Musculoskeletal

Joshua W. Atienza, USRN

 Musculoskeletal System
Anatomy and physiology
Femur
1. Long bones →
will circulate throughout the blood stream Ctatembolism
globules
.

Contains fat globules In case of Fracture fat

t, spoz related
.
•

2. Compact bones to Fmture

rash the
Hallmark sign : petechia
on
•
Bone density
neck and chest
problem osteoporosis
:

Osteoporosis
• Bone demeniralization
slsx
Bone pain
Reduce height
Easily Fractured
Always Fall
's hump
Kyphosis =
Dowager OF estrogen = Bone remodeling
Lack
Risk factors :
µ
, lstcommonp
menopausal Age ( 49 and above )
•
Age =

cause Breast / ovarian CA

early menarche
=

absorption
nicotine inhibit calcium
Smoking
=

parathyroid atomy
•

+ bone density
bone density
• caffeine = •

• Alcoholism = Can •
gushing syndrome weakness the bones
too much cortisol
can
•
sedentary lifestyle -

• Medications •
Family HX
↳ corticosteroids
•
small thin body Fame
American
proton pump inhibitor •
Race : Asian / African

Management Diagnostic test

: :

1. Encourage exercise
at least 30 mins a day > roentgenograms
Best exercises to offer: > DEXA = Bone density
-
walking ( compact bone)
Running / Jogging
= (
shoes tennis shoes )
to consider :
-

things
-

swimming
-
Isometric exercices = staying in one position -
Noninvasive
other exercises -
with old any calcium
-

yoga supplement prior

pilates
No stimulant prior
-

- Taichi
> Bone scan
2. Diet modification
except cottage cheese
-
high calcium foods -
cheese
Fish with fine bones avoid caffeine Foods
complication
•

:
-

> anchovies

>
sardines
Fracture
-

Milk
compartment syndrome
-

-
Green leafy veggies
yogurt Muscle Atrophy
-

-
TOFU

Medications :
)
"
"

> Bi phospho nates ( nate

-

↳ MOA : ti bone destruction (osteoclast)

example :

Doc : -
alendwnate ( Fosamax)
-

Risedwnate
Administration: water
1- take one medication upon arising with one Full glass of
irritation
2. Remain upright for 30
mins To prevent esophageal
Tacticsties in upright position
Reading newspaper
•

Jogging 1 Walking
•

* Find Raloxifene
↳ MOA : T estrogen production
3. Joint
-
serves as a connection of 2 bones
-
contains synovial Fluid =
prevents Friction
= Lubricator
= Arthwcentesis
* check For cloudy = Rheumatoid Arthritis
Problem related
to joints : Rheumatoid Arthritis
-
common in female
-
Autoimmune
: Swan
Neck
Deformities : Hallmarksign
-

-
Complication : Volks man contracture the site
blood Flow on
↳ joint pain with ti
Morning stiffness
-

↳ Firm mattress
Medication :
1- Corticosteroids
a. Methotrexate
3- NSAIDs =
naproxen

Oster Athrih's
-
common in male
-
Obesity
Heber den
.

Deformities :

Bouchard
-

Morning stiffness
Medications :
1- NSAIDS
2. COX -2 = celecoxib
3. Glucosamine

Gouty Athritis
-
common in male
-

T uric acid
-
(t ) Tophi formation
t
podagra ( Big to e)
Medications :
Maintenance dug
}
* 1-
Allopurinol woe : Hepato toxic WOF : Nephw to ✗
" °

d- colchicine pain relics

BUN
= -

↳ RUQ pain
3. probe head -
creatinine
↳ remove acid
uric 1^01=1
-

Through urination

septic Athritis
-
related to sepsis
antibiotic
give
-

4. other parts
to the thumb , point and middle finger
Median nerve
-
Connected
>

↳ risk For Carpal Tunnel Syndrome

1. Risk Factors :
t -
repetitive movement
keywords : -

pregnancy
•
Inability to form a - Arthritis
Fist Slsx :
"
Inability to hold -
numbness
dining utensils -

pain
Cannot turn a
•

Door Knob
paresthesia
-

Diagnostic Test :
Management
:
Tiriel 's Test
confirmatory Test :phallen 's Test -
vitamin B complex
* Hallmark sign : Papal sign -
NSAIDs
5- Tendons
and Ligaments
I 4

strain sprain

Management
:

Rest
Ice

Compress
Elevate

Bone Metabolism
Bone metabolism
Osteoclast

}
1.
-
bone destruction With in

2- Osteoblast 6 months
building ↳ IF more than
YLII.%af.LI?fiFr-ae+uo
-

Bone 6 months not okay

-
-

Certain conditions like appearance

and T osteoblast
=
Paget 's disease mosaic
=

1. Increased osteoclast severe bone

=
pain
O-stei-D-mans-platybas.in
↳ Invagination OF the skull
Fosa MAX Risk for blindness
of choice
:
Dwg
-

of legs
Osteomalacia ( Ricketts)
→ Bowing
2
Abnormal bone metabolism soft bones
.

→
-
Vitamin D deficiency →
→ skeletal muscle weakness
* Risk factors
of Vita D intake
-

• less exposure
to healthy sunlight

Amputation :

limbs Types of Amputation

- removal of
candidates : BKA
nutritional status before amputation 1
- .

Dm• =D Assess
Hypoglycemia AKA
↳ complication : severe
2.
Burgers
•

and raynaud s
•

Congenital defects
•

Gangrene
Tips :

1. post opposition the bed within

24 hrs
a. elevate Foot OF
contractures within 48 hrs
b. position to prevent gwtial
prone
2. Assistive di vices
* crutches
Type OF gaits
normal walking
2- point =

Best For amputation

3- point =
"
crutch palsy
"

rehab and arthritis damage

point none
=

4-
bars to prevent
biracial plexus
on the arm elastic Barrage
-

Weight =

the stump e

stump push by using a pillow cover

sthrengthening
= ,
3- OF

ph atom
limb pain
4. Assess for nerveending
physiological open
=

psychological
schedule
5- Follow strict rehab
at bedside = Possible bleeding
6. Turn iqvet
replacement
total knee replacement / total hip
use OF abduction pillow
d,
" →
Best management :
knee fracture Hip future
* shortened affected leg

Management :

-
no flexion
-
raised toilet seats
-
no over sthu thing
no
vigorous exarate
-
Fracture metabolism
OF bone
-
abrupt discontinuation
Risk factors :
•
Old age
•
Contact sports
•
Cushing syndrome
•
Hypercalcemia
types of Fracture
( school age 6- )
Ia
common in children
Green stick fracture
-

1.
risk For infection
2. Open Fracture -

-
Tetanus toxoid

3. Compound fracture - risk for multiple fracture

Management :

Immobilized
int )
Support ( splint
cover with
sterile game
Distal
Assess pulses =

↳ to verify compartment syndrome

to do bone alignment)
1- Reduction ( Attempt
* close manual manipulation =

* Open = Sx + use of another SX

2- Fixation
-

Use of
meth
* Internal fixation with open reduction
metal inside boner goes
* External fixation
freedom OF Mormont
External Fixation
RAEF
=
Roger Anderson
Nursing Mgt
:
-D
3. Traction -
trapeze bar
to promote independency
For bone alignment
pin case
-
-

Types of traction -
Assess a- mutation
1. Balance skeletal traction hog rolling
-

traction 2hm
2. Bryant 's
-

Turning every
3 Buck's traction
'

4. Halo traction = cervical spine injury

4. Cast [ Immobilizer
- Immobilizer fracture
Types OF Cart :
Plaster of Paris
* one color only Management :

syndrome
WOF compartment
assess a- mutation
:
* Heavy
-

* cheap -
use hair dryer cool settings
29 -48 hrr
*
Drying time =
-

Do not put anything inside the cast

Fiberglass -
Elevate the affected part to promote drainage
* Colorful
* light

*
Expensive
* Do -30min
Drying time =
 syndrome
Compartment
cannot escape
pressure that
-

Risk factor
-
cast is too tight
-

Fracture
-
Amputation

manifestations :
" "" "
tactile Disturbance
2 ①
"" *

5Pa
anesthesia
uselessness
+ cool to touch
analysis
2- ain not relieved by pain meds
and pain during elevation

management : muscle extension)

tissue that extend during
1. Fasciotomy = Fascia ( smooth

2 . Cast adjustment =
petaling
widowing

cast syndrome
-
cast too tight
-

Hip Spica cast Abdominal manifestations

↳ Pressure in the duodenum
=

-
absent bowel sound
-
abdominal pain / tenderness
management :
-
cast adjustment
-

Gastndwden ostomy
-
Gastric decompression (NGT)
Assistive Divicev

1. crutches
measurement
> Elbow
angle : 300 Flex
> Distance of crutch : 6- 10 inches
> Axillary Distance : 2- 3
Finger
breaths
>
weight : on hand barv

Gait pattern
2 point gait = robot like Gabay kamayatpaa alternate
3 point gait =
3 kamay
I paa
4 point gait =
2 ka
may
2 paa

cane measurements
Elbow angle : 30
level of the greater trochanter ( in between hips and waist ) Walker
6- to inches anterolateral Walker
cane
A affected leg
Opposite followed by

Affected unattended leg

beg