2. THE MUSCULOSKELETAL SYSTEM ANATOMY PHYSIOLOGY DISEASE PROCESS

3. Anatomy Bones – 206 total –Long –Short –Irregular –Flat

4. Anatomy Joints – union of bones –Ligaments – bones to bones –Tendons – muscles to bones Types of joints –Synarthroses – no movement –Amphiarthroses – little movement –Diarthroses – free movement

5. Anatomy Muscles –Smooth –Striated –Cardiac

6. Physiology Children’s bones more porous, thus less susceptible to fx Bone length growth occurs at epiphyseal plate – –Cartilage cells replced by osteocytes One end of bone grows more actively than the other

7. Physiology Bone growth to the diameter occurs by deposition of osteocytes directly onto bone surface Bone growth regulated by growth hormone Bone growth stops when epiphyseal plates replaced by bone –This occurs earlier in girls than boys

8. Physiology Children may require prolonged immobilization due to fx, congenital deformity, diseases Complications may include anemia, fatigue Feelings of isolation, withdrawal can occur

9. Sprains & Strains Pathophysiology –Strain – stretching of muscle or tendon –Sprain – tearing with ligament involvement Treatment –RICE Nursing Implications

10. Fractures Pathophysiology –Simple –Compound –Comminuted –See p 571 Types of traction –Skeletal traction –Skin traction –See p 571 Immobilization –Bryant’s traction –Buck’s traction –Russell traction Volkmann’s ischemia Compartment syndrome Nursing Implications –See p 572 & 574

11. Osteomyelitis Pathophysiology –Infection of bone –s. aureus & h. influenzae most common S/S –Infants – fever & limited movement of affected area –Children – fever, pain, swelling, redness, tenderness

12. Osteomyelitis Treatment –Antibiotic –Bedrest –I&D Nursing implications –Support affected area –Reduce pain –Give antibiotics

13. Duchenne’s Muscular Dystrophy Pathophysiology –most common –Genetic –Occurs in boys only –Lack of dystrophin, a protein found in muscle cells

14. Duchenne’s Muscular Dystrophy S/S –Frequently diagnosed between 2 & 6 years because child is slow to develop –Clumsiness –Gower’s maneuver –Hypertrophy of calf muscles (to overcome weakness of gluteal & lumbar muscles) –Mental impairment –Weakness progresses; child usually confined to w/c by adolescence

15. Duchenne’s Muscular Dystrophy Treatment –No cure –Palliative Nursing implications –Instructions –Prevent complications

16. Legg-Calve-Perthes Disease Pathophysiology –Necrosis occurs of femoral head due to interruption of blood supply –Eventually replaced with live bone –Cause is unknown

17. Legg-Calve-Perthes Disease S/S –Limping –Limited ROM –No pain Treatment –NSAIDs –Restricted activity –Brace –Bedrest –Good prognosis

18. Osteosarcoma Pathophysiology –Usually in long bone near epiphyseal growth plate –Lungs common met site S/S –Pain –Swelling Treatment –Chemotherapy –Surgery

19. Ewing’s Sarcoma Pathophysiology –Commonly in marrow of long bones –Mets to lungs & other bones S/S – Pain Treatment –Chemotherapy –Surgery

20. Juvenile Rheumatoid Arthritis Pathophysiology –An autoimmune disease –Usually attacks large joints Chronic inflammation of synovial membrane Involves connective tissue & viscera –Three types Systemic Polyarticular Pauciarticular

21. Juvenile Rheumatoid Arthritis Systemic –Fever –Rash –Abdominal pain –Eventual joint pain Polyarticular –> 5 joints –Usually small joints Pauciarticular –< 4 joints –Usually large joints –May develop iridocyclitis

22. Juvenile Rheumatoid Arthritis Treatment –Supportive –Reduce pain –Promote optimal level of independence and development Medications –NSAIDs –Immune suppressant drugs –Methotrexate –Antirheumatic drugs (sulfasalazine)

23. Juvenile Rheumatoid Arthritis Nursing Implicatioins –Instruct meds –Teach ROM –Adaptive devices such as velcro on shoes –Encourage parents to allow child to perform to max potential

24. Torticollis Pathophysiology –Shortening of sternocleidoomastoid muscle resulting in limited ROM S/S –Decreased ROM –Short neck –Asymmetry of head & neck

25. Torticollis Treatment – exercises to stretch muscle Nursing implications – instruct parents about exercises

26. Curvature Of The Spine Pathophysiology –Kyphosis – humpback –Lordosis – swayback –Scoliosis – lateral curvature; most common Functional Structural

27. Curvature Of The Spine Treatment –May require brace or surgery Harrington rod –Braces must be worn 20-22 hrs a day Milwaukee brace – p 582

28. Scoliosis Screening Look for asymmetry of: –Shoulders –Scapula –Arm to body –Hip

29. References Liefer, G. (2003). Introduction to maternity & pediatric nursing, (4 th ed.). Saunders: Philadelphia.