NUR 245 Exam 4 Flashcards
(138 cards)
1
Q
What are the functions of the MSK?
A
Support body
Protection (organs)
Movement
Hematopoiesis (RBC formation in bone marrow)
Storage for minerals
2
Q
What influences muscle mass?
A
- size and strength: genetics, nutrition, exercise,
- neurological: nerves
- sex: males usually have more
3
Q
Bones - structure (3 kinds) and function
A
structure:
1. compact - shaft and outer layer
2. cancellous bone - center and ends of the bones (spongy bone) –> short, flat, irregular, long
3. long bones - hollow, filled w/ bone marrow (break = risk for blood clot and obstructed blood flow)
function: support and protection ; site of hematopoiesis (formation of WBC, RBC, and platelets) ; stores minerals (calcium and phosphorus)
4
Q
Muscles - structure and function
A
Structure: fibers in bundles (fasciculi = bundles of muscle fibers)
Function: generates force and movement, provides shape, produces body heat (movement)
5
Q
Connective Tissue - function
cartilage
ligaments
tendons
fascia
A
cartilage: lets bone slide over each other = decreases friction / damage, absorbs shock
ligaments: connect bone to bone, stabilizes joints and limits movement
tendons: connects muscle to bone
fascia: flat sheets, attached muscles to bone, provides structure to nerves, blood vessels, and lymphatic
6
Q
Flexion
A
bending a limb at joint
7
Q
Extension
A
straightening a limb at a joint
8
Q
Abduction
A
moving away from body
9
Q
Adduction
A
moving toward the center of the body
10
Q
Pronation
A
turning palm down
11
Q
Supination
A
turning palm up
12
Q
Circumduction
A
moving arm in a circle around shoulder
13
Q
Inversion
A
moving the foot IN toward the middle of body
14
Q
Eversion
A
moving the foot out from body
15
Q
Rotation
A
moving the head around a central axis (saying no)
16
Q
Protraction
A
moving body part forward (moving bottom of the jaw forward)
17
Q
Retraction
A
moving body part backward (pushing chin back)
18
Q
Elevation
A
raising of body part
19
Q
Depression
A
lowering of body part
20
Q
What is a joint?
A
functional unit of the MSK; permits mobility
21
Q
What is a joint articulation?
A
where 2 joints come together = mobility
22
Q
What are the 3 types of joints?
A
Fibrous
Cartilaginous
Synovial
23
Q
Fibrous joint - what is it? and example
A
- synarthrotic, immoveable (think it’s a sin to not move)
- bones are connected with fibrous tissue
- example: cranial sutures
24
Q
Cartilaginous joint - what is it? and example
A
- amphiarthrotic, slightly movable (think amphibians can move a little on land and in water)
- example: ribs and sternum (costal cartilage)
25
Synovial joint - what is it?
- diarthrotic, freely movable (think when you die you can go wherever)
- named by the type of movement
- one bone is stable, other acts as an axis (movement)
26
What is a bursae?
fluid filled space between tendons, ligaments, or bones that reduces friction
27
What is a synovial fluid?
lubricant in joint cavity, provides nutrients
28
Pivot joint - example
C1/atlas and C2/axis
29
*Ball and socket joint* - example
Hip and shoulder
30
*Hinge joint* - example
Elbow, knee, TMJ, wrist
31
Saddle joint - example
Thumb
32
Condyloid joint - example
wrist
33
Gliding joint - example
intravertebral
34
Plane joint - example
tarsal bones
35
TMJ - what is it? function?
Temporal - mandible joint
*Hinge joint*
function: speaking and chewing
36
TMJ - landmarks
- depression in front of the tragus
- external auditory meatus
37
TMJ - motions
hinge: open and close jaw
protraction and retraction: forward and backward motion
excursion: side-to-side movement (lower jaw)
38
*Spine* - how many bones in each section?
Cervical (7)
Thoracic (12)
Lumbar (5)
Sacral (5 - fused)
Coccyx (3)
39
*Intervervetral discs* - structure and function
structure: fibrocartilage, make up 1/4 of the length of each column
function: shock absorbers
40
Spine - landmarks (4)
C7 and T1: spinous process
T7 and T8: inferior angle of the scapula is @ interspace
*L4: imaginary line of highest points in iliac crest*
Sacrum: superior iliac spines
41
Spine: movements
Flexion: bending forward
Extension: bending backward
Abduction and rotation: to each side
42
*Glenohumeral joint* - what is it?
articulation of humerus and glenoid fossa of the scapula
*ball and socket joint*
43
Rotator cuff - what is it? function?
encloses the glenohumeral joint and covers the head of the humerus
Function: rotates arm laterally and stabilizes the head of the humerus in glenoid fossa of scapula
44
What are the 4 muscles of the rotator cuff?
(think SITS)
S: supraspinatus
I: infraspinatus
T: teres minor
S: subscapularis
45
Shoulder joint - landmarks
- *acromion process*: very top of the shoulder, little bump
- greater tubercle: below acromion process
- coracoid process: anterior, bump on the front of the shoulder
- subacromial bursa: abduction of arm so greater tubercle can move easily under acromion process
46
Shoulder joint - movements
flexion and extension
internal and external rotation
abduction and adduction
47
*Ischial tuberosity (hip)* - landmarks
under glute, can feel when hip is flexed
48
*Greater trochanter (hip)* - landmarks
width of palm below glute, feel when standing, flat depression under lateral side of the thigh
49
MSK Considerations of pregnant woman
- Increased hormones = increased mobility in joints (estrogen, relaxin, and corticosteroids)
- sacroiliac, sacrococcygeal, and symphysis pubis joints = changes in posture
- *lordosis* - exaggerated lumbar curve = increased back strain
50
MSK Considerations for aging adult
- *osteoporosis* = loss of bone density (minerals) --> increased risk for fractures (women and over 40 y/o at greater risk) --> need more vit D and C supps
- postural changes: height decreases, kyphosis w/ flexion of hips and knees
- fat distribution: subcutaneous fat does to abdomen and bony prominences are more pronounced, muscles mass loss/atrophy = weakness
- sedentary lifestyle = increases MSK loss
51
What are the urgent MSK assessments?
- FOCI: identify specific prob, alleviating pain, preventing complications
- GALS locomotor screening (11 tasks): gait, arms, legs, spine
52
What should we educate patients on regarding osteoporosis and prevention?
**calcium and vitamin D supplements**
- limit caffeine = causes increased excretion of calcium
- weight bearing exercises (fast walking!!)
- avoid smoking and alcohol
- bone density tests and meds
53
What is FRAX? and what do we screen for with it?
fracture risk assessment tool
used for low bone mass density (BMI, sex arthritis, smoking, steroids, alcohol, femoral neck BMD)
54
How should a nurse conduct the MSK assessment?
In an orderly approach:
- head to toe
- *proximal to distal*
- from midline outward
(compare bilaterally, note normal and abnormal)
55
What is the order of the MSK assessment?
1. inspect
2. palpate
3. ROM
4. muscle strength
56
What are we looking for when we palpate? (MSK)
*temperature (circulation)*, muscles (compare R + L), articulations, *crepitus (audible/palpable/crunching)*, and pulses!!`
57
What is myalgia?
cramping/aching (intermittent claudication, viral illness)
58
What is arthralgia?
joint stiffness
59
What is ataxia?
lack of balance/coordination
60
What is a dislocation?
loss of contact between 2 bones in a joint
61
What is a sprain?
Ligament
62
What is a strain?
Tendon
63
What is subluxation?
joints stay in contact, but alignment is off
64
What is contracture?
shortening of muscle = limited ROM
65
What is ankylosis?
stiffness/fixation of a joint
66
What is the cerebral cortex? Functions?
Outer layer, grey matter, not myelin.
highest function (thought, memory, reasoning, sensation, and voluntary movement)
67
Temporal lobe: function
hearing and taste
68
Occipital lobe: function
vision
69
Frontal lobe: function
personality, behavior, emotions, intellectual function, voluntary movement
70
Parietal lobe: function
touch, pain, proprioception
71
Wernicke's area: location and function
in temporal lobe
function: language comprehension (damage = aphasia)
72
Broca's area: location and function
in frontal lobe
function: speech production (damage = expressive aphasia)
73
Basal ganglia: functions
- initiates and coordinates movements
- controls autonomic movements (arms swinging while you walk)
74
Thalamus: functions
- relay station
- interprets all sensations --> sleep, wake, consciousness, learning, and memory
75
Cerebellum: functions
- motor coordination
- voluntary movements (equilibrium, balance, and muscle tone)
76
Brainstem: function and components
function: mainly nerve fibers
components: medulla oblongata, pons, midbrain
77
Medulla oblongata: functions
- respirations
- heart rate
- GI
- nuclei of CN 8-12
(pyramidal decussation occurs here)
78
Pones: functions
- messages between cerebrum
- contains sensory and descending motor tracts pneumotaxic center
- respiratory function
79
mid brain: functions
merges hypothalamus and thalamus
(CN 3 and 4 eye and eyelid movement)
80
Spinal Cord: function
ascending and descending tracts connecting to the brain, contains spinal nerves (31 pairs) and *mediates reflexes*
81
What must be intact for pain and temperature reception?
*lateral spinothalamic tract --> thalamus --> sensory cortex*
82
Decussates - what is it?
right brain controls left side of the body and vice versa
83
Anterolateral tract (spinothalamic) - what is it?
sensory fibers of touch, pain, temp, itch, crude touch
(lateral: pain and temp)
(anterior: crude touch)
84
*Posterior dorsal column* - functions?
- position (aka proprioception)
- vibration
- finely localized touch
85
Sensory cortex - feeling?
*cannot localize pain in the heart, liver, or spleen*
86
Corticospinal/pyramidal tract - what is it?
very skilled and discrete/purposeful. movements (like writing)
- homunculus
87
Cerebellar system - what is it?
equilibrium, movements
- info on position of muscles and joints
- subconscious
88
Descending motor fibers - what is it?
motor impulses from motor areas of cerebral cortex to lower motor neurons in the anterior horn of the spinal cord
89
Nerve - what is it?
bundle of fibers outside of the CNS
90
Afferent pathway - what is it?
*carry input to CNS*
* (sensory)*
91
Efferent pathway - what is it?
*carry input away from CNS*
*(motor)*
92
Reflex arc - what its it?
involuntary
below level of conscious control --> maintain balance and appropriate muscle tone
93
What are the 3 types of reflexes and give an example of each.
deep/ stretch tendon - knee jerk
superficial (cutaneous) - plantar reflex
visceral (organic) - pupillary response to light
94
What are the 5 parts of the deep tendon reflex?
1. afferent (sensory)
2. functional synapse in spinal cord
3. efferent (motor)
4. neuromuscular junction
5. competent muscle
95
What happens to sensation when a nerve is severed?
*the sensation will be transmitted by nerves above and below it*
96
Neurological Older Adult Considerations
1. steady loss of neurons
2. motor system generally slows down
3. slowed conduction of velocity
4. progressive decrease in cerebral function (need to get up more slowly)
5. *sweet and salty impaired first (CN VII) and decreased smell (CN I)
6. meds can interfere with how they react
7. shuffling gait (loss of balance)
8. decreased upward gaze, adjust to light, corneal reflexes, ability to discriminate colors, more hearing loss
97
What is required to have interacranial regulation?
1. good blood supply (O2 and nutrients)
2. Blood volume and CO perfusion
3. blood glucose levels (fuel for brain)
4. good gas exchange (lungs, HgB capacity)
98
What is chorea?
jerky, rapid, sudden purposeless movements (trunk/face/limbs) regular intervals
99
What are early S&Sx of Parkinson's?
tremor when you go to do something, then it stops
100
What is paresis?
partial/incomplete paralysis
101
What is dysmetria?
inability to control distance/power or speed of muscle action
102
Wat is paraesthia?
abnormal sensation (burning/tingling)
103
What is dysarthria?
difficulty forming words
104
What is dysphasia?
difficulty expressing words
105
What relieved senile tremors?
alcohol
106
What is the sequence of which you perform a neuro assessment?
1. mental status: cognition, behavior, comprehension
2. cranial nerves
3. motor system: strength/coordination/gait
4. sensort system: pain, temp
5. reflexes: deep tendon (bicep, triceps, knee, plantar Achilles)
107
Cranial Nerve I - name, type, function, test, abnormal
Name: olfactory nerve
Type: sensory
Function: smell
Test: patient closes eyes and occludes one nostril, inhale to smell scent - bilaterally with different scents
Abnormal: anosmia (no smell)
108
Cranial Nerve II - name, type, function, test, abnormal
Name: optic
Type: sensory
Function: sight, sensory and visual acuity
Test: central = Snellen and peripheral = confrontation
Abnormal: absent central/peripheral vision, no light reflex, papilledema (Increase intracranial pressure), optic atrophy, retinal lesions
109
Cranial Nerve III - name, type, function, test, abnormal
Name: oculomotor
Type: motor
Function: opening eye; moving eye superiorly, medially, and diagonally; constricting pupils
Test: direct/consensual pupillary responses; measure pupil size
Abnormal: dilated pupil (1), ptosis, eye turns out and down, failure to more eye in 6 fields, absent light reflex
110
Cranial Nerve IV - name, type, function, test, abnormal
Name: Trochlear
Type: motor
Function: moving eye down and laterally
Test: accommodation
Abnormal: failure to move eye down/out
111
Cranial Nerve V - name, type, function, test, abnormal
Name: Trigeminal
Type: both
Function: motor = chewing and jaw opening and clenching; sensory = eyes (cornea), nose, mouth, teeth, jaw, forehead, scalp, and facial skin
Test: motor = palpating TMJ and corneal reflexes; sensory = cotton ball test / dull/sharp test on face
Abnormal: motor = weak masseter/temporalis muscles; sensory = no sensation, no blinking
112
Cranial Nerve VI - name, type, function, test, abnormal
Name: Abducens
Type: motor
Function: moving eye laterally
Test: 6 cardinal fields for extraocular movements
Abnormal: diplopia (double vision) in lateral gaze; cant move eyes laterally; nystagmus (shuttering of eyes when holding focus) = injury to cerebellum/brainstem
113
Cranial Nerve VII - name, type, function, test, abnormal
Name: Facial
Type: both
Function: facial expression - closing eyes, closing mouth, moving lips, raising eye brows, secreting saliva and tears, tasting on anterior tongue
Test: assess facial symmetry, raise eyebrows, puff cheeks, smile, frown, keep eyes closed against resistance
Abnormal: asymmetric/absent: facial movement, loss of taste
114
Cranial Nerve VIII: name, type, function, test, abnormal
Name: Acoustic
Type: sensory
Function: hearing, equilibrium
Test: whisper, weber and rinne test
Abnormal: disease/loss of hearing
115
Cranial Nerve IX: name, type, function, test, abnormal
Name: glossopharyngeal
Type: both
Function: swallowing, gag sensation, secretion of saliva; tasting on posterior tongue
Test: sour/bitter; gag reflex and ability to swallow; ask patient to open mouth and say "Ahhh" (uvula midline, palate should rise)
Abnormal: no gag reflex
116
Cranial Nerve V: name, type, function, test, abnormal
Name: Vagus
Type: both
Function: speaking/swallowing, sensation in pharynx and larynx, cardiovascular, respiratory, and GI systems
Test: ask patient to open mouth and say "Ahhh" (uvula midline, palate should rise); ability to swallow by noting how pt handles secretions
Abnormal: uvula deviates, no gag reflex, dysphagia, voice quality (hoarse)
117
Cranial Nerve XI: name, type, function, test, abnormal
Name: spinal
Type: motor
Function: contracting muscles in neck and shoulders
Test: trapezius muscle = shoulder shrug against resistance; sternocleidomastoid muscle = turn face against resistance; overall ROM of neck (flexion, extension, etc.)
Abnormal: absent movement of muscles/weakness
118
Cranial Nerve XII: name, type, function, test, abnormal
Name: Hypoglossal
Type: motor
Function: tongue movement and strength, speech, swallowing
Test: light, tight, and dynamite test; stick out tongue --> should be midline with no wasting or tremors
Abnormal: tongue deviates, slow rate of tongue movement, wasting/tremors
119
Muscles Assessment components (4)
1. size - L and R comparison
2. strength (push/pull/squeeze) - test simultaneously
3. tone - normal degree of tension, move through ROM
4. involuntary movements = look for tics, tremors, if there are any --> note location, frequency, rate, amplitude
120
How do we assess cerebellar function? (3)
(assess coordination and skilled movements)
1. rapid alternating movements: flip hands back and forth on legs (should be quick, equal, rhythmic) or have patient touch all fingers to thumb
2. finger-to-nose test: touch nose then touch finger
3. heel-to-shin: drag heel down shin, should be straight
121
What is dysmetria?
clumsy movement, overshooting the mark (can be caused bye cerebellar disease or alcohol)
122
How do we assess balance? (3)
(assess coordination and skilled movements)
1. tandem gait: walking straight heel to toe
2. Romberg test: stand with feet together and eyes closed - observe swaying
3. deep knee bend: bend at knee, one at a time, normal sense of position/strength
123
How do we assess the anterolateral (spinothalamic) tract? (2)
1. superficial pain: sharp and dull touch, start distally and touch pt with dull and sharp objects --> should be able to distinguish
2. light touch: cotton ball on skin, brush it over the skin in irregular intervals (arms, forearms, hands, chest, thighs, legs)
124
What is hypoalgeia?
Decreased pain sensation
125
What is analgesia?
Absent pain sensation
126
What is hypoesthesia?
decreased touch
127
What is anesthesia?
absent touch
128
What is hyperthesia?
increased touch
129
How do we assess the posterior (dorsal) column tract? (3)
1. tactile discrimination / fine touch (if issues here = sensory cortex damage or posterior column
2. stereognosis: place familiar object in hand with eyes closed (done bilaterally)
3. graphesthesia: read things that are draw on palm - letter or number (good test for sensory loss)
130
Tendon reflexes - what are they? what do you do? locations?
1. measure involuntary muscle contraction
2. limb = relaxed, strike tendon w/ hammer
3. bicep, tricep, brachioradialis, quadriceps, achilles, and plantar
131
Bicep reflex - what is the location and expected response?
- strike thumb at tendon
- contraction of bicep muscle and flexion of forearm
132
Tricep reflex - what is the location and expected response?
- hold upper arm, strike directly above elbow
- extension of forearm
133
Brachioradialis reflex - what is the location and expected response?
- strike 2 - 3 cm above radial styloid process
- flexion and supination
134
Quadriceps reflex (knee jerk) - what is the location and expected response?
- stroke tendon just below patella
- extension of lower leg and palpate for quad contraction
135
Achilles reflex (ankle jerk) - what is the location and expected response?
- hold foot dorsiflexed, strike tendon
- plantar flexion
136
Plantar reflex - what is the location and expected response
- draw an upward stroke on bottom of foot
- plantar flexion and inversion
137
What are neurological considerations for older adult?
- may need more time
- decrease in muscle bulk is most apparent in hands
- dorsal hand muscles = look wasted
- grip strength = should still be equal bilaterally
- benign tremors = hands, head nodding (yes and no) and tongue protrusion
- dyskinesias = repetitive stereotyped movements in jaw/tongue, may accompany senile tremors
- gait = slower/more deliberate
- difficulty performing rapid/alternating movements
- sensation of vibration in ankle = decreased and loss of ankle jerk
- position sense lost
- may need strong stimuli for pain
- *deep tendon reflexes = less brisk (plantar reflex can be lost)*
138
Glascow Coma Scale - what is it? what are the components? normal vs. abnormal
- looks are level of consciousness
1. eye opening response (spontaneous, to speech, and to pain)
2. motor response (obeys verbal commands, localizes pain, flexion/withdrawal, flexion/abnormal, extension/abnormal)
3. verbal response (oriented x3, conversation confused, speech inappropriate, speech incomprehensible)
Fully alert/normal = 15
Coma = less than 7
