1. Slide 1 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Textbook For Nursing Assistants Chapter 25 - The Musculoskeletal System

2. Slide 2 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Structure of the Musculoskeletal System

3. Slide 3 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Four major types of bones Long bones Short bones Flat bones Irregular bones The Skeletal System

4. Slide 4 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Joints: areas where two bones join together Range of motion: the complete extent of movement that a joint is normally capable of Three main types of joints: Fixed Slightly moveable Freely moveable Ligaments cross over the joint capsule and attach one bone to another The Skeletal System

5. Slide 5 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Consists of the muscles Skeletal muscle: Attached to the bones by bands of connective tissue called tendons Occasionally, skeletal muscles are attached to other muscles by a broad, flat sheet of tendon called an aponeurosis The Muscular System

6. Slide 6 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Function of the Musculoskeletal System

7. Slide 7 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Protection Support Movement Heat production Calcium storage Production of blood cells Vital Functions

8. Slide 8 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. The Effects of Aging on the Musculoskeletal System

9. Slide 9 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Age-related changes affecting the musculoskeletal system are the leading cause of disability in older adults Age-related changes include: Loss of bone tissue Loss of muscle mass Wear and tear on joints Age Related Changes

10. Slide 10 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Disorders of the Musculoskeletal System

11. Slide 11 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Osteoporosis Arthritis Muscular dystrophy Fractures Amputation Types of Disorders

12. Slide 12 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Excessive loss of bone tissue Commonly affects the bones of the spine and pelvis, and the long bones in the arms and legs Most common in older women who have gone through menopause Painful, debilitating, and person is at increased risk for fractures from minor trauma Osteoporosis

13. Slide 13 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Smoking Inactivity or immobility A diet lacking in calcium, vitamin D Certain drugs, such as steroids Diseases of the thyroid and adrenal glands White race Small bones Osteoporosis: Risk Factors

14. Slide 14 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Can be prevented by exercising regularly and eating a diet rich in calcium, protein, and vitamin D, starting early in life Some treatments are available: medication that helps to slow progression, hormone replacement therapy, calcium and vitamin D supplements, weight-bearing exercise When caring for a person with osteoporosis, be gentle, encourage proper nutrition and hydration, encourage light exercise, and be observant for loss of function, swelling, or pain Osteoporosis

15. Slide 15 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Inflammation of the joints Types of arthritis: Osteoarthritis: degenerative disease Rheumatoid arthritis: autoimmune disease Gout: metabolic disease Arthritis

16. Slide 16 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Use an abduction pillow to keep the legs in the proper position when the person is in the supine or lateral position When out of bed, have the person sit in a straight-backed chair with his hips flexed no more than 90 degrees Help the person with ambulation and transferring Ask the nurse for any specific instructions or restrictions that are specific to your patient or resident Joint Replacement Surgery: Post Care

17. Slide 17 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. A group of disorders that cause the skeletal muscles to become more and more weak over time Types of muscular dystrophy Myasthenia gravis Duchenne’s muscular dystrophy Person will need more and more help with ADLs as the disease progresses Muscular Dystrophy

18. Slide 18 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Broken bone caused by trauma Older people are at a high risk Types of fractures Closed fracture Open fracture Greenstick fracture Impacted fracture Comminuted fracture Spiral fracture Fractures

19. Slide 19 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Treatments for fractures Reduction and fixation  Reduction may be closed or open  Fixation may be external (cast) or internal (metal plates, screws, pin, wires, or rods) Traction: used to keep the ends of the bone in alignment until the fracture can be permanently repaired by casting or surgery Fractures: Treatment Methods

20. Slide 20 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. The removal of all or part of an arm or a leg May be necessary as a result of trauma or disease Adjusting to the amputation can be emotionally difficult for the person A prosthetic device may be fitted; allows the person to regain function and a more normal appearance Phantom pain is the feeling that the amputated body part is still present after it has been removed Amputation

21. Slide 21 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. General Care Measures

22. Slide 22 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Techniques to prevent complications of immobility, relieve musculoskeletal discomfort, and maintain or restore musculoskeletal function Range-of-motion exercises Application of heat or cold Rehabilitation Different Techniques

23. Slide 23 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Usually performed at least twice a day, often along with other personal care activities, such as bathing or dressing May be active, passive, or active-assistive Used to help prevent complications of immobility, such as contractures, muscle weakness, and brittle bones Range-of-motion Exercises

24. Slide 24 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Always follow the care plan or the instructions that you are given exactly Move through the exercises in a systematic way Unless instructed otherwise, perform the same exercise on each corresponding body part Watch the person’s face for signs of discomfort or pain Do not move the joint past its natural range of motion Guidelines for Assisting with Range-of-Motion Exercises

25. Slide 25 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Used to reduce or prevent tissue swelling, promote healing, ease pain, and promote comfort Risk factors for injury from heat and cold applications Very old or very young age Chronic illness Very fair skin Impaired sensation Disorientation (e.g., dementia, use of pain medications) Heat and Cold Applications

26. Slide 26 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Used for people who have musculoskeletal injuries resulting from trauma, such as sprains and fractures Application of cold reduces pain and swelling and decreases bleeding Cold applications can be either moist or dry Cold applications should not be left in place for longer than 20 minutes, and skin should be checked every 10 minutes Cold Applications

27. Slide 27 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Relaxes the muscles, relieves pain, and promotes blood flow to the area Can be either moist or dry Should not be left in place for longer than 20 minutes, and the skin should be checked every 5 minutes Heat Applications

28. Slide 28 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Person with a musculoskeletal disorder may need physical, emotional, or vocational rehabilitation, or a combination of the three Role of nursing assistant: reassurance and encouragement active listener and an attentive observer familiarity with the supportive, assistive and prosthetic devices in use Rehabilitation

29. Slide 29 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. End of Presentation