MEDICAL SURGICAL NURSING

ORTHOPEDIC
NURSING
 DEFINITION OF TERMS:
• ORTHOPEDICS: a branch of health care that is
concerned with the prevention and correction of disorders
of the musculoskeletal system of the body.
• ORTHOPEDIC SURGERY: The branch of medicine that
is concerned with the treatment of the musculoskeletal
system mainly by manipulative and operative methods.
• ORTHOPEDIST/ORTHOPEDIC SURGEON:
 a physician who specializes in orthopedics.
 ORTHOPEDIC NURSE/NURSING: a nurse whose
primary area of interest, competence , and professional
practice is the branch of nursing concerned with the
prevention and correction of disorders of the locomotor
system, including the skeleton , muscle joints, and related
tissues.
 THE MUSCULOSKELETAL SYSTEM
• The musculoskeletal system includes 206 bones which are
connected at joints, held together by ligaments , cushioned by
cartilages. Tendons attached muscle to the bones.
• Function:
1. Provide support for the body
2. Allows movement/locomotion
3. Protects the vital organs (brain, heart, lungs)
4. Stores calcium & release it to the blood stream, according to
body requirements
5. Manufactures new blood cells in the red bone marrow.
 BONES; the body’s framework or skeleton
 Two main division:
b. Axial: consist of 80 bones (skull, vertebral column, ribs)
c. Appendicular: body’s appendages consist of 126 bones (arms,
hips, legs).
 THE MUSCULOSKELETAL SYSTEM
• Four major bone types:
2. Long bones: bones which exceeds length and thickness. (ex. femur)
 Structure:
Diaphysis: shaft, provides strength, resist bending forces.
Metaphysis: flared portion between diaphysis & epiphysis, growing
portion
Epiphysis: end, primary cancellous bones, assist with bone
development.
Epiphyseal plate/line: between metaphysis and epiphysis, cartilages
growth in length of diaphysis and metaphysis.
Periosteum: connective tisssue covering the bone.
 Blood supply:
Nutrient artery of the humerus-one of a pair of branches of deep brachial
arteries arising near the middle of the arm & entering the nutrient
canal of the humerus
Periosteal vessels-blood vessels surrounding the memrane covering the
bone
Metaphyseal and epiphyseal vessels –blood vessels in the shaft & end
portion of the long bonesss
 THE MUSCULOSKELETAL SYSTEM
2. Short Bones: equal in dimensions, found mainly in hands
and feet (ex. carpals)
Types:
c. accessory: bones not normally present
d. Sesamoid; embedded in tendons or joint capsules,
sometimes mistaken for fractures on x-ray (no capsules,
edges aare smooth, often bilateral)
3. Flat Bones: primary made up of cancellous bone tissue. (ex.
skull, girdles)
4. Irregular Bones: (ex. vertebral, tarsal, carpals,)
g. sesamoid: occur in junction with tendon at points in the
body where pressure occurs (ex. Patellae)
h. Wormian: occur in cranial sutures.
THE MUSCULOSKELETAL SYSTEM
• CARTILAGE: contains a firm gel substance which gives
more flexibility to the bone, has a nutrient tissue fluid cells
called chondrocytes and its covering is called
perichondrium.
TYPES:
a. Fibrocartilage: greatest tensile strength, occurs in the
vertebral discs and in the symphysis pubis.
b. Elastic cartilage: possesses firmness & elasticity, occurs in
the external ear and the eustachian tube.
c. Hyaline cartilage: most common cartilage type cushion
most of the joints to help soften the impact, firm yet slightly
flexible, occurs also in part of nasal and bronchial rings.
 THE MUSCULOSKELETAL SYSTEM
• LIGAMENTS & TENDON CONNECTORS:
 Ligaments are strong cords of fibrous tissue.
 Joint capsule provides the primary connection between the bones but
ligaments bind the joints more firmly.
 Tendons also connects muscle and other tissues to each other.
 MUSCLE: action tissues.
 Purpose:
b. Movement d. protects the vital organs
c. Posture e. storage of minerals
d. Leverage f. heat production
 Types:
f. Striated (voluntary)-known as skeletal muscle, with volunatary control
(caused by actin & myosin protein filaments)
g. Smooth (involuntary)- produces slow long term contractions of w/c the
individual is unaware occurs in hollow organs (stomach, intestine, blood
vessels, bladder) controlled by the autonomic nervous system.
THE MUSCULOSKELETAL SYSTEM
 Eight ways of skeletal muscle contraction
2. Isotonic contraction-muscular contraction accompanied by joint
movement
3. Isometric contraction-muscular contraction not accompanied by
joint movement
4. Twitch contraction-contraction of small muscle units w/ quick,
simple spasmodic.
5. Tetanic contraction-continuous contraction in a voluntary
muscle caused by steady steam of efferent nerve impulses
6. Treppe (staircase phenomenon)-subsequennt powerful
contraction caused by increased release of calcium ions
7. Fasciculation-localized uncoordinated, uncontrollable twitching
of a single muscle group, that may be palpated under the skin
8. Fibrilation- involuntary recurrent contraction of a single muscle
fiber, usually described by the part that is contracting
abnormally
9. Convulsions-involuntary contraction of the muscles producing
contortion of the body & limbs
THE MUSCULOSKELETAL SYSTEM

Performing movement
b.Prime movers: muscles initiate bone
movement
c.Antagonist: muscles relax during movement
d.Synergist: muscles either directly assist prime
movers or steady another part of the
participating muscle-bone system to allow
more effective movement
THE MUSCULOSKELETAL SYSTEM
• JOINTS: are points of articulation/connections between bones, permitting
activities such as running or grasping. Others join bones firmly together
permitting little or no movement.
 Three basic joint types:
Synarthroses/ Fibrous-immovable joint w/c the bones are united by fibrous
tissue.
 Sutures-immovable joint w/ minimal amount of connective tissue between
the two bones (skull)
 Syndesmosis-immovable joint in w/c the bones are separated by
connective tissue (base of the tibia & fibula)
Amphiarthroses/ Fibro-Cartilagenous joint-a slightly movable jointin which
the bony surface are separated by fibrocatilage or hyaline cartilage
Diarthroses/ Synovial joints.-freely movable joint, the ends of adjoining
bones are covered w/ thin cartilaginous sheet and the bones are linked by a
ligament lined with synovial membrane w/c secretes synovial fluid
 Joint capsule-a fibrous sac-like structure of connective tissue that
encloses the end of the bones which contains the synovial fluid
 Synovial membrane-thin layer of tissue lining the articular capsule
sorrounding a freele movable joint.
 Articular cartilage-type of hyaline connective tissue that covers the
articulating surfaces of bones w/in synovial joints
 Synovial cavity/bursa- sac filled with synovial fluid in the connective
tissuebetween muscles, tendons, ligaments and bones
THE MUSCULOSKELETAL SYSTEM
 Different types of synovial joints
b. Synovial gliding/arthrodic joint-the bony surface slide
over each other without angular or rotational movement
(carpus and tarsus)
c. Synovial condyloid/condylarthrosis-an ovoid heads fits
into an elliptical cavity (knee joint, mandible, temporal
bone of the skull)
d. Synovial saddle joint-the articulating surfaces of the
bones are reciprocally saddle shaped, no axial rotation
but allows flexion, extension, abduction, adduction
movement (carpometacarpal joint of the thumb)
e. Synovial bone and socket joint/enarthrosis- (shoulder
joint, hip joint) always involves a long bone which allowed
to move in all planes
f. Synovial pivot joint/trochoid-a bone moves round a
central axis allowing rotational movement (atlas & axis
vertebrae)
g. Synovial hinge joint/ginglymus-allows angular movement
in one plane only, increasing or decreasing the angle
between the bones (knee & elbow joint)
THE MUSCULOSKELETAL SYSTEM
• BASIC JOINT MOTION:
2. Flexion-decreases the angle between the anterior surface of articulating bone (bending your
head forward).
3. Extension-increases the angle between the anterior surface of articulating bones, returns a
body part from flexed position to its original neutral anatomical position (straightening your
head after flexion).
4. Hyperextension-continues the act of extension beyond the original anatomical position (when
you look up toward the ceiling).
5. Abduction-moving away a bone away from the body’s midline (moving arms straight out from
the sides).
6. Adduction-moving a bone back toward the body’s midline (bringing arms back to sides of
body from outstretched or abducted position).
7. Rotation-pivoting the bone on its axis (turning the head from side to side: extrnal rotation,
moving the head from looking to the side to looking straight ahead: internal rotation).
8. Circumduction-describing surface of a cone with the moving part (moving arm around that
describes a circle, moving the head frm front , sides aad back)
9. Inversion-turns an extremity or part of an extremity inward towards the body’s midline (moving
sole of the foot inward).
10. Eversion-turns an extremity or part of an extremity outward or away from the body’s
midline(moving the sole of the foot outward).
11. Pronation-forearm movement turning the back of the hand forward.
12. Supination-forearm movement turning the palm forward
13. Protraction-moving a part such as the mandible forward
14. Retraction-pulling a part back, moving the mandible back to its neutral position
15. Plantar flexion-pointing the toes away from the body (a ballerina)
16. Dorsiflexion-pointing toes toward the body.
Two unique moving the movements of the forearm:
18. Pronation
19. Supination
 BODY MECHANICS
• Body Mechanics: refers to the function of muscles and
joints and the application of the mechanical principles to
the activities of the patient and the nurse. By applying
these principles a nurse ca efficiently lift and turn patient
when giving care without causing injury to her own body.
It also contributed to the attainment of nursing care goals.
2. Nursing Care Goals:
a) Permit normal functioning. e.g.: eating is usually done in sitting
position because the gravitational flow assist the food in reaching
the stomach.
b) Aids healing. Patient must also be positioned so that circulation is
maintained thus aids in healing.
c) Prevents complication and deformities.
d) Relieve pain.
 BODY MECHANICS
2. The check point for correct standing posture.
(standing posture is the ability of the body to
remain erect and to maintain this altitude be
resisting outside force with the least amount of
energy.)
a. Head: is held erect with the chin drawn in.
b. Chest: elevated.
c. Back: straightening the back which causes the
sternum to be front of the body and hips.
d. Feet: placed apart but parallel with no internal or
external rotation of the legs.
 BODY MECHANICS
3. The correct points for sitting position:
a. Head: held erect with the chin drawn in
b. Chest: elevated
c. Back: straightening the back which causes the
sternum to be in front of the rest of the body and
hips.
d. Abdomen: keep flat
e. Hips and knees: should be flexed and at right angle
f. Feet: are placed apart but parallel with no internal or
external rotation of the legs.
 BODY MECHANICS
4. Improper posture and body mechanics abnormal stress on weight joint
is a factor in the development of joint diseases such as
osteoarthritis.
5. To prepare to lift a load or a patient, face the object and stand close to
it.
6. The standing posture should be checked of pain when lifting. Get
ready to lift by contracting the muscles. It is easier to pull on the
object than to push it.
7. Head pillow is placed under the shoulder when patient is in supine
position to:
a. allow expansion of the chest.
b. Permit normal functioning of the lungs.
c. If the patient cannot maintain correct lower extremity position without
assistance after a short time; the anterior leg muscles are stretched and
the foot assumes a plantar flexion position, a board or sandbag is placed
against the sole to prevent foot drop.
 BODY MECHANICS
8. Maintenance of function of thee fingers and hands are very
essential because of its ability to grasp or pick.
9. Prone position is more comfortable if a pillow is placed
under the shoulder and chest and another beneath the
feet and lower legs to keep the toes off the bed.
10. When the patient is moved, joints must be supported to
avoid muscle spasms or strain. When positioning a limb,
place the hand under the joint to splint it.
11. To support the patient in left side lying, support the body by
placing pillows between the legs, arms and body parallel
with the back to prevent the following deformities;
abducted and internally rotated right leg abducted right
arm.
 BODY MECHANICS
• Related Musculo-Skeletal Terminologies
1. Atrophy: wasting away.
2. Causalgia: severe burning pain produced by
severed nerves that have malfunctioning nerve
endings, touch can often produce this pain.
3. Circumduction: motion involves abduction,
adduction, flexion, and extension (360 degrees) to
complete full circle; motion of the shoulder, hips
and ankle.
4. Contracture: the absence of full range of motion of
any joint. Most common is flexion contracture,
lack of full extension.
 BODY MECHANICS
• Related Musculo-Skeletal Terminologies (cont…)
5. Deformity; malformation or defect of any part of the
body.
6. Anisomelia: leg length discrepancy, an inequality
between corresponding limbs.
7. Dislocation: musculo-skelelal traumatic injury
resulting in disruption in the continuity of a joint’s
configuration and articulation causing the loss of
contact between the joint surfaces.
8. Dorsiflexion: the motion of moving the body part up
towards the dorsum; motion of the ankle that
moves foot up toward the leg.
 BODY MECHANICS
• Related Musculo-Skeletal Terminologies (cont…)
9. Dysplasia: abnormality of the development of an
organ or body part.
10. Eversion: motion of the ankle characterized by sole
of the foot facing away from the opposite foot.
11. Inversion: motion of ankle characterized by sole of
the foot facing towards the opposite foot.
12. Kyphosis: posterior convexity of thoracic portion of
vertebral column, normal curvature of the spine , but
becomes pathologic if excessive.
13. Lateral: side towards the outer aspect of the body.
 BODY MECHANICS
• Related Musculo-Skeletal Terminologies (cont…)
14. Lordosis: concavity of the vertebral column, normal
curvature existing in cervical and lumbar areas, which
may become pathologic if accentuated.
15. Medial: side towards the middle of the body.
16. Palsy: paralysis
17. Plane:
a. Cardinal Frontal: plane that divides body into front & back
b. Cardinal Horizontal: plane that divides the body into upper
&lower.
c. Cardinal Sagittal: plane that divides the body into left and right
d. Midsagittal; line between cardinal sagittal plane.
 BODY MECHANICS
• Related Musculo-Skeletal Terminologies
(cont…)
18. Range of Motion (ROM); the full motion a joint
can assume.
19. Recurvatum: hyperextension (extension beyond
neutral position).
20. Rotation: motion involving turning of one bone
on another; angle between the two bones do not
change.
a. External: outward rotation
b. Internal: inward rotation.