MORNING SESSION.

Its a start if an other week, I was so happy to see everyone in class, but a bit worried because, I wanted to see and know my mock exam grades, I was not too certain or happy about it. We discussed about the mock exam and informed us about the  result of it.

I learnt about the INTRODUCTION TO MUSCULO-SKELETAL SYSTEM.

The aim of this session was to introduce us to musculo- skeletal system, and the functions of the skeleton is to protect the internal organs and tissues.

To stabilise and support the body.

To provide a surface for muscle, ligaments and a tendon attachment.

To produce red blood cells and

To store mineral salts.

I learnt that, there are textbooks that teaches about 206 bones in the human skeleton as the anatomical norms but not everyone has this amount of bones. And that there are some people that are born with extra bones such as the 13th pair of ribs or an extra digit, and there are some people even develop extra bones during their lives.

In infant, I learnt that there skeleton has 300 – 350 bones as a child’s skeleton is mostly cartilage that through the process of ossification(process of bone formation) and eventually becomes bone. They are naturally born with over 300 bones, originally made of cartilage, which are mineralised during the first few years of life, and some bones fuses together. The average age that bones stop growing is 21 years.

There are  seven (7) cervical vertebrae, 12 Thoracic vertebrae, 5 lumbar vertebrae, 5 sacrum  and 4 coccyx.

The Femur is the strongest and biggest bone, it carries the red blood cells.

The smallest bone in the human body are in the ear, that is the malleus (hammer), incus (anvil) and the stapes  (stirrup) and are also known collectively  as  Ossicles, they are not only the smallest bone in the body but they are also the only bone that do not remodel after the age of one.

We looked at the types of bones, their functions and examples,  they are briefly described below:

1.Long bones : It’s function is to provide strength, has bone marrow and the examples of long bone are Femur, Tibia, Fibula, Humerus, Ulna, and Radius.

2. Short bones : the function of short bones are for  multi-directional motion. Examples of short bones are Carpal bones( hands/wrists) the tarsal bones(feet/ankles).

3. Flat bones: the function is to provide mechanical protection to soft tissues beneath and it examples are Cranial bones, Sternum, Ribs, Scapulae.

4. Irregular bones: the function is to provide major mechanical support for the body. the Vertebra protect the spinal cord. the examples are Vertebrae, Hyoid bone, Spheroid bone and facial bones.

5. Sesamoid bones: The function is to protects from additional friction and use – and can form in palms and soles. The example, only one type of sesamoid bone is present in all normal human skeletons so it has a name: The Patella.

I also learnt about the Bone Cells. That mature bone cells are known as OSTEOCYTES. There are also Osteoblasts and Osteoclasts

The Osteoblast( bone forming or they create new bone cells) are present where bone is growing, repairing or remodelling. for example at site of fracture – deposit new tissue around themselves and become trapped then they change into Osteocytes.

The Osteoclast – cells that break down bone releasing calcium and phosphate. They are carnivore that chews off bone.

We further looked at Bone Marrow, that long bones such as the thigh bone, are filled with bone marrow made of fat cells, blood cells and immune cells.

In children , the bone marrow is red reflecting its role in making blood cells. While in adults, the bone marrow is yellow and containing 10 percent of all the fat in the adults body.

The difference between Osteoporosis and Osteoarthritis. Osteoporosis develops when bone removal occurs too quickly, replacement occurs too slowly, or even both.

Osteoarthritis degenerates non-inflammatory disease. when the cartilage between joints becomes worn and the bones are damaged and may cause unwanted bone growth. Osteoarthritis causes pain and restricted movement.

I learnt about the types of muscles which are the SKELETAL STRIATED MUSCLES, that most of the 600 skeletal muscles are attached to bones and extend across joint. The contraction of skeletal muscles exerts force on the bones and causes movement.

 SMOOTH MUSCLES, is found in the blood vessels where its action brings about changes in the vessels diameter. It is also found in the walls of the internal organs (peristalsis).

 CARDIAC MUSCLES, forming in the myocardium of the heart where is propels blood.

We depend on the muscles for every movement you make, even for sitting and standing. We also depend on the muscles internally to move food along our digestive tract and to control excretion of body waste. We depend on the muscles to circulate blood around the body and for breathing. Our life depends on the actions of the muscles.

We also looked at the manual of clinical procedures from the Royal Marsden. The VENTROGLUTAEL injection site, the DELTOID  injection site, the DERSOGLUTAEL injection site, the RECTUS and VASTUS LATARALIS injection site.

AFTERNOON SESSION.

For the afternoon session, we looked at CONTINENCE MANAGEMENT AND URINALYSIS. We looked at the meaning of urinary incontinence and faecal incontinence. That urinary incontinence is the inability to hold urine in the bladder due to loss of voluntary control over the urinary sphincters resulting in the involuntary passage of urinary. The complaint of any involuntary leakage of urine.

Faecal incontinence is the involuntary loss of solid or liquid stool that is a social or hygienic problem.

For the types of continence, It is important to assess the underlying causes through assessment which is carried out on different level. A full assessment is required in order to reach a diagnosis and decide on the appropriate treatment.

Stress UI; is the voluntary leakage of urine on effort or on sneezing or coughing.

Urge UI; is the involuntary leakage of urine following a sudden uncontrollable urge to avoid.

Mixed UI; is the involuntary leakage of urine associated with urgency and also exertion, effort, sneezing or coughing.

It can be assess by the use of standard assessment form which is helpful when taking the history.  Record the urinary symptoms as described by the patient, such as frequency, urgency, nocturia and leaking.

*  Ask  about the onset of symptoms , their duration and any previous treatment the patient has had.

*  Record the patient’s bowel history. should note the patient’s past medical history, especially any gynaecological or urinary tract surgery.

For an additional assessments:

* a physical examination- the abdominal examination for palpable bladder and loaded colon which may indicate constipation.

*Examination of the genital for abnormalities, discharge and skin integrity

* Vaginal examination, including assessment of the pelvic floor contraction, and observation for urethral leakage when asking the patient to cough, which would indicate stress urinary incontinence.

* Voiding normally results in complete bladder emptying.

We looked at skin care for the patient with incontinence, which is good hygiene. To keep the skin clean and dry as safe as possible. To consider the use of barrier creams. Pressure reducing equipment. To change position. To regulate toileting or pad change. Avoid oil base creams such as Sudocrem and talc. Catheters: Some patients may feel apprehensive about having a catheter inserted. The procedure may have been necessary to relieve urinary retention, or to improve the patient quality of life and offer greater independence. It is essential that patient who have had an indwelling catheter inserted are given adequate information on how to care for their catheter and change the drainage equipment. Some patients may be able to choose between using a continuous urine drainage bag or a catheter valve.

The types of catheters are listed below:

* the single lumen – unidirectional flow- ISC & sterile urine collection.

* the double lumen – Inflatable retention balloon in one channel and urine drainage in another.

* the triple lumen – Retention balloon in one lumen and allow for bi-directional irrigation in the other two lumens. I learnt that the bigger the catheter, the more the urethra is dilated.

We ended up doing simulation on catheter.