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N321: Nursing Assessment of Clients > Module 11 - Muscular System Portion > Flashcards

Module 11 - Muscular System Portion Flashcards

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1
Q

Osteoblasts

A

Cells that form new bone

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2
Q

Osteoclasts

A

Cells that breakdown bone

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3
Q

Red Marrow is in ___ Bones

A

Flat

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4
Q

Yellow Marrow is in ___ Bones

A

Long

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5
Q

Long Bones

A

bones that are longer than they are wide

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6
Q

Flat Bones

A

thin bones that are often curved, like ribs

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7
Q

Red Marrow

A

Highly vascularized hematopoietic stem cells

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8
Q

Yellow Marrow

A

Fat

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9
Q

Short Bones

A

Bones approximately equal in length, width, and thickness

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10
Q

Irregular Bones

A

bones like that of the face with no characteristic shape

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11
Q

Compact Bone

A

dense bone

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12
Q

Spongy Bone

A

cancellous bones that are light, soft, and spongy in nature filling the inner layer of most bones and forming the epiphyses of long bones

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13
Q

Compact Bones

A

cortical bones that are heavy, tough, and compact in nature making the outer layer of most bones and forming the diaphysis of long bones

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14
Q

Epiphysis

A

the end part of a long bone

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15
Q

Diaphysis

A

shaft or central part of a long bone

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16
Q

Epiphyseal Plate

A

The area of growth in a long bone (could be interrupted by circulation issues)

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17
Q

Muscles account for ___% of the bodys weight

A

40-50%

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18
Q

3 Types of Muscles

A

Cardiac
Smooth
Skeletal

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19
Q

Cardiac Muscle

A

tissue that involuntarily controls heart movements through specialized pacemaker cells

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20
Q

Smooth Muscle

A

Involuntary Muscle

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21
Q

Skeletal Muscle

A

Voluntary Muscle

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22
Q

Tendons

A

Stabilizers connecting muscle to bone

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23
Q

Ligament

A

Stabilizers connecting bone to bone

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24
Q

Cartilage

A

Gel pad between bones offsetting wear and tear and bone erosion

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25
Q

Bursa

A

Disc shaped sacs filled with a synovial fluid for cushioning

Between bones or tendons/ major joints of the body

Eases friction

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26
Q

Bursitis

A

Inflammation and irritated synovial fluid composure and joint appearance / Bursa inflammation

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27
Q

Every joint has ____

A

flexion

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28
Q

Extension

A

movement that increases the angle between 2 body parts

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29
Q

Flexion

A

movement that decreases the angle between 2 body parts

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30
Q

Dorsiflexion

A

action of raising the foot upward toward the shin

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31
Q

Plantarflexion

A

action in which the top of your foot points away from your leg (opp of dorsiflexion)

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32
Q

Hyperextension

A

to extend so that the angle between bones of a joint is greater than normal

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33
Q

Abduction

A

the movement of limb or other parts away from the midline of the body, or another part

AB = Away from Body

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34
Q

Adduction

A

the movement of a limb or other part toward the midline of the body, or another part

AD = ADd toward

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35
Q

Circumduction

A

The movement of a body region in a circular manner, where one end of the body remains stationary while the other moves circularly

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36
Q

Internal Rotation

A

rotation toward the center of the body

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37
Q

External Rotation

A

rotation away from the center of the body

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38
Q

Pronation

A

Rotation of a body part toward the midline / Rotation of the hand and forearm so that the palm faces backwards or downwards (palm posterior up)

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39
Q

Supination

A

Rotation of forearm and hand so the palm faces forward or upward

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40
Q

Inversion

A

Turn the foot toward the midline of the body

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41
Q

Eversion

A

Turn the foot away from the midline of the body

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42
Q

TMJ

A

Temporal Mandibular Joint

A hinge and gliding joint for the jaw

It can retract or protract, retract, elevate, and depress the mandible

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43
Q

What kind of joint is TMJ

A

Hinge and Gliding

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44
Q

What kind of joint is the cervical spine?

A

Gliding

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45
Q

Cervical Spine

A

Gliding joint allowing for flexion, extension, hyperextension, hyperflexion, lateral bending, and lateral rotation

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46
Q

The Thoracic and Lumbar spine allow for what movements?

A

Flexion

Extension

Hyperextension

Lateral Bend

Rotation

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47
Q

What kind of joint is the shoulder and hip?

A

Ball and Socket

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48
Q

What sort of movement can shoulder and hip joints do?

A

Many since they are ball and socket joints - its like a baseball in a glove

Flexion, Abduction, Extension, Adduction, External and Internal rotation

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49
Q

What kind of joints are the elbow and knee

A

Hinge joints

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50
Q

What sort of movements can the elbow and knee do?

A

Extension

Flexion

Hyperextension

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51
Q

What kind of joint is the wrist?

A

condyloid joint

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52
Q

What sort of movements can the wrist do?

A

Flexion and Extension

Hyperextension

Ulnar and Radial Deviation

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53
Q

Ulnar Deviation

A

“Ulnar Drift”

Condition where knuckle bones swell and your fingers bend abnormally toward the ulnar (little finger) side

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54
Q

Radial Deviation

A

conditions where bones swell and your fingers bend abnormally toward the radial (thumb) side

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55
Q

What kind of joints are in the fingers and hands?

A

Hinge

Saddle

Condyloid

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56
Q

What movements can the hands and fingers do?

A

Fingers: Abduction/Adduction, Opposition/Reposition

Palmar: Adduction/Abduction

Hyperextension

Flexion

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57
Q

What kind of joints are the ankles?

A

Hinge

Gliding

Condyloid

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58
Q

What sort of movements can the ankles do?

A

Mainly dorsiflexion and plantarflexion

The feet can do eversion, inversion, abduction, and adduction

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59
Q

Special Musculoskeletal considerations for infants and children?

A

Cartilage Ossifies in adolescence

Epiphyses - closure around age 20

Scoliosis (Shoulder, hips) could be possible

Their Birth history is important to know for any issues

Genu varum

Genu valgum

Childhood illness with impact on bone growth

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60
Q

Genu Varum

A

Bow Leg (Birth issue or hip issue)

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61
Q

Genu Valgum

A

Knock knee (knees closer and feet apart)

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62
Q

Special musculoskeletal considerations for older adults?

A

After age 40, loss of bone matrix - Osteoporosis risk increases

Postural changes (Dowagers hump kyphosis, flexion of hips and knees)

Intervertebral disc dehydration

Atrophy of muscle mass and size lading to decreased agility, gait changes, potential balance issues

Greater risk for falls

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63
Q

Why does risk for osteoporosis increase with age?

A

Osteoclasts increase while osteoblasts decrease causing less formation and more absorption

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64
Q

Special musculoskeletal considerations for prenancy?

A

Increased hormone level

Increase mobility

Lordosis (r/t hormones)

Resultant upper cervical compensation

Possible pressure on ulnar and median nerves causing numbness and tingling in hands (carpal tunnel)

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65
Q

Lordosis

A

Inward/concave curve to the lumbar spine

May exaggerate in pregnancy and other areas need to compensate (like the cervical spine)

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66
Q

Information to gather during a musculoskeletal health history?

A

Musculoskeletal problems, pain, disease

Medications and OTC Meds

Accidents or Trauma

Nutrition

Personal Habits (Smoking and Caffeine)

Activity Limitations

Pain (Time of day, muscle cramping and soreness, bone deep dull throbbing, etc)

Weakness

Stiffness

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67
Q

Caffeine is linked to ____

A

osteoporosis

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68
Q

Smoking lowers ….

A

estrogen in both genders which usually helps bones keep calcium

69
Q

What time of day is Rheumatoid Arthritis pain worse?

A

Morning

70
Q

What time of day is Osteoarthritis pain worse?

A

Evening

71
Q

Stiffness w/ Rheumatoid Arthritis means you should do what?

A

Rest

72
Q

Stiffness w/ osteoarthritis means you should do what?

A

Movement

73
Q

Proximal musculoskeletal weakness is usually caused by …

A

myopathy

74
Q

Distal musculoskeletal weakness is usually caused by …

A

neuropathy

75
Q

What sort of specific history information should be gathered during the musculoskeletal assessment?

A

Childhood history: cerebral palsy at birth

Family history (gout, arthritis, etc)

Bone Scan after age 65+

PMH

Past injuries

Recent Infections or Exposure to Toxins: Lyme, STI, HIV, neuropathy

Are immunizations current (Tetanus)

Allergies to milk, calcium, or Vit D

Medications being taken for musculoskeletal reasons

76
Q

Anticonvulsants exasperate what musculoskeletal (MSSK) issue

A

Ataxia

77
Q

Antidepressants exacerbate what MSSK issue

A

aches and pains

78
Q

Antilipemic exasperates what MSSK issue

A

Rhabdomyolysis (Destruction of muscle tissue)

79
Q

Corticosteroids exasperate what MSSK issue

A

Osteoporosis

80
Q

Diuretics treat what MSSK issue

A

Cramping

81
Q

Information relevant to the musculoskeletal system during the ROS?

A

Feeling

Weight

Fever

Rash

Hair Distribution

Glands

Respiratory or Cardio issues

Dry or Red eyes

STIs

menopause

numbness or tingling

diabetes

thyroid issues

bruises easily

abdominal pain

bowel problems

blood in the urine

82
Q

Information important to the musculoskeletal system during a psychosocial profile?

A

Annual physical (did they go?)

typical body mechanics

typical day

nutrition habits

weight

hobbies, sports, recreation

type of work

coping mechanisms for stress

health promotion acitivties

stairs

living by themselves?

sexual activity

social supports

drugs

alcohol

smoking

exercise

sleep habits

shoes they wear

83
Q

The purpose of the psychosocial profile is to get what?

A

a comprehension of ability and roles of their orthopedic status

84
Q

Physical assessment order for the Musculoskeletal system?

A

Inspection –> Palpation

(No Percussion or Auscultation)

85
Q

The musculoskeletal physical assessment should be ….

A

systematic

head to toe

comparing right and left

86
Q

The general survey portion of the physical assessment should look for …

A

assess posture, gait, cerebellar function

measure limbs - length and circumference

assess joints and test movement

asses strength and ROM

test for shoulder, elbow, wrist, spine, hip, knee as indicated by history

check skin

87
Q

___ is even more critical to a musculoskeletal and neurologic exam

A

Safety

88
Q

Normal posture is …

A

Erect

Head midline

Shoulders over hips

normal spine curvature

89
Q

What is the normal spine curvature?

A

Cervical - Concave

Thoracic - Convex

Lumbar - Concave

Sacral - Convex

90
Q

Kyphosis

A

excessive back curvature

91
Q

Scoliosis

A

lateral curvature of the spin

92
Q

Lordosis

A

Exaggerated curvature of the LUMBAR spine (extreme)

seen in pregnancy

93
Q

A normal gait inspection should check for …

A
  1. Base of support (feet distance)
  2. Stride length
  3. Gait pattern
94
Q

Trendelenburg Gait

A

Lurch/Gait: lean to the weak side/hip when walking

95
Q

Hemiplegic Gait

A

Circumduction of the issue side leg

also, adduction of shoulder, flexion of elbow, pronation of wrist, and thumb tucked under in cortical fist

Other side normal

96
Q

Parkinsonian (Propulsive) Gait

A

Posture stooped over forward, and difficulty initiating gait

Once initiated, small steps occur with a tremor associated with it

As gait continues there might be a picking up of speed

When turning, they will need to slowly side step to turn

*Trouble starting up, then start going with trouble stopping

97
Q

What gait is associated with muscle weakness and neurologic issues?

A

Trendelenburg Gait (Gluteal Muscle Strength Issues)

98
Q

What gait is associated with parkinson’s disease?

A

Propulsive/Parkinsonian Gait

99
Q

What gait is associated with CVA issues like stroke?

A

Hemiplegic Gait

100
Q

Spastic Gait

A

Foot dragging walk

very stiff

101
Q

Scissors Gait

A

Both extremities effected

both sides of internal rotated lower extremities are swinging/adducting inward during walk

Upper extremities held close up front for balance

102
Q

Waddling Gait

A

Pelvic Girdle muscle weakness leads to you waddling similar to a penguin with larger steps

103
Q

Assessment of balance tells you about …

A

cerebellar function

104
Q

Romberg Sign test

A

Feet together, eyes open, doesnt sway when eyes closed = negative sign

Sways when eyes are closed = Positive sign

105
Q

Pronator drift test

A

Checks for muscle weakness

Arms extended, hands palm up, close eyes and for for 20-30 seconds

Downward drift or pronation = + sign (contralateral brain damage)

106
Q

Tandem Walking test

A

Test where people walk with toes to the back of the other foot

People with ataxia have trouble keeping balance

107
Q

Deep knee Bend Test

A

being able to do a deep knee bend/squat without falling over

108
Q

When checking ROM what should you check?

A

Passive and Active ROM

And note limitations on PROM

109
Q

When viewing deformities you should think about what aspects of it?

A

Did it happen over time

Was it from sudden trauma

Does it affect ROM or ADLs

110
Q

Areas to check ROM

A

TMJ

Cervical, thoracic, lumbar

shoulder

elbow

wrist

hands and fingers

hips

knees

ankles and feet

111
Q

When checking joints, what sort of findings are concerning?

A

Edema

Heat

Erythema

Tenderness

Deformity

Crepitus

112
Q

What is the range of the strenght scale?

A

0 to 5

113
Q

What is 5 on a strength scale

A

Normal - active motion against full resistance

114
Q

What is 4 on a strength scale

A

Slight weakness - active motion against some resistance

115
Q

What is 3 on a strength scale

A

Average weakness - active motion against gravity

116
Q

What is 2 on a strength scale

A

Poor ROM - Passive ROM (gravity removed, assisted by examiner)

117
Q

What is 1 on a strength scale

A

Severe Weakness - slight flicker of contraction

118
Q

What is 0 on a strength scale

A

Paralysis - no muscular contraction

119
Q

Alongside strength scale, what else should you assess with each ROM assessment?

A

Pain

120
Q

Drop Arm Test

A

Shoulder and elbow test

Abduct the arm and slowly lower it,

If the arm cannot be smoothly lowered –> Rotator cuff tear

121
Q

Allen Test

A

Checks for radial and ulnar artery blood supply

Have them open nd close fist quickly then make fist and you press radial and ulnar arteries

Open hand, release radial artery and see if color returns

Do again with ulnar artery this time instead

122
Q

Tests for Carpal Tunnel Syndrome

A

Phalens Test

Tinels Test

123
Q

Phalens Test

A

Do wrist flexion (downward) and put wrists together and hold for 60 seconds

If there is numbness/tingling/pain/anesthesia/paresthesia = + sign for carpal tunnel

124
Q

Tinels Test

A

Percuss the nerve of the inner wrist and if it elicits paresthesia then it is a positive sign for carpal tunnel *(due to irritated nerve)

125
Q

Pain or Numbness in the first three and a half digits is a sign of …

A

Carpal tunnel syndrome

126
Q

Edema that does not allow straightening of the fingers (Swans Neck) is a sign of …

A

Rheumatoid Arthritis

127
Q

Herberdens and Bouchards nodes are a sign of…

A

Osteoarthritis

128
Q

Herberden’s v Bouchard’s Nodes

A

H Nodes are more distal finger joint swellings and B nodes are more proximal

129
Q

Ganglion Cyst

A

a fluid filled non cancerous lump often on the joints of the wrist or hands

130
Q

The most common musculoskeletal problems are …

A

RA and OA

131
Q

What causes RA?

A

Inflammation / Systemic Autoimmune Issue

132
Q

What causes OA?

A

Wear and tear / Degenerative

133
Q

Characteristics of OA

A

Developed slowly and worsens over time

Pain and Stiffness affecting hands fingers and knees (and maybe spine and hip)

1 Joint is Affected

One side is worse than the other

Morning Stiffness is less than 30 minutes

Destruction of cartilage occurred

134
Q

Characteristics of RA

A

Rapidly develops

Pain, stiffness, swelling affecting mul. joints

Symmetrical/Bilateral

Morning stiffness occurs longer than 30 minutes

Fever, fatigue, malaise, weight loss, loss of appetite, edema, erythema, swelling

135
Q

Signs for Spinal Evaluation

A

Kernigs Sign

Brudzinskis Sign

Milgram Test

Straight Leg Raise Test

136
Q

Kernigs Sign

A

Positive sign is when patient is supine with the hip/knee flexed 90 degrees and leg straightened, and the knee cannot be fully extended without pain

Pain = positive sign = Nerve root irritation and potential meningitis

137
Q

Brudzinkis Sign

A

Positive sign if the patient is supine, and you place a hand behind their head and flex it onto the chest and it causes their knees or hips to raise in flexion (or if it elicits pain)

138
Q

Kernigs Sign and Brudzinskis sign can indicate what?

A

potential meningitis

139
Q

Milgram Test

A

assesses for herniated spinal disc

patient is supine with legs straight and raised from table holding as long as possible

Positive sign for herniated disc if they cannot hold for longer than 30 seconds or experience lumbosacral pain

140
Q

Straight Leg Raise Test

A

Assesses for herniated disc/sciatic nerve impingement

Patient is supine, raise leg high and dorsiflex the foot

Positive sign = pain

141
Q

What tests have positives indicating herniated discs?

A

Milgram Test

Straight Leg Raise test

142
Q

Spinal Stenosis

A

More common neck and lower back, and due to age related wear and tear

Symptoms: Pain, numbness, muscle weakness, bowel and bladder issues

Narrowing of spaces in spine thus pressuring nerves

143
Q

Spondylolisthesis

A

Noted in more active people (gymnasts, football, etc) that put stress on the back bone

Vertebrae slips forward onto the one below it

extremely painful

144
Q

Herniated disc

A

41 yo and older mostly (especially when you and poor body mechanics and obesity when younger)

Common cause of disability

problem with disk between spinal bones when the soft center of the disk pushes through the crack in the tougher exterior casing

145
Q

Faber Test (Patrick Test)

A

Hip Evaluation Test

Assesses sacroiliac and/or hip joints (to see if they’re still intact)

Flexion ABduction External Rotation

Pain = + sign

(crosses leg over other leg to check for pain)

146
Q

Trendelenburg Test

A

Sign: A positive side of gluteus Medius weakness will have the contralateral hip when you raise your one leg drop

Hip evaluation test

147
Q

Ortolani Click Test

A

Congenital Hip Dysplasia (good to check for in infants/newborns)

Flex knees 90 degrees and abduct the leg outward

Positive sign = Click sound or sensation

hip evaluation test

148
Q

Test for congenital hip dysplasia

A

ortolani click test

149
Q

Test for gluteus medius weakness

A

Trendelenburg test

150
Q

Lower Extremity Evaluation tests/ Tests to check for knee injury

A

Bulge Test

Patellar Ballottement

McMurrays Test

Drawer Test

151
Q

Bulge Test

A

Tests for effusion or fluid on knee

gently palpate the knee, then push on medial and lateral side of knee with the back of hand

positive sign - fluid movement while moving hand

152
Q

Patellar Test

A

tests for larger amounts of fluid in the knee

Move hands down the thigh to the patella and then gently percuss the kneecap

Positive sign - patella floats or bounces back post percussion - this indicates significant joint effusion

153
Q

McMurrays Test

A

Used to assess medial and lateral meniscus (near ACL)

Supine, grab hip and knee at the heel, put hand on knee meniscus and externally and internally rotate and then extend leg

Positive sign - click or thud (NOT PAIN)

154
Q

Drawer Test

A

Tests for ACL stability/tears

Supine patient, palpate bent knee and try moving tibia with hands

Positive sign if tibia moves more than 6 mm or if there is a soft/mushy feel

155
Q

Important considerations for doing PROM with a patient

A

do NOT need a providers orders

do 2-3 x per day

face direction of movement and work slowly

support areas and joints to be moved

pay attention to patient non verbals

156
Q

When doing PROM never …

A

exercise past the point of pain - only to the point of resistance

157
Q

Indications to do PROM

A

Prevent Contractures

Maintain Joint Mobility

Simulate circulation

158
Q

Contraindications to PROM

A

Acute Arthritis

Fractures

Joint dislocations

Acute Cardiac Conditions

159
Q

Gout

A

type of arthritis causing burning pain, stiffness, and swelling in joints

common in men

from a buildup of uric acid crystals in the joints

May require medications or a diet change

lots of erythema (angry and inflamed) visible

160
Q

What joint does gout most commonly occur in?

A

the great toe

161
Q

Tophi

A

deposits of monosodium urate crystals that result in gout

162
Q

Modifiable risk Factors for Osteoporosis

A

ETOH and Smoking

Low body mass index

insufficient exercise (Sedentary lifestyle)

Frequent falls

Diet: poor nutrition, Vit D Deficiency, eating disorder, low dietary calcium intake

163
Q

Nonmodifiable risk factors for osteoporosis

A

Age

gender

FMH

previous f(x)

ethnicity

primary and secondary hypogonadism in men

menopause/hysterectomy

RA

long term glucocorticoid therapy

164
Q

Osteoporosis is more common and least common in what populations?

A

Most common - white females

Lowest - AA males

165
Q

___ is a contributing factor for hip fractures and malformed vertebrae

A

Osteoporosis

166
Q

Muscular Dystrophy

A

Abnormal genes (mutations) lead to muscle degeneration, and most forms begin in childhood

Damaged muscle become progressively weaker, to the point most will need a wheelchair

Other symptoms include trouble breathing or swallowing

Many different forms exist

167
Q

Treatment for Muscular Dystrophy

A

TERTIARY PREVENTION ONLY - mostly supportive

Medications

therapy

breathing aids

surgery may help maintain function, but life span is often shorter in these people

168
Q

Nursing Diagnoses for the Musculoskeletal System

A

Pain

Altered mobility

risk for injury

disuse syndrome

adjustment, impaired

body image disturbance

self care deficit

knowledge deficit

impaired skin integrity

anxiety

depression

N321: Nursing Assessment of Clients (18 decks)

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