MEDSURG | Musculoskeletal Assessment

🦴 I. Impaired Bone Integrity & Structure

Core 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 Function

Core 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.