NUR 221 - Ch 40 WB - Musculoskeletal Function

List the essential amount of daily calcium that is necessary to maintain adult bone mass _____ mg for adults, _____ mg for postmenopausal women.

1200 mg, 1500 mg

Name the six structures of the musculoskeletal system

Bones, joints, muscles, tendons, ligaments and bursae of the body

Angiogenesis and cartilage formation: A bridge of soft tissue, called a callus, is formed

Cartilage calcification: Chondrocytes regulate calcification of the cartilage

Turning the foot outward

Eversion

Straightening at a joint

Extension

Name the posture complication seen most frequently in the elderly who have osteoporosis

Kyphosis

Write the sequence of the parathormone and calcitonin feedback response to serum calcium levels.

Low serum calcium levels

Pulling the jaw backward

Retraction

Turning around on a specific axis

Rotation

Moving away from the midline

Abduction

The nurse who is taking care of a patient with lower motor neuron destruction documents on the electronic health record that the muscle tone in the lower legs is

Atonic rationale a denervated muscle becomes soft and flabby atonic and atrophies. If flaccid muscle is limp and without tone, and muscle with greater than normal tone is considered spastic.

Trabecular bone is also known as this

Cancellous

Bending at a joint

Flexion

Increased levels of parathormone

Increased mobilization of calcium

Fibrous connective tissue bands

Ligaments

Name the three basic cell types that compose bone

Osteoblasts, osteocytes, and osteoclasts

The two major hormone Regulators of calcium hemostasis are

Parathormone and calcitonin

Parathormone regulates the concentration of calcium in the blood by

Promoting the movement of calcium from the bone rationale parathormone promotes the movement of calcium from the bone through a feedback mechanism that is triggered by low serum calcium levels.

Turning the palm of the hand downward

Pronation

Pushing the jaw forward

Protraction

Identify the parts of the structure of a long bone

Proximal epiphysis, diaphysis, distal epiphysis, cartilage, growth lines, spongy bone containing red marrow, medullary marrow cavity, endosteum, yellow marrow, periosteum, artery

Outline a list of questions that a nurse could use to assess sensory disturbances that are found with musculoskeletal problems.

Refer to box 40 - 2 in the text.

Explain the process of bone remodeling.

Remodeling is the primary process that occurs in bone maintenance. Remodeling maintains bone structure and function through simultaneous resorption removal destruction of tissue and osteogenesis bone formation.

There are 206 bones in the human body divided into four categories. Name each category and give an example

Short bones metacarpals, flat bones sternum, and irregular bones vertebrae

Calcitonin inhibits bone resorption and increases calcium deposits in the bone

Stimulation of the thyroid gland to secrete calcitonin

What diagnostic test would the nurse expect the healthcare provider to order?

The health care provider should order an X-ray of the lumbar sacral area

What structural abnormality does the health care provider suspect?

The healthcare provider suspect a compressed or herniated disc that applies pressure on one or more nerve Roots as they leave the spinal cord.

What is the rationale behind ordering this test?

The healthcare provider suspects a diagnosis of sciatica, which is inflammation of the sciatic nerve. This condition is marked by pain and tenderness along the course of the nerve.

Red bone marrow is located primarily in four areas

The sternum, ilium, vertebrae, and ribs - adults

The progress of bone healing is influenced by five variables

Type of fractured bone, adequacy of blood supply, the surface contact of the fragments, the person's age, and General Health of the person

A patient who needs to increase her intake of calcium is advised to also increase her intake of another vitamin that supports calcium absorption. The vitamin is

Vitamin D Rationale to support the absorption of calcium from the gastrointestinal tract and increase the amount of calcium in the bone, there needs to be sufficient active vitamin D.

A nurse practitioner provides health teaching to the family of a 75 year old woman who has trouble walking independently. The nurse reviews age-related changes to the musculoskeletal system with the family.

Which of the following statements would the nurse include in her teaching? Select all that apply. Intervertebral discs become thin, muscles atrophy, muscle fibrosis increases, collagen increases rationale refer to table 40-1 in the text

A type of diarthrosis joint

saddle

Patient education for musculoskeletal conditions for the Aging is based on the understanding that there is a gradual loss of bone after a peak of bone mass at age

30 years - rationale bone mass Peaks at about age 30, after which there is a universal and gradual loss of bone.

The percentage of total body calcium present in the bone is

98%

The most common musculoskeletal condition that necessitates hospitalization in patients over age 65 is

A hip fracture

Compare muscle hypertrophy and muscle atrophy.

Hypertrophy results from an increase in the size of individual muscle fibers without an increase in their number. A decrease in the size of a muscle is known as atrophy. This occurs with age and the disuse of a muscle over a long period of time.

A nurse understands the influence of hormones on bone maintenance. Therefore the nurse knows that a patient on long-term cortisol may experience

Increased bone resorption rationale increased levels of cortisol result in increased bone resorption and decreased bone formation. These patients are at increased risk for steroid induced osteopenia and fractures.

Turning the foot inward

Inversion

Describe the four important functions of the musculoskeletal system.

It protects the vital organs, provides a sturdy frame work to support body structures, support mobility and holds the bones together allowing the body to move.

Case study

Jenny is a 65 year old educational consultant who travels by car, train, and airplane for her job.

Turning the palm of the hand upward

Supination

cartilage removal: Bony callus becomes reserved by chondroblasts and osteoclasts

bone formation: Minerals are deposited until the bone is firmly reunited

Another term used to describe cartilage cells

chondrocytes

Another name for compact bone

cortical

The term describes bone formation

osteogenesis

Moving toward the midline

Adduction

Explain the role of active vitamin D calcitriol

Calcitriol functions to increase the amount of calcium in the blood by promoting absorption of calcium from the gastrointestinal tract. It also facilitates the mineralisation of osteoid tissue.

A nurse practitioner provides health information to a 56 year-old post-menopausal woman who has been diagnosed with osteopenia. Identify the mineral that the nurse would recommend.

Calcium. Rationale: calcium is essential in the bone because it prevents osteoporosis. Phosphorus is the next most abundant mineral in the body. Magnesium is the fourth most abundant. Fluoride helps keep teeth strong.

Cone like, circular movements

Circumduction

Choose the correct statement about the endosteum, a significant component of the skeletal system

Covers the marrow cavity of long bones Rationale the industrium is a thin vascular membrane that covers the marrow cavity of long bones and the spaces in cancellous bone. Osteoclast are located near the endosteum.

A nurse performs a neurovascular assessment on a patient two weeks after a wrist cast had been removed. She documents in the patient's chart that there is normal sensation in the ulnar nerve. To reach this conclusion, the nurse performed an assessment test on the fingers that involves pricking the:

Distal fat pad on the small finger. Rationale see table 42 in the text. The ulnar nerve runs near the ulnar bone and enters the palm of the hand. It branches to the fifth finger, the small finger, and the ulnar side of the fourth finger.

A patient is diagnosed with a fracture of a diarthrosis joint. The nurse knows that an example of this type of joint is the

Elbow rationale diarthrosis joint, like the elbow, is freely movable. The skull is an example of an immovable joint. The vertebral points and symphysis pubis are amphiarthrosis joints that have limited motion.

Explain the role of estrogen on bone remodeling

Estrogen stimulates osteoblast and inhibits osteoclast. Therefore, bone formation is enhanced and resorption is inhibited. Low levels of estrogen or increased levels of corticosteroids cause a disruption in normal osteoclast and osteoblast hemostasis.

Hinge joint of the knee identify the parts of the hinge joint of the knee

Femur, articular cartilage, medial meniscus, tibia, synovial joint cavity, Bursa, patella, synovial joint cavity, fat pad, infrapatellar bursa

The process of bone healing, post fracture, can take 6 to 16 weeks, sometimes longer. A nurse knows that a person with a three-week-old femur fracture is at the stage where angiogenesis is occurring. This stage is characterized by

New capillaries producing a bridge between the fractured bones. Rationale angiogenesis and cartilage formation begin when fibroblast from the periosteum produce a bridge between the fractured bones. This is known as callus.

A 10 year old boy who was brought to the emergency room after a skiing accident is diagnosed with a fracture of the distal end of the femur. The nurse understands that this type of fracture is significant because

Potential growth problems may result from damage to the epiphyseal plate. The distal and proximal ends of a long bone are called epiphysis, which are composed of cancellous bone. The epiphyseal plate, which separates the epiphysis from the diaphysis, is the center for longitudinal growth in children. It's damage can be a critical indicator of potential growth problems if fractured.

The nurse needs to reinforce a physical therapist exercises, post fracture healing. The nurse explains that isometric contraction of the vastus lateralis is part of an exercise pattern known as

Quadriceps setting exercises rationale quadriceps setting exercises increase the force generated by the muscles while the length of the muscles Remains the Same. This is an example of isometric contractions.

A 15 year old healthy boy presents to the emergency room with a fractured left angle that was injured during a soccer game. The patient describes his pain as a 7 on a scale of 1 to 10. The nurse prepares the patient for the application of a cast and explains that the pain and swelling should only last several days. This information is based on an understanding of the inflammatory stage of bone healing whereby:

Soon after a fracture, fibrin will become the framework for new bone growth. Rationale after a fracture, a hematoma is formed that facilitates the formation of fibrin, which becomes the framework for new bone to grow. Macrophages and fibroblasts survive and replicate.

A patient is scheduled for a bone marrow biopsy. The nurse explains to the family that the bone marrow is located mainly in four areas she tells the family that the site to be used would be the

Sternum rationale the sternum, along with the ilium, vertebrae, and ribs are responsible for producing red blood cells and are used for bone marrow aspiration sites.

A nurse practitioner assesses a patient's movement in his left hand after a cast is removed. The nurse asks the patient to turn his wrist so the palm of his hand is facing up. This movement is known as

Supination rationale refer to figure 40 - 3 in the text for an illustration of body movements produced by muscle contraction

A 16 year old patient is seen in the emergency room for a knee injury that happened during a basketball game. Diagnostic test reveal torn chords of fibrous connective tissue that connect muscles to bones. The nurse knows that the patient had suffered a tear of the

Tendon rationale tendons are broad, flat sheets of connective tissue that attach muscles to bones, soft tissue, and other muscles. Ligaments bind bones together. If Bursa is a synovial filled sac, and faccia surrounds muscle cells.

The nurse understands that bone maintenance requires a balance between forming and dissolving bone which of the following is a correct statement about the function of osteoblasts?

They secrete a matrix that consist of collagen Osteoblast function in bone formation by secreting bone matrix, which consists of collagen and ground substances that provide a framework for inorganic mineral salts to be deposited. The other choices are characteristic of osteoclast.

A nurse provides Nutritional Health teaching to a 52 year old who had two fractures in one year. Besides recommending supplemental calcium, the nurse suggest a high calcium diet. The nurse would recommend that the patient increase her intake of

Yogurt and cheese. rationale: yogurt and cheese are excellent sources of calcium. The other choices are low calcium foods.

The junction of two or more bones

articulation

learning objectives

describe the basic structure and function of the musculoskeletal system

discuss the relationship of the health history to the assessment of the musculoskeletal health

describe the significance of physical assessment findings to the diagnosis of musculoskeletal dysfunction specify the diagnostic test used for assessment of musculoskeletal function

Another term for fascia

epimysium

The projection of red blood cells

hematopoiesis

She spends a lot of time driving and sitting while traveling. She also spends several hours a day sitting at a computer. Jenny described her low back pain to the healthcare provider as quote localized on

her right side, intermittent, sharp and burning. She described a notch in the middle of her right buttock where the pain is localized, pressure helps relieve the pain. However lately she feels the pain radiates down her leg to her right foot. She is now having difficulty sleeping.

Blood congestion

hyperemia

This process describes bone growth and formation

modeling

Write the sequence of the stages of bone healing and include one physiologic characteristic in each of the six stages.

Hematoma and inflammation - inflammatory cells release growth factors.

A nurse practitioner presented a health promotion, fall prevention seminar at a retirement village. The nurse informed the group that the most common fracture in those over 65 years of age that necessitates hospitalization is a fracture of the

Hip, when a person loses his or her balance. Rationale hip fractures are the most common musculoskeletal condition that necessitates hospitalization for those over age 65 because they can be life-threatening. Surgery is usually done within 24 hours. Mortality rates can be as high as 25%. And neck fracture, which would require hospitalization is not the most common fracture.

The X-ray indicated a right-sided compression between L5 and S1 and a pinched nerve subsequent to the aging process. What would the nurse expect the health care provider to prescribe?

The healthcare provider would probably prescribe over-the-counter anti-inflammatory drugs and a course of physical therapy.