انت هنا الان : شبكة جامعة بابل > موقع الكلية > نظام التعليم الالكتروني > مشاهدة المحاضرة
الكلية كلية التمريض
القسم قسم التمريض العام
المرحلة 2
أستاذ المادة حسام عباس داود السلطاني
6/25/2011 9:49:29 AM
Musculoskeletal system
Adult nursing /second stage
Assistant Lecturer / Hussam Abbas Anatomy and physiology
A-Skeleton
Consist of 206 bones in the human body divided into four categories :
1-Long bone (femur)
2-Short bone(metacarpals)
3-Flat bone (sternum)
4-Irregular bone(vertebrae)
There are two type of bony tissue:
1-Concellous bone or spongy bone
2-Cortical bone or compact bone(hard)
There are three bones layers called:
1-periosteum
2-endosteum
3-bone marrow
-red bone marrow ,in sternum,ileum,vertebra,ribs,manfactures(blood cell &hemoglobin)
-yellow bone marrow: consist of fat cell(in the long bone)
-Long bones are shaped like rode or shaft with rounded ends. The shaft known as the diaphysis is primarily cortical bone. The ends of long bones called epiphysis are primarily cancellous bone.
The functions of the musculoskeletal system include:-
1-protection .
2-support
3-locomotion
4-mineral
5-hemopoiesis
6-heat production
-The bony structure provider protection for vital organs including the brain ,heart & lung.
-The bony skeleton supports body structure by providing a strong and sturdy framework .
-The muscles attached to the skeleton allow the body to move.
-Calcium,phosphorus & magnesium are among the minerals deposited bone ;but they are stored there.
-The red bone marrow located within the bone cavity is responsible for the production of red & white blood cells.
-Muscle contraction results in mechanical action as well as heat production . The heat production is important for keeping us warm.
Bone formation:-
Bone begins to form long before birth . The process in which hardening minerals deposited in bone is known as ossification .There are two basic models of ossification :-
1-Intramembranous ossification.
2-Endochondral ossification.
Most bones in the body are formed and healed by Endochondral ossification in the age of 21 years bone growth and maturation are complete .
-Bone is composed of cells ,protein matrix and mineral deposits. The cells are three basic types:
1-osteoblast –function in bone formation by secretion bone matrix .
the matrix is collagen and ground substances (build bones).
2-osteocytes –are mature bone cell involved in bone maintenance functions and located in lacunae.
3-osteoclasts-located in shallow how ships lacunae are multinucleate cells involved in destroying ,resorbing and remolding bone.
B-skeletal muscles which provide body movement and posture by tightening and shortening .
C-Ligaments
1-Are tough bands of collagen fibers that connect bones.
2-Encircle a joint to add strength and stability.
D-Tendons
1-Are non elastic collagen cords.
2-Connect muscles to bones.
E-Joints
1-Are the articulation of two surfaces
2-Provide stabilization and permit locomotion degree of joint movement is called range of motion (ROM)
F-Synovium
1-Is the membrane that lines a joints inner surfaces
2-secretes synovial fluid and antibodies
3-Reduces friction in joints
G-Cartilage
1-Serves as a smooth surface for articulating bones
2-Absorbs shock to joints
3-Atrophies with limited range of motion
H-Bursa
1-Is a fluid-filled sac
2-Serves as padding to reduce friction
Diagnostic tests
1-bone X-ray
2-MRI—magnetic resonance imaging
3-laminography
4-computed tomography(C.T.scan)
5-myelography
6-discography
7-arterigraphy
8-arthrography
9-arthrocentesis
10-biopsy
11-arthroscopy
12-bone scan
13-thermography
14-electomyography
Laboratory studies
-blood test (C.B.P ,W.B.C)
-urine test
-blood chemistry studies
-level of serum calcium , creatinine and uric acid
Risk factors for developing musculoskeletal disorders:-
1-Occupations that reguire heavy lifting
2- Vegetarian diets
3-Immobility
5-Medications
6- Stress
7-Contact sports
8-Obesity
9-Age
10-Family history of musculoskeletal diseases
11- Musculoskeletal injury
12-History of immune disorders
Clinical manifestation of M.S.S disorders:-
1-Pain , back pain
2-joint stiffness
3-swelling
4-numbness ,tingling and parenthesis
5-Fever
6-Fatigue
7-Difficulty with movement
8-Edema and redness
9-Skeletal deformity
10-Limited ROM
11-Skin breakdown
12-poor posture
13-muscle weakness and rigidity
14-abnormal skin color and temperature
15-abnormal vital signs
16- nodules
17-abnormal peripheral pulses
18-muscle spasms
19-malaise
20-crepitus
Fracture
Is break in the continuity of bone tissue or organs.
Type of fracture:-
1-complete
2-incomplete
3-close----simple
4-Open ----compound
There are thirteen types of fractures:
1- Greenstick fracture
2- Obligue fracture
3-Transverse fracture
4-Spiral F
5-Comminuted F
6-Linear F
7-Impacted F
8-Avulsion F
9-Compression F
10-Depressed F
11-Articular F
12-Segmental F
13-Pathologic F
Causes of fracture:-
1-Trauma
2-Osteoporosis
3-Multiple myeloma
4-Bone tumors
5-Immobility
6-Malnutrition
7-Cushing syndrome
8-Osteomeylitis
9-Steroid therapy
10-Aging
Clinical manifestations:-
1-Pain (caused by swelling at the site ,muscle spasm , damage prostium)
2-Tenderness over the fracture site
3-Loss of function
4-Deformity
5-False motion
6-Crepitus
7-Edema
8-Ecchymosis
9-Spasm
10-Paresthesia
11-Black and blue discoloration of the area
Healing of fracture:-
Immobilization of fracture bone is important for healing
1-physiologic splintage
2-External orthopedic splinting with devices as cast
3-Internal fixation (open reduction )
Methods of fracture repair:-
Objectives in the care and treatment of patient with fracture include:
1-Reduction of the fracture
2-Maintenance of the fragments in the correct position while healing takes place
3-Prevention of excessive loss of joint mobility and muscle tone
4-Prevention of complication
5-Maintenance of good general health
Medical and surgical management
1-Medical (closed)
A-traction
B-cast
2-Surgical (open)
Traction :-
Is the application of a pulling force to apart of the body
Purpose of traction :-
1-To reduce a dislocation joint
2-To correct minor deformities
3-To relieve muscular spasm
4- To reduce fractures and realign bone fragments
5-To immobilize and prevent further soft tissue damage
6-To rest a disease joint
7-To prevent the development of contractures
Type of traction:-
1-Manual traction
2-Skin traction
3-Skeletal (bone)traction
4- Plaster traction
5-Brace traction
Complication of traction:-
*Skin traction:-
1-Discomfort
2-Nicrosis
3-Deformity
4-foot drop
5-Muscle wasting
6-Joint stiffness
*Bone traction :-
1-Infection
2-Local sores
3-Edema
4-Disturbance of muscle growth
5-Muscle wasting
6-Joint stiffness
Nursing care for skin traction:-
1-Assess circulatory to prevent contraction
2-Skin condition
3-Maintain ROM
Nursing care for bone traction :-
1-Clean and shave
2-Dressing
3-Color checking
4-Make exercise
Management the care of the client in traction:-
1-Assess the clients neurovascular status frequently
2-Check traction equipment
3-Monitor client for signs of pressure area
4-Encourage client to be as mobile a possible and to perform exercises as indicated
5- Observe foot position and prevent foot drop
6-Cover tips of any protruding metal pins or rods with corks or other protective material
Cast :-
Is a rigid immobilizing device that is molded to the contours of the body to which it is applied .
Purpose of cast :-
1-To hold bone fragments in reduction and alignment
2-To permit early ambulation and weight bearing
3-To improve function by stabilization a joint
4-To correct and prevent deformity
Type of casts;-
1-Short arm cast
2-Thumb spica cast
3-long arm cast
4-Short leg cast
5-Long leg cast
6-Walking cast
7-body cast
8-Spica cast
-shoulder spica cast
-hip spica cast
Nursing management following application of a cast:-
Although it takes minutes for a cast to harden, it will take 24 to72hours for the cast to dry
1-Avoid covering the cast with bedding until it is dry
2-Avoid resting the cast on hard surfaces or sharp edges which will dent the cast and cause pressure area
3-Keep the affected extremity elevated above the heart
4-Assess the neurovascular status of the involved extremity hourly
a-watch for these damage signs (for arm or leg cast) blueness or paleness of toenails or fingernails accompanied by pain and tightness ,numbness and cold sensation
b- Elevate the affected extremity above the heart
Patient education after cast removal;-
1-cleane the skin gently with bland soap and water , blot dry
2-Apply baby powder,baby oil to avoid scratching the skin
3-Resume activities and exercise gradually
4-control swelling by elevating the extremity above heart level and use elastic bandages as directed
Complication of casts:-
1-Impaired circulation and nerve damage
2-Pressure ,tissue necrosis and irritation
3-Infection
4-Cast syndrome
5-Lack of fracture immobilization
6-Thermal effects of plaster
7-Tight cast
Complication of fracture :-
1-Shock
2-Hemorrhage
3-Fat embolism
4-Pulmonary embolism
5-Neurological complications
6-Infection
7-Mal union
-Delay union (4-6 months)
-Non union
Osteomyelitis
Bacterial infection of bone and soft tissue.
Causes of infection:
Direct
1-Open fracture
2-Short-gun
3-Wound
4-Bone surgery
Indirect
1-Infection tonsils
2-Boils
3-Upper respiratory infection
4-Infection of teeth
5-Infection vascular ulcer
6-middle ear infection
Type of Osteomyelitis:
1-Acute :children >adult
2-chronic :adult
-70-80% staphylococcus aureus
-Hemolytic streptococcus
Clinical manifestation :-
1-chill
Malaise
3-Fever
4-Bone pain
5-Edemaand redness
6-Painfull
7-Warm area
8-Muscle spasm
9-Swelling
10-Extremity tender
11-Pulsation pain
12-Increased pain with movement
Medical management :-
1-Blood culture to identify organism
2-Antibiotic
3-Analgesic
4-Wound irrigation
5-Heat therapy
6-Antipyretic—Aspirin
Nursing management :-
1-Maintain the patient diet
2-Rest and comfort to reduce pain
3-Adminster I-V fluids
4-Force fluids
5-Maintain the potency of wound irrigation
6-Monitor and record vital signs
7-Wound and skin care
8-Provide cast care
Complication :-
1-Septicemia
2-Acute bacterial arthritis
3-Pathologic fracture
4-Squanous cell carcinoma
5-Amyloidosis
6-Chronic Osteomyelitis
Inflammatory disorders
Rheumatoid arthritis(RA)
Systemic inflammatory disease that affects the synovial lining of the joints
Incidence :3/1women over man between25 and 35 years of age
Causes:-
1-Unknown
2-Autoimmune disease
3-Genetic transmission
Clinical manifestation :-
1- Fatigue and weakness
2-Anorexia
3-Signs of joint inflammation(redness,swelling ,warmth and pain)
4-Impaired mobility
5-Morning stiffness
6-Fixed deformity of the hand and feet
7-Spongy joints
8-Weight loss and fever
9-Anemia and muscle atrophy
10-Osteoporosis
11-The heart and lung may affect
12-dry mouth
13-Liver and spleen enlargement
Diagnostic test:-
1-X-rays joint space narrowing ,bone erosions
2-hematology :increased ESR,WBC,Platelets
3-Gamma globulin:increased TgM,IgG
4-Synovial fluid analysis increase WBC
5-Latex fixation test:positive rheumatoid factor
Assessment:-
1-Inspection ,palpation and range of motion
2-Observe for size ,shape ,skin color and general appearance joint swelling
3-Redness in the skin indicates inflammation
4-Pallor or cynosis
5-Ulceration or vascular skin lesions
6-Tenderness
7-Record the degrees of deviation from neural
8-Presence of crepitus
9-Pain during ROM
10-pain on palpation are record
11-Test muscle strength
12-Ask the patient to walk(15-24meters) as quickly and record the time 16 takes to walk
Management of rheumatoid arthritis:-
1-Relive pain and discomfort
2-Hot and cold application
3-Rest
4-Position and movement
5-Foot wear
*Pharmacotherapy
a-Salicylates
b-Non-steroidal anti inflammatory
c-Corticosteroids
* Surgical technique may be performed to minimize or correct the deformities of rheumatoid arthritis
*Occupational therapy
*Physical therapists
*Eat nutrition well balanced
*Education about disease is essential
Amputation
Is the surgical or traumatic removal of apart of an individuals body through bone.
Indications for amputation :-
1-To remove useless limbs
2-To reduce complications
3-To save the patients life
Causes of amputation :-
1-progressive peripheral vascular disease(PVD) and arteriosclerosis(often secondary to diabetes mellitus )
2-Infection(due to gangrene)
3- Trauma
4-Congenital deformity
5-Thermal and electrical injuries
6-Malignant tumors
Type of amputation:-
There are basically two types of amputation
1-Open or guillotine amputation
2-Closed or flap amputation
Level of amputation :-
1-Below the knee(BK)
2-Above the knee(AK)
3-Below the knee(BE)
4-Above the knee(AE)
Complication of amputation :-
1-Heamatoma
2-Hemorrhage
3- Infection
4-Chronic Osteomyelitis
5-Causalgia (burning may result from –neuroma- it is treated with injection of procaine
6-phantom pain(pain in the miss limb)
Nursing management:-
A-before surgery :-( physical)
1-Complete medical ,drug allergy history
2-Evaluating the client for mental and emotional acceptance of the surgical procedure
3-Assess the general patient condition
4-Reduction in pain and anxiety and support the client to grieve the loss of the limb and adapt to potential changes
5-Narcotic analgesics are give before surgery
6- handling the painful limb gental
7-Encouraging the family presence and support
8- Review the post-operative management such as deep breathing,coughing and exercises.
B-psychological problems:-
1-Patient permanent loss
2-disability and dependency
3-Alteration in body image
4-Life style change
5-Lack of understanding
6-Anxiety
C-The nurse must reduce anxiety and start the steps of patient rehabilitation to carry out the activity daily living .
D-The nurse needs to accept the expressed frustration and patient behavior
E-Support family and help the patient to adjustment
1-Monitor vital signs
2-Inspect the dressing or plaster shell
3-Inpsect the signs of infection
4-Evaluate the clients level of discomfort and general condition
5-Assess pain
6-promote healing and avoid skin breakdown
*Level of amputation are determine by circulatory adequacy.
1
المادة المعروضة اعلاه هي مدخل الى المحاضرة المرفوعة بواسطة استاذ(ة) المادة . وقد تبدو لك غير متكاملة . حيث يضع استاذ المادة في بعض الاحيان فقط الجزء الاول من المحاضرة من اجل الاطلاع على ما ستقوم بتحميله لاحقا . في نظام التعليم الالكتروني نوفر هذه الخدمة لكي نبقيك على اطلاع حول محتوى الملف الذي ستقوم بتحميله .
الرجوع الى لوحة التحكم
|