Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 39 Nervous System and Musculoskeletal System Disorders

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 2  NERVOUS SYSTEM DISORDERS  Nervous system disorders can affect mental and physical function.

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 3  Stroke (brain attack or cerebrovascular accident [CVA]) is a disease that affects the 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 brain (cerebral hemorrhage).  A blood clot blocks blood flow to the brain. Stroke is the third leading cause of death in the United States. Stroke is the third leading cause of death in the United States.  It is a leading cause of disability in adults.  The person needs emergency care. Sometimes a warning sign lasts a few minutes. Sometimes a warning sign lasts a few minutes.  This is called a transient ischemic attack (TIA).

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 4 Some risk factors can be controlled; others cannot. Some risk factors can be controlled; others cannot.  Age (Older persons are at greater risk than younger persons.)  Family history (The risk increases if a parent or sibling had a stroke.)  Gender (Both men and women are affected.)  Race (Blacks are at greater risk than other groups.)  Hypertension  Heart disease  Smoking  Diabetes  High blood cholesterol  Obesity  Previous stroke or TIA

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 5 Stroke can occur suddenly. Stroke can occur suddenly.  The person may have warning signs. –Sudden numbness or weakness of the face, arm, or leg, especially on one side of the body –Sudden confusion, trouble speaking, or understanding speech –Sudden trouble seeing in one or both eyes –Sudden trouble walking, dizziness, loss of balance or coordination –Sudden severe headache with no known cause

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 6 If the person survives, some brain damage is likely. If the person survives, some brain damage is likely.  Functions lost depend on the area of brain damage.  Rehabilitation starts at once.  The health team helps the person regain the highest possible level of function.

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 7  Parkinson’s disease Parkinson’s disease is a slow, progressive disorder with no cure. Parkinson’s disease is a slow, progressive disorder with no cure. The area of the brain that controls muscle movement is affected. The area of the brain that controls muscle movement is affected. Persons over the age of 50 are at risk. Persons over the age of 50 are at risk. Signs and symptoms include: Signs and symptoms include:  Tremors  Rigid, stiff muscles in the arms, legs, neck, and trunk  Slow movements  Stooped posture and impaired balance  Mask-like expression Other signs and symptoms develop over time. Other signs and symptoms develop over time.

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 8 Treatment includes: Treatment includes:  Drugs to treat and control the disease  Exercise and physical therapy to improve strength, posture, balance, and mobility  Therapy for speech and swallowing problems The person may need help with eating and self-care. The person may need help with eating and self-care. Normal elimination is a goal. Normal elimination is a goal. Safety measures are needed to prevent falls and injury. Safety measures are needed to prevent falls and injury.

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 9  Multiple sclerosis (MS) is a chronic disease. The myelin, which covers nerve fibers in the brain and spinal cord, is destroyed. The myelin, which covers nerve fibers in the brain and spinal cord, is destroyed.  Nerve impulses are not sent to and from the brain in a normal manner. There is no cure. There is no cure. Symptoms usually start between the ages of 20 and 40. Symptoms usually start between the ages of 20 and 40. More women are affected than men. More women are affected than men. Whites are at greater risk than other groups. Whites are at greater risk than other groups. A person’s risk increases if a family member has MS. A person’s risk increases if a family member has MS.

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 10 Signs and symptoms depend on the damaged area and may include: Signs and symptoms depend on the damaged area and may include:  Vision problems  Muscle weakness in the arms and legs  Balance problems that affect standing and walking  Tingling, prickling, or numb sensations  Partial or complete paralysis  Pain  Speech problems

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 11  Tremors  Dizziness  Problems with concentration, attention, memory, and judgment  Depression  Bowel and bladder problems  Problems with sexual function  Hearing loss  Fatigue  Coordination problems and clumsiness

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 12 MS can present as follows: MS can present as follows:  Relapsing-remitting  Primary progressive  Secondary progressive  Progressive-relapsing Persons with MS are kept active as long as possible and as independent as possible. Persons with MS are kept active as long as possible and as independent as possible.  The care plan reflects the person’s changing needs.

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 13  Amyotrophic lateral sclerosis (ALS) attacks the nerve cells that control voluntary muscles. Commonly called Lou Gehrig’s disease, it is rapidly progressive and fatal. Commonly called Lou Gehrig’s disease, it is rapidly progressive and fatal. ALS affects more men than women. ALS affects more men than women. 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 cord are affected. Motor nerve cells in the brain, brainstem, and spinal cord are affected.

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 14 Over time, the brain cannot start voluntary movements or control them. Over time, the brain cannot start voluntary movements or control them. The disease usually does not affect the mind, intelligence, or memory. The disease usually does not affect the mind, intelligence, or memory. Sight, smell, taste, hearing, and touch are not affected. Sight, smell, taste, hearing, and touch are not affected. ALS has no cure. ALS has no cure.  Some drugs can slow disease progression. Persons with ALS are kept active as long as possible and as independent as possible. Persons with ALS are kept active as long as possible and as independent as possible.  The care plan reflects the person’s changing needs.

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 15  Head injuries result from trauma to the scalp, skull, or brain. Traumatic brain injury (TBI) occurs when a sudden trauma damages the brain. Traumatic brain injury (TBI) occurs when a sudden trauma damages the brain.  Brain tissue is bruised or torn.  Bleeding can be in the brain or in nearby tissues.  Spinal cord injuries are likely. Causes include: Causes include:  Motor vehicle crashes  Falls  Firearms  Assaults  Sports and recreation injuries If the person survives TBI, some permanent damage is likely. If the person survives TBI, some permanent damage is likely.

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 16 Disabilities depend on the severity and location of the injury. They include: Disabilities depend on the severity and location of the injury. They include:  Cognitive problems  Sensory problems  Communication problems  Behavior or mental health problems  Stupor (This is an unresponsive state; the person can be briefly aroused.)  Coma (The person is unconscious, does not respond, is unaware, and cannot be aroused.)  Vegetative state (The person is unconscious and unaware of surroundings; he or she has sleep-wake cycles and periods of being alert.)  Persistent vegetative state (PVS) (The person is in a vegetative state for more than 1 month.) Rehabilitation is required. Rehabilitation is required.

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 17  Spinal cord injuries can permanently damage 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 wounds  Motor vehicle crashes  Falls  Sports injuries Problems depend on: Problems depend on:  The amount of damage to the spinal cord  The level of injury

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 18 The higher the level of injury, the more functions lost. The higher the level of injury, the more functions lost.  With lumbar injuries, sensory and muscle function in the legs is lost (paraplegia).  With thoracic injuries, sensory and muscle function below the chest is lost (paraplegia).  With cervical injuries, sensory and muscle function of the arms, legs, and trunk are lost (quadriplegia or tetraplegia). If the person survives, rehabilitation is necessary. If the person survives, rehabilitation is necessary.  The person learns to function at the highest possible level.  The person learns to use self-help, assistive, and other devices.  Some persons return home and live independently.  Some persons need long-term care, home care, or assisted-living settings.

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 19  Autonomic dysreflexia affects persons with spinal cord injuries above the mid-thoracic level. There is uncontrolled stimulation of the sympathetic nervous system. There is uncontrolled stimulation of the sympathetic 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 person sit upright if allowed  Determining and removing the cause The most common causes are: The most common causes are:  A full bladder  Constipation or fecal impaction  Skin disorders

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 20  MUSCULOSKELETAL DISORDERS  Arthritis means joint inflammation. It is the most common joint disease. It is the most common joint disease.  Osteoarthritis (degenerative joint disease) is the most common type of arthritis. Causes include: Causes include:  Aging  Being overweight  Joint injury  Stress  Muscle weakness  Heredity

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 21 Signs and symptoms include: Signs and symptoms include:  Joint stiffness occurs with rest and lack of motion.  Pain occurs with weight-bearing and joint motion.  Swelling is common after using the joint. There is no cure. There is no cure. Treatment involves: Treatment involves:  Drugs to decrease swelling and inflammation and decrease pain  Heat  Sometimes cold applications  Exercise  Rest and joint care  Weight control  Healthy life-style  Joint replacement surgery

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 22  Rheumatoid arthritis (RA) is a chronic inflammatory disease. It causes joint pain, swelling, stiffness, and loss of function. It causes joint pain, swelling, stiffness, and loss of function. RA is more common in women than in men. RA is more common in women than in men. It generally develops between the ages of 20 and 50. It generally 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 several years. Symptoms may last for several 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.

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 23 Treatment goals are to: Treatment goals are to:  Relieve pain  Reduce inflammation  Slow down or stop joint damage  Improve the person’s sense of well-being and ability to function The person’s care plan may include: The person’s care plan may include:  Rest balanced with exercise  Proper positioning  Joint care  Rest  Regular exercise  Weight control  Measures to reduce stress  Measure to prevent falls

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 24 Drugs are ordered for pain relief and to reduce inflammation. Drugs are ordered for pain relief and to reduce 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.

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 25  Arthroplasty is the surgical replacement of a joint. The artificial joint is called a prosthesis. The artificial joint is called a prosthesis. The surgery is done to: The surgery is done to:  Relieve pain  Restore or preserve joint function  Correct a deformed joint

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 26  Osteoporosis With osteoporosis, the bone becomes porous and brittle. With osteoporosis, the bone becomes porous and brittle.  Bones are fragile and break easily. Older men and women are at risk. Older men and women are at risk.  The risk for women increases after menopause. All ethnic groups are at risk. All ethnic groups are at risk.

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 27 Other risk factors include: Other risk factors include:  A family history of the disease  Being thin or having a small frame  Eating disorders  Tobacco use  Alcoholism  Lack of exercise  Bedrest  Immobility Signs and symptoms include: Signs and symptoms include:  Back pain  Gradual loss of height  Stooped posture  Fractures

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 28 Preventive measures include: Preventive measures include:  Calcium and vitamin supplements  Estrogen for some women  Exercising weight-bearing joints  Strength-training  Not smoking  Limiting alcohol and caffeine  Back supports or corsets if needed for good posture  Walking aids if needed  Safety measures to prevent falls and accidents  Good body mechanics  Safe handling, moving, transfer, and turning and positioning procedures

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 29  Fractures A fracture is a broken bone. A fracture is a broken bone. With a closed fracture (simple fracture), the bone is broken but the skin is intact. With a closed fracture (simple fracture), the bone is broken but the skin is intact. With an open fracture (compound fracture), the broken bone has come through the skin. With an open fracture (compound fracture), the broken bone has come through the skin. Causes include: Causes include:  Falls and accidents  Bone tumors  Metastatic cancer  Osteoporosis

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 30 Signs and symptoms of a fracture are: Signs and symptoms of a fracture are:  Pain  Swelling  Loss of function  Limited or no movement of the part  Movement where motion should not occur  Deformity  Bruising and skin color changes at the fracture site  Bleeding

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 31 For healing, bone ends are brought into normal position and held there. For healing, bone ends are brought into normal position and held there.  This is called reduction or fixation. –With closed reduction or external fixation, the doctor moves the bones back into place. –With open reduction or internal fixation, the bone is exposed and moved into alignment. After reduction, movement of the bone ends is prevented with a cast, traction, splint, walking boot, or external fixator. After reduction, movement of the bone ends is prevented with a cast, traction, splint, walking boot, or external fixator.

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 32 Casts are made of plaster of paris, plastic, or fiberglass. Casts are made of plaster of paris, plastic, or fiberglass. Traction Traction  Traction reduces and immobilizes fractures.  Traction also is used to treat muscle spasms and to correct deformities or contractures.  Weights, ropes, and pulleys are used.  Traction is applied to the neck, arms, legs, or pelvis.  Skin traction is applied to the skin.  Skeletal traction is applied directly to the bone.  For cervical traction, tongs are applied to the skull.

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 33  Hip fractures Fractured hips are common in older persons. Fractured hips are common in older persons.  Older women are at risk. Healing is slower in older people. Healing is slower in older people. These post-operative problems present life-threatening risks: These post-operative problems present life-threatening risks:  Pneumonia  Atelectasis (collapse of a part of a lung)  Urinary tract infections  Thrombi (blood clots) in the leg veins Pressure ulcers, constipation, and confusion are other risks. Pressure ulcers, constipation, and confusion are other risks.

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 34 The fracture requires internal fixation. The fracture requires internal fixation. Some hip fractures require partial or total hip replacement. Some hip fractures require partial or total hip replacement.  Adduction, internal rotation, external rotation, and severe hip flexion are avoided after surgery. Rehabilitation is usually needed after a hip fracture. Rehabilitation is usually needed after a hip fracture.

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 35  Loss of limb An amputation is the removal of all or part of an extremity. An amputation is the removal of all or part of an extremity. Most amputations involve a lower extremity. Most amputations involve a lower extremity. Common causes include: Common causes include:  Severe injuries  Tumors  Severe infection  Gangrene  Vascular disorders

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 36 Gangrene is a condition in which there is death of tissue. Gangrene is a condition in which there is death of tissue.  Causes include infection, injuries, and vascular disorders.  Surgery is needed to remove dead tissue.  If untreated, gangrene spreads throughout the body.  Gangrene can cause death. A prosthesis is an artificial replacement for a missing body part. A prosthesis is an artificial replacement for a missing body part.  Occupational and physical therapists help the person use the prosthesis. 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. This is called phantom limb pain. The person may complain of pain in the amputated part. This is called phantom limb pain.