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Endocrine & Musculoskeletal Disorders: Causes, Symptoms, Treatments, & Nursing Priorities, Exams of Nursing

An overview of various endocrine disorders, including diabetes, hyperthyroidism, hypothyroidism, cushing's syndrome, addison's disease, and graves disease, as well as musculoskeletal conditions such as joint dislocations, herniated disks, fractures, and osteoarthritis. It covers causes, symptoms, treatments, and nursing priorities for each condition.

Typology: Exams

2023/2024

Available from 04/08/2024

CarlyBlair
CarlyBlair ๐Ÿ‡บ๐Ÿ‡ธ

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Pathophysiology and Pharmacology - Sem 2

Yr

Pharmacology - The study of drugs and their interactions with living systems Pharmacokinetics - What the body does to the drug Pharmacodynamics - What the drug does to the body Pharmacotherapeutics - The treatment of pathologic conditions through the use of drugs Medication - A substance that is used to treat or prevent disease or relieve pain Drug -

  • A chemical agent capable of producing biological responses in the body
  • Therapeutic = positive effect
  • Adverse = negative effect Abbreviations -
  • PRN = when required
  • Stat = give immediately
  • Bd = 2x daily
  • Tds = 3x daily
  • Qid = 4x daily
  • Mane = morning
  • Nocte = night
  • PV = per vagina
  • PR = per rectum
  • NG = Nasogastric
  • MDI = metered dose inhaler
  • IM = Intramuscular
  • SUBCUT = subcutaneous
  • PO = Oral
  • Sublingual = under the tongue
  • IV = intravenous
  • Neb = nebulised
  • PICC = peripherally inserted central catheter
  • PEG = percutaneous endoscopic/enteral gastrostomy
  • CVC = central venous catheter
  • PCA = patient controlled analgesia Digestion -
    • Breakdown of ingested food
  • Absorption of nutrients into the blood Metabolism -
    • Production of cellular energy (ATP)
  • Anabolic and Catabolic pathways Process of The Digestive System -
    • Ingestion
  • Mechanical Digestion
  • Propulsion
  • Chemical Digestion
  • Absorption
  • Defecation Gastrointestinal Reflux - Weakness of the sphincter, acid back flows into the oesophagus with a less protective lining which causes a burning sensation (heartburn) Oesophagitis - Inflammation of the oesophagus Oesophageal Reflux (Pathophysiology & Cause) - Exposes the oesophageal mucosa to the irritant effects of gastric fluids Oesophageal Reflux (Symptoms) -
    • Heartburn
  • Painful to swallow
  • Burping Oesophageal Reflux (Nursing Priorities & A-E) -
    • Positioning = sit up, avoid bending
  • Small meals = avoid foods that reduce sphincter tone; caffeine, fats, chocolate
  • Avoid alcohol and smoking Oesophageal Reflux (Treatment - Medication & Interventions) -
    • Antacids
  • Proton pump inhibitors

Barium Swallow (Esophagogram/X-ray) - Swallow barium and a series of x-rays are taken to watch the barium moving through your mouth and throat Gastritis -

  • Acute Gastritis = inflammation of the gastric mucosa
  • Chronic Gastritis = chronic changes to the gastric mucosa Peptic Ulcer Disease (Pathophysiology & Cause) - An abrasion of the stomach or small intestine (ulcers) Peptic Ulcer Disease (Symptoms) -
  • Heartburn
  • Painful to swallow
  • Burping Peptic Ulcer Disease (Nursing Priorities & A-E) -
  • Positioning = sit up, avoid bending
  • Small meals = avoid foods that reduce sphincter tone; caffeine, fats, chocolate
  • Avoid alcohol and smoking Peptic Ulcer Disease (Treatment - Medication & Interventions) -
  • Antibiotics (where H. pylori is present)
  • Antacids (relieve ulcer symptoms) Inflammatory Bowel Disease -
  • Crohn's Disease
  • Ulcerative Colitis

Crohn's Disease (Pathophysiology & Cause) -

  • Chronic inflammation of the intestinal tract
  • Anywhere in digestive tract, mainly small intestine (illium and beginning of colon)
  • Entire depth
  • Surgery is not curative Crohn's Disease (Symptoms) -
  • Diarrhoea
  • Nutritional deficiencies
  • Pain in abdomen Crohn's Disease (Nursing Priorities & A-E) -
  • Symptom management
  • Nutritional support - total parenteral nutrition (TPN)
  • Pain management Crohn's Disease (Treatment - Medication & Interventions) -
  • Corticosteroids = decreasing the inflammatory response
  • Antibiotics = bacterial infection Ulcerative Colitis (Pathophysiology & Cause) -
  • Inflammatory condition of the large intestine (rectum and colon)
  • Inner lining
  • Bowel wall is affected symetrically
  • Surgery is curative Ulcerative Colitis (Symptoms) -
  • Diarrhoea
  • Stools contain mucous and blood
  • Fatigue, anorexia and weakness Ulcerative Colitis (Nursing Priorities & A-E) -
    • Symptom management
  • Surgery (complete removal of bowel, formation of ileoanal anastomosis or permanent ileostomy)
  • Nutritional support - total parenteral nutrition (TPN) Ulcerative Colitis (Treatment - Medication & Interventions) -
    • Anti-inflammatory drugs โ€” corticosteriods
  • Immunosuppressant drugs (eg cyclosporin) Irritable Bowel Syndrome (IBS) -
    • Functional gastrointestinal disorder
  • More likely to have anxiety and depression
  • Abdominal pain associated with altered bowel habits Colorectal Cancer (Pathophysiology & Cause) - Starts as a polyp, spreads and metastasis around the body Colorectal Cancer (Symptoms) -
    • Bleeding per rectum (PR)
  • Change in bowel habits
  • Alternating diarrhoea/constipation Colorectal Cancer (Nursing Priorities & A-E) -
    • Symptom management
  • Nutritional support - total parenteral nutrition (TPN)
  • Pain management

Colorectal Cancer (Treatment - Medication & Interventions) -

  • Polyp removal via colonoscopy
  • Postoperative chemotherapy or radiotherapy Colonoscopy - Allows the doctor to look inside the entire rectum and colon while a patient is sedated Biopsy - The removal of a small amount of tissue for examination under a microscope Diverticulitis -
  • Formation of pouches (diverticula) within the bowel wall
  • Large intestine, or colon Appendicitis -
  • Inflammation and infection of the appendix
  • Treatment = antibiotics or removal Ileostomy - Opening into the ileum Colostomy - Opening into the colon Stoma Management -
  • Routine postoperative observations
  • Pain relief
  • IV fluids, fluid balance chart
  • Observe wound and any drains
  • Positioning - pillow under knees for open surgery for comfort Bowel Obstruction (Pathophysiology & Cause) -
    • Mechanical Causes o Hernias o Tumours
  • Paralytic Causes o Impaired peristalsis o Intestinal ischaemia Bowel Obstruction (Symptoms) -
    • Abdominal Pain
  • Absolute constipation
  • Abdominal distension Bowel Obstruction (Nursing Priorities & A-E) -
    • Postoperative observations and care
  • Bowel observations and documentation
  • NGT and IV hydration (correct electrolyte imbalance) Bowel Obstruction (Treatment - Medication & Interventions) -
    • Surgery = if tumour or blood supply of bowel is in danger
  • Treatment depends on type and cause Haemorrhage -
    • Above the stomach = vomiting blood
  • Stomach = coffee- grounds
  • Intestine = faecal occult blood (melaena)
  • Rectum = red blood coating stools
  • Nursing management o ABCDE o IV access o Hypovolaemia o Prepare patient for scope and/or theatre Liver Cirrhosis - Liver tissue is replaced by fibrous tissue, as a result of tissue damage by toxins or other processes (eg: alcohol) Hepatitis -
    • Inflammation of the liver
  • Acute = up to 8 weeks
  • Chronic = 6+ months Pancreatitis - Inflammation of the pancreas Gallbladder Disease -
    • Gallstones
  • Inflammation of the gall bladder Causes of Constipation -
    • Metabolic and endocrine disorders = diabetes,
  • Neurogenic = parkinson's disease
  • Adverse drug effects = analgesics
  • Lifestyle = poor bowel movement habits Diarrhoea -

Increase in volume, fluidity or frequency of bowel movements Vomiting (Emesis) - The forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose Endocrine System - Secretes various hormones that regulate the activities of the body Hypothalamus - Portion of the brain that link the nervous system to the endocrine system via the pituitary gland The Pituitary Gland -

  1. Posterior Pituitary Gland
  2. Anterior Pituitary Gland
  3. Posterior Pituitary Gland -
  • Oxytocin = let down of milk
  • ADH = kidneys retain water
  1. Anterior Pituitary Gland -
  • TSH = thyroid gland to release its hormones
  • GH = consumption of fats as an energy source
  • ACTH = adrenal cortex to release its hormones
  • FSH = maturation & release of eggs
  • LH = maturation & release of eggs Thyroid Gland -
  • Thyroxine (T4)
  • Triiodothyronine (T3) Parathyroid Glands - Parathyroid hormone = increase level of calcium in blood Adrenal Glands -
    • Located on the tops of the kidneys
  • Medulla = Adrenaline and Norepinephrine
  • Cortex = aldosterone & cortisol Pancreas -
    • Alpha cells = glucagon
  • Beta cells = insulin
  • Delta cells = somatostatin Cellular Respiration โ€” ATP - Metabolic reactions that take place in the cells to convert energy from nutrients into ATP Glycogenesis - Glucose โ€”> glycogen Glycogenolysis - Fat/protein โ€”> glycogen Gluconeogenesis - Fats/protein โ€”> glucose Insulin Glucose Metabolism -
    • Cell membranes impermeable to glucose
  • Insulin binds to insulin receptor on cell surface
  • Moves from inactive site to cell wall
  • Glucose transported across cell wall Hormonal Regulation - Low BGL = Glucose uptake High BGL = Glycogenolysis Diabetes Mellitus -
    • Inability of the body to produce or to use insulin, resulting in a lack of ability to use or metabolise glucose
  • Type 1
  • Type 2 Diabetes Insipidus -
    • Hyposecretion of ADH
  • Treatment = surgical removal of the pituitary Diabetes Mellitus โ€” Type 1 (Pathophysiology & Cause) -
    • Autoimmune โ€” T-cells & antibodies attack the beta cells to prevent the making and secretion of insulin
  • Causes destruction of Beta cells
  • Decrease production of insulin = no glucose uptake into cells
  • High BGL, causes liver to release glucose into blood stream Diabetes Mellitus โ€” Type 1 (Symptoms) -
    • Marked elevation of Blood Glucose
  • Rapid onset of symptoms

Diabetes Mellitus โ€” Type 1 (Nursing Priorities & A-E) -

  • Symptom relief
  • Control of BSL
  • Prevention and treatment of long-term and acute complications Diabetes Mellitus โ€” Type 1 (Treatment - Medication & Interventions) -
  • Insulin
  • Pancreas/kidney and islet cell transplant Diabetes Mellitus โ€” Type 2 (Pathophysiology & Cause) -
  • Resistance to insulin (hyperglycaemia despite presence of insulin)
  • Pancreases makes insulin, but target cells needing to convert glucose into energy using insulin become resistant.
  • Increased glucose production causing high BGL Diabetes Mellitus โ€” Type 2 (Symptoms) -
  • Feeling very thirsty
  • Needing to urinate more often than usual
  • Blurred vision Diabetes Mellitus โ€” Type 2 (Nursing Priorities & A-E) -
  • Educate the patient (disease, diet, treatment)
  • Consider lifestyle change before starting medication Diabetes Mellitus โ€” Type 2 (Treatment - Medication & Interventions) -
  • Oral Hypoglycaemic
  • Insulin Gestational Diabetes -

Glucose intolerance detected during pregnancy (2-5%) Diabetic Ketoacidosis (Pathophysiology & Cause) -

  • Insulin doesn't work โ€”> hyperglycaemia/high BGL (can't breakdown glucose) โ€”> osmotic shift causing excessive urination โ€”> dehydrated & loose electrolytes โ€”>
  • Breaks down fatty acids to use as alternate energy source (glucose isn't available) โ€”> by-product of breaking down fats is ketones
  • Ketones โ€”> highly acidic which result in metabolic acidosis
  • Usually affects type 1 DKA pH -
  • Normal pH = 7.35-7.45 (DKA = 7.3 or less)
  • Normal BGL = 4-8 (DKA = 11+)
  • Normal DKA = under 0.6 (DKA = 1.5+) Diabetic Ketoacidosis (Symptoms) -
  • Lethargy
  • Nausea
  • Vomiting Diabetic Ketoacidosis (Nursing Priorities & A-E) -
  • Fluid replacement: lots around 6 - 8 litres lost
  • Insulin = IV insulin (faster, can increase/decrease rate)
  • Glucose = at fixed rate to stabilise glucose level while removing ketones (increase in ketones aren't lowering)
  • Potassium & electrolyte replacement Diabetic Ketoacidosis (Treatment - Medication & Interventions) -
  • Prevent hypoglycemias = glucose & insulin on the same cannula (can get both โ€” won't have one pump running while one might be broken etc)
  • Check BGL + Ketones levels hourly
  • Rebound DKA = taken off treatment too soon Hyperosmolar Hyperglycaemia State (HHS) -
    • BGL are too high for a long period (high concentration of salts & glucose)
  • Leading to severe dehydration and confusion, no Keatons just hyperglycaemia
  • Treatment = Lower blood glucose levels and hydrate patient Hypoglycaemia -
    • Low level of blood glucose
  • Treatment o Mild = glucose or fasting acting sugar (15gm) o Severe = SC or IM glucagon Hyperglycaemia -
    • High level of blood glucose
  • Treatment o Hydration and dietary status o Ketones o Missed doses of insulin Hyperthyroidism -
    • Overproduction of thyroxine, causing metabolism to speed up
  • Causes = graves disease, inflammation, noncancerous growths
  • S & S = Goiter & weight loss
  • Treatment = Removal of thyroid or destruction of thyroid Hypothyroidism -
    • Under-secretion of thyroxine, causing lowering of the body's metabolism
  • Causes = medications, surgical removal, hashimoto's disease
  • S & S = lethargy & weight gain
  • Treatment = Thyroxine replacement (medications) Cretinism -
    • A congenital form of hypothyroidism (deficiency of thyroid hormones in mother)
  • Treatment = thyroid hormones Cushing's Syndrome -
    • Overproduction of steroids by adrenal cortex, or by overuse/abuse of steroidal drugs
  • Treatment = removal of the adrenal cortex Addison's Disease -
    • Underproduction of steroids by adrenal cortex
  • Treatment = Replacement and regulation of steroids Graves Disease - Autoimmune disorder that is caused by hyperthyroidism and is characterised by goiter Hashimoto's Disease - Autoimmune disease in which the body's own antibodies attack and destroy the cells of the thyroid gland Insulin - Regulates blood sugar levels by facilitating the uptake of glucose into tissues Continuous Glucose Monitoring (CGM) - A device used to continuously monitor blood glucose levels

Sliding Scale Insulin - Adjusted doses dependent upon individual blood glucose Anaphylaxis -

  • Severe, life-threatening, generalised or systemic hypersensitivity reaction
  • Characterised by rapidly developing life threatening airway and/or breathing and/or circulation
  • Treatment = Epinephrine & Intravenous fluids Human Musculoskeletal System - It is made up of the bones of the skeleton, muscles, cartilage, tendons, ligaments, joints, and other connective tissue that supports and binds tissues and organs together Spongy (Cancellous) v Compact (Cortical) Bone -
  • Spongey = network of bone with spaces (strong but light), reduces energy to move around
  • Compact = weight bearing, strong
  • Marrow = red โ€”> produce blood cells Strain - A condition resulting from damaging a muscle or tendon Sprain - Stretching or tearing of ligaments Joint Dislocation (Pathophysiology & Cause) -
  • When a joint becomes disconnected from its socket
  • Joint will require immobilisation for several weeks to allow injured joint tissues to heal Joint Dislocation (Symptoms) -
  • Pain
  • Deformity
  • Limited movement Joint Dislocation (Nursing Priorities & A-E) -
    • Immobilisation to allow injured joint tissues to heal
  • Postoperative; elevation of limb
  • Pain relief, comfort
  • Check for complications - DVT, compartment syndrome Joint Dislocation (Treatment - Medication & Interventions) -
    • Realignment of bones/back into socket
  • Physical therapy to strengthen surrounding muscles
  • Surgery for repeated incidences Herniated Disk -
    • Discs are pads that serve as "cushions" between the vertebral bodies
  • Outer layers split or rupture, inner layer centre squeezed outwards Fractures (Pathophysiology & Cause) - A greater stress is placed on a bone than it can withstand Fractures (Symptoms) -
    • Pain
  • Tenderness at fracture site
  • Swelling Fractures (Nursing Priorities & A-E) -
    • Immobilisation to allow injured joint tissues to heal
  • Postoperative; elevation of limb
  • Pain relief, comfort
  • Check for complications = DVT, compartment syndrome Fractures (Treatment - Medication & Interventions) -
    • Realignment of bones
  • Physical therapy to strengthen surrounding muscles
  • Surgery for repeated incidences Fracture - Types -
    • Greenstick = a 'bend' or partial break
  • Impacted = fracture fragments are wedged together
  • Compression = two bones crushed together
  • Comminuted = More than two pieces of fractured bone Bone Healing -
    1. Haematoma formation (1-2 days)
  1. Fibrocartilaginous callus formation
  2. Ossification (3rd - 4th week)
  3. Remodelling (10 - 18 weeks) Complications of Fractures -
    • Hypovolaemic Shock
  • Deep Vein Thrombosis
  • Compartment Syndrome
  • Fracture blisters
  • Fat Embolism Syndrome
  • Osteomyelitis Hypovolaemic Shock -
  • Caused by insufficient circulating blood volume
  • Treatment = replace fluids Compartment Syndrome -
  • Increased pressure within a confined space
  • Puts pressure on blood vessels and nerves = compromises limb (limb ischemia)
  • Treatment = reduce the pressure (Fasciotomy) Fasciotomy - Excessive swelling and pressure, create incision in limb to elevate pressure until swelling is decreased 5 P's -
  • Pain = pain response in
  • Pulse = palpate peripheral pulses
  • Parlour = poor circulation/obstruction, no venous return
  • Parenthesis = sensation (tingling)
  • Paralysis = movement Surgical Reaction & Fixation of Fractures -
  • ORIF = open reduction internal fixation โ€” go in for surgery, open up wound and re-aline bone and use devices to pin fracture
  • Gets patient back on feet earlier
  • Infection risk = foreign object into body External Fixation -
  • Puts pins through the bone and immobilises the fracture (prevents movement), temporarily while waiting for swelling to decrease
  • Pin care = cleaned regularly and prevent infection

Joint Replacement Risks -

  • DVT
  • Anaesthetic risk
  • Compartment syndrome
  • Nerve damage
  • Infection Rhabdomyolysis -
  • Damaged muscle tissue releases its proteins and electrolytes into the blood
  • Causes renal failure
  • Makes patient acidotic
  • Treatment = fluid replacement & temporary dialysis Osteoarthritis (Pathophysiology & Cause) -
  • Inflammation of the bone and joint
  • Degenerative (joint overuse - wear and tear) Osteoarthritis (Symptoms) -
  • Joint pain
  • Swelling, stiffness
  • Limited ROM Osteoarthritis (Nursing Priorities & A-E) -
  • ADL assistance
  • Medication = analgesia, anti-inflammatories
  • Physical rehabilitation Osteoarthritis (Treatment - Medication & Interventions) -
  • Replacement of complete joint (arthroplasty)
  • Surgery = arthroscopic treatment Rheumatoid Arthritis (Pathophysiology & Cause) -
    • A chronic autoimmune disorder in which the joints and some organs of other body systems are attacked
  • Inflammation of entire joint (synovial membrane, cartilage, ligament, tendons)
  • Affects women more than men Rheumatoid Arthritis (Symptoms) -
    • Synovial tissues become inflamed
  • Joint pain and stiffness, swelling
  • Fatigue & weakness Rheumatoid Arthritis (Nursing Priorities & A-E) -
    • Reduce pain, stiffness, swelling, and maintain mobility
  • Education
  • Assistance with daily living Rheumatoid Arthritis (Treatment - Medication & Interventions) -
    • Medications = analgesia, anti- inflammatories, DMARDS
  • Physiotherapy Osteomyelitis - Inflammation & infection of bone and bone marrow
  1. Acute Osteomyelitis
  2. Chronic Osteomyelitis
  3. Acute Osteomyelitis - Acute infection of the bone (up to 6 weeks)
  1. Chronic Osteomyelitis - Chronic infection of the bone (6+ weeks) Osteoporosis (Pathophysiology & Cause) - Loss of bone mass, and deterioration in the structure of cancellous bone Osteoporosis (Symptoms) - No symptoms until bone fracture occurs Osteoporosis (Nursing Priorities & A-E) -
    • Increase in weight bearing exercise
  • Vitamin D supplementation
  • Prevention = diet, lifestyle changes Osteoporosis (Treatment - Medication & Interventions) - Drugs to stimulate bone formation Paget Disease -
    • Chronic inflammation of bones, resulting in thickening and softening of bones
  • Bones may bow or fracture
  • Treatment = NSAIDs or anti-inflammatories for pain Systemic Lupus Erythematosus "SLE" -
    • Chronic inflammatory disease that can affect any organ system, including musculoskeletal
  • Treatment = symptomatic Gout -
    • Hereditary metabolic disease that is a form of acute arthritis
  • Excessive uric acid in the blood and around the joints
  • Treatment = Pain relief, reduce dietary sources of purines Osteomalacia - Rickets (Pathophysiology & Cause) - Softening of the bones due to defective bone mineralization (lack of vitamin D) Osteomalacia - Rickets (Symptoms) -
    • Bowed legs
  • Soft weak bones
  • Poor nutrition Osteomalacia - Rickets (Nursing Priorities & A-E) -
    • Improved sunlight exposure
  • Improved diet: calcium and vitamin D Osteomalacia - Rickets (Treatment - Medication & Interventions) -
    • Treatment for any underlying disorder
  • Surgery to correct bone deformities Tendonitis - Inflammation of a tendon Bursitis - Inflammation of a bursa (fluid-filled sacs that reduce friction between joints) Blood -
    • Connective tissue made of plasma, erythrocytes, leukocytes, and platelets
  • Plasma = 55%
  • Formed elements = 45%

Plasma -

  • Straw colour fluid
  • 92% is water
  • 8% = proteins, antibodies, hormones, gases, waste products Red Blood Cells (Erythrocytes) -
  • Transport oxygen and carbon dioxide
  • Live for 120 days White Blood Cells (Leukocytes) -
  • Respond to injury or infection
  • Involved in phagocytosis, cell-mediated and antibody-mediated immune responses Platelets (Thrombocytes) -
  • Needed to form blood clots to stop bleeding
  • Clump together to form a platelet plug & stimulate clotting cascade Cell Mediated Immunity - Linked to the role of T-cell, stimulated by lots of different chemicals release in response to infection Anti-body Mediated Immunity - Brought about by exposure of B-lymphocytes to an antigen Innate Immunity -
  • No memory
  • Non-specific
  • First line of defence