med surge

consist of bones, muscle, joints, tendons, ligaments, cartilage, bursae

• bones-206 in body
• short bones- fingers, toes
• long bones- femur, ulna
• flats bones- sternum, rib
• Irregular bones- vertabrea

• 2 types of bony tissue
• cancellus bone/spongy bone- light & has many spaces, found @ the rounded, irregular ends, epiphyses of long bones
• cortical bone- compact bone- dense & hard, cortical boney tissue found mainly in long shaft or diaphyses bones in arms & legs
• both give strenght & support, yet keeps skeleton light
• bones compoed of cells, protein matrix, & mineral disposits

• osteoblast- cells that bulid bones, secrete bone matrix (collagen)
• osteocytes-change osteoblast 2 mature bone, by process of ossification & calcification, also involved in maintaining bone tissue
• oseoclast- cells involved in destrution, resorption, remodeling of bone
• part of mononucleat phagocyte system(blood cells that recycle old bone)

periosteum- layer of tissue, covers bone not joints, inner layer has osteoblast 4 bone formation, itz rich in blood & lymph vessels & supplies bone nourishments

• types of bone marrow
• red bone marrow- primarily in sternum, ilieum, vertabrae, & ribs, produces blood cells & hemoglobin
• yellow bone marrow- found in long bones, consist of fat cells & CT, if blood supply becomes compromised ittake characteristics of red bone marrow & begin producing blood cells when needed

• skeletal muscles
• voluntary, brain & spinal cord control their function
• promotes movements
• composed of muscle cell or fibers that have many myofibrils (made of sliding filaments called sarcomeres)
• actin & myosin promotes sliding of sarcomeres leading to contraction of muscle

• smooth & cardiac muslces
• involuntary, controlled by mechanism in their tissue & by neurotransmitters released from ANS
• found in walls of certain organs & cavities of body like stomach, intestne, blood vessels, & ureters, cadiac in heart

• junction between 2/more bones
• most are free-moving joints or diarthrodial joints (covered by hyaline cartilage which reduces friction during movement
• space between joint cavity which enclosed by a fibrous capsule lined w/ synovial memebrane which produces synovial fluid that lubs joint

• cordlike structures that attached muscles to periosteum of bone
• muscles have 2/more attachments
• *origin- more fixed
• *insertion- more movable
• when muscle contracts both attachments pulled & insertions moved closer to origin

• consist of fibrous tissue 2 adjacent freely movable bones
• helps protect joint by stabilizing their surfaces & keeping them alignment
• some completely enclose joint

• firm, dense type of CT that consist of cells embedded in a substance called a matrix which is firm & compact
• function is 2 redue friction between articlar surface, absorb shock, & reduce stress on joint
• hyaline or articular covers movable joint- elbow
• costal cartilage- connects ribs & sternum
• semilunar cartilage- knee
• fibrous cartilage- between vertabrea
• elastic cartilage- laynx, epiglottis, & outer ear

• sm. sac filled w/ synovial fluid
• reduces friction between areas like tendon & bone, & tendon & ligament
• inflammation to this area called brusitis

• chronic disorder: medical, drug, allergy; familial & occupational HX
• recent injury: when/ how trauma
• list of symptoms: onset, duration, location of discomfort/pain
• whether activity makes it better/worse
• identify other symptoms like leg cramping or skin lesions, & ask if it interferes w/ ADL
• if open wound find out when last tetnus shot was
• hx past disorders & medical/surgical tx ASAP
• attention to chronic/concurrent disorders like DM

• ability 2 ambulate, sit, stand, perform activities req. fine motor skills
• inspection symmetry,size, conour extremities & random movements
• palpates mucsle & joint 4 swelling, degree of firmness, warm areas, involuntary movements
• apply force 2 extremity as pt pushes aginst force
• neurovascular assessment: ROM (dont force), observe degree of movement & ROM
• note abnormal movements like spasm or tremors
• inspect/palpate 4 pain, tenderness, swelling, & redness
• check 4 muscle wasting

• look 4 abnormal size/alignment & symmetry comparing sides
• spinal inspection:
• *Kyphosis- exaggerated convex curvature of thoracic spine (hunchback)
• *Lordosis- excessive concave curvature of lumber spine (swayback)
• *Scoliosis- lateral curvature of spine

depending on finding also look 4 changes in gait & body posture, favoring certain side, ability 2 bend & twist trunk, head & extremities

by 35y/o may expirience loss of bone mass, HT, changes in structures of spine, joints

• v/s
• cut clothes if injury if needed
• compare structures
• b gental, b/c assessment can cause pain

• exam includes:
• check swelling, external bleeding, brusing
• palpate peripheral pulses
• check peripheral circulation, pulse, skin color, temp., capillary refill
• check senstation on injury area
• look broken skin, open wound, debris in/around wound, protusion of bone or other tissue
• examin area around injury
• look malalignment of injured limb
• assess 4 pain noting type & location

Dr. need to check pt before nurse

• imaging procedures:
• x-ray, CT scan, MRI, 4 fractures/dislocations, malignant bone lesions, joint diformities, calcifications, degenerative changes, osteoporosis, joint diseases

• arthrogram- usually knee/shoulder, 1st anesthetic, & inserts needle 2 joint space, fluoroscopy 2 check placement of needle, synovial fluid is aspirated & sent to lab, then contrast injected & x-ray taken
• nurse should tell pt that a cracking/clicking sound heard 4 about 2 days

• internal inspection
• seeing knee joint, give anesthetic, dr. insert lrg needle in joint & inject steril saline 2 distend joint
• checking 4 injury/deterioration
• fluid taken & sent to lab
• depending on finding DR may use arthroscope to remove bits of torn/floating cartilage
• after pt leg elavated w/o flexing knee
• appy cold pack over dressing @ site of arthroscope inserted
• RX analgesic given

• aspiration of synovial fluid, 4 discomfort or to inject meds (corticosteriod)
• give anesthetic before procedure
• fluid may b sent to lab
• may b performed during athrogram or arthroscopy

• fluid aspirated & examined traumatic arthritis, septic arthritis(caused by microorganism), gout, rhuematic fever, & systemic lupus, erythematosus
• normal fluid clear
• test includes exam of blood cells, crystals, & formed debri that may b present in joint space after injury
• if infection suspected C&S ordered
• chemical analysis 4 protein, glucose may b preformed

• uses IV injection of radioneuclide to detect uptake of radioactive sustances by bone
• 2 detect metastatic bone lesions, fractures & certain inflammatory disorders
• radioneuclide taken up in areas of increased metabolism which occurs in bone cancer, metastatic bone disease, & osteomyelitis (bone infection)

• radiography of wrist, hip, spine, helps determines bone mineral density (BMD)
• bone density scaning & dual-energy x-ray absorptiometry (DXA/DEXA) 2 measure BMD
• mostly on lower spine, hips
• portable DEX device use x-ray or ultrasoud 2 measure quantity & quality of wrist, finger, or heel

• test electrical potential of muscles & nerves leading to muscle
• 2 evaluates muscle weakness/deterioration, pain, disability, & 2 differantiate muscle & nerve problems
• Dr. inserts needle electrodes to selected muscle & stimlates muscle
• oscilloscope records responses to stimuli
• if pt get pain after study, apply warm compresses

• 2 identify composition of bone , muscle, or synovim
• removed w/ needle or excised surgically while pt under anesthetic
• after nurse checks 4 signs bleeding or swelling, pain, apply ice

CBC- detect infection, inflammation, anemia

• ex. dx test & findings of muscleskeletal disorders:
• elevated alkaline phosphatase levels, which may indicate bone tumors & healing fractures
• elevated acid phosphatase levels, indicates pagets disease(bone distruction & disorganized repair) & metastatic cancer
• decreased serum calcium level, indicates oseomalacia, oseoporosis, bone tumors
• increased serum phosphorus level, indicate bone tumor & healing fractures
• elevated serum uric acid level, indicate gout(treated/untreated)
• elevated antineuclear antibody level, indicate systemic lupus erythematosus, a CT disorder

• when ordered 24hr sample to check uric acid & calcium excretion
• when gout uric acid high
• calcium high inmetastati bone lesion & when pt w/ prolonged immobility