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The Musculoskeletal System

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Title: Few4y efewfwfny Author: Administrator Last modified by: Ruth Weiscarger Created Date: 4/11/2001 2:52:55 AM Document presentation format: On-screen Show (4:3) – PowerPoint PPT presentation

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Title: The Musculoskeletal System


1
Chapter 32
  • The Musculoskeletal System

2
Overview
  • Structure and functions of bones
  • Structure and functions of muscles
  • Age-related changes

3
Musculoskeletal system
  • The musculoskeletal systems consists of the
    bones, cartilage, ligaments, tendons, and
    muscles.
  • There are two distinct groups of bones cells that
    are transformed into mature cells.
  • These cells form Cartilage

4
Major Bones of the Human Skeleton
5
Skeleton and bones
  • There are 206 bones that make up the Human
    Skeleton
  • Bone is either compact or spongy
  • Spongy bone is made up of red bone marrow.
  • Bones are classified as long, short, flat or
    irregular
  • Each bone has markings on it that make it unique
    See Table 32-1 Bone Markings
  • The haversian system is a canal system that runs
    through the bone and contains the blood and lymph
    vessels

6
General Features of Long Bones
7
Functions of the Skeleton and bones
  • Bones provide shape to the body
  • Provides a ridged framework that supports and
    protects the internal organs of the body
  • Provides attachments for the tendons and
    ligaments and contribute to the movement of the
    body
  • The red bone marrow in the spongy bones forms red
    blood cells, white blood cells, and platelets.
  • Store and release minerals such as calcium and
    phosphorous

8
Musculoskeletal system
  • Joint Articulation point between two or more
    bones of the skeleton
  • Immovable EX The skull
  • Slightly moveable EX Vertebrae
  • And freely moveable EX Knee, elbow
  • Ligaments Join the bones of a joint together
  • Tendons Connective tissues that provide joint
    movement

9
Musculoskeletal System
  • Cartilage Connective tissue in which fibers and
    cells are embedded in a semisolid gel material.
    Serves as a cushion
  • Example is the meniscus in the knee
  • Bursa Fluid filled sac that provides
    cushioning at friction points in a freely
    moveable joint .
  • Skeletal muscle is made up of hundreds of muscle
    fibers bundled together surrounded by connective
    tissue.

10
Musculoskeletal System
  • Fascia is connective tissue that surrounds and
    separates the muscles
  • The muscle coverings contain blood vessels and
    and nerves
  • Muscles have properties that allow it to be
    electrically excites causing it to contract,
    extend or stretch, and provide elasticity.

11
Functions of the Muscles
  • Contraction of the skeletal muscle produces
    synchronized contraction of many muscle fibers
  • Skeletal muscles contract, thereby producing
    movement and joint stability, maintaining
    posture, and producing body heat.
  • Muscles provide movement of the joints

12
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13
Aging and the musculoskeletal system
  • Ossification occurs which is the replacement of
    cartilage by more boney tissue
  • Bone density decreases because of resorption of
    minerals
  • The loss of bone mass or osteoporosis, more
    common in women
  • Bone injury or fracture takes longer to heal
  • Bones in the elderly are more brittle and break
    easily
  • Thinning of the intervertebral cartilage causes a
    collapse of the vertebrae creating a kyphosis
    (hump)

14
Aging of musculoskeletal system
  • Joint cartilage thins and erodes resulting in
    stiffness and grating of the joints
  • Joint motion may decrease, causing limited
    mobility and swelling
  • Los of muscle mass and less strength
  • Muscle cramping especially at night increase due
    to impaired circulation

15
Prevention
  • Safety Measures
  • Using proper body mechanics when moving or
    lifting objects. (large muscle groups)
  • Using seat belts when riding in cars
  • If riding bicycles or motorcycles use helmets
  • Calcium and Vitamin D throughout life span

16
Causes of Musculoskeletal Disorders
  • Disease, trauma, malnutrition, and aging all
    contribute to musculoskeletal problems
  • Trauma may cause bruising, strain, sprain, or
    fracture
  • Poor nutrition may deprive the body of sufficient
    nutrients such as calcium and phosphorous to
    build strong bones
  • Inadequate protein can cause muscle wasting
  • Malignant tumors can invade bone either as a
    primary cancer or a metastatic disease
  • Decreased Estrogen after menopause can lead to
    osteoporosis

17
Prevention
  • Preservation of motion and mobility are important
    to prevent long term orthopedic problems
  • Weight-training and exercise throughout life to
    maintain bone mass and contribute to increase
    muscle strength, improved coordination and
    balance all decrease incidence of falls
  • Nutrition for bone growth and density
  • No Smoking contributes to musculoskeletal health

18
Diagnostic Tests and Procedures
  • Diagnostic Tests evaluate for Autoimmune
    disorders
  • Blood counts
  • Blood Culture
  • Erythrocyte sedimentation rate (ESR)
  • Serum protein electrophoresis
  • See charts 32-2 pgs 740-741

19
Diagnostic Blood Tests
  • Needed for bone formation
  • Needed for bone formation
  • Useful in determining if primary or metastatic
    cancer present
  • Used to test for skeletal muscle trauma or disease
  • Calcium
  • Phosphorous
  • AlP (Alkaline phosphotase)
  • CPK

20
Diagnostic lab tests
  • Used to detect gout
  • To detect antibodies, indicating rheumatoid
    arthritis, lupus or scleroderma
  • Useful to diagnosis rheumatoid arthritis, lupus,
    and other connective tissue disorders
  • Uric Acid
  • Rheumatoid Factor
  • ANA (Anti nuclear Antibody)

21
Diagnostic Tests and Procedures (cont.)
  • Imaging and use of contrasts to diagnose
    musculoskeletal disorders
  • MRI
  • CAT scan
  • X-rays of joints or bones
  • Goniometry and range of motion

22
Diagnostic tests
  • DEXA Scan
  • Bone Scan
  • Gallium/Thallium Scan
  • Arthrogram
  • Measures bone density
  • To detect bone injury/tumor
  • To detect bone problems especially tumor
  • Provides pictures of the joint cavity and soft
    tissue structures

23
Diagnostic Studies
  • Arthroscopy
  • Arthrocentesis
  • To inspect the interior aspect of a joint,
    usually knee with a fiberoptic scope to diagnoses
    problems with the meniscus, or arthritis
  • To extract synovial fluid for analysis or to
    reduce swelling

24
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25
Diagnostic procedures
  • Arthrocentesis

26
Measurement of Joint Motion with a Goniometer
  • The measurement of a joint. Each joint is
    evaluated in terms of degrees it can be moved
    from the 0 degrees position

27
Nursing Care post Procedure
  • Nursing Care post arthroscopy/ Arthrocentesis
  • Observe for signs of bleeding or swelling ice
    packs may be used post procedure
  • Assess for swelling, circulation, sensation,
    pulses, and color of extremity.
  • Apply ice packs post procedure
  • Wrap with elastic bandage if ordered
  • Instruct patient not to overuse joint until pain
    and selling decrease
  • Analgesics as ordered.

28
Diagnostic procedures
  • Bone marrow biopsy

29
Diagnostic Studies
  • Biopsy
  • EMG
  • Done to detect tumor cells. Muscle biopsy may be
    done to diagnose several muscles disorders
  • To determine abnormal nerve transmission to the
    muscle and abnormal muscle function.

30
Assessment (Data Collection)
  • Family history may be significant for
    musculoskeletal problems osteoporosis, rheumatoid
    arthritis
  • Assess pain. What makes it worse precipitating
    factors
  • Pain in wrists, knees, hips or feet?
  • Note problems of movement and changes in facial
    expression related to activities of daily living
  • Family members and patients ability to perform
    the activities of daily living

31
Data collection assessment
  • History Taking/Nursing Assessment
  • When reviewing the patient history the nurse
    needs to keep in mind the significance of
    disorders that affect other systems but
    secondarily affect bones and muscles.
  • Example psoriasis is sometimes the first sign
    of psoriatic arthritis.
  • Nutritional deficiencies can affect the
    nutritional composition of bone and muscle
  • Example Osteoporosis (Risk for falls/fracture.

32
Assessment data collection
  • Has the patient experienced any sensory changes?
    Sensation in feet, hands or elsewhere?
  • Any trouble sleeping because of muscle or joint
    pain?
  • Any restriction in movement?
  • Does the patient have any joint deformity?
    Example Bunion, Hammertoe, Swan neck deformity
  • Any previous injury to the bone?
  • Have any problems with ADLs

33
Physical Assessment of the Musculoskeletal System
  • Posture, gait, and balance
  • Mobility, range of motion, and strength
  • Spine
  • Appearance of joints
  • Skeletal muscle appearance in arms and legs
  • Ability to perform activities of daily living
  • Elder considerations

34
Examples of joint Deformities
35
Joint Deformities
  • HAMMERTOE

36
Joint Deformites
  • Rheumatoid Arthritis Swan Neck Deformity

37
Lifting and Turning the Patient
  • All movements need to be
  • gentle and firm movements
  • Sufficient help and adequately trained personnel
  • If the patient can help without damaging the
    diseased joint or limb, he should be
  • to do so
  • If the patient is not able to help, explain the
    procedure to him and instruct him to relax
    completely during the procedure

38
Interventions to Prevent Disability
  • Within a few days, the structures of immobilized
    muscles and joints begin to undergo changes
  • The forming of contractures, loss of muscle tone,
    and the fixation of joints can be prevented in
    most cases by consistent nursing intervention
  • The major components of this intervention
  • Gradual mobilization
  • Exercise program
  • Proper positioning
  • Patient and family teaching
  • Initiate and maintain measures to prevent
    complications

39
Preventing contractures
  • The major components of this intervention
  • Gradual mobilization
  • Exercise program
  • Proper positioning
  • Instruction of the patient and family

40
Interventions to Prevent Disability (cont.)
  • Preventing contractures When muscles are not
    regularly stretched and contracted they attempt
    to adapted them selves and become shorter
  • Adaptive shortening Can begin in 3 7 days
    after immobilization of a body part.
  • Most common footdrop, knee and hip flexion
    contractures, wrist drop, and contractures of
    the fingers and arms
  • Loss of muscle tone
  • ROM exercises important in preventing this and
    must begin as soon as possible .

41
Interventions to Prevent Disability (cont.)
  • Prevent ankylosis Result of injury the tissues
    of the joint are replaced by a bony overgrowth
    that completely obliterates the joint Proper
    positioning and movement of the joint can help
    prevent this
  • Gradual mobilization
  • Nursing responsibility Recognize patients who
    are at risk for falls while they are learning to
    regain their mobility
  • Set goals for progressive mobilization. Must take
    into account the pathological condition or cause
    for immobilization

42
Nursing Care/planning
  • Caring for immobile patients requires careful
    planning.
  • Making beds for the bed confined orthopedic
    patient is best done by two people.
  • Bathing and grooming are more time consuming when
    a patient has an immobilized limb, or a
    immobilizing device
  • Planning for toileting at regular Intervals for
    the patient who cant get out of bed by self.
  • Repositioning the patient is important q 2 hours
    and for comfort.

43
Preventing Contractures
  • ROM exercises 3-4 times a day
  • Physical/Occupational Therapy needs to be
    involved as soon as possible for evaluation and
    treat.
  • Patients experiencing intense pain need to be
    assess and proper analgesics and anti
    inflammatory drugs administered before their
    exercises. 30-60 minutes before
  • CPM Post joint surgery. This machine provides
    passive motion of the joint

44
Interventions to Prevent Disability (cont.)
45
Intervention to Prevent Diablity
  • CPM machine passive exercise

46
Interventions to Prevent Disability (cont.)
  • Exercise and ROM exercises
  • Isometric exercises
  • Administration of analgesic and anti-inflammatory
    drugs
  • Continuous passive motion
  • Positioning and special beds
  • Foot drop (Footboard may be appropriate) for
    flaccid paralysis
  • Foot Cradle may be appropriate for patients with
    specific paralysis (Relieves the pressure of bed
    sheets and blankets)

47
Prevention Devices
  • Foot Board and Bed Cradle

48
Interventions to Prevent Disability (cont.)
  • Speciality Beds Use Often use for patient in
    cervical traction Beds turn the patient 300 times
    a day. Allows access to all areas of te body.
  • Use of slings and splints
  • Teaching ambulation with assistive devices
  • Crutch safety see page 730-731
  • Special maneuvers on crutches
  • Psychosocial care

49
FluidAir Bed
50
PSYCHOSOCIAL cARE
  • Psychosocial Care
  • Many orthopedic conditions require prolonged
    periods of confinement to bed, immobilization,
    and restricted physical activity
  • This can lead to frustration and depression due
    to the dependence on others for care.

51
Wrist Splint
52
Sling Support device
53
Evaluation
  • Determine effectiveness of interventions
  • Be alert to nuances of body language
  • Observe patients ability to accomplish ADLs
  • Check x-rays and laboratory tests
  • Collaborate among all health professionals
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