Medical Surgical Nursing
Muscular-Skeletal System
I.
II.
Muscular – skeletal System
a. Highly ________________ system
b. What is the leading cause of disability in the US? ______________________
c. Function:
i. _______________________
ii. _______________________
iii. _______________________
1. Move
2. ______________________
3. Facilitates __________________ return
iv. _______________________
1. _______________________ cells
2. Minerals
a. ________________ & _________________
Skeletal System
a. How many bones are in the human body? ______________
b. Types of bones
i. ______________ bones
ii. ______________ bones
iii. ______________ bones
iv. ______________ bones
c. Bone structure:
i. __________________ bone: ____________________
ii. __________________ bone: Bone _________________________
__________ bone marrow
Location:
_____________ bone marrow
Location:
Contents:
Contents:
d. Bone cells
i. Osteo _______________________: Form _______________________
ii. Osteo_______________________: ____________________________
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III.
IV.
V.
iii. Osteo ______________________: Dissolving and _______________________
e. Bone Maintenance
i. Modeling: __________________hood
ii. Remodeling: ________________hood
Articulation:
a. AKA: ________________________
b. Where two or more _____________________ meet
c. Synovial joint
i. __________________ filed with synovial _____________________
d. Ligaments:
i. Connects _____________ to bones
ii. Function: Joint ________________________
e. Tendon:
i. Connects _______________ to bones
ii. Function: Joint _________________________
Muscular System
a. Types of Muscles
i. ______________________ muscles
1. _________________________ movement
ii. _____________________ muscles
1. _____________________ organs
2. ______________________
iii. ______________________ muscles
1. __________________ muscle
2. ________________________
b. Muscle structure: Thick ___________________ of parallel ___________________
c. Contraction
i. Each muscle cell is _______________________, can ____________________ &
_____________________ to stimuli
ii. Skeletal muscle cells contract (shorten) when motor ________________ release
_________________________ (neurotransmitter)
iii. _______________ neuron  acetylcholine  ________________ cell 
__________________
d. Extension
i. Muscle extend then they ______________________
e. Muscle Tone
i. _________________ impulses maintain muscle tone
ii. Lack of muscle use  __________________ (muscle _________________)
Geriatric Considerations
a. __________ bone mass
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VI.
VII.
b. Joints and disc ____________________  ___________ height
c. __________ flexibility
d. ____________ & _____________ flex, head tilts ___________________  Altered center
of ___________________  _________ risk of falls
Small Group Questions
a. What is the function of the muscular-skeletal system?
b. What minerals are stored by the skeletal system?
c. Differentiate between the two types of bone marrow.
d. What are the three types of bone cells and what are their functions?
e. How does muscle contraction and extension occur?
f. Define articulation, ligament and tendon
g. Describe common geriatric changes in the skeletal muscle system. (What do these changes
put an elder person more at risk of?)
Assessment of the muscular-skeletal system
a. Chief Complaints: ____________________ & limited ____________________
b. Gait: _______________________________________
c. Movement: ______________________________________
d. Posture: _________________________________________
i. ___________________: _______ curve of the _________________ spine
ii. ___________________: _______ curve of the _________________ spine
iii. ___________________: __________________ curve of the spine
e. Inspect & palpate
i. Crepitus: _________________ sound or sensation during ___________
f. Neurovascular Status
i. C ___________________________
1. ______________________
2. ______________________
3. ______________________
ii. M __________________________
1. _____________________/_____________________
iii. S ____________________________
1. Paresthesia
2. ____________
g. ROM
i. ___________________ ________________ _________________
ii. Types of movement
1. Flexion: _____________ joint
2. Extension: _________________ a joint
3. Abduction: Move ____________________ from midline
4. Adduction: Move _____________________ from midline
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iii. Passive: _____________________________
iv. Active: ______________________________
v. NEVER attempt to move a joint past its normal ROM!
VIII.
IX.
Dx test
a. Erythrocyte Sedimentation Rate: ________________________________
b. C-Reactive Protein: _______________________________
c. Serum _________ & _________ levels
d. X-rays: _____________________________________
e. CT-scan: ____________________________________
f. CT-scan with contrast: _________________________________________________
g. MRI: _______________________________________________________________
h. Bone density scan:
i. Used to diagnose: __________________________________________
ii. Prep. ____________________________________________________
i. Arthroscopy:
i. Flexible ______________________ endoscope used to visualize the __________
ii. Pre-procedure:
1. _____________ concent
2. _____________________
iii. Post-procedure
1. Assess _______________________________ status
2. __________________ management
3. Assess ___________________ & ___________________
4. ________________________
5. ________________________
Soft Tissue injury
a. Sprain
i. __________________ injury
b. Strain
i. Tear in the ___________________________
c. Diagnostic tests
i. ________________________: to rule out ________________
d. Treatment
i. R ______________________________
ii. I_______________________________
iii. C ______________________________
iv. E ______________________________
e. Crutches
i. Requirements:
1. Good _____________________
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X.
XI.
2. Strong ____________ body
3. _____________ posture
ii. Adjusting
1. Length: _______________ below axilla
2. Hand grip: _______________ elbow flexion
iii. Down stairs
1. _____________________
2. _____________________
3. _____________________
iv. Up stairs
1. _____________________
2. _____________________ & _____________________
f. Medications:
i. ______________________
ii. ______________________ (_____________________)
Small Group Questions
a. Define Gait, kyphosis, Lordosis, scoliosis, crepitus
b. How do you perform a neurovascular assessment?
c. Define flexion, extension, abduction, adduction, passive ROM and active ROM
d. What does a ESR and C-reactive protein test measure?
e. What nursing measures / should be implemented post arthroscopy
f. What is the difference between a sprain and a strain
g. Describe how to go up and down stairs using crutches.
Fractures
a. ___________________ in the continuity of the _____________________
b. S&S
i. _________________________
ii. Pain
iii. _________________________
iv. Crepitus
c. Emergency Tx
i. ___________________________________
ii. Open wound: cover with ________________ dressing
iii. Asses
1. _________________
2. CMS
d. Dx Tests:
i. _________________ to confirm fx
e. Tx:
i. ________________________: restore alignment
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XII.
XIII.
ii. ________________________
f. Cast Care
i. Frequently assess: _______________
ii. Promptly report:
1. _______________ in CSM
2. ______ or severe ______________
3. Drainage
iii. * READ TEXT CAST CARE: Ch 42 (especially Box 42-4)
g. Medications
i. _____________________ and NSAIDs
ii. _____________________ softeners
iii. ______________________________
Dislocation
a. __________________________ of contact between two bones of a joint
b. Common sites: _____________________ & __________________
c. S&S
i. ___________________
ii. Deformity
iii. ________________ change
iv. Immobility
d. Tx
i. _____________________
ii. ______________________________
Amputation
a. Partial or total __________________ of a body part
b. Indications:
i. Bone __________________________
ii. ______________________________
iii. Trauma
c. Affects: ___________________________________________________________
d. complications
i. _______________________________
ii. _______________________________
1. Permanent _______________________ for the muscle  __________
2. Prevention:
a. __________________: extension
iii. ________________________ leg pain
e. Tx.
i. ________________________________ dressing
ii. Limited ___________________ bearing: ________________ post-op
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XIV.
XV.
XVI.
Osteoporosis
a. _______________ bones
i. _________ bone mass
ii. _________ fragile
iii. _________ risk of fractures
iv. Assoc. with _____________
b. Pathophysiology
i. Bone is constantly being _________________
ii. ___________ age  more bone is ______________ than _________________ 
iii. ____________ bone mass
c. S&S
i. Asymptomatic
ii. ____________ height
iii. Progressive _________________ of the spine
iv. Low back _________________
v. ________________
d. Complications:
i. __________________________
ii. ________________________ Fx
e. Dx tests
i. Bone mineral _______________________
ii. ________________
f. Tx
i. Diet: ________________ & Vitamin ___________ (needed for Ca+ absorption)
Small Group Questions
a. What is the emergency first responder treatment for a fracture?
b. How do you know if someone has fractures a bone?
c. How are dislocations similar to fractures?
d. What are common complications of a amputated limb? How do you prevent these
complications?
e. Describe the pathophysiology of osteoporosis
f. What are the advanced signs and symptoms of osteoporosis?
g. What is the treatment for osteoporosis?
Osteomyelitis
a. _____________________ of the bone
b. Usually d/t ______________________________
c. Dx tests
i. _________________
ii. _________________
iii. Blood / tissue ____________________
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iv. Imaging: _______________ or ________________
d. Tx
i. _______________________
XVII.
XVIII.
XIX.
XX.
Arthritis
a. _______________________ of the joint
Osteoarthritis
a. _________________________ joint disease (DJD)
b. Progressive loss of joint ______________________
c. S&S
i. _________________________
ii. _________________________
d. Dx tests
i. _______________
ii. _______________
e. Tx plan
i. Lose ___________________
ii. _______________________
iii. _______________________
f. Medications
i. Mild ___________________________
1. Aspirin, acetaminophen, ______________________
g. Surgery
i. ________________________________
Small group questions
a. Why is osteomyelitis so hard to treat / cure?
b. What is osteoarthritis?
c. What are the signs and symptoms of DJD
d. What advice would you give to a patient who was newly diagnosed with osteoarthritis?
Mid-Term notes
a. 100 questions
b. There will be approximately 9 questions on Culture; disease transmission; fluid &
electrolytes; integumentary system, hematology, immune system and Skeletal-muscular
system. There will be approximately 15 questions on the cardiovascular system and the
respiratory system.
c. There will be 5 bonus questions on the skeletal muscle system.
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