MEDICAL SURGICAL NURSING

ORTHOPEDIC NURSING

DEFINITION OF TERMS:
• ORTHOPEDICS: a branch of health care that is concerned with the prevention and correction of disorders of the musculoskeletal system of the body. • ORTHOPEDIC SURGERY: The branch of medicine that is concerned with the treatment of the musculoskeletal system mainly by manipulative and operative methods. • ORTHOPEDIST/ORTHOPEDIC SURGEON:
 a physician who specializes in orthopedics.

 ORTHOPEDIC NURSE/NURSING: a nurse whose primary area of interest, competence , and professional practice is the branch of nursing concerned with the prevention and correction of disorders of the locomotor system, including the skeleton , muscle joints, and related tissues.

THE MUSCULOSKELETAL SYSTEM
• The musculoskeletal system includes 206 bones which are connected at joints, held together by ligaments , cushioned by cartilages. Tendons attached muscle to the bones. • Function: 1. Provide support for the body 2. Allows movement/locomotion 3. Protects the vital organs (brain, heart, lungs) 4. Stores calcium & release it to the blood stream, according to body requirements 5. Manufactures new blood cells in the red bone marrow.  BONES; the body’s framework or skeleton  Two main division: b. Axial: consist of 80 bones (skull, vertebral column, ribs) c. Appendicular: body’s appendages consist of 126 bones (arms, hips, legs).

THE MUSCULOSKELETAL SYSTEM
• 2. Four major bone types: Long bones: bones which exceeds length and thickness. (ex. femur)  Structure: Diaphysis: shaft, provides strength, resist bending forces. Metaphysis: flared portion between diaphysis & epiphysis, growing portion Epiphysis: end, primary cancellous bones, assist with bone development. Epiphyseal plate/line: between metaphysis and epiphysis, cartilages growth in length of diaphysis and metaphysis. Periosteum: connective tisssue covering the bone.  Blood supply: Nutrient artery of the humerus-one of a pair of branches of deep brachial arteries arising near the middle of the arm & entering the nutrient canal of the humerus Periosteal vessels-blood vessels surrounding the memrane covering the bone Metaphyseal and epiphyseal vessels –blood vessels in the shaft & end portion of the long bonesss

THE MUSCULOSKELETAL SYSTEM
2. Short Bones: equal in dimensions, found mainly in hands and feet (ex. carpals) Types: c. accessory: bones not normally present d. Sesamoid; embedded in tendons or joint capsules, sometimes mistaken for fractures on x-ray (no capsules, edges aare smooth, often bilateral) 3. Flat Bones: primary made up of cancellous bone tissue. (ex. skull, girdles) 4. Irregular Bones: (ex. vertebral, tarsal, carpals,) g. sesamoid: occur in junction with tendon at points in the body where pressure occurs (ex. Patellae) h. Wormian: occur in cranial sutures.

THE MUSCULOSKELETAL SYSTEM
• CARTILAGE: contains a firm gel substance which gives more flexibility to the bone, has a nutrient tissue fluid cells called chondrocytes and its covering is called perichondrium. TYPES: a. Fibrocartilage: greatest tensile strength, occurs in the vertebral discs and in the symphysis pubis. b. Elastic cartilage: possesses firmness & elasticity, occurs in the external ear and the eustachian tube. c. Hyaline cartilage: most common cartilage type cushion most of the joints to help soften the impact, firm yet slightly flexible, occurs also in part of nasal and bronchial rings.

THE MUSCULOSKELETAL SYSTEM
• LIGAMENTS & TENDON CONNECTORS:
   Ligaments are strong cords of fibrous tissue. Joint capsule provides the primary connection between the bones but ligaments bind the joints more firmly. Tendons also connects muscle and other tissues to each other. Purpose: Movement d. protects the vital organs Posture e. storage of minerals Leverage f. heat production Types: Striated (voluntary)-known as skeletal muscle, with volunatary control (caused by actin & myosin protein filaments) Smooth (involuntary)- produces slow long term contractions of w/c the individual is unaware occurs in hollow organs (stomach, intestine, blood vessels, bladder) controlled by the autonomic nervous system.

MUSCLE: action tissues.
 b. c. d.  f. g.

THE MUSCULOSKELETAL SYSTEM
 Eight ways of skeletal muscle contraction
2. 3. 4. 5. 6. 7. 8. 9. Isotonic contraction-muscular contraction accompanied by joint movement Isometric contraction-muscular contraction not accompanied by joint movement Twitch contraction-contraction of small muscle units w/ quick, simple spasmodic. Tetanic contraction-continuous contraction in a voluntary muscle caused by steady steam of efferent nerve impulses Treppe (staircase phenomenon)-subsequennt powerful contraction caused by increased release of calcium ions Fasciculation-localized uncoordinated, uncontrollable twitching of a single muscle group, that may be palpated under the skin Fibrilation- involuntary recurrent contraction of a single muscle fiber, usually described by the part that is contracting abnormally Convulsions-involuntary contraction of the muscles producing contortion of the body & limbs

THE MUSCULOSKELETAL SYSTEM
Performing movement b.Prime movers: muscles initiate bone movement c.Antagonist: muscles relax during movement d.Synergist: muscles either directly assist prime movers or steady another part of the participating muscle-bone system to allow more effective movement

THE MUSCULOSKELETAL SYSTEM
• JOINTS: are points of articulation/connections between bones, permitting activities such as running or grasping. Others join bones firmly together permitting little or no movement.  Three basic joint types: Synarthroses/ Fibrous-immovable joint w/c the bones are united by fibrous tissue.  Sutures-immovable joint w/ minimal amount of connective tissue between the two bones (skull)  Syndesmosis-immovable joint in w/c the bones are separated by connective tissue (base of the tibia & fibula) Amphiarthroses/ Fibro-Cartilagenous joint-a slightly movable jointin which the bony surface are separated by fibrocatilage or hyaline cartilage Diarthroses/ Synovial joints.-freely movable joint, the ends of adjoining bones are covered w/ thin cartilaginous sheet and the bones are linked by a ligament lined with synovial membrane w/c secretes synovial fluid  Joint capsule-a fibrous sac-like structure of connective tissue that encloses the end of the bones which contains the synovial fluid  Synovial membrane-thin layer of tissue lining the articular capsule sorrounding a freele movable joint.  Articular cartilage-type of hyaline connective tissue that covers the articulating surfaces of bones w/in synovial joints  Synovial cavity/bursa- sac filled with synovial fluid in the connective tissuebetween muscles, tendons, ligaments and bones

THE MUSCULOSKELETAL SYSTEM
 b. c. d. Different types of synovial joints Synovial gliding/arthrodic joint-the bony surface slide over each other without angular or rotational movement (carpus and tarsus) Synovial condyloid/condylarthrosis-an ovoid heads fits into an elliptical cavity (knee joint, mandible, temporal bone of the skull) Synovial saddle joint-the articulating surfaces of the bones are reciprocally saddle shaped, no axial rotation but allows flexion, extension, abduction, adduction movement (carpometacarpal joint of the thumb) Synovial bone and socket joint/enarthrosis- (shoulder joint, hip joint) always involves a long bone which allowed to move in all planes Synovial pivot joint/trochoid-a bone moves round a central axis allowing rotational movement (atlas & axis vertebrae) Synovial hinge joint/ginglymus-allows angular movement in one plane only, increasing or decreasing the angle between the bones (knee & elbow joint)

e. f. g.

THE MUSCULOSKELETAL SYSTEM
• 2. BASIC JOINT MOTION: Flexion-decreases the angle between the anterior surface of articulating bone (bending your head forward). 3. Extension-increases the angle between the anterior surface of articulating bones, returns a body part from flexed position to its original neutral anatomical position (straightening your head after flexion). 4. Hyperextension-continues the act of extension beyond the original anatomical position (when you look up toward the ceiling). 5. Abduction-moving away a bone away from the body’s midline (moving arms straight out from the sides). 6. Adduction-moving a bone back toward the body’s midline (bringing arms back to sides of body from outstretched or abducted position). 7. Rotation-pivoting the bone on its axis (turning the head from side to side: extrnal rotation, moving the head from looking to the side to looking straight ahead: internal rotation). 8. Circumduction-describing surface of a cone with the moving part (moving arm around that describes a circle, moving the head frm front , sides aad back) 9. Inversion-turns an extremity or part of an extremity inward towards the body’s midline (moving sole of the foot inward). 10. Eversion-turns an extremity or part of an extremity outward or away from the body’s midline(moving the sole of the foot outward). 11. Pronation-forearm movement turning the back of the hand forward. 12. Supination-forearm movement turning the palm forward 13. Protraction-moving a part such as the mandible forward 14. Retraction-pulling a part back, moving the mandible back to its neutral position 15. Plantar flexion-pointing the toes away from the body (a ballerina) 16. Dorsiflexion-pointing toes toward the body. Two unique moving the movements of the forearm: 18. Pronation 19. Supination

BODY MECHANICS
• Body Mechanics: refers to the function of muscles and joints and the application of the mechanical principles to the activities of the patient and the nurse. By applying these principles a nurse ca efficiently lift and turn patient when giving care without causing injury to her own body. It also contributed to the attainment of nursing care goals. Nursing Care Goals:
a) b) c) d) Permit normal functioning. e.g.: eating is usually done in sitting position because the gravitational flow assist the food in reaching the stomach. Aids healing. Patient must also be positioned so that circulation is maintained thus aids in healing. Prevents complication and deformities. Relieve pain.

2.

BODY MECHANICS
2. The check point for correct standing posture. (standing posture is the ability of the body to remain erect and to maintain this altitude be resisting outside force with the least amount of energy.)
a. Head: is held erect with the chin drawn in. b. Chest: elevated. c. Back: straightening the back which causes the sternum to be front of the body and hips. d. Feet: placed apart but parallel with no internal or external rotation of the legs.

BODY MECHANICS
3. The correct points for sitting position:
a. Head: held erect with the chin drawn in b. Chest: elevated c. Back: straightening the back which causes the sternum to be in front of the rest of the body and hips. d. Abdomen: keep flat e. Hips and knees: should be flexed and at right angle f. Feet: are placed apart but parallel with no internal or external rotation of the legs.

BODY MECHANICS
4. Improper posture and body mechanics abnormal stress on weight joint is a factor in the development of joint diseases such as osteoarthritis. 5. To prepare to lift a load or a patient, face the object and stand close to it. 6. The standing posture should be checked of pain when lifting. Get ready to lift by contracting the muscles. It is easier to pull on the object than to push it. 7. Head pillow is placed under the shoulder when patient is in supine position to:
a. b. c. allow expansion of the chest. Permit normal functioning of the lungs. If the patient cannot maintain correct lower extremity position without assistance after a short time; the anterior leg muscles are stretched and the foot assumes a plantar flexion position, a board or sandbag is placed against the sole to prevent foot drop.

BODY MECHANICS
8. Maintenance of function of thee fingers and hands are very essential because of its ability to grasp or pick. 9. Prone position is more comfortable if a pillow is placed under the shoulder and chest and another beneath the feet and lower legs to keep the toes off the bed. 10. When the patient is moved, joints must be supported to avoid muscle spasms or strain. When positioning a limb, place the hand under the joint to splint it. 11. To support the patient in left side lying, support the body by placing pillows between the legs, arms and body parallel with the back to prevent the following deformities; abducted and internally rotated right leg abducted right arm.

BODY MECHANICS
• Related Musculo-Skeletal Terminologies 1. Atrophy: wasting away. 2. Causalgia: severe burning pain produced by severed nerves that have malfunctioning nerve endings, touch can often produce this pain. 3. Circumduction: motion involves abduction, adduction, flexion, and extension (360 degrees) to complete full circle; motion of the shoulder, hips and ankle. 4. Contracture: the absence of full range of motion of any joint. Most common is flexion contracture, lack of full extension.

BODY MECHANICS
• Related Musculo-Skeletal Terminologies (cont…) 5. Deformity; malformation or defect of any part of the body. 6. Anisomelia: leg length discrepancy, an inequality between corresponding limbs. 7. Dislocation: musculo-skelelal traumatic injury resulting in disruption in the continuity of a joint’s configuration and articulation causing the loss of contact between the joint surfaces. 8. Dorsiflexion: the motion of moving the body part up towards the dorsum; motion of the ankle that moves foot up toward the leg.

BODY MECHANICS
• Related Musculo-Skeletal Terminologies (cont…) 9. Dysplasia: abnormality of the development of an organ or body part. 10. Eversion: motion of the ankle characterized by sole of the foot facing away from the opposite foot. 11. Inversion: motion of ankle characterized by sole of the foot facing towards the opposite foot. 12. Kyphosis: posterior convexity of thoracic portion of vertebral column, normal curvature of the spine , but becomes pathologic if excessive. 13. Lateral: side towards the outer aspect of the body.

BODY MECHANICS
• Related Musculo-Skeletal Terminologies (cont…)

14. Lordosis: concavity of the vertebral column, normal curvature existing in cervical and lumbar areas, which may become pathologic if accentuated. 15. Medial: side towards the middle of the body. 16. Palsy: paralysis 17. Plane:
a. b. c. d. Cardinal Frontal: plane that divides body into front & back Cardinal Horizontal: plane that divides the body into upper &lower. Cardinal Sagittal: plane that divides the body into left and right Midsagittal; line between cardinal sagittal plane.

BODY MECHANICS
• Related Musculo-Skeletal Terminologies (cont…) 18. Range of Motion (ROM); the full motion a joint can assume. 19. Recurvatum: hyperextension (extension beyond neutral position). 20. Rotation: motion involving turning of one bone on another; angle between the two bones do not change.
a. External: outward rotation b. Internal: inward rotation.

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