Chapter 8

Muscular System

Anterior Superficial Muscles

Posterior Superficial Muscles

Lateral Facial Muscles

Effects of Immobility

Range of Motion

Use of Heat

Use of Cold

Massage

Positioning

For an in-depth study of the muscular system, consult the following publications:

Lewis SM, et al: Medical-surgical nursing, ed 8, St. Louis, 2011, Mosby.

Nugent P, Green J, Hellmer Saul MA, Pelikan P: Mosby’s comprehensive review of nursing for the NCLEX-RN examination, ed 20, St. Louis, 2012, Mosby.

Patton K, Thibodeau G: Structure and function of the human body, ed 14, St. Louis, 2012, Mosby.

Potter PA, Perry AG, Stockert PA, Hall A: Fundamentals of nursing, ed 8, St. Louis, 2013, Mosby.

Weilitz P, Potter PA: Pocket guide for health assessment, ed 6, St. Louis, 2007, Mosby.

Anterior Superficial Muscles

FIGURE 8-1 Anterior superficial muscles.

Posterior Superficial Muscles

FIGURE 8-2 Posterior superficial muscles.

Lateral Facial Muscles

FIGURE 8-3 Lateral facial muscles. (From Patton K, Thibodeau G: Structure and function of the human body, ed 14, St. Louis, 2012, Mosby.)

Grading Muscle Strength

Effects of Immobility

Benefits

Decreased need for oxygen

Decreased metabolism and energy use

Reduced pain

Bowel Changes

Constipation caused by decreased peristalsis

Poorer sphincter and abdominal muscle tone

Cardiac Changes

Heart rate increase of one-half beat per day caused by increased sympathetic activity

Decreased stroke volume and cardiac output caused by increased heart rate

Hypotension caused by vasodilatation, leading to thrombosis or edema

Integumentary Changes

Decreased turgor caused by fluid shifts

Increased decubitus ulcers caused by prolonged pressure

Increased skin atrophy caused by decreased nutrition

Metabolic Changes

Decreased metabolic rate

Increased catabolism (protein breakdown) leading to a negative nitrogen imbalance, which results in poorer healing

Hypoproteinemia leading to fluid shifts and edema

Musculoskeletal Changes

Decreased muscle strength of 20% per week

Decreased physical endurance and muscle mass

Muscle atrophy caused by decreased contractions

Osteoporosis caused by increased calcium extraction

Demineralization begins on second day of immobilization

Increased fractures caused by porous bones

Increased hypercalcemia

Muscle shortening leading to contracture

Respiratory Changes

Less alveoli expansion caused by less sighing

Increased mucus in lungs caused by less ability to clear them

Decreased chest movement restricts lung expansion

Stiff intercostal muscles caused by less stretching

Shallow respirations leading to decreased capacity

Increased secretions caused by supine position of lungs

Less oxygen leading to more carbon dioxide, which results in acidosis

Atelectasis caused by decreased blood flow

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