bstrandable NCLEX musculoskeletal and immune

Terms in this set (931)

DESCRIPTION: Chronic, systematic, progressive deterioration of the connective tissue (synovioum) of the joints; characterized by inflammation. The exact cause is unknown but it is classified as an immune complex disorder, autoimmune. Joint involvement is bilateral and symmetrical. Severe cases may require joint replacement.
NURSING ASSESSMENT: Fatigue; Generalized weakness; Weight loss; Anorexia; Morning stiffness; Bilateral inflammation of joints with: decreased ROM, joint pain, warmth, edema, erythema (rash). Joint deformity.
DIAGNOSIS: Elevated erythrocyte sedimentation rate (ESR); Positive rheumatoid factor (RF). Presence of antinuclear antibody, positive (ANA). Joint-space narrowing indicated by arthroscopic examination, (provides joint visualization). *Spongy and boggy joints* Abnormal synovial fluid (fluid in joint) indicated by arthrocentesis. C-reactive protein (CRP) indicated by active inflammation.
NANDA: Chronic pain r/t..... * antidepressants usually ordered.*
A. Pain relief measures:
1. Use moist heat. Warm, moist compresses, Whirlpool baths, Hot shower in the morning.
2. Use diversionary activities. Imaging, Distraction, Self-hypnosis, Biofeedback.
3. Administer meds and teach client about meds.
B. Provide periods of rest after periods of activity:
1. Encourage self-care to maximal level.
2. Allow adequate time for the client to perform activities.
3. Perform activities during time of day when client feels most energetic.
C. Encourage the client to avoid overexertion and to maintain proper posture and joint position.
D. Encourage use of assistive devices to promote funtional ADL's:
1. Elevated toilet seat.
2. Shower chair.
3. Cane, walker, wheelchair.
4. Reachers.
5. Adaptive clothing and shoes with velcro closures.
6. Straight-backed chair with elevated seat. (remember you can build up a chair with pillows if needed).
Develop a teaching plan to include the following:
1.Medication regimen.
2. Need for routine follow-up for evaluation of possible side effects.
3. ROM and stretching exercies tailored to specific client needs.
4. Safety tips and precaustions about equipment use and environment.
**Early diagnosis is better because DMAR's can be given to prevent joint deformity**
DESCRIPTION: Surgical procedure in which a mechanical device, designed to act as a joint, is used to replace a diseased joint.
The most commonly replaced joints: Hip; Knee; Shoulder; Finger
Accurate fitting is essential.
Client must have healthy bone stock for adequate healing.
Infection is the concern postoperatively.
NURSING ASSESSMENT: Joint pathology: 1.Osteoarthritis
2. Rheumatoid arthritis
3. Fracture
Pain not relieved by medication.
Poor ROM in the affected joint.
NURSING INTERVENTIONS:Provide postoperative care for wound and joint.
Monitor incision site: assess for bleeding and drainage; assess suture line for erythema and edema; assess suction drainage apparatus for proper functioning; assess for signs of infection.
Monitor functioning of extremity: check circulation, sensation, and movement of extremity disal to replacement; provide proper alignment of affected extremity. Client will return from the operating room with alignment for the initial postoperative period; Provide abductor appliance (hip replacement) or continuous passive motion (cpm) device if indicated; monitor I&O every shift, including suction drainage.
Encourage fluid intake of 3L per day. Enourage client to perform self-care activities at maximal level. Coordinate rehabilitation: work closely with health care team to increase client's mobility gradually.
Get client out of bed as soon as possible.
Keep client out of bed as much as possible.
Keep abductor pillow in place while client is in bed (hip replacement).
Use elevated toilet seat and chairs with high seats for those who have had hip or knee replacements (prevents dislocation).
Do not flex hip more than 90 degrees (hip replacement)
Provide discharge planning that includes rehabilitation on an outpatient basis as prescribed.
DESCRIPTION: Metabolic disease in which bone demineralization results in decreased density and subsequent fractures. Many fractures in older adults occur as result of osteoporosis and often occur prior to the client's falling rather than as the result of a fall *pathologic fracture. The cause of osteoporosis is unknown. Postmenopausal women are at highest risk estrogen keeps calcium in bone*
NURSING ASSESSMENT: Classic dowager's hump, or kyphosis of the dorsal spine. Loss of height, often 2-3 inches. Back pain, often radiating around the trunk. Pathologic fractures, often occurring in the distal end of the radius and the upper third of the femur. Compression fracture of spine- assess ability to void and defecate.
NURSING PLANS AND INTERVENTIONS: Create a hazard-free environment *safety first*. Keep bed in low position. Encourage client to wear shoes or nonskid slippers when out of bed. Encourage environmental safety: adequate lighting, keep floor clear, discourage use of throw rugs, slean spills promptly, keep side rails up at all times. Provide assistance with ambulation: client may need walker or cane. Client may need standby assistance when initially getting out of bed or chair. Teach regular exercise program. ROM exercise several times a day, ambulation several times a day, use of proper body mechanics. Provide diet that is high in protein, calcium, and vitamin D; discourage use of alcohol and caffeine. Preventive measures for females: HRT has been used as a primary prevention straegy for reducing bone loss in the postmenopausal woman. Recent studies demonstrated that HRT may increase a woman's risk of breast cancer, cardiovascular disease, and stroke. If using HRT the benefits should outweigh the risks.
Take prescribed meds to prevent further loss of bone mineral density (BMD). *Bisposphonates: inhibits osteoclast-mediated bone resorption, thereby increasing BMD. Common side effects are anorexia, weight loss, and gastritis. Instruct the client to take with full glass of water, take 30 minutes before food or other meds and remain upright for at least 30 minutes after taking*.
Fosamax, Bonefos, Actonel.
Selective estrogen receptor modulator: to mimmic the effect of estrogen on bone by reducing bone resorption without stimulating the tissues of the breast or uterus. The most common side effects are leg cramps, hot flashes, vaginal dryness. Evista
High calium and vitamin D intake beginning in early adulthood. Calcium supplementation after menopause (Tums are an excellent source of calcium).
Weight-bearing exercise.
Osteopenia is defined as a bone loss that is more than normal and has a T-score less than or equal to a range of -1 to -2.5 but is not yet at the level for a dx of osteoporosis.
DESCRIPTION: Any break in the continuity of the bone. Fractures are described by the type and extent of the break. Fractures are caused by a direct blow, crushing force, a sudden twisting motion, or a disease such as cancer or osteoporosis. Comple fracture breaks across the entire cross section of the bone. Incomplete fracture breaks only part of the bone. Closed fracture there is no break in the skin. Open fracture has broken bone that protrudes theough skin or mucous membranes and are much more prone to infection. *update tetanus toxoid, prophylactic antibiotics*.
NURSING ASSESSMENT:Signs and symptoms of fracture include:
Pain, swelling, tenderness.
Deformity, loss of functional ability.
Discoloration, bleeding at the site throguh an open wound.
Crepitus-crackling sound between two broken bones.
Fracture is evident on radiograph.
Therapeutic management is based on: reduction of the fracture. Maintenance of realignment by immobilization. *Don't dislodge hematoma*. Restoration of function.
Crutches: there should be 2-3 finger widths between the axilla and the top of the crutch. A three-point gait is most common. The client advances both crutches and the impaired leg at the same time. The client then swings the uninvolved leg ahead to the crutches.
Cane: It is placed on the unaffected side. The top of the cane should be at the level of the greater trochanter.
Walker: Strength of upper extremity and unaffected leg is assessed and improved with exercises, if necessary so that upper body is strong enough to use walker. Client lifts and advances the walker and steps forward.
BURST: Characterized by multiple pieces of bone; often occurs at bone ends or in vertebrae.
COMMINUTED: More than one fracture line; more than two bone fragments; fragments may be splintered or crushed.
COMPLETE: Break across the entire section of bone, dividing it into distinct fragments; often displaced.
DISPLACED:Fragments out of normal position at fracture site.
INCOMPLETE:Fracture occurs theough only one cortex of the bone; usually nondisplaced.
LINEAR: Fracture line is intact; fracture line is intact; fracture is caused by minor to moderate force applied directly to the bone.
LONGITUDINAL:Fracture line extends in the direction of the bone's longitudinal axis.
NONDISPLACED: Fragments aligned at fracture site.
OBLIQUE: Break occurs at an angle across the bone. Occurs at approximately 45 deg angle across the longitudinal axis of the bone.
SPIRAL: Break twists around the bone.Fracture line results from twisting force.
STELLATE:Fracture lines radiate from one central point.
TRANSVERSE: Break occurs across the bone. Fracture line occurs at a 90 deg angle to longitudinal axis of bone.
AVULSION:Bone fragments are torn away from the body of the bone at the site of attachment of a ligament or tendon.
COMPRESSION:Bone buckles an deventually cracks as the result of unusual loading force applied to its longitudinal axis.
GREENSTICK: One side of a bone is broken; the other side is bent.
COLLES':Fracture within the last inch of the distal radius; distal fragment is displaced in a position of dorsal and medial deviation.
POTT'S: fracture of the distal fibula, seriously disrupting the tibiofibular articulation; a piece of the medial malleolus may be chipped off as a result of rupture of the internal lateral ligament.
IMPACTED: Telescoped fracture, with one fragment driven into another.
DESCRIPTION: Surgical removal of a diseased part or organ.
Causes for amputation include the following:
Peripheral vascular disease, 80% (75% ar diabetics).
Congenital deformities.
Malignant tumors
Amputation necessitates major lifestyle and body-image adjustments.
NURSING ASSESSMENT: Prior to amputation, symptoms of peripheral vascular disease include:
Cool extremity.
Absent peripheral pulses.
Hair loss on affected extremity.
Necrotic tissue or wounds: blue or blue-gray, turning black. Drainage possible with or without odor.
Leathery skin on affected extremity.
Decrease of pain sensation in affected extremity.
Inadequate circulation is determined by: Arteriogram and Doppler flow studies.
Mark dressing for bleeding, and check marking at least every 8 hours.
Measure suction drainage every shift.
Change dressing as needed (physician usually performs initial dressing change): ***large tourniqiet at bedside for frank hemorrhage***
Maintain aseptic technique.
Observe wound color and warmth.
Observe for wound healing.
Monitor for signs of infection: fever, tachycardia, redness of incision area.
Maintain proper body alignment in and out of bed.
Position client to relieve edema and spasms at residual limb (stump) site.
**Elevate stump for the first 24 hours postop**
Do not continually elevate stump after 48 hrs postop. (can cause contracture).
Keep stump in extended position, and turn client to prone position three times a day to prevent hip flexion contracture.
Be aware that phantom pain is real; it will eventually diappear, and it responds to pain meds.
Handle affected ody part gently and with smooth movements.
Provide passive ROM until client is able to perform active ROM. Collaborate with rehab team members for mobility improvement.
Encourage independence in self-care, allowing sufficient time for client to complete care and to have input into care.
2 Types: Chronic open-angle glaucoma and Acute closed angle glaucoma.
DESCRIPTION: Condition characterized by increased intraocular pressure (IOP). Glaucoma involves gradual, painless vision loss (peripheral lost). Glaucoma may lead to blindness if untreated. Glaucoma usually occurs bilaterally in those who have a family hx of the condition. Aqueous fluid is inadequately drained from the eye. It is generally asymptomatic, especially in early stages. It tends to be dx during routine visual examinations. It cannot be cured but can be treated with success pharacologically and surgically.
NURSING ASSESSMENT: Early signs: Decreased accommodation or ability to focus.
Late signs: Loss of peripheral vision. Seeing halos ar ound lights. Decreased visual acuity not correctable with glasses. Headache or eye pain that may be so severe as to cause n/v. **acute closed-angle glaucoma-surgical emergency**
DX Tests: Tonometer, used to measure IOP. Electronic tonometer, used to detect drainage of aqueous humor. Gonioscopy, used to obtain a direct visualization of the lens.
RISK FACTORS: Family Hx of glaucoma. Family Hx of diabetes. Hx of previous ocular problems. Medication use, glaucoma is a side effect of many meds eg. antihistamines, anticholinergics. It can also result from the interaction of meds.
NURSING PLANS AND INTERVENTIONS: Administer eye drops as prescribed.
Orient client to surroundings. Avoid nonverbal communication that requires visual acuity.
Develop a teaching plan that includes the following: Careful adherence to eye-drop regimen can prevent blindness.
Vision already lost cannot be restored.
Eye drops are needed for the rest of life.
Proper eye-drop instillation technique: Wash hands and external eye. Tilt head back slightly. Instill drop into lower lid, without touching the lid with the tip of the dropper. Release the lid, and sponage excess fluid from lid and cheek. Close eye gently, and leave closed 3-5 minutes. Apply gentle pressure on inner canthus to decrease systemic absorption.
Safety measures to prevent injuries: Remove throw rugs. Adjust lighting to meet needs.
Avoid activites that may increase IOP: Emotional upsets. Exertion like pushing, heavy lifting, shoveling. Coughing severely or excessive sneezing (get medical attention before upper respiratory infection worsens.) Wearing constrictive clothing eg tight collar or tie, tight belt or girdle. Straining at stool and constipation.
DESCRIPTION: Condition characterized by opacity of the lens. Aging accounts for 95% of cataracts. The remaining 5% result from trauma, toxic substances, or systemic diseases or are congenital. Safety precatuions may reduce the incidence of traumatic cataracts. Surgical removal is done when vision impairment interferes with ADL's. Intraocular lens implants may be used. Most operations are performed under local anesthesia on an outpatient basis.
NURSING ASSESSMENT:Early signs: Blurred vision and decreased color perception. Late signs include: Diplopia (double vision). Reduced visual acuity, progressing to blindness. Clouded pupil, progressing to a milky-white appearance.
DX Tests: Ophthalmoscope. Slit-lamp biomicroscope.
Preoperative: Demonstrate and request a return demonstration of eye medication instillation from client or family member.
Develop a postop teaching plan that includes:
Warning not to rub or put pressure on eye.
Teach that glasses or shaded lens should be worn during waking hours. An eye shield should be worn during sleeping hours.
Teach to avoid lifting objects over 15lbs, bending, straining, coughing, or any other activity that can increase IOP.
Teach to use a stool softener to prevent straining at stool.
Teach to avoid lying on operative side.
Teach the need to keep water from getting into eye while showering or washing hair.
Teach to observe and report signs of increased IOP and infection (eg. pain, changes in vital signs).
Tylenol should control postop pain.
DESCRIPTION: Form of hearing loss in which sound passes properly through the outer and middle ear but is distorted by a defect in the inner ear. It involves perceptual loss, usually progressive and bilateral. It involves damage to the 8th cranial nerve. (vestibulocochlear). It is detected easily by the use of a tuning fork.
Common causes: Infections.
Ototoxic drugs-aspirin, lasix, aminoglycasides, vancomycin
Aging process- presbycusis
NURSING ASSESSMENT: Inability to hear a whisper from 1-2 feet away. Inability to respond if nurse covers mouth when talking, indicating that client is lip reading. Inability to hear a watch tick 5 inches from ear. Shouting in conversation. Straining to hear. Turning head to favor one ear. Answering questions incorrectly or inappropriately. Raising volume of radio or tv.
NURING PLANS AND INTERVENTIONS:The nurse should do the following to enhance therapeutic communication with the hearing impaired:
Prior to starting conversation, reduce distraction as much as possible.
Turn the tv or radio down or off, close the door, or move to a quieter location.
Devote full attention to the conversation; do not try to do two things at once.
Look and listen during the conversation.
Begin with casual topics, and progress to more critical issues slowly.
Do not switch topics abruptly.
If you do not understand, let the client know.
If the client is a lip reader, face them directly.
Speak slowly and distinctly; determine whether you are being understood.
Allow adequate time for the conversation to take place; try to avoid hurried conversations.
Use active listening techniques.
Be sure to inform the health care staff of the clients hearing loss.
Helpful aids may include a d telephone amplifier, earphone attachments for the radio and tv, and lights or buzzers that indicate the doorbell is ringing, located in the most commonly used rooms of the house.
DESCRIPTION: Traumatic injury to bone. Fractures that occur in the epiphyseal plate (growth plate) may affect growth of the limb.
ASSESSMENT: General condition: visible bone fragments. Pain, swelling, contusions. Child guarding or protecting the extremity.
Possibility of being able to use fractured extremity due to intact periosteum.
NURSING PLANS AND INTERVENTIONS:Obtain baseline data, and frequently perform neurovascular assessments.
Report abnormal assessment promptly! Compartment syndrome may occur; it results in permanent damage to the nerves and vasculature of the injured extremity due to compression.
Maintain traction if prescribed. Note bed position, type of traction, weights, pulleys, pins, pin sites, adhesive strips, ace wraps, splints and casts.
Skin traction: force is applied to skin.
Buck extension traction: lower extremity, legs extended, no hip flexion.
Dunlop traction: two lines of pull on the arm.
Russell traction: two lines of pull on the lower extremity, one perpendicular, one longitudinal.
Bryant traction: both lower extremities flexed 90 degrees at hips (rarely used because extreme elevation of lower extremities causes decreased peripheral circulation).
Skeletal traction: pin or wire applies pull directly to the distal bone fragment. 90 degree traction: flexion of hip and knee; lowr extremity is in a boot cast, can also be used on upper extremities. Dunlop traction may be used as skeletal traction.
Maintain child in proper body alignment; restrain if necessary.
Monitor for problems of immobility.
Provide age-appropriate play and toys.
Prepare child for cast application; use age-appropriate terms when exlpaining procedures.
Provide routine cast care following application; petal cast edges.
Teach home cast care to family: neurvascular assessment of casted extremity; not to get cast wet; not to place anything under cast; keep small objects, toys, and food out of cast.
Teach family to modify diapering and toileting to prevent cast soilage.
Teach that in the presence of a hip spica, family may use a Bradford frame under a small child to help with toileting; they must not use abduction bar to turn child.
Teach to seek follow-up care with HCP.
Multiple Sclerosis (MS) starts in ages 20-50 usually, in females more than males. It is due to a demylization of the myelin sheaths of neuron cells in the CNS.

Symptoms include extreme fatigue, dizziness, muscle twitching/spasms, numbness, tingling, loss of concentration, sensory and/or visual and/or speech impairment., depression.

Myasthenia Gravis starts in ages 20-30 usually, and in females more than males. Autoantibodies from the thymus gland directed at acetylcholine receptor sites impair transmission of impulses across the myoneural junction. This reduces the number of receptor sites. The difference (from MS) is that M. Gravis does not affect the CNS, but instad the nerve-muscle communication point of the PNS.

Symptoms include at first diplopia (double vision) and ptosis (dooping of eyelids), and often are accompanied by facial muscle weakness, speech and swallowing impairment, and generalized weakness of the muscles. It is purely a motor disorder and has no effect on sensation or coordination

Amyotrophic Lateral Sclerosis (ALS) is a fatal disease of known cause. Death usually occurs as a result of infection, respiratory failure, or aspiration with an avg. time from onset of 3 years. There is a loss of motor neurons in the brain and spinal cord, which decreases function of all smooth and skeletal muscles. The muscles eventually atrophy.

Symptoms depend on the location of the affected motor neurons, because spefic neurons activate specific muscle fibers Chief complaints are fatigue, progressive muscle weakness, craps, fasciculations (twitching), and incoordination.
Helping to determine what kind of stroke it is, and acting appropriately. If ischemic, determine if pt is candidate for thrombolytic therapy. If hemorrhagic stroke, measures to reduce bleeding and IICP should be taken.

Ischemic: (If non-thrombolytic therapy is needed)
Interventions during this period include measures to reduce ICP, such as administering an osmotic diuretic (eg, mannitol), maintaining the partial pres- sure of carbon dioxide (PaCO2) within the range of 30 to 35 mm Hg, and positioning to avoid hypoxia. Other treatment measures include the following:
• Elevation of the head of the bed to promote venous drainage and to lower increased ICP
• Possible hemicraniectomy for increased ICP from brain edema in a very large stroke
• Intubation with an endotracheal tube to establish a patent airway, if necessary
• Continuous hemodynamic monitoring (the goals for blood pressure remain controversial for a patient who has not received thrombolytic therapy; antihyperten- sive treatment may be withheld unless the systolic blood pressure exceeds 220 mm Hg or the diastolic blood pressure exceeds 120 mm Hg)
• Neurologic assessment to determine if the stroke is evolving and if other acute complications are devel- oping; such complications may include seizures, bleeding from anticoagulation, or medication-
induced bradycardia, which can result in hypotension and subsequent decreases in cardiac output and cere- bral perfusion pressure

During the acute phase, a neurologic flow sheet is main- tained to provide data about the following important mea- sures of the patient's clinical status:
• Change in level of consciousness or responsiveness as evidenced by movement, resistance to changes of po- sition, and response to stimulation; orientation to time, place, and person
• Presence or absence of voluntary or involuntary movements of the extremities; muscle tone; body pos- ture; and position of the head
• Stiffness or flaccidity of the neck
• Eye opening, comparative size of pupils and pupillary
reactions to light, and ocular position
• Color of the face and extremities; temperature and
moisture of the skin
• Quality and rates of pulse and respiration; arterial
blood gas values as indicated, body temperature, and
arterial pressure
• Ability to speak
• Volume of fluids ingested or administered; volume of
urine excreted each 24 hours
• Presence of bleeding
• Maintenance of blood pressure within the desired pa-
1.Reposition the client on a regular schedule as dictated by individual situation.
® Allow proper blood circulation, prevents venous stasis and formation of decubitus ulcers
2.Place patient on moderate high back rest position with head at the midline
® allows greater lung expansion and prevent compression on the diaphragm from prolong bed rest.
3.Support body part especially the affected side using pillows or rolls
®Prevention from developing pressure ulcers particularly on bony prominences
4.Keep body aligned and place extremities in proper position
® Proper positioning and turning maintains joint function and prevents contractures.
5.Perform active range of motion on unaffected extremities and passive range of motion exercises on affected extremities every 4 hours.
®Active range of motion exercise improves muscle strength while passive range of motion exercise improves joint mobility
6.Encourage patient to perform certain movements according to ones capability such as moving left upper and lower extremities, moving tongue, and moving head.
®To maintain strength and integrity of the functioning body parts.
7. Raise the siderails and provide a responsible watcher.
®weakness and loss of body coordination are at risk for fall or accidents.
8.Provide enteral feeding via NGT
®Provision of nutrition for metabolic and energy demand.
9. Perform regular skin care. (e.i sponge bath,apply lotion)
®Maintains skin integrity and decreases risk for skin breakdown.
10.Schedule activities with adequate rest periods
®To reduce fatigue and decrease energy demand
11. Provide a positive atmosphere while acknowledging ones difficulty.
®Helps minimize frustration and rechannel energy.
Medicaid: U.S government sponsored program for low-income individuals and families to pay the cost of health care. Medicaid beneficiaries are low income families and individuals. Covers a wider range than Medicare: hospitalization, x-rays, laboratory services, midwife services, clinic treatment, pediatrics care, family planning, nursing services and in-home nursing facilities for 21+ years, medical and surgical dental care.
In some states Medicaid beneficiaries are required to pay the provider a small fee (co-payment) of up to $30 per month for medical services. May require payment of deductibles and co-pay for certain services provided. Program is run by individual states so the type of coverage and policies may vary between states. But generally, patients usually pay no (or very little) part of costs for covered medical expenses.

Medicare: U.S government sponsored health care program for people above 65 years of age, people under 65 with certain disabilities and all people with end stage renal disease. Medicare beneficiaries are senior citizens over the age of 65, end stage renal disease, and disabled eligible to receive social security benefits. Divided in to Part A which covers hospital care, Part B which covers medical insurance and Part D covers prescription drugs.
May require payment of deductibles and co-pay for certain services provided., Medicare reserves the right to refuse to pay for treatments it deems unnecessary. Small monthly premiums are required for non-hospital coverage. Federally run so the program and coverage is uniform throughout the country. Run by the Health Care Financing Administration.
the most common general symptoms:
Impulsive behavior
Loss of memory
Impaired perception
Personality changes
Loss of taste and smell
Diminished concentration
Hearing and balance disorders
Cognitive fatigue

open head injury: open wound on head, no nerves receptors so patient might not even realize the extent of injuries. Most open head injuries expose the brain to the outside environment, leaving victims extremely susceptible to infection (meningitis).

closed head injury:
Loss of consciousness
Dilated pupils
Respiratory issues
Nausea and vomiting
Cerebrospinal fluid leaking from nose or ears
Speech and language problems
Vision issues

scalp injury:

concussion: immediate loss of consciousness for <5min. drowsiness, confusion, dizziness, HA, blurred or double vision.

contusion: varies with the size and location of injury. initial loss of consciousness;if LOC remmains altered, client may become combative. During unconsciousness, lies motionless; has pale, clammy skin; faint pulse; hypotension; shallow resps; altered motor responses.

epidural hematoma: brief loss of consciousness followed by a short period of alterntess. the client rapidly progresses into coma with decorticate or decerebate posturing, ipsilateral pupil dilation, and seizures.

subdural hematoma:
acute - rapid deterioration from drowsiness and confusion to coma, ipsilateral pupil dilation and contralateral hemiparesis
subacute - appear 48 hours - 2 weeks later; alert period followed by slow progression to coma
chronic - develops within weeks/months after initial injury. slowed thinking, confusion, drowsiness; may progress to pupil changes and motor deficits

intracerebral hematoma: decreased LOC; pupil changes and motor deficits.
A child advocacy team or child protective services should be contacted if child abuse is suspected, the mechanism of injury is unknown or unexplained, or the history is inconsistent.

NB shock is rarely due to isolated head injury except in young children and in patients with medullary injuries or large scalp lacerations.

Pediatric head injury has unique issues that make patient management and outcome different from that of adult head injury. Age related aspects will determine a greater or lesser degree of craniocervical junction injuries (disproportionate cranial size to trunk in infancy and early childhood). Other factors are potential underlying congenital anomalies, physiological factors (cerebrovascular reactivity and blood flow), differing support systems needed from that of adults for neuro imaging and specialized medical, nursing and allied health care support. Pediatric rehabilitation and educational needs and goals are different to that of adult head injury.

intubating a child is harder than intubating and adult

The physical exam is frequently normal

CT scan = significant radiation exposure

children sometimes cannot talk but frequently vomit due to stress (instead of head injury)

Brain is less myelinated, results in greater sensitivity to shearing forces

Cranial bones thinner, resulting in greater transmission of a single force to brain

Non-fused sutures makes skull easily deformable

Children (particularly < 24 months old) are at increased
risk of cerebral hypo-perfusion after TBI
Alzheimer's effects cranial nerves, especially #19.

1. loss of nerve cells 2. reduce brain size 3. presence of neurofibrillary tangles 4. neuritic plaques by amyloid protein.

Aging. One out of eight people over age 65 has Alzheimer's. Nearly half of people over age 85 have the disease.

Family history and genetics
Another risk factor is family history. Research has shown that those who have a parent, brother or sister with Alzheimer's are two to three times more likely to develop the disease.

There appears to be a strong link between serious head injury and future risk of Alzheimer's. It's important to protect your head by buckling your seat belt, wearing your helmet when participating in sports and "fall-proofing" your home.

Some evidence suggests that strategies for general healthy aging may also help reduce the risk of developing Alzheimer's. These measures include controlling blood pressure, weight and cholesterol levels; exercising both body and mind; eating a balanced diet; and staying socially active.

Scientists don't know yet exactly how Alzheimer's and diabetes are connected, but they do know that excess blood sugar or insulin can harm the brain in several ways:

Diabetes raises the risk of heart disease and stroke, which hurt the heart and blood vessels. Damaged blood vessels in the brain may contribute to Alzheimer's disease.
The brain depends on many different chemicals, which may be unbalanced by too much insulin. Some of these changes may help trigger Alzheimer's disease.
High blood sugar causes inflammation. This may damage brain cells and help Alzheimer's to develop.