locomotion ppt

8/11/2019 Locomotion ppt

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Care of Clients With Problems inLocomotion


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Bone

Provides a frameworkto support the body.


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Bones

Mechanical Function

Support of body tissue

Protection of body organs

Movement, affected by contraction of musclepulling on bones that provide leverage formotion.


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Bones

Other Functions:

Storage of calcium

Morrow produces RBC


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Bones

Composed of Living Intracellular Material

Osteoblast (bone forming cells)

Osteoclast (absorbs and remove osseous

tissue) Osteocytes (mature osteoblast embedded in

bone matrix)

Non-living Intracellular Materials

Mucopolysaccharides

Collagen (insoluble protein that combine toform white glistening inelastic fibers of

tendons, ligaments and fascia


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Bones

4 types of bones according to shape

Long

Short

Flat

irregular


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Haversian Units


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Bones

Long Bone is composed of:


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Bones

Periosteumwhitefibrous layer thatcovers the bone,

except on its articularspaces.


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Bones

Endosteumlines themarrow-filledmedullary cavity and

the Haersian canals


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Callus formation

Callusnew growth of bone.

5 stages of callus formation

1. Hematoma formation

2.Fibrin meshwork formation (semisolid character ofblood clots)

3. Invasion by osteoblast

4. Callus formation5. Remodelling


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The Muscle


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Muscle

1. Skeletal (Striated,Voluntary)

- Produces movement,

maintains posture,stabilises joints andgenerates heat


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Muscle

2. Visceral ( smooth,involuntary)

- found in the walls of

hollow organs likeyour intestines andstomach. They workautomatically without

you being aware ofthem.


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Muscle

3. Cardiac Muscle

- Cardiac musclecontracts to squeeze

blood out of yourheart, and relaxes tofill your heart withblood.


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Different types of MuscleContraction

1. Tonic

- a continual partial contraction that is vital inmaintenance of posture.

2. Isotoniccontraction in which tension andlength of the muscle change.

3. IsometricTension within the muscle

increases but the muscle doenot shorten.4. Twitcha jerky reaction to a single stimulus.

5. Tetanica more sustained contraction of

individual fibers.


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Different types of MuscleContraction

6. Fibrillationasynchronous contraction ofindividual fibers.

7. Convulsiveabnormal coordinated tetanic

contraction occuring in varying groups ofmuscles.


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Other Structure ofMusculoskeletal System

1. Cartilagefibersembedded in a firmgel. These reducefriction in the joint.

2. Ligamentstheseare bands of densefibrous tissue that areflexible and tough.


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3. Tendonsbonds offibrous tissue that areattached to the bone.


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4. Fascia this is asheet of looseconnective tissue thatmaybe found directlyunder skin or sheet ofdense, fibrousconnective tissue

making up sheet ofmuscles, nerve andblood vessel.


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5. Bursaesmall sacsof connective tissuelocated wheneverpressure is exertedover moving parts.


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Joints

- provides flexibility within skeletal framework.


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Classifications of Joints

1. Synarthroses (fibrousjoints)allow nomovement.

2. Amphiarthroses(cartilaginous joints)allow little movement.


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Classifications of Joints

3. Diarthroses ( synovialjoints)allow freemovement.

A t f Cli t ith


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Assessment of Clients withMusculoskeletal Disorders

History

Biographic data: age, sex

Chief complaints:

Pain Joint Stiffness

Swelling

Deformity and Immobility

Sensory changes

A t f Cli t ith


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Medical History

Childhood and Infectious Diseases

Major illnesses, Hospitalizations

Medications

Family History

Psychosocial History and Lifestyle

Daily activities: Occupation; Habits

A t f Cli t ith


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Review of systems

Muscle pain, spasm, tenderness

Joint pains, swelling, redness

Weakness, limited movement, clumsiness

Crepitus, backache, changes in joints andbones.

A t f Cli t ith


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Physical Examination

Inspection and Palpation of

Muscle masses (symmetry, involuntarymovements, tenderness, tone, strength and size)

Weakness (polyneuropathy, electrolyteimbalance)

Joints for symmetry, crepitus, tenderness or pain,ROM

Bone deformity

Assessment of Clients with


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Note for:



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Posture: normalcurvature of the spineis convex through thethoracic and concavethrough the cervicaland lumbar portion.



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Observe the gait for smoothness and rhythm

Unsteadiness or irregular movement, Limpingmotion

Spastic hemiparesis gait Steppage gait

Shaffling gait


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Laboratory and Diagnostic Test

1. Blood Test

a. Erythrocyte Sedimentation Rate (ESR)

- useful in detecting inflammation in the body that may

be caused by infection, some cancers, and certainautoimmune diseases such as rheumatoid arthritis,lupus, and Kawasaki disease.


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b. Rheumatoid factor

- a blood test that measures the amount of the RFantibody in the blood.

- diagnosed rheumatoid arthritis

c. Antinuclear Antibodies (ANA)

- is ordered to help screen for autoimmune disordersand is most often used as one of the tests to

diagnose systemic lupus erythematosus (SLE).


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d. C-reactive Protein

- is produced by the liver. The level of CRP rises whenthere is inflammation throughout the body.

e. Uric Acid

- Uric acid is a chemical created when the bodybreaks down substances called purines.

f. Minerals

Calcium Alkaline hosphatase

Phosphoros


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Muscle enzymes

Aldolase - a protein (called an enzyme) that helpsbreak down certain sugars into energy. It is found inhigh amounts in muscle tissue.

AST - is an enzyme found in high amounts in heartmuscle and liver and muscle cells. It is also found inlesser amounts in other tissues.

CK-MM (creatine Phosphokinase)elevated intraumatic injuries.

LDH


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2. X-raydetect bone fractures.

3. Bone Scan


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3. Arthroscopy


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4. Arthrocentesis

- removal of synovialfluid, blood or pus

from a joint.


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5. Myelography

- lumbar puncture isdone to withdraw a

small amount of CSF,which is replaced witha radiopaque dye,used to detect tumors

or herniatedintravertebral disc.

L b t d Di ti T t


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6. Electromyography(EMG)

- measures and records

activity of muscles inresponse to electricalstimulations.

N i di


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Nursing diagnoses

- Pain

- Altered peripheral tissue perfusion

- Impaired physical mobility

- Risk for infection

- Risk for injury

- Self-care deficit

- Knowledge deficit

- anxiety

I l t ti


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Implementation

a. Perform a neurovascular assessment (6 Ps)

1. Assess pain (signals the beginning of muscle

ischemia)

2. Assess pulses (disruption of arterial blood flow)

3. Assess for pallor (disruption of blood flow)

4. Assess for paresthesia (nerve function may bedisruptive by nerve compression)


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5. Assess for paralysis (inceasing edema causesnerve compression)

6. Assess for polar (coldness)disrupted arterial

blood flow

Infectious/ Inflammatory and


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ect ous/ a ato y a dDegenarative Disorders

1. Osteomyelitis

- acute or chronicinfection of the bone

and surrounding softtissues.

Cause?


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Cause: staphylococcus aureus


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Cause: staphylococcus aureus

- affects person with low resistance or withdecreased blood flow to the trauma site

- Blood borne (hematogenic) osteomyelitis ismore common in children after throat infection

- Osteomyelitis resulting from trauma ororthopedic procedures is more common inadults


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Osteomyelitis


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Osteomyelitis

Clinical Manifestations:

Malaise, fever

Pain and tenderness of bone, redness and

swelling over bone Difficulty with weight bearing

Drainage from wound site may be present

Osteomyelitis


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Osteomyelitis

Diagnostic Test:

CBC (increased)

ESR (increased)

Osteomyelitis


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Osteomyelitis

CollaborativeManagement:

Collaborative mgnt


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Collaborative mgnt

-analgesics

-antibiotics

-Dressing change in sterile technique

-maintain body alignment and change positionfrequently to prevent deformities

-immobilization of affected part

-psychological support

Osteomyelitis


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Osteomyelitis

Surgeries:

Surgeries


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Surgeries

If needed:

- incision and drainage of bone abscess

- Sequestrectomy- removal of the dead, infected

bone and cartilage- Bone grafting after repeated infections

Nsg mngt


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Nsg mngt

1. Adminster prescribed medication

2. Protect the affected extremity from furtherinjury and pain

3. Promote healing and tissue growth-local treatments (warm saline soaks, wet to

dry dressing)

4. Prepare patient for surgical treatment e.g. bonegrafting, debridement etc

5. Provide health teachings

Septic Arthritis


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Septic Arthritis

A closed -spacedinfection caused byinavasion of thesynovial membrane by

pus-forming bacteriaor other pathogen.


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Septic Arthritis


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Septic Arthritis

Cause: Neisseriagonorrhoeae.

Commonly affected:Knee, hip, shoulder,wrist and ankle.

Septic Arthritis


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Septic Arthritis

Clinical Manifestations: Pain, swelling, warmth and tenderness in a

single joint.

Low grade fever, malaise High grade fever and chills

Septic Arthritis


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Septic Arthritis

Collaborative Management:1. Synovial fluid culture

2. Antibiotic therapy

3. Decompression of the infected joint

4. Synovectomy

Systemic Lupus Erythematosus(SLE)


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(SLE)

- Chronic multisystem,collagen disorder.

- higher incidence infemale (15 to 40 y.o)

Cause: UNKNOWN



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(SLE)

Diagnostic Test: CBC

ESR

ANA

Anti- DNA



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(SLE)




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(SLE)



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(SLE)

Clinical manifestations


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1. Musculo-skeletala. Arthralgia and arthritis (synovitis)

b. Joint edema and tenderness

c. Pain on movement and morning sickness

2. Integrumentary

a. Butterfly rush across the bridge of the nose andcheeks


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b. Oral ulcers of the mucosa and hard palate andmay be accompanied by skin lesions

3. Cardiovasculara. Pericarditis (up to 30% of patients)

b. Papular, erythematous and purpuric lesions on

fingers, elbows, toes, fore-arms and hands


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4. Respiratory systema. Pleural effusion

b. Pleuritis

5. Neurologic

a. Subtle changes in personality and cognitive

ability

b. Depression and psychosis often occur


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6. Other systemsa. Glomeruli of the kidneys usually affected

b. lymphadenopathy



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(SLE)

Collaborative Management:1. Rest

2. ROM exercises

3. Prevent infection

4. Avoid exposure to sunlight

5. Pharmacotherapy (NSAIDS, Salycilate for joint

pains, oral/topical cortecosteroids for skinrashes)

6. Apply warm packs to relieve joint pains and

stiffness


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7. Provide meticulous mouth care8. Maintain skin integrity by keeping skin clean

and dry, using mild soaps and lotions, andinspect for vascular lesions

Rheumatoid Arthritis


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- Chronic systemicdisease characterizedby inflammatorychanges in joints and

related structures,specially the synovialmembrane.



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Cause: Unknown May be autoimmune process or genetic

Causative factors include fatigue, cold, emotionalstress, infection

Joint distribution is symmetrical

Women > men

Between 20-55 years old

Complications (infections, osteoporosis, vasculitis,carpal tunnel syndrome)



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Clinical Manifestations: Fatigue, anorexia, weight loss, slight

temp.elevation

Painful, warm, swollen joints with limited motion,stiffness in the morningand after period ofinactivity.

Crippling deformity

Muscle weakness secondary to inactivity

stages


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a. Firstsynovitis (joint inflammation andswelling)

b. Secondpannus (inflammatory granulationtissue)

c. Thirdtough fibrous connective tissue

d. Fourthcalcification of bone



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Clinical Manifestations: Sjorgren's syndrome

-excessive dryness of the eyes, mouth and

vagina Felty's syndrome

- leukopenia, splenomegaly



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Collaborative Management:1. Bed rest during acute phase

2. Passive ROM exercises to prevent

contractures.3. Splint painful joints.

4. Heat and cold application.

5. Warm bath in the morning to relieve morningstiffness.

6. Protect the client from infection.



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Surgery:1. Osteotomysurgical removal of the wedge of

the joint.

2. Synovectomyremoval of the synovia.3. Arthroplastyreplacement of joints with

prostheses.



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Pharmacotherapy:1. Aspirin

2. NSAIDS

Indocin (Indomethacin) Butazolidin (Phenylbutazone)

Motrin (Ibuprofen)

Nalfon ( Fenoprofen) Naprosyn( Naproxen)



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Gold compounds (Chrysotherapy) Injectable forms

Oral forms

Corticosteroids (intra-articular injections)

Health therapyParrafin deep

Osteoarthritis


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Osteoarthritis


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Metabolic Response


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- Chronic, nonsystemic disorder of the jointscharacterized by degeneration of the articularcartilage

- Male = female affected, incidence increased

with age. Related to obesity and joint trauma

- Weight bearing jointsspine, knees, hips andends of the fingers are most commonly affected

Assesment


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-pain aggravated by use and relieve by rest-stiffness of the joints

-Herberdens nodes/Bouchard Nodes bony

overgrowth at terminal interphalangeal joints-Decreased ROM

Collaborative Mngt


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Assess joints for pain and ROMRelieve pain and prevent further trauma to joints

-cane or walker as indicated

-posture and body mechanics, avoid weightbearing and continous standing

- physical therapy to maintain joint mobilty andmuscle strength

-promote comfort/pain relief (NSAIDS,analgesics

-Decreased calories

Gout


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-Disorder of purine metabolism-precipitation of urine cyrstals in the joints (tophi)

-causes of inflammation and pain

-occurs in males, familial

Clinical manifestations


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- Joint pains, redness, heat, swelling (great toeand ankle mostly affected)

- Headache, malaise, anorexia

- Tachycardia, fever, tophi in outer ear, handsand feet

- Uric acid elevated in blood/urine

Collaborative Mngt


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- Drug therapya. Acute attackcolchicine (discontinue with

diarrhea or N/V); NSAIDS (indocin, butazolidin)

b. Prevention

-uricosuric agents

a. Probenecid (Benemid), sulfinpyrazoneincrease renal excretion of uric acid


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b. Allupurinol inhibits uric acid formationc. Encourage fluids to 2-3 L a day when givingantigout drugs to prevent stone formation inkidneys

Food


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- Low purine dieta. foods to avoid

-organ meats, shellfish, legumes, sardines,

mushrooms, sweetbreads, beer/wine

Paget's Disease (OsteitisDeformans)


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- Increase rate of bonetissue breakdown(resorption) byosteoclasts.

- Bone is weak andprone to fracture.


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- Etiology is unkown but may be due to virusacquired 20-40 years prior to onset

- May be familial risks, found 30% with familyhistory

- Older adults are susceptible (3M in US)

- Cultural (more in European Descent, not seenmostly in Asia and Scandinavian countries)

Complications


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- Gout- Hyperhtyroidism

- Renal stones

- Heart failure- If untreated, blindness or deafness



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- 80% are asymptomatic- Pain in the lower back and extremeties and

nerves

- Posture changes

- Bowing of long bones

- Enlarged skull

- Pathological fractures- Fatigue

- Flushed warm skin

Collaborative Management


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2. Calcitonin/ Etidronate

3. Cytotoxic Antibiotic

Legg-Calve-Parthe's Disease


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- a.k.a Coxa plana or Osteochondritis deformsjuvenilis.

- Characterized by aseptic necrosis of the head ofthe femur.

Legg-Calve-Parthe's Disease


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Cause: Unknown- Disturbance in circulation to the

Femoral capital epiphysis that causes

Ischemic, aseptic necrosis to femoral head

- incidence: dominant in caucasian males (4-8

years old); 1 in 12,000 in children


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- Can be familial, trauma, inflammation, orcoagulation defects

Clinical Manifestations


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Joint dysfunction

Xray reveals changesin bone.

Manifestations


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- Mild pain in the hip and anterior thigh- Limp aggravated by increased activity and

relieved by rest

- Stiffness in the morning or after rest

- Progressive stages may have limited ROM,weakness, muscle wasting, shortening ofaffected limb



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1. Pain relief2. Limit activities (Bed rest)

3. Provide mobility equipment

4. Use of brace5. Cast application

6. Surgery

7. Prevent Trauma to the hips( avoid contactsports, high impact running)

Fibromyalgia


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- Chronic syndrome ofmusculoskeletal tissuecharacterized bywidespread pain.

Fibromyalgia


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Excessresponse tocold



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Pharmacologic Management


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Osteoporosis

Systemic skeletal


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- Systemic skeletaldisease characterizedby low bone mass,leading to enhanced

bone fragility and aconsent increase infracture risk.

Risk Factors

Age 50 y o


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Age50 y.o

Low body weight(less than 70kg)

Famiy history

Low physical activity Female

Tobacco use

Estrogen deficiency

Increase with age

Clinical Manifestations


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Diet supplementation


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Diet supplementation

Exercise

Avoid tobacco and alcohol

Pharmacotherapy Evista

Calcitonin

Forteo

Carpal Tunnel syndrome

- Form of repetitive stress injury


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Form of repetitive stress injury

- Characterized by progressive compression ofthe median nerve caused by narrowing of thecarpal tunnel in the wrist through overuse

- Women 30-60 years old, is a seriousoccupational health problems

- Complications: partial paralysis, sensory

disturbance, atrophy in the muscles of thepalms and three fingers

Assessment

- numbness, paresthesia


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numbness, paresthesia

- Pain in the hand and fingers progressing up thearm in time

- Inability to clench fist

- May be decreased strength and flexibility of thethumb

- Temp in the palm may be cold; palm may be

discolored

Diagnostic tests

- X-ray to rule out fracture


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X ray to rule out fracture

- Electromyography- electrodes are placed atspecific places along the median nerve toassess diminished nerve conduction of the

elec. Current- Phalens wrist-flexion testclient places the

elbow on the table, letting the wrist drop, + testindicates when carpal tunnel syndrome occursin hand/fingers in 60 second or less

- Tinel sign- percuss the median nerve at the


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e s g pe cuss e ed a e e a ewrist, + sign if tingling occurs in the thumb/3fingers

- Compression testblood pressure cuff is

inflated above systolic pressure on the forearmfor 1.5 min, + test when carpal syndrome ispresent after 1.5 min

Nsg Interventions

a. Immobilize the affected area using splint for 1-2


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g pweeks

b. Apply compression of the affected wrist

c. Administer analgesia or muscle relaxant

d. NSAIDs to decrease pain

e. Instruct patient who has surgical repair that noheavy lifting or direct pressure in the palm is

permitted for 2-3 weeks

Surgical Mgnt

- Decompression is achieved by resecting the


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p y gcarpal ligament and may need synovectomy orremoval of synovium

Trauma

1. Straindamage to


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gtendon due to twistingmotion.


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2. Spraindamage to

Trauma


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ligaments due totwisting motion.

3. Subluxationpartiadisarticulation of joint.

Trauma

4. Fractureany


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impairement in thebone integrity.


R- est/ immobilized affected joints


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I- ce application (1st72 hours)

C- ompression(elastic bandage)

E- levate affected joint

Types of Fractures:

1. Completeentire


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circumference of thebone is impaired.

2. Incompleteonypartial circumferenceof bone is impaired.

Types of Fracture:

3. Transversethe lineb k i th


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or break is across thebone.

4. Obliqueline ofbreak goes diagonal

along the bone.

5. Spiralline of breakd th b

Types of Fracture:


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goes around the bone.

6. Greenstickone sideof the bone is

impaired, the other isbent.

Types of Fracture:

7. Comminutedboned li t d


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ends are splinteredinto two more smallpieces.

8. Impactedone boneenters theintramedullary spaceof another bone end.

Types of Fracture:

9. Closed or simpleN b k i ki


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No break in skinintegrity.

10. Open or compoundwith break in skin.


Pain aggravated by motion


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Loss of motion

Edema

Crepitus Shortening of the limbs due to spasm

Obvious deformity



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Fracture complications

a. Direct


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1. Alteration in union, delayed union, andmalunion and etiologies include:

1.1 inadequate immobilization

1.2 inadequate reduction

1.3 excess movement

1.4 infection

1.5 poor nutrition

1.6 agehealing time for fractures increases withage.

2. Avascular necrosisdeath of cells from no

blood supply


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blood supply

3. Osteomyelitisbone infection

b. Indirect

1. Associated with blood vessel and nervedamage: etiologies include:

1.1 compartment syndromedistal humerus andproximal tibia are mostly affected affected by thissyndrome

1.2 venous thrombosis


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1.3 fat embolism

1.4 hypovolemic shock

Assessment

a. Immediate localized pain

b D d f ti


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b. Decreased function

c. Inability to use affected part

d. Visible deformitye. Ecchymosis

f. Limited sensation in distal to the site

g. Crepitus or clicking sounds on movement

Diagnostic tests

a. X-ray to confirm fracture

b Bl d t di ifi t th f t


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b. Blood studies specific to the fracture

c. Client-specific history

Nsg Mgnt

a. Maintain anatomic realignment of the bone,

known as reduction


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known as reduction

b. Maintain immobilization to maintainrealignment

c. Restore fxn on the injured part

d. Adminster muscle relaxants or analgesia forpain and muscle spasm

e. High protein, high calorie, high fiber

f. Encourage vit B, C and D

I fl id i t k 2 3 L t t b l


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g. Increase fluid intake 2-3 L to promote bowelmovement and prevent constipation or renalcalculi

h. Apply direct pressure if active bleeding

Surgical Mgnt

a. Immediate re-alignment of bones if possible

b ORIF of fracture if no other realignment method


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b. ORIF of fracture if no other realignment methodcan be completed

Traction

- Application of a pulling force to a part of the body

by pulleys and weights to correct deformities


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by pulleys and weights to correct deformities,improve joint contractures, treat dislocation,immobilization, treat disease processes

Types and Uses

a. Skeletalforce applied directly to the bone by

inserting pins wires or tongs into the bone


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inserting pins, wires or tongs into the bone

b. May have 40 lbs of traction up to 8 weeks at atime

c. Used to reduce fractures

b. Manualcompleted by application of the handsof a health care worker; temporary form of


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of a health care worker; temporary form oftraction until application of a cast to reduce afracture

c. Skinusually 5 lb of traction is applied directly

to the skin; may be used continuously or


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to the skin; may be used continuously orintermittently

Traction type (upper extremeties)

a. Dunlops (sidearm)

1 Used to immobilize the arm to correct


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1. Used to immobilize the arm to correctcontractures or fractures

2. Pull is upward

3. Elbow flexion usually 90 degrees

4. May be skin or skeletal traction

2. Olecranon pin (overhead arm)

1 Used to immobilize arm to prevent contractures


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1. Used to immobilize arm to prevent contracturesor fractures

2. Pull is upward

3. Elbow flexion usually 90 degrees

4. May be skin or skeletal traction

Traction type: lower extremity

a. Bucks (extension)

1 Used to immobilize the leg to correct


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1. Used to immobilize the leg to correctcontractures of the knee and joint or fracture ofthe hip or femoral shaft

2. A form of skin traction

3. Pull on the lower extremity with knee and hipfully extended

b. Russell

1 Used to immobilize the leg generally for a


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1. Used to immobilize the leg generally for afracture of the hip of femur

2. A form of skin traction

3. Exerts pull on the lower extremity

c. Balanced traction with thomas ring splint and

Pearson attachment


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1. Used to immobilize the leg to correct fracturesgenerally of the femoral shaft of the femur, hip

or tibia2. Entire leg is supported with a ring placed at the

groin of the affected leg to support thigh off theleg

3. Skeletal type of traction


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locomotion ppt

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