THE MUSCULOSKELETAL SYSTEM ANATOMY PHYSIOLOGY DISEASE PROCESS.
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Transcript of THE MUSCULOSKELETAL SYSTEM ANATOMY PHYSIOLOGY DISEASE PROCESS.
THE MUSCULOSKELETAL SYSTEM
ANATOMY
PHYSIOLOGY
DISEASE PROCESS
Anatomy
• Bones – 206 total– Long– Short– Irregular– Flat
Anatomy
• Joints – union of bones– Ligaments – bones to bones– Tendons – muscles to bones
• Types of joints– Synarthroses – no movement– Amphiarthroses – little movement– Diarthroses – free movement
Anatomy
• Muscles– Smooth– Striated– Cardiac
Physiology
• Children’s bones more porous, thus less susceptible to fx
• Bone length growth occurs at epiphyseal plate – – Cartilage cells replced by osteocytes
• One end of bone grows more actively than the other
Physiology
• Bone growth to the diameter occurs by deposition of osteocytes directly onto bone surface
• Bone growth regulated by growth hormone
• Bone growth stops when epiphyseal plates replaced by bone– This occurs earlier in girls than boys
Physiology
• Children may require prolonged immobilization due to fx, congenital deformity, diseases
• Complications may include anemia, fatigue
• Feelings of isolation, withdrawal can occur
Sprains & Strains
• Pathophysiology– Strain – stretching of muscle or tendon– Sprain – tearing with ligament involvement
• Treatment– RICE
• Nursing Implications
Fractures
• Pathophysiology – Simple– Compound– Comminuted– See p 571
• Types of traction– Skeletal traction– Skin traction– See p 571
• Immobilization– Bryant’s traction– Buck’s traction– Russell traction
• Volkmann’s ischemia• Compartment syndrome
• Nursing Implications– See p 572 & 574
Osteomyelitis
• Pathophysiology– Infection of bone– s. aureus & h.
influenzae most common
• S/S– Infants – fever &
limited movement of affected area
– Children – fever, pain, swelling, redness, tenderness
Osteomyelitis
• Treatment– Antibiotic– Bedrest– I&D
• Nursing implications– Support affected area– Reduce pain– Give antibiotics
Duchenne’s Muscular Dystrophy
• Pathophysiology –most common– Genetic– Occurs in boys only– Lack of dystrophin, a protein found in muscle
cells
Duchenne’s Muscular Dystrophy
• S/S– Frequently diagnosed between 2 & 6 years because
child is slow to develop– Clumsiness – Gower’s maneuver– Hypertrophy of calf muscles (to overcome weakness
of gluteal & lumbar muscles)– Mental impairment– Weakness progresses; child usually confined to w/c
by adolescence
Duchenne’s Muscular Dystrophy
• Treatment – No cure– Palliative
• Nursing implications– Instructions– Prevent complications
Legg-Calve-Perthes Disease
• Pathophysiology– Necrosis occurs of femoral head due to
interruption of blood supply– Eventually replaced with live bone– Cause is unknown
Legg-Calve-Perthes Disease
• S/S– Limping– Limited ROM– No pain
• Treatment– NSAIDs– Restricted activity– Brace – Bedrest– Good prognosis
Osteosarcoma
• Pathophysiology– Usually in long bone
near epiphyseal growth plate
– Lungs common met site
• S/S – Pain – Swelling
• Treatment – Chemotherapy– Surgery
Ewing’s Sarcoma
• Pathophysiology– Commonly in marrow of long bones– Mets to lungs & other bones
• S/S – Pain
• Treatment– Chemotherapy– Surgery
Juvenile Rheumatoid Arthritis
• Pathophysiology– An autoimmune disease– Usually attacks large joints
• Chronic inflammation of synovial membrane
• Involves connective tissue & viscera
– Three types• Systemic• Polyarticular• Pauciarticular
Juvenile Rheumatoid Arthritis
• Systemic– Fever – Rash– Abdominal pain– Eventual joint pain
• Polyarticular– > 5 joints– Usually small joints
• Pauciarticular – < 4 joints– Usually large joints– May develop
iridocyclitis
Juvenile Rheumatoid Arthritis
• Treatment– Supportive– Reduce pain– Promote optimal level
of independence and development
• Medications– NSAIDs– Immune suppressant
drugs– Methotrexate– Antirheumatic drugs
(sulfasalazine)
Juvenile Rheumatoid Arthritis
• Nursing Implicatioins– Instruct meds– Teach ROM– Adaptive devices such as velcro on shoes– Encourage parents to allow child to perform to
max potential
Torticollis
• Pathophysiology – Shortening of
sternocleidoomastoid muscle resulting in limited ROM
• S/S– Decreased ROM– Short neck– Asymmetry of head &
neck
Torticollis
• Treatment – exercises to stretch muscle
• Nursing implications – instruct parents about exercises
Curvature Of The Spine
• Pathophysiology– Kyphosis – humpback– Lordosis – swayback– Scoliosis – lateral curvature; most common
• Functional• Structural
Curvature Of The Spine
• Treatment– May require brace or surgery
• Harrington rod
– Braces must be worn 20-22 hrs a day• Milwaukee brace – p 582
Scoliosis Screening
• Look for asymmetry of:– Shoulders– Scapula– Arm to body– Hip
References
• Liefer, G. (2003). Introduction to maternity & pediatric nursing, (4th ed.). Saunders: Philadelphia.