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N1180 > MSK > Flashcards

MSK Flashcards

1
Q

Active VS. Passive ROM

A

Active ROM: Can do motions without assistance

Passive ROM: requires assistance to do motions

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2
Q

Atony VS. Hypotonicity

A

Atony: lack of tone in the muscle

Hypotonicity: diminished tone of muscles

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3
Q

What is Crepitus?

A

Crepitus: popping sounds from joints related to gas escape

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4
Q

What is Contracture?

A

Contracture: the joint frozen in flexion due to shortened muscles

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5
Q

What is Fasciculation?

A

Fasciculation: involuntary muscle twitching

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6
Q

What is Spasticity?

A

Spasticity: stiff movements related to hypertonicity

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7
Q

What is a Spasm?

A

Spasm: sudden violent involuntary contraction of muscle

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8
Q

What is a Tremor?

A

Tremor: involuntary muscle contractions produce fine or more exaggerated shaking movements

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9
Q

What is Gait?

A

Gait: Walking Pattern

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10
Q

When is a Peripheral vascular assessment performed?

A
  • when there is risk for (or actual) compromise of the circulation to the limb and/or the nerve conduction to the limb.
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11
Q

What is a Musculoskeletal assessment?

A
  • not for the acutely injured limb
  • mostly concerned with function of the muscles, joints, and bones
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12
Q

What questions about function/lifestyle are important when gathering data about an MSK injury?

A

○ What type of home do you live in? One floor? Stairs?

○ Who do you live with? Do you have/want/need assistance?

○ Do you work? Nature of the work? Physical? Dangerous? Sitting? Standing?

○ Pain? How have they been coping?

○ Safety issues at home? Level of competence/independence?

○ What are they able to do despite the MSK problem (strengths)?

○ What do they struggle with/can no longer do because of the MSK problem?

○ How does the issue affect them socially/emotionally–isolation?

○ Do they have any particular goals for their experience/care?

○ If needing/receiving support of some sort, is it enough? Where are the gaps?

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13
Q

What are the SIGNS of an MSK problem?

A
  • Rash
  • Bruising/redness
  • Fever
  • Edema
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14
Q

What are the SYMPTOMS of an MSK problem?

A
  • Sensory changes
  • Anorexia (loss of appetite)
  • Chills
  • Pain/discomfort
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15
Q

What could be either a sign or a symptom of an MSK problem?

A
  • Deformity
  • Loss of balance/coordination
  • Weight loss
  • Stiffness/reduced ROM
  • Crepitus
  • Changes in gait/posture
    Weakness
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16
Q

What is the FOCUS of an MSK assessment?

A

FUNCTION

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17
Q

When should acute injury be assessed?

A
  • in a PV assessment, not an MSK assessment
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18
Q

Does cracking knuckles lead to arthritis?

A
  • a capsule covers joints, protecting the bones connected at that joint
  • Protective fluid fills the capsule, cushioning the cartilage and tissues, while keeping the muscles lubricated and well-nourished.
  • Nutrients float inside the fluid, with gases.
  • As fingers bend, the joint capsule stretches and the air pressure inside of the fluid decreases .
  • This creates a vacuum that the gases fill.
  • When the bubble pops, it creates a loud noise.
  • Joints won’t make another popping noise right away because the joint must refill with gases first.
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19
Q

What are the 2 physical assessment techniques used to evaluate the MSK system:

A

1) Inspection
2) Palpation

20
Q

Gait VS. Pathological Gait

A

Gait - clients walking pattern

Normal Gait - balance and coordinated

Pathological gaits - ie. Parkinson’s gait: clients with Parkinson disease demonstrate that can leads to falls

21
Q

How do you assess clients with an unsteady gait?

A
  • ask client to walk a short distance while observing the pattern
  • Inspect clients posture, foot position, balance, coordination
  • look for things like: does the heel strike first? Do they pick their feet up off the ground? Do they look at the floor?
22
Q

If a client reports difficulty with certain ADLs (ie. dressing and bathing) because of joint stiffness in their shoulders, what should you do?

A
  • peripheral vascular assessment 1st to rule out circulation/nerve problems (bc it is unclear whether shoulders were injured or not)
23
Q

If a client has a history of osteoarthritis and they are experiencing some inflammation in the joints, what should you do?

A
  • collect relevant data and work through ROM exercises to assess mobility
  • inspect and palpate the shoulders for heat, color, edema, crepitus, etc.
24
Q

When will nurses engage in health promotion?

A
  • Sometimes there is nothing ‘wrong’ but the nurse will see an opportunity for health promotion regarding the MSK system.

Ex. Nurse is caring for an older adult client with a history of osteoporosis who is receiving a bone density test.
- The nurse might engage in teaching around falls prevention since osteoporosis increases the likelihood that the client will fracture a bone if they fall.

25
Q

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

A

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

26
Q

What are the 2 Types of ROM Excercises?

A

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

27
Q

Purpose of ROM Exercises

A

○ 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.

28
Q

How are Contractures Caused?

A
  • 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.
29
Q

Contractures are:

A
  • permanent
  • can not be treated without surgery to break the bones and reset them
  • painful
  • preventable
30
Q

What are the 5 Common Risks Amongst the Older Population?

A

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

31
Q

What are the 5 ways in which MSK health can be promoted for seniors:

A

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.

32
Q

What are fontanelles?

A
  • ‘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.

33
Q

What is considered as ‘normal’ development for infants?

A
  • 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
34
Q

Where is the centre of gravity for infants and adults?

A

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.

35
Q

How do kids bones develop?

A
  • 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.
36
Q

What bodily changes occur during pregnancy?

A
  • 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.
37
Q

Can you spot abuse during an MSK assessment?

A
  • 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

38
Q

What is Developmental Dysplasia of the Hip (DDH)?

A
  • 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.
39
Q

What are the common symptoms of falls in older adults?

A
  • 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
40
Q

What is Slipped capital femoral epiphysis?

A
  • 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
41
Q

How can the Spinal Column cause pain?

A
  • 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
42
Q

What is a pathological fracture?

A
  • 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.
43
Q

What is Polio?

A

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
44
Q

What is Iron Lung?

A
  • 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
45
Q

What is Scoliosis?

A
  • 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.
46
Q
A

N1180 (13 decks)

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