MUSCULOSKELETAL

System

By:
MR. MARK ANTHONY P. PLACIDO, RN, RM
BONES:

• Support and protect

structures of the body
• Attachment of
muscles, tendons and
ligaments
• Formation of blood
cells
• Ca and Phosphate
regulation
BONES:
SKELETON
AXIAL
Cranium
Vertebrae
Ribs

APPENDICULAR
Shoulders
Pelvis
Limbs
Anatomy and Physiology
Types of Bones:
• Long
• Short
• Flat
• Irregular
• Spongy
• Compact (Dense)
JOINTS:
• Allow movement between bones
• Covered with cartilage
• Enclosed in a capsule
• Contain SYNOVIAL FLUID
JOINTS
Types of Joints:
• Synarthrosis Fibrous/fixed
• Amphiarththrosis Slightly movable
• Diarthosis Ball and socket
• Condyloid Freely movable
MUSCLES:
 Force to move the bones
 Maintain posture
 Ca for contraction

Types:
• SKELETAL
• SMOOTH
• CARDIAC
X-RAYS

Nursing Care::
 Handle injured area carefully
 Remove metal objects
 Shield testes, ovaries
 CI Pregnancy
 Lie still during x-ray
Radiation is minimal
Companion; wear lead apron
Administer prescribed analgesics
ARTHROCENTESIS

• Aspiration of synovial
fluid, blood and pus
• Use of needle
ARTHROCENTESIS
Nursing Care:
Secure informed consent
Post-op: Compress bondage
Post-op: Rest joint 8-24 hrs
EXTENDED POSITION
Notify MD if fever & swelling occur
ARTHROSCOPY
• Visualization of joints
• Use of endoscope
• Surgical procedure
ARTHROSCOPY
Pre-op Care:
Informed consent
NPO 8-12 hrs
ARTHROSCOPY
Post-op Care:
Elastic wrap worn x 2-4 days
Elevate the extremity x 2 days
Place ice compress
Use of crutches when walking 5-7 days
Notify MD if with fever, knee pain,
and edema
BONE/ MUSCLE BIOPSY

Nursing Care:
Informed consent
Monitor for bleeding
Apply ice packs
Post-op: Elevate x 24 hrs
Assess for signs of
infection
Electromyography (EMG)

• Determine electrical
potential associated with
muscle contraction
• Needles inserted into the
muscles
Electromyography (EMG)
Nursing Care:
Informed consent
Needle insertion is
uncomfortable
NO stimulants nor
sedatives 24 hrs prior
Slight bruising
STRAINS

• Excessive stretching of a
muscle or tendon

Nursing Care:
 Cold and hot compress
 Exercise with activity
limitation
 Analgesics/
Anti-inflammatory
 Severe: Surgical repair
SPRAINS
• Excessive stretching of a
ligament

Nursing Care:
 IMMOBILIZE joint:
 EXTENDED position
 Apply ice packs
 Use of compression
bandage
Moderate: Casting
Severe: Surgery
FRACTURE
• Break in the continuity of the bone

Types:
• Closed/ Simple
• Open/ Compound
• Complete
• Incomplete
• Comminuted
• Greenstick
• Pathological
FRACTURES
Assessment:
Pain, tenderness
Swelling
Redness, heat
Deformity
Crepitation
Loss of function
Classification According to External Environment
Classification According to Location
FRACTURES
Initial Care:
IMMOBILIZE
Compound: Splint the extremity
Cover with sterile dressing
 REDUCTION
• Restoring the proper alignment

Types:
 CLOSED:
Manual manipulation
Local or general anesthesia

 OPEN:
Surgical intervention
Internal fixating devices
FIXATION:
 INTERNAL:
 Follows open reduction
 Application of screws,
plates, nails
 Immediate bone strength
 Risk of infection
 External Fixation

Indicated in Simple fractures and complex fractures with

extensive soft tissue damage, Correction of bony defects
(congenital), Nonunion or malunion, Limb lengthening
FIXATION
 EXTERNAL:
 External frame with
multiple pins
 Risk for infection
TRACTION
• Exertion of 2 opposing
forces to reduce and
immobilize a fracture
TRACTION
Nursing Care:
Proper body alignment
Weights hang freely
Do not remove weights without MD’s order
Pulleys are not obstructed
Checks ropes for frying
TRACTION
 SKELETAL TRACTION:
Pins and wires applied
to the bones
Monitor insertion site
• Cervical Thongs
• Halo Fixation Device
SKIN TRACTION
 CERVICAL TRACTION
• Upper extremities & neck
• Head halter and chin pad
SKIN TRACTION
 PELVIC SKIN TRACTION
 Low back, hip or leg pain
 Apply over the pelvis
SKIN TRACTION
 BUCK’S
• Straight pull on the lower
limb with weights
• Boot appliance
 BRYANT
• Both lower limbs
extended vertically
• Children
 RUSSELL
• Lower limb
• Foot of bed is elevated
Buck’s Traction
BALANCED SUSPENSION

• Fractures of the femur,

tibia or fibula
• Use with skin or
skeletal traction
• Counter force other
than the client
BALANCED SUSPENSION
Nursing Care:
Low fowlers position
Thigh to the bed: 20 degree angle
Protect from skin breakdown
Provide pin care
CASTS
• Immobilize a bone or joint
after fracture or injury

Types:
 Plaster of Paris
 Fiberglass
Common Types of
Casts
Knee Immobilizer
CASTS
Nursing Care:
Wet cast: 24 to 48 hrs to dry
Synthetic cast: 20 min to dry
HANDLE a wet cast with the PALMS
ELEVATE cast and extremity
Examine the skin for pressure sores
Monitor for circulatory impairments
(5 P’s and C)
 CASTS

Nursing Care:
Notify MD
Prepare for bivalving or cutting of cast
Maintain smooth edges
Assess for signs of infection; foul odor
Instruct not to stick objects
Keep casts dry and clean
Isometric exercises
FRACTURE
Complications:
• Fat Embolism (within 24 hrs)
• Compartment Syndrome
• Infections/ Osteomyelitis
• Avascular Necrosis
CRUTCH WALKING:

Nursing Care:
 Distance between axilla and the
arm piece
• 2 fingerbreadths
 Elbow should be slightly flexed
20-30 degrees
 Ambulating with the client;
stand on the BAD side
 Never rest the axilla on the bars
 When ambulating; look up and
forward
4 POINT GAIT
• Most stable
• Partial use/ weight bearing on BOTH LEGS

Sequence
1. Advance L crutch
2. Advance R foot
3. Advance R crutch
4. Advance L foot
 3 POINT GAIT
• Allows the BAD LEG to be partially or
completely FREE of USE/ weight bearing

Sequence:
1. Advance BOTH CRUTCHES forward with the
BAD LEG and shift weight to the crutches
2. Advance GOOD LEG and shift weight onto it
2 POINT GAIT
• Faster version of 4 point gait
• Partial weight bearing on BOTH LEGS

Sequence:
1. Advance L crutch and R foot
2. Advance R crutch and L foot
CRUTCH WALKING
 GOING UP THE STAIRS:
1. GOOD LEG up first
2. Bad leg and the crutches up

 GOING DOWN THE

STAIRS:
1. Crutches and BAD LEG first
2. Good leg down
CANES
• Lightweight with a rubber tip at the bottom
CANES
Nursing Care:
 When ambulating; Stand on the BAD SIDE
Handle at the level of the greater trochanter
 Hold cane close to the body
Elbow should be flexed 25-30 degree angle
 HOLD cane in the HAND of GOOD side
 CANE and BAD LEG work together with each step
 Inspect rubber tips
WALKERS:

Nursing Care:
Put all 4 points of walker flat on the floor
before putting weight on the hand pieces
Move the walker forward and walk into it
LOWER EXTREMITY
AMPUTATION
• Surgical removal of lower limb
AMPUTATION
Post-op Care:
 Monitor VS
 Assess for bleeding
 Watch out for pulmonary embolism
 Check for signs of infection
 Assess for phantom limb pain
Provide reassurance and give medications
 1st 24 hrs: Elevate the foot of the bed as prescribed
 Keep FLAT on bed; prevent contractures
 AMPUTATION OF LOWER
EXTREMITY
Post-op Care:
After 24-48 hrs, place in PRONE position
Place pillow under the abdomen and stump
Rewrap elastic bandage 3-4x/ day
Wash stump with soap and water
Massage towards the suture line
Prepare for cast application and/or prosthesis
Encourage verbalization of feelings
RHEUMATOID ARTHRITIS

• Chronic systemic inflammatory disease

• Destruction of connective tissues and
synovial membrane
• 30-50 years of age
• Permanent deformity
• Pannus formation
RHEUMATOID ARTHRITIS
Assessment:
Inflammation and
tenderness of joints
Morning stiffness
Joint deformities
Fever
Fatigue, weakness
Weight loss
RHEUMATOID ARTHRITIS
Diagnostic:
• RA Factor Reactive: ↑80 IU/mL
• ↑ ESR
• Synovial Biopsy (+) inflammation
 RHEUMATOID ARTHRITIS

Nursing Care:
Immobilize affected joints
Apply heat or cold therapy as prescribed
Avoid weight bearing on inflamed joints
Encourage ROM exercises
Prevent flexion contractures
Balance activity and rest
 RHEUMATOID ARTHRITIS

Management:
Administer analgesics
• Salicylates (Aspirin)
• NSAIDS
• Corticosteroids
 Cause bleeding and GI discomfort
 Taken with meals or PC
• Antineoplastic medications
• Gold salts
Prepare for surgery:
• Synovectomy
• Joint replacement (Arthroplasty)
OSTEOARTHRITIS
• Degenerative Joint Disease
• Wear and tear
• Affects weight bearing joints
• knees, toes, lower spine

Risk factors:
 Age
 Obesity
OSTEOARTHRITIS
Assessment:
 Joint pain intensifies after activity
diminishes after rest
 Joint pain aggravated by
temperature changes
Joint enlargement
 Heberden’s and Bouchard’s nodes
Limited ROM
 Difficulty getting up after
prolonged sitting
OSTEOARTHRITIS
Management:
Immobilize affected joint
Cold and hot compress as prescribed
Administer analgesics
• Salicylates (Aspirin)
• NSAIDS
• Corticosteroids
Cause bleeding and GI discomfort
Taken with meals or PC
OSTEOARTHRITIS

Nursing Care:
Encourage weight loss PRN
Prepare for surgery:
• Total Joint Replacement
GOUTY ARTHRITIS

↑Uric Acid
↓
Urate crystals deposited in joints & tissues
GOUTY ARTHRITIS

Stages:
I. Asymptomatic
II. Acute
III. Intermittent
IV. Chronic
GOUTY ARTHRITIS
Assessment:
 Excruciating joint pain
 Joint swelling
 Tophi formation
Low grade fever
Malaise; weakness
 Colic pain and hematuria
Renal stones
GOUTY ARTHRITIS
Diagnostic:
• ↑ Uric Acid
• Synovial Biopsy →Urate crystals
GOUTY ARTHRITIS
Nursing Care:
Diet: LOW PURINE
Avoid foods like organ meat, wine,
cheese, nuts and beans
Increase fluid intake
ALKALINE ASH DIET
Fruits and juices, milk
Bed rest during attacks
Apply heat and cold compress
Avoid ASA during attacks
Anti-gout Medications:
 COLCHICINE
Acute gout attacks
SE: Diarrhea and vomiting

 ALLOPURINOL
Xanthine oxidase inhibitor
reduces uric acid

 PROBENECID
enhances excretion of uric acid
Increase fluid intake
OSTEOPOROSIS
• Age related metabolic disease
• Bone demineralization;
subsequent fractures
• Vertebral column, hips, wrist

Risk Factors:
 Menopause
 Ca deficiency
OSTEOPOROSIS
Assessment:
Back pain
Pelvic and hip pain
Decline in height
Spinal deformity;
Kyphosis
Pathological fractures
OSTEOPOROSIS
Diagnostic:
• X-ray thin porous bone
OSTEOPOROSIS
Nursing Care:
Provide safe and hazard-free environment
Maintain side rails
Move client gently
Use of assistive devices
Good body mechanics
Avoid activities that causes vertebral
compression
ROM exercises
OSTEOPOROSIS
Nursing Care:
Use of back brace support
Diet: Ca, Vitamin D
Increase fluid intake
Administer estrogen and androgen
Administer analgesics