M5 L1

• Overview of the Skeletal System:

  • Supports soft tissue of the body
  • Protects underlying organs
  • Produces blood cells & stores minerals
  • Facilitates movement
• Periosteum:

  • Dense layer of fibrous tissue enclosing the bone
  • Rich in blood and lymph vessels & supplies nourishment
• Endosteum:

  • Thin membrane lining the marrow cavities of long bones and spaces in cancellous bones
• Hambone:

  • Cross-section of a typical bone
• Haversian Systems:

  • Repeating, circular units that compose the bone tissue
  • Each system has a central canal composed of blood vessels and nerves
• Bone Marrow:

  • A vascular tissue located in the medullary shaft cavity of long and flat bones
  • Red Marrow: found in cancellous bone containing immature red blood cells and manufactures cells and hemoglobin
  • Yellow Marrow: fills medullary cavities and is composed mostly of fat and myelocytes
• Regulating factors for bone formation and resorption:

  • Growth hormone
  • Thyroxine and Insulin
  • Glucocorticoids
  • Estrogens and androgens
• Types of Muscle Tissue:

  • Voluntary
  • Involuntary
  • Cardiac Muscles: involuntary and striated, contracts with sliding filaments
  • Skeletal Muscles: voluntary and striated, controlled by the nervous system during contraction
  • Smooth Muscles: involuntary and non-striated, controlled by the nervous system and hormones
• Tendons:

  • Bands of fibrous tissue connecting bone to muscle to allow bone movement
  • Results in a strain if overly stretched, located in the back, feet, and legs
• Ligaments:

  • Strong, dense bands of fibrous tissue connecting bone to bone
  • Results in a sprain
• Joints:

  • Two bones connected (articulations)
• Cartilage:

  • Dense, connective tissue consisting of fibers embedded in a strong gel-like substance
  • Serves as a cushion and shock absorber, reduces friction
• Bursae:

  • Sac containing fluid to prevent friction
  • Allows prominent joints to slide and glide easily
• Congenital Hip Dysplasia:

  • Disorder in children present at birth or shortly thereafter
  • During gestation, the infant's hip should develop with the head of the thigh bone sitting perfectly centered in its shallow socket (acetabulum)
  • Asymmetry, fat folds, and decreased movement on the affected side
  • More females are affected
  • Related to common practices like swaddling and using cradleboards that place infants' hips into extreme adduction
  • Higher in infants born by caesarian & breech position births
  • Greater chances in first-born compared to second or third child
• Manifestations of Congenital Hip Dysplasia:

  • Uneven folds of thigh
  • Stretch of skin between anus & genitals unusually wide
  • Lordosis (curved spine in lower back); restricted abduction
  • Reduced joint mobility & flexibility of the affected area
  • Limping and duck-walk
  • Low clunking sound heard when leg is gently rotated, sound of femur engaging in socket
  • Unilateral Dislocation:
  • Skin creases of buttocks don't match
  • One knee joint is higher than the other
• Diagnostic Tests for Congenital Hip Dysplasia:

  • Ortolani Test: distinct clicking sound with motion
  • Barlow Test: hip sliding out and back in the joint
  • X-Ray: detects abnormal findings of the hip joint & proper positioning for treatments of casting
• Treatment for Congenital Hip Dysplasia:

  • Objective: Replace head of the femur into the acetabulum and apply constant pressure to enlarge and deepen the socket
  • Pavlic Harness: worn continually for 12 weeks, hips are abducted in a frog-like position
  • Spica Cast: stabilizes femur fracture, made of fiberglass with a soft lining inside
  • Physiotherapy: builds up strength of the muscles
• Osteomyelitis:

  • Infection of the bone caused by microbial agents (S. aureus) leading to inflammation, necrosis & bone formation
  • Modes of contamination: extension of soft tissue infection, direct bone contamination, hematogenous spread
  • Predispositions: diabetes, weakened immune system, sickle cell disease, hemodialysis, IV drug users, elderly
• Manifestations of Osteomyelitis:

  • Sepsis (Blood infection)
  • Non-healing ulcer
  • Anemia
• Diagnostic Tests for Osteomyelitis:

  • Blood Tests: CBC, ESR, CRP
  • Blood Culture: detects bacteria
  • Needle Aspiration: checks for invading microorganism
  • Biopsy: tested for signs of an invading organism
  • Bone Scan: detects infection in the bone
  • MRI: checks extent of infection
• Treatment for Osteomyelitis:

  • Antibiotic Therapy: Rifampicin, Quinolones, Cotrimoxazole
  • Splinting or Cast Immobilization: immobilizes affected bone and nearby joints
  • Surgery: debridement of necrotic tissue, sequestrectomy, antibiotic-impregnated beads
• Nursing Care for Osteomyelitis:

  • Risk for Infection: hand washing, maintain dietary kcal and protein intake
  • Hyperthermia: maintain cool environment, light clothing, adequate fluid intake
  • Impaired Physical Mobility: maintain functional position, rest, elevate area, avoid weight-bearing activities
  • Pain: splint area, administer analgesics, distraction techniques
• Pott's Disease:

  • Musculoskeletal tuberculosis affecting the spine
  • Most common site of bone infection in TB: lower thoracic and upper lumbar vertebrae
• Manifestations of Pott's Disease:

  • Vomiting
  • Fever (worse at night)
  • Cough
  • Anorexia
  • Diaphoresis
  • Localized back pain & tenderness; cold abscess mass around infection
  • Para-Vertebral Swelling
  • Neurological signs (Paraplegia); disoriented
  • Thoracic kyphosis
  • Muscle spasms
• Diagnostic Tests for Pott's Disease:

  • Blood Tests: ESR, Blood Culture, Biopsy
  • Imaging: Spinal X-Ray, MRI, CT scans, nuclear bone scans
  • Mantoux Tuberculin Skin Test
• Management of Pott's Disease:

  • Anti-Infective Agents: Isoniazid, Rifampin, Ethambutol, Streptomycin, Pyrazinamide
  • Surgery: debridement, bone fusion with bone grafting, spinal immobilization with brace
  • Other Treatments: high caloric diet, drug compliance, adequate rest periods
• Scoliosis:

  • Abnormal curvature of the spine, "S" or "C" shape
  • Predispositions: family history, more common in girls, can develop in childhood or adulthood
• Types of Scoliosis:

  • Functional Scoliosis: compensatory mechanism, flexible curvature not associated with true structural deformity
  • Structural Scoliosis: permanent due to damaged vertebrae, not flexible
• Manifestations of Scoliosis:

  • Uneven shoulders
  • Prominent shoulder blade
  • Uneven waist
  • One hip higher than the other
• Management of Scoliosis:

  • Treatment depends on the type and severity of scoliosis
  • Functional Scoliosis can often be corrected with exercises and physical therapy
  • Structural Scoliosis may require bracing or surgery
• Scoliosis is a condition characterized by lateral flexion of the spine, common in women
• Manifestations of scoliosis include:

  • Uneven shoulders
  • One shoulder blade appearing more prominent
  • Uneven waist
  • One hip higher than the other
  • Ribs on one side sticking out farther
  • Back pain and difficulty breathing
• Diagnostic tests for scoliosis:

  • Physical examination of the spine, shoulders, hips, legs, and rib cage
  • X-rays to confirm diagnosis and determine curve angle
  • Periodic x-rays to monitor the curve
• Descriptions of scoliosis:

  • Shape: C- or S-shaped curve
  • Location: Upper back (thoracic), lower back (lumbar), or both (thoracolumbar)
  • Direction: Curve can bend left or right
  • Angle: Normal spine is at 0 degrees
• Types of scoliosis:

  • Mild: Less than 25 degrees curvature
  • Moderate: 30 to 50 degrees curvature
  • Severe: Cobb’s curvature with Kyphosis
• Treatment options for scoliosis:

  • Braces to prevent further progression
  • Underarm or Low-Profile Brace (TLSO)
  • Milwaukee Brace for upper spine curves
  • Surgery involving fusion and instrumentation
• Complications of scoliosis:

  • Lung and heart damage with severe curves
  • Chronic back pain and risk of arthritis
  • Body image issues from wearing a brace
  • Nerve damage and motor-sensory deficits
• Nursing care for scoliosis patients:

  • Assess for skin irritation
  • Use undergarments to reduce friction
  • Teach to avoid powders and lotions
  • Loosen brace during meals
• Herniated Nucleus Pulposus:

  • Prolapsed disc causing cervical or lumbar radiculopathy
  • Soft gelatinous central portion of an intervertebral disc forced through a weakened part
• Manifestations of herniated nucleus pulposus:

  • Low back pains
  • Tingling sensations
  • Numbness
  • Muscle weakness (lumbar)
  • Neck and arm pains (cervical)