Monday, May 19, 2008

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Neurosurgical Disorders Eye Disorders and PAE and PAE





brain tumors • Brain tumors represent a large and heterogeneous group of diseases involving the brain and related structures. The variability of these is very large, ranging from benign and curable tumors without major complications until very aggressive and malignant processes, difficult to treat and produce serious sequelae and high mortality.
risk factors in the formation of brain tumors

-Hereditary Genetic Factors

In diseases such as neurofibromatosis or Von Recklinhausen disease have been observed acoustic neuromas and a variety of gliomas. Glioma optic nerve is common.
• Tuberous sclerosis, disease-Lindau Von Hipel and Sturge-Weber syndrome is a disease associated with the presence of CNS tumors. Approximately 16% of patients with brain tumors have a family history of cancer.

Environmental Factors:

• have been related to the presence of CNS tumors, radiation, trauma, occupational factors and infectious factors. Radiation



• It has been reported an association between risk of glioma and meningioma and a history of repeated X-ray exposures. Injuries



• It has been reported higher incidence of meningioma in patients who complain of severe traumatic brain injury several years before diagnosis. Hormonal Factors



• The prevalence of meningiomas in women, or their growth during pregnancy, suggesting a hormonal factor.

Immunosuppression:

• The patients with AIDS and medically immunosuppressed are at increased risk of developing primary brain lymphoma.
• However, little is known about the etiology of CNS tumors and is not yet possible to take timely preventive measures. Classification



• A wide variety of brain tumors, dependent in the genesis of different cell types found in the brain and its surroundings. Thus, we have tumors of the same cells that form the brain and nerves:
• gliomas (the most common tumors, "primary")
• neurocytoma
• Schwannomas or neurinomas
• Tumors of the membranes covering the brain or meninges (meningiomas)
• Tumours related to bony structures
• •
pseudotumors cysts or tumors which has associated glands (pituitary gland tumor) and embryonal tumors
• •
primitive blood vessels associated with tumors; etc.
• Another important group is made up of brain metastases or tumors "side" who have traveled from another organ with a primary tumor or cancer and has been installed in the brain, where they grow back like a tumor.

Symptoms:

• Symptoms vary, depending on size and location of the tumor. A growing tumor is often associated with fluid accumulation, because it exerts pressure on the brain. Symptoms may develop gradually or rapidly.
• Symptoms may include:
• Headache. The vast majority of headaches are not caused by brain tumors. The headaches associated with brain tumors have the following features:
- gets progressively worse over a period of months or weeks
- Worse in the morning or cause you to wake during the night
- are different from common headaches
- Aggravated change of posture, straining or coughing
• Seizures

• Nausea or vomiting • Weakness in arms and / or legs
• Loss of sensation in the arms and / or legs

• Difficulty walking • Changes
vision
• Language problems • Sleepiness
• Memory problems • changes in personality


Clinical manifestations:

• Despite their diversity pathological, clinical effects of brain tumors depend on a number of pathophysiological mechanisms relatively scarce. One of the most important concepts regarding the pathophysiology of brain tumors that grow within the limits of the rigid and inflexible skull. As the volume of the cranial cavity is constant, any expansion process will necessarily produce a proportional rise in intracranial pressure (ICP). Once they pass the compensation mechanisms, continued growth will be at the expense of volumetric brain needs a critical event that results in distortion and herniation of the brain and ultimately death. Initially, the brain shows a remarkable tolerance to the effects comprehensive and invasive brain tumors, so early symptoms can be scarce.

• Eventually, all brain tumors cause symptoms by one or more of the following mechanisms
1) Increase in ICP caused by the mass of the tumor, brain swelling or obstruction of the flow of cerebrospinal fluid (CSF )
2) destruction local compression or distortion of brain tissue, resulting in specific neurological deficits
3) compression or distortion of cranial nerves, resulting in paralysis of these features
4) local electrochemical instability seizures.


• Symptoms of brain tumors are of two basic types:
- no focus, related to the overall effect of increased ICP
- focal-specific localization and functional changes attributable to the area of \u200b\u200bbrain tissue affected.
- The elevations of ICP are responsible for many of the nonspecific symptoms produced by brain tumors.
- Headache is one symptom that most often accompanies brain tumors. When due to a carcinoma, tends to show some special features. Thus, usually a type headache "pressure" of moderate intensity, typically generalized or retroorbital more intense in the early morning, these headaches tend to worsen with coughing, exertion, leaning forward or any other type Valsalva maneuver is due to irritation of the pain-sensitive structures (dura or blood vessels), often accompanied by nausea and vomiting, the latter sometimes described as the "shotgun" especially in children.
- The effects of raised ICP in the optic nerve cause blurred vision, expansion of the blind spot and papilledema. The sixth cranial nerve, because of its long intracranial course, is very sensitive to elevations in ICP and functional impairment resulting in lateral rectus weakness, and diplopia. Finally, in young children, increases in ICP may lead to diastasis of cranial sutures, with growth in head circumference.

• The focal symptoms are location-specific variables as dependent neuroanatomical structures affected, and are characterized by loss gradual and progressive neurological functions.
• Injuries affecting the motor cortex produce a contralateral hemiparesis.
• Involvement of the sensory cortex alters one or more sensory functions.
• The impairment of memory, trial and personality is typical of the lesions of frontal and temporal lobes.
• Injuries to the dominant frontal and temporal hemispheres can result in various deficiencies of language.
• occipital lesions produce contralateral hemianopsia homonymous visual defects.
• The posterior fossa tumors tend to alterations of functions of the cerebellum, loss of coordination ipsilateral (cerebellum) and ataxia (cerebellar vermis). Tumors in the region of the hypothalamus and pituitary gland can produce a wide variety of systemic endocrine disruption.

• When brain tumors affect the cranial nerves, leading to a wide variety of symptoms that have great value in the study of localization: the base lesions of the anterior fossa cause anosmia (cranial nerve I).
• paraselares neoplasms affecting the nerve and chiasm produce characteristic patterns of loss of vision. The optic nerve compression monoocular usually cause loss of vision, while compression chiasm is associated with a bitemporal hemianopsia.
• Lesions involving the cavernous sinus producing paralysis of cranial nerves that pass through it (III, IV, V and VI). The posterior fossa tumors can cause facial anesthesia (par V), facial weakness (even Vll), hearing impairment (VIII pair) and difficulty swallowing (cranial nerves IX, X).

• Finally, brain tumors can cause a partial or generalized seizure activity. In fact, the recent convulsions in an adult should be considered secondary to space occupying lesion until proven otherwise. Although seizure activity may appear in the context of any structural abnormality supratentorial (neoplastic or not), its association with brain tumors is usually caused by prolonged compression or irritation of the brain tissue immediately adjacent to the tumor. Epileptogenic capacity as compressed or infiltrated brain is a phenomenon that develops over time, seizures of long duration usually indicate tumor biological evolution.


OVERVIEW OF TREATMENT OPTIONS

treatment of brain tumors in adults:
• There are treatments for all patients with brain tumors. Using three kinds of treatment:
• radiotherapy • surgery


• chemotherapy • Surgery is the most common treatment for brain tumors in adults.
• To remove the cancer of the brain, cut a section of skull bone to reach the brain, craniotomy. After the bone is put back in place or put a piece of metal or cloth to cover the opening in the skull.
• Radiation therapy is the use of X-rays produced by a linear accelerator or cobalt machine and its purpose is to eliminate cancer cells from the outside and shrink tumors (EBRT). Radiotherapy can also be used by putting materials that produce radiation in the tumor (radioisotopes) to kill cancer cells from the inside (internal radiation therapy).
• Chemotherapy uses drugs to kill cancer cells.
• Clinical trials are ongoing with biological therapy to treat the body that fight cancer. In this therapy uses materials made by the body or made in a laboratory to boost, direct or restore the body's natural defenses against disease. Biological therapy is also known as therapy biological response modifier or immunotherapy.

Surgery

• Surgical removal is the most important initial therapeutic approach in virtually all primary brain tumors. Fulfills three essential and immediate objectives: Sets
histological diagnosis  
quickly relieves intracranial pressure and mass effect, thus improving neurological function  Achieves
oncological cytoreduction may prolong life, improve the efficacy and safety adjuvant treatments such as radiotherapy, or both.
• The technological and conceptual advances of neurosurgery are continuous and have allowed the design safest and most effective forms of treatment. Tumors previously considered inaccessible, such as those located in deep regions can be addressed safely using a surgical microscope, microinstrumentación and microsurgery. • Few
intracranial tumors beyond the direct surgical access achieved by the current neurosurgical technology, laser, ultrasonic aspirators, ultrasounds, stereotactic surgery procedures and neuronavigation.

• In the majority of benign extra-axial lesions (meningiomas and acoustic neuromas), the goal of surgery is total removal healing potential. In these cases, the challenge is to remove the tumor as completely as possible, while reducing surgical trauma to adjacent nerve structures. This can be achieved, especially with the use of intraoperative electrophysiological monitoring techniques, which can alert the surgeon about the risk to vulnerable neural structures during the removal of the tumor.
• In invasive malignant intra-axial tumors of glial origin in most cases, surgery can get to the histological diagnosis and is a measure of temporal control, it reduces the mass effect and ICP. By its nature locally aggressive, malignant brain tumors are not susceptible of cure at present and require control to go to multimodal strategies. Although there is some discussion on what should be the mission of aggressive surgery in the treatment of these lesions, most of the neuro-oncologists agree that the "debulking" and elimination of tumor surgical goals are reasonable, provided that achieve without causing neurological deficits.
• Morbidity and mortality of cranial operations have decreased dramatically in recent decades. Mortality rates at 30 days after the extirpation of brain tumors are generally less than 3% in recent series. The rate of complications depends on the nature of the tumor and its location. Severe complications (bleeding at the site of surgery, infection and permanent neurological damage) together, affect < 10% de los pacientes.

Corticosteroids and cerebral edema

• By mechanisms not yet clarified, it is common for brain tumors, both benign and malignant causing vasogenic edema in the peritumoral brain tissue. Sometimes can be massive brain swelling, which contributes significantly to the overall mass and accelerated neurological deficits clinically all caused by the tumor itself.
• Corticosteroids have become an important therapeutic role antiiflamatorios agents capable of rapid and effective reduction of peritumoral edema. The fact that these agents may occur often on their own, immediate and dramatic improvement of clinical status and neurological function, frames the pathophysiological contribution to the deterioration of global cerebral edema secondary to neoplasia.
• In general, steroids are administered in the perioperative period and their doses are reduced gradually after the removal of the tumor. Also serve a palliative function in patients with progressive and recurrent malignant tumors, where they can enhance the function residual neurological, at least temporarily. Radiotherapy



• It has demonstrated the efficacy of radiotherapy in the majority of malignant brain tumors. Once the pathologic diagnosis of malignancy and performed brain surgery to remove the maximum, the default is that radiation therapy is indicated. Although the different histological entities show individual differences in their sensitivity to radiation, the improvement in survival in the short term (1-5 years) to get to her becoming well established in use in most CNS tumors. The main factor limiting their long-term effects is the level of tumoricidal radiation doses, which often exceed the tolerance thresholds of the CNS. Even when prescribed dose of radiation contained within the set tolerance levels (40-60 Gy), the brain is vulnerable to various toxic effects.
• Acute reactions that occur during or immediately after radiation, are the result of acute brain swelling and is manifested by increased neurological deficits. Fortunately, these reactions respond well to steroids and generally are reversible, from 1 to 3 months after radiation syndrome usually appears similar but delayed, also reversible with steroids. The reaction brain less frequent but more severe and irreversible, is known as radiation necrosis, which can appear months or years after radiation therapy. It is a progressive brain reaction presumably due to direct toxicity to the brain and its microvasculature.

• Affected patients suffer from an insidious and progressive deterioration, focal neurologic signs and dementia. Radiation necrosis may be difficult to distinguish from tumor recurrence, and both show the clinical and imaging characteristics similar. In these circumstances, treatment may include steroids or rescue decompressive intervention. However, many patients are often in terminal stages of their disease, so the most appropriate treatment is, in most cases, conservative and palliative.
• As the survival of patients with CNS tumors is prolonged, there are several additional complications of long-term radiation aroused increasing concern. These include hypopituitarism, occlusive disease of the arteries and radiation-induced oncogenesis. The radiation-associated tumors (meningiomas, sarcomas and gliomas) are a rare late complication that usually occurs decades after cranial radiation. More worrying are the risks of radiation in young children, such as learning disorders, pituitary insufficiency, the myelopathy and spinal deformities, in addition to the adverse effects mentioned above. As a CNS myelination usually completed towards the 2 to 3 years of age, radiation therapy prior to these dates is especially dangerous and generally should be avoided. Chemotherapy



• Despite periodic episodes cause short-term optimism, chemotherapy has not yet produced significant impact on the treatment of malignant brain tumors. Virtually all available antitumor agents for the treatment of hematologic malignancies and systemic also have been studied in brain tumors. Except for some recent successes in certain childhood tumors such as germinoma and medulloblastoma, this therapy has not produced consistent benefits for most patients. • In purely
cancer, brain tumors, with highly localized position, relatively small tumor mass and metastatic nature should respond well to chemotherapy, however, these factors are offset by the peculiar complexity of the CNS, hamatoencefálica barrier which severely limit access to most antitumor agents. Although farmacolofisiológica integrity of this barrier is altered in varying degrees among different brain tumors, the penetration of most chemotherapeutic agents remains limited.
• However, a small number of non-polar soluble compounds and low molecular weight able to freely cross the blood brain barrier intact. These include the nitrosoureas, the hydroxyureas and diazoquinona (AZQ).
• Access from other less permeable agents (methotrexate, vincristine, cisplatin) can sometimes be facilitated by breaking the osmotic blood-brain barrier, or by Intrathecal and intra-arterial administration. Of these six agents, the nitrosoureas and hydroxyureas are the best studied. In a recent analysis of prospective randomized studies conducted in the last decade has shown that chemotherapy given after surgery and radiation for malignant gliomas, provides a modest increase in survival.
• The average survival rate at 24 months was 23.4% in the group receiving chemotherapy and 15.9% in those treated with surgery and radiotherapy. However, this gain is small but statistically significant, it can often be masked by other variables such as age and functional at the time that expresses the tumor.


Other adjunctive treatments

• Almost without exception, virtually all patients with malignant brain tumors eventually develop local recurrence, although the treatment has been aggressive and multimodal (surgery, radiotherapy and chemotherapy). In the last decade has significantly defined adjuvant strategies to control local tumor growth, among which are alternative methods of administration of radiation and immunotherapy. Of these, interstitial brachytherapy and stereotactic radiosurgery are gradually gaining acceptance, if While immunotherapy also get some minor results in certain patients. All these modalities are options that can be offered.

CRANIOTOMY:

• Definition: The surgery is performed to treat brain injuries and its surrounding structures through an incision in the skull (craniotomy).

Description:
• The scalp is partially shaved, cleaned and prepared for surgery, an incision through the scalp and the skull is punctured. While doing brain surgery involves removing a portion of cranial bone (usually temporarily) which is then placed back and set in place.

Directions:

• The brain surgery may be needed to treat: brain tumors

• • bleeding (hemorrhage) or blood clots (hematomas) from injuries (subdural or epidural hematomas)
• weakness of blood vessels (cerebral aneurysms)
• arteriovenous malformations (AVM, abnormal blood vessels)
• damage to the lining of the brain (dura)
• accumulations of infection in the brain (brain abscesses)
• severe facial neuralgia or pain (eg neuralgia trigeminal or tic douloureux)
• head injury and skull fracture repair

Risks:

• Risks for any anesthesia are:
• Drug reactions

• breathing problems • The risks for any surgery are :

• infection • bleeding
• Additional risks of brain surgery are:
• cerebral tissue injury
• blood vessel damage
• muscle weakness or paralysis or nerve
• loss of mental functions (memory, speaking, understanding)
Expectations after surgery
• The results depend largely on the underlying disease being treated, the patient's general health, the extent of the procedure and the surgical techniques employed. Convalescence



• Recovery time ranges from 1 to 4 weeks and full recovery can take up to 8 weeks.
• Brain (brain) is located inside the skull, which is formed by a series of bones. The skull protects and supports the brain.

• Brain surgery is performed to treat: brain tumors

• • Bleeding (hemorrhage) or blood clots from injuries (subdural hematoma or epidural)
• Weakness of blood vessels (cerebral aneurysm)
• Damage to tissues covering the brain (dura)
• pockets of infection in the brain (abscesses brain)
• Severe pain or facial nerve (trigeminal neuralgia or tic douloureux)


• Epilepsy • The craniotomy is a surgical procedure that can enter the brain through the skull. Shaving the scalp for an incision and then make a hole through the skull. He takes a piece of the skull while the brain is operated and is put back before suturing the scalp.
• The results depend on the origin, severity and location of the problem.

herniated nucleus pulposus (HNP)

Alternative Names: Cervical Radiculopathy, Herniated disc, herniated intervertebral disk; Radiculopathy lumbar intervertebral disc prolapse, ruptured disc, herniated disc
Definition:
• A herniated disc is a dislocated disc herniated disc or along the spinal cord. The condition occurs when all or part of the soft center of a spinal disk is forced to pass through a weakened part of the disc.

Causes and risk factors:

• The bones of the spine or vertebrae running down the back, connecting the skull to the pelvis. These bones protect nerves that come out of the brain, down the back and then travel from there throughout the body. The spinal vertebrae are separated by disks filled with a soft, gelatinous substance, which provide cushioning to the spine. These disks may herniate (move out of place) or rupture from trauma or strain.
• The spine is divided into several segments: the cervical spine (neck), thoracic spine (part of the back behind the chest), lumbar spine (lower back) and sacral spine (the part connected to the pelvis).
• The Radiculopathy refers to any disease affecting the spinal nerve roots. A herniated disk is one cause of radiculopathy (sciatica).
• Most hernias occur in the lower back or lumbar spine area. Lumbar disk herniation occurs 15 times more frequently than cervical disc herniation (neck) and is one of the most common causes of back pain. For its part, the cervical discs are affected 8% of cases, while discs of mid-back (thoracic) in only 1 to 2%.
• Nerve roots (Large nerves that branch off the spinal cord) may become compressed resulting in neurological symptoms such as sensory or motor changes.
• Disk herniation occurs more frequently in middle-aged men and elderly, especially those involved in strenuous physical activity. Other risk factors include any congenital conditions that affect the size of the lumbar canal.

How does it occur?

• The fissure, protrusion or herniated disc occurs when pressure inside the disc is greater than the resistance of the fibrous. As the fibrous is third thicker in its anterior wall in the later, most of the cracks, protrusions and herniations occur in the latter.
• The typical mechanism consists of the following movement sequence:
• Bending the spine forward: When you do the wheel is more load on the front. When jelly-like nucleus pulposus is compressed against the back wall of the fibrous. • Load weight
important: When do you tend to be compressed a vertebra against the other, increasing the pressure within the disc.
• Extension of the spine with the weight loaded: In doing so, the increased pressure load disc that carries the weight is "squeezing" the core pulposus back harder. If the pressure against the back wall of the fibrous enough, the envelope tears (fissures disk), bulges (prorusión disk) or part (herniated disk).
• A similar effect can be achieved by repeated flexion and extension movements with a smaller load or no load. Each time you generate small impacts against the rear wall of the fibrous.
• These mechanisms occur more readily when the muscles of the back are not very powerful. If they are sufficiently developed, these muscles protect the disc by several mechanisms. Symptoms



LUMBAR DISK HERNIA SYMPTOMS: Severe


• Lumbago • Pain that radiates to the buttocks, legs and feet
• Pain that worsens with coughing, straining, or laughing
• Tingling or numbness in the legs or feet
• Muscle weakness or atrophy in later stages
• Muscle spasm

SYMPTOMS OF CERVICAL DISK HERNIA:

• Neck pain, especially in the back and sides
• Deep pain near or over the scapula on the affected side
• Pain radiating to the shoulder, upper arm, forearm, and rarely the hand, fingers or
• Worsening chest pain when coughing, straining, or laughing
• Increased pain when bending the neck or turning head to one side
• cervical muscle spasm
• Weak arm muscles

Signs and tests

• A history and physical examination of pain may be sufficient to diagnose a herniated disc. The doctor perform a neurological exam to evaluate muscle reflexes, sensation and muscle strength. Often, examination of the spine revealed a decrease in the curvature of the spine in the affected area.
• Pain in the leg occurs when the person sits on the exam table and lift your leg straight up usually suggests a herniated lumbar disc.
• "foraminal compression test of Spurling" is done to diagnose cervical radiculopathy. For this test, you will bend your head forward and sideways, while the physician applies a slight downward pressure on the top of the head. In general, increased pain or numbness during this test is indicative of cervical radiculopathy.

DIAGNOSTIC TESTS:

• You can take a spine radiograph to rule out other causes of neck pain or back. However, it is not possible to diagnosis herniated disk by a radiograph of the spine.
• Spine MRI or spine CT will reveal the spinal canal compression by the herniated disc.
• myelogram may be done to determine the size and location of the hernia.
• You can take an EMG to determine exactly what the involved nerve root.
• You can also conduct a test of nerve conduction velocity.

Treatment:

• The main treatment for a slipped disc is a short period of rest anti-inflammatory analgesics and physical therapy followed. Over 95% of people who follow these treatments will recover and return to normal activities. A small percentage of people need additional treatment may include steroid injections or surgery.

DRUGS:

• For people with a sudden herniated disk caused by some type of trauma (like a car accident or lifting a heavy object), immediately followed by acute back pain and leg were prescription narcotic analgesics and nonsteroidal antiinflammatory drugs (NSAIDs).
• If the patient has back spasms, usually given muscle relaxants and, on rare occasions, steroids may be given either by pill or directly into the bloodstream through an intravenous (IV).
• NSAIDs are used to control prolonged pain, but narcotics may be given if the pain does not respond to anti-inflammatory drugs.

LIFESTYLE CHANGES:

• Any extra weight being carried by an individual, especially in the top front of the abdomen, worsen any back pain. Exercise and diet are crucial to improving back pain in overweight patients.
• Physiotherapy is important to almost all people with disease disc. The therapists provide advice on how to properly lift, walk, dress and perform other activities. They will also work on strengthening the muscles of the abdomen and lower back to help support the spine. The flexibility of the spine and legs is taught in many therapy programs.
• Some recommend the use of braces (brace) for the back to help support the spine. However, overuse of these devices can weaken the abdominal muscles and back, causing a worsening of the problem. Special straps to lift weights can be useful to prevent injuries in those whose work involves heavy lifting.

SURGERY:

• For the few patients whose symptoms persist despite the above interventions, surgery may be a good choice.
• discectomy is a procedure that requires general anesthesia to remove a protruding disc. The hospital stay is 2 to 3 days. The patient is encouraged to walk the first day after surgery to reduce the risk deTVP.
• Full recovery takes several weeks. If it is necessary to remove more than one disc or if there are other problems in the back besides a herniated disk, may require more extensive surgery, which may require a recovery period much longer.
• Other surgical options include microdiscectomy, a procedure removing fragments of nucleated disk through a very small incision.
• Chemonucleolysis involves the injection of an enzyme (called chymopapain) into the herniated disk to dissolve the protruding gelatinous substance. This procedure may be an alternative to diskectomy in certain situations.

Expectations (prognosis):

• Most people improve with conservative treatment and only a small percentage continues to suffer from chronic back pain even after treatment.
• It may take several months to a year or more for the patient can resume all activities without pain or tightness in the back. It is possible that people with certain occupations that involve heavy lifting or straining your back have to change job activities to prevent recurrent back injury.



Complications • Chronic back pain
• Permanent injury to the spinal cord (rare)
- loss of movement or sensation in the feet or las piernas
– pérdida de la función de la vejiga y de los intestinos

Prevención

• Las prácticas seguras durante el trabajo y el juego, las técnicas apropiadas para levantar objetos y el control de peso pueden ayudar a prevenir las lesiones de espalda en algunas personas.

HIDROCEFALIA:

• ESPACIO DEL LIQUIDO CEFALORRAQUIDEO
• El líquido cefalorraquídeo circula normalmente por el sistema ventricular, que encierra el espacio interno, y por el espacio subaracnoideo, el espacio externo, pasando por los orificios de Luschka y de Magendie. El líquido es producido por los plexos coroideos y reabsorbido en parte por las vellosidades of Pacchioni. In adults, usually amounting to about 150 ml, of which about a quarter are located in the ventricular system. Normally produce and reabsorb about 20 milliliters per hour, about 500 ml per day.


CONCEPT AND METHODS OF HYDROCEPHALUS

• Hydrocephalus is essentially a pathological increase of cerebrospinal fluid, which especially in children leads to increased brain volume and head. Dilation of the ventricular system causes a pressure atrophy. The atrophy may be so strong that the brain walls are reduced to a millimeter thick. • distinguish
pathogenetic hydrocephalus communicating and not communicating.
• In the first form the liquid flows freely through the internal and external spaces. This is an increase in fluid reabsorption by decreasing or overproduction. The most common form is the first condition. This is caused by blockage of the hairs usually Pacchioni fibrosis. The fibrosis may be a sequel to meningitis or meningeal hemorrhage. Hydrocephalus caused by overproduction is rare and may occur in cases of choroid plexus papilloma.
• In noncommunicating hydrocephalus there is a blockage in the flow of the liquid located between the sites of production and resorption. The most commonly frequent in the aqueduct, where the obstruction can be caused by a malformation with branching and stenosis by inflammation or tumors. Less commonly the blockage is in the holes of Luschka and Magendie, caused by fibrosis as a consequence of inflammation or bleeding.

• Causes of hydrocephalus:

• There are many causes within the most frequent are: tumors that obstruct the normal circulation, bleeding, head trauma, infections (meningitis), stroke in certain areas, bruising, parasitic diseases in the nervous system (such as neuro-cysticercosis) some obstructions and congenital malformations of the nervous system (brain and spinal or vertebral column). There are also called primary hydrocephalus, where there is no clear causal for the genesis of hydrocephalus.

Symptoms:

• The symptoms usually are due to increased pressure inside the skull or intracranial hypertension due to abnormal accumulation of cerebrospinal liquid. These consist of severe headache and increasing (more commonly in the morning), vomiting, impaired consciousness (drowsiness, somnolence), changes in vision and eyes, trouble walking, impaired breathing, among others. In the long term, untreated hydrocephalus can time serious intellectual sequelae in patients, especially children (delays).
• In young children, when the skull has not closed yet, you can see an abnormal increase in head size and a protrusion at the level of Fontanellas or soft spots. Symptoms, especially in acute hydrocephalus, a patient can lead to coma and even death without appropriate treatment. Acute Hydrocephalus



• hydrocephalus is a type of violent onset that quickly leads to a syndrome of intracranial hypertension and can cause death if not resolved. The patient moves from normal to eat quickly, and there is usually a history of trauma, bleeding, stroke, an infection of the nervous system, brain tumors that have complicated and others. This table often occurs in patients previously operated for hydrocephalus in which the fluid diverter valve that is installed can be covered or dysfunction.


What normo-tensive hydrocephalus or hydrocephalus in adults?

• A special type of hydrocephalus where the pressure of cerebrospinal fluid is normal or slightly increased (hence the name), which usually occurs in older adults with impaired absorption of fluid is not produced by any specific disease (primary) and it causes very characteristic symptoms: impaired consciousness (memory and other skills), a particular imbalance in walking and loss of sphincter control. This triad (3 symptoms) feature can occur in elderly patients for many other reasons (dementia, Alzheimer's, Parkinson's disease, genital prolapse, multiple strokes, etc.) So that the diagnosis of this type of hydrocephalus is particularly difficult and requires a careful medical assessment, special tests and sometimes therapeutic trials with serial lumbar punctures.

Diagnosis:

 Diagnosis is based on a rigorous assessment specialist with the support of imaging tests like magnetic resonance scanner, which will increase the size of the cerebral ventricles. In the case of normo-tensive hydrocephalus are also requested a special study of the circulation of fluid called radio-isotope cisternography, where a measurable isotope is introduced into the cerebrospinal fluid to determine its absorption.
• In the case of a patient previously operated and suspected a malfunction of the valve but not fully clarified by the initial images and when it is not an absolute emergency, you may also do a valvulografía, which determines a possible obstruction of the valve and the latter's position.

Treatment:

• When hydrocephalus diagnosed with certainty, the procedures are designed to remove excess fluid puts pressure on the nervous system. For this there are drainage systems (internal and external) and neuro-endoscopy.
• Internal systems are valves that can be ventriculo-peritoneal (the most often used to draw fluid from the cerebral ventricles to peritoneum in the abdomen where it gets reabsorbed) ventriculo-atrial (from the ventricles into a cavity of the heart, reserved for special cases); valves lumbo-peritoneal (from fluid in the lumbar region into the peritoneum in abdomen), among the most used. Systems operate at different pressures and adjustable pressure valve to be used depending on the case.
• The external drainage of cerebrospinal fluid are temporary and serve to pass an emergency where the cause of hydrocephalus is not supposed to be permanent, or when an infection can not be for some time install a valve definitive risk contamination. These systems are introduced into the ventricles and fluid accumulates in a reservoir bag or sterile. In some cases the catheter can drain the fluid from the area of \u200b\u200bthe spine to an external reservoir (in some cases of communicating hydrocephalus).
• The neuro-endoscopy is a breakthrough in the treatment of hydrocephalus of non-communicating or obstructive type. This procedure makes a small hole in the base of the brain that produces a by-pass bridge that bypasses the site of the blockage in certain types of hydrocephalus. This allows not stop valves. However, you can only raise this procedure in a group of patients, usually in pediatric patients.


Forecast and possible sequelae of hydrocephalus

• This is very variable and depends heavily on other diseases of the patient, such as hydrocephalus and early diagnosis and treatment. If the cause of hydrocephalus manages to be treated, and it is managed and compensated hydrocephalus, evolution can be successful and you can choose to optimal quality of life. A patient with a bypass valve can perform a completely normal life. The most common complications of these valves are possible infections and obstructions

• Cerebrospinal fluid (CSF) bathes the brain and spinal cord. The highest concentration of this fluid is located in the ventricles of the brain, which are large cavities that produce and reabsorb the CSF.

• In cases of hydrocephalus, the ventricles of the brain increase in size the effect of cerebrospinal fluid. This causes the brain tissue is compressed against the skull and cause serious neurological problems, so it is necessary to place a shunt, also called ventriculoperitoneal shunt to drain excess fluid and relieve pressure on the brain. This procedure should be performed as soon as hydrocephalus is diagnosed, to offer the child the best neurological perspectives.
• A flap is cut in the scalp to drill a small hole in the skull, while the patient is in the operating room under general anesthesia.
• A small catheter is inserted into one of the ventricles of the brain and you connect a pump to keep the fluid away from the brain. Another catheter is connected to the pump and placed in a tunnel (under the skin) behind the ear, that goes down the neck and chest. The catheter should reach the peritoneal cavity or abdominal cavity, where the fluid is absorbed.

• Often the ventriculo peritoneal is crucial to prevent and avoid serious brain damage in children with hydrocephalus. Common problems associated with ventriculo peritoneal include the same malfunction and shunt infection.
• However, when there is no problem, they often leave the derivation for many years.


NURSING CARE OF PATIENTS WITH NEUROLOGICAL

NURSING CARE PLAN IN ACV. • Assessment



- Making history, how the symptoms started and how long.
- Level of consciousness
- Headache
-
vision disturbances - signs of hypertensive crisis (redness, tinnitus)
- previous pathologies (hypertension, arrhythmias)
- Difficulty breathing
- Rating hemodynamic (hypertension associated with bradycardia)
- Rating neurologic
- size and reaction of pupils.
- Language, memory, comprehension (dysarthria)
- motor response (movement of limbs)
- signs are valued and Brudzinsky Kerning.
-
usual treatment - Urinary incontinence
- muscular flaccidity
- Disorientation, agitation or drowsiness
- emotional lability
- aphasia, apraxia, hemianopsia, hemiparesis, anisocoria
- Seizures
- Paralysis Nursing Diagnoses



sensory perception disorders associated with brain damage caused by the disease process
Impaired physical mobility associated with decline of brain function
functional urinary incontinence associated with impaired cognitive and sensory
risk of aspiration associated with a decreased level of consciousness and reflexes


Objectives

gradually Regain sensory perception functions, aided by interdisciplinary therapy.
gradually recover mobility features of the limbs. Lost
functionality of the bladder and sphincter, with the help of therapy and exercises.
Reduce the risk of aspiration with preventive measures.




Implementation and activities • Conduct monitoring the vital signs according to patient severity.
• Maintain adequate food supply
• Attend
• If the patient has difficulty swallowing keep feeding baby food. • Maintain position
fowler. • Installing SNY
feed if necessary.
• Care nasojejunal tube. • Maintain adequate hydration

• Teaching family to care to be maintained during feeding.
• In patients with hemiparesis, performing daily exercise program and coordination with physical therapist.
• Making changes of positions and bedsore prevention every 2 hours.
• Schedule an early ambulation.
• In patients with urinary incontinence avoid the use of urinary catheters.
• Start education program bladder
• Schedule frequent genital grooming.
• Avoid use of diapers and encourage the patient to urinate at least every two hours.
• Avoid liquids that increase urine output during the acute stage.
• Teaching to perform Kegel exercises to strengthen pelvic floor muscles.
• Teach breathing exercises improve breathing capacity pair.
• Prevention of DVT in immobilized patient.
• Encourage the patient to perform self-care activities alone.
• Maintain proper sleep patterns, avoid nighttime stimulation.
• Use natural methods to induce sleep, music, relaxation methods.
• Management of sleep medications as directed by medical.
• Help the patient to recognize their limitations and how to deal with them.
• Education on temporary or permanent changes that may occur to the patient. Evaluation





• The multidisciplinary therapy helped patients regain function gradually deteriorated during the stroke.
• The patient gradually regained lost mobility during the evolution of stroke.
• The patient regains its function to maintain urinary continence sphincter using exercises and therapy.
• The patient has no signs or symptoms of aspiration pneumonia during hospitalization.


NURSING CARE OF PATIENTS WITH INFECTIOUS DISEASES OF THE NERVOUS SYSTEM

• Assessment

- Signs and symptoms of infectious (ears, lungs, sore throat, etc.).
- lethargy, irritability, drowsiness, seizures, behavioral disorders, focal deficits, hemiparesis.
- vomiting, fever, dry skin and mucous membranes.
- Signs and symptoms of shock
- headache and stiff neck
- Seizures
- Presence of cutaneous rush, petechiae or purpura (meningococcal meningitis)
- Kerning and Brudzinski signs



Nursing Diagnoses infectious process associated with hyperthermia
cerebral intracranial pressure increased inflammatory process associated with risk of deterioration
cognitive function, sensory and motor cerebral pathological process associated with




Objectives - Maintain a temperature below 37 ° C helped physical and therapeutic measures.
- Promote the reduction and prevent the increase in ICP with therapeutic measures and nursing.
- Reduce the risk of deterioration of brain functions across medical and therapeutic measures. Performances and activities



• Control of vital signs and T ° every 2 to 4 hours in the acute phase.
• Administration of antipyretic medications as directed.
• Application of physical for fever.
• Increase hydration and fluid intake. BH

• EVA • Assess pain characteristics.
• Administration of pain medication as medical indication. • Avoid overstimulation
environmental and noise.
• Keep room with dim light. • Restrict visits
case suspend bacterial meningitis.
• Avoid vomiting, if you have to ask the doctor antiheméticos management. • Keep head
30 ° with the head in midline.
• Avoid prolonged efforts (defecar9
• neurological assessment continuously for at least 4 times a day for signs of neurological impairment.
• Protect against falls.
• Attending physician for lumbar puncture:
- Preparation of material (trocar, syringes, culture bottles, clothing, etc.).
- Position of the patient.
- Monitoring
- Care puncture
 promote patient mobility passive exercises. Prevention of thromboembolism

  Perform patient comfort.
 Observe signs and symptoms of seizures



Evaluation • Patient presenting its temperature decreases new pick fever.
• The patient shows no signs of increased intracranial pressure.
• Patient to its high deficit shows no signs of cognitive, sensory or motor.

NURSING CARE degenerative



• Assessment - Anamnesis
- Duration
box -
to Symptoms - Engine: loss of strength fatigue, clumsiness, spasticity, dysphagia.
- Sensitive: numbness, paresthesia, decreased sensation, Lhermitte's sign (electric shock sensation)
- Visuals: optic neuritis, blurred vision, diplopia.
- Sphincter: spastic bladder hyperreflexivity (Incontinence), urinary retention, constipation, rectal urgency or incontinence.
- Sex: lack of desire, impotence, decreased sensitivity.
- Psychological: euphoria, cognitive disturbances.
- Onset of symptoms in outbreaks last for days, weeks or months.
- Symptoms can is related to endogenous or exogenous factors such as elevation of the t ° body, emotional stress, fatigue and viral infections.
- Rate
ulcers - Power Type
- Altered urinary or fecal.
- disorders of gait.
- Activities of daily living performed.


Nursing diagnosis

physical mobility impairment associated with disorder of neuromuscular function.
Altered urinary excretion associated with spinal cord dysfunction and impaired cognitive and motor skills.
body image disturbance associated with progressive deterioration of cognitive functions, sensory and motor. Objectives




Lost or decrease physical inactivity through comprehensive program of exercises
Regain urinary function appropriate to the patient.
help the patient maintain a healthy body image adapting to physical and intellectual changes that will arise.

Execution and activities

• Carrying out a program of exercises with rest periods.
• Help plan activities to avoid wastage of energy.
• Drug Administration for spasticity according to medical indications. • Avoid self-medication

• Make prevention of bedsores
• Adapting your home to meet the changes in his daily life
• Maintain a balanced diet
• Prevent constipation
• Facilitate access to the bathroom
• Establish regular times for
toilet • Use of urinary catheters only when necessary.
• Education families and caregivers about the disease process and home care. Evaluation



• The patient has a good mobility without showing greater degree of impairment.
• The patient recovers all or part of urinary function.
• Patient to its high is calm with a good adaptation to their shortcomings and improve their body image.

After Gallbladder Surgery







INTRODUCTION

ü The eyes are the organs of vision which we connect with the visual world. They consist of highly specialized and complex structure that receives and sends visual information to the cortex. This sense allows us to identify different qualities of bodies are animate and inanimate in the environment, more or less near the body.
This is done by pro's ability to catch the eye of light rays reflected on the bodies.

Physiology of the ocular system:

ü Anatomically differs in the eyeball, optic pathway (optic nerve), central nervous structures and accessory structures eye. Ü


accessory structures of the eye: around the globe and their functions are protection, cleaning, lubrication, eye movement and encouraging proper refraction. Ü
These structures include: eyebrows, eyelids, eyelashes, lacrimal apparatus and extrinsic oculomotor muscles.

Eyeball


is reversed from 3 primary layers: sclera, uvea and retina. Ü

Sclera: outer layer at the back has an opening for passing the optic nerve and retinal blood vessels in the anterior part is continuous with cornea. Ü
Uvea: pigmented middle layer consists of choroid, iris and ciliary body. Ü
Retina: inner layer is semi-transparent thin tissue that covers eight layers inside the eye wall. It contains light-sensitive cells (rods and cones)

anterior chamber structures:

ü portion of the eye is limited in the rear by the front surface of the iris and lens, and part earlier in the cornea.
ü The anterior chamber is filled with liquid, the aqueous humor maintains intraocular pressure. Ü
Cornea: transparent convex structure that covers one sixth of the eye. Ü
Iris: raised vascular structure with variable pigment. Ü
Pupil: is the space left by the inner ring of the iris. Ü
Lens: biconvex structure not clear colorless vascular sustained lifting behind the iris by the ciliary body zonules. Ü
ciliary body: is a ring adjacent to the iris tissue following a course of 360 ° in the rear. Produces aqueous humor and adjusts the shape of the lens to accommodate, or focus. Ü
Humor aqueous: is produced in the posterior chamber by the ciliary body and circulates around the lens and iris in the anterior chamber. Provides essential nutrients to the nonvascularized tissues of the anterior chamber of the eye removed metabolites and provides a suitable chemical environment.

posterior chamber structure:

ü Limited is a small segment in the anterior and posterior vitreous humor. Ü
ciliary body was found, the ciliary zonules, the posterior aspect of the lens and aqueous humor.
ü The vitreous is the largest chamber and posterior. For the front is limited by the lens and ciliary body, on the back of the retina. It is made of transparent and liquid collagen gel, shapes the eyeball.

The outer layer or tunic (sclera, or white of the eye and cornea) is fibrous and protective. The layer of the tunica media (consisting of the choroid, ciliary body and iris) is vascular. The innermost layer is nervous or sensory retina. Eye fluids are separated by the lens into the vitreous humor behind the lens and aqueous humor in front of the lens. The lens itself is flexible and suspended by ligaments which allow it to change shape to focus light on the retina, which is composed of sensory neurons.

visual processing:

ü phototransduction of light in bioelectric potentials takes place in outer segments of photoreceptors (cone and rod). Ü
Stimulation of the photo pigments by photons of light is the first mechanism of phototransduction. Ü
chemical changes caused in the photo pigments containing rods and cones produce visual cell hyperpolarization and the generation of photoreceptor potential is transmitted to the bipolar cell, ganglion and optic nerve. Ü


The visual signals are processed in the thalamus and occipital cortex carried, in the visual cortex produces a holistic integration of all information related to your subject: color, shape, size, movement and spatial organization. Considerations

gerantológicas

ü With advancing age, the vision becomes less efficient. The pupil reacts less in accordance with the light, pupillary sphincter sclerosis, which reduces the diameter of this hole.
ü The lens becomes more opaque visual field decreases, which makes peripheral vision
ü eyes adapt to darkness more slowly, so vision at night or in poorly lit areas is less clear. Ü
slows the process of accommodation and the lens loses its elasticity and becomes a relatively solid mass ü
ciliary muscles become less flexible and functional. The vision of nearby objects require more work of the ciliary muscles.
ü The liquid portion of the vitreous is increased by 50%. The collagen material coalesce and vitreous floaters occur typically seen in the visual field. Ü
degenerating retina, especially in the macula, which cause deterioration sclerotic changes vision.


rating ophthalmology

ü ophthalmic Background: Data on changes in vision, congenital disorders, diseases such as diabetes or hypertension, use of glasses. Ü
ophthalmic symptoms such as photophobia, headache, tingling, sore eyes or eyebrows, itching, tearing, floaters, secretions. Ü Use of drugs


Medical History:

§ observable changes in the structure and visual function.
§ § Background Psychosocial Assessment
physics of vision and §
eye visual acuity assessment (Snellen chart) §
eye movement rating


visual field assessment:

- Physical examination of the eye (external and internal structures): exophthalmos, ptosis, entropy , poliosis
- Consideration of the anterior sclera and conjunctiva of the eye.
- Review of the cornea, anterior chamber, iris, pupil, lens.
- Ophthalmoscopy
- Measurement of eye pressure (tanometría)

slit lamp examination:

slit lamp, which is a microscope specialized growth, is used to examine the structures of the eye such as cornea, iris, vitreous and retina. The slit lamp is used to examine, treat with laser and shoot the eye.


EYE DISORDERS

The eye is subject to various conditions, the different structures of the eye.

disorders of the eyelids:


blepharitis: inflammation of the eyelid margins.


Horzuelo: infection of the glands of Zeis or Moll's surface eyelids.

lacrimal system disorders:


has to do with the production of tears or inflammation of the drainage system.


dacryocystitis: suppurative cellulitis of the lacrimal sac secondary to nasolacrimal duct obstruction.

disorders of the conjunctiva:


Conjunctivitis: inflammation of the conjunctiva characterized by inflammation and exudate. Can be infectious, immunologic, imitative, related to systemic disease.


pterigon: overdevelopment of fibrovascular tissue triangular intrapalpebral bulbar conjunctiva with extension into the cornea.


hemorrhage of the conjunctiva: dilated superficial blood vessels in the conjunctival background which fades into the corneal scleral limbus.


cornea disorders:

ü corneal abrasions: epithelial layer defects caused by trauma, foreign bodies, contact lenses, difficulty closing the eyelids or eyelid malposition or eyelashes. Ü


microbial keratitis: infection of the cornea, produces a marked inflammation of the eye, drainage mucupurulenta, hypopyon (pus in anterior chamber)

crystalline disorder:

ü Cataracts: Opacity Crystal


ü It is a cloudy or opaque area (an area through which a person can not see) in the lens of the eye.

Causes and risk factors

The lens of the eye is normally clear and when the lens becomes cloudy, the condition is known as cataract. Rarely, cataracts may be present at or shortly after birth, in which case they are called congenital cataracts.
The Adult cataracts usually develop with advancing age and can run in families. Cataracts develop more quickly in the presence of some environmental factors such as smoking or exposure to other toxic substances, and can occur at any time after an eye injury. Metabolic diseases such as diabetes also greatly increase the risk of developing cataracts and certain medications such as cortisone, can also accelerate their training.

Cataracts defects can also be inherited and the gene that produces it is autosomal dominant (autosomal dominant), which means that the defective gene will cause the condition even if only one parent passes it along. In families where one parent carries the gene, there is a 50% chance in each pregnancy that the child is concerned.
Congenital cataracts can also be caused by infection of the mother during pregnancy such as rubella may be associated with metabolic disorders such as galactosemia.

Risk factors are inherited metabolic diseases, family history of cataracts and infection maternal viral during pregnancy.
The Adult cataracts are generally associated with aging and they develop slowly and painlessly, with a gradual deterioration in vision.


Visual problems may include the following changes:


• Difficulty seeing at night
• Seeing halos around lights
• Being sensitive to glare
• Problems with vision associated with cataracts generally move towards decreased vision, even during the day.

cataracts in adults are classified as immature, mature and hypermature. A lens that has maintaining clear areas called an immature cataract. A mature cataract is completely opaque, while hypermature cataract has a liquefied surface that leaks through the capsule and can cause inflammation of other structures in the eye.
Most people develop some clouding of the lens after age 60. About 50% of people between 65 and 74 years old, like 70% of people 75 years or older, have cataracts that affect vision.
Most people with cataracts have similar changes in both eyes, although one eye is worse than the other. Many people with this condition have only slight visual changes and are not aware of the problem.
Other factors that may contribute to cataract development are low serum calcium levels, diabetes, prolonged use of corticosteroids, and various inflammatory and metabolic disorders. Environmental causes include trauma, radiation exposure and too much exposure to ultraviolet light (sunlight).
In many cases, the cause of cataracts is unknown.

Cataracts are a leading cause of vision loss in older individuals, but children may have congenital cataracts. With surgery, cataract removal is possible and a new lens implanted and the patient can usually return home the same day. Symptoms



- Blurred vision, blurry, fuzzy or blurred
- Loss of color intensity
- Frequent changes in prescription glasses or goggles
- The glare from bright lights causes problems vision at night, especially when driving
- sensitivity to glare from lamps or the sun
- Halos around lights
- Double vision in one eye
- Decreased contrast sensitivity (the ability to see shadows or shapes against a background)

Signs and tests


- Standard ophthalmic exam, including slit lamp examination
- Ultrasound of the eye in preparation for cataract surgery
- Other tests may be done (rarely) are
- Test
brightness - contrast sensitivity test
-
potential vision test - specular microscopy of the cornea in preparation for cataract surgery treatment



The only treatment Cataract surgery is to remove them, which takes place when a person is unable to perform normal activities, even with glasses. For some, the act of changing glasses, getting stronger bifocals, or using a magnifying lens is helpful, while others choose to undergo cataract surgery.
If cataracts do not disturb a person, surgery is usually not necessary. There are times when you may have an additional eye problem that can not be solution without first having cataract surgery.
This surgery involves removing the eye's lens and its replacement with an artificial one. The cataract surgeon will discuss the options with the patient and together will decide on the type of removal and lens replacement is best.

REMOVAL OF LENS:


There are two different types of surgery that can be made for the removal of a cataractous lens. The
extracapsular surgery is the surgical removal of the lens leaving the back half of the intact capsule (the outer covering of the lens). You can use high frequency sound waves (phacoemulsification) to soften the lens to facilitate removal through a smaller incision.
The intracapsular surgery involves the surgical removal of the entire lens, including the capsule and is a procedure that is now very rare.

REPLACEMENT LENS:


People who perform cataract surgery usually receive an artificial lens at the same time. This artificial lens is a hard synthetic (manufactured) called intraocular lens is usually placed in the lens capsule inside the eye.
There are other options such as contact lenses or cataract glasses.
The surgery can be performed in a hospital or in an outpatient setting. Most people do not need to be hospitalized overnight, but need a friend or family member to move them from their homes and care after outpatient surgery. It is important that the surgeon will follow up the patient.

- The lens of the eye is normally clear. A cataract occurs when the lens becomes cloudy as you get older.
- Surgery is recommended for people with vision problems or other major problems caused by cataracts.
- In the treatment of cataracts using two procedures. In the manual extraction procedure, a small incision is made on the edge of the outer lining of the eye (cornea). After the lens is removed and replaced with an artificial

- Another procedure is called phacoemulsification, which involves inserting a needle through a small incision in the eye. The end of the needle produces sound waves that break the lens, which is then sucked through the needle.
- This procedure requires a smaller incision than the manual extraction procedure.
- The outcome of cataract surgery is usually excellent. The operation has few risks, pain and recovery time are minimal and the improvement of vision is remarkable. 95% or more of all cataract surgeries improve vision.


system disorders uveal

uveal ü The system consists of iris, ciliary body and choroid. Ü


Uveitis inflammation of one or all three uveal system structures. Produces pain, photophobia, blurred vision, and red eye.

MOVEMENT DISORDERS OF THE AQUEOUS HUMOR


Glaucoma:


Glaucoma refers to a group of disorders that lead to damage occurs to the optic nerve, the nerve that carries visual information from the eye to the brain. The damage to the optic nerve causes vision loss, which may progress to blindness. Most people with glaucoma have increased fluid pressure in the eye, a condition known as increased intraocular pressure.

Causes and risk factors


- Glaucoma is the second most common cause of blindness in the United States and there are four main types:


- open-angle glaucoma (chronic)
- Angle-closure glaucoma (acute)
- congenital glaucoma
- Glaucoma secondary


The four types are characterized by increased pressure within the eyeball, and therefore all can cause progressive damage to the optic nerve. Open-angle glaucoma (chronic) is by far the most common type of glaucoma.
The front of the eye is filled with clear fluid called aqueous humor, which is produced constantly in the back of the eye. It leaves the eye through channels located in the anterior chamber (front) and eventually drains into the bloodstream. The channels that drain the aqueous humor are in an area called the anterior chamber angle or simply angle.
In open-angle glaucoma, the channels in the angle gradually narrow with time, preventing proper fluid drainage. The accumulation of fluid causes increased pressure in the eye, which pulls the junction of the optic nerve and retina at the back of the eye, reducing the blood supply to the optic nerve.
As the optic nerve deteriorates due to decreased blood supply, blind spots develop in the field of vision. Affected first is the peripheral vision (side vision). This is usually not noticed until you lose a little vision. If the disease is not diagnosed and it is, you can lose much of the vision before the person is aware of the problem.
open-angle glaucoma tends to run in families and the risk is greater if you have a parent or grandparent with this condition. The black people have a particularly high risk for this disease.
angle-closure glaucoma (acute) is caused by a change in the position of the iris of the eye that suddenly blocks the exit of aqueous humor. This causes a quick, severe and painful pressure within the eye (intraocular pressure). Most people with angle-closure glaucoma redness and swelling in the affected eye. You can have nausea and vomiting. Angle-closure glaucoma is an emergency situation is very different from open angle glaucoma, which damages vision painlessly and slowly.
If you have had acute glaucoma in one eye, almost certainly at risk of an attack in the second eye, and the doctor may recommend preventive treatment.
drops to dilate the eyes and certain systemic medications may trigger an acute glaucoma attack if the person is at risk.
Secondary glaucoma is caused by other diseases, including eye diseases such as uveitis, systemic diseases, as well as by the use of some medications such as corticosteroids.
congenital glaucoma, present at birth is the result of abnormal development of the liquid flow channels of the eye and requires surgical correction. Congenital glaucoma is usually inherited.

Glaucoma is a condition caused by increased fluid pressure in the eye. The increased pressure causes compression of the retina and optic nerve, which can gradually lead to nerve damage. Glaucoma can cause partial vision loss and even blindness as a possible outcome over time.



Symptoms

OPEN ANGLE:


- Most people have no symptoms
- gradual loss of vision (side)


ACUTE:


- severe eye pain, facial pain
- Blurred vision or decreased
-
Red eye - Inflammation of the eye
- pupil does not react to light
- Nausea and vomiting (may be the major symptoms in the elderly)


CONGENITAL


- Tearing
- Sensitivity
light - Red eye
- Opacity in front of the eye
- Enlargement of one or both eyes

Signs and tests


An eye exam can be used to diagnose glaucoma. However, it is not enough to check the intraocular pressure alone (tonometry), since pressure changes. It is necessary to examine inside the eye looking through the pupil, often when it is enlarged.
usually makes a complete eye examination.


Tests include:


- Review of the retina
- Measurement of intraocular pressure by
tonometry - visual field measurement
- visual acuity
- Refraction
- pupillary reflex response
- Examination with the slit lamp
- Optic nerve imaging (photographs of the interior of the eye)
- consisting Gonioscopy in the use of special glasses to observe the flow channels

angle Treatment


The goal of treatment is to reduce intraocular pressure, which is achieved by using drugs or surgery, depending on the type of glaucoma .

treatment of open angle glaucoma:


Most people with glaucoma can be successfully treated with eye drops. In the past, eye drops for glaucoma caused blurring of vision, but most of the drops used today have few side effects. Your doctor will evaluate your medical history and determine the appropriate drops for everyone. It is possible that a person needs more than one type of drop. Some patients are also treated with pills to lower pressure in the eye.
drops are being developed and new pills that directly protect the optic nerve from glaucoma damage. Some patients
require additional forms of treatment such as laser treatment to help open the fluid flow channels. This procedure is usually painless. Others may need traditional surgery to open a new outflow channel.

treatment of angle closure glaucoma:

This type of glaucoma is a medical emergency and blindness can occur within a few days if not treated. Using eye drops, pills and intravenous drugs to lower blood pressure. It is likely that the patient also needs an emergency operation, called an iridotomy, a laser procedure used to open a new channel in the iris. This new channel relieves pressure and prevents another attack.

Congenital glaucoma


ü This form of glaucoma is almost always treated with surgery to open the channels of flow angle and is performed under general anesthesia (asleep and pain free).

posterior chamber Disorders:

Retinal detachment:

ü is the separation of light-sensitive membrane located on the back of the eye (retina) from its supporting layers .

Causes and risk factors


ü The retina is a transparent tissue in the back of the eye that helps you see the images focused on it by the cornea and lens. Retinal detachments are often associated with a tear or hole in the retina through which fluid can leak from the eye. This causes separation of the retina from underlying tissues. Ü
Retinal detachment often occurs spontaneously, without an underlying cause. However, it also can be caused by trauma, diabetes, an inflammatory disorder.
ü During detachment, bleeding from small retinal blood vessels can cause opacity inside the eye, which is normally filled with vitreous humor. Central vision becomes severely affected if the macula, the part of the retina responsible for fine vision, becomes detached. Ü
risk factors are previous eye surgery, myopia, family history of retinal detachment, uncontrolled diabetes, and trauma. Approximately 10,000 people per year have a retinal detachment.


Symptoms


ü Bright flashes of light, especially in peripheral vision
ü Translucent specks of various shapes (floaters) in the eye Blurred vision

ü ü Shadow or blindness in one part of the visual field of one eye

Signs and tests


ü Tests that are performed to determine the integrity of the retina are : ü
direct and indirect ophthalmoscopy
visual acuity
ü ü ü Refraction test
disorders Determination of color vision ü
pupillary reflex response
ü slit lamp examination
ü intraocular pressure determination
ü Eye ultrasound
ü Retinal photography
Angiofluoresceinografía
ü ü Electroretinogram (a record of electrical currents in the retina produced by visual stimuli)

Treatment


Laser surgery can be used to seal the tears or holes in the retina, which generally precede detachment.
The application of intense cold, for example, with an ice probe (known as cryopexy) is another technique that leads to the formation of a scar that holds the retina to the underlying layer. This technique is used in combination with the injection of a bubble gas and maintenance of certain specific positions of the head to prevent re-accumulation of fluid behind the retina.
Surgery is required if the retina has already detached. Some detachments can be repaired by placing a gas bubble in the eye to the retina back into place (pneumatic retinopexy), followed by laser surgery to permanently fix it in place. This procedure is usually performed in the office, but more extensive detachments may require surgery in the operating room. The aim of such surgery may be to indent the eye wall (scleral buckle) or remove vitreous gel or scar tissue pulling on the retina using microsurgery (vitrectomy).


Diabetic Retinopathy


is a progressive damage of the retina of the eye caused by the prolonged presence of diabetes and can cause blindness.

Causes and risk factors

ü Diabetic retinopathy is a leading cause of blindness in Americans of working age and risk of developing both people with type I diabetes, as those with type II diabetes.
ü The likelihood and severity of retinopathy increases with duration of diabetes and can worsen if there is a good control of it. Almost all people who have had diabetes for over 30 years show signs of diabetic retinopathy.
ü The cause of this disease is damage to blood vessels of the retina. In the earliest type and less severe in this condition (diabetic retinopathy prolifetrativa), existing blood vessels become porous and keep out the fluid into the retina, causing blurred vision. In the most advanced type and more severe disease (proliferative retinopathy) presents a new vessel growth blood inside the eye, which are fragile and can bleed, causing vision loss and scarring. Symptoms



ü Decreased visual acuity
ü floaters in the eyes (floaters)
ü Many people have no early symptoms before a major hemorrhage in the eye, which is why everyone with diabetes should be reviewed regularly.

Signs and tests


ü ü
Eye Examination Retinal Photography
Treatment


The goal of treatment is to control diabetes and high blood pressure that is associated with it. Treatment usually does not reverse existing damage, but slows the progression of the disease. It may recommend laser surgery to seal leaking vessels or eliminate abnormal fragile blood vessels.
surgical treatment (vitrectomy) is used in cases of bleeding in the eye or retinal detachment repair, caused by bleeding and subsequent healing. TThe
people with diabetes should see an ophthalmologist for an exam Routine eye retina once a year to reduce the likelihood of severe vision loss.

Hypertensive retinopathy

is damage to the retina caused by high blood pressure.

Causes and risk factors


ü High blood pressure can cause damage to blood vessels of the eyes. The higher the blood pressure and the longer the time that it remains high, it is likely that the injury is more serious.
ü The doctor may see a narrowing of the vessels blood and excess fluid oozing from them with an instrument called an ophthalmoscope. The degree of retina damage (retinopathy) is graded on a scale of I to IV.
ü In Grade I, the lesion may be asymptomatic. Grade IV hypertensive retinopathy includes swelling of the optic nerve and visual center of the retina (macula), which can cause decreased vision.

The damage to the retina caused by high blood pressure is called hypertensive retinopathy occurs as the existing high blood pressure causes changes in the microvasculature of the retina. Some early findings in this disease are flame hemorrhages and cotton wool spots. As hypertensive retinopathy progresses, hard exudates can appear around the macula along with swelling of the latter and the optic nerve, causing vision impairment. In severe cases, permanent damage can occur to the optic nerve or macula. Symptoms



ü ü Headaches
visual disturbances

Signs and tests


Ophthalmoscopic examination
ü ü ü
fluorescein angiography Pressure
blood
Treatment


The only treatment for this disease is to control high blood pressure (hypertension).


NURSING CARE OF PATIENTS WITH EYE PROBLEMS


rating

-
lens wear - Background morbid (DM, hypertension)
- Visual Impairment (does not see near or far objects, decreased night-vision distinguish whether one or both eyes, evolution of deficiencies)
- Eye pain
- Appearance
secretions - Redness
- Itching
- Overview
flashes - Diplopia
- Photophobia
- tearing or dry eyes
- Grade automonia
- Posture towards reading

Under consideration as the fundus observed:
Absence of red reflex
-rings or crescents around the pupil
-bleeding, lesions or holes in the back of the retina opacities
-color anomalies.
- blind spots or areas
- Photophobia
- opacities
- pupillary reflexes
-
eyestrain - Pupil (size and reaction to light)
- Arco senile
- Purulent
- Symmetry facial and ocular (protrusion = exophthalmos, enophthalmos sunken eyes =)
- Eyebrows and eyelashes
- Eyelid: ptosis, redness, stiffness, injury, swelling and closing
- lacrimal apparatus, swelling or edema
- Cornea: cloudy or mottled
- Parallel or alignment of the eyes
- Giro
Eye - Movements conjugated or misuse of movements: nystagmus, strabismus, exodesviación (turning out), esodesviación (turning inward)
- Muscle imbalance
eye - Blinking, efficiency of eyelid closure.
- Assessment of complementary examinations (visual acuity, visual fields, fundus, intraocular pressure, etc)



Nursing diagnosis

- visual sensory impairment related to an inflammatory condition of ocular structures.
- Acute pain related to alteration of ocular structures.
- Fear related to symptoms of vision loss
- Risk of injury related to decreased vision. Objectives



- Recover in whole or in part acuity aided visual medical treatment and nursing measures.
- Reduce the pain all the time with nursing care and therapeutic measures
- Reduce the fear of verbal expression and providing education about their disease.
- Reduce the risk of injury, through the implementation of safety measures and education.


Performances and activities
WC
ü ü eye as needed

Control vital signs ü Maintain accident prevention measures. (Railings, timbre)
ü Maintain an appropriate environment, easy access to the bathroom, unfurnished or hinder the passage carpets. Ü
manager helps determine your care
ü Encourage their independence in their personal care
Administration ü as appropriate medical treatment (antibiotics, eye drops, analgesics) ü
instillation of drops properly (hand washing prior application)
ü Use of devices for ambulation
ü instruct on how to handle eye (avoid rubbing or applying ointments and nonprescription)
ü Patient education about surgical intervention when appropriate. Ü
preparation for surgery. Ü
assess pain intensity according to schedule. Ü
dressings or eye patches Keep clean and dry.
ü Place the patient eye protection when required. Ü Keep
control of chronic diseases (hypertension and DM)



Assessment - The patient shows an improvement in visual perception.
- The patient has no pain or pain EVA <>

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Kinematics of Trauma Bill



Introduction

ü pre-traumatic phase: conditions that induced the traumatic incident (alcohol intake, intake drug, preexisting medical conditions. Ü


Phase effect: a moving object moves against another object. The second may be mobile or stationary.


Kinematics: is the procedure by which we analyze an accident or traumatic event and determine the damage that might occur as a result of the forces and movements involved. Ü
should be considered in any scenario of an accident. Ü
serves as a guide to predict: possible injury, seek, evaluate and treat. Ü

Newton's Law: a body at rest will stay at rest, a body in motion remains in motion unless a force acts on it. Ü
energy can not be created nor destroyed but merely changes the way (thermal, electrical, area, heating, mechanical, etc) ü


Kinetic energy: mass x (v) 2 / 2 EV = mx

v2 / 2


Trauma:

ü Closed: cavitation (drop)
ü Open: Penetrating Trauma
ü closed two types of forces involved:
ü Gearbox: tear, shear, acceleration, deceleration .

Areas involved:



-Head-Thorax (descending aorta)

-tips-
Abdomen Abdomen: injuries to the mesentery attachment point, these are kidney, small intestine, large intestine, spleen and liver.

or compression:


are caused by crushing and clamping force can affect both the external structure of the body and internal organs.
can cause different damages:
-head: skull fracture, bleeding, bruising of the brain (severe injury)
-Chest: External compression causes:
-wheel rib fractures and chest
-cardiac contusion (arrhythmia)
-contusion (pneumothorax)
-Shock seeks lateral rib fractures and

pelvis or pelvis and abdomen:

-laceration
blood vessels (pelvic area)
-Rupture of the pancreas, spleen, liver and kidneys occasionally. Ü

injuries increased abdominal pressure diaphragm
-tear-Rupture
aortic valve.

motor vehicle accidents

There are three types of collisions:
- Automotive
against object - Passenger car against
- Internal organs against the body cavity

Frontal impact causes dislocation of knee, femur, acetabulum. Impact

later: occur on a stationary object or moving slowly, it is beaten by causing a movement behind the acceleration. Ü
damage occurs because of differences in speed of both vehicles. Ü
should investigate the causes of rear impact. Side impact

: The first vehicle is in the same place but it is damaged and deformed by the impact.
The second vehicle traveling in the opposite direction to the point of impact.
The impact energy is transformed in damage to vehicle causing the displacement of the vehicle. ROPS



ü Impact repeatedly from different angles. Injuries occur and various damages, are virtually impossible to predict. Ü


seatbelt: it is known that one of every thirteen victims of accidents are expelled for not using seat belts. They produce the impact of the blow on the vehicle and the impact of striking the ground. Ü
who do not use seat belts has six times more likely to die to be ejected from the vehicle. Ü


Injury from the seatbelt:
-Rupture of the diaphragm
-lumbar spine fracture T12, L1, L2. Injuries
-face, head, neck board or steering wheel impact.

AIRBAG


ü cushion the forward movement only. Ü
effect only in the first collision in frontal impact ü
are not effective in side or rear impacts. Ü
should be used in combination with seat belt

Ø motorcycle accidents, injuries occur:

front-impact-impact-ejection angular

ü pedestrian accidents: two kinds of pedestrians Ü Adult
tries to protect himself and turns, side impact pelvis level. Ü Child
face without moving the vehicle frontal impact. Ø

Falls: multiple impact injuries. Should be evaluated fall height, surface on which it falls, it hits the body first.


explosion or injury, also has three types of impact. You must determine distance between explosion and victim. Ø


Penetrating injuries: there are different factors that affect the area are damaged this profile, the bearing and fragmentation. Ø


Sports injuries: produced by:
-sharp slowdown

-compression-torsion over
-hyperextension or hyperflexion.

Ø In all types of injury should always evaluate:
ü-threatening injuries
Mechanism of Injury ü ü
Use of protective equipment
ü Force
injury occurred ü Possible associated injuries

In lesions by white or fire weapons should be evaluated:
ü Degree of injury and
energy inputs and outputs Wounds ü ü
multiple wounds and injuries associated
ü ü
Sex attacker's known position of the victim, attacker and weapon used. Ü
low-energy injuries, multiple injuries should be discarded and movements of the weapon in a circulation. Ü
injury by high energy: simple or caliber bullet.

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types Musculoskeletal and PAE




INTRODUCTION

• The musculoskeletal system allows humans to interact with the surrounding environment through the movement or motion.
• It is based on four elements:
• Bones

• • Joints Muscles Nerves


• The locomotor system is not independent or autonomous, is an integrated with various systems, for example, with the nervous system for the generation and modulation of motor commands. This system consists of the structures responsible for supporting and lead the movements of the body and are two systems.

A) System Bone is the passive element is formed by the bones, cartilage and ligaments.


B) Muscular System: Formed by the muscles to be united by bone to shrink causing the movement of the body. System

Bone

Bone is a strong body, hard and tough which is part of the skeleton of vertebrates. Is mainly composed of bone tissue, a specialized type of connective tissue consisting of cells, and calcified extracellular components.
The adult human body consists of approximately 206 bones, which are rigid and serve to protect the soft organs of our body. Bones are made mostly by calcium, and in turn help to balance it (homeostasis). A joint
in anatomy is the contact point between two bones of the body. It is important to classify the different types of joints according to the tissue that connects in fibrous, cartilaginous, synovial or diartrodias. The human body has different types of joints such as synarthrosis (not mobile), symphysis (single-axis motion) and synovial (greater breadth and complexity of motion).

skeletal features:

• Hold the body allowing this to remain upright.
• Helps movements, along with the muscles and joints. • Da projection
internal organs and tissues
• Bone mineral reserves remain.
• Participate in hematopoiesis or blood cell formation in bone marrow.



muscular system


• Muscle is becoming one of the contractile organs of the human body and other animals, made up of muscle tissue. The muscles are intimately connected well with the skeletal-muscle skeletal-or part of the structure of various organs and systems-visceral muscles.
• The structural and functional unit of muscle is the muscle fiber.


The muscles are divided into:

striated muscle: striated in nature and voluntary control. Form the skeletal muscles of the body or voluntary muscles.


• Smooth muscle: contains no streaks and is controlled involuntarily. Muscles form the walls of the digestive, urinary, blood vessels and uterus: involuntary or visceral muscles.


• cardiac muscle: striated in nature and control involuntary. Present only in the heart.


The human body consists of approximately 40% of skeletal muscle and 10% of heart muscle and visceral.

• Ligaments are structures to hold the bones together with each other and stabilize the joints.
• They are long strips of dense connective tissue and fibrous, tough, composed mainly of collagen type I.
• Nerves are extensions of the central nervous system.
• Skeletal muscles are primarily governed by the spinal nerves.

LOCOMOTOR SYSTEM ASSESSMENT:

• musculoskeletal assessment can focus on a specific part of the body or can be made as part of a general physical examination.


• The most common symptoms that we find can be pain, weakness, deformity, stiffness and limited movement, crepitus of the joint. • Background morbid
previous.
• Medications you are using. Previous surgeries


Supplementary examinations:


• muscle strength tests
• X-Ray • MRI

• Arthroscopy
• arthrocentesis and synovial fluid analysis.
• muscle enzymes. Serological studies

• MAJOR CHANGES
LOCOMOTOR

Sprains:

• A sprain is an injury to the ligaments around a joint. Ligaments are strong, flexible fibers that hold bones together when they are stretched too far or tears, the painful and inflamed joint. Causes



• Sprains are caused when a joint is forced to move in an unnatural position. For example, "twisting" one's ankle causes a sprain to the ligaments around it. Symptoms



• Pain in the joint or muscle pain • Swelling

• Discoloration of the skin, especially bruising
• Joint stiffness

First Aid.

ü Apply ice immediately to help reduce swelling, wrap the ice in a cloth and avoid applying it directly on the skin. Ü
DO NOT try to move the area. To help do this, place a firm but not tight bandage over the affected area. The bandages work well for this purpose. If necessary, use a splint.
ü Keep the swollen joint elevated above heart level, including the time at night when going to sleep. Ü
Rest the affected joint for several days. Ü
Aspirin, ibuprofen and other pain medications may help, but DO NOT give aspirin to children.
ü Do not apply pressure to the affected area until the pain subsides (usually 7 to 10 days for mild sprains and 3 to 5 weeks for severe sprains) and the person may require the use of crutches to walk. Rehabilitation to regain motion and strength of the joint should begin within a week.


Keep in mind that attention is required when:

• You suspect a broken bone
• The joint appears deformed
• You have a severe injury or severe pain
• Presents an audible popping sound and immediate difficulty using the joint
• Inflammation is not reduced in two days.
• You have signs of infection: the area becomes redder, hot, it hurts more or fever above 100 degrees F (37.7 º C).
• The pain does not disappear after several weeks. Prevention



• Wear protective footwear for activities that place stress on the ankle and other joints.
• Make sure that shoes fit your feet properly.
• Avoid high-heeled shoes.
• Always warm up and stretch before exercising or playing sports.
• Avoid sports and activities for which you are not well trained.

Minor injuries like sprains may treated at home if there are suspected bone fractures. The acronym RICE is helpful in remembering how to treat minor injuries: rest, ice, compression and elevation (RICE, for its acronym in English). Pain and swelling should decrease within 48 hours and gentle movement may be beneficial, but pressure should not be applied in a sprained joint until pain is completely gone (one to several weeks).

The ankle joint connects the foot with the leg and allows the foot to move up and down and in a move inward and outward. Muscles, tendons and ligaments that surround the ankle providing the stability the ankle joint needs for walking and running.

The most common way the ankle can be injured is by a sprain, and when this occurs, the ankle ligaments are stretched or torn partially or completely. The most common type of sprain is an inversion injury, where the foot is rotated inward. Ankle sprains can range from mild to moderate and severe.


The Type I ankle sprain is mild and occurs when you have had at least a stretch or tear the ligaments.

The Type II ankle sprain is a moderate level occurs when some the fibers of the ligaments are torn completely

ankle sprain type III is the most severe and occurs when the entire ligament is torn and shows great instability in the ankle joint.


Fractures:

• Applying more pressure on a bone than it can stand, it will split or break. A break of any size is called a fracture and if the broken bone punctures the skin, called an open fracture (compound fracture).
• The overload stress fracture is a hairline crack in the bone that develops because of prolonged or repetitive force on it. General considerations



• It is hard to tell a dislocated bone from a broken, but both are emergency situations and basic first aid measures are the same. Causes



• The following are common causes of broken bones:
• Fall from a height

• Car accidents • Direct blow

• Child abuse • Repetitive forces, such as those that occur when a person running, can cause stress fractures in the feet, ankles, tibia or hip symptoms



§ Tip or joint visibly out of place or deformed
• Limited movement or inability to move a limb
• Swelling, bruising or bleeding, severe pain

• • Numbness and tingling
• Broken skin with bone protruding

First Aid:


should examine the airways and breathing of the victim.
should keep the person still and calm.
• It needs to carefully watch the victim to detect other injury.
• In most cases, if medical help responds quickly, allow medical personnel take the necessary measures.
• If the skin is broken, it must be treated immediately to prevent infection. Do not breathe on the wound or probe it, if possible, lightly rinse to remove visible dirt or other pollutants, taking care not to rub too hard or flush. Be covered with sterile dressings.
• If necessary, the injury must be splinted or sling. Among the possible elements of splints include a rolled up newspaper or strips of wood. Immobilize the area both above and below the injured bone.
• You can apply ice packs to reduce pain and swelling.
• You should try to prevent shock. Lay the person flat, elevate the feet about 12 inches (30 centimeters) and covered with a coat or blanket, but DO NOT move if you suspect a head injury, back or legs.


CHECK BLOOD CIRCULATION:

• You must verify the person's blood circulation and press hard on the skin that lies beyond the fracture site. For example, if the fracture presented in a leg, press on the foot, the skin should first blanch white and then "pink up" in about two seconds. Other signs that circulation is inadequate include pale or blue skin, numbness and tingling and loss of pulse. If circulation is poor and there are no trained personnel quickly, try to realign the limb into a normal resting position. This will reduce swelling, pain or tissue damage due to lack of blood.

TREAT BLEEDING


• It is recommended to cover the wound with a clean cloth and dry.
• If of continued bleeding, apply direct pressure to the site. DO NOT apply a tourniquet to the extremity to stop the bleeding unless it is a life-threatening situation.

• DO NOT move the person unless the broken bone is stable.
• DO NOT move a person with an injured hip, pelvis or upper leg unless it is absolutely necessary. If you must move the victim, you must drag them to safety by his clothes (for the shoulders of the shirt, belt or pants).
• DO NOT move a person who has a possible spine injury.
• NO Attempt to straighten a misshapen bone or joint or to change its position unless blood circulation appears hampered.
• DO NOT try to reposition a suspected spine injury.
• DO NOT test a bone's ability to move.

a situation is considered serious if:

• There is a suspected broken bone in the head, neck or back.
• There is a suspected broken bone in the hip, pelvis or upper leg.
• A bleeding
• The area below the injured joint is pale, cold, clammy or bluish.
• You can not immobilize the injury completely into the scene without assistance from another person.
• There is a bone through the skin.
• Although it is possible that other fractures are not emergencies, they still deserve medical attention, therefore, call your doctor to find out where and when.
• If a child refuses to put weight on an arm or leg after an accident, not moving the arm or leg, or deformity can be seen clearly, assume that the child has a broken bone and Get medical help.


Prevention


• The should wear protective gear while skiing, cycling, skating and participating in contact sports. This includes helmet, elbow pads, knee pads and shin guards.
• You must create a safe environment for young children, such as placing gates on stairways and keep windows closed.
• Teaching safety measures and help children learn how to care for themselves.
• Supervise children closely. No matter how safe it may seem, the environment or situation, there is no substitute for supervision.
• Avoid falls by not standing on chairs, desks or other unstable objects and remove small rugs and electrical cords from floor surfaces. Use handrails on staircases and non-skid mats in bathtubs. These measures are especially important for older people.

Types of fractures:

Among the various types of bone fracture include:


Oblique - a fracture of the shaft angle
Comminuted - a fracture of many relatively small fragments
Spiral - a fracture of the bone around the shaft or open
Compound - a fracture that breaks the skin

Among the types of bone fracture, there are:
En tallo verde - fractura incompleta en la que el hueso se dobla
Transversa - fractura que atraviesa el axis del hueso
Simple - fractura que no perfora la piel

•Se puede utilizar un dispositivo de fijación externa para mantener huesos fracturados fijos y alineados. Dicho aparato puede ajustarse externamente para asegurar que los huesos permanezcan en posición óptima durante el proceso de consolidación. El dispositivo de este tipo por lo general se utiliza en niños y cuando la piel sobre la fractura ha sufrido daños.

•Se puede utilizar un dispositivo de fijación interna para mantener los huesos fracturados estabilizados y alineados. Este aparato se inserta quirúrgicamente para asegurar The bones remain in an optimal position during and after consolidation.




• Arthritis is an inflammation of one or more joints that causes pain, swelling and limited movement.

Causes and risk factors


Arthritis involves the breakdown of cartilage, which normally protects the joint, allowing for smooth movement. Cartilage also absorbs shock when pressure is exerted on the joint, like when you walk. Without the usual amount of cartilage, bones rub together, causing pain, swelling (inflammation) and stiffness.
joint inflammation can occur for various reasons, including:


- Bone fracture
- Infection (usually caused by bacteria or viruses)
- An autoimmune disease that occurs when the body attacks itself because the immune system believes a body part is foreign.
- "wear and tear" on joints.


Often, the inflammation goes away after the injury has healed, the disease has been treated or after the infection has been eliminated.
With some injuries and diseases inflammation does not go away or destruction results in long-term pain and deformity, which is considered chronic arthritis. Osteoarthritis is the most common and is likely to occur more frequently as people age. You can feel in any joint but most commonly occurs in the hips, knees and fingers.


Risk factors for osteoarthritis include:


- Being overweight
- Previously injuring the affected joint
- Using the affected joint in a repetitive action that puts stress on it (the baseball players ballet dancers and construction workers are all at risk)
- Arthritis can occur in men and women of all ages.

Osteoarthritis is a chronic disease of the cartilage and bone of joints and is thought to be the result of wear and tear on them, although there are other causes such as congenital defects, trauma and metabolic disorders. Joints appear larger, are stiff and pain that increases as they are used during the day.

Other types or causes of arthritis include:


• rheumatoid arthritis (adults)
• Arthritis JRA (children)
• Lupus erythematosus (SLE) Gout

• • •
Scleroderma Psoriatic arthritis Ankylosing spondylitis

• • Reiter syndrome (reactive arthritis)
• Adult Still's disease Viral arthritis

• • gonococcal arthritis
• Other bacterial infections (non-gonococcal bacterial arthritis)
• Tertiary Lyme disease (the late stage) Tuberculous arthritis

• • Fungal infections such as blastomycosis symptoms


The

arthritis patients may experience the following symptoms:
• Joint pain Joint swelling

• • Stiffness, especially in the morning
• Warmth around a joint
• Redness of the skin around a joint
• Decreased ability to move


joint • Osteoarthritis is associated with the aging process and can affect any joint. The affected joint cartilage gradually wears away and the bone ends to rub against bone. Bony spurs develop on the unprotected bones causing pain and inflammation.

• The effects of rheumatoid arthritis can progress to the point of being disabling. Deformities distinctive to late-stage disease, such as ulnar deviation (ulnar) of the bones of the hands, or swan-neck deviation, due to which bones are not aligned because the muscles and tendons on one side joint dominate the other side.

Signs and tests


• You develop a detailed medical history to see if arthritis or another musculoskeletal problem is the likely cause of symptoms.
• After a thorough physical examination may show an accumulation of fluid around the joint (called a "stroke"). The joint may be tender when gently pressed, and can be warm and red, which is more typical in infectious arthritis and autoimmune arthritis. It may be painful or difficult to rotate the joints in some directions, which is known as "limited range of motion."
• In some autoimmune forms of arthritis, the joints may become deformed if the disease is not treated, these deformities are the hallmarks of severe rheumatoid arthritis that has not been addressed.
• The tests vary according to the suspected cause, and often include blood tests and radiographs of joints. To check for infection and other causes of arthritis (like gout caused by crystals), fluid is removed from the joint with a needle and examined under a microscope. For more information, see specific types of arthritis. Treatment



• Treatment of arthritis depends on the particular cause, the severity of the disease, the affected joints and how the condition affects daily activities. In addition, age and occupation are also taken into account when the doctor works together with the patient to develop a treatment plan.
• If possible, treatment can focus on eliminating the underlying cause of arthritis. However, usually the cause is not necessarily curable, as with osteoarthritis and rheumatoid arthritis, therefore, treatment is aimed at reducing pain and discomfort and preventing further disability.
• You can dramatically improve symptoms of osteoarthritis and other types of arthritis without the use of drugs. In fact, making changes in lifestyle without the use of medications is preferable for osteoarthritis and other forms of joint inflammation. If needed, medications should be used in addition to changes in lifestyle.
• The Exercise for arthritis is necessary to maintain healthy joints, relieve stiffness, reduce pain and fatigue, and improve muscle and bone strength. The exercise program must be designed individually for each person and is recommended to work with a physical therapist to design an individualized program, which should include:


• Range of motion exercises for flexibility
• Strength training for
muscle tone • low-impact aerobic activity (also called resistance training)

• A physical therapist can apply heat and cold treatments to the extent necessary and prepare the person for splints or orthotic (straightening) devices to support and align joints, which may be particularly necessary for rheumatoid arthritis. The physical therapist may also consider water therapy, ice massage or transcutaneous nerve stimulation (TENS, for its acronym in English).
• Rest is as important as exercise. In fact, sleep for 8 to 10 hours each night and taking naps during the day can help people recover more quickly from a flare-up and may even help prevent the worsening of it.

Also, you must:


• Avoid positions or movements that place extra stress on joints affected.
• Avoid holding one position for too long.
• Reduce stress can worsen symptoms. You can try meditation or guided imagery. You may also talk to the therapist about yoga or tai chi.
• Make home modifications to facilitate the activities, for example, where rods have taken in the bathroom, tub or near the toilet.

Other steps you can try are:


• Taking glucosamine and chondroitin, as they are the building blocks of cartilage, the substance that lines the joints. These supplements are available in health food stores or supermarkets. Preliminary studies indicate that these compounds are safe and may improve symptoms of arthritis. Are currently conducting further investigations.
• Eat a diet rich in vitamins and minerals (especially antioxidants like vitamin E) found in fruits and vegetables. The sources of selenium include brewer's yeast, wheat germ, garlic, whole grains, sunflower seeds and Brazil nuts, while the omega-3 fatty acids obtained from cold water fish (salmon, mackerel and herring) flaxseed, rapeseed (canola), soybeans, soybean oil, pumpkin seed and walnuts.
• Apply capsaicin cream (derived from chili peppers) on the surface of the skin over painful joints. The improvement can be felt after applying the cream for 3 to 7 days.

• For treatment of arthritis using different drugs within these include:

• Acetaminophen (Tylenol) recommended by the American College of Rheumatology (American College of Rheumatology) and the American Geriatrics Society (American Geriatrics Society) as the first line of treatment for osteoarthritis. It Take up to 4 grams per day (2 extra-strength Tylenol every 6 hours), which can provide significant relief of arthritis pain without many of the side effects of prescription drugs. However, DO NOT exceed the recommended doses of acetaminophen or take the drug in combination with large amounts of alcohol, which can damage liver.


• Aspirin, ibuprofen or naproxen: noesteroides these anti-inflammatory drugs (NSAIDs) are often effective in combating arthritis pain. However, they have potential risks, especially if used for an extended period, so that should not be taken in any amount without consulting doctor. Potential side effects include heart attack, stroke, stomach ulcers, digestive tract bleeding and kidney damage. In April 2005, the FDA asked manufacturers of NSAIDs to include a warning label on their product that alerts users of an increased risk of heart attack, stroke and gastrointestinal bleeding. Patients with kidney or liver disease or a history of gastrointestinal bleeding should not take these medicines unless your doctor specifically recommends them.


• Prescription drugs include:

inhibitors of cyclo-oxygenase 2 (COX-2): These drugs block an inflammation-promoting enzyme called COX-2. Initially it was believed that these drugs work as well as traditional NSAIDs, but with fewer stomach problems. However, numerous reports of heart attacks and stroke have prompted the FDA to reevaluate the risks and benefits of COX-2. Rofecoxib (Vioxx) and valdecoxib (Bextra) were withdrawn from the U.S. market after reports of heart attacks in patients taking the drugs. Celecoxib (Celebrex) is still available, but labeled with strong warnings and a recommendation that it be prescribed at the lowest dose for the shortest time possible. You should discuss with your doctor about the advisability of using individual COX-2.


• Corticosteroids ("steroids"): these are medications that suppress the immune system and symptoms of inflammation. Usually used in severe cases of osteoarthritis and can be administered orally or by injection. Steroids are used to treat autoimmune forms of arthritis but should be avoided in infectious arthritis. Steroids have multiple side effects include stomach upset and gastrointestinal bleeding, hypertension, bone thinning, cataracts, and increased infections. These risks are most pronounced when steroids are taken for long periods of time or higher doses, which is essential for the strict supervision of a physician.

• modifying antirheumatic drugs disease: these drugs have been used traditionally to treat rheumatoid arthritis and other autoimmune causes of arthritis include gold salts, penicillamine, sulfasalazine and hidroxcloroquina. More recently, methotrexate has been shown to slow the progression of rheumatoid arthritis and improves quality of life of patients. Methotrexate itself can be highly toxic and requires tests Frequent blood for patients who are on medication.


antibiological: this is the latest advancement in the treatment of rheumatoid arthritis. Such drugs, including etanercept (Enbrel), infliximab (Remicade) and adalimumab (Humira), are administered by injection and can dramatically improve the quality of life of patients.

Immunosuppressants these drugs such as azathioprine or cyclophosphamide, are used for severe cases of rheumatoid arthritis when other drugs have failed.


SURGERY AND OTHER APPROACHES


• In some cases, surgery to rebuild the joint (arthroplasty) or replacement (such as total joint replacement of the knee) can help maintain a normal lifestyle. The decision to perform joint replacement surgery is normally made when other alternatives such as changes in lifestyle and medications are no longer effective.


• Normal joints contain a lubricant called "synovial fluid" and in those with arthritis, this fluid is not produced in adequate amounts. A relatively new method of treatment is to inject arthritic joints with a manmade version of the liquid as articular hylan GF 20 (Synvisc) or other hyaluronic acid preparations. The synthetic fluid may postpone the need for surgery at least temporarily and improve the quality of life of patients with arthritis. Many studies are evaluating the effectiveness of this therapy.

Call your doctor if:


• Joint pain persists beyond 3 days.
• present a severe unexplained joint pain.
• The affected joint is significantly swollen.
• The person has difficulty moving the joint.
• The skin around the joint is red or hot to the touch.
• You have fever or unintentional weight loss. Prevention



• If arthritis is diagnosed and treated early, can prevent joint damage. You should find out if there is family history of arthritis and share this information with your doctor, even if the person has no symptoms in the joints.
• Osteoarthritis may be more likely to develop if you abuse your joints (injure them many times or the overloaded while injured). Must be careful not to overwork to a damaged or sore joint and also to avoid repetitive movements.
• Being overweight also increases the risk of developing osteoarthritis in the knees and possibly in the hips and hands. See the article on body mass index to know whether a person's weight is healthy.


osteomyelitis


• An acute or chronic bone infection, usually caused by bacteria.

Causes and risk factors


• Often, the infection that causes osteomyelitis often is in another part of the body and spreads to bone through the blood. The bone may have been predisposed to infection because of recent trauma.


• In children, generally, are usually affecting the long bones, while adults are most commonly affected vertebrae and pelvis. Bone infection can be caused by bacteria or fungi. When the bone is infected, pus is produced within it, which can cause an abscess, and abscess then deprives the bone of its blood supply.


• Chronic osteomyelitis results when bone tissue dies from loss of blood supply. Chronic infection can persist intermittently for years. Risk factors are recent trauma, diabetes, hemodialysis, and intravenous drug abuse. People who have had their spleen removed are also at high risk for this disease, whose incidence is 2 cases per 10,000 people

Symptoms


• bone pain • Swelling
local redness and warmth

• Fever • Nausea
• General discomfort, uneasiness, or ill feeling (malaise)
• Drainage of pus through the skin (in chronic osteomyelitis)
• Other symptoms that may be associated with this disease:
• Excessive sweating • chills


• Lumbago • Swelling of ankles, feet and legs


Signs and tests


A physical examination shows bone tenderness and possibly swelling and redness.

• Examinations may be:
• bone scan

• Blood cultures • MRI (MRI Maget)
• Needle aspiration of the area around the affected bones
• Bone lesion biopsy
• This disease may alter the results of the following tests: • X-

joints • Hand x-ray
• Extremity x-ray • X-ray bone

• ALP isoenzyme (ALP) alkaline phosphatase


Treatment

• The goal of treatment is to eliminate infection and prevent its deterioration.
• Supplied antibiotics to kill bacteria that are causing the infection.
• For infections that do not disappear, it may need surgery to remove the dead bone tissue and the space left by the removed bone tissue may be filled or filled with bone graft material to stimulate new bone growth. Antibiotics are continued for at least 6 weeks after surgery.
• Infection of an orthopedic prosthesis may require surgical removal of the prosthesis and infected tissue around the area. In the same operation, you can implant a new prosthesis or delayed until the infection has disappeared.

Expectations (prognosis)


• The forecast Acute osteomyelitis is usually good if treated.
• The prognosis is worse for chronic osteomyelitis, even if carried out surgery. It may require an amputation, especially in diabetics or other patients with poor blood circulation. The prognosis is guarded in those who are infected with a prosthesis.


Nursing Care in Patients with musculoskeletal disorders.


Rating:


or previous clinical diseases such as diabetes, tuberculosis, poliomyelitis, hemophilia, etc.
or drugs used.
or physical activities performed.
or body mass index
or pain (joints, limbs, frequency) or Type Diet


In patients with traumatic injuries (fractures, sprains), you should inquire about:

-Mechanism of injury-related circumstances
injury-diagnostic rating

Physical: observation, palpation, movement and muscle assessment. Palpation of
realiza en cuello, hombros, codos, muñecas, manos, espalda, cadera, rodillas, tobillos, pies. Esto permite valorar la temperatura de la piel, dolor a la palpación local, inflamación y crepitación.


Se debe valorar el grado de movilidad tanto activa como pasiva. El rango de movilidad activa significa que el paciente es capaz de hacer todos los movimientos sin ayuda. El rango de movilidad pasiva se produce cuando otra persona mueve las articulaciones del paciente sin su participación.


- Valorar exámenes imagenológicos y de laboratorio


Diagnósticos de enfermería

- Impaired mobility R / C with skeletal muscle involvement m / p
stay in bed - Pain R / C skeletal muscle injury m / p

EVA 7 - Anxiety r / c immobility m / p facie case of trouble and concern
- Risk for impaired skin integrity R / C immobility or immobilizer
- Risk of stroke: thrombotic fat or R / C broken bones or prolonged immobility therapy. Objectives



- Recover physical mobility gradually with the help of multidisciplinary treatment.
- Reduce the pain to tolerable levels.

- Reduce patient anxiety while maintaining your emotional state
- Maintaining the patency of avoiding skin injury or pressure ulcers.
- Preventing stroke risk through preventive measures.


Plan and implementing activities

Control vital signs ü ü
Administration of physical modalities for pain. Ü
Administration of antibiotics by medical indication (fractures)
ü Coordinate with passive exercise kinesiologist scheme in immobilized patients. Ü
Perform preventive treatment of stroke signs
ü Evaluate embolism and thrombosis care
ü Make cast: indemnity
-Rate-Rate
skin distal pulse
prevent erosion
-foot-Keeping
-Avoid high-
soak the patient and family education

ü Make changes position
common areas of support Protect ü ü Keep
surgical wounds clean and dry. Ü Constantly evaluate
cleats (external tutors, splints, traction skeletal)
ü adequate mobilization (block in a patient with fractures of the pelvis, to avoid abduction in hip fractures)
ü Monitor bleeding and drainage as appropriate pattern
ü Conduct daily exercise in patients with chronic diseases. Ü
Helping the patient to his expression of fear and fear in chronic disease. Ü
facilitate the use of props to ambulation (walking sticks, burritos)
ü Collaboration arthrocentesis



Assessment

ü The patient improves mobility without showing progressively account deficit.
ü The patient is in pain VAS less than 3. Ü

patient decreased their anxiety, staying calm
ü The patient remains intact skin without injury or pressure ulcer.
ü The patient shows no signs of a stroke during their hospital stay.



RULES OF PREPARATION OF THE SKIN OF PATIENTS ACIRUGÍA Trauma:



Objectives:

- preventing wound infections in patients undergoing orthopedic surgery by microorganisms from the patient's skin.


Preconditions:


- The material used in the procedure must be sterile and clean to use.
"The operator must be protected gloved procedures, according to the area to prepare.


Preparedness hospital room:


1. Should be performed preoperative shower or bed bath the day before and the day with ordinary soap.


2. You should wash the area thoroughly with soap operative afternoon the day before surgery. The nurse clearly indicate the area to prepare.


3. Should be repeated washing with soap operative site or as close to surgery (30 minutes before taking the flag).


4. Avoid shaving. If necessary to remove hair must be cut this with sterile clipper (clipper).


5. Change the bed sheets and put a clean shirt after preparing the patient.


6. Remind the patient to leave the area prepared and strictly avoid further physical examination procedures.


7. It should record the clinical records preparation (date - time - procedure and operator).


8. Transfer the patient to the flag with sheets and clean shirt. Preparation

Hall:


1. Repeat washing zone operations with povidone foaming and remove with sterile dressings.
2. Brush the area with antiseptic widely operative demarcated by the surgeon (povidone-iodine - iodized alcohol - alcohol 70 ° allergic to iodine).
3. Wait while the antiseptic action (90 seconds) in case of povidone or evaporation in case of alcohol.


Drive transesquelética


is the use of the tension (or force) to move a body part from a problematic position to an optimal functional position. View lateral stability.

Information:


- Traction is used to place tension on a displaced bone or joint (such as a dislocated hip), with weights and pulleys to realign the bone and immobilize it. Traction is also used to place tension on a muscle group (such as lower spinal muscles) so as to reduce muscle spasms, stretching the muscles and keeping them in a state of stretch.


- For treatment of traction are important amount of tension to take a body part to another position, the time during which voltage is applied and the means used to maintain tension.



INFECTION PREVENTION STANDARD INSTALLATION DECREASE IN SKELETAL:



Objective:


- Reducing infection at the site of installation of traction.


Directions of Use:


- a procedure that is performed subject to freeze and control pain in trauma patients.

Procedures:


1 .- Using aseptic technique:


üLavado hands with antiseptic. ÜUso
sterile apron.
ü Use of sterile gloves. ÜUso
mask and hat.
üLimpieza and disinfect the skin before the procedure. Ü
Using sterile field. Ü
Using sterile - Kirschner - Stirrup - Motor or high level disinfection. ÜManejo
biological waste and sharps material.


2 .- Technique:


local anesthesia: skin - subcutaneous and periosteum with lidocaine 2% 5 to 10cc.
skin incision with a scalpel in place of entry and exit of K-wire. Using
Kirschner wires between 2.5 and 3.5 mm. thickness. Use of motor
low-speed (manual)
Kirschner wire tension, healing site of entry and exit.
Protection of the wound with sterile gauze.

• Target:


avoid or reduce the risk of infection in patients with skeletal traction.


1. The residence time of skeletal traction should be the minimum necessary to prevent colonization by hospital germs.
2. Daily review of the traction system by treating physician.
3. Daily Healing sterile technique as sites of entry and exit of K-wire by the nurse.