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Clinical Nursing Skills

Introduction

Clinical Nursing SkillsIntroduction
A man is doing a leg stretch on a treatment table with assistance from a woman in a physical therapy clinic, while a sports channel plays on a TV in the background.
Figure 25.1 A comprehensive musculoskeletal assessment can identify a patient’s ability to perform daily activities of living. (credit: modification of work "Physical therapy" by SrA Jeff Parkinson/Air Force Medical Service, Public Domain)

Chapter Outline

25.1 Structure and Function
25.2 Physical Assessment
25.3 Recognizing Common Musculoskeletal Disorders

The human musculoskeletal system is composed of muscles, bones, and joints, and is most recognized for the framework and shape of the body. This system offers the ability to stand upright and to move. Protection is another factor offered by the musculoskeletal system, as critical organs and structures like the heart and lungs are enclosed within the thoracic cage, the brain inside the skull, and the spinal cord sheathed within the vertebral column. Hematopoiesis, or production of red and white blood cells and platelets, is another function of the musculoskeletal system. It is within the bone marrow where the production of these cells occurs. And finally, this body system supplies certain minerals as needed, as bones are the primary storage facility for the electrolytes calcium and phosphorous.

While diagnosis of musculoskeletal problems—injuries and disease processes—is within the realm of diagnosticians—physicians, nurse practitioners, and physician’s assistants, generalist nurses are expected to assess the musculoskeletal system and to recognize normal versus abnormal findings. As with other body systems, abnormal assessment results should be brought to the attention of the advanced practitioner for further diagnostic testing, a definitive diagnosis, and creation of the treatment plan.

There are problems that plague the musculoskeletal system in a variety of ways. Fractures, for example, may be problematic at any age, especially in consideration of traumatic accident or injury. Certain issues arise from birth and may be either congenital or have a genetic component; childbirth itself may lead to compression injuries or fractures of the skeletal system or certain muscles. The aging process impacts musculoskeletal structures, as degenerative changes cause deterioration of bones or atrophy of muscles. Generalist nurses are expected to use clinical judgment to assess and act on common musculoskeletal disorders and, once again, refer such patients, as well as those with unusual, rare conditions, to diagnosticians for diagnosis and treatment planning.

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