Musculoskeletal System Review and Nursing Role

Musculoskeletal System Review

• Bones provide structural support, protect internal organs, enable movement, store minerals, and produce blood cells.
• The skeleton is divided into axial (skull, vertebrae, ribs) and appendicular (shoulder, pelvic, upper/lower limbs) skeletons.
• Muscles contract to create movement, stimulated by nerve impulses. Muscles connect to bones via tendons and work in opposing pairs.
• Joints connect bones, allowing varying degrees of movement based on structure (immovable, slightly movable, freely movable).
• Cartilage smooths joint surfaces for motion and flexibility. Ligaments connect bones, while tendons connect muscles to bones.

Nurse's Role in Musculoskeletal Assessment

• Baseline Data: Collect patient history (medical and health).
• Neurovascular Examination: Assess circulation, sensation, motor function.
• Physical Examination:
  • Posture: Observe patient posture.
  • Gait: Evaluate patient gait (walking).
  • Range of Motion (ROM): Assess joint movement.
  • Mobility: Inspect muscle wasting, deformities, swelling, skin changes. Palpate for tenderness, warmth, crepitus, and muscle tone.
  • Assess strength against resistance (major muscle groups).
  • Observe functional mobility, balance, and coordination.
  • Obtain injury/condition history.
  • Collaborate with physical therapists (or other specialists) as needed.

Developmental Stage Impact

• Infants: Soft spots on the head, more cartilage than bone, developing epiphyses (ends of long bones). Infants are more vulnerable to fractures as bones are developing.
• Adolescents: High risk of osteosarcoma (bone cancer).
• Adults: Peak bone mass is generally reached around age 35. Older adults are at risk of osteoarthritis and decreased bone density.

Diagnostic Tests & Nursing Care

• Assessment (A): Evaluate pain levels, range of motion, strength, deformities, functional limitations related to bone and soft tissue disorders.
• Diagnosis (D): Identify impaired physical mobility, acute/chronic pain, risk for injury related to various factors.
• Planning (P): Develop interventions like immobilization, weight bearing limits, assistive devices, and pain management. Implement positioning, exercises, and patient education.
• Implementation (I): Establish and implement individualized plans based on patient needs.
• Evaluation (E): Assess effectiveness of care and evaluate mobility and independence.

Post-Operative Complications

• Post-operative complications often include wound infection, injury, acute pain, and related precautions.

Fracture Manifestations & Treatment

• Signs & Symptoms:*

• Deformity, swelling, muscle spasms, tenderness, pain, impaired sensation, decreased mobility.

• Emergency Treatment for Fractures: Immediately immobilize the affected limb (padding above and below fracture), address bleeding (if present), and immobilize using splints, or other methods.

Fracture Differences

• Skin traction uses bandages and weights to stabilize the affected limb while the injured area is protected and reduced.
• Skeletal traction uses pins or wires inserted into the bone to support the extremity.

Nursing Observations for Traction

• Skin Integrity: Assess for skin breakdown, injury or ulcerations at traction site.
• Neurovascular Status: Evaluate distal pulses, movement, sensation.
• Proper Alignment and Traction Weights: Monitor weights to ensure proper alignment.
• Pain Levels: Assess and manage pain.

Bone Healing

• Clot formation, fibroblast and osteoblast activity, fibrocartilage callus formation, new bone formation, and remodeling.

Fracture Complications

• Blood clots (deep vein thrombosis), compartment syndrome (intense pain and swelling), nerve damage, infection.

Unrelated Notes

• Malunion: Improper fracture alignment
• Nonunion: Fracture failure to heal
• Joint Stiffness/Contractures: Immobility leads to joint stiffness.
• Muscle Atrophy (Disuse): Reduced muscle mass from inactivity.