Chapter 52 Assessment of the Musculoskeletal System Skeletal
- Slides: 44
Chapter 52 Assessment of the Musculoskeletal System
Skeletal System • • Bone types Bone structure Bone function Bone growth and metabolism affected by calcium and phosphorus, calcitonin, vitamin D, parathyroid hormone, growth hormone, glucocorticoids, estrogens androgens, thyroxine, and insulin
Bone Structure
Joints • Types include synarthrodial, amphiarthrodial, diarthrodial. • Structure synovial joint. • Subtyped by anatomic structure: – Ball-and-socket – Hinge – Condylar – Biaxial – Pivot
Structure Diarthrodial Joint
Muscular System Assessment • • Patient history Nutritional history Family history and genetic risk General inspection: – Posture and gait
Muscular System Assessment (Cont. )
Specific Assessments • • Face and neck Spine Hand Hip Ankles, feet Neurovascular assessment Psychosocial assessment
Diagnostic Assessment • Laboratory tests—serum calcium and phosphorus, alkaline phosphatase, serum muscle enzymes • Radiographic examinations—standard radiography, bone density, tomography and xeroradiography, myelography, arthrography, and CT • Other diagnostic tests—bone and muscle biopsy
Electromyography • EMG aids in the diagnosis of neuromuscular, lower motor neuron, and peripheral nerve disorders; usually with nerve conduction studies. • Low electrical currents are passed through flat electrodes placed along the nerve. • If needles are used, inspect needle sites for hematoma formation.
Arthroscopy • Fiberoptic tube is inserted into a joint for direct visualization. • Patient must be able to flex the knee; exercises are prescribed for ROM. • Evaluate the neurovascular status of the affected limb frequently. • Analgesics are prescribed. • Monitor for complications.
Arthroscopy (Cont’d)
Other Tests • • Bone scan Gallium or thallium scan Magnetic resonance imaging Ultrasonography
Chapter 53 Care of Patients with Musculoskeletal Problems
Osteoporosis • Chronic metabolic disease, in which bone loss causes decreased density and possible fracture • Osteopenia (low bone mass), which occurs when osteoclastic activity is greater than osteoblastic activity
Osteoporosis (Cont’d)
Osteoporosis (Cont’d) • • Etiology and genetic risk Genetic considerations Incidence/prevalence Cultural considerations
Classification of Osteoporosis • Generalized osteoporosis occurs most commonly in postmenopausal women and men in their 60 s and 70 s. • Secondary osteoporosis results from an associated medical condition such as hyperparathyroidism, long-term drug therapy, long-term immobility. • Regional osteoporosis occurs when a limb is immobilized.
Health Promotion/Illness Prevention • Teaching should begin with young women who begin to lose bone after 30 years of age. • The focus of osteoporosis prevention is to decrease modifiable risk factors. • Ensure adequate calcium intake. • Avoid sedentary lifestyle. • Continue program of weight-bearing exercises.
Assessment • • Physical assessment Psychosocial assessment Laboratory assessment Imaging assessment: – DXA – QCT – QUS
Osteoporosis: Interventions • Nutrition therapy • Exercise • Other lifestyle changes
Osteoporosis: Drug Therapy • • • Calcium and vitamin D supplements Estrogen or hormone therapy Bisphonates Selective estrogen receptor modulators Calcitonin Other agents used with varying results
Osteoporosis: Surgical Interventions • Vertebroplasty • Kyphoplasty
Osteomalacia • Loss of bone related to vitamin D deficiency • Bone softens because of inadequate deposits of calcium and phosphorus in the bone matrix • Rickets
Collaborative Care • Assessment • The major treatment for osteomalacia is vitamin D
Paget’s Disease of the Bone • Chronic metabolic disorder in which bone is excessively broken down and reformed • Genetic considerations • Collaborative care: – Physical assessment – Diagnostic assessment
Paget’s Disease: Nonsurgical Management • • Analgesics Decrease bone resorption Selected bisphonates Calcitonin Plicamycin Diet therapy Nonpharmacologic pain-relief measures
Paget’s Disease: Surgical Management • Tibial osteotomy • Partial or total joint replacement • Surgical decompression and stabilization of the spine
Osteomyelitis • Infection in bony tissue
Osteomyelitis: Collaborative Care • • Assessment Antibiotic therapy Hyperbaric oxygen therapy Surgical management: – Sequestrectomy – Microvascular bone transfers
Benign Bone Tumors • Often asymptomatic and may be discovered on routine x-ray or as a cause of pathologic fracture: – Chrondrogenic tumors—from cartilage – Osteogenic tumors—from bone – Fibrogenic tumors—from fibrous tissue; most commonly found in children
Interventions • Non-drug pain-relief measures • Drug therapy—analgesics, NSAIDs • Surgical therapy—curettage (simple excision of the tumor tissue), joint replacement, or arthrodesis
Bone Cancer • • • Primary tumors Metastatic lesions Pathophysiology Assessment Nonsurgical management: – Drug therapy – Radiation therapy
Bone Cancer: Surgical Management • Preoperative care • Operative procedure • Postoperative care
Bone Cancer: Community. Based Care • Home care management • Health teaching • Health care resources
Disorders of the Hand • Dupuytren's contracture—slowly progressive contracture of the palmar fascia resulting in flexion of the fourth or fifth digit of the hand
Ganglion • Round, benign cyst often found on a wrist or foot joint or tendon
Disorders of the Foot • • • Hallux valgus Hammertoe Morton’s neuroma Tarsal tunnel syndrome Plantar fasciitis Other problems of the foot
Foot
Scoliosis • Changes in muscles and ligaments on the concave side of the spinal column
Scoliosis (Cont’d) • • Pathophysiology History Treatment of children Treatment of adults
Progressive Muscular Dystrophies • • • Pathophysiology Genetic considerations Diagnosis Management Nursing interventions
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