Assessment of Musculoskeletal System

Question 1

Decreased bone density (osteopenia)
Increased bone prominence
Kyphotic posture - can lead to a widened gain and shift in the center of gravity
Cartilage degeneration
Decreased ROM
Slowed movement

Answer 1

Musculoskeletal changes with aging

Question 2

Imp because safety - decrease risk fractures
Fall more likely bones break
More weight-bearing exercises - increases bone density

Answer 2

Decreased bone density (osteopenia) - Musculoskeletal changes with aging

Question 3

Increased risk for pressure ulcers
Precautions - skin things and turning frequently

Answer 3

Increased bone prominence - Musculoskeletal changes with aging

Question 4

Increased risk for falling and injury
Leaned over posture
Do proper body mechanics

Answer 4

Kyphotic posture - can lead to a widened gain and shift in the center of gravity - Musculoskeletal changes with aging

Question 5

Wear and tear - less cartilage
Moist heat - increase blood flow and decrease pain

Answer 5

Cartilage degeneration - Musculoskeletal changes with aging

Question 6

Assess safety; how IADLs and ADLS

Answer 6

Decreased ROM - Musculoskeletal changes with aging

Question 7

Be patient and do not rush

Answer 7

Slowed movement - Musculoskeletal changes with aging

Question 8

Patient - lifestyle, how get around, exercise
Nutrition - Ca and vitamin D: decreased bone density; protein - keep muscle mass; overeating
Family and genetic risk - bone cancers and osteoporosis
Current health problems - pain (common) and weakness (issues getting around)

Answer 8

Assessment: history

Question 9

Muscle strength and Range of motion
Observe patient’s posture and gait
Mobility

Answer 9

Assessment: Physical Assessment

Question 10

Assess for crepitus (grating sound in joints with movement) - limited ROM - is diminished as age but want check
Feelings sponginess if effusion in joint

Answer 10

Muscle strength and Range of motion

Question 11

Assess balance, steadiness, symmetry of stride (limping) and ease and length of stride (shuffle) - smooth

Answer 11

Observe patient’s posture and gait

Question 12

Assess need for ambulatory devices
Asses ability to perform ADL’s and IADLS

Answer 12

Mobility

Question 13

Increases: bone cancer, Paget’s disease, healing bone fracture
Decreases: osteoporosis, osteomalacia
Gen Decreased in older adults

Answer 13

Serum calcium (9.0-10.5)

Question 14

Increases: healing bone fractures, bone tumors, acromegaly
Decreases: osteomalacia
Gen Decreased in older adults

Answer 14

Serum phosphate (3.0-4.5)

Question 15

Increases: bone cancer, Paget’s disease, osteomalacia
Slightly increased in older adults

Answer 15

Alkaline phosphatase ALP (30-120)

Question 16

Standard x-rays-can see bone density, alignment bones, and swelling in joints - fracture
Myelography-inject contrast media into subarachnoid space in spine - see if issues in vertebral column
Arthrogram-x-ray of joint after contrast media or air injected
CT

Answer 16

Radiography

Question 17

Bone scan-radioactive material injected and entire skeleton is viewed
Gallium and thallium scans-another type of scan with use of radioactive injection; more time
Inject then do scan
No precautions before/after

Answer 17

Nuclear scans

Question 18

Better diagnostic tool for joints, soft tissue and bony tumors
Go-to for MS probs

Answer 18

MRI

Question 19

Used for soft tissue, traumatic joint injuries, and osteomyelitis

Answer 19

Ultrasonography

Question 20

Bone or muscle
Suspect cancers/presence of weakness

Answer 20

Biopsies

Question 21

Not commonly used today
Used to evaluate diffuse or localized muscle weakness
Usually accompanied by nerve conduction studies for determining the electrical potential generated in an individual muscle - see nerve innervation of muscle
May cause temporary discomfort when subjected to episodes of electrical current
Mild sedation is prescribed for selected patients
Skeletal muscle relaxants may be held several days prior to procedure - testing func of muscle

Answer 21

Electromyography (EMG)

Question 22

May be used as a diagnostic test or surgical procedure
Fiberoptic tube inserted into a joint for direct visualization or surgical repair - see and do diagnostic tests
Nursing care after procedure:

Answer 22

Arthroscopy

Question 23

Assess neurovascular status of the affected limb every hour or according to protocol - perfusion
Monitor and document distal pulses, warmth, color, capillary refill, pain, movement, and sensation
Mild analgesic or opioid (not often), follow orders for activity, ice for 24 hours, elevation of extremity for 12 to 24 hours
Observe for complications which may include swelling, increased joint pain, thrombophlebitis, infection - diminished circ: clot

Answer 23

Nursing care after procedure: - Arthroscopy