skeletal

• Skeletal System

  • Supports muscle
  • Protects organs
  • Part of immune system
  • Stores minerals (calcium)
  • Aids in erythropoiesis
• Consists 206 bones for adults
• Babies are born with around 270-300 bones at birth: some bones are unfused
• Erythropoiesis

  New RBC formation which is responsible for carrying O2 around the body
• Types of Anemia

  • Renal Anemia
  • Aplastic Anemia
  • Nutritional Anemia
  • Morphologic anemia
• Renal Anemia

  Treated with synthetic REF (epogen alfa with iron)
• Nutritional Anemia

  • Iron - microcytic anemia
  • Folic acid - megaloblastic anemia
  • B12 - pernicious anemia
• If patient will drink iron (fluid): offer straw because it stains teeth, and iron can be taken with vitamin C for better absorption
• Ligaments

  • Connect bone to bone
  • Encircle joints to add strength
• Tendons

  Connect bone to muscle
• Sprain

  Damage to ligaments
• Strain

  Damage to tendons
• Parts of a Joint

  • Fibrous Capsule
  • Synovial membrane
  • Synovial Fluid
  • Cartilage
  • Ligaments
• Fibrous Capsule

  Seals synovial membrane
• Synovial membrane


  Produces synovial fluid
• Synovial Fluid

  Lubricates to avoid friction
• Cartilage

  Shock absorption
• Types of Osteoporosis

  • Primary
  • Post-Menopausal
  • Secondary
• Causes of Secondary Osteoporosis

  • Lack nutrition - calcium, Vit D
  • Chronic pancreatitis
  • Endocrine problems
  • Hypothyroidism
  • Hyperparathyroidism
  • Cushing's Disease - GSM steroids
  • Stress
  • Steroid therapy
  • Immobility
• Osteoporosis Symptoms

  • Early stages: Asymptomatic
  • Pain: Middle - late
  • Early: upper back
  • Late: lower back
• Compression Fracture of Spine

  Weight loss
• Bone Density Test

  DEXA (Dual X-ray Absorptiometry) - scans or measure bone density
• Nursing Interventions for Osteoporosis

  • Teach body mechanics
  • Balanced diet with Vit D and calcium
  • Advice to sleep on a firm mattress
  • Teach how to wear back brace
  • Collaborate with physical therapists
• Medications for Osteoporosis

  • Analgesics
  • Antihyperglycemic drug
  • Hormonal agents
  • Vitamin D supplement
• Analgesics

  • Aspirin 300-500 mg
  • Type of NSAID - can cause gastric irritation - if melena occur notify physician
  • Given after meals
  • Anti platelet - WOF: bleeding
  • Ototoxic drug
• Antihyperglycemic drug

  • Didronel (etidronate) – helps to reduce calcium by releasing it through urination
  • Force fluid: 3000-5000 mL
• Hormonal agents

  • Calcitonin (thyrocalcitonin) - prevents PTH to go out from bones
  • Conjugated estrogen (premarin)
• Fracture

  Break in continuity of bone
• Possible Causes of Fractures

  • Major trauma (physical)
  • Fall: common in children and elderly
  • Vehicular accident: adult, teenager
  • Osteoporosis
  • Bone tumors
• Types of Fractures


  • Close
  • Open
  • Transverse
  • Spiral
  • Comminuted
  • Impacted
  • Oblique
• Neurovascular Finding

  Assessment for fractures
• Fracture Complications

  • Fat embolism
  • Stroke
• Fracture Management

  • Closed Reduction - manual
  • Open Reduction - uses rods, plates and screws
  • Cast application – depends on age
  • Splint - purely immobilization
  • Cast - immobilization with reduction
  • Traction - immobilization, reduction and alignment
  • Open fracture: surgery
  • Debridement – if failed to do, septicemia from osteomyelitis may occur
  • Repair
• Fracture Medications

  • Analgesics - Acetaminophen, Morphine, Codeine Sulfate
  • Prophylactic Antibiotic (before exposure) - Cefazolin (Ancef)
• Septicemia

  Increased WBC, decreased basophils and eosinophils, increased RBC
• Tetanus Prophylaxis

  • 1st dose - immediate immunity
  • 2nd dose - 3 years
  • 3rd dose - 5 years
  • 4th dose - 10 years
  • 5th dose - 20 years
  • 6th dose (booster) - lifetime
• Types of Arthritis

  • Rheumatoid
  • Osteo
  • Gout
• Rheumatoid Arthritis

  • Autoimmune disorder
  • Age: 10-40 years old
  • Gender: male
  • Hallmark: bony ankylosis
• Rheumatoid Arthritis Deformities

  • Ulnar drift
  • Boutonniere
  • Swan neck
• Rheumatoid Arthritis Diagnostics

  • X-ray
  • CBC - decreased RBC, decreased WBC, increased ESR
  • Anti-streptolysin (ASO) Titer — blood test