Muscleskeletal Flashcards
Strengthening the abdominal muscles adds support to…
the muscles supporting the lumbar spine
What is an electromyogram?
the graphic record of resting and voluntary muscle activity as a result of electrical stimulation
What kind of procedure is an electromyogram?
a non-invasive procedure that takes 30 min
Where are the electrodes attached in an electromyogram?
in the legs
What is muscular dystrophy?
generalized or localized muscle weakness
How can a nurse assist a pt to ambulate with an affected lower extremity?
the nurse must stand slightly behind the pt’s strong side
When should warm up or stretching exercises be done?
prior and after exercising
What is the bulge test?
its used to confirm the presence of fluid in the knee; pt’s leg should be extended and supported on the bed
Fat embolism is common with…
fractures of long bones, it results in pulmonary or cerebral emboli. It interferes with adequate circulation.
First symptom of fat embolism?
confusion
If a pt has fat embolism, what tests should be done?
blood gas
How do you use crutches?
- Arms should be bent at 35 degrees and weight should be placed on hands and arms
- Crutches should be placed 8 - 10 inches in front with each step.
- The strong leg leads to way going up the stairs
- The weak leg leads the way going down the stairs
- Crutches tips should be inspected regularly for cracks, wear and tightness of fit.
Crutch walking gaits: 4 point gaits
Slow, safe; right crutch, left foot, left crutch , right foot. This is used when weight bearing is allowed in both leg
Crutch walking gaits: 2 point gaits
Faster, safe; right crutch and left foot advance together; left crutch and right foot advance together. This is used when weight bearing is allowed in both legs
Crutch walking gaits: 3 point gaits
Faster gait, safe; advance weaker leg and both crutches simultaneously, then advance the good leg. This is used when weight bearing is allowed on one leg
Swing-to-swing through with crutches:
Fast gait but requires more strength and balance; advance both crutches followed by both legs (or one leg is held up). Used when partial weight-bearing is allowed on both legs
How do you go up the stairs using crutches?
advance good leg first, followed by crutches and affected leg
How do you go down the stairs with crutches?
advance crutches with affected leg first, followed by the good leg
How is multiple myeloma detected?
with a plan radiograph
How to prevent recurrent attacks of gout:
- increase fluid intake to increase uric acid excretion
- pt must eliminate alcohol
- High carbohydrate diet; it increases uric acid excretion
What kind of diet is needed if a pt has gout?
low purine diet; no fish or organ meat (red meat, shellfish and oily fish). High carbohydrate diet
Which drugs are used for gout?
- Colchicines (Colsalide)
- Allopurinol (Zyloprim)
- NSAIDs
How should a pt ambulate to relieve pressure and stress on affected leg if pt has gout?
encourage partial weight bearing, may use walker
What can aggravate pain if a pt has gout?
ROM exercises
What may precipitate gouty arthritis?
Excessive weight loss (more than 1 pound a week)
If a pt is severely underweight, __________ can be dangerous.
exercise. Because is prevents weight gain
__________ women are at risk for calcium deficiency.
Small-frame, non-obese white women; they have lost bone mass and absorb calcium less efficiently. They should take regular calcium supplements
Pts with osteoporosis should avoid ________
bowling or other high impact forms of activities
Range of motion exercises prevents __________
contractures; important to stretch Achilles tendon
Elderly its should carry out ROM exercises that emphasis _______
activities of daily living
Pts with rheumatoid arthritis need to:
- maintain mobility by exercises and independent ADLs.
- Take warm showers or baths to increase blood flow and joint mobility
- Balance rest and activities, do not allow long rest periods between exercises
- active exercises are better than passive exercises
- if pt experiences pain, they should reduce repetition
What kind of diet is needed for a pt with rheumatoid arthritis?
High in complex carbohydrates and calcium
What is Buck’s traction (extension)?
a method of producing traction by applying regular adhesive tape to the skin and keeping it in smooth close contact by circular bandaging of the part to which it is applied.
6 things to know about Buck’s traction:
- observe for skin breakdown; a second nurse should support the extremity during inspection
- Check circulation
- Appropriate if pt has a fracture; if no fracture, may turn to either side.
- the head of the bed needs to be elevated 15 - 20 degrees
- strict bed rest
- footboard on the bed would interfere with traction
Elevating the foot of the bed with Buck’s traction can provide _________.
counter-traction. it is used to reduce fractures and assisting with surgical dissection
________ is the leading cause of problem with Buck’s traction.
Immobility. turn pt to the unaffected side every 2 hours
_________ can provide a decrease in muscle tension and muscle spasm and decrease inflammation in various muscle skeletal conditions.
Moist heat
How to assess for hypocalcemia or tetany?
Taping the pt’s face just below and in front of the ear and leaving a BP cuff inflated on the pt’s arm for 3 min
What is Chvostek’s sign?
a spasm of the facial nerve muscle following a tap on the facial nerve. Seen in hypocalemia.
What is Trousseau’s sign?
a muscular spasm of the hand and wrist resulting from pressure applied to nerves and vessels with an inflated BP cuff
A complication of thyroid removal is ________.
Hypocalcemia
________ causes decreased deep tendon reflexes.
Hypercalcemia
What is phalen’s maneuver?
to put the back of your hands together and bend both wrists at the same time; this maneuver produces paresthesia of the median nerve distribution within 60 seconds; 80% of pts diagnosed with CTS have a positive result.
What position should be avoided if you have lower back pain?
Prone (abdomen) in order to maintain proper body alignment
To decrease pressure on the lower spine, how should a pt sit?
With their feet elevated
When are pts discharged after they have total hip replacement surgery?
3 to 6 days to either a rehab facility or home
After a total hip replacement there should be no __________
weight bearing on the affected hip because dislocation may occur
Pain is the body’s signal that there is a potential for _________
physical harm
If you have a long leg cast and compartmental syndrome occurs what should you do?
contact physician
What is compartment syndrome?
pressure on the skin that decrease blood flow
How do you handle short leg casts?
using the palms of hands to prevent development of pressure areas
When a pt has a short leg cast, the affected limb is elevated to ___________
the level of the heart to decrease edema
If you have a short leg cast, circulation of air in the room should be increased to __________
facilitate drying of the cast
What is a trapeze bar?
a triangular device above a bed to facilitate transferring and positioning pt
When pt’s feet rest against a board at the foot of the bed, that prevents __________
foot drop; plantar surface of feet should be against board to maintain dorsiflexion
What is Volkmann contracture?
a type of compartment syndrome cause by the obstruction of arterial blood flow to the forearm and hand; cannot straighten fingers, has severe pain and there may be signs of diminished circulation
What is Dupuytren contracture?
a slow progressive contracture of the palmar fascia usually causing the ring and little finger to bend into the palm so they cannot be extended
Which digits are contracted into the palm with Dupuytren contracture?
4th and 5th fingers
Dupuytren contracture occurs most often in ________
men over 50 years of age, of Scandinavian or Celtic descent
Dupuytren contracture is associated with
diabetes, gout, arthritis and alcoholism
_________ will dissipate anxiety and stimulates the release of endorphins.
Low impact physical activity
3 things to know about degenerate joint disease:
- large joints should be encouraged to use instead of small joints
- reduce stress on joints of wrist and hands; apply heat prior to beginning day
- maintain body in good alignment; prevent bending or stooping
4 things to know about below the knee amputation:
- elevating the limb minimizes edema; do not elevate more than 24 hours because of hip flexion.
- in order to prevent hip flexion, during the first 24 hours, pt may lie prone for a short period of time; after the first day, pt should lay prone for 30 min 3 times a day
- pt should perform active range of motion to strengthen leg
Tetany may result in _________
airway obstruction, respiratory arrest, cardiac dysrhythmias and cardiac arrest
After a total hip replacement, the leg should not be __________
outwardly rotated
The first 6 to 7 days after a total hip replacement flexion should be limited to ________ degrees.
60
After a total hip replacement flexion should be limited to ________ degrees for 2 - 3 months.
90
What to instruct the pt after a total hip replacement:
- do not sit/stand for long periods of time
- do not cross legs beyond midline of the body
- use assistive device to put on shoes and socks
If a pt is wearing a halo vest traction how should the leg rests be positioned?
they should be lowered because the wheelchair may tip backwards because of the heavy traction.
Halo vest provides ________ and _________
immobilization and allows for early ambulation
What is Paget’s disease?
chronic form of osteitis of unknown cause
After an above the knee amputation what position should you be in and why?
prone position. Because it provides maximum extension of the hip joint and prevent flexion contractures
If hip flexion contracture occurs after an above the knee amputation __________
it will be very difficult to correctly fit or use a prosthesis
Patient with above the knee amputations should expose ____________
the stump to air daily to facilitate healing. Stump should be inspected for pressure areas, dermatitis and blisters
If an above the knee amputation is infected, the pt will complain of ___________
persistent pain
What is a Posey vest?
a type of medical restraint use dot restrain a pt to a bed or chair.
How do you take a pt out of the elevators?
always back into and out of elevators to ensure pt safety so that elevator doors won’t close on them.
How to turn a pt?
a pillow should be placed longitudinally between the legs to prevent hip and lower leg adduction and spinal torque
Twitching occurs only with ___________
electrolyte imbalances, especially calcium
If you suspect a bone fracture, priority is to prevent further injury by _________
providing adequate splinting
