Med-Surg Final Exam m m
Musculoskeletal (New Material)
m m m
➢ Bones
• Bonesmsupport, m protectmi nternalm organs, m voluntarym movement, m bloodm cellm productionm&m mineralm storage. m The
ymprovidem supporting mframework mthatmkeepsmthem bodym from m collapsi ng m&m alsomallowsmthem bodymtom bearm weigh
t.
➢ Epiphyseal Plate m
• Alsom calledm growthm zone, m itm ismthem cartilaginousm aream betweenm them epiphysism&m m etaphysis, m itm acti velym producesm
bonemtomallowmlongitudi nalmgrowthminm children. mInjurymtomthemgrowthm plateminm childrenm canm leadmtomamshortermextre
mitymthatmcanm causemsignifi cant m functionalm problems. m Inmadultsmthem epiphysi sm&mm etaphysi sm becom em joinedmasmthem
platemhardensm tom maturem bone.
➢ Joints
• Articulationmism am placem wherem them endsm ofmtwom bonesmaremi nm proximitym &mm ovemi nmrelati onm tom eachm other, m jointsm
aremclassifi edm bymthem degreem ofmmovementmthatmtheymallow.
➢ Cartilage
• Hyalinem Cartilage: m themmostm common, m contai nsm ammoderatemamountm ofm collagenm fi bers, mfoundmi nmthemtrachea
, mbronchi, mnose, m epiphysealm plate. m& marticularmsurfaces.
• Fibrousm Cartilage: m consistsm mostlym ofm collagenm fi bersm &m ism am tough m tissuem thatm oftenm functionsm as m am shock
absorber, mitm canm bem found m betweenm them vertebralm discsm&m alsom formsmam protectivem cushionm betweenmthem bones mofm t
hempelvi cmgirdle. m Knee, m&m shoulder.
• Elasticm Cartilage: m containsm bothm collagen m& m elastic m fibers, mis mmorem flexi ble mthanm hyali nem cartilage, mitmi sm found min
ear, m epiglottis, m &m larynx.
➢ Muscle
• Cardiacm Muscles: m foundm i nm them heart, m itsm spontaneousm contractionsm propelm bloodm throughm them circulatorym system.
• Smoothm Muscles: m occursmi nmthem wallsm ofm hollowmstructuresmsuchmasm airways, m arteries, mGImtract, muri narym bladder, m
&muterus. mSmoothmmusclem contractionmism modulatedm bym neuralm&m hormonalmi nfluences.
• Skeletalm Muscles: m requiresm neuronal m stimulationm form contraction, m accountsm form halfm ofm am hum anm begi nsm weight.
➢ Contractions
• Isometricm Contractions: m increasesm tensionm withinm am musclem butm doesm notm producem m ovement, m repeat
edmisometricm contractionsmmakemthemmusclesmgrowmlargerm &mstronger.
• Isotonicm Contractions: m shortenm am musclem tom produce m movement, m mostm contractionsm arem am com binationm of
isometricm&misotoni c.
, ➢ Ligaments
• Connectm bonesmtom bones, m havema mhigherm elasti cm contentmthanm tendons, m theym provi dem stabilitym whilem permitti
ng mcontrolledm movementm atm them joint.
• Ligamentsm&mtendonsm have ma mrelati vely m poorm bloodm supply, m usually mmaking mtissuemrepairm slowm processm afterminjury.
➢ Tendons
• Attachmtommusclesmtom bonem asm an mextensionm ofmthemmusclesmsheathmthatmadheresmtomthem periosteum. mBothmtendonsm
&mligamentsmarem composedm ofm dense, m fibrous, mconnectivem tissuemthatm contains m bundlesm ofm closelym packedm collagenm
fibersmarrangedmi nmthem samem planem form additionalm strength.
➢ Fascia
• Refersmtom layersmof m connectivem tissuem withmintermeshedm fi bersm thatm canm withstandm limitedmstretchi ng. m Canm bem eith
ermsuperficialm orm deep.
➢ Bursae
• Smallmsacsmofmconnectivem tissuem linedm withm synovialmmembranesm &m containi ng m viscousm synovialm flui d. mTheymarem typic
allymlocatedmi nmthem bonym prominencesm orm jointsmtomrelievem pressurem &m decreasesm fri ctionm between mm ovi ng m parts.
➢ Older Adult Related Changes
m m m
• Muscles: m decreasedm numberm&m diameterm ofmmusclem cell, m lossm ofmelasticitymi nm ligam ents, mtendons, m&m cartilage
, mreducedmabi lity mtomstorem glycogen, m decreasedm abilitym tom releasemglycogenmasm quick masm energymism needed mduri
ng mstress, m&mdecreasedm basal mmetaboli cmrate.
• Joints: mincreasedmrisk m form carti lagem erosi onm thatm contri butesmtomdirectm contactm betweenm bonem&m endsm&m overgrowth
ofm bonem aroundm jointmmargins, m lossm ofm waterm from m discsm betweenm vertebrae, m decreasedm heightmofmi ntervertebr
almspaces.
• Bone: m decreasedm bonem densitym &m strength, m brittleness, m&m slowedmremolding m process.
Fractures mL ew is m1 5 1 1
Etiology DiagnosticmInd Factorsm Manifestations Nursing mInte MedicalmTrea
icators Effecting rventions tment
Healing
Amdisruptionm orm br -historym&mphysical - -edemam&mswelling - -
eak minmthemcontinu -X- sitemofmthemfra -painm&mtenderness neurovascularmas manipulation, mtracti
itymofmthemstructur raym(mostmcommon) cture -musclem spasm sessmentmthink m6 on, mclosedmormopenm
emofmthem bone. mAlt -CTmscan - -deformity mP’s reduction, mfixationm
houghmtraumati cmi -MRI bloodmsupplymtom t - -immobilization devices
njuriesmaccountm fo hemarea lossmofmfunctionm(inmth - -
rmthemmajoritym ofm f Ongoing mAss - emaffectedmarea) propermnutritionmi surgicalmdebri dem e
ractures, msomemar essment displacementmorm fix -crepitation smessential ntm&mirrigation
emsecondarym to mam Ongoing mmonitorin ationmdevices - - -
diseasemprocess. g m- -infections ecchymosis, mco teachmROMm ex prophylacticm anti
Vitalmsigns, mlevelm -poorm nutrition ntusionmTable ercise bioticmtherapym&m
ofmconsciousness, -age m63-4 - DTaPmshot
-hormones - assessmform com plica -
-smoking immediatemlocalize tionsmassociatedmwi musclemrelaxantsmi
, dmpainmwith thmimmobility ncluding mflexeril,
oxygenmsaturation, anminabilitymtombea - somam& mrobaxin
mneurovascular m stat rmweightmwithmguar perform mcastm
us, mandmpai n ding, mpatientmmaym care
- alsomhave mam bonem -
Compartmentmsynd deformitym oncemitm determinemproperm
rome, mcharacterize ismhealed bodymalignm ent
dmbymexcessivem pai -
n, mpallor, mparesthe dietmhighminmcalci u
sia, mparalysis, m and m m, mphosphorous, m&
pulselessness mmagnesium
- -
MonitormformFAT elevatemextremitym
mEMBOLISM. abovemheartmlevelm
formthemfirstm24hrs
-
initiallymdom notm pla
cemextremitymi nmthe
mdependent mpositio
n
➢ Classification of Fractures
m m
• Openm orm Closed: minm openm the mski nmism brokenmexposing m bonem&m casing msoftm tissueminjury. m Closedm the mski nmhas mno
tm ruptured m&mremainsmintact.
• Complete m orm Incomplete: m completem them break m itm completelym throughm them bone, m incom pletem them fracturesm occur
partlymacross mam bonem shaftm butm them bonemi smstillminm onem piece.
• Displacedm orm Non- displaced: m displacedm fracturem the m twom endsm ofm them brokenm bone m arem separatedm from m one
anotherm&moutmofm theirm normalm positionsm(theymarem usuallym comminuted), m non-
displacedm fracturem them peri osteum mismintact macrossmthem fracturem &mthem bonemism sti llmi nmalignm entm(usuallymtransvers
e, mspiral, mormgreensti ck)
• Basedmonmthemdirectionmof mthemfracturemline:
• Pathologic: mamspontaneousmfracturematmthemsitemofmambonemdisease
, • Oblique: mthemli nemofm them fracturem extendsminm anmobli quem direction
• Transverse: mthem linem ofm them fracture m extendsm acrossmthem bone mshaftm atm amrightm anglem tomthem longitudinal maxis
• Stressm fracture: m occursm i nm normalm orm abnormalm bonem thatm ism subjectm tom repeatedm stressm suchm asm from m runni ng
• Greenstick: m i ncomplete m fracturem withm one msi demspli nteredm &mthem otherm side mbent
• Comminuted: m am fracturem withm morem thanm twom fragmentsm (smallerm fragm entsm appearm tom bem floating
• Spiral: mthemli nemofm them fracture mextendsminm amspiral m directionmalong mthem bonemshaft.
➢ Fracture Healing
m
• Hematoma: m when mfracture moccurs, m bleedi ng m createsm amhematoma, m whichm surroundsmthem endsm ofmthem fragm ents,
mthemhematoma mism extravastedm bloodm thatm changesm from m am liqui dmtomam semisolidm clot, mthism occursmi nmtheminitialm 7
2mhours.
• GranulationmTissue: mduring mthismstagemactivemphagocytosismabsorbsmthemproductsmofmlocalmnecrosis, mthe
hematomamconvertsmtomgranulationm tissue. m Granulationmtissuem producesmthem basism form newm bonemsubstancem calledm o
steoidmduri ng m daysm3-14m post-injury.
Musculoskeletal (New Material)
m m m
➢ Bones
• Bonesmsupport, m protectmi nternalm organs, m voluntarym movement, m bloodm cellm productionm&m mineralm storage. m The
ymprovidem supporting mframework mthatmkeepsmthem bodym from m collapsi ng m&m alsomallowsmthem bodymtom bearm weigh
t.
➢ Epiphyseal Plate m
• Alsom calledm growthm zone, m itm ismthem cartilaginousm aream betweenm them epiphysism&m m etaphysis, m itm acti velym producesm
bonemtomallowmlongitudi nalmgrowthminm children. mInjurymtomthemgrowthm plateminm childrenm canm leadmtomamshortermextre
mitymthatmcanm causemsignifi cant m functionalm problems. m Inmadultsmthem epiphysi sm&mm etaphysi sm becom em joinedmasmthem
platemhardensm tom maturem bone.
➢ Joints
• Articulationmism am placem wherem them endsm ofmtwom bonesmaremi nm proximitym &mm ovemi nmrelati onm tom eachm other, m jointsm
aremclassifi edm bymthem degreem ofmmovementmthatmtheymallow.
➢ Cartilage
• Hyalinem Cartilage: m themmostm common, m contai nsm ammoderatemamountm ofm collagenm fi bers, mfoundmi nmthemtrachea
, mbronchi, mnose, m epiphysealm plate. m& marticularmsurfaces.
• Fibrousm Cartilage: m consistsm mostlym ofm collagenm fi bersm &m ism am tough m tissuem thatm oftenm functionsm as m am shock
absorber, mitm canm bem found m betweenm them vertebralm discsm&m alsom formsmam protectivem cushionm betweenmthem bones mofm t
hempelvi cmgirdle. m Knee, m&m shoulder.
• Elasticm Cartilage: m containsm bothm collagen m& m elastic m fibers, mis mmorem flexi ble mthanm hyali nem cartilage, mitmi sm found min
ear, m epiglottis, m &m larynx.
➢ Muscle
• Cardiacm Muscles: m foundm i nm them heart, m itsm spontaneousm contractionsm propelm bloodm throughm them circulatorym system.
• Smoothm Muscles: m occursmi nmthem wallsm ofm hollowmstructuresmsuchmasm airways, m arteries, mGImtract, muri narym bladder, m
&muterus. mSmoothmmusclem contractionmism modulatedm bym neuralm&m hormonalmi nfluences.
• Skeletalm Muscles: m requiresm neuronal m stimulationm form contraction, m accountsm form halfm ofm am hum anm begi nsm weight.
➢ Contractions
• Isometricm Contractions: m increasesm tensionm withinm am musclem butm doesm notm producem m ovement, m repeat
edmisometricm contractionsmmakemthemmusclesmgrowmlargerm &mstronger.
• Isotonicm Contractions: m shortenm am musclem tom produce m movement, m mostm contractionsm arem am com binationm of
isometricm&misotoni c.
, ➢ Ligaments
• Connectm bonesmtom bones, m havema mhigherm elasti cm contentmthanm tendons, m theym provi dem stabilitym whilem permitti
ng mcontrolledm movementm atm them joint.
• Ligamentsm&mtendonsm have ma mrelati vely m poorm bloodm supply, m usually mmaking mtissuemrepairm slowm processm afterminjury.
➢ Tendons
• Attachmtommusclesmtom bonem asm an mextensionm ofmthemmusclesmsheathmthatmadheresmtomthem periosteum. mBothmtendonsm
&mligamentsmarem composedm ofm dense, m fibrous, mconnectivem tissuemthatm contains m bundlesm ofm closelym packedm collagenm
fibersmarrangedmi nmthem samem planem form additionalm strength.
➢ Fascia
• Refersmtom layersmof m connectivem tissuem withmintermeshedm fi bersm thatm canm withstandm limitedmstretchi ng. m Canm bem eith
ermsuperficialm orm deep.
➢ Bursae
• Smallmsacsmofmconnectivem tissuem linedm withm synovialmmembranesm &m containi ng m viscousm synovialm flui d. mTheymarem typic
allymlocatedmi nmthem bonym prominencesm orm jointsmtomrelievem pressurem &m decreasesm fri ctionm between mm ovi ng m parts.
➢ Older Adult Related Changes
m m m
• Muscles: m decreasedm numberm&m diameterm ofmmusclem cell, m lossm ofmelasticitymi nm ligam ents, mtendons, m&m cartilage
, mreducedmabi lity mtomstorem glycogen, m decreasedm abilitym tom releasemglycogenmasm quick masm energymism needed mduri
ng mstress, m&mdecreasedm basal mmetaboli cmrate.
• Joints: mincreasedmrisk m form carti lagem erosi onm thatm contri butesmtomdirectm contactm betweenm bonem&m endsm&m overgrowth
ofm bonem aroundm jointmmargins, m lossm ofm waterm from m discsm betweenm vertebrae, m decreasedm heightmofmi ntervertebr
almspaces.
• Bone: m decreasedm bonem densitym &m strength, m brittleness, m&m slowedmremolding m process.
Fractures mL ew is m1 5 1 1
Etiology DiagnosticmInd Factorsm Manifestations Nursing mInte MedicalmTrea
icators Effecting rventions tment
Healing
Amdisruptionm orm br -historym&mphysical - -edemam&mswelling - -
eak minmthemcontinu -X- sitemofmthemfra -painm&mtenderness neurovascularmas manipulation, mtracti
itymofmthemstructur raym(mostmcommon) cture -musclem spasm sessmentmthink m6 on, mclosedmormopenm
emofmthem bone. mAlt -CTmscan - -deformity mP’s reduction, mfixationm
houghmtraumati cmi -MRI bloodmsupplymtom t - -immobilization devices
njuriesmaccountm fo hemarea lossmofmfunctionm(inmth - -
rmthemmajoritym ofm f Ongoing mAss - emaffectedmarea) propermnutritionmi surgicalmdebri dem e
ractures, msomemar essment displacementmorm fix -crepitation smessential ntm&mirrigation
emsecondarym to mam Ongoing mmonitorin ationmdevices - - -
diseasemprocess. g m- -infections ecchymosis, mco teachmROMm ex prophylacticm anti
Vitalmsigns, mlevelm -poorm nutrition ntusionmTable ercise bioticmtherapym&m
ofmconsciousness, -age m63-4 - DTaPmshot
-hormones - assessmform com plica -
-smoking immediatemlocalize tionsmassociatedmwi musclemrelaxantsmi
, dmpainmwith thmimmobility ncluding mflexeril,
oxygenmsaturation, anminabilitymtombea - somam& mrobaxin
mneurovascular m stat rmweightmwithmguar perform mcastm
us, mandmpai n ding, mpatientmmaym care
- alsomhave mam bonem -
Compartmentmsynd deformitym oncemitm determinemproperm
rome, mcharacterize ismhealed bodymalignm ent
dmbymexcessivem pai -
n, mpallor, mparesthe dietmhighminmcalci u
sia, mparalysis, m and m m, mphosphorous, m&
pulselessness mmagnesium
- -
MonitormformFAT elevatemextremitym
mEMBOLISM. abovemheartmlevelm
formthemfirstm24hrs
-
initiallymdom notm pla
cemextremitymi nmthe
mdependent mpositio
n
➢ Classification of Fractures
m m
• Openm orm Closed: minm openm the mski nmism brokenmexposing m bonem&m casing msoftm tissueminjury. m Closedm the mski nmhas mno
tm ruptured m&mremainsmintact.
• Complete m orm Incomplete: m completem them break m itm completelym throughm them bone, m incom pletem them fracturesm occur
partlymacross mam bonem shaftm butm them bonemi smstillminm onem piece.
• Displacedm orm Non- displaced: m displacedm fracturem the m twom endsm ofm them brokenm bone m arem separatedm from m one
anotherm&moutmofm theirm normalm positionsm(theymarem usuallym comminuted), m non-
displacedm fracturem them peri osteum mismintact macrossmthem fracturem &mthem bonemism sti llmi nmalignm entm(usuallymtransvers
e, mspiral, mormgreensti ck)
• Basedmonmthemdirectionmof mthemfracturemline:
• Pathologic: mamspontaneousmfracturematmthemsitemofmambonemdisease
, • Oblique: mthemli nemofm them fracturem extendsminm anmobli quem direction
• Transverse: mthem linem ofm them fracture m extendsm acrossmthem bone mshaftm atm amrightm anglem tomthem longitudinal maxis
• Stressm fracture: m occursm i nm normalm orm abnormalm bonem thatm ism subjectm tom repeatedm stressm suchm asm from m runni ng
• Greenstick: m i ncomplete m fracturem withm one msi demspli nteredm &mthem otherm side mbent
• Comminuted: m am fracturem withm morem thanm twom fragmentsm (smallerm fragm entsm appearm tom bem floating
• Spiral: mthemli nemofm them fracture mextendsminm amspiral m directionmalong mthem bonemshaft.
➢ Fracture Healing
m
• Hematoma: m when mfracture moccurs, m bleedi ng m createsm amhematoma, m whichm surroundsmthem endsm ofmthem fragm ents,
mthemhematoma mism extravastedm bloodm thatm changesm from m am liqui dmtomam semisolidm clot, mthism occursmi nmtheminitialm 7
2mhours.
• GranulationmTissue: mduring mthismstagemactivemphagocytosismabsorbsmthemproductsmofmlocalmnecrosis, mthe
hematomamconvertsmtomgranulationm tissue. m Granulationmtissuem producesmthem basism form newm bonemsubstancem calledm o
steoidmduri ng m daysm3-14m post-injury.
