Presentation on theme: "Musculoskeletal System Day 1. What is the first step of the nursing process? A.Nursing Diagnosis B.Assessment C.Building a relationship of trust D.Empathy."— Presentation transcript:
Physical Activity Weight-bearing stimulates bone formation & remodeling
What happens if… A person is on prolonged bed rest or physically disabled and they don't engage in regular weight bearing activities? – bone resorption – Calcium loss – Osteopenic bones – fractures
Nutrition Calcium – 1000 – 1200 mg / day – 16 – 24 oz. milk
What two endocrine hormones work in harmony to maintain normal serum Calcium levels? What? I need to give you multiple choice answers! NO way! Turn to your neighbor and tell them the answer to this question PTH Calcitonin
Hormones PTH Secreted by – Parathyroid Effect – Serum Ca+ levels Action – Promotes movement of Ca + from bone to blood Calcitonin Secreted by – Thyroid Effect – Serum Ca+ levels Action – Inhibits bone resorption & deposits of Ca + in the bone
Hormones Hyperthyroidism – bone resorption – bone formation Cushing’s syndrome – bone resorption – bone formation
What is the name of the most common form of hyperthyroidism in the U.S.A? A.Hashimoto’s thyroiditis B.Graves disease C.Addison’s disease D.Cretinism E.Pheochromocytoma
Cushing’s Disease is caused by what hormonal imbalance? A.Steroid excess B.Steroid deficit C.Thyroid hormone excess D.Thyroid hormone deficit E.Excess ADH
Small Group Questions 1.What are the 4 main functions of the M/S system? 2.What & where is the periosteum? 3.What types of bone marrow are there? (location & function) 4.What are the 3 main types of bone cells and their main function? 5.Describe resorption and osteogenesis.
Articular System Joint – Junction of 2 or more bones
Joints Synarthrosis – immovable Amphiarthrosis – Limited motion – Joined by cartilage Diarthrosis – Freely movable
Types of diarthrosis joints Ball & Socket Hinge Saddle Pivot Gliding
Synovial Joints Bones covered with hyaline cartilage Form capsule Lined with synovium membrane Secretes lubricant
Do the bone surfaces of a normal functioning synovial joint come in direct contact with each other? A.Yes B.No Synovial fluid acts as a shock absorber
Ligaments, tendons, bursa Tendons – Bind muscle to bone
Ligaments, tendons, bursa Ligaments – Bind bone to bone
Ligaments, tendons, bursa Bursa – Sac filled with synovial fluid Elbow Shoulder Hip Knee
Small Group Questions 1.Define synarthrosis, amphiarthrosis & diaarthrosis? 2.What is a synovial joint? 3.Define ligament, tendon & bursa. 4.What hormones are vital for Ca + and Ph + homeostasis?
Types of Muscles Skeletal Muscles – Voluntary movement Smooth muscles – Internal control – e.g. bladder, GI, bronchi Cardiac muscles – Heart
Muscle Cell Parallel cells encased – Fascia Contains – Myofibrils – Contain Sarcomeres Contracting unit
Contraction Cell contract in response to electrical stimulation Ca+ ion enters sacromeres Sacromeres contract Ca+ rapidly removed Sacromere relaxes Ca
Energy Source ATP – Adenosine triphosphate – Glucose Metabolism Not all ATP is used with muscle contraction excess energy heat
Types of contractions Isometric – Length of muscle remains constant but force Isotonic – Shortening of the muscle without increase in tension Combination
Muscle Tone State of readiness Flaccid: – tone Spastic: – tone Atonic: – No nerve impulse no tone atrophy
Assessment: Health History Common symptoms – Pain – Alt. sensation Past health Social history Family history
Small Group Question Mrs. Jones comes into the doctor’s office complaining of pain in her left knee. What questions will you ask her to assess her pain?
Did you ask the following questions? Characteristics Location Rating Onset Duration Manifestations Precipitating factors Effect of ADL’s Aggravations Diminishes Radiating Associated complaints Past injuries
Physical Examination Posture – What is this? – Kyphosis curve of the thoracic spine
Physical Examination Posture – What is this? – Lordosis Curve of the lumbar spine
Physical Examination Posture – What is this? – Scoliosis Lateral curve of the spine
ROM Internal rotation / Medial rotation Move inward on a central axis External rotation / Lateral rotation Move outward on a central axis
Range of Motion Passive Total assist Active Independent
Range of Motion Never attempt to move a joint past its normal range of motion for the client or past the point at which pain is experienced.
Physical Assessment Joint Function – ROM – Deformity – Stability – Contracture Permanent shortening of the muscle – Crepitus – Effusion
Bulge Sign Position: supine Milk upward on the medial side of the knee Tap the lateral side of the patella Observe for a fluid bulge = effusion http://www.youtube.co m/watch?v=LsgutijmX7 U http://www.youtube.co m/watch?v=LsgutijmX7 U http://www.youtube.co m/watch?v=fNUGyNYV hqE http://www.youtube.co m/watch?v=fNUGyNYV hqE
Ballottement Apply downward pressure just above the knee Tap the patella Fluid will cause the patella to rebound http://www.youtube.co m/watch?v=PlgSsE8EvX E http://www.youtube.co m/watch?v=PlgSsE8EvX E
Balloon sign AKA – Water on the knee http://www.youtube.co m/watch?v=FfO4Nhu0u 3s http://www.youtube.co m/watch?v=FfO4Nhu0u 3s
Muscle Strength & Size GradeDescription 0No contraction, paralysis 1Contraction felt, no movement 2Passive ROM 3Full ROM against Gravity 4Full ROM against some resistance 5Full ROM against full resistance
Muscle Strength & Size Measure Girth – Max circumference – At rest
Small group Questions 1.Define lordosis, scoliosis, kyphosis. 2.Differentiate between the different movement of ROM. 3.How are the bulge and ballottement signs assessed and what do they indicate? 4.How do you assess neurovascular status?
Diagnostic Tests Laboratory tests Erythrocyte sedimentation rate (ESR) C-reactive protein (CRP) Calcium Phosphate Uric Acid Diagnostic test X-ray CT-scan MRI Bone scan Densitometry Arthrocentesis Arthroscopy Electromyelogram
Erythrocyte Sedimentation Rate (ESR) What does an elevated ESR indicate? A.Bone cancer B.Osteoporosis C.Inflammation D.Anemia E.Auto-immune disease
C-reactive Protein What does an positive CRP indicate? A.Bone cancer B.Osteoporosis C.Inflammation D.Anemia E.Auto-immune disease
Arthroscopy Purpose – Direct visualization of the joint Nrs. Considerations – Compression bandage – Ice – Elevate – S&S of infection http://www.youtube.co m/watch?v=Yb2YsSbSdc k http://www.youtube.co m/watch?v=Yb2YsSbSdc k
Electromyelogram (EMG) Purpose – Electrical potential of a muscle – Differentiate muscle & nerve problem
Small Group Questions 1.What do the following tests measure? – ESR, CRP, Ca+, Ph+, Uric acid and ANA 2.How are the following diagnostic tests performed, what do they diagnose and what are the nursing considerations? – X-ray, Ctscan, MRI, Bone scan, Densitometry, Arthrocentesis, Arthroscopy, EMG
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