19.1 Assess and Analyze the Impact of Nutrition on the Musculoskeletal and Integumentary Systems

Normal Function of the Musculoskeletal and Integumentary Systems

Bones, muscles, tendons, ligaments, joints, and connective tissue hold the body together. The main function of the musculoskeletal system is to support the body. This system also allows for movement of the body as well as providing protection for internal organs. The bones that comprise the skeletal system store calcium and phosphorus—minerals important to body function—blood components, and certain fats. The skeletal muscles attached to bones are empowered by nerves with electrical current from the central nervous system. These nerves located throughout the muscles allow for the contraction of the muscles. Only two types of muscles, the skeletal muscles and the smooth muscles, are considered a part of the musculoskeletal system. The skeletal muscles provide for the movement of the body and the smooth muscles are found in intestinal and vessel walls. Ligaments and tendons help with body movement by connecting bones together to form joints (LibreTexts Medicine, 2019).

Aging influences the musculoskeletal system. As a person ages, height decreases because calcium, phosphorus, and other minerals are lost. Fluid decreases between the disks in the vertebrae of the spine, which can cause pain and deformity. Joints tend to lose cartilage contributing to stiff joints and joint pain. This contributes to osteoarthritis and worsens its symptoms associated. Working to maintain a healthy musculoskeletal system is important throughout the lifespan (Academic Senate for California Community Colleges (ASCCC) Open Educational Resources Initiative, 2021).

The integumentary system is made up of the skin and accessory structures—such as hair, nails, sweat glands, and sebaceous glands—and is the largest organ system in the human body. The function of the integumentary system is to protect the body from invading microorganisms, chemicals, and other environmental irritants. The skin helps to control temperature and regulate electrolytes by preventing dehydration. The skin and its structures play a role in storing fats and synthesizing vitamin D. The integumentary system is susceptible to diseases and injuries, many of which are life threatening. Maintaining a healthy integumentary system is vital for maintaining good health. Musculoskeletal tissue is especially vulnerable to injury (ASCCC Open Educational Resources Initiative, 2021).

Assessment of the Musculoskeletal and Integumentary Systems

Nursing assessment of the musculoskeletal system involves the collection of subjective and objective data. Subjective data is gathered through a thorough interview of the client’s past medical and surgical history, family medical history, current medical problems, lifestyle history, and nutritional history. The following interview questions are good examples that focus on the musculoskeletal system:

• Are you experiencing any pain, weakness, swelling, or stiffness in any of your bones/joints?
• Have you ever been told that you have a long-term musculoskeletal disease such as osteoarthritis or rheumatoid arthritis?
• Have you ever been diagnosed with nerve pain that affects the muscles of any of your extremities?
• Have you ever had any fractures, sprains, or strains that required medical treatment?
• Have you ever been told you had tendonitis or bursitis?
• Have you ever had any orthopedic surgeries?
• Have you ever had to undergo physical therapy for pain management?
• What is the list of your current medications including herbs and supplements?

Objective data is gathered as the nurse observes or inspects the client’s posture, movements, gait, deformities, muscle tone, and range of motion. Range of motion reflects the client’s ability to move their joints actively or passively.

General objective findings within the healthy musculoskeletal system are muscles with no wasting, no edema noted over bones and joints, and skin color appropriate for skin tone over bones, joints, ligaments, and muscles. Assessment findings should include posture that is well balanced with the head positioned over the shoulders, a slight curve in the lower back, and a level pelvis. The knees are symmetrical, the toes face forward when standing, and the shoulders and extremities are all symmetrical.

In healthy individuals, the movement of the musculoskeletal system is not restricted. There is full range of motion (ROM), which is defined as the movement potential of the joints using flexion and extension. Movement is fluid and smooth with no sounds heard from joints upon movement. There is full symmetrical muscle strength in all extremities. The gait is balanced with no shuffling or limping. A center of gravity is maintained when standing—there is no leaning or swaying, dragging feet, or waddling. Full ROM is evidenced by no pain.

The healthy musculoskeletal system is strong and symmetrical. Strong active movement is noted against gravity and resistance. Muscle tone is a measure of a muscle’s resistance to stretching while at rest. Even when at rest, muscle fibers are at least partially contracted, so muscle tone should have no flaccidity.

Nursing assessment of the integumentary system can often be done simultaneously with the musculoskeletal system. If fact, observing for redness and swelling in the joints as already described relates both to the musculoskeletal and integumentary systems. This is why these systems are grouped together. One system influences the other and abnormal findings are typically related to both systems. Another example is for the sprain and strain mentioned earlier—the skin will reflect bruising (ecchymosis) and swelling.

General objective findings within the healthy integumentary system includes normal skin, hair, and nails. Skin should be distributed over the body in three tissue layers, all intact without any breaks in the skin. Healthy skin is free of lesions, ulcers, irritations, skin tears, blisters, and sores. The color is appropriate for race with no disturbances in pigmentation. Birthmarks and moles are smooth and consistent in color. Skin is warm and dry or appropriate for present environmental factors. Skin temperature does not vary from one site on the body to another. Normal moisture level is indicated by good skin turgor, with no tenting. To measure skin turgor, pinch up skin on the back of the hand and observe for tenting (when the skin stands up like a tent).

The hair of a healthy integumentary system is equally distributed in places where hair should be growing. There is no hair loss or hair growing where it does not belong. Texture is within normal limits for client per genetics, hormones, and chemical use. There are sufficient oils to prevent breakage. No parasite infestation is noted, and there is no fungus on the scalp.

The nails are translucent with pinkish tone. The base of the nail is about 160 degrees with normal sized fingertips. There is no clubbing and no spoon-shaped nails. The nails should be smooth and firm. The nails are clean, with no material growing under the nails. The cuticles are intact, and the surrounding skin is intact with no redness or edema (Figure 19.2).

Figure 19.2 An assessment includes nail color and shape. (credit: “Fingernails, about 2 mm long, just the right length” by Kommissar/Wikimedia Commons, Public Domain)

Tests Used in the Assessment of the Musculoskeletal and Integumentary Systems

During the assessment, nurses and providers use screening tests to determine objective findings in the musculoskeletal and integumentary systems. The provider uses this information to determine the diagnostic tests needed. The provider combines subjective data with these objective findings to help make a diagnosis. Refer to Table 19.1 for screening and diagnostic tests used for the musculoskeletal system.

The nurse’s assessment of the integumentary system includes the skin, hair, and nails. Abnormalities found in this system often reflect a dysfunction in other body systems. See Table 19.2 for screening tests and diagnostic tests for the integumentary system.

Figure 19.3 A recurrent erysipelas is evident on an edematous leg. (credit: “Recurrent erysipelas on edematous leg” by Mikael Häggström/Wikimedia Commons, Public Domain)