long bones
cylindric with rounded ends and often bear weight (femur)
short bones
small and bear little or no weight (fingers)
flat bones
-protect vital organs
-often contain blood forming cells
irregular bones
unique shapes (wrist bones)
sesamoid bone
develops within a tendon
cortex
-outer layer of bone
-composed of dense compact bone tissue
haversian system
microscopic blood vessels that supply nutrients and oxygen to bone as well as lacunae
osteocytes
bone cells
cancellous tissue
contains large spaces (trabeculae) filled with red and yellow marrow
Hematopoiesis
production of red blood cells occurs in the red marrow
yellow marrow
contains fat cells which can dislodge, enter the bloodstream and cause fat embolism syndrome (FES)
periosteum
outermost covering of the bone
osteoblasts
bone forming cells
osteoclasts
bone destroying cells
the skeletal system
-provides a framework for the body and allows the body to be weight bearing or upright
-supports the surrounding tissues
-assists in movement
-protects vital organs
-manufactures blood
-storage for mineral salts
by 35 yrs old
bone destruction is more frequent and formation slows down
as calcium levels rise
phosphorus levels decrease
in response to PTH
calcium is released into the bloodstream by the bones
calcitonin
-produced by the thyroid
-decreases serum calcium concentration
-inhibits bone resorption (destruction)
-increases renal excretion of calcium and phospherus when needed
Vit D
-produced in the body
-transported in the blood to promote absorption of calcium and phosphorus
a decrease in Vit D
can result in osteomalacia (softening of the bone)
mineral and hormones affecting bone growth
-calcium
-phosphorus
-calcitonin
-Vit D
-parathyroid hormone (PTH)
-growth hormone
-glucocorticoids
-estrogens & androgens
-thyroxine
-insulin
PTH
-released when calcium levels are low
-stimulates bone to promote osteoclastic activity which releases calcium into blood
growth hormone
-secreted by the pituitary gland
-increases bone length
-determines the amount of bone matrix formed before puberty
adrenal glucocorticoids
-regulate protein metabolism
-reduce or intensify organic matrix of bone
estrogens
-stimulate osteoblastic
-inhibit PTH
androgens
increase bone mass
thyroxine
increase the rate of protein synthesis
insulin
works with growth hormone to build and maintain healthy bone tissue
synarthrodial joint
completely immovable (cranium)
amphiarthrodial joint
slightly movable (pelvis)
diarthrodial (synovial)
-freely movable (elbow, knee)
-most common
-synovial fluid lubricates and absorbs shock
synovitus
synovial inflammation
ball-and-socket joint
permit movement in any direction (shoulder, hip)
hinge joint
allow flexion and extension (elbow)
smooth muscle
-contractions of organs and blood vessels
-controlled by autonomic nervous system
cardiac muscle
-striated
-involuntary muscle
-autonomic nervous system
skeletal muscle
-striated
-voluntary muscle
-controlled by central and peripheral nervous system
-main function: movement of the body and its parts
tendons
bands of tough, fibrous tissue that attach muscle and bones
ligaments
attach bones to other bones at joints
Osteopenia
-decreased bone density (bone loss)
-when severe causes osteoporosis
Osteoporosis
-causes postural and gait changes
-predisposes the person to fractures
Osteoarthritis (OA)
a result from the synovial joint cartilage becoming less elastic and compressible leading to joint damgage
Nursing Interventions (NI) for decreased bone density
-teach pt safety tips to prevent falls
-reinforce need to exercise, especially weight-bearing exercise
NI for Increased bone prominence
prevent pressure on bone prominences
NI for kyphotic posture
-teach proper mechanics
-instruct pt to sit in supportive chairs with arms
NI for cartilage degeneration
assess the pt's ability to perform ADL's and mobility
NI for muscle atrophy, decreased strength
teach isometric exercises
NI for slowed movement
-do not rush pt
-be patient
taking patient history
-ask about any previous traumatic or sports injuries no matter how old
-ask about any previous hospitalizations, illnesses, or complications
-ask about ability to perform ADL's (ind. or assisted?)
-ask about current lifestyle
-exercise?
-alcohol?
-tobacco
arthralgias
joint aching
taking a nutrition history
-significant weight gain or loss?
-what is a typical food day?
-getting enough calcium?
-afford healthy food?
-enough vitamins, minerals?
-vit C & D deficiency slows bone and tissue healing
obesity
-places stress and strain on bones and joints
-result in fractures and trauma to joint cartilage
-inhibits mobility
-can lead to resp and circulatory problems
family history/genetic risk
-any serious illness/disease?
-cancer?
common symptoms of musculoskeletal problems
-pain
-weakness
current health problem
-date of onset
-factors that cause or worsen problem
-clinical manifestations
-what improves manifestations
assessment of pain
-can be related to bone, muscle, or joint
-acute or chronic
-intensity (0-10)
-dull, burning, aching, stabbing
-location, radiation
-pt should describe in his/her own words
weakness
-one muscle, or a group of muscles
-proximal, distal
-proximal; may indicate myopathy
-distal; may indicate neuropathy
-location
-lower extremeties; increase risk for falls
-upper extremities; may interfere with ADL's
posture and gait
-assess curvature of spine
-assess length, shape, and symmetry of extremities
-inspect muscle mass of size and symmetry
-evaluate balance, steadiness, and stride
mobility and functional assessment
-need for ambulatory devices
-ability to perform ADL's
-assess bones, joints, and muscles by:
-inspection
-palpation
-assessing ROM
goniometer
used to provide an exact measurement of flexion and extension or joint ROM
antalgic gait
-an abnormality in the stance phase of gait
-pt shortens step on affected side
lurch gait
-abnormality in the swing phase of gait
-shoulders are moved side-to-side or front-to-back for help in shifting the weight from one leg to the other
crepitus
a grating sound
effusion
fluid accumulation
genu valgum
inward kness "knock knees
genu varum
bow legged
Lovet's scale
used for grading muscle strength
Lovet's scale 5
normal: ROM unimpaired against gravity with full resistance
Lovet's scale 4
Good: can complete ROM against gravity with some resistance
Lovet's scale 3
Fair: can complete ROM against gravity
Lovet's scale 2
poor: can complete ROM with gravity eliminated
Lovet'sscale 1
trace: no joint motion and slight evidence of muscle contractility
Lovet's scale 0
Zero: no evidence of muscle notractility
neurovascular assessment (circ chack)
-palpation of pulses in extremities below level of injury
-assess sensation
-assess movement
-assess color
-assess temp
-assess pain in injured part
psychosocial assessment
-anxiety and depression are common with chronic pain
-deformity/amputation can affect a person's body image and self-concept
muscle enzymes affected in disease or injury
in result to damage, muscle tissue releases additional amounts of these enzymes, increasing serum levels:
-creatine kinase (CK-MM)
-aspartrat aminotransferase (AST)
-aldolase (ALD)
-lactic dehydrogenase (LDN)
hypercalcemia may indicate
-metastatic cancers of the bone
-Paget's disease
-bone fractures in healing stage
hypocalcemia may indicate
-osteoporosis
-osteomalacia
hyperphosphatemia may indcate
-bone fractures in healing stage
-bone tumors
-acromegaly
hypophosphatemia may indicate
-osteomalacia
elevations in ALP may indicate
-metastatic cancers of the bone
-Paget's disease
-osteomalacia
elevations in CK may indicate
-muscle trauma
-progressive muscular dystrophy
-effects of electromyography
elevated LDH levels my indicate
-skeletal muscle trauma
-extensive cancer
-progressive muscular dystrophy
elevated AST may indicate
-skeletal muscle trauma
-progressive muscular dystrophy
elevated ALD may indicate
-polymyositis and dermatomyositis
-muscular dystrophy
what x-rays show
bone:
-bone density
-alignment
-swelling
-intactness
joints:
-size of joint space
-smoothness of articular cartilage
-synovial swelling
arthroscopy
a tube is inserted into the joint for direct visualization of ligaments, menisci, and articular surfaces of joint.
post-arthroscopy
-assess neurovascular of affected limb q1hr
-monitor/document:
-distal pulses
-warmth
-color
-capillary refill
-pain
-movement
-sensation of affected limb
-pt should perform taught exercises
-take prescribed analgesics/opioids for pian
-may have short ter