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Health Assessment 4 > Ch. 22 Musculoskeletal > Flashcards

Ch. 22 Musculoskeletal Flashcards

1
Q

What shape is an infants spine at birth

A

At birth, the spine has a single C curve.

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2
Q

By what age does the infant spine fully develop all curves

A

By 18 months

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3
Q

What type of foods help prevent obesity and promote bone mass accrual in children

A

Dark greens, deep yellow vegetables, low in fried foods.

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4
Q

By what age gestation has a fetus formed a scale model of the skeleton

A

3 months gestation

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5
Q

Of what is the fetus skeleton made initially

A

cartilage

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6
Q

From where does bone lengthening occur in infants

A

epiphyses, or growth plates

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7
Q

At what age is the last closure of the epiphyses in children/adolescents

A

by age 20

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8
Q

at what point in development is growth markedly increased

A

adolescent growth spurt

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9
Q

what leads to increased mobility in joints during pregnancy

A

increased hormone levels

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10
Q

What is the result of increased joint mobility in pregnancy

A

noticeable changes in posture

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11
Q

What is lordosis

A

compensation for the fetus by shifting weight farther back on the lower extremities. This shift in balance creates back strain, which is why some woman experience back pain during pregnancy.

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12
Q

What are other postural changes that occur during pregnancy

A

anterior flexion of the neck and slumping of the shoulder girdle compensate for lordosis.
Upper back changes may put pressure on the ulnar and median nerves during 3d trimester.
Nerve pressure leads to aching, numbness, weakness in UE of woman.

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13
Q

What is remodeling (in context of of aging adult musculature)

A

cyclic process of bone reabsorption and deposition

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14
Q

By what age does bone mass peak

A

25 - 35 y.o.

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15
Q

At what does loss of bone matrix start to occur more rapidly.

A

40 y.o.

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16
Q

What is the definition of osteoporosis

A

gradual loss of bone density

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17
Q

At what age does osteoporosis become more prominent in women and why

A

5 years after menopause (due to lack of estrogen leading to accelerated bone loss).

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18
Q

At what age does decrease in height predominately occur and why

A

most sign. after 60; greater decrease occurs in 70-80’s as a result of osteoporotic collapse of vertebrae.

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19
Q

What are some postural changes that occur in the aging adult?

A

kyphosis, backward head tilt to compensate for kyphosis, slight flexion of hips/knees, loss of subq fat, Loss of fat in face and deposits of fat in abdomen and hips.

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20
Q

What is the result of loss of subq. fat in the aged adult?

A

leaves bony prominences more marked, absolute loss of muscle mass occurs, some decrease in size, and some atrophy, producing weakness.

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21
Q

Subj. data: joints: Pain

A

joint pain and loss of f’n are most common reasons ppl seek care
RA involves symmetric joints; other illnesses involve unilateral.
Acute inflammation can lead to tenderness
RA pain is worse in am when arising; osteoarthritis is worse later in the day; tendinitis is worse in the morning, improves during day.
Mvt ^ most jt pain except in RA in which mvt decreases pain.
Rheumatic fever can be suggested if joint pain 10-14 days after untreated step throat

22
Q

Subj. data: joints: stiffness

A

RA stiffness occurs in am and after rest periods

23
Q

Subj. data: joints: swelling

A

Swelling, heat, redness: suggests acute inflammation

24
Q

Subj. data: joints: limitation of mvt

A

Limitation of mvt: decreased ROM may be caused by jt injury to cartilage or capsule or to muscle contracture

25
Q

Subj. data: Knee Joint (if injured)

A
  1. inside knee injury can strain or rupture medial ligament; outside injury can be strain or rupture of lateral ligament; abrupt twisting can injure anterior cruciate ligament
  2. Pop: may mean tear in ligament or fracture. For trauma, get xray if pt unable to flex knee 90 degrees or unable to bear weight.
26
Q

Subj. data; muscles: pain

A
  1. Myalgia: usually felt as cramping or aching.
  2. Calf muscle cramps/pain: can suggest claudication
  3. Flu can lead to myalgia (viral illness)
  4. Smaller muscles can indicate atrophy
27
Q

Subj. data; muscles: weakness

A

ask about weakness: may involve musculoskeletal or neurologic systems

28
Q

Subj. data: bones: bone pain, deformity, accidents or trauma hx

A

Fx causes sharp pain that ^ with movement. Other bone pain usually feels dull and deep and unrelated to mvt.
DEFORMITY: injury or trauma related? Does it affect ROM?
TRAUMA (FX, SPRAINS, DISLOCATIONS): accidents, traumas, sprain, dislocation.

29
Q

What are the parts of functional assessment for musculoskeletal?

A

i. Screens for safety of independent living, need for home health services, quality of life.
ii. Assess any self-care deficit.
iii. Bathing
iv. Toileting
v. Dressing
vi. Grooming
vii. Eating
viii. Mobility (impaired physical mobility?)
ix. Communicating (impaired verbal communication)

30
Q

Subj. Data: musculoskeletal: pt. centered care

A

Assess risk for carpel tunnel or back pain based upon occupation or repetition
A strict program of regular high dose exercise ^ bone strength and reduce fx risk.
Review daily aspirin and NSAID schedule; screen for adverse effects (GI);
Menopausal hormone therapy ^ BMD and reduce fx rates, although benefits disappear in a few years once hormones are discontinued.
Ask about supplemental meds: Dietary Ca is better absorbed than supplements.
If pt has chronic disability or crippling illness, Assess for
1. Self-esteem disturbance
2. Loss of independence
3. Body image disturbance
4. Role performance disturbance
5. Social isolation
Smoking/alcohol: smoking ^ bones loss and risk of fx in older women; alcohol moderate to heavy ^ falls risk.

31
Q

additional hx for infants/children

A

Ask about traumatic delivery which increases risk for trauma; did baby need resuscitation? period of anoxia may result in hypotonia of muscles; ask about bone deformity, including spinal curvature, unusual shape of toes or feet.

32
Q

additional hx for adolescents

A

rationales: assess safety of sport for child. Note if ht and wt are adequate for particular sport; use of safety equipment and presence of adult supervision dec. risk for sports injuries; students may not report injury or pain for fear of limiting participation in sport so import. to ask if they have been hurt.

33
Q

add’l hx for aging adult

A

Use fn’l ass’t hx q. to elicit any loss of f’n, self care deficit, or safety risk that may occur as a process of aging or M.S. illness.
Ask about any changes in weakness; encourage exercise

34
Q

what are some guidelines for aging adult when reviewing fall risk hx?

A

Assess mobility devices

  1. Screening interval should be q. 2 years to measure change in BMD (Bone mineral density).
  2. Screening time is based upon osteopenia severity (i.e.. woman at moderate risk for ostopenia should be screened q 5 yrs).
35
Q

Obj. data: ROM: abnormal findings

A

limitation in ROM is most sensitive sign of jt disease.

36
Q

Obj. data: ROM: what is articular disease

A

inside the joint capsule, such as arthritis, produces swelling and tenderness around whole joint, even if it limits all planes of ROM in both active and passive m’n.

37
Q

Obj. data: ROM: what is extra-articular disease

A

injury to a specific tendon, ligament, nerve produces swelling and tenderness to that 1 spot in jt. and affects only certain planes of ROM, especially during active (voluntary) m’n.

38
Q

What is crepitation

A

audible and palpable crunching or grating that accompanies mvt. Occurs when articular surfaces in jts are roughened, as with RA

39
Q

HIPS: normal findings

A

Note symmetric levels of iliac crests, gluteal folds, equally sized buttocks. Smooth gait reflects equal leg lengths and functional hip motion.

40
Q

HIPS: abnormal findings, including ROM

A

abnormal pain with palpation and crepitation with palpating hip joints.
Abnormal findings include limited motion, pain with motion, flexion flattens lumbar spine; if this reveals a flexion deformity in the opposite hip, it is a positive Thomas test.
Limited internal rotation of hip is an early and reliable sign of hip disease
Limitation of abduction of hip while supine is most common motion dysfunction found in hip disease

41
Q

What are some important things to remember/do when pt has injury of musculoskeletal?

A

Check pulses distal to the injury

Any time you move pt, check circulation, sensory and motor senses.

42
Q

SPINE; normal findings

A

Knees and feet should be aligned w/ trunk and pointing forward.
Should have normal convex thoracic curve and concave lumbar curve.
Palpate spinous process. Should be straight and nontender.
Palpate the paravertebral muscles, they should feel firm w/o tenderness or spasm.
Check ROM of spine: flexion of 75 -90 degrees and smoothness and symmetry of mvt. Concave lumbar curve should disappear w/ this motion and back should have a single convex C-shaped curve.

43
Q

SPINE: abnormal findings

A
  • a difference in shoulder elevation and in level of scapulae and iliac crests occurs w/ scoliosis
  • Lordosis is pronounced lumbar curve (common in obesity)
    Spinal curvature is abnormal
    Tenderness; spasm of paraverterbral muscles
  • Chronic axial skeletal pain occurs with fibromyalgia syndrome.
44
Q

Obj. data, Dev. Comp. Adolescents

A

spinal posture is key. screen for scoliosis which is most apparent during the preadolescent growth spurt; marked asymmetry suggests scoliosis – ribs hump up one side as child bends forward, with unequal landmark elevation

45
Q

Obj. data, Dev. Comp. Aging Adult; Postural Changes

A
  1. Decrease in height, more apparent in 8th and 9th decades.
  2. Lengthening of the arm-trunk axis describes shortening of truck with comparatively long extremities.
  3. Kyphosis is common – with backward head tilt to accommodate.
  4. Slight flexion of hips and knees are also common
46
Q

Get up and Go

A

Performance > 10 seconds together w/ hx of falls and mobility problems increases risk for future falling.

47
Q

Rheumatoid arthritis ; discuss symptoms

A
  • Pain worse in morning when arising
  • Stiffness occurs in the morning & after rest periods
  • Movement decreases pain
48
Q

Osteoarthritis - when are symptoms worse

A
  • Is worse later in day
49
Q

Tendinitis- when are symptoms worse

A
  • Worse in the morning, improves during day
50
Q

what are some characteristics/recommendations for osteoporosis?

A
  • Not a part of normal aging
  • Bones of wrist, hip, spine most often affected
  • Prevention / health promotion important, why ? ( osteoporosis is treatable, but no cure)
  • Protect bones by eating a well-balanced diet, regular exercise, avoid smoking, limit alcohol intake
  • Getting enough vit D and calcium
  • Our body does not produce new calcium – must come from food, if not body will take calcium from bones.
  • Connection between vit D and Calcium- body needs vit D to absorb calcium

Health Assessment 4 (4 decks)

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