AFAMS Master Lesson Plan (MLP)
Nursing Program
Introduction To The Musculoskeletal System
Instructor
Serial/Semester
Location
Start/Finish Time
Date
LESSON OBJECTIVE
Performance: To gain an understanding of the musculoskeletal system.
Conditions:
The student will be presented a powerpoint presentation by the instructor and will have
all necessary references made available to him/her.
Standard:
1.
Given the five elements of the nursing care process and a scenario of a patient
undergoing diagnostic testing for a musculoskeletal problem by correctly
responding to written, oral, and experiential assessment measures.
TEACHING POINTS
1. Define key terms related to the
musculoskeletal system.
2. Identify major structures and functions of the
musculoskeletal system.
3. Describe elements of the nursing assessment
of the musculoskeletal system.
4. Identify common diagnostic and laboratory
tests used in the evaluation of musculoskeletal
disorders.
5.
6.
7.
8
9.
10.
INSTRUCTIONAL STRATEGY
Interactive Lecture
Method:
Instructor
Media:
Classroom
Environment:
OTHER LESSON SPECIFICATIONS
Knowledge Lesson
Type of Lesson:
1/50
Ratio:
Resources:
.
End of Lesson Test: None
Minutes
Instructional Time: 102
Reference(s):
ISBN 0-323-01728-2
Adult Health Nursing, 4th Edition
01 Jan 2003
ISBN 0-7817-3553-X
Introductory Medical-Surgical Nursing, 8th Edition
01 Jan 2002
LESSON PLAN APPROVAL
Signature of Standards Officer
Date
AFAMS Master Lesson Plan (MLP)
Nursing Program
Introduction To The Musculoskeletal System
INTRODUCTION
Allocated Time:
Review:
5 Minutes
You have had previous anatomy and physiology lectures in your combat medic
training, this lecture will build upon prior instruction.
Objective:
To discuss/describe topics related to the nursing process.
Importance:
Nurses work in various health care settings so it is important to gain an
understanding of this subject as it will apply to your clinical practice.
Fit:
Opening Statement: Understanding the function and structure of the
musculoskeletal system will allow you as a healthcare provider to better assess
your patient's neurovascular function and provide safe, effective care.
Approach:
You will be presented the subject in lecture format and will be tested using a
written exam at a later date.
Control Statement:
If you have any questions during the lesson please feel free to ask.
BODY
1. Teaching Point: Define key terms related to the musculoskeletal system.
Minutes
Allocated Time:
Introduction:
Learner Participation:
Knowledge Lesson
Skill Lesson
Learning Support:
a. Ankylosis - fixation of a joint, usually in an abnormal position resulting from destruction of cartilage
or bone
b. Arthrocentesis - puncture of a joint with a needle to withdraw fluid used for diagnostic purposes
c. Bipolar hip replacement - prosthetic implant used to replace the femoral head and neck in hip fractures
when the vascular supply to the femoral head is or may become compromised
d. Blanching test - a test of the rate of capillary refill
e. Callus - bony deposits formed between and around the broken ends of a fractured bone during healing
f. Colles' fracture - a fracture of the distal portion of the radius within 1 inch of the wrist
g. Crepitus - sounds that represent the graiting noise heard when rubbing hair between fingers. It is
associated with broken bones
h. Fibromyalgia - a musculoskeletal chronic pain syndrome of unknown etiology that causes pain in the
muscles, bones or joints
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AFAMS Master Lesson Plan (MLP)
Nursing Program
Introduction To The Musculoskeletal System
i. Kyphosis - an abnormal condition of the vertebral column, characterized by increased convexity in the
curvature of the thoracic spine
j. Lordosis - an increase in the curve at the lumbar space region that throws the shoulders back
k. Open reduction with external fixation - a surgical procedure allowing fracture alignment under direct
visualization while using various internal fixation devices applied to the bone
l. Paresthesia - any subjective sensation, such as prickling "pins and needles" or feeling of numbness
m. Scoliosis - curvature of the spine usually consisting of two curves; the original abnormal curve and a
compensatory curve in the opposite direction. This results in an "S" shaped appearence.
n. Sequestrum - a fragment of necrotic that is partially or entirely detached from the adjacent healthy
bone
o. Subluxation - partial dislocation
p. Volkmann's contracture - a permanent contracture with clawhand
Knowledge Lesson:
Question:
Answer:
Check on Learning
In a knowledge lesson, pose questions to the class.
What are the three terms relating to the curvature of the spine?
lordosis, kyphosis, and scoliosis
Skill Lesson:
In a skill lesson, provide practice and watch students perform a skill.
2. Teaching Point: Identify major structures and functions of the musculoskeletal system.
Minutes
Allocated Time:
Introduction:
Learner Participation:
Knowledge Lesson
Skill Lesson
Learning Support:
a. Functions of the musculoskeletal system include:
(1) Support - the skeleton provides the body framework that supports internal tissues and organs
(2) Protection - the skeleton forms a firm, cage-like structure that protects many internal organs
(3) Movement because the skeletal muscles are attached to the bone, the bone provides leverage for
movement
(4) Mineral Storage - the bones serve as a storage area for various mineral particularly calcium and
phosphorus
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AFAMS Master Lesson Plan (MLP)
Nursing Program
Introduction To The Musculoskeletal System
(5) Hemopoiesis (blood cell formation) takes place in the bone marrow
b. Structures of the musculoskeletal system include bones, joints, and muscles. There are 206 bones in
the skeletal system. Bones are classified based on the shape
(1) Long - found in the extremities
(2) Short - found in the hand
(3) Flat - found in the skull and sternum
(4) Irregular - found in the vertebrae (backbone)
*The skeletal system can be divided into the axial skeleton and the appendicular skeleton. See Box 4-1.
c. Joints perform two important functions
(1) Hold bones together to form a skeleton
(2) They allow movement and flexibility of the skeleton
*The skeletal system can be divided into the axial skeleton and the appendicular skeleton. See Box 4-1
d. Joints are the points of contact between two bones. There are three types of joints
(1) Synarthrosis - no movement
(2) Amphiarthrosis - slight movement
(3) Diathrosis - free movement
e. Bones and joints provide the framework for the body, but muscles are necessary for movement.
Muscles perform three vital functions
(1) Motion
(2) Maintenance of posture
(3) Contraction assist venous blood and lymph back to the right side of the heart
f. The structure of the muscle
(1) It is composed of hundreds of muscle fibers
(2) Each muscle fiber is surrounded by a connective tissue called epimysium
3
AFAMS Master Lesson Plan (MLP)
Nursing Program
Introduction To The Musculoskeletal System
Knowledge Lesson:
Question:
Answer:
Check on Learning
In a knowledge lesson, pose questions to the class.
What are the functions of the musculoskeletal system?
Support, protection, movement, mineral storage and hemopoiesis
Skill Lesson:
In a skill lesson, provide practice and watch students perform a skill.
3. Teaching Point: Describe elements of the nursing assessment of the musculoskeletal system.
Minutes
Allocated Time:
Introduction:
Learner Participation:
Knowledge Lesson
Skill Lesson
Learning Support:
a. Remember the 7Ps
(1) Pulselessness
(2) Paresthesia
(3) Paralysis
(4) Polar temperature
(5) Pallor
(6) Puffiness (edema)
(7) Pain
b. In addition it is important to assess your patient's ability to stand, move, perform ADLs, any weakness,
and problems with their gait
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AFAMS Master Lesson Plan (MLP)
Nursing Program
Introduction To The Musculoskeletal System
Knowledge Lesson:
Question:
Answer:
Check on Learning
In a knowledge lesson, pose questions to the class.
Identify 3 of the 7 Ps
(1) Pulselessness
(2)
Paresthesia
(3)
Paralysis
(4)
Polar temperature
(5)
Pallor
(6)
Puffiness (edema)
(7) Pain
Skill Lesson:
In a skill lesson, provide practice and watch students perform a skill.
4. Teaching Point: Identify common diagnostic and laboratory tests used in the evaluation of
musculoskeletal disorders.
Minutes
Allocated Time:
Introduction:
Learner Participation:
Knowledge Lesson
Skill Lesson
Learning Support:
a. Diagnostic tests
(1) X-ray is used to determine presence of fluid, joint irregularity, or fractures
(2) Myelogram - involves the injection of a radiopaque dye into the subarachnoid space at the lumbar
spine to detect the presence of herniated disks
(3) MRI - used to detect pathological conditions of the cerebrum and spinal cord
(4) CT - Body sections can be examined from many different angles using a CT scanner that produces
a narrow x-ray beam
(5) Bone scan - this test involves the intravenous administration of nuclides 2-3 hours before the test is
scheduled. A scanning camera detects the areas concentration of radionuclide uptake which may
represent a tumor or other abnormality
(6) Endoscopic Exam - a lighted tube is used to visualize inside a body cavity
(7) Aspiration - is done to obtain a specimen of body fluid
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AFAMS Master Lesson Plan (MLP)
Nursing Program
Introduction To The Musculoskeletal System
(8) Electromyogram - is a procedure that involves the insertion of needle electrodes into the skeletal
muscle so that electrical activity can be recorded
b. Laboratory tests
(1) Calcium
(a) Normal values 9-10.5 mg/dl
(b) Increased in tumor of the bone, renal failure, Vitamin D deficiency, etc.
(2) Erythrocyte sedimentation rate
(a) Normal values - males up to 15 mm/hr and females up to 20mm/hr
(b) Indicates presence of inflammation as seen in rheumatoid arthritis
(3) Lupus erythematosus
(a) Normal values - no LE seen
(b) Lupus erythematosus and rheumatoid arthritis
(4) Rheumatoid factor
(a) Normal values < 60U/ml
(b) Lupus erythematosus and rheumatoid arthritis
(5) Uric acid
(a) Normal value - males 2.1-8.5 mg/dl and females 2.0-6.6 mg/dl
(b) Increases with patients with gout, kidney failure, dehydration, etc.
Knowledge Lesson:
Question:
Answer:
Check on Learning
In a knowledge lesson, pose questions to the class.
What is the normal value of Calcium?
Normal values 9-10.5 mg/dl
Skill Lesson:
In a skill lesson, provide practice and watch students perform a skill.
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AFAMS Master Lesson Plan (MLP)
Nursing Program
Introduction To The Musculoskeletal System
END OF LESSON TEST
Allocated Time:
Instructions:
Test Questions or
Performance
Expected:
Test Key:
0 Minutes
CONCLUSION
Allocated Time:
Summary:
5 Minutes
Review and re-emphasize the difficult Teaching Points below.
1.
2.
3.
4.
Define key terms related to the musculoskeletal system.
Identify major structures and functions of the musculoskeletal system.
Describe elements of the nursing assessment of the musculoskeletal
system.
Identify common diagnostic and laboratory tests used in the
evaluation of musculoskeletal disorders.
Closing Statement:
You will be presented the subject in lecture format and will be tested using a
written exam at a later date.
Re-motivating
Statement:
Opening Statement: Understanding the function and structure of the
musculoskeletal system will allow you as a healthcare provider to better assess
your patient's neurovascular function and provide safe, effective care.
7