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Chapter 32

Chapter 32. The Musculoskeletal System. Theory Objectives. Recall the normal anatomy of the musculoskeletal system. Describe how the musculoskeletal system provides the function of motion. Explain how the musculoskeletal system provides protection for the body.

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Chapter 32

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  1. Chapter 32 The Musculoskeletal System

  2. Theory Objectives • Recall the normal anatomy of the musculoskeletal system. • Describe how the musculoskeletal system provides the function of motion. • Explain how the musculoskeletal system provides protection for the body. • Describe the steps included in a nursing assessment of the musculoskeletal system.

  3. Theory Objectives (cont.) • Teach a patient about the following diagnostic tests: bone scan, arthroscopy, electromyography. • List ways in which the elderly can increase musculoskeletal strength and protect bones.

  4. Clinical Practice Objectives • Gather positioning aids and place them correctly for the patient who has sustained trauma to the left knee. • Institute measures to reduce the chance of contracture for patients with musculoskeletal injuries. • Assist patients with musculoskeletal injuries with active or passive range of motion.

  5. Clinical Practice Objectives (cont.) • Provide care for a patient who has undergone an arthroscopy. • Teach a patient to properly use crutches. • Teach an elderly patient with a mobility problem about ways to prevent a fall at home.

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

  7. Major Bones of the Human Skeleton

  8. General Features of Long Bones

  9. Causes of Musculoskeletal Disorders • Trauma and bruising, strain, sprain, or fracture • Poor nutrition and weak bones • Inadequate protein and muscle wasting • Malignant tumors • Estrogen and osteoporosis

  10. Prevention • Weight-training • Safety measures • Nutrition for bone growth and density • Smoking and musculoskeletal health

  11. Diagnostic Tests and Procedures • Blood counts • Blood cultures • Immune tests • Erythrocyte sedimentation rate (ESR) • Serum protein electrophoresis

  12. Diagnostic Tests and Procedures (cont.) • Serum complement and immunoglobulins • Imaging and use of contrasts • Nursing management • Goniometry and range of motion

  13. Measurement of Joint Motion with a Goniometer

  14. Assessment (Data Collection) • Note problems of movement and changes in facial expression related to activities of daily living • Precipitating events • Family members’ and patient’s ability to perform the activities of daily living

  15. 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

  16. Lifting and Turning the Patient • 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 encouraged 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

  17. Interventions to Prevent Disability • Gradual mobilization • Exercise program • Proper positioning • Patient and family teaching • Nursing responsibility • Initiate and maintain measures to prevent complications

  18. Interventions to Prevent Disability (cont.) • Prevent contractures • “Adaptive shortening” • Most common: “footdrop,” knee and hip flexion contractures, “wrist drop,” and contractures of the fingers and arms • Loss of muscle tone

  19. Interventions to Prevent Disability (cont.)

  20. Interventions to Prevent Disability (cont.) • Prevent ankylosis • 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

  21. 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

  22. Interventions to Prevent Disability (cont.) • Use of slings and splints • Teaching ambulation with assistive devices • Crutch safety • Special maneuvers on crutches • Psychosocial care

  23. Continuous Passive Motion Machine

  24. FluidAir Bed

  25. Wrist Splint

  26. Evaluation • Determine effectiveness of interventions • Be alert to nuances of body language • Observe patient’s ability to accomplish ADLs • Check x-rays and laboratory tests • Collaborate among all health professionals

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