2010 Spr Musculoskeletal System Ppt.
Transcript of 2010 Spr Musculoskeletal System Ppt.
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The Musculoskeletal System
Red Rocks Community College
RN Refresher Program
Anne Corbett, RN MSN
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Functions of Bones
Framework
Movement Protection
Storage
Manufacture bloodcells (marrow)
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Anatomy and Physiology 206 bones
Longweight-bearing (ex. Femur) Short..non-wt. bearing (ex. Phalanges)
Flat..protect organs (ex. Scapula)
Irregular(ex. Carpals)
Sesamoiddevelops within tendons (ex. Patella)
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Cortical vs Trabecular 20/80
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How to build a bone: Calcium one large helping
Collagen (22%)
Other ingredients / factors: Phosphorous
Calcitonin
Vitamin D (renal synthesis)
PTH parathyroid hormone
GH- growth hormone Glucocorticoids
Hormones
Thyroxine
Insulin
99% of bodyscalcium is in the
bones
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20% bone tissue replaced annually
Osteoblasts and Osteoclasts
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In the United States, 1 in every 3 adults65 years old or older falls each year,with hip fractures resulting in the greatestnumber of deaths and most serious health
problems.
Women account for 80% of the300,000 hip fractures that occurannually. Source: Harvard University Gazette
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Osteoporosis Calcium, Vit D deficiencies
Age Women > Men
Decreased sex hormones (menopause)
Smokers Small / thin frame
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Tx:
Calcium supplements
Medications Fosamax
Actonel (monthly)
Boniva
Reclast (annually)
Weight-bearing activities
Bone density testing
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Fracture RepairInjury (pg 1190)
48-72 hoursHematoma formation(Migration of fibroblasts, osteoblasts to site)
3-14 days Fibrocartilage formation
2-6 weeks.Callus formation
(non-bony union)
3 wks-6 months..Bone formation
(callus resorbed)
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Joints
Synarthrotic immovable
Amphiarthrotic slightly movable
Diarthrotic freely movable
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Joints Diarthrodic aka Synovial
most common
Ball and socket
Hinge
Condylar
Axial Pivot
Saddle
Gliding
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Components of a Joint Hyaline (articular) cartilage
Capsule lined with synovialmembrane
Synovial fluid
Bursae Meniscus
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DJDOsteoarthritis
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RA
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Arthroscopy and
Arthrocentesis Examination of joint
and synovial fluid
Normal: 1-3 mL
Cartilage tears
Cell count Uric acid crystals
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Hook em Up
TENDONS
Bone to Muscle
LIGAMENTS
Bone to Bone
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Knee Replacement (TKA)
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Hip Replacement
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Orthopedic fixative devices
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Ortho devices
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CPM Continuous Passive Motion
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Nursing considerations Pain control
Infection
Positioning
Ambulation
Labs to monitor? Diet ?
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Muscles Over 600
SmoothInvoluntary
Autonomic
Cardiac
Striated
Involuntary
Skeletal
Striated
Voluntary
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Smooth -Involuntary
in hollow structures (GI tract, bladder,uterus, blood vessels)
Modulated by neuronal and hormonalinfluences
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Skeletal Largest mass of tissue inthe body
Neuromuscular junction
Acetylcholine - ATP
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Movement(pg 1150)
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Musculoskeletal Issues Mechanical
Arthritis, RA Osteoporosis Deformities
Disease Processes: Osteomyelitis
Tumor, malignancies Gout Muscular dystrophy MS
Trauma Fractures Sprains, strains
Amputations
Other: Compartment syndrome Ganglion Bunion Scoliosis Plantar fasciitis O.I.
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Nursing considerations?
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Compartment Syndrome
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Fasciotomy
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Aging and the
Musculoskeletal system Decreased bone density
Increased bone
prominence Posture changes shift in
center of gravity
Cartilage degeneration
Muscle atrophy Slowed movement
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Assessing muscle strength 0 No detection of contraction
1 barely detectable trace of contraction
2 Active movement with elimination ofgravity
3 Active movement against gravity
4 Active movement against gravity and
some resistance 5 Active movement against full resistance
(normal muscle strength)
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Talking Points Rhabdomyolysis
Release of myoglobin into bloodstream
Risk for acute tubular necrosis
IV fluids, diuretics, low-dose Dopamine
Bicarb if acidotic
Desired urine output: 100-200 mL/hr
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Talking Points FES (Fat Embolism Syndrome)
Higher incidence in long bone fractures
Males ages 20-40
Geriatric population ages 70-80
Catecholamines >>> free fatty acids >>> plateletaggregation >>> globule formation>>>vesselocclusion
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Diagnostic Tests1. Radiologic studies (+ contrast)
2. Angiography
3. Bone/Gallium Scan
4. Computerized Tomography (+ contrast)
5. Magnetic Resonance Imaging (MRI)
6. Electromyography (EMG)
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Labwork CBC, Chem panel (pg. 1152)
Serum calcium
Phosphorous
Thyroid function
Lipase
ESR Uric acid
CK
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Alphabet soupAROM
PROMORIF
5 Ps
CPM
PT/OTAKA
BKA
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Nursing Considerations Assess Assess Assess!!!!!!
5 Ps
Treat pain
Monitor labwork
Anticipate complications (DVT, FES)
Nutrition issues Teaching re: lifestyle changes
Monitor depression, psychosocial issues
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Case Study 25 yo male, ski accident
To ER via ambulance
Dx:
R Femur fx
CHI
multiple R rib fxs
Admit to PCU via OR
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Before and AfterBefore and After
Nursing considerations?
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Nursing considerationsNursing considerations
Group 1Group 1
PACURNPACURN
Report fromReport fromOR?OR?
Assessment?Assessment?Focus?Focus?
ComplicationsComplications??
Group 2
Step-down RN
Report fromPACU?
Assessment?
Consults?
MD orders?
Group 3
Day 2 RN
Report fromRN?
Assessment?Focus?
D/Cplanning?
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Case Study #2 79 yo Female, fall at home
Dx:
L clavicle fxMultiple contusions
AMS
Afib
IDDM
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dmission course?
Nursing Dx?
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Nursing considerationsGroup 1
Tele RN
Report fromER?
Assessment?Focus?
POC?
Group 2
CNA
Duties?
Report to RN?
Considerationsfor
ADLs/hygiene?
Group 3
Case Mgr
Report fromMD,RN?
Info neededfrom family?
D/Cplanning?
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Got milk?