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Nursing Assessment > Neurological and Musculoskeletal > Flashcards

Neurological and Musculoskeletal Flashcards

1
Q

nerves that go from your brain to your eyes, mouth, ears, and head

A

cranial

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2
Q

nerves in your brain and spinal cord

A

central

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3
Q

nerves go from your spinal cord to your arms, hands, legs, feet

A

peripheral

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4
Q

nerves go from your spinal cord to your lungs, heart, stomach, intestines, bladder, and sex organs

A

autonomic

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5
Q

major considerations for neuro system assessment

A

chief complaint
physical condition
ability to cooperate with assessment

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6
Q

dysarthria

A

difficulty speaking

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7
Q

dysphagia

A

difficulty swallowing

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8
Q

defective muscular coordination manifested with attempted voluntary movements

A

ataxia

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9
Q

Rigid body position assumed by a patient who has lost cerebral control

A

decerebrate

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10
Q

Characterized by arms that are stiff and extended, the forearms pronated, and the deep tendon reflexes exaggerated.

A

decerebrate

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11
Q

Posture of a patient with a lesion at or above the upper brainstem

A

decorticate

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12
Q

Character: Rigidly still with arms flexed, fists clenched, and legs extended.

A

decorticate

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13
Q

Remembers events or information from a few minutes before

A

immediate

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14
Q

Remembers events or information from earlier in the day

A

recent

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15
Q

Remembers events or information from months or years ago

A

remote

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16
Q

partial or incomplete paralysis

A

paresis

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17
Q

abnormal or unpleasant sensation that results from injury to one or more nerves (burning, tingling)

A

paresthesia

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18
Q

Awareness of posture, movement, and changes in equilibrium.

A

proprioception

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19
Q

alternate involuntary muscular contraction and relaxation in rapid succession.

A

clonus

hyperreflexivity – jerky beat

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20
Q

four major components of cerebral function assessment

A

LOC
orientation
verbal responsiveness
mental status exam

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21
Q

a&o

A

alert and oriented

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22
Q

The patient is drowsy but awakens—although not fully—to stimulation. She will answer questions and follow commands, but will do so slowly and inattentively. Sluggish.

A

lethargy

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23
Q

The patient is difficult to arouse and needs constant stimulation in order to follow a simple command. They may respond verbally with one or two words, but will drift back to sleep between stimulation. Confused when awake.

A

obtunded

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24
Q

The patient arouses to vigorous and continuous stimulation; typically, a painful stimulus is required. They may moan briefly but does not follow commands. Their only response may be an attempt to withdraw from or remove the painful stimulus.

A

stupor

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25
Q

The patient does not respond to continuous or painful stimulation. They do not move—except, possibly, reflexively—and does not make any verbal sounds.

A

comatose

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26
Q

loc

A

loss of consciousness or level of consciousness (clarify!)

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27
Q

The patient is alert, attentive, and follows commands. If asleep, she responds promptly to external stimulation and, once awake, remains attentive.

A

full consciousness

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28
Q

oriented x4

A

person
place
time
situation

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29
Q

triceps, biceps, brachioradialis, patellar, achilles

A

deep tendon reflex

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30
Q

reflex response: very brisk, hyperactive with clonus, always abnormal

A

4+

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31
Q

reflex response: diminished, low normal, or occurs only with reinforcement

A

1+

32
Q

reflex response: average

A

2+

33
Q

reflex response: no response

A

0

34
Q

reflex response: very brisk, hyperactive with clonus, always abnormal

A

3+

35
Q

Extension of the big toe upon plantar reflex check

A

Babinski’s sign: abnormal, except in children younger than 2 years

36
Q

normal response to plantar reflex check

A

plantar flexion (curling under)

37
Q

four qualities of muscle

A

size, strength, tone, involuntary movements

38
Q

rapid alternating movements, finger to nose, heel to shin test assess what function?

A

coordination and skilled movements

39
Q

loses balance with feet together, arms at side, eyes closed

A

positive Romberg test

40
Q

spinothalamic tract assessments

A

pain, temperature, light touch

41
Q

the ability to recognize forms by touch

A

stereognosis

42
Q

the ability to recognize letters, words, numbers, outlines, or symbols when drawn on the skin

A

graphesthesia

43
Q

glasgow coma scale

A

easily reproducible basic neuro exam.

44
Q

musculoskeletal functions

A 
support
movement
protection of internal vital organs
production of red blood cells
storage of minerals
45
Q

non inflammatory joint pain on weight bearing joints

A

degenerative joint disease

46
Q

inflammation of the joint

A

osteoarthritis

47
Q

systemic disease where chronic inflammation leads to erosion/destruction of the joint

A

rheumatoid arthritis

48
Q

loss of bone mass; more common after menopause

A

osteoporosis

49
Q

pivot joint example

A

skull on spine

50
Q

ball and socket joint example

A

shoulder

51
Q

ellipsoidal joint example

A

wrist

52
Q

hinge joint example

A

elbow

53
Q

crunching noise on movement

A

crepitus

54
Q

muscle wasting

A

atrophy

55
Q

increased muscle mass

A

hypertrophy

56
Q

shortened muscle

A

contracture

57
Q

twitch or involuntary muscle movement

A

fasciculation

58
Q

muscle grade: Able to move joint w/ full resistance through ROM

A

5

59
Q

muscle grade: able to move joint against gravity

A

3

60
Q

muscle grade: slight contraction

A

1

61
Q

muscle grade: able to move joint with some resistance through ROM

A

4

62
Q

muscle grade: no contraction

A

0

63
Q

muscle grade: able to move joint in a gravity eliminated position

A

2

64
Q

normal gait

A

smooth, rhythmic, effortless, contralateral

65
Q

syndactyly

A

fewer digits

66
Q

polydactyly

A

additional digits

67
Q

genu varum

A

bowlegged (can be caused by Ricketts)

68
Q

genu valgum

A

knock knee

69
Q

talipes equinovarus

A

clubfoot

70
Q

hallux valgus

A

deformation of big toe joint (can be with bunion)

71
Q

inflammation of the synovial sac

A

bursitis

72
Q

joint with uric acid and crystals

A

gout

73
Q

most common gout attack location

A

big toe joint

74
Q

one or more bones in a joint being out of position

A

dislocation

75
Q

partial dislocation of a joint

A

subluxation

76
Q

stiffness or fixation of a joint

A

ankylosis

Nursing Assessment (13 decks)

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