Musculoskeletal System

Chapter 41-43

Musculoskeletal SystemFUNCTION!

• Protection• Framework• Mobility• Reservoir – Blood cells– Minerals

• Ca• Ph

Anatomy & PhysiologySKELETAL SYSTEM

How many bones are in the human body?A. 206B. 1,245C. 847D. 145E. 666

Bone Types

• Long bones• Short bones• Flat bones• Irregular bones

Which of the following are formed in the bone marrow?

A. Red blood cellsB. White blood cellsC. PlateletsD. HemoglobinE. All of the above

Bone structure

• Types of bone tissue– Compact bone

• Dense– Spongy bone

• Bone marrow

Bone Marrow

Red

• Locations– Flat bones

• Contents– RBC– WBC – Platelets– Hgb

Yellow• Location– Long bones

• Contents– Fat

Bone Cells

• Osteoblasts– Form matrix

• Osteocytes– Maintenance

• Osteoclasts– Dissolving & resorbing

Bone Maintenance

• Modeling– Childhood

• Remodeling– Adulthood

Cool Fact!Complete skeletal turnover

occurs every 10 years

Joints

• AKA:– Articulations

• Defined– Where two or more

bones meet

Synovial joints

• Cavity filled with synovial fluid

Ligaments

• Defined– Connects bones to

bones• Function– Joint stability

Tendon

• Define– Connects muscles to

bone• Function– Joint movement

Muscles

• Types of muscles– Skeletal muscles

• Voluntary movement– Smooth muscles

• Internal organs• Involuntary

– Cardiac muscles • Heart muscle• Involuntary

Muscle structure

• Muscle thick bundles of parallel fibers

Muscle contraction

• EACH muscle cell is “excitable”– Receive and respond to

stimuli• Skeletal muscle cells

contract when motor neurons release acetylcholine (neurotransmitter)

Muscle contraction

• Motor neuron • Acetylcholine • Muscle cells • Contraction

Muscle extension

• Muscles extend when they relax

Muscle Tone

• Nerve impulses maintain muscle tone.

• Lack of muscle use atrophy– Muscle wasting

M/S system of the older adult

• i in bone mass• Joint & disc dehydrate

i height• i flexibility• Hips & knees flex• Head tilted backward

• Alt. center of gravity • h risk of falls

Assessment

• Chief complaint– Pain– Limited mobility

Physical assessment

• Gait• Movements• Posture

Physical Examination

• Posture– What is this?– Kyphosis

• h curve of the thoracic spine

Physical Examination

• Posture– What is this?– Lordosis

• h Curve of the lumbar spine

Physical Examination

• Posture– What is this?– Scoliosis

• Lateral curve of the spine

Physical assessment

• Inspect & palpate

Physical assessment

• Crepitus– Grating sound or

sensation during ROM

Neurovascular status

• CMS– Circulation

• Color• Temp• Cap. refill

– Motion• Weak / paralysis

– Sensation• Paresthesia• Pain

Range of Motion

• Flexion– Bend a joint

• Extension– Straighten joint

• Abduction– Move away from midline

• Adduction– Move towards midline

Range of Motion

Passive• Total assist

Active• Independent

Clinical Alert!

• Never attempt to move a joint past its normal range of motion for the

client or past the point at which pain is experienced.

Erythrocyte Sedimentation Rate (ESR)

• What does an elevated ESR indicate?A. Bone cancerB. OsteoporosisC. InflammationD. AnemiaE. Auto-immune disease

C-reactive Protein

• What does an positive CRP indicate?A. Bone cancerB. OsteoporosisC. InflammationD. AnemiaE. Auto-immune disease

Dx Tests

• Ca+ – Calcium

• Ph– Phosphate

Dx Test - imaging

• X-ray– No special prep

• CT – scan – No special prep

• CT-scan with contrast– Assess for allergies

• MRI

Dx tests

• Bone density scan– Used to diagnosis

osteoporosis – No special prep

Dx Test

• Arthroscopy– Flexible fiberoptic

endoscope to visualize joint

• Arthroscopy–Pre-procedure• √ Consent• NPO 8 hours

–Post-procedure• Assess neurovascular

status

• Arthroscopy–Pain management–Assess bleeding,

swelling– Elevated – Ice

• Dr Behl show – Knee arthroscopy

• http://video.search.yahoo.com/search/video;_ylt=A2KJkIdUcqhOFU0ARt2JzbkF?p=knee+arthroscopy&fr=&fr=moz2-ytff-&fr2=tab-web

• Shoulder Arthroscopy• http://video.search.yahoo.com/search/vid

eo;_ylt=A2KJke5zc6hOyQsANouJzbkF?p=shoulder+arthroscopy+surgery&fr=&fr2=sg-gac

Soft Tissue Injury: Sprain

• Ligament injury

Soft Tissue injury: Strain

• Tear in the muscle

IDT care: Sprain / Strain

• X-ray– To rule out fx

IDT care: Sprain / Strain

• Rest

• Ice– First 48 hours

• Compression dressing

• Elevate – Above level of the heart

Crutches

• Requirement for use– Good balance– Strong upper body – Erect posture

Crutches: Adjust

• Length– 5 cm below axilla

• Hand grip– 20 – 30o elbow flexion

Crutches

• Down Stairs1. Crutches2. Affected leg3. Unaffected leg

Crutches

• Up stairs1. Unaffected leg2. Crutches & affected

• http://video.search.yahoo.com/search/video?p=how+to+use+crutches&n=21&ei=utf-8&fr2=sg-gac&tnr=20&js=1

• http://video.search.yahoo.com/video/play?n=21&ei=utf-8&js=1&fr2=sg-gac&tnr=20&p=how+to+use+crutches&vid=1341945283100&dt=1261036800&l=178&turl=http%3A%2F%2Fts1.mm.bing.net%2Fvideos%2Fthumbnail.aspx%3Fq%3D1341945283100%26id%3D28462d837da23020773e3305fe3a6ac6%26bid%3Da0hUVla987q2jA%26bn%3DThumb%26url%3Dhttp%253a%252f%252fwww.youtube.com%252fwatch%253fv%253dM4LHBfVUo6A&rurl=http%3A%2F%2Fwww.youtube.com%2Fv%2FM4LHBfVUo6A%26autoplay%3D1%26fs%3D1%26autoplay%3D1&tit=How+To+Use+Crutches&sigr=11vv8bk5b&newfp=1&surl=http%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3DM4LHBfVUo6A&sigs=11a74ridu

Medications: Sprains & Strains

• NSAID’s• Analgesics – narcotics

Fracture

• Defined– Break in the continuity

of the bone

Fracture S&S

• Deformity• Pain• Immobility• Crepitus

Fractures: IDT care

• Emergency care–Immobilization–Open wounds• Cover with

sterile dressing

–Assess• Pulse–CMS

• X-ray to confirm FX

Fracture reduction: IDT care

• Reduction– Restore alignment

• Immobilization

Cast Care

• Frequently assess–CMS

• Promptly report –Changes in CMS–h or severe pain–Drainage

• Read text book on cast care

• Ch. 42

Medications: fracture

• Analgesics & NSAIDs• Stool softeners • Antibiotics

Dislocation

• Separation of contact between two bones of a joint.

Dislocation

• Most common– Shoulder– Knee

S&S of dislocation

• Pain• Deformity• Length change• Immobility

Dislocation: Tx

• Reduced

Dislocation: Tx

• Immobilized

Amputation

• Partial or total removal of a body part

Amputation: WHY?!

• Bone Cancer• Infection• Trauma

What’s your biggest problem?

• You’ve been in an automobile accident and your right leg was crushed. You wake up from surgery to find that your leg had to be amputated, they could not save it. How do you feel? What are you most worried about.

• Remembering that nurses deal with patient’s responses to illnesses and injury – what would be your priority nursing diagnosis for yourself?

Amputation: Affect

• Physical• Mental• Social

Amputation: Complications

• Infection• Contractures• Phantom leg pain

Contractures

• Permanent shortening of the muscle flexion

Contracture prevention

• ROM– Extension

IDT care

• Compression dressing

• Limited weight bearing 2wks post-op

Osteoporosis

• Porous bones– i Bone mass –h fragile–h risk of fractures–Assoc. with age

Osteoporosis: Pathophysiology

• Bone is constantly being remodeled

• h Age • More bone is lost

than gained • i Bone mass

Osteoporosis: S&S

• Asymptomatic– Loss of height– Progressive curvature

of the spine– Low back pain– Fx

Which of the following is a complication of osteoporosis

A. LordosisB. KyphosisC. ScoliosisD. Barrel chest

Osteoporosis: complications

• Pathological fx

IDT: diagnosis

• Bone mineral density (BMD)

• X-ray

IDT: Nutrition

• Calcium• Vitamin D– Needed for Ca+

absorption

Osteomyelitis

• Infection of the bone

Osteomyelitis

• Pathophysiology– Usually D/T open wound

Osteomyelitis

• Dx– WBC– ESR– Blood/tissue cultures– Imaging

• MRI• CT scan

Osteomyelitis: Rx

• What do they need?–Antibiotics

Arthritis

• Inflammation of the joint

Osteoarthritis

• Degenerative joint disease

• Progressive loss of joint cartilage

Osteoarthritis

• Affect entire joint

Osteoarthritis:S&S

• Gradual• Arthalgia

IDT:Dx

• S&S• X-ray

IDT:care

• Lose weight• Exercise• Heat

Osteoarthritis: Rx

• Mild analgesics– Aspirin– Acetaminophen– NSAIDs

Osteoarthritis: Surgery

• Arthroplasty– Reconstruction of the

joint