MEDSURG | Musculoskeletal Assessment

🦴 I. Impaired Bone Integrity & StructureCore Concept: Bone = dynamic tissue of collagen (organic) + calcium/phosphate (inorganic). Remodeling = resorption (osteoclasts) + formation (osteoblasts). Imbalance → bone weakness, ↓ density, ↑ fracture risk.⚕️ Common Meds & Nursing Cues:Ca & Vit D: Maintain mineral balance. Monitor diet/nutrition.Opioids/NSAIDs: Pain control. Watch for GI bleed (NSAIDs), resp depression (opioids).👩‍⚕️ Interprofessional Care:MD: Orders X-ray, DEXA, bone scans.RN: Pre/post-procedure care, pain/mobility checks.Radiology Tech: Verify pregnancy, renal function (contrast).Dietitian: Optimize Ca, Vit D, protein intake.🚨 Manifestations:Acute: Loss of function, severe pain → possible fracture or neurovascular compromise.Labs: ↑ Alk Phos (30–120 u/L) = bone formation or cancer. Abnormal Ca (9.0–10.5 mg/dL) = metabolic issue.Chronic: Kyphosis, lordosis.💉 Nursing Mgmt:Bone Scan: Stay still; hydrate post-scan.CT/Myelogram: Check iodine allergy, renal fx, hold metformin; explain flushing sensation.Fall Risk: Use assistive devices, declutter, proper lighting.🧠 Quick Cues:↑ Alk Phos = bone healing.Always assess allergies/meds before contrast.Bone = collagen + Ca + phosphate; remodeling = key.DEXA = Bone Density Test.💪 II. Impaired Joint Mobility & Muscle FunctionCore Concept: Muscles → tendons → bones via ligaments/joints. Joints = synovial sacs with fluid for smooth movement. Dysfunction (OA, RA, dystrophy, trauma) → stiffness, atrophy, contracture.⚕️ Common Meds:Corticosteroids: ↓ inflammation; monitor for HTN, hyperglycemia, osteoporosis.Muscle Relaxants: ↓ spasms; watch for sedation, fall risk, driving caution.🤝 Interprofessional Care:RN: Pain mgmt, coordinate PT/OT, support ADLs.PT: ROM, strength; medicate before sessions.OT: Teach adaptive methods for independence.RT: Support if scoliosis or dystrophy impairs breathing.🚨 Manifestations:Critical: Sudden ↓ pulse, pale/cool limb = neurovascular emergency.Severe: Weakness (use 0–5 scale), crepitus, ↑ CK (20–200 u/L = muscle injury), ↑ CRP (<1.0 mg/dL normal = inflammation).💉 Nursing Mgmt:Pain: Assess 0–10; medicate pre-activity; add heat/cold.Immobility: Measure ROM (goniometer), grade strength, rest when fatigued, teach body mechanics.Sleep/Fatigue: Optimize environment; control pain before bed.🧠 Quick Cues:5/5 = full muscle strength.↑ CK = muscle damage.EMG: No caffeine 2–3 h before; no lotions.Bursae: Cushions reduce friction near joints.Chronic pain affects self-image & roles.