ADULT HEALTH Exam 4 2024 LATEST
VERSION
Musculoskeletal, Ortho Surgery, and Rheumatologic Problems
Function of Skeletal System
Framework
206 bones in body
Supports surrounding tissue
Protects vital organs
Manufactures blood cells
Stores calcium and phosphorus
Bone Marrow: Hematopoiesis
Growth and Metabolism
Bone reaches maturity after puberty
Later years > 35 bone resorption (loss of bone mass)
Hormone regulates calcium in body
Parathyroid
Predisposes to injury
Numerous minerals and hormones affect bone growth
Menopause = loss of estrogen = loss of bone
Vitamin D, Calcium, phosphorus, parathyroid hormone, and estrogen
Calcitonin produced by thyroid promotes bone formation
Testosterone stimulates bone formation
Joints
Space that two or more bones come together
Synovial joints are freely moveable diarthrodial
Wrist, elbow, hip, knee
Articulation
Provides movement and flexibility
Bursae
Small sacs lined with synovial fluid
Can become inflamed
Supporting Structures
Cartilage
Surface for joint movement
Tendons
Connect muscle to bone
Ligaments
, Connect bone to bone
Fascia
Connective tissue that covers muscles, blood vessels, and nerves
Muscles
Cardiac
Occurs only in heart
Smooth
Found in GI, bladder, uterus, airways, arteries
Skeletal
Require a nerve impulse to contract
Nursing Assessment
Patient History
Demographics
Family history
Diet
Foods high in calcium?
Dark leafy greens, dairy, almonds
Medications
Socioeconomic
Current health problems
Psychosocial issues
Work
Lifestyle
Obese
Smoker
Physical Assessment
Look - Inspect Area
Posture
Kyphosis - outward curvature of spine
Lordosis - sway back (preg ladies)
Gait
Mobility
Swelling
Color
ROM
If possible compare to other extremity “contralateral”
Neurovascular Assessment
5 P’s
Pain
Pulses
Paresthesia
Numbness and tingling
Pins and needles
Pallor
, Paralysis
Common Clues to Musculoskeletal Problems
DEPT
Deformity
Edema
Pain
Throbbing
Diagnostics
Radiographic Examinations
Standard X-Ray
Myelogram
Spinal headache from CSF leak
Arthrogram
CT
MRI
Bone Biopsy
Labs
Calcium
Normal 8.6-10
Decrease Calcium =
Osteomalacia (decrease bone density)
Kidney Disease
Increase Calcium =
Bone Tumors
Hyperparathyroidism
Phosphorus
Normal 2.4-4.4
Serum Muscle Enzymes
Creatine Kinase
Marker for muscle injury
Found in skeletal muscle
Alkaline Phosphatase
Produced by bone
C Reactive Protein
General inflammation marker
Tests
Arthroscopy
Minimally invasive look into internal structures
Check neuro after
Ice on and off for 24 hours, and elevate
DEXA
Dual energy x-ray absorptiometry
Measures bone mass
Need baseline for patient before bone loss starts before age 50
VERSION
Musculoskeletal, Ortho Surgery, and Rheumatologic Problems
Function of Skeletal System
Framework
206 bones in body
Supports surrounding tissue
Protects vital organs
Manufactures blood cells
Stores calcium and phosphorus
Bone Marrow: Hematopoiesis
Growth and Metabolism
Bone reaches maturity after puberty
Later years > 35 bone resorption (loss of bone mass)
Hormone regulates calcium in body
Parathyroid
Predisposes to injury
Numerous minerals and hormones affect bone growth
Menopause = loss of estrogen = loss of bone
Vitamin D, Calcium, phosphorus, parathyroid hormone, and estrogen
Calcitonin produced by thyroid promotes bone formation
Testosterone stimulates bone formation
Joints
Space that two or more bones come together
Synovial joints are freely moveable diarthrodial
Wrist, elbow, hip, knee
Articulation
Provides movement and flexibility
Bursae
Small sacs lined with synovial fluid
Can become inflamed
Supporting Structures
Cartilage
Surface for joint movement
Tendons
Connect muscle to bone
Ligaments
, Connect bone to bone
Fascia
Connective tissue that covers muscles, blood vessels, and nerves
Muscles
Cardiac
Occurs only in heart
Smooth
Found in GI, bladder, uterus, airways, arteries
Skeletal
Require a nerve impulse to contract
Nursing Assessment
Patient History
Demographics
Family history
Diet
Foods high in calcium?
Dark leafy greens, dairy, almonds
Medications
Socioeconomic
Current health problems
Psychosocial issues
Work
Lifestyle
Obese
Smoker
Physical Assessment
Look - Inspect Area
Posture
Kyphosis - outward curvature of spine
Lordosis - sway back (preg ladies)
Gait
Mobility
Swelling
Color
ROM
If possible compare to other extremity “contralateral”
Neurovascular Assessment
5 P’s
Pain
Pulses
Paresthesia
Numbness and tingling
Pins and needles
Pallor
, Paralysis
Common Clues to Musculoskeletal Problems
DEPT
Deformity
Edema
Pain
Throbbing
Diagnostics
Radiographic Examinations
Standard X-Ray
Myelogram
Spinal headache from CSF leak
Arthrogram
CT
MRI
Bone Biopsy
Labs
Calcium
Normal 8.6-10
Decrease Calcium =
Osteomalacia (decrease bone density)
Kidney Disease
Increase Calcium =
Bone Tumors
Hyperparathyroidism
Phosphorus
Normal 2.4-4.4
Serum Muscle Enzymes
Creatine Kinase
Marker for muscle injury
Found in skeletal muscle
Alkaline Phosphatase
Produced by bone
C Reactive Protein
General inflammation marker
Tests
Arthroscopy
Minimally invasive look into internal structures
Check neuro after
Ice on and off for 24 hours, and elevate
DEXA
Dual energy x-ray absorptiometry
Measures bone mass
Need baseline for patient before bone loss starts before age 50
