chapter 41 nervous system and musculo-skeletal disorders copyright © 2012 by mosby, an imprint of...

Chapter 41Chapter 41

Nervous System and Nervous System and Musculo-skeletal DisordersMusculo-skeletal Disorders

Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Nervous system disorders can affect mental and Nervous system disorders can affect mental and physical function.physical function. Nervous system disorders can affect the ability to:Nervous system disorders can affect the ability to:

• SpeakSpeak• UnderstandUnderstand• FeelFeel• SeeSee• HearHear• TouchTouch• ThinkThink• Control bowels and bladderControl bowels and bladder• MoveMove

Slide 2Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Nervous System DisordersNervous System Disorders

Stroke (brain attack or cerebrovascular Stroke (brain attack or cerebrovascular accident [CVA]) is a disease that affects the accident [CVA]) is a disease that affects the arteries that supply blood to the brain.arteries that supply blood to the brain. Stroke occurs when one of the following happens.Stroke occurs when one of the following happens.

• A blood vessel in the brain bursts. Bleeding occurs in the A blood vessel in the brain bursts. Bleeding occurs in the brain (cerebral hemorrhage). brain (cerebral hemorrhage).

• A blood clot blocks blood flow to the brain.A blood clot blocks blood flow to the brain. Stroke is the third leading cause of death in the Stroke is the third leading cause of death in the

United States.United States.• It is a leading cause of disability in adults.It is a leading cause of disability in adults.

Warning signs may last a few minutes.Warning signs may last a few minutes.• This is called a This is called a transient ischemic attack transient ischemic attack (TIA).(TIA).


Nervous System Disorders (cont’d)Nervous System Disorders (cont’d)

Stroke risk factors include:Stroke risk factors include:• High blood pressureHigh blood pressure

• Cigarette smoking; exposure to second-hand smokeCigarette smoking; exposure to second-hand smoke

• Heart diseaseHeart disease

• DiabetesDiabetes

• TIAsTIAs

• Age 55 and olderAge 55 and older

• Being over-weightBeing over-weight

• Lack of physical activityLack of physical activity



Stroke can occur suddenly.Stroke can occur suddenly.• The person may have warning signs.The person may have warning signs.

Sudden numbness or weakness of the face, arm, or leg, Sudden numbness or weakness of the face, arm, or leg, especially on one side of the bodyespecially on one side of the body

Sudden confusion, trouble speaking, or understanding Sudden confusion, trouble speaking, or understanding speechspeech

Sudden trouble seeing in one or both eyesSudden trouble seeing in one or both eyes Sudden trouble walking, dizziness, loss of balance or Sudden trouble walking, dizziness, loss of balance or

coordinationcoordination Sudden severe headache with no known causeSudden severe headache with no known cause



If the person survives, some brain damage is If the person survives, some brain damage is likely.likely.• Functions lost depend on the area of brain damage.Functions lost depend on the area of brain damage.

• Rehabilitation starts at once.Rehabilitation starts at once.

• The health team helps the person regain the highest The health team helps the person regain the highest possible level of function.possible level of function.



Parkinson’s disease is a slow, progressive Parkinson’s disease is a slow, progressive disorder with no cure.disorder with no cure. Movement is affected.Movement is affected. Persons over the age of 50 are at risk.Persons over the age of 50 are at risk. Signs and symptoms become worse over time. Signs and symptoms become worse over time.

They include:They include:• TremorsTremors• Rigid, stiff muscles in the arms, legs, neck, and trunkRigid, stiff muscles in the arms, legs, neck, and trunk• Slow movementsSlow movements• Stooped posture and impaired balanceStooped posture and impaired balance• Mask-like expressionMask-like expression

Other signs and symptoms develop over time.Other signs and symptoms develop over time.



Treatment includes:Treatment includes:• Drugs to treat and control the diseaseDrugs to treat and control the disease

• Exercise and physical therapy to improve strength, Exercise and physical therapy to improve strength, posture, balance, and mobilityposture, balance, and mobility

• Therapy for speech and swallowing problemsTherapy for speech and swallowing problems

The person may need help with eating and self-The person may need help with eating and self-care.care.

Normal elimination is a goal.Normal elimination is a goal. Safety measures are needed to prevent falls and Safety measures are needed to prevent falls and

injuries.injuries.



Multiple sclerosis (MS) is a chronic disease.Multiple sclerosis (MS) is a chronic disease. The myelin, which covers nerve fibers in the The myelin, which covers nerve fibers in the

brain and spinal cord, is destroyed.brain and spinal cord, is destroyed.• Nerve impulses are not sent to and from the brain in a Nerve impulses are not sent to and from the brain in a

normal way.normal way.

There is no cure.There is no cure.



Blurred or double vision, Blurred or double vision, blindness in one eyeblindness in one eye

Muscle weakness in the Muscle weakness in the arms and legsarms and legs

Balance and coordination Balance and coordination problemsproblems

Tingling, prickling, or Tingling, prickling, or numb sensationsnumb sensations

Partial or complete Partial or complete paralysisparalysis

PainPain Speech problemsSpeech problems

TremorsTremors DizzinessDizziness Concentration, attention, Concentration, attention,

memory, and judgment memory, and judgment problemsproblems

DepressionDepression Bowel and bladder Bowel and bladder

problemsproblems Problems with sexual Problems with sexual

functionfunction Hearing lossHearing loss FatigueFatigue

Slide 10

Signs and symptoms may include:Signs and symptoms may include:

Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.


MS can present in many ways. For example:MS can present in many ways. For example:• The person’s symptoms last for a few weeks or a few The person’s symptoms last for a few weeks or a few

months. The symptoms gradually disappear with months. The symptoms gradually disappear with partial or complete recovery. The person is in partial or complete recovery. The person is in remissionremission. At some point, symptoms flare up again . At some point, symptoms flare up again ((relapserelapse).).

• The person’s condition gradually declines with more The person’s condition gradually declines with more and more symptoms. There are no remissions.and more symptoms. There are no remissions.

• Symptoms become worse. More symptoms occur with Symptoms become worse. More symptoms occur with each flare-up. The person’s condition declines.each flare-up. The person’s condition declines.

Persons with MS are kept active as long as Persons with MS are kept active as long as possible and as independent as possible.possible and as independent as possible.• The care plan reflects the person’s changing needs.The care plan reflects the person’s changing needs.



Amyotrophic lateral sclerosis (ALS) is a Amyotrophic lateral sclerosis (ALS) is a disease that attacks the nerve cells that control disease that attacks the nerve cells that control voluntary muscles.voluntary muscles. Commonly called Commonly called Lou Gehrig’s diseaseLou Gehrig’s disease, it is rapidly , it is rapidly

progressive and fatal.progressive and fatal. ALS is more common in men.ALS is more common in men. It usually strikes between 40 and 60 years of age.It usually strikes between 40 and 60 years of age. Motor nerve cells in the brain, brainstem, and spinal Motor nerve cells in the brain, brainstem, and spinal

cord are affected.cord are affected.• These cells stop sending messages to the muscles.These cells stop sending messages to the muscles.

• Muscles weaken, waste away (atrophy), and twitch.Muscles weaken, waste away (atrophy), and twitch.



Over time, the brain cannot start voluntary Over time, the brain cannot start voluntary movements or control them.movements or control them.

The disease usually does not affect the mind, The disease usually does not affect the mind, intelligence, or memory.intelligence, or memory.

Sight, smell, taste, hearing, and touch are not Sight, smell, taste, hearing, and touch are not affected.affected.

ALS has no cure.ALS has no cure.• Some drugs can slow disease and improve symptoms.Some drugs can slow disease and improve symptoms.

Persons with ALS are kept active and independent Persons with ALS are kept active and independent to the extent possible.to the extent possible.• The care plan reflects the person’s changing needs.The care plan reflects the person’s changing needs.



Head injuries result from trauma to the scalp, skull, Head injuries result from trauma to the scalp, skull, or brain.or brain. Traumatic brain injury (TBI) occurs when a sudden trauma Traumatic brain injury (TBI) occurs when a sudden trauma

damages the brain.damages the brain.• Brain tissue is bruised or torn.Brain tissue is bruised or torn.• Bleeding can be in the brain or in nearby tissues.Bleeding can be in the brain or in nearby tissues.• Spinal cord injuries are likely.Spinal cord injuries are likely.

Causes include:Causes include:• Motor vehicle crashesMotor vehicle crashes• FallsFalls• AssaultsAssaults• FirearmsFirearms• Sports and recreation injuriesSports and recreation injuries

Death can occur at the time of injury or later.Death can occur at the time of injury or later.• If the person survives, some permanent damage is likely.If the person survives, some permanent damage is likely.



Disabilities depend on the severity and site of the injury. They Disabilities depend on the severity and site of the injury. They include:include:• Cognitive problemsCognitive problems

• Sensory problemsSensory problems

• Communication problemsCommunication problems

• Behavior or mental health problemsBehavior or mental health problems

• Stupor—an unresponsive state; the person can be briefly arousedStupor—an unresponsive state; the person can be briefly aroused

• Coma—the person is unconscious, does not respond, is unaware, Coma—the person is unconscious, does not respond, is unaware, and cannot be arousedand cannot be aroused

• Vegetative state—the person is unconscious and unaware of Vegetative state—the person is unconscious and unaware of surroundings. He or she has sleep-wake cycles and periods of surroundings. He or she has sleep-wake cycles and periods of being alertbeing alert

• Persistent vegetative state (PVS)—the person is in a vegetative Persistent vegetative state (PVS)—the person is in a vegetative state for more than 1 monthstate for more than 1 month

Rehabilitation is required.Rehabilitation is required.Slide 15Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.


Spinal cord injuries can permanently damage Spinal cord injuries can permanently damage the nervous system.the nervous system. Young adult men have the highest risk.Young adult men have the highest risk. Common causes are:Common causes are:

• Stab or gunshot woundsStab or gunshot wounds

• Motor vehicle crashesMotor vehicle crashes

• FallsFalls

• Sports injuriesSports injuries

Problems depend on the:Problems depend on the:• Amount of damage to the spinal cordAmount of damage to the spinal cord

• Level of injuryLevel of injury



The higher the level of injury, the more functions lost.The higher the level of injury, the more functions lost.• Lumbar injuries—sensory and muscle function in the legs is lost Lumbar injuries—sensory and muscle function in the legs is lost

((paraplegiaparaplegia).).

• Thoracic injuries—sensory and muscle function below the chest is Thoracic injuries—sensory and muscle function below the chest is lost (lost (paraplegiaparaplegia).).

• Cervical injuries—sensory and muscle function of the arms, legs, Cervical injuries—sensory and muscle function of the arms, legs, and trunk are lost (and trunk are lost (quadriplegia quadriplegia or or tetraplegiatetraplegia).).

If the person lives, rehabilitation is needed.If the person lives, rehabilitation is needed.• The person learns to function at the highest possible level.The person learns to function at the highest possible level.

• The person learns to use self-help, assistive, and other devices.The person learns to use self-help, assistive, and other devices.

• Some persons live independently at home or with home care.Some persons live independently at home or with home care.

• Some persons need long-term care or assisted-living settings.Some persons need long-term care or assisted-living settings.



Autonomic dysreflexia occurs with spinal cord Autonomic dysreflexia occurs with spinal cord injuries above the mid-thoracic level.injuries above the mid-thoracic level. There is uncontrolled stimulation of the sympathetic There is uncontrolled stimulation of the sympathetic

nervous system.nervous system. If untreated, stroke, heart attack, and death are risks.If untreated, stroke, heart attack, and death are risks. Treatment involves: Treatment involves:

• Raising the head of the bed 45 degrees or having the Raising the head of the bed 45 degrees or having the person sit upright if allowedperson sit upright if allowed

• Determining and removing the causeDetermining and removing the cause The most common causes are:The most common causes are:

• A full bladderA full bladder• Constipation or fecal impactionConstipation or fecal impaction• Skin disordersSkin disorders



Musculo-skeletal DisordersMusculo-skeletal Disorders

Musculo-skeletal disorders affect movement.Musculo-skeletal disorders affect movement. Injury and aging are common causes.Injury and aging are common causes.

Arthritis means joint inflammation.Arthritis means joint inflammation. It is the most common joint disease.It is the most common joint disease. Pain, swelling, and stiffness occur.Pain, swelling, and stiffness occur. The joints are hard to move.The joints are hard to move.


Osteoarthritis (degenerative joint disease) is the Osteoarthritis (degenerative joint disease) is the most common type of arthritis.most common type of arthritis. Causes include:Causes include:

• AgingAging• Being over-weightBeing over-weight• Joint injuryJoint injury• StressStress• Muscle weaknessMuscle weakness• HeredityHeredity

Signs and symptoms include:Signs and symptoms include:• Joint stiffness occurs with rest and lack of motion.Joint stiffness occurs with rest and lack of motion.• Pain occurs with weight-bearing and motion.Pain occurs with weight-bearing and motion.• Swelling is common after using the joint.Swelling is common after using the joint.

There is no cure.There is no cure.Slide 20Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Musculo-skeletal Disorders (cont’d)Musculo-skeletal Disorders (cont’d)

Treatment involves:Treatment involves:• Drugs to decrease swelling and inflammation and Drugs to decrease swelling and inflammation and

relieve painrelieve pain• Heat and sometimes cold applicationsHeat and sometimes cold applications• ExerciseExercise• Rest and joint careRest and joint care• Weight controlWeight control• Healthy life-styleHealthy life-style• Joint replacement surgeryJoint replacement surgery

Falls are prevented.Falls are prevented. Help is given with ADL as needed.Help is given with ADL as needed.



Rheumatoid arthritis (RA) is a chronic Rheumatoid arthritis (RA) is a chronic inflammatory disease.inflammatory disease. It causes joint pain, swelling, stiffness, and loss of It causes joint pain, swelling, stiffness, and loss of

function.function. RA is more common in women than in men.RA is more common in women than in men. It usually develops between the ages of 20 and 50.It usually develops between the ages of 20 and 50. RA occurs on both sides of the body.RA occurs on both sides of the body. Joints are tender, warm, and swollen.Joints are tender, warm, and swollen. Fatigue and fever are common.Fatigue and fever are common. Symptoms may last for many years.Symptoms may last for many years. Other body parts may be affected.Other body parts may be affected. RA varies from person to person.RA varies from person to person.



Treatment goals are to:Treatment goals are to:• Relieve pain.Relieve pain.• Reduce inflammation.Reduce inflammation.• Slow down or stop joint damage.Slow down or stop joint damage.• Improve well-being and ability to function.Improve well-being and ability to function.

The person’s care plan may include:The person’s care plan may include:• Rest balanced with exerciseRest balanced with exercise• Proper positioningProper positioning• Joint careJoint care• Weight controlWeight control• Measures to reduce stressMeasures to reduce stress• Measure to prevent fallsMeasure to prevent falls



Drugs are given for pain relief and inflammation.Drugs are given for pain relief and inflammation. Heat and cold applications may be ordered.Heat and cold applications may be ordered. Some persons need joint replacement surgery.Some persons need joint replacement surgery. Emotional support is needed. Emotional support is needed.



Total joint replacement surgeryTotal joint replacement surgery Arthroplasty is the surgical replacement of a joint.Arthroplasty is the surgical replacement of a joint. The damaged joint is removed and replaced with The damaged joint is removed and replaced with

an artificial joint.an artificial joint.• The artificial joint is called a The artificial joint is called a prosthesisprosthesis..

The surgery is done to:The surgery is done to:• Relieve pain.Relieve pain.

• Restore joint function.Restore joint function.

• Correct a deformed joint.Correct a deformed joint.



OsteoporosisOsteoporosis With osteoporosis, the bone becomes porous With osteoporosis, the bone becomes porous

and brittle.and brittle.• Bones are fragile and break easily.Bones are fragile and break easily.

Older people are at risk.Older people are at risk.• The risk for women increases after menopause.The risk for women increases after menopause.

All ethnic groups are at risk.All ethnic groups are at risk.



Other risk factors include:Other risk factors include:• A family history of the diseaseA family history of the disease• Being thin or having a small frameBeing thin or having a small frame• Eating disordersEating disorders• Tobacco useTobacco use• AlcoholismAlcoholism• Lack of exerciseLack of exercise• BedrestBedrest• ImmobilityImmobility

Signs and symptoms include:Signs and symptoms include:• Back painBack pain• Gradual loss of heightGradual loss of height• Stooped postureStooped posture• FracturesFractures



Preventive measures include:Preventive measures include:• Calcium and vitamin supplementsCalcium and vitamin supplements• Estrogen for some womenEstrogen for some women• Exercising weight-bearing jointsExercising weight-bearing joints• Strength trainingStrength training• Not smokingNot smoking• Limiting alcohol and caffeineLimiting alcohol and caffeine• Back supports or corsets for good postureBack supports or corsets for good posture• Walking aids if neededWalking aids if needed• Safety measures to prevent falls and accidentsSafety measures to prevent falls and accidents• Good body mechanicsGood body mechanics• Safe moving, transfer, and turning and positioning Safe moving, transfer, and turning and positioning

proceduresproceduresSlide 28Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.


FracturesFractures A fracture is a broken bone.A fracture is a broken bone. Fractures are open or closed.Fractures are open or closed.

• Closed fracture (simple fracture)—the bone is broken Closed fracture (simple fracture)—the bone is broken but the skin is intact.but the skin is intact.

• Open fracture (compound fracture)—the broken bone Open fracture (compound fracture)—the broken bone has come through the skin.has come through the skin.

Causes include:Causes include:• Falls and accidentsFalls and accidents

• Bone tumorsBone tumors

• Metastatic cancerMetastatic cancer

• OsteoporosisOsteoporosis



Signs and symptoms of a fracture are:Signs and symptoms of a fracture are:• PainPain

• SwellingSwelling

• Loss of functionLoss of function

• Limited or no movement of the partLimited or no movement of the part

• Movement where motion should not occurMovement where motion should not occur

• DeformityDeformity

• Bruising and skin color changes at the fracture siteBruising and skin color changes at the fracture site

• Bleeding (internal or external)Bleeding (internal or external)



For healing, bone ends are brought into and held For healing, bone ends are brought into and held in normal position.in normal position.• This is called This is called reductionreduction or or fixationfixation..

Closed reduction and external fixation—the bone is Closed reduction and external fixation—the bone is moved back into place; the bone is not exposed.moved back into place; the bone is not exposed.

Open reduction and internal fixation—requires surgery; Open reduction and internal fixation—requires surgery; the bone is exposed and moved into alignment.the bone is exposed and moved into alignment.

After reduction, the bone ends must not move.After reduction, the bone ends must not move.• The person has a cast or traction.The person has a cast or traction.

• Splints, walking boots, and external fixators are also Splints, walking boots, and external fixators are also used.used.



Casts are made of plaster of paris, plastic, or Casts are made of plaster of paris, plastic, or fiberglass.fiberglass.

TractionTraction• A steady pull from two directions keeps the bone in place.A steady pull from two directions keeps the bone in place.

• Traction also is used for muscle spasms and to correct Traction also is used for muscle spasms and to correct deformities or contractures.deformities or contractures.

• Weights, ropes, and pulleys are used.Weights, ropes, and pulleys are used.

• Traction is applied to the neck, arms, legs, or pelvis.Traction is applied to the neck, arms, legs, or pelvis.

• Skin traction is applied to the skin. Skin traction is applied to the skin.

• Skeletal traction is inserted through the bone.Skeletal traction is inserted through the bone.

• For cervical traction, tongs are applied to the skull.For cervical traction, tongs are applied to the skull.



Hip fracturesHip fractures Fractured hips are common in older persons.Fractured hips are common in older persons.

• Older women are at risk.Older women are at risk.

Healing is slower in older people.Healing is slower in older people. These post-operative problems present life-These post-operative problems present life-

threatening risks.threatening risks.• Respiratory complicationsRespiratory complications

• Urinary tract infectionsUrinary tract infections

• Thrombi (blood clots) in the leg veinsThrombi (blood clots) in the leg veins

Other risks include pressure ulcers, constipation, Other risks include pressure ulcers, constipation, and confusion.and confusion.



The fracture requires internal fixation.The fracture requires internal fixation. Some hip fractures require partial or total hip Some hip fractures require partial or total hip

replacement.replacement.• Adduction, internal rotation, external rotation, and Adduction, internal rotation, external rotation, and

severe hip flexion are avoided after surgery.severe hip flexion are avoided after surgery.

Rehabilitation is usually needed after a hip Rehabilitation is usually needed after a hip fracture.fracture.



Loss of limbLoss of limb An amputation is the removal of all or part of an An amputation is the removal of all or part of an

extremity.extremity. Most amputations involve a lower extremity.Most amputations involve a lower extremity. Common causes include:Common causes include:

• Severe injuriesSevere injuries

• TumorsTumors

• Severe infectionSevere infection

• GangreneGangrene

• Vascular disordersVascular disorders



Gangrene is the death of tissue.Gangrene is the death of tissue.• Causes include infection, injuries, and vascular disorders.Causes include infection, injuries, and vascular disorders.

• Surgery is needed to remove dead tissue. Surgery is needed to remove dead tissue.

• If untreated, gangrene spreads throughout the body.If untreated, gangrene spreads throughout the body.

• Gangrene can cause death.Gangrene can cause death.

A prosthesis is an artificial replacement for a missing body A prosthesis is an artificial replacement for a missing body part.part.

The person may feel that the amputated limb is still there.The person may feel that the amputated limb is still there.• The person may complain of pain in the amputated part (phantom The person may complain of pain in the amputated part (phantom

pain).pain).

Lower limb amputations are common in older persons.Lower limb amputations are common in older persons.• After amputation, most need long-term care on a temporary or After amputation, most need long-term care on a temporary or

permanent basis.permanent basis.



chapter 41 nervous system and musculo-skeletal disorders copyright © 2012 by mosby, an imprint of...

Documents

imprint of elsevier

stroke brain attack

brain bursts

area of brain damage

blood vessel

warning signs

brain cerebral hemorrhage

stroke risk factors