TRAUMATIC HEAD INJURY

- trauma to the skull, resulting in mild to extensive damage to the brain

- Complications: cerebral bleeding, hematomas, uncontrolled increased ICP, infections, and
seizures.

Interventions:
- Monitor respiratory status and maintain a patent airway because increased CO2 levels
increase cerebral edema.
- Maintain head elevation to reduce venous pressure.
- Prevent neck flexion
- Initiate seizure precautions
- Morphine sulfate may be prescribed to decrease agitation and control restlessness caused
by pain for the head-injured client on a ventilator; administer with caution because it is a
respiratory depressant and may increase ICP.
- Do not attempt to clean the nose, suction, or allow the client to blow his or her nose if
drainage occurs.
- Do not clean the ear if drainage is noted, but apply a loose, dry sterile dressing
- Check drainage for the presence of CSF
- Instruct the client to avoid coughing because this increases ICP

Types:
Concussion- a jarring of the brain within the skull, with no loss of consciousness
Contusion- bruising type of injury to the brain tissue; may occur along with other neurological
injuries, such as with subdural or extradural collections of blood

Epidural Hematoma- forms rapidly and results from arterial bleeding; forms between the dura and
skull from a tear in the meningeal artery; a surgical emergency

Subdural Hematoma- forms slowly and results from a venous bleed; occurs under the dura as a
result of tears in the veins crossing the subdural space.
Intracerebral Hemorrhage- occurs when a blood vessel within the brain ruptures allowing blood to
leak inside the brain

Subarachnoid Hemorrhage- bleeding into the subarachnoid space; may occur as a result of head
trauma or spontaneously, such as from a ruptured cerebral aneurysm.
INCREASED INTRACRANIAL PRESSURE (ICP) SPINAL CORD INJURY
- Cause: trauma, hemorrhage, growths or - Most common causes: motor vehicle
tumors, hydrocephalus, edema, or accidents, falls, sporting and industrial
inflammation. accidents, and gunshot or stab wounds.
- can impede circulation to the brain, - Complications: respiratory failure,
impede the absorption of CSF, affect the autonomic dysreflexia, spinal shock,
functioning of nerve cells, and lead to further cord damage, and death
brainstem compression and death.
Frequently involved vertebrae:
Sx/S: 1. Cervical—C5, C6, and C7
1. Altered level of consciousness (most sensitive - at C2 to C3 is usually fatal; Involvement
and earliest indication) above C4 causes respiratory difficulty
2. Headache
3. Abnormal respirations
4. Rise in blood pressure; widening pulse
pressure
5. Slowing of pulse
6. Elevated temperature
7. Vomiting
8. Pupil changes
9. Late signs: increased systolic blood pressure,
widened pulse pressure, and slowed heart rate.
10. changes in motor function from weakness to
hemiplegia, a positive Babinski reflex, decorticate
or decerebrate posturing, and seizures.
Intervertions:
- Limit fluid intake to 1200 mL/day.
- avoid Valsalva’s maneuver
- avoid straining activities, such as
coughing and sneezing
- Anticonvulsant- to prevent seizures
- Antipyretics and Muscle Relaxants
- Blood Pressure Medication- maintain
cerebral perfusion at a normal level.
- Corticosteroids- decrease cerebral
edema
- Intravenous Fluids-
- Hyperosmotic Agent- increases
intravascular pressure by drawing fluid
from the interstitial spaces and from the
brain cells.
and paralysis of all four extremities.
- may have movement in the shoulder if
the injury is at C5 through C8, and may
also have decreased respiratory reserve.
2. Thoracic—T12
- Loss of movement of the chest, trunk,
bowel, bladder, and legs may occur,
depending on the level of injury;
Autonomic dysreflexia with lesions or
injuries above T6 and in cervical lesions
may occur.
- Visceral distention from a noxious
stimuli such as a distended bladder or
impacted rectum may cause reactions
such as sweating, bradycardia,
hypertension, nasal stuffiness, and goose
flesh.
3. Lumbar—L1
- Loss of movement and sensation of the
lower extremities; S2 and S3 center on
micturition; therefore, below this level,
the bladder will contract but not empty
(neurogenic bladder)
- Injury above S2 in males allows them to
have an erection, but they are unable to
ejaculate because of sympathetic nerve
damage.
- Injury between S2 and S4 damages the
sympathetic and parasympathetic
response, preventing erection or
ejaculation.

Sx/S:
1. Dependent on the level of the cord injury
2. Level of spinal cord injury: Lowest spinal cord
segment with intact motor and sensory function
3. Respiratory status changes
4. Motor and sensory changes below the level of
injury
5. Total sensory loss and motor paralysis below
the level of injury
6. Loss of reflexes below the level of injury
7. Loss of bladder and bowel control
8. Urinary retention and bladder distention
9. Presence of sweat, which does not occur on
paralyzed areas
 Emergency interventions:
2. Assess the respiratory pattern and maintain a
patent airway.
3. Prevent head flexion, rotation, or extension.
4. During immobilization, maintain traction and
alignment on the head by placing hands on both
sides of the head by the ears.
5. Maintain an extended position.
6. Logroll the client.
7. No part of the body should be twisted or
turned, and the client is not allowed to assume a
sitting position.
8. client who has sustained a cervical fracture
should be placed immediately in skeletal traction
via skull tongs or halo traction to immobilize the
cervical spine and reduce the fracture and
dislocation

CEREBRAL ANEURYSM SPINAL CORD SYNDROMES:

- Dilation of the walls of a weakened 1. Central cord syndrome- occurs from a
cerebral artery lesion in the central portion of the spinal
cord; Loss of motor function (upper
Sx/S: extremities)
1. Headache and pain
2. Irritability 2. Anterior cord syndrome- cause: damage
3. Diplopia to the anterior portion of the gray and
4. Blurred vision white matter of the spinal cord; Motor
5. Tinnitus function, pain, and temperature
6. Hemiparesis sensation are lost below the level of
7. Nuchal rigidity injury
8. Seizures
3. Posterior cord syndrome- cause: damage
Interventions: to the posterior portion of the gray and
- Maintain a patent airway (suction only white matter of the spinal cord; Motor
with an HCP’s prescription) function remains intact, but the client
- Administer oxygen as prescribed. experiences a loss of vibratory sense,
- Avoid taking temperatures via the rectum crude touch, and position sensation.
- Maintain the client on bed rest in a semi-
Fowler’s or a side-lying position 4. Brown-Séquard syndrome- results from
- Maintain a darkened room (subdued penetrating injuries that cause
lighting and avoid direct, bright, artificial hemisection of the spinal cord or injuries
lights) without stimulation (a private that affect half the cord; Motor function,
room is optimal). vibration, proprioception, and deep
- Provide a quiet environment touch sensations are lost on the same
- fluid restrictions. side of the body (ipsilateral) as the
- provide stool softeners to prevent lesion or cord damage.
 straining.
- prophylactic anticonvulsant medications 5. Conus medullaris syndrome- damage to
the lumbar nerve roots and conus
medullaris in the spinal cord; bowel and
bladder areflexia and flaccid lower
extremities

6. Cauda equina syndrome- injury to the

lumbosacral nerve roots below the conus
medullaris; areflexia of the bowel,
bladder, and lower reflexes
SEIZURES
STROKE (BRAIN ATTACK)
- abnormal, sudden, excessive discharge of - sudden focal neurological deficit caused by
electrical activity within the brain cerebrovascular disease.
- Causes: genetic factors, trauma, tumors, - cerebral circulation is interrupted, causing
circulatory or metabolic disorders, neurological deficits.
toxicity, and infections.
Sx/S: - Causes: Thrombosis, Embolism,
1. Seizure history Hemorrhage from rupture of a vessel
2. Type of seizure
3. Occurrences before, during, and after the Risk factors:
seizure 1. Atherosclerosis
4. Prodromal signs, such as mood changes, 2. Hypertension
irritability, and insomnia 3. Anticoagulation therapy
5. Aura: Sensation that warns the client of the 4. Diabetes mellitus
impending seizure 5. Stress
6. Loss of motor activity or bowel and bladder 6. Obesity
function or loss of consciousness during the 7. Oral contraceptives
seizure
7. Occurrences during the postictal state, such as Sx/S:
headache, loss of consciousness, sleepiness, and 1. Assessment findings depend on the area of the
impaired speech or thinking brain affected; stroke scales may be used by the
health care facility for assessment.
Interventions: 2. Lesions in the cerebral hemisphere result in
-place the client on the floor and protect the manifestations on the contralateral side.
head and body 3. Airway patency is always a priority.
- Administer oxygen 4. Pulse (may be slow and bounding)
- Turn the client to the side to allow secretions to 5. Respirations (Cheyne-Stokes)
drain 6. Blood pressure (hypertension)
- Do not restrain the client 7. Headache, nausea, and vomiting
- 8. Facial drooping
9. Nuchal rigidity
10. Visual changes
11. Ataxia
12. Dysarthria
13. Dysphagia
14. Speech changes
 15. Decreased sensation to pressure, heat, and
cold
16. Bowel and bladder dysfunctions
17. Paralysis

Interventions:

PERIPHERAL NEUROPATHY MONONEUROPATHY

- disorder affecting the peripheral motor - limited to a single peripheral nerve and
and sensory nerves. its branches.
- Characterized by: bilateral and - It arises when the trunk of the nerve is
symmetric disturbance of function, compressed or entrapped (as in carpal
usually beginning in the feet and hands tunnel syndrome), traumatized (as when
- Common Cause: diabetes with poor bruised by a blow), overstretched (as in
glycemic control joint dislocation), punctured by a needle
used to inject a drug or damaged by the
Sx/S: drugs thus injected, or inflamed because
1. loss of sensation an adjacent infectious process extends
2. muscle atrophy to the nerve trunk
3. weakness - frequently seen in patients with
4. diminished reflexes diabetes
5. pain
6. paresthesia of the extremities. Sx/S:
1. Pain
Interventions: 2. Skin in the areas supplied by nerves that
- Elimination or control of the cause may are injured or diseased may become
slow progression. reddened and glossy
- inspection of the lower extremities for 3. subcutaneous tissue may become
skin breakdown. edematous
- Assistive devices such as a walker or cane 4. nails and hair in this area are altered
may decrease the risk of falls.
- Bathwater temperature is checked to Interventions:
avoid thermal injury. - remove the cause, if possible (e.g.,
freeing the compressed nerve)
- Local corticosteroid injections- reduce
inflammation and the pressure on the
nerve
- Aspirin or codeine- to relieve pain
- Chronic pain can be treated with
neuropathic pain medications such as
Gabapentin
 MULTIPLE SCLEROSIS
- chronic, progressive, noncontagious,
degenerative disease of the CNS
characterized by demyelinization of the
neurons
- occurs between the ages of 20 and 40
years and consists of periods of
remissions and exacerbations.
- Causes: unknown; thought to be the
result of an autoimmune response or
viral infection
Electroencephalographic findings: abnormal
Lumbar puncture: increased gamma globulin
level; serum globulin level: normal.
Sx/S:
1. Fatigue and weakness
2. Ataxia and vertigo
3. Tremors and spasticity of the lower
extremities
4. Paresthesias
5. Blurred vision, diplopia, and transient
blindness
6. Nystagmus
7. Dysphasia
8. Decreased perception to pain, touch, and
temperature
9. Bladder and bowel disturbances, including
urgency, frequency, retention, and incontinence
10. Abnormal reflexes, including hyperreflexia,
absent reflexes, and a positive Babinski reflex
11. Emotional changes such as apathy, euphoria,
irritability, and depression
12. Memory changes and confusion
Interventions:
- eye patch on the eye for diplopia
- Initiate physical and speech therapy
- avoid fatigue, stress, infection,
overheating, and chilling.
- increase fluid intake and eat a balanced
diet, including low-fat, high-fiber foods
and foods high in potassium.
- regulating the temperature of bath water
and avoiding heating pads.
- avoiding the use of scatter rugs and using
assistive devices.
MYASTHENIA GRAVIS
- neuromuscular disease characterized by
considerable weakness and abnormal
fatigue of the voluntary muscles.
- defect in the transmission of nerve
impulses at the myoneural junction
occurs
- Causes: insufficient secretion of
acetylcholine, excessive secretion of
cholinesterase, and unresponsiveness of
the muscle fibers to acetylcholine
Sx/S:
1. Weakness and fatigue
2. Difficulty chewing and swallowing
3. Dysphagia
4. Ptosis
5. Diplopia
6. Weak, hoarse voice
7. Difficulty breathing
8. Diminished breath sounds
9. Respiratory paralysis and failure
Interventions:
- Administer anticholinesterase
medications
- avoid stress, infection, fatigue, and over-
the-counter medications.
- Encourage the client to sit up when
eating
- suctioning and emergency equipment at
the bedside
 PARKINSON’S DISEASE
- degenerative disease caused by the
depletion of dopamine, which interferes
with the inhibition of excitatory
impulses, resulting in a dysfunction of
the extrapyramidal system.
- results in a crippling disability
GUILLAIN-BARRÉ SYNDROME
- an acute infectious neuronitis of the
cranial and peripheral nerves.
- immune system overreacts to the
infection and destroys the myelin sheath
- preceded by a mild upper respiratory
infection or gastroenteritis

Sx/S:
1. Bradykinesia, abnormal slowness of
movement, and sluggishness of physical and
mental responses
2. Akinesia
3. Monotonous speech
4. Micrographia
5. Tremors in hands and fingers at rest (pill
rolling)
6. Tremors increasing when fatigued and
decreasing with purposeful activity or sleep
7. Rigidity with jerky movements
8. Restlessness and pacing
9. Blank facial expression; masklike faces
10. Drooling
11. Difficulty swallowing and speaking
12. Loss of coordination and balance
13. Shuffling steps, stooped position, and
propulsive gait
Sx/S:
1. Paresthesias
2. Pain and/or hypersensitivity such as with the
weight of bed sheets or other items touching the
body
3. Weakness of lower extremities
4. Gradual progressive weakness of the upper
extremities and facial muscles
5. Possible progression to respiratory failure
6. Cardiac dysrhythmias
7. CSF that reveals an elevated protein level
8. Abnormal electroencephalogram
Interventions:
- Provide respiratory treatments.; initiate
respiratory support
- IVIG

Interventions:
- high-calorie, high-protein, high-fiber soft
diet with small, frequent feedings
- Increase fluid intake to 2000 mL/day.
- Instruct the client to rock back and forth
to initiate movement
- wear low-heeled shoes.
- lift feet when walking and to avoid
prolonged sitting
- Provide a firm mattress and position the
client prone, without a pillow, to
facilitate proper posture
- Administer antiparkinsonian medications
to increase the level of dopamine in the
CNS (Levodopa)
- avoid foods high in vitamin B6 because
they block the effects of antiparkinsonian
medications.
- avoid monoamine oxidase inhibitors
because they will precipitate
 hypertensive crisis.

CATARACT
- opacity of the lens that distorts the image
projected onto the retina and that can
progress to blindness.
- Causes: aging process (senile cataracts),
heredity (congenital cataracts), and injury
(traumatic cataracts); cataracts also can
result from another eye disease
(secondary cataracts)
GLAUCOMA
- group of ocular diseases resulting in
increased intraocular pressure
- damages the optic nerve and can result in
blindness.
Sx/S:
a. Early signs include diminished
accommodation and increased
intraocular pressure.

Sx/S: b. Primary open-angle glaucoma (POAG):

a. Blurred vision and decreased color perception Painless, and vision changes are slow; results in
are early signs. “tunnel” vision.
b. Diplopia
c. reduced visual acuity c. Primary angle-closure glaucoma (PACG):
d. absence of the red reflex, and the presence of Blurred vision, halos around lights, and ocular
a white pupil are late signs. erythema.
e. Pain or eye redness is associated with age-
related cataract formation. Interventions:
c. Loss of vision is gradual. - Miotics- to constrict the pupils
- Carbonic anhydrase inhibitors- decrease
Interventions: the production of aqueous humor
- Surgical removal of the lens, one eye at a - β-blockers- to decrease the production
time of aqueous humor and intraocular
- partial iridectomy may be performed pressure
with the lens extraction to prevent acute - avoid anticholinergic medications.
secondary glaucoma - Prepare the client for trabeculectomy as
- lens implantation may be performed at prescribed, which allows drainage of
the time of the surgical procedure. aqueous humor into the conjunctival
spaces by the creation of an opening.
RETINAL DETACHMENT
- Detachment or separation of the retina from the epithelium
- occurs when the layers of the retina separate because of the accumulation of fluid between
them, or when both retinal layers elevate away from the choroid as a result of a tumor.

Sx/S:
a. Flashes of light
b. Floaters or black spots (signs of bleeding)
c. Increase in blurred vision
d. Sense of a curtain being drawn over the eye
e. Loss of a portion of the visual field; painless loss of central or peripheral vision
Interventions:
- bed rest.
- Cover both eyes with patches as prescribed to prevent further detachment.
- Avoid jerky head movements.
MEINIERE’S DISEASE
- also called endolymphatic hydrops; it
refers to dilation of the endolymphatic
system by overproduction or decreased
reabsorption of endolymphatic fluid
- Characterized by: tinnitus, unilateral
sensorineural hearing loss, and vertigo
- Causes: . Any factor that increases
endolymphatic secretion in the labyrinth,
Viral and bacterial infections, Allergic
reactions, Biochemical disturbances,
Vascular disturbance, producing changes
in the microcirculation in the labyrinth,
Long-term stress may be a contributing
factor.
Sx/S:
a. Feelings of fullness in the ear
b. Tinnitus, as a continuous low-pitched roar or
humming sound, that is present much of the time
but worsens just before and during severe attacks
c. Hearing loss that is worse during an attack
d. Vertigo, that is, a sensation of whirling, that
might cause the client to fall to the ground
e. Vertigo that is so intense that even while lying
down, the client holds the bed or ground in an
attempt to prevent the whirling
f. Nausea and vomiting
g. Nystagmus
h. Severe headaches
Interventions:
- Provide bed rest in a quiet environment.
- move the head slowly to prevent
worsening of the vertigo.
- Sodium and fluid restrictions
- Stop smoking
- avoid watching television because the
flickering of lights may exacerbate
symptoms.
- Nicotinic acid (niacin)- vasodilatory effect
HEARING IMPAIREMENT
Sensorineural hearing loss
- pathological process of the inner ear or
of the sensory fibers that lead to the
cerebral cortex.
- often permanent, and measures must be
taken to reduce further damage.
- Causes: Damage to the inner ear
structures, eighth cranial nerve or brain
itself, Prolonged exposure to loud noise,
Medications, Trauma, Inherited
disorders, Metabolic and circulatory
disorders, Infections, Surgery, Meniere’s
syndrome, Diabetes mellitus, Myxedema
Mixed hearing loss
- both sensorineural and conductive
hearing los
Central hearing loss
- inability to interpret sound, including
speech, due to a problem in the brain.
Sx/S:
1. Frequently asking others to repeat
statements
2. Straining to hear
3. Turning head or leaning forward to favor
one ear
4. Shouting in conversation
5. Ringing in the ears
6. Failing to respond when not looking in
the direction of the sound
7. Answering questions incorrectly
8. Raising the volume of the television or
radio
9. Avoiding large groups
10. Better understanding of speech when in
small groups
11. Withdrawing from social interactions
 - Antihistamines- to reduce the production
of histamine and the inflammation.
- Antiemetics
- Tranquilizers and sedatives- to calm the
client, allow the client to rest, and
control vertigo, nausea, and vomiting.
Facilitating Communication:
- Using written words if the client is able to
see, read, and write
- Providing plenty of light in the room
- Getting the attention of the client before
beginning to speak
- Facing the client when speaking
- Talking in a room without distracting
noises
- Moving close to the client and speaking
slowly and clearly
- Keeping hands and other objects away
from the mouth when talking to the
client
- Validating with the client the
understanding of statements made by
asking the client to repeat what was said
- Encouraging the client to wear glasses
when talking to someone to improve
vision for lip reading
- Using sign language, which combines
speech with hand movements that signify
letters, words, or phrases

FRACTURE MOTOR VEHICLE COLLISION

- a break in the continuity of the bone
caused by trauma, twisting as a result of
muscle spasm or indirect loss of leverage,
or bone decalcification and disease that
result in osteopenia

Sx/S:
1. Pain or tenderness over the involved area
2. Decrease or loss of muscular strength or
function
3. Obvious deformity of affected area
4. Crepitation, erythema, edema, or bruising
5. Muscle spasm and neurovascular impairment

Interventions:
- Immobilize affected extremity with cast
or splint.
- Reduction- restores the bone to proper
alignment.
- Fixation
-Internal fixation involves the
application of screws, plates, pins, or
 intramedullary rods to hold the
fragments in alignment
- External fixation is the use of an
external frame to stabilize a fracture by
attaching skeletal pins through bone
fragments to a rigid external support

- Traction- provides proper bone alignment and

reduces muscle spasms.
-Maintain proper body alignment.
- Ensure that the weights hang freely and do
not touch the floor.
- Ensure that pulleys are not obstructed and
that ropes in the pulleys move freely.
- Place knots in the ropes to prevent slipping
- Check the ropes for fraying.

-Casts- Plaster, fiberglass, or air casts are used to

immobilize bones and joints into correct
alignment after a fracture or injury.
- Allow a wet plaster cast 24 to 72 hours to
dry (synthetic casts dry in 20 minutes)
- Turn the extremity every 1 to 2 hours,
unless contraindicated, to allow air circulation
and promote drying of the cast.
- hair dryer can be used on a cool setting to dry
a plaster cast (heat cannot be used on a plaster
cast because the cast heats up and burns the
skin)
- Prepare for bivalving or cutting the cast if
circulatory impairment occurs.
SPORTS INJURY
- very common, and, unfortunately, sports-related injuries are also common consequences
- time required to recover from a sports-related injury can be as short as a few days or as long
as 12 weeks
Management:
- Adherence to restriction of activities and gradual resumption of activities need to be
reinforced.
- diminish their level and intensity of activity to a comfortable level
Prevention:
- using proper equipment (e.g., running shoes for joggers, wrist guards for skaters) and by
effectively training and conditioning the body
- Stretching, maintaining hydration, and proper nutrition aid in injury prevention

OSTEOARTHRITIS GOUT
- progressive deterioration of the articular - systemic disease in which urate crystals
 cartilage.
- causes bone buildup and the loss of
articular cartilage in peripheral and axial
joints.
- affects the weight-bearing joints and
joints that receive the greatest stress,
such as the hips, knees, lower vertebral
column, and hands.
Sx/S:
1. Client experiences joint pain that diminishes
after rest and intensifies after activity, noted
early in the disease process.
2. As the disease progresses, pain occurs with
slight motion or even at rest.
3. Symptoms are aggravated by temperature
change and climate humidity.
4. Presence of Heberden’s nodes or Bouchard’s
nodes (hands)
5. Joint swelling (may be minimal), crepitus, and
limited range of motion
6. Difficulty getting up after prolonged sitting
7. Skeletal muscle disuse atrophy
8. Inability to perform activities of daily living
9. Compression of the spine as manifested by
radiating pain, stiffness, and muscle spasms in
one or both extremities
Interventions:
- Acetaminophen (Tylenol) or topical
applications- pain
- Muscle relaxants- muscle spasm
- Corticosteroid injections
- Immobilize the affected joint with a splint
or brace until inflammation subsides
- Provide a bed or foot cradle to keep linen
off of feet and legs
- cold applications
- well-balanced diet.
- Maintain weight within normal range
- balance activity with rest and to
participate in an exercise program that
limits stressing affected joints.
- exercises should be active rather than
passive and to stop exercise if pain
occurs.
- limit exercise when joint inflammation is
severe
deposit in joints and other body tissues
- results from abnormal amounts of uric
acid in the body.
- results from a disorder of purine
metabolism
Sx/S:
1. Swelling and inflammation of the joints,
leading to excruciating pain
2. Tophi: Hard, irregularly shaped nodules in the
skin containing chalky deposits of sodium urate
3. Low-grade fever, malaise, and headache
4. Pruritus from urate crystals in the skin
5. Presence of renal stones from elevated uric
acid levels
Interventions:
- a low-purine diet as prescribed, avoiding
foods such as organ meats, wines, and
aged cheese.
- high fluid intake of 2000 mL/day to
prevent stone formation
- weight reduction diet if required
- avoid alcohol and starvation diets
because they may precipitate a gout
attack.
- Increase urinary pH (above 6) by eating
alkaline ash foods
- bed rest during acute attacks, with the
affected extremity elevated
- Monitor joint range-of-motion ability and
appearance of joints
- Protect the affected joint from excessive
movement or direct contact with sheets
or blankets.
- Provide heat or cold for local treatments
to affected joint as prescribed
- Administer medications such as
analgesic, antiinflammatory, and
uricosuric agents as prescribed.
 CARPAL TUNNEL SYNDROME LOW BACK PAIN
- an entrapment neuropathy that occurs - caused by one of many musculoskeletal
when the median nerve at the wrist is problems, including acute lumbosacral
compressed by a thickened flexor tendon strain, unstable lumbosacral ligaments
sheath, skeletal encroachment, edema, or and weak muscles, intervertebral disc
a soft tissue mass. problems, and unequal leg length.
Causes: - Depression, smoking, alcohol abuse,
 Pressure on the nerve which can happen obesity, and stress are frequent
several ways comorbidities
 Swelling of the lining of the flexor
tendons, called tenosynovitis
Sx/S:
 Joint dislocations 
1. acute back pain (lasting fewer than 3
 Fractures 
months) or chronic back pain (3 months
 Osteoarthritis can narrow the tunnel 
or longer without improvement) and
 Posture - keeping the wrist bent for long
periods of time fatigue.
 Repetitive wrist movements 2. pain radiating down the leg, which is
 Hereditary known as radiculopathy (i.e., pain
radiating from a diseased spinal nerve
Sx/S: root) or sciatica (i.e., pain radiating from
 Pain an inflamed sciatic nerve)
 Numbness 3. gait, spinal mobility, reflexes, leg length,
 Paresthesia leg motor strength, and sensory
 weakness along the median nerve perception may be affected
distribution.
 Night pain and/or fist clenching upon Interventions:
awakening is common. - Most back pain is self-limited and
 Tinel’s sign resolves within 4 to 6 weeks with
 Phalen’s sign analgesics, rest, and avoidance of strain
- Nonprescription analgesics such as
Interventions: nonsteroidal anti-inflammatory drugs
 Wrist splinting. A splint that holds your (NSAIDs) and short-term prescription
wrist still while you sleep can help relieve muscle relaxants (e.g., cyclobenzaprine
nighttime symptoms of tingling and
[Flexeril]) are effective in relieving acute
numbness.
low back pain
 Nonsteroidal anti-inflammatory drugs
- thermal applications (hot or cold) and
(NSAIDs).
 Corticosteroids spinal manipulation (e.g., chiropractic
therapy)
- change position frequently
- Sitting should be limited to 20 to 50
minutes
- Absolute bed rest is no longer
recommended; typical activities of daily
living (ADLs) should be resumed as soon
as possible
- Lumbar flexion is increased by elevating
the head and thorax 30 degrees by using
pillows or a foam wedge and slightly
flexing the knees supported on a pillow.
 - assume a lateral position with knees and
hips flexed (curled position) with a pillow
between the knees and legs and a pillow
supporting the head
- prone position should be avoided
because it accentuates lordosis. The
nurse instructs the patient to get out of
bed by rolling to one side and placing
the legs down while pushing the torso
up, keeping the back straight
- exercise program is gradually initiated
with low-stress aerobic exercises, such as
short walks or swimming.
- Each 30-minute daily exercise period
begins and ends with relaxation.
OSTEOPOROSIS
- metabolic disease characterized by bone demineralization, with loss of calcium and
phosphorus salts leading to fragile bones and the subsequent risk for fractures.
- Bone resorption accelerates as bone formation slows.
- occurs most commonly in the wrist, hip, and vertebral column.
- can occur postmenopausally or as a result of a metabolic disorder or calcium deficiency.

Risk factors:
■ Cigarette smoking
■ Early menopause
■ Excessive use of alcohol
■ Family history
■ Female gender
■ Increasing age
■ Insufficient intake of calcium
■ Sedentary lifestyle
■ Thin, small frame
■ White (European descent) or Asian race

Sx/S:
1. Possibly asymptomatic
2. Back pain occurs after lifting, bending, or stooping.
3. Back pain that increases with palpation
4. Pelvic or hip pain, especially with weight bearing
5. Problems with balance
6. Decline in height from vertebral compression
7. Kyphosis of the dorsal spine, also known as “dowager’s hump”
8. Degeneration of lower thorax and lumbar vertebrae on radiographic studies

Interventions:
- Move the client gently when turning and repositioning
- Assist with ambulation if client is unsteady.
- Provide gentle range-of-motion exercises
- Apply a back brace as prescribed during an acute phase to immobilize the spine and provide
spinal column support.
- exercises to strengthen abdominal and back muscles to improve posture and provide support
for the spine.
- avoid activities that can cause vertebral compression
- high in protein, calcium, vitamins C and D, and iron
- avoid alcohol and coffee.
- maintain an adequate fluid intake to prevent renal calculi