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----CHAPTER 26----Group 3
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BONESProvide structure
Give protectionServes as levers
Store calciumProduce blood cells
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HARD
DENSE
MAKES UP THE
SHAFT & OUTER
LAYER
CONTAINS
NUMEROUS SPACES
MAKES UP ENDS
AND CENTER OF
BONES
2 TYPES OF BONES:
COMPACT BONE: SPONGY BONE:
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BONES OSTEOBLASTS- active cells in w/c bone tissue is formed.
OSTEOCLASTS - active cells in w/c bone tissue is broken
down.
RED MARROW - produces blood cells.
YELLOW MARROW- composed mostly of fats.
PERIOSTEUM- covers the bones & contains osteoblasts &
blood vessels that promote nourishment &
formation of new bony tissues.
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--OSTEOBLASTS--
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--OSTEOCLASTS--
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--RED MARROW--
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--YELLOW MARROW--
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--PERIOSTEUM--
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VARIATION OFBONES :SHORT BONES
e.g., carpals
LONG BONES
e.g., humerus, femur
FLAT BONES
e.g., sternum, ribs
IRREGULAR SHAPE BONES
e.g., hips, vertebrae
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SHORT BONE
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LONG BONES
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FLAT BONE
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IRREGULAR SHAPE
BONE
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SKELETAL MUSCLES
made up of 650 skeletal (voluntary) muscles, w/c are under
conscious control.
Made up of long muscle fibers (fasciculi)that are arranged
together in bundles & joined by connective tissue, skeletal muscles
attach to bones by way of strong , fibrous cords called tendons.
Assist withposture, produce body heat& allow body to
move.
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JOINTS is the place where 2 or more bones meet
Provide a variety of (ROM) for the body parts and may be classified as:
Fibrous( sutures b/n skull bones ) are joined by fibrous connective tissue andare immovable.
Cartilaginous ( joints b/n vertebrae) are joined by cartilage.
Synovial (shoulder, hips, knees, ankles) contain a space b/n the bones that
is filled with synovial fluid ( a lubricant that promotes a sliding movement at
the end of the bones.
LIGAMENTS- strong dense bands of fibrous connective tissue
BURSAE- small sacs filled w/ synovial fluid that serves to cushion the joint
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Have you had any recent weight gain?
Describe any difficulty that you have
chewing. Is it associated w/ tenderness or
pain?
Describe any joint , muscle or bone pain
you have . Where is the pain? What does the
pain feel like (stab, ache) ? When did the
pain start? When does it occur? How longdoes it last ? any stiffness, swelling,
limitation of movement?
Weight gain can increase physical stress & strain on
the musculoskeletal system. Clients w/ TMJ dysfunction may have difficulty
chewing and may describe their jaws as getting
locked or stuck Jaw tenderness, pain, or a clicking
sound may also be present w/ ROM
Bone pain is often dull, deep, & throbbing. Joint or
muscle pain is described as aching. Sharp, knife like
pain occurs w/ most fractures & increases w/ motion
of the affected body part. Motion increases painassociated w/ many joint problems but decreases pain
associated w/ rheumatoid arthritis
H I S T O RY OF PRE S E N T HE ALT H C ONC E RN
QUESTION RATIONALE
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Do you have a family history
of rheumatoid arthritis, gout
or osteoporosis?
These condition tend to be
familial & can increase the
clients risk of development of
these diseases.
FAMILY HISTORY
QUESTION RATIONALE
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RHEUMATOID ARTHRITIS
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OSTEOPOROSIS
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What activities you engage in to
promote the health of your
muscles & bones ( e.g., exercise,
diet, weight reduction )
The question provides the
examiner w/ knowledge of how much
the client understands & actively
participates in trying to promote the
health of the musculoskeletal system.
LIFESTYLE & HEALTHPRACTICES
QUESTION RATIONALE
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What medication are you
taking?
Do you smoke tobacco? How
much & how often?
Some medications can affect
musculoskeletal function. Diuretics, for
example, can alter electrolyte levels
leading to muscle weakness. Steroids
can deplete bone mass, thereby
contributing to osteoporosis.
Smoking increases the risk of
osteoporosis.
RATIONALE
LIFESTYLE & HEALTHPRACTICES
QUESTION
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Do you drink alcohol or
caffeinated beverages? How
much and how often.
Describe your typical 24-hour
diet. Are you able to consume
milk or milk-containing products.Do you take any calcium
supplements.
Excessive consumption of alcohol
or caffeine can increase the risk ofosteoporosis.
Adequate protein in the diet
promotes muscle tone and bone
growth; vitamin C promotes healing
of tissues and bones. A calcium
deficiency increases thee risk ofosteoporosis. A diet high in
purine(e.g. liver, sardines).
LIFESTYLE & HEALTHPRACTICES
QUESTION RATION ALE
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Describe your activities
during a typical day. How
much time do you spend in
the sunlight.
Describe any routine
exercise that you do.
A sedentary lifestyle increases the risk of
osteoporosis. Prolonged immobility leads to muscleatrophy. Exposure to 20 min. of sunlight per day
promotes the production of vitamin D in the body.
Vitamin D deficiency can cause osteomalacia.
Regular exercise promotes flexibility, bone density,
and muscle tone and strength, and can help to slow the
usual musculoskeletal changes(progressive loss of totalbone mass and degeneration of skeletal muscle fibres)
that occur with aging.
LIFESTYLE & HEALTH
PRACTICES
Question Rationale
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--OSTEOMALACIA--
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Describe your
occupation?
Certain job-related activities increase
the risk for development of
musculoskeletal problems. For example,
incorrect body mechanics, heavy lifting,
or poor posture can contribute to back
problems; consistent, repetitive wrist
and hand movements can lead to the
development of carpal tunnel syndrome.
LIFESTYLE & HEALTH
PRACTICES
QUESTION RATIONALE
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- -CARPAL TUNNEL SYNDROME-
-
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Describe your posture
at work & at leisure.What type of shoes do
you usually wear? Do you
use any special footwear
(i.e., orthotics)?
QUESTION RATIONALE
Poor posture prolonged
forward bending ( as in sitting)
or backward leaning (as inworking overhead. Or long
term carrying of heavy objects
on the shoulders can result in
back problems. Contracture of
the achilles tendon can occur
w/ prolonged use of high
heeled shoes.
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--ACHILLES TENDON--
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Do you have difficulty
performing normal activities of
daily living (bathing, dressing,
grooming, eating)? Do you use
assistive devices (e.g., walker,
cane braces) to promote your
mobility?
QUESTION RATIONALE
Impairment of the musculoskeletal
system may impair the clients ability
to perform normal activities of daily
living. Correct use of assistive
devices can promote safety &
independence. Some clients may feel
embarrassed & & not use their
prescribed or needed assistivedevice.
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How have your
musculoskeletal problems
interfered w/ your ability to
interact or socialize w/ others?
Have they interfered w/ your
usual sexual activity?
QUESTION--RATIONALE
Musculoskeletal problems,
especially chronic ones, can
disable & cripple the client,
w/c may impair socialization &
prevent the client from
performing the same roles asin the past.
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P H Y S I C A L A S S E S S M E N T( G A I T )Assessment Procedure Normal Findings Abnormal Findings
Inspection:Observe gait: Observe theclients gait as the client enters and
walks around the room. Note-Base of support-Weight-bearing stability
-Foot position- Stride and length and
cadence of stride
- Arm swing- Posture
Assess for the risk of falling
backward in the older orhandicapped client by performingthe nudge test. Stand behind
the client and put your armsaround the client while you gentlynudge the sternum.
Evenly distributed weight. Clientable to stand on heels and toes.
Toes point straight ahead. Equalon both sides. Posture erect,movements coordinated andrhythmic, arm swing in opposition,
stride length appropriate .
Client does not fall backward.
Uneven weight bearing is evident. Clientcannot stand on heels or toes. Toespoint in or out. Client limps, shuffles,propels forward, or has wide-based gait.
Falling backward easily is seen withcervical spondylosis and Parkinsonsdisease.
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PHYSICAL ASSESSMENT(TEMPOROMANDIBULAR JOINT)
Assessment Procedure Normal Findings Abnormal Findings
Inspection and PalpationInspect and palpate the TMJ.
Have the client sit; put your
index and middle fingers justanterior to the external to theexternal ear openings. Ask to:- Open the mouth as widely as
possible.( The tips of yourfingers should drop into thejoint spaces as the mouthopen.)
- Move the jaw from side to
side.- Protrude(push out) andretract(pull in ) jaw.
Jaw moves laterally 1 to 2 cm.snapping and clicking may be feltand heard in the normal client.
Mouth opens 1 to 2 inches(distance between upper and lowerteeth).
Jaw protrudes and retracts easily.The clients mouth opens and
closes smoothly.
Decreased ROM, swelling, tenderness, orcrepitus may be seen in arthritis.
Decreased muscle strength with muscleand joint disease, ROM, and a clicking,popping, or grating sound may be noted
with TMJ dysfunction.
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PHYSICAL ASSESSMENT ( C E R V I C A L T H O R A C I C , A N D L U M B A R
S P I N E )
Assessment Procedure Normal Findings Abnormal Findings
Inspection and PalpationObserve the Cervical, Thoracic,
Lumbar curves from the side thefrom behind. Have the client standingerect with the gownpositioned to allow an adequate view ofthe spine. Observe for symmetry, notingdifferences in height of the shoulders,the iliac crests and the buttocks creases
Cervical and Lumbar spine areconcave; Thoracic spine is
convex. Spine is straight ( whenobserved from behind).
An exaggerated thoracic curve(kyphosis) is common withaging.
Some finding that appear to beabnormalities are, in fact
variations related to cultures orsex. For example, some africanamericans have a large glutealprominenece, making the spineappear to have lumbar lordosis.
a flattened lumbar curvature may beseen w/ a herniated lumbar disc or
ankylosing spondylitis. Lateral curvatureof the thoracic spine w/ an increase inthe convexity on the curve side is seenin scoiliosis an exaggerated lumbarcurve (lordosis) is often seen inpregnancy or obesity. Unequal heightsof the hips suggests unequal leg lengths.
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ABNORMALITIES OFTHE FEET AND
TOES
THE FOLLOWING ABNORMALITIES AFFECT THE FEET AND
TOES, TYPICALLY CAUSING DISCOMFORT AND IMPENDING
MOBILITY. EARLY DETECTION AND TREATMENT CAN HELP TO
RESTORE OR MAXIMIZE FUNCTION.
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I. ACUTE GOUTY
ARTHRITIS
In gouty arthritis,
metatarsophalangeal
joint of the great
toe is tender,
painful, reddened,
hot, and swollen.
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II. CALLUS
Calluses are non
painful, thickened
skin that occur at
pressure points.
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III. CORN
Corn are painful
thickenings of the
skin that occur over
bony prominences and
at pressure points.
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IV. PLANTARWARTS
Plantar warts are
painful warts
( veruca vulgaris) that
often occur under
callus, appearing as a
tiny dark spots
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V. FLAT FEET
A flat foot (pes
planus) has no arch
and may cause pain
and swelling of the
foot surface.
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VI. HALLUXVALGUS
Hallux valgus is an
abnormality in which the
great toe is deviated laterally
and may overlap the 2nd toe.
An enlarged, painful, inflamed
bursa (bunion) may form on
the medial side.
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VII. HAMMERTOE
Hyperextension at the
metarsophalangeal joint
with flexion at theproximal interphalangeal
joint (hammer toe)
commonly occurs with the
second toe.
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--THE END--
SEMBRANO
NALES
CUEVA
CAMACHO
DELOS REYES
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