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Health Assessment > Ch 21: Musculoskeletal assessment > Flashcards

Ch 21: Musculoskeletal assessment Flashcards

1
Q

How many muscles are in the body and what is the function

A

There are 600 muscles in the body and they give the body its shape

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2
Q

What is the function of skeletal muscles

(2)

A
  1. Give body shape

2. Facility movement

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3
Q

Where are Cartlidge discs
what are they used for
and what do they allow

A

Cartlidge discs:
Located between bones
Used to absorb shocking cushion joints
Hello bones slide over one another

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4
Q

Give what they connect/ do (last)

  1. Ligaments
  2. Tendons
  3. Fascia
A
  1. Ligaments: connect bone to bone
  2. Tendons: connect muscle to bone
  3. fascia: Flat sheet that lines and protects muscle fibers
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5
Q

What is another name for a joint and where are joints found, what do joints provide

A

Joints a.k.a. articulations

Joins or where two balloons come together

Joints provide mobility

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6
Q

Define a bursae and its function (cushions what)

A

Bursae is a fluid filled sac in areas of friction used to cushion bone

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7
Q

What do “compact bone” form

Give another name for cancellous bone and what does it make up

A

Compact bone forms shaft and outer layer of bone

Cancellous bone a.k.a. spongy bone
-Cancellous (spongy) bone make up ends and center

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8
Q

Give the types of muscles

A

Cardiac, smooth, skeletal

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9
Q

Joints:

Give other names and Describe the types of joints

A

Fibrous ( Synarthrotic) : immobile
-sutures in school

Cartilaginous (Amphiarthriotic): slightly movable
-located: between sternum, ribs, symphysis pubis

synovial (diarthrotic): Freely movable

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10
Q

What is the articulation of the temporomandibular joint

give its range of motion

A

TMJ: articulation of the mandible and temporal bone

Protrusion, retraction, side to side



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11
Q

Where does the shoulder articulate

give its range of motion

A

Shoulder: articulated humerus with glenoid fossa

Flex/extend
ABD/ADD
INT/external rotation

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12
Q

What does the elbow articulate with

Give its range of motion

A

Elbow: articulates with humerus and radius/ulna

Flex/extend
Pro/supinate

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13
Q

What does the wrist and hand articulate

give its range of motion

A

Wrist and hand: articulate radius and ulna with row of carpal muscles

Flex/extend
Sup/pronate
Rotate
Fist

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14
Q

What does the hip articulate with

 give its range of motion

A

Hip: articulate with acetabulum and head of femur

Flex/extend
ABD/ADD 
Intern/extern

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15
Q

What does the knee articulate

give it range of motion

A

Knee: articulate femur, TIbia, patella

Flex/extend

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16
Q

What do the ankle and foot articulate

give it range of motion

A

Ankle and foot: articulate tibia, fibula, talleus

Dorsiflex/plantar flex
In/Eversion

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17
Q

How many vertebrae does the spine have

give its divisions

give it range of motion

A

SPINE has 33 vertebrae

  • 7 cervical
  • 12 jurassic
  • 5 lumbar
  • 5 Sacral 
  • 3–4 coccygeal

Flex/extend
Lat rotation

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18
Q

What tests are used for evaluating carpal tunnel

Who is carpal tunnel most common in
(2)

How do you perform the exams

  1. Norm
  2. Abnorm
A

For carpal tunnel use Phallen and tinel test

Carpal tunnel most common in

  • secretarial
  • nurses
  1. Fallon test:
    -Have patient flex wrist at 90°
    -hold back of hands to each other
    -hold position for 60 seconds
    NORM: (NEG) No pain, numbness, burning
  2. Tinel test:
    - Percuss over medial nerve on inner aspect of wrist

Abnorm: pain equals carpal tunnel

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19
Q

What lifespan consideration condition is most common in your older adults due to aging

How is this disease process described

Who is this most common in

Give a few risk factors for a disease process

A

Osteoporosis: lack of bone density most common in older due to density

Osteoporosis: bone resorption more rapidly V deposition

Osteoporosis more common in women than men

Risk factors:

  • age/race
  • hereditary/ smoking
  • alcohol intake/steroidal use
  • Physical activity/high salt intake
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20
Q

Give older lifespanconsiderations for

Posture changes
Common occurrence
Joint flex
-what happens to the Cartlidge and how does the patients bidy respond

A

Older population:

  • Undergo possible changes of decreasing height
  • noted kyphosis: bending of the upper thoracic spine
  • decreased joint flexibility
  • cartilage begins degenerating and patient now has stiff joints/muscle atrophy
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21
Q

What are lifespan considerations related to pregnant women

A

lordosis present:
-Lumbar curves inward to compensate for uterine enlargement in third trimester

Increase in Joint mobility due to hormones progesterone Relaxin



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22
Q

What diagnostic test do you want to do in children, and how

What is common among infants that is tested in nursery what are the tests

A

In children assess bone growth with compared of x-ray

Congenital hip dislocation are common among infants noticing using

  • Ortolani maneuver
  • Barlow maneuver
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23
Q

What kind of movement does the Barlow/ ortolani maneuver examine

A

Barlow/ortolani maneuver examine internal/external rotation

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24
Q

What is most common among your caucasians and Asians

3 things

A

-osteoporosis
-curvature of long bones
_ metabolism of vitamin D

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25
Q 
Describe the type of injury:

1. Sprain 
2. fracture 
3. dislocation
A
  1. sprain: ligament/muscle injury
  2. fracture injury: bone
  3. dislocation: joint
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26
Q

What are the seven PS to use during urgent musculoskeletal assessments

What do you wanna do with any type of problem (I. E: soft tissue injury) involving bleeding

A 
Pain 
pallor 
poikilothermia 
 paresthesia
 pulseless 
paralysis 
perfusion

What’s any type of problem: stop the bleed

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27
Q

What vital things do we nurses do to prevent complications during urgent assessments and what are our nursing roles in the situation (3)

A

Prevent complications by immobilizing

  • assess using 7 P’s
  • splint area
  • Continue readsessing /adjusting
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28
Q

What is required:

For neck injury
For spinal injury
For fracture or joint upper or lower
Dislocation of bone upper or lower

A

Neck injury: cervical collar required

Spinal injury: back collar required

Fracture/joint: assess ans immobilize

Dislocation of bone: immobilize

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29
Q

What do you want to note in a patient with a hip fracture

What kind of assessment is a dislocated knee and what does it cause?

A

If hip fracture note one leg shorter than the othe

Dislocated knee = surgery emergency
Cause:
-trapped blood vessels leading to vascular necrosis


30
Q

What assessment tool is used for quickly inspecting gait

Give what it stands for

A

GALS locomotor screen used for quick gait assessment
G: Gait, Any wide base support

A arms: arms swing ?


L legs: 1 foot in front of the other



S: spine: straight/midline

31
Q

Give respecters for the musculoskeletal system

A 
Personal history
-congenital/musculoskeletal history/disease

Occupational, lifestyle, behaviors
-teach body mechanics, Risk for injury

Meds
Fam HX
-muscle, bone joint problems

Psychosocial history
-Smoking, alcohol, body image deformity
32
Q

What body mechanic teachings do you want to teach those at risk for injury at work

A 
TEACH 
Donts: 
-don’t bend 
-don’t twist
-don’t lift over 51 pounds alone

Do:
-use legs

33
Q

Give the causes of compartment syndrome

A 
Cast 
surgery 
crush injury
 burn 
snakebite 
area with splint
34
Q

Give signs and symptoms for compartment syndrome

A

Pain and pallor to area
Cool to touch
Cap refill + 3 seconds

35
Q

Give the health goals related to the musculoskeletal assessment

A

Decrease work related injuries
Increase physical activity
Encourage smoke cessation

36
Q

What do you want to look for when screening for scoliosis

Where are you going to see asymmetry with scoliosis

What ages are most often screened for scoliosis

A

When screening for scoliosis look for lateral curvature at spine, thoracic + lumbar areas

A symmetry at:

  • shoulders
  • scapula

Screening for scoliosis happens from preschool through high school
-hips

37
Q

Give a few osteoporosis prevention strategies

A
  • calcium, vitamin D intake
  • do weight bearing exercise
  • Avoid smoking/drinking
  • limit caffeine
38
Q

 Give common musculoskeletal symptoms

A

Pain/discomfort

  • Myalgia: muscle pain
  • Arthralgia: bone/joint pain

Weakness

stiffness
-limited movement: (contractures)

Deformities

Ataxia

39
Q

Define myalgia

Define arthralgia

What do you note along with weakness when examining the musculoscallet system

A

Myalgia: muscle pain

Arthralgia: bone joint pain

Along with weakness assessed for any tingling/numbness

40
Q

What is rheumatoid arthritis

What can it be

What is the patient main complaint

A

RA: Systemic inflammatory disorder
-Could be either symmetrical or bilateral

In a patient with RA main complaint will be pain worse in AM

41
Q

What is osteoarthritis what is the patient’s main complaint

A

OA: joints wear out

Osteoarthritis main complaint is pain worse at rest

42
Q

What are contractures

What do contractures develop from and what is needed if they pose an issue to daily activities


A

Contractures: shortening of tendon, Fascia, and muscles

Contractures develop from limited movement

Surgery is needed for contractures if prolonged positioning

43
Q

What do you want a note in joints and connective tissue

What can deformities effect

A

For joints and connective tissue note any inflammatory disease

Deformities can affect activities of daily living plus body image

44
Q

What will a fracture present with

A

Fractures Will present with:

  • Redness to area/warmth
  • unable to move extremity
  • inflammation
  • crepitus/pain
45
Q

What is a fasciculation and what are causes

A

Fasciculation: involuntary twitching of muscle fibers

Causes:

  • damage/weakened muscle
  • muscle fatigue
  • medication side effects
  • Low magnesium
  • anxiety
46
Q

Regarding lifespan considerations what are common age related changes in older populations

Strength
Biggest risk
What do we want to prevent

A

Common age related changes:

Decreased muscle strength

Increased rate of falls
-assess with Morse fall scale

Increased osteoporosis prevention strategies

  • calcium/vitamin D
  • limit coffee
  • do weight-bearing exercise
  • avoid smoking/alc
47
Q

Describe the Morse fall scale

What does it identify

What do the scores mean

A

Morse false scale is a nursing fall risk assessment

Morse full scale identifies if patient needs to be placed on a fall risk

Scores: The higher score the higher risk for falls
-0 to 24: no risk
-25 to 50: low risk
-51 and above: high risk

48
Q

Who is osteoporosis more commonly seen in

A

Osteoporosis more common in Caucasians and Asians + women

49
Q

What do you want to do for children and teens to prevent musculoskeletal injuries

A
  1. Look at the type of sport they play
    2 warm up to prevent injury
  2. Use safety equipment
50
Q

What are abnormal findings you can identify in A baby Assessment
(2)

A

Polydactyly
: extra toes usually on the ends -otherwise removed unless ROM and sensation

Syndactyly
:fused webbed fingers/toes -causes limited range of motion

51
Q

When beginning comprehensive assessment what do you want to look for

A

Look for erectness in patient
head that’s midline
DME
shoulders equal 

52
Q

What is normal gait

A

Normal gait: smooth rhythmic with arms swinging IN OPPOSITE Direction of legs

53
Q

What are ways to assess for balance

A

Assess for balance with

  • Romberg
  • tiptoes/heel walks
  • ** tandem walking: heel to toe
54
Q

How do you assess coordination

A

Is says coordination with rapid movements
-supinate and pronate
hands fingers to thumbs
-tap on Thigh

55
Q

When you’re inspecting extremities what is the most vital thing you want to do

 what are you looking for

What is the #1 thing that causes gait issues

Do unequal arms cause issues

A

Do bilat comparisons with extremities

Look at size shape and limb measurements
any casts

Discrepancies in leg length of + 1CM cause gait issues

Unequal arms do not cause issues

56
Q

What are the types of joint range of motion

what do you do if the patient has pain when completing range of motion

A

Joint ROM: active and passive

If pain with ROM stop and DO NOT FORCE 

57
Q

How do you access for muscle strength

Describe muscle tone and strength using scale
What outcomes on the muscle strength scale or against gravity

A

Assess for muscle strength by have patient push V your resistance

•3/5: (fair) v gravity
•4/5:(Good) V moderate resistance
• 5/5: (norm/ Full resistance) 
-3/5 to 5/5 Are against gravity

58
Q

What is a goniometer used for

Who uses the goniometer

A

Gonometer used to measure maximum angle of the joint extended/flexed
-Used by physical therapists

59
Q

Give the order in which the musculoskeletal assessment is completed

A

Musculoskeletal assessment completed:

  • Inspection
  • Palpation
  • ROM
  • muscle strength
60
Q

What is a common finding the patient may have when testing TMJ

When assessing cervical spine what is something abdorm you will note
2 things)

A

Testing TMJ may cause patient to have ear pain, H/ A

When assessing cervical spine abnormal notation:
Torticollis: lateral tilt muscle spasm of head
RA: asymmetrical deformity with joint stiffness in the AM

61
Q

What is an abnormal finding you will note on the ankle and foot

Give signs and symptoms of gout

What do you Want to monitor and how do you know if gout is present

A

On ankle and foot you can note:
-gout to RIGHT big toe

Signs and symptoms:

  • pain
  • redness
  • swelling

If gout monitor uric acid level
-if +8 level= Gout plus symptoms

62
Q

When assessing thoracic and lumbar spine what are three things you will note

A

Thoracic and lumbar spine inspection and palpation findings:

  • kyphosis: protrusion of spine backwards
  • lordosis: lumbar curving inward
    • especially with pregnant
  • Scoliosis
63
Q

What is the percentage of sustained injury when people fall

A

About 30 to 35% of people sustained injury when falling

64
Q

How do you measure true leg length

What will affect gait in relation to legs

A

True leg length: from anterior superior iliac crest to medial malleous

Leg Length discrepancies of +1 CM will affect gait


65
Q

What will happen if a patient falls in an acute care setting like a hospital

What do we do to prevent fall risk and what do you teach

A

If patient falls in hospital CMS (Medicaid) will not reimburse and if patient needs surgery or extended stay hospital will have to cover costs

Now to prevent fall risks we label patient with bracelet indicating for risk and implement special/frequent monitoring

teach patient to call you to toilet and be mobile

66
Q

What are working conditions that develop the most carpal tunnel

Why do you wanna be careful with lifting
-Give tips to prevent injury

A

Secretarial and nurses are at risk for developing carpal tunnel

Be careful with lifting because you can cause strain or back injury
-don’t live over 51 pounds alone, ask for help

67
Q

What are common laboratory Tests run give the inflammatory markers

A

LDH, CK, ALT/AST

  • ** uric acid
  • ** Inflammatory markers
  • sed rate
  • C reactive proteins
  • rheumatoid factor
68
Q

What are coming diagnostic test run for muscular skeletal assessments

A

X-ray: comparison x-ray for children with musculoskeletal issues to see if developing correctly

CT, MRI, bone density scan

69
Q

 What are nursing outcomes related to musculoskeletal assessments

A

Patient does not fall
Patient dresses, grooms, eats independently
Patient ambulate halls 3x daily


70
Q

Give nursing interventions related to musculoskeletal assessments

A

Teach patient to ask for help to ambulate

Open food packages, arrange food tray to encourage independent eating

Document type of assistance needed

71
Q

Give nursing diagnosis related to the musculoskeletal assessment

A

Impaired physical mobility
activity intolerance
self-care deficit
impaired walking

Health Assessment (20 decks)

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