Nursingbulletin: Musculoskeletal System

Anatomy and Physiology

The musculo-skeletal system consists of the muscles, tendons, bones and cartilage together swith the joints The primary function of which is to produce skeletal movements

MusclesThree types of muscles exist in the body 1. Skeletal Muscles

Voluntary and striated Involuntary and striated Involuntary and NON-striated

2. Cardiac muscles

3. Smooth/Visceral muscles

TENDONS

Bands of fibrous connective tissue that tie bones to muscles

LIGAMENTS

Strong, dense and flexible bands of fibrous tissue connecting bones to another bone

BONESVariously classified according to shape, location and size Functions 1. Locomotion 2. Protection 3. Support and lever 4. Blood production 5. Mineral deposition

JOINTS

The part of the Skeleton where two or more bones are connected

CARTILAGES

A dense connective tissue that consists of fibers embedded in a strong gel-like substance

BURSAE

Sac containing fluid that are located around the joints to prevent friction

ASSESMENT OF THE MUSCULOSKELETAL SYSTEM

The nurse usually evaluates this small part of the over-all assessment and concentrates on the patients posture, body symmetry, gait and muscle and joint function

ASSESMENT OF THE MUSCULOSKELETAL SYSTEM

1. HISTORY 2. Physical Examination

Perform a head to toe assessment Nurses need to inspect and palpate The special procedure is the assessment of joint and muscle movement Usually, a tape measure and a protractor are the only instruments

ASSESSMENT OF THE MUSCULO-SKELETAL SYSTEM

Gait Posture Muscular palpation Joint palpation Range of motion Muscle strength

ASSESMENT OF THE MUSCULOSKELETAL SYSTEMLABORATORY PROCEDURES 1. BONE MARROW ASPIRATION

Usually involves aspiration of the marrow to diagnose diseases like leukemia, aplastic anemia Usual site is the sternum and iliac crest Pre-test: Consent Intratest: Needle puncture may be painful Post-test: maintain pressure dressing and watch out for bleeding

ASSESMENT OF THE MUSCULOSKELETAL SYSTEMLABORATORY PROCEDURES 2. Arthroscopy A direct visualization of the joint cavity Pre-test: consent, explanation of procedure, NPO Intra-test: Sedative, Anesthesia, incision will be made Post-test: maintain dressing, ambulation as soon as awake, mild soreness of joint for 2 days, joint rest for a few days, ice application to relieve discomfort

ASSESMENT OF THE MUSCULOSKELETAL SYSTEMLABORATORY PROCEDURES 3. BONE SCAN Imaging study with the use of a contrast radioactive material Pre-test: Painless procedure, IV radioisotope is used, no special preparation, pregnancy is contraindicated Intra-test: IV injection, Waiting period of 2 hours before X-ray, Fluids allowed, Supine position for scanning Post-test: Increase fluid intake to flush out radioactive material

ASSESMENT OF THE MUSCULOSKELETAL SYSTEMLABORATORY PROCEDURES 4. DEXA- Dual-energy XRAY absorptiometry Assesses bone density to diagnose osteoporosis Uses LOW dose radiation to measure bone density Painless procedure, non-invasive, no special preparation Advise to remove jewelry

Nursing Management of common musculoskeletal problemsPAIN These can be related to joint inflammation, traction, surgical intervention 1. Assess patients perception of pain 2. Instruct patient alternative pain management like meditation, heat and cold application, TENS and guided imagery 3. Administer analgesics as prescribed Usually NSAIDS Meperidine can be given for severe pain

4. Assess the effectiveness of pain measures

Nursing ManagementIMPAIRED PHYSICAL MOBILITY 1. Instruct patient to perform range of motion exercises, either passive or active 2. Provide support in ambulation with assistive devices 3. Turn and change position every 2 hours 4. Encourage mobility for a short period and provide positive reinforcements for small accomplishments

Nursing ManagementSELF-CARE DEFICITS

1. Assess functional levels of the patient 2. Provide support for feeding problems

Place patient in Fowlers position Provide assistive device and supervise mealtime Offer finger foods that can be handled by patient Keep suction equipment ready Assist with bath only when patient has difficulty Provide ample time for patient to finish activity

3. Assist patient with difficulty bathing and hygiene

Musculoskeletal Modalities

Traction Cast

Nursing ManagementTraction A method of fracture immobilization by applying equipments to align bone fragments Used for immobilization, bone alignment and relief of muscle spasm

Traction

Skin traction- Buck, Bryant Skeletal traction

Traction

Balanced Suspension traction Running/Straight traction

Traction

Pulling force exerted on bones to reduce or immobilize fractures, reduce muscle spasm, correct or prevent deformities

Traction

TO decrease muscle spasms TO reduce, align and immobilize fractures To correct deformities

Nursing ManagementTraction: General principles 1. ALWAYS ensure that the weights hang freely and do not touch the floor 2. NEVER remove the weights 3. Maintain proper body alignment 4. Ensure that the pulleys and ropes are properly functioning and fastened by tying square knot

Nursing ManagementTraction: General principles 5. Observe and prevent foot drop

Provide foot plate

6. Observe for DVT, skin irritation and breakdown 7. Provide pin care for clients in skeletal traction- use of hydrogen peroxide

Nursing ManagementTraction: General principles 8. Promote skin integrity

Use special mattress if possible Provide frequent skin care Assess pin entrance and cleanse the pin with hydrogen peroxide solution Turn and reposition within the limits of traction Use the trapeze

Nursing ManagementCAST Immobilizing tool made of plaster of Paris or fiberglass Provides immobilization of the fracture

Nursing ManagementCAST: types Long arm Short arm Short leg Long leg Spica Body cast

Casting Materials

Plaster of Paris

Drying takes 1-3 days If dry, it is SHINY, WHITE, hard and resistant Lightweight and dries in 20-30 minutes Water resistant

Fiberglass

Cast application1. 2. 3. 4. 5.

TO immobilize a body part in a specific position TO exert uniform compression to the tissue TO provide early mobilization of UNAFFECTED body part TO correct deformities TO stabilize and support unstable joints

Nursing ManagementCAST: General Nursing Care 1. Allow the cast to air dry (usually 2472 hours) 2. Handle a wet cast with the PALMS not the fingertips\ 3. Keep the casted extremity ELEVATED using a pillow 4. Turn the extremity for equal drying. DO NOT USE DRYER for plaster cast Encourage mobility and range of motion exercises

Nursing ManagementCAST: General Nursing Care

5. Petal the edges of the cast to prevent crumbling of the edges 6. Examine the skin for pressure areas and Regularly check the pulses and skin

Nursing ManagementCAST: General Nursing Care 7. Instruct the patient not to place sticks or small objects inside the cast 8. Monitor for the following: pain, swelling, discoloration, coolness, tingling or lack of sensation and diminished pulses

Nursing ManagementCAST: General Nursing Care Hot spots occurring along the cast may indicate infection under the cast

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