MS Nursing I Chapter 66

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M/S Nursing IChapter 66

• Introduction to the Musculoskeletal System

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A P Review

• Bones, 206 in body
• short bones, fingers toes
• long bones, femur
• flat bones, sternum
• irregular bones, vertebrae

• Cancellous or spongy bone found in the epiphyses
  or rounded, irregular ends of long bones
• Cortical or compact bone found in the diaphyses
  or long shafts of arm leg bones

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• Types of bone cells
• osteoblasts cells that build bone cells
• osteocytes mature bone cells
• osteoclasts involved in the destruction,
  resorption, remodeling of bone

• Periosteum a layer of tissue that covers the
  bones
• Red bone marrow found in the sternum, ileum,
  vertebrae, ribs make blood cells hgb
• Yellow bone marrow in long bone consisting
  mostly of fat connective tissue

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Muscles Joints

• Skeletal
• voluntary
• found in the arms, legs, etc
• Smooth
• involuntary
• found in the walls of the stomach, intestine,
  blood vessels, etc
• Cardiac
• involuntary
• found only in the heart

• Joints
• junction between 2 or more bones
• see table 66-2 for types of joints
• types of diarthrodial movements - box 66-1

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• Tendons cordlike structures that attach muscles
  to the periosteum of the bone
• origin, more fixed
• insertion, more movable

• Ligaments connect 2 adjacent freely movable bones
• provide stability alignment

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• Cartilage
• a type of connective tissue
• functions to reduce friction between articular
  surfaces, absorb shocks reduce stress on the
  joint surfaces
• examples elbow, knee

• Bursae
• a small sac filled with synovial fluid
• functions to reduce friction between a tendon
  bone bursitis

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Assessment

• History
• chronic problem
• new injury
• Physical exam table 66-3
• mobility
• inspection
• compare 2 sides
• strength
• ROM
• pulses

• Be gentle with assessment especially with recent
  injury
• pain assessment
• wounds?

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Testing

• Imaging procedures
• CT scans, MRI
• Arthrogram xray of joint MD aspirates
  synovial fluid sends to lab contrast medium
  injected xrays are taken client may hear
  clicking or crackling noises in joint for up to 2
  days
• Arthroscopy internal inspection of a joint
  Nursing Guidelines 66-1
• Arthrocentesis aspiration of synovial fluid for
  s/s of traumatic arthritis, septic arthritis,
  gout, rheumatic fever, or SLE

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• Synovial fluid analysis sent to lab to assess
  for traumatic or septic arthritis gout
  rheumatic, SLE
• Bone density radiography of the wrist, hip or
  spine to determine bone mineral density
• Bone scans involves the IV injection of
  radioactive substance to assess for metastatic
  bone cancer or fractures
• Biopsy
• needle
• surgical excision

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BLOOD TESTS

• CBC infection, inflammation or anemia
• increased Alk phos bone tumors, healing
  fractures
• increased acid phos Pagets dz and metastatic
  cancer
• decreased serum calcium osteomalacia,
  osteoporosis, bone tumors
• increased serum phosphorus bone tumors
  healing fractures
• increased uric acid - gout
• elevated antinuclear antibody level (ANA) SLE

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Nursing Management nursing process

• Prepare for tests with instructions
• Answer any questions
• Check any surgical sites for bleeding,
  inflammation, serous drainage
• Pain assessment
• If a new, traumatic injury keep client calm,
  application of cold, slings, etc
• Explain all procedures prior to performing them
  as much as situation will allow
• Client family teaching musculoskeletal care,
  66-1