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Exam 4 | Health Assessment > Musculoskeletal > Flashcards

Musculoskeletal Flashcards

1
Q

When examining, use what kind of assessment organization techniques?

A
  • cephalocaudal: head to toe organization
  • comparing one side to another
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2
Q

If pt presenting w/ joint pain, asses what first?

A

joint that doesn’t feel pain then the one that does for comparison and comfort

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3
Q

ROM (in general: AROM, PROM, Goal, When to do, Assessing for)

A
  • AROM: pt can do it themselves
  • PROM: nurse does it for them
  • Goal: know if movement limited
  • When to do: if pt presents w/ crepitus → do AROM & PROM tests
  • Assess for:
    • Pain
    • Limited ROM
    • Spastic movement
    • Stability of joint
    • Deformity
    • Contractures
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4
Q

Muscle Strength: comparing one side of limbs to other (Grades 0 - 5)

A
  • 0: no evidence of muscle contraction
  • 1 (trace): evidence of slight muscle contraction, no movement though
  • 2 (poor): full ROM but passive
  • 3 (fair): full ROM & active but w/ no resistance
  • 4 (good): full ROM & active but w/ some resistance
  • 5 (norm): full ROM & active w/ full resistance
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5
Q

Low Back Pain In General

A
  • Most common CC
  • Rarely emergency in exceptions of…
    • presenting w/ lower extremity weakness
    • presenting w/ incontinence
    • male and presents w/ impotence
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6
Q

Mechanical Lower Back Pain

A
  • What: Aching pain in lumbosacral area that may radiate to lower leg
  • Cause: work-related
  • Acute & self-limiting
  • Risk factors: heavy lifting, obesity, poor conditioning
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7
Q

Sciatica (Radicular) Lower Back Pain

A
  • What: Shooting pain below knee (usually lateral leg or posterior calf)
  • Associated S&S: paresthesia and weakness
  • Cause: herniated discs
  • Aggravated by: sneezing, coughing, straining during bowel movements
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8
Q

Chronic Back Stiffness

A
  • Causes:
    • Ankylosing spondylitis
    • Diffuse idiopathic skeletal hyperostosis
    • Other inflammatory diseases
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9
Q

Pain Referred From Abdomen or Pelvis

A
  • What: Deep, aching pain, varying w/ origin
  • Cause: digestive tract issues or endometriosis
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10
Q

Fx: Traverse

A

horizontal bone break straight through bone

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11
Q

Fx: Compound

A

Bone exposed through skin ⇒ big infection risk ⇒ life-threatening

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12
Q

Fx: Linear

A

vertical break along side of bone

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13
Q

Fx: Oblique Non-Displaced

A

slash or parallel bone beak but still aligned

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14
Q

Fx: Oblique Displaced

A
  • slash or parallel bone break but bone moved out of alignment
  • Commonly seen in kids
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15
Q

Fx: Greenstick

A
  • bone bends and cracks a little
  • not a full break at all
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16
Q

Fx: Stress

A
  • Small crack in a bone caused by repeated stress or overuse
  • Common in athletes
17
Q

Fx: Impacted

A

bone breaks and broken ends are driven together by pressure

18
Q

Fx: Avulsion

A

small piece of bone breaks away from main part of bone due to physical trauma

19
Q

Fx: Segmental

A

at least two fracture lines separate segment of bone

20
Q

Fx: Torus

A

incomplete bone fracture that occurs when bone bulges out instead of breaking

21
Q

Vertebral Compression (What & Can be seen in)

A
  • What: 2 bones coming together and breaks/crush against each other
  • Can be seen in pts w/ osteoporosis ⇒ leads to height loss
22
Q

Osteoporosis (what, S&S, risk factors, results in, health promotion)

A
  • What: loss of bone density
  • S&S: generally asymptomatic (usually caught w/ screening)
  • Risk factors:
    • Age: older > younger
    • Gender: women > men
    • Lower BMI
    • Lack of weight-bearing exercises
    • Ca+ or Vit D deficiencies
    • Steroids can also affect bone density
    • Proton pump inhibitors long-term use can cause osteoporosis
  • Results in:
    • Kyphosis
    • Loss of Height
    • Spontaneous Fx
  • Health Promotion
    • Ca+ supplement in postmenopausal women
    • Avoiding falls
23
Q

OA

A
  • Degenerative joint disease
  • Not an inflammatory condition
  • Decrease cartilage
  • Pain increases w/ activity
  • Relieved by rest
  • Pain at end of day after day’s movement
  • Unilateral
  • More common in weight-bearing joints
    • Ie. hips, knees, fingers (distal interphalangeal (DIP) joint, proximal interphalangeal (PIP) joint)
  • S&S:
    • Crepitus !!!
    • Heberden’s nodes (DIP)
    • Bouchard’s nodes (PIP)
    • Can be tender
    • Sxs not as severe
  • Greatest risk factor: old age
  • Common in aging process
24
Q

RA

A
  • Autoimmune disease
  • Inflammatory condition
  • Inflammation of connective tissue (typically synovium)
  • Pain increases w/ rest
  • Waking up in morning in pain because of long period of resting/sleeping & need to move for hrs for pain to subside
  • BIL joints affected
  • More common in smaller joints
    • Ie. hands (metacarpal phalanges [MCP]), wrist
  • S&S:
    • Ulnar deviation
    • Swan-neck deformities
    • Rheumatoid nodules
    • Edematous joints
    • Erythematous joints
    • Systemic Sxs: Malaise & Fever
  • Risk factor: other autoimmune diseases
    More common in adults > kids & women > men
25
Q

Gout (what, cause, S&Ss, onset, risk factors, common location, avoiding triggers of)

A
  • What: another type of arthritis
  • Cause: increase in uric acid
  • S&S:
    • Erythema
    • Edema
    • Stiffness of affected joint(s)
  • Onset: sudden, comes and goes ⇒ give anti-inflammatory meds
  • Very painful !!!
  • Risk factors:
    • Gender: men > women
    • EtOH
    • Renal disease
    • Obesity
  • Common location: great toe because of warm, moist environment
    • Sometimes so painful and can’t bear weight on affected toe
  • Avoid Triggers: Avoid purine foods
    • Red meat
    • Seafood
    • Nuts
26
Q

Spinal Column Deformities (measurement meaning, tx)

A
  • How deviated spine is matters because if you have anything less than 5* ⇒ nothing can be done abt it
  • Major deviations to point of internal thoracic cage organ changes ⇒ needs surgery or braces to straighten column
27
Q

Kyphosis

A
  • What: exaggerated outward or convex curvature of thoracic spine (hunchback)
  • Results in: increase in anteroposterior diameter of chest ⇒ barrel chest
  • Common in: aging
28
Q

Lordosis

A
  • What: deviation in lumbar region where lower back has exaggerated inward curve
  • Common in: kids and pregnant women
29
Q

Scoliosis

A
  • What: lateral curvature of spine appearing as asymmetrical rise in thoracic region, lumbar region, or both
  • Results in: elevation of one shoulder, unequal leg length changes
  • Common in: children and adolescents w/ neurologic or musculoskeletal abnormalities
    • Scoliosis in young child is unusual and abnormal
    • Mild scoliosis in older child uncommon
  • Notes:
    • < 5 measurement not concerning → just monitor
30
Q

Osteomyelitis (what, causes, S&Ss, Tx)

A
  • What: inflammation or swelling of bone tissue (bone infection)
    • From infection somewhere else in body that spread to bone
  • Causes: bacteria, fungi, etc.
  • S&S:
    • Bone pain
    • Night sweats
    • Flu-like Sxs
    • 4 signs of inflammation: Swelling, Warmth, Tenderness, Redness
  • Tx: surgical removal of bone + antibiotics
31
Q

Age-Related Considerations: Infants & Children (All Norm)

A
  • Ligaments stronger than bones till adolescence
    • More common to get fractures than sprains when you’re younger but the opposite when older
      • Torus (buckle) and greenstick (incomplete) Fx most common
  • Congenital hip dysplasia
    • Assess in infants: lay them down and move hips ⇒ if you hear/feel clunking ⇒ need ultrasound and is treatable
  • In adolescence → rapid growth results in decreased strength and flexibility (important to remain active)
  • Bone growth complete ~20 yo (after that you start losing bone density)
32
Q

Age-Related Considerations: Pregnant Women (All Norm)

A
  • Ligaments relax and cartilage softens around pelvis (~12-20 wks) to accommodate for fetus
  • Increased lordosis that can cause back pain
    • Helps shift center of gravity as uterus continues to grow ⇒ increases fall risk
  • Increased stress on muscles and ligaments of lower back ⇒ leads to very common finding on low back pain (LBP)
33
Q

Age-Related Considerations: Older Adults (All Norm)

A
  • Loss of bone density (~30% by 80 yo)
  • Decreased cartilage around joints
    • If you have enough degradation of cartilage → called osteoarthritis (degenerative joint disease)
  • Decreased muscle mass
  • Increased risk of Fx in weight-bearing joints (likely because of decreased cartilage)
  • Important to maintain active lifestyle, healthy weight, balanced diet to slow progression of these changes
34
Q

How to Document General OBJECTIVE Findings

A
  • Pt sitting erect, appears comfortable
  • Gait smooth and coordinated
  • FROM (full ROM) observed in cervical spine, back, BUE & BLE w/o pain
  • Strength 5+ in all muscles
  • Vertebral column straight, shoulders aligned
35
Q

Spasticity

A

Increased resistance that worsens at extremes of range

36
Q

Rigidity

A

Increased resistance throughout ROM and in both directions

Exam 4 | Health Assessment (6 decks)

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