MSK Flashcards

Question

How do Nurses Gauge Muscle Strength Using the Standardized Rating Scale?

Answer 1

5/5 (100%) - Complete ROM against gravity and full resistance - full resistance means the clinician places a palm on the limb and pushes down to assess the client's ability to keep the limb in position 4/5 (75%) - Complete ROM against gravity and moderate resistance - moderate resistance means the clinician places 2 fingers to push on the limb and pushes down to assess the client's ability to keep the limb in position 3/5 (50%) - Complete ROM against gravity 2/5(25%) - Complete ROM with the joint supported - Can NOT perform ROM against gravity 1/5 (10%) - Muscle contraction detectable - No movement of the joint 0/5 (0%) - No visible muscle contraction

Answer 2

1) Active ROM - when clients can complete the movements themselves - They may not have full range, but if they can do it alone it is active ROM. 2) Passive ROM - for clients who need assistance completing the movement or are completely dependant on others for movement ○ The body parts that are frequently forgotten during passive range are fingers/hands

Answer 3

○ The axial skeleton (head/neck/spine) and the appendicular skeleton (all limbs) benefit from range of motion exercises ○ ROM exercises maintain function of joints, bones, and muscles ○ ROM exercises can NOT increase strength or bone density ○ A resistance band can help with increasing strength and flexibility over time.

Answer 4

- If bones, muscles, and joints are immobilized, muscles will shorten - When muscle shorten, they pull joints into a bent position which eventually develops into a contracture. - immobility causes contractures and contractures perpetuate immobility - The immobility results in: muscle wasting, more weakness, skin breakdown, blood clots, respiratory compromise/pneumonia, and deterioration of mental health. - If active ROM is not possible, nurses must provide support for passive ROM on ALL parts/joints to protect clients from this type of avoidable harm.

Answer 5

- permanent - can not be treated without surgery to break the bones and reset them - painful - preventable

Answer 6

1) Osteoporosis and decreased bone density 2) Changes with mobility, balance, and coordination related to aging/disease processes 3) Sensory impairments can complicate navigation around dark rooms, cluttered spaces, and unfamiliar environments 4) Disease processes such as dementia can contribute to physical decline, disorientation/confusion, forgetting limits, and even unrecognized pain. **hip fractures are considered 1 of the most serious fractures bc of the life-threatening complications that often ensue**

Answer 7

1) Receive bone density scans in line with provincial screening programs 2) Advocate for Calcium and vitamin D supplementation to strengthen bones 3) Promote exercise and stretching to maintain function and flexibility 4) Advocate for clutter-free environments (discouraging loose floor mats and installing night lights) 5) Promote functional activities/exercises that contribute to maintaining and/or improving safe mobility such as walking, climbing stairs, and utilizing assistive devices correctly.

Answer 8

- 'soft spots' that are present on the heads of infants and eventually close on their own. - There is a posterior fontanelle that is usually closed by 2 months of age. ○ The anterior fontanelle on the top/front of the skull closes later, usually between 9-18 months.

Answer 9

- an infant would have gross motor movements, but no fine motor movements. - Nurses would observe the infant for quality of movement such as spastic movements (normal), tone vs. flaccid limbs, and might assess other things such as reflexes - Babies have a C-shaped spine - their arms and legs should be tucked close to the body. - Raising and holding the head up eventually produces the normal spinal curvature. - Genu varum ('bow legs') is normal in infants. - bow legs is followed by genu valgus ('knock knees'): The legs do not begin to straighten until the child starts walking. - Weight-bearing eventually produces straight legs (by about age 6-7) and the anterior curve of the spine

Answer 10

Adult: low on the body, around the hips - bc adults are full grown and proportionate. Babies: extremely high - bc they are not proportionate yet - Babies have large heads in comparison to their small bodies and short limbs. - This is important bc: ○ babies are at risk for falling bc their heads are heavier than the rest of their bodies.

Answer 11

- Kids legs straighten out and experience rapid growth - Long bones (ie. the femur) have growth plates (epiphyses) on the ends and, as a result, these bones receive more circulation - The increased blood flow can cause infections of the long bones - If infections of long bones affect the the growth plates at the ends, it can disrupt normal growth. - Longbones are mostly in the appendicular skeleton in the limbs. - Bones such as the tibia, fibula, humerus, radius, ulna, and bones of the fingers and toes are also long bones with growth plates at the ends. - These plates are made of cartilage and ossify/turn into bone by approximately age 20.

Answer 12

- Pregnancy increases levels of circulating hormones which increases joint mobility. ○ Hips loosen to facilitate passage of baby down the birth canal and joints throughout the body (even in feet) - Posture changes, tendons/joints loosen, which creates back pain and other symptoms (ie. altered balance and gait) - The lumbar spine develops extreme curvature in later stages of pregnancy - compensatory due to growing fetus. ○ A common concern in late pregnancy is lumbar lordosis - the centre of gravity shifts forward due to the expansion of the abdomen which can cause changes to balance. - pregnant women experience altered sensation due to downward pressure on the sciatic nerves and have to get off their feet to relieve the pain. - Pregnant women need to consume adequate calcium to support bone health of the developing fetus. ○ If they are not consuming enough calcium, the baby is usually ok bc it will take the calcium it needs from mom's bones.

Answer 13

- Bruising remains the commonest sign of physical abuse in children - Abuse bruising is different from 'accidental' bruising which is common amongst most mobile kids. - School aged kids frequently have bruised up shins, knees, and elbows - Uncommon areas for accidental bruising that can point to abuse - Non-mobile children/babies will not have areas of accidental bruising on the shins and knees like other kids. - Bruising on babies is not ordinary **Nurses are required to report to Child & Family Services for confirmed and suspected cases of child abuse**

Answer 14

- DDH can develop because the acetabulum (socket of the hip) is shallow and the head of the femur (ball) won't stay in. - The hip can be completely dislocated or the hip slips in and out of alignment. - It affects 0.4% of live births and is the most common hip issue in newborns. - DDH affects female babies 5x more than male babies, and the left hip is 3x more likely than the right to be affected. - DDH is not painful for babies - makes it difficult to spot if not screened for routinely. - If left alone, the hip will not develop properly so it requires intervention. - Providers place baby on its back and circle the hips around while they feel for any popping or asymmetrical movement.

Answer 15

- unilateral (one-sided) bruising - edema - other skin damage (often from urine & feces if they were on the floor for a while) - if the hip fractures, there is usually some bleeding. - When the client lies on the fractured side for a long time, the blood pools in the dependant tissues leaving a large bruise

Answer 16

- hip pathology that affects adolescents. - The most prevalent risk factor is obesity. - The condition involves a damaged growth plate. - The head of the femur stays in the acetabulum while the neck/rest of the femur 'slips' down and backward at the growth plate. - This usually causes pain, sometimes a limp, the foot might turn out on that side when walking - it affects normal growth and development if it does not get surgically repaired. - Surgeons will prophylactically correct the opposite hip as well since it usually affects both

Answer 17

- The spine allows for movement throughout the torso. - It can be the source of pain, limitation, and disability - The vertebrae of the spine, themselves, are not flexible. ○ It's the thin cushion-layer between them and stacking one on top of the other than creates the flexibility of the spine. - When there is misalignment of the spine due to injury, a disease process, or a herniated (sticking out of line) disc, it disrupts functional impact. - 'Slipped' discs, multiple 'bulging' discs, and reduced fluid cushion between discs are vertebral pathologies that can cause clients pain and restricted mobility. - If a client has a history of cervical spinal fusion, they experience challenges driving

Answer 18

- occurred as a result of another disease process, usually cancer - Because the cancer cells degrade the bone causing it to become friable and brittle in spots ○ Clients with cancer sustain pathological fractures from doing something as simple as reaching for an object. - Cancer usually does not originate in the bone, but often metastasizes from its site of origin to the bone.

Answer 19

Polio - a virus that infects the nervous system and is spread by contact. - it kills motor neurons that affect certain muscles, mostly in the legs. - It spread amongst children, mostly boys, in the 1950s and resulted in death, paralysis, and lifelong disability. - 'post polio syndrome' - when the virus lies dormant in an individual for a long time until symptoms spontaneously develop

Answer 20

- The iron lung became closely associated with the polio era. - Some patients were in one due to paralysis of the diaphragm bc of polio, but they also treated other illnessess

Answer 21

- Scoliosis - an abnormal curvature of the spine. - It affects more females than males and is usually detected in childhood. - Sometimes corrective surgery is needed, sometimes bracing is enough, and other times the scoliosis may be mild enough that medical intervention is not necessary. - If moderate-severe and left untreated, clients can experience pain, disability, and decreased quality of life. - when assessing, ask client to bend forward slightly at the waist - this accentuates the appearance and asymmetry of the curvature.