Presentation by Andreas Schleicher Tackling the School Absenteeism Crisis 30 ...
5-191010195405.pdf
1.
2. Skeletal System
Bone types
Bone structure
Bone function
Bone growth and metabolism affected by calcium and
phosphorous, calcitonin, vitamin D, parathyroid,
growth hormone, glucocorticoids, estrogens and
androgens, thyroxine, and insulin.
3. Bones
Human skeleton has 206 bones
Provide structure and support for soft tissue
Protect vital organs
6. Bones
Compact bone
Smooth and dense
Forms shaft of long bones and outside layer of other
bones
Spongy bone
Contains spaces
Spongy sections contain bone marrow
7. Bone Marrow
Red bone marrow
Found in flat bones of sternum, ribs, and ileum
Produces blood cells and hemoglobin
Yellow bone marrow
Found in shaft of long bones
Contains fat and connective tissue
10. Synovial Joints
Found at all limb articulations
Surface covered with cartilage
Joint cavity covered with tough fibrous capsule
Cavity lined with synovial membrane and filled with
synovial fluid
11. Ligaments
Bands of connective tissue that connect bone to bone
Either limit or enhance movement
Provide joint stability
Enhance joint strength
12. Tendons
Fibrous connective tissue bands that connect bone to
muscles
Enable bones to move when muscles contract
13. Muscles
Skeletal (voluntary)
Allows voluntary movement
Smooth (involuntary)
Muscle movement controlled by internal mechanism
e.g., muscles in bladder wall and GI system
Cardiac (involuntary)
Found in heart
14. Skeletal Muscle
600 skeletal muscles
Made up of thick bundles of parallel fibers
Each muscle fiber made up of smaller structure
myofibrils
Myofibrils are strands of repeating units called
sarcomeres
15. Skeletal Muscle
Skeletal muscle contracts with the release of
acetylcholine
The more fibers that contract, the stronger the muscle
contraction
16. Changes in Older Adult
Musculoskeletal changes can be due to:
Aging process
Decreased activity
Lifestyle factors
17. Changes in Older Adult
Loss of bone mass in older women
Joint and disk cartilage dehydrates causing loss of
flexibility contributes to degenerative joint disease
(osteoarthritis); joints stiffen, lose range of motion
18. Changes in Older Adult
Cause stooped posture, changing center of gravity
Elderly at greater risk for falls
Endocrine changes cause skeletal muscle atrophy
Muscle tone decreases
19. Assessment
Health history
Chief complaint
Onset of problem
Effect on ADLs (Activity of Daily Living)
Precipitating events, e.g., trauma
20. Assessment
Examine complaints of pain for location, duration,
radiation character (sharp/ dull), aggravating, or
alleviating factors
Inquire about fever, fatigue, weight changes, rash, or
swelling
21. Physical Examination
Posture
Gait
Ability to walk with or without assistive devices
Ability to feed, toilet, and dress self
Muscle mass and symmetry
22.
23.
24.
25. Physical Examination
Inspect and palpate bone, joints for visible deformities,
tenderness or pain, swelling, warmth, and ROM
Assess and compare corresponding joints
Palpate joints knees and shoulder for crepitus
26. Physical Examination
Never attempt to move a joint past normal ROM or
past point where patient experiences pain
Bulge sign and ballottement sign used to assess for
fluid in the knee joint
Thomas test performed when hip flexion contracture
suspected
33. Musculoskeletal - Radiographic
Standard radiography, tomography and
xeroradiography, myelography, arthrography and CT
Other diagnostic tests: bone and muscle biopsy
34. Arthroscopy
Fiberoptic tube is inserted into a joint for direct
visualization.
Client must be able to flex the knee; exercises are
prescribed for ROM.
Evaluate the neurovascular status of the affected limb
frequently.
Analgesics are prescribed.
Monitor for complications.
35.
36. Bone Scan
Nuclear medicine procedure in which amount of
radioactive isotope taken up by bones is evaluated
Abnormal bone scans show hot spots due to
malignancies or infection
Cold spot uptakes show areas of bone that are
ischemic
37. Arthroscopy
Flexible fiberoptic endoscope used to view joint
structures and tissues
Used to identify:
Torn tendon and ligaments
Injured meniscus
Inflammatory joint changes
Damaged cartilage
38.
39. Musculoskeletal Trauma
Tissue is subjected to more force than it can absorb
Severity depends on:
Amount of force
Location of impact
Trauma is a very difficult or unpleasant experience that
causes someone to have mental or emotional problems
usually for a long time.
medical: a serious injury to a person's body.
40. Musculoskeletal Trauma
Mild to severe
Soft tissue
Fractures
Affect function of muscle, tendons, and ligaments
Complete amputation
41. Preventing Trauma
Teach importance of using safety equipment
Seat belts
Bicycle helmets
Football pads
Proper footwear
Protective eyewear
Hard hats
42. Soft Tissue Trauma
Contusion
Bleeding into soft tissue
Significant bleeding can cause a hematoma
Swelling and discoloration (bruise)
Contusion: a region of injured tissue or skin in which
blood capillaries have been ruptured; a bruise.
43. Soft Tissue Trauma -
Sprain
Ligament injury (Excessive stretching of a ligament)
Twisting motion
Overstretching or tear
◦ Grade I—mild bleeding and inflammation
◦ Grade II—severe stretching and some tearing and
inflammation and hematoma
◦ Grade III—complete tearing of ligament
◦ Grade IV—bony attachment of ligament broken away
◦ (hematoma is a solid swelling of clotted blood within the
tissues.)
44. Sprains
Treatment of sprains:
first-degree: rest, ice for 24 to 48 hr,
compression bandage, and elevation
second-degree: immobilization, partial weight
bearing as tear heals
third-degree: immobilization for 4 to 6 weeks,
possible surgery
A sprain, also known as a torn ligament, is damage to
one or more ligaments in a joint, often caused by trauma
or the joint being taken beyond its functional range of
motion. ... Sprains can occur in any joint but are most
common in the ankle and wrist.
45. Soft Tissue Trauma - Strain
Microscopic tear in the muscle
May cause bleeding
“Pulled muscle”
Inappropriate lifting or sudden acceleration-
deceleration
A muscle strain, or pulled muscle, occurs when
your muscle is overstretched or torn. This usually
occurs as a result of fatigue, overuse, or improper use of
a muscle. ... These strains can cause pain and may limit
movement within the affected muscle group.
46. Soft Tissue Trauma
To decrease swelling and pain, and encourage rest
Ice for first 48 hours
Splint to support extremities and limit movement
Compression dressing
Elevation to increase venous return and decrease swelling
NSAIDs
Compression implies the deliberate application of pressure in
order to produce a desired clinical effect. It is usually achieved
by the use of elasticated stockings or an
appropriate bandage, and is most commonly used to control
oedema and reduce swelling in the treatment of venous
disorders of the leg.
49. Fractures
Break in the continuity of bone
Direct blow
Crushing force (compression)
Sudden twisting motions (torsion)
Severe muscle contraction
Disease (pathologic fracture)
50. Fractures
Classification of Fractures
Closed or simple
Open or compound
Complete or incomplete
Stable or unstable
Direction of the fracture line
Oblique
Spiral
Lengthwise plane (greenstick)
51. Stages of Bone Healing
Hematoma formation within 48 to 72 hr after
injury
Hematoma to granulation tissue
Callus formation
Osteoblastic proliferation
Bone remodeling
Bone healing completed within about 6 weeks; up
to 6 months in the older person
52. Fractures – Emergency Care
Immobilize before moving client
Joint above and below
Check pulse, color, movement, sensation before
splinting
Sterile dressing for open wounds
55. Acute Compartment Syndrome
Serious condition in which increased pressure
within one or more compartments causes
massive compromise of circulation to the area
Prevention of pressure buildup of blood or fluid
accumulation
Pathophysiologic changes sometimes referred to
as ischemia-edema cycle
56. Emergency Care - Acute Compartment
Syndrome
Within 4 to 6 hr after the onset of acute
compartment syndrome, neuromuscular damage
is irreversible; the limb can become useless
within 24 to 48 hr.
Monitor compartment pressures.
(Continued)
57. Emergency Care (Continued)
Fasciotomy may be performed to relieve pressure.
Pack and dress the wound after fasciotomy.
58. Possible Results of Acute Compartment
Syndrome
Infection
Motor weakness
Volkmann’s contractures: (a deformity of the hand,
fingers, and wrist caused by a lack of blood flow (ischemia) to
the muscles of the forearm)
59. Other Complications of Fractures
Shock
Fat embolism syndrome: serious complication
resulting from a fracture; fat globules are
released from yellow bone marrow into
bloodstream
Venous thromboembolism
(Continued)
60. Other Complications of Fractures
(Continued)
Infection
Ischemic necrosis
Fracture blisters, delayed union, nonunion, and
malunion
61. Musculoskeletal
Complications (continued)
Muscle Atrophy, loss of muscle strength range
of motion, pressure ulcers, and other problems
associated with immobility
Embolism/Pneumonia/ARDS (Acute respiratory
distress syndrome (ARDS) is a life-threatening lung
condition that prevents enough oxygen from
getting to the lungs and into the blood.
TREATMENT – hydration, albumin, corticosteroids
Constipation/Anorexia
UTI
DVT (Deep vein thrombosis (DVT) occurs when a
blood clot (thrombus) forms in one or more of the deep
veins in your body, usually in your legs.
62. Musculoskeletal Assessment - Fracture
Change in bone alignment
Alteration in length of extremity
Change in shape of bone
Pain upon movement
Decreased ROM
Crepitation
Ecchymotic skin
(Continued)
Ecchymosis is the medical term for the
common bruise. Most bruises form when blood
vessels near the surface of the skin are
damaged, usually by impact from an injury.
The force of the impact causes your blood
vessels to burst open and leak blood.
63. Musculoskeletal Assessment – Fracture
(Continued)
Subcutaneous emphysema with bubbles under
the skin
Swelling at the fracture site
64. Special Assessment Considerations
For fractures of the shoulder and upper arm,
assess client in sitting or standing position.
Support the affected arm to promote comfort.
For distal areas of the arm, assess client in a
supine position.
For fracture of lower extremities and pelvis, client
is in supine position.
66. Osteoporosis
A disease in which loss of bone exceeds rate of
bone formation; usually increase in older women,
white race, nulliparity.
Clinical Manifestations – bone pain, decrease
movement.
Treatment – Calcium, Vit. D, estrogen
replacement, Calcitonin, fluoride, estrogen with
progestin, SERM (Selective Estrogen Receptor Modulator)
with anti-estrogens, exercise.
Pathologic fracture-safety.
67. Classification of Osteoporosis
Generalized osteoporosis occurs most commonly
in postmenopausal women and men in their 60s
and 70s.
Secondary osteoporosis results from an
associated medical condition such as
hyperparathyroidism, long-term drug therapy,
long-term immobility.
Regional osteoporosis occurs when a limb is
immobilized.
68. Health Promotion/Illness Prevention -
Osteoporosis
Ensure adequate calcium intake.
Avoid sedentary life style (a type of lifestyle with a
lack of physical exercise) .
Continue program of weight-bearing exercises.
73. Osteoporosis
Hormone replacement therapy
Parathyroid hormone
Calcium and vitamin D
Bisphosphonates
Selective estrogen receptor modulators
Calcitonin
Other agents used with varying results
74. Diet Therapy - Osteoporosis
Protein
Magnesium
Vitamin K
Trace minerals
Calcium and vitamin D
Avoid alcohol and caffeine
75. Fall Prevention - Osteoporosis
Hazard-free environment
High-risk assessment through programs such as
Falling Star protocol
Hip protectors that prevent hip fracture in case of
a fall
77. Osteomalacia
Softening of the bone tissue characterized by
inadequate mineralization of osteoid
Vitamin D deficiency, lack of sunlight exposure
Similar, but not the same as osteoporosis
Major treatment: vitamin D from exposure to sun
and certain foods
78. Paget’s Disease of the Bone
Metabolic disorder of bone remodeling, or
turnover; increased resorption (the process by
which osteoclasts break down bone and release the
minerals, resulting in a transfer of calcium from bone fluid
to the blood) of loss results in bone deposits
that are weak, enlarged, and disorganized
Nonsurgical management: calcitonin,
selected bisphosphonates, mithramycin
Surgical management: tibial osteotomy or
partial or total joint replacement
79. Paget’s Disease
An imbalance of increase osteoblast and
osteoclast cells; thickening and hypertrophy.
Bone pain most common symptom; bony
enlargement and deformities usually bilateral,
kyphosis, long bone.
Analgesics, meds bisphosphonates and
calcitonin, NSAID, assistance devices, and
hot/cold treatment.
80. Osteomyelitis
A condition caused by the invasion by one or
more pathogenic microorganisms that
stimulates the inflammatory response in bone
tissue
Exogenous, endogenous, hematogenous,
contiguous
81. Osteomyelitis
Infection of bone; causative agent – Staph/Strept
Typical signs and symptoms : Acute osteomyelitis include:
Fever that may be abrupt
Irritability or lethargy in young children
Pain in the area of the infection
Swelling, warmth and redness over the area of the
infection
Chronic osteomyelitis include:
Warmth, swelling and redness over the area of the
infection
Pain or tenderness in the affected area
Chronic fatigue
Drainage from an open wound near the area of the
infection
Fever, sometimes
Treatment – IV antibiotic; long term for 4-6 months
82. Surgical Management
Osteomyelitis
Sequestrectomy (Surgical removal of a sequestrum), a
detached piece of necrotic bone that often migrates to a
wound, abscess, etc.
Bone grafts
Bone segment transfers
Muscle flaps
Amputation
83. Bone Tumors
Benign Bone Tumors
Malignant Bone Tumors
Metastatic Bone Disease
A tumor is an abnormal growth of cells that serves no purpose. A benign tumor
is not a malignant tumor, which is cancer. It does not invade nearby tissue
or spread to other parts of the body the way cancer can. In most cases, the
outlook with benign tumors is very good. But benign tumors can be serious if
they press on vital structures such as blood vessels or nerves. Therefore,
sometimes they require treatment and other times they do not.
Multiple myeloma is the most common primary malignant bone tumor but
is often considered a marrow cell tumor within the bone rather than a bone
tumor because it is of hematopoietic derivation . It occurs mostly in older adults.
Multiple myeloma is a cancer of plasma cells that produce monoclonal
immunoglobulin and invade and destroy adjacent bone tissue. Common
manifestations include bone pain, renal insufficiency, hypercalcemia, anemia,
and recurrent infections.
84. Osteosarcoma is the 2nd most common primary bone tumor and is highly
malignant. It is most common among people aged 10 to 25, although it can
occur at any age. Osteosarcoma produces malignant osteoid (immature bone)
from tumor bone cells. Osteosarcoma usually develops around the knee (distal
femur more often than proximal tibia) or in other long bones, particularly the
metaphyseal-diaphyseal area, and may metastasize, usually to lung or other
bone. Pain and swelling are the usual symptoms.
Bone metastasis occurs when cancer cells spread from their original site to a
bone. Nearly all types of cancer can spread (metastasize) to the bones. But
some types of cancer are particularly likely to spread to bone, including breast
cancer and prostate cancer. Bone metastasis can occur in any bone but more
commonly occurs in the spine, pelvis and thigh. Bone metastasis may be the
first sign that you have cancer, or bone metastasis may occur years after
cancer treatment. Bone metastasis can cause pain and broken bones. With
rare exceptions, cancer that has spread to the bones can't be cured.
Treatments can help reduce pain and other symptoms of bone metastases.
86. Interventions
Non-drug pain relief measures
Drug therapy: analgesics, NSAIDs
Surgical therapy: curettage (simple excision
of the tumor tissue), joint replacement, or
arthrodesis*
*Arthrodesis is the fusion of vertebrae over a joint space that occurs
through a natural process or as a result of surgical procedure. In
surgery, arthrodesis, or fusion between two vertebrae, can be
achieved by placing bone graft and/or bone graft substitute to bridge
the vertebrae so that new bone grows into the spaces. (Mid-foot, Flat
foot deformity , joints, hip, knee, feet etc.)
87. Malignant Bone Tumors
Primary tumors, those tumors that originate in the
bone
Osteosarcoma
Ewing’s sarcoma (bones/ soft tissues)
Chondrosarcoma (cancer composed of cells derived from
transformed cells that produce cartilage)
Fibrosarcoma Fibrosarcoma (fibroblastic sarcoma) is a
malignant connective (soft) tissue tumor which originates
from fibroblasts. The tumor may present different degrees of
differentiation : low grade (differentiated), intermediate
malignancy and high malignancy (anaplastic).
Metastatic bone disease
88. Osteosarcoma
Cancer of the bone – metastasis to the lung is
common. Most in long bones.
Clinical manifestations – dull pain, swelling,
intermittent but increases per time; night
pain common.
Treatment – radiation, chemotherapy,
hormonal therapy, surgical excision with
prosthetics, assistance devices, palliative
measures.
89. Treatment Cancer of Bone
Interventions include:
Treatment aimed at reducing the size or
removing the tumor
Drug therapy; chemotherapy
Radiation therapy
Surgical management
Promotion of physical mobility with ROM
exercises
90. Cancer of Bone
Anticipatory Grieving
Interventions include:
Active listening
Encouraging client and family to verbalize feelings
Making appropriate referrals
Helping client and others to cope with the loss and
grieving
Promoting the physician-client relationship
91. Cancer of Bone
Disturbed Body Image
Interventions include:
Recognize and accept the client’s view of body
image alteration.
Establish and maintain a trusting nurse-client
relationship.
Emphasize the client’s strengths and remaining
capabilities.
Establish realistic mutual goals.
92. Potential for Fractures
Bone Cancer
Interventions
Nonsurgical management: radiation therapy and
strengthening exercises.
Surgical management: replace as much of the
defective bone as possible, avoid a second
procedure, and return client to a functioning state
with a minimum of hospitalization and
immobilization.
93. Carpal Tunnel Syndrome
Common condition; the median nerve in the wrist
becomes compressed, causing pain and
numbness
Common repetitive strain injury via occupational
or sports motions
Nonsurgical management: drug therapy and
immobilization
Possible surgical management
94. Scoliosis
Abnormal spinal curvature of various degrees
or severity involving shortening of muscles
and ligaments.
Milwaukee brace (a back brace used in the
treatment of spinal curvatures) , internal fixative
devices.
95. Scoliosis
Changes in muscles and ligaments on the
concave side of the spinal column
Congenital, neuromuscular, or idiopathic in
type
Assessment: complete history, pain
assessment, observation of posture
Interventions: exercise, weight reduction,
bracing, casting, surgery
96.
97. Treatment for lumbar lordosis is dependent on the severity
of the spine abnormality as well as the occurrence of
additional symptoms. Treatment is aimed at halting the
progression of abnormal curvature and preventing the
onset of further deformity.
98. Some of the treatment options for lumbar lordosis are as
under:
•Physical therapy is beneficial for many patients. Physical therapy along with
some types of postural exercises may be needed to correct the abnormalities
associated with the spine curvature. Physical therapy also helps in
strengthening the main muscles.
•If lumbar lordosis arises due to poor or improper posture, then simple
exercises are all that are needed.
•Patients who suffer from pain may be given anti-inflammatory drugs for
alleviation of pain and reduction of swelling and inflammation.
•Obese people are recommended to lose weight
•Yoga and meditation can help enhance the strength, awareness about the
body, the range of motion,and flexibility.
•Teens and young children may need to wear braces to correct the spine
curvature anomaly.
•Severe instances of lumbar lordosis may need different types of surgical
procedures such as artificial disc replacement, spinal instrumentation, or
kyphoplasty to rectify the condition.
99. A majority of patients do not suffer from any major
health complications even if lumbar lordosis is left
untreated.
However, as the spine plays a vital role in much of human
flexibility and movements, it is essential to manage the
health of the spine.
Untreated cases can also increase the susceptibility
to developing additional problems of the spine, legs, hip
girdle, and internal glands.
