2010 spr musculoskeletal system ppt

8/8/2019 2010 Spr Musculoskeletal System Ppt.

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The Musculoskeletal System

Red Rocks Community College

RN Refresher Program

Anne Corbett, RN MSN


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Functions of Bones

Framework

Movement Protection

Storage

Manufacture bloodcells (marrow)


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Anatomy and Physiology 206 bones

Longweight-bearing (ex. Femur) Short..non-wt. bearing (ex. Phalanges)

Flat..protect organs (ex. Scapula)

Irregular(ex. Carpals)

Sesamoiddevelops within tendons (ex. Patella)


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Cortical vs Trabecular 20/80


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How to build a bone: Calcium one large helping

Collagen (22%)

Other ingredients / factors: Phosphorous

Calcitonin

Vitamin D (renal synthesis)

PTH parathyroid hormone

GH- growth hormone Glucocorticoids

Hormones

Thyroxine

Insulin

99% of bodyscalcium is in the

bones


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20% bone tissue replaced annually

Osteoblasts and Osteoclasts


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In the United States, 1 in every 3 adults65 years old or older falls each year,with hip fractures resulting in the greatestnumber of deaths and most serious health

problems.

Women account for 80% of the300,000 hip fractures that occurannually. Source: Harvard University Gazette


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Osteoporosis Calcium, Vit D deficiencies

Age Women > Men

Decreased sex hormones (menopause)

Smokers Small / thin frame


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Tx:

Calcium supplements

Medications Fosamax

Actonel (monthly)

Boniva

Reclast (annually)

Weight-bearing activities

Bone density testing


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Fracture RepairInjury (pg 1190)

48-72 hoursHematoma formation(Migration of fibroblasts, osteoblasts to site)

3-14 days Fibrocartilage formation

2-6 weeks.Callus formation

(non-bony union)

3 wks-6 months..Bone formation

(callus resorbed)


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Joints

Synarthrotic immovable

Amphiarthrotic slightly movable

Diarthrotic freely movable


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Joints Diarthrodic aka Synovial

most common

Ball and socket

Hinge

Condylar

Axial Pivot

Saddle

Gliding


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Components of a Joint Hyaline (articular) cartilage

Capsule lined with synovialmembrane

Synovial fluid

Bursae Meniscus


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DJDOsteoarthritis


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RA


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Arthroscopy and

Arthrocentesis Examination of joint

and synovial fluid

Normal: 1-3 mL

Cartilage tears

Cell count Uric acid crystals


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Hook em Up

TENDONS

Bone to Muscle

LIGAMENTS

Bone to Bone


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Knee Replacement (TKA)


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Hip Replacement


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Orthopedic fixative devices


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Ortho devices


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CPM Continuous Passive Motion


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Nursing considerations Pain control

Infection

Positioning

Ambulation

Labs to monitor? Diet ?


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Muscles Over 600

SmoothInvoluntary

Autonomic

Cardiac

Striated

Involuntary

Skeletal

Striated

Voluntary


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Smooth -Involuntary

in hollow structures (GI tract, bladder,uterus, blood vessels)

Modulated by neuronal and hormonalinfluences


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Skeletal Largest mass of tissue inthe body

Neuromuscular junction

Acetylcholine - ATP


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Movement(pg 1150)


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Musculoskeletal Issues Mechanical

Arthritis, RA Osteoporosis Deformities

Disease Processes: Osteomyelitis

Tumor, malignancies Gout Muscular dystrophy MS

Trauma Fractures Sprains, strains

Amputations

Other: Compartment syndrome Ganglion Bunion Scoliosis Plantar fasciitis O.I.


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Nursing considerations?


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Compartment Syndrome


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Fasciotomy


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Aging and the

Musculoskeletal system Decreased bone density

Increased bone

prominence Posture changes shift in

center of gravity

Cartilage degeneration

Muscle atrophy Slowed movement


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Assessing muscle strength 0 No detection of contraction

1 barely detectable trace of contraction

2 Active movement with elimination ofgravity

3 Active movement against gravity

4 Active movement against gravity and

some resistance 5 Active movement against full resistance

(normal muscle strength)


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Talking Points Rhabdomyolysis

Release of myoglobin into bloodstream

Risk for acute tubular necrosis

IV fluids, diuretics, low-dose Dopamine

Bicarb if acidotic

Desired urine output: 100-200 mL/hr


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Talking Points FES (Fat Embolism Syndrome)

Higher incidence in long bone fractures

Males ages 20-40

Geriatric population ages 70-80

Catecholamines >>> free fatty acids >>> plateletaggregation >>> globule formation>>>vesselocclusion


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Diagnostic Tests1. Radiologic studies (+ contrast)

2. Angiography

3. Bone/Gallium Scan

4. Computerized Tomography (+ contrast)

5. Magnetic Resonance Imaging (MRI)

6. Electromyography (EMG)


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Labwork CBC, Chem panel (pg. 1152)

Serum calcium

Phosphorous

Thyroid function

Lipase

ESR Uric acid

CK


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Alphabet soupAROM

PROMORIF

5 Ps

CPM

PT/OTAKA

BKA


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Nursing Considerations Assess Assess Assess!!!!!!

5 Ps

Treat pain

Monitor labwork

Anticipate complications (DVT, FES)

Nutrition issues Teaching re: lifestyle changes

Monitor depression, psychosocial issues


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Case Study 25 yo male, ski accident

To ER via ambulance

Dx:

R Femur fx

CHI

multiple R rib fxs

Admit to PCU via OR


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Before and AfterBefore and After

Nursing considerations?


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Nursing considerationsNursing considerations

Group 1Group 1

PACURNPACURN

Report fromReport fromOR?OR?

Assessment?Assessment?Focus?Focus?

ComplicationsComplications??

Group 2

Step-down RN

Report fromPACU?

Assessment?

Consults?

MD orders?

Group 3

Day 2 RN

Report fromRN?

Assessment?Focus?

D/Cplanning?


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Case Study #2 79 yo Female, fall at home

Dx:

L clavicle fxMultiple contusions

AMS

Afib

IDDM


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dmission course?

Nursing Dx?


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Nursing considerationsGroup 1

Tele RN

Report fromER?

Assessment?Focus?

POC?

Group 2

CNA

Duties?

Report to RN?

Considerationsfor

ADLs/hygiene?

Group 3

Case Mgr

Report fromMD,RN?

Info neededfrom family?

D/Cplanning?


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2010 spr musculoskeletal system ppt

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