MSK and mobility assessment Flashcards
What is probably the most important health promotion aspect of the MSK system for older adults?
Fall prevention
What is the amount of physical activity that one should be engaging in on a weekly basis?
30-60 minutes a day, a couple times a week
What is a major purpose of weight-bearing exercises in the geriatric population?
Prevent osteoporosis by stimulating osteoblasts
What are weight-bearing exercises?
foot on pavement type activities
How much vitamin D should someone be taking a day to prevent osteoporosis?
1000-2000 international units
How much exogenous calcium should someone be supplementing their diet with?
500 mg at most
What are some past medical history conditions related to MSK?
Arthritis, osteoporosis, congenital issues (e.g. spina bifida), scoliosis, autoimmune diseases
What are meds/drugs that affect the MSK system?
Depo provera - birth control - reduces bone formation
exogenous estrogen - reduces hip fractures
chemo - reduces bone density
steroids - risk factor for osteoporosis
meds affecting thyroid and kidneys
meds for hypertension and gout
How can psychosocial factors affect the MSK system?
Social isolation can put old people at risk for immobility
depression - exercise isn’t at the forefront of the person - not taking care of bones or joints
What is important to know when someone has an MSK issue related to trauma?
The mechanism of injury
What does a functional assessment as part of the MSK system relate to?
ADLs
What are some common MSK symptoms or signs?
Pain or discomfort Weakness Stiffness or limited movement Deformity Swelling Joint pain Lack of balance/coordination Bruising and erythema
Stiffness in the morning is mainly associated with what MSK condition?
Osteoarthritic pain
Stiffness that persists throughout the day is related to what MSK condition?
Rheumatoid arthritis
Medical emergency related to lower back pain?
Saddle paresthesia
caude equina
What is one of the best assessments for older individuals?
Gait assessment - get lots of information on functional ability and neurological status
What are some circulating hormones that increase joint mobility in pregnancy?
Relaxin
What are the changes in maternal posture seen in pregnancy?
Lordosis
In late pregnancy, what kind of pain occurs?
Strain or lower back muscle pain
There are upper neck changes in pregnancy, what does this cause?
Pressure on radial and ulnar nerves in 3rd trimester
Are the changes in pregnancy in the MSK system pathological?
No, but clinicians should keep in mind that there may be pain.
Children below 18 months tend to walk how? What does this change to?
Walk bow-legged until about 18 months
Transition to knock-knee
What is another name for bowlegged?
Genu varus
What is another word for knock knee?
Genu valgus
At about what age do legs straighten?
6-7 years old
These are not fused when the child is born to accomodate the birthing process; located on the head
Fontanels
When are the anterior fontanels closed by?
Posterior?
anterior - 18-24 months
Posterior - 2 months
When should we check for scoliosis, mainly?
10-16 years of age
At what time does the fetal cartilage skeleton form?
3 months gestation
Closure of the epiphysial plates occurs at about what age?
around 20 years olds
Spine curvature at birth can be described as what?
C-shaped
What establishes the cervical curve? When does this happen?
At about 3-4 months - raising the head
What develops the anterior curve in a child? Time frame?
Standing - 1-18 months
What is the most common fracture type in children?
Greenstick fracture
What do we always have to look for when viewing MSK issues in children?
Potential abuse cases
What do we do in preparation for objective data collection?
Promote patient comfort, dignity, and safety
What is part of the initial survey for MSK assessment?
Posture
Gait and mobility
Balance
Coordination
What kind of posture do we have?
Static
What is an antalgic gait?
Walking with a limp
IF you see a child limping under the age of four, what should you do?
Children cannot fabricate a limp under that age - must be investigated
In the unaffected leg, hip will drop due to glute weakness.
Trendelenburg gait
Function of the cerebellum - integration of somatosensory vestibular, and visual stimuli
Balance
For posture, we think _______.
For gait and mobility, we think _________.
For balance, we think ______.
For coordination, we think _________.
Foundation
Locomotion
Base
Organizing
Coordination is typically an assessment of the __________ system but is a common test for ______ function.
neurological
motor
When inspecting joints, muscles and extremities, what do we look for?
size symmetry contour colour edema/deformity facial expression curvature of spine
When palpating for muscle tone, what are we looking for?
Flaccid, stiff, symmetry
When we palpate for temperature variations, what are we looking for?
Inflammation or injury;
coolness - lack of perfusion (Arterial insufficiency)
Small muscle twitching
fasciculations
When palpating for tenderness, what is important to keep in mind?
Don’t go for the money shot first - palpate around to get extent of pain, then leave most tender area last
What is the point of ROM testing?
move joinst through different ROMS to see if there is pain or immobility
What is the difference between active and passive ROM testing?
Active - when client is able to move own joints
Passive - nurses uses both hands to assist client
When would you not do passive ROM testing?
IF active ROM can be done in all joints, without pain
Which ROM testing do we start with?
Active first – only do passive if active is abnormal
For either passive or active ROM, what do we note and do?
Note:
- degree and type of limitation
- increased ROM or instability
- compare side to side
What is an example of an injury causing hypermobility of a joint?
MCL or ACL tear
Full muscle strength requires what?
complete active ROM
How is strength testing accommodated for a person laying down?
Assess legs specifically with person lying down
will only have issues (although doable) for upper body
Lack of residual tension
atony
Diminished tone of skeletal muscles
Hypotonicity
Hypertonic, so the muscles are stiff and movements awkward
spasticity
Sudden, violent, involuntary contraction of a muscle
Spasm
Involuntary twitching of muscle fibers
Fasciculations
Involuntary contractions of muscles
Tremors
What are some lifespan considerations for older adults?
Kyphotic posture
- lower bone density in post-menopausal women
age in general is a risk factor for MSK and falls
Buildup of uric acid in a joint. Where does it usually manifest? What types of foods should be avoided?
gout
tends to target great toe
avoid high in purine foods
Normal movement that causes a fracture.
Fragility fracture
What is the number one risk for falls?
Being afraid to fall
You will be hardpressed to find a neurological issue if this is intact.
Gait
What is the TUG test?
Get up and go test
have then sit in chair, get out, walk 3m, turn around and walk back within 20 seconds
What is a dynamic gait test?
Adding distractions when the person is walking - ex: talking to them
Indicator of total body strength.
Grip strength
What are some fall prevention guidelines for older adults?
Tape down rugs, exercise good footwear night lights railings raised toilet seats don't rush to answer the phone
