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WVC Ch 52 muscskelet
WVC musculoskeletal unit
| Question | Answer |
|---|---|
| The musculoskeletal system includes… | the bones, joints and skeletal muscles as well as supporting structures needed to them. |
| When mobility is impaired d/t such things as surgery, trauma, or disease, what else can be affected? | other body systems->skin breakdown, constipation, thrombus formation. |
| The skeletal system consists of… | 206 bones and multiple joints. |
| The bone can be classified in two ways… | by shape and structure |
| The shapes of bones… | *long *short *flat *irregular *sesamoid |
| Long Bones | *cylinderic with rounded ends *often bear weight *ex: femur |
| Short Bones | *small *bear little or no weight *ex:phalanges |
| Flat Bones | *protect vital organs *often contain blood forming cells *ex:scapula |
| Irregular Bones | *bones with unique shapes *ex:carpal bones in wrist or inner ear bones |
| Sesamoid Bones | *least common type *develops within a tendon *ex:patella |
| The second way the bone is classified after shape is structure or composition which include… | *cortex *medulla *diaphysis *epiphyses |
| Cortex | *the outer layer of bone *composed of dense, compact tissue. |
| Medulla (Medullary Cavity) | *the inner layer *contains spongy, cancellous tissue |
| Diaphysis | *typically what the long bones have *the long shaft of a long bone |
| Epiphyses | two knoblike ends of a bone |
| The structural unit of the cortical, compact bone is… | the haversian system |
| The haversian system | a complex canal network containing microscopic blood vessels that supply nutrients and oxygen to bone, as well as lacunae. These canals run vertically with the hard, cortical bone tissue. |
| Lacunae | small cavities that house osteocytes (bone cells). |
| The softer, cancellous tissue within the medullary cavity contains large spaces, or…. | trabeculae which are filled with bone red or yellow marrow. |
| Hematopoiesis (production of blood cells) occurs… | in the red marrow. |
| The yellow marrow contains… | fat cells which could potentially cause (FES)fat embolism symdrome if it becomes dislodged. |
| Volkmann’s Canals | connect bone marrow vessels to haversian system and periosteum (outer most covering of bone). |
| In the deepest layer of the periosteum are.. | osteogenic cells which later differentiate into osteoblasts and osteoclasts. |
| Osteoblasts | bone forming cells |
| Osteoclasts | bone destroying cells |
| Bone also contains a matrix, or osteiod consisting chiefly of… | *collagen *mucopolysaccharides *lipids *inorganic calcium salts (carbonate and phosphate) |
| Carbonate and phosphate in this matrix provide… | the hardness of the bone |
| Bone is a very vascular tissue and its estimated total blood flow is between… | 200-400 mL/min |
| Each bone has a main… | nutrient artery, which enters middle of shaft and branches into ascending and desending vessels that supply the cortex, marrow and haversian system. |
| Very few ______ ________ are connected to bone… | nerve fibers-> but some sympathetic nerve fibers control dilation of blood vessels. |
| Function of the skeletal system: | *provides framework for body,allows body to be weight bearing & upright *Supports surrounding tissues (muscles/tendons) *Assist in movement thru muscle attachment and joint formation *protects vit organs *manufac. bl. cells *provides storage for mineral |
| Bone undergoes a continuous process of… | formation and resorption(aka destruction) at equal rates. |
| However, in later years, resorption… | increases which decreases bone mass and predisposes pts to injury, esp. older women. |
| Numerous minerals and hormones affect bone growth and metabolism: | *Ca+ *P+ *Calcitonin *Vit. D *Parathyroid Hormone (PTH) *Growth Hormone *Glucocorticoids *Estrogen and androgens *Throxine *Insulin |
| Bone accounts for about 99% of calcium in the body and about ____% of phosphorus… | 90% |
| In healthy adults, the serum concentrations of calcium and phosphorus maintain an… | inverse relationshipas Ca+ levels ↑= P+↓ |
| When the calcium/phosphorus serum levels are altered, ___________ and ____________ work to maintain equilibrium… | calcitonin and PTH |
| If calcitonin in the blood is decreased, the bone, which stores calcium… | releases calcium into the bloodstream in response to PTH stimulation. |
| Calcitonin | *produced by thyroid gland *↓Ca+ serum concentration if it is increased above its normal levels *Inhibits bone resorption *increases renal excretion of Ca+ and P+ as needed to maintain balance |
| Vitamin D | *produced in body and transported to blood *promotes absorption of Ca+ and P+ from small intestine *enhance PTH activity to release Ca+ from bone |
| A decrease in the body’s vitamin D levels can result in… | osteomalacia (softening of bone) in the adult. |
| When serum Ca+ levels are ↓ , _________ secretion ↑… | PTHparathyroid hormone |
| PTH stimulates bone to… | promote osteoclastic activity and RELEASE Ca+ from bone. |
| PTH also reduces… | the renal excretion of Ca+ and facilitates its absorption from the intestine |
| If serum Ca+ levels increases… | *PTH secretion diminishes to preserve bone calcium supply(aka feedback loop system of endocrine system) |
| Growth Hormone | *secreted by anterior lobe of pituitary gland *responsible for Increasing bone length *determines amount of bone matrix formed before puberty |
| Adrenal Glucocorticoids | *regulates protein metabolism by either ↑/↓ catabolism to reduce or intensify organic matrix of bone *aids in regulation of intestinal absorption of Ca+ and P+. |
| Estrogen | *stimulates osteoblastic activity *Inhibits PTH |
| When estrogen levels ↓ in menopause, women are susceptible to… | low serum Ca+ with increased bone loss (osteoporosis) |
| Androgens, such as testosterone in men… | promote anabolism (body tissue building) and increase bone mass. |
| Thyroxine | *principal hormone secreted by thyroid gland *primary fxn is to ↑ rate of protein synthesis in all types of tissue including bone. |
| Insulin | *works together with growth hormone to build healthy bone tissue. |
| A joint is… | a space in which two or more bones come together. |
| The major function of a joint… | to provide movement and flexibility to the body. |
| There are 3 types of joints in the body: | *Synarthrodial *Amphiarthrodial *Diarthrodial |
| Synarthrodial Joints | completely immovable jointsex: in the cranium |
| Amphiarthrodial Joints | slightly moveable jointsex:in the pelvis |
| Diarthrodial Joints | (synovial) or freely movable jointsex: elbow and knee |
| The most common type of joint in the body… | diarthrodial or synovial joint |
| Synovial Joints are the only type of joint lined with… | synovium, which is a membrane that secretes synovial fluid for lubrication and shock absorption. Synovium only lines the internal portion of the joint capsule and does not extend onto surfaces of cartilage at spongy bone ends. |
| Articular cartilage in the joint consists of… | a collagen fiber matrix impregnated with a complex ground substance. |
| Pts with inflammatory types of arthritis often have… | synovitis (synovial inflammation) and breakdown of the cartilage. |
| Bursae | small sacs lined with synovial membrane located at thejoints and bony prominences to prevent friction between bone and structures adjacent to bone. |
| The types of synovial joints… | *ball-and-socket *hinge *condylar *biaxial *pivot |
| Ball-and-socket joint | permit movement in any direction (shoulder and hip) |
| Hinge Joints | allow motion in one plane, flexion and extension (elbow) |
| Condylar Joints | rotates slightly, as well as flexes and extends (knee) |
| Biaxial Joint | gliding movements such as the wrist |
| Pivot Joints | permit rotation only such as the radioulnar area. |
| There are 3 types of muscle in the body.. | smooth, cardiac, skeletal |
| Smooth Muscle | aka non-striated, involuntary muscle responsible for contractions of organs and blood vessels and is controlled by ANS. |
| Cardiac Muscle | aka striated, involuntary muscle. Also controlled by ANS |
| Skeletal Muscle | is striated, voluntary muscle controlled by the Central and Peripheral Nervous Systems. |
| Motor End Plate | the junction of a peripheral motor nerve and the muscle cells that it supplies. |
| Muscle fibers are held in place by… | connective tissue in bundles called fasciculi. |
| The entire muscle is surrounded by dense, fibrous tissue called… | fascia-> this fascia contains the muscles blood, lymph, and nerve supply. |
| The main function of skeletal muscle is… | movement of the body and parts. |
| During the aging process, muscle fibers ___________ in size and number… | decrease |
| Supporting structures of the muscular system… | *tendons *ligaments |
| Tendons | bands of tough fibrous tissue that attach MUSCLE TO BONE. |
| Ligaments | attach BONES TO OTHER BONES at joints. |
| Osteopenia | decreased bone density (bone loss)->occurs as one ages. |
| Severe osteopenia is aka… | osteoporosis->causes postural and gait changes and predisposes pt to fractures. |
| Osteoarthritis (OA) | when synovial joint cartilage that becomes less elastic and compressible and then becomes damaged->aka joint disease->may also be genetic |
| The most common joints affected by osteoarthritis | the weight-bearing joints: *hip *knee *cervical and lumbar spine |
| Musculoskeletal changes cause… | *decreased coordination *loss of muscle strength *gait changes *risk of falls with injury. |
| In assessment of a pt with actual or potential musculoskeletal problems, what areas need to be assessed? | *patient history *assessment of skeletal system *assessment of muscular system *psychosocial assessment *diagnostic assessment |
| When assessing Patient History in a person with musculoskeletal issues, what information should be gathered? | prior hx of accidents, illnesses, lifestyle, allergies and drugs that could contribute to a pts current problem. |
| What are other key components to assess for in pt hx? | *nutrition hx *family/genetic hx *Current health problems |
| A brief review of a person’s nutritional history helps determine… | any risks of inadequate nutrient intakeinadequate amounts could be related to such things as lactose intolerance(↓ Ca+) or some may not be able to afford proper nutrition. |
| Inadequate protein or insufficient vitamin C and D in the diet slows… | tissue healing. |
| People with eating disorders such as anorexia nervosa or bulemia are at risk for… | osteoporosis related to decreased intake of Ca+ and vitamin D. |
| Importance of Family/Genetic Hx risk assessment… | assists in identifying disorders that have familial or genetic tendency such as: *osteoporosis *gout *osteogenic sarcoma |
| The most common reports of people with musculoskeletal problems are… | pain and weakness |
| When assessing for a persons current health problems, collect data pertinent to the pts presenting health problem as follows: | *Date/time of onset *factors that exacerbate *course of problem(intermittent or continuous) *clinical manifestations *measures that improve clinical manifestations. |
| Assessment of pain can present many challenges because… | px can be related to bone, muscle, or joint problems. |
| Assess intensity of pain by… | *using pain scale *describing quality (dull, burning, stabbing) *determine location *where does it radiate? |
| Weakeness may be related to individual or muscle groups and is important to determine if weakness occurs in… | proximal or distal muscles or muscle groups. |
| Proximal weakness may indicate… | myopathy (problem with muscle tissue) |
| Distal weakness may indicate… | neuropathy (problem with nerve tissue) |
| For physical assessment of the musculoskeletal system use: | *inspection *palpation *range of motion (ROM) |
| For general inspection of the skeletal system you need to assess: | *posture/gait *mobility/function *neurovascular |
| When inspecting posture and gait, look at… | *body build/alignment when walking and standing *curvature of spine and length, shape, symmetry of extremities *inspect muscle mass for size/symmetry *balance *ease/length of stride |
| The two phases of normal automatic gait.. | *stance phase *swing phase |
| Abnormality in the stance phase of gait… | called antalgic gait->pt shortens stance d/t px. |
| Abnormality in the swing phase of gait… | lurch->occurs when muscles in butt and/or legs too weak to allow person to change wt from one foot to the other. |
| What to look for in a mobility/functional assessment? | *pts need for ambulatory devices (canes, walkers,ect.) *observe ability to perform ADL’s *assess major bones, joints, and muscles by inspection, palpation and ROM. |
| For each anatomic location during assessment, observe for… | skin color, elasticity, and lesions that may r/t musculoskeletal dysfunction.aka redness, inflammation, pressure injury. |
| While completing a physical assessment of the musculoskeletal system, perform an assessment of… | peripheral vascular system and nerve integrity. |
| Always begin your neurovascular assessment on… | the injured side and compare that extremity with the other. |
| Also during a neurovascular assessment you want to perform palpation of… | pulses in the extremities below the level of injury along with assessment of sensation, movement, color, temp and px in the injured part. |
| If pulses are not palpable, then use… | a Doppler to find them. |
| At the same time that you are performing you skeletal assessment, you are also assessing… | size, shape, tone, and strength of major skeletal muscles by using resistance that pt pushes against. |
| A person experiencing musculoskeletal problems may be experiencing some psychosocial issues because of such things as.. | *prolonged absence from work *stress *anxiety *depression *deformities(body image) * |
| Interventions we as nurses can do to help with psychosocial issues r/t musculoskeletal problems: | *help identify support systems and coping mechanisms *encourage pt to verbalize feelings r/t loss or body image changes *refer pt for psychosocial or spiritual counseling |
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