Chapter 18

• short
• long
• flat
• irregular

a union of two or more bones; moves freely

a small fluid like sac that provides a cushion at friction points in the joints

striated muscle surrounded by a connective tissue sheath

fibrous tissue that connects muscle to bone

connects bone to cartilage

Fibrous connective tissue; acts as a cushion

• provides a scaffolding to support the body
• give shape to the body and support the internal organs
• provides places for ligaments and tendons to attach to facilitate movement
• joints allow movement and flexibility of the skeleton

• can stretch; can be stimulated to contract electrically or to extend elastically
• provide movement
• stabilize joints
• produce heat
• maintain posture

• bone mass loss leading to osteoporosis (always more sever in women)
• loss of bone density predisposes the elderly to fractures
• muscle cells lost and replaced with fat cells
• elasticity of muscle fibers is decreased, limiting flexibility
• joint motion may decrease, limiting motion and mobility

• use it or lose it
• meaning inactivity leads to deterioration

common in bedbound, neromuscular disease,cva, head injury

atrophy of the muscles, decreased circulation, breakdown of the skin, contractures and foot drop

shirtening and drawing up of the muscles can be permanent

promotes comfort safety and health in the work place

• maintain correct anatomical postioning
• change positions frequently

• poor circulation
• pressure ulcers
• muscle cramps
• possible contractures
• fluid collection in lungs

sway back/curve of lumbar spine

humpback of the thoracic spine

• muscles- weakness,decreased tone, mass and strength, atrophy and stiffness of joints
• Skeletal- poor posture contractures, foot drop, osteoporosis, and fractures
• cardiovascular- decreased circulation,increased clots, edema, more MI, CHF and CVA

less efficient resp., more secretions, more atelectasis, and pneumonia

decreased output, UTI's, more kidney stones and incontinenece

constipation, decreased peristalsis, hemmorroids, and indigestion

more skin break down, dryer

increased pain perception, sleep pattern disturbances, increased depression

less efficient calorie. less efficient use of insulin and unstable blood sugar,

with age and can gain the same amount of weight off the same amount of food

center of gravity, widen your stance for more stability

MS movement originates in the joint

attach muscle to bone

attach bone to bone, muscle to muscle,and support organs

little or no purposeful movement (hemi and quad) They will have more skin issues on the injured side

overstimulation of the muscle with uncontrolled movement as in Muscular Dystrophy

too little stimulation, decreased or no muscle toneas in CVA, head or cord injury

• also know as decubitis ulcers, or bedsores
• occurs when pressure on the skin causes an area of local tissue necrosis(breakdown)
• on bony prominence or surface
• shearing may occur

• risk for injury
• impaired physical mobility
• risk for impaired skin integrity
• impaired walking

• decide about patients positioning and delegate talk to assistant
• plans made for home setting as well

• patient will experience no musculoskeletal injury
• formal level of mobility after 6 months
• skin integrity intact while patient is on bed rest
• no injury while ambulating
• ROM exercise passive or active several times of day

patient lying on her back

HOB 60 to 90

HOB 30 to 60

HOB 15 to 30

supine with knees up and feet flat on the bed

feet in stirrups

alleviates pressure on bony prominence of the back

• removes pressure from shoulder or hip
• easier for patients

• a variation of side lying used for rectal exams 
• \insertion of tubes or suppositories

• patient lying face down
• often used for pts. with spinal cord injuries
• not tolerated well

• on all fours
• also used for rectal exams