Nur 105 Module i
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Transcript of Nur 105 Module i
MUSCULOSKELETAL SYSTEM
MODULE I
NURSING 105: ADULT NURSING
Myrna Williamson, MSN, RN, OCN
In the very young…
• The skeleton is composed of mostly cartilage and is therefore, pliable with a decreased incidence of bone fractures and breakage in childhood
Mature Bone
• Rigid connective tissue consisting of cells;– Collagen– Calcium– Phosphate
SKELETON
From Herlihy, B. & Maebius, N. (2000). The human body in health and illness. Philadelphia: W.B. Saunders.
SKELETON
• AXIAL PORTION– Cranium– Vertebrae– Ribs
• APPENDICULAR PORTION– Limbs– Shoulders – Hips
ANATOMY & PHYSIOLOGY REVIEW
• Structure & Function – Skeletal System
• Bone Formation, Maintenance, Healing
– Articular System• Joints – synarthrosis, amphiarthrosis, & diarthrosis
– Skeletal Muscle System• Contraction• Tone• Actions• Exercise, Disuse, & Repair
Bone Cells
Osteogenic CellsOsteoblastsOsteocytesOsteoclasts
Bone Formation & Maintenance
• Ossification• Resorption &
Formation– Local stress– Vit. D– Parathyroid hormone– Calcitonin– Blood supply
TYPES OF BONES
From Herlihy, B. & Maebius, N. (2000). The human body in health and illness. Philadelphia: W.B. Saunders.
SPONGY BONE
• Located in the ends of long bones and the center of flat and irregular bones
• Can withstand forces applied in many directions
DENSE (COMPACT) BONE
• Covers spongy bone
• Cylinder around a central marrow cavity
• Can withstand force predominantly in one direction
SPONGY BONE AND COMPACT BONE
From Herlihy, B. & Maebius, N. (2000). The human body in health and illness. Philadelphia: W.B. Saunders.
FUNCTIONS OF BONE
• Framework• Support• Movement• Shape• Maintain Position• Attachment of
Muscles
• Protects Organs• Storage• Hematopoiesis• Remodeling• Reformation• Movable Joints
CHARACTERISTICS OF JOINTS
• Allow the movement between bones
• Formed where two bones join
• Surfaces are covered with cartilage
• Enclosed in a capsule
Classification of Joints
• A-C; Synarthrotic (immovable) & amphiarthrotic (slightly movable) joints.
• D-E: Diarthrodial (freely movable) joints
Types of Diarthrodial Joints
• Hinge• Ball &
Socket• Pivot• Condyloid• Saddle• Gliding
SYNOVIAL JOINT
From Applegate E: The Anatomy and Physiology Learning System, ed. 2, Philadelphia, 2000, W.B. Saunders.
SYNOVIAL JOINT OF THE KNEE
From Herlihy, B. & Maebius, N. (2000). The human body in health and illness. Philadelphia: W.B. Saunders.
ANTERIOR VIEW OF MAJOR MUSCLES
From Herlihy, B. & Maebius, N. (2000). The human body in health and illness. Philadelphia: W.B. Saunders.
POSTERIOR VIEW OF MAJOR MUSCLES
From Herlihy, B. & Maebius, N. (2000). The human body in health and illness. Philadelphia: W.B. Saunders.
SKELETAL MUSCLE
From Herlihy, B. & Maebius, N. (2000). The human body in health and illness. Philadelphia: W.B. Saunders.
Neuromuscular Junction
CHARACTERISTICS OF MUSCLES
• Made up of bundles of muscle fibers
• Provide the force to move bones
• Assist in maintaining posture
• Assist with heat production
4 Steps of Muscle Contraction
• Excitation
• Coupling
• Contraction
• Relaxation
Body Movements
• Flexion• Extension• Abduction• Adduction• Rotation• Circumduction• Supination
• Pronation• Inversion• Eversion• Protraction• Retraction
Age Related Changes of Musculoskeletal System
• Bones• Muscles• Joints• Ligaments
Nursing Assessment
• Health History– Initial Interview
– Assessment Data• Pain• Altered Sensations
Nursing Assessment
• Physical Assessment– Posture– Gait– Bone Integrity– Joint Function– Muscle Strength & Size– Skin– Neurovascular Status
RISK FACTORS
• Autoimmune disorders
• Calcium deficiency
• Degenerative conditions
• Falls
• Hyperuricemia
• Infection
RISK FACTORS (Continued)
• Medications
• Metabolic disorders
• Neoplastic disorders
• Obesity
• Postmenopausal states
• Trauma and injury
Diagnostic Evaluation
• Imaging Procedures– X-ray– Computed Tomography
(CT)– Magnetic Resonance
Imaging (MRI)– Arthrography– Bone Densitometry
Diagnostic Evaluation
• Nuclear Studies– Bone Scan
• Endoscopic Studies– Arthroscopy
• Other Studies– Arthrocentesis– Electromyography– Biopsy
• Laboratory Studies– (CBC)– Urinalysis (Calcium)– Blood Chemistry– Serum Calcium– Serum Phosphate– Uric Acid– Serum Creatinine– LDH, SGOT, CPK
X-RAYS
• DESCRIPTION• IMPLEMENTATION
ARTHROCENTESIS
• DESCRIPTION• IMPLEMENTATION
ARTHROGRAM
• DESCRIPTION• IMPLEMENTATION
Arthrogram of the Knee
ARTHROSCOPY
• DESCRIPTION• IMPLEMENTATION
BONE SCAN
• DESCRIPTION• IMPLEMENTATION
BONE OR MUSCLE BIOPSY
• DESCRIPTION• IMPLEMENTATION
Muscle Biopsy Showing Polymyositis
ELECTROMYOGRAPHY (EMG)
From Mourad LA (1991) Orthopedic disorders. St. Louis: Mosby.
MYELOGRAM
From Herlihy B, Maebius NK: The human body in health and illness, Philadelphia, 2000, W.B. Saunders.
MUSCULOSKELETAL INJURIES
• Skeletal Trauma• Injuries to Support
Structures
Fractures
• Described according to location and type
Types of Fractures
• Complete or Incomplete
• Open (formerly referred to as compound)
• Closed (formerly referred to as simple)
Complete Fractures
• Linear
• Oblique
• Transverse
• Spiral
Complete Fractures
• Comminuted
• Impacted
• Pathologic
• Avulsion
Complete Fractures
• Compression
• Displaced
• Extracapsular
• Intracapsular
Incomplete Fractures
• Greenstick
• Torus
• Bowing fracture
• Transchondral fracture
• Stress Fractures
TYPES OF FRACTURES
From Ignativicius, D. & Workman, M. (2002). Medical-surgical nursing, ed 4, Philadelphia: W.B. Saunders.
Types of Fractures
Pathophysiology of a Fracture
• Tissue Disrupted• Bleeding Occurs • Hematoma Forms• Bone Tissue
Healing of a Fracture
• Inflammatory response
• Vascular tissue • Bone-forming cells• Callus formation• Osteoblasts • Remodeling
Speed of Healing
• Hematoma formation – within hours• Procallus – within days• Callus formation – within weeks• Replacement and remodeling – up
to 4 years
Fractures – Clinical Manifestations
• Impaired function• Deformity (unnatural
alignment)• Swelling• Muscle spasm• Tenderness• Pain• Impaired sensation
FRACTURE OF AN EXTREMITY
• ASSESSMENT• INITIAL CARE
INTERVENTIONS FOR A FRACTURE
• Reduction• Fixation• Traction• Casts
Fractures - Treatment
• Reduction– Closed manipulation– Traction (skin or skeletal)– Open reduction and internal fixation (ORIF),
(insertion of prosthesis, screw, plate, nail or wire).
CLOSED REDUCTION
From Black, J., Hawks, J., and Keene, A. (2001). Medical-surgical nursing, ed 6, Philadelphia: W.B. Saunders.
INTERNAL FIXATION
From Browner BB et al (1992) Skeletal trauma. Philadelphia: W.B. Saunders.
Types of Internal Fixation for a Hip Fracture
EXTERNAL FIXATION
From Ignatavicius, D., Workman, M. (2002). Medical-surgical nursing, ed 3, Philadelphia: W.B. Saunders. Courtesy of Smith and Nephew, Inc., Orthopedics Division, Memphis, TN.
TYPES OF HIP FRACTURES
• Intracapsular
• Extracapsular
HIP REPLACEMENTS
From Mosby’s Medical, Nursing, and Allied Health Dictionary, ed 6, (2002). St. Louis: Mosby. Courtesy of Zimmer, Inc., Warsaw, IN.
TOTAL HIP REPLACEMENT
From Beare PG, Myers JL (1998): Adult Health Nursing, ed. 3 St. Louis: Mosby.
HIP FRACTURE
• POSTOPERATIVE CARE
• CLIENT EDUCATION
TOTAL KNEE REPLACEMENT
• DESCRIPTION• POSTOPERATIVE
CARE
KNEE PROSTHESIS
From Black, J., Hawks, J., and Keene, A. (2001). Medical-surgical nursing, ed 6, Philadelphia: W.B. Saunders.
CONTINUOUS PASSIVE MOTION
CASTS
Cast Care
• Educate• Apply Ice• Instruct• Prevent• Attend
TRACTION
• DESCRIPTION• IMPLEMENTATION
SKELETAL TRACTION
• DESCRIPTION• IMPLEMENTATION
SKIN TRACTION
• DESCRIPTION– Traction applied by the
use of elastic bandages or adhesive
Side Arm
CERVICAL SKIN TRACTION
From James, S. Ashwill, R., & Droske, S. (2002). Nursing care of children, ed 2, Philadelphia: W.B. Saunders.
HEAD HALTER TRACTION
From Black JM, Matassarin-Jacobs E (1993) Luckman and Sorensen’s medical-surgical nursing: a psychophysiologic approach, 4th ed., Philadelphia: W.B. Saunders.
BUCK’S SKIN TRACTION
From Black JM, Matassarin-Jacobs E (1993) Luckman and Sorensen’s medical-surgical nursing: a psychophysiologic approach, 4th ed., Philadelphia: W.B. Saunders.
PELVIC SKIN TRACTION
From Black JM, Matassarin-Jacobs E (1993) Luckman and Sorensen’s medical-surgical nursing: a psychophysiologic approach, 4th ed., Philadelphia: W.B. Saunders.
BALANCED SUSPENSION
From Black JM, Matassarin-Jacobs E (1993) Luckman and Sorensen’s medical-surgical nursing: a psychophysiologic approach, 4th ed., Philadelphia: W.B. Saunders.
DUNLOP’S SKIN TRACTION
From Mosby’s Medical, Nursing, and Allied Health Dictionary, ed 6, (2002). St. Louis: Mosby.
COMPLICATIONS OF FRACTURES
• Fat embolism
• Compartment syndrome
• Infection and osteomyelitis
• Avascular necrosis
• Pulmonary emboli
• Venous thrombosis
• Delayed union & nonunion
FAT EMBOLISM• DESCRIPTION
• ASSESSMENT
• IMPLEMENTATION
COMPARTMENT SYNDROME
INFECTION AND OSTEOMYELITIS
• DESCRIPTION
• ASSESSMENT
• IMPLEMENTATION
AVASCULAR NECROSIS
• DESCRIPTION
• ASSESSMENT
• IMPLEMENTATION
PULMONARY EMBOLISM• DESCRIPTION
– Caused by immobility precipitated by a fracture
Venous Thrombosis
• Description
• Assessment
• Implementation
Delayed Union & Nonunion
• Description
• Assessment
• Implementation
Other Skeletal Trauma
• Dislocation• Subluxation• Injuries to Support Structures
– Tendon tear– Ligament tear– Strain– Sprain– Avulsion– Tendonitis– Bursitis
Soft Tissue Injury of Hip
CARPAL TUNNEL SYNDROME
Associated with occupations that require continuous wrist movement.
Sports-Related Injuries
• Rotator Cuff Tears
• Epicondylitis (Tennis Elbow)
• Lateral & Medial Collateral Ligament Injury
• Anterior & Posterior Cruciate Ligament Injury
• Meniscal Injuries
• Rupture of Achilles Tendon
CRUTCH WALKING
CRUTCH GAITS
From Mosby’s Medical, Nursing, and Allied Health Dictionary, ed 6, (2002). St. Louis: Mosby.
SINGLE- AND QUAD-FOOT CANES
From Beare PG, Myers JL (1998): Adult Health Nursing, ed. 3 St. Louis: Mosby.
WALKERS
HERNIATION: INTERVERTEBRAL DISC
CERVICAL DISC
CERVICAL COLLAR
LUMBAR DISC
• DESCRIPTION• IMPLEMENTATION
LOW BACK CARE
From Black, J., Hawks, J., and Keene, A. (2001). Medical-surgical nursing, ed 6, Philadelphia: W.B. Saunders.
TYPES OF DISC SURGERY
• CHEMOLYSIS• DISCECTOMY• DISCECTOMY WITH
FUSION• LAMINOTOMY• LAMINECTOMY
DISC SURGERY
• PREOPERATIVE
• POSTOPERATIVE: CERVICAL DISC
• POSTOPERATIVE: LUMBAR DISC
AMPUTATION OF A LOWER EXTREMITY
• DESCRIPTION– The surgical removal
of a lower limb or part of the limb
AMPUTATION FLAPS
From Beare PG, Myers JL (1998): Adult Health Nursing, ed. 3 St. Louis: Mosby.
AMPUTATION OF A LOWER EXTREMITY
• POSTOPERATIVE– Monitor vital signs– Monitor for infection and hemorrhage– Mark bleeding and drainage on the dressing if
it occurs– Keep a tourniquet at the bedside– Monitor for pulmonary emboli
STUMP WRAPPING
From Black, J., Hawks, J., and Keene, A. (2001). Medical-surgical nursing, ed 6, Philadelphia: W.B. Saunders.
BELOW-THE-KNEE AMPUTATION
• POSTOPERATIVE– Prevent edema– Do not allow the stump to hang over the edge
of the bed– Do not allow the client to sit for long periods of
time to prevent contractures
ABOVE-THE-KNEE AMPUTATION
• POSTOPERATIVE– Prevent internal or external rotation of the
limb– Place a sandbag or rolled towel along the
outside of the thigh to prevent rotation
DISORDERS OF BONE
• Metabolic Bones Diseases
• Infectious Bone Disease
• Bone Tumors
Infectious Bone Disease: Osteomyelitis
• Difficult to treat
• Physical disability
• Bacteria– Exogenous– Endogenous
OSTEOMYELITIS
• DESCRIPTION• ASSESSMENT • IMPLEMENTATION
Bone Tumors
• Incidence
• Signs & Symptoms
• Diagnosis
DISORDERS OF JOINTS
• Noninflammatory joint disease
• Inflammatory joint disease
INFLAMMATORY JOINT DISEASE
• Rheumatoid arthritis• Ankylosing
Spondylitis• Gouty arthritis
RHEUMATOID ARTHRITIS (RA)
• DESCRIPTION• ASSESSMENT
RHEUMATOID ARTHRITIS
From Lemmi FO, Lemmi CAE: Physical assessment findings CD-ROM, Philadelphia, 2000, W.B. Saunders.
MUSCLE ATROPHY
BOUTONNIERE DEFORMITY
SWAN NECK DEFORMITY
RHEUMATOID NODULE
From Lemmi FO, Lemmi CAE: Physical assessment findings CD-ROM, Philadelphia, 2000, W.B. Saunders.
RHEUMATOID ARTHRITIS (RA)
• NONSTEROIDAL ANTIINFLAMMATORY DRUGS (NSAIDs)
• CORTICOSTEROIDS• ANTINEOPLASTIC
MEDICATIONS• GOLD SALTS
RHEUMATOID ARTHRITIS (RA)
• PHYSICAL MOBILITY• SELF-CARE
RHEUMATOID ARTHRITIS (RA)
• FATIGUE• BODY IMAGE
DISTURBANCE
RHEUMATOID ARTHRITIS (RA) SURGICAL INTERVENTIONS
• SYNOVECTOMY• ARTHRODESIS• JOINT REPLACEMENT
(ARTHROPLASTY)
Ankylosing Spondylitis
• Chronic Inflammatory Disease
• Systemic autoimmune disease
• Differs from RA
• Signs & Symptoms
• Treatment
GOUTY JOINT • Description• Phases• Assessment• Implementation
GOUT
From Clinical Slide Collection of the Rheumatic Diseases, © 1991,1995,1997. Used with permission of the American College of Rheumatology.
Noninflammatory Joint Disease
• Degenerative joint disease (osteoarthritis) is the most common
OSTEOARTHRITIS
• DESCRIPTION– Also known as
degenerative joint disease (DJD)
JOINT CHANGES IN OSTEOARTHRITIS
OSTEOARTHRITIS
From Kamal A, Brockelhurst J: Color atlas of geriatric medicine, ed. 2, St. Louis, 1991, Mosby.
SEVERE OSTEOARTHRITIS
HEBERDEN’S NODES
BOUCHARD’S NODES
OSTEOARTHRITIS
• PHYSICAL MOBILITY
OSTEOARTHRITISSURGICAL INTERVENTIONS
• OSTEOTOMY• TOTAL JOINT
REPLACEMENT (TJR)
RHEUMATOID ARTHRITIS AND OSTEOARTHRITIS
CLIENT EDUCATION• Assist
• Instruct
• Review
Metabolic Bone Diseases
• Osteoporosis
• Osteomalacia
• Paget’s Disease
OSTEOPOROSIS
DOWAGER’S HUMP
OSTEOPOROTIC CHANGES
From Black, J., Hawks, J., and Keene, A. (2001). Medical-surgical nursing, ed 6, Philadelphia: W.B. Saunders.
SEVERE OSTEOPOROSIS
From Lemmi FO, Lemmi CAE: Physical assessment findings CD-ROM, Philadelphia, 2000, W.B. Saunders.
MILWAUKEE BRACE
From Mosby’s Medical, Nursing, and Allied Health Dictionary, ed 6, (2002). St. Louis: Mosby.
OSTEOMALACIA
• Metabolic disease
• Bone volume unchanged
• Osteomalacia – adults
• Rickets - children
Paget’s Disease
• Osteitis Deformans
• Increased metabolic activity
• Usually no TX
• Affects men and women equally
Nursing Diagnoses• Knowledge Deficit
• Impaired Physical Mobility
• Self-care Deficit
• Risk for Infection
• Impaired Skin Integrity
• Imbalanced Nutrition
• Acute/Chronic Pain
THE END OF MUSCULOSKELETAL