Ch 21: Musculoskeletal assessment Flashcards
How many muscles are in the body and what is the function
There are 600 muscles in the body and they give the body its shape
What is the function of skeletal muscles
(2)
- Give body shape
2. Facility movement
Where are Cartlidge discs
what are they used for
and what do they allow
Cartlidge discs:
Located between bones
Used to absorb shocking cushion joints
Hello bones slide over one another
Give what they connect/ do (last)
- Ligaments
- Tendons
- Fascia
- Ligaments: connect bone to bone
- Tendons: connect muscle to bone
- fascia: Flat sheet that lines and protects muscle fibers
What is another name for a joint and where are joints found, what do joints provide
Joints a.k.a. articulations
Joins or where two balloons come together
Joints provide mobility
Define a bursae and its function (cushions what)
Bursae is a fluid filled sac in areas of friction used to cushion bone
What do “compact bone” form
Give another name for cancellous bone and what does it make up
Compact bone forms shaft and outer layer of bone
Cancellous bone a.k.a. spongy bone
-Cancellous (spongy) bone make up ends and center
Give the types of muscles
Cardiac, smooth, skeletal
Joints:
Give other names and Describe the types of joints
Fibrous ( Synarthrotic) : immobile
-sutures in school
Cartilaginous (Amphiarthriotic): slightly movable
-located: between sternum, ribs, symphysis pubis
synovial (diarthrotic): Freely movable
What is the articulation of the temporomandibular joint
give its range of motion
TMJ: articulation of the mandible and temporal bone
Protrusion, retraction, side to side

Where does the shoulder articulate
give its range of motion
Shoulder: articulated humerus with glenoid fossa
Flex/extend
ABD/ADD
INT/external rotation
What does the elbow articulate with
Give its range of motion
Elbow: articulates with humerus and radius/ulna
Flex/extend
Pro/supinate
What does the wrist and hand articulate
give its range of motion
Wrist and hand: articulate radius and ulna with row of carpal muscles
Flex/extend
Sup/pronate
Rotate
Fist
What does the hip articulate with
 give its range of motion
Hip: articulate with acetabulum and head of femur
Flex/extend
ABD/ADD 
Intern/extern
What does the knee articulate
give it range of motion
Knee: articulate femur, TIbia, patella
Flex/extend
What do the ankle and foot articulate
give it range of motion
Ankle and foot: articulate tibia, fibula, talleus
Dorsiflex/plantar flex
In/Eversion
How many vertebrae does the spine have
give its divisions
give it range of motion
SPINE has 33 vertebrae
- 7 cervical
- 12 jurassic
- 5 lumbar
- 5 Sacral 
- 3–4 coccygeal
Flex/extend
Lat rotation
What tests are used for evaluating carpal tunnel
Who is carpal tunnel most common in
(2)
How do you perform the exams
- Norm
- Abnorm
For carpal tunnel use Phallen and tinel test
Carpal tunnel most common in
- secretarial
- nurses
- 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 - Tinel test:
- Percuss over medial nerve on inner aspect of wrist
Abnorm: pain equals carpal tunnel
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
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
Give older lifespanconsiderations for
Posture changes
Common occurrence
Joint flex
-what happens to the Cartlidge and how does the patients bidy respond
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
What are lifespan considerations related to pregnant women
lordosis present:
-Lumbar curves inward to compensate for uterine enlargement in third trimester
Increase in Joint mobility due to hormones progesterone Relaxin

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
In children assess bone growth with compared of x-ray
Congenital hip dislocation are common among infants noticing using
- Ortolani maneuver
- Barlow maneuver
What kind of movement does the Barlow/ ortolani maneuver examine
Barlow/ortolani maneuver examine internal/external rotation
What is most common among your caucasians and Asians
3 things
-osteoporosis
-curvature of long bones
_ metabolism of vitamin D
Describe the type of injury:  1. Sprain 2. fracture 3. dislocation
- sprain: ligament/muscle injury
- fracture injury: bone
- dislocation: joint
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
Pain pallor poikilothermia paresthesia pulseless paralysis perfusion
What’s any type of problem: stop the bleed
What vital things do we nurses do to prevent complications during urgent assessments and what are our nursing roles in the situation (3)
Prevent complications by immobilizing
- assess using 7 P’s
- splint area
- Continue readsessing /adjusting
What is required:
For neck injury
For spinal injury
For fracture or joint upper or lower
Dislocation of bone upper or lower
Neck injury: cervical collar required
Spinal injury: back collar required
Fracture/joint: assess ans immobilize
Dislocation of bone: immobilize
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?
If hip fracture note one leg shorter than the othe
Dislocated knee = surgery emergency
Cause:
-trapped blood vessels leading to vascular necrosis

What assessment tool is used for quickly inspecting gait
Give what it stands for
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
Give respecters for the musculoskeletal system
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
What body mechanic teachings do you want to teach those at risk for injury at work
TEACH Donts: -don’t bend -don’t twist -don’t lift over 51 pounds alone
Do:
-use legs
Give the causes of compartment syndrome
Cast surgery crush injury burn snakebite area with splint
Give signs and symptoms for compartment syndrome
Pain and pallor to area
Cool to touch
Cap refill + 3 seconds
Give the health goals related to the musculoskeletal assessment
Decrease work related injuries
Increase physical activity
Encourage smoke cessation
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
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
Give a few osteoporosis prevention strategies
- calcium, vitamin D intake
- do weight bearing exercise
- Avoid smoking/drinking
- limit caffeine
 Give common musculoskeletal symptoms
Pain/discomfort
- Myalgia: muscle pain
- Arthralgia: bone/joint pain
Weakness
stiffness
-limited movement: (contractures)
Deformities
Ataxia
Define myalgia
Define arthralgia
What do you note along with weakness when examining the musculoscallet system
Myalgia: muscle pain
Arthralgia: bone joint pain
Along with weakness assessed for any tingling/numbness
What is rheumatoid arthritis
What can it be
What is the patient main complaint
RA: Systemic inflammatory disorder
-Could be either symmetrical or bilateral
In a patient with RA main complaint will be pain worse in AM
What is osteoarthritis what is the patient’s main complaint
OA: joints wear out
Osteoarthritis main complaint is pain worse at rest
What are contractures
What do contractures develop from and what is needed if they pose an issue to daily activities

Contractures: shortening of tendon, Fascia, and muscles
Contractures develop from limited movement
Surgery is needed for contractures if prolonged positioning
What do you want a note in joints and connective tissue
What can deformities effect
For joints and connective tissue note any inflammatory disease
Deformities can affect activities of daily living plus body image
What will a fracture present with
Fractures Will present with:
- Redness to area/warmth
- unable to move extremity
- inflammation
- crepitus/pain
What is a fasciculation and what are causes
Fasciculation: involuntary twitching of muscle fibers
Causes:
- damage/weakened muscle
- muscle fatigue
- medication side effects
- Low magnesium
- anxiety
Regarding lifespan considerations what are common age related changes in older populations
Strength
Biggest risk
What do we want to prevent
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
Describe the Morse fall scale
What does it identify
What do the scores mean
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 
Who is osteoporosis more commonly seen in
Osteoporosis more common in Caucasians and Asians + women
What do you want to do for children and teens to prevent musculoskeletal injuries
- Look at the type of sport they play
2 warm up to prevent injury - Use safety equipment
What are abnormal findings you can identify in A baby Assessment
(2)
Polydactyly
: extra toes usually on the ends -otherwise removed unless ROM and sensation
Syndactyly
:fused webbed fingers/toes -causes limited range of motion
When beginning comprehensive assessment what do you want to look for
Look for erectness in patient
head that’s midline
DME
shoulders equal 
What is normal gait
Normal gait: smooth rhythmic with arms swinging IN OPPOSITE Direction of legs
What are ways to assess for balance
Assess for balance with
- Romberg
- tiptoes/heel walks
- ** tandem walking: heel to toe
How do you assess coordination
Is says coordination with rapid movements
-supinate and pronate
hands fingers to thumbs
-tap on Thigh
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
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
What are the types of joint range of motion
what do you do if the patient has pain when completing range of motion
Joint ROM: active and passive
If pain with ROM stop and DO NOT FORCE 
How do you access for muscle strength
Describe muscle tone and strength using scale
What outcomes on the muscle strength scale or against gravity
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
What is a goniometer used for
Who uses the goniometer
Gonometer used to measure maximum angle of the joint extended/flexed
-Used by physical therapists
Give the order in which the musculoskeletal assessment is completed
Musculoskeletal assessment completed:
- Inspection
- Palpation
- ROM
- muscle strength
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)
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
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
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
When assessing thoracic and lumbar spine what are three things you will note
Thoracic and lumbar spine inspection and palpation findings:
- kyphosis: protrusion of spine backwards
- lordosis: lumbar curving inward
- especially with pregnant
- Scoliosis
What is the percentage of sustained injury when people fall
About 30 to 35% of people sustained injury when falling
How do you measure true leg length
What will affect gait in relation to legs
True leg length: from anterior superior iliac crest to medial malleous
Leg Length discrepancies of +1 CM will affect gait

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
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
What are working conditions that develop the most carpal tunnel
Why do you wanna be careful with lifting
-Give tips to prevent injury
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
What are common laboratory Tests run give the inflammatory markers
LDH, CK, ALT/AST
- ** uric acid
- ** Inflammatory markers
- sed rate
- C reactive proteins
- rheumatoid factor
What are coming diagnostic test run for muscular skeletal assessments
X-ray: comparison x-ray for children with musculoskeletal issues to see if developing correctly
CT, MRI, bone density scan
 What are nursing outcomes related to musculoskeletal assessments
Patient does not fall
Patient dresses, grooms, eats independently
Patient ambulate halls 3x daily

Give nursing interventions related to musculoskeletal assessments
Teach patient to ask for help to ambulate
Open food packages, arrange food tray to encourage independent eating
Document type of assistance needed
Give nursing diagnosis related to the musculoskeletal assessment
Impaired physical mobility
activity intolerance
self-care deficit
impaired walking
