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

PATHOPHYSIOLOGY:
Cause is unknown, but genetic factors may be involved, specifically people with a gene called HLA-B27 are significantly at high risk. Affects males more often and onset usually occurs between the ages of 16-40 years of age.

SIGNS AND SYMPTOMS:
-frequent pain and stiffness in the lower back and buttocks, this pain happens gradual and over time of a few weeks to months
-pain is worse during the mornings and the night, in some cases a warm shower and light exercise improves pain
-mild fever, loss of appetite, general discomfort
-pain becomes chronic and felt on both side
-after months can spread to spine and neck
-pain tenderness can spread to ribs, shoulder, blades, hips, thighs, and heals

DIAGNOSTIC/TESTS:
-X-rays which allows to check for changes in the joints and bones
-CT, MRI scans, to detect inflammation and other changes in the joints
-Blood Tests:
(ESR) erythrocyte sedimentation rate: inflammation is signaled by elevation in the speed at which RBC settle to the bottom of a tube of blood in 1 hr.
(CRP) C-reactive protein: indicates inflammation by the presence of a protein that your liver produces as part of your immune system response to injury or infection

MEDICATIONS:
-NSAIDS: for inflammation and pain
-aspirin for pain
-corticosteroids for inflammation and pain
-TNF inhibitors: study’s show can potentially slow or even halt the pregression of (AS) in some people. (still in research)

NURSING MANAGEMENT:
-take medication as prescribed to reduce pain and increase comfort
-exercise program is very important, if to painful do in intervals
-maintain good posture, flexibility and eventually help to lessen pain
-emotional support, very important because some people become physically deformed from this disease.

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

Heel spurs

A heel spur is an inflammation of the plantar fascia, bony part of the foot, also known as the plantar. Fascia is a type of connective tissue. Heel spurs are often soft, bendable deposits calcium that results from tension, pressure, inflammation in the plantar fascia attachment to the heel. Heel spurs are made of calcium deposits, which so much stress under the heel the plantar fascia stretched abnormally. However heel spurs do not formally cause pain.
The indication of symptoms of a heel spur is heal pain within the first few steps in the morning. The use of bad shoes with the ones that have no actual back support with cushion, alternating high shoes to flat shoes will cause it because calf muscles become accustomed to extra heel height and loose there actual flexibility. The cause of the heel spur is still unknown. There are many factors to what have contributed to a heel spur but it is not definite and is an unknown cause.
To avoid further problems with heel spur apply ice to reduce inflammation and pain. Furthermore taking cortisone injections will reduce inflammation. Further treatments stretching the calf muscles at least several times a day, especially in the morning and after a long time from sitting down. Stretching every morning and periodic rests as well will help. Arch support especially if you have flat feet. Losing weight in over weight women are six times more likely to have this problem. This is because fat deposits lower on the body in women than in men. To indicate whether a patient has an actual heel spur, a physician will order a x-ray scan. They are normally hooked an extent into the heel.
Preventative measures first proper footwear is very important. Wearing a orthotic is a good method of stretching the plantar fascia. Athletes in particular should make sure to stretch priority to any physical activity. Stretching helps prevent heel spurs by making the tissue stronger as well as more flexible.
Nursing interventions assess appearance, temperature, level of pain, skin integrity,
to rule out pressure ulcer . Apply ice to the heel to relieve and inflammation. If pain
persist contact physician or health care provider and administer medication as prescribed.
Medications such as cortisone injections, anti-inflammatory medications will help with
inflammation. . Last resort if all other measures fail surgery will release tension on the plantar fascia and the removal of the spur.

Reference:
Heel spurs.com
http://www.lib.oiowa.edu

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

Bunions are when your big toe points towards the second toe causing a bump on the edge of the foot at the joint of your big toe. This condition can be painful because there is extra bone and fluid grows at the base of the big toe. Most often you can get this by wearing ill-fitting shoes.

Signs and symptoms
You may see redness, calloused skin along the foot, a bony bump at the site of the toe. There will pain over the joint and can be aggravated by pressure. The big toe is going to turn towards the other toes.

Treatment can begin as preventative. Wear wide toed shoes and take cares of feet. Wearing foam or pad to protect bunions and aggravating it. Bunions that have gotten worse, surgery can be done to realign and remove the bony bump, this is called bunionectomy.

Nursing intervention can be done:
-educate and encourage patient on how to do foot care
-educate patient on how to find shoes the fit their feet and avoid wearing high heeled, narrowed shoes
-educate patient on the importance of wearing foam pads to protect bunion from getting worse
-educate patients the signs and symptoms of bunions
A callus generally refers to a flat, diffuse build-up of hard skin and may or may not hurt but it depends on the thickness
A corn is a thicker more focal area with a central nucleus or core which forms over a bony prominence such as a joint. Corns occur more commonly on the toes and can often be very painful.
Signs and symptoms of a corn and callous
• A thick, rough area of skin
• A hardened, raised bump
• Tenderness or pain under your skin
• Flaky, dry or waxy skin
Treatments and nursing interventions of corns and callous
• Educate the importance of regular maintenance to keep the corn and calluses reduced
• Teach the importance of preventative foot care
• Teach proper use of padding to prevent the pressure
• Advice about wearing correct fitting footwear
• Educate about the use of foot orthotics to relieve the pressure under the foot
• Educate that there is a surgical correction for the bony prominence, to help relieve pain————————————————–L.Huot, M.Yago SVN
American academy of orthopedic surgeons
http://orthoinfo.aaos.org/topic.cfm?topic=A00152

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

Paget Disease

Fist described by British surgeon Sir James Paget in 1882 from observations of a patient treated over a twenty year period for a deforming bone disease. The disease process is characterized by local, intermittent, and uncontrolled osteoblast formation of bone, and osteoclast destruction of bone. The overactive bone cells cause an overproduction of unusually displaced weak bone, making them also more susceptible to fractures. The cause of Paget’s Disease is unknown, although it has been associated with heredity and viral infections.
Initially the disease may be asymptomatic but can become severe consisting of pain, enlarged bones, broken bones, and damaged cartilage in joints. The skull, spine, pelvis and leg bones are the most common sites of disease. Theses deformities can lead to other disorders such as deafness, blindness, headaches, and facial paralysis due to compression of skull bones on cranial nerves. In severe cases areas of diseased bones may also develop into osteosarcomas.
Treatment is palliative consisting of pain management with analgesics such as aspirin or NSAIDS. For severe pain treatment with calcitonin (drug that reduces number of osteoclasts) may be used. Calcitonin reduces rate of bone turnover as well as decreasing serum alkaline phospatase levels, and urinary excretion of hydroxyproline diminishing lesions from bone overproduction. Drugs used in advanced form of disease are etidronate disodium (EHDP), and alendronate sodium (Fosomax) which both reduce bone formation. For severe disease mithramycin an antibiotic used for its cytotoxic effect can be used. Surgery may also be preformed to relieve neurological complications, or repair fractures acquired.
The nurse would implement physician ordered drug therapy, and monitor for side effects. If unable to care for themselves help patients with activities of daily living. Because this disease is so devastating to bone structure teach safety technique, use of ambulatory aids such as front wheel walker, or cane. Inform patient about self-administration of drugs, and how to check home for fall risks.

References:

Introductory Medical Surgical Nursing
Lippincott Williams & Wilkins a Wolters Kluwer business

The Human Body in Health and Disease, Fourth Edition
Elsevier Mosby

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

Scoliosis
Is a lateral curvature of the spine. Scoliosis is usually first diagnosed just before or during adolescence. It affects about 2 percent of the population, runs in families and is more common in girls than in boys. Signs/symptoms of scoliosis include:
• Uneven shoulders
• One shoulder blade more prominent than the other
• Uneven waist
• One hip higher than the other
• Leaning to one side
• Severe curves may also cause the spine to twist, causing the ribs of one side of the body to stick out farther than on the other side.
Treatment:
Treatment for scoliosis varies, depending on the severity of the curve at diagnosis and the likelihood that the curve will worsen. Typically, curves that are less than 20 degrees are considered mild and usually only require monitoring for any changes. For growing children, your spine center physician will want to evaluate your child and have X-rays of his or her spine taken every six to 12 months until the child stops growing. Braces
Curves of between 25 and 40 degrees often require the use of a brace to keep the curve from worsening. It will not cure scoliosis or improve the curve. Surgery
Doctors usually recommend surgery to correct a curve of greater than 40 to 50 degrees or for curves that rapidly progress despite bracing.

Nursing interventions for scoliosis, kyphosis, and lordosis:
Management: depends on extent of curvature. Exercises, Milwaukee brace or Silastic jacket brace – for treatment of 20-30 degree curvature (Worn 23 hours a day)
Invasive: Spinal fusion and stabilization by instrumentation provides stabilization and corrects twisting of vertebrae by derotation and bone graft. Spinal Fusion with Instrumentation (Harrington rod, Luque system, Cotrel-dubousset)

Resources at Cedars-Sinai
• Cedars-Sinai Institute for Spinal Disorders
• Cedars-Sinai Orthopedic Center
• http://www.mc.edu
By: Agnes & Vanessa