore, the bracing techniques are only work when used, once the brace is removed, the big toe will immediately go back into its deformed position. Custom molded Orthotics can take some pressure off the big toe and redistribute the forces of the ground through the rest of the foot. Orthotics can slow the progression of the deformity. There is no way to stop the progression or reverse the deformity without literally moving the bones back into the correct position and realigning the joint. This can only be accomplished through surgery.

Instructions for a Client after Foot Surgery
Pain Management – Methods To Reduce Pain
• Elevate foot
• Apply ice as instructed
• Take pain medicated as prescribed
• Call physician for pain not relieved
Sings of impaired circulation to report to physician
• Change in sensation
• Inability to move toes
• Toes or foot cool to touch
• Toes or foot are pale or blue
Mobility
• Use assistive devices appropriately
• Adhere to weight- bearing restrictions
• Wear protective shoes over wound dressing
Wound care
• Keep dressing or cast clean and dry
• Report signs of wound infection-pain, drainage, fever
• Take antibiotics as prescribed
• Change dressing as prescribed

References:
http://orthoinfo.aaos.org/topic.cfm?topic=A00155
Barbara K. Timby
Nancy E. Smith

By: Elizabeth Woodworth
Jeovany Lopez

Spinal Stenosis

Spinal stenosis is the narrowing in the space inside the spinal canal in the back. This is caudes by pressure applied to the nerves in the spine, is also congenital, aquired, or combination of both.
Signs and symptoms associated with this include pain in the buttocks thighs and lower legs. The pain often worsens when walking or standing for a long period of time. The pain can be relieved by sitting, squating, and bearing forward at waist may relieve the symptom. You may also experience numbness and weakness in the legs, back, neck, shoulders or even arms. Loss of sensation in the lower extremeties may be experineced along with burning and tingling sensation. In severe cases nerves to the bladder or bowel may be affected which may led to a emergeny. Initial treatment is usuallt conservative measures such as physical thearapy to help build up strengh and it also helps maintain stability of the spine. Swimming, walking and biking may be great comfortasble measures to excercise the back muscles. NSAIDs such as over the counter and prescriptions may relieve pain and inflammtion. Moderate rest followed with gradual retirn to activity may improve symptoms also. Even using a back brace helps provide support. After many of these measures have been taken and are not succesful surgery may be the last option. The surgery will help relieve the pressure on the spinal cord or nerves to maintain integrity and strengh of the spine. There are many surgical procedures such as the decompressive laminectomy which is the removal of all the back part of the bone over the spinal canal to relieve tge pressure. Another surgical procedure may be the laminotmy which is when a portion of the back part of the bone over the spinal canal is removed to allow access to a disk or bone spur that presses on the nerve and relieves the pressure. Usually all of the surgeries are done with a singal incision on the back.
Most of the nursing interventions would be concentrated on how to prevent the signs and symptoms of the diease.As nurses we would encourge excercises such as swimming, walking, biking, streching and more. Most of the excercises would be non weight baring. Also if the patient went through surgery we would maintain a infection free incision to prevent further measures of treatment for the patient.
In order to do that we would provide dressing changes as needed and medicate antibiotic to prevent any infection from occuring.

Nurse Tpatel and Atorres SLVNs

Osteoporosis

Osteoporosis is a bone disorder characterized by loss of minerals and collagen from bone matrix, reducing the volume and strength of skeletal bone. The name osteoporosis means “condition of bone pores” referring to the holes or pores formed as bone tissue is lost. The cause of this disease is unknown, yet genetics plays a major part in the disease as well as postmenopausal status in women. Small-framed thin white women are at greatest risk for osteoporosis. African American women have a greater bone density and thus are less susceptible to osteoporosis. Men have an increased bone mass and do not have hormonal changes, and thus do not acquire osteoporosis as frequently and get it at a later age.
In early stages of bone loss, you usually have no pain or other symptoms, but once bones have been weakened by osteoporosis, you may have: back pain, which can be severe if you have a fracture or a collapsed vertebra; lost of height over time with an accompanying of shorten statue and the classic kyphosis of the thoracic spine called “dowager’s hump”; fracture of the vertebrae, wrist, hips or other bones.
Radiographic examination of the bone shows bone loss once it is 25% or more and also shows bone deformities especially in the spine. Dual-energy x-ray absorptiometry (DEXA) is a test that measures bone mineral density (BMD) at the spine and hip. Quantitative ultrasonic studies (QUS) (bone sonometer) measure heel density and provide baseline information for diagnosing osteoporosis and predicting risk of fractures. Treatments or preventative measures may include weight bearing exercise, drug therapy, dietary supplements of calcium and vitamin D to replace deficiencies or to offset intestinal malabsorption.
When providing care of patients with osteoporosis, the nurse emphasizes the need for nutritious, balanced diet that is high in calcium, vitamin D, and protein. It is also recommended to drink three glass of milk daily or eat other dairy products to acquire about 1000 to 1500mg of calcium. Orange juice fortified with calcium is a nutritious alternative for milk. Promote an exercising plan consisting of preferably of a high impact exercise such as high impact aerobic, dancing, jogging, hiking, etc. For patient that cannot tolerate high impact exercise a low impact exercise plan can be substituted such as walking, stair stepping machine, elliptical machines, etc.
Some possible medication use to prevent or treat osteoporosis are: Bisphosphonates, Raloxifene (Evista), Calcitonin, Teriparatide (Forteo), and Tamoxifen. Bisphosphonates like estrogen is type of drugs that can inhibit bone breakdown, preserve bone mass, and even increase bone density, reducing the risk of fractures. Raloxifene belongs to a class of drugs called selective estrogen receptor modulators (SERMs). It mimics estrogens effects on bone density in postmenopausal women, without some of the risks associated with estrogen. This drug is approved only for women with osteoporosis and is not currently approved for use in men.
Calcitonin, a hormone that is produced by your thyroid gland, reduces bone reabsorption and may slow bone loss. Because calcitonin isn’t as potent as bisphosphonates, it’s normally reserved for people who can’t take other drugs. Teriparatide is a powerful drug, an analog of parathyroid hormone, treats osteoporosis in postmenopausal women and men who are at high risk of fractures. It works by stimulating new bone growth, as opposed to preventing further bone loss.

National Osteoporosis Foundation, Mayo Clinic, Timby, Thibodeau

——————D. Montalvo SVN & H. Tran SVN

Spinal Stenosis References

http://www.mayoclinic.com
http://www.spinalhealth.com

Herniated Disk
A herniated disk is a rupture of a fibro cartilage intervertebral disk that pushes against the spinal cord or spinal nerve roots, causing pain.

The Signs and Symptoms for herniated disk are severe low back pain, pain radiating to the buttocks, legs, and feet. Also pain increases with coughing, straining, and or laughing
Because of the pressure on the nerves tingling or numbness in legs or feet also increases. In later stages muscle weakness or atrophy along with muscle spasms. Patient may experience neck pain, deep pain near or in the shoulder blades on affected side, the pain may radiate to the shoulder, upper arm, forearm and rarely the hand is affected. Pain increases when bending the neck and or turning head because of increased pressure to nerves.

Treatments
Some treatments for herniated disks consist of nonsurgical options which include pain medication such as acetaminophen, NSAIDs, neuropathic pain medication, tricyclic antidepressants, muscle relaxants, corticosteroids, and or narcotics. Cold and or heat therapy. Cold packs can be used initially to relieve pain. . Hold it on the sore area for about 15 minutes several times a day. Heat therapy is used to relieve pain after. Electrical stimulation is used to block pain fibers and releases endorphins. Bracing to increase comfort and help regain mobility it also reduces spinal motion, decreases pressure within the affected disk and helps to keep the soft tissues of the back warm to reduce pain. Hydrotherapy involves either sitting in a whirlpool bath and or performing a variety of exercises, this treatment to relieve pain and help muscles relax. Traction is used to keep patient immobilized. Stretching relieves acute pain. Surgical options are a last resort to keep the herniated disk from pressing on nerves and to relieve pain.

Nursing Interventions
• Administer medications
• Assess pain levels
• Encourage rest
• Help keep patient immobilized.( when using traction or bracing)
• Offer comfort measures (ex. use of cold or heat therapy)
• Help with stretching exercises

http://www.umm.edu
http://www.mayoclinic.com
Thibodeau Text Book

Submitted by:
—J. Cowgill, SVNEC
—E. Garibaldi, SVNEC

Tendonitis

Definition:
An inflammation of a tendon caused by overuse.

Pathophysiology and Etiology:
The primary causes of this injury is trauma and repeated stress. the injury typically follows excessive pronation and supination of a body part where you exceed its maximum strain such as excessive exercising, lifting weights, running with out first streching, basically pushing your body to a point beyond its flexion.

Signs and Symptoms:
Pain and inflammation are the most common signs and symptoms. Numbness and a burning sensation are some of the other signs and symptoms.

Diagnostic findings:
X-ray studies are usually done to identify abnormalities and rule out fracture and other problems such as breaks and tears.

Medical and Surgical management:
the main treatment of these disorders include applying cold ice and heat, mild exercises and antiinflammatory medication, local injection of corticosteroids, analgesic, NSAID’s, and lots of rest. physical therapy is usually prescribed to a patient with upper extremity damage.

Nursing Management:
A nurse provides the patient with information about the medication. the nurse shows patient on how to properly use and care for a splint that may have been prescribed. Also on how to do ROM exercises. The main teaching is for the client to rest the joint in a position that reduces stress. support joint with pillows while slepping. apply cold for the first 24 to 48 hours to reduce swelling and pain. Avoid any straining to joint. Perform ROM and take medication as prescribed. _____________________
_________________LealPSVN

Resorces:
Intoductory Medical-Surgical Nursing NINTH EDITION Timby-Smith

Ganglion Cysts

Here is information on Ganglion cysts that I found to contribute to our study information. I picked this because I just found out I have one in my right wrist.

Ganglion cysts are a noncancerous fluid-filled lump. They are most common along the tendons or joints in your wrist or hands but may also appear in your feet. Their exact cause is unknown and they may appear suddenly or gradually over some time.

In most cases, ganglion cysts won’t cause any pain nor require any treatment. Normally, they go away on their own. Sometimes pain may be caused by pressure on the nerves near the joint, which can also cause weakness or numbness in your hand. If you do experience pain or interference with joint movement and you need treatment, it usually consists of removing the fluid from the cyst or surgical removal of the cyst.

The symptoms of a ganglion cyst include: raised lumps near your wrist or finger joints that are round, firm and smooth, they are fixed in one place but may “give” a little when you push against them, they range in size depending on your activity level, the more you use the affected joint the larger they tend to grow.

Ganglion cysts are more common in women. You are at risk if you have regular, repetitive movement that stresses your wrist or hand, have osteoarthritis or injury to the joints or tendons of your hands or feet.

If you experience a noticeable lump or pain in your wrist, hand or foot, see your doctor. Write down any symptoms you may be experiencing, any key personal information, make a list of all medications you are taking and any questions you would like to ask. He or she will make a diagnosis and determine if you need treatment.

References: http://www.mayoclinic.com/health/ganglion-cysts/DS00767

By: Brandee Spencer SVN