Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Health Assessment > Nervous and Musculoskeletal Systems > Flashcards

Nervous and Musculoskeletal Systems Flashcards

1
Q

What can we do to protect musculoskeletal system with anesthesia?

A
  • With sedation, regional or general anesthesia, we take away the normal protective pain reflexes
  • Determine preop range of motion abnormalities and joint integritu (document baseline)
  • maintain natural range of motion for all anesthetic procedures and sx positioning (document)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How can you assess TMJ?

A
  • Place tips of index finger just in front of tragus of ear- ask pt to open mouth
  • fingertips should drop inot joint spaces as mouth opens
  • chekc for smooth ROM, swelling/tnederness
  • snapping and clicking are normal
  • ask pt to open and close mouth, protrued and retract (jutting the jaw)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How should you ask the patient to move their neck (what directions)?

A

Flexion= touch chin to chest

Extension- look up at ceiling

Rotation- turn head to each side looking directly over shoulder

lateral bending- tilt the head touching ear to shoulder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How can you assess patients shoulder girdle?

A
  • Abduct the arms to shoulder level
  • Raise arms vertical position above head, palms facing each other
  • place both hands behind the neck with elbows out to the side
  • place both hands behind the small of the back
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is thoracic outlet syndrome?

A
  • Compression of brachial plexus and SCL vessels near the first rib
    • be certain patient can work or sleep with arms elevated over their head before putting arms beside hear (prone positioning)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Muculoskeletal assessment for the elbow?

A

Ask pt to bend and straightne elbow (flexion and extension)

with armsa t sides, and elbows flexed, instruct pt to turn palms up (supination) and down (pronation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How do you perform musculoskeletal assessment for the hip?

A
  • Concentrate on ROM that can impact positioning
  • flexion- supine, pt bends each knee to chest/abdomen
  • abduction- supine pt, stabilize anterior superior iliac spine and abduct the extended leg until the iliac spine moves= limit
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How can you assess cranial N I?

A

Smell- alcohol pad, somethig noxious. challenging to assess preop

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How do you assess cranial nerve II?

A

Confrontation test (sit opposite, both cover same eye, move your figner from periphery in, should see finger at same time)

check pupillary reaciton to light

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How can you test cranial nerve III?

A

Oculomotor- pupillary reaction to light, extraoccular movement (everythign except SO4, LR 6)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How can you assess CN IV?

A

Trochlear

superior oblique muscle- depresses and rotates eye medially (diagonal motion)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How do you assess cranial nerve VI?

A

Abducens

assess lateral eye movement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How can you assess cranial nerve V?

A
  • Ask pt to clench his/her teeth as you palapte temporal and massetter muscle
  • chekc sensation in check, chin, forehead on both L and R side
  • corneal reflex (cotton blal)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How can you assess cranial nerve VII?

A

Facial

  • Ask pt to raise both eyebrows
  • frown
  • close eyes tightly so you can’t open them
  • show teeth
  • smile
  • puff out both cheeks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How can you test CN VIII?

A

Acoustic (hearing)

challenging to assess periop

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How can you test CN IX? X?

A

Glossopharyngeal (IX) and Vagus (X)

Voice hoarseness, gag reflex, AHHH- palate should rise symmetrically

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How can you test CN XII?

A

Hypoglossal

tongue movement, ask them to move tongue side to side

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How can you assess CN XI?

A

SPinal accessory

ask pt to turn head to each side against your hand

ask pt to shrug both shoulders upward against your hand- trapezii strenght

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are some major dermatome levels?

c8?

t4?

t10?

A
  • C8- ring finger/pinky finger
    • important for detecting high spinals
  • T4- nipple
  • T10- umbilicus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the assessment of muscle strength?

A

0-5

  • 0- no muscular contraction detected
  • 1- barely detectable
  • 2- active movmeent with gravity eliminated
  • 3- active movement against gravity
  • 4- active movement against graivty with some resistance
  • 5- active movement against gravity with full resistance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What nerves do you test with elbow flexion? extension?

A

Elbow flexion- C5, C6

Elbow extension C6,C7, C8

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What nerves are tested with hand grip?

A

C7, C8 , T1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What nerves are tested with finger ABDUCTION

A

C8. T1, ulnar nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What nerves are tested with oppostion of the thumb?

A

C8, T1, median n

25
Q

What neres are tested with hip flexion and adduction

A

L2-L4

26
Q

What nerves are tested with hip abduction?

A

L4, L5, S1

27
Q

What nerves tested with hip extension?

A

S1

28
Q

What nerves are tested with knee extension

A

L2-L4

29
Q

What nerves are assessmed with knee flexion?

A

L4-S2

30
Q

What nerves are tested with dorsiflexion

A

L4. L5

31
Q

What nerves are tested with plantar flexion?

A

S1

32
Q

What does the glasgow coma scale test for in head injury?

A
  • Defines neuro function impairment
    • eyes open- never 1- spontaneous 4
    • best verbal response none1- oriented 5
    • best motor response none 1- obeys commands 6
  • mortality closely related to initial score
  • score <8 considered severe (come) will require intubaiton and controlled vent for ICP and airway control

don’t need to know exact GCS score for test, just know factors that go into it

33
Q

What are some consideraitons when patient is on steroids?

A
  • Suppression or disease of pituitary-adrenal axis will prevent the patient from responding to the stress of sx appropriately
  • any patient who has received corticosteroid therapy (suppression of pituitary-adrenal aix) for at least a month in the past 6-12 months needs supplementation
  • 2 possible regiments
    • 100 mg hydrocortison preop, intraop and post op
      • seems aggressive according to Bowman
    • 25 mg hydrocortison preop+100 mg IV gtt over 12-24 hours
34
Q

What are some considerations when patient on MAOI?

A
  • Inhibits degradation of monoamines, increasing the serotonin and norepi available at presynaptic nerve terminal for uptake and storage
  • life-threatneing interactions can occur with consumption of foods containtin tyramine and with Ephedrine and Meperidine
35
Q

What are the MAOIs we need to know?

A
  • Befloxatone
  • Brofaraomine
  • Iproniazid
  • Isocarboxazide
  • Moclobemide
  • Phenelzine
  • Selegiline
  • Tranylcypromine
36
Q

What are some considerations iwth methotrexate and anesthesia?

A
  • Used in MS, ankylosing spondylitis and rheumatoid arthritis
  • immuno-suppression, anemia, thrombocytopenia, pulmonary toxicity, renal and hepatic toxicity
  • CBC
  • Chem panel
  • consider PFT, and LFT if hisotry warrants
37
Q

What are some quesitons to ask for patient with multipel sclerosis?

A
  • Any recent history of illness or infection?
    • Take extra care with infection prevention
  • Which medications are they taking and how often?
  • Steroids in past year?
  • Remission and exacerbation intervals
  • Severity and nature of symptoms
    • respiratory status
    • previous triggers
38
Q

Anesthetic considerations for patient on disease modifying therapy for MS?

A
  • Disease modifying therapy (immunomodulators) all aincrease risk of infection
    • interferon B (flu like symptoms, hepatotoxicity, myelosuppression, depression)
    • dimethyl fumarate (GI disocmfort, infections)
    • Glatiramer acetate (well tolerated)
    • Natalizumab (leukoencephalopathy, hepatotoxicity)
    • Fingolomid (bradycardia, hepatotoxicity)
    • Teriflunomide (neutropenia, hepatotoxicity)

don’t need to memorize drugs, but know what to assess for in general!

39
Q

What are some considerations for immunosuppressant drugs around mutliple sclerosis?

A
  • Corticosterois (exacerbations)
    • elevated BG levels, DM, Cushings type picture
  • mitoxantrone (severe myelosuppressiona nd cardiac toxicity- reduced EF- heart failure)
40
Q

What are some symptom management treatments in MS?

A
  • Bladder dysfucntion (alpha antagonist, anticholinergics VS bethanechol- agonist)
  • Fatigue and depression
  • cognitive dysfucntion (cholinesterase inhibitos, memantine)
  • neuropathic pain
  • spasticity (baclofen)<– important to continue! otherwise r/f seizures!
41
Q

What is it important to document with MS?

A

document pre-eixsting deficits!

  • paralysis (assess for motor strength)
  • sensory distubances (assess along dermatomes)
  • autonimc distrubance (resting HR, orthostatic hypotension)
  • visual impairment (cranial nerve check)
  • seizures (meds)
  • emotional disturbances

Counsel pt regarding increased relapse incidence with surgery

42
Q

What is important to dcoument with GBS?

A
  • Document time course of the disease
    • precipitating factors
    • onset of symptoms
    • disease progression (worsening, stable, improving)
    • should never, ever do elective procedures with GBS
  • Document severity and current states of symptoms
    • facial paralysis- bulbar involvemet
    • difficult swallowing- pharyngeal muscle weakness
    • impaired ventialtion- current ventilatory support required (vent)
    • decreased DTR- lower motor neurons
    • extremity paresthesia
    • pain- HA, backache, muscle tenderness + note meds helpful for contorlling pain
43
Q

WHat is another dysfunction possible with GBS?

A

Autonomic dysfunction

  • Review ICU flow sheet for VS trengds
  • inquire with nurse/pt regarding tolerance of positon hanges
  • ECG, any recent arrhtyhmias
  • vasoactive med hx for HTN, and hypotension (vasopressers, B blockers)
44
Q

What is important to note with parkinson’s diases?

A
  • Age of dx, recent exacerbation and hospitalizations
  • Current and past symptoms (oculogyric crisis- loosing contorl eye movement, staring striaght ahead. How long did it last? What helped?)
    • ANS symptoms (orhtostatic BPs)
    • hx of pergolide therapy - aortic/mitral regurg
    • Temp regulation issues?
    • PUlmonary status optimized
      • dysphagia and/or dyspnea
      • pulmonary infection
  • Continue current meds and note s/e
    • levodopa- what happens if patient misses a dose?
      • need dose every 6 hours
    • anticohlinergics and MAOIs
  • Note natural range of motion for positioning
  • deactivate deep brain stimulators before electrocautery
45
Q

Considerations for intervertebral disc herniation?

A
  • Natural ROM for positioning and laryngoscopy
  • baseline motor strenght and sensation in applicable areas
  • med regimen (pt on high dose opioids), what drug improve pain, what has been ineffective
  • consider potential for operative blood loss
    • CBC
    • Type and cross
46
Q

Consideration for ankylosing spondylitis?

A
  • Evaluate coexist vasculitis, aortitis, aoritc insuff., pulmonary fibrosis
  • evaluate for severity of kyphosis
  • spo2, ekg, echo, cxr, pft
  • CBC, BUN, Cr
  • D/c nsaids at least 2 days preo
  • may have positioning challenges
47
Q

Considerations for acute SCI?

A
  • Fluid and blodo status
    • CBC, T&C, chem7
  • EKG/CXR
  • Vasopressor requirement?
  • Vent support?
  • Associated injuries

level of lesion?

48
Q

Consideration for chronic SCI?

A
  • Hx of autnomic dysreflexia? What intitiated it?
  • Old OR/ICU records helpful- response to vasopressors/tracheal sxn
  • Ventialtory reserve - level of lesion
  • assessment of skin integrity
  • positioning- note normal ROM
49
Q

What are some considations for CVA?

A
  • Hx of recent TIA or CVA increse risk of perioperative stroke
  • optimal time for subsequent elective sx after stroke is controversial
  • ensure optimization has occurred
    • emboli- PFO corrected?
    • a fib 1-3 months antiocoag therapy
    • carotid bruit noted on exam?
      • ask about ITA symptoms (be aggressive with quesitoning!)
      • consider carotid doppler US study- refer vasular sx
50
Q

What are some considerations with CVA, head injury or intracranial tumor?

A
  • Mechanism of injury/ilness
  • location, size, time course of lesion
  • CT/MRI (secondary edema, hydrocephalus?)
  • LOC
  • ICP status
    • current sypmotsm of headache, nausea, vomiting, bardycardia, HTN
  • Eval CV status
  • consider cranial nerve assessment
  • consider muscle strenght and sensation assessment
  • Review meds
    • endocrine
    • fluid
    • cbc
    • t&c
    • electolyte
    • ekg
    • echo
  • Review current vent status
  • note baseline VS and set BP parameter
  • continue current meds
51
Q

Consideration for seizure d/o?

A
  • Type of sz acitivity; typical lneght, freq, severity, recovery
  • Precipitatin./causative factors (ETOH withdrawal, brain tumor)
  • Hx of status epilepticus (how long did it last, how was it treated, were treatments effective)
  • pharm therapy
    • testing direted based on meds- CBC, plt, electolye panel
    • routine level of anticonvulsants unecessary in pt with good sz contorl
    • cancel elective sx utnil sz d/o optimized by neurologist
52
Q

WHat are things to not for physical exam/lab and tests of patient with Lupus?

A
  • Note natural ROM (arthritis)
  • note NM stregnht, cranial and peripherla neuropahteis
  • note mentation (CNS involvement)
  • fluid and electolyte status- CMP
  • Hematologic- CBC, PT/PTT and INR
  • Skin- not existing rashes
  • Distal extremities- raynaud’s common- pulse ox may be difficult
  • Renal fxn- glomerulonephritis, protienuria, albumin levle, chem panel
  • Cardiac status- echo, cardiac consult, pericarditis? conduciton abnormaliities? chf? valuvlar dysfunction?
  • Pulmonary status- PFT
  • GI- prone to n/v?
53
Q

What are some medications considerations with lupus?

A
  • Note dose amt, frequency, timing of last dose, side effects
  • drugs that affect coag status
    • ibuprofen
    • indomethain
    • ASA
    • cox-2 inhbitos
    • DVT preventative therpy
  • Immunosuppressive therapy
  • steroids
  • optimized by PCP or rheumatologies
54
Q

Considerations for RA?

A
  • Focus area- airway, neuro, pulm, CV
  • Note natural ROM
    • TMJ- limited mouth opening
    • Atlantoaxial joint- lateral neck radiogrpah or MRI
    • Cricoarythenoid arthritis- hoarseness, pain on swallowing, dypnea, stridor, laryngeal tenderness
    • individualized airway plan based on findings
  • Dyspnea is often sign of cardiac ischemia in this patient pop
    • PFT and ABG if you suspect lung involvement (restrictive pattern)
    • EHCO, EKG esp if cardiac involvement suspected
  • consider effect of meds: ASA, NSAIDS, methotrexate, immunosuppressive drug and steroids
55
Q

Consideraiton si OA?

A
  • Note natural ROM- focus on key problem areas
  • meds of rpain relief, what works, what does not work, last dose, etc
56
Q

Consideration with myasthenia gravis?

A
  • Note degree of skeletal muscle weakness, progerssion of the disease
  • note med hx-
    • cholinesterase inhibitors
    • steroids
    • immunosuppressive therapy
  • may stay inbuated afterwards, make sure they’re aware
57
Q

Consideraitons for muscular dystrophy?

A
  • Note progression of dx, natural ROM, strenght
  • Delayed gastric motility< RSI, aspiration risk
  • vent status (PFT, cough strenght) aspiration risk
  • Cardiac (EKG, echo)
  • succinycholine contraindicated
  • may not be extubated right away
58
Q

Considerations for myasthenic syndrome?

A
  • Note degree of skeletal muscle weakenss and progression of disease, meds
59
Q

Marfan syndrome consideration?

A

Cardiopulmonary assessment, echo, TMJ, high pneumothorax risk

Health Assessment (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions