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Chapter 41
Nervous System and
Musculo-skeletal Disorders
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Nervous System Disorders
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Nervous system disorders can affect mental and
physical function.
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Nervous system disorders can affect the ability to:
• Speak
• Understand
• Feel
• See
• Hear
• Touch
• Think
• Control bowels and bladder
• Move
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 2
Nervous System Disorders (cont’d)

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.
• 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.
• It is a leading cause of disability in adults.
 Warning signs may last a few minutes.
• This is called a transient ischemic attack (TIA).
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 3
Nervous System Disorders (cont’d)

Stroke risk factors include:
• High blood pressure
• Cigarette smoking; exposure to second-hand smoke
• Heart disease
• Diabetes
• TIAs
• Age 55 and older
• Being over-weight
• Lack of physical activity
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 4
Nervous System Disorders (cont’d)
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Stroke can occur suddenly.
• The person may have warning signs.
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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
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 5
Nervous System Disorders (cont’d)

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.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 6
Nervous System Disorders (cont’d)

Parkinson’s disease is a slow, progressive
disorder with no cure.

Movement is affected.
 Persons over the age of 50 are at risk.
 Signs and symptoms become worse over time.
They 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.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 7
Nervous System Disorders (cont’d)

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 selfcare.


Normal elimination is a goal.
Safety measures are needed to prevent falls and
injuries.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 8
Nervous System Disorders (cont’d)

Multiple sclerosis (MS) is a chronic disease.

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 way.

There is no cure.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 9
Nervous System Disorders (cont’d)
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Signs and symptoms may include:
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Blurred or double vision,
blindness in one eye
Muscle weakness in the
arms and legs
Balance and coordination
problems
Tingling, prickling, or
numb sensations
Partial or complete
paralysis
Pain
Speech problems
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Tremors
Dizziness
Concentration, attention,
memory, and judgment
problems
Depression
Bowel and bladder
problems
Problems with sexual
function
Hearing loss
Fatigue
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 10
Nervous System Disorders (cont’d)

MS can present in many ways. For example:
• The person’s symptoms last for a few weeks or a few
•
•
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months. The symptoms gradually disappear with partial
or complete recovery. The person is in remission. At
some point, symptoms flare up again (relapse).
The person’s condition gradually declines with more
and more symptoms. There are no remissions.
Symptoms become worse. More symptoms occur with
each flare-up. The person’s condition declines.
Persons with MS are kept active as long as
possible and as independent as possible.
• The care plan reflects the person’s changing needs.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 11
Nervous System Disorders (cont’d)
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Amyotrophic lateral sclerosis (ALS) is a
disease that attacks the nerve cells that control
voluntary muscles.
Commonly called Lou Gehrig’s disease, it is rapidly
progressive and fatal.
 ALS is more common in men.
 It usually strikes between 40 and 60 years of age.
 Motor nerve cells in the brain, brainstem, and
spinal cord are affected.
• These cells stop sending messages to the muscles.
• Muscles weaken, waste away (atrophy), and twitch.

Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 12
Nervous System Disorders (cont’d)
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Over time, the brain cannot start voluntary
movements or control them.
The disease usually does not affect the mind,
intelligence, or memory.
Sight, smell, taste, hearing, and touch are not
affected.
ALS has no cure.
• Some drugs can slow disease and improve symptoms.
Persons with ALS are kept active and independent
to the extent possible.
• The care plan reflects the person’s changing needs.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 13
Nervous System Disorders (cont’d)
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Head injuries result from trauma to the scalp, skull,
or brain.
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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:
• Motor vehicle crashes
• Falls
• Assaults
• Firearms
• Sports and recreation injuries
Death can occur at the time of injury or later.
• If the person survives, some permanent damage is likely.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 14
Nervous System Disorders (cont’d)
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Disabilities depend on the severity and site of the injury. They
include:
• Cognitive problems
• Sensory problems
• Communication problems
• Behavior or mental health problems
• Stupor—an unresponsive state; the person can be briefly aroused
• Coma—the person is unconscious, does not respond, is unaware,
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•
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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.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 15
Nervous System Disorders (cont’d)
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Spinal cord injuries can permanently damage
the nervous system.
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Young adult men have the highest risk.
 Common causes are:
• Stab or gunshot wounds
• Motor vehicle crashes
• Falls
• Sports injuries
 Problems depend on the:
• Amount of damage to the spinal cord
• Level of injury
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 16
Nervous System Disorders (cont’d)
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The higher the level of injury, the more functions lost.
• Lumbar injuries—sensory and muscle function in the legs is lost
(paraplegia).
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•
Thoracic injuries—sensory and muscle function below the chest is
lost (paraplegia).
•
Cervical injuries—sensory and muscle function of the arms, legs,
and trunk are lost (quadriplegia or tetraplegia).
If the person lives, rehabilitation is needed.
• The person learns to function at the highest possible level.
• The person learns to use self-help, assistive, and other devices.
• Some persons live independently at home or with home care.
• Some persons need long-term care or assisted-living settings.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 17
Nervous System Disorders (cont’d)
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Autonomic dysreflexia occurs with spinal cord
injuries above the mid-thoracic level.
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There is uncontrolled stimulation of the sympathetic
nervous system.
If untreated, stroke, heart attack, and death are risks.
Treatment involves:
• Raising the head of the bed 45 degrees or having the
person sit upright if allowed
Determining and removing the cause
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•
The most common causes are:
• A full bladder
• Constipation or fecal impaction
• Skin disorders
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 18
Musculo-skeletal Disorders
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Musculo-skeletal disorders affect movement.
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Injury and aging are common causes.
Arthritis means joint inflammation.
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It is the most common joint disease.
Pain, swelling, and stiffness occur.
The joints are hard to move.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 19
Musculo-skeletal Disorders (cont’d)
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Osteoarthritis (degenerative joint disease) is the
most common type of arthritis.
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Causes include:
• Aging
• Being over-weight
• Joint injury
• Stress
• Muscle weakness
• Heredity
 Signs and symptoms include:
• Joint stiffness occurs with rest and lack of motion.
• Pain occurs with weight-bearing and motion.
• Swelling is common after using the joint.
 There is no cure.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 20
Musculo-skeletal Disorders (cont’d)
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Treatment involves:
• Drugs to decrease swelling and inflammation and
relieve pain
Heat and sometimes cold applications
Exercise
Rest and joint care
Weight control
Healthy life-style
Joint replacement surgery
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 Falls are prevented.
 Help is given with ADL as needed.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 21
Musculo-skeletal Disorders (cont’d)
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Rheumatoid arthritis (RA) is a chronic
inflammatory disease.
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It causes joint pain, swelling, stiffness, and loss of
function.
RA is more common in women than in men.
It usually develops between the ages of 20 and 50.
RA occurs on both sides of the body.
Joints are tender, warm, and swollen.
Fatigue and fever are common.
Symptoms may last for many years.
Other body parts may be affected.
RA varies from person to person.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 22
Musculo-skeletal Disorders (cont’d)
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Treatment goals are to:
• Relieve pain.
• Reduce inflammation.
• Slow down or stop joint damage.
• Improve well-being and ability to function.
The person’s care plan may include:
• Rest balanced with exercise
• Proper positioning
• Joint care
• Weight control
• Measures to reduce stress
• Measure to prevent falls
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 23
Musculo-skeletal Disorders (cont’d)
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Drugs are given for pain relief and inflammation.
Heat and cold applications may be ordered.
Some persons need joint replacement surgery.
Emotional support is needed.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 24
Musculo-skeletal Disorders (cont’d)
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Total joint replacement surgery
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Arthroplasty is the surgical replacement of a joint.
The damaged joint is removed and replaced with
an artificial joint.
• The artificial joint is called a prosthesis.
The surgery is done to:
• Relieve pain.
• Restore joint function.
• Correct a deformed joint.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 25
Musculo-skeletal Disorders (cont’d)
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Osteoporosis
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With osteoporosis, the bone becomes porous
and brittle.
• Bones are fragile and break easily.
 Older people are at risk.
• The risk for women increases after menopause.
 All ethnic groups are at risk.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 26
Musculo-skeletal Disorders (cont’d)
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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:
• Back pain
• Gradual loss of height
• Stooped posture
• Fractures
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 27
Musculo-skeletal Disorders (cont’d)
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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 for good posture
• Walking aids if needed
• Safety measures to prevent falls and accidents
• Good body mechanics
• Safe moving, transfer, and turning and positioning
procedures
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 28
Musculo-skeletal Disorders (cont’d)
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Fractures
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A fracture is a broken bone.
Fractures are open or closed.
• Closed fracture (simple fracture)—the bone is broken
•
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but the skin is intact.
Open fracture (compound fracture)—the broken bone
has come through the skin.
Causes include:
• Falls and accidents
• Bone tumors
• Metastatic cancer
• Osteoporosis
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 29
Musculo-skeletal Disorders (cont’d)
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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 (internal or external)
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 30
Musculo-skeletal Disorders (cont’d)
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For healing, bone ends are brought into and held
in normal position.
• This is called reduction or fixation.
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Closed reduction and external fixation—the bone is
moved back into place; the bone is not exposed.
Open reduction and internal fixation—requires surgery;
the bone is exposed and moved into alignment.
After reduction, the bone ends must not move.
• The person has a cast or traction.
• Splints, walking boots, and external fixators are also
used.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 31
Musculo-skeletal Disorders (cont’d)
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Casts are made of plaster of paris, plastic, or
fiberglass.
Traction
• A steady pull from two directions keeps the bone in place.
• Traction also is used for muscle spasms and to correct
•
•
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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 inserted through the bone.
For cervical traction, tongs are applied to the skull.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 32
Musculo-skeletal Disorders (cont’d)
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Hip fractures
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Fractured hips are common in older persons.
• Older women are at risk.
 Healing is slower in older people.
 These post-operative problems present lifethreatening risks.
• Respiratory complications
• Urinary tract infections
• Thrombi (blood clots) in the leg veins
 Other risks include pressure ulcers, constipation,
and confusion.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 33
Musculo-skeletal Disorders (cont’d)
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The fracture requires internal fixation.
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.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 34
Musculo-skeletal Disorders (cont’d)
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Loss of limb
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An amputation is the removal of all or part of an
extremity.
 Most amputations involve a lower extremity.
 Common causes include:
• Severe injuries
• Tumors
• Severe infection
• Gangrene
• Vascular disorders
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 35
Musculo-skeletal Disorders (cont’d)
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Gangrene is the 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.
The person may feel that the amputated limb is still there.
• The person may complain of pain in the amputated part (phantom
pain).

Lower limb amputations are common in older persons.
• After amputation, most need long-term care on a temporary or
permanent basis.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 36