Our Lady of Fatima University

Quezon City

NCMB 316 LECTURE & RLE

CARE OF CLIENTS WITH

PROBLEMS IN NUTRITIONAL
& GASTROINTESTINAL
METABOLISM & ENDOCRINE,
PRECEPTION &
COORDIANTION

(ACUTE & CHRONIC)

Step Five

Rose Ann C. Lacuarin

Academician Head
 FINALS

Week 15

Bone Disorders

Week 13

Musculo-Skeletal System
Disorders (1)

Week 16

Problems in Perception: EYES

Week 14

Musculo-Skeletal System
Disorders (2)

Week 17

Problems in Perception: EARS

Rose Ann C. Lacuarin

Academician Head
 Week 13

TERMINOLOGIES
Atonic Epiphysis
without tone; enervated muscle that end of long bone.
atrophies.
Fascia (epimysium)
Atrophy fibrous tissue that covers, supports, and
shrinkage like decrease in the size of a
separates muscles.
muscle.
Bursa Fasciculation
fluid-filled sac found in connective involuntary twitch of muscle fibers
tissue, usually in the area of joints. flaccid: limp; without muscle tone.
Callus Hypertrophy
cartilaginous / fibrous tissue at fracture enlargement; increase in size of muscle.
site.
Isometric contraction
Cancellous bone
muscle tension increased, length
lattice like bone structure; trabecular
unchanged, no joint motion.
bone.
Cartilage Isotonic contraction
tough, elastic, avascular tissue at ends muscle tension unchanged, muscle
of bone. shortened, joint moved.
Clonus Joint
rhythmic contraction of muscle. area where bone ends meet; provides
Contracture for motion and flexibility.
abnormal shortening of muscle or joint,
Joint capsule
or both; fibrosis.
fibrous tissue that encloses bone ends
Cortical bone and other joint surfaces.
compact bone.
Kyphosis
Crepitus
increase in the convex curvature of the
grating or crackling sound or sensation;
may occur with movement of ends of a spine.
broken bone or irregular joint surface. Lamellae
Diaphysis mature compact bone structures that
shaft of long bone. form concentric rings of bone.
Effusion Matrix
excess fluid in joint endosteum: a thin, lamellar bone.
vascular membrane covering the
marrow cavity of long bones and the Ligament
spaces in cancellous bone. fibrous band connecting bones.

Rose Ann C. Lacuarin

Academician Head
 Week 13

Lordosis Tendon
increase in lumbar curvature of the cord of fibrous tissue connecting
spine. muscle to bone.
Tone (tonus)
Ossification normal tension (resistance to
process in which minerals (calcium) are stretch) in resting muscle.
deposited in bone matrix. Trabeculae
Osteoblast lattice like bone structure;
cancellous bone.
bone-forming cell.
Osteoclast
bone resorption cell.
Osteocyte
mature bone cell.
Osteogenesis
bone formation.
Osteon
microscopic functional bone unit
paresthesia: abnormal sensation (eg,
burning, tingling, numbness).
Periosteum
fibrous connective tissue covering bone.
Remodeling
process that ensures bone maintenance
through simultaneous bone resorption
and formation.
Resorption
removal / destruction of tissue, such as
bone.
Scoliosis
lateral curving of the spine.
Spastic
having greater-than-normal muscle
tone.
Synovium
membrane in joint that secretes
lubricating fluid.

Rose Ann C. Lacuarin

Academician Head
 Week 13
Musculo-Skeletal System Disorders Types of Muscles

The skeletal system is a vital Skeletal muscle – the specialised tissue

component of the human body.
This mechanism is inextricably linked
to the  musculoskeletal system. Both
systems collaborate to allow the body
to move.
Mobility disorders primarily affect the
bones and joints.and the soft tissues
that surround it
that is attached to bones and allows
movement.
Smooth muscle – located in various
internal structures including the digestive
tract, uterus and blood vessels such as
arteries.
Cardiac muscle – the muscle specific to
the heart.

BONE CELLS

OSTEOBLAST
Bone formation - children
Estrogen

OSTEOCLAST
Bone resorption - elderly

OSTEOCYTES
Mature bone cells
Classification of bones Maintain matrix

A. Long bones What helps bone formation

B. Short bones
C. Flat bones Calcium - bone & teeth
D. Irregular bones Blood (Unionized & Ionized Ca)
Muscles
Types of Joints Blood = clotting factor
Hormones
A. Immovable fibrous joint PTH - Parathyroid glands
B. Movable synovial joint Calcitonin - thyroid glands
C. Slightly movable cartilaginous joint
PTH Calcitonin
Increase Ca Decrease Ca - Inhibit
osteoclast activity

Rose Ann C. Lacuarin

Academician Head
 Week 13
PTH
CREPITUS = DO NOT ASSESS FOR CREPITUS
Increase Ca reabsorption (Ca from
the bone to the blood) (inc
osteoclast)
Sprain Strain
Increase Ca absorption from the GIT
Increase Ca reabsorption from the
kidneys Ligaments Muscle & Tendons

Ligaments - bone to bone

Tendons - muscles to bones

POP
Factor Fiberglass Plaster of
Paris

Cost
Weight High Low
Strength Light Heavy
Excellent Good
Allergencity
Moderate Low
Radiolucency
Excellent Fair
Molding Capability
Poor Excellent
Ease of Application Good Excellent
Drying & Hardening Short Long
Risk of thermal burn Low Moderate

Vit. D is needed to inc Ca absorption in Nursing Interventions

the GIT

Best source is food 1. Monitor neurovascular status (NVS)

Skin - 7, hydroxycholesterol
Sunlight
Cholescalciferol (Vit D3)
Liver = 25 hydroxycholecalciferol
PTH
Kidneys = 1,25 dihydroxycholecalciferol
help absorb Ca from the GIT
6Ps
PAIN - Priority is analgesic as ordered.
If
Unrelived --> REFER! compression of BV -
> ischemia -> necrosis -> pain
PALLOR - BV
PULSELESSNESS - Arterial blood flow
PARALYSIS - Nerve compression
PARESTHESIA - Nerve damage
POKILOTHERMIA - Changes in
temperation

Rose Ann C. Lacuarin

Academician Head
 Week 13
2. Petal cast the edges
3. Assess pulses, temp and capillary refill
distal to the cast
4. Assist in self care
5. Body cast - assess breathing pattern
6. Monitor and manage complications

FRACTURE

Is a break, usually in a bone. If the

broken bone punctures the skin, it is
called an open or compound fracture.
FRACTURES ARE CHARACTERIZED
Fractures commonly happen because BY THEIR CAUSE:
of car accidents, falls, or sports
injuries.
1. Pathologic /Spontaneous fracture
Other causes are low bone density
occurs after minimal trauma to a bone
and osteoporosis, which cause
that has been weakened by disease
weakening of the bones
Ex. client with bone cancer or osteoporosis

CLASSIFICATION OF FRACTURES: 2. Fatigue/ Stress fracture

by the extent of the break
1. COMPLETE FRACTURE
-involves a break across the entire
cross-section of the bone
2. INCOMPLETE FRACTURE
-the break occurs through only part
of the cross-section of the bone
by the extent of associated soft-tissue
damage
Closed / Simple
--> does not cause a break in the skin
Open / Compound / Complex
--> one in w/c the skin or mucous
membrane wound extends to the
fractured bone
results from excessive strain or stress on
the bone
3. Compression fracture
produced by loading force applied to the
long axis of cancellous bone
often occur in the vertebrae of clients
with osteoporosis
CLINICAL MANIFESTATIONS:
PAIN
↑
continuous & ses in severity until bone
fragments are immobilized.
LOSS OF FX
fx of muscles depends on the integrity of the
bones to w/c they are attached.

DEFORMITY
displacement, angulation or rotation of
fragments either visible or palpable

SHORTENNG
due to the contraction of muscles attached
above & below the site
Rose Ann C. Lacuarin
Academician Head
 Week 13
CREPITUS Open reduction
caused by rubbing of bone fragments Primarily refers to surgery that is
against each other performed to realign bones or
fragment
SWELLING & DISCOLORATION
May be treated with internal fixation
as a result of trauma & bleeding into
devices
the tissues may not develop for several Cast or traction may be applied
hrs after the injury after the procedure

4 R’s Management of Fracture

1. RECOGNITION
2. REDUCTION
Closed Reduction
Open Reduction
3. RETENTION
Fixation (internal/ external) *Fractures with little or no
Cast displacement may not require any
Traction form of reduction.
Braces & Splints
Bandage
4. REHABILITATION
An internal fixation device may be used to
keep fractured bones stabilized and in
Fracture Reduction alignment. The device is inserted surgically
is the procedure by which a fractured to ensure the bones remain in an optimal
bone is realigned in normal position position during and after the healing
process.
It can be either closed or open

Closed reduction An external fixation devicecommonly

Refers to realigning bones without used in children, when the skin over the
breaking the skin fracture has been damaged, provides
It is performed with manual more freedom of movement than with
manipulation and/or traction and is traction.
commonly done with some kind of
anesthetic (LA or GA).
Cast or splint may be applied after

Rose Ann C. Lacuarin

Academician Head
 Week 13
Treatment
FRACTURE HEALING COMPLICATIONS
Fluids and electrolytes intravenously
(through a vein).
Early
SHOCK COMPARTMENT SYNDROME

Hypovolemic or traumatic shock Occurs when pressure rises in and

resulting from hemorrhage and from around muscles. Compartment
loss of extracellular fluid into damaged syndrome can limit the flow of blood,
tissues may occur in fractures of the oxygen and nutrients to muscles and
extremities. nerves
Signs & Symptoms Signs & Symptoms
1. Pain out of proportion to the
1. Anxiety or Agitation
2. Cool, Clammy Skin or Sweating, Moist Skin associated injury
3. Confusion 2. Pain on passive movement of the
4. Decreased or No Urine Output muscles of the involved
5. Generalised Weakness compartments
6. Pale Skin Color (Pallor) 3. Severe Swelling
7. Rapid Breathing
4. Neurovascular Changes - 5P’s
Treatment
Restoring of blood volume &circulation Treatment
Relieving patient’s pain Anti-inflammatory medications like
Provide adeq splinting non-steroidal anti-inflammatory
Protect patient from further injury & other drugs (NSAIDs)
complications Cross-training (mixing up exercise
types, instead of doing the same thing
RHABDOMYOLYSIS
over and over)
Can be a life-threatening condition
Low-impact exercise
caused by muscle breakdown and muscle
Orthotics (inserts for your shoes)
death.
Physical therapy
As muscle cells disintegrate, they release
a protein called myoglobin into the blood Softer surfaces for workouts (running
on tracks instead of concrete, for
Signs & Symptoms example)
1. Significant Muscle Pain
2. Swelling FAT EMBOLISM SYNDROME
3. Fever
4. Vomiting is a rare syndrome that, when severe,
5. Confusion is associated with respiratory failure,
6. Tea-colored urine neurocognitive deficit, and death.
7. Irregular heartbeat Signs & Symptoms
1. Hypoxia 3. Tachycardia
2. Tachypnea 4. Pyrexia

Rose Ann C. Lacuarin

Academician Head
 Week 13
Treatment Signs & Symptoms
May be given oxygen, if needed. 1. Swollen, Hard, Painful Limb
Some people will need help breathing 2. Tender to Touch
with mechanical ventilation. 3. Heat
May also receive intravenous fluids 4. Discolouration (usually red but can be
and drugs that will increase blood blueish-grey)
volume. Treatment
Blood thinners
PULMONARY EMBOLISM Clot busters
Is a blood clot that develops in a Filters
blood vessel in the body (often in the Compression stockings
leg). It then travels to a lung artery
DISSEMINATED INTRAVASCULAR
where it suddenly blocks blood flow.
COAGULOPATHY (DIC)
Signs & Symptoms
Group of bleeding disorders with
1. Pyrexia diverse causes, including massive
2. Dyspnea and/or Tachypnea tissue trauma.
3. Crackles Signs & Symptoms
4. Second Heart Sound 1. Ecchymoses
5. Pleuritic Chest Pain 2. Unexpected Bleeding after Surgery
6. Profuse Sweating 3. Bleeding from Mucous Membranes,
7. Haemoptysis Venipuncture Sites, Gastrointestinal
8. Tachycardia and Urinary Tracts.
9. Hypotension
Treatment
10. Lightheaded / Dizzy
Plasma transfusions to reduce
11. Syncope bleeding. Plasma transfusion replace
12. Cyanosis blood clotting factors affected by DIC.
Treatment Transfusions of red blood cells and/or
Medications include different types of platelets.
blood thinners and clot dissolvers
Anti-coagulant medication (blood
such as Blood thinners
thinners) to prevent blood clotting.
(anticoagulants) and Clot dissolvers
(thrombolytics) INFECTION

Risk Factors
DEEP VEIN THROMBOSIS
Open Fractures
occurs when a blood clot (thrombus) Internal Fixation
forms in one or more of the deep veins Surgical Wound
in your body, usually in your legs. Pin Sites

Rose Ann C. Lacuarin

Academician Head
 Week 13
Signs & Symptoms
1. New or Increasing Pain
2. Heat
3. Redness
4. Swelling
5. Green or Cloudy Oozing/Discharge
6. Tenderness
Treatment
Antibiotics may be all that's necessary
to cure your bone infection
Sub-acute or Delayed
Complications
OSTEOMYELITIS
Inflammation or swelling that occurs in
the bone. It can result from an infection
somewhere else in the body that has
spread to the bone, or it can start in the
bone — often as a result of an injury.
Signs & Symptoms
1. Fever
2. Lethargy, Malaise or Irritability in Children
3. Pain
4. Swelling
5. Redness
6. Warm Sensation Over an Area of Bone
7. Loss of Range of Movement
Treatment
Antibiotics: Antibiotics kill infection-
causing bacteria
Antifungals: To treat fungal infections,
you may need to take oral antifungal
medications for months.
Needle aspiration: Your healthcare
provider uses a fine needle to drain
fluid and pus from the abscess.
Pain relievers: Nonsteroidal anti-
inflammatory drugs (NSAIDs) treat
pain and inflammation.
Rose Ann C. Lacuarin
Academician Head
Surgical options include:
Bone surgery
Spine surgery
DELAYED UNION
Occurs when the bone does not heal
at a normal rate for the location and
type of fracture.
Signs & Symptoms
1. Discomfort
2. Pain
3. Reduced Function in Affected Area
Treatment
The most common nonsurgical
treatment is a bone stimulator. This
small device delivers ultrasonic or
pulsed electromagnetic waves that
stimulate healing.
MALUNION
Occurs when bone heals but not in the
right position. You may have never had
treatment for the broken bone. Or, if
you did have treatment, the bone
moved before it healed.
Signs & Symptoms
1. Discomfort
2. Pain
3. Deformity
4. Reduced Function in Affected Area
5. Swelling
Treatment
Surgery to correct the alignment of
the fractured bone and improve
function in the involved leg
NON-UNION
Describes the failure of a fractured
bone to heal and mend after an
extended period of time; malunion
refers to a fracture that has healed in a
deformed position, or with shortening or
rotation of the limb.
 Week 13
Signs & Symptoms
1. Discomfort
2. Pain
3. Continued Movement at Fracture Site
beyond Expected Healing Times
4. Reduced Function in Affected Area
5. Swelling
Treatment
Some nonunions can be treated
nonsurgically. The most common
nonsurgical treatment is a bone
stimulator.
COMPLEX REGIONAL PAIN SYNDROME
(CRPS)
Abnormally severe pain and reduced
function that develops following injury.
Signs & Symptoms
1. Continuing Pain, Allodynia, or
Hyperalgesia in which the pain is
disproportionate to any known inciting
event
2. Oedema
3. Changes in skin blood flow
4. Abnormal Sudomotor Activity (Sweating,
Abnormal Hair or Nail Growth)
5. Reduced Range of Movement in the
Region of Pain
Treatment
Pain relievers
Antidepressants and anticonvulsants
Corticosteroids
Bone-loss medications
Sympathetic nerve-blocking
medication
Intravenous ketamine
Medicines to lower blood pressure
Rose Ann C. Lacuarin
Academician Head
Therapies
Heat therapy. Applying heat may offer
relief of swelling and discomfort on skin
that feels cool.
Topical analgesics
Physical or occupational therapy
Mirror therapy - Research shows that
this type of therapy might help improve
function and reduce pain for those with
CRPS.
Transcutaneous electrical nerve
stimulation (TENS). Chronic pain is
sometimes eased by applying electrical
impulses to nerve endings.
Biofeedback - more aware of body so
that the patient can relax body and
relieve pain.
Spinal cord stimulation - Your provider
inserts tiny electrodes along your spinal
cord. A small electrical current delivered
to the spinal cord results in pain relief.
Intrathecal drug pumps - In this therapy,
medications that relieve pain are
pumped into the spinal cord fluid.
Acupuncture
AVASCULAR NECROSIS
The death of bone due to loss of blood
supply. It may occur after a fracture
with disruption of the blood supply,
especially in femoral neck.
Signs & Symptoms
1. Gradually worsening pain, in particular
on weight bearing
2. Reduced range of movement in the
affected joint
 Week 14
Treatment
Nonsteroidal anti-inflammatory
drugs. Medications, such as ibuprofen
(Advil, Motrin IB, others) or naproxen
sodium (Aleve) might help relieve the
pain associated with avascular
necrosis.
Osteoporosis drugs
Cholesterol-lowering drugs
Blood thinners
Rest
Exercises
Electrical stimulation.
REACTION TO INTERNAL FIXATION
DEVICE
Some patient may have a reaction to
the Internal fixation devices. The device Musculoskeletal System
may be removed after bony union has
taken place. In most patients, however,
the device is not removed unless it
produces symptoms.
Signs & Symptoms
1. Discomfort
2. Pain
3. Reduced Function in Affected Area
Treatment
Nonsteroidal anti-inflammatory
drugs. Medications, such as ibuprofen
(Advil, Motrin IB, others) or naproxen
sodium (Aleve) might help relieve the
pain associated with avascular
necrosis.
Osteoporosis drugs
Cholesterol-lowering drugs
Blood thinners
Rest
Exercises
Electrical stimulation.
Rose Ann C. Lacuarin
Academician Head
AUTOIMMUNE DISORDERS
SYSTEMIC LUPUS ERYTHEMATOSUS
Is the most common type of lupus.
SLE is an autoimmune disease in which
the immune system attacks its own
tissues, causing widespread
inflammation and tissue damage in the
affected organs.
It can affect the joints, skin, brain, lungs,
kidneys, and blood vessels.
Onset may be insidious or acute
SLE may remain undiagnosed for yrs
SYSTEMIC MANIFESTATIONS
arthralgias (joint pain) & arthritis
(synovitis) is a common presenting sx
joint swelling
tenderness & pain on movt are also
commonfreq accompanied by morning
stiffness
Skin
A. Subacute cutaneous lupus erythematosus
papulosquamous or annular polycyclic
lesions
B. Discoid lupus erythematosus
chronic rash that has erythematous
papules/ plaques& scaling & can cause
scarring & pigmentation changes
C. Acute cutaneous lesion
butterfly-shaped rash across the bridge
of the nose & cheeks & most familiar
occurring in <half of patients
lesion worsen during flare ups
(exacerbations) & provoked by sunlight or
artificial UV light
oral ulcers may also occur
 Week 14
Cardiac
Promote systemic rest = 8 to 10 hrs
pericarditis is the most common
sleep
Renal
Skin care
screening: serum creatinine levels &
Prevent flexion contractures
urinalysis
may lead to HPN
Kidney involvement
leading cause of death
renal biopsies show progressive changes
within the glomeruli:
► glomeruli slightly irregular
=minimal lupus nephritis
►further glomerular changes; shows clinical
signs of renal impairment
=focal/mild lupus nephritis
►50% of glomeruli are affected; client is in
renal failure
=diffuse/ severe proliferative nephritis
CNS
widespread, encompassing the entire
range of neurologic disease
neuropsychiatric presentations as
demonstrated by subtle changes of in
behavior patterns or cognitive ability,
depression, psychosis

DIAGNOSTIC TESTS
1. Anti nuclear antibody test (ANA test)
2. Elevated ESR
3. CBC - Inc WBC
4. Elevated C - reactive proteins
5. Skin Biopsy
NURSING INTERVENTIONS
Monitor VS
Monitor kidney function tests
Monitor and assess affectation of other
organs
Avoid exposure to sunlight
Provide rest
Provide safety
Rest between activities

Rose Ann C. Lacuarin

Academician Head
 Week 14
Rheumatoid Arthritis (RA) Ostheoarthritis (OA) Gouty Arthritis (GA)

Metabolic joint disease

characterized by
Autoimmune systemic Degenerative joint hyperuricemia more
inflammatory disease disease than 7 mg/dl
of the synovial joints Destruction of the ETIO: Gout - metabolic
ETIO: Idiophatic cartilages in the joint disease characterized
RF: Women, Family ETIO: Trauma, overused by hyperuricemia
of joints Primary - Idiophatic
History, Viral infection
RF: Age, Obesity, Secondary - diet
First joints MCP -PIP
Athletes Uric acid crystals
(Metacarpophalangeal First joints - weight precipitate in the joints
joint and Proximal bearing joints (hip joint, -> destruction ->
intephalangeal joints) knee joints) inflammation
Bilateral, Symmetrical Assymetrical, Unilateral First Joint - Big toe
and migratory and non migratory Assymetrical,
walang migratory
inflammation
kapag acute
RHEUMATOID ARTHRITIS Diagnostic Tests
(+) Rheumatoid factor
Rheumatoid arthritis is a chronic
(+) ANA test
inflammatory disorder that can affect
Elevated ESR
more than just your joints
Inc WBC
Symptoms Treatment
1. Tender, warm, swollen joints Medications (NSAIDs)
2. Joint stiffness that is usually worse in Physical therapy
the mornings and after inactivity Occupational therapy
3. Fatigue, fever and loss of appetite Counseling
Surgery
Rheumatoid arthritis increases
your risk of developing: Nursing DIagnosis
Osteoporosis 1. Acute or Chronic Pain
Rheumatoid nodules 2. Impaired Mobility
Dry eyes and mouth 3. Fatigue/Activity Intolerance
4. Risk for complications
Infections
Abnormal body
composition
Carpal tunnel syndrome
Heart problems
Lung disease
Lymphoma

Rose Ann C. Lacuarin

Academician Head
 Week 14
Management
1. Rest in between activities
2. Morning stiffness - move the joints
up to the limits of pain to prevent
contracture
3. Avoid flexion position
4. Health teaching
5. Surgery
6. Drug therapy
A. COX 2 Inhibitors (NSAIDs)
Example: Celecoxib, Etoricoxib (Coxib
drugs) - inhibit PG only in inflammation
Adverse: Cardiotoxicity, Hepatoxocity
B. DMARDs - disease modifying
antirheumatic drugs Methotrexate
C. Immunosuppresant drugs
D. Steroids
OSTEOARTHRITIS
The most common form of arthritis,
affecting millions of people worldwide.
It occurs when the protective cartilage
that cushions the ends of the bones
wears down over time.
Although osteoarthritis can damage any
joint, the disorder most commonly
affects joints in your hands, knees, hips
and spine.
Symptoms
1. Pain -> Affected joints might hurt during
or after movement.
2. Stiffness -> Joint stiffness might be most
noticeable upon awakening or after
being inactive.
Rose Ann C. Lacuarin
Academician Head
3. Tenderness -> Your joint might feel
tender when you apply light pressure to or
near it.
4. Loss of flexibility -> You might not be
able to move your joint through its full
range of motion.
5. Grating sensation -> You might feel a
grating sensation when you use the joint,
and you might hear popping or crackling.
6. Bone spurs -> These extra bits of bone,
which feel like hard lumps, can form
around the affected joint.
7. Swelling -> This might be caused by soft
tissue inflammation around the joint.
Diagnostic Tests
X-ray - (+) bone spur/osteophytes
MRI
Treatment
Osteoarthritis can't be reversed, but
treatments can reduce pain and help
you move better.
Medications
1. Acetaminophen (Tylenol, others) has
been shown to help some people with
osteoarthritis who have mild to
moderate pain
2. Nonsteroidal anti-inflammatory drugs
(NSAIDs) Over-the-counter NSAIDs, such
as ibuprofen (Advil, Motrin IB, others) and
naproxen sodium (Aleve), taken at the
recommended doses, typically relieve
osteoarthritis pain
3. Duloxetine (Cymbalta) Normally used
as an antidepressant, this medication is
also approved to treat chronic pain,
including osteoarthritis pain.
 Week 14
Nursing Management
GOUTY ARTHRITIS
1. Provide rest between activities
2. Systemic rest Is a common and complex form of
3. Promote safety arthritis that can affect anyone. It's
characterized by sudden, severe attacks
4. Avoid overuse of joints
of pain, swelling, redness and tenderness
5. Weight reduction
in one or more joints, most often in the
6. Exercises big toe.
7. Drug therapy
A. Paracetamol/Acetaminophen - no
anti inflammatory effect
B. NSAIDSs
C. Steroids
8. Heat application/Warm compress -
Symptoms
Liniment --> relaxes the muscles
9. Surgery 1. Intense joint pain. Gout usually affects the
A. Osteotomy big toe, but it can occur in any joint.
B. Arthroplasty 2. Lingering discomfort
C. Total hip joint arthroplasty post op 3. Inflammation and redness. The affected
--> prevent external rotation joint or joints become swollen, tender,
--> prevent adduction warm and red.
--> prevent extreme flexion 4. Limited range of motion. As gout
10. Viscosupplementation progresses, you may not be able to move
11. Rehabilitation therapy your joints normally.

Therapy Complications
Physical therapy
Recurrent gout
Occupational therapy
Advanced gout
Transcutaneous electrical nerve
Kidney stones
stimulation (TENS)
Surgical and other procedures Nurisng Interventions
If conservative treatments don't help,
1. Provide rest between activities
you might want to consider procedures
2. Systemic rest
such as:
3. Promote safety
1. Cortisone injections 4. Diet
2. Lubrication injections 5. Increase oral fluid intake
3. Realigning bones 6. Acute attack
4. Joint replacement 7. Rehabilitation therapy

Rose Ann C. Lacuarin

Academician Head
 Week 14
Treatment
NSAIDs can reduce pain and swelling.
Some people with kidney disease,
stomach ulcers and other health
problems are unable to take NSAIDs.
Colchicine can reduce inflammation and
pain if you take it within 24 hours of a
gout attack. It’s given by mouth.
Corticosteroids can relieve pain and
swelling. You take steroids by mouth or
with an injection.

Drugs that help lower levels of uric acid in

your body to prevent or reduce future
episodes of gout attacks:
Allopurinol, taken as a pill.
Febuxostat, taken as a pill.
Pegloticase, given as an intravenous (in
the vein) infusion.
Probenecid, taken as a pill.

Rose Ann C. Lacuarin

Academician Head
 Week 15
Bone Disorders

OSTEOPOROSIS OSTEOMALACIA OSTEOMYELITIS OSTEITIS DEFORMANS

Reduced Inflammation of Also called Paget's

bone mass the bone disease
Decrease ETIO: Bacteria - Rapid bone turnover
Osteomalacia
collagen staphyloccocus Inc osteoblast
Dec Ca salts
Dec Ca salts RF: Open fracture activity and
(hardness)
"brittle bone compensatory inc
"Soft bone (bacteria-bone;
disease" osteoclast activity
disease" immunocompromis
ETIO: Idiopathic Weak
Rickets in ed patients ->
RF: Female, hypervascularized
children blood -> bone
menopausal, bone
ETIO: Ca & Vit D inflammatory/
age, genetics, ETIO: Idiophatic
deficiency infectious bone
diet, lack of RF: Family history, male
metabolic bone disease
exercise localized rapid bone
BONE: Long bone BONE: Long bone
metabolic bone turnover
disease POTTS DISEASE: BONE: Skull, vertebra,
BONE: Vertebrae Vertebrae pelvis, femur and tibia

OSTEOPOROSIS

A metabolic disease in which bone

demineralization results in decreased
density and subsequent fractures=
BONES BECOME PROGRESSIVELY POROUS,
BRITTLE & FRAGILE. Dietary factors

Affects men and women of all races Low calcium intake --> Low calcium
intake contributes to diminished bone
Symptoms density, early bone loss and an
1. Back pain, caused by a fractured or increased risk of fractures.
collapsed vertebra
Eating disorders --> Severely
2. Loss of height over time restricting food intake and being
3. A stooped posture underweight weakens bone in both
4. A bone that breaks much more easily men and women.
than expected
Gastrointestinal surgery --> Surgery
to reduce the size of your stomach or
to remove part of the intestine limits
the amount of surface area available
to absorb nutrients, including calcium.

Rose Ann C. Lacuarin

Academician Head
 Week 15
Nursing Interventions
Provide rest between activities
Promote safety
Systemic rest
Assistive devices
Rehabilitation - exercises to strengthen
muscles --> improve balance
Diet --> Ca and Vit D rich foods
Drug therapy
A. HRT (Hormone replacement therapy)
B. PTH
C. Calcitonin
D. SERMs (Selective Estrogen Receptor
Modulators)
-newer class of drugs designed to mimic
estrogen in some parts of the body
while blocking its effect elsewhere
E. Biophosponates --> adv GERD
Wearing braces deformity -> DOWAGER'S
HUMP
Diagnostic Tests
Bone mineral density (BMD) tests are
also known as dual-energy X-ray
absorptiometry (DEXA or DXA) scans.
OSTEOMALACIA
is softening of the bones, caused by not
having enough vitamin D, or by
problems with the metabolism
Nursing Interventions
(breakdown and use) of this vitamin.
Diagnostic Tests
Blood
and urine tests A. Calcium
X-ray
Bone biopsy
Rose Ann C. Lacuarin
Academician Head
Causes
Vitamin D deficiency --> most
common cause of osteomalacia
worldwide.
Certain surgeries --> remove part or
all of your stomach or to bypass your
small intestine and can result in
vitamin D and calcium deficiency.
Celiac disease --> A damaged
intestinal lining doesn't absorb
nutrients well, and can lead to vitamin
D and calcium deficiency.
Kidney or liver disorders --> These
organs are involved in activating
vitamin D in your body. Problems with
your kidneys or liver can affect your
body's ability to make active vitamin
D.
Drugs --> Some drugs used to treat
seizures, including phenytoin (Dilantin,
Phenytek) and phenobarbital, can
cause severe vitamin D deficiency
and osteomalacia.
Provide rest between activities
Promote safety
Systemic rest
Diet
Assistive devices
Rehabilitation
Drug therapy
B. Vitamin D
Correction of deformities
 Week 15
Treatment
Fortunately, getting enough vitamin D
through oral supplements for several
weeks to months can cure osteomalacia.
To maintain normal blood levels of vitamin
D, you'll likely have to continue taking the
supplements. weight bearing*
walking is the best
Prevention
Eat foods high in vitamin D
Foods naturally rich in vitamin D include
oily fish (salmon, mackerel, sardines) and
egg yolks. BIPHOSPONATE*
Also look for foods fortified with vitamin D,
such as cereal, bread, milk and yogurt.
Take supplements, if needed.
If you don't get enough vitamins and
minerals in your diet or if you have a
medical condition that keeps your
digestive system from absorbing nutrients
properly, ask your doctor about taking
vitamin D and calcium supplements.
OSTEOMYELITIS
Is an infection in a bone. Infections can
reach a bone by traveling through the
bloodstream or spreading from nearby
tissue. Infections can also begin in the
bone itself if an injury exposes the bone to
germs.
It became infected by one of 3 MODES:
1. Extension of soft tissue infection (infected
pressure or vascular ulcer, incisional infection)
2. Direct bone contamination
from bone surgery, open fracture
or traumatic injury (GSW).
3. Hematogenous (bloodborne)
spread from other sited of
infection (infected tonsils, boils,
infected teeth, upper resp
infections). Typically occurs in a
bone area of trauma or lowered
resistance.
Rose Ann C. Lacuarin
Academician Head
Signs & Symptoms
1. Fever
2. Swelling, warmth and redness over
the area of the infection
3. Pain in the area of the infection
4. Fatigue
Diagnostic Tests
Blood tests
X-rays
Magnetic resonance imaging (MRI)
Computerized tomography (CT)
Bone biopsy
Treatment
Drain the infected area
Opening up the area around
infected bone allows surgeon to
drain any pus or fluid that has
accumulated in response to the
infection.
Remove diseased bone and tissue
In a procedure called
debridement, the surgeon
removes as much of the diseased
bone as possible and takes a
small margin of healthy bone to
ensure that all the infected areas
have been removed. Surrounding
tissue that shows signs of infection
also may be removed.
Restore blood flow to the bone
Surgeon may fill any empty space
left by the debridement procedure
with a piece of bone or other
tissue, such as skin or muscle, from
another part of your body.
Remove any foreign objects
In some cases, foreign objects,
such as surgical plates or
screws placed during a
previous surgery, may have to
be removed.
 Week 15
Amputate the limb
As a last resort, surgeons may
amputate the affected limb to stop
the infection from spreading further.
Nursing Interventions
Promote safety
Provide rest
Good hygiene
Good Nutrition
Assistive devices
Rehabilitation
Drug therapy
A. Pain management - NSAIDs
B. Antibacterial drugs
Surgery --> drainage
Complications
Bone death (osteonecrosis)
An infection in your bone can impede
blood circulation within the bone,
leading to bone death. Areas where
bone has died need to be surgically
removed for antibiotics to be effective.
Septic arthritis
Sometimes, infection within bones can
spread into a nearby joint.
Impaired growth
Normal growth in bones or joints in
children may be affected if
osteomyelitis occurs in the softer areas,
called growth plates, at either end of
the long bones of the arms and legs.
Skin cancer
If your osteomyelitis has resulted in an
open sore that is draining pus, the
surrounding skin is at higher risk of
developing squamous cell cancer.
Rose Ann C. Lacuarin
Academician Head
PAGET'S DISEASE
Paget's (PAJ-its) disease of bone interferes
with your body's normal recycling process,
in which new bone tissue gradually
replaces old bone tissue. Over time, bones
can become fragile and misshapen. The
pelvis, skull, spine and legs are most
commonly affected.
Signs & Symptoms
1. Pelvis --> Paget's disease of bone in the
pelvis can cause hip pain.
2. Skull --> An overgrowth of bone in the skull
can cause hearing loss or headaches.
3. Spine --> If your spine is affected, nerve
roots can become compressed. This can
cause pain, tingling and numbness in an
arm or leg.
4. Leg --> As the bones weaken, they may
bend — causing you to become bowlegged.
Enlarged and misshapen bones in your legs
can put extra stress on nearby joints, which
may cause osteoarthritis in your knee or hip.
Risk factors
Age --> People older than 50 are most
likely to develop the disease.
Sex --> Men are more commonly
affected than are women.
National origin --> Paget's disease of
bone is more common in England,
Scotland, central Europe and Greece —
as well as countries settled by European
immigrants. It's uncommon in
Scandinavia and Asia.
Family history
 Week 15
Diagnostic Tests Signs and Symptoms
X-rays 1. It begins little by little-often without
Laboratory tests --> A blood test called pain at first.
serum alkaline phosphatase may also 2. A bump develops in the backbone. This
be used to help confirm the diagnosis. is because the front part of one or more
Bone scan
vertebrae is destroyed and collapses.
Biopsy
3. The child has trouble bending over to

Treatment pick things up.

4. Back pain
Nonsurgical
5. Fever
Nonsteroidal anti-inflammatory drugs
(NSAIDs). 6. Night sweating
Assistive devices 7. Anorexia
Bisphosphonate medications 8. Weight loss
Surgical 9. Spinal mass, sometimes assoc with
Internal fixation numbness,
Osteotomy 10. Tingling, or muscle weakness of the legs
Total joint replacement
Diagnostic Tests
Nursing Interventions
Blood tests - elevated ESR
Provide rest
Tuberculin skin test
Promote safety
Radiographs of the spine
Pain relief
Bone scan
Rehabilitation therapy
Druh therapy CT & MRI of the spine
A. NASAIDs Bone biopsy
B. Biphosphonates
Prevention
C. Calcitonin
BCG vaccination
D. Plicamycin
Improvement of socio-economic
Prevent and manage complications
conditions
POTT'S DISEASE Prevention of HIV and AIDS
Patients who have a positive PPD test
Tuberculosis (TB) of the backbone is not (but not active tuberculosis) may dec
common, but is still seen in poor their risk by properly taking medicines
communities, especially in children. to prevent tuberculosis
It is the most common form of
tuberculosis of the bone. Therapy
Non-operative - antituberculous drugs
It is important to
analgesics
recognize and treat it
early, before damage Immobilization of the spine region by rod
to the backbone (Hull)
causes nerve damage Surgery may be necessary, especially to
and paralysis. drain spinal abscesses or to stabilize the
spine

Rose Ann C. Lacuarin

Academician Head
 Week 16
Problems in Perception: EYES Emmetropia

The eyes are highly specialized sense absence of refractive error

organ for vision.
Loss of this function causes too
much disability in a person.
enucleation complete removal of the
eyeball and part of the optic nerve.
Mydriatics

medications that cause pupillary

dilation

Myopia

nearsightedness, a refractive error in

which the focus of light rays from a
distant object is anterior to the retina

Rods

retinal photoreceptor cells essential

for bright and dim light.

Accommodation Vitreous humor

process by which the eye adjusts for near gelatinous material (transparent and
distance (eg, reading) by changing the colorless) that fills the eyeball behind
curvature of the lens to focus a clear the lens.
image on the retina.

Anterior chamber

space in the eye bordered anteriorly by

the cornea and posteriorly by the iris and
pupil.

Aqueous humor

watery fluid that fills the anterior and

posterior chambers of the eye.

Binocular vision

normal ability of both eyes to focus on

one object and fuse the two images into
one.

Cones

retinal photoreceptor cells essential for

visual acuity and color discrimination

Rose Ann C. Lacuarin

Academician Head
 Week 16
Symptoms
1. A tendency to hold reading material
farther away to make the letters clearer
2. Blurred vision at normal reading
distance
3. Eyestrain or headaches after reading or
doing close-up work
Causes
hardening of the lens of eye, which
occurs with aging

Risk factors

-> Age

-> Other medical conditions

Being farsighted or having certain
diseases — such as diabetes,
multiple sclerosis or cardiovascular
diseases — can increase your risk of
premature presbyopia, which is
presbyopia in people younger than
40.

PRESBYOPIA
is the gradual loss of your eyes' ability to
focus on nearby objects.
It's a natural, often annoying part of aging.
Presbyopia usually becomes noticeable in
your early to mid-40s and continues to
worsen until around age 65.
-> Drugs
Certain drugs are associated with
premature presbyopic symptoms,
including antidepressants,
antihistamines and diuretics.
Diagnostic Tests
Presbyopia is diagnosed by a basic
eye exam, which includes a
refraction assessment and an eye
health exam.
Treatment
Eyeglasses

1. Prescription reading glasses

2. Bifocals
3. Trifocals
4. Progressive multifocals
5. Office progressives

Rose Ann C. Lacuarin

Academician Head
 Week 16
Contact lenses
Bifocal contact lenses. Bifocal contact
lenses provide distance and close-up
correction on each contact.
Lens implants
--> Some ophthalmologists use a
procedure in which they remove the lens
in each eye and replace it with a

synthetic lens. This is called an

Monovision contact lenses. With
intraocular lens.
monovision contacts, you wear a
contact lens for distance vision in one
eye (usually your dominant eye) and a Corneal inlays
contact lens for close-up vision in the
--> Some people have had success with
other eye.

a presbyopia treatment that involves

Modified monovision. With this option,
you wear a bifocal or multifocal contact
lens in one eye and a contact lens set
for distance in the other (usually your
dominant eye). You use both eyes for
distance and one eye for reading.
inserting a small plastic ring with a
central opening, into the cornea of one
eye.
--> The opening acts like a pinhole
camera and allows in focused light so
that you can see close objects.

Lifestyle and home remedies

Refractive surgery
Conductive keratoplasty --> a
noninvasive procedure which utilizes
radiofrequency energy to correct
presbyopia and low hyperopia with or
without astigmatism
Laser-assisted in situ keratomileusis
(LASIK) --> a procedure that
permanently changes the shape of the
cornea, the clear covering of the front of
the eye, using an excimer laser
Laser-assisted subepithelial
keratectomy (LASEK) --> a laser
surgical procedure for the correction of
refractive error
Have your eyes checked
Control chronic health conditions.
Protect your eyes from the sun
Prevent eye injuries
Eat healthy foods
Use the right glasses
Use good lighting
See your doctor immediately if you
experience any of these symptoms —
1. sudden loss of vision in one eye with or
without pain
2. sudden hazy or blurred vision
3. double vision, or see flashes of light
4. black spots or halos around lights

Photorefractive keratectomy (PRK) -->

a laser to change the shape of cornea.

This improves the way light rays are Any of these symptoms may signal a
focused on the retina. The goal is to serious medical or eye condition.
correct refractive error to improve your
vision

Rose Ann C. Lacuarin

Academician Head
 Week 16
MYOPIA / NEARSIGHTEDNESS
is a common vision condition in which
you can see objects near to you clearly,
but objects farther away are blurry.
It occurs when the shape of your eye
causes light rays to bend (refract)
incorrectly, focusing images in front of
your retina instead of on your retina.
Symptoms
1. Blurry vision when looking at distant
objects
2. The need to squint or partially close the
eyelids to see clearly
3. Headaches caused by eyestrain
4. Difficulty seeing while driving a vehicle,
especially at night (night myopia)
A child with nearsightedness may:
Persistently squint
Need to sit closer to the television, movie
screen or the front of the classroom
Seem to be unaware of distant objects
Blink excessively
Rub his or her eyes frequently
Cause
Idiopathic - Eye experts are still unsure of
the exact cause of myopia.
A refractive error - When the shape of
your eye doesn’t allow light to focus
correctly on the retina, eye experts call this
a refractive error
Rose Ann C. Lacuarin
Academician Head
Risk factors
Genetics
Environmental conditions -> Some
studies support the idea that a lack
of time spent outdoors may
increase the chances of
developing myopia.
Diagnostic Tests
A retinoscope shines a special light
into your eyes that reflects off your
retina. Retinoscopy can show whether
a person is nearsighted or farsighted.
A phoropter measures the amount of
refractive error you have. It also helps
determine the proper prescription to
correct your vision.
Treatments to slow or stop progression
of nearsightedness
The topical medication, atropine
used to dilate the pupil of the eye,
often as part of eye exams or before
and after eye surgery.
Increased time outside
Researchers think exposure to the
sun's ultraviolet (UV) rays may
change the molecular structure of the
sclera and cornea and help maintain
a normal shape.
Dual focus contact lenses
A new type of dual focus contact lens
has been shown to slow the
progression of nearsightedness in
children between 8 and 12 years old.
Orthokeratology
In this procedure, you wear rigid, gas
permeable contact lenses for several
hours a day until the curvature of
your eye evens out
 Week 16
Lifestyle and home remedies
Have your eyes checked.
Control chronic health conditions
Protect your eyes from the sun
Prevent eye injuries
Eat healthy foods
Don't smoke
Use the right corrective lenses
Use good lighting
Reduce eyestrain
See your doctor immediately if you
experience any of these symptoms —
1. sudden loss of vision in one eye with or
without pain
2. sudden hazy or blurred vision
3. double vision, or see flashes of light
4. black spots or halos around lights
Any of these symptoms may signal a
serious medical or eye condition.
HYPEROPIA / FARSIGHTEDNESS
Is a common vision condition in which
you can see distant objects clearly, but
objects nearby may be blurry.
The degree of your farsightedness
influences your focusing ability.
Rose Ann C. Lacuarin
Academician Head
Symptoms
1. Nearby objects may appear blurry
2. You need to squint to see clearly
3. You have eyestrain, including burning
eyes, and aching in or around the eyes
4. You have general eye discomfort or a
headache after doing close tasks, such
as reading, writing, computer work or
drawing, for a time
Cause
a cornea (the clear layer at the front of
the eye) that isn't curved enough or by
an eyeball that's too short.
These two problems prevent light from
focusing directly on the retina. Instead,
light focuses behind the retina, which
makes close-up objects look blurry.
Diagnostic Tests
By shining a special light into your eyes,
a retinoscope will be used to see how
light reflects off your retina.
As the light is reflected back from inside
the eye, it can indicate whether a
person is farsighted or nearsighted.
Treatment
The goal of treating farsightedness is to
help focus light on the retina through
the use of corrective lenses or
refractive surgery.
Prescription lenses
1. Eyeglasses. This is a simple, safe way
to sharpen vision caused by
farsightedness. The variety of
eyeglass lenses is wide and includes
single vision, bifocals, trifocals and
progressive multifocals.
2. Contact lenses. These lenses are
worn right on your eyes.
 Week 16
Refractive surgery
Laser-assisted in situ keratomileusis
(LASIK)
Eye surgeon makes a thin, hinged flap
into your cornea.
He or she then uses a laser to adjust
the curves of the cornea that corrects
the farsightedness.
Laser-assisted subepithelial
keratectomy (LASEK)
The surgeon creates an ultra-thin flap
only in the cornea's outer protective
cover (epithelium).
He or she then uses a laser to reshape
the cornea's outer layers, changing its
curve, and then replaces the
epithelium.
Photorefractive keratectomy (PRK)
This procedure is similar to LASEK,
except the surgeon completely
removes the epithelium, then uses the
laser to reshape the cornea.
The epithelium is not replaced, but will
grow back naturally, conforming to
your cornea's new shape.
Lifestyle and home remedies
Have your eyes checked
Control chronic health conditions
Protect your eyes from the sun
Prevent eye injuries
Eat healthy foods
Don't smoke
Use the right corrective lenses
Use good lighting
Reduce eyestrain
Rose Ann C. Lacuarin
Academician Head
ASTIGMATISM
Is a common and generally treatable
imperfection in the curvature of the eye
that causes blurred distance and near
vision.
Astigmatism occurs when either the
front surface of the eye (cornea) or the
lens inside the eye has mismatched
curves.
Instead of having one curve like a round
ball, the surface is egg-shaped. This
causes blurred vision at all distances.
Symptoms
1. Blurred or distorted vision
2. Eyestrain or discomfort
3. Headaches
4. Difficulty with night vision
5. Squinting
Cause
When either the cornea or the lens has
mismatched curves.
Diagnostic Tests
Photokeratoscopy. It's a technique that
maps the curve of your
cornea using a
special camera.
 Week 16
Treatment

Corrective lenses Epi-LASIK

Eyeglasses
Are made with lenses that help
compensate for the uneven shape of
the eye. The lenses make the light bend
into the eye properly. Eyeglasses can
also correct for other refractive errors,
such as nearsightedness or
farsightedness.
Contact lenses
Like eyeglasses, contact lenses can
correct most astigmatism. They are
available in a variety of types and styles.
Refractive surgery
Laser-assisted in-situ keratomileusis
(LASIK).
An eye surgeon makes a thin, hinged flap
in the cornea.
He or she uses an excimer laser to sculpt
the shape of the cornea and then
repositions the flap.
This is a variation of LASEK. The
surgeon uses a special mechanized
blunt blade — instead of the alcohol
— to separate a very thin sheet of
epithelium. He or she then uses an
excimer laser to reshape the cornea
and repositions the epithelium.
Small-incision lenticule extraction
(SMILE)
This newer type of refractive
surgery reshapes the cornea by
using a laser to make a lens-
shaped bit of tissue (lenticule)
below the cornea's surface.
The lenticule is then removed
through a very small incision. For
now, the SMILE procedure is only
approved for treating mild
nearsightedness.

Laser-assisted subepithelial keratectomy

(LASEK)
Instead of creating a flap in the cornea,
the surgeon loosens the cornea's thin
protective cover (epithelium) with a
special alcohol.

He or she uses an excimer laser to change

the curvature of the cornea and then
repositions the loosened epithelium.

Photorefractive keratectomy (PRK).

This procedure is similar to LASEK, except
the surgeon removes the epithelium.

It will grow back naturally, conforming to

the cornea's new shape. You may need to
wear a bandage contact lens for a few
days after surgery.

Rose Ann C. Lacuarin

Academician Head
 Week 17
Problems in Perception: EARS Inner ear, consisting of:

The ear is a special sense organ for Cochlea

hearing and balance. This contains the nerves for hearing.

It is actually protected by the bones of Vestibule

the skull This contains receptors for balance.

Semicircular canals
This contains receptors for balance.

Inspection of the External Ear

Otoscopic Examination
The otoscopic exam is performed by
gently pulling the auricle upward and
backward. In children, the auricle should
be pulled downward and backward.
External or outer ear, consisting of:

Pinna or auricle
This is the outside part of the ear.
External auditory canal or tube
This is the tube that connects the outer
ear to the inside or middle ear.
Tympanic membrane (eardrum)
The tympanic membrane divides the
external ear from the middle ear. An otoscope is a tool which shines a
beam of light to help visualize and
Middle ear (tympanic cavity), consisting of: examine the condition of the ear
Ossicles canal and eardrum.
Three small bones that are connected
Examining the ear can reveal the
and transmit the sound waves to the inner
cause of symptoms such as an
ear. The bones are called:
earache, the ear feeling full, or
1. Malleus
hearing loss.
2. Incus
3. Stapes
Eustachian tube
A canal that links the middle ear with the
back of the nose. The eustachian tube
helps to equalize the pressure in the
middle ear. Equalized pressure is needed
for the proper transfer of sound waves.
The eustachian tube is lined with mucous,
just like the inside of the nose and throat.

Rose Ann C. Lacuarin

Academician Head
 Week 17
Evaluation of Gross Auditory Acuity Whisper Test
Simple and accurate screening test
Weber Test to detect hearing impairment.
Is a screening test for hearing performed
with a tuning fork.
It can detect unilateral (one-sided)
conductive hearing loss (middle ear
hearing loss) and unilateral sensorineural
hearing loss (inner ear hearing loss).

Diagnostic Evaluation

Audiometry
An audiometry exam tests how well
your hearing functions. It tests both the
intensity and the tone of sounds,
balance issues, and other issues
related to the function of the inner ear.
Rinne test
Is used to evaluate hearing loss in one This may be done as part of a routine
ear. screening or in response to a
noticeable loss of hearing.
The Rinne test differentiates sound
transmitted through air conduction from
those transmitted through bone
conduction via the mastoid bone.

By comparing air and bone conduction, it

helps detect conductive hearing loss in
The common causes of hearing loss
one ear.
include:
1. Birth defects
2. Chronic ear infections
3. Inherited conditions, such as
otosclerosis, which occurs when an
abnormal growth of bone prevents
structures within the ear from
functioning properly
4. An injury to the ear
5. Inner ear diseases, such as Ménière’s
disease or an autoimmune disease
that affect the inner ear
6. Regular exposure to loud noises
7. A ruptured eardrum

Rose Ann C. Lacuarin

Academician Head
 Week 17
Tympanogram
Is a graphic representation of how the
eardrum moves in response to the air
pressure in the ear canal.
Electronystagmography
Is used to evaluate people with vertigo
(a false sense of spinning or motion that
can cause dizziness) and certain other
disorders that affect hearing and vision.

Electrodes are placed at locations above

and below the eye to record electrical
activity.

The test can help your doctor determine

if you have:
Fluid in your middle
ear

Otitis media (a middle ear infection)

DISEASES OF THE EARS
A perforation (tear) in the tympanic
membrane
OTOSCLEROSIS
A problem with the eustachian tube,
which links the upper part of the throat This disease involves the footplate of
and nose with the middle ear the stapes.

There is hardening of the footplate of

Auditory Brain Stem Response
Test tells us how the inner ear, called the
cochlea, and the brain pathways for
hearing are working.
You may also hear it called an auditory
evoked potential (AEP).
The test is used with children or others
who cannot complete a typical hearing
screening.
the stapes causing it to be fixated in
the oval window of the cochlea.
It affects the conduction of sound from
the middle ear to the inner ear.
IDIOPHATIC
Common in women than men

Rose Ann C. Lacuarin

Academician Head
 Week 17
Signs & Symptoms The operation can be done under either
general anaesthetic, where you're asleep,
1. Hearing loss that gets gradually worse
or local anaesthetic, where you're awake
over time
but your ear is numbed.
2. Particular difficulty hearing low, deep
sounds and whispers A cut is made inside ear canal, or
occasionally above or in front of ear, to
3. Speaking quietly because your voice
access the bones inside ear.
sounds loud to you
4. Finding it easier to hear when there's MENIERE’S DISEASE
background noise (unlike many other
Is a disorder of the inner ear that can
types of hearing loss)
lead to dizzy spells (vertigo) and
5. Hearing sounds, such as buzzing or hearing loss.
humming, that come from inside your
In most cases, Meniere's disease
body (tinnitus)
affects only one ear.
6. Dizziness (though this is rare)
Can occur at any age, but it usually
Diagnostic Tests
starts between young and middle-
Hearing tests aged adulthood.
A person with otosclerosis typically has a
It's considered a chronic condition, but
hearing loss that affects all frequencies
various treatments can help relieve
(pitches). The hearing loss may be
symptoms and minimize the long-term
conductive or mixed in nature.
impact on your life.
CT scan
To check for damage to the cochlear
nerve and labyrinth.

Treatments
1. Hearing aids

Is an electronic device that increases the

volume of sound entering your ear so you
can hear things more clearly. Signs & Symptoms
The advantage of using a hearing aid is 1. Recurring episodes of vertigo
that, unlike surgery, it does not carry any
2. Hearing loss
risks.
3. Ringing in the ear (tinnitus)
Modern hearing aids are small and
discreet, and some can be worn inside 4. Feeling of fullness in the ear
your ear so they're not obvious.

2. Surgery
Surgery is an option if patient prefer not to
wear a hearing aid. The main operation
used is called a stapedotomy or
stapedectomy.

Rose Ann C. Lacuarin

Academician Head
 Week 17
Causes
IDIOPHATIC
Factors that affect the fluid, which might
contribute to Meniere's disease, include:
Improper fluid drainage, perhaps
because of a blockage or anatomic
abnormality
Abnormal immune response
Viral infection
Genetic predisposition
Diagnostic Tests
1. Electrocochleography (ECoG)
Is a test that evaluates the cochlea, which
is the organ of hearing in the inner ear.
This painless test evaluates inner ear
functions and the electrical potentials of
the inner ear.
The results help the doctor diagnose the
source of your symptoms and the best
course of action.
A higher-than-normal ratio of SP to AP
tells that increased fluid pressure may
be present in your inner ear.
2. Magnetic Resonance Imaging
MRI scan may reveal a buildup of fluid
or inflammation in the inner ear or a
growth on the nerve.
The MRI scan will not confirm a
diagnosis of Ménière’s disease, nor will
it show which ear is affected or how
severe the condition is.
Rose Ann C. Lacuarin
Academician Head
During initial investigation it is important to
exclude many serious conditions which can
cause vertigo or unilateral hearing loss and
tinnitus.
elongation of the saccule (height >1.5-
1.6 mm)
nonvisibility of the endolymphatic duct
and sac
reduced fluid length within the
cochlear aqueduct
dilated cochlear ducts, saccule and
utricle
Treatment
Medications for vertigo
Motion sickness medications, such as
meclizine or diazepam (Valium), may
reduce the spinning sensation and
help control nausea and vomiting.
Anti-nausea medications, such as
promethazine, might control nausea
and vomiting during an episode of
vertigo.
Noninvasive therapies and procedures
Rehabilitation
--> rehabilitation therapy might improve
your balance.
Hearing aid
--> might improve your hearing. Your doctor
can refer you to an audiologist to discuss
what hearing aid options would be best.
Positive pressure therapy
--> For vertigo that's hard to treat, this
therapy involves applying pressure to the
middle ear to lessen fluid buildup
 Week 17
Middle ear injections
Gentamicin
--> an antibiotic that's toxic to your inner
ear, reduces the balancing function of
your ear, and your other ear assumes
responsibility for balance. There is a risk,
however, of further hearing loss.
Steroids
--> such as dexamethasone, also may
help control vertigo attacks in some
people. Although dexamethasone may be
slightly less effective than gentamicin, it's
less likely than gentamicin to cause
further hearing loss.
Surgery
Endolymphatic sac procedure
During the procedure, the endolymphatic
sac is decompressed, which can alleviate
excess fluid levels. In some cases, this
procedure is coupled with the placement of
a shunt, a tube that drains excess fluid
from your inner ear.
Labyrinthectomy
Surgeon removes the balance portion of
the inner ear, thereby removing both
balance and hearing function from the
affected ear.
This procedure is performed only if you
already have near-total or total hearing
loss in your affected ear.
Vestibular nerve section
This procedure involves cutting the nerve
that connects balance and movement
sensors in your inner ear to the brain
(vestibular nerve).
This procedure usually corrects problems
with vertigo while attempting to preserve
hearing in the affected ear. It requires
general anesthesia and an overnight
hospital stay.
Rose Ann C. Lacuarin
Academician Head
Lifestyle and home remedies
Sit or lie down when you feel dizzy
During an episode of vertigo, avoid
things that can make your signs and
symptoms worse, such as sudden
movement, bright lights, watching
television or reading. Try to focus on an
object that isn't moving.
Rest during and after attacks
Don't rush to return to your normal
activities.
Be aware you might lose your balance
Falling could lead to serious injury. Use
good lighting if you get up in the night.
A cane for walking might help with
stability if you have chronic balance
problems.
Lifestyle changes
To avoid triggering a vertigo attack, try the
following.
Limit salt
Consuming foods and beverages high
in salt can increase fluid retention. For
overall health, aim for less than 2,300
milligrams of sodium each day. Experts
also recommend spreading your salt
intake evenly throughout the day.
Limit caffeine, alcohol and tobacco
These substances can affect the fluid
balance in your ears.