Med-Surg Chapters 45 & 46 - Musculoskeletal

Musculoskeletal system functions

Movement, protection, and calcium storage.

Articular cartilage

Cushions joints and reduces friction.

Ligaments

Connect bone to bone.

Tendons

Anchor muscles to bones.

Fascia

Strong membranes that enclose individual muscles.

Skeletal muscle

Voluntary muscle specialized for contraction and movement.

Muscle origin

The stationary muscle attachment.

Muscle insertion

The more movable muscle attachment.

Osteocytes

Bone cells that make up bone tissue.

Osteoblasts

Cells that produce bone growth and repair.

Osteoclasts

Cells that resorb/remove old bone.

Periosteum

Connective tissue covering the outer surfaces of bones except at joints.

Axial skeleton

Skull, hyoid, vertebral column, and rib cage.

Appendicular skeleton

Arms, legs, shoulder girdle, and pelvic girdle.

Synovial joint

A freely movable joint containing synovial fluid.

Bursa

Small sac of synovial fluid that reduces friction.

Neuromuscular junction

Location where a motor neuron terminates on a muscle fiber.

Acetylcholine (ACh)

Neurotransmitter released at the neuromuscular junction.

Aging musculoskeletal changes

Decreased muscle mass and strength, decreased elasticity, decreased intervertebral space, posture/gait changes, and loss of height.

Subjective musculoskeletal assessment

History of injury, occupation, family history, nutrition, chronic pain, body image, and psychological stress.

Objective musculoskeletal assessment

Inspection, palpation, range of motion, and muscle tone.

Inspection

Assess posture, gait, mobility aids, deformities, and crepitation.

Palpation

Assess warmth, tenderness, and neurovascular status.

Muscle strength testing

Ask the patient to push feet against resistance or squeeze the nurse's fingers.

Neurovascular assessment

Assess circulation, sensation, movement, pulse, temperature, color, and capillary refill.

Calcium normal range

8.2–10

Phosphorus normal range

2.5–4.5

Myoglobin

An indicator associated with rhabdomyolysis.

Strain

Injury involving a muscle or tendon.

Sprain

Injury involving a ligament.

Dislocation

Displacement of a joint from its normal position.

RICE

Rest, ice, compression, and elevation.

Ice for a sprain

20 minutes, four times daily.

Carpal tunnel syndrome

Compression of the median nerve in the wrist's carpal tunnel.

Carpal tunnel symptoms

Finger, hand, and arm pain or numbness.

Fracture

A break in a bone.

Pathological fracture

A fracture caused by a disease process.

Closed fracture

A fracture that does not break the skin.

Open fracture

A fracture that breaks the skin and increases infection risk.

Fracture signs and symptoms

Pain, decreased ROM, limb rotation, deformity, shortening, swelling, and bruising.

Emergency fracture treatment

Splint it as it lies and seek medical treatment.

Therapeutic goals of fracture care

Realignment of bone ends and immobilization.

Closed reduction

Manual realignment of bone ends without open surgery.

Open reduction with internal fixation

Use of plates, screws, or prostheses to stabilize a fracture.

External fixation

Use of pins and a metal frame to stabilize a fracture.

Fracture complications

Hemorrhage, compartment syndrome, neurovascular compromise, infection, nonunion, thromboembolism, and fat embolism syndrome.

Priority fracture assessment

Neurovascular checks.

Absent pulse after fracture

A priority finding indicating possible circulatory impairment.

Compartment syndrome

Increased pressure within a compartment that can impair circulation and tissue function.

Compartment syndrome priority

Severe/increasing pain with neurovascular changes requires immediate attention.

Cast care

Perform neurovascular checks, manage pain, monitor skin, and palm a wet cast.

Palming a wet cast

Support a wet cast with the palms rather than fingertips to prevent indentations.

External fixation pin care

Follow agency protocol, monitor pin sites at least daily, and use strict aseptic technique.

Osteomyelitis

Infection of bone.

Osteomyelitis signs

Pain, redness, warmth, swelling, and fever.

Osteomyelitis treatment

Debridement, reconstruction, antibiotics, chronic suppressive antibiotics, or amputation if nonresponsive.

Osteomyelitis prevention

Hand hygiene and sterile dressing changes.

Osteoporosis

A metabolic disorder characterized by low bone mass and increased fracture risk.

Common osteoporosis fracture sites

Spine, wrist, and hip.

Osteoporosis nonmodifiable risks

Aging, female sex, family history, previous fractures, postmenopause, petite body build, and certain hormonal/racial factors listed in the chapter.

Osteoporosis modifiable risks

Alcohol, low calcium/vitamin D, excessive caffeine/protein/sodium, sedentary lifestyle, and smoking.

Osteoporosis prevention

Adequate calcium and vitamin D, weight-bearing exercise, avoiding smoking and excessive alcohol.

Osteoporosis signs and symptoms

Back pain, decreased height, fractures, and kyphosis.

Kyphosis

Forward curvature of the spine.

Osteoporosis diagnostic test

DEXA scan.

Osteoporosis chapter lab changes

Decreased vitamin D; increased phosphorus and alkaline phosphatase.

Osteoporosis medications

Bisphosphonates, calcitonin, denosumab, raloxifene, estrogen therapy, and teriparatide.

Bisphosphonates

Alendronate, ibandronate, risedronate, and zoledronic acid.

Paget disease

Rare, noncurable metabolic bone disease causing abnormal, weak, painful bones.

Paget disease treatment

Bisphosphonates and calcitonin

Osteosarcoma

The most common primary malignant bone tumor listed in the chapter.

Ewing sarcoma

A highly malignant primary bone tumor mainly affecting children and young adults.

Bone cancer symptoms

Site pain, swelling, tenderness, and a palpable mass.

Metastatic bone disease

Cancer spread to bone; bone-seeking cancers include prostate, breast, lung, and thyroid.

Gout

Uric acid buildup with urate crystal deposition in joints and connective tissue.

Acute gout

Red, hot, swollen, painful joint, commonly involving the great toe.

Chronic gout

Can cause tophi and renal stones.

Tophi

Urate deposits under the skin associated with chronic gout.

Gout diagnosis

Serum uric acid and joint fluid showing uric acid crystals.

Acute gout medications

Colchicine and NSAIDs.

Gout prevention medications

Febuxostat, allopurinol, and probenecid.

Gout teaching

Avoid high-purine foods, alcohol, aspirin, diuretics, and stress; increase fluids.

Osteoarthritis (OA)

A common degenerative joint disease that increases with age.

OA pathophysiology

Articular cartilage and bone ends deteriorate, joint space narrows, bone spurs develop, and joints become painful and less mobile.

OA risk factors

Heredity, aging, obesity, and excessive wear and tear.

OA pain

Usually intensifies after physical activity.

Heberden and Bouchard nodes

Bony nodes on the joints of the fingers associated with osteoarthritis.

OA treatment

Exercise, weight control, medications, heat/cold, complementary therapies, and total joint replacement when needed.

Rheumatoid arthritis (RA)

Chronic, progressive, systemic inflammatory autoimmune disease.

RA pathophysiology

Synovitis causes synovial thickening and fluid accumulation; pannus damages cartilage and bone.

RA joint pattern

Bilateral and symmetrical joint inflammation.

RA stiffness

Stiffness occurs after resting and activity can decrease pain and stiffness.

RA systemic symptoms

Low-grade fever, weakness, fatigue, and anorexia.

RA late findings

Joint deformity and secondary osteoporosis.

RA diagnostic tests

Rheumatoid factor, RBC, C4 complement, ESR, ANA, and CRP.

RA medications

DMARDs, methotrexate, leflunomide, etanercept, NSAIDs, prednisone, and others listed in the chapter.

OA vs RA

OA is degenerative/wear-and-tear; RA is systemic autoimmune/inflammatory.

Total hip replacement

Replacement of the acetabular cup and femoral component.

Major total hip replacement concern

Prevent hip dislocation.

Hip replacement precautions

Prevent adduction and hyperflexion.