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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
``` Describe the type of injury:  1. Sprain 2. fracture 3. dislocation ```
1. sprain: ligament/muscle injury 2. fracture injury: bone 3. dislocation: joint
26
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
27
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
28
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
29
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 
30
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
31
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 ```
32
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
33
Give the causes of compartment syndrome
``` Cast surgery crush injury burn snakebite area with splint ```
34
Give signs and symptoms for compartment syndrome
Pain and pallor to area Cool to touch Cap refill + 3 seconds
35
Give the health goals related to the musculoskeletal assessment
Decrease work related injuries Increase physical activity Encourage smoke cessation
36
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
37
Give a few osteoporosis prevention strategies
- calcium, vitamin D intake - do weight bearing exercise - Avoid smoking/drinking - limit caffeine
38
 Give common musculoskeletal symptoms
Pain/discomfort - Myalgia: muscle pain - Arthralgia: bone/joint pain Weakness stiffness -limited movement: (contractures) Deformities Ataxia
39
# 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
40
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
41
What is osteoarthritis what is the patient’s main complaint
OA: joints wear out Osteoarthritis main complaint is pain worse at rest
42
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
43
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
44
What will a fracture present with
Fractures Will present with: - Redness to area/warmth - unable to move extremity - inflammation - crepitus/pain
45
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
46
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
47
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  ```
48
Who is osteoporosis more commonly seen in
Osteoporosis more common in Caucasians and Asians + women
49
What do you want to do for children and teens to prevent musculoskeletal injuries
1. Look at the type of sport they play 2 warm up to prevent injury 3. Use safety equipment
50
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
51
When beginning comprehensive assessment what do you want to look for
Look for erectness in patient head that’s midline DME shoulders equal 
52
What is normal gait
Normal gait: smooth rhythmic with arms swinging IN OPPOSITE Direction of legs
53
What are ways to assess for balance
Assess for balance with - Romberg - tiptoes/heel walks * ** tandem walking: heel to toe
54
How do you assess coordination
Is says coordination with rapid movements -supinate and pronate hands fingers to thumbs -tap on Thigh
55
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
56
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 
57
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
58
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
59
Give the order in which the musculoskeletal assessment is completed
Musculoskeletal assessment completed: - Inspection - Palpation - ROM - muscle strength
60
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
61
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
62
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
63
What is the percentage of sustained injury when people fall
About 30 to 35% of people sustained injury when falling
64
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 
65
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
66
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
67
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
68
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
69
 What are nursing outcomes related to musculoskeletal assessments
Patient does not fall Patient dresses, grooms, eats independently Patient ambulate halls 3x daily 
70
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
71
Give nursing diagnosis related to the musculoskeletal assessment
Impaired physical mobility activity intolerance self-care deficit impaired walking

Health Assessment (20 decks)

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