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TOPICS

Accidents.

·         Tachycardia and hypotension are indicative of shock, especially if patient has been in an auto accident

 

Amputation

·         Results in phantom limb pain because of interruption of peripheral nervous system.

·         Ask patient to keep active to help in alleviating the pain.

 

Amyptrophic Lateral Sclerosis

·         Patients exhibits fatigue, dysphagia, and involuntary facial  twitching

 

Assistive Devices

  1.     Cane Use   

·              Hold cane on the unaffected side.  

 

  2.     Crutch Use   

·              Axilla is at least 2 fingers away from the top of the crutch.

·              Do not rest the axilla at any time to prevent nerve damages.

·              Use the crutch by alternating your feet and the crutches.

·              Patient should bear weight on the his/her hands.

            Techniques:

                        a.  Two Point Technique

·              Crutches and legs move in unison.

                        b.  Three Point Technique

·              Right crutch and left foot then left crutch and right foot.

                        c.  Swing Technique

·              Move both crutches together and legs swing through.

 

  3.     Walker Use   

·              Hands on the side with palms resting lightly on the side bars.

·              Stay in the middle of the walker and do not lift the walker while in use

 

Autonomic Hyperreflexia

·         Major symptoms are headache, sweating profusely, nasal congestion and can include hypertension.

·         May exhibit facial flushing and high BP

·         The patient is experiencing a very high blood pressure. So, place patient in high Fowler position and check the blood pressure

·         Can be caused by a full bladder

 

 

Arthritis

·         Means joint inflammation. Each type of arthritis can have different symptoms but the following are the general symptom:

1.       Pain

2.       Swelling

3.       Stiffness

4.       Redness

5.       Warmth

 

   Common Types

  1.     Rheumatoid Arthritis

·              This is an autoimmune disease where the body’s own immune system attacks the body’s joints.

·              Having pain usually in the morning. Morning warm shower would benefit the patient.

·              Stiffness lasting longer than 60 minutes is common.

·              Nodules (bumps) that vary in size may develop over pressure points in the body such as the elbows, knuckles, spine and lower leg bones.

·              It usually affect both sides of the body at the same time. 

·              Applying heat rather than cold compress is more beneficial.

·              A good morning activity to relieve pain is holding a cup of coffee

·              Patient is encouraged to continue moving the affected joint within limits of pain

·              A patient may develop Sjogren syndrome (dryness of the eye – see EYE section under Integumentary)

 

  2.     Osteoarthritis

·              More common than rheumatoid arthritis.

·              Mainly different from rheumatoid arthritis because osteoarthritis is mainly caused by mechanical wear and tear of joints.

·              Stiffness that occurs in the morning may re-occur any time during the day, at times after doing an activity.

 

Rheumatoid Arthritis in comparison to Osteoarthritis

Characteristic

Rheumatoid arthritis

Osteoarthritis

Age of onset

Any time in ones life

Usually later in life

Speed of onset

Relatively rapid, weeks to months

Slow, over years

Symptoms

Swelling, stiffness and pain at joints

Achy and tender joins but no swelling

Pattern

Affects both small and large joints on both sides of the body

Begins on one side of the body . May spread to the other side. Often begins gradually and is limited to one set of joints, usually the finger joints closest to the fingernails or the thumbs, or large weight-bearing joints such as the hips, knees, or the spine.

Duration of discomfort

Morning stiffness may last for an hour. Stiffness is alleviated with movement.

Morning stiffness lasts less than 1 hour and may re-occur at the end of the day or after periods of activity.

 

















 

  3.     GOUT 

·              A painful form of arthritis where there is a build up of uric acid, a waste product of the body, that usually accumulates in the big toe but can also build up on other joints such as the knee and elbow.

·              The attack could be very sudden without warning and is very painful

·              May or may not re-occur but if it does, repeated inflammation of the same joint may cause damage.

·              Avoid foods high in purine, a chemical compound found in proteins, (beans, peas, spinach, oatmeal, anchovies, poultry, fish, liver, lobster, kidneys, mackerel, mussels, sardines, scallops, shrimp oysters, yeast extracts, beer,)

·              A 1950 study showed that eating ½ pound of cherries or drinking the equivalent cherry juice helped prevent attacks of gout. The active ingredient in cherries that help in gout is not yet known but it has been found to decrease the C-reactive protein level (a measure of inflammation). 


Babinski
Sign

·         Not normal in adults and if present would represent a lesion of the corticospinal tract

 

Bell’s Palsy

·         Paralysis on one side of the face

 

Car Accidents

·         Can lead to autonomic dsyreflexia (also referred to as autonomic hyperreflexia). Major symptoms are headache, sweating profusely, nasal congestion and can include hypertension.

·         A patient experiencing for head injury should be assessed for any leakage from the ear or nose. The output should be checked for any glucose since it may indicate cerebrospinal fluid.

·         Autonomic hyperreflexia can be caused by a full bladder or wrinkled sheet

 

Cast Care

·         Plaster of Paris takes 24 hours to dry. So, avoid any weight bearing on the casted area and handle with your palms not fingers.

·         End of the cast should be covered with sock or cast batting to  prevent irritation on skin

·         Do not use hair dryer to help dry the cast because it causes unequal drying and can cause burning in certain parts.

·         For the first  24 – 48 Hours, elevate the arm that has been casted; Elevate to prevent swelling.

·         Any casts should be handled with Palms without fingers to avoid indentations and Deformities

·         Attempt to turn the patient every 2 hours to prevent immobility complications.

·         Always consider neurovascular checks for casts (think 5 Ps - pulselessness, pain, pallor, paresthesia and paralysis)

·         Quadricep setting of the affected limb is the same as isometric exercise

·         T1 - T6 injuries - often result in respiratory problems.  Patients are independent of wheelchair and of self-care

·         Watch for COMPARTMENT SYDNROME - paresthesia (tingling sensation) of the toes distal to the cast?

 

Cerebral Palsy

·         Affects the muscle movements caused not by problems in the muscles or nerves but by abnormalities in the parts of the brain that control muscle movement.

·         Bacterial or viral encephalitis, head injury from vehicular accident, child abuse or fall – all these can cause cerebral palsy also

·         Most common muscle incoordination observed are:

                      ataxia (inability to perform voluntary movements)

                      spasticity (exaggerated reflexes)

                      walking wth one foot or dragging of leg

                      waling on toes

                      scissored” gait

·         A child may have visual and auditory difficulties.

·         Allow rest periods to patient in order to relax muscles.

·         There is no cure but supportive treatments, medications and surgery may help individuals improve their motor skills and ability to communicate.

 

  Cranial Nerves

 

Number

Cranial Nerve

 Functions

Quick Test

I

Olfactory

smell

The olfactory nerve is not commonly tested during a screening physical exam but can be performed if damage secondary to trauma or intracranial mass is suspected. Each nostril should first be evaluated for patency by compressing one nostril and having the patient breath through the opposite. Each nostril should then be tested separately with a volatile, non-irritating substance such as cloves, coffee or vanilla. The patient should close his eyes, occlude one nostril and identify the substance placed under the open nostril.

New onset, unilateral loss of smell (anosmia) is concerning for pathology while chronic bilateral anosmia is normally congenital.         

II

Optic

vision

Gross visual acuity can be tested with a Snellen eye chart (or hand held chart if Snellen chart is unavailable). Visual fields can then be tested by having patient cover one eye at a time, facing patient, and determining when patient can detect examiner's hands coming into their field of view. 
The pupillary light reflex tests for both CN II and CN III. Light shown in the ipsilateral eye will cause constriction of both eyes provided both CN II and CNIII are functioning properly.         

III

Oculomotor

eyelid and eyeball movement

Extraocular movements are tested by having patient follow examiner's finger throughout 360° range. Pupils are first assessed for size and symmetry. Anisocoria (unequal pupils) of up to 0.5 mm is fairly common and benign.

 

Pupillary reflex is tested in a darkened room. It is performed by shining light in one pupil and observing constriction of ipsilateral pupil (direct reflex) and contralateral pupil (contralateral reflex).

 

Pupillary accommodation can be tested by having patient focus on object at distance, then focus on object 10 cm from nose. Pupils should converge and constrict at close focus.

Pupillary abnormalities may be a result of either CN II or CN III lesions. A CN II lesion (blind eye) will not react to direct light (and will not elicit a consensual pupillary constriction) but will constrict if light is shown in the opposite eye. 

 

IV

Trochlear

innervates superior oblique
turns eye downward and laterally

Cranial Nerve IV is tested for extraocular movements by having the patient move the eye downward, upward, and sideways.         

V

Trigeminal

chewing
face & mouth touch & pain

Cranial Nerve V is tested by assessing facial sensation to light touch and pain on the forehead, cheeks and chin. This is performed with use of a cotton wisp and safety pin. Temperature can be tested by applying hot or cold objects (tuning fork dipped in hot or cold water) if an abnormality in pain or light touch is discovered. Patient is also asked to clench teeth while observing for deviation of jaw or asymmetry in muscle contraction.
 

VI

 

Abducens

turns eye laterally

This nerve is tested with extraocular movements. Damage to the nerve is seen with decreased ability to abduct the eye.

         

VII

Facial

controls most facial expressions
secretion of tears & saliva
taste

The muscular innervation of CN VII is tested by first observing the patient's face while at rest. The patient is then asked to raise eyebrows, wrinkle forehead, show teeth, puff out cheeks and close eyes tight while examiner attempts to open eye).
Any weakness or asymmetry may indicate a lesion in the facial nerve.

         

VIII

Vestibulocochlear
(auditory)

hearing and equillibrium

Cranial nerve VIII is tested by assessing hearing. This can be done by simply talking to the patient or determining if patient can hear sound of fingers rubbing together by ears. If decreased hearing is suspected, a Weber test is done where a tuning fork, placed in the middle of ones head, will lateralize to the affected side in conductive hearing loss and will lateralize to the unaffected side in sensorineural hearing loss.

 

In conductive hearing loss, the Rhine tuning fork test a tuning fork placed first on mastoid process, then brought in front of, but not touching, ear, will demonstrate bone conduction greater than air conduction in the affected ear. 

       

IX

Glossopharyngeal

taste
senses carotid blood pressure

Cranial nerves IX and X are tested by the gag reflex or having the patient say "Ah.." while looking for symmetrical elevation of the palate. The gag reflex is performed by touching the posterior pharyngeal wall with a tongue depressor.

           

X

Vagus

senses aortic blood pressure
slows heart rate
stimulates digestive organs
taste

Cranial nerve X is tested with CN IX by having patient say "Ah" and looking for symmetrical elevation of palate or by testing the gag reflex. In an ipsilateral lesion of CNX the uvula deviates towards the affected side.        

XI

Spinal Accessory

controls trapezius & sternocleidomastoid
controls swallowing movements

The patient is instructed to turn head and shrug shoulders against resistance. Weakness in turning head in one direction indicates problem in contralateral CN XI, while weakness in shoulder shrug indicates ipsilateral CN XI lesion

XII

Hypoglossal

controls tongue movements

The patient is asked to protrude tongue and move tongue in all directions. The muscles of the unaffected side will tend to push th tongue towards the affected side. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 





Crainotomy

·         Post operatively it is expected for the patient to have an increase in temperature.

·         Assess patient for level of consciousness and pupil reaction which both should improve within 24- 48 hours

 

Elcectroconlcusive Therapy (ECT)

·         Expect the patient to develop a grand-mal seizure (now called tonic-clonic) to indicate that the treatment is complete.

·         A treatment where seizures are induced in anesthetized patients for treatment mainly of severe major depression and for which other treatments have not worked.

·         Side effect can be a loss of memory around the time period of treatment.

 

 

Epilepsy / Seizures

·         Antivconvulsant medications decrease white blood cell count.

·         Allcohol, stress coffee and constipation can trigger seizures. It can also be increased during menses.

·         Call a code only if prolonged (greater than 5 minutes).

·         A patient on continuous Dilantin (Phenytoin) can develp aplastic anemia or agranulocytosis. So, frequent CBC is needed. Dilantin can also cause gingivitis and hyperplasia of gums that oral hygiene and gum care are necessary.

·         Seizure medication should not be stopped abruptly cause it may cause Status epilepticus.

 

    Types of Seizures

  1.     Grand Mal Seizure – now referred to as Tonic Clonic  

·              Quick bilateral jerking movements.

  2.     Petit Mal Seizure   

·              Brief lapse of consciousness with rapid eye blinking, lip smacking and myoclonus (muscle contractions that are short and abrupt) of upper extremities.

 

Fractures

·         Watch for hematuria which is an indication of a bleeding disorder

·         Femur fractures – leg would appear adducted and with external rotation

·         A patient in MVA with bone protruding – priority is to cover the area with sterile dressing only then one immobilizes. No manual traction should be done.

                                               

Frostbite

·         Continuous warming of the area that has a frostbite can lessen the amount of cellular damage.

 

Gout

·         A painful form of arthritis where there is a build up of uric acid, a waste product of the body, that usually accumulates in the big toe but can also build up on other joints such as the knee and elbow.

·         May or may not re-occur but if it does, repeated inflammation of the same joint may cause damage. 

·         Avoid foods high in purine, a chemical compound found in proteins, (beans, peas, spinach, oatmeal, anchovies, poultry, fish, liver, lobster and oysters).

 

 

Guillain-Barre Syndrome (GB)

·         Could be self limiting because it can lead to peripheral and ascending paralysis and loss of motor function.

·         Progressive loss and weakness of sensation that starts on the lower extremities

·         Evaluation of CSF is important to help in the diagnosis.  Elevated CSF is indicative of GB

 

 

Hip Replacement

·         A surgical procedure where diseased parts of the hip are replaced with artificial part, called prosthesis in order to improve the function of the hip join and relieve pain.

·         Osteoarthritis is the most common cause of damage to the hip joint cartilage. Other causes are rheumatoid arthritis, injury, and bone tumors.

·         The most common problem after surgery is dislocation. So, advise patient not to pull knees up tot the chest.

·         The most common complication later after surgery is inflammation. Less common complications are infection, blood clots.  

·         Avoid hip flexion. Avoid low seats.  

 

 

ICP (Intracranial Pressure) 

·         An increase in the normal brain pressure. The pressure can damage the Central Nervous system by putting pressure on the brain structures and restricting the blood flow from vessels that supply the brain.

·         Normal range for adults  = 4 - 10 mmHg, with upper limits of 15mmHg

·         Tracheal suctioning only done as necessary cause it can increase ICP; keep Patient’s head from flexing and rotating, elevate bed at 30 degrees to prevent pressure and alleviate headache

·         Widening pulse pressure, increase in BP, decreased heart rate and high temperature are signs of ICP

·         Restlessness, complains of headache, nausea and vomiting are EARLY signs of ICP but unequal pupil size or edema around the eyes (papillaedema) are late signs of ICP

·         Unilateral NOT bilateral change in pupil size is a sign of ICP and also bradycardia

·         Patient may be given Hypotonic solutions that can increase urine output as a determinant of the solutions effectiveness.

·         Early signs of ICP are confirmed with MRI and CT scan.

·         A lumbar tap is done to measure ICP

 


Intracranial Tumors

  • Watch for dizznes (suggests cerebellum problem), seizures (suggests motor cortex problem), personality changes (suggests frontal lobe disturbance), nausea and vomiting, change in language and motor skills.
  • Patient may undergo surgery. Makes sure to have baseline neurological assessment before surgery. Prepare client, particularly with shaving of head.
  • Post operatively, makes sure head of bed is elevated at least 30 - 35 degrees. Patient is usually placed flast and laterally on either side. Observe of any complications - SOB, increased intracranial pressure, fever, wound incision infection.
  • Give medications as needed - antiseizures, antibiotics, antipyretics, antiemetics, diuretics, mild analgesia (NOTE: Narcotics are usually not given since it can mask level of consciousness)

Injury Type

  1.     Coup – brain damage is under the site of the impact

     2.    Countercoup – The opposite side of the impact

 

           

Lumbar puncture (also called Spinal Tap)

·           A lumbar puncture, or spinal tap, is a procedure to collect cerebrospinal fluid to check for the presence of disease or injury. A spinal needle is inserted, usually between the 3rd and 4th lumbar vertebrae in the lower spine. When the needle is properly positioned in the subarachnoid space (space between the spinal cord and its covering, the meninges), pressures can be measured and fluid can be collected for testing. See picture below.

Lyme Disease

·         Bulls eye type of rash

·         Named after a town in Connecticut where the disease was first discovered

·         Transmitted by ticks found mostly in deers or mice in heavily wooded areas. Best to remove ticks with a twissor and do not hit kill the tick against the skin.

·         Encourage wearing of longs sleeves when doing outdoor activities.

·         Complication can lead to Bell’s palsy 

 

Meningitis

·         Best diagnosed by lumbar puncture (see Lumbar puncture) it is the inflammation of the membranes covering the brain the spinal cord.

·         Sometimes correlated with Cerebral Palsy, a neurological disorder.

·         Common causes are viral infections but bacterial infections require immediate attention. Some bacterial strains that cause meningitis are Streptococcus pneumoniea, Haemophilus influenza, Neisseria meningitides, Listeria monocytogenes.

·         Common symptoms are change in mental status, nausea, vomiting, fever and chills, photophobia, severe headache. Additional symptoms to watch out for babies are poor feeding and irritability, bulging fontanelles, stiffness, rapid breathing.  

·         Early prevention for children is immunization with:

                      a.    Haemophilus vaccine (HiB vaccine) – helps in prevention of one type of meningitis

                      b.    Pneumococcal vaccine – to prevent pneumococcal meningitis

·         See pictures below of physical demonstration of symptoms of meningitis  

a. Brudzinski's Sign

b. Kernig's Sign

Brudzinski Sign


One of the physically demonstrable symptoms of meningitis is Brudzinski's sign. Severe neck stiffness causes a patient's hips and knees to flex when the neck is flexed.

Kernig Sign

One of the physically demonstrable symptoms of meningitis is Kernig's sign. Severe stiffness of the hamstrings causes an inability to straighten the leg when the hip is flexed to 90 degrees.

 

 

Multiple Sclerosis

·         Affects the myelin sheath of nerve fibers, which when damaged leaves a scarred tissue (sclerosis) -- so watch for bowel bladder function, gait, speech and swallowing ; ADL activity is not the priority in assessing.

·         Myelin is the fatty tissue that surrounds and protects the nerve fibers of the CNS.

·         Does not affect the peripheral and has remissions. Most people will have normal or near-normal life expectancy. 

·         Patient’s condition worsens at the end of the day.

·         Visual disturbance and diplopia can develop.

·         Patient has unsteady gait, tremors, and facial weakness.

·         (See Trigeminal Nerve)

 

 

Myasthenia Gravis

·         Caused when the transmission of impulse from the nerve endings to the muscles is interrupted. Usually, nerve endings release the acetycholine to bind or attach to receptors on the muscles but in MG, this transmission is blocked by antibodies produced the body’s own immune system.

·         Characterized mainly by muscle weakness that increases during activity and improves after rest. So, encourage rest periods on patients. 

·         Involves muscles that control the eyelid movement (drooping of the eyelids, called pytosis), facial expressions, chewing, talking, swallowing, impaired speech and even muscles that control breathing and neck and limb movements.

·         Also, characterized by increase in BP, respirations, heart rate, anoxia and the absence of cough reflex

·         Can have problem breathings. So, put patient in high Fowler position.

·         Patient with Myasthenia Gravis will experience cholinergic crisis (reversal of the myasthenia crisis) if there is over medication or toxicity. Patient may exhibit involuntary twitching of muscles, facial grimacing and tongue protrusion.

·         Patients may given drugs that have cholinesterase inhibitors such as Neostigmine and Pyridostigmine in order to help improve the nerve signals to the muscles. Immunosuppressive drugs like Prednisone, Cyclosporins may be ordered in order to suppress the production of abnormal antibodies.

·         Encourage plenty of rest, avoid overexertion and a diet rich in potassium to help ease fatigue. Good sources of potassium are oranges and bananas.

 

Myasthenia Crisis

·         Occurs when the muscles that control breathing are very weak and the patient will require a respirator to help breath.

·         Can be triggered by infection, fever, or stress.

 

Myelogram 

·         Cleansing enema the night before is important; Patient will be moved around and will be instructed during exam.

·         Lumbar puncture to is done inject a dye to and visualize the spinal canal.

 

Pagets Disease

·         Problem with mobility. So, makes sure the patients environment is clutter free.

·         Process of bone growth is abnormal that the bone breaks down easier and is replaced by softer bones. In essence bone is continually breaking and rebuilding but remodeled by a weaker bone.

·         The disease can affect any bone but usually affects the skull, hips, pelvis bones and bones of legs and back.

 

 

Paraplegia

·         Would require bowel and bladder retraining to prevent any complications.

 

Parkinsons Disease

·         Decrease in Dopamine.

·         The four main symptoms are:

                      a.     Trembling of hands, arms, legs, jaw and face

                      b.     Rigidity or stiffness of limbs and trunks.
                      c.     Slowness of movement

                      d.     Impaired balance or coordination

·         Loss of coordination and is identified by the “cogwheel” rigidity.

·         Allow patient to lie periodically lie prone without a pillow on neck to prevent curvature of the spine, which is associated with the disease. 

·         Patients can undergo Stereotatic surgery that can destroy parts of the brain that are responsible for the intractable tremors since it is these shaking that affects the daily activities of the patients.  

·         There is no cure for PD but patients are usually on Levodopa which is given in combination with Carbidopa, which delays the conversion of levodopa into dopamine until it reaches the brain. Levedopa is used by the nerve cells to make dopamine.

 

 

Postions

  1.     Trendelenberg   

·              Good for surgeries of lower abdomen and pelvis.

  2.     Lithotomy  

·              Good for vaginal or perineal or rectal surgeries.

  3.     Sims    

·              Good for renal surgery.

  4.     Prone    

·              Good for back or rectal surgery.

 

Seizures / Epilepsy

·         Antivconvulsant medications decrease white blood cell count.

·         Allcohol, stress coffee and constipation can trigger seizures. It can also be increased during menses.

·         Call a code only if prolonged (greater than 5 minutes).

·         A patient on continuous Dilantin (Phenytoin) can develop aplastic anemia or agranulocytosis. So, frequent CBC is needed. Dilantin can also cause gingivitis and hyperplasia of gums that oral hygiene and gum care are necessary.

·         Seizure medication should not be stopped abruptly cause it may cause Status epilepticus.

 

    Types of Seizures

  1.     Grand Mal Seizure – now referred to as Tonic Clonic  

·              Quick bilateral jerking movements.

  2.     Petit Mal Seizure   

·              Brief lapse of consciousness with rapid eye blinking, lip smacking and myoclonus (muscle contractions that are short and abrupt) of upper extremities.

 

SPICA care

·         A body cast from the abdomen all the way down to the knee to keep a child’s hips and legs from moving after an operation or injury.

·         No weight bearing or walking should be done while on the cast  

·         Check for bowel sounds to ensure that paralytic ileus is not occurring.

·         Check that toes of child are pink and warm to touch, without swelling and are able to wiggle the toes.

·         Don’t use lotion or powders on child’s skin since they might form a cake

·         Don’t stick any object under the cast to prevent any injuries to the skin.

·         Don’t use hair dryer under the cast, especially warm or hot settings, since they can cause burns.

·         Elevate head and upper body at all times.  

 

 

Surgeries

   Common Types of Surgeries

  1.     Knee Replacement

·              Apply ice to control edema and bleeding; Heat worsens both.

·              Foot flexion is encouraged to avoid complications such as thromboembolism.

·              CPM (Continuous Passove Motion) machine should not be at 90 degree flexion until at least the 5th day of replacement. CPM use can be painful at first but must not be turned off.

·              Blood drainage from a Davol drain may be up to 30ml.

 

  2.     Hip Replacement / Hip Fracture     

·              Ice is fine (see above) and ice is a better choice than giving medication for pain management.

·              CPMD is used to promote healing and circulation.

·              Patient will feel pain and coolness of extremities. BUT, absence of pedal pulses is sign of compartment syndrome.

·              Prevent abduction by putting a pillow in between the legs.

·              Avoid 90 degree flexion by using a high seat commode when using the toilet.

 

          For BOTH knee and hip replacements -- Nurse is not responsible for drainage removal postoperatively ; Notify doctor if large drainage (approximately > 30ml/ Hr).

 

  3.     BKA / AKA  - Below / Above the Knee Amputation

·              Usually has no drainage and involves a very tight dressing. Thus, provide cast care (see above).

·              Infection is determined if there is warmth above the amputation and if there is persistent pain.  DO NOT ELEVATE for the first 24 hours to prevent contractures.

·              To reduce phantom pain, encourage patient to stay active.

·              To prevent contractures, the patient should be put on prone position 15- 30 minutes twice a day.

 

TIC Douloureux (also referred to as Trigeminal Neuralgia)

·         Intense stabbing facial pain that usually affects one side of the face. The trigeminal nerve is the nerve that supplies the sensation to the face. The pain may last from seconds to minutes and could be so intense causing one to wince, hence, the term tic.

·         Pain can be triggered by talking, eating, brushing teeth, or even cool air on the face.

·         Though attacks can last for week to months, there may be a remission period of months to years of being symptom free.

·         People with Multiple Sclerosis are affected frequently Possibly because the myelin sheath that covers the nerve erode, causing it to be more excitable and “firing” pain impulses.

·         To prevent any strain ask a patient to take in soft warm foods, chew food on the unaffected side.

 

Tinel Sign

·         Used to check for carpal tunnel syndrome.

·         Tap the median nerve of the wrist and ask patient if there is pain. Can also be done by using a pressure cuff and inflate up to the patient’s normal systolic pressure and see if there is pain.

 

Tractions

·         Skeletal tractions involve use of pins and screws. Steinman pin goes through large bones to stabilize large bones such as the femur.

·         PIN care is done with sterile gloves and Q-tips can be used when cleaning pin.

 

   Types of Tractions

  1.     Bryant Traction   

·              A skin traction NOT a skeletal traction.

·              Infants hip is off the bed (about 15 degrees).

·              Used for fractured femurs and dislocated hips.

 

  2.     Bucks Traction   

·              Does not involve pins. It is a skin traction.

 

  3.     Russel Traction   

·              Used for bones of the lower extremities.

 

  4.     Halo and Cruchfield Tong    

·              Used for those patients with cervical fracture and is used after the patient has been released from the hospital. Cervical tong is used to immobilize the cervical fracture while the patient is in the hospital.

 

  5.     Pavlik Harness  

·              Do not use lotions and powders since they may cause irritation BUT one can provide massage underneath.

·              Harness is adjusted by a Doctor. It is not even removed for bathing. Must be worn for 3 – 5 months.  

 

 

Trigeminal Neuralgia (also called Tic Douloureux )

·         Intense stabbing facial pain that usually affects one side of the face. The trigeminal nerve is the nerve that supplies the sensation to the face. The pain may last from seconds to minutes and could be so intense causing one to wince, hence, the term tic.

·         Pain can be triggered by talking, eating, brushing teeth, smiling or even cool air on the face.

·         Though attacks can last for week to months, there may be a remission period of months to years of being symptom free.

·         People with Multiple Sclerosis are affected frequently Possibly because the myelin sheath that covers the nerve erode, causing it to be more excitable and “firing” pain impulses.

·         To prevent any strain ask a patient to take in soft warm foods, chew food on the unaffected side.

 

 

Vehicular Accident

·         A patient in MVA with bone protruding – priority is to cover the area with sterile dressing only then, one immobilizes. No manual traction should be done.

 

 

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