Musculoskeletal

Description:	Health Assessment Test 3
Category:	Nursing
Created by:	Mranda130 on 2008-10-28

Question	Answer
skeleton includes the facial bones, auditory ossicles, vertebrae, ribs, sternum, and hyoid bones	axial skeleton
skeleton that includes the scapula, clavicle, pelvis, and extremeties	appendicular skeleton
skeletal muslces are under _____ control	voluntary
strong, dense, flexible bands of connective tissue that hold BONES TO BONES	ligaments
hold bones to bones	ligaments
flexible bands of connective tissue	ligaments
strong, nonelastic cords of collagen located at the end of MUSCLES TO ATTACH THEM TO BONES	tendons
nonelastic cords of collagen	tendons
at attach muscle to bones	tendons
number of cervical vertebrae	7
number of lumbar vertebrae	5
number of sacral vertebrae	5
number of thoracic vertebrae	12
most active joints in spine	cervical
long bones are generally longer, narrower, and denses in what culture?	african americans
risk factors:females between puberty and menopause; bad bite, grinding of teeth, abnormal bite, faulty dentures	TMJ - temporomandibular joint dysfunction
middle age men (30-50); positive family history; HYPOthyroidism; obesity, hypertensin, alcohol abuse	GOUT
women over at 45 and men under age 45; obesity; overuse of joints; joint injury; lack of exercise	OSTEOARTHRITIS
what age does bone density begin decreasing in women?	35 years old
white and asian women; small-bones; thin women; family history; smoking; alcohol; inadequate calcium intake; inadequate weight-bearing exercise; meds to treat chronic diseases; estrogen deficienty from menopause or removal of ovaries	OSTEOPOROSIS
over age 75; tall at a young age and thin; osteoporosis; fluoride deficit; sedative benzodiazepine use; caffeine	HIP FRACTURE
What are the most commonly related problems to the musculoskeletal system?	pain, problems with movement, and problems with daily activities
joint pain is described as...	pain around joint with edema and erythemia. MOST COMMON MUSCULOSKELETAL SYMPTOM FOR WHICH CLIENTS SEEK HELP..
bone pain is described as..	"deep, dull, boring, intense" - usually not related to movement unless there is a fracture and then described as "sharp"
muscle pain is described as...	"crampy"
muscle pain with weakness suggests a...	primary muscular disorder
numbness and tingling of the dominante hand suggests..	carpal tunnel
sudden onset of pain and erythema in the great toe, ankle, and lower leg suggests..	gout
this pain may awaken the client, especially when the client islying on the affected limb	rheumatoid arthritis and tendonitis
morning stiffness lasting 1-2 hours suggests	rheumatoid arthritis
pain when weight bearing but relieved by rest suggests...	osteoarthritis
movement usually reduces joint pain	rheumatoid arthritis
primary predictive factor for osteoporosis-related fractures	BMD bone mineral density
primary prevention against osteoporosis...	calcium and vitamin d in diets; engage in weight bearing exercise;high-impact exercises; avoid smoking and alcohol
secondary prevention against osteoporosis..	screenings for women over 65; women at increased risk should begin screenings at 60; screenings at least every 2 years; measurement of BMD to make sure it is less than 2.5 standard deviations away from norm
secondary prevention against low back pain	tyeach how NOT to twist when lifting, moving
skills to assess musculoskeletal...	imspect, palate, ROM, test strength
when measuring the lower extremeties..what do you use as a landmark?	anterior superior iliac spine to the medial malleolus
while greater than 1 cm difference in limb size is abnormal.. what is a normal finding in relation to limb size?	dominant side is usually slightly larger than the nondominant side
muscle twitching of a single muscle group	fasciculations
ROM for neck and cervical spine	flextion, extension, lateral flextion, rotation
ROM for shoulder	flextion, extension, hyperextension, abducti8on, adduction, internal rotation, circumduction
ROM for elbow	flextion, extension, hyperextension
ROM for forearm	supination, pronation
ROM for wrist	flestion, extension, hyperextension, radial, ulnar
ROM FOR fingers	flextion, extension, hyperextension, abduction, adduction
ROM for thumb	flexion, extension, abduction, addution, opposition
ROM for hip	flextion, extension, abduction, addution, internal and external rotation, circumduction
ROM for knee,	flexion, extension
ROM for ankle	dorsiflextion and plantar flexion
ROM for foot	inversion, eversion
ROM for toes	flextion, extension, abduction, adduction
LOVETT SCALE - no evidence of contractility	0-grade;0% normal
LOVETT SCALE - complete range of motion against gravity w/ some resistance	4 - 75% normal -good
LOVETT SCALE - evidence of slight contractility	1 - 10% normal -trace
LOVETT SCALE - complete range of motion against gravity w/ full resistance	5 - 100% normal -normal
LOVETT SCALE - complete range of motion w/ gravity	3 - 50% normal - fair
LOVETT SCALE - complete range of motion with gravity eliminated	2 - 25% normal - poor
flexion of chin to chest..	45 degrees
hyperextend head...	55 degrees
bend head laterally..	40 degrees both ways
chin to shoulders	70 degrees
kyphosis	posterior curvature of the thoracic spine
lordosis	anterior curvature of the spine
scoliosis	lateral curvature of th espine
bending over to touch toes	75 degrees - anything less; any pain or muscle spasm is abnormal
bending laterally right and left.. at hip..	35 degrees both directions
hyperextend spine	30 degrees
rotation of upper trunk..	30 degrees in both directions
what part of body do you percuss for tenderness when doing a musculoskeletal assessment?	spinal processes
hyperextension of arms (backward)..	50 degrees
swing arm across fron of body..	50 degrees adduction
external rotation (hands behind head)..	90 degrees
internal rotation (hands on small of bakc)..	90 degrees
flexion of elbow	160 degrees
tenderness or pain with pronation and supination of the elbow and point tenderness of the lateral epicondyle	tennis elbow
tenderness or pain with pronation and supination of the elbow and point tenderness at medial epicondyle	golfer's elbow
bouchard's nodes form where? as a result of what disease?	PIP joints, osteoarthritis
Heberden's nodes form where? as a result of what disease?	DIP joints, osteoarthritis
wrist should hyperextend..	70 degrees
wrist should flex..	90 degrees
radial deviation of wrist should be	20 degrees
ulnar deviation of wrist should be..	55 degrees
PATRICK TEST	test external hip rotation
describe patrick test	place heel of one food on the opposite patella. apply gentle pressure on the medial aspect of the flexed knee until it touches table.
bent knee to chest should be..	120 degrees
internal hip rotation should be..	40 degrees
abduction of knee is..	45 degrees
adduction of knee is..	up to 30 degrees
hyperextension of knee is	up to 30 degrees
genu varum	bowlegged
genu valgum	knock-kneed
dorsiflection of snkle should be..	20 degrees
plantarflextion of ankle should be..	45 degrees
eversion of ankle should be	20 degrees
inversion of the ankle should be	30 degrees
abduction of ankle should b e	10 degrees
adduction of ankle should be	20 degrees
PHALEN'S SIGN	test for carpal tunnel
describe phalen's sign	flex both wrists and press the dorsum of the hands against each other for one minute... should NOT report any numbness or tingling
positive phalen's sign - ABNORMAL	client complains of numbness, pain, or paresthesis over the palmar surface of the hand of the first three fingers and part of the fourth - may indicate carpal tunnel syndrome
TINEL'S SIGN	test for carpal tunnel
describe tinel's sign	tap on median nerve
positive Tinel's sign - ABNORMAL	client reports tingling sensation or pain radiating from the wrist to the hand along the median nerve
bulge sign test	test for small effusion of the knee
describe the bulge sign test	milk medial aspect of knee 2-3 times then tap lateral side of patella.. no waves should be seen
postive bulge sign- ABNORMAL	fluid on knee
ballotttement test	test for large effusions on knee
DRAWER TEST	test ACL/PCL
positive drawer test - ABNORMAL	tibia can be pulled more than 2 cm from the femur = ACL injury; tibia can be pused into femur = PCL injury
MCMURRAY'S TEST	test for meniscus damage in knee
positive McMurray's Test - ABNORMAL	pain on medial or lateral surfaces of knee; audible clikcing or locking of knee on movement; pain reproduced in the joint lines
what menicus tear is most common?	medial
apley test	test for menicus tear in knee
describe apley test	lying on stomach, lift knee and rotation externally and internally
postive Apley test - ABNORMAL	pain, locking of the knee, or clikcing during rotation
THOMAS TEST	test for flexion contractures of the hip
describe Thomas test	lift one leg off table.. other leg should remain flat when extended
postivie Thomas test - ABNORMAL	lifting of extended leg in response to the other leg being flexed indicates a hip flexion contracture
straight leg raises	test for nerve root irriation or lumbar disk herniation - if pain is reported after 30-60 degrees of elevation then there is peripheral nerve pressure somewhere
Barlow-Ortolani maneuver	performed on babies up to 2 months to assess hip location - put knees together and make sure they extend to touch table on both sides
Allis' sign	assessment of hip location in infants - bend knees towards babies body
syndactyly	fused digits
polydactyly	extra digits
Erb's palsy	paralysis of shoulder and upper arm muscles
Abnormal findings in infant..	positive barlow=Ortolani's and Allis' sign
metatarsus varus	pingeon-toed
talipes equinovarus	club-foot
Trendelenburg's sign	measures hip dysplasia in children - when standing on one leg, the other hip should raise, not drop
wide gait pattern until 24-36 months in children.. abnormal? or normal?	normal finding
common finding but NOT normal in children 12-18 months..	lumbar lordosis
which race is lordosis more common in?	african americans
Lumbar lordosis is abnormal after what age?	six years old
valgus rotation	medial malleolus greater than 2 inch apart with knees touching is NORMAL in ages 2-3.5 and may be present up to 12 years
varus rotation	medial malleolus touching with knees greater than 1 inch apart may be normal until 18-24 months but is ABNORMAL after that
what is abnormal in adolescent girls but common?	kyphosis
older men tend to walk how as opposed to women?	men walked w/ smaller steps and a wider ase and women become bowlegged with a narrow standing base
what is the single most important determinant of a cilent's risk of falling?	observation of mobility
scoliosis.. what curvature is considered a normal variation?	<10%
scoliosis.. what curvature is considered mild?	10-20%
RA - who is more at risk?	women 25-55 years; whites and afrian americans
RA- common things you see?	ulnar deviation, swan-neck deformity, boutonniere deformity
OA - who is at risk?	almost everyone over 70; usually more women
OA -common things you see?	Heberden's nodes at DIP joints and Bouchard's nodes in PIP joints
GOUT	increased in serum uric acid
gout - who is at risk?	men over 40 years
what is a clinical sign of gout?	tophi - round, pealike depostits of uric acid in ear cartilage or large, irregularly shaped deposits in subcutaneous tissue or other joints.