MUSCULOSKELETAL

SYSTEM
Musculoskeletal Structure and Function

• Made up of:
–Skeleton
–Skeletal muscles
–Tendons and ligaments
SKELETON
• Consists of 206 bones
• Supports muscles
• Protect internal organs
• Part of the immune system
• Store minerals
• Aids in erythropoiesis
A. Role of Bone Marrow in Immune System
B. ERYTHROPOEISIS

Penal
Erythropoeitiu Factor I. Penal %
1.
Bone Mwrowlplastinuvs ) II.
t
Aplastic
Erythroblasts # "wtilionai

I. ÷¥%p;!;↳)
folic Avid FADA

RBC Bloodless
.a m/1Im orph1qi c
-

"
hYy¥g
-
C. Calcium Regulation and Transport

Dairy
Calcium / Inactive is
vegetables
-

Vitamin D ✓ bony foods = Hydroxyl

/ UIR

Active
Parathyroid Hormone
Li
PIG
Thyrocalcitonin
-

↳
Thyroid
gland
Calcium Regulation and Transport

1- Anionized Calcium
2. Ionized

Vil:D PTH
?
Thyrocakitonin
1. Matrix formation -

Lactose

g. Mineralization -
pancreatic
enzymes
 1. Estrogen
1.
t Thyrocakilonin
I
p PTH
 SKELETAL MUSCLES

• Provide body movement and

posture by contracting and relaxing.
 LIGAMENTS AND TENDONS
• Are tough bands of collagen fibers.
• Ligaments sprain
-

– connect bones to bones

– encircle joints to add strength and
stability
• Tendons connect muscles to bones
=

↳ STRAIN
I
 JOINTS
• Formed by articulation of two bone
surfaces.
• Provide stabilization and permit
locomotion.
• The degree of its movement is called range
of motion (ROM)
A

¥¥FmiH
Skeletal Disorders
• A generalized, progressive
metabolic disorder
• Loss of bone density
• Causes osteomalacia
"
"
malaise
Normal Osteoporosis
Types:

• Primary: Postmenopausal women

tvit D .

1. Poor diet /
• Secondary: l t calcium
6. Stroh 2
Malabsorption syndromes
f. steroids 3. chronic
pancreatitis
4. Bone problems pppt
5. Hormonal 4. to
 Early
-

Asymptomatic
Assessment Findings
moderate →
severe
• Pain lbnukl
• Compression fractures of spine
6
SCI
• Height loss
Nursing Interventions
• Teach body mechanics
• Balanced diet É%itD
• Advise to sleep on a firm
mattress
• Teach how to wear a back
brace -230
• Collaborate with a physical
therapist
• Medications:
–Analgesic: aspirin g- EL
/ Dray
–Antihypercalcemic drug: etidronate (Didronel)
–Hormonal agents:
–calcitonin (calcimar)
–conjugated estrogen (Premarin)
–Vitamin D supplements
 maintenance

Aspirin 125
"
- -

AMMI
325 Aiatsis
Antipyretic
-

300mg
-

625 -

MI
500 My -
1-
Analgesic
600mg
-
+
Anti-inflammatory
FRACTURES
• Break in the continuity of a bone
• Prognosis varies with:
–Extent of disability or deformity
–Amount of tissue damage
–Vascular damage
–Adequacy of reduction and immobilization
–Client’s age, health, and nutritional status
 Possible Causes
toddlers Fhm
9
erpderly
-

✓
• Major trauma \ adults -

4. A .

• Osteoporosis
• Bone tumors
↳ Concealed I chose d
Comminuted Fragmented
Compression crushed
is
Depressed Broken bone pressed inward

Impacted
Broken bones are pressed to each
other

Spiral Ragged break

Greenstick
arm
II. Open / compound
→
P risk for osteomyelitis
 Assessment Findings
1. Pain
• Neurovascular damage
– 6 P’s 2. Pallor
• Swelling
"
3. Poikilothermic
• Loss of function
"

• Deformity
4. paresthesia
• Crepitus
=

truly 65 .

Paralysis
G. Pvlselessness
 Injury
1.
Prostaglandin Andy mirin
, , → Pain
lentic acid
t
Vasodilation
1.
swelling
 Diagnostic Evaluation

• X-ray
Principles of Fracture Management

immobilization

eduction

ligament
Emergency Management

est
ce CE 24° )

compression IAK Wrap )

leiation

plint
After diagnosis:
• Closed reduction ✗ normal manipulation
• Open reduction
–use of rods, plates, and screws

(followed by cast application)

• Other interventions
–Splint Immobilization
-

–Cast -
I 1 R
–Skin or skeletal traction - IMA
Open fractures
• Surgery
-

Debridement
-

Repair
• Medications:
–Analgesic:
–acetaminophen
–codeine -
skit / rib fracture
–morphine
-

–Prophylactic antibiotic: cefazolin (Ancef)

–Tetanus prophylaxis: tetanus toxoid

Arthritis
 RHEUMATOID
ARTHRITIS
Disorder: Rheumatic lttloimmvre )
Age / gender: 10-40 / Female
Ag

RHEUMATOID ARTHRITIS
Group
A =
VRTI
Beth
Hemolytic
Streptococcus
GABHS
I
3 days /
→

Immune Complex Reaction Antigen

A.Allergic Toxin
B.Rheumatoid Factor
C.Anti-Glomerular Basement Membrane (GBM)
ICRA
RHEUMATOID ARTHRITIS
Immune Complex Reaction Antigen
1. Scarlet fever
A.Allergic Toxin 2. Kawasaki dse .

B.Anti-GBM 3. Glomerulonephritis
(Glomerular Basement Membrane)

C.Rheumatoid Factor 4. Rheumatic

Heart Dse .

5 Juvenile RA
( Rheumatic fever)
'

6. f. A .
 stages :

I.
Synovitis -

Asymptomatic
2. Punks formation -

get like
-

stiffness "
"

3. Fibrous ankylosis - broken gksg

-

pain
% Bony ankylosis
-

sharp edge
to
-
deformities
Hallmark
• Deformities:

Ulnar Drift
• Diagnostics:
1. ✗ my
-
6
.
CBC
- b RBC
2. PESR
1. WBC
Rheumatoid factor
-

(f)
-

3.

4. (f) Antinuclear Abb

5. P Anti streptomycin
-

-0 titer
post GABIAS
→ -

RHEUMATOID ARTHRITIS
• Symmetry: Bilateral

• Common joints: small 1 fingers )

• Involvement: systemic #

RHEUMATOID ARTHRITIS
a) Sjogren 's syndrome -

excessive dryness
1. eyes % UTI
2. mouth

b) Felty 's syndrome

1. to RBC
-
Anemia

2. ☒ Wac
-

Infection
• Stiffness: 7730 mins
Am / prolonged activity
-

pain
• Activity: A- time A- on
⑤

RHEUMATOID ARTHRITIS
• Management:
• Application: a) swelling -

cold

b) Stiffness worm
-

• Medications:
( next page )

silicon )
• Surgery: s-y.ro vectoring c-
injection 1
RHEUMATOID ARTHRITIS
oil
 Analgesic
Maki
1.
a

Aspirin 600mg q4H

Anti-inflammatory
%) Bleeding
,
b) GIupstart -

pc
NSAID 's Otto
2.
-

KI
upset c) city
-

pc
3. steroids -

Intra articular
-

4. Disease * Gold compounds ( Chryso therapy )

Mortifying →
Thio malate -

1M I✗ / WK
Anti
Rheumatoid
→
onset :3- 6 Mos
Drugs
→
drmlion : 3- 4 years
OSTEOARTHRITIS
[ Degenerative Joint Pge )
Disorder: Degenerative D. o .

Age / gender: 40-80

/ Female
OSTEOARTHRITIS
• Deformities:

OSTEOARTHRITIS
• Diagnostics:
joint
]
1. x " " " With A space
ray
-

b) tt bone spur
2. arthroscopy

OSTEOARTHRITIS
• Symmetry: Unilateral

• Common joints: weight -

bearing a) spine
b) hips
c) Knees
• Involvement: Local

OSTEOARTHRITIS
• Stiffness: 4 30 min
-

pm , during / after activity

• Activity: Non weightbearing

-

⑧
aquatic exercises -
wt loss
.

OSTEOARTHRITIS
• Management:
A. stiffness : worm
• Application:
and
El sweating i

⑧ Dieti -

lose WE
• Medications:
[ next page ) removal
-

aged portion

I prosthesis t.FI
• Surgery: EEE,
↳ goy pom RHEUMATOID ARTHRITIS
.
1. Aspirin 600
my q4
.

2. ASAD 's

3. steroids
g. Cox -2 . inhibitors
" "
→
Wxin
 3000 cal .
=
④
I. Prudent CHO = 50%
11-41-0 -
30 %

Fats e
no %

2. caloric substitution
ai n

counting
4. Inverted pyramid
 D 1200007 A -

I 300 300

/
2 300

3 300

4 700
5
3¥ = 3000
 GOUTY
ARTHRITIS
Disorder: Metabolic carts ; -4¥
'
pidrey
Age / gender: Middle
/ MF problems
 protein 10
Blood ! Deamination
liver
urea
?
•

Nitrogen [ '

Ammonia
Wiring)
* 80 Anion:B •

Acid
-

heavy toxin
II Kickers Albumin Uric
b Globulin to
f Blood 12.5 8MM) -

will
feces go to
✗ Kidneys → win
GOUTY ARTHRITIS
• Deformity
PODAGRA
• Diagnostics
1. P serum uric acid 175 -8 My 1dL )
2. Arturo antes is

GOUTY ARTHRITIS
• Symmetry: Random

• Common joints: Lower extremities

190% -

great to e)

• Involvement: systemic
.
→
vrolithasis

GOUTY ARTHRITIS
• Stiffness: None

• Activity: CBR II )
elevate the foot part

GOUTY ARTHRITIS
• Management: Diet :b
purine
Increase 0T¥

Dialysis
• Medications:

( Next page)
µ present
/ septicemia
• Surgery: Amprtnh'm
GOUTY ARTHRITIS
1. Acetaminophen
2. steroids
% Halt wz balance the pH
-

4. Uri cosmic drugs Pnbenecid

=

13-5 L
/ day )
bunt mid
5. Anti govt drugs -
-
analgesic
Awtei Colchicine
chronic : Allopurinol } pl