Meidcal Nursing week 5

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Gia_bella
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Meidcal Nursing week 5
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2012-10-09 17:21:49
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Medical Nursing Week 5
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  1. Musculoskeletal System
    Anatomy
    • Bones and ligaments
    • Joints
    • Muscle and tendons
  2. Musculoskeletal System
    Purpose
    •  Locomotion
    • Skeletal support
  3. Musculoskeletal System
    Pathological symptoms
    • Pain
    • Limping or lameness
    • Muscle atrophy
  4. Musculoskeletal System
    Diagnostics
    • Palpation
    • Radiographs
    • Isotope bone scan
    • Biopsy- looking for cancer
    • Blood Profile    
    •      Osteomyelitis- coccidiomycosis
    • Osteomyelitis is a bone infection caused by bacteria or other germs Coccidiomycosis- fungal infection "vally Fever"
    • Joint tap-cytology
  5. Musculoskeletal System
    Diseases
    Fractures
    Types of fractures
    • Comminuted- multiple fragments
    • Coumpound- out of the skin
    • Epiphseal- at or through epiphyseal plate
    • Greenstick- an incomplete fracture
    • Oblique- at an angle
    • Spiral- curves around the bone
    • Transverse-straight across
  6. Musculoskeletal System
    Diseases
    Fractures
    Diognostics
    • Radiographs
    • Palpation
  7. Diognostics  Musculoskeletal System
    Diseases
    Fractures
    Treatment
    • Surgery
    • Splints  
    •    Uses       
    •      Arthrodesis       
    •      Pressure wraps post surgery        
    •      Temporary immobilization- fractures       
    •       Wound skin shears- dragging by car
  8. Musculoskeletal System
    Diseases
    Fractures
    Types of splints
    • Robert Jones Bandage        
    •      Used below stifle or elbow joint
    • Metaspoon splint   
    •      Provide support to injuries of           
    •          distal radius and ulna       
    •         carpus and tarsus          
    •         metacarpus and metatarsus        
    •        phalanges
    • Mason metaspoon splint- metal
    • Spica splint     
    •        Immobilization of humoral or femoral fractures
    • Ehmer sling 
    •     Closed or open reductions of hip luxations
    • Velpeau sling  
    •        Shoulder luxations and scapular fractures
    • Schoeder- Thomas Splint    
    •       Stabilize radius, ulna and tibia      
    •      Fractures
  9. Musculoskeletal System
    Diseases
    Hip Dysplasia- abnormal development, genetic
    Etiology
    • a.Characterized by abnormal development of Coxofemoral joint that initially resents as joint laxity and later as femoral and acetabular Remodeling and degenerative joint disease
    • b. Hip dysplasia is multifactoral disease of genetic Originc.
    • Dietary factors as increased protein and calcium
    • Levels lead to joint dysplasia    
    •         Which causes a discongruity between muscle mass growth and skeletal    
    •        Growth
  10. Musculoskeletal System
    Diseases
    Hip Dysplasia
    Clinical signs
    • Lameness of hind limbs 
    • Bunny hopping gait
    • Pain on extension of hips
  11. Musculoskeletal System
    Diseases
    Hip Dysplasia
    Diagnosis
    • Radiographs 
    •      Coxofemoral subluxation   
    •      Flattening of femoral head   
    •     Shallow acetabulum  
    •     Osteophyte and degenerative       
    •     Joint Disease
    • Palpation
    •     Ortolani sign- checking for hip displasia       
    • Measures angles of subluxation and reduction
    • English bull dogs will always have hip dysplasia Greyhounds never will have hop dysplasia
  12. Musculoskeletal System
    Diseases
    Hip Dysplasia
    Medical Treatments
    • Medical   
    • 1. Restrict activity  
    • 2. Corticosteroids  
    • 3. Carprofen          2.2 mg/kg PO Bid 
    • 4. Cartilage protective agents       
    •          Adequan      
    •         Glycoflex      
    •        Cosequin
    • 5. Analgesics      
    •         Torbutrol
  13. Musculoskeletal System
    Diseases
    Hip Dysplasia
    Surgery Treatments
    • Surgery   
    • 1.Best choice before osteoarthriosis develops  
    •   2.  Triple Pelvic Osteotomy (TPO)          
    •        Young animals with no DJD             
    •        Will prevent further problems    
    • 3. Femoral head and neck excision (FHO)            
    • Salvage procedure              
    •      Releives pain, but decreases Function    
    • 4. Total Hip Replacement (THR)               
    • >90% success              
    •   Hips with DJD or angle of luxation to large
  14. Musculoskeletal System
    Diseases
    Panosteitis- bone marrow should be black in x-rays Introduction
    • Spontaneous and self limiting disease of young and rapidly growing large breed dogs.   
    • 6-14 months of age
    • Involves the diaphysis and metaphysis of long bones   Primary- ulna, radius, humerus, femur, tibia in decreasing order of prevalence
    • Cause is unknown-rapid growth
  15. Musculoskeletal System
    Diseases
    Panosteitis
    Clinical Signs
    • Limping and painful long bones   
    •     Breed and young age
    • May show intermittent and shifting leg lameness
    • Pain on palpation of diaphysis of longbone
    • Fever and anorexia
    • Diaphysis -main or midsection (shaft) of a long bone
  16. Musculoskeletal System
    Diseases
    Panosteitis
    Diagnosis
    • Clinical sign on palpation
    • Radiographs 
    •     Increased intramedullary density
  17. Musculoskeletal System
    Diseases
    Panosteitis- treatment
    • Rest and confinement    
    •       self limiting
    • Anti- inflammatory  
    •      Rimadyl    
    •      Aspirin    
    • Corticosteroids
    • Anagesics   
    •     Torbugesic
  18. Musculoskeletal System
    Diseases
    Osteochondrosis Dissicans (OCD)
    Introduction
    • Incomplete development and defect of articular cartilage  
    • Resulting in a cartilage flap in the joint Cause is unknown, but suspected heritable
    • Breed specific   
    •   Labs, Rotweillers, german shepards, large breed dogs
    • Common cause of Elbow Dysplasia  
    •   Osteochondrosis   
    • Fragmented coronoid process- tip of the joint of the  skin  
    • Unlimited anconeal process- back of the joint
  19. Musculoskeletal System
    Diseases
    Osteochondrosis Dissicans (OCD)
    Clinical Signs
    • Unilateral or bilateral lameness in any limb
    • Pain and decreased ROM on palpation
    • Usually effects:   
    • Scapulohumeral joint- humeral head   
    • Elbow  
    •   Tarsus- Talus  
    •   Stifle- femoral condyl
  20. Musculoskeletal System
    Diseases
    Osteochondrosis Dissicans (OCD)
    Treatment
    • Arthrotomy and removal of cartilage flap     
    •       Curretage bone to stimulate fibrocartilage
    • Chondroprotective agents    
    •     Adequan    
    •     Cosequin
    • Corticosteroids
  21. Musculoskeletal System
    Diseases
    Elbow Dysplasia- Introduction
    A heritable disease that consists of elbow joint incongruence and malfunction that leads to osteoarthritis. Elbow dysplasia is caused by fragmented medical coronoid process (FMCP), osteochondrosis dissecans (OCD), and ununited anconeal process.
  22. Musculoskeletal System
    Diseases
    Elbow Dysplasia-
    Clinical Signs
    • Forelimb lameness in large breed dogs between 4-12 month of age.     
    • German Shepards, Rottweillers, labs, etc.
    • Pain during flexion of elbow joint and decreased ROM
  23. Musculoskeletal System
    Diseases
    Elbow Dysplasia- Diagnosis
    • Radiographs 
    • Flexed lateral views
    • Palpation
    • Isotope bone scam
    • Arthroscopy
  24.  Musculoskeletal System
    Diseases
    Elbow Dysplasia- Treatment
    • Surgery 
    • Remove coronoid process or aconeal process 
    • Currete and remove OCD 
    • Currete- surgical instrument designed for scraping biological tissue or debris in a biopsyosteochondral dessicans fragment (OCD)
    • Arthroscopy
    • Total Elbow Replacement
    • Medical Treatment
    • Anti-inflammatory 
    • NSAIDS 
    • Prednisolone 
    • Adequan or Cosequin
    • Since disease is genetic disorder surgery and medical managelemtn only control the disease, elbow joint will eventually become arthritic. 
  25. Musculoskeletal System
    Diseases
    Cranial Cruciate Ligament Rupture (RACL)
    Ruptured Anterior Cruciate Ligament
    Introduction
    • Cranial cruciate ligament prevents cranial movement in the stifle joint between the femur and the tibia.
    • Injury usually occrs traumatically that either partially or completly tears the cruciate ligament
    • The tear will secondarily cause joint effusion and pain that leads to meniscal injury, joint capsule fibrosis and osteoarthritis.
    • Remember ligament never heal, the joint capsule will have to scar to prevent joint instability.
  26. Musculoskeletal System
    Diseases
    Cranial Cruciate Ligament Rupture (RACL)
    Ruptured Anterior Cruciate Ligament
    Clinical signs
    • Acute hindlimb lameness
    • Joint effusion and pain on stifle palpation
    • Chronic injury will have off and on intermittent lameness
    • Large breed dogs are more prone to RACL
  27. Musculoskeletal System
    Diseases
    Cranial Cruciate Ligament Rupture (RACL)
    Ruptured Anterior Cruciate Ligament
    Diagnosis
    • Palpation for stifle pain and medial meniscus thickening
    • Positive cranial drawer movement
    • Radiographs   
    • Osteoarthritis
    • Isotope bone scan
    • Arthroscopy
    • MRI
  28. Musculoskeletal System
    Diseases
    Cranial Cruciate Ligament Rupture (RACL)
    Ruptured Anterior Cruciate Ligament
    Treatment
    • Surgery
    •   1. Extracapsular suture stabilization 
    • 2. Tibia Plateau Leveling Osteotomy (TPLO)      Recommended technique for large size dogs    
    •   Changes the biochemicanis of the stifle joint to prevent arthritis and maintain function
    • 3. Tibial Tuberosity Advancement (TTA) 
    •   TTA surgery moves the tibial tuberosity in a cranial proximal direction to reach 90 degree neutralization of the forces.
    • 4. Cranial cruciate (CCL) surgery goals-biomechanically    
    •      a. during a dogs step, there is a natural tendency for the distal femur to slide caudally to the proximal tibia.    1. The CCL neutralizes this forceb.
    • When the CCL is damaged, the tibea plateau and patellar tendon no whave to be in a 90 degree to each other to neutralize the forces.
    • c. TTA surgery moves the tibial tuberosity and TPLO moves the Tibial Plateau.
  29. Musculoskeletal System
    Diseases
    Cranial Cruciate Ligament Rupture (RACL)
    Ruptured Anterior Cruciate Ligament
    • Medical Management
    • Corticosteroids
    • NSAIDS
    • Chondroprotective agents
    • Does not treat the problem only help with the pain
    • Cats due to their size and function rarely need surgery for cruciate injury, unlike dogs.
  30. Musculoskeletal System
    Diseases
    Congenital Patella Luxations
    Introduction
    • A. Congenital patella luxation is heredity in origin
    • b. Young dogs develop angular and torsinal malformations of the stifle joint causing shallow femoral trochlear groove and medial or lateral rotation of the tibia.
    • c. Secondary joint degeneration later develops due to damage of articular cartilage.
    • D. Medial luxation is the most common in small toy breed (poodle, Maltese, lhasa, etc) and lateral luxation most common in large breed dogs. (sharpei, chow chow, ect)
    •     Cats usually have medial luxating patella
  31. Musculoskeletal System
    Diseases
    Congenital Patella Luxations
     Clinical Signs
    • Intermittent hindlimb lameness that starts from 2 months - 10 years of age.
    • Skipping or hopping hindleg gait

    Cats Bermese
  32. Musculoskeletal System
    Diseases
    Congenital Patella Luxations
     Diagnosis
    • Palpation of stifle and luxating patella
    • Patella luxation grading
    •    Grade 1
    •       Patella can be luxated with palpation or stifle flexion and stays out until reduced
    •        Management
    • Grade 2
    • Patella luxates with palpation or stifle flexion and stays out until reduced
    • Management or surgery
    • Grade 3
    • Patella is luxated continually, but can be reduced
    • Surgery
    • Grade 4
    • Patella is luxated continually and cannot be reduced
    • Surgery
  33. Musculoskeletal System
    Diseases
    Congenital Patella Luxations
    Treatment
    • Surgery if lameness is a continual problem
    • Some dogs with luxating patella never need surgery, but long term risks of stifle osteoarthritis or developing a cruciate ligament injury
    • Types of surgery
    •   Joint capsule imbrication
    •   Tibial crest transposition
    •   Trochleoplasty or trochlear wedge resection
  34. Nuerological System
    Anatomy
    • Brain
    • Spinal cord
    • Peripheral nerves
  35. Nuerological System
    Purpose
    • Information gathering and processing
    • Actions
    • Coordination
    • Cerebelum
  36. Nuerological System
    Terminology
    • Dysmetria- abnormal muscular gait
    • Hypermetria- over stepping (goose stepping)
    • Paresis- Slight or incomplete paralysis
    • Torticollis- twisting of neck, head bent to chest
    • Nystagmus- involuntary movement of eyeballs
    • Strabismus- uncontrolled deviation of eye, cross eyed
    • Anisocoria- unsymmetrical pupil sizes
  37. Nuerological System
    Pathological conditions
    • Dysmetria
    • Paresis or paralysis
    • Weakness
    • Circling, head tilt, torticollis
    • Seizures
    • Special senses
    •   Blindness
    •   Deafness
    •   Nystagmus
  38. Nuerological System
    Diagnostic Tests
    • Neurological exam- brain or spinal cord
    • Blood Profile
    • Cerebral spinal fluid analysis (CSF)
    • electroencephalogram (EEG) Brain Wavelength
    • Cat Scan or MRI- Brain
    • Myelogram- Highlight spine
    • Vestibular
    • Head Pressing- Brain Tumors
    • Horner's Syndrome eyes, chest cavity
  39. Nuerological System
    Diseases
    • Seizures
    • Excessive and hypersynchronous abnormal neuronal activity in the cerebral cortex. Too much stimuli
    • Phases of seizure
    •   Aura
    •      Initial manifestation of seizure
    •     Pacing, barking, nervous, salivating
    • Ictal
    •    Actual seizure
    • Post Ictal
    •    Period after seizure
    •    Disorientation, circling, blindness, weakness
  40. Nuerological System
    Etiology
    • Primary Seizure
    •       Epilepsy
    • Secondary Seizure
    •      Abnormalities of brain
    •      Hydrocephalus
    •      Canine distemper
    •     Granulamatous meningioencephalitis (GME)
    •     Trauma
    •     Neoplasia
    •     Stroke
    • Metabolic
    • Liver Disease
    •     Ammonia
    • Renal disease
    •    Uremia
    • Hypoglycemia
    • Poisoning
    •    Strychnine
    •    Metaldehyde
  41. Nuerological System
    Clinical Signs
    Seizure or convulsion
  42. Nuerological System
    Diagnosis
    • History
    •    Trauma or poison
    • Blood Panel
    • MRI or CT scan- general anesthesia
    • EEG -  General anesthesia
    • CSF analysis
  43. Nuerological System
    Treatment
    • Treat disease process
    •    Kidney or liver disease
    • Brain Tumor
    •    Radiation therapy
    •    Surgery
    • Medical Management
    •     Phenobarbital- anti- convulsant
    •           2.5 mg/kg PO BId
    •          Takes phenobarbitol 12-15 days to get blood levels effects
    •          Monitor Medication
    •                    Blood Phenobarbitol levels
    •                             2-4 weeks after initial therapy, then every 6-12 months
    • Blood venipuctures must be placed in red top tumors for serum, not serum separators.
    • Valium (diazapam)- light sensitive
    •    Status seizures IV
    • Potassium Bromide
    •   30mg/kg day PO
    •   Takes KBr 3-4 months to get blood levels to control seizures
    • Monitor Medication
    •    Every 4-6 weeks with KBr serum levels
  44. Nuerological System
    Intervertebral Disease IVD
    • 1. Intervertebral disc disease is the extrusion is the extrusion or protrusion of the Intervertebral disc, resulting in compression if the spiral cord Spinal nerves, or nerve root.
    • 2. Extrusion of the disc is tearing of the annulus fibrosis and the rupturing of the nucleus pulposus into the vertebral canal (type I disc)
    • 3. Protrusion is partial tearing of the annulus fibrosis and bulging of the dorsal aspect of the disc into the vertebral canal. )Type II)
  45. Nuerological System
    Intervertebral Disease IVD
    Etiology
    • Type I disc
    •    Most common in chondrodystrophoid breeds of dogs.
    •    Daschund, shitzu, lhasa apso
    • Type II Disc
    •   NOnchondrodystrophoid breeds
    •   Usually large breeds
    • Neurological sign progression
    •    Progression from start to worse
    •         Back pain
    •         Ataxia
    •         Paresis- incomplete Paralysis
    •         Paralysis
    •         Loss of deep pain
  46. Nuerological System
    Intervertebral Disease IVD
    Clinical Signs
    • Type I
    • Breeds: dachshund, lhasa, shih tzu, pekingese, cocker, beagle
    • Age 1-10 years, peak 3-6 years
    • Type II
    •      Large breeds
    •     Age >5 years
    • Cervical disc disease
    •    onset acute
    •    Neck Pain
    •    Neurological signs may be bilateral or asymmetrical
    •         Ranges from ataxia to tetraparesis
    •         Normal to exaggerated reflexes
    • Thoracolumbar disc disease
    •   thoracolumbar pain
    •   Neurological signs
    •       Usually bilateral, but may be asymmetrical
    •        Range from mild ataxia to paralysis
    •      Cutaneous trunci (Panniculus) reflex is lost Caudal to lesion
    • URinary and fecal incontinence
    • Loss of deep pain caudal to lesion
  47. Nuerological System
    Intervertebral Disease IVD
    Diagnosis
    • Radiographs
    •      Narrowed or calcified disc space
    • Myelography
    •       Contrast Dye (Iohexol) used to pin point lesion
    • MRI or CT scan
    • CSF analysis
  48. Nuerological System
    Intervertebral Disease IVD
    Treatment
    • Medical Management
    •    Initial episode of back pain with no or mild neurological deficits
    •   Cage rest for 2-3 weeks
    •   Corticosteroids
    •        Prednislolone 0.5mg/kg PO SID
    •   Analgesic
    •       Butorphanol 0.2-0.4mg/kg IM or SQ
    • Muscle relaxants- stop spasms
    •    Methocarbamol (Robaxin)
  49. Nuerological System
    Intervertebral Disease IVD
    Surgery
    • Indicated for severe neuroligical deficits, failure of medical mangaement, reoccuring problems
    • Myelogram and surgery should be recommended when a patient shows paresis to paralysis
    • Emergency time is when the animal show paralysis and loss of deep pain
    •     40-50% success if surgery performed within 24-48 hours
    • Surgery is usually hemilaminectomy and disc space fenestrations

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