Week 8 - Urinary and Musculoskeletal

Question 1

How does a supine position impact the urinary system?

Answer 1

Impacts normal kidney contraction and emptying of bladder resulting in urinary stasis

Question 2

What happens when urinary stasis occurs?

Answer 2

• Increase in microorganism growth
• Increase in calcium excretion = High amount of crystals.
• Decreased bladder sensitivity due to higher levels of calcium in urine
• Loss of muscle tone

Question 3

What is Urinary Calculi?

Answer 3

Kidney stones associated with precipitation of calcium

Question 4

What are the symptoms of Urinary Calculi?

Answer 4

• extreme pain
• dysuria
• haematuria
• urinary spasm/colic
• infection

Question 5

What is Urinary Retention?

Answer 5

• Inability to effective empty the bladder
• extreme cases may even lead to reflux back up ureter to kidney (hydronephrosis)

Question 6

What are the symptoms of Urinary Retention?

Answer 6

• discomfort
• abdominal distention
• palpate and percuss bladder above the symphysis pubis
• retention with ‘overflow’ (incontinence)

Question 7

What are the nursing interventions for the urinary system?

Answer 7

• Avoid bed rest and immobility
• Promote activity and weight bearing exercises to ‘stress’ the bones and reduce likelihood of demineralisation and excessive calcium production
• Push fluids (3 litres) to flush out the calcium and small stones; adequate fluid intake to fill the bladder (2 litres)
• Facilitate correct upright position to pass urine
• Monitor fluid balance, 1mL/kg/hour; or approximately 200-300 mL 6 times a day

Question 8

How does immobility affect the skeleton?

Answer 8

• Lack of exercise and weight bearing results in impaired osteoblast activity
• demineralisation of bones
• Progressive loss of bone mass and deterioration of bone tissue; size & strength of bone reduced

Question 9

How does immobility affect the muscles?

Answer 9

• Become weak and stiff; lose 7-10% of strength weekly
• Atrophy and shortening of muscle begins in 3-7 days; deconditioning
• Progressive loss of range of motion over 2 weeks
• Tendons become resistant to movement

Question 10

What are the common symptoms for when immobility affects the musculoskeletal system?

Answer 10

• Joint stiffness & pain
• Muscle atrophy
• Pain on movement
• Unsteadiness, balance problems, falls
• Foot drop – unable to maintain foot in correct
  position

Question 11

What is Contractures?

Answer 11

A permanent contraction of a muscle group caused by shortening and fibrosis of the muscle fibres, leading to loss of/alteration in function

Question 12

What are the symptoms of Contractures?

Answer 12

• Permanent shortening of muscle
• deformity of a joint
• reduced range of motion

Question 13

What is Osteoporosis?

Answer 13

Loss of bony tissue resulting in bones that are brittle and liable to fracture

Question 14

What are the symptoms of Osteoporosis?

Answer 14

• Silent disease
• Factures (hip, vertebrae)
• Back pain
• Loss of height
• Spinal Deformities

Question 15

What are the nursing interventions for musculoskeletal?

Answer 15

• Mobilise or stand the patient (walking and weights)
• Correct positioning and body alignment (splinting)
• Support, cushioning, avoid weight on feet (bed cradle, bed sheet ‘tuck’)
• Active and passive exercises; ROM; isometric (tense muscle) exercises
• Vitamin D and calcium supplements; calcium rich diets – milk, yogurt,
  cottage cheese, seafood (sardines), green vegetables (spinach”, almonds
• Exposure to sunlight (15 min, 4-6 times a week)
• Hip protectors; avoid smoking and excessive alcohol consumption