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Musculoskeletal System
Anatomy and Physiology

The musculo-skeletal system consists
of the muscles, tendons, bones and
cartilage together swith the joints

The primary function of which is to
produce skeletal movements
Muscles
Three types of muscles exist in the body
● 1. Skeletal Muscles

– Voluntary and striated


● 2. Cardiac muscles
– Involuntary and striated
● 3. Smooth/Visceral muscles
– Involuntary and NON-striated
TENDONS

Bands of fibrous connective tissue that
tie bones to muscles
LIGAMENTS

Strong, dense and flexible bands of
fibrous tissue connecting bones to
another bone
BONES

Variously classified according to shape,
location and size

Functions
1. Locomotion
2. Protection
3. Support and lever
4. Blood production
5. Mineral deposition
JOINTS

The part of the Skeleton where two or
more bones are connected
CARTILAGES

A dense connective tissue that
consists of fibers embedded in a
strong gel-like substance
BURSAE

Sac containing fluid that are located
around the joints to prevent friction
ASSESMENT OF THE MUSCULO-
SKELETAL SYSTEM

The nurse usually evaluates this
small part of the over-all
assessment and concentrates on
the patient’s posture, body
symmetry, gait and muscle and
joint function
ASSESMENT OF THE MUSCULO-
SKELETAL SYSTEM

1. HISTORY

2. Physical Examination
– Perform a head to toe assessment
– Nurses need to inspect and palpate
– The special procedure is the
assessment of joint and muscle
movement
– Usually, a tape measure and a
protractor are the only instruments
ASSESSMENT OF THE
MUSCULO-SKELETAL SYSTEM


Gait

Posture

Muscular palpation

Joint palpation

Range of motion

Muscle strength
ASSESMENT OF THE MUSCULO-
SKELETAL SYSTEM
LABORATORY PROCEDURES

1. BONE MARROW ASPIRATION
– Usually involves aspiration of the marrow
to diagnose diseases like leukemia, aplastic
anemia
– Usual site is the sternum and iliac crest
– Pre-test: Consent
– Intratest: Needle puncture may be painful
– Post-test: maintain pressure dressing and
watch out for bleeding
ASSESMENT OF THE MUSCULO-
SKELETAL SYSTEM
LABORATORY PROCEDURES

2. Arthroscopy
– A direct visualization of the joint
cavity
– Pre-test: consent, explanation of
procedure, NPO
– Intra-test: Sedative, Anesthesia,
incision will be made
– Post-test: maintain dressing,
ambulation as soon as awake, mild
soreness of joint for 2 days, joint
rest for a few days, ice application to
relieve discomfort
ASSESMENT OF THE MUSCULO-
SKELETAL SYSTEM
LABORATORY PROCEDURES
3. BONE SCAN

Imaging study with the use of a contrast
radioactive material

Pre-test: Painless procedure, IV radioisotope
is used, no special preparation, pregnancy is
contraindicated

Intra-test: IV injection, Waiting period of 2
hours before X-ray, Fluids allowed, Supine
position for scanning

Post-test: Increase fluid intake to flush out
radioactive material
ASSESMENT OF THE MUSCULO-
SKELETAL SYSTEM
LABORATORY PROCEDURES
4. DEXA- Dual-energy XRAY absorptiometry

Assesses bone density to diagnose
osteoporosis

Uses LOW dose radiation to measure
bone density

Painless procedure, non-invasive, no
special preparation

Advise to remove jewelry
Nursing Management of common musculo-
skeletal problems
PAIN

These can be related to joint inflammation,
traction, surgical intervention

1. Assess patient’s perception of pain

2. Instruct patient alternative pain management
like meditation, heat and cold application, TENS
and guided imagery

3. Administer analgesics as prescribed
– Usually NSAIDS
– Meperidine can be given for severe pain

4. Assess the effectiveness of pain measures
Nursing Management
IMPAIRED PHYSICAL MOBILITY

1. Instruct patient to perform range of
motion exercises, either passive or active

2. Provide support in ambulation with
assistive devices

3. Turn and change position every 2 hours

4. Encourage mobility for a short period and
provide positive reinforcements for small
accomplishments
Nursing Management
SELF-CARE DEFICITS

1. Assess functional levels of the patient

2. Provide support for feeding problems
– Place patient in Fowler’s position
– Provide assistive device and supervise mealtime
– Offer finger foods that can be handled by patient
– Keep suction equipment ready

3. Assist patient with difficulty bathing and hygiene
– Assist with bath only when patient has difficulty
– Provide ample time for patient to finish activity
Musculoskeletal Modalities

Traction

Cast
Nursing Management
Traction

A method of fracture immobilization
by applying equipments to align bone
fragments

Used for immobilization, bone
alignment and relief of muscle spasm
Traction

Skin traction- Buck, Bryant


Skeletal traction
Traction

Balanced Suspension traction


Running/Straight traction
Traction

Pulling force exerted on bones to
reduce or immobilize fractures,
reduce muscle spasm, correct or
prevent deformities
Traction

TO decrease muscle spasms

TO reduce, align and immobilize
fractures

To correct deformities
Nursing Management
Traction: General principles

1. ALWAYS ensure that the weights
hang freely and do not touch the floor

2. NEVER remove the weights

3. Maintain proper body alignment

4. Ensure that the pulleys and ropes are
properly functioning and fastened by tying
square knot
Nursing Management
Traction: General principles

5. Observe and prevent foot drop
– Provide foot plate

6. Observe for DVT, skin irritation and
breakdown

7. Provide pin care for clients in
skeletal traction- use of hydrogen
peroxide
Nursing Management
Traction: General principles
8. Promote skin integrity
– Use special mattress if possible
– Provide frequent skin care
– Assess pin entrance and cleanse the pin
with hydrogen peroxide solution
– Turn and reposition within the limits of
traction
– Use the trapeze
Nursing Management
CAST

Immobilizing tool made of plaster of
Paris or fiberglass

Provides immobilization of the fracture
Nursing Management
CAST: types

Long arm

Short arm

Short leg

Long leg

Spica

Body cast
Casting Materials

Plaster of Paris
– Drying takes 1-3 days
– If dry, it is SHINY, WHITE, hard and
resistant

Fiberglass
– Lightweight and dries in 20-30 minutes
– Water resistant
Cast application
1. TO immobilize a body part in a
specific position
2. TO exert uniform compression to
the tissue
3. TO provide early mobilization of
UNAFFECTED body part
4. TO correct deformities
5. TO stabilize and support unstable
joints
Nursing Management
CAST: General Nursing Care

1. Allow the cast to air dry (usually 24-
72 hours)

2. Handle a wet cast with the PALMS
not the fingertips\

3. Keep the casted extremity
ELEVATED using a pillow

4. Turn the extremity for equal drying.
DO NOT USE DRYER for plaster cast
– Encourage mobility and range of
motion exercises
Nursing Management
CAST: General Nursing Care

5. Petal the edges of the cast to prevent
crumbling of the edges

6. Examine the skin for pressure areas
and Regularly check the pulses and skin
Nursing Management
CAST: General Nursing Care

7. Instruct the patient not to place
sticks or small objects inside the
cast

8. Monitor for the following: pain,
swelling, discoloration, coolness,
tingling or lack of sensation and
diminished pulses
Nursing Management
CAST: General Nursing Care

Hot spots occurring along the cast
may indicate infection under the
cast
Thank you! :)