Chapter 31 Musculoskeletal System

A patient on bed rest has been instructed on performing quadriceps setting exercises. What statement by the patient indicates the need for further instruction?

"I should hold the muscle in contraction for at least a minute."

When explaining the structure of the knee to a patient who has knee swelling, the nurse states:

"The meniscus in the joint acts as a cushion." "The tendons are needed for movement and can be injured." "Muscles attach to the bones to help provide movement."

A 56-year-old man complains to the nurse of joint pains, difficulty rising, and limping. He demonstrates poor posture and uncoordinated gait. The nurse sees the priority problem on his care plan as:

Altered physical mobility.

The nurse is educating the patient with osteoporosis on the best diet choices to improve bone density. The patient would demonstrate an understanding of the teaching by selecting which food choice that has the highest calcium content?

1 cup low-fat yogurt

The nurse is caring for a patient who has experienced a stroke. The nurse has implemented range-of-motion exercises. The nurse recognizes that contractures may begin within what time period?

1 week

the pathologic changes most commonly associated with lack of motion are

Contractures, Loss of Muscle tone, and Ankylosis (permanent fixation of joint)

Which nursing action is most appropriate for monitoring a patient with a casted lower extremity for infection?

Assess temperature trends and sniff around the cast for signs of foul odor

A nurse is working on a busy orthopedic floor. Which task(s) can be assigned to the UAP?

Assist an older adult who has an arm sling to perform ADLs. Escort a patient in a wheelchair to the radiology department. Perform passive ROM on a patient who needs a bed bath

The patient presents to the clinic with symptoms indicative of osteoporosis. The nurse anticipates which study will be performed in order to confirm the diagnosis?

Bone density

Physiologic consequences of immobility of the urinary system

Calcium from bone increases in the blood from immobility, bladder tone decreases, and more time in a supine position from immobility leads to urinary stasis. Infection, renal calculi, and urinary tract infection may occur

Sitting down with the use of crutches

Crutch-walk to the chair. Turn around slowly so that the back is to the chair and the backs of the legs touch the seat of the chair. Transfer both crutches to the side with the injured leg and grasp both handgrips with that one hand. As weight is supported on the crutches and the good leg, reach back with the free hand and grasp the arm of the chair. Lower slowly onto the chair seat, using the support of both the crutches and chair. Sit back in the chair and elevate the leg. Keep the knee slightly flexed when elevated because too much extension can decrease the circulation. To get up, bring both crutches along the side of the injured leg and grasp the handgrip firmly. Make sure the crutch tips are firmly on the floor. Place the other hand on the arm of the chair and push up. After becoming upright, transfer one crutch to the other hand for walking.

Common Clues to Musculoskeletal Woes

DEPT D-Deformity -Bone or muscle disease, as well as trauma, can cause alteration in bone and muscle shape E-Edema -Fluid in the interstitial tissue, which is called edema, interferes with nerve function and blood flow, causing tissue deterioration P-Pain -Muscle pain can be caused by damage to nerves that service the area of discomfort T-Throbbing -Throbbing occurs as a result of swelling. This may slow blood flow

Source of Calcium.

Dairy products such as cheese, yogurt, and milk are better choices. Nondairy sources of calcium include canned sardines, salmon, tofu, figs, and dried apricots

Physiologic consequences of immobility of the cardiovascular system

Decreased cardiac output with reduced force of cardiac contraction results from a lack of physical activity. Immobility causing decreased use of leg muscles leads to venous stasis and potential formation of blood clots

The nurse recruits the assistance of adequately trained personnel to turn an immobile patient. To prevent injury to the patient and the nursing staff, which measure should be taken before repositioning the patient?

Explain the details of the move

Physiologic consequences of immobility of the psychological effects

Feelings of helplessness or hopelessness, boredom, depression, and disturbed body image may be accompanied by anger or anxiety and loss of self-esteem during extended periods of immobility. Social isolation may also occur.

The nurse is providing education to a middle-aged female about her changing health needs. The nurse should be sure to include information on which age-related changes?

Loss of bone mass, decrease in height and decreased muscle mass

The nurse is participating in a patient care conference to plan the care for a patient with osteoporosis. Which issues should be discussed for inclusion in this patient's care plan?

Pain, difficulty providing own hygiene and difficulty moving about the house and/or work setting(s)

What action should the nurse perform for the postprocedural care of a patient who just had an arthroscopy?

Prepare an ice pack and obtain an elastic bandage.

Physiologic consequences of immobility of the musculoskeletal system

Prolonged immobility leads to reduced muscle mass and atrophy. Demineralization of bones occurs with lack of weight bearing; osteoporosis may occur

A nurse assesses the condition of a patient with a splint applied to the right arm. Which clinical finding is cause for the greatest concern?

Redness of skin under the splint

Physiologic consequences of immobility of the respiratory system

Reduced lung expansion and consequent reduced gas exchange with potential for atelectasis and pooling of secretions occurs with immobility. Reduced cough effort along with pooled secretions predisposes to stasis pneumonia.

Physiologic consequences of immobility of the integumentary system

Skin breakdown may occur from a reduced flow of oxygenated blood from pressure on the skin resulting from immobility. Combined with lack of appetite from immobility and poor nutritional status, pressure ulcers may develop

Physiologic consequences of immobility of the gastrointestinal system

Slowing of peristalsis and decreased muscle strength occur with decreased physical activity. Decreased appetite and an inability to assume an upright position for defecation also contribute to the constipation that can occur with immobility.

The nurse is assessing injuries on a patient admitted to the unit who had fallen at home several hours ago. When looking at the patient's history, the nurse notices that he has smoked at least four packs of cigarettes per day for the past 60 years. What impact does smoking have on the musculoskeletal health of a patient?

Smoking increases the risk of developing osteoporosis.

Walking upstairs with crutches

Stand at the foot of the stairs with weight on the good leg and crutches. Put weight on the crutch handles and then lift the good leg up onto the first step of the stairs. Put weight on the good leg and lift the injured leg and crutches up to that step. Repeat for each step.

Walking downstairs with crutches

Stand at the top of the stairs with weight on the good leg and crutches. Shift weight completely onto the good leg and put the crutches down on the next step. Put weight on the crutch handles and transfer the injured leg down on the step with the crutches. Bring the good leg down to that step. Repeat for each stair step.

For the patient who needs the support of a crutch while walking, the type of crutch selected will depend on which assessment?

The extent of the patient's disability or paralysis

A nurse evaluates a patient's ability to use a cane. Which action indicates proper use of the cane?

The handgrip is at the hip level.

The nurse is assisting the patient to use the 4-point gait with crutches. Which behavior by the patient demonstrates understanding?

The patient initially advances the left crutch.

Electromyelography (EMG)

To detect abnormal nerve transmission to the muscle and abnormal muscle function; helps determine rehabilitation progress no coffee or smoking 3 hr before test consent form withhold muscle relaxants, anticholingerics, cholinergic before test slight discomfort when electrodes placed pt will be asked to relax and contract muscles

A nurse is teaching an older adult patient how to increase musculoskeletal and bone strength. Which interventions would be helpful?

Walk at least 30 minutes a day 5 to 7 days a week Walk up stairs as often as possible. Perform strength training exercises at least three times a week.

Crutch Safety

When in the standing position with axillary crutches, the axillary bar should be two finger breadths below the axilla. The elbow should be flexed at a 30-degree angle when the palms of the hands rest on the handgrip. It is important that the patient not rest her body at the axilla on the top of the crutch; body weight should be borne by the arms on the hand rests of the crutches.

What will help decrease musculoskeletal problems later on in life?

adequate exercise and weight training

Walker height is correct when the person's

elbow is bent at a 15- to 30-degree angle while standing upright and grasping the handgrips. The walker is lifted or rolled on its wheels slightly in front of the patient while leaning the body slightly forward. A step or two is taken into the walker, and then it is lifted and placed in front of the person again

Main functions of the musculoskeletal system are

motion, support, and protection

When a 76-year-old female patient has a complaint of pain and soreness in the back, a first step in the assessment specific to this patient should include:

physical examination of muscle strength of the extremities

To manage joint discomfort associated with movement for a patient with severe rheumatoid arthritis, the nurse should:

schedule pain medication administration before exercise.

Primary problems for patients with musculoskeletal injuries or disorders

self-care deficit, impaired physical mobility, and pai

The purpose of the skeleton is to provide a rigid framework that ____________________________ and the skin

supports internal organs

Within a matter of a few days, the structures of immobilized muscles and joint begin to

undergo changes. If no effort is made to prevent these changes, the patient will become permanently disabled

Age Related Changes in the Musculoskeletal System

• Ossification, or replacement of cartilage by more solid bony tissue, is not completed throughout the body until age 20 to 25 years. • Bone density decreases in older adults because of the resorption of minerals. • The loss of bone mass, or osteoporosis, occurs with aging and is more severe in women. • The bones of older adults are brittle and less compact; thus they break easily. • The bones of older adults do not heal readily after a fracture because the physiologic exchange of minerals decreases with advancing age, making the process of repair much slower. • Thinning of the intervertebral cartilage and collapse of the vertebra result in kyphosis (dowager's hump). This is partially responsible for the decrease in height in older adults. • Joint cartilage thins and erodes from years of use and results in stiffness and crepitation (a grating sound) of the joints. • Joint motion may decrease, limiting mobility; swelling may occur. • Ligaments become calcified and lose their elasticity. • Older adults have a decrease in muscle mass; cells decrease in number and the muscles atrophy. Consequently, older adults have less strength and endurance than younger people. • Tendons shrink and become sclerotic, slowing muscle movement. • Muscle cramping, especially at night, increases because of impaired circulation and accumulation of metabolic wastes.