med surge

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med surge
2010-07-18 02:49:25
muscleskelatal system

ch 60
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  1. muscleskeletal system
    consist of bones, muscle, joints, tendons, ligaments, cartilage, bursae

    • bones-206 in body
    • short bones- fingers, toes
    • long bones- femur, ulna
    • flats bones- sternum, rib
    • Irregular bones- vertabrea

    • 2 types of bony tissue
    • cancellus bone/spongy bone- light & has many spaces, found @ the rounded, irregular ends, epiphyses of long bones
    • cortical bone- compact bone- dense & hard, cortical boney tissue found mainly in long shaft or diaphyses bones in arms & legs
    • both give strenght & support, yet keeps skeleton light
    • bones compoed of cells, protein matrix, & mineral disposits

    • osteoblast- cells that bulid bones, secrete bone matrix (collagen)
    • osteocytes-change osteoblast 2 mature bone, by process of ossification & calcification, also involved in maintaining bone tissue
    • oseoclast- cells involved in destrution, resorption, remodeling of bone
    • part of mononucleat phagocyte system(blood cells that recycle old bone)

    periosteum- layer of tissue, covers bone not joints, inner layer has osteoblast 4 bone formation, itz rich in blood & lymph vessels & supplies bone nourishments

    • types of bone marrow
    • red bone marrow- primarily in sternum, ilieum, vertabrae, & ribs, produces blood cells & hemoglobin
    • yellow bone marrow- found in long bones, consist of fat cells & CT, if blood supply becomes compromised ittake characteristics of red bone marrow & begin producing blood cells when needed
  2. muscles
    • skeletal muscles
    • voluntary, brain & spinal cord control their function
    • promotes movements
    • composed of muscle cell or fibers that have many myofibrils (made of sliding filaments called sarcomeres)
    • actin & myosin promotes sliding of sarcomeres leading to contraction of muscle

    • smooth & cardiac muslces
    • involuntary, controlled by mechanism in their tissue & by neurotransmitters released from ANS
    • found in walls of certain organs & cavities of body like stomach, intestne, blood vessels, & ureters, cadiac in heart
  3. joints
    • junction between 2/more bones
    • most are free-moving joints or diarthrodial joints (covered by hyaline cartilage which reduces friction during movement
    • space between joint cavity which enclosed by a fibrous capsule lined w/ synovial memebrane which produces synovial fluid that lubs joint
  4. tendons
    • cordlike structures that attached muscles to periosteum of bone
    • muscles have 2/more attachments
    • *origin- more fixed
    • *insertion- more movable
    • when muscle contracts both attachments pulled & insertions moved closer to origin
  5. ligaments
    • consist of fibrous tissue 2 adjacent freely movable bones
    • helps protect joint by stabilizing their surfaces & keeping them alignment
    • some completely enclose joint
  6. cartilage
    • firm, dense type of CT that consist of cells embedded in a substance called a matrix which is firm & compact
    • function is 2 redue friction between articlar surface, absorb shock, & reduce stress on joint
    • hyaline or articular covers movable joint- elbow
    • costal cartilage- connects ribs & sternum
    • semilunar cartilage- knee
    • fibrous cartilage- between vertabrea
    • elastic cartilage- laynx, epiglottis, & outer ear
  7. bursae
    • sm. sac filled w/ synovial fluid
    • reduces friction between areas like tendon & bone, & tendon & ligament
    • inflammation to this area called brusitis
  8. Assessment
    • chronic disorder: medical, drug, allergy; familial & occupational HX
    • recent injury: when/ how trauma
    • list of symptoms: onset, duration, location of discomfort/pain
    • whether activity makes it better/worse
    • identify other symptoms like leg cramping or skin lesions, & ask if it interferes w/ ADL
    • if open wound find out when last tetnus shot was
    • hx past disorders & medical/surgical tx ASAP
    • attention to chronic/concurrent disorders like DM
  9. physical exam
    • ability 2 ambulate, sit, stand, perform activities req. fine motor skills
    • inspection symmetry,size, conour extremities & random movements
    • palpates mucsle & joint 4 swelling, degree of firmness, warm areas, involuntary movements
    • apply force 2 extremity as pt pushes aginst force
    • neurovascular assessment: ROM (dont force), observe degree of movement & ROM
    • note abnormal movements like spasm or tremors
    • inspect/palpate 4 pain, tenderness, swelling, & redness
    • check 4 muscle wasting

    • look 4 abnormal size/alignment & symmetry comparing sides
    • spinal inspection:
    • *Kyphosis- exaggerated convex curvature of thoracic spine (hunchback)
    • *Lordosis- excessive concave curvature of lumber spine (swayback)
    • *Scoliosis- lateral curvature of spine

    depending on finding also look 4 changes in gait & body posture, favoring certain side, ability 2 bend & twist trunk, head & extremities

    by 35y/o may expirience loss of bone mass, HT, changes in structures of spine, joints
  10. asssessment if traumatic injury
    • v/s
    • cut clothes if injury if needed
    • compare structures
    • b gental, b/c assessment can cause pain

    • exam includes:
    • check swelling, external bleeding, brusing
    • palpate peripheral pulses
    • check peripheral circulation, pulse, skin color, temp., capillary refill
    • check senstation on injury area
    • look broken skin, open wound, debris in/around wound, protusion of bone or other tissue
    • examin area around injury
    • look malalignment of injured limb
    • assess 4 pain noting type & location

    Dr. need to check pt before nurse
  11. DX test
    • imaging procedures:
    • x-ray, CT scan, MRI, 4 fractures/dislocations, malignant bone lesions, joint diformities, calcifications, degenerative changes, osteoporosis, joint diseases

    • arthrogram- usually knee/shoulder, 1st anesthetic, & inserts needle 2 joint space, fluoroscopy 2 check placement of needle, synovial fluid is aspirated & sent to lab, then contrast injected & x-ray taken
    • nurse should tell pt that a cracking/clicking sound heard 4 about 2 days
  12. arthroscopy
    • internal inspection
    • seeing knee joint, give anesthetic, dr. insert lrg needle in joint & inject steril saline 2 distend joint
    • checking 4 injury/deterioration
    • fluid taken & sent to lab
    • depending on finding DR may use arthroscope to remove bits of torn/floating cartilage
    • after pt leg elavated w/o flexing knee
    • appy cold pack over dressing @ site of arthroscope inserted
    • RX analgesic given
  13. arthrocentisis
    • aspiration of synovial fluid, 4 discomfort or to inject meds (corticosteriod)
    • give anesthetic before procedure
    • fluid may b sent to lab
    • may b performed during athrogram or arthroscopy
  14. synovial fluid analysis
    • fluid aspirated & examined traumatic arthritis, septic arthritis(caused by microorganism), gout, rhuematic fever, & systemic lupus, erythematosus
    • normal fluid clear
    • test includes exam of blood cells, crystals, & formed debri that may b present in joint space after injury
    • if infection suspected C&S ordered
    • chemical analysis 4 protein, glucose may b preformed
  15. Bone scan
    • uses IV injection of radioneuclide to detect uptake of radioactive sustances by bone
    • 2 detect metastatic bone lesions, fractures & certain inflammatory disorders
    • radioneuclide taken up in areas of increased metabolism which occurs in bone cancer, metastatic bone disease, & osteomyelitis (bone infection)
  16. bone densitometry
    • radiography of wrist, hip, spine, helps determines bone mineral density (BMD)
    • bone density scaning & dual-energy x-ray absorptiometry (DXA/DEXA) 2 measure BMD
    • mostly on lower spine, hips
    • portable DEX device use x-ray or ultrasoud 2 measure quantity & quality of wrist, finger, or heel
  17. electromyography
    • test electrical potential of muscles & nerves leading to muscle
    • 2 evaluates muscle weakness/deterioration, pain, disability, & 2 differantiate muscle & nerve problems
    • Dr. inserts needle electrodes to selected muscle & stimlates muscle
    • oscilloscope records responses to stimuli
    • if pt get pain after study, apply warm compresses
  18. biopsy
    • 2 identify composition of bone , muscle, or synovim
    • removed w/ needle or excised surgically while pt under anesthetic
    • after nurse checks 4 signs bleeding or swelling, pain, apply ice
  19. blood test
    CBC- detect infection, inflammation, anemia

    • ex. dx test & findings of muscleskeletal disorders:
    • elevated alkaline phosphatase levels, which may indicate bone tumors & healing fractures
    • elevated acid phosphatase levels, indicates pagets disease(bone distruction & disorganized repair) & metastatic cancer
    • decreased serum calcium level, indicates oseomalacia, oseoporosis, bone tumors
    • increased serum phosphorus level, indicate bone tumor & healing fractures
    • elevated serum uric acid level, indicate gout(treated/untreated)
    • elevated antineuclear antibody level, indicate systemic lupus erythematosus, a CT disorder
  20. urine test
    • when ordered 24hr sample to check uric acid & calcium excretion
    • when gout uric acid high
    • calcium high inmetastati bone lesion & when pt w/ prolonged immobility