Nervous and Musculoskeletal Systems Flashcards Preview

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Flashcards in Nervous and Musculoskeletal Systems Deck (59)
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1

What can we do to protect musculoskeletal system with anesthesia?

  • 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)

2

How can you assess TMJ?

  • 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)

3

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

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

4

How can you assess patients shoulder girdle?

  • 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

5

What is thoracic outlet syndrome?

  • 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)

6

Muculoskeletal assessment for the elbow?

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)

7

How do you perform musculoskeletal assessment for the hip?

  • 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

8

How can you assess cranial N I?

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

9

How do you assess cranial nerve II?

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

10

How can you test cranial nerve III?

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

11

How can you assess CN IV?

Trochlear

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

12

How do you assess cranial nerve VI?

Abducens

assess lateral eye movement

13

How can you assess cranial nerve V?

  • 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)

14

How can you assess cranial nerve VII?

Facial

  • Ask pt to raise both eyebrows
  • frown
  • close eyes tightly so you can't open them
  • show teeth
  • smile
  • puff out both cheeks

 

15

How can you test CN VIII?

Acoustic (hearing)

challenging to assess periop

16

How can you test CN IX? X?

Glossopharyngeal (IX) and Vagus (X)

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

17

How can you test CN XII?

Hypoglossal

tongue movement, ask them to move tongue side to side

18

How can you assess CN XI?

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

19

What are some major dermatome levels?

c8?

t4?

t10?

 

  • C8- ring finger/pinky finger
    • important for detecting high spinals
  • T4- nipple
  • T10- umbilicus

20

What is the assessment of muscle strength?

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

21

What nerves do you test with elbow flexion? extension?

Elbow flexion- C5, C6

Elbow extension C6,C7, C8

22

What nerves are tested with hand grip?

C7, C8 , T1

23

What nerves are tested with finger ABDUCTION

C8. T1, ulnar nerve

24

What nerves are tested with oppostion of the thumb?

C8, T1, median n

25

What neres are tested with hip flexion and adduction

L2-L4

26

What nerves are tested with hip abduction?

L4, L5, S1

27

What nerves tested with hip extension?

S1

28

What nerves are tested with knee extension

L2-L4

29

What nerves are assessmed with knee flexion?

L4-S2

30

What nerves are tested with dorsiflexion

L4. L5