Transcript Medical-Surgical Nursing: An Integrated Approach, 2E Chapter 24

Chapter 66
Assessment of Musculoskeletal
Function
Orthopedics
The branch of medicine that deals with the
prevention and correction of the disorders and
diseases of the musculo-skeletal system.
 The primary goal of the nurse caring for a
client with locomotor disorders is the
prevention of contractures (permanent
shortening of a muscle) or deformities.
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Skeletal Functions
To provide the body with a structural
framework.
 To act as a protective casing for internal
organs ( the brain, heart, lungs, etc.).
 To allow movement by muscles attached
to the skeleton.
 To store calcium, phosphorus, and
magnesium.
 To manufacture blood cells in the red
bone marrow.
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Structure
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206 Bones in the body
Long bones
 Short bones
 Flat bones
 Irregular bones
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Joints
 Muscles
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Bone Cells
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Osteoblasts
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Osteocytes
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Function in bone formation
Mature bone cells that function in bone
maintenance
Osteoclasts
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Multinuclear cells function in destroying,
resorbing, and remodeling bone
Bone Formation and Maintenance
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Osteogenesis: process of bone formation
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Ossification: the process of formation of the bone
matrix and deposition of minerals
Bone is in constant state of turnover
 Regulating factors
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Stress and weight-bearing
 Vitamin D
 Parathyroid hormone and calcitonin
 Blood supply
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Role of calcium
Bone Healing
Hematoma and inflammation
 Angiogenesis and cartilage formation
 Cartilage calcification
 Cartilage removal
 Bone formation
 Remodeling
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Joints
A joint is a junction of two or more bones.
 Three types:
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Diarthosis: freely movable such as hinge
(elbow, knee); ball and socket (hip,
shoulder), pivot (skull, first vertebrae), gliding
(wrist) and saddle (thumb).
 Synarthosis: joints are immovable (skull
sutures).
 Amphiarthosis: slightly movable (vertebrae
and pelvic bones).
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Hinge Joint of the Knee
Muscles
Attached to bones and other structures by
tendons
 Encased in a fibrous tissue—fascia
 Contraction of muscle causes movement
 Contraction utilizes energy in the form of ATP
 Anaerobic pathways using glucose metabolized
from stored glycogen provide energy for more
strenuous muscle activity
 Movement of the muscles may be voluntary or
involuntary.
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Assessment of the
Musculoskeletal System
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Include data related to function ability; ADLs and ability
to perform various activities. Note any problems related
to mobility.
Health history: family history, general health
maintenance, nutrition, occupation, learning needs,
socioeconomic factors, and medications—include OTC
Assessment of pain and altered sensations
Physical assessment: posture, gait, bone integrity, joint
function, muscle strength and size, skin, neurovascular
status
Assessment of the Bony
Skeleton
Notation on any deformities.
 Body alignment.
 Abnormal growths due to bone tumors.
 Shortened extremities, symetry.
 Amputations.
 Abnormal angulation other than at joints.
 Crepitus (a grating or crackling sensation
or sound).
 posture
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Assessment of Spine
Three common spinal curvatures:
Scoliosis (crooked back; lateral curving
deviation).
 Kyphosis (hump back; increased
roundness of the thoracic spinal curve).
 Lordosis (sway back; exaggeration of the
lumbar spine curvature as seen in
pregnancy).
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Normal Spine and 3
Abnormalities
Range of Motion (ROM)
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Active
person does the moving
 Have person move joint through each of its
various ROM movements
 Note the angle of each joint movement
 Note any pain, tenderness, or crepitus
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Range of Motion (ROM)
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Passive
person relaxes and allows you to move the
joints
 Done if person is unable to do active ROM
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• ALWAYS stop if the person complains of pain
• NEVER push a joint beyond its anatomic angle
Muscle Strength
As you are testing ROM
 Test muscle strength
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Ability to perform the ROM against resistance
• Symmetry
• Involuntary movements
Detecting Fluid in the Knee
Rheumatoid Arthritis—Ulnar
Deviation and “Swan-Neck”
Deformity
Diagnostic Evaluation
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X-rays
Computed tomography
MRI
Arthrography
Bone densitometry
Bone scan
Arthroscopy
Arthrocentesis
Electromyography
Biopsy
Laboratory studies