Musculoskeletal assessment (3).ppsx

Musculoskeletal system Prepared By Dr Samah El Garhy Assist. Prof. Medical Surgical Nursing Outlines -Introduction - Function of musculoskeletal system - Components of musculoskeletal system a - Bones classification of b...

Musculoskeletal system Prepared By Dr Samah El Garhy Assist. Prof. Medical Surgical Nursing Outlines -Introduction - Function of musculoskeletal system - Components of musculoskeletal system a - Bones classification of bones b- Skeletal muscles c- Joints d- Tendons e- Ligaments Assessment of Musculoskeletal System Abnormal findings Diagnostic tests - Introduction The musculoskeletal system provides form, stability, and movement to the human body. It consists of the body's bones, muscles, tendons, ligaments, joints, cartilage, and other connective tissue. Function of musculoskeletal system Support for the body. Protection for internal organs. Movement (bones and muscles act as levers to produce movement through joints). Mineral storage (minerals such as calcium and phosphorus). Blood cell formation (red marrow produces red and white blood cells and platelets). Anatomy of the skeleton system  Bones 206 bones classified as: Long bones: such as the femur and ulna Short bones: such as those in the fingers and toes. Flat bones: such as the sternum Irregular bones: such as the vertebra. Sesamoid bones: such as the palms of hand or soles of the feet. Ligament: Connect bone to bone Tendons: Connect bone to muscle  Muscle Types of Muscles Skeletal (voluntary) muscle: Attached to the bones of the body Smooth (involuntary) muscle: Carry out the automatic muscular functions of the body Cardiac muscle is an Involuntary muscle  Joints That join the body bones that allow for a variety of movements. The junction of two or more bones is called a joint  Cartilage is a firm, dense type of connective tissue that consists of cells embedded in a substance called the matrix. The primary functions of cartilage are to reduce friction between articular surfaces, absorb shocks, and reduce stress on joint surfaces. Bursa is a small sac filled with synovial fluid. That helps in reducing friction between areas, such as tendon, bone and ligament. Components of health assessment: Health assessment Health history Physical examination History of present illness, Inspection Past, present medical Palpation history Percussion Family history Auscultation Social history  PATIENT ASSESSMENT Chief Complain Pain Where is located? In joints as in arthritis or In bone as in fractures or tumors Limited Range of motion and its associated symptoms Numbness, Paresthesia, Weakness Medication Including name, the dose and frequency. Length of time it was taken, its effects, and any possible side effects. Many drugs can affect bone metabolism. As heparin chemotherapeutic agents  PATIENT ASSESSMENT Health history: Because certain illnesses are known to affect the musculoskeletal system either directly or indirectly. These include tuberculosis. poliomyelitis, diabetes mellitus, rickets. Information should be obtained about past hospitalizations and surgical procedures  PATIENT ASSESSMENT Health perception The nurse should ask about the patient's health perception related to the musculoskeletal system, such as maintenance of a normal body weight, avoidance of excessive stress on muscle, and joint, and the use of proper body mechanics when lifting objects.  PATIENT ASSESSMENT Nutritional metabolic pattern The patient's description of a typical day's diet provides clues to areas of nutritional concern that can affect the musculoskeletal system. Adequate amounts of vitamins C and D, calcium and protein are essential for a healthy, intact musculoskeletal system. Abnormal nutritional patterns can predispose individuals to problems such as osteoporosis. Sleep-rest pattern The discomfort caused by musculoskeletal disorder can interfere with a normal sleep pattern.  PATIENT ASSESSMENT Elimination pattern Decreased mobility secondary to a musculoskeletal problem can lead to constipation. Activity-exercise pattern The nurse should obtain a detailed account of the type, duration, and frequency of exercise and ask patient about limitation of movement, pain, weakness, or any change in the bone or joints that interferes with daily activities.  PATIENT ASSESSMENT Physical examination. Assessing joints and bones Inspection  Observes the movement and the range of motion.  Observing for external bleeding.  Evaluating peripheral circulation.  Checking the pupils and mental status if a head injury occurred.  PATIENT ASSESSMENT Motion: Evaluate both passive and active range of joint motion. The nurse should be cautious in performing passive range of motion because of the risk of injury to underlying structures. Muscle-strength testing The nurse grades the strength of individual muscles or group of muscles during contraction. The patient should be instructed to apply resistance to force exerted by the nurse. Muscle strength should also be compared with the strength of the opposite extremity.  PATIENT ASSESSMENT Palpation The nurse's hands should be warm to prevent muscle spasm, palpation of both muscle and joint allows for evaluation of skin temperature, local tenderness, and swelling.  Common musculoskeletal abnormalities  Foot drop: plantar flexion of the foot with the toes bent toward the instep is a characteristic sign of certain peripheral nerve or motor neuron disorders. It results from weakness or paralysis of the dorsiflexor muscles of the foot and ankle. Foot drop may also stem from prolonged immobility.  Muscle spasms: or cramps are strong, painful contractions. They can occur in virtually any muscle but are most common in the calf and foot. Muscle spasms typically result from simple muscle fatigue, exercise, electrolyte imbalances, neuromuscular disorders, and pregnancy. Common musculoskeletal abnormalities  Muscle atrophy, or muscle wasting, results from denervation or prolonged muscle disuse. Some muscle atrophy also occurs with aging  Crepitus: is an abnormal crunching or grating can hear and feel when a joint with roughened articular surfaces moves. It occurs in patients with rheumatoid arthritis or osteoarthritis or when broken pieces of bone rub together  Common musculoskeletal abnormalities  Muscle weakness: can result from a malfunction in the cerebral hemispheres, brain stem, spinal cord, nerve roots, peripheral nerves, or myoneural junctions and within the muscle itself.  Traumatic injuries: include fractures, dislocations, amputations, crush injuries, and serious lacerations. Common musculoskeletal abnormalities  Pain: anywhere from the hand to the shoulder and leg pain usually result from musculoskeletal disorders, but they can also stem from neurovascular, cardiovascular, or neurologic disorders. The 5 p's of musculoskeletal injuries Pain—Does the patient feel pain? If he does, assess its location, severity, and quality. Paresthesia—Assess for loss of sensation by touching the injured area with the tip of an open safety pin. Abnormal sensation or loss of sensation indicates neurovascular involvement. Paralysis—Can the patient move the affected area? If he can’t, he might have nerve or tendon damage.  Pallor—Paleness, discoloration, and coolness on the injured side may indicate neurovascular compromise. Pulse—Check all pulses distal to the injury site. If a pulse is decreased or absent, blood supply to the area is reduced.  Diagnostic procedures for orthopedic disorders Plain x-ray plain x-ray of the affected joint is one of the most useful investigations. Changes that occur on plain x-ray can be characteristic of specific musculoskeletal diseases such as rheumatoid arthritis, osteoarthritis and gout  Dual-energy x-ray absorptiometry (DXA) is an enhanced form of x-ray technology that is used to measure bone loss. It is calso called Bone density scanning, DXA is today's established standard for measuring bone mineral density. It is commonly used to diagnose osteoporosis, to assess an individual's risk for developing osteoporotic fractures. It is the most standard method for diagnosing osteoporosis. Diagnostic procedures for orthopedic disorders count….. Bon scan: A bon scan is radionuclides provide information valuable in the diagnosis of metastasis Pre-procedure preparation The procedure is not painful. The patient needs lie still for the examination and may therefore experience some discomfort. A consent may be required The nurse should inquire about possible allergy to the radioisotope and should assess for any condition that would contraindicate performing the procedure (e.g., pregnancy). Approximately 3 hours prior to the actual scan the patient is injected intravenously with technetium phosphate.  Patient should be instructed to drink large quantities of fluids. The fluids help hydrate the patient and reducing the radiation dose to the bladder. Patient’s bladder should be emptied immediately prior to the bone scan. Because a full bladder interferes with scanning of the pelvis bones. Post-procedure care and instructions: Following this procedure the patient is once again instructed to drink large quantities of fluids. It is important to remember that the patient’s urine is radioactive and should be handled only while wearing latex gloves. Pregnant staff members and visitor should use discretion in the length of time they spend with the patient Magnetic Resonance Imaging: Magnetic resonance imaging (MIR) is a noninvasive diagnostic examination that uses a magnetic field. Specific indications: is considered more sensitive than computed tomography used in disease such as disc disease, strokes, and tumors. Computed tomography: Computed tomography is a non invasive producer uses x-rays beams that intersect and a scanner that takes sectional pictures of particular area. Computed tomography enables examiner to evaluate bone, soft tumors, nerves, vessels, and bone mineral density Ultrasonography is being used more and more frequently to identify inflammation in and around joints and tears or inflammation of tendons. Ultrasonography is also used as a guide when a needle needs to be put into a joint (for example, to inject drugs or to remove joint fluid). Electromyography is the examination of the electric potentials of muscles. Often used to examine the action potentials created during skeletal muscle contraction. Electromyography is used in the detection and diagnosis of primary muscle disease. Joint aspiration ( arthrocentesis): Is a procedure carried out to obtain synovial fluid for examination. It may also serve as a treatment for aseptic arthritis Bone marrow examination: Bone marrow located in cavities of long bone, functions primarily to manufacture erythrocytes, leukocytes, and platelets. Bone marrow examination includes aspiration, biopsy, and microscopic evaluation of the red marrow. A complete blood count (includes a red blood cell count, hemoglobin level, white blood cell count) may be ordered to detect infection, inflammation, or anemia. Elevated alkaline phosphatase level, which may indicate bone tumors. Decreased serum calcium level, which may indicate osteoporosis, and bone tumors. Elevated serum uric acid level, which may indicate gout (treated or untreated). Elevated antinuclear antibody level, which may indicate lupus erythematous, a connective tissue disorder. The erythrocyte sedimentation rate (ESR) is one of the best-known inflammatory markers and indicates what has been happening over the last few days or longer. C-reactive protein: responds more rapidly to changes in inflammation – normally within days. Tests for rheumatoid factor: and the more recently used anti-CCP (cyclic citrullinated peptide) antibody test, for example, are both often strongly positive in patients with rheumatoid Urine tests: The 24-hour collection of urine samples for analysis to determine levels of uric acid and calcium excretion.  Age-related changes in musculoskeletal system and health promotion strategies Changes Subjective and objective Health promotion findings strategies Loss of bone density; Height loss; prone to Exercise regularly; eat loss of muscle strength fractures; kyphosis; back a high-calcium diet; and size; degenerated pain; loss of strength, limit phosphorus joint cartilage flexibility, and endurance, intake; take calcium joint pain and vitamin D supplements as prescribed