NRS 480 NEURO/MUSCULOSKELETAL WORKSHEET 1

Fill in the following table.

NAME OF DISEASE NURSING ASSESSMENT DIAGNOSTICS NURSING

PROCESS/CAUSE
Osteroporosis
CAUSE(S)
Chronic, progressive metabolic bone
disease
-low bone mass and structural
deterioration of bone tissue
leading to increased bone fragility.
bone resorption exceeds bone
deposition.
ACCESS: alcohol use
Corticoid use
Calcium low
Smoking
Sedentary Lifestyle
Osteomyelitis
CAUSE(S)
Severe infection of bone, bone
marrow, and surrounding soft tissue
Most common microorganism is
Staphylococcus aureus , but can be
caused by variety of organisms.
Amputation Patients who have a lot
of drainage with a white count but
do not have a fever need to go into
isolation r/o MRSA, especially in
the elderly
FINDINGS
May have no symptoms
Bone fractures
Loss of height
 Pain unrelieved by rest, fever,
edema, elevated leukocyte
count, fatigue, and general
malaise.
 Older adults may not have an
extreme temperature elevation
because of lower core body
temperature and compromised
immune system that occur with
normal aging.
 Systemic findings (similar to
sepsis)
INTERVENTIONS
 X-ray and lab studies not Calcium
diagnostic Vit D
 Bone mineral density (BMD) - Weight-bearing exercise
determined by peak bone mass Build up and maintain
and amount of bone loss bone mass
Increase strength,
coordination, balance
Walking, hiking, weight
training, stair climbing,
tennis, dancing
Quit smoking.
Decrease alcohol intake.
 Bone or soft tissue biopsy Casts or braces
 Blood and/or wound cultures Negative-pressure wound
 WBC count therapy
 Erythrocyte sedimentation rate Hyperbaric oxygen therapy
(ESR) Removal of prosthetic
 X-rays devices
 Bone scans Muscle flaps, skin grating,
 MRI/ CT scans bone grafts
NRS 480 NEURO/MUSCULOSKELETAL WORKSHEET
NAME OF DISEASE
PROCESS/CAUSE
Compartment Syndrome
CAUSE(S)
(1) decreased compartment size
resulting from restrictive dressings,
splints, casts, excessive traction, or
premature closure of fascia and (2)
increased compartment contents
related to bleeding, inflammation,
edema,or IV infiltration.
2
NURSING ASSESSMENT DIAGNOSTICS NURSING
FINDINGS INTERVENTIONS
6 Ps are characteristic of Neurovascular assessments  NO elevation above
compartment syndrome: (ischemia can occur in 4-8 hours heart.- (may lower
1) pain distal to the injury after onset) venous pressure and
that is not relieved by slow arterial perfusion)
opioid analgesics and pain  NO ice – results in
on passive stretch of vasoconstriction
muscle traveling through  Loosen bandage and
the compartment; split (bivalve) cast.
2) pressure increases in the  Reduce traction
compartment; weight.
3) paresthesia (numbness and  Surgical
tingling); decompression
4) pallor, coolness, and loss of (fasciotomy)
normal color of the
extremity;
5) paralysis or loss of
function; and
6) pulselessness or
diminished/absent
peripheral pulses.
The classic sign of acute
compartment syndrome is pain,
and the pain is more intense than
what would be expected from the
injury itself. Other symptoms
include tingling or burning
sensations (paresthesias) in the
skin. Decreased pulses and
numbness or paralysis are late
signs of compartment syndrome.
NRS 480 NEURO/MUSCULOSKELETAL WORKSHEET 3

NAME OF DISEASE NURSING ASSESSMENT DIAGNOSTICS NURSING

PROCESS/CAUSE FINDINGS INTERVENTIONS
Autonomic Dysreflexia VASODILATION ABOVE LEVEL OF Vital signs Elevate head, notify HCP
INJURY Assess for and remove
CAUSE(S) Severe and rapid hypertension cause
• Massive uncompensated Flushing immediate catheterization
cardiovascular reaction Bradycardia remove stool impaction if
mediated by the sympathetic JVD cause
nervous system. – Triggered by HA remove constrictive
T6 or below (restrictive clothing, Diaphoresis clothing and tight shoes
fecal impaction, full bladder,
pressure areas) VASOCONSTRICTION BELOW LEVEL
• It involves stimulation of OF INJURY
sensory receptors below the Pale
level of the SCI. Cool
No sweating
Seizure  Prodromal phase precedes  EEG Immediate medical care if
seizure with signs or activity.  May help determine the type  Status epilepticus
CAUSE(S)  Aural phase with sensory of seizure and help pinpoint occurs.
Paroxysmal, uncontrolled electrical warning. the seizure focus (Many  Significant bodily harm
discharge of neurons in brain,  Ictal phase with full seizure. patients did not have abnormal occurs.
interrupting normal function  Postictal phase with rest and findings.)  The event is a first-time
– Metabolic disorders recovery.  CBC, serum chemistries, liver seizure
– Acute alcohol withdrawal and kidney function, UA to rule Anti-seizure drugs.
– Electrolyte disturbances out metabolic disorders Seizure Precautions
– Heart disease  CT or MRI in new-onset seizure ■ Oxygen
– High fever to rule out structural lesion ■ Suction equipment
– Stroke  Cerebral angiography, SPECT, ■ Airway
– Substance abuse MRS, MRA, and PET in selected ■ IV access
situations ■ Side rails up and
padded
NRS 480 NEURO/MUSCULOSKELETAL WORKSHEET 4

NAME OF DISEASE NURSING ASSESSMENT DIAGNOSTICS NURSING

PROCESS/CAUSE
Parkinson’s Disease
CAUSE(S)
Lack of dopamine in brain
FINDINGS INTERVENTIONS
Classic triad of PD ■ No specific tests for PD No cure
• Tremor - More prominent at ■ Diagnosis based solely on ■ Aimed at correcting
rest and is aggravated by history and clinical features imbalances of
emotional stress or ↑ – Firm diagnosis can be neurotransmitters
concentration, Described as pill made when at least within the CNS
rolling two of three ■ Antiparkinsonian drugs
• Rigidity - increased resistance characteristics of the either
to passive motion when limbs classic triad (tremor, – Enhance or
go through their range of rigidity, and release supply
motion. bradykinesia) are of DA
• Bradykinesia - loss of automatic present. – Antagonize or
movements, such as blinking of Ultimate confirmation is positive block the
the eyelids, swinging of the response to antiparkinson drugs effects of
arms while walking, swallowing overactive
of saliva, and self-expression cholinergic
with facial and hand neurons in the
movements. striatum
Later stages may have shuffling, Levodopa with carbidopa
propulsive gait with arms flexed, (Sinemet) - converts to
and loss of postural reflexes. dopamine in basal ganglia
■ Complications ↑ as disease
progresses THEN (after few years) 
– Motor symptoms directly stimulate DA
– Weakness receptors - (Parlodel),
– Akinesia pergolide (Permax),
– Neurologic problems ropinirole (Requip), and
– Neuropsychiatric pramipexole (Mirapex).
problems
■ Dementia occurs in 70% of May also use
patients. anticholinergics
NRS 480 NEURO/MUSCULOSKELETAL WORKSHEET 5

NAME OF DISEASE NURSING ASSESSMENT DIAGNOSTICS NURSING

PROCESS/CAUSE FINDINGS INTERVENTIONS
Meningitis General symptom CSF analysis  Broad-spectrum
Fever CT scan antibiotic
CAUSE(S) Neurologic symptoms Blood cultures  Hyperosmolar agents
Inflammation of the meninges Headache Counterimmunoelectrophoresis  Anticonvulsants
Viral: Most common Photophobia CBC  Steroids (controversial)
No organisms are typically isolated Indications of increased ICP X-rays to determine presence of  Prophylaxis treatment
from CSF Nuchal rigidity infection for those in close
Bacterial Positive Kernig’s - (positive when contact with
the thigh is flexed at the hip and meningitis-infected
knee at 90 degree angles, and patient
subsequent extension in the knee is
painful (leading to resistance),
Brudzinski’s signs - Severe neck
stiffness causes a patient's hips and
knees to flex when the neck is
flexed.
Decreased mental status
Focal neurologic deficits
GI symptoms
Nausea and vomiting
NRS 480 NEURO/MUSCULOSKELETAL WORKSHEET 6