21 the musculoskeletal system 1. define important words in this chapter abduction moving a body part...

21The Musculoskeletal System

1. Define important words in this chapter

abductionmoving a body part away from the midline of the body.

adduction moving a body part toward the midline of the body.

amputation the surgical removal of an extremity.

arthritis a general term that refers to inflammation of the joints.



bones rigid connective tissues that make up the skeleton, lend support to body structures, allow the body to move, and protect the organs.

bursae tiny sacs of fluid that are located near joints and help reduce friction.

bursitis a condition in which the bursae become inflamed and painful.

cartilage the protective substance that covers the ends of bones and makes up the discs that are found between vertebrae.



flexion bending a body part.

fracture a broken bone.

full weight-bearing (FWB) a doctor’s order stating that a person has the ability to support full body weight on both legs and has no weight-bearing limitations.

joints the points where two bones meet; provide movement and flexibility.


1. Define important words in this chapterligaments strong bands of fibrous connective tissue that connect bones or cartilage and support the joints and joint movement.

muscles groups of tissues that contract and relax, allowing motion, supporting the body, protecting organs, and creating heat.

muscular dystrophy an inherited, progressive disease that causes a gradual wasting of muscle, weakness, and deformity.

non-weight-bearing (NWB) a doctor’s order stating that a person is unable to touch the floor or support any weight on one or both legs.



osteoarthritis a type of arthritis that usually affects weight-bearing joints, especially the hips and knees; also called degenerative joint disease.

osteoporosis a condition in which the bones become brittle and weak; may be due to age, lack of hormones, not enough calcium in bones, or lack of exercise.

partial weight-bearing (PWB) a doctor’s order stating that a person is able to support some body weight on one or both legs.

phantom limb painpain in a limb (or extremity) that has been amputated.



phantom sensationwarmth, itching, or tingling from a body part that has been amputated.

prosthesisan artificial device that replaces a body part, such as an eye, hip, arm, leg, tooth, or heart valve; helps improve function and/or appearance.

rheumatoid arthritisa type of arthritis in which joints become red, swollen, and very painful; movement is restricted and deformities of the hands are common.

sling a bandage or piece of material that is suspended from the neck for the purpose of holding and supporting a forearm.



tendons tough fibrous bands that connect muscle to bone.

total hip replacement (THR) a surgical replacement of the head of the femur (long bone of the leg) and the socket it fits into where it joins the hip with artificial materials.

total knee replacement (TKR) a surgical replacement of a damaged or painful knee with artificial materials.


Define the following terms:muscles groups of tissues that contract and relax, allowing motion, supporting the body, protecting organs, and creating heat.

bones rigid connective tissues that make up the skeleton, lend support to body structures, allow the body to move, and protect the organs.

joints the points where two bones meet; provide movement and flexibility.

2. Explain the structure and function of the musculoskeletal system


Define the following terms:

cartilage

the protective substance that covers the ends of bones and makes up the discs that are found between vertebrae.

bursae

tiny sacs of fluid that are located near joints and help reduce friction.

tendons

tough fibrous bands that connect muscle to bone.

ligaments

strong bands of fibrous connective tissue that connect bones or cartilage and support the joints and joint movement.


21 The Musculoskeletal System

Transparency 21-1: The Musculoskeletal System



Know the three types of muscles:• Skeletal muscles

Also called voluntary muscles, these muscles control body movements by contracting and relaxing. A voluntary muscle is a muscle that can be controlled voluntarily, or at will.

• Smooth musclesAlso called involuntary muscles, these muscles make up the walls of organs, such as the bladder and uterus. Involuntary muscles are controlled automatically and are not under a person’s conscious control.



Three types of muscles (cont’d.):• Cardiac muscles

Another type of involuntary muscles, these muscles are found only in the heart. The cardiac muscles contract and relax anywhere from 60 to 100 times each minute.



Know the four types of bones:• Long bones: e.g. the humerus (upper arm bone), the femur (upper leg or thigh bone)

• Short bones: e.g. carpals (wrist bones), tarsals (ankle bones)

• Flat bones: the sternum (breastbone) and scapula (shoulder blade)

• Irregular bones: bones of the vertebrae (spine)



Know the three types of joints:• Immovable joints: Examples of immovable joints are the bones of the cranium (skull).

• Slightly movable joints: An example of a slightly movable joint is the joint between the pubic bones.

• Movable joints: The joint between the scapula and the humerus is an example of a freely movable joint. Other types of movable joints are the hip and shoulder joints, which are ball-and-socket joints, and the elbow and knee joints, which are types of hinge joints.



Functions of the musculoskeletal system:• Gives shape and form to the body• Maintains posture• Permits movement• Protects internal organs• Stores calcium and phosphorus• Produces heat• Produces some blood cells


3. Discuss changes in the musculoskeletal system due to agingNormal changes of aging in the musculoskeletal system:• Muscles weaken and lose tone.• Bones lose calcium, causing them to become porous and brittle.

• Height is gradually lost due to shrinkage of space between the vertebrae in the spine.

• Loss of muscle mass in the body causes weight loss.• Joints are less flexible and stiffer, which slows normal body movements and decreases range of motion.


4. Discuss common disorders of the musculoskeletal systemDefine the following term:muscular dystrophy an inherited, progressive disease that causes a gradual wasting of muscle, weakness, and deformity.


4. Discuss common disorders of the musculoskeletal systemKnow these points about muscular dystrophy:• Hereditary, progressive disease in which muscle tissue is destroyed and muscles atrophy

• Symptoms: muscle weakness, stiffness, twitching of the hands and arms

• Cause: specific gene in the body• Generally appears at birth or during childhood• There is currently no cure.


4. Discuss common disorders of the musculoskeletal systemRemember these care guidelines for muscular dystrophy:• Allow time for movement.• Give frequent skin care to prevent pressure ulcers.

• Reposition residents often to prevent contractures.• Perform ROM exercises as directed.• Assist with ADLs. Encourage independence.• Report red skin; pale skin; signs of the beginning of a pressure ulcer; stiffening of muscles; pain, swelling, or burning in a leg; symptoms of UTI; or signs of pneumonia.


4. Discuss common disorders of the musculoskeletal systemDefine the following term:osteoporosis a condition in which the bones become brittle and weak; may be due to age, lack of hormones, not enough calcium in bones, or lack of exercise.


4. Discuss common disorders of the musculoskeletal systemKnow these points about osteoporosis:• Bones lose mass, causing them to become brittle.• Causes: lack of calcium in diet, loss of estrogen, lack of regular exercise, reduced mobility, age

• More common in women, especially after menopause• Symptoms: low back pain, loss of height, fractures, stooped posture

• Treatment: medication, exercise, calcium supplements• Be patient and reposition residents carefully.• Report any decline in activity or movement.


4. Discuss common disorders of the musculoskeletal systemDefine the following terms:arthritis a general term that refers to inflammation of the joints.

osteoarthritis a type of arthritis that usually affects weight-bearing joints, especially the hips and knees; also called degenerative joint disease.

rheumatoid arthritisa type of arthritis in which joints become red, swollen, and very painful; movement is restricted and deformities of the hands are common.


4. Discuss common disorders of the musculoskeletal systemKnow these points about arthritis:• General term for inflammation of joints that cause pain, stiffness and swelling

• May cause decreased mobility


4. Discuss common disorders of the musculoskeletal systemKnow these points about osteoarthritis:• Condition in which cartilage between bones and the pads at the ends of bones begins to erode.

• Symptoms: pain, redness, swelling, stiffness, limited motion

• Generally occurs due to aging and may be due to joint injury

• Cold, damp weather can increase pain and stiffness.


4. Discuss common disorders of the musculoskeletal systemKnow these points about rheumatoid arthritis:• Form of arthritis that may become crippling• Symptoms: stiffness, swelling, severe pain, deformities which may be severe and disabling, fever, fatigue, weight loss

• Cause: autoimmune illness• Treatment: rest, controlled exercise, ROM exercises, medication, weight loss, heat applications, joint replacement


4. Discuss common disorders of the musculoskeletal systemRemember these care guidelines for arthritis:• Assist with exercise program.• Perform ROM exercises as directed.• Let nurse know, before exercise, if pain medication is needed.

• Assist with ADLs as needed.• Encourage use of handrails and safety bars in bathroom.

• Be positive and supportive; listen if resident wants to talk.

• Report stiffness, swelling, pain, reduced ability to perform ROM exercises, or decline in activity.


4. Discuss common disorders of the musculoskeletal systemDefine the following term:bursitis a condition in which the bursae become inflamed and painful.


4. Discuss common disorders of the musculoskeletal systemKnow these points about bursitis:• Condition in which bursae become inflamed• Symptoms: tissue around joint may become painful, swollen, and tender

• Treatment: application of ice, immobilization to rest joint, medication, removal of fluid from joint, and cortisone injections


4. Discuss common disorders of the musculoskeletal systemDefine the following terms:amputation the surgical removal of an extremity.

prosthesisan artificial device that replaces a body part, such as an eye, hip, arm, leg, tooth, or heart valve; helps improve function and/or appearance.

phantom sensationwarmth, itching, or tingling from a body part that has been amputated.

phantom limb painpain in a limb (or extremity) that has been amputated.


4. Discuss common disorders of the musculoskeletal systemDefine the following term:flexion bending a body part.


4. Discuss common disorders of the musculoskeletal systemKnow these points about amputations: • Surgical removal of an extremity• Causes: disease, cancer, injury, accidents• Person may have prosthesis or transplant.


4. Discuss common disorders of the musculoskeletal systemREMEMBER:Phantom sensation, phantom limb pain, and stump pain are real and should not be ignored or ridiculed.


4. Discuss common disorders of the musculoskeletal systemKnow these guidelines for amputation and prosthesis care:• Be supportive during process of adjustment.• Follow orders for bed elevation or positioning.• Follow orders for positioning of the leg.• Assist with ADLs.• Encourage activity.• Perform range of motion exercises as directed.• Physical therapists will assist resident in learning to bear weight on prosthesis.


4. Discuss common disorders of the musculoskeletal systemGuidelines for amputation and prosthesis care (cont’d.):• Be careful when handling prostheses.• Follow instructions to apply or remove prostheses.• Apply special compression bandages and/or stump shrinkers as ordered.

• Change socks often and place seams on the sock to the outside to prevent abrasions.

• Give regular, careful skin care to avoid complications with the stump and the prosthesis.

• Bathe and rinse the stump.• Clean and dry the socket of the prosthesis when it is removed.


4. Discuss common disorders of the musculoskeletal systemGuidelines for amputation and prosthesis care (cont’d.):• Before applying a prosthesis, make sure the area is completely dry.

• Provide support for phantom pain, phantom sensation, or stump pain. The pain or sensation is real and should be treated that way.

• Do not react negatively to the stump or the prosthesis during care.

• Report redness or swelling; drainage, bleeding or sores; stump pain, phantom pain, or phantom sensation; reduced ability to move extremity; cyanosis; or problems with the prosthesis.


4. Discuss common disorders of the musculoskeletal systemDefine the following terms:fracture a broken bone.

sling a bandage or piece of material that is suspended from the neck for the purpose of holding and supporting a forearm.


4. Discuss common disorders of the musculoskeletal systemKnow these points about fractures:• A fracture is a broken bone.• Causes: trauma or accidents; falling is a common cause

• Symptoms: pain, swelling, bruising• Generally diagnosed with x-ray• Treatment: bone must be set and allowed to heal in normal alignment

• Can take four to eight weeks to heal; longer in elderly people


4. Discuss common disorders of the musculoskeletal systemKnow these types of fractures:• Closed or simple fracture The skin is closed. Bone is in proper position, and has not dislocated.

• Hairline fractureThe skin is closed. Bone has fine-line crack noted on X-ray, and has not dislocated.

• Open or compound fractureThe skin is open. Bone may come through the skin. The person has an increased risk of infection.


4. Discuss common disorders of the musculoskeletal systemTypes of fractures (cont’d.):• Greenstick fracture The skin is usually closed. The fracture is incomplete. Only one side of the bone is broken; the other side is bent. Greenstick fractures are more common in children.

• Comminuted fracture The skin is open or closed. Bone has fractured in two or more places.

• Compression fracture The fracture occurs in the spine. The skin is usually closed. Bone may break with trauma or without significant trauma. This fracture can be due to osteoporosis, tumor, or other condition. It is commonly seen in the elderly.


4. Discuss common disorders of the musculoskeletal systemRemember these guidelines for cast care:• Allow time for movement.• Follow orders on moving and repositioning.• Help with ROM exercises as ordered.• Extremity may need to be elevated.• Pad cast edges, as needed.• Assist with use of cane, walker, or crutches.


4. Discuss common disorders of the musculoskeletal systemGuidelines for cast care (cont’d.):• Do not get cast wet.• Use bed cradles to reduce pressure from bed linens.• Keep cast clean.• Report numbness, tingling, or increased swelling; cyanosis or pale skin; redness, drainage, bleeding or sores; changes in temperature of skin; complaints that cast is too tight; pain, burning, or pressure; wetness in or around cast; odor, or resident placing sharp objects inside cast.


4. Discuss common disorders of the musculoskeletal systemDefine the following terms:total hip replacement (THR) a surgical replacement of the head of the femur (long bone of the leg) and the socket it fits into where it joins the hip with artificial materials.

partial weight-bearing (PWB) a doctor’s order stating that a person is able to support some body weight on one or both legs.

non-weight-bearing (NWB) a doctor’s order stating that a person is unable to touch the floor or support any weight on one or both legs.


4. Discuss common disorders of the musculoskeletal systemDefine the following terms:full weight-bearing (FWB) a doctor’s order stating that a person has the ability to support full body weight on both legs and has no weight-bearing limitations.

abductionmoving a body part away from the midline of the body.

adduction moving a body part toward the midline of the body.


4. Discuss common disorders of the musculoskeletal systemRemember these care guidelines for total hip replacement (THR):• Keep often-used items in easy reach.• Follow care plan exactly.• Follow orders regarding positioning and elevation of head of bed.

• Assist with dressing, starting with weaker side.• Use adaptive devices.


4. Discuss common disorders of the musculoskeletal systemCare guidelines for THR (cont’d.):• Ask resident to use handrails in shower.• Encourage fluids.• Assist with coughing and deep breathing exercises.• Apply anti-embolic stockings as ordered.• Never rush resident.


4. Discuss common disorders of the musculoskeletal systemCare guidelines for THR (cont’d.):• Never perform ROM exercises on side of hip replacement without orders from nurse.

• Caution resident not to cross legs.• Ask nurse for pain medication prior to moving and positioning.

• Report incisions that are red, draining, bleeding or warm; numbness or tingling; cyanosis or pale skin; increase in pain; burning sensation; edema of the legs; fever or other change in vital signs; constipation; problems with appetite; or resident not following doctor’s orders.


4. Discuss common disorders of the musculoskeletal systemDefine the following term:total knee replacement (TKR) a surgical replacement of a damaged or painful knee with artificial materials.


4. Discuss common disorders of the musculoskeletal systemRemember these care guidelines for total knee replacement (TKR):• Apply special stockings to prevent blood clots.• Do not perform special exercises unless trained and ordered.

• Assist with coughing and deep breathing exercises, as ordered.

• Encourage fluids.• Ask nurse for pain medication prior to moving and positioning.

• Report incisions that are red, draining, bleeding or warm; numbness or tingling; cyanosis or pale skin; increase in pain; burning sensation; reduced mobility in the extremity; fever or other change in vital signs; constipation; problems with appetite; or resident not following doctor’s orders.


4. Discuss common disorders of the musculoskeletal systemKnow these points about continuous passive motion (CPM) machines:• May be used for people who have had TKR• Moves joint through normal range of motion• Notify nurse if the resident complains of pain or discomfort or if the extremity moves out of the proper position.


4. Discuss common disorders of the musculoskeletal systemRemember these points about traction:• Method of treating fractures that keeps bones in place

• Uses weights and pulleys to keep bones in proper position

• Do not disconnect traction assembly or adjust the weights.

• Keep resident in proper body alignment.• Report numbness or tingling, cyanosis or pale skin, wetness on sling, odor around sling or boot, sling or boot becomes loose or comes off, pain, burning, pressure, swelling, changes in skin temperature, redness, drainage, bleeding, sores, or resident moving to the side or sliding down.


5. Describe elastic bandages

Know these points about elastic bandages:• Bandages that are wrapped around a body part• Used to keep dressings in place, hold splints in place, and provide protection, compression and support for body parts, decrease swelling from injuries and hold ice in place

• Must be snug enough to provide proper compression and support but not interfere with circulation

• Report pale, gray, cyanotic, or white skin; skin that is cold to the touch; swelling; complaints of bandage feeling too tight; pain or discomfort; numbness or tingling



Know the “RICE” acronym:Rest: Rest is important to help an injury heal properly. Putting any weight on the injury could cause more harm. Ice: Ice helps to prevent or reduce swelling. The skin should always be protected when using ice. Compression: As you have learned, elastic bandages are used to compress the injured area, hold the extremity in place, and reduce discomfort. In addition, elastic bandages help decrease tissue swelling that occurs with an injury. Elevation: Elevating the extremity also helps prevent or reduce swelling. When an extremity is elevated above the level of the heart, swelling may decrease.



REMEMBER: Memorize the “RICE” (Rest, Ice, Compression, Elevation) acronym for care when a person is injured.

Applying elastic bandages

Equipment: elastic bandage in the correct size, clip, safety pin, or tape (if using self-adhering bandage, these are not needed)

1. Identify yourself by name. Identify the resident. Greet the resident by name.

2. Wash your hands.

3. Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible.


4. Provide for the resident’s privacy with a curtain, screen, or door.

5. Adjust bed to safe working level, usually waist high. Lock bed wheels.

6. Avoid trauma or pain to the resident throughout the procedure.

7. Assist resident to get into the supine (flat on the back) position.

8. Expose only the part to be bandaged.


9. Hold the rolled bandage with one hand and, with the other hand, put the loose end on top of the extremity.

10. Wrap extremity, beginning at the spot furthest from the heart. Circulation returns toward the heart, and this allows extra fluid to flow to the heart and leave the area. (For the wrist, begin wrapping at the hand. For the ankle, begin at the foot.)


(For the wrist, begin wrapping at the hand. For the ankle, begin at the foot.)

11. Wrap bandage once around the beginning spot, and turn over the tip so that an anchor is made.

12. Wrap one more time around the spot where the anchor lies, and then begin slowly wrapping in overlapping spirals up the extremity.

13. Smooth out entire bandage, removing any wrinkles.


14. Secure bandage with self-closure, clip, safety pin, or tape. If using a pin, be careful not to pierce the resident’s skin.

15. Straighten all of the linens.

16. Remove and re-apply bandage as directed. Wash and dry bandages as necessary.

17. Make resident comfortable.


18. Return bed to lowest position. Remove privacy measures.

19. Leave call light within resident’s reach.

20. Wash your hands.

21. Be courteous and respectful at all times.

22. Report any changes in the resident to the nurse. Document procedure using facility guidelines.


ExamMultiple Choice. Choose the correct answer.1. Which of the following type of muscle is a voluntary muscle?(A) Skeletal muscle(B) Smooth muscle(C) Pulmonary muscle(D) Cardiac muscle

2. Which of the following is a function of the bones?(A) Protecting the body from disease(B) Lending support to body structures(C) Sending messages throughout the human body(D) Pumping blood throughout the body


Exam (cont’d.)3. Normal age-related changes for the musculoskeletal system include:(A) Muscles weaken and lose tone(B) Bones gain calcium(C) Muscle mass increases, causing weight gain(D) Joints become more flexible

4. Weakening, wasting away, and decrease in size of a muscle is called:(A) Dystrophy(B) Atrophy(C) Contracture(D) Dislocation


Exam (cont’d.)5. The painful and permanent stiffening of a muscle is called:(A) Dystrophy(B) Atrophy(C) Contracture(D) Dislocation

6. Osteoporosis is caused by a lack of _______ in the diet.(A) Sodium(B) Calcium(C) Iron(D) Protein


Exam (cont’d.)7. Rheumatoid arthritis is an autoimmune illness. With an autoimmune illness the body’s ______ system attacks normal tissue.(A) Endocrine(B) Lymphatic(C) Circulatory(D) Immune

8. Which of the following statements is true of osteoarthritis?(A) Jaw and neck are usually affected.(B) Pain and stiffness increase in cold or damp weather.(C) Antibiotics are usually the first type of medication to treat osteoarthritis.(D) Residents will not be able to perform any ADLs if they have osteoarthritis.


Exam (cont’d.)9. After an amputation, a resident may experience phantom sensation. Phantom sensation is: (A) Not real(B) Sensations where the limb existed(C) The inability to use a new body part(D) The desire to get rid of a new body part

10. Which of the following is an example of a prosthesis?(A) An adaptive device to assist residents with dressing(B) Handrolls to keep residents’ fingers from curling too tightly(C) Special shoes to help residents with flat feet(D) An artificial arm to replace an arm that has been lost


Exam (cont’d.)11. Before applying a prosthesis, the area must be: (A) Dry(B) Damp(C) Cold(D) Warm

12. A fracture in which the skin is open and the bone may come through the skin is a(n):(A) Closed fracture(B) Open fracture(C) Greenstick fracture(D) Compression fracture


Exam (cont’d.)13. Which of the following statements is true of cast care?(A) Keep the cast wet or damp.(B) Use a sharp object to remove items that have fallen inside the cast.(C) Elevate an extremity that is in a cast.(D) Use warm water and soap to wash the cast when it gets dirty.

14. A full weight-bearing order for a resident with a total hip replacement means that:(A) The resident is able to support some body weight on one or both legs(B) The resident is unable to support any body weight on one or both legs(C) The resident can bear full weight on both legs(D) The affected hip needs to be kept in abduction


Exam (cont’d.)15. After a total hip replacement, the hip cannot be bent or flexed more than ______ degrees.(A) 45(B) 75(C) 90(D) 100 16. Fluids are encouraged for residents who have had a total knee replacement to help prevent:(A) Myocardial infarctions(B) Urinary tract infections(C) Depression(D) Side effects of medication


Exam (cont’d.)17. Elastic bandages are commonly used to:(A) Treat reddened skin(B) Keep dressings in place(C) Cover cuts in the skin(D) Stop numbness and tingling

18. Which of the following is a nursing assistant’s responsibilities regarding traction?(A) The nursing assistant should adjust weights if the resident’s limb starts to lower.(B) The nursing assistant should keep the traction unit’s weights flat on the floor.(C) The nursing assistant should give pain medication if traction is causing the resident pain.(D) The nursing assistant should report to the nurse if the weights move.

21 the musculoskeletal system 1. define important words in this chapter abduction moving a body part...

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