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25.1 Structure and Function

The structure and function of the musculoskeletal system has been a focus of this section. Bones, muscles, tendons, ligaments, collagen, and other connective tissue are the major structures of this body system. These interact with the neurological system in order to provide movement. There are five musculoskeletal system functions: structure and support, movement, protection of vital organs, storage and supply of calcium and phosphate, and hematopoiesis.

Under normal circumstances and with normal abilities, the musculoskeletal system is a fine-tuned machine, delivering on its many functions flawlessly. However, with any impairment of the intricate workings of the system, any of the five functions may be affected, with an assortment of potential disorders and diagnoses. Effects may be apparent in both physical and psychological signs and symptoms experienced by the patient.

25.2 Physical Assessment

Nursing assessments are relied on by healthcare teams and patients, in all sorts of settings. Such data provide baseline information as well as ongoing documentation of changes in a patient’s status, whether positive changes as the patient heals or otherwise improves or negative and concerning alterations. Assessments may be comprehensive and complete or focused on a particular body system and situation. They are compared and reviewed, and updates are frequently provided to show dynamic and ongoing care. These past paragraphs and pages have explored some general concepts about bedside nurses and assessments, and the musculoskeletal assessment in particular. Additionally, one system does not exist in isolation, so connections as to how this system fits and functions with other systems have also been discussed.

The nursing process initiates nursing care through assessment and on through diagnosis/analysis, planning, implementation, and evaluation. A newer model, the clinical judgment measurement model (CJMM), includes four phases: recognize cues to start the process; analyze cues, prioritize hypotheses, and generate solutions; take action; and evaluate outcomes (National Council of State Boards of Nursing [NCSBN], 2023). As generalist nurses are educated and prepared for practice, nursing programs introduce students to the normal assessment. Nursing education also introduces a multitude of disorders through varied teaching and experiential methods, helping learners to make connections between potential patient presentations and possibilities as to what is happening physiologically. The bedside nurse is typically tasked not with differential diagnosis but with identifying normal findings and recognizing those that are abnormal. Therefore, an introductory look at some abnormalities associated with the musculoskeletal system is included in this section.

Finally, this section offers some details as to frequently expected documentation to be done by nurses. Whether a nursing assistant or the individual nurse has obtained certain assessment data (e.g., vital signs, point-of-care glucose), the RN is responsible for validation of results, typically made by reviewing and acknowledging the information. Healthcare settings have different expectations about documentation, including format and frequency requirements. It is important for nurses to be aware of expectations and requirements, as well as evidence-based best practice, in order to maintain quality care and communication among members of the interdisciplinary healthcare team.

25.3 Recognizing Common Musculoskeletal Disorders

There are certain musculoskeletal disorders that are associated most frequently with particular regions. These include certain diagnoses that are common in the spine; those common to upper extremities, specifically wrists, hands, and fingers; and those typified as ankle, foot, and toe problems. It is important to realize that while some of these are commonly recognized in relationship to one area, they may occur elsewhere. An example is DJD, most commonly OA, which has been explored as both a spinal disorder and that which can occur in other joints.

Several disorders have been exemplified for each musculoskeletal area, focusing on the nursing assessment as the primary angle. Nursing is not practiced in isolation; an interdisciplinary approach is needed for holistic patient care, and some mention of that is included in this section and chapter. Also, drug therapies may need to be incorporated, if briefly, and patient responses to such treatment are assessed as part of nursing care.

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