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MS Nursing I Chapter 66

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Cancellous or spongy bone found in the epiphyses or rounded, irregular ends of long bones. Cortical or compact bone found in the diaphyses or long shafts of arm ... – PowerPoint PPT presentation

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Title: MS Nursing I Chapter 66


1
M/S Nursing I Chapter 66
  • Introduction to the Musculoskeletal System

2
A P Review
  • Bones, 206 in body
  • short bones, fingers toes
  • long bones, femur
  • flat bones, sternum
  • irregular bones, vertebrae
  • Cancellous or spongy bone found in the epiphyses
    or rounded, irregular ends of long bones
  • Cortical or compact bone found in the diaphyses
    or long shafts of arm leg bones

3
  • Types of bone cells
  • osteoblasts cells that build bone cells
  • osteocytes mature bone cells
  • osteoclasts involved in the destruction,
    resorption, remodeling of bone
  • Periosteum a layer of tissue that covers the
    bones
  • Red bone marrow found in the sternum, ileum,
    vertebrae, ribs make blood cells hgb
  • Yellow bone marrow in long bone consisting
    mostly of fat connective tissue

4
Muscles Joints
  • Skeletal
  • voluntary
  • found in the arms, legs, etc
  • Smooth
  • involuntary
  • found in the walls of the stomach, intestine,
    blood vessels, etc
  • Cardiac
  • involuntary
  • found only in the heart
  • Joints
  • junction between 2 or more bones
  • see table 66-2 for types of joints
  • types of diarthrodial movements - box 66-1

5
  • Tendons cordlike structures that attach muscles
    to the periosteum of the bone
  • origin, more fixed
  • insertion, more movable
  • Ligaments connect 2 adjacent freely movable bones
  • provide stability alignment

6
  • Cartilage
  • a type of connective tissue
  • functions to reduce friction between articular
    surfaces, absorb shocks reduce stress on the
    joint surfaces
  • examples elbow, knee
  • Bursae
  • a small sac filled with synovial fluid
  • functions to reduce friction between a tendon
    bone bursitis

7
Assessment
  • History
  • chronic problem
  • new injury
  • Physical exam table 66-3
  • mobility
  • inspection
  • compare 2 sides
  • strength
  • ROM
  • pulses
  • Be gentle with assessment especially with recent
    injury
  • pain assessment
  • wounds?

8
Testing
  • Imaging procedures
  • CT scans, MRI
  • Arthrogram xray of joint MD aspirates
    synovial fluid sends to lab contrast medium
    injected xrays are taken client may hear
    clicking or crackling noises in joint for up to 2
    days
  • Arthroscopy internal inspection of a joint
    Nursing Guidelines 66-1
  • Arthrocentesis aspiration of synovial fluid for
    s/s of traumatic arthritis, septic arthritis,
    gout, rheumatic fever, or SLE

9
  • Synovial fluid analysis sent to lab to assess
    for traumatic or septic arthritis gout
    rheumatic, SLE
  • Bone density radiography of the wrist, hip or
    spine to determine bone mineral density
  • Bone scans involves the IV injection of
    radioactive substance to assess for metastatic
    bone cancer or fractures
  • Biopsy
  • needle
  • surgical excision

10
BLOOD TESTS
  • CBC infection, inflammation or anemia
  • increased Alk phos bone tumors, healing
    fractures
  • increased acid phos Pagets dz and metastatic
    cancer
  • decreased serum calcium osteomalacia,
    osteoporosis, bone tumors
  • increased serum phosphorus bone tumors
    healing fractures
  • increased uric acid - gout
  • elevated antinuclear antibody level (ANA) SLE

11
Nursing Management nursing process
  • Prepare for tests with instructions
  • Answer any questions
  • Check any surgical sites for bleeding,
    inflammation, serous drainage
  • Pain assessment
  • If a new, traumatic injury keep client calm,
    application of cold, slings, etc
  • Explain all procedures prior to performing them
    as much as situation will allow
  • Client family teaching musculoskeletal care,
    66-1
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