Exam 2 Flashcards
(229 cards)
1
Q
What is the definition of the thoracic cage?
A
A bony structure with a conical shape, which is narrower at top
2
Q
What is the anatomy of the thoracic cage?
A
-Surrounded by the sternum
-12 pairs of ribs
-12 thoracic vertebrae
3
Q
Where do the first seven ribs attach to?
A
Attach to sternum by costal cartilages
4
Q
Where do ribs 8, 9, and 10 attach to?
A
Attach to costal cartilage above
5
Q
True or False:
Ribs 11 and 12 are considered to be “floating”
A
True
6
Q
What are costochondral junctions?
A
Points at which ribs join their cartilages
-Not palpable
7
Q
What are the anterior thoracic landmarks?
A
-Suprasternal notch
-Sternum
-Sternal angle
-Costal angle
8
Q
Where is the suprasternal notch located?
A
A U-shaped depression just above the sternum between the clavicle
9
Q
What is the sternum considered to be?
A
The breastbone
10
Q
Where is the sternal angle located?
A
“Angle of Louis”
-At articulation of manubrium and sternum, and continuous with the second rib
11
Q
Where is the costal angle located?
A
The right and left costal margins form an angle where they meet at the xiphoid process
12
Q
What are the posterior thoracic landmarks?
A
-Vertebra prominens
-Spinous processes
-Inferior border of scapula
-Twelfth rib
13
Q
Where is the vertebra prominens located?
A
Flex your head and feel for most prominent bony spur protruding at the base of the neck
14
Q
Where is the spinous processes located?
A
Count down these knobs on vertebrae, which stack together to form spinal column
15
Q
Where is the inferior border of scapula located?
A
Scapulae are located symmetrically in each hemothorax
16
Q
Where is the 12th rib located
A
Palpate midwat between spine and a person’s side to identify its free tip
17
Q
What are the reference lines for the anterior chest?
A
Midsternal and midclavicular lines
18
Q
What are the reference lines of the posterior chest?
A
Vertebral (midspinal) line and scapular line
19
Q
What 3 lines do you divide the lateral chest by?
A
-Anterior axillary line
-Posterior axillary line
-Midaxillary line
20
Q
What is the definition of the mediastinum?
A
Middle section of thoracic cavity containing esophagus, trachea, heart, and great vessels
21
Q
Which lung has 3 lobes?
A
Right lung
22
Q
Which lung is shorter?
A
Right lung because of the liver
23
Q
Which lung is narrower?
A
The left because the heart bulges to the left
24
Q
What are the 4 major functions of the respiratory system?
A
1) Supplying oxygen to the body for energy production
2) Removing CO2 as a waste product of energy reactions
3) Maintaining homeostasis (acid-base balance) of arterial blood
4) Maintaining heat exchange (less important in humans)
25
What are the respiratory consequences of aging?
-Decreased vital capacity
-Increased residual volume based on structural change
-Cannot take in as much air b/c they lack the ability to
-Capacity to take in air is weaker
25
What questions do you ask the pt in regards to a cough?
-Duration
-Frequency
-Timing
-Presence of cough as an irritating factor
-Productive or non-productive
-Quality of cough
-Precipitating and/or alleviating factors
-Any tx tried
-Associated symptoms
-Impact of cough on ADLs and quality of life
26
What questions do you ask a pt in regards to shortness of breath?
-Precipitating factor
-Severity
-Duration
-Impact of change of position and specific timing pattern
-Association with other symptoms
-Any triggering mechanisms related to food, emotion, or environment
-Measures taken when SOB occurs
-Impact of SOB on ADLs
-Progression of SOB
27
What questions do you ask pts in regards to chest pain with breathing?
-Onset
-Timing (constant vs intermittent)
-Pain characteristics in terms of quality or intensity
-Associated symptoms
-Interventions used to decrease pain
28
What do you ask the pt in regards to a hx of respiratory infections?
-Any unusually frequent or unusually severe colds
-Any family hx of allergies, TB, or asthma
29
What do you ask a pt in regards to a hx of smoking?
-Onset
-Duration
-Pattern of smoking
-2nd hand exposure
-Smoking cessation
-Counseling using 5 A's
30
What are the 5 A's?
-Ask
-Advise
-Assess
-Assist
-Arrange
31
What do you ask pts in regards to environmental exposure?
-Occupational factors and exposure
-Protection from exposure
-Monitoring and f-up to exposure
-Awareness of symptoms that might signal breathing problems
32
What do you ask pts in regards to pt-centered care?
-Screening and f-up testing
-When was the last time you had the following: TB skin test, Chest x-ray, pneumonia or influenza immunization
33
When do you use a Lung Function Questionnaire?
For aging adults with a hx of COPD, lung cancer, or TB
34
What is the order for assessment of the respiratory system?
-Inspect
-Palpation
-Percussion
-Auscultation
35
What do you need to inspect for on the thoracic cage?
-Shape and configuration of chest wall
-Position the person takes to breath
-Skin color and condition
-Any lesions
-Any changes
36
How do you percuss the lung fields?
-Start at apices and percuss band of normally resonant tissue across tops of both shoulders
37
What is resonance?
A low-pitched, clear, hollow sound that predominates in healthy lung tissue in adults
38
What creates a characteristic set of noises that are audible through the chest wall?
Passage of air through the tracheobronchial tree
39
What are the two phrases you can uses to assess for palpable vibrations of the tactile (vocal) fremitus?
- 99
- Blue moon
40
What is tactile fremitus?
A palpable vibration from the larynx that is transmitted through patent bronchi and lung parenchyma to the chest wall
41
What is crepitus?
A course, crackling sensation palpable over the skin surface
42
What causes crepitus?
Subcutaneous emphysema -- when air escapes from the lung and enters the subq tissues (pot-op, open thoracic injury, chest tube air leak)
43
How do you assess breath sounds with your stethoscope?
-Use the diaphragm
-Listen to one full respiration in each location bilaterally
44
What are the 3 types of breath sounds normally heard?
-Bronchial (tracheal or tubular)
-Bronchovesicular
-Vesicular
45
What are the adventitious sounds (added sounds that are not normally heard)?
-Crackles (or rales)
-Wheeze (or rhonchi)
-Atelectactic crackles
46
What do atelectactic crackles sound like?
Short, popping crackles that sound like fine crackles but do not last beyond a few breaths
47
What do fine crackles (or rales) sound like?
Discontinuous popping sounds heard over inspiration
48
What causes fine crackles (or rales)?
-Pneumonia
-CHF
-Interstitial fibrosis
-Bronchitis
-Asthma
-Emphysema
49
What do coarse crackles sound like?
Loud, low-pitched bubbling and gurgling sounds in inspiration and expiration
50
What causes coarse crackles?
-PE
-Pneumonia
-Pulmonary fibrosis
-Depressed cough reflex
51
What does a wheeze (or rhonchi) sound like?
Continuous musical sounds heard mainly over expiration
52
What causes wheezing?
-Diffuse airway obstruction d/t asthma or emphysema
-Bronchitis
-Airway tumor/obstruction
53
What causes atelectactic crackles?
Bedridden persons or recently awoken pts
54
What do you look for in inspection of the anterior chest?
-Shape and configuration of chest wall
-Pts facial expressions
-Skin color and condition
-Assess LOC and quality of respirations (effort, symmetry, accessory muscle use)
55
What do you assess when palpating the anterior chest?
-Symmetric chest expansion
-Tactile (vocal) fremitus
-Palpate anterior chest wall
-Not tenderness of lumps
-Skin mobility
-Skin turgor
-Skin temp
-Moisture
56
How do you percuss the anterior chest?
Begin by percussing apices in supraclavicular areas bilaterally
**Note borders of cardiac dullness normally found on anterior chest
57
Where is dullness evident when palpating for right hemothorax?
Upper border of liver dullness is located in 5th intercostal space in the right midclavicular line
58
In left hemothorax, where in tympany evident?
Over the gastric space
59
What is forced expiratory time?
The number of seconds it takes to exhale from total lung capacity to residual volume
60
What is a safer, simple, inexpensive, clinical measure of functional status in aging adults?
The 6 min walk test
61
What respiratory changes can be expected with the aging adult?
-Increasing AP diameter
-Kyphosis
-Outward curvature of thoracic spine
-Chest expansion may be decreased, but still symmetric
-Tend to tire easily when auscultating when deep mouth breathing is required
62
What are abnormal findings of the configurations of the thorax?
-Barrel chest -- equal AP to transverse diameter and ribs are horizontal
-Pectus excavatum
-Pectus carinatum
-Scoliosis
-Kyphosis
63
What is pectus excavatum?
-Funnel breast
-Sunken sternum and adjacent cartilage
64
What is pectus carinatum?
Forward portrusion of the sternum
-Ribs sloping back
65
What is scoliosis?
S-shaped curve of the thoracic/lumbar spine with vertebrae rotation
66
What is kyphosis?
Exaggerated posterior curvature of thoracic spine
67
What are abnormal findings of tactile fremitus?
-Increase/decrease tactile fremitus
-Rhonchial fremitus
-Pleural friction fremitus
68
What are abnormal respiration patterns?
-Sigh
-Tachypnea/bradypnea
-Hyperventilation/hypoventilation
-Cheyne-Stokes respiration
-Biot's respiration
-Chronic obstructive breathing
69
What are the discontinuous adventitious lung sounds?
-Crackles -- fine
-Crackles -- course
-Atelectatic crackles
-Pleural friction rub
70
What are continuous adventitious sounds?
-Wheeze -- sibilant
-Wheeze -- sonorous rhonchi
-Stridor
71
What is atelectactic?
Collapsed shrunken section of alveoli or an entire lung as a result of airway obstruction, compression on the lung, lack of surfactant
72
What is IPPA for atelectactic?
I- Cough, slow expansion on affected side, Increased RR and HR
P- Chest expansion decreased on affected side
P- Dull over area
A- Breath sounds decreased vesicular or absent over area, none or fine crackles
73
What is bronchitis?
Proliferation of mucus glands in passageways, resulting in excessive mucus secretion
74
What is IPPA for bronchitis?
I- Hacking, rasping cough, productive thick mucus
P- Normal
P- Resonant
A- Crackles over deflated areas, wheezes
75
What is emphysema?
-Caused by destruction of pulmonary connective tissue
-Permanent enlargement of air sacs
76
What is IPPA for emphysema?
I- Increased AP diameter, barrel cheat, accessory muscle use, tripod position, SOB, tachypnea
P- Decreased chest expansion
P- Hyperresonant
A- Decreased breath sounds, muffled heart sounds d/t overdistention of lungs, wheezes
77
What is asthma?
Allergic hypersensitivity to certain inhaled allergens, irritants, microbes, stress or exercise that causes bronchospasm and inflammation
78
What is IPPA for asthma?
I- Tachypnea, SOB, audible wheezes, accessory muscle use, labored
P- Tachycardia
P- Resonant
A- Diminished air movement, wheezes expiration and/or inspiration
79
What organs are located in the RUQ of the abdomen?
-Liver
-Gallbladder
-Duodenum
-Head of pancreas
-Right kidney and adrenal gland
-Hepatic flexure of colon
-Part of ascending and transverse colon
80
What organs are located in the RLQ of the abdomen?
-Cecum
-Appendix
-Right ovary and tube
-Right ureter
-Right spermatic cord
81
What organs are located in the LUQ of the abdomen?
-Stomach
-Spleen
-Left lobe of liver
-Body of pancreas
-Left kidney and adrenal gland
-Splenic flexure of colon
-Part of transverse and descending colon
82
What organs are located in the LLQ of the abdomen?
-Part of descending colon
-Sigmoid colon
-Left ovary and tube
-Left ureter
-Left spermatic cord
83
What organs are located in the midline of the abdomen?
-Aorta
-Uterus (if enlarged)
-Bladder (if distended)
84
True or False:
As you age, your abdominal wall musculature relaxes and increased reporting of constipation
True
85
True or False:
As we age, salivation decreases, leading to a dry mouth and decreased sense of taste
True
86
True or False:
As we age, esophageal emptying and gastric acid secretion are delayed
True
87
True or False:
As we age, the incidence of gallstones increases and drug metabolism is impaired
True
88
What are the common causes of constipation related to aging?
-Decreased physical activity
-Inadequate intake of water
-Low-fiber diet
-Side effects of medications
-IBS
-Bowel obstruction
-Hypothyroidism
-Inadequate toilet facilities
89
What subjective data do you ask for related to appetite?
-Any changes in appetite (time period and amount)
-Changes in weight? (loss/gain and time period)
90
What subjective data do you ask about relating to dysphagia?
-Any difficulty swallowing?
-Onset and associated symptoms
91
What subjective data do you ask for relating to food intolerance?
-Type of food reaction that occurs
-Use of Rx or OTC medication (amount and frequency)
92
What subjective data do you ask about relating to pain?
-Onset, duration, location, and severity
-Characteristics (quality and pattern) and associated symptoms
-Association with any other clinical symptoms
-Alleviating factors and aggravating factors
-Treatment methods: Rx and OTC
93
What subjective data do you ask about relating to nausea and vomiting?
-Onset, frequency, type, and amount
-Associated symptoms and/or triggers
-Recent foods eaten and/or travel habits
94
What subjective data do you ask about relating to bowel habits?
-Frequency, color, consistency, diarrhea or constipation
-Any recent changes
-Laxative use? type, amount, and frequency
95
What subjective data do you ask about relating to past abdominal history?
-GI disease/pathology
-GI diagnostic procedures
-GI surgeries and clinical response
96
What subjective data do you ask about relating to medications?
-Rx and OTC
-Alcohol (type, amount, frequency)
-Smoking history
97
What subjective data do you ask about relating to nutritional assessment?
-Dietary history
98
What additional history can you gather from the aging adult relating to abdominal health?
-Access to groceries and food preparation
-Shared meals or eat alone
-24 hr dietary recall
-Swallowing or feeding difficulties
-Activities done following mealtimes
-Bowel health (fiber in diet, use of laxative, frequency, constipation)
-Meds (Rx and OTC)
99
What do you do in preparation for examining the abdomen?
-Ensure good lighting
-Drape genitalia and breasts
-Encourage abdominal wall relaxation
100
What are some ways that we can encourage abdominal wall relaxation?
-Empty bladder
-Keep room warm
-Position supine
-Head on pillow
-Knees bent
-Arms at sides
-Warm stethoscope
-Exam painful areas last
-Distraction techniques
101
What do you assess in the inspection phase for the abdomen?
-Contour
-Symmetry
-Umbilicus
-Skin
-Pulsation or movement
-Hair distribution
-Demeanor
102
Where may you typically see pulsation or movement in the abdominal area?
May see pulsations from the aorta beneath the skin in the epigastric area
103
How is the umbilicus typically located?
Normally it is midline and inverted
104
What are the abnormal bowel sounds?
-Hypoactive
-Hyperactive
-Perfectly "silent abdomen"
105
Where do bowel sounds originate from?
From movement of air and fluid through the small intestine
106
Where do you palpate for vascular sounds?
Use firm pressure and check over:
-Aorta
-Renal arteries
-Iliac
-Femoral arteries
107
True or false:
When placing an NG tube, you use auscultation for the initial placement verification
False- you do not use auscultation for initial placement verification
108
How do you initially confirm the placement of an NG tube?
With evidenced-based practice
-Confirm by imaging study and assessment (tube length, pH, color)
109
When you percuss the general tympany, liver, and splenic dullness, what are to assessing for?
-Relative density of abdominal contents
-Locate organs
-Screen for abnormal fluid or massess
110
What is tympany?
A medical condition in which excess gas accumulates in the GI tract and causes abdominal distention
111
How do you assess for general tympany?
First, percuss lightly in all 4 quadrants to determine prevailing amount of tympany and dullness in clockwise manner
112
True or false:
Percussing the liver span, splenic dullness, and bladder yield highly variable results
True -- therefore not typically recommended
113
How do you percuss/assess the kidney?
-Place one hand over the 12th rib at the costovertebral angle on the back
-Thump that hand with the ulnar edge of your other fist
**Pt will feel thud but no pain
114
What is the general rule to follow when palpating a pts abdomen?
Begin with light palpation and then gradually go deeper
115
How deep is light palpation?
1 cm with 4 fingers close together, lift fingers and move clockwise
116
How deep is deep palpation?
5-8 cm
**if there is resistance, use the bimanual technique
117
What do you note if you identify a mass?
-Location
-Size
-Shape
-Consistency (soft, firm, hard)
-Surface (smooth or nodular)
-Mobility (including movement with respirations)
-Pulsatility
-Tenderness
118
True or false:
As we age, there are increased deposits of subcutaneous fat on the abdomen and hips found during inspection
True
119
True or False:
As we age, our abdominal musculature is thinner
True
120
True or False:
As we age, organs are more difficult to palpate in the absence of obesity
False -- organs may be EASIER to palpate d/t thinner, softer abdominal wall
121
Where can the liver be palpated in an older adult if their lungs are distended and their diaphragm is depressed?
-Liver can be palpated lower
-Descends 1-2 cm below costal margin with inhalation
122
What does IPPA stand for?
Inspect
Palpate
Percuss
Auscultate
123
What does it mean when you palpate and area of the body?
You are feeling that specific region of the body with your fingers or hands
124
What does it mean if you are percussing a specific region of the body?
You are producing sounds usually by tapping on specific areas of the body
125
What is IPPA for obesity in the abdomen?
I- uniformly rounded, umbilicus sunken
P- Normal
P- Tymapny with scattered dullness
A- Normal BS
126
What is IPPA for air or gas in the abdomen?
I- Single rounded curve
P- Muscle spasm of abdominal wall possible
P- Tympany over large areas
A- Depends on cause
127
What is IPPA for ascites?
I- Single curve, everted umbilicus, bulging flank when supine, taut and glistening skin
P- Taut skin
P- Tympany at top, dull over fluid, fluid wave
A- Normal BS except in ascitic area (diminished)
128
What is IPPA for feces?
I- Localized distention
P- Plastic like or ropelike mass
P- Tympany over large areas predominantes, scattered dullness over fecal mass
A- Normal BS
129
What is IPPA for tumor in the abdomen?
I- Localized distention
P- Defined borders
P- Dull over mass if reaches skin surface
A- Normal BS
130
What is an umbilical hernia and what does it look like?
-Protrusion through omentum or intestine d/t weakness or incomplete closure in the umbilical ring
-Soft, skin covered mass
131
What is an umbilical hernia usually seen with?
Abdominal pressure (crying, coughing, straining, vomiting)
132
What is an epigastric hernia?
-Small fatty nodule at the epigastrium in midline
-Protrusion of abdominal structures
-Palpable when standing
133
What is an incisional hernia?
-Bulge near old operative scar
-Seen with increased abdominal pressure
134
What is a diastasis recti?
-Midline longitudinal ridge that is a separation of abdominal rectus muscles
-Seen with intra-abdominal pressure by raising HOB
135
What do hypoactive bowel sounds indicate?
Decreased motility d/t
-Inflammation (periotinitis)
-Paralytic ileus post op
-Bowel obstruction
136
What do hyperactive bowel sounds indicate?
Increased motility d/t:
-Mechanical bowel obstruction
-Gastroenteritis
-Diarrhea
-Laxative use
-Subsiding paralytic ileus
137
What does the musculoskeletal system consist of?
-Muscles
-Bones
-Joints
138
What is the musculoskeletal system needed for?
-To stand and stand erect
-Movement
-Encase and protect inner vital organs
-Produce RBCs in the bone marrow
-Reservoir for storage of essential minerals
139
What is flexion?
Bending limb at joint
140
What is extension?
Straightening limb at joint
141
What is abduction?
Moving limb away from midline of the body
142
What is adduction?
Moving limb toward midline of the body
143
What is pronation?
Turning forearm so that the palm is down
144
What is supination?
Turning the forearm so the palm is up
145
What is circumduction?
Moving arm in circle around shoulder
146
What is inversion?
Moving sole of foot inward at the ankle
147
What is eversion?
Moving sole of the foot outward at ankle
148
What is rotation?
Moving head around central axis
149
What is protraction?
Moving body part forward, parallel to the ground
150
What is retraction?
Moving body part backward, parallel to the ground
151
What is elevation?
Raising a body part
152
What is depression?
Lowering a body part
153
What health hx questions do you ask regarding joints?
-Pain
-Location (unilateral or bilateral)
-Characteristics (quality and severity)
-Onset, duration, frequency
-Aggravating or precipitating factors
-Associated clinical presentations
-Limitation of motion, stiffness, or swelling or erythema
-Impact on ADLs
154
What health hx questions do you ask regarding muscles?
-Location of pain or cramping
-Pain while walking vs pain relief at rest
-Associated clinical presentation
-Muscle characteristics (weakness and size)
-Onset and duration of symptoms
155
What health hx questions do you ask regarding bones?
-Pain (at rest or affected by movement)
-Presence of deformity d/t injury or trauma and effect on ROM
-Hx of accidents or trauma with impact on bones
-Medical and/or surgical tx (any residual deficits)
-Presence of back pain (provide pain characteristics description)
-Presence of neurological or physical deficits
156
Who do we typically recommend DEXA screenings for?
Females ages 65+
157
What is the order of examination for the musculoskeletal system?
-Inspect
-Palpate
-ROM
-Muscle testing
158
True or False:
Joints are usually tender to palaptation
False- they are NOT usually tender to palpation
159
What is the grading scale for muscle testing?
0-5
160
What does a score of 5 mean for muscle testing?
Full ROM against gravity, full resistance
161
What does a score of 4 mean on muscle testing?
Full ROM against gravity, some resistance
162
What does a score of 3 mean on muscle testing?
Full ROM with gravity
163
What does a score of 2 mean on muscle testing?
Full ROM with gravity eliminated (passive)
164
What does a score of 1 mean on muscle testing?
Slight contraction
165
What does a score of 0 mean on muscle testing?
No contraction
166
What is a fracture?
A break in a bone
167
What is a dislocation?
Complete loss of contact between the two bones in a joint
168
What is a sublaxation?
Two bones in a joint stay in contact, but their alignment is off
169
What is a contracture?
Shortening of a muscle leading to limited ROM of joint
170
What is ankylosis?
Stiffness or fixation of a joint
171
What is articular disease?
Disease inside the joint capsule produces swelling and tenderness around joint
Ex: Arthritis
172
What is crepitation?
An audible and palpable crunching or grating that accompanies movement
173
What is TMJ?
Temporomandibular Joint
-Articulation of mandible and temporal bone
-Permits jaw function of speaking and chewing
***Can feel it in depression anterior to tragus of ear
174
What 3 motions does TMJ allow?
-Hinge action to open and close jaws
-Gliding action for protrusion and retraction
-Gliding for side-to-side movement of lower jaw
175
How do you inspect and palpate for TMJ?
-Pt is in a seated position
-Place tips of your first 2 fingers in front of each ear
-Open mouth maximally
-Measure between upper and lower incisors (3-6 cm or 3 fingers)
-Partially open mouth & protrude lower jaw and move it side to side
175
True or false:
When you stick out your lower jaw, it should protrude with deviation normally
False -- it should protrude without deviation
176
Where do you palpate the jaw to check for TMJ?
-Contracted temporalis and masseter muscles as pt clenches their teeth
-Compare R and L for size, firmness, and strength
177
How many vertebrae are in humans?
32-33
178
How many cervical vertebrae are there?
7
179
How many thoracic vertebrae are there?
12
180
How many lumbar vertebrae are there?
5
181
How many sacral vertebrae are there?
5
182
How many coccygeal vertebrae are there?
3-4
183
What are the surface landmarks of the spine and vertebrae?
1) Spinous processes of C7 and T1 prominent at base of neck
2) Inferior angle of scapula normally at level of interspace between T7 and T8
3) Imaginary line connecting highest point on each iliac crest crosses L4
184
Where should you palpate on the cervical spine?
-Spinous processes
-Sternomastoid
-Trapezius
-Paravertebral muscles
***Should feel firm with no muscle spasms or tenderness
185
What motions should the patient do to assess the cervical spine?
-Touch chin to chest
-Lift chin toward the ceiling
-Tough ear toward corresponding shoulder
-Turn chin toward each shoulder
186
True or False:
For the spine, a person can normally maintain flexion against full resistance
True
187
What tests the integrity of cranial nerve XI (spinal nerve)?
See if pt can maintain flexion against full resistance
188
What 3 bony articulations do your elbows contain?
-Humerus
-Radius
-Ulna of forearm
189
Where do the radius and ulna articulate with each other?
At 2 radioulnar joints
-One at elbow
-One at wrist
190
What is the Phalen test?
Have pt hold both hands back to back whole flexing wrists at 90 degrees
***Hold for 60 seconds and no pain should occur
191
What is the Tinel Sign Test?
Direct percussion of the location of median nerve at the wrist
***Should produce no symptoms
192
Where is the articulation of the hip?
Between acetabulum and head of the femur
193
What permits a wide range of motion on many axes for the hip?
Ball and socket
-More stability for weight-bearing function
-Muscles enhance stability and bursae facilitate movement
194
What guides examination of the hips?
Palpation of bony landmarks?
195
What bony landmarks can you palpate at the hip?
-Iliac crest -- anterior superior spine to posterior
-Ischial tuberosity
-Greater trochanter of the femur
196
What is the most common dysfunction found in hip disease?
Limitation of abduction of hip while supine
197
What 3 bones are the articulation of the knee joint?
-Femur
-Tibia
-Patella
198
What is the largest joint in the body?
Knee joint
199
What permits flexion and extension of lower leg, and can also supinate?
Hinge joint
200
What 2 wedge-shaped cartilages cushion the tibia and femur?
Medial and lateral menisci
201
What is a bulge sign and how do you assess it?
-Confirms the presence of small amount of fluid
-Firmly stroke up on the medial aspect on knee 2-3 times to displace fluid
-Tap the later aspect
-Watch for a bulge from fluid wave
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What is ballottement of patella and how do you assess it?
-Confirms larger amounts of fluid
-Use left hand to compress supratellar pouch to move fluid into the knee joint
-With right hand, push the patella sharply against the femur
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What bones does the ankle articulate?
-Tibia
-Fibula
-Talus
***Limited dorsiflexion and plantar flexion
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What is plantar flexion?
Point toes towards floor
-45 degreees
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What s dorsiflexion?
Point toes towards nose
-20 degrees
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How many degrees for eversion of the foot?
20
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How many degrees for inversion of the foot?
30
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What happens to the musculoskeletal system as we age?
-Bone remodeling is cyclic process of reabsorption and deposition
-Postural changes and decreased height
-Distribution of subq fat changes leading to different contour
-Absolute loss in muscle mass
-Impact of sedentary lifestyle
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After what age does resorption occur more rapidly than deposits in the musculoskeletal system?
after 40
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What physiological changes happen with posture and decreased height as we age?
-Kyphosis with slight flexion of hips and knees to compensate
-Shortening of the vertebral column
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True or false:
Loss of subcutaneous fat leaves bony prominences more marked
True
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What health promotion and pt teachings do you provide for the musculoskeletal system?
-Diet to protect and maintain healthy bones
-Smoking cessation
-Alcohol intake pattern
-Exercise promotion
-Osteoporosis screening
-Fall prevention risk
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What are the 2 abnormal inflammatory conditions of the musculoskeletal system?
-Rheumatoid arthritis
-Ankylosing Spondylitis
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What is the definition of rheumatoid arthritis?
Chronic inflammatory pain condition that is started by an autoimmune response, inflammatory event, or infection
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What are the S&S of rheumatoid arthritis?
-Weakness
-Anorexia
-Weight loss
-Low grade fever
-Lymphadenopathy
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What is the pathophysiology behind rheumatoid arthritis?
-Inflammation causes fibrosis
-Cartilage and bone destruction
-Limited motion and deformities
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What is the definition of ankylosing spondylitis?
Chronic inflamed vertebrae that in extreme form leads to bony fusions of vertebral joints
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What are the S&S of ankylosing spondylitis?
-Inflammatory back pain (dull, deep ache in lower back/butt)
-Morning stiffness
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What areas does ankylosing spondylitis affect?
-Spine
-Pelvis
-Thoracic cage
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What is the pathophysiology of ankylosing spondylitis?
-Spams of muscles pull spine forward
-Obliterating lumbar and cervical curves
-Thoracic curve is exaggerated
-Flexion of deformed hips and knees d/t spinal flexion
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What are the 2 degenerative conditions of the musculoskeletal system?
-Osteoarthritis
-Osteoporosis
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What is the definition of osteoarthritis?
Non-inflammatory, localized, progressive disorder involving deterioration of articular cartilages, subchondral bone remodeling, synovial inflammation, and formation of new bone at joint surface
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What does osteoarthritis cause?
-Stiffness
-Swelling
-Pain with motion
-Limited ROM in hands, knees, hips, lumbar and cervical spine
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What is the pathophysiology of osetoarthritis?
-Inflammation causes fibrosis
-Cartilage and bone destruction
-Limited motion and deformities occur
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What is the definition of osteoporosis?
Decrease in skeletal bone mass leading to low bone mineral density and impaired bone density
226
Who is at the highest risk of developing osteoporosis?
-Those smaller in height and weight
-Younger at menopause
-Lack of physical activity
-Lack of estrogen
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