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Chapter 52. Assessment of the Musculoskeletal System. Skeletal System. Bone types Bone structure Bone function

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Chapter 52

Chapter 52

Assessment of the Musculoskeletal System


Skeletal 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 and androgens, thyroxine, and insulin



Joints
Joints

  • Types include synarthrodial, amphiarthrodial, diarthrodial.

  • Structure synovial joint.

  • Subtyped by anatomic structure:

    • Ball-and-socket

    • Hinge

    • Condylar

    • Biaxial

    • Pivot



Muscular system assessment
Muscular System Assessment

  • Patient history

  • Nutritional history

  • Family history and genetic risk

  • General inspection:

    • Posture and gait



Specific assessments
Specific Assessments

  • Face and neck

  • Spine

  • Hand

  • Hip

  • Ankles, feet

  • Neurovascular assessment

  • Psychosocial assessment


Diagnostic 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
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
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.



Other tests
Other Tests

  • Bone scan

  • Gallium or thallium scan

  • Magnetic resonance imaging

  • Ultrasonography


Chapter 53

Chapter 53

Care of Patients with Musculoskeletal Problems


Osteoporosis
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 d1
Osteoporosis (Cont’d)

  • Etiology and genetic risk

  • Genetic considerations

  • Incidence/prevalence

  • Cultural considerations


Classification of osteoporosis
Classification of Osteoporosis

  • Generalized osteoporosis occurs most commonly in postmenopausal women and men in their 60s and 70s.

  • 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
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
Assessment

  • Physical assessment

  • Psychosocial assessment

  • Laboratory assessment

  • Imaging assessment:

    • DXA

    • QCT

    • QUS


Osteoporosis interventions
Osteoporosis: Interventions

  • Nutrition therapy

  • Exercise

  • Other lifestyle changes


Osteoporosis drug therapy
Osteoporosis: Drug Therapy

  • Calcium and vitamin D supplements

  • Estrogen or hormone therapy

  • Bisphosphonates

  • Selective estrogen receptor modulators

  • Calcitonin

  • Other agents used with varying results


Osteoporosis surgical interventions
Osteoporosis: Surgical Interventions

  • Vertebroplasty

  • Kyphoplasty


Osteomalacia
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
Collaborative Care

  • Assessment

  • The major treatment for osteomalacia is vitamin D


Paget s disease of the bone
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
Paget’s Disease: Nonsurgical Management

  • Analgesics

  • Decrease bone resorption

  • Selected bisphosphonates

  • Calcitonin

  • Plicamycin

  • Diet therapy

  • Nonpharmacologic pain-relief measures


Paget s disease surgical management
Paget’s Disease: Surgical Management

  • Tibial osteotomy

  • Partial or total joint replacement

  • Surgical decompression and stabilization of the spine


Osteomyelitis
Osteomyelitis

  • Infection in bony tissue


Osteomyelitis collaborative care
Osteomyelitis: Collaborative Care

  • Assessment

  • Antibiotic therapy

  • Hyperbaric oxygen therapy

  • Surgical management:

    • Sequestrectomy

    • Microvascular bone transfers


Benign bone tumors
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
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
Bone Cancer

  • Primary tumors

  • Metastatic lesions

  • Pathophysiology

  • Assessment

  • Nonsurgical management:

    • Drug therapy

    • Radiation therapy


Bone cancer surgical management
Bone Cancer: Surgical Management

  • Preoperative care

  • Operative procedure

  • Postoperative care


Bone cancer community based care
Bone Cancer: Community-Based Care

  • Home care management

  • Health teaching

  • Health care resources


Disorders of the hand
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
Ganglion

  • Round, benign cyst often found on a wrist or foot joint or tendon


Disorders of the foot
Disorders of the Foot

  • Hallux valgus

  • Hammertoe

  • Morton’s neuroma

  • Tarsal tunnel syndrome

  • Plantar fasciitis

  • Other problems of the foot



Scoliosis
Scoliosis

  • Changes in muscles and ligaments on the concave side of the spinal column


Scoliosis cont d
Scoliosis (Cont’d)

  • Pathophysiology

  • History

  • Treatment of children

  • Treatment of adults


Progressive muscular dystrophies
Progressive Muscular Dystrophies

  • Pathophysiology

  • Genetic considerations

  • Diagnosis

  • Management

  • Nursing interventions


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