----CHAPTER 26----

Group 3

BONES
Provide structure
Give protection

Serves as levers
Store calcium

Produce blood cells

2 TYPES OF BONES:
COMPACT BONE: SPONGY BONE:

HARD

CONTAINS NUMEROUS SPACES MAKES UP ENDS

DENSE
MAKES UP THE

SHAFT & OUTER

LAYER

AND CENTER OF
BONES

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.

--OSTEOBLASTS--

--OSTEOCLASTS--

--RED MARROW--

--YELLOW MARROW--

--PERIOSTEUM--

VARIATION OF BONES :
SHORT BONES
e.g., carpals LONG BONES

e.g., humerus, femur

FLAT BONES e.g., sternum, ribs

IRREGULAR SHAPE BONES

e.g., hips, vertebrae

SHORT BONE

LONG BONES

FLAT BONE

IRREGULAR SHAPE BONE

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 with posture , produce body heat & allow body to

move.

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 and are 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

HISTORY OF PRESENT HEALTH CONCERN

QUESTION
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 long

RATIONALE
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 pain associated w/ many joint problems but decreases pain associated w/ rheumatoid arthritis

does it last ? any stiffness, swelling,

limitation of movement?

FAMILY HISTORY
QUESTION
Do you have a family history of rheumatoid arthritis, gout or osteoporosis?

RATIONALE
These condition tend to be familial & can increase the clients risk of development of these diseases.

RHEUMATOID ARTHRITIS

OSTEOPOROSIS

LIFESTYLE & HEALTH PRACTICES

QUESTION
What activities you engage in to promote the health of your muscles & bones ( e.g., exercise, diet, weight reduction )

RATIONALE
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 & HEALTH PRACTICES

QUESTION What medication are you taking? RATIONALE
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.

Do you smoke tobacco? How much & how often?

LIFESTYLE & HEALTH PRACTICES

QUESTION
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.

RATION ALE
Excessive consumption of alcohol or caffeine can increase the risk of osteoporosis. 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 of

osteoporosis. A diet high in

purine(e.g. liver, sardines).

LIFESTYLE & HEALTH PRACTICES

Question
Describe your activities during a typical day. How much time do you spend in the sunlight. Describe any routine exercise that you do.

Rationale
A sedentary lifestyle increases the risk of osteoporosis. Prolonged immobility leads to muscle atrophy. 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 total bone mass and degeneration of skeletal muscle fibres) that occur with aging.

--OSTEOMALACIA--

LIFESTYLE & HEALTH PRACTICES

QUESTION
RATIONALE
Certain job-related activities increase the risk for development of

Describe your occupation?

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.

- - C A R PA L T U N N E L S Y N D RO M E -

QUESTION
Describe your posture at work & at leisure. What type of shoes do you usually wear? Do you use any special footwear (i.e., orthotics)?

RATIONALE
Poor posture prolonged forward bending ( as in sitting) or backward leaning (as in working 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.

--ACHILLES TENDON--

QUESTION
Do you have difficulty performing normal activities of daily living (bathing, dressing,

RATIONALE
Impairment of the musculoskeletal system may impair the clients ability to perform normal activities of daily

grooming, eating)? Do you use

assistive devices (e.g., walker, cane braces) to promote your mobility?

living. Correct use of assistive

devices can promote safety & independence. Some clients may feel embarrassed & & not use their prescribed or needed assistive device.

QUESTION--RATIONALE
How have your musculoskeletal problems interfered w/ your ability to Have they interfered w/ your usual sexual activity? Musculoskeletal problems, especially chronic ones, can disable & cripple the client, prevent the client from performing the same roles as

interact or socialize w/ others? w/c may impair socialization &

in the past.

PHYSICAL ASSESSMENT ( GFindings AIT) Assessment Procedure Normal Abnormal Findings

Inspection: Observe gait: Observe the clients gait as the client enters and walks around the room. Note -Base of support Evenly distributed weight. Client able to stand on heels and toes. Toes point straight ahead. Equal on both sides. Posture erect, movements coordinated and rhythmic, arm swing in opposition, stride length appropriate . Uneven weight bearing is evident. Client cannot stand on heels or toes. Toes point in or out. Client limps, shuffles, propels forward, or has wide-based gait.

-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 or handicapped client by performing the nudge test. Stand behind the client and put your arms around the client while you gently nudge the sternum.

Client does not fall backward.

Falling backward easily is seen with cervical spondylosis and Parkinsons disease.

PHYSICAL ASSESSMENT
( T E M P O RO M A N D I BU L A R J O I N T )
Assessment Procedure
Inspection and Palpation Inspect and palpate the TMJ. Have the client sit; put your index and middle fingers just anterior to the external to the external ear openings. Ask to: - Open the mouth as widely as possible.( The tips of your fingers should drop into the joint spaces as the mouth open.) - Move the jaw from side to side. - Protrude(push out) and retract(pull in ) jaw.

Normal Findings
Jaw moves laterally 1 to 2 cm. snapping and clicking may be felt and heard in the normal client. Mouth opens 1 to 2 inches( distance between upper and lower teeth). Jaw protrudes and retracts easily. The clients mouth opens and closes smoothly.

Abnormal Findings
Decreased ROM, swelling, tenderness, or crepitus may be seen in arthritis. Decreased muscle strength with muscle and joint disease, ROM, and a clicking, popping, or grating sound may be noted with TMJ dysfunction.

PHYSICAL ASSESSMENT
( C E RV I C A L T H O R AC I C , A N D L U M B A R SPINE)
Assessment Procedure
Inspection and Palpation Observe the Cervical, Thoracic, Lumbar curves from the side the from behind. Have the client standing erect with the gown positioned to allow an adequate view of the spine. Observe for symmetry, noting differences in height of the shoulders, the iliac crests and the buttocks creases

Normal Findings
Cervical and Lumbar spine are concave; Thoracic spine is convex. Spine is straight ( when observed from behind). An exaggerated thoracic curve (kyphosis) is common with aging. Some finding that appear to be abnormalities are, in fact variations related to cultures or sex. For example, some african americans have a large gluteal prominenece, making the spine appear to have lumbar lordosis.

Abnormal Findings
a flattened lumbar curvature may be seen w/ a herniated lumbar disc or ankylosing spondylitis. Lateral curvature of the thoracic spine w/ an increase in the convexity on the curve side is seen in scoiliosis an exaggerated lumbar curve (lordosis) is often seen in pregnancy or obesity. Unequal heights of the hips suggests unequal leg lengths.

ABNORMALITIES OF THE 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.

I. ACUTE GOUTY ARTHRITIS

In gouty arthritis, metatarsophalangeal joint of the great toe is tender,

painful, reddened,
hot, and swollen.

II. CALLUS
Calluses are non painful, thickened skin that occur at pressure points.

III. CORN
Corn are painful thickenings of the skin that occur over bony prominences and at pressure points.

IV. PLANTAR WARTS

Plantar warts are painful warts ( veruca vulgaris) that often occur under callus, appearing as a tiny dark spots

V. FLAT FEET
A flat foot (pes planus) has no arch and may cause pain and swelling of the foot surface.

VI. HALLUX VALGUS

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.

VII. HAMMER TOE

Hyperextension at the metarsophalangeal joint with flexion at the proximal interphalangeal joint (hammer toe)

commonly occurs with the

second toe.

--THE END- SEMBRANO NALES CUEVA CAMACHO DELOS REYES