1. Medical-Surgical Nursing: Concepts & Practice
3rd edition
Chapter 31
The Musculoskeletal System
Copyright © 2017, Elsevier Inc. All rights reserved.

2. Overview Structure and functions of bones
Structure and functions of muscles
Age-related changes

3. Major Bones of the Human Skeleton
See Figure 31-1 on p. 720.

4. General Features of Long Bones
See Figure 31-2 on p. 720.
From Lewis SL, Heitkemper MM, Dirksen SR, et al: Medical-surgical nursing: assessment and management of clinical problems, ed. 9, St. Louis, 2014, Mosby.

5. Causes of Musculoskeletal Disorders
Trauma and bruising, strain, sprain, or fracture
Poor nutrition and weak bones
Inadequate protein and muscle wasting
Malignant tumors
Estrogen and osteoporosis

6. Prevention Weight training Safety measures
Nutrition for bone growth and density
Smoking and musculoskeletal health

7. Diagnostic Tests and Procedures
Blood counts
Blood cultures
Immune tests
Erythrocyte sedimentation rate (ESR)
Serum protein electrophoresis
Serum complement and immunoglobulins

8. Diagnostic Tests and Procedures (Cont.)
Imaging and use of contrasts
Nursing management
Goniometry and range of motion

9. Measurement of Joint Motion with a Goniometer
See Figure 31-3 on p. 725.
From Mourad LA: Orthopedic disorders, St. Louis, 1991, Mosby.

10. Assessment (Data Collection)
Note problems of movement and changes in facial expression related to activities of daily living (ADLs).
Precipitating events
Family members’ and patient’s ability to perform the ADLs

11. Physical Assessment of the Musculoskeletal System
Posture, gait, and balance
Mobility, range of motion, and strength
Spine
Appearance of joints
Skeletal muscle appearance in arms and legs
Ability to perform ADLs
Older adult considerations

12. Nursing Diagnosis and Planning
Requires careful planning
Making beds
Planning for toileting
See Table 31-4 on pp

13. Lifting and Turning the Patient
Gentle and firm movements
Sufficient help and adequately trained personnel
If the patient can help without damaging the diseased joint or limb, he or she should be encouraged to do so.
If the patient is not able to help, explain the procedure to the patient and instruct him or her to relax completely during the procedure.

14. Interventions to Prevent Disability
Gradual mobilization
Exercise program
Proper positioning
Patient and family teaching
Nursing responsibility
Initiate and maintain measures to prevent complications.

15. Interventions to Prevent Disability (Cont.)
Prevent contractures.
“Adaptive shortening”
Most common: “footdrop,” knee and hip flexion contractures, “wrist drop,” and contractures of the fingers and arms
Loss of muscle tone

16. Interventions to Prevent Disability (Cont.)
See Figure 31-4 on p. 730.

17. Interventions to Prevent Disability (Cont.)
Prevent ankylosis.
Gradual mobilization
Nursing responsibility: Recognize patients who are at risk for falls while they are learning to regain their mobility.
Set goals for progressive mobilization.

18. Interventions to Prevent Disability (Cont.)
Exercise and ROM exercises
Isometric exercises
Administration of analgesic and anti-inflammatory drugs
Continuous passive motion
Positioning and special beds

19. Interventions to Prevent Disability (Cont.)
Use of slings and splints
Teaching ambulation with assistive devices
Crutch safety
Special maneuvers on crutches
Psychosocial care

20. Continuous Passive Motion Machine
See Figure 31-4 on p. 730.

21. FluidAir Bed
See Figure 31-6 on p. 733.

22. Wrist Splint
See Figure 31-7 on p. 733.

23. Evaluation Determine the effectiveness of interventions.
Be alert to nuances of body language.
Observe the patient’s ability to accomplish ADLs.
Check radiographs and laboratory tests.
Collaborate among all health professionals.