...States and the resultant health problems are leading to visits to physicians’ offices and hospitals more than ever before. Diabetic neuropathy, a debilitating nerve disorder which can affect almost any part of the nervous system, occurs in nearly 50 percent of patients with diabetes. Diabetic peripheral neuropathy is found in 12 percent of insulin dependent diabetics and 32 percent of those who are not, equaling approximately 3 million people in the United States. (Chen et al. 2007) The number of patients with other neuropathies, such as autonomic, proximal, and focal, comprises the other 1 million diabetic neuropathy patients, most of whom suffer in pain from the dysfunction of the nervous system. (Chen et al. 2007) This disorder’s elusive nature is such that it can not only present in any part of the body but it can be completely without symptoms that the average patient would report to their physician. Since the patients themselves are less likely to naturally disclose their suffering through their assumption that their symptoms are not relevant to their diabetic condition, the physician’s role in the diagnosis and recognition of this disorder is even more critical. II. Definition and Types of Diabetic Neuropathy The most common type of diabetic neuropathy is peripheral, considered, more generally, sensorimotor. Peripheral neuropathy causes pain or loss of feeling in the toes, feet, legs, hands, and arms. (NIDDKD 2002) Specifically, distal symmetric polyneuropathy...
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...brought about behaviour that appeared analogous to human neuropathic pain conditions (Bennett and Xie, 1988). The pathological mechanism behind neuropathic pain is thought to be spontaneous activity in damaged sensory neurones. Chahine et al (2005) found that the release of hyperalgesic pro-inflammatory agents can result in changes in either expression or inappropriate regulation of sensory Nav channels, suggesting that Nav channels have an important rcontribution to neuropathic pain Central neuropathic pain Experienced as a symptom of CNS disorders such as stroke and multiple sclerosis. Peripheral neuropathic pain Experienced as a symptom of disorders associated with peripheral nerve damage such as mechanical injury, diabetic neuropathy, (Usual Treatment) Anti-depressants 1) tricyclic anti-depressants 2) Selective Serotnin re-uptake inhibitors Anti-convulsants Ion channel blockers (anti-dysrythmics) (Structure/function of opiod receptors) Discovered in 1973, confined to nervous tissue (Pert and Synder 1973) Areas of neuronal membrane which opiods bind to resulting in inhibition of the cell. Opiods refers to a substance that produces morphine like effects Four distinct types (Why targeting particular gpcr would be affective) Opiods excite neurons in the periagueductal gray-gate control theory...
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...Guillain-Barre Syndrome is a rare disorder in which your body's immune system attacks your nerves. It often begins with tingling and weakness that starts in your feet and legs and spreads to your upper body and arms. In about 10 percent of people with the disorder, symptoms begin in the arms or face. As it progresses muscle weakness can evolve into paralysis. Signs and symptoms may include: Prickling, "pins & needles" sensations in your fingers, toes, ankles or wrists Weakness in your legs that spreads to your upper body Unsteady gait or an inability to walk or climb stairs Difficulty with eye or facial movements, including speaking, chewing or swallowing Severe pain that may feel achy or cramp-like and may be worse at night Difficulty with bladder control or bowel function Rapid heart rate Low or high blood pressure Difficulty breathing (a potentially fatal complication) Guillain-Barre Syndrome is a medical emergency & Most people with the condition must be hospitalized for treatment. Although there's no known cure, the sooner treatment is started, the better the chance for recovery. The most significant weakness begins within two to four weeks after symptoms start & recovery usually begins two to four weeks after the weakness plateaus. Although the exact cause is unknown, it often precedes an infectious illness such as a respiratory infection or the stomach flu. The disorder usually appears within days or weeks...
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...OF THE DRUG | GENERAL ACTION | SPECIFIC ACTION | INDICATIONS | CONTRAINDICATIONS | ADVERSE EFFECTS | NURSING INTERVENTIONS | Isoniazid200mg/5mL, 5.5mL OD, 30 minutes before meals | Antitiberculotic | Bactericidal: interferes with lipid and nucleic acid biosynthesis in actively growing tubercle bacilli. | * TB, all forms in which organisms are susceptible. * Prophylaxis in specific patient who are tuberculin reactors or household members of recently diagnosed tuberculars or who are considered to be high risk. | * Contraindicated with allergy to Isoniazid, Isoniazid-associated hepatic injury or other severe adverse reactions to isoniazid, acute hepatic disease. * Use cautiously with renal impairment. | * CNS: peripheral neuropathy, seizures, toxic encephalopathy, optic neuritis and atrophy, memory impairment, toxic psychosis. * GI: nausea, vomiting, epigastric distress, bilirubinemia, bilirubinuria, elevated AST, ALT levels, jaundice, hepatitis. * Hematologic: Agranulocytosis, hemolytic or aplastic anemia, thrombocytopenia, eosinophilia, pyridoxine deficiency, pellagra, hyperglycemia, metabolic acidosis, hypocalcemia, hypophosphatinemia due to altered vitamin D metabolism. * Hypersensitivity: fever, skin eruptions, lymphadenopathy, vasculitis. * Others: gynecomastia, rheumatic syndrome, SLE syndrome | Assessment * History: allergy to Isoniazid, Isoniazid-associated adverse reactions; acute hepatic disease; renal impairment * Physical: skin color, lesions;...
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...A. Which symptoms that Nick has described so far are relevant to the nervous system? Are his symptoms sensory, motor, or both? a. The pains in his feet and the dizziness in when he stands or sits. b. His symptoms are both sensory and motor. B. Do you think the symptoms Nick describes are likely to be caused by peripheral nerve damage? Could they be caused by damage to the central nervous system? c. His symptoms are caused by peripheral nerve damage. Peripheral nerve damage causes numbness and pain normally in the hands and feet. d. No damage to the central nervous system would lead to a possible stroke but they both share similar symptoms. C. Diabetic neuropathies damage peripheral nerves. Which component of the reflex arc is most likely to be damaged in Nick’s situation? e. The integrating sensor is more likely to be damaged because the integrating sensor is a single synapse between a sensory neuron and a motor neuron. D. Which division of the autonomic nervous system would be affected and would be causing Nick’s GI tract symptoms? f. The division that would be affected would be the parasympathetic system. E. Nick’s light-headedness is cause by a condition known as orthostatic hypotension, a rapid drop in blood pressure upon standing up. Based on what you have learned so far, how does the autonomic nervous system control blood pressure? g. The autonomic nervous system senses a rise or fall in the blood pumping...
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...A patient presents with an extremely painful corn on the sole of their foot. The corn is located directly under the first metatarso-phalangeal joint. What gait pattern would be expected? What would the effects of their condition be on various parts of the gait cycle? antalgic gait a limp adopted so as to avoid pain on weight-bearing structures, characterized by a very short stance phasehttp://medical-dictionary.thefreedictionary.com/antalgic+gait. Antalgic gait refers to the way one walks, usually with a limp, to avoid pain. It’s a form of gait abnormality where the stance phase is shortened relative to the swing phase. There are many types of gait, but antalgic gait is the result of pain. The patient tries to minimize the amount of weight placed on the painful leg, knee, ankle or foot while walking or running. The stride is shortened on the injured side, affecting the posture or style of the patient’s normal gait cycle. Antalgic gait can come on suddenly or gradually due to a disease or damage to the nerve or musculoskeletal system. It can be mild, moderate or severe, temporary or permanent. Antalgic gait can affect anyone at any age, but seniors and athletes seem to suffer from it more often and it is seen in men more than women. http://www.footanklehealth.com/health/antalgic-gait.html A limp is a type of asymmetric abnormality of the gait. When due to pain it is referred to as an antalgic gait which has a shortened duration in which the foot is in contact with...
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...WALKING 1. How many times you walking in a day? (hours) Below 2 6 – 8 2 – 4 Others _____________ 4 – 6 2. How many distance you walking in a day? (meters) 0 – 200 800 – 1000 200 – 400 Others _____________ 600 – 800 3. At what part of your body feel the pain mostly while walking in a day? Ankle No pain Knee Others______________ Waist 4. How long do you need to rest the body from muscular paint? ½ hours two 2 hours 1 hour Others_____________ 5. What is other activity that you do to overcome the muscular pain? Massages Exercise / Cool down Go to spa / Sauna Massage oiling Sleep Others____________ BENDING FORWARD 1. How many times per hours your body bending forward? 1 – 5 times 10 – 15 times 6 – 10 times More than 15 times 2. For how long your body bending? (average) State: hours minutes 3. Which part on your body experience muscular pain? Waist Back ...
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...Ever experience muscle tingling, muscle weakness, or paralysis? If so we need to talk. Guillain-Barre Syndrome is a disorder that occurs when the body’s defense (immune) system mistakenly attacks part of the nervous system (Guillain-Barre Syndrome, 2009). This leads to nerve inflammation that causes muscle weakness. If you are experiencing any of these symptoms, we need to get you informed on what could be the possible diagnosis. Guillain-Barre Syndrome has several symptoms can present themselves very quickly but weakness increasing over several days is common (Guillain-Barre Syndrome, 2009). Muscle weakness or paralysis happens on both sides of the body, starting in lower extremities and traveling upwards. Clumsiness or tingling of hand or foot is one of the first symptoms to arise. If the diaphragm is affected additional help breathing could be needed. Symptoms include loss of reflexes, muscle weakness, loss of muscle function, decreased sensation, numbness, sensation changes, tenderness, muscle pain, uncoordinated movement, blurred vision, falling, difficulty moving facial muscles, palpitations, and muscle contraction. Watch for symptoms that need emergency attention like breathing stops, can’t take a deep breath, difficulty breathing or swallowing, drooling, fainting, or feeling light heading (Guillain-Barre Syndrome, 2009). Guillain-Barre Syndrome occurs at any age but average is between 30-50 years of age. At this time there in no known cause. Possible triggers...
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...Case study 76 Endocrine Disorders 1. Interpret Y.L.'s laboratory results • HbA1C is elevated at 8.8% and the goal for diabetics is to keep that value below 7% Hemoglobin A1c. Her number is concerning because it indicates that her blood sugar has been way too high over the past few months. The A1c is an indication of glycosylation in the body which is damaging to the blood vessels and peripheral nerves. It causes thickening of the basement membrane which will impair oxygen transport to the tissues and carbon dioxide removal. • High BP • Total Cholesterol is elevated at 256mg/dL, normal value is below 200mg/dL • Fasting glucose is high at 184mg/dL, normal value is below 126mg/dL • Triglycerides are elevated at 346 mg/dL, normal levels are below 150mg/dL. Y.L. indicates levels that are high. • LDL levels are elevated at 155mg/dL and ideal values are below 100mg/dL; LDL is the value you want to be the lowest. • HDL levels are low and the HDL levels need to be high, 40-60mg/dL is desired. • Urine Analysis indicates that Y.L. is spilling glucose into her urine. 2. Identify the three methods used to diagnose DM. - Fasting blood glucose of > 126 mg/dl - Random Glucose Level >200 mg/dl (plus presence of other symptoms) - A1C > 6.5% 3. Identify three functions of insulin. • regulates glucose metabolism • stimulates lipogenesis • stimulates growth 4. Describe the major pathophysiologic difference between type 1 and type 2 DM. • Type 1 diabetes,...
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...Case Study NSG/340 March 3, 2015 Sandra Gilderson, MSN/Ed, RN Case Study Y.L. laboratory result The fasting glucose is over the limits, fasting should be no more 126. HgbA1c is over limits and should be less than 6.5 or 7 the most. Her cholesterol demonstrates hyperlipidemia with low HDL. UA demonstrates glycosuria which represents a degree of damage in the kidneys. The lab result presented is not within normal range and patient is also at risk for heart disease. Methods for diagnosis First one can do a spot test using a fasting plasma glucose test and is found to be positive if it is greater than 126. Secondly, an order of two-hour glucose test known as oral glucose tolerance test greater than 200 is positive for diabetes. Lastly if the random glucose plasma level is tested and found to be greater than 200, with demonstrated symptoms such as polyuria, polydipsia, or polyphagia diabetes can be diagnosed. Functions of insulin Insulin is responsible for assisting the body in the storage of fat by taking lipids from blood into the cells. Additionally, it is responsible for the regulation of glucose by transporting glucose from the blood into the muscles, and liver. Insulin also aids in gluconeogenesis Type1 vs Type 2 DM Type 1 is known to be caused by the autoimmune destruction of the beta cells within the pancreas leading to diabetes. Type 2 is a progressive destruction of the beta cells due to increased glucose levels, leading to a decreased production of insulin...
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...diabetes; Retinopathy, Neuropathy, and Nephropathy. Here is some information about these diseases and steps to help prevent and to manage these complications, do research online and find an every site that will give them the information needed to obtain the first steps in working out this problem. Diabetic Retinopathy When the retina gets nerve damage by the diabetes it weakens the blood vessels. There are steps people can take to reduce their chance of vision loss from complications from diabetic retinopathy. ‘’Hyperglycaemia results in thickening of the basement membrane in the capillaries and loss of endothelial cell adhesion, leading to lose of integrity of these small vessels. This causes a change in blood vessel permeability and the leakage of water, blood, protein, and fat into the surrounding retinal tissue’’ (Shotliff, & Balasanthiran, 2009). They will have to know all of the warning signs and act accordingly. Some of the signs are blurry vision, black or gray spots, cobwebs or strings that move of float when they moves his eyes. Developing control of their sugar, blood pressure, and remove the intake of alcohol, cigarettes will give them a better chance to reduce the risk of getting Diabetic Retinopathy. [pic] Diabetic Neuropathy Occurs when the body has numbness in hands and feet, this is the nerves in their body are damaged, and send messages to the brain and other body parts. Gastroparesis is a type of neuropathy;...
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...surgical wounds from abdominal, chest and cardiac (heart) surgical procedures. Currently VAC can be used on all types of wounds: acute, subacute or chronic. Introduction Diabetes is becoming a common problem in most of the countries all over the world. About 1.8 million people are affected by diabetes and with rapidly increasing diabetic patients the count is estimated to go up to 2.7 million in next 25 years (Speak K, 2007). Diabetic foot complications are more frequent in males individuals aged over 60 years. The life expectancy of the diabetic patients has increased due different treatments, which in turn increases the number of complications as the disease progresses. Prolonged uncontrolled diabetes leads to complications like neuropathy and peripheral arterial disease (PAD), which are the risk factors for diabetic foot ulcers (Speak K, 2007). Nearly, 15%-20% of diabetic patients suffer from diabetic foot ulcer and 85% suffer amputations because of diabetic foot ulcer (Bergin S, 2006). Amputations not only responsible for social,...
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...vasculitic autonomic neuropathy diagnosed at University of Michigan Hospital by nerve biopsy, presented to the ED with pain in his hands and feet for the last 2 days and flare up of "Chilblain" symptoms. No signs of swelling or change in color, no rash, no erythema, No lesion, no fever, and no change in his walking. He was admitted to the floor for IV steroid and pain management. When we received the sign-out from the ED doctor on this case; I was wondering what “chilblains” means and how I can manage it. The term chilblains is a descriptive word usually referring to an idiopathic medical condition, often cold-induced vasculopathy characterised by dusky red-purple nodules over skin of the hands and feet (Collins, Arnold, & Kissel, 2013). Chilblain is a clinical diagnosis; therefore, it is important to obtain a detailed history and do a comprehensive physical examination to exclude associated conditions, such as systematic disease or connective tissue disorder. Furthermore, full laboratory workup for a patient with chilblains should be done to exclude any systemic or autoimmune disorders, including the following lab tests: complete blood count with differentia, antinuclear antibody screen, cold agglutinin, cryoglobulin, cryofibrinogen and antiphospholipid antibody pane. Moreover, nerve biopsy is crucial for definitive diagnosis of a patient with suspected vasculitic neuropathy that leads to chilblains; a histologic diagnosis of definite vasculitic neuropathy requires inflammation...
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...paternal copy, which may be of normal sequence, is imprinted and therefore silenced. The sister syndrome, Prader–Willi syndrome, is caused by a similar loss of paternally inherited genes and maternal imprinting. AS is named after a British pediatrician, Harry Angelman, who first described the syndrome in 1965.[1] An older, alternative term for AS, "happy puppet syndrome", is generally considered pejorative and stigmatizing so it is no longer the accepted term. People with AS are sometimes referred to as "angels", both because of the syndrome's name and because of their youthful, happy appearance Charcot–Marie–Tooth disease Charcot–Marie–Tooth disease (CMT), also known as Charcot–Marie–Tooth neuropathy and peroneal muscular atrophy is one of the hereditary motor and sensory neuropathies, a group of varied inherited disorders of theperipheral nervous system characterised by progressive loss of muscle tissue and touch sensation across various parts of the body. Currently incurable, this disease is the most commonly inherited neurological disorder, and affects approximately 1 in 2,500 people.[1][2] CMT was previously classified as a subtype of muscular dystrophy.[1] Cri du chat syndrome, also known as chromosome 5p deletion syndrome, 5p− (said minus) syndrome orLejeune’s syndrome, is a rare genetic disorder due to a missing part (deletion) of chromosome 5.[1] Its name is a French term (cat-cry or call of the cat) referring to...
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...In 1859, French physician Jean-Baptiste Octave Landry first documented Guillain- Barré syndrome (GBS) as “ascending paralysis.” Guillain- Barré Syndrome is an acute, acquired peripheral neuropathy with a course that is usually monophasic (Hardy, Blum, McCombe, & Reddel, 2011). It is typically triggered after an infection and rarely during vaccination. While there is currently no known cure, there are ways to decrease the severity of the illness. Without treatment, this disorder is fatal and immediately causes paralysis. If a person receives treatment soon after developing GBS, the ailments affects can be less detrimental. Landry worked with ten patients who were diagnosed with GBS. After extensively studying these patients, he was able to...
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