Musculoskeletal System Review PDF

**Review anatomy and physiology of the musculoskeletal system.** - **Bones provide structural support, protect internal organs, allow for movement by serving as points of attachment for muscles, store minerals, and produce blood cells. The skeleton is divided into the axial skeleton (...

**Review anatomy and physiology of the musculoskeletal system.** - **Bones provide structural support, protect internal organs, allow for movement by serving as points of attachment for muscles, store minerals, and produce blood cells. The skeleton is divided into the axial skeleton (skull, vertebrae, ribs) and appendicular skeleton (shoulder, pelvic girdles, upper and lower limbs).** - **Muscles are composed of bundles of muscle fibers that contract to produce movement when stimulated by nerve impulses. Skeletal muscles attach to bones via tendons and work in opposing pairs to allow for movement.** - **Joints are the areas where two or more bones meet. They allow for different types and degrees of movement based on their structural composition. The main joint types are immovable, slightly movable, and freely movable (synovial).** - **Cartilage provides smooth surfaces for joint motion and flexibility. Ligaments connect bones to other bones, while tendons attach muscles to bones. These connective tissues help stabilize joints and facilitate movement.** 2. **Interpret the nurse's role in assessment of the musculoskeletal system.** - **Baseline** - **Health history (PMH)** - **Neurovascular examination** - **Physical examination** i. **Posture** ii. **Gait** iii. **ROM** iv. **Mobility gait** - **- Inspecting for muscle wasting, deformities, swelling, and skin changes** - **- Palpating for tenderness, warmth, crepitus, and muscle tone** - **- Assessing active and passive range of motion in all major joints** - **- Testing muscle strength against resistance in major muscle groups** - **- Observing gait, balance, coordination, and functional mobility** - **- Obtaining history of musculoskeletal injuries, conditions, or limitations** - **- Collaborating with other disciplines like physical therapy as needed** 3. **Explain how the client's developmental stage may affect musculoskeletal function.** - **Infant -** v. **Soft spots on heads** vi. **More cartilage than bone** vii. **Epiphyses that are not fully developed** - **Adolescent -** viii. **More at risk for osteosarcoma** - **Adults-** ix. **Peak bone mass is at age 35** - **Older adults-** x. **Osteoarthritis** xi. **Bone density decrease** 4. **Apply nursing care of client's under-going diagnostic tests of the musculoskeletal system.** 5. **Apply the nursing process to the following: ADPIE** - **bone and soft tissue disorders** - **A-ssess pain levels, range of motion, strength, deformities, and functional limitations.** - **D-iagnose impaired physical mobility, acute/chronic pain, risk for injury related to factors.** - **P-lan interventions like immobilization, weight-bearing limits, assistive devices, pain management.** - **I-mplement positioning, transfers, exercises, and patient education on self-care.** - **E-valuate effectiveness of interventions on improving mobility and independence.** - **musculoskeletal surgeries** - **A-ssess pre-op mobility, pain, anxiety, and health literacy.** - **D-iagnose deficient knowledge, acute pain, impaired mobility risks.** - **P-lan for pre-op teaching, post-op positioning, exercises, and pain control.** - **I-mplement pre-op education, post-op monitoring, analgesics, and mobility aids.** - **E-valuate understanding, pain levels, range of motion, and discharge readiness.** - **Post-operative complications** - **A-ssess surgical sites, drains, neurovascular status, vital signs, and lab results.** - **D-iagnose risks like infection, injury, acute pain based on assessment data.** - **P-lan interventions like wound care, monitoring, medications, and precautions.** - **I-mplement dressing changes, neurovascular checks, analgesics, and activity limits.** - **E-valuate for resolution of complications and readiness for discharge teaching.** 6. **List clinical manifestations of fractures** - **Signs and Symptoms** - **unnatural alignment (deformity),** - **swelling** - **muscle spasm** - **tenderness** - **pain** - **impaired sensation** - **decreased mobility** - **Describe the emergency treatment for fractures** - **Immediately immobilize the affected limb.** - **Unless there is bleeding, apply splints and padding above and below the fracture site, directly over the clothing. For bleeding, the site may need to be seen before pressure can be applied to the origin of the bleeding** - **If the fracture is in the leg, the other leg can be used as a splint by bandaging both legs together if needed.** - **Monitor color, warmth, circulation, and movement of the limb distal to the fracture.** - **For an open fracture, cover protruding bone with a clean (sterile preferred) dressing.** - **Do not attempt to straighten or realign a fractured extremity. Move the affected limb as little as necessary.** - **If not in a hospital, transport for emergency medical care** - **Compare the following three methods for obtaining fracture reduction:** - **Closed- While manually pulling on the bone (limb), the health-care provider (HCP) manipulates the bone ends into alignment.** - **Open- The fractured bone ends are reduced (aligned) by direct visualization through a surgical incision (open reduction)** - **Traction- Traction is the application of a pulling force with prescribed weights to part of the body to position and hold bone fragments in correct alignment.** - **Explain two methods of immobilizing fractures.** - **Splinting - This involves applying a rigid or semi-rigid device like a board or pre-formed splint to the injured area to prevent movement.** - **Casting - A cast is a firm, rigid outer shell that completely encases and immobilizes the injured area.** 7. **Summarize the difference between skin and skeletal traction.** 8. **State two examples for each of the following:** 9. **Skin traction-** - **1) Buck\'s traction - Used for femur fractures** - **2) Skin traction with weights - Used for hip/pelvic fractures** 10. **Skeletal traction-** - **1) Balanced suspension skeletal traction - Used for femur fractures** - **2) Skeletal traction with pins/wires into bone - Used for fractures of long bones** - **[List nursing observations for the client in traction. ]** - **neurovascular status distal to traction site** - **- Skin integrity at traction site** - **- Proper alignment and traction weights** - **- Pain levels** - **- Respiratory status if lower extremity traction** - **- Bowel/bladder function** - **[State major aspects of nursing care for a client in:]** - **[Traction]** - **- Maintain proper alignment and countertraction** - **- Check weights are freely moving through pulleys** - **- Provide skin care at traction site** - **- Reposition regularly** - **- Encourage deep breathing/coughing** - **- Provide pain medication as needed** - - **[Cast ]** - **- Monitor for excessive swelling, pain, numbness** - **- Elevate casted extremity** - **- Reinforce cast care instructions** - **- Encourage use of assistive devices** - **- Provide exercises for unaffected areas** 11. **Explain the physiology of bone healing from the time of fracture to the formation of callus.** - **The fracture occurs** - **Clot formation at fracture** - **Fibroblast and osteoblasts arrive** - **Fibrocartilage callus forms (within 1 week)** - **New bone forms over the callus** - **Complete healing and remodeling may take up to 1 year** 12. **List six complications associated with reduction and immobilization of a fracture.** **1[. Blood clot -- DVT]** - **S/S = swelling, redness, pain,** - **NI = sequential, early ambulation, anticoagulant** 2. **[Compartment syndrome ]** - **Pain (severe, unrelenting, and increased with passive stretching)** - **Paresthesia (painful tingling or burning)** - **Pallor (but there may be warmth or redness over the area)** - **Paralysis (late symptom)** - **Pulselessness (late and ominous sign)** - **Poikilothermic (temperature matches environment, i.e., the extremity is cool to touch).** 3. **[Regular neurovascular checks, report s/s immediately to provider, CSMPT checks frequently]** 4. **[Malunion - improper alignment leading to deformity]** 5. **[Nonunion - failure of the fracture to heal]** 6. **[Joint stiffness or contractures from immobilization]** 7. **[Muscle atrophy from disuse]**