1. Copyright © 2008 Delmar Learning. All rights reserved. Unit 41 Musculoskeletal System

2. Copyright © 2008 Delmar Learning. All rights reserved. Objectives Spell and define terms. Describe the location and functions of the musculoskeletal system. Describe some common conditions of the musculoskeletal system.

3. Copyright © 2008 Delmar Learning. All rights reserved. Objectives Describe the nursing assistant actions related to the care of patients with conditions and diseases of the musculoskeletal system. List seven specific diagnostic tests for musculoskeletal conditions.

4. Copyright © 2008 Delmar Learning. All rights reserved. The Musculoskeletal System Skeleton –Bony frame of the body Muscles –Tissues made up of contractile fibers or cells that produce movement –Together, the skeleton and muscles are termed the musculoskeletal system

5. Copyright © 2008 Delmar Learning. All rights reserved. Review the parts of the human skeleton Structure and Function

6. Copyright © 2008 Delmar Learning. All rights reserved. Review the major muscles of the body Structure and Function

7. Copyright © 2008 Delmar Learning. All rights reserved. Common Conditions Many conditions can affect the bones, muscles, tendons, ligaments, and joints Often, when one of these structures is diseased or injured: –Surrounding tissues are also involved

8. Copyright © 2008 Delmar Learning. All rights reserved. Range of Motion Patients who have been ill or confined to bed are not as active as usual –Their joints may not move through the normal range of motion daily Atrophy –Weakness and muscle wasting from lack of use

9. Copyright © 2008 Delmar Learning. All rights reserved. Range of Motion Over time –Muscles become rigid –Joints do not move as freely as they once did –Joint movement may be painful because the muscles have shortened from lack of use

10. Copyright © 2008 Delmar Learning. All rights reserved. Range of Motion When the joint moves –Muscles stretch This causes discomfort or pain –As a result the patient may move even less

11. Copyright © 2008 Delmar Learning. All rights reserved. Abduction – Moving away from midline Adduction – Moving toward the midline Flexion- Decreasing the angle between two bones Extension – Increasing the angle between two bones

12. Copyright © 2008 Delmar Learning. All rights reserved. Bursitis – Inflammation of the bursae (small sacs of fluid around joints) Treatment – use heat to promote healing

13. Copyright © 2008 Delmar Learning. All rights reserved. Arthritis Rheumatoid – autoimmune response can occur with any age Osteoarthritis – affects the cartilage covering the ends of the bones that form a joint. Most common symptom is Pain

14. Copyright © 2008 Delmar Learning. All rights reserved. Gout – The great toe is usually first affected. Caused by uric acid not metabolized correctly. It may go into remission

15. Copyright © 2008 Delmar Learning. All rights reserved. osteoporosis Metabolic disorder of the bones Most common in women The first sign is a fracture Treatment is to prevent fractures and control pain

16. Copyright © 2008 Delmar Learning. All rights reserved. Fibromyalgia Chronic pain syndrome. Not sure of cause Affects more women than men Criteria for dx: Pain on both sides of the body, pain above and below the waist, and pain upon palpatation in at least 11 of 18 body sites

17. Copyright © 2008 Delmar Learning. All rights reserved. Fractures See pg 709

18. Copyright © 2008 Delmar Learning. All rights reserved. Signs/Sx of fracture Edema, Pain, Limited movement, ecchymosis – Bruising Treatment – Keep immobile, in most cases will not exercise the fractured extremity

19. Copyright © 2008 Delmar Learning. All rights reserved. Cast Elevated the casted extremity on a pillow Turn the patient frequently using the palms of your hands Observe the uncasted area of the extremity for signs off decreased circulation. Report coldness, cyanosis, swelling, increased pain, numbnessor tingling

20. Copyright © 2008 Delmar Learning. All rights reserved. Signs of infection under cast Odor and drainage

21. Copyright © 2008 Delmar Learning. All rights reserved. Traction It is designed to pull two body areas slightly apart. Do Not disturb the weights Check under straps for pressure areas Keep bed covers off of ropes and pulleys

22. Copyright © 2008 Delmar Learning. All rights reserved. Hip fractures most common with elderly The leg on the affected side may be shortened and in a position of external rotation At risk of pressure ulcers on the heels therefore a pressure relieving mattress may be ordered

23. Copyright © 2008 Delmar Learning. All rights reserved. THA total hp arthroplasty (Insertion of a hip prosthesis) Care: Anti embolism stockings trapeze bar Use an abduction pillow to keep legs apart Avoid flexion of the hip and legs Bed is not elevated more than 45 degrees (see pg 715)

24. Copyright © 2008 Delmar Learning. All rights reserved. Total Joint Replacement Goal is to relieve pain. Most common is hip and knee

25. Copyright © 2008 Delmar Learning. All rights reserved. CPM (Continuous Passive Motion) CPM therapy prevents stiffness by delivering a form of passive ROM so the joint is moved without the patient’s muscles being used. CPM therapy is effortless for the patients

26. Copyright © 2008 Delmar Learning. All rights reserved. Compartment syndrome Painful condition that occurs when pressure within the muscles builds up, preventing blood and oxygen from reaching muscles and nerves, This is a serious complication that may develop following an injury or surgical procedure Report to nurse immediately this is surgical emergency.

27. Copyright © 2008 Delmar Learning. All rights reserved. Amputation Phantom pain - this is a real pain Avoid abduction Avoid flexion of the knee Avoid placing pillow under the amputated extremity Avoid elevating HOB Keep legs in adduction

28. Copyright © 2008 Delmar Learning. All rights reserved. Range of Motion Prevents contractures (disfigurement caused by muscle shortening) Easier to prevent than reverse

29. Copyright © 2008 Delmar Learning. All rights reserved. EMG – measure the effectiveness of muscle/nerve interaction