Nursing Data 29 MU

🔽Iumber Disc Herniation

🔻Anatomy : 🫧The discs are made of connective tissue. Connective tissue holds the living cells of the body together. Most connective tissue is made of fibers of a material called collagen. These fibers help the disc withstand tension and pressure. A disc is made of two parts. The center, called the nucleus, is spongy It provides most of the disc's ability to absorb shock. The nucleus is held in place by the annulus, a series of strong ligament rings surrounding it. Ligaments are connective tissues that attach bones to other bones. ➖➖➖➖➖➖ √Most common in >> 30- 40 years √Human supine formed by >> 24 spinal bone 📌ناخد بالنا ان عندي 3 type of pain: 1⃣ Sharp pain >> دا ف حاله لو حصل complete disc herniation بيبقي ممتد الي جزء من الرجل او الرجل كامله 2⃣ Throbbing pain >> ودا ف حاله لو حصل inflammation بلاقيه موجود ومنتشر عندي ف : *Low back *Both hip and buttocks 3⃣pins.needles.numbness >> ودا ف حاله لو حصل pressure on nerve 📌عندنا كمان Symptoms of nerve compression الضغط دا لو نزل ع lower limbs هيسببلي 1-Reflex slow 2-Nerve weaken 3-Impaired sensation in the skin 4- Change in bowel and bladder function 📌 Non-Surgical Treatment (conservative treatment) 1- anti-inflammatory drugs >> aspirin+ ibuprofen 2-narcotic drug >> codeine+ morphine ودا بستخدمه ف حاله لو الأعراض عند المريض Severe 3-muscle relaxants >> ف حاله لو عنده spasm 4-Oral steroids >> ف حاله لو pain spread down to the leg 🫧Lying on back can take pressure off sore discs and nerves. 🫧back support belt (حزام الضهر) can help lower pressure inside the problem 🫧Note:Patients are encouraged to gradually discontinue wearing the support belt over a period of two to four days ، their trunk muscles begin to rely on the belt and start to atrophy (shrink). يعنى مينفعش المريض يلبس حزام الضهر ده فتره طويله لان كده مش هيستخدم back muscle بتاعته وهيعتمد على حزام الضهر ومع الوقت هيحصلها atrophy لو لابس الحزام طول الوقت 🫧Some patients who continue to have symptoms are given an epidural steroid injection (ESI). 🫧Note :Lumbar traction may also be used at first to ease symptoms of lumbar disc herniation. 🔻 surgical treatment: laminotomy discectomy microdiscectomy posterior lumbar fusion 🔻 Indication of surgery 🫧weakening in the leg muscles. 🫧 pain that won't ease up. 🫧 problems with the bowels or bladder.

💥Epilepsy الصرع 💥 👉Def: central nervous system disorders اضطراب فى الجهاز العصبي نتيجه  ان نشاط الخلايا بيحصل ليها فهتسبب ليا disruptd هتعمل ليا seizures, loss of consciousness ومشكلة فى السلوك والاحساس 👈أسبابها اي 👻Genetic influence هنا بمختلف عن ال stroke فى الجزئية دي 👻Head trauma 👻Brain condition فى حالات ال brain tumors , stroke ايوه السكتة الدماغية تعمل ليا epilepsy فى المرضى إللى المرهم اكتر من 35 👻Infection diseases (Meningitisالتهاب الاغيشه السحاقيه فى المخ ، AIDS ,encephalitis التهاب في المخ ➡️ inflammation in active tissue of the brain ) 👻Prenatal injury بيحصل والطفل لسه جنين نتيجه عدوى عند الأم أو نقص الأكسجين أو التغذيه 👻Development disorders Autism التوحد ، neurofibromatosis مجموعه من الأمراض العصبية ➡️ high risk of tumer formation / بتكون وراثية 👈أي هي risk factors 🧜Age بتحصل فى اي عمر بس بتزيد فى الطفوله المبكرة واللى سنهم فوق 60  🧜Family history 🧜Head injury ➡️ when you riding a car wear seat belts ➡️ bicycling wear helmet 🧜Stroke, vascular disease 🧜Dementia الخرف 🧜Seizures in childhood لو عنده high fever فى مرحله الطفوله بتكون مصاحبة بنوبات صرع 👈اعراض ال seizures اي ☠️Temporary confusion ☠️A staring spell تحديق ☠️Loss of consciousness ☠️Uncontrollable jerking movements ☠️Psychic symptoms 🚨انواعها مهمه عندي 🚨 ♦️ partial seizures: 👻Simple seizures ال awareness مش بتتغير ولا بتتأثر 👻Complex seizures ال awareness بتتأثر عكس إللى فوق ♦️ generalized seizures : 👻Absence seizures (petit mal) More in children بتحصل ليا فجأه بدون warning signs Brief loss of awareness Lasting  less than 15 s Stare without moving تحديق المريض مش بيكون فاكر اي حاجه من الى حصلت بتحصل ليا مرات عديدة فى اليوم بيكتشفها المدرس 👻Tonic - clonic (grand mal ) بتنقسم عندى ل ٣ مراحل 1. Pre ictal ( aura phase ) الحلو فيها انها بمثابة warning sings السىء فيها انها بتقعد 2-3 min وبعدها تحصل ال attack بتحس هنا انك شايف شىء مش موجود سامع حد او حتى ف طعم metal ف فمك 2. Ictal ( attack phase ) تفقد الوعى لمدة 10 min ♦️ Tonic بتاخد ١٠ ثوانى اطتر من كدا المريض هيموت بيحصل انو المريض بيرفع عينو لفوق وبيعض ع سنانو و extention للجسم عامة وركز ف دى عضلات التنفس تنقبض يدخلى ف cyanosis ♦️clonic من 2-3 دقايق بيحصل contraction و relaxation وال micturation ويعض لسانو 3. Post ictal تعبان هلكان مصدع وعاوز ينام وعندو Todd's paralysis ودا شلل مؤقت 👻Myoclonic seizures Super jerking بتأثر ليا على limbs , Jaws When falling sleep or waking in the morning 👻Atonic seizures A static seizures or drop attacks No loss of consciousness وعندي فيها slumping , nodding 👉🏻 complication Falling فيأذى دماغو Drowning فيغرق عشان كدا بمنع انو مريض الصرع يعوم Car accident أصلو هيفقد وعيو Pregnancy مضاعافات للأم وللطفل سواء بسبب الحركات أثناء الصرع او الدوا * مضاعفات تهدد الحياة un common بس ممكن تحصل : 👀Status epilepticus دى نركز فيها شوية النوبة فضلت اكتر من 5 min وكذا نوبة ورا بعض من غير فاصل من رجوع الوعى Sudden death 👈مهم عندي اعرف ال diagnosis زي EEG MRI, CT Neurologic exam 👈ال treatment عندي فى non pharmacological Ketogenic ياخد اكل high in fat Not miss drug وخد بالك انا بعطيه ال drug أصلا عشان اعمل prevent مش cure ال mono therapy هو ال best ال multiple لا يفضل عشان عشان drug interaction منوقفش ال antiepileptic drugs الا بعد سنتين وتكون free من ال fits 👈أي الإجراءات إللى بعملها أثناء seizures 🦄Put the patient in the lateral position 🦄Auxiliary temperature should be  measured 🦄أتجنب أعطيه IV line فى منطقه antecubital area لأن وقت التشنجات هيحصل عند flexion لل arm هتعمل ليا  block off IV site 🦄افضل normal saline أعطيه للمريض عشان نتجنب الترسيب (precipitation )هو IV diazepam 🚨أي هي الاحتياطات اللازمة لل phenytoin infusion 🧜اننا نطهر IV line بمحلول ملح قبل استخدامها 🧜بنحقن الدوا بمعدلات بطيئة not rapid than 50 mg / min 🧜Monitor ECG , BP 🚨اي الإجراءات إللى بعملها بعد ال seizures 👻Put the patient in the side lying position to facilitate drainage of secretions 👻بعمل documents لل events  إللى أدت ليا للنوبه الصرع وأثناء حدوثها برضو

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🚨أي هي ال nursing care اهم حاجه عندي 👻Turn pt head to the side to open airway 👻Loosen any tight clothing , 👻نضع تحت راسه اي حاجه soft, flat 👻نتجنب ندخل اي حاجه فى فم المريض 👻Avoid using tongue blade, spoon during attacks 👻Place a soft object to protect tongue 👻أعطي للمريض anticonvulsants لل prevent ليست لل cure 👻مراقبه  و حمايه المريض من اي injury أثناء نوبه الصرع 👻مدى التزامه بالعلاج سنيتن لعند ما يكون free from fits ♦️ لو المريض حس بال aura اهم حاجة ال safty بتاعتو ♦️ هشوف ال toxic signs زى ال slurred speech , ataxia , lethergy and dizziness ♦️ انصح المريض ياخد ال enough sleep to prevent attacks ♦️ avoid restraining نركز على الأسئلة ف نهاية الباور 👩‍🦯 بالتوفيق يا أحلى دفعة 🥰

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Burn management 💫 Skin : the largest organ in the body , 16 % of total body weight 💫 Epidermis : completely replaced every 3:4 weeks 💫 Most common cause of burn ➡️ Thermal Most dangerous cause of burn ➡️ electrical 💫 Radiation burn ➡️ cause first degree burn like sun burn 🌞 Chemical burn ➡️ cause third degree burn Electrical burn ➡️ cause cardiac arrest عشان كده المريض بحريق ناتج عن مصدر كهربي مهم assess the heart rythm 💫 Wash burned area with running water for at least 10 minutes 💫 Higher mortality with burn among children and old age 💫 Deep partial thickness and third degree burn are more danger 💫 Burn not exceed 25% ➡️ local response Burn exceed 25% ➡️ local and systemic response 💫 The affinity of hemoglobin for carbon monoxide is 200 times greater than for oxygen 💫 Emergent = resucitative = fluid shifting phase 💫 Colloid ➡️ plasma, blood Crystalloid ➡️ ringer , normal saline 💫 Urine output following fluid shifting Thermal Adult ➡️ greater than 30 ml/hr Child ➡️ greater than 2 ml/kg/hr Electrical Adult ➡️ greater than 75 ml/hr Child ➡️ greater than 4 ml/kg/hr 💫 Normal urine output: 0.5 : 1 ml/kg/hr Oliguria < 30 ml/hr Polyuria > 60 ml/hr 💫 Monitor urine output at least hourly, patient weight daily 💫 Acute = intermediate phase fluid remobilization = state of diuresis 💫 Acute phase begins 48 : 72 hours after burn 💫 Hypokalemia begins on the fourth or fifth post burn day 💫 مهم جدا في مرحلة ال Acute phase إني بعمل nutritional support 💫 Protein requirement : 3 gm of protein/ kg / day Calories: 5000 calorie/ day Multivitamins should be given daily Iron and potassium are needed 💫مريض الحروق في مرحلة ال acute لو عنده weight loss greater than 10% of normal body weight ده indicator for TPN 💫 Activity intolerance Body image disturbance Knowledge deficit من أهم المشاكل اللي بركز على حلها في ال rehabilitation phase

نيجى للحته دى مهمه جدا Fluid replacement يعنى المريض فقد سوائل كتيير خاصه ف اول فبنعوضه بسوايل مكان اللى فقدها طيب بنعوضه بشكل عشوائي ولا هنمشى على جدول هنمشى على جدول اسمه Brooke formula ده نظامه اى اول يوم بنضرب 2ml لكل كيلو جرام من وزن العيان فى TBSA اللى مساحه الجلد اللى اتعرضت للحرق ده كله عشان نعوض فقد السوائل + basic requirements اللى هى اى دى بقا؟...طيب هو اصلا الشخص الطبيعي بيحتاح سوايل ف اليوم بعيداً عن انه عنده حرق طيب السوائل دى طبعا هنديهاله لانه مش بيشرب يعنى كل حاجه بياخدها I.V ف احنا هندهاله IV والطبيعى بتاع السوايل ف اليوم 2000 الى 2500ml فى اليوم هنديهمله على هيئه glucose 5% طيب ندى مثال مريض وزنه 60kg و TBSA =10 احسب حجم السوايل اللى هنعوضهاله هنعمل اى 2×60 ×10 +2000ml = 3200ml طيب 3200ml دول هنديهملوا ازاى نصهم بيتاخدوا على هيئة colloid زى البلازما والنص التانى على هيئه crystalloid زى الرنجر وده احسن واحد وزى saline طيب هنديهملوا امتى اول 8h بنديله نص الكميه تانى 8h ربع الكميه تالت 8h ربع الكميه ___ تانى يوم نفس اول يوم بالظبط بس بدل مكنا بنضرب ٢×وزن العيان × مساحه الجلد اللى اتحرقت لا احنا هنشيل ٢ ونحط ١ وبالتالى اما نيجى نديله المحاليل هيبقى 1/2 coloid و 1/2 crystalloid طيب هنديهاله امتى كل ٨ ساعات هنديله تُلت الكميه

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Total hip replacement 🔻Def: 1-also called (total hip arthroplasty) the damaged bone and cartilage is removed and replaced with prothesis component 2-replacement of a severely damaged hip with an artificial joint. 🔻Joints frequently replaced include the hip, knee, and، finger joints(most common) 🔻Less frequently, more complex joints (shoulder, elbow, wrist, and ankle) are replaced. 🔻 indication Arthritis Degenerative joint disease Rheumatoid arthritis Autoimmune inflammatory disease. Femoral neck fractures. 🔻 Two basic parts 1-The femoral component, a metal stem fits down into femur, to which a ball shaped head is attached. 2-The acetabular component (socket) is a cup made of a metal , In some total hips, the acetabular cup is of polyetheylene or ceramic. 🔻Pelvic component (acetabular) femoral component 💥 Prepare femoral canal with femoral rasp. 💥 Reaming Acetabulum= widening Acetabulum. 🔻Complications: Dislocation of the hip prosthesis (lees common) Excessive wound drainage Thromboembolism (most common) Infection most serious problem لو حصلت ببلغ الدكتور على طول عشان ممكن نشيل الطرف اللى ركبناه 🔻Preventing dislocation of the hip prosthesis: 🫧The nurse teaches the patient about positioning the leg in abduction 🫧Use two or three pillows between the legs keeps the hip in abduction. 🫧The patient’s hip is never flexed more than 90 degree. 🫧 To prevent hip flexion, the nurse does not elevate head of bed more than 60 degrees. 🫧 use of bedpan, nurse instructs patient to flex the unaffected hip and to use the trapeze to lift the pelvis onto pan. 🫧The patient is also reminded not to flex the affected hip to avoid hip dislocation 🫧High-seat (orthopedic) chairs and raised toilet seats may be used to minimize hip joint flexion. 🫧affected hip extension 🫧When sitting, the patient’s hips should be higher than the knees. 🫧The patient’s affected leg should not be elevated when sitting. 🔻 Sign of hip dislocation: Increased pain at the surgical site, swelling, immobilization - Acute groin pain in affected hip - Abnormal external or internal rotation - Restricted ability or inability to move leg - Reported “popping” sensation in hip مهم جدا ال nurse تعمل early notify doctor 🔻Monitoring wound drainage: 🫧Drainage of 200 to 500 mL in the first 24 hours. 🫧At 48 hours postoperatively, the total drainage in 8 hours usually decreases to 90 mL or less لو اكتر من 90 يبقى كده دخل فى bleeding 🔻 prevent DVT 🫧The incidence of DVT is 45% to 70%. The peak occurrence is 5 to 7 days after surgery. 🫧About 20% of patients with DVT develop pulmonary emboli, of which about 1% to 3% of cases are fatal. 🫧Signs of DVT include calf pain, swelling, and tenderness. 🫧Encourage patient to perform ankle and foot exercises hourly while awake. 🫧Ask patients to use elastic stockings and sequential compression devices as prescribed. 🫧Low-dose heparin is frequently prescribed as prophylaxis for DVT 🔻 prevent infection 🫧Nurse must be considered patients who have poorly nourished and diabetes ، infections ( urinary tract infection )are at high risk for infection. لازم ال nurse تعمل early detection 🫧Prophylactic antibiotics are prescribed. 🫧If indwelling urinary catheters used, should be removed as soon as possible to avoid infection. لأن ال urinary catheter اشهر سبب لحدوث infection 🔻Type of infection 🫧Acute infections may occur within 3 months after surgery and are associated with progressive superficial infections or hematomas فى مكان العمليه 🫧 Delayed infections appear 4 to 24 months after surgery cause discomfort in the hip. 🔻Health teaching to Patient 🫧At 3 months, the patient can resume routine ADLs. 🫧 Stair climbing is permitted to a minimum for 3 to 6 months 🫧Frequent walks, swimming, use of a high chair for hip exercises 🫧During the first 4 months patient should not cross legs or flex hip more than 90 degrees 🔻 Shoulder and Hip Joint are Ball and Sockets ➙ Multiaxial Joint and Move in all three Planes 🔻Use elastic stockings and sequential compression devices ال Diameter هيقل وبالتالى Force of blood هيزيد