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Health assessment > objective 11 > Flashcards

objective 11 Flashcards

1
Q

206 ____ in the body; they are hard, rigid, and very dense; cells in the ____ are continuously remodeling and turning over

A

bones

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2
Q

where two or more bones come together

A

joints

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3
Q

immoveable or only slightly moveable, fibrous tissue or cartilage unite the bones

A

nonsynovial joints

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4
Q

freely moveable, bones are separate from each other and enclosed in a joint cavity that is filled with synovial fluid

A

synovial joints

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5
Q

covers the surface of opposing bones, cushions the bones, and creates a smooth surface that facilitates movement

A

cartilage

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6
Q

fibrous bands connecting one bone to another; strengthen the joint, stabilize movement

A

ligaments

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7
Q

enclosed sac that contains synovial fluid; located in areas of potential friction; help muscles and tendons slide smoothly over bone

A

bursa

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8
Q

produce movement when they contract

A

muscles

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9
Q

what are the 3 types of muscles?

A

skeletal, smooth, cardiac

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10
Q

what is the musculoskeletal system needed for?

A

support
movements
protection
hematopoiesis
reservoir for storage of essential minerals

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11
Q

Articulation of the mandible and temporal bone
* Palpable in the depression anterior to the tragus
* Enables jaw function for speaking and chewing

A

temporomandibular joint

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12
Q

what does the temporomandibular joint allow for?

A

Opening and closing of the jaws (hinge action)
* Protrusion and retraction (gliding action)
* Moving the lower jaw from side to side (gliding action)

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13
Q

what are the connecting bones in the vertical column?

A

7 cervical
* 12 thoracic
* 5 lumbar
* 5 sacral
* 3-4 coccygeal vertebrae

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14
Q

what are the surface landmarks?

A

C7 and T1; T7 and T8; L4; sacrum

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15
Q

what does the spines unique structure allow for?

A

upright posture
flexion, extension, abduction, rotation

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16
Q

what are the 4 curves of the vertebral column?

A

cervical and lumbar- concave
thoracic and sacrococcygeal- convex

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17
Q

cushion the spine and help it move

A

intervertebral discs

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18
Q

articulation of the humerus with the glenoid fossa of the scapula; ball and socket allows for greater mobility

A

glenhumeral joint

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19
Q

consists of muscles and tendons that support and stabilize the glenohumeral joint

A

rotator cuff

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20
Q

during abduction of the arm it helps the greater tubercle of the humerus moves easily

A

subacrimial bursa

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21
Q

what are the palpable landmarks of the shoulder joint?

A

acromian process
greater tubercle
coracoid process

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22
Q

contains 3 bony articulations of the humerus, radius and forearm
flexion and extension

A

elbow joint

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23
Q

what are the palpable landmarks for the elbow joint?

A

Medial and lateral epicondyles of the humerus
* Olecranon process of the ulna in between the
epicondyles

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24
Q

articulation of the radius and a row of carpal bones
allows for flexion and extension; side to side deviation

A

radiocarpal joint

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25
Q

articulation between the two parallel rows of carpal bones
allows for flexion extension, some rotation

A

midcarpal joint

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26
Q

allow for flexion and extension of the fingers

A

metacarpophalangeal and interphalangeal joints

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27
Q

articulation between the acetabulum and the head of the femur

A

hip joint

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28
Q

allows a wide range of motion on many axes

A

ball and socket

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29
Q

what are the landmarks for the hip joint?

A

anterior superior iliac spine; ischial tuberosity; greater trochanter

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30
Q

articulation of three bones in one common articular cavity- femur, tibia, patella
largest joint in the body, synovial membrane largest in the body

A

knee joint

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31
Q

allows for flexion and extension of the lower leg on one plane

A

hinge joint

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32
Q

2 wedge-shaped cartilages that cushion the tibia and femur

A

medial and lateral menisci

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33
Q

what is the knee joint stabilized?

A

cruciate ligaments
collateral ligments

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34
Q

articulation of the tibia, fibula, and talus

A

ankle joint

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35
Q

allows flexion and extension

A

hinge joint

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36
Q

what are the landmarks for the ankle joint?

A

medial malleolus and lateral malleolus

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37
Q

what are the developmental considerations for infants and children?

A

Bone growth – from in utero through to adolescence when a rapid growth
spurt occurs
* Long bones grow in 2 dimensions: width (diameter) and length
* Skeletal contour changes noted at the vertebral column
* Development of dysplasia of the hip (DDH) - congenital abnormalities of the
hip joint
* Infants should be examined periodically until they are walking
independently
* Several risk factors. Examples: having a first=degree relative with DDH,
breech delivery etc.
* Growing Pains - Noninflammatory pain syndrome affecting children between
ages 3-12

38
Q

what are the developmental considerations for pregnancy?

A

Increased joint mobility occurs
due to increased levels of
circulating hormones such as
estrogen, relaxing etc.
* Change in posture - lordosis which
compensates for the growing
fetus

39
Q

Reabsorption of bone occurs more rapidly then deposition
after the age of 40 years

A

osteoporosis

40
Q

Caused by shortening of the vertebral column - due to loss of
water content, thinning of the vertebral discs

A

decreased height

41
Q

how do we inspect the musculoskeletal system?

A

Assess size and contour of the joint
* Inspect the skin and tissues over the joint (colour, swelling,
masses, deformity)
* Presence of swelling is significant – indicates joint irritation
* Swelling can be caused by:
* Excess joint fluid (effusion)
* Thickening of the synovial lining
* Inflammation of surrounding soft tissue
* Bony enlargements
* Deformities include: Dislocation, subluxation, contracture ,
ankylosis

42
Q

how do we palpate the musculoskeletal system?

A

Palpate skin (temperature), muscles, bony articulations, area of the
joint capsule
* Note heat, tenderness, swelling, masses

43
Q

what are the normal findings for palpation of the musculoskeletal system?

A

Joints not tender to palpation, synovial membrane is not
palpable
* Note: a small amount of fluid is present in the normal joint but it is
not palpable

44
Q

what are the abnormal findings for palpation of the musculoskeletal system?

A

Warmth, tenderness, palpable fluid, tenderness, thickened
synovial membrane
* If tenderness is noted– try to localize it to specific anatomical
structures (i.e. muscles, tendons, joint capsule etc.)
* When the synovial membrane is thickened, it feels doughy or boggy

45
Q

what are the normal findings for testing ROM?

A

no tenderness, pain, or crepitation with joint motion
* Active and passion ROM (normal ranges) should be the same

46
Q

what are the abnormal findings for testing ROM?

A

enderness, pain, crepitation
* Crepitation - crunching or grating, that is audible and palpable, that occurs
with movement
* Articular disease and extra-articular disease

47
Q

what is the grading system for ROM?

A

5 - Full ROM against gravity, full resistance
* 4 - Full ROM against gravity, some resistance
* 3 - Full ROM with gravity
* 2 - Full ROM with gravity eliminated (passive motion)
* 1 - Slight contraction
* 0 - No contraction

48
Q

how do we inspect the temporomandibular joint?

A

Inspect the area just anterior to the ear.
* Assess for a bulge over the joint - this indicates swelling
* To be visible, at least a moderate amount of swelling has to
be present

49
Q

how do we palpate the temporomandibular joint?

A

The examiner places the tips of their first two fingers in front
of each ear
* Ask client to open the mouth
* The examiner then drops their fingers into the depressed
area over the joint

50
Q

what are the normal and abnormal findings for palpation of the temporomandibular joint?

A

Normal: Smooth motion of the mandible
* Consideration: An audible or palpable snap/click occurs when the
client opens their mouth
* Abnormal: Swelling over the joint, crepitus, and pain

51
Q

how do we test muscle strength in the temporomandibular joint?

A

Ask the client to:
* Clench their teeth
* Examiner palpates the contracted temporalis and masseter
muscles
* Compare bilaterally for size, firmness, and strength
* Move their jaw forward and laterally against resistance
* Open their mouth against resistance
* See Figure 24., p. 654
* Note: Muscle strength testing is also testing the integrity of the
trigeminal nerve

52
Q

how do we inspect the cervicalm spine?

A

inspect alignment of the head and neck

53
Q

how do we palpate the cervical spine?

A

Palpate the: spinous process, sternomastoid muscle, trapezius
muscle, and the paravertebral muscles

54
Q

what are the normal and abnormal findings when palpating the cervical spine?

A

Normal: Firm with no muscle spasm or tenderness
* Abnormal: Asymmetry of the muscles, tenderness, and hard
muscles with muscle spasm

55
Q

how do we test muscle strength of the cervical spine?

A

Ask the client to repeat the ROM while the examiner applies
opposing force

56
Q

what are the normal and abnormal findings when testing muscle strength of the cervical spine?

A

Normal: The client can maintain flexion against full
resistance
* Abnormal: The client cannot maintain flexion

57
Q

how do we inspect the shoulders?

A

Compare both shoulders posteriorly and anteriorly.
* Check the size and contour of the joint, & the equality of bony landmarks
* Check the anterior aspect of the joint capsule and subacromial bursa for
swelling

58
Q

what are the normal and abnormal findings when inspecting the shoulders?

A

Normal: No redness, muscular atrophy, deformity, or swelling
* Abnormal: Redness, inequality of bony landmarks, atrophy, dislocated
shoulder, swelling from excess fluid (this is best seen anteriorly), swelling
of subacromial bursa (localized under the deltoid), pain

59
Q

how do we palpate the upper extremities?

A

Stand in front of the client
* Palpate both shoulders, starting at the clavicle (note: muscular spasm,
atrophy, swelling, heat, or tenderness)
* Explore the following: Acromioclavicular joint, scapula, greater tubercle
of the humerus, area of the subacromial bursa, biceps groove, and
anterior aspect of the glenohumeral joint, axilla

60
Q

what are the normal and abnormal findings when palpating the upper extremities?

A

Normal: No swelling, tenderness, muscle spasm, adenopathy or masses
* Abnormal: Swelling, tenderness, hard muscles with muscle spasm,
presence of adenopathy or masses

61
Q

how do we test muscle strength of the shoulders?

A

Ask client to shrug their shoulders against resistance:
* Shoulder shrug is also a test of the integrity of the spinal
nerve
* Ask the client to flex their shoulders forward and up and abduct
them against resistance

62
Q

how do we inspect the elbow?

A

Size and contour
* This should be done in both the flexed and extended positions
* Deformity, redness, or swelling
* Check the olecranon bursa - there are normally hollows on
either side and no swelling should be present

63
Q

how do we palpate the elbow?

A

When palpating:
* The elbow should be flexed about 70 degrees and relaxed
* The examiner uses their left hand to support the client’s left forearm
* Palpate the extensor surface of the elbow with right thumb and fingers
* Palpate the olecranon process by placing the thumb in the lateral groove and
index and middle fingers in the medial groove
* Use varying pressure when palpating

64
Q

what are the normal and abnormal findings when palpating the elbow?

A

Normal:
* Tissues and fat pads feel fairly solid, no synovial thickening, swelling,
nodules, or tenderness
* No swelling, tenderness, consistency, nodules noted in the area of the
olecranon bursa
* Abnormal: soft or boggy when palpated, local heat or redness, subcutaneous
nodules

65
Q

how do we test muscle strength of the elbow?

A

When testing muscle strength:
* Stabilize the client’s arm with one hand
* Apply resistance proximal to the wrist
* Instruct client to both flex and extend the elbow against
resistance

66
Q

how do we inspect the wrist and hands?

A

During inspection of the hands and wrists, assess the following:
* Dorsal and palmer sides
* Observe: position, contour, shape
* Normal functional position of the hand: Wrist is slightly extended;
fingers in same axis as the forearm
* Skin
* Muscles - should be full; note the thenar eminence

67
Q

what are the normal and abnormal findings when inspecting the hands and wrists?

A

Normal: Skin is smooth with knuckle wrinkles present; no swelling
or lesions, redness, deformity, or nodules
* Abnormal: Subluxation of the wrist, ulnar deviation, ankylosis,
Dupuytren’s contracture, generalized swelling, tenderness etc.

68
Q

how do we palpate the hands and wrists?

A

Palpate each joint:
* Examiner faces the client
* Examiner supports the client’s hand with their fingers under it, palpate
wrist firmly with both thumbs on its dorsum
* Client’s wrist should be relaxed and in straight alignment
* Move palpating thumbs side to side – note depressed areas that overlie
joint space

69
Q

what are the normal and abnormal findings when palpating the wrists and hands?

A

Normal: Joint surfaces smooth, no swelling, bogginess, nodules, or
tenderness
* Abnormal: Absence of the thenar eminence, swelling, tenderness
etc.
* Using their thumbs, the examiner palpates the metacarpophalangeal
joints
* Palpate distal to and on either side of the knuckle
* Using their thumb and index finger in a pinching motion, the
examiner palpates the sides of the interphalangeal joints
* Findings:
* Normal: No synovial thickening, redness, warmth, or nodules noted

70
Q

how do we test muscle strength of the wrists and hands?

A

To test muscle strength:
* Place client’s forearm in supinated position on a table
* Stabilize client’s arm - examiner places their hand at the mid-
forearm
* Apply resistance at the client’s palm
* Instruct client to flex their wrist against the examiner’s resistance

71
Q

how do we inspect the hip?

A

Inspection of the hip joint is completed with assessment of the
spine
* The client will be in the standing position
* Inspect for:
* Symmetrical levels of iliac crests and gluteal folds;
* Equal size buttocks
* Smooth, even gait

72
Q

how do we palpate the hip?

A

For palpation of the hips:
* Position the client supine

73
Q

what are the normal and abnormal findings when palpating the hip?

A

Normal: Joints feel stable and symmetrical, no tenderness or
crepitation
* Abnormal: pain with palpation, crepitation

74
Q

how do we inspect the knee?

A

Client should be in the supine position with legs extended
* Inspect the skin

75
Q

what are the normal and abnormal findings when inspecting the skin of the knee?

A

Normal: Skin smooth, even colouring, no lesions
* Abnormal: Shiny, atrophic skin, swelling, inflammation, lesions

76
Q

what are the normal and abnormal findings when inspecting the lower leg alignment?

A

Normal: Leg extends in same axis as the thigh
* Abnormal: Genu varum, Genu valgum, flexion contractures

77
Q

how do we inspect the shape and contour of the knee?

A

Normal: Distinct concavities present on either side of the
patella - no sign of fullness or swelling
* Abnormal: Concavities disappear, bulging noted

78
Q

how do we inspect the quads for atrophy?

A

Normal: No atrophy
* Abnormal: Atrophy (occurring with disuse or chronic disorders)

79
Q

how do we palpate the lower extremities?

A

Palpate each joint:
* Client should be in the supine position with complete relaxation
of quadriceps muscle
* Start 10 cm above patella and proceed down to the knee
* Palpate using left thumb and fingers in a grasping manner

80
Q

what are the normal and abnormal findings when palpating the lower extremities?

A

Normal: Muscles and soft tissue feel solid, joint smooth with
no warmth, tenderness, thickness, or nodules
* Abnormal: Boggy texture, warmth, tenderness, thickness, or
nodules

81
Q

how do u test muscle strength in the lower extremities?

A

Client maintains knee flexion while the examiner opposes by
trying to pull the leg forward

82
Q

how do we test muscle extension in the lower extremities?

A

Client rises from a seated position (low chair or from a squat)
without using the hands for support

83
Q

how do we inspect the ankle and foot?

A

When client is sitting, standing, and walking
* Compare both feet
* Positioning of feet and toes, contour of joints, skin, foot alignment with
axis of lower leg, weight bearing, pointing of toes, longitudinal arch,
ankles

84
Q

what are the normal and abnormal findings when inspecting the ankle and foot?

A

Normal: Smooth skin, even colouring, no lesions, no issues noted with
above
* Abnormal: Hallux valgus, hammertoes, claw toes, swelling,
inflammation, calluses, ulcers

85
Q

how do you palpate the ankle and foot?

A

Examiner supports the ankle by grasping the heel while palpating
with fingers and thumbs
Examiner palpates the metatarsophalangeal joints between the
thumb (on the dorsum) and fingers (on plantar surface)
* Examiner uses a pinching motion to palpate the interphalangeal joints
on the medial and lateral sides of the toes

86
Q

what are the normal and abnormal findings when palpating the ankle and foot?

A

Normal: Joint spaces should feel smooth and depressed, with no
fullness, swelling, or tenderness
* Abnormal: Tenderness, swelling, inflammation

87
Q

how do you assess the spine?

A

The client should
be standing
* The hospital gown
should be open in
the back

88
Q

how do we examine the spine?

A

The examiner should be positioned so that the client’s entire back can be
seen.
* For inspection:
* Assess the spine for straightness`

89
Q

what are the normal and abnormal findings when inspecting the spine?

A

Normal:
* Imaginary straight line from the client’s head, down the spinous
processes, and down the gluteal cleft
* Equal horizontal positioning of: the shoulders, scapulae, iliac
crests, and gluteal folds
* Equal spaces between the arm and lateral thorax on both sides
* Knees and feet are aligned with truck and pointing forward
* Abnormal:
* Difference in shoulder elevation, level of scapulae, and level of
the iliac crests

90
Q

what are the normal and abnormal findings when palpating the spinuous processes?

A

Normal: Straight and non-tender
* Abnormal: Spinal curvature

91
Q

what are the normal and abnormal findings when palpating the paravertebral muscles?

A

Normal: Feel firm with no tenderness or spasm
* Abnormal: Tenderness, spasm

92
Q

what are the normal and abnormal findings when testing rom of the spine?

A

Normal: Expected range, no pain with movement
* Abnormal: Limited ROM, pain with movement
* Note: Movements will only reveal gross restriction.
* Once the ROM assessment is completed, ask the client to:
* Walk on their toes for a few steps
* Walk on their heels

Health assessment (11 decks)

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