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SummerC
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joint
a union of two or more bones; moves freely
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bursa
a small fluid like sac that provides a cushion at friction points in the joints
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Skeletal muscle
striated muscle surrounded by a connective tissue sheath
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Tendon
fibrous tissue that connects muscle to bone
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Ligament
connects bone to cartilage
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Cartilage
Fibrous connective tissue; acts as a cushion
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Functions of bones
- 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
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Functions of Muscles
- can stretch; can be stimulated to contract electrically or to extend elastically
- provide movement
- stabilize joints
- produce heat
- maintain posture
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changes occuring with age
- 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
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body mechanics
- use it or lose it
- meaning inactivity leads to deterioration
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Disuse syndrome
common in bedbound, neromuscular disease,cva, head injury
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Signs and symptoms of disuse syndrome
atrophy of the muscles, decreased circulation, breakdown of the skin, contractures and foot drop
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Contractures
shirtening and drawing up of the muscles can be permanent
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Ergonomics
promotes comfort safety and health in the work place
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Two main principles for alignment of patients
- maintain correct anatomical postioning
- change positions frequently
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hazards of improper alignment
- poor circulation
- pressure ulcers
- muscle cramps
- possible contractures
- fluid collection in lungs
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Lordosis
sway back/curve of lumbar spine
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Kyphosis
humpback of the thoracic spine
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effects of inactivity
- 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
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Respiratory
less efficient resp., more secretions, more atelectasis, and pneumonia
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Urinary
decreased output, UTI's, more kidney stones and incontinenece
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Gastrointestinal
constipation, decreased peristalsis, hemmorroids, and indigestion
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Integumentary
more skin break down, dryer
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CNS
increased pain perception, sleep pattern disturbances, increased depression
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Metabolic/Endocrine
less efficient calorie. less efficient use of insulin and unstable blood sugar,
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When does the metabolism usually slow down?
with age and can gain the same amount of weight off the same amount of food
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Base of support
center of gravity, widen your stance for more stability
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Mobility
MS movement originates in the joint
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Tendons
attach muscle to bone
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ligaments
attach bone to bone, muscle to muscle,and support organs
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plegia (Paralysis)
little or no purposeful movement (hemi and quad) They will have more skin issues on the injured side
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spastic
overstimulation of the muscle with uncontrolled movement as in Muscular Dystrophy
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Flaccid
too little stimulation, decreased or no muscle toneas in CVA, head or cord injury
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Pressure Ulcers
- 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
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Nursing Diagnosis for Problems of body movement
- risk for injury
- impaired physical mobility
- risk for impaired skin integrity
- impaired walking
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Planning
- decide about patients positioning and delegate talk to assistant
- plans made for home setting as well
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Goals and Expected outcomes
- 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
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Supine
patient lying on her back
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Fowlers position
HOB 60 to 90
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Semi-fowlers
HOB 30 to 60
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Dorsal rucumbent
supine with knees up and feet flat on the bed
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Dorsal Lithotomy
feet in stirrups
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Patient lying on their side
alleviates pressure on bony prominence of the back
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Oblique side lying
- removes pressure from shoulder or hip
- easier for patients
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Sims position
- a variation of side lying used for rectal examsÂ
- \insertion of tubes or suppositories
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Common positions and variations:
Prone
- patient lying face down
- often used for pts. with spinal cord injuries
- not tolerated well
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Knee chest position
- on all fours
- also used for rectal exams
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