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🦴MUSCLOSKELETAL DISORDER🦴 🦴PAGET'S DISEASE🦴 🦴DEFINITION:- It is a chronic skeletal disorder resulting from excessive osteoclast activity, mostly affecting the long bones and skull, backbone, pelvis. 🦴CAUSES:- ●Unknown cause but some risk-factors are there ●Family history ●More common in man then woman ●Age above 40 years. 🦴SIGNS AND SYMPTOMS:- ●Generally asymptomatic ●Pain ●Fracture ●Paget's lesions, may lead to osteoarthritis joint destruction ●Hearing problem due to skull enlargement ●Tinnitus ●Vertigo ●Bone tumour. 🦴DIAGNOSTIC FINDING:- ●Physical examination ●X-ray ●Bone biopsy ●Bone scan show paget's activity. 🦴MEDICAL MANAGEMENT:- ●Bone resorption antagonist, e.g., biphosphate (risedronate, pamidronate) ●Antineoplastic agent, e.g., plicamycin ●Analgesics to relieve pain. 🦴NURSING MANAGEMENT:- ■Nursing Diagnosis ●Chronic pain related to disease process. ●Risk for injury related to falls.

🦴MUSCULOSKELETAL DISORDER🦴 🦴OSTEOPOROSIS🦴 🦴DEFINITION:- - It is an age related metabolic disease, in which bone matrix (mass) is lost thereby weakening the bones and making them more susceptible to fracture. - In this condition, mostly three bones are affected: ●Wrist bone ●Hip bone ●Vertebral column. 🦴CAUSES:- ●Lack of calcium and phosphate salts ●Post menopausal women ●Age above 40-50 ●Chronic illness ●Medications, e.g., corticosteroids (for excessive thyroid replacement) ●Calcium and vitamin D deficiency ●Family history ●Smoking and alcohol habits ●Excessive caffeine intake ¤Immobilization of part ●Prolonged bed rest. 🦴SIGNS AND SYMPTOMS:- ●Generally asymptomatic until later stages ●Acute pain with movement ●Back pain while bending ●Pain in affected area ●Khyposis of dorsal spine ●Decline in height ●Multiple fracture ●Weakness. 🦴PATHOPHYSIOLOGY:- Bones make a balance by two process: ■Osteoclast (engulf old cells) ■Osteoblast (synthesis of new cells) ●If there is imbalance in between both process the bones leads to increase its fragility. 🦴DIAGNOSTIC FINDING:- ●Dual energy X-ray absorptiometry (Dexa scanning shows decreased bone mineral density) ●Bone biopsy shows thin, porous bone ●Serum calcium level. 🦴MEDICAL MANAGEMENT:- ●Adequate intake of calcium 1.5 gm/day ●Adequate intake of vitamin D (400-800 IU) ●Weight bearing exercise ●Biphosphonate (for decrease activity of osteoclast) Actions: Inhibits the resorption of bone by blocking the action of osteoclast. 🦴DIETARY MANAGEMENT:- ●Intake more milk ●Diet should be rich in vitamin D and protein ●Plenty of fluid in diet

🦴MUSCULOSKELETAL DISORDER🦴 🦴OSTEOMYELITIS🦴 🦴DEFINITION:- It is an inflammation of bone due to infection, it may affect any bone. 🦴CAUSES:- ●Bacterial infection: - Staphylococcus Aureus - Streptococcus ●Viral infection ●Fungal infection 🦴PATHOPHYSIOLOGY:- Due to infection in medullary part of bone ↓ Infection spreads to periosteum ↓ Oedema or abscess formation ↓ Narcotic bone (sequestra) ↓ Peritonsillar abscess (Pus formation) 🦴SIGNS AND SYMPTOMS:- ●Fever ●Inability in weight bearing ●Signs of sepsis ●Erythema ●Chills ●Nausea ●Malaise ●Restlessness ●Spontaneous fracture. ●Night sweats ●Swelling, tenderness, and ●warmth at infection site. 🦴DIAGNOSTIC FINDING:- ●C.B.C - WBC es - ESR es ●X-ray ●C.T. scan/MRI ●Radionuclide bone scan 🦴COMPLICATIONS:- ●Non-healing wound ●Sepsis ●Immobility ●Amputation. 🦴MEDICAL MANAGEMENT:- ●Antibiotics, - Penicillin - Tetracycline - Cephalosporin, e.g., cefalexin ●Analgesics and antipyretics as prescribed ●Application of plaster cast and traction ●FNAC (Fine needle aspiration cytology) for the drainage of bone abscess. 🦴SURGICAL MANAGEMENT:- ●Sequestrectomy (removal of sequestra), sequestra (a portion of dead bone formed). 🦴NURSING MANAGEMENT:- ■Nursing Diagnosis ●Acute or chronic pain related to inflammatory process. ●Deficit knowledge related to disease and medications. ●Impaired physical mobility related to rest of affected part.

🦴MUSCULOSKELETAL DISORDERS🦴 🦴FRACTURE🦴 🦴DEFINITION:- A break in continuity of bones is called fracture, it may be due to excessive pressure on bone and bone is unable to absorb this pressure. 🦴TYPES OF FRACTURES:- ●Complete fracture:It involves the entire section of the bone. ●Incomplete fracture: Also called greenstick fracture, break occurs only through part of the cross section of the bone. ●Comminuted fracture: A break with several bone fragments. ●Closed fracture: It is also called "simple fracture" it does not produce a break in skin. ●Open fracture: It is also called compound or complex fracture. A break in which the skin or mucous membrane wound extends to fractured bone. ●Impacted fracture: When one bone impact to another bone. ●Pathologic fracture: Fracture occurs due to bone disease or without any other pressure, e.g., osteoporosis bone, osteomyelitis. 🦴PATTERNS OF FRACTURE:- ●Greenstick fracture: One side of the bone is broken and the other side is bent. ●Oblique fracture: At an angle across the bone. ●Transverse fracture: Straight across the bone. ●Spiral fracture: Twists around the shaft of bone. ●Compression fracture: Bone collapse on itself. 🦴CLINICAL MANIFESTATIONS:- ●Acute pain ●Loss of function ●Deformity ●Shortening of the extremity. ●Crepitus (abnormal mobility) ●Swelling ●Tenderness ●Localized edema ●Ecchymosis (bruise mark on skin due to impaired muscles) ●Numbness (paresthesia) Injured muscles, blood vessels, nerves ●If open fracture, there may be chance of haemorrhage that leads to shock. 🦴DIAGNOSTIC EVALUATION:- ■X-ray ●Anterior ●Posterior ●Lateral view. 🦴COMPLICATIONS:- ●Muscle atrophy ●Loss of muscle strength ●Pressure sores ●Venous stasis and thromboembolism ●Infection ●Shock ●Pulmonary embolembolism ●Fat embolism ●Bone union problem. 🦴Management:- ●Emergency Management ●Check ABC of patient and also maintain it. ●Check vital signs. ●Immediately after injury, immobilize the body part while the patient have to move. ●Splint the fracture. To support the fracture site. ●In an upper extremity injury, the arm may be bandaged to the chest, or an injured forearm may be placed in a sling. ●Cover the wound of an open fracture with a sterile dressing to prevent contamination of deeper tissues. 🦴Reductionn of Fractures It is of three types: ●Closed Reduction: It is method of fracture alignment. It is performed manually (by hands) apply a traction force to bone till end of the bone together. ●Open Reduction: Surgical placement of internal fixation devices (e.g., metallic pins, wires, screws, plates, nails, or rods. ●Traction Reduction: The application of a pulling force, especially as a means of counteracting the nature of tension in the tissues, surrounding a broken bone. ■Two Directions: ●Pull of traction ●Pull of counter of traction. 🦴NURSING MANAGEMENT:- ■Assessmentment ●Assess ABC of patient. ●Assess types, location and severity of fractured part. ●Observe condition of shock and haemorrhage. ●Assess patients requirements according to fracture. ●Immobilize injured part. Provide comfortable position to patient. ●Provide prescribed analgesics, e.g., Diclofenac sodium

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👃E.N.T DISORDERS👂 ⭕️TONSILITIS⭕️ ⭕️DEFINITION:- It is an inflammation of tonsils due to viral and bacterial infection is called tonsillitis. ⭕️CAUSES:- ●Group A streptococci bacteria ●Adenovirus ●Rhinovirus ●Influenza virus ⭕️SIGN/SYMPTOMS:- ●Enlarge red tonsils ●Sore throat ●Difficulty in swallowing Snoring ●Fever (moderate to severe) ●Foul breathing ●Voice impairment ●Noisy respiration ●White patches or nodules on tonsils. ⭕️PATHOPHYSIOLOGY:- Due to cause ↓ Invasion of causative organism into the tosils ↓ Antigen-Antibody reaction occurs leads to histamine, prostaglandin (PGs) releases ↓ Increases blood supply to the area edematous of tonsil ↓ Peritonsilar abscess (Pus formation) ⭕️DIAGNOSTIC FINDING:- ●Physical examination ● signs and symptoms ●CBC ●Throat cultures ⭕️MEDICAL MANAGEMENT:- ●Antibiotic Therapy if bacterial infection present, e.g., Penicillin Amoxicillin. ●Anti-allergic, e.g., Levocetrizine ●Antipyretics, Analgesics, e.g., Acetaminophen, Paracetamol, Ibuprofen etc. ⭕️SURGICAL MANAGEMENT:- ●Tonsillectomy: Surgical removal of the tonsils. ■Indications for Tonsillectomy: ●Recurrent tonsillitis ●Abscess around tonsils ●Obstruction in breathing. ⭕️NURSING MANAGEMENT:- ●Provide pre and post operative care to patient. ⭕️GENERAL POST OPERATIVE CARE:- ●Check the bleeding side or surgery side. ●Check the bleeding colour. ●Provide comfortable position. ●Give Health education. ●Use alkaline mouthwash and warm saline solution. ●A liquid or semi-liquid diet given for patient. ●Avoid spicy, hot, acidic food.

👃E.N.T DISORDERS👂 👃SINUSITIS👃 👃DEFINITION:- It is an inflammation of mucous membranes of paranasal sinuses. The main sinuses: ●Maxillary ●Ethmoid ●Frontal ●Sphenoid 👃TYPES:- Acute Sinusitis (3 weeks) Chronic Sinusitis (3 months) 👃CAUSES:- ●Upper respiratory tract infections ●Swimming ●Dental infection ●Viral infection, e.g., Coxsacci, H.influenza ●Bacterial infection, e.g., Streptococci ●Anatomical changes, e.g., Deviated Nasal septum, Nasal polyps and Tumors. 👃SIGN/SYMPTOMS:- Common sign and symptoms are: ●Fever ●Sore throat ●Malaise ●Headache ●Pain in sinuses ●Red and edematous nasal mucosa. ■Signs and symptoms (According to Classification) ●Maxillary Sinusitis: Pain in upper jaw, upper teeth. ●Frontal Sinusitis Pain in forehead. ●Ethmoid Sinusitis: Pain over nasal bridge. ●Pain over the occiput or vertex. ■Others ●Anosmia (lack of smell) ●Nasal congestion and discharge ●Pain increase during 90° position ●Feeling of facial fullness pressure. 👃PATHOPHYSIOLOGY:- Due to Causes ↓ Mucous accumulates in the sinuses ↓ Infection occurs (virus and Bacteria) ↓ Antigen and antibody reaction occurs leads to histamine and prostaglandins release ↓ Inflammation of sinuses ↓ Necrosis (pus formation) cells death 👃DIAGNOSTIC FINDING:- ●Clinical presentation and physical examination ●Sinuses radiographs ●CBC (es WBC) ●Culture and sensitivity test ●CT scan. 👃COMPLICATIONS:- ●Osteomyelitis (bone infection) ●Meningitis ●Brain abscess. 👃MEDICAL MANAGEMENT:- ●Antibiotic Therapy e.g., Amoxyclav 625 mg (Amoxicillin 500 mg + Clavulanic acid 125 mg) ●Antipyretic therapy e.g., (Paracetamol) ●Analgesics Ibuprofen Acetaminophen ●Nasal decongestant, e.g., Xylometazoline Hydrochloride. ●Antihistamines, e.g., Chlorpheniramine ●Mucolytics ●Steam inhalations with menthol. 👃SURGICAL MANAGEMENT:- ●Endoscopic sinus surgery ●Nasal antrostomy ●External sphenoethmoidectomy Caldwell-Lue procedure. 👃NURSING MANAGEMENT:- ●Warm compresses apply in the sinus area ●Increase fluid intake ●Avoid swimming/driving ●Educate the patient to avoid cold environment ●Provide good oral hygiene ●Avoid smoke in the environment ●Avoid blowing nose.

👃E.N.T DISORDERS👂 👃RHINITIS👃 👃DEFINITION It is an inflammation of nasal mucosa membrane. It may develop due to allergy, cold or due to flu. ■ Allergic Rhinitis: It may be seasonal, and usually occurs as an acute response to a specific antigen. Causes: Pollen, grass, trees, flowers etc. ■ Acute Rhinitis: (Also known as coryza): Common cold. Causes: Rhinovirus Adenovirus Influenza virus. ■ Vasomotor Rhinitis:(Chronic idiopathic or Non-allergic Rhinitis) An abnormality of parasympathetic nervous activity. Causes: Tumors Granulomatous Septal deviation Nasal polyps T.B ■ Medicamentosa: (Due to abused or overuse of topical agent): Such as afrin and Neosynephrine nasal sprays. 👃SIGN/SYMPTOMS:- ●Rhinorrhea ●Cold ●Fever ●Anxiety ●Loss of appetite ●Nausea ●Swelling ●Redness ●Malaise ●Fatigue. 👃COMPLICATIONS:- ●Serous O.M. ●Sinus infection ●Nasal polyps 👃DIAGNOSTIC FINDING:- ●Allergy testing ●By signs and symptoms ●Rhinoscopy ●Nasal smear ●Culture of nasal drainage. 👃MEDICAL MANAGEMENT:- ●Antimicrobial agents for infections ●Antihistamines Chloropheremine Cetrizine ●Anticholinergics ●Corticosteroids (Systemic/Topical) ●Decongestants (Reduce nasal congestion), e.g., ●Xylometazoline (Nasal drops) ●Analgesics. 👃NURSING MANAGEMENT:- ●Instruct the patient for proper administration of medication. ●Instruct the patient for blowing the nose before applying medication. ●Instruct the patient to avoid allergens.

👂E.N.T DISORDERS👂 👂OTITIS MEDIA👂 👂DEFINITION:- It is an inflammation of middle ear or infection of middle ear caused by entrance of pathogenic organisms. 👂TYPES:- It is mainly of three types: ●Acute O.M. (Suppurative otitis media) ●Serous O.M. ●Chronic O.M. - Acute O.M.: It is an acute infection of middle ear, usually lasting less than 6 weeks. - Serous O.M.: It means accumulation of serous fluid in middle ear without evidence of active infection, but fluids results from a negative pressure in the middle ear caused by Eustachian tube obstruction. - Chronic O.M.: It is the result of repeated episodes of acute O.M. causing irreversible tissue pathology and persistent perforation of tympanic membrane. It also leads to mastoid bone infection. 👂CAUSES:- ■ Pathogenic infections: ●Bacteria (streptococcus pneumonia) ●Virus ●Upper respiratory infection, e.g., sinusitis. ●Allergic reaction ■Entrance of foreign body in ear. ■Inadequate treatment of acute otitis media. 👂SIGN/SYMPTOMS:- ■ACUTE OTITIS MEDIA: ●Pain ●Hearing loss ●Purulent drainage (otorrhoea) ●Fever may be rise to 104F-105F ●Irritability ●Headache ●Anorexia ●Nausea/Vomiting. ■CHRONIC OTITIS MEDIA: ●Otalgia. ●Redness and swelling ●Perforation of tympanic membrane ●Tinnitus (Ringing sound hears in ears) ●Dizziness ●Bulging of tympanic membrane ●Obstruction of Eustachian tube. 👂PATHOPHYSIOLOGY:- Acute Otitis Media↓Due to infection↓Inflammation occurs and exudate edema in Eustachian tube in middle ear↓Serous exudation in middle ear↓Thickened, purulent and pus formation↓Leads to tympanic membrane perforations↓ Chronic Otitis Media↓Accumulation pf pus inflammatory exudate under pressure in middle ear cavity↓May leads to necrosis of tissue↓Damage of tympanic membrane↓Conductive hearing loss↓Extension of infection may occur into the mastoid cells (mastoiditis) 👂DIAGNOSTIC FINDING:- ●Physical Examination ●Otoscopic Examination ●Audiometry ●Tympanometry ●Culture and sensitivity test ●Microscopic views ●MRI. 👂COMPLICATIONS:- ●Complete hearing loss ●Facial nerves paralysis ●Meningitis ●Mastoiditis. 👂MEDICAL MANAGEMENT:- ●Broad spectrum antibiotics therapy. ●Antihistamines, e.g., Phinamine maleate, Chlorphenamine. ●NSAIDs drugs (for inflammation and pain) e.g., Nimuslide ●Antiseptic ear wash with antibiotic therapy in case of chronic otitis media. 👂SURGICAL MANAGEMENT:- ●Myringotomy: Incision through eardrum to create an artificial opening, either to allow infected fluid to drain from the middle ear in acute otitis media. ●Tympanotomy: (In Chronic Otitis Media): A surgical operation to expose the middle ear and allow access to the ossicles. It is usually performed by using around the eardrum and turning it forwards. ●Tympanoplasty: Surgical repair of tympanic membrane (eardrum) or surgical repair of a perforated eardrum by grafting.

👃E.N.T DISORDERS👂 👃MASTOIDITIS👂 💥DEFINITION:- It is an inflammation of mastoid process behind the ear and of the ear space connecting it to the cavity of the middle ear. 💥CAUSES:- ●Infection of middle ear ●Injury of mastoid bone and cells ●Upper respiratory Infection ●Rhinitis ●Sinusitis ●Related to zygoma fracture. 💥SIGN/SYMPTOMS:- ●Otalgia (ear pain) ●Swelling on mastoid bone ●Loss of hearing ●Perforation of ear-drum ●Severe pain at eating time ●Painless discharge from the affected ear ●Nausea, Vomiting ●Increased intracranial pressure ●Otorrhoea (purulent discharge) may be odourless or foul smelling. 💥PATHOPHYSIOLOGY:- Due to infection ↓ Acute otitis media ↓ Chronic otitis media ↓ Mastoiditis 💥DIAGNOSTIC FINDING:- ●Physical Examination ●Mastoid bone X-ray ●C.T. scan ●Tympanometry ●MRI 💥MEDICAL MANAGEMENT:- ●Antibiotic and steroid ear drop for infection and inflammation, e.g., Ciplox-D. ●Ear-irrigation- for removing purulent drainage. ●Analgesics drugs, e.g., Aspirin, Nimuslide. 💥SURGICAL MANAGEMENT:- ■ Mastoidectomy: Surgical removal of mastoid bone.

👂E.N.T DISORDERS👃 👃LARYNGITIS👂 👃DEFINITION It is an inflammation of mucous membranes of larynx. 👃TYPES: ●Acute Laryngitis ●Chronic Laryngitis 👃CAUSES:- ●Virus infection, e.g., - Adenovirus - Rhinovirus - Influenza virus - Parainfluenza virus ●Bacterial infections, e.g., - streptococcus pneumonia ●Environmental changes Smoke, dust, chemicals or polluted environment ●Malnutrition ●Chronic sinusitis ●Chronic bronchitis. 👃SIGN/SYMPTOMS:- ●Aphonia (complete loss of Voice) ●Hoarseness ●Sore throat ●Malaise ●Fever ●Dry cough ●Vocal cord swollen ●Dysphagia ●Dyspnea ●Dry cough. 👃PATHOPHYSIOLOGY:- Invasion of causative organism into laryngeal mucosa and non-infectious disease ↓ Antigen-Antibody reaction ↓ Histamine and prostaglandin releases ↓ Inflammation of laryngeal mucosa ↓ Edematous of vocal cord ↓ Persistent voice disability 👃DIAGNOSTIC FINDING:- ●Presence of positive manifestation ●Laryngoscopy ●CBC 👃MEDICAL MANAGEMENT:- ●Antibiotic Therapy if bacterial infection present, e.g., -Amoxicillin -Amoxicillin -Azithromycin -Erythromycin ●Corticosteroids therapy (for inflammation), e.g., -prednisolone ●Antipyretics, Analgesics, e.g., Acetaminophen ●Antitussive Medication, e.g., Codeine, Dextromethrophan. 👃NURSING MANAGEMENT:- ●Instruct the patient to avoid chemical and allergents. ●Plenty of fluid intake. ●Instruct the patient to avoid smoking. ●Provide rest to patient. ●Maintain well humidifying environment. ●Steam inhalation.