Neuro-muscular disorders

How many bones in the body

206....207 if im hard ;)

Axis

Bone in your neck that helps the head turn freely. C2 bone.

Aging and vertebral column

Aging can cause herniated intervertebral discs.

the disc can push some of its softer interior jellylike substances through a crack in the exterior of the disc. The result is pressure against the spinal nerves and pain that radiates out from the spinal cord.

What is a Intervertebral disc:

a small pad or disc of rubbery-like cartilage (nucleus pulposus) located between two vertebrae.

Herniated disc tx:

Laminectomy, Diskectomy, Spinal Fusion

Classification of bones:

Long, short, flat, Irregular

sesamoid bones

type of irregular : bones the develop within joints & tendons (patella is the largest one)

Function of muscle:

body movement, blood circulation, and heat production

Ossification

Process of bone formation

Vitamin D increase in calcified tissue is ossification

Occipital lobe

Visual transmission and interpretation occur in the visual areas.

Direct visual experiences

temporal lobe

Controls the sensations of hearing, auditory interpretation, smell, and some memory

Auditory areas both receive and interpret transmissions

parietal lobe

Speech and some Sensory area

Interprets sensations such as touch, temperature, and pain, which are received from the skin

Spatial ability (the ability to recognize shapes and sizes) is also located in this area.

Cerebellum

muscle control

Pons

carries messages between cerebellum and medulla, responsible for resp.

Broca's area:

area of cerebrum.

Associated with speech .

CVA affects ability to speak clearly

Sympathetic nervous system (look at flashcard outside of Learn)

Fight or flight.

Example- involuntary defecation and urination, tachycardia.

how to promote healing in severe joint pain

Hot compress

Arthroscopy

Endoscope used to visualize joints for diagnostics and treatments. Done in the OR, can remove loose objects such as bone spurs or pieces of cartilage

Arthroscopy Considerations

Elevate extremity, apply ice to area, monitor for signs of infection

What do we need to know about CSF?

Cerebral spinal fluid

contains glucose

What are Erythrocyte sedimentation rate (ESR), Rheumatoid factor (RF), Creatine Kinase (CK) tests used for?

show inflammation related to an infection or inflammatory condition

what are CBC, uric acid, calcium, and phosphorus levels tests used for?

Used to indicate the overall condition of MS system

arthrogram

Study of a joint by injecting a radiopaque substance

(check for iodine & shellfish allergies)

Myelogram

Exam of the spinal cord and vertebral canal after contrast is injected into the subarachnoid space.

Checks spinal cord for abnormalities caused by tumors, herniated intervertebral disks, or other lesions

Electromyogram

Test of electrical conductivity in the muscles both at rest and activity

Immobilization device complication

-Pressure from swelling.

-Edema

-Blanched, mottled or cyanotic skin color

-Numbness, tingling, or the inability to move

-Cold fingers

-Severe pain

-Lack of digital pulse

-Slow capillary refill

Activity and exercise for casts or splints to reduce immobilization

-Elevate

-Wiggle exposed fingers or toes

-Isometric exercise

-Use assistive devices as needed

Amputations levels

BEA: below elbow amputation

AEA: Above elbow amputation

BKA: Below knee amputation

AKA: Above knee amputation

Amputations considerations

-Protects limb

-Promotes healing

-Controls edema

-Minimize pain & trauma

Amputations complications

-Observe for bleeding

-Monitor drains

-Avoid dislodging drains

-Check incision closely when changing dressing:

-With leg amputation: Have patient lie in prone position to prevent contractures

Most at risk of an amputation

homeless with DM

phantom limb pain Tx.

pain meds

Replantation post op care

-Anticoagulation therapy

-Caffeine-free diet (prevents vasospasm)

-Wound care

-Antibiotics

-Frequent neuro vascular checks

-Monitor for bleeding, arterial or venous compromise, infection, decrease ROM

Lordosis

Curvature of lumbar vertebrae

kyphosis

Curvature of thoracic spine often caused by osteoporosis, hump back

Lordosis & kyphosis edu

Have patient make frequent position changes in bed

Lumbar decompression concerns

-Nerve damage

-Edema:

-Change in level of consciousness:

-Muscle spasms:

-Thrombophlebitis:

-Infection

Muscle Dystrophies:

chronic, degenerative diseases of skeletal muscles that are often inherited.

These disorders are characterized by various degrees of progressive weakening and wasting of the muscles.

Muscular dystrophy complication education

Prevent upper respiratory infections

Carpal tunnel syndrome test

-Test for Tinel sign

-Tinel sign: When the provider taps the median nerve, the client experiences paresthesia and pain in the thumb and first three fingers.

Carpal Tunnel Tx:

wrist splinting, rest, NSAIDs, and corticosteroid injections, surgery.

What is a Bursa

The bursa is a sac filled with synovial fluid that pads bony prominences in the joints.

Bursitis, care, gout

inflammation of a bursa related to mechanical irritation, bacterial infection, trauma, or gout. In response to inflammation, fluid increases, causing distention.

Bursitis S/S & Tx.

S/S: With chronic inflammation, calcification may result. Pain and tenderness in the joint limit movement.

Tx: heat, rest, anti-inflammatory medications.

Tenosynovitis

Inflamm of tendon sheath

Tenosynovitis S/S

Pain, tenderness.

Tenosynovitis Tx

Rest, ice for 1-2 dyas, NSAIDs, surgery, antibodies

Systemic Lupus Erythematosus (SLE)

A type of arthritis

The characteristic sign of SLE is a butterfly rash on the face.

Systemic Lupus Erythematosus (SLE) cause

damage to the collagen sys.

Arthritis Tx:

Arthroplasty or joint replacement.

Scleroderma

Hard skin caused by a collagen disorder

Chronic hardening & shrinking of connective tissues

Care for sprained ankle

Keep area immobilized with elastic bandage

Fractures: greenstick

One side of bone breaks, one side bends

Fractures: compression

Bone collapses in itself

Cast removal education

-Explain skin under may be covered with scales or crusts of dead skin

-Wear gloves, protective eye-wear, and mask

-Removed with a cast saw

Plaster Case nursing consideration

If dried edges are rough, cover with tape for protection

Skin traction

the pull is applied to the client's skin, which transmits the pull to the musculoskeletal structures

Skin traction types

-Bucks (A): One or both legs wrapped with bandage. Applied with weight attached below the foot

-Bryant (B): Variation of bucks for child 2 years and younger

-Cervical Halter (C): Used for neck pain, neck strain, or whiplash

Skin traction; Dunlop (Side-Arm)

Fractures of upper arm and shoulder dislocation prior to surgery

Skin traction; Russell (Balanced)

Balanced pulley system for leg traction. Femur

Skin traction Nursing alert

monitor for difficulty swallowing. indicates signs that the vertical bar of the device is too long.

External Fixator

Device used for complex fractures

Observe closely for infection.

Hip surgery care

-Do not bed body more than 90 degrees

-no 90 degrees turn frequently in bed

What is osteomyelitis

-Serious bone infection that is curable if it is detected early and treated appropriately.

-Modern antibiotics have greatly improved the chances for recovery from this infection.

Acute osteomyelitis

may result from a compound fracture that exposes bone to infection. Because blood supply to the bone is compromised, the bone becomes necrotic. Pus drains through the primary wound.

Embolism

A sudden blockage of one or more arteries by a piece of foreign material.

Fat embolism

most common embolism associated with fractures. Involves a bolus of fat.

Fat embolism S/S

dyspnea, tachycardia, fever, petechial rash, hypoxemia, chest pain, pulmonary edema.

extra info about Embolus

can travel to heart, lung, or brain

Prevention for DVT & Pulmonary Embolism

Sequential Compression Devices (SCDs), subcutaneous heparin, ambulation.

Compartment syndrome

inadequate or obstructed blood flow to muscles, nerves and tissue. Medical emergency- damage can occur in 4-6hrs.

Compartment syndrome S/S

The cardinal symptom is pain that is unrelieved by medications and aggravated by passive stretching of the ischemic muscle.

Tightness, swelling, numbness and tingling of affected extremity.

Compartment syndrome Tx.

Fasciotomy (excision of the fascia)

Angiogram- Dye

Encourage fluid intake due to injected dye

radiopaque dye used- drink fluids. Cerebral arteriography- obtain baseline neuro status

Arteriography

obtain baseline neuro assessment

Thrombus can become dislodged during exam

Elderly with contrast dye

Monitor the older adult client's blood urea nitrogen (BUN) and creatinine before and after any procedure that uses dye.

The aging population is at increased risk for kidney damage; promptly report any elevations in BUN and creatinine.

types of brain scans

CT & MRI

Brain Scan evaluates for

-Vascular lesions

-Neoplasms

-Abscesses

-Areas of ischemia

Lumbar Puncture

(LP, spinal tap) involves the insertion of a hollow needle with a stylet (guide) into the subarachnoid space of the lumbar region of the spinal canal.

CSF contains glucose.

Electroencephalogram (EEG)

Used in the diagnosis of:

Seizures, brain tumors, intracranial lesions, blood clots, infections, sleep disorders, and confirmation of brain death

Paraplegia neuro chair

-Provides a comfortable place to rest out of bed,

-Adjusts to various positions: Fowlers, Trendelenburg,

-Place chair flat first, Reposition to desired position,

-Lock the wheels,

-Obtain additional help when moving.

Cephalgia

Headache

Most common symptoms of neurologic disorder. Not a disease, a symptom of underlying disorder. Not the same as an occasional HA that responds to meds

Migraine S/S

Sensory warnings (Aura)

Mood changes

Anorexia

Numbness or body part

Visual symptoms: Flashing lights, floating spots

Throbbing or steady pain

N/V

Trigeminal neuralgia

the root of the trigeminal (fifth cranial) nerve becomes painful.

Cause: unknown

generally occurs in the older population.

pain is excruciating and comes in spasms that can last for seconds to hours, occurring in the jaw and parts of the face.

Trigeminal neuralgia trigger

slightest touch to various parts of the face, or even by a breeze, a change in temperature, or a mouthful of food, depending on the trigger zone's location.

Bell's Palsy

temporary, partial, one-sided facial paralysis and weakness caused by ischemia or inflammation of the seventh cranial nerve.

Bell's Palsy S/S

temporary, partial, lopsided facial appearance, The eye on the affected side will not close. caused by ischemia or inflammation of the seventh cranial nerve.

A Bell palsy-type syndrome may result from?

a brain lesion

Spinal cord function & extra info

Communication between the brain and body

Spinal cord cannot regenerate

Transection of spinal cord causes permanent paralysis

Paraplegia care

Immobility: Beds and chairs with special features, Prevents skin breakdown, Reduces pain

Parkinson disease- S/S

Bradykinesia (slow movements), fine, rhythmic tremors of hands, arms, legs, jaw, face, limbs and trunk rigid and stiff

Parkinson disease- Tx

Levodopa (replaces missing dopamine), Carbidopa-levodopa, Dopamine agonists, MAO B Inhibitors, Anticholinergics

Myasthenia Gravis- S/S

Double vision (diplopia), Drooping face/lids (ptosis), Sleepy, Expressionless, Difficulty breathing, Dysphagia, Dysphasia, Weaker arms than legs

Myasthenia crisis

life threatening complication of Myasthenia

severe muscle weakness, particularly of the respiratory muscles, requiring mechanical ventilation

Epilepsy

CNS disorder in which nerve cell activity in the brain becomes disrupted, causing periods of unusual behavior. Sometimes loss of consciousness.

Huntington disease

Chronic, progressive, Hereditary, Brain cells in basal ganglia prematurely die, physical, intellectual, emotional symptoms

Child has 50-50 chance of inheriting gene: Will develop disease, Can pass to next generation, Age on onset varies, Symptoms about 30-40 years old

ALS- Lou Gehrig disease

Destruction of motor neurons: Cortex, brain stem, spinal cord,

ALS- Lou Gehrig disease S/S & onset

Voluntary movement degenerates, Always progresses to respiratory dysfunction and death,

onset at 50-70 yrs., more men than women

Brain abscess can lead to?

meningitis if untreated

Positive Brudzinski sign

The client lies on the back and brings the head forward toward the chest.

-Pain or resistance indicates meningeal irritation, arthritis, or a neck injury.

-If the person responds by flexing the hips and knees, meningeal inflammation is indicated.