Week 9 Learning Outcomes

PNUR 124


Week 9 Learning Outcomes: Immobility

1. Describe frailty and fatigue as complications of immobility.
Musculoskeletal System Overview
 Bones
o The human skeleton has 206 bones
o Functions include:
 Structure and support for soft
tissue
 Protect vital organs
 Joints
o Area where two or more bones meet
o Key function is to hold skeleton together
while allowing body to move
o Types of Joints
 Synarthrosis : immoveable (e.g.
skull)
 Amphiarthrosis: slightly movable
(e.g. vertebral joints)
 Diarthrosis or synovial: freely moveable (e.g. hips, shoulders)
o Surface of joints is covered with cartilage
o Synovial joints are found at all limb articulations
o Joint cavity is covered with tough fibrous capsule
o Cavity lined with synovial membrane and filled with synovial fluid
 Ligaments
o Bands of connective tissue that connect bone to bone
o Function:
 Either limit or enhance movement
 Provide joint stability
 Enhance joint strength
o Tendons: Fibrous connective tissue bands that connect bone to muscles
 Function: enable bones to mover when muscles contract.
o Ligaments are bands of connective tissue that connect bone to bone, and
either limit or enhance movement. They also provide joint stability and
enhance joint strength.
 Muscles: Skeletal muscle (voluntary muscles)
o Structure: 600 skeletal muscles
o Made up of thick bundles of parallel fibers
o Each muscle fiber made up of smaller myofibrils
o Skeletal muscles contracts with the release of acetylcholine
o The more fibers that contract, the stronger the muscle contraction
o Smooth Muscles Involuntary muscle movement (involuntary) controlled
by internal mechanism (e.g. GI system, bladder wall)

, PNUR 124



Musculoskeletal Changes in Older Adults
 Changes are related to:
o The aging process
o Decreased activity.
o Lifestyle factors
 Pathophysiological Changes
o Loss of bone mass in older women
o Joint and disk cartilage dehydrates causing loss of flexibility contributing to
degenerative joint disease (OA)
o Joints tend to stiffen, lose range of motion ability
o Stooped posture, changing center of gravity
o Elderly are at greater risk of falls
o Endocrine changes also result in skeletal muscle atrophy
o Decreased muscle tone, loss of height

2. Identify valid assessment tools to measure and analyze a person's ability to perform
activities of daily living and/or level of frailty. Nursing Process: MSK Assessment.
 Subjective Data:
o Health history
o Chief Complaint
o Onset
o Effect on ADLs
o Precipitating events (trauma etc.)
o Full pain assessment
o Assess for any systemic effects (fatigue, weight changes, rash or swelling)
 Objective Data: Physical Exam
o Posture
o Gait (slow, shuffled)
o Independent mobility or use of assistive devices
o Ability to feed, toilet and dress self.
o Muscle mass and symmetry
o Check muscle strength (ROM against resistance)
o Inspect and palpate joints for any visible deformities, pain, swelling, or
warmth.
 Fatigue is described as, “feeling tired” or “having
less energy than normal” and it affects a person’s
physical, emotional, and mental energies.”
o Some signs of fatigue are:
 Spends more time in bed.
 Unable to completed ADLs.

 Distressed