KAWASAKI DISEASE If left untreated

Clinically significant heart failure or myocardial dysfunction

Definition: an acute febrile vasculitic syndrome. It was first described in 1967 (unlikely to occur once fever is resolved)
by Dr. Tomisaku Kawasaki in Japan. Diffuse coronary artery ectasia and aneurysm formation, giant
aneurysm (internal luminal diameter 8 mm)
Anatomy and physiology: Myocarditis (common but rarely causes chronic heart failure)
Rupture of coronary artery aneurysms with hemopericardium
Nursing Diagnosis
1. Elevated body temperature
2. Impaired skin integrity
3. Activity intolerance
4. Pain related swollen joints
5. Risk for decreased cardiac output related to accumulation of fluid in
the pericardial sac
Nursing management
1. Monitor pain level and childs response to analgesics.
2. Institute continual cardiac monitoring and assessment for complications;
report arrhythmias.
3. Take vital signs as directed by condition; report abnormalities.
4. Assess for signs of myocarditis (tachycardia, gallop rhythm, chest pain).
5. Monitor for heart failure (dyspnea, nasal flaring, grunting, retractions,
cyanosis, orthopnea, crackles, moist respirations, distended jugular
veins, edema).
6. Closely monitor intake and output, and administer oral and I.V fluids as
Etiology: ordered.
Idiopathic 7. Monitor hydration staus by checking skin turgor, weight, urinary output,
Genetic specific gravity, and presence of tears.
Autoimmune response 8. Observe mouth and skin frequently for signs of infection.
Symptomatology: 9. Perform comfort measures related to the eyes.
Stage I Acute Febrile Phase (First 10 days) Conjunctivities can cause photosensitivity, so darken the room,
High, spiking fever for 5 days or more. offer sunglasses.
Bilateral conjunctival injection. Apply cool compress.
Oropharyngeal erythema, Strawberry tongue, or red dry lips. Discourage rubbing the eyes.
Erythema and edema of hands and feet, periungal desquamation.
Erythematous generalized rash. 10. Monitor temperature every 4 hours. Provide sponge bath if temperature
Cervical lymphadenopathy greather than 0.6 inch (1.5cm) above normal.

Stage II Subacute Phase (Days 11 to 25)

Acute symptoms of stage I subside as temperature returns normal.
The child remains irritable and anorectic.
Dry, cracked lips with fissures.
Desquamation of toes and fingers.
Coronary thrombus, aneurysm, myocardial infarction, and heart
failure.
Thrombocytosis peaks at 2 weeks.
Stage III Convalescent Phase (Until sedimentation rate and platelet count
normalize)
The child appears well.
Transverse grooves of fingers and toenails (Beaus lines).
Coronary thrombosis, aneurysms may occur.

Medical Management
Labs
Based on s/s
Electrocardiogram, echocardiogram, cardiac catheterization, and
angiocardiography
CBC leukocytosis during acute stage.
Erythrocytes and hemoglobin slight decrease.
Platelet count increased during second to fourth week of illness.
IgM, IgA, IgG, and IgF transiently elevated.
Treatment
Immunoglobulin
Methotrexate or cyclophosphamide: In IVIG-resistant cases
Aspirin

Prognosis
With prompt treatment, the prognosis is good.
HEPATITIS B
Imaging studies
Definition: Hepatitis B is an infectious disease caused by the hepatitis B virus Abdominal ultrasonography
(HBV) which affects the liver. Abdominal computed tomography (CT) scanning
Abdominal magnetic resonance imaging (MRI)
Anatomy and physiology Treatment
Alpha interferon
Tenofovir (Nucleos(t)ide reverse transcriptase inhibitors)
Entecavir
Prophylaxis
Hepa B vaccine
Immunoglobulin
Prognosis
Patients who have lost the hepatitis B e antigen (HBeAg) and in whom
hepatitis B virus (HBV) DNA is undetectable have an improved clinical
outcome, as characterized by the following:
Slower rate of disease progression
Prolonged survival without complications
Reduced rate of HCC and cirrhosis
R hypochondriac region Clinical and biochemical improvement after decompensation
Largest internal organ Complications: Hepatocellular carcinoma and cirrhosis
Produce proteins and blood clotting factors, bile
Stores Nursing Diagnosis
vitamin B12, 1. Imbalanced Nutrition, Less Than Body Requirements relate to:
folic acid, discomfort in the right upper quadrant
iron required to make red blood cells, 2. Acute pain related to: swelling of the liver, the inflamed liver and
vitamin A for vision, portal vein dam.
vitamin D for calcium absorption, and 3. Hyperthermia related to: invasion agent in blood circulation
vitamin K to help blood to clot properly. secondary to liver inflammation
Etiology 4. Fatigue related to: chronic inflammatory process secondary to
HBV, bodily fluids, sexual intercourse, IV drug abuse hepatitis
5. Risk for skin integrity and tissue damage related to: pruritus
Symptomatology secondary to the accumulation of the pigment bilirubin in the bile
Icteric Hepatitis salts
Anorexia
Nausea Nursing management
Vomiting 1. Monitor I&O, compare with periodic weight. Note enteric losses: vomiting
Low-grade fever and diarrhea. Provides information about replacement needs and
Myalgia effects of therapy.
Fatigability
fulminant and subfulminant hepatitis 2. Assess vital signs, peripheral pulses, capillary refill, skin turgor, and
Hepatic encephalopathy mucous membranes. Indicators of circulating volume and perfusion.
Jaundice
Somnolence 3. Check for ascites or edema formation. Measure abdominal girth as
indicated. Useful in monitoring progression and resolution of fluid
Mental confusion
shifts.
Coma
Ascites 4. Observe for signs of bleeding: hematuria, melena, ecchymosis, oozing
Gastrointestinal bleeding from gums, puncture sites Prothrombin levels are reduced and
Laboratories coagulation times prolonged when vitamin K absorption is altered in GI
Alanine aminotransferase and/or aspartate aminotransferase tract and synthesis of prothrombin is decreased in affected liver.
levels
Alkaline phosphatase levels 5. Monitor periodic laboratory values: Hb/Hct, Na, albumin, and clotting
Gamma-glutamyl transpeptidase levels times. Reflects hydration and identifies sodium
Total and direct serum bilirubin levels retention/protein deficits, which may lead to edema formation. Deficits in
Albumin level clotting potentiate risk of bleeding and hemorrhage.
Hematologic and coagulation studies (eg, platelet count, complete
blood count [CBC], international normalized ratio) 6. Administer antidiarrheal agents: diphenoxylate with atropine (Lomotil).
Ammonia levels Reduces fluid and electrolyte loss from GI tract.
Erythrocyte sedimentation rate
Serologic tests 7. Provide IV fluids (usually glucose), electrolytes. Protein hydrolysates.
Hepatitis B surface antigen (HBsAg) Provides fluid and electrolyte replacement in acute toxic state.
Hepatitis B e antigen (HBeAg)
Hepatitis B core antibody (anti-HBc) immunoglobulin M (IgM) 8. Administer medications as indicated: Vitamin K Correction of albumin
anti-HBc IgG and protein deficits can aid in return of fluid from tissues to the circulatory
Hepatitis B e antibody (anti-HBe) system. Because absorption is altered, supplementation may prevent
hepatitis B virus (HBV) deoxyribonucleic acid (DNA) coagulation problems, which may occur if clotting factors and
prothrombin time (PT) is depressed.
Cerebrovascular Accident
Symptomatology
Definition: an ischemic stroke or brain attack, is a sudden loss of brain
function resulting from a disruption of the blood supply to a part of the brain.
Ischemic stroke. This is the loss of function in the brain as a result
of a disrupted blood supply.
Hemorrhagic stroke. Hemorrhagic strokes are caused by bleeding
into the brain tissue, the ventricles, or the subarachnoid space.
Sudden numbness or weakness in the face, arm, or leg, especially
on one side of the body.
Sudden confusion, trouble speaking, or difficulty understanding
speech.
Sudden trouble seeing in one or both eyes.
Sudden trouble walking, dizziness, loss of balance, or lack of
coordination.
Sudden severe headache with no known cause.

Diagnostics/Laboratories
CT scan. Demonstrates structural abnormalities, edema,
hematomas, ischemia, and infarctions
PET scan. Provides data on cerebral metabolism and blood flow
changes.
MRI. Shows areas of infarction, hemorrhage, AV malformations,
and areas of ischemia.
Cerebral angiography. Helps determine specific cause of stroke,
e.g., hemorrhage or obstructed artery, pinpoints site of occlusion or
rupture. Digital subtraction angiography evaluates patency of
cerebral vessels, identifies their position in head and neck, and
detects/evaluates lesions and vascular abnormalities.
Anatomy and physiology
Lumbar puncture. Pressure is usually normal and CSF is clear in
cerebral thrombosis, embolism, and TIA. Pressure elevation and
grossly bloody fluid suggest subarachnoid and intracerebral
hemorrhage. CSF total protein level may be elevated in cases of
thrombosis because of inflammatory process. LP should be
performed if septic embolism from bacterial endocarditis is
suspected.
Transcranial Doppler ultrasonography. Evaluates the velocity of
blood flow through major intracranial vessels; identifies AV
disease, e.g., problems with carotid system (blood flow/presence
of atherosclerotic plaques).
EEG. Identifies problems based on reduced electrical activity in
specific areas of infarction; and can differentiate seizure activity
from CVA damage.
Skull x-ray. May show a shift of pineal gland to the opposite side
from an expanding mass; calcifications of the internal carotid may
be visible in cerebral thrombosis; partial calcification of walls of an
aneurysm may be noted in subarachnoid hemorrhage.
ECG and echocardiography. To rule out cardiac origin as source of
embolus (20% of strokes are the result of blood or vegetative
emboli associated with valvular disease, dysrhythmias, or
endocarditis).
Laboratory studies to rule out systemic causes: CBC, platelet and
clotting studies, VDRL/RPR, erythrocyte sedimentation rate (ESR),
chemistries (glucose, sodium).

Medical Management
Etiology 1. Recombinant tissue plasminogen activator would be prescribed
Nonmodifiable unless contraindicated, and there should be monitoring for
Advanced age (older than 55 years) bleeding.
Gender (Male) 2. Increased ICP. Management of increased ICP includes osmotic
Race (African American) diuretics, maintenance of PaCO2 at 30-35 mmHg, and positioning
Modifiable to avoid hypoxia through elevation of the head of the bed.
Hypertension 3. Endotracheal Tube. There is a possibility of intubation to establish
Atrial brillation patent airway if necessary.
Hyperlipidemia 4. Hemodynamic monitoring. Continuous hemodynamic monitoring
Obesity should be implemented to avoid an increase in blood pressure.
Smoking 5. Neurologic assessment to determine if the stroke is evolving and if
Diabetes other acute complications are developing
6. Surgical Management
Asymptomatic carotid stenosis and valvular heart disease (eg,
endocarditis, prosthetic heart valves)
Periodontal disease
Surgical management may include prevention and relief from increased ICP. Discharge
1. Consult an occupational therapist. An occupational therapist may
7. Carotid endarterectomy. This is the removal of atherosclerotic be helpful in assessing the home environment and recommending
plaque or thrombus from the carotid artery to prevent stroke in modifications to help the patient become more independent.
patients with occlusive disease of the extracranial cerebral arteries. 2. Physical therapy. A program of physical therapy may be beneficial,
8. Hemicraniectomy. Hemicraniectomy may be performed for whether it takes place in the home or in an outpatient program.
increased ICP from brain edema in severe cases of stroke. 3. Antidepressant therapy. Depression is a common and serious
Prognosis problem in the patient who has had a stroke.
Weakness and paralysis 4. Support groups. Community-based stroke support groups may
Spacticity allow the patient and the family to learn from others with similar
Difficulty walking problems and to share their experiences.
Changes in sensation 5. Assess caregivers. Nurses should assess caregivers for signs of
Memory depression, as depression is also common among caregivers of
Attention - Survivors may find it hard to choose when they need to stroke survivors.
pay attention and when they dont. Focusing on a task may be
difficult and it may become harder to concentrate, especially on
several tasks at a time.
Depression
Aphasia.
Fatigue
Visual problems

Nursing Diagnosis
1. Impaired physical mobility related to hemiparesis, loss of balance
and coordination, spasticity, and brain injury.
2. Acute pain related to hemiplegia and disuse.
3. Deficient self-care related to stroke sequelae.
4. Disturbed sensory perception related to altered sensory reception,
transmission, and/or integration.
5. Impaired urinary elimination related to flaccid bladder, detrusor
instability, confusion, or difficulty in communicating.
6. Disturbed thought processes related to brain damage.

Nursing management

1. Prevent venous stasis. Exercise is helpful in preventing venous

stasis, which may predispose the patient to thrombosis and
pulmonary embolus.
2. Assess skin. Frequently assess skin for signs of breakdown, with
emphasis on bony areas and dependent body parts.
3. Elevate affected arm to prevent edema and brosis.
4. Change position every 2 hours; place patient in a prone position for
15 to 30 minutes several times a day.
5. Provide full range of motion four or ve times a day to maintain joint
mobility, regain motor control, prevent contractures in the
paralyzed extremity, prevent further deterioration of the
neuromuscular system, and enhance circulation. If tightness
occurs in any area, perform a range of motion exercises more
frequently.
6. Begin walking as soon as standing balance is achieved (use
parallel bars and have a wheelchair available in anticipation of
possible dizziness).
7. Keep training periods for ambulation short and frequent.
8. Encourage personal hygiene activities as soon as the patient can
sit up; select suitable self-care activities that can be carried out with
one hand.
9. Help patient to set realistic goals; add a new task daily.
10. As a rst step, encourage patient to carry out all self-care activities
on the unaffected side.
11. Make sure patient does not neglect affected side; provide assistive
devices as indicated.
12. Improve morale by making sure patient is fully dressed during
ambulatory activities.
13. Assist with dressing activities (e.g., clothing with Velcro closures;
put garment on the affected side rst); keep environment
uncluttered and organized.
14. Provide emotional support and encouragement to prevent fatigue
and discouragement.
GLAUCOMA
Medications
Definition: a condition of increased pressure within the eyeball, causing Prostaglandin analogs (Xalatan, Lumigan, and Travatan)
gradual loss of sight. o Increasing the outflow of fluid from the eye.
Beta blockers such (Timolol)
2 types of glaucoma: o Decreasing production of fluid.
1. Chronic or Open-angle glaucoma Alpha agonists (AlphaganP, iopidine)
Also called wide-angle glaucoma. o Work to both decrease production of fluid and increase
The structures of the eye appear normal, but fluid in the eye drainage.
does not flow properly through the drain of the eye, called the Carbonic anhydrase inhibitors (CAIs)
trabecular meshwork. o Reduce eye pressure by decreasing the production of
2. Acute or close angle glaucoma intraocular fluid. These are available as eye drops
Also called acute or chronic angle-closure or narrow-angle Treatment & Surgery
glaucoma. The most common laser treatments for glaucoma are argon laser
Poor drainage is caused because the angle between the iris trabeculoplasty (ALT) and selective laser trabeculoplasty (SLT).
and the cornea is too narrow and is physically blocked by the
iris. Nursing Diagnosis & Interventions
1. Acute pain related to increased intraocular pressure
Anatomy & Physiology Asses severity of pain
Administer analgesics to relieve pain
Provide comfort measures such as hot/cold compress
Provide calm environment
Provide adequate periods of rest
2. Increased intraocular pressure related to blockage of aqueous
drainage in the eye
Assist in lab exams for determining IOP
Administer eye drop medications to lower IOP
Advise patient to avoid lifting heavy objects
Encourage patient to wear eye protection
Avoid valsalva maneuver or straining at stool
3. Impaired vision related to damage in the optic nerve
Assess patients vision, noting its character
Allow patient to express emotions about his/her vision
Administer medications for lowering IOP
Etiology: Advise patient to avoid activities that increase IOP such as
African-American, Irish, Russian, Japanese, Hispanic, Inuit, or valsalva maneuver and lifting objects
Scandinavian descent Encourage patient to comply with medication and diet to
Over age 40 avoid vision loss
Family history of glaucoma 4. Nausea and vomiting related to severe pain
poor vision Administer pain medications
diabetes Administer anti-emetics
Take certain steroid medications, such as prednisone Give medicated eye drops after vomiting since n/v increases
Have had trauma to the eye or eyes IOP
Assist in relaxation techniques to lessen pain and n/v
Symptomatology Provide adequate rest periods
Seeing halos around lights 5. Risk for vision loss related to damage in the optic nerve
Vision loss Place personal objects within field of vision
Redness in the eye Encourage patient to comply with medications and diet
Eye that looks hazy (particularly in infants) Encourage patient to seek laser treatments
Nausea or vomiting Allow patient to verbalize feelings about his/her condition
Pain in the eye Encourage patient to make necessary lifestyle changes
Narrowing of vision (tunnel vision)
Prognosis
Laboratory/Diagnostic Tests At this time, loss of vision caused by glaucoma is irreversible and
Tonometry - measures the pressure in the eye. The range for cannot be restored.
normal pressure is 12-22 mm Hg However, successfully lowering eye pressure can help prevent
Ophthalmoscopy - helps examine your optic nerve for glaucoma further visual loss from glaucoma.
damage. Most people with glaucoma do not go blind if they follow their
Perimetry - visual field test that produces a map of your complete treatment plan and have regular eye exams.
field of vision.
Gonioscopy - helps determine whether the angle where the iris
meets the cornea is open and wide or narrow and closed.
Pachymetry a simple, painless test to measure the thickness of
your cornea
 Age: < 15 years of age
LEPTOSPIROSIS Sex: male
Season: rainy months
Definition: Leptospirosis is a fairly uncommon bacterial infection caused by a
strain of Leptospira. It is most commonly transmitted from animals to humans Geographic: prevalent in slum areas
when people with unhealed breaks in the skin, come into contact with water or Leptospirosis is caused by spiral bacteria that belong to the
soil that has been contaminated with animal urine - the bacterium can also genus Leptospira, the family Leptospiraceae, and the order
enter the body through the eyes or mucous membranes. Spirochaetales.
These spirochetes are finely coiled, thin, motile, obligate, slow-
Anatomy & Physiology: Immune & Lymphatic System growing anaerobes.
. 2 species: the pathogenic Leptospira interrogans and the
First line of defense nonpathogenic Leptospira biflexa
1. Mechanical barriers, for example, intact skin and mucous
membrane. Symptomatology
2. Chemical barriers. For example, saliva, tears. Diarrhea
3. Reflexes, for example, coughing, sneezing, and vomiting. Fever
Second line of defense Headache
1. Inflammation and fever. Nausea and vomiting
2. .Protective proteins that are produced in response to viruses and Muscle pain
bacteria Non-pruritic rash
3. Natural killer cells (lymphocytes). Jaundice
4. Phagocytes (special white cells that eat pathogens) Edema
Third line of defense Bleeding
1. Lymphocytes: T cells, B cells that fight specific invaders.
2. Immunity can be either natural or active. Medical Management
3. Natural immunity is an individuals ability to ward off pathogens and Laboratory tests:
is influenced by the persons state of health, their nutritional status o CBC high WBC count, low platelet count
and their emotional response to stress. o Urinalysis mild proteinuria, pyuria, hematuria
4. Active immunity occurs as the body builds up a resistance to o Dark field examination presence of spirochetes
pathogens that have been introduced through exposure or by
Medical treatment
immunization.
o Antibiotics such as penicillin
Function of the immune system
o Streptomycin
1. The immune system is a complex system of cells and responses
that recognizes something as foreign and acts to remove it.
Nursing Diagnosis & Interventions
2. For example micro-organisms, foreign tissue, body cells cancer.
1. Imbalanced nutrition: less than body requirements related to
Structure of the lymphatic system
anorexia
Review complaints of nausea and vomiting
The lymphatic system is comprised of
Give food a little but often
Lymphatic capillaries
Assess how to eat that served
Lymphatic vessels
Give a warm meal
Lymphatic nodes
Measure the patient's body weight per day
Lymphatic tissue
2. Increased body temperature (hyperthermia) related to increased
Lymphatic ducts
metabolic diseases
Increase oral fluid intake
Monitor temperature
Tepid sponge bath
Wear light clothing
3. Activity intolerance related to physical weakness
Assist patient in ambulating
Put things in place where it can be easily accessed
4. Fluid volume deficit related to lack of fluids and electrolyte active
Monitor intake and output
Volume per volume replacement
Regulate intravenous fluid
5. Acute pain related to bacterial infections
Administer meds as ordered

Etiology
Multiule Sclerosis communicating with body cells is electrical impulses, which are rapid and
specific and causes almost immediate responses.
Definition Three functions:
- Multiple sclerosis is a chronic, degenerative progressive disorder 1. Monitor changes inside and outside the body
ease of the central nervous system characterized by the Changes are called as stimuli
occurrence of small patches of demyelination in the brain and Gathered information is called as sensory input
spinal cord. 2. Processes and interprets sensory input
- Demyelination refers to the destruction of myelin, the fatty and Integration making decision about what should be
protein material that surrounds certain nerve fibers in the brain and done at the moment
spinal cord, which results in impaired transmission of the nerve 3. Effects a response by muscle or gland activation
impulses.
Types Structural Classification
1. Benign 1. Central Nervous System
Nervous system, dysfunction will occur in different - Consists of the brain and the spinal cord, which
episodes, full recovery occurs occupies the dorsal body cavity
2. Relapsing Remitting - Acts as the integrating and command centers of the
Most common nervous system
Neurological exacerbations occur but - Interpret sensory information and issue instructions
improvement can be seen with either complete or based on past/present experiences
partial recovery 2. Peripheral Nervous System
3. Primary Progressive - Spinal nerves (carry impulses to and from the spinal
Sudden loss of neurological function occurs, cord) and cranial nerves (carry impulses to and from the
which may not resolve brain)
Leaves severe functional impairments - Links all body parts of the body by carrying impulses
These may actually worsen over time from the sensory receptors to the CNS and from the
No remission follows CNS to the glands and muscles
4. Secondary Progressive
Starts familiar to relapsing remitting Functional Classification
Changes to a primary progressive form 1. Sensory or Afferent Division
No remission follows - Nerve fibers that convey the impulses to the CNS from
sensory receptors from the body
- Sensory fibers
o Somatic sensory fibers skin, skeletal
muscles and joints
o Visceral sensory fibers visceral organs
2. Motor or Efferent Division
- Carry impulses from the CNS to effector organs,
muscles and glands
- Two subdivisions
o Somatic Nervous System - allows to
consciously and voluntarily control the
skeletal muscles
o Parasympathetic Nervous System
automatic or involuntary
Sympathetic
Parasympathetic

Nervous Tissue: Structure and Function

1. Neuroglia (Supporting Cells)
- Support, insulate and protect the delicate neurons
- Not able to transmit nerve impulses
- Never lose the ability to divide
- Astrocytes
o Forms a living barrier between capillaries
and neurons and play a role in making
exchanges between the two
o Control the chemical environment in the
brain by picking up excess ions and
recapturing neurotransmitters

- Microglia
o Dispose debris, including dead brain cells
and bacteria
- Ependymal
o Lines the cavities of the brain and spinal cord
o Helps to circulate the CSF that fills those
Anatomy and Physiology
cavities and forms a protective cushion
Nervous System
- Oligodendrocytes
Is the master and communicating system of the body. Every thought, action
and emotion reflects its activity. Its signaling device or means of
 o Wrap the flat extensions tightly around the
nerve fibers, producing fatty insulating
coverings called as the myelin sheaths
- Schwann Cells
o Form the myelin sheaths around nerve fibers
found in the PNS
- Satellite Cells
o Protective and cushioning cells
2. Neurons
- Transmits messages from one part of the body to the
another
- *Axons transmit nerve impulses away from the cell
body. When these impulses reach the axon terminals,
they stimulate the release of neurotransmitters into the
extracellular space.
- Cell body
o Metabolic center of the neuron
o Contains the usual organelles
- Neurofibril
o Intermediate filaments that are important in
maintaining cell shape
- Processes or fibers
o Convey incoming messages toward the cell
body
- Dendrites
o Generate nerve impulses and conduct them
away from the cell body
- Axons
o Each neuron has only one axon
o Arises from the axon hillock
- Axon terminals
o Contain the chemicals called as
neurotransmitters
Axon Terminal
- Separated from the next neuron by a tiny gap called
synaptic cleft
- Such a functional junction is called as synapse
- Very close, but never actually touch other neuron
- Covered with a white, fatty material called as myelin
o Protects and insulates the fibers and
increases the transmission rate of the nerve
impulses
- Axons outside the CNS are myelinated by Schwann
cells, specialized supporting that wrap themselves
tightly around the axon
- After the wrapping process, a tight coil of wrapped
membranes, myelin sheaths, encloses the axons
- Since the myelin sheath is formed by many Schwann
Cells, it has gaps or indentations called as the Nodes of
Ranvier
Neurons
- Myelinated fibers are also found in the central nervous
system, however, it is oligodendrocytes that for the CNS
myelin sheaths
- Although the myelin sheaths formed by the
oligodendrocytes and those formed by the Schwann
cells are similar, the CNS sheaths lacks a neurilemma
o Neurilemma remains intact when a
peripheral nerve fiber is damaged
o Plays an important role in fiber regeneration
Etiology
M More common in women
Women produce more protein called as S1PR2 which
controls the permeability of the blood brain barrier
Hormones may also play a significant role of the
susceptibility to MS
U Usually occurs between ages 20 to 40 years old
L later reaction ta viral infection
T Trauma
I Infection (viral)
The virus Epstein Barr is the most consistently linked to
MS, a virus that causes mononucleosis
P Pregnant
Symptoms decrease during pregnancy and increase
after delivery
Disabling effects makes it difficult for the mother to carry
pregnancy
Increases likelihood for falls
Worsen fatigue
Increases risk for infection
L Loss of energy
E Emotional stress
Symptomatology
MS course assume different patterns
A Ataxia or impaired coordination of movements
Due to involvement of the cerebellum or basal ganglia
M Muscle spasticity and muscle weakness
Due to involvement of the main motor pathways of the spinal cord
U Unusual reflexes (positive Babinski)
L Loss of energy (fatigue) COMMON SYMPTOM
T Tremors
T Two visions (diplopia) EARLIEST SIGN
Due to lesions in the optic nerves or their connections
I Incontinence in urinary and bowel
Secondary complications of MS
P Paresthesia and pain
Due to disruption of the sensory axons
L Less perception to pain, touch and temperature
E Emotional changes (apathy, euphoria)
D Depression
Due to frontal or parietal lobe involvement
Laboratory Tests
MRI
- Test that produces clear pictures of the human body without
the use of x rays
- Uses large magnets, radio waves and a computer to produce
images
- To visualize small plaques and to evaluate the course of the
disease and effect of the treatment
Spinal Tap or Lumbar Puncture
- A procedure used to remove and test CSF to diagnose brain
and spinal cord disorders including multiple sclerosis
- CSF studies help define the extent of the disease process and
monitor changes
Evoked Potential Tests
- Tests that measure the electrical activity of the brain caused
by light, sound and touch
- Detects problems along the cranial and spinal nerves
Medications
Corticosteroids (prednisone and methylprednisolone) and ACTH
o Used as anti inflammatory agents that may improve nerve
conduction
Immunosuppressive agents like cyclosporine and glatiramer
acetate
o Reduce the rate at which the disease progresses and
decrease the frequency and severity of exacerbations
Interferons beta 1b (Betaseron and Avonex)
o Used in relapsing remitting MS and significantly reduces the
area of demyelination in the brain tissue
Baclofen
o An antispasmodic agent, choice for spasticity
Beta adrenergic blockers, anticonvulsants, and benzodiazepines
 o Used to treat ataxia Prognosis
Ascorbic acid Prognosis for people with MS is encouraging. Studies show that
o To acidify urine, making bacterial growth less likely majority of MS patient will experience a normal (or almost normal) life span.
People with MS tend to die from many of the same conditions that people
Treatments and Surgery without MS die form, like cancer and heart disease.
No cure is available, supportive care should be maintained Prognosis for longevity is good except in cases of sever MS. Symptoms cause
Maximum support to client and family is usually needed pain, discomfort and inconvenience, even though patients will never become
Safety precautions severely disabled. Some patient will need crutches or cane to remain
Promoting physical mobility ambulatory, however.
Preventing injury
Enhancing bladder and bowel control
Managing speech and swallowing difficulties
Improving sensory and cognitive function
Improving self care abilities
Promoting sexual functioning

Nursing Diagnosis and Interventions

1. Impaired physical mobility related to weakness, muscle paresis,
spasticity
Perform passive ROM on affected limbs
Safety precautions at all times
Encourage ambulation for short, frequent walks, with
assistance if unsteady
Teach proper ways to use ambulatory devices like
crutches, walkers and wheelchair
2. Risk for injury related to sensory and visual impairment
Orient to surroundings
Supervise patient during first few nights/days to assess
safety
Encourage to ask assistance at all times
Keep bed at lowest level during night
Teach proper ways to use ambulatory devices like
crutches, walkers and wheelchair
Provide nonslip handgrips, railings along hallways and
bathrooms
Remove protruding objects
Safety precautions at all times
3. Altered urinary and bowel elimination related to spinal cord
dysfunction
Administer medications
Bladder training
Catheterization
Increase oral fluid intake
4. Ineffective individual coping
Verbalize feelings related to emotional state
Identify coping patterns and consequences of the
behavior that results
Identify personal strengths and accept support through
the nursing relationship
Determine risk for client inflicting self harm
Maintain environment with low levels of stimuli
5. Impaired home maintenance management related to physical,
psychological and social limits imposed by MS
potential for sexual dysfunction related to spinal cord involvement
or psychological reactions to conditions
Determine information needed to be taught and learned
Determine type of equipment needed, considering
availability, cost and durability
Determine type of assistance needed
Discuss implications of caring for a chronically ill family
member
Allow patient to share thoughts and feelings
Refer to community agencies as indicated
6. Impaired speech and swallowing related to cranial nerve
involvement
7. Altered thought processes related to cerebral dysfunction
ORAL REVALIDA NCM1O5 JMCD
OSTEOPOROSIS
Definition
Progressive systemic skeletal disease characterized by low bone
mass (osteopenia = due to inadequate osteoid synthesis) and
micro-architectural deterioration of bone tissue, leading to
enhanced bone fragility and a consequent increase in fracture risk.
Anatomy & Physiology: Skeletal System
3 Classes of cells:
o Osteoclasts latches to the bone and releases enzymes
which break down the bone tissue
o Osteoblasts puts up collagen fibers which are used as a
framework for the osteoblasts work which is to create and
repair new bone by building around itself, new bone is called
osteoid.
o Osteocytes once osteoblast is finished working it is trapped
inside the bone once it hardens, the trapped osteoblast is
called osteocyte.

4 Steps in Bone Remodeling Cycle

1. Activation preosteoclasts are stimulated to mature into
active osteoclasts.
2. Resorption new osteoclasts secretes acid like substance,
dissolving and digesting the organic matrix and mineral of old
bone.
3. Reversal resorption stops when the cavity reaches a
predetermined depth. Monocyte derived cells form a cement
surface that prevents further bone erosion.
4. Formation osteoblasts are attracted into the resorption
cavity and mature to refill the resorptive cavity with new
bone.
Decreased Blood Calcium Levels parathyroid
glands (at throat) are stimulated to release
parathyroid hormone (PTH) into the blood. Then
PTH activates osteoclasts to breakdown bone
206 different bones matrix and release calcium ions into the blood.
Five Functions: Increased Blood Calcium Levels calcium is
Protection of vital organs deposited in bone matrix as hard calcium salts.
Support for body tissue Calcium Salts deposited in the matrix gives
bone its hardness
Assistance in movement
o Organic Part (Esp. Collagen Fibers)
Storage of minerals
provide for bones flexibility and great
Hematopoiesis or blood cell formation tensile strength.
Two types of osseous or bone tissue: Etiology
1. Compact/Cortical dense and looks smooth and homogenous. Three Main Factors
2. Spongy/Cancellous/Trabecular composed of small needle like 1. Microarchitecture of the bone thinning of trabecular
pieces of bone and lots of open space. bone and cortical bone loss
2. Reduced bone mass (Osteopenia) 70% of bone tissue
Classification: Shape strength
Long bones femur, humerus, radius 3. Fall reduced muscle mass and strength, reduced soft
Short bones tarsal & carpals tissue, CNS disorders, or drug therapies
Flat bones skull, sternum, ribs, ilium Primary Osteoporosis
Irregular bones mandible, vertebra Juvenile Osteoporosis
Components of Long bones Idiopathic Osteoporosis
Diaphysis or shaft, composed of compact bone o Postmenopausal
Periosteum fibrous connective membrane that covers and o Senile
protects Secondary Osteoporosis
diaphysis Genetic or Congenital
Epiphysis ends of long bone that consist of thin layers of Hypogonadal States (Anorexia/ Bulimia/ etc.)
compact bone enclosing an area filled with spongy bone Endocrine Disorders (Cushing/ DM/Hyperthyroidism /
Epiphyseal line thin line that spans the epiphysis Pregnancy/ etc.)
Sharpeys Fibers secures the periosteum to the underlying Deficiency States (Ca/ Mg/ Vit. D/ Estrogen/ etc.)
bone. Inflammatory Diseases (Rheumatoid/SLE/Ankylosis)
Articular Cartilage covers external surface Hematologic and Neoplastic Disorders (Hemophilia/
Bone Formation or Ossification Leukemia/ Sickle Cell Anemia/ etc.)
Hyaline cartilage model is completely covered by bone matrix by forming cells Medications (Lithium/ Anticonvulsants/ Anti-psychotic/
(Osteoblast). Heparin/ etc.)
After osteoblast becomes surrounded with bone matrix, it becomes mature
bone cell (Osteocyte).
ORAL REVALIDA NCM1O5 JMCD
Risk Factors
O Low Calcium Intake Nursing Diagnosis & Interventions
S Seizure medication
T Thin build 1. Chronic Pain R/T Fracture and Muscle Spasm
E Ethanol intake Assess the location of pain, level of pain, duration, frequency and
O Thyroid Excess intensity of pain.
R Race (White and Asian) Encourage clients to rest in bed and encourage clients to take a supine
O Other relatives with osteoporosis or oblique position that is comfortable for the client.
Rationale: Back pain relief can be done with bed rest with supine position
S Steroids
or tilted to the side for a few days.
I Inactivity
Give solid and not flexible mattress.
S Smoking Rationale: Provide comfort for the client.
Teach client to perform relaxation technique of knee flexion.
Symptomatology Rationale: Knee flexion can increase comfort by relaxing the muscles.
Silent Disease = Asymptomatic Give intermittent warm compresses and massage the back.
Back Pain Rationale: Warm compress and massage on the back repairing muscle
Painful Fractures (occur more easily than expected) relaxation.
Progressive loss of height
Dowagers Hump (Rounded upper back or kyphosis) 2. Impaired physical mobility R/T pain and discomfort
Provide comfort measures such as use of heat/ cold packs to the affected
body part.
Laboratory Tests Rationale: To promote non-pharmacologic relief of pain.
o Dual-Energy X-ray Absorptiometry (DXA) Advice patient (and assist patient in turning sides) to move the trunk as
To test the bone mineral density. a unit and avoid twisting.
One beam is high energy while the other is low energy. Rationale: To maximize back pain and prevent further injury of the back.
The amount of X-rays that pass through the bone is Encourage patient to perform relaxing activities/exercise (deep breathing
measured for each beam thatll vary depending on the exercises).
thickness of the bone. Rationale: To distract attention from pain and reduce tension.
Based on the difference between the two beams, the Assist patient to turn to sides every 2 hours.
bone density can be measured. Rationale: To prevent pressure ulcers.
o Qualitative Computed Encourage increase fluid intake within cardiac tolerance.
To measure spinal BMD Rationale: to keep body well hydrated and to decrease risk for
It measures trabecular bone within the vertebral body. constipation.
o Bone Scanning
To assess the function and tissue metabolism of organs by using a 3. Disturbed self-esteem R/T loss of health status and dependent
radionuclide that emits radiation in proportion to its attachment to a functioning
target structure. Develop therapeutic relationship by providing encouragement for efforts
This technique detects an increase in osteoblastic activity. and maintaining open communication.
Medications Rationale: Promotes trusting situation in which patient is free to be open
o Bisphosphonates and honest with self.
Slow down excessive bone activity, stabilize BMD (bone Talk to patient with positive outlook in life.
mineral density) and reduce fracture risk Rationale: Addressing issues openly provides opportunity for change.
o Calcitonin Advise to recall past successes and strengths.
Slows down excessive bone activity and reduces fracture Rationale: Can develop an internal focus of control by recognizing these
risk in the spine, but not clearly in other bones such as the aspects.
hip. Give reinforcement for progress noted.
It can also reduce pain from acute spinal fractures. Rationale: Positive word encouragements promote continuation of
Recent reports suggest that long-term use of the drug may efforts supporting development of coping behaviors.
lead to tumor growth. Encourage to involve in exercise program and promote socialization.
o Tariparitide Rationale: Enhances sense of well-being and can help energize patient.
Builds new bone and may be particularly helpful in people 4. Self-care deficit: Bathing and Toileting R/T pain and discomfort
with very low bone mass, fracture while on other forms of upon moving
therapy, or very poor ability to form new bone. Provide for communication among those who are involved in caring,
Treatments instruct to provide privacy and equipment within easy reach during
o Kyphoplasty personal care activities.
Balloon tamp is inflated within and between the fracture Rationale: Enhances coordination and continuity of care.
fragments before the cement is infused, in order to restore Apply intermittent local heat and back rubs.
vertebral body height. Rationale: To promote muscle relaxation.
o Strontium Encourage good posture and teach proper body mechanics.
Chemically similar to calcium. Rationale: To promote good posture and prevent back pain.
It appears to play a role in how your body makes new bone Provide tepid sponge bath.
while slowing the breakdown of old bone, so it may impact Assist patient upon moving.
your bone density.
Mainly from seafood, but you can also get small amounts 5. Risk for injury: Fracture R/T effects of change in bone structure 2o
of it in whole milk, wheat bran, meat, poultry, and root to Osteoporosis
vegetables. Maintain bedrest as indicated. Provide support when moving/turning.
o Exercises Rationale: Provides stability, reducing possibility of disturbing alignment/
Ensure that patient maintains an upright spinal alignment. muscle spasms, which enhances healing.
ORAL REVALIDA NCM1O5 JMCD
Advice patient (and assist patient in turning sides) to move the trunk as
a unit and avoid twisting.
Rationale: To minimize back pain and prevent further injury of the
affected back.
If the patient takes a calcium supplement, encourage liberal fluid intake.
Rationale: To help maintain adequate urine output and thereby avoid
renal calculi, hypercalcemia, and hypercalciuria.
Tell the patient to report new pain sites immediately, especially after
trauma.
Rationale: To prevent patient from having pressure ulcers.
Assist patient to turn to sides every 2hours.
Rationale: To prevent pressure ulcers.
Encourage the patient to install safety devices, such as grab bars and
railings, at home.
Rationale: To prevent additional injury.
Prognosis
The prognosis for osteoporosis is good if bone loss is detected in the early
phases and proper intervention is undertaken.
Patients can increase BMD and decrease fracture risk with the appropriate
anti-osteoporotic medication.
In addition, patients can decrease their risk of falls by participating in a
multifaceted approach that includes rehabilitation and environmental
modifications.
Worsening of medical status can be prevented by providing appropriate pain
management and, if indicated, orthotic devices.
ORAL REVALIDA NCM1O5 JMCD
Rabies Laboratory
Direct fluorescent antibody (DFA) test = for animals
Definition: Preventable viral disease of mammals most often transmitted Looks for the presence of rabies virus antigens in brain tissue
through the saliva of a rabid animal
Several tests are necessary to diagnose rabies ante-mortem (before death) in
Anatomy and Physiology humans
No single test is sufficient
Saliva can be tested by virus isolation or reverse transcription
followed by polymerase chain reaction (RT-PCR)
Serum and spinal fluid are tested for antibodies to rabies virus
Skin biopsy specimens are examined for rabies antigen in the
cutaneous nerves at the base of hair follicles

Medication
Immediate gentle irrigation with water or a dilute water povidone-
iodine solution
Wound cleansing is especially important in rabies prevention since,
in animal studies, thorough wound cleansing alone without other
postexposure prophylaxis has been shown to markedly reduce the
likelihood of rabies.
Tetanus shot if you have not been immunized in ten years

For people who have never been vaccinated against rabies

previously, combination of human rabies immune globulin (HRIG)
and postexposure anti-rabies vaccination

People who have been previously vaccinated or are receiving

preexposure vaccination for rabies should receive only vaccine.

Nursing Diagnosis
1. Impaired skin integrity r/t break in the skin
2. Ineffective breathing pattern related to asphyxia
3. Imbalanced Nutrition: less than body requirements related to
decreased swallowing reflexes
4. Hyperthermia related to viremia
5. Risk for injury related to seizures and weakness

Signs and Symptoms
Prodromal/Invasion Phase
o Fever, headache, and general weakness or discomfort
Excitement or neurological phase
o Characterized by marked excitation, and apprehension.
Terror may even occur
o Delirium associated with nuchal rigidity, involuntary
twitching or generalized convulsions
Terminal/paralytic phase
o The patient becomes quiet and unconscious. Death
occurs due to respiratory paralysis, circulatory collapse,
or heart failure
Note: disease progression
o Insomnia, anxiety, confusion, slight or partial paralysis,
excitation, hallucinations, agitation, hypersalivation
(increase in saliva), difficulty swallowing, and
hydrophobia (fear of water)
Nursing Management
1. Isolate the patient.
2. Give emotional and spiritual support.
3. Provide optimum comfort.
4. Darken the room and provide a quiet environment.
5. Patient should not be bathed and there should not be any running
water in the room or within the hearing distance of the patient.
6. If IV fluid has to be given it should be wrapped and needle should
be securely anchored in the vein to avoid dislodging in times of
restlessness.
7. Concurrent and terminal disinfection should be carried out
8. Providing public education, especially among children, in avoiding
and reporting all animals that appear sick.
Prognosis
About 60,000 people die every year of rabies, mostly in Asia and
Africa.
In the U.S., one to three people die from rabies each year.
Every year, more than 15 million people worldwide receive a post-
bite vaccination to prevent the disease; this is estimated to prevent
hundreds of thousands of rabies deaths annually.

Etiology Rhabdovirus
ORAL REVALIDA NCM1O5 JMCD
SYSTEMIC LUTHUS ERYTHIMATOUS

Definition An autoimmune disease that causes a chronic inflammatory Nursing Management

condition which can affect many organs in the body including the skin, joints,
kidneys, lungs, and nervous system. 1. Instruct to avoid direct sunlight
2. Take medications as ordered
Anatomy and Physiology 3. Instruct to avoid physical and emotional stress
4. Avoid exosure to people that are sick
5. Provide emotional support

B cells form and mature in the red bone

marrows from predecessor cells. Once
mature, they migrate to the lymph nodes
and remain inactive until antigens that
matches their receptor sites stimulate
them.
The main function of B cells is in the
antibody-mediated immunity. B cells attach themselves to the antigens that
match their receptor sites to be activated. Once activated, the B cells grow and
multiply rapidly into a large homogenous group. Each of these cells
secrete antibodies specific to the activating antigen in the lymph
fluid which will then enter the blood plasma to circulate throughout the body.
Antibodies, or immunoglobulins, attach to the antigens making it easier for
phagocytosis by neutrophils, monocytes, and macrophages.
Nursing Diagnosis
1. Fatigue r/t increased energy requirements secondary to chronic
inflammation
2. Acute pain r/t widespread inflammatory process affecting multiple
systems aeb verbal reports
3. Impaired skin tissue integrity r/t chronic inflammation, edema
formation, and altered circulation aeb skin rash and photosensitivity
4. Disturbed body image r/t chronic condition with skin rash, lesions,
ulcers, purpura, loss of strength, and altered body function aeb
hiding body parts and negative feelings about body.

Etiology
Idiopathic
Risk Factors
Genetics
Hormones
Environmental Factors
UV
Drugs
Infection (EBV)

Signs and Symptoms

-Joint pain and stiffness
-Skin rash (Malar and Discoid)
-Photosensitivity
-Fever
-Extreme fatigue
-Weight loss
-Loss of appetite, nausea
-Chest pain
-Bruising
-Menstrual irregularities
-Dry eyes
-Mouth ulcers
-Brittle hair or hair loss
-Raynauds phenomenon
-Anxiety, depression, forgetfulness, and difficulty concentrating

Medical Management
>Labs
-ANA test
-Complement test (low)
-CBC
-Erythrocyte sedimentation rate (high)
-C-reactive protein (high)
>Medication
-Corticosteroids (Prednisone)
-Anti-malarial (Plaquenil)
-Immunosuppresant (Benlysta)
-NSAIDs (Ibuprofen)
-Sunblock (SPF > 55)
>Surgical
-None