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

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

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

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.

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

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

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

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

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

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

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

Nursing Diagnosis and Planning Requires careful planning Making beds Planning for toileting See Table 31-4 on pp. 727-728.

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.

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

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

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

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.

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

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

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

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

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

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.