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Osteoarthritis aka Degenerative Joint disease (DJD)
- Noninflammatory, localized, progressive disorder involving degenration of articular cartilage and subchondral bone and formation of new bone (osteophytes) at bone surface.
- Assymetrical joint involvement, stiffness, swelling, bony protuberances, pain with motion and decreased ROM
- Autoimmune, chronic, systemic inflammatory disease of joints surrounding connective tissue
- Inflammation of synocial membrane leads to thickening, then fibrosis, whcih decreases ROM, and finally bony ankylosis
- Symmetric joint involvement, hear, redness, swelling, painful motion, fatigue, weakness, anorexia, weight loss, low grade fever, lymphadenopathy
- Can come after osteopenia (decreased bone)
- Decrease in skeletal bone mass when rate of bone resorption is greater than bone formation
- Increased risk for stress fractures (wrist, hip,vertebrae are most common)
- Loss of height frequently first clinical sign of osteoporosis (due to vertebral fracture and collapse)
- ROM- forward flexion, hyperextension, internal/external rotation, abduction/adduction
- strength- against resistance have pt shrug, flex shoulders forward, and abduct
- ROM- Flexion/extension, supination/pronation
- Strength- Against resistance have pt flex and extend
- ROM- Wrist Flexion/extension, radial deviation, ulnar deviation, finger flexion/hyperextension/abduction, make a fist, and finger opposition
- Strength- Position pts forearm palm up resting on a table. Hold mid forearm and ask pt to flex wrist against your resistance
Osteoarthritis nodes in Proximal finger joints
Osteoarthritis nodes in distal finger joints
Phalen's test for carpal tunnel
- Have pt hold both hands back to back while flexing wrists 90 degrees
- Normal: no symptoms in habnds after 60 sec
- Abnormal: burning and tingling along median nerve distribution
Tinel's test for carpal tunnel
- Directly percuss over median nerve at wrist
- Normal: no symptoms with percussion
- Abnormal: burning and tingling alongl median nerve distribution
ROM- Flexion-hyperextension, internal/external rotation, abduction/adduction
hyperextended knees due to weak quads
- ROM- flexion/extension, some hyperextension
- Strength- against resistance have pt flex knee, extend knee
- ROM- plantar/dorsi flexion, eversion/inversion, toe flexion/extension
- Strength-Against resistance have pt dorsiflex and plantarflexion
- ROM- cervical-flexion,hyperextension, lateral bend, roation; lumbar- flexion, hyperextension, lateral bend, rotation
- Strength- cervical (flexion, extension, rotation) lumbar (asess L5 & S1 nerve root by having pt walk on toes and heels)
Crossed leg raise diagnoses:
Straight leg raise diagnoses:
herniated disc if there is a pain when leg is raised 30-60 degrees
Ms. Lieu shares with the nurse that she often experiences knee pain. The nurse asks Ms. Lieu about other common joint symptoms. On which symptoms should the nurse focus:
Stiffness, swelling, and warmth
To check for scoliosis, the nurse provides which client instruction?
Stand with arm straigh at your sides and your feet together
Ms. Lieu follows the nurse's instructions to swing her arms forward and up in a wide arc, then back. This action allows the nurse to observe what shoulder range of motion?
Flexion and hyperextension
Ms. Lieu is able to move her upper extremities through complete range of motion. In documenting full range of motion of the upper extremeties, the nurse is able to note the absence of which abnormality?
Ms. Lieu lies down on the exam table in a supine position. The nurse assesses adduction and abduction of the hip by instructing the client to take what action?
Swing the entire leg laterally and then medially, keeping the knee straight while moving
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