Professional Documents
Culture Documents
SYSTEM
1. Locomotion
2. Protection
3. Support and lever
4. Blood production
5. Mineral deposition
JOINTS
The
part of the Skeleton where two or
more bones are connected
CARTILAGES
A dense connective tissue that consists
of fibers embedded in a strong gel-like
substance
BURSAE
Saccontaining fluid that are located
around the joints to prevent friction
ASSESMENT OF THE
MUSCULO-SKELETAL SYSTEM
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
ASSESMENT OF THE
MUSCULO-SKELETAL SYSTEM
1. HISTORY
2. Physical Examination
Perform a head to toe assessment
Nurses need to inspect and palpate
The special procedure is the
assessment of joint and muscle
movement
Usually, a tape measure and a
protractor are the only instruments
ASSESSMENT OF THE
MUSCULO-SKELETAL SYSTEM
Gait
Posture
Muscular palpation
Joint palpation
Range of motion
Muscle strength
ASSESMENT OF THE
MUSCULO-SKELETAL SYSTEM
LABORATORY PROCEDURES
1. BONE MARROW ASPIRATION
Usually involves aspiration of the marrow to
diagnose diseases like leukemia, aplastic
anemia
Usual site is the sternum and iliac crest
Pre-test: Consent
Intratest: Needle puncture may be painful
Post-test: maintain pressure dressing and
watch out for bleeding
ASSESMENT OF THE
MUSCULO-SKELETAL SYSTEM
LABORATORY PROCEDURES
2. Arthroscopy
A direct visualization of the joint cavity
Pre-test: consent, explanation of
procedure, NPO
Intra-test: Sedative, Anesthesia, incision
will be made
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
ASSESMENT OF THE
MUSCULO-SKELETAL SYSTEM
LABORATORY PROCEDURES
3. BONE SCAN
Imaging study with the use of a contrast
radioactive material
Pre-test: Painless procedure, IV radioisotope is
used, no special preparation, pregnancy is
contraindicated
Intra-test: IV injection, Waiting period of 2 hours
before X-ray, Fluids allowed, Supine position for
scanning
Post-test: Increase fluid intake to flush out
radioactive material
ASSESMENT OF THE
MUSCULO-SKELETAL SYSTEM
LABORATORY PROCEDURES
4. DXA- Dual-energy XRAY absorptiometry
Assesses bone density to diagnose
osteoporosis
Uses LOW dose radiation to measure bone
density
Painless procedure, non-invasive, no special
preparation
Advise to remove jewelry
Common musculoskeletal
problems
4.
Assess the effectiveness of pain
measures
Nursing Management
IMPAIRED PHYSICAL MOBILITY
1. Instruct patient to perform range of motion
exercises, either passive or active
2. Provide support in ambulation with
assistive devices
3. Turn and change position every 2 hours
4. Encourage mobility for a short period and
provide positive reinforcements for small
accomplishments
Nursing Management
SELF-CARE DEFICITS
1. Assess functional levels of the patient
2. Provide support for feeding problems
Place patient in Fowler’s position
Provide assistive device and supervise
mealtime
Offer finger foods that can be handled by
patient
Keep suction equipment ready
Nursing Management
SELF-CARE DEFICITS
3. Assist patient with difficulty bathing
and hygiene
Assist with bath only when patient has
difficulty
Provide ample time for patient to finish
activity
Musculoskeletal Modalities
Traction
Cast
Nursing Management
Traction
A method of fracture immobilization by
applying equipments to align bone
fragments
Used for immobilization, bone
alignment and relief of muscle spasm
Traction
Skin traction
Skeletal traction
Traction
Pulling
force exerted on bones to
reduce or immobilize fractures,
reduce muscle spasm, correct or
prevent deformities
Nursing Management
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
Nursing Management
Traction: General principles
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
Nursing Management
CAST
Immobilizing tool made of plaster of
Paris or fiberglass
Provides immobilization of the fracture
Nursing Management
CAST: types
2. Long arm
3. Short arm
4. 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
CAST: General Nursing Care
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
Nursing Management
CAST: General Nursing Care
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
Nursing Management
CAST: General Nursing Care
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
Common Musculoskeletal
conditions
Nursing management
METABOLIC BONE
DISORDERS
Osteoporosis
A disease of the bone characterized by
a decrease in the bone mass and
density with a change in bone structure
METABOLIC BONE
DISORDERS
Osteoporosis: Pathophysiology
Normal homeostatic bone turnover is
altered rate of bone RESORPTION is
greater than bone FORMATION
reduction in total bone mass
reduction in bone mineral density
prone to FRACTURE
METABOLIC BONE
DISORDERS
Osteoporosis: TYPES
1. Primary Osteoporosis- advanced
age, post-menopausal
2. Secondary osteoporosis- Steroid
overuse, Renal failure
METABOLIC BONE
DISORDERS
RISK factors for the development of
Osteoporosis
1. Sedentary lifestyle
2. Age
3. Diet- caffeine, alcohol, low Ca and Vit D
4. Post-menopausal
5. Genetics- caucasian and asian
6. Immobility
METABOLIC DISORDER
ASSESSMENT FINDINGS
1. Low stature
2. Fracture
Femur
3. Bone pain
METABOLIC DISORDER
LABORATORY FINDINGS
1. DEXA-scan
Provides information about bone mineral
density
T-score is at least 2.5 SD below the young
adult mean value
2. X-ray studies
METABOLIC DISORDER
Medical management of Osteoporosis
1. Diet therapy with calcium and Vitamin D
2. Hormone replacement therapy
3. Biphosphonates- Alendronate, risedronate
produce increased bone mass by inhibiting
the OSTEOCLAST
4. Moderate weight bearing exercises
5. Management of fractures
METABOLIC DISORDER
Osteoporosis Nursing Interventions
1. Promote understanding of osteoporosis and
the treatment regimen
Provide adequate dietary supplement of
calcium and vitamin D
Instruct to employ a regular program of
moderate exercises and physical activity
Manage the constipating side-effect of
calcium supplements
METABOLIC DISORDER
Osteoporosis Nursing Interventions
Take calcium supplements with meals
Take alendronate with an EMPTY
stomach with water
Instruct on intake of Hormonal
replacement
METABOLIC DISORDER
Osteoporosis Nursing Interventions
2. Relieve the pain
Instruct the patient to rest on a firm
mattress
Suggest that knee flexion will cause
relaxation of back muscles
Heat application may provide comfort
Encourage good posture and body
mechanics
Instruct to avoid twisting and heavy lifting
METABOLIC DISORDER
Osteoporosis Nursing Interventions
3. Improve bowel elimination
Constipation is a problem of calcium
supplements and immobility
Advise intake of HIGH fiber diet and
increased fluids
METABOLIC DISORDER
Osteoporosis Nursing Interventions
4. Prevent injury
Instruct to use isometric exercise to
strengthen the trunk muscles
AVOID sudden jarring, bending and
strenuous lifting
Provide a safe environment
Juvenile rheumatoid Arthritis
Definition:
AUTO-IMMUNE inflammatory joint disorder
of UNKNOWN cause
SYSTEMIC chronic disorder of connective
tissue
Topical analgesics