Musculoskeletal-System NLE Review
Musculoskeletal-System NLE Review
Musculoskeletal-System NLE Review
The musculo-skeletal system consists of the muscles, tendons, bones and cartilage together with the joints The primary function of which is to produce skeletal movements
2. Cardiac muscles
Involuntary and striated
3. Smooth/Visceral muscles
Involuntary and NON-striated
Strong, dense and flexible bands of fibrous tissue connecting bones to another bone
Variously classified according to shape, location and size Functions 1. Locomotion 2. Protection 3. Support and lever 4. Blood production 5. Mineral deposition
The part of the Skeleton where two or more bones are connected
A dense connective tissue that consists of fibers embedded in a strong gel-like substance
Sac containing fluid that are located around the joints to prevent friction
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
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
Gait Posture Muscular palpation Joint palpation Range of motion Muscle strength
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
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
LABORATORY 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
LABORATORY PROCEDURES 4. DXA- 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
PAIN 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
IMPAIRED 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
SELF-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
Traction
Cast
Traction A method of fracture immobilization by applying equipments to align bone fragments Used for immobilization, bone alignment and relief of muscle spasm
Skin traction
Skeletal traction
Pulling force exerted on bones to reduce or immobilize fractures, reduce muscle spasm, correct or prevent deformities
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
6. Observe for DVT, skin irritation and breakdown 7. Provide pin care for clients in skeletal traction- use of hydrogen peroxide
CAST Immobilizing tool made of plaster of Paris or fiberglass Provides immobilization of the fracture
Plaster of Paris
Drying takes 1-3 days If dry, it is SHINY, WHITE, hard and resistant
Fiberglass
Lightweight and dries in 20-30 minutes Water resistant
CAST: General Nursing Care 1. Allow the cast to dry (usually 24-72 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
CAST: 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
CAST: 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 management
Osteoporosis A disease of the bone characterized by a decrease in the bone mass and density with a change in bone structure
Osteoporosis: Pathophysiology Normal homeostatic bone turnover is altered rate of bone RESORPTION is greater than bone FORMATION reduction in total bone mass reduction in bone mineral density prone to FRACTURE
Osteoporosis: TYPES 1. Primary Osteoporosis- advanced age, post-menopausal 2. Secondary osteoporosis- Steroid overuse, Renal failure
RISK factors for the development of Osteoporosis 1. Sedentary lifestyle 2. Age 3. Diet- caffeine, alcohol, low Ca and Vit D 4. Post-menopausal 5. Genetics- caucasian and asian 6. Immobility
3. Bone pain
mean value
2. X-ray studies
Medical management of Osteoporosis 1. Diet therapy with calcium and Vitamin D 2. Hormone replacement therapy 3. Biphosphonates- Alendronate, risedronate produce increased bone mass by inhibiting the OSTEOCLAST 4. Moderate weight bearing exercises 5. Management of fractures
Osteoporosis Nursing Interventions 1. Promote understanding of osteoporosis and the treatment regimen Provide adequate dietary supplement of calcium and vitamin D Instruct to employ a regular program of moderate exercises and physical activity Manage the constipating side-effect of calcium supplements
Osteoporosis Nursing Interventions Take calcium supplements with meals Take alendronate with an EMPTY stomach with water Instruct on intake of Hormonal replacement
Osteoporosis Nursing Interventions 3. Improve bowel elimination Constipation is a problem of calcium supplements and immobility Advise intake of HIGH fiber diet and increased fluids
Osteoporosis Nursing Interventions 4. Prevent injury Instruct to use isometric exercise to strengthen the trunk muscles AVOID sudden jarring, bending and strenuous lifting Provide a safe environment
Definition:
AUTO-IMMUNE inflammatory joint disorder of UNKNOWN cause SYSTEMIC chronic disorder of connective tissue Diagnosed BEFORE age 16 years old
PATHOPHYSIOLOGY : unknown
Affected by stress, climate and genetics Common in girls 2-5 and 9-12 y.o.
Polyarticular
Morning joint stiffness and fever
IRIDOCYCLITIS
Symptoms may decrease as child enters adulthood With periods of remissions and exacerbations
Medical Management 1. ASPIRIN and NSAIDs- mainstay treatment 2. Slow-acting anti-rheumatic drugs 3. Corticosteroids
Nursing Management 1. Encourage normal performance of daily activities 2. Assist child in ROM exercises 3. Administer medications 4. Encourage social and emotional development
OSTEOARTHRITIS: Pathophysiology Injury, genetic, Previous joint damage, Obesity, Advanced age Stimulate the chondrocytes to release chemicals
chemicals will cause cartilage degeneration, reactive inflammation of the synovial lining and bone stiffening
OSTEOARTHRITIS: Risk factors 1. Increased age 2. Obesity 3. Repetitive use of joints with previous joint damage 4. Anatomical deformity 5. genetic susceptibility
1. Joint pain 2. Joint stiffness 3. Functional joint impairment limitation The joint involvement is ASYMMETRICAL This is not systemic, there is no FEVER, no severe swelling Atrophy of unused muscles Usual joint are the WEIGHT bearing joints
commonly occurs in the morning after awakening Lasts only for less than 30 minutes DECREASES with movement Crepitation may be elicited
OSTEOARTHRITIS: Diagnostic findings 1. X-ray Narrowing of joint space Loss of cartilage Osteophytes 2. Blood tests will show no evidence of systemic inflammation and are not useful
OSTEOARTHRITIS: Medical management 1. Weight reduction 2. Use of splinting devices to support joints 3. Occupational and physical therapy 4. Pharmacologic management
Use of PARACETAMOL, NSAIDS Use of Glucosamine and chondroitin Topical analgesics Intra-articular steroids to decrease inflam
be used in the early acute stage!!! Plan daily activities when pain is less severe Pain meds before exercising
A type of chronic systemic inflammatory arthritis and connective tissue disorder affecting more women (ages 35-45) than men
FACTORS: Genetic Auto-immune connective tissue disorders Fatigue, emotional stress, cold, infection
Pathophysiology
Immune reaction in the synovium attracts neutrophils releases enzymes breakdown of collagen irritates the synovial liningcausing synovial inflammation edema and pannus formation
and joint erosions and swelling
SYMMETRICAL, Bilateral 3. Warmth, erythema and lack of function 4. Fever, weight loss, anemia, fatigue
BILATERAL
Characteristically beginning in the hands, wrist and feet Joint STIFFNESS occurs early morning, lasts
MORE than 30 minutes, not relieved by movement, diminishes as the day progresses
ASSESSMENT FINDINGS Joints are swollen and warm Painful when moved Deformities are common in the hands and feet causing misalignment
3. Arthrocentesis shows synovial fluid that is cloudy, milky or dark yellow containing numerous WBC and inflammatory proteins
to reduce inflammation
2. Chemotherapy with methotrexate, antimalarials, gold therapy and steroid 3. For advanced cases- arthroplasty, synovectomy 4. Nutritional therapy
MEDICAL MANAGEMENT GOLD THERAPY: IM or Oral preparation Takes several months (3-6) before effects can be seen Can damage the kidney and causes bone marrow depression
USE splints to immobilize the affected extremity during acute stage of the disease and inflammation to REDUCE DEFORMITY
Administer prescribed medications Suggest application of COLD packs
during the acute phase of pain, then HEAT application as the inflammation subsides
Nursing MANAGEMENT 2. Decrease patient fatigue Schedule activity when pain is less severe Provide adequate periods of rests 3. Promote restorative sleep
Nursing Management 4. Increase patient mobility Advise proper posture and body mechanics Support joint in functional position Advise ACTIVE ROME
Nursing Management 5. Provide Diet therapy Patients experience anorexia, nausea and weight loss
Regular
diet with caloric restrictions because steroids may increase appetite Supplements of vitamins, iron and PROTEIN
Lie FLAT on a firm mattress Lie PRONE several times to prevent HIP FLEXION contracture Use one pillow under the head because of risk of dorsal kyphosis NO Pillow under the joints because this promotes flexion contractures
HOT
Cold
Use to RELIEVE joint stiffness, pain and muscle spasm After acute attack
A systemic disease caused by deposition of uric acid crystals in the joint and body tissues CAUSES: 1. Primary gout- disorder of Purine
metabolism
deposits in the skin that break open and reveal a gritty appearance
4. PODAGRA
ASSESSMENT FINDINGS 5. Fever, malaise 6. Body weakness and headache 7. Renal stones
DIAGNOSTIC TEST Elevated levels of uric acid in the blood Uric acid stones in the kidney
2. Colchicine
For acute attack
Avoid Organ meats, aged and processed foods STRICT dietary restriction is NOT necessary 2. Encourage an increased fluid intake (23L/day) to prevent stone formation
3. Instruct the patient to avoid alcohol 4. Provide alkaline ash diet to increase
urinary pH
Nursing Intervention 6. Position the affected extremity in mild flexion 7. Administer anti-gout medication and analgesics
A break in the continuity of the bone and is defined according to its type and extent
2. Incomplete fracture
The break occurs through only a part of the crosssection
2. Open fracture
The fracture that involves a break in the skin
2. Simple fracture
A fracture that involves break of bone into two parts or one
ASSESSMENT FINDINGS 1. Pain or tenderness over the involved area 2. Loss of function 3. Deformity 4. Shortening 5. Crepitus 6. Swelling and discoloration
ASSESSMENT FINDINGS 1. Pain Continuous and increases in severity Muscles spasm accompanies the fracture is a reaction of the body to immobilize the fractured bone
ASSESSMENT FINDINGS 2. Loss of function Abnormal movement and pain can result to this manifestation
ASSESSMENT FINDINGS 3. Deformity Displacement, angulations or rotation of the fragments Causes deformity
ASSESSMENT FINDINGS 4. Crepitus A grating sensation produced when the bone fragments rub each other
EMERGENCY MANAGEMENT OF FRACTURE 1. Immobilize any suspected fracture 2. Support the extremity above and below when moving the affected part from a vehicle 3. Suggested temporary splints- hard board, stick, rolled sheets 4. Apply sling if forearm fracture is suspected or the suspected fractured arm maybe bandaged to the chest
EMERGENCY MANAGEMENT OF FRACTURE 5. Open fracture is managed by covering a clean/sterile gauze to prevent contamination 6. DO NOT attempt to reduce the facture
MEDICAL MANAGEMENT 1. Reduction of fracture either open or closed, Immobilization and Restoration of function 2. Antibiotics, Muscle relaxants and Pain medications
General Nursing MANAGEMENT For CLOSED FRACTURE 1. Assist in reduction and immobilization 2. Administer pain medication and muscle relaxants 3. teach patient to care for the cast 4. Teach patient about potential complication of fracture and to report infection, poor alignment and continuous pain
General Nursing MANAGEMENT For OPEN FRACTURE 1. Prevent wound and bone infection Administer prescribed antibiotics Administer tetanus prophylaxis Assist in serial wound debridement 2. Elevate the extremity to prevent edema formation 3. Administer care of traction and cast
FRACTURE COMPLICATIONS Early 1. Shock 2. Fat embolism 3. Compartment syndrome 4. Infection 5. DVT
FRACTURE COMPLICATIONS Late 1. Delayed union 2. Avascular necrosis 3. Delayed reaction to fixation devices 4. Complex regional syndrome
FRACTURE COMPLICATIONS: Fat Embolism Occurs usually in fractures of the long bones Fat globules may move into the blood stream because the marrow pressure is greater than capillary pressure Fat globules occlude the small blood vessels of the lungs, brain kidneys and other organs
FRACTURE COMPLICATIONS: Fat Embolism Onset is rapid, within 24-72 hours ASSESSMENT FINDINGS
2. tachycardia 3. Chest pain 4. Crackles, wheezes and cough 5. Petechial rashes over the chest, axilla and hard palate
FRACTURE COMPLICATIONS: Fat Embolism Nursing Management 1. Support the respiratory function Respiratory failure is the most common cause of death Administer O2 in high concentration Prepare for possible intubation and ventilator support
FRACTURE COMPLICATIONS: Fat Embolism Nursing Management 2. Administer drugs Corticosteroids Dopamine Morphine
FRACTURE COMPLICATIONS: Fat Embolism Nursing Management 3. Institute preventive measures Immediate immobilization of fracture Minimal fracture manipulation Adequate support for fractured bone during turning and positioning Maintain adequate hydration and electrolyte balance
Early complication: Compartment syndrome A complication that develops when tissue perfusion in the muscles is less than required for tissue viability
Early complication: Compartment syndrome ASSESSMENT FINDINGS 1. Pain- Deep, throbbing and UNRELIEVED pain
by opiods
Pain is due to reduction in the size of the muscle compartment by tight cast Pain is due to increased mass in the compartment by edema, swelling or hemorrhage
Early complication: Compartment syndrome ASSESSMENT FINDINGS 2. Paresthesia- burning or tingling sensation 3. Numbness 4. Motor weakness 5. Pulselessness, impaired capillary refill time
Early complication: Compartment syndrome Medical and Nursing management 1. Assess frequently the neurovascular status of the casted extremity 2. Elevate the extremity above the level of
the heart
Excessive stretching of a muscle or tendon Nursing management 1. Immobilize affected part 2. Apply cold packs initially, then heat packs 3. Limit joint activity 4. Administer NSAIDs and muscle relaxants
Excessive stretching of the LIGAMENTS Nursing management 1. Immobilize extremity and advise rest 2. Apply cold packs initially then heat packs 3. Compression bandage may be applied to relieve edema 4. Assist in cast application 5. Administer NSAIDS