Overview Of Anatomy & Physiology Of Musculoskeletal System
· Consist of bones, muscles, joints, cartilages, tendons, ligaments, bursae
· To provide a structural framework for the body
· To provide a means for movement
Bones
· Function of Bones
· Provide support to skeletal framework
· Assist in movement by acting as levers for muscles
· Protect vital organ & soft tissue
· Manufacture RBC in the red bone marrow (hematopoiesis)
· Provide site for storage of calcium & phosphorus
1. Types of Bones
· Long Bones
· Central shaft (diaphysis) made of compact bone & two end (epiphyses) composed of cancellous bones (ex. Femur & humerus)
· Short Bones
· Cancellous bones covered by thin layer of compact bone (ex. Carpals & tarsals)
· Flat Bones
· Two layers of compact bone separated by a layer of cancellous bone (ex. Skull & ribs)
· Irregular Bones
· Sizes and shapes vary (ex. Vertebrae & mandible)
Joints
· Articulation of bones occurs at joints
· Movable joints provide stabilization and permit a variety of movements
Classification
1. Synarthroses: immovable joints
2. Amphiarthroses: partially movable joints
3. Diarthroses (synovial): freely movable joints
· Have a joint cavity (synovial cavity) between the articulating bone surfaces
· Articular cartilage covers the ends of the bones
· A fibrous capsule encloses the joint
· Capsule is lined with synovial membrane that secretes synovial fluid to lubricate the joint and reduce friction.
Muscles
· Functions of Muscles
· Provide shape to the body
· Protect the bones
· Maintain posture
· Cause movement of body parts by contraction
· Types of Muscles
· Cardiac: involuntary; found only in heart
· Smooth: involuntary; found in walls of hollow structures (e.g. intestines)
· Striated (skeletal): voluntary
1. Characteristics of skeletal muscles
· Muscles are attached to the skeleton at the point of origin and to bones at the point of insertion.
· Have properties of contraction and extension, as well as elasticity, to permit isotonic (shortening and thickening of the muscle) and isometric (increased muscle tension) movement.
· Contraction is innervated by nerve stimulation.
Cartilage
· A form of connective tissue
· Major functions are to cushion bony prominences and offer protection where resiliency is required
Tendons and Ligaments
· Composed of dense, fibrous connective tissue
· Functions
1. Ligaments attach bone to bone
2. Tendons attach muscle to bone
The nurse usually evaluates this small part of the over-all assessment and concentrates on the patient’s posture, body symmetry, gait and muscle and joint function
1. HISTORY
2. Physical Examination
F Perform a head to toe assessment
F Nurses need to inspect and palpate
F The special procedure is the assessment of joint and muscle movement
F Usually, a tape measure and a protractor are the only instruments
3. Gait
4. Posture
5. Muscular palpation
6. Joint palpation
7. Range of motion
8. Muscle strength
LABORATORY PROCEDURES
1. BONE MARROW ASPIRATION
G Usually involves aspiration of the marrow to diagnose diseases like leukemia, aplastic anemia
G Usual site is the sternum and iliac crest
G Pre-test: Consent
G Intratest: Needle puncture may be painful
G Post-test: maintain pressure dressing and watch out for bleeding
2. Arthroscopy
µ A direct visualization of the joint cavity
µ Pre-test: consent, explanation of procedure, NPO
µ Intra-test: Sedative, Anesthesia, incision will be made
µ Post-test: maintain dressing, ambulation as soon as awake, mild soreness of joint for 2 days, joint rest for a few days, ice application to relieve discomfort
3. BONE SCAN
R Imaging study with the use of a contrast radioactive material
R Pre-test: Painless procedure, IV radioisotope is used, no special preparation,pregnancy is contraindicated
R Intra-test: IV injection, Waiting period of 2 hours before X-ray, Fluids allowed, Supine position for scanning
R Post-test: Increase fluid intake to flush out radioactive material
4. DXA- Dual-energy XRAY absorptiometry
I Assesses bone density to diagnose osteoporosis
I Uses LOW dose radiation to measure bone density
I Painless procedure, non-invasive, no special preparation
I Advise to remove jewelry
Musculoskeletal Modalities
® Traction
® Cast
Nursing Management
Traction
-A method of fracture immobilization by applying equipments to align bone fragments
S -Used for immobilization, bone alignment and relief of muscle spasm
S Traction
S Skin traction
S Skeletal traction
S Traction
S Pulling force exerted on bones to reduce or immobilize fractures, reduce muscle spasm, correct or prevent deformities
Traction: General principles
1. ALWAYS ensure that the weights hang freely and do not touch the floor
2. NEVER remove the weights
3. Maintain proper body alignment
4. Ensure that the pulleys and ropes are properly functioning and fastened by tying square knot
5. Observe and prevent foot drop
Provide foot plate
6. Observe for DVT, skin irritation and breakdown
7. Provide pin care for clients in skeletal traction- use of hydrogen peroxide
CAST
-Immobilizing tool made of plaster of Paris or fiberglass
-Provides immobilization of the fracture
CAST: types
1. Long arm
2. Short arm
3. Spica
Casting Materials
® Plaster of Paris
® Drying takes 1-3 days
® If dry, it is SHINY, WHITE, hard and resistant
® Fiberglass
® Lightweight and dries in 20-30 minutes
® Water resistant
Nursing Management
1. Allow the cast to dry (usually 24-72 hours)
2. Handle a wet cast with the PALMS not the fingertips
3. Keep the casted extremity ELEVATED using a pillow
4. Turn the extremity for equal drying. DO NOT USE DRYER for plaster cast
5. Petal the edges of the cast to prevent crumbling of the edges
6. Examine the skin for pressure areas and Regularly check the pulses and skin
7. Instruct the patient not to place sticks or small objects inside the cast
8. Monitor for the following: pain, swelling, discoloration, coolness, tingling or lack of sensation and diminished pulses
Medical Management
1. Drug therapy
a. Aspirin: mainstay of treatment: has both analgesic and anti-inflammatory effect.
b. Nonsteroidal anti-inflammatory drugs (NSAIDs): relieve pain and inflammation by inhibiting the synthesis of prostaglandins.
· Ibuprofen (Motrin)
· Indomethacin (Indocin)
· Fenoprofen (Nalfon)
· Mefenamic acid (Ponstel)
· Phenylbutazone (Butazolidin)
· Piroxicam (Feldene)
· Naproxen (Naprosyn)
· Sulindac (Clinoril)
c. Gold compounds (Chrysotherapy)
· Injectable form: given IM once a week; take 3-6 months to become effective
· Sodium thiomalate (Myochrysine)
· Aurothioglucose (Solganal)
· SI: monitor blood studies & urinalysis frequently
· Proteinuria
· Mouth ulcers
· Skin rash
· Aplastic anemia.
· Oral form: smaller doses are effective; take 3-6 months to become effective
· Auranofin (Ridaura)
· SI: blood & urine studies should be monitored.
· Diarrhea
d. Corticosteroids
· Intra-articular injections: temporarily suppress inflammation in specific joints.
· Systemic administration: used only when client does not respond to less potent anti-inflammatory drugs.
e. Methotrexate: given to suppress immune response
· Cytoxan
· SI: bone marrow suppression.
2. Physical therapy: to minimize joint deformities.
3. Surgery: to remove severely damaged joints (e.g. total hip replacement; knee replacement).
Nursing Interventions
1. Assess joints for pain, swelling, tenderness & limitation of motion.
2. Promote maintenance of joint mobility and muscle strength.
a. Perform ROM exercises several times a day: use of heat prior to exercise may decrease discomfort; stop exercise at the point of pain.
b. Use isometric or other exercise to strengthen muscles.
3. Change position frequently: alternate sitting, standing & lying.
4. Promote comfort & relief / control of pain.
a. Ensure balance between activity & rest.
b. Provide 1-2 scheduled rest periods throughout day.
c. Rest & support inflamed joints: if splints used: remove 1-2 times/day for gentle ROM exercises.
5. Ensure bed rest if ordered for acute exacerbations.
a. Provide firm mattress.
b. Maintain proper body alignment.
c. Have client lie prone for ½ hour twice a day.
d. Avoid pillows under knees.
e. Keep joints mainly in extension, not flexion.
f. Prevent complications of immobility.
6. Provide heat treatments: warm bath, shower or whirlpool; warm, moist compresses; paraffin dips as ordered.
a. May be more effective in chronic pain.
b. Reduce stiffness, pain & muscle spasm.
7. Provide cold treatments as ordered: most effective during acute episodes.
8. Provide psychologic support and encourage client to express feelings.
9. Assists clients in setting realistic goals; focus on client strengths.
10. Provide client teaching & discharge planning & concerning.
a. Use of prescribed medications & side effects
b. Self-help devices to assist in ADL and to increase independence
c. Importance of maintaining a balance between activity & rest
d. Energy conservation methods
e. Performance of ROM, isometric & prescribed exercises
f. Maintenance of well-balanced diet
g. Application of resting splints as ordered
h. Avoidance of undue physical or emotional stress
i. Importance of follow-up care
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