Mod 3: Musculoskeleton

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  1. Kyphosis:
    a curving of the spine that causes a bowing back, leads to Hunchback posture.
  2. Scoliosis:
    the sideways curving of the spine.
  3. Lordosis:
     an increased curving of the spine.
  4. Cachexic:
    wasting syndrome, loss of weight, muscle atrophy, fatigue weakness
  5. Contracture:
    results of a stiffness or constriction in muscles, joints tendon, lligaments or skin that restricts normal movment.
  6. Contracture:
    results of a stiffness r constriction in muscles, joints tendon, lligaments or skin that restricts normal movment.
  7. Flexion vs. Extension
    Flexion: Bending of joints as a result of muscle that results in decreasing angle between two bones.

    Extension: straightening of joint that increases angle b/w two bones.
  8. Exudate
    :a mass cells and fluid that has seeped out of blood vessels or an organ, especially in inflammation.
  9. Supination vs. pronation
    Supination: turn palm upwards

    pronation: turning of palm downwards
  10. Abduction vs. Adduction
    Abduction: move part AWAY from midline

    Adduction: move part TOWARD midline of body.
  11. Circumduction:
    combination of flexion, extension, abduction, adduction. Results in circular motion. Crepitu
  12. Crepitus: c
    haracterized by a peculiar cracking, crinkling or grating feeling or sound under the skin around the lungs or in joints.
  13. =>Protection of vital organs
    • Mobility and movement
    • Facilitate return of blood to the heart
    • Production of blood cells (hematopoiesis)
    • Reservoir for immature blood cells
    • Reservoir for vital minerals (Ca, Phos)
  14. =>Muscles and Bones: Size, Density, and Strength Influenced by
    • :Genetic make-up
    • Nutrition
    • Exercise
    • Muscles increase in size with use and shrink with inactivity
    • Bones become stronger with use and weaker with inactivity
  15. =>Assessment of the Musculoskeletal System
    Include data related to function

    Health history: family hx, exercise, nutrition, occupation, learning needs, socioeconomic factors, and medications Assessment of pain and altered sensations

    Physical assessment: posture, gait, bone integrity, joint function, muscle strength and size, skin, and neurovascular status
  16. =>Inspection
    • -Gait
    • -->Posture
    • Kyphosis (Hunchback)
    • Lordosis (Sway back)
    • scoliosis-Symmetry of extremities

    -Muscles, skin -of motion
  17. =>Muscle Strength
    • 0 No evidence of contractility
    • 1 Slight contractility, no movement
    • 2 Full ROM, gravity eliminated
    • 3 Full ROM with gravity only
    • 4 Full ROM against gravity, some resistance
    • 5 Full ROM against gravity, full resistance
  18. =>Musculoskeletal changes in the Elderly--
    • Posture: dorsal kyphosis
    • flexion of the hips and knees
    • feet more widely spaced
    • arms held away from body
    • -Decreased bone mass
    • -Decreased muscle mass
    • -Decreased elasticity and tone of muscles and tendons
    • -Decreased ROM of the hip
  19. =>Diagnostic Evaluation
    • X-rays
    • Computed tomography
    • MRI
    • Arthrography
    • Bone densitometry
    • Bonescan
    • Arthroscopy
    • Arthrocentesis
    • Electromyography
    • Biopsy
    • Laboratory studies
  20. =>Mobility/Immobility
    Impaired physical mobility: has or at risk for limitation of physical movement

    Causes: disease process, fatigue, bed rest, having a cast, traction, illness, or impairment of motor or skeletal function

    Even healthy young men put on bed rest had physiologic problems (Dietrick, 1948)

    =>Systemic effects of immobility

    • Neuro: Nerve damage
    • Metabolic: decreased energy requirements, decreased metabolism
    • Respiratory: diminished lung capacity, atelectasis
    • skin: pressure
    • Cardiovascular
    • Musculoskeletal
    • Integumentary
    • GI: Intestines slow down, constipation
    • GU: Bladder stasis,
    • UTI-If allowed to ambulate, encourage and assist them! If not allowed to, assist with AROM or PROM
  21. =>Prevention of falls
    • Remove scatter rugs
    • Use walker
    • cane
    • Good nutrition
    • Regular exercise
    • Well-fitting shoes
    • Dangle before standing
    • Lighting
    • Grab bars
    • Supervision
    • Answer Call light stat
    • Educate patient on fall risk, precautions
  22. =>Nursing Diagnoses: Associated with Immobility
    • Airway clearance, ineffective
    • Breathing pattern, ineffective
    • Gas exchange, impaired
    • Fluid volume deficit, risk for
    • Tissue perfusion, altered (peripheral)
    • Infection, risk forUrinary elimination, altered
    • Skin integrity, impairedSkin integrity, impaired, risk forSleep pattern disturbance
    • Social isolation
    • Coping, ineffective individual
  23. =>Musculoskeletal Effects of Immobility
    • Decreased mobility and muscle atrophy
    • Loss of endurance, decreased muscle mass and strength, and joint instability
    • Increased risk for falls
    • Bone Effects: Osteopenia/osteoporosis
    • Joint contractures

    => Immobility:Leads to muscular atrophy, negative nitrogen balance, further loss of mass, increased weakness, decrease in nutritional intake due to anorexia and/or restrictions (also leads to more weakness and neg nitrogen balance)
  24. Sims’ position
    positioning technique
  25. =>Positioning after Hip Prosthesis surgery
    • No Adduction, internal rotation, crossing legs, or sitting with knees higher than hips
    • -Do not put on own shoes or socks without adaptive device for 8 weeks post op
    • -Use elevated toilet seat-While in bed, use pillow between legs
    • -Lie on “good” side with pillows to keep legs from crossing-Keep hip in proper alignment
  26. Discuss the technique of assessing muscle strength and active/passive joint range of motion.
    a. Active: Means that patient takes his or her own joints through all movements without assistance. Stabilizing the body area proximal to that being moved.

    b. Passive: anchor joint with one hand while your other hand slowly moves to its limit. Note for crepitation:

    c. Muscle Testing: test the strength of the prime move of muscle goups for each join. Repeat motions you elicited for active ROM. Ask the person to flex and hold as you apply opposing pressure.
  27. 3. Identify changes in physiological and psychosocial function associated with aging, mobility and immobility.
    a. May range from mild discomfort and decreased ability to perform activities of daily living to sever, chronic pain and immobility.

    b. Risk for falls increases and imbalance, unsteady, proprioception (awareness of self in relation to the environment may be altered)

    c. Increased bone resorption and decreased bone formation cause loss of bone density, contributing to the decelopment of osteopenia and osteoporosis.

    d. Muscle mass decreases, 30% loss by age 70.

    e. Tendons/ligaments become less flexible and movement becomes more rigid.

    f. Joints: increased risk for cartilage erosion, loss of water from vertebrae disks, decreased height.

    g. Muscle: decreased number of muscle cells. Replacement of muscle cells by fibrous connective tissue. Loss of elasticity in ligaments, tendosns, and cartilage. Reduced ability to store glycogen. Decreased ability to rlease glycogen as quick energy during stress. Decreased basal metabolic rate (slow reflexes and quicker fatigue)
  28. Review the purpose and techniques of applying warm and cold compresses.
    Cold application is usually appropriate at the time of the intitial trauma to promote vasoconstriction and dcrease swelling, pain, and congestion from increased metabolishm in the area of inflammation. Heat may be used later to promote healing by increasing the circulation to the inclamed site and subsequent removal of debris. Heat is also used to to localize the inflammatory agents. Warm moist heat may help debride the wound site if necrotic material is present.
  29. Discuss how to assess for deep vein thrombosis; and how to prevent this complication of immobility and trauma.
    Inspect, increase size of extremity when compared with other side: taut shiny warm skin, erythematous, tender to palpation, no physical changes in the affected extremity in some patients. encourage early ambulation, recommend or provide food & Ankle exercises when client unable to ambulate freely. Apply intermittent compression devices or grauaged compression stockings to lower extermities to reduce risk of deep vein thrombosis or tissue ulceration in client with limited activity. Elevate legs when sitting to minimize edema formation.
  30. Limited Range  of Motion
    Joint does not achieve the expected degrees of motion due to injury, inflammation and contracture.
  31. Standard x-ray:
    Determines density of boneure, ; evaluates structural changes in composition; avoid excessive expos
  32. Computed Tomography (CT) scan:
    X ray beam used  with a computer to provide a 3D pic; identifies soft tissue abnormalities, body abnormalities, musculoskeletal trauma. Inform patient of remaining skills and shellfish allergies is contrast medium is being used.
  33. Magnetic Resonance Imaging (MRI)
    Radio waves and magnetic field are used to view soft tissue, useful in diagnosing avascular necrosis, disc disease, tumors, osteomyelitis, ligament tears, cartilage teears. Ear plugs can be given
  34. Bone Mineral Density tests
    Dual Energy xray absorptiometry  (DXA)

    Quantitative Ultrasound (QUS)
  35. Bone Scan
  36. Arthroscopy:
    Endoscopy; involves insertion of arthroscope into joint for visualization of structior and contents, can be used for exploratory surgery, repair of joint structure and diagnosing
  37. Mineral Metabolism of Bones:
    Alkaline phosphatase
    Alkaline phophatase: produced by osteoblasts, needed for bone matrix, elevated levels signify healing fractures or bone cancers. 

    calcium: increased levels signify hyperparathyroidism and some bone tumors.

    Phosphorous: Decreased level means osteomalacia, increased level means chronic kidney disease, healing fractures and osteolytic metastatic tumor.
  38. Muscle Injury Markers.
    Creatine Kinase (CK): highest concentration found in skeletal muscle. Incrasesd levels found in progressive muscular dystrophy, polymyositis, and traumatic injuries. 

    Potassium: increased in muscle trauma as cell destruction releases this electrolyte into the serum.  Cardiac dysrhythmias can be caused by hyperkalemia or hypokalemia. 

    aldolase: Useful in monitoring muscular dystrophy and dermatomyositis.
  39. Arthrocentesis
    • Incision or puncture of joint capsule to obtain samples of synovial fluid from within the joint cavity or to remove excess fluid (synovial fluid usually).
    • Useful to diagnosis joint inflammation, infection, meniscal tears, and subtle fractures.
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Mod 3: Musculoskeleton
2014-09-15 00:15:09
Nursing Musculoskeleton Mod3

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