Basics of Human Anatomy and Muscle Types

Anatomy is the study of body structures Physiology is the study of how the body structures work Anatomical Position Anterior – front of body Posterior – back of body Midline – line dividing body from right and left sides Cells the body’s building blocks – most basic functional unit of body structure is the cellular level; all cells have similar structure but the function, size and shape may be different Tissues are a group of cells that are similar to each other in structure and function (Epithelial Tissue; Connective Tissue; Muscle Tissue; Nerve Tissue) Organs are structures made of different tissues that are arranged to perform a specialized function Organ Systems are formed by organs that work together to perform special functions Functions of Muscle: • Provide Movement of Body parts • Maintain Posture • Produce Body Heat TYPES OF MUSCLES Over 600 muscles in your body Voluntary: • Skeletal Involuntary: • Smooth • Cardiac Muscle Movement Tendons: • Connect muscle to bones • Allow for movement when muscles contract Joints • The point at which two or more bones meet • Joints allow for body movement Cartilage • Is connective tissue that cushions the joints so that bone does not grind on bone Synovial Membrane • Lines the joints – secretes synovial fluid – acts as a lubricant so joints can move Ligaments • Strong band of connective tissue that holds bones together at a joint FUNCTIONS OF THE SKELETAL SYSTEM Support • Hard framework that anchors soft organs, keeps us upright, weight bearing ability Protection • Protects vital organs- brain, heart, spinal cord Movement • Skeletal muscles attach to bones by tendons and allow for movement Storage • Of fats, minerals- calcium 97%, phosphorus Blood cell formation- in bone marrow • White cells larger than red but fewer in number unless infection present Age Related MSK Changes Strength • Muscle amount decreases and muscles loose strength. Muscle fibers don’t contract as much as they normally wouldperson has decreased coordination and ability to perform ADL’s, walking and balance affected • Bones lose strength and become more brittle Stability • Less protection for bones, nerves and blood vessels (d/t less muscle tissue) • Shuffling gait, poorer coordination, poor stability • Loss of ability to shiver- decreased heat production Vision changes • Eye muscles weaken and decrease visual acuity Respiratory muscles • Older adults lose muscle function and may not breath as deeply Bowel and bladder • Muscles weaken leading to possible bowel and bladder difficulties OSTEOPOROSIS What is Osteoporosis? • excessive loss of bone mass and mineral content • Osteo (bone) Porosis (porous, brittle) • Not enough new bone is being produced What are the signs and symptoms? • As bones become thinner, they can fracture more easily • Vertebrae shrink- lose height • “Hump back” kyphosis occurs making balance and walking difficult • Pain due to fractures What are the potential problems associated with osteoporosis? • Pain, spontaneous fractures, undetected fractures, immobility PSW Role – Care for client with Osteoporosis • Physical Needs: diet (high calcium and vitamin D), exercise (weight bearing) • • • • Safety Needs: prevention of falls Social Needs: isolation Self Esteem Needs: self image Other: pain medication, braces, walking aids, repositioning Osteoporosis Risk Factors Age Female Caucasian or Asian Inactivity Low body weight Estrogen deficient - post menopausal Smoking Inadequate calcium, vitamin D intake Short/Tall body frame Alcoholism Caffeine Heredity Arthritis Arthritis: Arth (Joint) Itis (Inflammation) • An inflammation or degenerative changes in joints Common Types of Arthritis: • Osteoarthritis • Rheumatoid Arthritis • Gout OSTEOARTHRITIS (OA) • “Degenerative Joint Disease” • Causes- aging, obesity, joint injury, over-use (athletes) • Loss of cartilage at joint ends-eventual collapse of joint end • Affects weight- bearing joints • In women often affects - hands, feet, knees, ankles • In men often affects- spine, hips Care for clients with Osteoarthritis • No cure, just care • Always check the care plan! • Rest and Sleep • Hot and Cold applications • ADL assistance • Assistive devices Rheumatoid Arthritis • Auto-immune disorder • Peak incidence age 30-40- can occur in children and elderly • • • • • Attacks connective tissue throughout body Synovial fluid and joint capsule affected Symmetrical joint affected Commonly affected areas- hands, feet, ankles, shoulders, elbows Arthroplasty Signs and Symptoms of Rheumatoid Arthritis • Pain in joints affecting smaller joints first and moving to larger joints • Redness, stiffness and swelling in joint area • Pain relieved with movement • Joint stiffness greater in morning • Fever, Fatigue • Decreased appetite, weight loss Care for Client with Rheumatoid Arthritis • Meds for pain control: Corticosteroids, ASA, Naprosyn • Heat/Cold applications: if ordered • Safety devices: splints, walking aids • Positioning and gentle ROM • Rest • Maintain joint movement, prevent deformities • Emotional support GOUT (Metabolic Arthritis) • Metabolic Disease • Possibly Hereditary • Dietary Causes • High in red meats, wine, fish and alcohol can aggravate condition • Symptoms • Sudden painful attacks can occur lasting 5-8 days • Most common sites of attacks are the great toes and thumb • Care Required • monitor diet, limit foods high in purines • medication • Rest and medication during attacks FRACTURES Fracture: break in a bone; usually involves tissues, muscles, blood vessels, nerves and tendons Types of fractures: • Open (compound) -bone protrudes through skin • Closed (simple) -skin intact over fracture site Signs and symptoms: pain, swelling, limited function, movement, bruising, colour changes over fracture site, bleeding-internal or external Treatments: may need surgery(open reduction), cast application(closed reduction), in severe cases traction may be needed- may put in screws, plates to hold bones together Arthroplasty: most common are hips and knees- joint replaced due to fracture or disease Fractures: How can I help my client? Cast Care Pain Medications Repositioning Monitor for and report immediately: pain, swelling, skin color changes, fever, odour or drainage ATHROPLASTY CARE Care for first 6-8 weeks post surgery: • Must keep hip abducted, no internal rotation or bending of the hip joint • Avoid lying on affected side • Avoid sitting in low seats (use riser on toilet) • Avoid crossing legs • Avoid bending at the waist (will need help with socks and shoes) • Use caution when turning patient in bed (use pillows and wedges to keep hip abducted) • ROM and weight bearing for affected side as per careplan • TED stockings for circulation Disorders of Muscles Polio: viral disease- causes weakening of the muscles, paralysis Post-Polio Syndrome: 25% of polio victims Muscular Dystrophy: genetic disorder, often affecting male children Fibromyalgia: syndrome causing pain and fatigue MUSCULAR DYSTROPHY • Progressive disease of voluntary muscles • Commonly an inherited disease • Muscle tissues weakens, wastes away- replaced by fatty & connective tissue • Usually only affects baby boys- rarely girls • S & S start around age 3-5 years FIBROMYALGIA • Chronic pain illness • Affects women mainly but also men, children • All races affected • Unknown cause- possibly central nervous system disorder • Affects social aspects of life Symptoms: • Pain, tingling, stiffness, numbness, burning to all parts of body • Fatigue, sleep problems-often lack deep sleep • Headaches, bowel/bladder, dizziness, impaired memory • Symptoms come/go Care With Fibromyalgia • Individual to symptoms • Pain Management • Promote rest and sleep • Physiotherapy • Emotional support • Lifestyle changes • Choosing daily priorities Nervous System – 2 Main Divisions Central Nervous System (CNS)controls brain, spinal cord Peripheral Nervous System (PNS)- controls nerves throughout the body- sensory and motor Central Nervous System – The Brain Three Main parts: 1. Cerebrum 2. Cerebellum 3. Brain Stem Functions of the Nervous System • Provides rapid form of communication for the body • Maintains homeostasis • Sensation (5 senses) • Higher mental function • Emotional responses • Activation of glands and muscles Age Related Changes • Decrease in Senses: vision, hearing, taste, smell, and touch/pain • safety concerns- can’t tell hot / cold , pain • Injuries may go unnoticed, skin breakdown, cuts, blisters • Decreased blood flow to brain: increases chances of dizziness, can lead to confusion, memory loss • Progressive loss of brain cells: difficulty remembering things- need mental stimulation • Decreased reflexes: safety issues, need extra protection from injury • Decreased need for sleep: seniors only require 4-5 hours of sleep- need more rest periods during day as may fatigue more easily Cerebral Vascular Accident (Stroke) • Common term “ Stroke” • Definition: Blood supply to a part of the brain is suddenly interrupted. Damage results in loss of function. Disability depends on severity and location of stroke. Brain cells cannot live longer than a few minutes without oxygen and will die quickly if blood supply cut off. Causes: • Interruption of blood flow to brain; blood clot – 80% • Rupture of a blood vessel in brain; hemorrhage - 20% • Can occur in young or old. Cerebral Vascular Accidents Common Causes: • Hypertension is #1 • Congested Heart Failure • Trans Ischemic Attacks • Diabetes, obesity • Arteriosclerosis • Smoking, stress • Family history of strokes Signs and Symptoms of a CVA F – FACE – is it drooping? A – ARMS – can you raise both? S – SPEECH – is it slurred or jumbled? T – TIME to call 9-1-1 Other: Dizziness, Headache, Weakness to one side of body, Ringing in ears, Blurred vision, Unconsciousness Effects of a Stroke Hemiplegia Weakness to one side Loss of facial control Changing emotions Dysphagia Loss of visiondistorted vision Aphasia Changes in sight, movement, thought, touch Impaired memory Urinary incontinence, frequency Care for Clients After a CVA Positioning- do not lay on weakened side, use pillows to support limbs and prevent skin breakdown. Position in appropriate wheelchair etc. when up. Support weak limbs. ROM- prevention of contractures- use splints and pillows etc. as ordered to support limbs. Follow care plan for exercises Incontinence- follow bowel and bladder routine to assist in maintaining continence, may require catheter Safety- use belts only as ordered, monitor for safety hazards in bed and when up, proper foot wear when walking, use of assistive devices Nutrition- may have dysphasia, monitor swallowing difficulties. Feed in an upright position, may require special utensils. Use thick-it and supplements as ordered Communication- language and perception problems are not dementia, adapt communication to suit client’s needs Emotional Support- may have anger, out bursts, crying, mood changes, swearing, impulsiveness, sadness- need calm, understanding support- have experienced many losses- need active listening and support. Give time to do tasks themselves if ablehelps to increase self-esteem Acquired Brain Injury (ABI) • Permanent or temporary injury to the brain from trauma • Client may have mild to severe: •Attention and concentration deficits •Memory issues •Difficulty with decision-making and problem solving •Trouble learning new ideas •Behaviour changes •Physical symptoms – headaches, fatigue, visual changes, seizures, mobility issues •Each client is different due to the extent of the injury •Often people live mislabelled or misdiagnosed PSW role with a client with ABI • DIPPS • Follow the Care Plan • Focus will be on Rehabilitation • Use of adaptive devices Multiple Sclerosis • Progressive - degenerative disease of the neuron • Exacerbations and Remissions • Demyelination- myelin sheath breaks down and nerve impulses cannot be sent to the brain • Young adult onset Common Signs & Symptoms of MS • Blurred vision • Extreme fatigue • Loss of balance, dizziness, clumsiness • Muscle weakness, stiffness • Tingling, burning, numbness to parts of body • Sensitivity to heat • Difficulty speaking • Difficulty swallowing • Bowel & bladder problems • Impotency • Short-term memory loss • Impaired judgment/reasoning Caring For a Client with MS Physical Needs • Need Rest Periods • Mobility challenges • Thicken Fluids, soft foods • Speech Difficulties • Incontinence Social/Emotional Needs • Reminding • Active listening • Sexual challenges • Self-esteem building • Independence Parkinson’s Disease • Imbalance of neurotransmitter Dopamine in brain- cells producing it die off • Age of onset 40+ • Slow progression • Called “ shaking” disease- tremors start with head shaking and hand tremors • Stress and anxiety make it worse Signs & Symptoms of Parkinson’s Disease • Tremors- ‘pill rolling’ • Stiff muscles; “freezing” • ‘Masking’ of face – staring or emotionless expressions • Shuffling of feet or inability to lift feet; poor balance • • • • • • • Swallowing-chewing difficulties and drooling Soft, slurred and/or monotone speech Constipation Incontinence Depression Memory loss Late stage - dementia Role of PSW in Care of Client with Parkinson’s Disease • Ambulation- exercises, physio, encourage to lift feet, use aids • Safety- high risk for falls • Eating – sit upright, watch for choking, may need thickened fluids • Social- ask closed questions, speech therapy, leisure activities • Self- esteem- encourage independence, emotional support Amyotrophic Lateral Sclerosis What is it? • Progressive disease that causes the motor neurons in spinal cord & brain to die • Symptoms vary person to person • 5% hereditary • 95% sporadic – cause unknown • Life expectation 2-5 years ALS Does Not: • Affect mind • Affect mental awareness and senses • Affect bowel/bladder or sexual function • Usually cause pain • Is not contagious Symptoms of ALS Voluntary Muscle weakness resulting in: • Swallowing- food, saliva • Speech problems +++ • Weakness to limbs, difficulty walking and doing ADLs • Become Total Care • Usually die of respiratory failure Seizure Disorders • Uncontrolled electrical activity in the brain • Characterized by convulsions, uncontrolled movements, sensory disturbances, loss of consciousness (General seizures) • Or be subtle and go unnoticed (Absent seizures) • Some people will get an Aura – warning sign of impeding seizure. First Aid for Seizures • Remain calm, stay with person • Prevent self-injury - protect head, move sharp objects • Do not put anything in the person’s mouth • Side-lying if possible, do not restrain • Provide for privacy • Main complication- choking • Allow to rest afterwards Age Related Changes of the Eye • Fading of the iris • Decreased size of the pupil • Lens yellows • Retinal changes • Decreased tears • Vision changes Common Diseases and Disorders of the Eye Cataract: • clouding of lens Glaucoma: • blocked drainage ducts leading to increased pressure within eye Macular degeneration: • deterioration of center of retina Lens becomes cloudy preventing light from entering eye • Gradual blurring and vision dimming- loss side vision • Causes- age, diabetes, UV exposure, heredity • Surgery done to replace lens Cataracts Nerve cells in retina die off due to increased pressure within eye • Can be sudden or gradual • Signs and symptoms • Treatments Glaucoma Macular Degeneration • Leading cause of blindness over 55 • No known cause or cure • Centre portion of retina damaged • Often slow progression • Two types – Wet and Dry • Treatments Effects of Impaired Vision • Psychosocial health affected • Independence may be most impacted • Adapt over time to taking longer to complete ADLs and tasks • Adapt to different methods of reading Aids to Assist with Visual Impairment • Eyeglasses, contact lenses, magnifying glasses • Reading with Braille • Communication devices • Computer software • Entertainment devices • Artificial eyes-permanent prosthesis or removable Cardiovascular System The cardiovascular system is made up of blood, the heart and blood vessels. The heart works as a pump to transport blood into 2 systems of blood vessels. The right side pumps deoxygenated blood to the lungs (pulmonary circulation) and the left side pumps oxygenated blood to the body (systemic circulation). Types of Blood Cells and Vessels Blood cells: • Red- erythrocytes-transport oxygen and give blood its red color through hemoglobin • White- leukocytes- protect body from infection • Platelets- clotting Blood Vessels: • Arteries- carry oxygenated blood • Veins- carry deoxygenated blood • Capillaries- tiny vessels that transfer food and oxygen into cells Age Related Changes in the Cardiovascular System • Heart muscle becomes less flexible • Increase in fatty tissue • Thickening and hardening of valves • Arteries narrow, less elastic • Veins dilate, stretch • Less waste removal • Heart needs more rest • Electrical system changes – may need pacemaker Hypertension Risk Factors • Age, Male • Family Hx • Obesity, lack of exercise, high sodium diet • Stress • Smoking, alcohol in excess • Atherosclerosis • Fat stored in the abdomen Hypertension Signs and Symptoms • may be none • headaches • dizziness • blurred vision Treatments • regular medications • monitor B.P. • exercise • low salt diet • rest • quit smoking Coronary Artery Disease (CAD) • Coronary arteries become narrow • decreased blood flow to heart muscle Risk Factors for CAD Hypertension High blood cholesterol Obesity Smoking, excessive alcohol Uncontrolled Diabetes Age - Male Family History Coronary Artery Disease Angina Pectoris Myocardial Infarction Two major complications result: Angina Pectoris • Caused from decreased blood flow to heart muscle • Often occurs on exertion Triggers for Angina Triggers • Physical Exertion • Heat /Cold • Emotional Stress • Heavy Meal • Alcohol Signs and Symptoms • Chest pain- left side • Shortness of Breath • Indigestion • Sweating • Dizziness • Fatigue • Palpitations Care for Clients with Angina • Avoid triggers • Rest - stop exertion activity • Medication – nitroglycerine • Should recover in 3-15 minutes • Seek medical attention if pain continues Myocardial Infarction (MI) • Sudden interruption of blood flow to heart muscle • Damage great or small • Cardiac Arrest can occur Signs and Symptoms of MI • Sudden, severe chest pain- left side, radiates • Squeezing, crushing pain, radiates into jaw, arm, back • SOB, cyanosis • Nausea, indigestion • Perspiration- cold clammy skin • Weak, irregular pulse • Dizziness- losing consciousness • Women tend to have less pain but tend to report nausea, sudden fatigue or SOB Treatment for MI • Call 911! May need CPR and defibrillation • If survive may need surgery • Dietary Changes • Life-style changes (no smoking, no alcohol) • Exercise rehab program • Emotional Challenges Other Cardiac Related Issues  Arrhythmias – abnormal heart rhythms  Phlebitis – Inflammation of a vein  Thrombus – blood clot that forms in a blood vessel Congestive Heart Failure (CHF) • Heart cannot pump blood normally • Blood backs up into system • Congestion forms in tissues as edema • Difficulty breathing – sputum in lungs, fluid • Decreased oxygen to cells • Kidney – impaired function, failure Signs and Symptoms of CHF Right Sided HF: • Peripheral Edema: Swelling / edema in legs, ankles, feet, weight gain, distended jugular veins Left Sided HF: • Pulmonary Edema: Congested cough- pinkish-tinged sputum • Shortness of breath/ wheezing / dyspnea Other symptoms: • Frequent urination- especially at night • Fatigue Care for Clients with CHF  Positioning: semi-fowler’s position  Fluid Restrictions  Monitor intake and output  Daily weights  TED stockings  Mild exercise- promote circulation  ADL assistance  Medications- take in am  Avoid salt, alcohol, caffeine, stress  Good mouth care Respiratory System: Age-Related Changes ▪ Lungs become less elastic and flexible ▪ Respiratory muscles weaken ▪ Chest wall becomes more rigid ▪ Decreased cough reflex & Ciliary action ▪ O2 / CO2 exchange decreased ▪ Decreased saliva Respiratory Diseases COPD- chronic obstructive pulmonary (lung) disease 2 disorders within COPD: 1. Emphysema 2. Chronic Bronchitis Emphysema Chronic Bronchitis -Breakdown of alveoli; air gets trapped in lungs -Minimal Cough -Pursed lip breathing -Decreased breath sounds with ausculatation -Barrel chest forms due to inability to expel trapped air -Accessory muscle use -Tend to be underweight; weight loss Same: -Dyspnea and SOB -Fatigue – with eating and talking -Inflammation of bronchi -Develops after recurrent episodes of bronchitis -Chronic, productive cough with purulent sputum -Mucus obstructs airflow (in and out of lungs) -Wheezes and crackles hear audibly and with auscultation -Peripheral edema -Tend to be overweight -Cyanosis Same: -Dyspnea and SOB -Fatigue – with exertion Caring for the Client with COPD ▪ Monitor sputum- color, amount ▪ Eliminate unnecessary activity – allow for rest periods ▪ Positioning ▪ Provide assistance for ADLs ▪ Frequent mouth care ▪ Encourage fluids, if allowed ▪ Easy to eat meals ▪ Assistive devices ▪ Deep breathing and coughing (DB & C) ▪ Oxygen care Asthma ▪ Possible causes ▪ Narrowing of air passages ▪ Sudden Onset ▪ Treatments ▪ May become medical emergency Asthma: What is your role? ▪ Monitor client for breathing concerns ▪ Remember DIPPS ▪ Remind clients to take their medications ▪ Support your client during stressful situations Pneumonia ▪ Inflammation of lung tissue due to infection ▪ Alveoli in affected area fill with fluid-poor O2/CO2 exchange ▪ Causes: bacteria, viruses ▪ Risk factors: aspiration, immobility, poor immune system Signs and Symptoms of Pneumonia ▪ fever, chills, painful cough, pain on breathing, cyanosis, rapid pulse ▪ Sputum may be clear, yellowish, green or rust colored Care for Client with Pneumonia ▪ Medication for pain and infection ▪ Increased fluids- for fever and to thin secretions ▪ Semi- Fowler’s position ▪ Standard precautions-isolation if necessary ▪ Frequent mouth care ▪ Skin care, repositioning, physio if ordered Tuberculosis ▪ Bacterial infection ▪ Spread by airborne droplet ▪ Usually develops in lungs first ▪ Can affect lungs, bones, kidneys, brain ▪ May lay dormant for years Signs and Symptoms of Active Tuberculosis ▪ Tiredness ▪ Loss of appetite, weight loss ▪ Fever in late afternoon, night sweats ▪ Coughing occurs, becomes more frequent as disease progresses ▪ Sputum and chest pain when coughing Tuberculosis: Care Measures ▪ Clients may need to be treated in hospital ▪ Upon return home may need to take TB medications daily for several months ▪ Clients need to cover their noses and mouths with tissues when coughing or sneezing and then flush the tissues down the toilet ▪ In facilities tissues used by clients with TB are placed in biohazard bags and disposed of according to facility policy ▪ Standard Practices and Airborne Precautions must be practiced during care of clients with TB