1. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 39 Nervous System and Musculo-Skeletal Disorders

2. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Nervous System Disorders  Stroke (brain attack or cerebrovascular accident [CVA])  Stroke is a disease that affects the arteries that supply blood to the brain.  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.  Some risk factors can be controlled; others cannot.  Stroke can occur suddenly, or the person may have warning signs.  If the person survives, some brain damage is likely.  Rehabilitation starts at once.  In a transient ischemic attack (TIA), blood supply is interrupted for a short time. Slide 2

3. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.  Parkinson’s disease is a slow, progressive disorder with no cure.  The area of the brain that controls muscle movement is affected.  Persons over the age of 50 are at risk.  Signs and symptoms become worse over time. Tremors Tremors Rigid, stiff muscles in the arms, legs, neck, and trunk Rigid, stiff muscles in the arms, legs, neck, and trunk Slow movements Slow movements Stooped posture and impaired balance Stooped posture and impaired balance Mask-like expression Mask-like expression  Treatment includes: Drugs to treat and control the disease Drugs to treat and control the disease Exercise and physical therapy Exercise and physical therapy Therapy for speech and swallowing problems Therapy for speech and swallowing problems Help with eating and self-care as needed Help with eating and self-care as needed Safety measures to prevent falls and injury Safety measures to prevent falls and injury Slide 3

4. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.  Multiple sclerosis (MS) is a chronic disease.  The myelin in the brain and spinal cord is destroyed.  Nerve impulses are not sent to and from the brain in a normal manner.  Functions are impaired or lost.  There is no cure.  Symptoms usually start between the ages of 20 and 40.  Risk factors 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.  Symptoms depend on the damaged area.  The person is kept active and independent as long as possible. Slide 4

5. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.  Amyotrophic lateral sclerosis (ALS) (Lou Gehrig’s disease) attacks the nerve cells that control voluntary muscles.  ALS affects more men than women.  It usually strikes between 40 and 60 years of age.  Motor nerve cells in the brain, brainstem, and spinal cord are affected.  The disease usually does not affect: The mind, intelligence, or memory The mind, intelligence, or memory Sight, smell, taste, hearing, and touch Sight, smell, taste, hearing, and touch Bowel and bladder functions Bowel and bladder functions  ALS has no cure. It is rapidly progressive and fatal.  Persons with ALS are kept active as long as possible and as independent as possible. Slide 5

6. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.  Head injuries result from trauma to the scalp, skull, or brain.  Traumatic brain injury (TBI) occurs when a sudden trauma damages the brain.  Causes include motor vehicle crashes, falls, firearms, assaults, and sports and recreational injuries.  Death can occur at the time of injury or afterward.  If the person survives TBI, some permanent damage is likely.  Disabilities depend on the severity and location of the injury.  Rehabilitation is required. Slide 6

7. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.  Spinal cord injuries can permanently damage the nervous system.  Young adult men have the highest risk.  Common causes are stab or gunshot wounds, motor vehicle crashes, falls, and sports injuries.  Problems depend on the amount of damage to the spinal cord and the level of injury.  Damage to the spinal cord may be incomplete or complete.  The higher the level of injury, the more functions are lost.  Reactions to paralysis and loss of function are often severe. Emotional needs require attention. Slide 7

8. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.  If the person survives, rehabilitation is necessary.  Autonomic dysreflexia affects persons with spinal cord injuries above the mid-thoracic level. If untreated, stroke, heart attack, and death are risks. If untreated, stroke, heart attack, and death are risks. Autonomic dysreflexia is treated by raising the head of the bed 45 degrees or having the person sit upright if allowed. Autonomic dysreflexia is treated by raising the head of the bed 45 degrees or having the person sit upright if allowed. The most common causes of autonomic dysreflexia are a full bladder, constipation or fecal impaction, and skin disorders. The most common causes of autonomic dysreflexia are a full bladder, constipation or fecal impaction, and skin disorders. Slide 8

9. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Musculo-Skeletal Disorders  Arthritis  Arthritis means joint inflammation; pain, swelling, and stiffness occur in the affected joints.  It is the most common joint disease.  There are two basic types of arthritis. Osteoarthritis (degenerative joint disease) Osteoarthritis (degenerative joint disease) Rheumatoid arthritis (RA) Rheumatoid arthritis (RA)  Arthroplasty is the surgical replacement of a joint. Hip and knee replacements are the most common. Hip and knee replacements are the most common. Surgery can relieve pain, restore or preserve joint function, or correct a deformed joint. Surgery can relieve pain, restore or preserve joint function, or correct a deformed joint. Slide 9

10. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.  With osteoporosis, the bone becomes porous and brittle.  Older men and women are at risk.  All ethnic groups are at risk.  Other risk factors include: A family history of the disease A family history of the disease Being thin or having a small frame Being thin or having a small frame Eating disorders Eating disorders Tobacco use Tobacco use Alcoholism Alcoholism Lack of exercise Lack of exercise Bedrest and immobility Bedrest and immobility Slide 10

11. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.  A fracture is a broken bone.  Fractures are open or closed.  Causes include falls and accidents, bone tumors, metastatic cancer, and osteoporosis.  For healing, bone ends are brought into and held in normal position (reduction or fixation). Closed reduction or external fixation Closed reduction or external fixation Open reduction or internal fixation Open reduction or internal fixation Slide 11

12. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.  Casts immobilize fractures.  Traction reduces and immobilizes fractures.  Hip fractures 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. The fracture requires internal fixation. The fracture requires internal fixation. Post-operative problems from hip fractures present life- threatening risks. Post-operative problems from hip fractures present life- threatening risks. Slide 12

13. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.  Loss of limb  An amputation is the removal of all or part of an extremity.  Much support is needed.  The person is fitted with a prosthesis.  The person may feel that the limb is still there.  Gangrene is a condition in which there is death of tissue. Sometimes limbs are amputated to prevent the infection from spreading to the whole body. Slide 13

14. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Quality of Life  A person may have one or many problems affecting the nervous and musculoskeletal systems. systems.  The care you give affects the person’s quality of life.  Protect the person’s rights.  Follow Standard Precautions and the Bloodborne Pathogen Standard. Slide 14