medical surgical nursing - musculoskeletal disorders and their interventions

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Nursing Interventions for clients with Musculoskeletal Dysfunction

Nursing Interventions for clients with Musculoskeletal DysfunctionsBy: Andreas Admassu TeferraNursing Interventions for clients with Musculoskeletal Dysfunctions

On completion of this chapter, the learner will beable to:

Describe the basic structure and function of the musculoskeletal system.Discuss the significance of the health history to the assessment of musculoskeletal health.Describe the significance of physical assessment to the diagnosis of musculoskeletal dysfunction.Specify the diagnostic tests used for assessment of musculoskeletal function.Nursing Interventions for clients with Musculoskeletal Dysfunction

Nursing Interventions for clients with Musculoskeletal Dysfunction

3By: Andreas Admassu TeferraAdigrat University: Department of Nursing

Anatomic and Physiologic reviewThe musculoskeletal system includes the bones, joints, muscles, tendons, ligaments, and bursae of the body.The musculoskeletal system provides protection for vital organs, including the brain, heart, and lungs; provides a sturdy framework to support body structures; and makes mobility possible.Muscles and tendons hold the bones together and joints allow the body to moveTendons attach muscles to bones.Nursing Interventions for clients with Musculoskeletal Dysfunction

The musculoskeletal system serves as a reservoir for immature blood cells and essential minerals, including calcium, phosphorus, magnesium, and fluoride. More than 98% of total body calcium is present in bone. There are 206 bones in the human body, divided into four categories: long bones (eg, femur), short bones (eg, metacarpals), flat bones (eg, sternum), and irregular bones (eg, vertebrae).

Nursing Interventions for clients with Musculoskeletal Dysfunction

Long bones are designed for weight bearing and movement. Short bones consist of cancellousbone covered by a layer of compact bone. Flat bones are important sites of hematopoiesis and frequently protect vital .organs.Adigrat University: Department of NursingBy: Andreas Admassu Teferra5

Nursing Interventions for clients with Musculoskeletal Dysfunction

Covering the bone is a dense, fibrous membrane known as the periosteum. The endosteum is a thin, vascular membrane that covers the marrow cavity.Red bone marrow, located mainly in the sternum, ilium, vertebrae, and ribs in adults, is responsible for producing red blood cells, white blood cells, and platelets through a processcalled hematopoiesis.Adigrat University: Department of NursingBy: Andreas Admassu Teferra6

The cells are of three basic typesosteoblasts, osteocytes, and osteoclasts.Osteoblasts function in bone formation by secreting bone matrix. The matrix consists of collagen and ground substances (glycoproteins and proteoglycans) that provide a framework in which inorganic mineral salts are deposited.Osteocytes are mature bone cells involved in bone maintenance.Osteoclasts are multinuclear cells involved in dissolving and resorbing bone.Osteogenesis (bone formation) begins long before birth.Ossification is the process by which the bone matrix is formed and hard mineral crystals composed of calcium and phosphorus are bound to the collagen fibers.Nursing Interventions for clients with Musculoskeletal Dysfunction

By early adulthood (ie, early 20s), remodeling is the primary process that occurscalcium; and several hormones, including calcitriol (ie, activated vitamin D), parathyroid hormone regulates the concentration of calcium in the blood, In response to low calcium levels in the bloos (PTH), involved in bone remodeling increased levels of PTH prompt the mobilization of calcium, the demineralization of bone,Adigrat University: Department of NursingBy: Andreas Admassu Teferra7

The junction of two or more bones is called a joint (articulation).There are three basic kinds of joints: synarthrosis, amphiarthrosis, and diarthrosis joints.Synarthrosis joints are immovable (eg, the skull sutures). Amphiarthrosis joints (eg, the vertebral joints and the symphysis pubis) allow limited motion.Diarthrosis joints are freely movable jointsThere are several types of diarthrosis joints: Examples are Ball-and-socket joints and Hinge joints.Nursing Interventions for clients with Musculoskeletal Dysfunction

Adigrat University: Department of NursingBy: Andreas Admassu Teferra8

A tough, fibrous sheath called the joint capsule surrounds the articulating bones.The capsule is lined with a membrane, the synovium, which secretes the lubricating and shock absorbing synovial fluid into the joint capsule.Ligaments (fibrous connective tissue bands) bind the articulating bones together.Nursing Interventions for clients with Musculoskeletal Dysfunction

The ends of the articulating bones of a typical movable joint are covered with smooth hyaline cartilage.Adigrat University: Department of NursingBy: Andreas Admassu Teferra9

Nursing Interventions for clients with Musculoskeletal Dysfunction

bursa: fluid-filled sac found in connective tissue, usually in the area of jointsAdigrat University: Department of NursingBy: Andreas Admassu Teferra10

The muscles of the body are composed of parallel groups of muscle cells (fasciculi) encased in fibrous tissue called fascia (epimysium).Each muscle cell (also referred to as a muscle fiber) contains myofibrils, which in turn are composed of a series of sarcomeres, the actual contractile units of skeletal muscle.Muscle cells contract in response to electrical stimulation delivered by an effector nerve cell at the motor end plate.Relaxed muscles demonstrate a state of readiness to respond to contraction stimuli. This state of readiness is known as muscle tone.Nursing Interventions for clients with Musculoskeletal Dysfunction

Review of skeletal muscle system A muscle that is limp and without tone is described as flaccid; a muscle with greater-than normal tone is described as spastic.

Adigrat University: Department of NursingBy: Andreas Admassu Teferra11

Assessment of clients with MS problemsHealth HistoryPainAltered sensationsParesthesias - burning, tingling sensations or numbness.Past Health, Social, and Family Historyexercise patterns, dietary intakePhysical AssessmentPostureKyphosis, Scoliosis, LordosisGaitsmoothness and rhythmNursing Interventions for clients with Musculoskeletal Dysfunction

Bone integrityShortened extremities, amputations, crepitusJoint functionROM, effusion, dislocation, nodules*Muscle strength and functionWeakness (Myasthenia Gravis, Poliomyelitis)Muscle toneGrasp strengthClonus Nursing Interventions for clients with Musculoskeletal Dysfunction

Precise measurement of range of motion can be made by a goniometer (a protractor designed for evaluating joint motion).As in RA and gout

Clonus rhythmic contraction of a muscleAdigrat University: Department of NursingBy: Andreas Admassu Teferra13

Nursing Interventions for clients with Musculoskeletal Dysfunction

SkinEdema, temperature, colorNeurovascular statusBy assessing sensation and movement (peripheral nerve function)Diagnostic EvaluationX-Ray, CT scan, MRIArthography useful in identifying acute or chronic tears of the joint capsule or supporting ligaments of the knee, shoulder, ankle, hip, or wrist.A radiopaque contrast agent or air is injected into the joint cavity to visualize irregular surfaces and a series of X-Rays will be done.

Nursing Interventions for clients with Musculoskeletal Dysfunction

Nursing Interventions for clients with Musculoskeletal DysfunctionArthroscopy allows direct visualization of a joint to diagnose joint disordersArthrocentesisis carried out to obtain synovial fluid for purposes of examination or to relieve pain due to effusion.BiopsyLab studiesSerum calcium level (PTH dysfunction, bone metastasis)Acid Phosphate (increases during metastatic bone cancer)Urine calcium level (indicate bone destruction)

Hemarthrosis bleeding inside the joint cavityAdigrat University: Department of NursingBy: Andreas Admassu Teferra16

Management of Patients with Musculoskeletal DisordersNursing Interventions for clients with Musculoskeletal Dysfunction

Low Back Pain

Most low back pain is caused by one of many musculoskeletal problems, including acute lumbosacral strain, unstable lumbosacral ligaments and weak muscles, osteoarthritis of the spine, spinal stenosis, intervertebral disk problems, and unequal leg length.

Nursing Interventions for clients with Musculoskeletal Dysfunction

PathophysiologyThe spinal column can be considered an elastic rod constructed of rigid units (vertebrae) and flexible units (intervertebral disks)Its unique construction allows for flexibility while providing maximum protection for the spinal cord.The trunk muscles help stabilize the spine. The abdominal and thoracic muscles are important in lifting activitiesDisuse weakens these supporting muscular structures. Obesity, postural problems, structural problems, and overstretching of the spinal supports may result in back painNursing Interventions for clients with Musculoskeletal Dysfunction

Disk degeneration is a common cause of back pain. The lower lumbar disks, L4L5 and L5S1, are subject to the greatest mechanical stress and the greatest degenerative changes.Clinical Manifestationsacute back pain (lasting less than 3 months) or chronic back pain (lasting more than 3 months without improvement) Fatiguepain radiating down the leg, which is known as radiculopathy or sciaticaThe patients gait, spinal mobility, reflexes, leg length, leg motor strength, and sensory perception may be affected.Physical examination may disclose paravertebral muscle spasm (greatly increased muscle tone of the back postural muscles)Nursing Interventions for clients with

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