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⭕️ENDOCRINE DISORDER⭕️ ⭕️HYPOTHYROIDISM⭕️ ⭕️DEFINITION:- Subnormal secretion of thyroid hormone by thyroid gland is known as hypothyroidism ⭕️TYPES:- ●Primary: Insufficient amount of thyroid hormone secreted by thyroid gland. ●Secondary: It is due to pituatary gland failure (which causes Inadequate secretion of TSH) ●Tertiary: It is due to hypothalmus failure (Which causes Subnormal TRH secretion) ⭕️CAUSES:- ●Use of radioactive Iodine ●Over treated with antithyroid drugs ●Thyroidectomy ●Mal-development ●Malignancy of neck or forehead ●Pituatary Dysfunction ●Goitrogenic food e.g., cauliflower, turnip. ⭕️CLINICAL MANIFESTATION:- ■CVS: ●Hypotension ●Bradycardia ●↓es Heart Rate ●Hyperlipidemia ●Hypercholestrolemia ●Anaemia Tendency to develop: ●CHF (Congestive Heart Failure) ●AP (Agina Pectoris) ●MI (Myocardial Infraction) ■Respiratory system: ●Dyspnoea ■G.I.T: ●Loss of Appetite ●Increase Weight ●Abdomianal distension ●Constipation ●Nausea and Vomiting ●Enlargement of tongue ■Skin: ●Dry skin, thick and elasticity increase. ●Brittle nails ●Dry hair ●Puffy face ●Excessive sweating ●Pallorness ●Cold Intolerance. ■Musculo-Skeletal: ●Fatigue ●Muscle weakness. ●Muscular Pain ●Slow movement. ■Reproductive: ●Decrease lipido ●Menstrual irregularities. ■Others ●Myxoedema (A dry firm waxy swelling of skin) ●Goitre ●Sleeplessness. ⭕️COMPLICATIONS:- ●Myxoedema ●Hypoventilation ●Convulsion ●Cerebral hypoxia. ⭕️DIAGNOSTIC EVALUATION:- ●Subnormal T3 and T4 level ●ECG ●Elevate serum cholestrol level. ⭕️MEDICAL MANAGEMENT:- ●Synthetic levothyroxine (levothyroid or synthroid) is preferred. ●Concentrated glucose may be given if hypoglycemia is evident. ●If myxedema coma is present, thyroid hormone is given IV until consciousness is restored. ⭕️DIETARY MANAGEMENT:- ●If patient having hypothyroidism due to iodine deficiency then provide high iodine diet. ●Avoid soyabean ●Avoid green leafy vegetables. ⭕️NURSING DIAGNOSIS:- ●Altered cardiac output related to elevated cholestrol and decreases metabolic rate. ●Activity intolerance due to decrease fatigue and lethargy.

⭕️ Endocrine Disorders ⭕️ Soon...🔥🔥

🦴MUSCLOSKELETAL DISORDER🦴 🦴AMPUTATION🦴 🦴DEFINITION:- The removal of a limb, part of a limb, or any other portion of the body (such as breast or rectum) is called Amputation. It is a surgical reconstructive procedure. 🦴INDICATIONS:- ●Peripheral vascular disease in D.M. ●Severe trauma ●Congenital deformity ●Malignant tumour ●Osteomyelitis/infection ●To relieve symptoms, improve function and save or improve patients quality of life 🦴TYPES OF AMPUTATION:- ●Open (Guillotine) Used with infection and for patients who are poor surgical risks. Wounds heals by granulation over time or secondary closure 1 week later. ●Closed (Myoblastic or Flap) Residual limb is covered by a flap of skin Flap of skin is sutured posteriorly. 🦴TYPES OF DRESSING:- ●Soft Dressing: Secure with elastic bandage. ●Closed Rigid Plaster Dressing: Secure with plaster. 🦴PREOPERATIVE MANAGEMENT:- ●To relieve anxiety. ●To reduce pain. ●To increase mobility. ●To maintain good nutrition. ●Provide Preoperative teaching. ●To give general preoperative care. ●Evaluation of cardiovascular, respiratory, renal systems. 🦴POSTOPERATIVE MANAGEMENT:- ●Complications are monitored: haemorrhage, infections, non healing wound. ●Acceptance of body image change should be promoted. ●To monitor fluid balance. ●Maintaining adequate tissue perfusion. ●Give psychological support. ●To control pain. ●To promote physical activities. ●To give general post-operative care. 🦴LEVEL OF AMPUTATION:- Amputation is performed at the most distal point that will heal successfully. ■ The site of amputation is determined by two factors: ●Circulation in the part. ●Functional usefulness, i.e., meet the requirement for the use of the prosthesis. ■There are two levels of Amputation: ●Level of amputation of upper extremity. ●Levels of amputation of lower extremity. 🦴COMPLICATIONS:- ●Haemorrhage. ●Infection. ●Skin breakdown. ●Phantom limb pain (a sensable pain in arm or leg). ●Joint contracture. 🦴NURSING DIAGNOSIS:- ■Acute pain related to Amputation Nursing Intervention ●Provide opioid analgesics (morphine) to relieve pain. ●Change the patients position or placing a light sand bag on residual limb to counteract the muscle spasm may improve patient's level of comfort. ■Risk for Disturbed sensory perception (phantom limb pain) related to amputation Nursing Intervention ●Early intensive rehabilitation and stump desensitisation with kneading massage brings relief. ●Transcutaneous electrical nerve stimulation and local anesthetics may provide relief to some patients. ●Beta-blockers may relieve dull, burning discomfort. ●Antiseizure medications control stabbing and cramping pain. ●Also antidepressants are used to improve mood and coping ability. ■Disturbedrbed Body Image related to Amputation Nursing Intervention ●Nurse has to establish a trust relationship with the patient to communicate acceptance of patient who has experienced an amputation. ●The nurse encourages the patient to look at, feel, and then care for residual limb. ●Provide psychological support to patient. ■Ineffective coping related to failure to accept loss of body part Nursing Intervention ●Nurse creates an accepting and support atmosphere in which the patient and family are encouraged to express and share their feelings and work through the grief process. ●Provide psychological support also. ■Self care deficit feeding, bathing, hygiene, dressing, grooming, or toileting related to loss of extremity Nursing Intervention ●Patient is encouraged to be an active participant in self care. ●Nurse should do works with the physical therapist an occupational therapist to teach and supervise the patient in these self-care activities.

🦴MUSCLOSKELETAL DISORDER🦴 🦴BONE TUMOURS🦴 🦴DEFINITION:- Formation of tumour inside the bone is known as bone tumour. 🦴TYPES:- ■It is of three types: ●Benign bone tumour, e.g., osteoma, chondroma. ●Malignant bone tumour, e.g., Multiple Myeloma, Osteosarcoma, Chondrosarcoma. ●Metastatic bone tumors: It is most frequently associated with cancers of the breast, the prostate and lungs 🦴SIGNS AND SYMPTOMS:- ●Pain at the tumour site is severe or persistent ●Swelling ●Immobility ●Anaemia ●Tenderness ●Inability to hold heavy objects and things. ●Pathogenic or spontaneous fractures etc. 🦴DIAGNOSTIC FINDING:- ●By X-ray ●Biopsy-Bone marrow aspiration ●FNAC (fine needle aspiration cytology) 🦴MEDICAL MANAGEMENT:- ●Chemotherapy ●Radiotherapy 🦴NURSING MANAGEMENT:- ●To relieve pain by administer analgesics. ●To prevent pathologic fractures by maintaining hazard free environment and to help in movement of patient. ●To reduce patients anxiety by providing psychological support and provide supportive environment. ●To promote self care activities. ●If surgery is done (amputation) then should give pre and post operative care.

🦴MUSCLOSKELETAL DISORDES🦴 🦴ARTHRITIS🦴 🦴DEFINITION:- It is an inflammation of one or more joints. 🦴CAUSES:- ■Rheumatoid Arthritis ■Rheumatoid Spondiolytis ■Osteoarthritis 1. RHEUMATOID ARTHRITIS 🦴DEFINITION:- Most severe form of inflammation of joints of fingers, wrists, feet, and ankles with later involvement of hips, knees, shoulders and neck. It is a disease of synovial lining of joints. 🦴CAUSES:- ●Unknown 🦴PREDISPOSING FACTORS:- ●Autoimmune disorder ●Infection ●Endocrine imbalance ●Metabolic disturbances ●Genetic ●Environmental ●DM, obesity, lack of exercise. 🦴PATHOPHYSIOLOGY:- Immunologic processes ↓ Inflammation of synovium ↓ Antigens and Inflammatory reactions ↓ Destruction of articular cartilage ↓ Oedema, production of grannular tissue (Pannus) ↓ Granular tissue forms adhesions ↓ Decreased joint mobility 🦴SIGNS AND SYMPTOMS:- ●Fever ●Inability in weight bearing ●Swelling over the joints ●Deformity of joint ●joint stiffness in morning time ●Reduced ROM (Range of motion) ●Warmth feeling ●Joint pain ●Muscleache. 🦴DIAGNOSTIC FINDING:- ●MRI and bone scan ●X-ray shows deformed joints ●E.S.R increases ●Synovial fluid assessment it appears turbit yellow. ●W.B.C 2000-80000 ●Low viscosity ●CBC (Complete blood count) 🦴MANAGEMENT:- ●To give NSAIDs (Non-steroids Anti-inflammatory drugs), e.g., Voveran-SR, Diclofenac sodium, Ibuprofen. ●Antirheumatic drugs, e.g., D-Penicillamine 250mg. Chloroquine 100mg Methotrexate (2.5 mg tab) Sulfasalazine (500 mg tab) ●Heat apply for vasodilation ●Exercises and corticosteroid therapy. ⭕️⭕️⭕️⭕️⭕️⭕️⭕️⭕️ 2. ANKYLOSIS SPONDIOLITIS 🦴DEFINITION:- Rheumatoid spondiolysis is an inflammation of joint between the vertebrae and sacroiliac joints. 🦴CAUSES:- ●Ankylosis 🦴SIGN/SYMPTOMS:- ●Backache ●Inability in weight bearing ●Kyphosis: abnormal increase in curvature of thoracic vertebra stiffness of cervical region. 🦴MANAGEMENT:- ●To give NSAIDs (Non-steroids Anti-inflammatory drugs), e.g., Voveran-SR, Diclofenac sodium, Ibuprofen. ●Antirheumatic drugs, e.g., D-Penicillamine 250mg. Chloroquine 100mg Methotrexate (2.5 mg tab) Sulfasalazine (500 mg tab) ●Heat apply for vasodilation ●Exercises and corticosteroid therapy. ⭕️⭕️⭕️⭕️⭕️⭕️⭕️⭕️ 3. OSTEOARTHRITIS 🦴DEFINITION:- It is a non-inflammatory disorders due to cartilages degeneration. 🦴RISK FACTORS:- ●Aging process ●Obesity ●Poor posture ●Excessive strain ●Strain of joint muscles. 🦴PREDISPOSING FACTORS:- ●Autoimmune disorder ●Infection ●Endocrine imbalance ●Metabolic disturbances ●Genetic ●Environmental ●DM, obesity, lack of exercise. 🦴PATHOPHYSIOLOGY:- Due to degeneration of articular cartilages and calcification of ligaments ↓ Weight bearing joints become immobile ↓ Overgrowth of cartilage ↓ Joint immobility ↓ Pertonsilar abscess (Pus formation) 🦴SIGNS AND SYMPTOMS:- ●Swelling ●Joint pain ●Stiffness of joint ●Reduced range of motion ●Heberden's nodule (a bony thickening arising at the terminal joint of a figure) ●Pain increases during movement 🦴COMPLICATIONS:- ●Limited Mobility ●Neurologic deficits associated with spinal involvement. 🦴MANAGEMENT:- ●Management focuses on slowing and treating symptoms because there is no treatment available that stops the degenerative joint disease process. 🦴PREVENTION:- ●Weight reduction ●Prevention of injuries ●Perinatal screening for congenial hip disease. 🦴PHARMACOLOGICAL THERAPY:- ●Cox-2 enzyme blockers (NSAIDs), e.g., Nimuslide, Celecoxib. ●Corticosteroids therapy. ●Anti Rheumatoid drugs should not be given. 🦴SURGICAL MANAGEMENT:- ●Arthrotomy: Surgical opening of joint. ●Arthroplasty: Replacement, e.g., ○Knee replacement ○Tendon replacement ○Complete hip replacement. 🦴NURSING MANAGEMENT ●To reduce pain related to local tissue trauma due to surgical incision trauma by administering narcotics analgesics. ●To promote physical mobility. ●To reduce risk of infection. ●To promotes self care activities. ●Provide psychological support to the patient. ●Provide proper nutrition to the patient.

🦴 MUSCLOSKELETAL DISORDER🦴 🦴CONTUSIONS /SPRAIN /STRAIN🦴 ■CONTUSIONS:- - A contusion is a soft tissue injury produced by blunt force, such as a blow, kick, or fall, causing small blood vessels to rupture and bleed into soft tissues (ecchymosis or bruising). 🦴CAUSES:- ●By falls ●Direct blows ●Crust injury ●Motor vehicle collisions ●Sport injuries. 🦴MANAGEMENT:- P- Protection R- Rest I- Ice C- Compression E- Elevation. ■STRAIN:- Injury to a muscle or tendon from overuse, overstretching, or excessive stress may cause strain. 🦴TYPES:- ●Acute:- Acute strains can result from a single injurious incident. ●Chronic:- Chronic strains result from repetitive injuries. Chronic strains can result from improper management of acute strains. 🦴DEGREES:- ■A first-degree strain is mild stretching of the muscle or tendon with no loss of range of motion (ROM). Signs/symptoms: ●Gradual onset of ●palpation-induced tenderness ●Mild muscle spasm. ■A second-degree strain involves moderate stretching and/or partial tearing of the muscle or tendon. Signs/symptoms: ●Acute pain during the precipitating event ●Tenderness at the site ●Edema ●Significant muscle spasm ●Ecchymosis. ■A third-degree strain is severe muscle or tendon stretching with rupturing and tearing of the involved tissue. Signs/symptoms: ●Immediate pain described as tearing Snapping, or burning, ●Edema ●Loss of function. ●Significant muscle spasm ●Bone injury ●Ecchymosis. ■Sprain:- A sprain is an injury to the ligaments the tough bands of fibrous tissue that connect two bones together in your joints. It is caused by a twisting motion or hyperextension (forcible) of a joint. ■A first-degree/mild grade sprain results from tears in some fibers of the ligament and mild, localized hematoma formation. Sign/Symptoms:- ●Mild pain ●Edema ●Local tenderness. ■A second-degree/moderate grade sprain involves partial tearing of the ligaments. Sign/Symptoms:- ●Increased edema ●Tenderness ●Pain with motion ●Joint instability ●Partial loss of normal joint function. ■A third-degree/severe grade sprain occurs when a ligament is completely torn or ruptured. A third-degree sprain may also cause an avulsion of the bone. Sign/Symptoms ●Severe pain ●Increased edema ●Abnormal joint motion. 🦴DIAGNOSTIC FINDING:- ●By X-ray ●Sign and Symptoms 🦴MEDICAL MANAGEMENT:- ●Apply ice while swelling is present. ●NSAIDs drug (Analgesics), e.g., Ibuprofen, Diclofenac sodium. ●Provide rest and comfort to patient. ●Elevation of extremity to reduce edema. ●Administer tetanus toxoid if skin integrity is broken. ●Do warmup and stretching to patient to reduce strain or sprain 🦴NURSING MANAGEMENT:- ●Apply cold compresses for the first several days (15-20 minutes at a time every few hours). ●Assess neurovascular status of contused extremity every 1 to 4 hours as patients condition indicates ●Instruct patient on use of pain medication as prescribed. ●Educate patient that rest is must for injured part. ●Teach the patient to avoid excessive exercise of injured part. ●Teach the patient to resume activities gradually.