Exam 3 Study Guide - Musculoskeletal System

Question 1

Changes w/ Aging

dcrd bone density
incrd bone prominence
kyphotic posture

Answer 1

• Dcrd bone density (osteopenia)
  > porous bones are more likely to fracture, exercise slows bone loss
  > Interventions: teach safety tips to prevent falls, reinforce need to exercise, especially weight-bearing exercise
• Incrd bone prominence
  > there is less soft tissue to prevent skin breakdown
  > Interventions: prevent pressure on bone prominences
• Kyphotic posture can lead to a widened gait & shift in center of gravity
  > correction of posture problems prevents further deformity, support for bony structures
  > Interventions: teach proper body mechanics, sit in supportive chairs w/ arms

Question 2

Changes w/ Aging

cartilage degeneration
dcrd ROM
slowed movement

Answer 2

• Cartilage degeneration
  > moist heat incrs blood flow to area
  > Interventions: provide moist heat; warm shower/moist compresses
• Dcrd ROM
  > pt may need assistance w/ self-care skills
  > Interventions: assess ability to perform ADLs & mobility
• Slowed movement
  > may become frustrated if hurried
  > Interventions: do not rush, be patient

Question 3

History & Physical

Answer 3

• Hx
  > pt
  > nutrition
  > family & genetic risk
  > current health probs
• Physical Assessment
  > muscle strength & ROM: assess for crepitus (grating sound in joints w/ movement)
  > observe pt’s posture & gait: assess balance, steadiness, symmetry of stride & ease & length of stride
  > mobility: assess need for abulatory devices & ability to perform ADLs

Question 4

Labs

Answer 4

• Serum Calcium (9.0-10.5)
  > incrd in: bone cx, Paget’s disease, healing bone fracture
  > dcrd in: osteoporosis, osteomalacia
  > dcrd in older adults
• Serum Phosphate (3.0-4.50
  > incrd in:healing bone fractures, bone tumors, acromegaly
  > dcrd in: osteomalacia
  > dcrd in older adults
• Alkaline Phosphatase (ALP) (30-120)
  > incrd in: bone cx, Paget’s disease, osteomalacia
  > slightly incrd in older adults

Question 5

Diagnostics

imaging

Answer 5

• Radiography
  > standard x-rays: can see bone density, alignment, & swelling
  > Myelography: inject contrast media into subarachnoid space
  > Arthrogram: x-ray of joint contrast media or air injected
  > CT
• Nuclear Scans
  > bone scan: radioactive material injected & entire skeletin is viewed
  > Gallium & Thallium scans: another type of scan w/ used of radioactive injection
• MRI
  > better diagnostic tool for joint, soft tissue & bony tumors
• Ultrasonography
  > used for soft tissue, traumatic joint injuries, & osteomyelitis
• Biopsies
  > bone or muscle

Question 6

Electromyography (EMG)

Answer 6

• 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
• May cause temporary discomfort when subjected to episodes of electrical current
• Mild sedation is prescribed for selected pts
• Skeletal muscle relaxants may be held several days prior to procedure

Question 7

Arthroscopy

Answer 7

• May be used as a diagnostic test or surgical procedure
• Fiberoptic tube inserted into joint for firect visualization or surgical repair
• Post Op Care:
  > assess neurovascular status of affected limb q1 or according to protocol
  > monitor & document distal pulses, warmth, color, capillary refill, pain, movement, & sensation
  > mild analgesic or opioid, follow orders for activity, ice for 24hrs, elevation for 12-24hrs
  > observe for comps: swelling, incrd joint pain, thrombophlebitis, infection