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Musculoskeletal System

Musculoskeletal System. Day 1. What is the first step of the nursing process?. Nursing Diagnosis Assessment Building a relationship of trust Empathy Teaching. Highly integrated system. JOINT. BONE. TENDON. MUSCLE. BURSAE. LIGAMENT. What is the leading cause of disability in the US?.

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Musculoskeletal System

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  1. Musculoskeletal System Day 1

  2. What is the first step of the nursing process? • Nursing Diagnosis • Assessment • Building a relationship of trust • Empathy • Teaching

  3. Highly integrated system JOINT BONE TENDON MUSCLE BURSAE LIGAMENT

  4. What is the leading cause of disability in the US? • Motor Vehicle accidents • Sports injuries • Arthritis • Diabetes • Cardio-vascular impairment

  5. Musculoskeletal SystemFUNCTION! • Protection

  6. Musculoskeletal SystemFUNCTION! • Protection • Framework • Mobility • Move • Heat • Facilitates blood return

  7. Musculoskeletal SystemFUNCTION! • Protection • Framework • Mobility • Reservoir • Blood cells • Essential minerals • Ca • Ph

  8. Anatomy & PhysiologySKELETAL SYSTEM How many bones are in the human body? • 206 • 1,245 • 847 • 145 • 666

  9. Bone Types • Long bones • Short bones • Flat bones • Irregular bones

  10. Bone components Compact Bone Spongy bone Porous • Dense

  11. Diaphysis • Shaft • Epiphyses • End • Epiphyseal plate • growth

  12. Periosteum • Covering • Contains • Nerves • Blood vessels • Lymph tissue • Function • Nourishment • Attachment

  13. Which of the following are formed in the bone marrow? • Red blood cells • White blood cells • Platelets • Hemoglobin • All of the above

  14. Bone Marrow Red Yellow Location Long bones Fatty • Locations • Flat bones • Function • RBC • WBC • Platelets • Hgb

  15. Bone Cells • Osteoblasts • Form matrix • Osteocytes • Maintenance • Osteoclasts • Dissolving & resorbing

  16. Bone Maintenance • Modeling • Childhood • Bones grow & form • Remodeling • Adulthood • Resorption • Osteogenesis

  17. Cool Fact! Complete skeletal turnover occurs every 10 years

  18. Resorption / OsteogenesisHomeostasis • Physical activity • Nutrition • Hormones

  19. Physical Activity • Weight-bearing stimulates bone formation & remodeling

  20. What happens if… • A person is on prolonged bed rest or physically disabled and they don't engage in regular weight bearing activities? • h bone resorption  • Calcium loss  • Osteopenic bones  • fractures

  21. Nutrition • Calcium • 1000 – 1200 mg / day • 16 – 24 oz. milk

  22. What two endocrine hormones work in harmony to maintain normal serum Calcium levels? • What? I need to give you multiple choice answers! NO way! Turn to your neighbor and tell them the answer to this question • PTH • Calcitonin

  23. Hormones PTH Calcitonin Secreted by Thyroid Effect i Serum Ca+ levels Action Inhibits bone resorption & h deposits of Ca+ in the bone • Secreted by • Parathyroid • Effect • h Serum Ca+ levels • Action • Promotes movement of Ca+ from bone to blood

  24. Hormones • Hyperthyroidism  • h bone resorption • i bone formation • Cushing’s syndrome  • h bone resorption • i bone formation

  25. What is the name of the most common form of hyperthyroidism in the U.S.A? • Hashimoto’s thyroiditis • Graves disease • Addison’s disease • Cretinism • Pheochromocytoma

  26. Cushing’s Disease is caused by what hormonal imbalance? • Steroid excess • Steroid deficit • Thyroid hormone excess • Thyroid hormone deficit • Excess ADH

  27. Small Group Questions • What are the 4 main functions of the M/S system? • What & where is the periosteum? • What types of bone marrow are there? (location & function) • What are the 3 main types of bone cells and their main function? • Describe resorption and osteogenesis.

  28. Articular System • Joint • Junction of 2 or more bones

  29. Joints • Synarthrosis • immovable • Amphiarthrosis • Limited motion • Joined by cartilage • Diarthrosis • Freely movable

  30. Types of diarthrosis joints • Ball & Socket • Hinge • Saddle • Pivot • Gliding

  31. Synovial Joints • Bones covered with hyaline cartilage • Form capsule • Lined with synovium membrane • Secretes lubricant

  32. Do the bone surfaces of a normal functioning synovial joint come in direct contact with each other? • Yes • No Synovial fluid acts as a shock absorber

  33. Ligaments, tendons, bursa • Tendons • Bind muscle to bone

  34. Ligaments, tendons, bursa • Ligaments • Bind bone to bone

  35. Ligaments, tendons, bursa • Bursa • Sac filled with synovial fluid • Elbow • Shoulder • Hip • Knee

  36. Small Group Questions • Define synarthrosis, amphiarthrosis & diaarthrosis? • What is a synovial joint? • Define ligament, tendon & bursa. • What hormones are vital for Ca+ and Ph+ homeostasis?

  37. Types of Muscles • Skeletal Muscles • Voluntary movement • Smooth muscles • Internal control • e.g. bladder, GI, bronchi • Cardiac muscles • Heart

  38. Muscle Cell • Parallel cells encased • Fascia • Contains • Myofibrils • Contain • Sarcomeres • Contracting unit

  39. Contraction • Cell contract in response to electrical stimulation  • Ca+ ion enters sacromeres  • Sacromeres contract  • Ca+ rapidly removed  • Sacromere relaxes Ca Ca Ca

  40. Energy Source • ATP • Adenosine triphosphate • Glucose Metabolism • Not all ATP is used with muscle contraction  excess energy  heat

  41. Types of contractions • Isometric • Length of muscle remains constant but  h force • Isotonic • Shortening of the muscle without increase in tension • Combination

  42. Muscle Tone • State of readiness • Flaccid: • i tone • Spastic: • h tone • Atonic: • No nerve impulse  no tone atrophy

  43. Muscle Action • Contraction  movement! • Exercise  • Function • Strength • Size • Hypertrophy • Over exercise  • Lactic acid • Fatigue

  44. Gerontologic Considerations • Aging vs… • i activity • Lifestyle • Pathophysiological factors

  45. Aging Structural Changes • Bones • i bone mass • Vertebrae collapse • Muscles • h collagen • Atrophy • i elasticity • Joints • Cartilage deteriorates • Ligaments • Lax

  46. Aging functional Changes • Bones • Fragile, prone to fracture • Muscles • i strength, weak, tired, stumble • Joints • Stiff, pain • Ligaments • Postural changes

  47. Aging H&P findings • i height • Kyphosis • Flexion of hips & knees • Fractures • Stiffness • i strength

  48. Assessment: Health History • Common symptoms • Pain • Alt. sensation • Past health • Social history • Family history

  49. Small Group Question • Mrs. Jones comes into the doctor’s office complaining of pain in her left knee. What questions will you ask her to assess her pain?

  50. Did you ask the following questions? • Characteristics • Location • Rating • Onset • Duration • Manifestations • Precipitating factors • Effect of ADL’s • Aggravations • Diminishes • Radiating • Associated complaints • Past injuries

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