Anda di halaman 1dari 121



Congratulations for making your 3 years in nursing GREAT!!!

Rules
Punctuality in Attending Classess Late comers will enter the room after one hour  No ID no entry


Prayer Leader


Starting from no.1 onwards Same person before and after

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

EATING IS NOT 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


No Permit ,No Exam policy

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
    

Quiz Requirement Att/Att Major Exam -

40% 20% 10% 30% 100%

Recitation
Perfect points is 5  Recited but not related to the topic 1  No recitation 0


References
Any medical and surgical book

Film Analysis


Questions will be provided based on the film

My consultation day
Monday: 1pm-5pm Tuesday: 8am-5pm Wednesday: 8am-5pm Thursday: ipm-5pm

ANY QUESTION?  REACTIONS?




Understanding The Musculoskeletal System


Prof. Gina T. Vierne

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

Identify the risk factors associated with musculoskeletal disorders

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

Patient teaching:Crucial nursing activity  Why?




Anatomy and physiology review

Video clip presentation

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.

Blood Cell Formation




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

Axial- green Appen - golden

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.

Long bones Short bones Flat bones Irregular bones

Long bones Humerus of arms

Flat Parietal bone of skull

Short bones Carpals of wrist

Irregular vertebra

Assignment


How an individual bone is structured? Please read

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


Key facts about skeletal muscle


Provide body movement and posture  Attach to bones by tendons  Retain some contraction for muscle tone


ligaments
Tough bands of collagen fibers that connect bones  Encircle a joint to add strength and stability


tendons Nonelastic collagen cords  Connect muscle to bones




joints
Articulation of two bone structures  Provide stabilization and permit locomotion;degree of joint movement is called ROM


Key facts about joints


Articulation of two bones surfaces  Provide stabilization permit locomotion  ROM is degree of joint movement


synovium
Membrane that line a joint s inner surfaces  Secrete synovial fluid and antibodies  Reduces friction in joints( in conjunction with cartilage)


Key facts about synovium


Lines a joint s inner surfaces  Secretes synovial fluid  Reduces friction


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


Key facts about cartilage


Composed of fibers embedded in firm gel  Smooth surface for articulating bones  Absorbs shocks to joints


bursa
Fluid filled sac  Serves as padding to reduce friction  Facilitates the motion of body structures that rub against each other


Key facts about the bursa


Fluid filed sac  Serves as padding  Facilitates motion of body structures


Jingle( the bone dance)

Understanding skeletal muscle movement




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

8 ways of muscle contraction


       

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


Joint Motion Terminology


      

Flexion Extension Hyperextension Abduction/Adduction Rotation Circumduction Inversion

    

Eversion Pronation Supination Protraction Retraction

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
     

Atrophy Causalgia Contracture Deformity Leg length discrepancy Dislocation

Musculoskeletal Terminology
    

Dorsiflexion Dysplasia Kyphosi Lateral Lordosis

Musculoskeletal Terminology
     

Palsy Range of Motion Recurvatum Subluxation Valgus varus

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


Malformation or defect of any part of the body

deformity

Leg length discrepancy




(anisomelia)an inequality between corresponding limbs

Leg length discrepancy

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


Lateral curvature of the spine

scoliosis

 

Palsy- paralysis Range of motion- the full motion of joint can assume

palsy

recurvatum


Hyperextension( beyond neutral position) Subluxation-partial or complete dislocation of joint surfaces

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

Key assessment findings in disorders of MS


Pain  Numbness, tingling  Joint stiffness  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?)


P.E. bone integrity




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

Key physical findings in disorders of the MS


Skeletal deformity  Limited ROM  Inflammation  edema