Professional Documents
Culture Documents
Rules
Punctuality in Attending Classess Late comers will enter the room after one hour No ID no entry
Prayer Leader
Attendance
The door will be closed exactly 1pm Checking of attendance is by number Seat plan will be provided Stay in your place or else you will be marked absent
Cellphones
NO CELPHONES ALLOWED
QUIZZES
Either announced,unannouced Can be before,at the middle of discussion or after Late comers who entered the room after 1 hour will not be given special exams meaning you ve missed 1 exam
No borrowing and lending of papers Always have a paper with you. ( ,1/2,1 whole)
Cheating
Once caught in the act automatic deduction of 5 points from the total score
Grooming
A. Female 1. All female students should wear their complete proper uniform with ID 2. Hair should be neatly tied up into a bun with black hairnet and hair clip
Grooming
B. Male 1. All male students should also wear their complete uniforms with ID 2. Hair should be properly trimmed according to the College of nursing required haircut
Major Exams
Requirements:
Case study per group Case will not be taken from PCGH,but other tertiary Hospital Musculoskeletal case to be presented during the class Exposure at Orthopedic Hospital starting June 27
Assignment
Either by group Individual Must be submitted on time
Grading System
Recitation
Perfect points is 5 Recited but not related to the topic 1 No recitation 0
References
Any medical and surgical book
Film Analysis
My consultation day
Monday: 1pm-5pm Tuesday: 8am-5pm Wednesday: 8am-5pm Thursday: ipm-5pm
Objectives: On completion of this chapter, you will be able to: Describe the basic structure and function of the musculoskeletal system
Discuss the significance of the health history of the assessment of the musculoskeletal health
Describe the significance of the health history of the assessment of musculoskeletal dysfunction
Specify the diagnostic tests for assessment of musculoskeletal function Identify medications applicable to musculoskeletal problems
Identify medical and surgical management with musculoskeletal problems Define terms used in musculoskeletal function
Chapter Overview
Caring for patient with musculoskeletal disorders requires a sound understanding of musculoskeletal anatomy and physiology as well as body mechanics
Overview
Thorough assessment Assessment includes: Complete history Physical examination diagnostic testing Risk factors Informations r/t psychosocial impact of the disorder on the pt and his family
overview
Nursing diagnoses focus: impaired physical mobility Altered peripheral tissue perfusion
overview
Nursing interventions : designed to maintain or improve the pt s ability to carry out ADLs and prevent further injury
overview
The musculoskeletal system include 206 bones which are connected at joints. The joints are held together by ligaments and cushioned by cartilages Tendons attach muscles to the bones
The Bones-body s framework Functions: Support Protection Movement Storage Blood Cell Formation
protection
Bones provide a hard framework that support and anchors all soft organs of the body.The bones of the legs act as pillars to support the body trunk when we stand,and the rib cage supports the thorax wall
Protection
The fused bone of the skull provide a snug enclosure for the brain. The vertebrae surround the spinal cord,and the rib cage helps protect the vital organs of the thorax.
Movements
Skeletal muscles, attached to bones by tendons ,use the bones as levers to move the body and its parts.As a result, we can walk,grasp and breathe.The arrangement of bones and the design of joints determine the types of movement possible
Example:
Saddle joint Hinge joint plane joint Condyloid joint Ball and socket joint Pivot joint
Storage
Bone matrix itself serves as a storehouse, a reservoir for minerals, the most important being calcium and phosphorous, although K, Ca,Na,Sulfur magnesium and copper are also stored.
The bulk of blood cell formation, or hematopoiesis, occurs within the marrow cavities of certain bones.
1.
DIVISIONS Axial s upright structure with 80 bones 22 bones in skull 6 middle ear 1 hyoid bone 26 vertebral column 25 thoracic cage
2. Appendicular-body s appendages with 126 bones 4- pectoral girdle 60 upper limbs 60 lower limbs 2 pelvic girdle
Types of Bones
1. 2. 3. 4.
Irregular vertebra
Assignment
skeleton
Consist of 206 bones(long, short, flat, irregular) Store calcium, magnesium, phosporous,and carbonate, marrow produces RBCs
skeleton
Key facts: 206 bones Stores calcium,magnesium,phosporous and carbonate
Skeletal muscles
Provide body movemetn and posture Attach to bones by tendons Begin contracting with the stimulus of a muscle fiber Retain some contraction to maintain muscle tone
ligaments
Tough bands of collagen fibers that connect bones Encircle a joint to add strength and stability
joints
Articulation of two bone structures Provide stabilization and permit locomotion;degree of joint movement is called ROM
synovium
Membrane that line a joint s inner surfaces Secrete synovial fluid and antibodies Reduces friction in joints( in conjunction with cartilage)
CARTILAGES
Contains a firm gel substance in its matrix, which gives it more flexibility than bone
cartilage
Serves as a smooth surface for articulating bones Absorb shock to joints Atrophies with limited ROM or in the absence of weight bearing
TYPES
1.
Fibrocartilage Greatest tensile Occurs in the invertebral discs and in the symphysis pubis
2. Elastic Cartilage Possesses firmness and elasticity Occurs in the external ear and the eustachian tube
3. Hyaline CArtilage Most common cartilage type Cushions most of the joints to help soften any impact Firm yet slightly flexible Occurs also in part of the nasal bronchial rings
bursa
Fluid filled sac Serves as padding to reduce friction Facilitates the motion of body structures that rub against each other
Skeletal muscles contract to move bone, while joints allow this movement to occur
To contract, all skeletal muscles require some form of stimulation either internal from motor neurons or external from stimuli such as electricity, heat or injury
isotonic Isometric twitch contraction Tetanic contraction Treppe or staircase phenomenon Fasciculation Fibrillation convulsion
isotonic contraction- shorten muscle length while maintaining muscle tension, generating movement Isometric contraction-tighten a muscle by increasing muscle tension without shortening the muscle Twitch contraction- are quick, jerky reactions to a single stimulus
Tetanic contraction- serial, continuous contractions,in which individual contractions can t be distinguish Treppe( staircase) phenomenon-series of increasingly stronger twitch contraction occuring in response to repeated stimuli Fibrillation- abnormal contraction in which individual fibers contact in an unsynchronized way
Fasciculation- abnormal contraction visible through the skin as a slight ripple Convulsions- abnormal, violent rhythmic contractions and relaxations of muscle groups
Flexion-Decreases the angle between the anterior surfaces of articulating bones Extension-increases the angle between the anterior surfaces of articulating bones Hyperextension-continues the act of extension beyond the original anatmical position Abduction-when seen from the front, moves a bone in the appendicular skeleton away from the body s midline
Adduction-when seen from the front, moves a bone in the appendicular skeleton towards the body s midline Rotation- pivots the bone on its axis Internal External; Circumduction-combines a number of movements to cause the distal end of a bone to describe a circle.360 degrees to complete full circle Inversion-turns an extremity or part of an extremity inward towerd the body s midline
Eversion-turns an extremity or part of an extremity outward from the body s midline Pronation-turns the palm of body s front toward the floor Supination-turns the palm, foot, or body s front toward the ceiling Protraction-moves the mandible forward Retraction-moves the protracted mandible back into its neutral anatomical position
Musculoskeletal Terminology
Musculoskeletal Terminology
Musculoskeletal Terminology
Atrophy-wasting away
causalgia
A severe burning pain produced by several nerves that have malfunctioning nerve endings, touch can often produce this pain
Causalgia
circumduction
contracture
The absence of full range of motions of any joint. Most common is flexion contracture, the lack of full extension
contracture
deformity
deformity
dislocation
Musculo skeletal, traumatic injury resulting in disruption of the continuity of joint s configuration and articulation causing the loss of contact between the joint surfaces
dislocation
dorsiflexion
dysplasia
Abnormality of movement
dysplasia
eversion
inversion
kyphosis
Posterior convexity of thoracic portion of vertebral column, normal curvature of spine, but becomes pathologic if excessive
kyphosis
lordosis
Concavity of the vertebral column, normal curvature existing in cervical and lumbar areas, which may become pathologic if accentuated
Lordosis
scoliosis
scoliosis
Palsy- paralysis Range of motion- the full motion of joint can assume
palsy
recurvatum
Valgus-angular deformity denoting angulation away from the midline of the body distal to the anatomic part named Ex. Knock knee. Varus- angular deformity denoting angulation toward the midline of the body distal to the anatomic part named Ex. bowlegged
Assessment Findings
Health History Pain Numbness, tingling Joint stiffness Swelling Fatigue Fever Difficulty with movement
Physical examination
Abnormal vital signs Inflammation Edema Skin breakdown Skeletal deformity
Physical examination
Limited ROM Poor posture Muscle weakness Muscle stiffness and rigidity Abnormal skin color and temperature
Physical examination
Paresthesia Nodules Erythema Tophi Abnormal peripheral pulses Tremors Gait abnormalities(how to assess?)
Compare the left and right sides of the body,take note any deformities and anatomical misalignment
joints
Evaluate ROM, defprmities,stabilty and nodular formation Active passive
muscles
Note pts s ability to change position,presence of atrophy or hypertrophy Check carefully the origin of muscle weakness because pt s fear, unwillingness, or malingering might give false positive results(muscle strength)
muscles
Note for muscle tone: sensation of resistance felt as one manipulates a joint through it ROM Measure the muscle girth at the bulkiest portion of the extremity: location and position must be the same on both extremities