PAPER ENGLISH IN NURSING I

“MUSCULOSKELETAL AND INTEGUMENTARY SYSTEM”

By :
Group 5 ( A1 )

1. Siti Sholihah 131411131013

2. Venni Hariani 131411131034
3. Ryna Istighfarin Azizah 131411131049
4. Putri Mei Sundari 131411131067
5. Elyta Zuliyanti 131411131085
6. Tessa Widya Kosati 131411131103
7. Citra Intan Trisnalia 131411133017
8. Mar’atul Hasanah 131411133035

Teacher : Nuzul Qur’aniati, S.Kep., Ns., M.Ng

FACULTY OF NURSING
UNIVERSITAS AIRLANGGA
SURABAYA
2015

i
 PREFACE

With the utter sense of gratitude to Allah Almighty who has given His
blessing and guidance, the authors managed to complete a paper about
Musculoskeletal and Integumentary System.
Authors would like to thank anyone who have helped in the settlement
process of this paper especially the teacher of English in Nursing, Ma’am
Nuzul Qur’aniati, S.Kep., Ns., M.Ng. Hopefully this paper can be beneficial
to all people, especially students of the Faculty of Nursing, Universitas
Airlangga.
Authors are aware in this paper there are so many weakness spot. thus,
authors really expected to take any criticism and constructive suggestions in
order to improve this paper in the near future. Hopefully this paper can be
utilized as appropriate and useful to readers.

Surabaya,
May, 24th 2015

Authors

ii
 CONTENS

TITLE PAGE .................................................................................................. i

PREFACE ....................................................................................................... ii
CONTENS ...................................................................................................... iii
CHAPTER 1 INTRODUCTION
1.1 Background ................................................................................................ 1
1.2 Purpose ....................................................................................................... 2
1.2.1 General Purpose ............................................................................... 2
1.2.2 Spesific Purposes ............................................................................. 2
1.3 Problem Formulation ................................................................................. 2
1.4 Benefit ....................................................................................................... 2
CHAPTER 2 CONTENTS
2.1 Musculoskeletal System
2.1.1 Anatomy and Physiology of the Musculoskeletal System .............. 3
2.1.2 Types and Classifications ............................................................... 3
2.1.3 Etiology and Clinical Appearances .................................................. 15
2.2 Integumentary System
2.2.1 Anatomy and Physiology of the Integumentary System. ................. 16
2.2.2 Types and Classifications. ............................................................... 17
2.2.3 Etiology and Clinical Appearances .................................................. 18
CHAPTER 3 CONCLUDING
3.1 Conclusion ................................................................................................ 21
REFERENCES................................................................................................. iv

iii
 CHAPTER 1
INTRODUCTION

1.1 Background
The musculoskeletal system is the body system that consist of muscle
and the bones that compose the scale. Muscle is the body tissues that has the
ability to convert chemical energy into mechanical energy (motion).
Meanwhile, framework is the part of body that is consist of bones that allows
the body to maintain the shape, posture, and position.
Musculoskeletal system have many diseases, such as Osteoporosis. Today
experts have finally come to the realisation that osteoporosis can effect
everybody, independent of sex and age. Twenty-five per cent of cases of
osteoporosis and fractures now occur in men. Exceptional progress has been
made in fundamental research on osteoporosis, its diagnosis, and therapy.
(Bartl, 2004)
Osteoporosis is now identified as one of the most important diseases
affecting the human race, along with hypertension and diabetes mellitus. For
example, an estimated 30 million people suffer from it in USA, and equally
high precentages of the population in European and other countries. While
every eighth woman suffers from breast cancer, every third woman sustains a
fracture due to osteoporosis. Seventy per cent of the 1.3 million fractures that
occur annually in the USA in patients aged 45 years or older are attributable to
osteoporosis. From the age of 50 years a woman has the following risk of
fracture: (Bartl, 2004)
a. Vertebral 32%
b. Lower arm 16%
c. Hip 15%
As a nurse, we should give education to the client, include exercises to
keep the joint moving as well as application of ice and heat. Also we told to
the client to have a bedrest.
The skin and its accessory structures (hair, nails, and glands) make up the
integumentary system. The primary function of the integumentary system are
protection, thermoregulation, metabolism, sensation, and communication. The
skin, the largest organ in the body, is vital for survival. The principal layers of
the skin are the superficial epidermis and the deep dermis. (Rosdahl, 2008)
The skin is important for human, and there is disease of skin is burning
skin. There are two causes of burning skin, they called burns and scalds. Burn
means burning of skin from dry heat (for example from hot electric, press,
from fire flame, burning charcoal, chemicals) used in face creams and from
sun-heat called sun burn. Scald means burning of skin with hot liquids (for
example, burning with boiling water, milk, tea or hot oil). (Gupta, 1999)
Burn injuries take a huge toll in global health care and may represent the
greatest worldwide need for reconstructive surgery. With the advancements in
trauma and burn management over the past three decades, there has been a
significant improvement in survival from major burns. Better resuscitation and
a multidisciplinary burn team approach have facilitated the reduction in
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 mortality an improved care; hence, there is an increased need for burn
reconstruction. Without question, access to health care and available resources
for reconstruction are the limiting steps in providing adequate reconstruction
of burn injuries worldwide. (Norman, 2014)
As nurse, we should spend some time educating the clients about treating
their skin at home. Emphasize the importance of avoiding activities and
procedures that can increase redness or chance of reactions and damage to the
barrier function. With the client, discuss the following precautions. (Lees,
2011)

1.2 Purpose
1.2.1 General Purpose
To understand the Musculoskeletal system and the Integumentary system.
1.2.2 Spesific Purpose
1. To understand the anatomy and physiology of Musculoskeletal system
2. To understand types and clasification of Musculoskeletal system
3. To understand etiology and clinical appearances of Musculoskeletal
system
4. To understand the anatomy and physiology of Integumentary system
5. To understand types and clasification of Integumentary system
6. To understand etiology and clinical appearances of Integumentary system

1.3 Problem Formulation

1. What is anatomy and physiology of Musculoskeletal system?
2. What is types and clasification of Musculoskeletal system?
3. What is etiology of Musculoskeletal system? How the clinical
appearances of Musculoskeletal system?
4. What is anatomy and physiology of Integumentary system?
5. What is types and clasification of Integumentary system?
6. What is etiology of Integumentary system? How the clinical
appearances of Integumentary system?

1.4 Benefit
1. Adding insight to students about Musculoskeletal and Integummentary
2. Increase student knowledge about the clinical appearances of
musculoskeletal.

2
 CHAPTER 2
CONTENTS

2.1 Musculoskeletal System

2.1.1 Anatomy and Physiology of the Musculoskeletal system
A. Definition of Musculoskeletal System
The musculoskeletal system is composed of several key structures, and
each component of the system is essential for the mobility and movement
associated with survival. The skeleton, or bony framework of the body,
provides support and attachments for muscles, tendons and ligaments. The
various bones of the body are connected together at different parts of their
surfaces by articulations or joints. All movements that change the position
of bony parts of the body occur at the joints. Although bones and joints
provide leverage, they are not capable of moving the body themselves.
Muscles are attached to bones by tendons and ligaments, which are strong
fibrous bands. Motion is an essential function of the human body that results
from the contraction and relaxation of muscles, and sensory and motor
fibres from the c5entral nervous system innervate muscles. (Martini,2009)

B. Anatomy Musculoskeletal System

Musculoskeletal consists of :
a. Muscular / muscle : muscles , tendons , and ligaments
b. Skeletal / order : bone and joints
C. Physiology Musculoskeletal system
1. protect and support the internal structures and organs of the body
2. allow movement
3. give shape to the body
4. produce blood cells
5. store calcium and phosphorus
6. produce heat.
2.1.2 Types and Classification of Musculoskeletal System
1. Muscle
No Image Medical English Function
1 Pectoral Chest to control the movement of
the arm, with the contractions
of the pectoralis major
pulling on the humerus to
create lateral, vertical, or
rotational motion. The
www.physioadvisor.com.au pectorals also play a part in
deep inhalation, pulling the
ribcage to create room for the
lungs to expand.

3
2 Brachii Arm it helps control the motion of
two different joints,
playing minor roles in
moving the arms forward,
upward, and sideways.

en.wikipedia.org
3 Carpus
Wrist To flex the flexor tendons
cannot shorten sufficiently to
produce effective movement
at the interphalangeal joints.

www.studyblue.com
4 Palmaris Palm of the that runs to the palm and
hand activates flexibility at the
wrist. Muscles assist in
movement, blood flow,
speech, heat production, body
shaping, and protection of
some internal organs.

en.wikipedia.org
5 Digiti
Finger or toes, to control the movement of
singular the little finger. When the
muscle moves, it forces the
little finger to bend and
stretch.

metrocrossfit.com

4
6 Digitorum
www.rad.washington.edu
7 Indicis
www.studyblue.com
8 Hallucis
bochikun.com
9 Femoris
en.wikipedia.org
Finger or toes, In producing the thrust from
plural the toes when the demand
arises
Index finger to enable extension of the
index finger. It also helps in
extension of the midcarpal
joints and the wrist.
Great or big toe To runs along the medial, or
interior, border of each foot,
covering the origins for most
of the plantar (sole of foot)
nerves and vessels.
Thigh To support the weight of the
body and allowing motion of
the lower extremity
5
10 Gluteus Gluteal or To play its most important
buttock region role in the support and control
of pelvic movement.

breatheeasymassage.wordpress.co
m
11 Tibialis Lower leg or as a dorsiflexor of the foot by
shin bone pulling the top, or dorsum, of
the foot towards the shin also
provides a slight inversion of
the foot by pulling the plantar
surface of the foot toward the
body’s midline.

http://upload.wikimedia.org/wikip
edia/commons/d/d4/Tibialis.png
12
Peroneus Fibula/Fiburalis Working as a plantar flexor,
the peroneus longus assists
the much larger
gastrocnemius and soleus
muscles in pointing the toes,
Eversion of the foot is an
important part of standing on
one foot, centering the body’s
weight over the planted foot.

thewellnessdigest.com
13 Spina, Spinalis Spine as flexion, extension, or
rotation. Muscles and
ligaments work together to
support the spine, hold it
upright, and control
movement during rest and
activity.

www.med.umich.edu

6
14 Spinatus Spine of the 1. lateral/external rotation of
scapula the shoulder
2. stabilizing the shoulder
joint

canuckrmt.wordpress.com
15 Pollicis Thumb to abduct the thumb at
the carpometacarpal joint,
there by moving the thumb
anteriorly. It also assists in
extending and rotating the
thumb

pixshark.com
16 Oculi Eye receiving the light entering
the eye and then continues
with refraction to come down
to the retina and can detect
light.

healthfixit.com
17 Oris Mouth to destroy food's mouth with
teeth so its size is small
enough to be swallowed into
the stomach. Besides the
mouth is also a tool for
talking.

en.wikipedia.org

7
18 Labii Lips to keep food and drinks are
not scattered out, feeling hot
and cold food, to play
musical instruments, and
much more.

www.theodora.com
19 Capitis Head to rotate and bend toward one
side; together, these muscles
bring the head into an upright
position.

code.google.com
20 Cervicis Neck Neck serves to prop up the
head and protect the throat
(breathing), esophagus (food)
and the vocal cords
(producing sound).

www.memrise.com
21 Thoracis Mid Back/ to hold the rib cage and
Thorax protect the heart and lungs.

www.kidport.com

8
22 Abdominis Abdomen The muscle is activated while
doing crunches because it
pulls the ribs and the pelvis in
and curves the back. The
muscles are also used when a
child is delivered, during
bowel movements, and
coughing. Breathing in and
holding the rectus abdominis
in pulls in the abdomen.
thewellnessdigest.com
23 Lumborum Lower back or 1. Lateral rotation of the
lumbar lumbar spine when acting
unilaterally
2. Elevation of the pelvis
when acting unilaterally

www.onlinehealthmag.com
24 Scapularis Scapula to stabilize and rotate the
shoulder joint to allow the
arm to turn inward. When the
arm is extended, it draws the
humerus forward and
downward. It also prevents
the dislocation of the head of
the humerus.

en.wikipedia.org
25 Costals Ribs The external intercostal
muscles are responsible for
forced and quiet inhalation.
The internal intercostal
muscles are responsible for
forced exhalation. They
depress the ribs and decrease
space in the chest cavity.

www.medguidance.com
9
2. Tendon
Tendons are bands of fibrous connective tissue that attach muscles to
periosteum, the fibrous covering of the bone. Tendons enable bones to
move when skeletal muscles contract. (Lippincott, 2009)

(Source: www.artintercepts.org) (Source: http://www.eorthopod.com/)

3. Ligament
Ligaments are dense, strong, flexible bands of fobrous connective tissue
that bind bones to other bones. (Lippincott, 2009) Function of Ligaments
is connecting one bone to another bone, according to
MedlinePlus. Ligaments also protect the joints from damage by limiting
certain types of movements.

(Source: fungsi.web.id)

10
4. Skeletal

(Source: http://hes.ucfsd.org/gclaypo/skelweb/skel03.htmsl)

11
No Image Medical English Function
1 Cranium Skull to encloses the brain and
protect the organs of sight,
hearing and balance.
Protect the brain
To protect the brain.

www.visiondoble.net
2 Facial Face to support the face and and
hold the eyes in place

en.wikipedia.org
3 Rib Cage Ribs protects vital organs, such
as the heart and lungs.

www.sciencekids.co.nz
4 Clavicle
Collarbone to provide support for free
range movement of the arms
and to protect the
neurovascular bundle.

en.wikipedia.org

12
5 Scapula
en.wikipedia.org
6 Sternum
commons.wikimedia.org
7 Vertebrae
en.wikipedia.org
8 Humerus
en.wikipedia.org
Shoulder blade to provide movement and
stabilization of the arm at
the shoulder by attaching it
to the trunk of the body,
known as the thorax.
Breast bone to protects the aorta, vena
cava, heart and thymus
gland
Spine To support body weight,
support the head, gives
shape to our body, contains
spinal cord for most reflex
action
Upper arm bone to anchor the major muscles
that move the shoulder and
elbow
13
9 Radius Short forearm To rotate the forearm

commons.wikimedia.org
10 Ulna Long forearm to support the forearm and
allow it to move

en.wikipedia.org
11 Carpals Wrist to allow for the easy and
free movement of the wrist.

oncourse.iu.edu
12 Femur Thigh bone support of the body,
providing a human the
ability to be walk, run or
jump.

en.wikipedia.org

14
13 Patella Knee protects the knee-joint
anteriorly and improves the
leverage of the knee
extensor muscles

www.alientravelguide.com
14 Tibia Shin bone connecting the knee to the
ankle in the bodies of
humans and other
vertebrates. to form part of
the skeleton in the lower leg

en.wikipedia.org
15 Tarsals Ankle supporting movement,
creating insertion points for
muscles, tendons, and
ligaments, and storing some
minerals

www.sundayobserver.lk

2.1.3 Etiology and Clinical Appearances of Musculoskeletal System

A. Etiology of Musculoskeletal System in an Osteoporosis
According to Catherine (2004), there are some possible mechanisms to
caused osteoporosis, include physiological processes related to:
1. Calcium Deficiency
In humans, epidemiological studies also point to the role of calcium in
osteoporosis, because an increase in the incidence of osteoporosis is often
found in geographical areas where dietary calcium intake is low.
Increased sodium or protein intake increases calcium excretion.
2. Vitamin D Absorption and Metabolism
Vitamin D, essential for maintaining serum calcium concentrations, is
quite variable in osteoporosis. In general, vitamin D is often much lower
in the elderlu compared to younger adults. In some (younger) patients,
15
 vitamin D levels are appropriate but the receptors are either deficient or
unresponsive.
3. Fluctuations in Parathyroid Hormone (PTH)
The role of PTH in the development of osteoporosis continues to be
defined. As is true with many hormones, PTH is not secreted continuosly
but in a circadian pattern with episodic release throughout the day.
4. Estrogen Deficiencies

B. Clinical Appearances of Musculoskeletal in an Osteoporosis

1. High levels of serum calcium or alkaline phosphatase on a blood test
2. Vitamin D deficiency
3. Difficulty getting up from a chair without using your arms to push
4. Joint or muscle aches
5. A resting pulse greater than 80 beats per minute
6. Height loss
7. Increasing stooping (curvature of the spine)
8. BMD results of -2.5 or less

2.2 Integumentary System

2.2.1 Anatomy and physiology of the Integumentary System
The integument is composed of skin and its associated tissue sweat
glands, sebaceous glands, hair and nails. This is the largest organ of the
body : 16 % of the body weight that covers the entire body. Then it
continuous with the digestive system (lips and anus), respiratory system
(nose) and urogenital system (uretha).
A. Anatomy of Integument

(Source: biostudy4u.com)

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 Skin Structure
Skin is composed of two primary layers (Nursalam, 2010) :
1. The epidermis is the ectodermally derived outer layer composed of
keratinized stratified squamous epithelium
2. The dermis is the mesodermally derived layer of dense irreguler
collagenous connective tissue that underlines and interdigitates with
the epidermis
3. The hypodermia is a loose connective tissue contain varying amounts
of adipose that underlines and support the skin; it is the superficial
fascia that covers the entire body.

B. Physiology of Integument
1. The function of protection
2. The function of absorbtion
3. The function of excreation
4. The function of making vitamin D
5. The function of temperature setting
6. The function of ceratinisation

2.2.2 Types and Classifications of Integumentary System

1. The Epidermis
The epidermis is an epithelium comprised of keratinocytes undergoing
a program of sequential differentiation. The four major layers arise from
the sequential differentiation of cells migrating from the basal layer to the
surface. (Nursalam, 2010).

(Source: jcb.rupress.org)

Epidermis, divided into 4 layers:

a) Stratum Corneum
b) Granula Layer
c) Spinous Layer
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 d) Basal Layer

2. Dermis
The dermis is a dense, irregular, connective tissue, and composed of
collagen. Its networks of elastic fibers function to support epidermis and
bind the skin to the deeper hypodermis. The dermis contains two layers,
the papillary layer and the reticular layer. (Nursalam, 2010)

3. Hypodermis
The hypodermis provides insulation, shock absorption, energy storage, and
the ability of skin to slide over joints. It also contains major blood vessels
of the skin. (Nursalam, 2010)

2.2.3 Etiology and Clinical Appearances of Integumentary System

A. Etiology Of Integumentary System in Burning Skin
1. First degree burn
a. Sunburn
Sunburn develps when you stay out in the sun too long and do not
apply sufficient sunscreen. The sun produces intenses ulttraviolet (uv)
rays that can penetrate the outer layer of your skin and cause it to
redden, blister, and peel.
b. Scalds
Scalds are common cause of first degree burns to children, typically
those under age 4. Hot liquid spilled from a pot on the stove or the
steam emitted from hot liqiud may cause burns to the hands, face, and
body. Keep hot cooking pots on the back burners with the handles
turned toward the center of the stovetop to prevent accident. Scalds can
also occur if you bathe or shower in extreamly hot water.
c. Electricity
Electricity socket, electrical cords, and appliances can appear
intriguing to unsuspecting child, but they pose considerable dangers. If
you sticks a finger (or any object) into the opening of socket, bites on
an electrical cord, or play with appliance, can get burned/ or
electrocuted from exposure to elctricity.
2. Second degree burn
a. Heat (thermal) injury.
This happens when skin cimes in contact with something very hot. It
could be a flame, a hot object, hot liquid, or steam.most second degree
burns are thermal injuries.
b. Radiation.
Sunlight is one type of radiation that can burn the skin. Another type of
radiation is used to heat food. Radiation is also used to treat some
18
 deases. All types of radiation can burn the skin. Sunlight usually
causes of first degree burn. Radiation used for heating food or traetung
a disease can cause a second degree burn.
c. Electricity.
Electrical burn cans can cause more damage under the skin that on the
surface. They should always be treated as major burns.
d. Chemical.
Many chemical canburn the skin. The burn should be flushed with cool
air water and checked by an emergency caregiver.
3. Third degree burn
a. Heat (thermal) injury.
This happens when skin comes in contact with something very hot. It
could be a flame, a hot object, hot liquid, or steam.
b. Chemical.
Many chemicals can urn the skin. The burn should be flushed with
cool wasterand checked by an emergency caregiver.

B. Clinical Appearances of Integumentary System in Burning Skin

1. First degree burn
a. Redness
b. Minor inflammation (swelling)
c. Pain
d. Dry, peeling skin (occurs as the burn heals)
e. Red without blisters.
2. Second degreen burn
a. Blisters and some thickening of the skin
b. Severe pain
c. Extreme tenderness
d. Deep redness
e. Blistered skin
f. Skin that has changed color. It might look blotchy, wet or shiny
g. Swelling
h. Redness with clear blister
i. Blanches with pressure
j. Skin that is painful to the touch.
3. Third degree burn
a. Widespread thickness with a white, leathery appearence
b. Waxy and white
c. Chareed
d. Dark brown

19
 e. Raised and leathery
f. The skin may feel clammy. Lips and fingernails may turn blue.
Breathing may be very fast, and you could faint.
g. Dehydration. You might feel very thirsty, dizzy, weak, or have trouble
urinating.
h. Color changes in the skin. The skin might look white or yellow,
brown, purple, or black.
i. Skin that looks feels thick, dry and leather like.
j. Numbess or only a little pain. This happen because nerve endings have
been destroyed. The area around the burn may hurt more than the
burned area of skin.
4. Fourth degree burn
a. The most severe form of burn affect structures well beyond the skin,
such as muscle and bones.
b. The skin may appear blackened or charred.
c. If nerve damage is substantial, you may feel no pain at all.

20
 CHAPTER 3
CONCLUSION

3.1 Conclusion
Musculoskeletal system consists of muscles, tendons, ligaments, bones,
and joints. These structures give the human body its shape and ability to
move. Various parts of the musculoskeletal system work with the nervous
system to produce voluntary movements. Muscles contract when stimulated
by impulses from the nervous system. (Lippincott, 2009)
Musculoskeletal system have many diseases, such as Osteoporosis.
Osteoporosis is now identified as one of the most important diseases affecting
the human race, along with hypertension and diabetes mellitus. (Barti, 2004)
Osteoporotic fractures affect more women than heart attacks, strokes and
all female cancers combined. Primarily through complications stemming from
hip fractures. (Barti, 2004)
Etiology of Osteoporosis is calcium deficiency, Vitamin D Absorption and
Metabolism, Fluctuations in Parathyroid Hormone (PTH), Estrogen
Deficiencies. There are clinical appearances of osteoporosis is High levels of
serum calcium or alkaline phosphatase on a blood test, Vitamin D deficiency,
etc.
The integumentary system is the largest body system and includes the
skin, or integument, and its appendages (the hair, nails, and certain glands).
(Lippincott, 2009)
Function of the integumentary system is protection, absorbtion, excreation,
making vitamin D, temperature setting, and ceratinisation. (Nursalam, 2010)
The skin is important for human, and there is disease of skin is burning
skin. There are three degree until four degree, refer to the severity of that
wounds. Etiology of burning skin it called burns and scalds. Clinical
appearances of burning skin from all of the degree is so different in each
degree. For first degree is redness and peeling skin, etc. For the second degree
is deep redness and Skin that is painful to the touch, etc. For the third degree
is The skin may feel clammy. Lips and fingernails may turn blue. Breathing
may be very fast, and the client could faint also dehydration. For the fourth
degree is The most severe form of burn affect structures well beyond the skin,
such as muscle and bones.

21
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