Module 8. Musculoskeletal system is composed of the bones muscles joints tendons ligaments ...
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Transcript of Module 8. Musculoskeletal system is composed of the bones muscles joints tendons ligaments ...
Module 8
Musculoskeletal system is composed of the bones muscles joints tendons ligaments cartilage
Long bones- tibia, fibula, femur, humerus, ulna
Sort bones- such as those in wrist and ankle
Flat bones- skull, sternum, ribs Irregular bones- pelvis, vertebrae,
scapula
Skeletal (striated)- voluntary muscles; deltoid, biceps, gluteal, etc..
Smooth (short-fibered)- involuntary muscles; GI tract, lungs, pupils, etc..
Cardiac (striated, special function)
Fibrous membrane still exists between the cranial bones (fontanels)
Posterior closes between 2-3 months, anterior stays open until approx. 18 months of age to allow for brain and skull growth
Secondary ossification occurs as the long bones grow
Calcium intake during childhood and adolescence is essential for bone density
Growth takes place in the epiphyseal plates, injury in this portion is of concern in childhood
Rapid bone growth facilitates healing after a fracture
Can have growing pains because of rapid growth as well
Long bones are porous and less dense; bones can bend, buckle or break
In utero thoracic and sacral spine are convex curves (rounded)
Cervical region becomes concave as baby can hold head up
When learning to stand, the lumbar region becomes concave
Abnormalities can occur- scoliosis, lordosis, kyphosis
Muscular system is almost completely formed at birth
The length and circumference grow, but not the number
Maximum diameter for girls 10 years of age; 14 in boys
Strength continues to increase until 25-30 yrs
Almost completely formed at birth Muscles don’t increase in number, just
length and circumference Fibers reach maximum diameter around
10 years of age for girls and 14 yrs in boys
Strength continues until 25-30 yrs of age Until puberty, ligaments and tendons are
stronger than bone
Ligaments are the structural support connecting bones
Tendons connect bones to muscles
Cervical and lumbar areas become concave
Bowed legs (genu varum) in infant Knock knees (genu valgum) in
preschool child Resolve with growth
Developmental dysplasia of the hip Scoliosis, kyphosis, lordosis
Femoral head and acetabulum are improperly aligned Hip instability Dislocation Subluxation Dysplasia of
acetabulum
Figure 28–10 The asymmetry of the gluteal and thigh fat folds is easy to see in this child with developmental dysplasia of the hip.
Left hip more often than right Maternal estrogen may be a link to
laxity of joint, especially in females Possible cultural factors Assessment
Limited abduction of affected hip Asymmetric gluteal and thigh folds Allis’ sign; Ortolani-Barlow maneuver
Treatment Pavlik harness Skin traction- Bryant’s traction Casting Pain control Prevent complications from immobility Promote normal growth and development
Figure 28–11 The most common treatment for DDH in a child under 3 months of age is a Pavlik harness. A shirt should be worn under the harness to prevent skin irritation (it was omitted for clarity in this photograph).
Figure 28–12 For infants older than 3 months of age, skin traction is commonly used for treatment of DDH
Abnormal curvature of the spin Congenital Idiopathic Acquired
Can be structural or compensatory More often in girls than boys Ages 10-13 is highest incidence
Figure 28–15 A child may have varying degrees of scoliosis. For mild forms, treatment will focus on strengthening and stretching. Moderate forms will require bracing. Severe forms may necessitate surgery and fusion. Clothes that fit at an angle, such as this teenage girl’s shorts, and anatomic asymmetry of the back provide clues for early detection.
Most commonly right thoracic, left lumbar Ribs forced closer together Uneven shoulders Uneven hips, one-sided rib hump Prominent scapula X-ray Can also us CT, MRI, bone scan for
degree of curvature
Limit or stop the progression Rehab Bracing- Boston brace Spinal fusion
Nursing concerns? Nursing consideration? Nursing diagnoses? Nursing interventions?
Juvenile Rheumatoid Arthritis- Chapter 17 Chronic autoimmune inflammatory disease More common in girls Ages 2-5, or 9-12 Can enter into remission, or become chronic Joint inflammation
Decreased mobility Swelling pain
Figure 17–5 Joint inflammation and destruction in rheumatoid arthritis
Diagnosis made by jistory and assessment findings
Onset before 17 yrs of age, persisting for >6weeks
Pain Impaired mobility Interference with
growth and development
Fever Rash Lymphadenopathy
Splenomegaly Hepatomegaly Limp Favor one extremity Slow or uneven
growth Pain Swelling
Pauciarticular- knees, ankles, elbows, more common in girls
Systemic arthritis- males and females equally; high fever, polyarthirits and rheumatoid rash; affects internal organs and joints
Polyarticular arthritis; many joints (5 or more), particularly small joints (hands, fingers, hips, knees feet, ankles and neck)
May occur for a limited time and them improve, may recur periodically, or may last for 3-6 months or longer
No specific lab test, but can run Rheumatoid factor Human leukocyte antigen B27 Antinuclear antibody (ANA) ESR
Drug therapy Physical therapy Surgery Relieve pain Prevent contractures Aspirin or NSAIDS Steroids
Pain relief Promoting mobility Adequate nutrition Promotion of growth and development Prevent contractures
Break in bone integrity Result from direct trauma-falls, sports
injuries, abuse, MVA Result from bone diseases-
osteogenesis imperfecta Occur frequently in children because
bones are less dense and more porous
Pain Abnormal positioning Edema Immobility or decreased ROM Ecchymosis Guarding Crepitus
Common sites Clavicle Tibia Ulna Femur Distal forearm of ulna and radius most
common
X-ray Examination and palpation
Good hx, identify cause of injury Pain management Cast care Traction Internal vs. external fixation Care post realignment
Open reduction Closed reduction
Complications Pain Infection Vascular injury Malunion Non union Fat or bone embolus
Assessment for compartment syndrome
Delayed G & D Neurovascular
assessment Pain Pulses Paraesthesias
Maintain proper alignment Monitor neurovascular status Promote mobility Home care teaching Pain management Prevention of infection
Diagnoses Considerations Priorities Medications
Analgesics Antibiotics Muscle relaxers