Musculoskeletal System & Disorders (Chapter 18 & 77)

Nursing Interventions: Sprain

A sprain is a traumatic injury to the tissues around a joint. The tissues, such as tendons, muscles, and ligaments, can stretch and tear. Bone fractures may result, as the tearing forces of the tendons and ligaments pull against the bone. Sprains cause swelling, pain, and interference with movement. At first, a sprain may seem mild with minimal swelling. Rupture of the nearby blood vessels often leaves bruises (ecchymosis). Tissue damage can be mild or quite severe. If the sprain is left untreated and the client continues to use the extremity, the tissue damage can become worse. X-ray examinations may be indicated to rule out fractures. Treat a sprain by elevating the injured part and using an elastic bandage or splint to immobilize and support the affected area. Relieve pain and swelling by applying ice for 24 to 48 hours. After the first 24 to 48 hours, use warm, moist packs to provide pain relief and prevent muscle spasms. Occasionally, the healthcare provider will apply a cast to keep the area immobile and to facilitate healing. Ligament rupture may require surgical repair.

What type of surgery do they do on joints?

Arthroscopy is a minimally invasive procedure used in viewing joints for diagnostic and treatment purposes. It uses a special endoscope, called an arthroscope, which has a lens and a light source at its end that transmits a picture to a video monitor in the operating room (OR). Because the flexible scope can bend inside the joint, the surgeon views and operates on the joint's interior, using only a very tiny incision referred to as a "stab wound." The procedure is known as a closed procedure because the joint does not need to be laid open. The procedure is performed in the OR or same-day surgery facility, often under local anesthesia. Surgeons use arthroscopy to diagnose and treat joint disorders. For example, foreign or loose objects (e.g., a piece of cartilage, a bone spur) can be removed. A rough and worn joint can be made smoother and more comfortable. Tissue samples can be obtained via biopsy, and a torn meniscus or ligament can be diagnosed and possibly repaired. Arthroscopic surgery is much safer, more comfortable, and more cost effective than open surgery, and for these reasons it is used whenever possible. Following the procedure, elevate the client's joint and apply ice to control edema and pain. Teach the client how to monitor the site for evidence of infection.

What vitamins are needed for bone health?

Calcium and Vit D

What is the Tinel Sign and what is it used to diagnose?

Carpal tunnel syndrome is a compression neuropathy of the median nerve in the wrist. Often, its cause is repetitive movements, such as knitting or keyboarding. Other causes include arthritis, trauma, myxedema, gout, or tumors. Signs and symptoms include forearm and wrist pain, numbness, and tingling. Symptoms often increase at night. The client's grip is weak. When the provider taps the median nerve, the client experiences paresthesia and pain in the thumb and first three fingers (Tinel sign).

Function of Ginglymus Joint

Hinge (ginglymus) joints (Fig. 18-3) allow movement in only one plane (flexion and extension), similar to the hinge of a door—as in the elbow, knee, and the finger and toe joints between phalanges. (The jaw, knee, and elbow joints are hinge joints, but can also move slightly from side to side.)

Function of Newborns Fontanels

In newborns and infants, skull bones are separated by spaces (fontanels or "soft spots"). The anterior (front) fontanel is diamond-shaped; the posterior fontanel is triangular. Fontanels can be gently palpated on all healthy newborns.

What is happening to a muscle during isometric exercising?

Isometric contractions do not increase the length of a muscle, but do increase muscle tension. For example, if you push against an unmovable object or tense the muscles in your upper arm, your muscles tighten. This is an isometric contraction or exercise. Bedridden clients are encouraged to do isometric exercises, even if they cannot be out of bed. Isotonic contractions shorten and thicken the muscle, causing movement. Exercises such as swimming, jogging, or bicycling are examples, but a person in bed also can move the extremities and move about in bed to exercise the muscles. It is important to vary the exercise program; different exercises use different muscles.

Lumbar Decompression

Lumbar Laminectomy

Complications seen with Muscular Dystrophy

Muscular dystrophies are chronic, degenerative diseases of skeletal muscles that are often inherited. These disorders are characterized by various degrees of progressive weakening and wasting of the muscles. Although causes of muscular dystrophies are unknown, some researchers believe that they are related to a disruption in enzyme production. Treatment focuses on support. Encourage clients to continue all activities as normally as possible. Exercise programs and splints may help prevent deformities. Often, clients can use special braces to permit ambulation. Inform clients of the need to prevent upper respiratory infections, to maintain ideal weight, and to strive for general good health.

S&S of gout

Periodic gout attacks are characterized by joint swelling, redness, and severe pain. The slightest touch or weight on the affected area is unbearable during an attack. The person may have fever, tachycardia (rapid heartbeat), and anorexia. An attack lasts from 3 to 14 days, after which it disappears suddenly. It may return at any time. However, at other times, the joint is normal. Eventually, repeated attacks permanently damage the joint and limit its ROM. Renal damage and vascular damage (especially atherosclerosis) can follow.

Care of a Patient with Phantom Limb Pain

Residual limb pain, a frequent after effect of amputation, refers to the sensation of pain, pressure, or itching that occurs in the area of the amputation, and the feeling that the absent body part is still present. If possible, discuss this concept with the client before surgery because he or she may be too embarrassed to mention residual limb pain when it occurs. Encourage clients who seem to be disturbed and uneasy following amputation to discuss their feelings. If residual limb pain or discomfort is causing the distress, explain that the sensation is common and results from damage to the nerves in the residual limb. Reassure clients that residual limb pain generally disappears in time. For pain relief, tell clients to "move" the missing limb. By activating the damaged nerves leading to the amputated limb, clients usually feel great relief. Other interventions include use of analgesics, transcutaneous electrical nerve stimulation (TENS), ultrasound, and visual imaging. Persistent pain can interfere with prosthesis fitting.

S&S of Rickets

Rickets is a disease that results from a deficiency of vitamin D during childhood. The adult form of vitamin D deficiency, which results in softening of the bones, is called osteomalacia. The deficiency causes faulty absorption of calcium and phosphorus, both of which the body needs for normal bone hardening. In rickets, bones remain soft and become distorted as the child grows. When the bones finally do harden, they remain in this deformed state. Severely bowed legs are an example of an effect of rickets. Children with rickets are slow to walk and cut teeth; they are pale, irritable, and inactive. Exposure to sunshine and vitamin D from an early age prevents rickets, making it rare in developed countries. Milk with vitamin D and exposure to sunshine are preventive measures.

S&S of Systemic Lupus Erythematosus

SLE ("lupus") is an autoimmune systemic disorder that affects many body systems. People with SLE produce autoantibodies that ultimately contribute to immune-complex formation and tissue damage. SLE primarily affects women. It can be acute or chronic, marked by remissions and exacerbations. It causes widespread damage to the collagen system, affecting any organ system, including the kidneys, heart, and lungs. The characteristic sign of SLE is a butterfly rash on the face. However, a rash may appear over other body parts as well. Arthritic symptoms include joint pain and muscle aches. Other symptoms include anorexia, nausea, vomiting, swollen glands, and general malaise. In severe cases, the inflammatory process may involve the lining of the lungs and heart, with damage to the kidneys, central nervous system, or brain.

Function of Skeletal Muscles

Skeletal (voluntary striated) muscles control skeletal movements and are under voluntary (conscious) control. There are more than 630 skeletal muscles in the human body, constituting approximately 40% of body weight (Fig. 18-18A). Their functions include locomotion, facial expression, and posture. The two types of voluntary muscles are fast-twitch—those which contract quickly and powerfully, but encounter rapid fatigue, and slow-twitch—those which can sustain a contraction, but do not exert great force.

Function of Atlas Vertebrae

The first cervical vertebra, the atlas, supports the skull

Nursing Interventions: Halo device to stabilize the neck

The halo device (Fig. 77-6B) is a form of external fixation device. A halo device consists of skeletal traction used for cervical fractures that is applied to the skull and allows the client to ambulate and perform self-care activities. The four pins holding the halo device in place penetrate the skull only a fraction of an inch. The tightness of the screws influences the amount of traction. Nursing Alert The halo device comes with a wrench. Always tape the wrench to the halo device so that the device can be quickly removed in an emergency. Nurses may assist healthcare providers with applying halo devices. Explain to clients what will be done. Provide the healthcare provider with the halo, vest, special wrench and positioning plate, regular wrench, and Xylocaine. Follow Standard Precautions as well as sterile technique when indicated. • Be prepared to place a client in a special bed or chair before the application of the halo device. Use caution not to change the alignment of the head or neck. Support the client's head and neck on movement and during application. After the device is applied, help the client to sit up slowly. Rationale: The client may become dizzy or faint. Support the client in a sitting position while the healthcare provider adjusts the halo's vertical bars. • Give good skin care around the device and at the pin sites. Using a sterile cotton-tipped applicator, apply sterile hydrogen peroxide to the pins; rinse with sterile normal saline. Even though the insertion sites are small, watch for evidence of infection. Wear gloves. • Administer analgesics, as ordered. Typically, the client may experience some mild discomfort. Immediately report pain that is not relieved by medications. • Monitor the client for possible complaints of difficulty in swallowing, inability to open the mouth all the way, or persistent neck pain; report such findings immediately because they are signs that the vertical connecting bar is too long. • Note if the client complains of not being able to see straight ahead, a sign that the apparatus is not straight. If any complications occur, a healthcare provider must readjust the apparatus. • Provide emotional support. Always encourage clients to be as independent as possible. Inform them about community resources and support groups. Nursing Alert Severe headache is a specific danger sign for the client wearing a halo device. Clients will wear the halo device for about 10 to 12 weeks, during which time they or their families will become responsible for care. Teaching is vital (see In Practice: Educating the Client 77-3). Carefully document all teaching.

Function of Axis Vertebrae

The second cervical vertebra, the axis, has an especially wide surface so the head can turn freely.

S&S of Scleroderma

The term scleroderma means "hard skin." Scleroderma is considered a collagen disorder that involves chronic hardening and shrinking of connective tissues. Most often, this condition affects women, usually beginning in middle age. Its most severe forms commonly affect men, African Americans, and older people. Scleroderma may have an autoimmune component. The disorder may be localized or generalized. Localized scleroderma primarily involves the skin, muscles, and bones and is a less-severe form. Generalized scleroderma involves the skin, muscles, joints, and internal organs, such as the heart, digestive tract, lungs, and kidneys. Sclerodactyly is scleroderma of the fingers and toes; acrosclerosis is scleroderma of the distal extremities and face. The disorder begins on the face and hands, where the skin becomes hard and unwrinkled and cannot be raised from the underlying structures. The condition slowly spreads. The person often has joint pain and difficulty moving. Raynaud phenomenon, evidenced by hands or fingers that are cold, numb, tingling, or blanched, is usually an early symptom. Over time, the face appears tight, shiny, and rigid. The fingers may become flexed and atrophied. Death may result from respiratory or renal failure or cardiac dysrhythmias. Treatment is symptomatic. Joint manifestations are treated in the same manner as in other arthritic conditions. Drug therapy has been ineffective in treating scleroderma.

spiral fracture

a fracture in which the bone has been twisted apart

greenstick fracture

bending and incomplete break of a bone; most often seen in children

The client was prescribed a lumbosacral brace for treatment of a herniated intervertebral disc. The client has had significant pain relief in the short time of wearing the brace and asks the nurse if the nruse if the brace can be worn long-term. What is the best response by the nurse? a. "No, because prolonged use will weaken your supporting abdominal muscles." b. "Yes, because the brace assures us the diagnosis of herniated disc is accurate." c. "No, because the cost is prohibitive for the amount of benefit from the brace." d. Yes, because the back is protected fro further injury while the brace is worn."

a. "No, because prolonged use will weaken your supporting abdominal muscles."

A client is having symptoms associated with an alteration in muscle function. What diagnostic tests should the nurse prepare the client for? Select all that apply. a. Creatine kinase b. Electromyelogram c. Lumbar puncture d. Muscle biopsy e. Electrocardiogram

a. Creatine kinase b. Electromyelogram e. Electrocardiogram Explanation: Tests of muscle function and/or disorders include the blood level of creatine kinase, electromyogram (measurement of electrical activity of muscle tissue), and muscle biopsy. Neither a lumbar puncture nor an electrocardiogram are tests for muscle function.

A client is experiencing residual limb pain following a surgical amputation to the right lower extremity below the knee. What action by the nurse would help alleviate the pain? a. Have the client "move" the missing limb. b. Apply ice packs to the residual limb. c. Have the client discuss feelings of loss. Present reality and do not support the delusion of sensation.

a. Have the client "move" the missing limb. Explanation: Reassure clients that residual limb pain generally disappears in time. For pain relief, tell clients to "move" the missing limb. By activating the damaged nerves leading to the amputated limb, clients usually feel great relief. Ice packs to the limb may cause vasoconstriction and tissue damage. It is important to encourage clients who seem to be disturbed and uneasy following amputation to discuss their feelings; however, this will not alleviate physical pain. The client is not delusional or having hallucinations.

An older adult client is admitted to the acute care facility. What nursing action is a priority to help with the prevention of falls? a. Perform a fall risk assessment. b. Have restraints in the room if the client tries to get out of bed. c. Obtain a walker for ambulation. d. Inform the client not to get out of bed without assistance.

a. Perform a fall risk assessment. Explanation: A fall risk assessment should be performed on all clients regardless of age to determine what interventions may be required. Although the client in this scenario is an older adult, the level of ambulation may be independent and would not necessarily require a walker or other assistive device. The client should be able to ambulate in the room but if it is determined after performing a fall risk assessment that the client requires assistance, the client should be instructed to use the call bell so someone can come and assist the client out of bed.

1) A client is diagnosed with arthritis and wants to maintain an active lifestyle. What exercises should the nurse recommend to the client? Select all that apply. a. Swimming b. Jumping rope c. Bicycling d. Running e. Slow walking

a. Swimming c. Bicycling e. Slow walking Explanation: Swimming, bicycling, and slow walking are low-impact activities that a client with arthritis may still engage in that will not damage joints. Jumping rope and running are high-impact activities that may cause pain and injury to joints, so those activities should be avoided.

A muscle that opposes the movement made by another muscle is known as which of the following? a. antagonist b. synergic muscle c. prime mover e. synergistic muscle

a. antagonist

The nursing is caring for a client who has limited mobility. For which musculoskeletal change will the nurse monitor the client? a. decreased joint flexibility b. increased muscle tone c. increased muscle tone d. increased risk for clots

a. decreased joint flexibility

The nurse is caring for a client who underwent a BKA secondary to gangrene of the foot. What nursing interventions will the nurse in the client's plan of care? a. encourage the client to report residual limb pain b. place a pillow under the stump when the client is in supine c. wrap the amputation stump so that it forms a cone shape d. keep the foot end of the client's bed lowered to prevent pain e. assist and encourage the client to lie on supine

a. encourage the client to report residual limb pain c. wrap the amputation stump so that it forms a cone shape

The nurse obtains report on a client being treated at the community clinic for an injury to the left patella bone. What would the nurse expect to provide teaching on for the client? a. patella b. arm sling c. fibula d. tibia e. femur f. ankle brace g. crutches h. bedside commode

a. petella g. crutches

What would a nursing instructor indicate to the nursing class as the function of the thoracic cage? Which are the functions of the thoracic cage? Select all that apply. a. protects the liver b. supports shoulder girdle c. protects lungs d. protects intestine e. protects heart

a. protects the liver b. supports shoulder girdle c. protects lungs e. protects heart

Definition of lordosis

an abnormal increase in the lumbar curvature of the spine; sometimes called swayback.

Definition of kyphosis

an abnormal increase in the thoracic curvature of the spine, giving a hunchback appearance, commonly as a result of osteoporosis.

A client suffered a stroke that affected the left side of the body. What nursing action will assist with the prevention of contractures of the lower extremities? a. Apply heat to the extremities. b. Position the client as if standing. c. Apply sequential compression devices to the lower extremities. Stand the client on both feet several times a day.

b. Position the client as if standing. Explanation: Positioning clients as if they are standing while in the bed will help prevent contractures and foot drop. Applying heat will not prevent contractures. Applying sequential compression devices will assist with the prevention of thrombophlebitis. The client may not be ready for aggressive physical therapy and standing at this time could cause falls.

The nurse is caring for a client postoperatively who has had cervical decompression. What statements by the client should the nurse immediately report to the primary care provider? Select all that apply. a. Reports of discomfort when moving b. Reports of change in sensation of arms c. Difficulty breathing d. Difficulty moving arms e. No bowel movement for 2 days

b. Reports of change in sensation of arms c. Difficulty breathing d. Difficulty moving arms Explanation: Reports of change in sensation of arms, difficulty breathing, and difficulty moving arms are indications of possible nerve damage and should be reported immediately. Reports of discomfort when moving are common and do not indicate a complication. Not having a bowel movement in 2 days is not an indication that a complication is present; however, the client may need added roughage in the diet as well as a stool softener.

An older adult client diagnosed with the arthritis is being cared for at a healthcare facility. What client teachings will the nurse include in the client's care plan? Select all that apply. a. always turn doorknobs away from the radial side b. apply heat over the joints before exercise c. sleep on a soft bed to reduce pain d. perform low-impact exercises such as bicycling e. exercise daily even in pain occurs

b. apply heat over the joints before exercise d. perform low-impact exercises such as bicycling e. exercise daily even in pain occurs

Which muscle, along with the intercostals, is the primary muscle of respiration? a. rectus abdominis b. diaphragm c. pectoralis major d. internal oblique

b. diaphragm

The shaft of the long bone is known as which of the following? a. periosteum b. diaphysis c. condyle e. epiphysis

b. diaphysis

What special characteristics of muscle allows it to respond to a stimulus? A. elasticity B. irritability C. contractility D. Extensibility

b. irritability

Where is yellow marrow found in the human body? a. bodies of the vertebrae b. medullary cavities of the long bones c. cavities of the spongy bones d. cavities of the sternum

b. medullary cavities of the long bones

The nurse is assessing a client diagnosed with a trochanteric fracture following a fall. What assessment should the nurse consider as expected in this client? a. depressed deep tendon reflex b. shortening of the leg c. decreased muscle tone d. internal rotation of the foot

b. shortening of the leg

The charge nurse is mentoring a student nurse is caring for a client who had surgical report of a fracture hip (hip prosthesis) 48 hours ago. Which action by the student nurse would alert the charge nurse to provide additional teaching? a. the student maintains the client's legs in an abducted position b. the student provides PROM to the non operative leg several times per day c. the student assists the client in putting on the client's socks and shoes d. the student check the circulation of the affected leg every eight hours

b. the student provides PROM to the non operative leg several times per day

Traverse Fracture

break across the bone

The nurse is caring for a client who states, "My knees are so stiff this morning." What nursing action may the healthcare provider order to alleviate the discomfort? a. Apply cool compresses to the knees. b. Encourage adequate nutrition. c. Apply moist heat to the knees. d. Administer a narcotic analgesic.

c. Apply moist heat to the knees. Explanation: For joint stiffness and discomfort, hydrotherapy and warm heat are helpful to alleviate the discomfort. Cool compresses will cause more stiffness in the joints. Adequate nutrition and maintaining weight can help with arthritic pain in the future but is not an immediate remedy.

The nurse is preparing to administer allopurinol for a client with gout. What should the nurse include in the instructions? a. Use aspirin to additionally relieve pain. b. Eat foods high in purine. c. Drink at least 3 L of fluids each day. d. Alcohol may be used while taking this drug.

c. Drink at least 3 L of fluids each day. Explanation: Allopurinol inhibits uric acid formation. Instruct clients taking any of these medications to drink at least 3 L of a variety of fluids each day to promote excretion of a large urine volume. When taking these medications, clients should not take aspirin or any other salicylate because they counteract the effects of gout-relieving drugs. A diet low in purine helps prevent the accumulation of uric acid and should be encouraged. Alcohol should be avoided while taking this medication.

The nurse is discussing preventative interventions to avoid musculoskeletal injuries. What should the nurse encourage the client to take with calcium to help metabolize the calcium? a. Vitamin B6 b. Magnesium c. Vitamin D d. Potassium

c. Vitamin D Explanation: Communicate to clients the importance of appropriate exercise and a diet that includes adequate amounts of proteins and minerals. Calcium is especially important. Adequate vitamin D is also required for the body to metabolize calcium. Although important to the diet, vitamin B6, potassium, and magnesium do not assist with the metabolizing of calcium.

The client states, "The doctor said I have damage to one of my ball and socket joints." The nurse would provide education to the client including which joints are considered "ball and socket" joints by describing which joints? Select all that apply. a. elbow joint b. ankle joint c. hip joint d. the vertebrae e. shoulder joint

c. hip joint e. shoulder joint

The nurse is caring for a client who has had a lower extremity amputation. What intervention by the nurse will best prevent hip contractures? a. Change drains using aseptic technique. b. Elevate the foot of the bed. c. Inspect the limb for signs of infection. d. Do not place a pillow under the residual limb.

d. Do not place a pillow under the residual limb. Explanation: To prevent hip contractures, do not place pillows under the residual limb when the client is on the back. Changing drains will not having any bearing on the status of hip fractures. Elevating the foot of the bed will decrease edema but not prevent contractures. Inspecting the limb for signs of infection will not prevent contractures but will prevent sepsis.

The nurse is providing post-operative care for a client 8 hours post lumbar decompression surgery. Which assessment finding would the nurse determine to be a priority? a. The client reports being drowsy after a narcotic pain mediatin is administered. b. The client complains of discomfort at the surgery site that is relieved with turning. c. The client reports concerns regarding insurance payment and time absent from work d. The client complains of difficulty "wiggling" their toes when the nurse assesses sensation

d. The client complains of difficulty "wiggling" their toes when the nurse assesses sensation

A nurse is caring for an adult client who has undergone joint replacement surgery. What nursing measure should the nurse employ when caring for this client? a. avoid turning of repositioning the client to their back b. provide the client prolonged bed rest to the extent possible c. decrease the amount of fiber in the client's diet plan d. avoid or minimize the use of soaps when bathing the client

d. avoid or minimize the use of soaps when bathing the client

The nurse is working at a summer camp for adults and is summoned for a camper who fell in a swimming pool. The nurse suspects an injury to the client's vertebral column. The client is currently alert and breathing. What nursing action would the nurse do next? a. Monitor the client for overheating and keep client dry with a towel b. notify the client's family or next of kin to determine choice of hospital c. ask the client about specific drug allergies and medical history d. immobilize the client while another camper notifies the emergency response system

d. immobilize the client while another camper notifies the emergency response system

A healthcare provider ordered an electromyogram (EMG) for a client with muscular dystrophy. The nurse knows that what principle is the performance of an EMG based on? a. scanning of the three-dimensional radiographic image b. use of sound waves and their echoes c. application of a powerful magnetic field and scanning d. measurement of electrical conductivity

d. measurement of electrical conductivity

The client reports several concerns following a cast application to the lower right secondary to a bone fracture. The cast was placed 6 hours ago. Which concern is the priority for the nurse to address? a. fear of deformity from the fracture and cast placement b. pain and soreness at the site of the fracture c. frustration at not being mobile and needing to use crutches d. numbness and tingling of the right foot toes

d. numbness and tingling of the right foot toes

The nursing is caring for a client with a decrease in cardiac muscle function. What assessment finding would the nurse expect to assess? a. decreased sweating b. signs of dehydration c. increased urination d. shortness of breath

d. shortness of breath

Definition of ligament

fibrous band connecting bones or cartilages.

Definition of scoliosis

lateral curvature of the normally straight, vertical line of the spine, sometimes is S-shaped ("curvature of the spine").

Nursing Interventions: Pre and post Arthrogram

page 1310 An arthrogram is an x-ray study of a joint (e.g., knee or shoulder). A radiopaque or radiolucent substance is injected, and then a sequence of x-rays films is taken to determine the joint's condition.

Linear Fracture

the fracture is parallel to the long axis of the bone

Definition of tendon

tough cords that attach muscle to bone.

Conditions of Musculoskeletal system that are the result of normal aging

•Bone mass and strength are lost. •Calcium is lost. •Vertebral column shortens. •Degeneration occurs in joints. •Muscle cells are lost. •Muscle cells are replaced by fat. •Elasticity of fibers is lost. Osteoporosis, a condition in which bone mass decreases, occurs in men and women of all races. Risk factors include white females, advanced age, family history, early menopause, low intake of dietary calcium, excessive alcohol or caffeine intake, sedentary lifestyle, and smoking. Osteoporosis can cause pathologic bone fractures, difficulty in weight bearing, loss of height, and the spinal curvature kyphosis.