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Nursing Health Assessment > Muscleoskeletal > Flashcards

Muscleoskeletal Flashcards

1
Q

Define the 4-point grading scale for deep tendon reflexes.

A

4+ Very brisk, hyperactive with clonus, indicative of disease
3+ Brisker than average, may indicate disease, probably normal
2+ Average, normal
1+ Diminished, low normal, or occurs only with reinforcement
0 No response

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2
Q 
Which vertebral level is assessed when eliciting each of these reflexes:
Biceps reflex
Triceps reflex
Brachioradialis reflex
Quadriceps reflex   
Achilles reflex
A 
Biceps reflex: C5-C6
Triceps reflex: C7-C8
Brachioradialis reflex: C5-C6
Quadriceps reflex: L2-L4     
Achilles reflex: L5-S2
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3
Q

Denver II

A

method of screening for evidences of slow development in infants and preschool children. The test covers four functions: gross motor, language, fine motor-adaptive, and personal-social.

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4
Q

physiologically why is “crampy” associated with muscle pain?

A

clotication arteriole insufficiency causing pain with movemoent dur to muscle ichemia

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5
Q

Claudication

A

Pain, commonly in the legs, caused by too little blood flow, usually during exercise. Often indicates peripheral artery disease.

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6
Q

What can morining vs night pain indicate?

A

Morning (pain from not using)

Night (pain from prolonged use): OA

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7
Q

Dislocation:

A

loss of contact between 2 bones in a joint

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8
Q

Subluxation:

A

misalignment of two bones in a joint (partial dislocation)

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9
Q

Contracture:

A

shortening of muscle leading to decreased ROM (usually results from prolonged immonbility)

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10
Q

Crepitation:

A

audible and palpable crunching or grating that accompanies movement

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11
Q

Myaliga
Ostealgia
Arthralgia

A

“-aliga” = pain

muscle, bone, joint

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12
Q

Cephalocaudal

A

means head to toe

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13
Q

During inspection and palpation of the musculoskeletal system, what are you appreciating?

A

color, swelling, deformities, masses, alignment, thenderness, pain, crepitus, heat, spasms (muscles)

This is the same for all joints!!

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14
Q

How is muscle strength appreciated?

A

though passive ROM

Grading scale out of 5 (5=normal, 0= no movement)

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15
Q

How is CN XI tested?

A

turning head against resistance, shoulder shrug

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16
Q

Spinal column:
inspection
assess
ROM

A
  • inspect- normal S shape standing, curved when bent at waist
  • assess- spinal movement with measuring tape (+2”)
  • ROM- flex/ extend (forward/ back); rotational; lateral bend
17
Q

Shoulders:
ROM
muscle strength

A
  • ROM: add/ abd (rotator cuff injury); internal (hands behind head)/ external rotation (hands at small of back); flex (bring arms straight up)/ extend (bring back down/ hyperflexion (behind)
  • muscle strength (performed against resistance!): shoulder shrug (CN XI); add/ abd
18
Q

Elbows:
ROM
muscle strength

A

-ROM: flex/ extrend; supinate/ pronate

-muscle strength (performed against resistance!)
while supporting pt. elbow with one hand: flex (biceps)/ extrend (triceps)

19
Q

Wrists and Hands:
ROM
muscle strength
2 tests for carpal tunnel

A
  • ROM: spread fingers and make a fist; touch thumb to each finger and base of pinky
  • muscle strength: Finger grips, wrist flexion/ extension/ hyperflexion (performed against resistance!)

-Phalen: hold hands dorsal surface of hands together for 60s
-Tinel Sign: tap on medial nerve
Paresthesia= positive for carpal tunel

20
Q

Hips:
ROM
muscle strength

A
  • Pt. should be supine
  • ROM: flex/ extension (bring knee up, then back straight); internal/ external rotation (knee bent rotate away, then toward the midline); abd/ adducction (straight leg to side and back to midline)
  • Muscle Strength: straingth led raise
21
Q 
Leg and Knees:
Palpation/ inspection
ROM
Muscle strength
Length
A
  • Palpation/ inspection: signs of fluid accumulation- Bulge Sign or Ballottement of Patella
  • ROM: flex/ extension (bring heel back, then back to ground); Hyperextension
  • Muscle strength: hamstring and quads

-Length: True- anterior iliac spine to medial malleolus;
Apparent- umbilicus to medial malleolus (abnormalities caused by pelvic)

22
Q

Ankels and Feet:
ROM
Muscle strength

A
  • ROM: dorsi/ plantar flexion; eversion/ inversion; equal and bilateral flexion/ extension of toes
  • Muscle strength: walk on toes/ heels; foot pushes/ pulls
23
Q 
Developmental Competence: INFANTS
shape of spine
congenital dislocation (3 tests)
ROM
motor development
A

-C shaped spine

  • Ortolani’s Manueuver (most reliable): abduction, will hear and see dislocation
  • Barlow: adduction
  • Allis: knee height
  • ROM: through spontaneouls movement and responces to reflexes (may signal fractures)
  • Denver II: motor milestones
24
Q

Developmental Competence: Pregnancy
shape of spine
joints

A

-Lordosis

  • Paresthesia; carpal tunnel
  • Estrogen relaxes ligaments leading to joint instability
25
Q

Developmental Competence: Older Adults
sape of spine
ADLs
Muscle strength

A
  • Kyphosis
  • Decreased height due to loss of water content and thinning of intervertebral disks
  • slower at performing ADLs
  • muscle strength slightly lower than adult, shoulf not be <4/5 bilaterally
26
Q

When are CMS checks done for muscleoskeletal

A
  • 6 P’s
  • checks that arteries are oxygenating the lower extremities
  • checks are done distal to the site of injury
  • eg: after a femur break, check the toes
27
Q

Osteoporosis
what is it
what is this caused by
primary vs secondary treatment

A

NOT a normal part of aging! But caused by factors associated with aging

  • Loss of bone density
  • caused by decline in estrogen related to Ca deficit, vit. D; lack of impact exercise
  • Primary: fast walking
  • Secondary: bone density screening (DEXA- examines density)
28
Q 
RA:
what is it
what is this caused by
common clinical findings
advanced stage findings
A

Rheumatoid Arthritis

  • Inflammation of connective tissue, bilateral
  • Chronic autoimmune disease (gradual onset)
  • Findings: bilateral pain, edema, stiffness (espically in the morning)
  • Ulnar deviation, swan-neck, boutonniere
29
Q 
OA:
what is it
what is this caused by
common clinical findings
Heberden's Nodes
Bouchard's Nodes
A

OsteoArthritis

  • Noninflammatory degenerative change in articular cartilage, unilateral or bilateral
  • caused by repetitive movement; affects weight bearing joints
  • Findings: stiffness, swelling, hard/ bony nontender protuberances, limited ROM
  • Heberden’s Nodes: in distal IP joints
  • Bouchard’s Nodes: in proximal IP joints
30
Q 
Gout:
what is it
what is this caused by
common clinical findings:
acute
chronic
A
  • A type of arthritis
  • caused by increased serum uric acid due to increased productin and/ or decreased excretion (diet, renal function)
  • Acute: severe throbbing joint pain; limited ROM
  • Chronic: >1 attack/ yr; Tophi (uric acid deposits on ear pinna, subcutaneous tissue, or joints); kindney stones may cause flank pain and CVA tenderness
31
Q 
Herniated Nucleus Pulposus:
what is it
what is this caused by
common clinical findings
How to test
A
  • Herniated/ slipped disk:
  • Caused by lifting, twisting etc

-Clinical findings: L5/S1 most common: may cause lateral tilting and forward lean; numbness or radiating pain in leg.
Cervical herniation: arm pain and paresthesia

  • Lasegue Test: Passive straight leg raise cause sciatic pain (the slipped disk puts pressure on spinal nerve); confirm by lifting the pt opposite leg, and notice pain in 1st leg
  • DTRs may be depressed
32
Q

Scoliosis:
shape of spine
clinical findings

A

-S shaped spine from posterior view
-Depends on severity: uneven shoulder and hip levels; rib or flak asymmetry.
Lungs, spine, pelvis may be compromised

33
Q 
Carpal Tunnel Syndrome
what it is
cause
clinical findings
2 tests
A

-Occures when medial nerve is compressed
-caused by repetitive movements or hand/ arms, injury, systemic disorders (RA, gout, hypothyroidism).
May also occure with fluid retention that occures with pregnancy and menopause.

  • clinical findings: Parethesia in hands (often at night)
  • Phalen’s, Tinel’s

Nursing Health Assessment (16 decks)

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