Bone Structure (Nursing)

by Rhonda Lawes, PhD, RN

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    00:01 So, I want to walk you through the inside of a bone.

    00:04 It is amazing what is going on in there.

    00:07 Now, you look at the screen you see the pelvic bone.

    00:09 Do you see that you have the hip sockets? And you've got the femurs. That's where we're going to zero in.

    00:15 So you've got a close up shot because I wanted to make sure you're aware that this is one of the most vulnerable areas in our geriatric population.

    00:23 When a geriatric client has a fall and they damage a hip, they break their hip that can start a really difficult series of events with bad outcomes.

    00:34 They're not the kind of outcomes we want for our geriatric clients.

    00:37 So keep at the forefront of your mind, safety and falls are really important that we help educate family members, and the geriatric clients themselves and how to keep themselves safe.

    00:49 Now, after that public service announcement, I want to show you a deeper look into our long bones.

    00:55 So take a look at the difference now of the bone on the right, and the bone on the left.

    01:00 Okay, we wanted that there.

    01:01 So you saw that this is we're looking at the inside of the bone.

    01:05 So that's why you see on the right side, it's all solid.

    01:08 Remember we said that bones turn from cartilage with calcium, they get ossified.

    01:13 Ossification is a process of making it much harder and stronger.

    01:17 The bone on the left is like we've taken an inside view for you.

    01:22 So same bone, but one side is how it looks on the outside, the left is how it looks on the inside.

    01:30 So, let's pull that bone up and really dig down.

    01:33 Now, you've got different types here of material in the bone.

    01:37 Spongy bone, as you see we have that highlighted.

    01:40 It's found in the long bones, and it's surrounded by compact bone.

    01:44 So the first things we want you to understand is that you have different types of let's call them material in the bone.

    01:51 Now, this is a femur. It's considered a long bone.

    01:54 So see the spongy bone and how it is surrounded by compact bone, because that's heavy, tough, and kind of dense and compact.

    02:03 That's what keeps you safe, and allows you to support your body weight when you have that compact bone.

    02:09 So let's show you once again, where is the spongy bone.

    02:13 Got it? Good.

    02:14 Where is the compact bone? Excellent. Now, we've got some other layers that we're going to introduce.

    02:21 Look at the yellow bone marrow.

    02:24 Okay, now you've heard the term bone marrow, right? A lot of things that go on in there. It's pretty cool.

    02:30 Another layer is the periosteum.

    02:33 Now, at the bottom, we've got the red bone marrow.

    02:36 So you have two different types of bone marrow: Yellow bone marrow, and red bone marrow.

    02:42 Now on the outside, we have the term cartilage.

    02:45 And that's what helps keep your bone staying together, right? I have cartilage that keeps that femur bone in my hip socket, so I can move my leg, and I can walk, and I can take steps.

    02:57 So cartilage is really important, and you want to keep that healthy.

    03:01 Now, let's talk about something like smoking.

    03:03 I know it's a pretty personal topic.

    03:05 And we've covered that in lots of our videos.

    03:07 But did you know that smoking is really hard on cartilage? So if someone has a lifetime habit of smoking, while they're cartilage is going to be really delicate.

    03:18 So if your cartilage is not good, you have an increased risk for falling or really having severe damage when you do.

    03:26 So just a side note, keep that in mind, that smoking doesn't just damage your lungs, it also is very difficult on your cartilage.

    03:37 Now, we've got a more detailed kind of anatomical breakdown of what a bone is really comprised of.

    03:43 Please don't let this overwhelm you.

    03:46 We were very particular and what we chose to illustrate here, so that you get a good understanding of your bone tissue.

    03:53 So let's take a look at the big picture first.

    03:57 Now, when you start on the inside, you'll see we've got the spongy bone.

    04:00 It's got that different web kind of look.

    04:03 When you're moving to the outside in the middle of the bone, you see we've got some blood canals there like Volkmann's canal.

    04:10 So, many times students don't think about the circulatory system being inside the bone, but it is.

    04:16 I mean, even in a crisis or an emergency, if we couldn't get a vein in a patient's arm, we couldn't start a peripheral IV, we can do a pretty traumatic entry into their thigh bone or their femur and access their circulatory system right there.

    04:30 So we can enter IV fluids and medications in an emergency.

    04:34 So we've got this bone.

    04:36 Pull back a little bit what's in the middle? Yeah, right. In this picture, you've got the spongy bone.

    04:42 And then we talked about, on the outside, we've got blood supplies going in there.

    04:48 Now, I want to focus on the osteons.

    04:51 These are the parts that make up the compact bone.

    04:54 So we're going to highlight those just for a minute because I really wanted to point out to you, there's a lots of them. There's not just one in the bone, there are many osteons.

    05:04 Okay, so before we go on, I want you to point out, where's this spongy bone? Good.

    05:10 Where's the blood supply? Excellent.

    05:15 And do you have one osteon or many osteons? Yes, you've got several. Like lots and lots and lots of them.

    05:25 Now, we're going to show you a big blown up picture of just a single osteon. Right.

    05:30 I want you to understand what's going on there.

    05:32 See that how you have the different labels there? Got those different levels and right in the middle, you've got your capillaries, which is your arteries, and your venules, which is your veins.

    05:43 So in the middle of every osteon is where we have that blood supply.

    05:47 Okay, I promise we're going to continue to break this down.

    05:51 But it's critically important all healthcare workers understand this part of their bone.

    05:59 So, you see our previous drawing on one side of your screen and you see spongy bone.

    06:04 Then we show you on the part that's in the shape of a femur, where the spongy bone is.

    06:09 Compact bone. We show it's all made up those osteons. Right? And now you see it in the other picture on a femur bone.

    06:17 So we're helping you visualize the different types of tissue.

    06:20 In this picture, we're featuring spongy bone and compact bone.

    06:26 Now, I'm going to help you compare the difference between compact bone and spongy bone.

    06:32 Now, in compact bone, the Lamellae are arranged in this regular kind of pattern right the Haversian systems.

    06:38 They've got canaliculi, and you see Volkmann's canal, they're all present.

    06:43 But if you look at the spongy bone, the Lamellae arranged kind of like this interfacing network, right? They've got Haversian systems are not in this type of bone in the spongy bone.

    06:55 So, what are some differences between the compact bone and a spongy bone right now that you could write down in regards to Lamellae and Haversian canals.

    07:06 Okay, now let's talk about the gaps.

    07:08 In compact bone, there are no gaps in between the lamellae.

    07:12 That's why we call it compact bone and why it is so much stronger.

    07:17 In spongy bone, you can see you've got some small spaces between the lamellae.

    07:22 That's why we call it spongy bone because it's got kind of holes like you see in a sponge.

    07:28 Now compact bone, it's in the shaft, right? So you saw when we looked at that femur, the compact bone is in the shaft.

    07:35 Sometimes you heard that called the diaphysis of long bones.

    07:40 Spongy bone forms the epiphysis of long bones.

    07:44 Besides forming skull bones, and vertebra and ribs.

    07:47 So they're actually in kind of different locations.

    07:51 Compact bone has a marrow and has a cavity for marrow.

    07:56 Spongy bone does not have a cavity for marrow.

    08:00 So when you're looking at those pictures, you can see we haven't noted any marrow area in the spongy bone.

    08:06 You see it in the compact bone.

    08:08 That's why if we were accessing, right, a thigh bone, we would do it right in the middle.

    08:13 We wouldn't do it at the top or bottom of the femur.

    08:17 Now, marrow cavity and compact bone has yellow bone marrow.

    08:23 So keep that in mind.

    08:24 But in spongy bone, the spaces between the lameliae they have the red marrow.

    08:30 So we'll talk a little bit more about red marrow versus yellow bone marrow.

    08:34 But remember that you have both.

    08:36 So wow, we've given you a lot of facts.

    08:39 Pause for just a minute without looking at your notes and see if you can make a quick chart that compares compact bone to spongy bone and see what you can remember.

    08:56 Now, let me have a time.

    08:58 Just to give you a chance to answer some questions.

    09:01 Let's see how you do with these.

    09:03 So which type of bone? Spongy bone or compact bone has a cavity for marrow? The answer is compact bone.

    09:17 Where is red bone marrow located? Spongy bone or compact bone? Spongy bone. Good.

    09:27 Who has lamellae? Now, who? Compact bone or spongy bone? Where are the lamellae arranged in a regular system? And where are they more of an interlacing network? Spongy bone is interlacing and therefore compact bone is the one that's more in order.

    09:47 Okay, are you staying with us? Keep in mind when you're going over this much information, especially with terms that you may not be familiar with yet, you need to pause and quiz yourself, and ask questions.

    10:00 Look for ways that you can personally write out the information in your own handwriting, because that really helps your brain encode things in a much more efficient manner.

    10:12 And two more fun facts. Let's talk about marrow.

    10:16 Now, in compact bone, the bone marrow stores fat.

    10:22 Listen, we need it to survive.

    10:24 But some of us wish we can have a little less storage.

    10:26 Don't you? Right.

    10:28 But look at the spongy bone.

    10:30 This is something I really want to focus on.

    10:32 Now, I know it is easy when we're going through all this content in terms you may not know to feel kind of overwhelmed or think, why do I need to memorize this? Well, in your classes before your nursing program, you may have had the opportunity to take a chart like this, memorize it, and you could get a great grade on your test.

    10:53 And that's fine.

    10:54 That was appropriate for that part of your program.

    10:56 But now, we're teaching you to be a nurse and develop clinical nursing judgment.

    11:02 So it's never enough for you just to memorize something.

    11:04 You have to think two things.

    11:06 Why would a nurse need to know this? How would it keep a patient safe? So let's take a look at what happens in your spongy marrow, and I'll give you an example.

    11:15 Remember, nursing is an applied science.

    11:18 Memorizing is the first baby step, but always asking, Why do I need to know this as a nurse in my practice? How can I use it to keep patients safe? Now, you're doing what a professional nurse does.

    11:30 You're on your way to developing your clinical nursing judgment.

    11:34 Because what the spongy marrow does, it actually produces your red cells and your white cells, and we're talking about blood cells.

    11:42 So, it produces your red blood cells and your white blood cells.

    11:47 If that bone marrow is damaged or suppressed, you're not going to have enough red cells or white cells.

    11:53 So, when would this type of thing happen? We'll see, That's why you need to think about why do I need to know this? Because there's certain medications that can suppress bone marrow.

    12:05 Now, it seems weird, but oftentimes, in healthcare, we have to weigh out the risk of a treatment versus the benefits.

    12:12 I know you've probably heard of patients on chemotherapy.

    12:15 That's going to have a really significant impact on bone marrow.

    12:19 So you end up with less white cells, which diminishes a patient's ability to fight off infection.

    12:25 White blood cells, there are fighters, right? They're the ones that keep us safe.

    12:30 Red blood cells are the ones that promote oxygen moving around in your body.

    12:35 So without those, you're not going to be as well perfused.

    12:38 So, bone marrow matters.

    12:41 You understanding where red cells and white blood cells are created matter. So when you're studying your drugs, and you see that this drug causes bone marrow suppression, you immediately know, "Oh, that's gonna be a problem with my white cells, and my red cells." So keep going stick with us.

    12:59 Remember, you're not just studying to pass a test.

    13:02 You're studying to be the kind of nurse you would want taking care of you or someone you really care for.

    About the Lecture

    The lecture Bone Structure (Nursing) by Rhonda Lawes, PhD, RN is from the course Bone Growth across the Lifespan (Nursing).

    Included Quiz Questions

    1. Compact bone
    2. Yellow bone marrow
    3. Red bone marrow
    4. Cartilage
    1. Two
    2. One
    3. Three
    4. Four
    1. Osteons
    2. Trabeculae
    3. Bone marrow
    4. Volkmann’s canal
    1. Lamellae are arranged in an interlacing system.
    2. They are made up of osteons.
    3. It is found in the shaft of long bones.
    4. There are no gaps between the lamellae.
    1. It is found in the shaft of long bones.
    2. There are no gaps between the lamellae.
    3. It does not have a cavity for bone marrow.
    4. Lamellae are arranged in an interlacing system.
    5. It contains red bone marrow.
    1. Blood cell production
    2. Fat storage
    3. Structural integrity
    4. Calcium storage

    Author of lecture Bone Structure (Nursing)

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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