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Friday, May 9, 2008

Nursing Slides: Muscoloskeletal System

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Nursing Slides: Muscoloskeletal System Slide Transcript
Slide 1: Muscoloskeletal System

Slide 2: Musculoskeletal System Consists of: Bones Muscles Joints cartilage

Slide 3: function Support to stand erect Movement Protect inner vital organs Hemopoiesis – Bone marrow produces white & red bld cells and platelets Reservoir for storage of minerals & energy – Ca. & Phosphorus in the bones.

Slide 4: Bones 206 Bones & cartilage are types of Connective tissue Bone is hard and rigid and dense

Slide 5: Joints 2 or more bones connecting Mobility Nonsynovial = immovable, skull sutures Synovial = movable Synovial joints – ends of bones are covered with cartilage & enclosed in a joint cavity filled with synovial fld.

Slide 6: Ligaments are fibrous bands – connect one bone to another. Strengthen joint & prevent movement in the wrong direction Bursa – enclosed sac filled with synovial fld.& are located in areas of potential friction = shoulder, knee. Help muscles & tendons glide over bone.

Slide 7: Muscles 40 – 50 % body weight Contract & produce movement Skeletal muscle is voluntary Composed of Bundles of muscle fibers or fasciculi Muscle is attached to bones via tendons

Slide 8: Skeletal muscles produce the following movements Flexion – bending Extension – straightening Abduction – away from midline Adduction – toward midline Pronation – palm down Supination – palm up Circumduction - circular

Slide 9: Skeletal muscles produce the following movements Inversion – sole inward Eversion – sole outward Rotation – head around central axis Protraction –forward movement parallel to ground (chin) Retraction – backward parallel movement Depression/elevation – Shoulders up & down

Slide 11: Temporomandibular Joint (TMJ) Articulation of temporal & mandible Depression anterior to tragus of ear Jaw function for chewing & speaking Movements – Hinge – open/close – Gliding – protrusion/retraction – Gliding- side to side

Slide 12: Spine 33 Vertebrae Spinous process posterior midline 7 Cervical 12 Thoracic 5 Lumbar 5 Sacral 3 – 4 Coccygeal

Slide 13:  C7 & T1 prominent base of neck  Inferior angle of scapula in line with T7 & T8  Highest point iliac crest at L4  Curves Double S – lateral view – cervical & lumbar are concave;(inward) – Thoracic & sacrococcygeal are convex  Intervertebral discs cushion the spine = shock absorber

Slide 14: Shoulder Articulation of humerus & glenoid fossa of scapula Ball & socket – enclosed by rotator cuff (4 muscles and tendons) Acromion process – bump at top of shoulder

Slide 15: Elbow Articulation humerus, radius, & ulna Landmarks are the Medial & lateral epicondyles of the humerus & large olecranon process of the ulna in between Sensitive ulnar nerve

Slide 16: Wrists and Carpals Wrist –articulation of radius & carpal bones Permits flexion, extension & side to side deviation Metacarpophalangeal & interphalangeal joints – permit finger flexion and extension

Slide 17: Hip Acetabulum & femur Ball & socket joint Weight bearing function Landmarks ( IM injections) – Anterior, superior iliac crest – Ischial tuberosity (↓ gluteus maximus, flex hip) – Greater trochanter of femur

Slide 18: Knee Femur, tibia & patella Largest joint Hinged joint & largest synovial membrane 2 cartilages – medial & lateral menisci cushion the tibia & femur

Slide 19: Ankle & Foot Ankle joint is the articulation of Tibia, fibula & talus Hinged joint – Dorsiflexion – Plantar flexion Landmarks – Medial & lateral malleolus

Slide 20: Aging adult Loss of bone density = osteoporosis Postural changes ↓ height due to shortening of the vertebral column

Slide 21: Subjective Data Joints – Pain – Stiffness – Swelling, heat, redness Muscles – Pain, cramps – weakness

Slide 22: Subjective Data Bones – Pain – Deformity – Trauma Functional Assessment ( ADL’s ) Self – care behaviors

Slide 23: Objective Assessment Physical Exam Musculoskeletal Purpose – To assess function for ADL’s – Screen for abnormalities

Slide 24: Screening Exams Inspection Palpation ROM with movement active or passive if apparent limitations Age Specific

Slide 25: Important to : Client comfort Systemic approach Support joints Bilateral exam

Slide 26: Equipment Tape measure Goniometer Skin marking pen

Slide 27: Inspection  Size & contour of joint  Color, swelling, masses, deformity

Slide 28: Palpation  Each joint Temperature Muscles Bony articulations joint capsule Tenderness, swelling, masses

Slide 29: ROM Active ROM Limitation – try passive motion  or in ROM, use a goniometer to measure angles

Slide 30: Muscle Testing Repeat movements for Active ROM Client flexes & holds against opposing force = bilaterally, resists opposing force

Slide 31: Grade muscle strength (pg. 616) Values 0- 5 Grade 5= Normal –Full ROM against gravity, full resistance

Slide 33: TMJ Swelling, tenderness, crepitation Crepitation = audible & palpable crunching or grating with movement

Slide 34: Cervical Spine  Inspection – Head & neck alignment – Spine  Palpation – Spinous processes, Trapezius, Paravertebral muscles – ROM, flexion, extension, hyperextension, lateral flexion, rotation, circumduction – Repeat applying opposing force

Slide 35: Shoulders Inspect – Bilateral comparison Palpate – Bilaterally for muscle spasms, atrophy, swelling, heat, tenderness – Clavicle to acromioclavicular joint, scapula, greater tubercle of humerus, subacromal bursa, biceps groove & anterior aspect glenohumeral joint

Slide 36: Test for Shoulder ROM  Flexion  Extension  Internal rotation  External rotation  Abduction  Adduction  Circumduction Test for strength; shrug shoulders, flex forward, up & abduct against resistance

Slide 37: Elbow  Inspect – Size & contour with flexion, extension – Deformity, redness, swelling – Olecranon bursa  Palpate – Flexed 70 degrees • Olecranon process, medial & lateral epicondyles of humerus • Olecronon bursa for heat, swelling, tenderness, nodules

Slide 38: ROM of Elbow Flexion Extension  pronation supination

Slide 39: Muscle Strength of Elbow Flex elbow – then extend against resistance applied just proximal to the wrist

Slide 40: Wrist and Hand Inspect – Palmar & dorsal surface • Position, contour and shape – Swelling, redness, deformity or nodules

Slide 41: Wrist and Hand Palpate – Wrist and hand joints – Support hand, use both thumbs to palpate – Metacarpophanlangeal joints – Use thumb and index finger in a pinching motion to palpate interphalangeal joints

Slide 42: ROM of Wrists and Hands Hyperextension Palmar flexion Flexion of fingers Abduction for fingers Opposition Ulnar deviation, Radial deviation

Slide 43: Muscle Strength for Wrist and Hands Flex wrist against palm resistance Phalen’s test – both hands flexed & back to back for 60 secs. Normally no symp. Carpel tunnel syndrome will give a + result of numbness & burning Tinel’s Sign – direct percussion @ median nerve of wrist. In carpel tunnel + result = burning & tingling

Slide 44: Hip Inspect hip joint with spine when client is standing Client is supine, palpate the hip joints ROM

Slide 45: Knee Supine with legs extended ( knees can be flexed or dangling for inspection) Swelling = ? Soft tissue or ↑ fld in the joint Bulge Sign – stroke up medial aspect 2-3x. Tap lateral aspect. Watch for a bulge in the medial hollow. Ballottement of the Patella – lger amt of flds

Slide 46: Ankle & foot Inspect while nonweight- bearing, then standing & walking ROM Muscle strength

Slide 47: Spine Standing Inspect Palpate spinous processes ROM of spine is checked by asking to touch toes

Slide 48: Leg measurement True leg length = measure b/t fixed points, the anterior iliac spine cross the medial side of the knee to the medial malleolus

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