Week 5: Musculoskeletal Assessment Flashcards
Definition: Abduction
Moving a limb away from the midline of the body
Definition: Active Range of Motion
The range of movement a person can achieve by contracting and relaxing their muscles
Definition: Adduction
Moving a limb toward the midline of the body
Definition: Ankylosis
Stiffness or fixation of a joint
Definition: Atrophy
Part of the body has decreased in size or wasted away
Definition: Bouchard’s Nodes
Bony nodules, or osteophytes, that form on the middle joint of the fingers.
Definition: Circumduction
Moving the arm in a circle around the shoulder
Definition: Contracture
Shortening of muscle (limited ROM)
Definition: Crepitation
A crackling or rattling sound.
Definition: Dislocation
Bones out of position
Definition: Extension
Straightening a limb at a joint
Definition: External Rotation
A rotational movement that moves a limb away from the body’s midline
At the beach!!
Definition: Flexion
Bending a limb at a joint
Definition: Functional Assessment
A process that evaluates a patient’s ability to perform tasks and make clinical decisions.
Definition: Heberden’s Nodes
Bony bumps that develop on the joints closest to the tips of the fingers.
Definition: Hyperextension
A movement where extension is performed at any joint beyond its normal range of motion
Definition: Internal Rotation
A rotational movement that moves a limb toward the body’s midline
Doing up a bra!!
Definition: Arthralgia (Joint Pain)
A symptom of injury, infection, or illness specifically in the joints.
Definition: Lordosis (Swayback)
Increased lumbar curvature; often seen in pregnant ladies and toddlers
Definition: Myalgia
Term for Aching
Definition: Opposition
Positioning something near or close to each other
Definition: Osteoarthritis
A degenerative joint disease that causes pain, stiffness, and swelling in the joints.
Definition: Passive Range of Motion
The ROM that is achieved when an outside force (such as a therapist or a CPM machine) exclusively causes movement of a joint
Definition: Phalen Test
Dorsal aspects of hands pressed together; carpal tunnel syndrome would feel burning/numbness
Definition: Pronation
Turning the forearm so that the palm is down
Definition: Rheumatoid Arthritis
A long-term autoimmune disease that causes joint pain, swelling, and stiffness.
Definition: Scoliosis
Lateral spinal curvature
Definition: Subluxation
Partial dislocation; bone is partially out of place
Definition: Supination
Turning the forearm so that the palm is up
Definition: Swelling
Inflammation of the tissues/muscle often due to injury
Definition: Tinel’s Sign
Light percussion (tapping) over the median nerve at the flexor that elicits a tingling sensation in carpal tunnel syndrome
Where should you perform a Physical Assessment?
In an environment that is well lit, warm, and private
True or False: 16 is the legal age for healthcare consent
FALSE
There is no minimum age for consent or refusal of consent
True or False: An example of implied consent would be a patient holding out their arm for blood to be withdrawn
TRUE
True or False: A patient can withdraw their consent at any time
TRUE
True or False: If the nurse determines that the patient is incapable of providing consent, then implied consent is assumed
FALSE
The nurse is responsible for assessing the patient’s ability to provide consent. The substitute decision maker should be notified and used appropriately
True or False: The substitute decision-maker giving or refusing consent is expected to make decisions based on the client’s known wishes, which the client expressed when they were 16 years of age or older and capable
TRUE
If unknown, should act in best interests, taking into account values and beliefs, impact of treatment
True or False: Information provided before a client provides consent is required to only include the risks of the treatment
FALSE
Information must include nature of treatment, expected benefits, risks and side effects, alternative courses of action, likely consequences of not receiving the treatment
How should you approach an exam with Toddlers?
- Keep them and their parents involved.
- Focus more on the parent and let the toddler get used to it at first.
- Start with games/non-threatening data collection and move from the least distressing to most distressing.
- Have the parent undress one piece of clothing at a time.
- Use a clear, firm tone.
- Don’t give choices if there are none!
How should you approach an exam with Pre-schoolers?
- More likely to cooperate and want to act like “big kids” – may sit with mom/dad or may sit on “big table”
- May help getting undressed
- May see illness as punishment; give reassurance wherever possible
- Play games (ex. trace their body on the paper, blow out penlight, listen to teddy)
- Assess head, eye, ear, nose, and throat last as they become comfortable
How should you approach an exam with School-age Children?
- Build comfort relationship - talk about school, friends, sports etc.
- Children should dress/undress themselves
- Explain what you are doing and what is happening in the body – curiosity and interest
- Demonstrate equipment – curiosity
Assess head to toe
How should you approach an exam with Adolescents?
- They are developing self-identity.
- Assess alone, without parents (genitals as quickly as possible).
- Educate teen on the wide variability of G&D patterns and sexual changes as teens will compare themselves to other their age.
- Communication - not a child, not an adult.
- Focus on health teaching.
Which of the following is considered when preparing to examine an older adult?
a) Basing the pace of the examination on the patient’s needs and abilities.
b) Avoiding physical touch to offset making the older adult uncomfortable.
c) Being aware that loss will result in poor coping mechanisms.
d) That confusion is a normal, expected finding in an older adult.
a) Basing the pace of the examination on the patient’s needs and abilities.
During inspection, the nurse should use careful watching to compare:
A. Front body to back of body
B. Peripheral to distal
C. Head to toe
D. Right side to left side of body
D. Right side to left side of body
The dorsa of the hands are used to determine:
a) vibration
b) temperature
c) an organ’s position
d) fine tactile discrimination
b) temperature
When performing percussion, the examiner:
a) strikes the flank area with the palm of the hand.
b) strikes the stationary finger at the distal interphalangeal joint
c) strikes the stationary finger at the proximal interphalangeal joint.
d) taps fingertips over bony processes.
b) strikes the stationary finger at the distal interphalangeal joint
During auscultation, you may use the diaphragm of the stethoscope to hear:
a) Low pitched respiratory sounds
b) The radial pulse
c) High pitched sounds such as bowel sounds
d) Low pitched sounds such as abnormal heart sounds
c) High pitched sounds such as bowel sounds
What does the MSK system consist of?
Bones
Joints
Muscles
Why do humans need the MSK system?
- For support to stand upright.
- For movement.
- To enclose and protect the inner vital organs (e.g., brain, spinal cord, heart).
- To produce the red blood cells in the bone marrow (hematopoiesis).
- For storage of essential minerals such as calcium and phosphorus in the bones.
Why do we want to start with a focused health history?
- Assess for past injuries/previous weakness
- Narrow down subjective data and focus objective assessment on him.
What is the order of MSK assessments?
- Inspection
- Palpation
- Range of Motion
- Muscle Testing
During an MSK assessment, in what order should you assess?
Pick ALL that apply:
a) Head to toe
b) Distal to proximal
c) Most painful to least painful
d) Proximal to distal
a) Head to toe
d) Proximal to distal
What does Inspection in a MSK assessment include?
- Inspect the size and contour of the joint.
- Inspect tissues over the joint for swelling, redness, masses or deformity.
- Inspection for alignment.
What does Palpation in a MSK assessment include?
Palpate for temperature, muscles, bony articulations, and area of the joint capsule (landmarks).
What does Range of Motion in a MSK assessment include?
What actions can each joint perform?
(ex. flexion/extension, eversion/inversion of the ankle)
Limitation/restriction of ROM is the most sensitive way sign of joint disease/injury
What does Muscle Testing in a MSK assessment include?
Test the strength of the prime mover muscle groups for each joint
What is Flexion?
Bending a limb at a joint
What is Extension?
Straightening a limb at a joint
What is Abduction?
Moving a limb away from the midline of the body
What is Adduction?
Moving a limb toward the midline of the body
What is Pronation?
Turning the forearm so that the palm is down
What is Supination?
Turning the forearm so that the palm is up
What is Circumduction?
Moving the arm in a circle around the shoulder
What is Inversion?
Moving the sole of the foot inward at the ankle
What is Eversion?
Moving the sole of the foot outward at the ankle
What is Rotation?
Moving the head around a central axis
What is Protraction?
Moving a body part forward and parallel to the ground
What is Retraction?
Moving a body part backward and parallel to the ground
What is Elevation?
Raising a body part
What is Depression?
Lowering a body part
When testing for muscle strength, the examiner does which of the following?
A) Observes muscles for the degree of contraction when the individual lifts a heavy object
B) Applies an opposing force when the individual puts a joint in flexion or extension
C) Measures the degree of force that it takes to overcome joint flexion or extension
D) Measures the degree of flexion and extension with a goniometer
B) Applies an opposing force when the individual puts a joint in flexion or extension
What is the order of examination?
- Neck, Cervical Spine, and Back
- Upper Body (Shoulders, Elbows, Wrists, and Fingers)
- Lower Body (Hips, Knees, Ankles, and Toes)
What is Kyphosis?
Kyphosis (hunchback) is an exaggeration of the posterior curvature of the thoracic spine and is common in older adults.
During general inspection of the musculoskeletal system of an older client, the nurse notes kyphosis.
How is kyphosis defined?
A) Lateral spinal curvature
B) Loss of or decrease in muscle tone
C) Increased lumbar curvature
D) Exaggeration of the posterior curvature of the thoracic spine
D) Exaggeration of the posterior curvature of the thoracic spine
What is Lordosis?
Lordosis (swayback) is increased lumbar curvature.
What is Scoliosis?
Scoliosis is lateral spinal curvature.
What is Hypotonic Muscle?
Hypotonic muscle has little tone and feels flabby, usually because of atrophy of muscle mass.
Cervical Spine: Which ROM has no muscular strength testing?
Cervical hyperextension
When should you NOT perform muscular strength testing?
If you suspect cervical trauma
Crepitation is an audible sound that is produced by:
A) Roughened articular surfaces moving over each other.
B) Tendons or ligaments that slip over bones during motion.
C) Joints that are stretched when placed in hyperflexion or hyperextension.
D) An inflamed bursa.
A) Roughened articular surfaces moving over each other.
Bruno is being assessed for range of joint movement. You ask Bruno to move the arm toward the body so you can evaluate which of the following?
A) Flexion
B) Extension
C) Abduction
D) Adduction
D) Adduction
The knee joint is the articulation of three bones, the:
Femur
Tibia
Patella
