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Nursing 1220
Knowledge and Process
| Question | Answer |
|---|---|
| What is the MSK made up of | bones - 206 joints - nonsynovial, synovial, cartilage, ligaments, bursa muscles - fasciculi (bundles of muscle fibres), tendon |
| What is the function of the MSK? | support (posture and positioning) movement protection (encases and protects inner vital organs) hematopoiesis (RBC production)resevoir of essential minerals |
| What are the different types of joints | non synovial - fibrous, cartilaginous synovial |
| what is a fibrous joint? ex? | joints connecting bones without any movement bones of the skull |
| what is a cartilaginous joint? ex? | joint where bones are connected by cartilage - allow only limited movement spine, ribs, pelvis |
| what is a synovial joint? ex? | joints with bursa containing synovial fluid which lubricates and allows free movement (supported and facilitated by cartilage, ligaments, tendons and muscles) knee, shoulder, elbow, wrist, knee, ankle |
| what is a ginglymus? ex? | hinge joint flexion and extension only elbow, knee, ankle, interphalangeal joints of hand |
| What is a condyloid? ex? | write and carpal joints permit movement in tow different planes wrist - radiocarpal (flexion/extension) side to side deviation midcarpal - flexion/ extension, some rotation |
| what is a ball and socket ex? | allow movement on several axis flexion, extension, abduction, adduction, rotation and circumduction shoulder girth, hip |
| What is an anthrodial? ex? | gliding/plane join permits gliding or sliding movements clavicle metatarsals |
| what is a cylindrical joint? ex? | pivot joint allows rotation, pronation, supination cervical spine, forearm |
| what is the temporal mandibular joint (TMJ)? | ginglymus and anthrodial joint at jaw |
| what accounts for 40-50% of body weight | muscles |
| what is skeletal muscle composed of | muscle fibers (faciculi) |
| how to muscles attach to bone? | tendons |
| extension/flexion | bending movement that decreases the angle between two parts bending movement that increases the angle between body parts |
| abduction/adduction | motion that moves a structure away from or towards the center of the body (midline) |
| circumduction | concical movemnt of a body part (ball and socket joint) |
| internal / external rotation | rotation of body parts towards the axis of the body or away from the center of the body |
| pronation/supination | rotation of the forearm where it goes from palm up to down and vice versa rotation of the foot big toes out and in |
| protraction/ retraction | moving forward and moving back |
| depression/ elevation | moving up and down |
| opposition/ reposition | grasping with the thumb and releasing an object |
| inversion/eversion | sole of the foot towards or away from the midline of the body |
| ulnar deviation/ radial deviation | adduction of the wrist, abduction of the wrist |
| what are developmental considerations in infants and children for the MSK | epiphyseal plates vs epiphyseal line spinal curvature C to s to ss developmental dysplasia of hip growing pains |
| what are developmental considerations in pregnant women for the MSK | increased joint mobility lordosis (big butt) spinal curvature |
| what are developmental considerations in pregnant women for the MSK | osteoporosis decreased height (thinning of intervertebral discs) influence of exercise on skeletal mass kyphosis |
| what is the leading cause of pain, disability, and health care utilization in canada | arthritis |
| who is at greater risk for arthritis | aging women with lower education and lower income levels |
| what are osteoarthritis risk factors | job, nutrition, female, age, smoking |
| rickets | vit D, calcium or phosphate deficiency softening/ weakening of the bone |
| osteoporosis | porous bones, calcium deficiency |
| what are endocrine disorders associated with MSK | carpal tunnel: pregnancy, hypothyroidism, diabetes, acromegaly joint problems: hyperthyroidism, hyperparathyroidism muscle atrophy: adrenocorticoid insufficiency bone disorders: glucocorticoid excess hyperparathyroidism |
| what are neuromusclar diseases associated with MSK disorders | CVA - stroke parkinson's MS |
| hyperthyroidism/ hyperpituitarism in MSK system | auto immune disorder increased risk of disorders of skeletal system slow bone growth resulting in short limbs |
| excess GH from anterior pituitary in MSK system | depends on onset, if it was before or after the epiphyseal plate closure at puberty acromegaly (after) gigantism (before) |
| what should you watch for to notice endocrine disorders that impact the MSK system in children | delayed tooth development delayed puberty hoarse voice/ cry (if infant) |
| congenital hip dysplasia | misalignment of the hip joint - head of femur does not sit properly in the acetabulum bilateral or unilateral present at birth higher risk with multiple births due to crowing in utero trendelenburg sign |
| talipes equinovarus | when a baby's foot is stuck in inversion/ eversion congenital defect often picked up by nurses best results if treated early on with better resolution |
| trendelenburg sign | when a child stands on affected side, shifting occurs to instability (positive) pelvis line drop, lean toward affected side |
| Legge-calve-perthe disease | coxa plana aseptic necrosis of femoral head hip or referred knee pain may be mistaken for growing pains progressive flattening of femoral head limp tx: non weight bearing abduction brace until bone grows and heals. may need hip replacement |
| muscular dystrophy | causes progressive muscle degeneration always affects symmetrical muscle groups may have mild mental imipairment gower's sign die early from obesity and cardiopulmonary disorders |
| Gower's sign | when child rises from floor there is a lack of lower body strength so the child gets up in a climbing fashion |
| scoliosis | lateral curvature of the spine may interfere with lung expansion congenital secondary to neuromuscular conditions idiopathic - most common in girls |
| Juvenile rheumatoid arthritis | idiopathric girls aged 1-3 or 8-10 chroinc inflammation of joints and tissues - joint effusion eventual erosion, destruction and fibrosis of articular cartilage adhesions results in loss of function (ankylosis) can be single or multiple joints |
| ankylosis | loss of function in joints |
| joint effusion | chronic inflammation of jionts and tissues |
| adhesion | band of scar like tissue that forms between two surfaces inside the body causing them to stick together |
| bone cancers | osteosarcoma Ewing's sarcoma |
| osteosarcoma | important to treat early because it can metastasize more common in adolescent boys often in long bones - 6th leading cause of cancer in children under 15 S&S - pain, swelling, limp, pathologic fractures |
| ewing's sarcoma | translocation of Genes 11 and 12 |
| Hemophilia | bleeding that doesn't clot bleeding in the knees, elbows, or other joints no obvious injury initial tightness in the joint with no real pain or any visible signs of bleeding. then joint becomes swollen, hot to touch and painful to bend treat quickly |
| what are the different types of fractures | complete - bones break completely comminuted - complete separation with little pieces broken off compound - through skin (risk of infection) greenstick - not complete S&S pain, swelling, redness, bruising, abnormal position, inability to move |
| osteomyelitis | infection of bone from open fracture through blood stream usually bacterial (staph aurous), at risk for pathological fractures |
| Rating scale for Muscle Strength complete ROM against gravity and full resistance | 5/5 |
| Rating scale for Muscle Strength complete ROM against gravity and moderate resistance | 4/5 |
| Rating scale for Muscle Strength complete ROM against gravity | 3/5 |
| Rating scale for Muscle Strength complete ROM with joint supported; cannot perform ROM against gravity | 2/5 |
| Rating scale for Muscle Strength muscle contraction detectable, but not movement of the joint | 1/5 |
| Rating scale for Muscle Strength no visible muscle contraction | 0/5 |
| SEADS (muscle) | swelling/ strength erythema (reddness) atrophy deformity skin changes |
| atony | lack of residual tension in muscle tone |
| hypotonicity (muscle tone) | diminished tone of skeletal muscles |
| spasticity | hypertonic, so the muscles are stiff and movements awkward |
| spasm | sudden violent involuntary contraction of a muscle |
| fasciculation | involuntary twitching of muscle fibres |
| tremors | involuntary contraction of muscles |
| what is the shape of the spine in adults | double s |
| what are the movements of the spine? | flexion, extension, abduction, rotation |
| to what degree can the thoracic and lumbar spine move flexion extension hyperextension lateral flexion rotation | 90 0 30 35 30 |
| What are the movements of the shoulder | abduction, adduction, circumduction, rotation, flexion, extension |
| what are common abnormalities of the shoulder | atrophy dislocated shoulder joint effusion tear of the rotator cuff frozen shoulder (adhesive capsulitis) subacromial cursitis |
| subacromial bursitis | inflammation of the bursa in the shoulder that causes upper extremity muscle weakness |
| what are the movements of the hand | flexion, extension, rotation, side to side deviation |
| phalen's test | test for carpal tunnel putting back of hands together |
| Tinel's sign | lightly percussing nerves in hand (+) tingling sensation and pain |
| to what degree can the wrist/ hand move? flexion extension hyperextension radial deviation ulnar deviation | 90 0 70 20 55 |
| ganglyion cyst | non cancerous lumps that develop along the tendons or joints of ones wrists or hands |
| carpal tunnel syndrome | median entrapment neuropathy that cuases paresthesia, pain, numbness and other symptoms in the distribution of the median nerve due to is compression at the wrist in the carpal tunnel |
| colles' fracture | fracture of the distal radium in the forearm with dorsal and radial displacement of the wrist and hand (landing on wrist with hand up |
| Dupuytren's contracture | fixed flexion contracture of the hand due to palmar fibromatosis |
| swan-neck and boutonniere deformities | hyperextension of the proximal interphalangela (PIP) joint and flexion of the distal interphalangela (DIP) joint presents the flexion of the PIP and hyperextension of the DIP |
| ulnar deviation/ drift | swelling of metacarpophalangeal joints causes the fingers to become displaced, tending towards the little finger |
| degenerative joint disease or osteoarthritis | mechanical abnormalities involving degradation of joints joint pain, tenderness, stiffness, locking and sometimes an effusion |
| acute rheumatoid arthritis | chronic inflammatory disorder that typically affects the joints in your hands and feet |
| syndactyly | condition where two or more digits are fused together |
| polydactyl | having an abnormal number of digits |
| what movements can the elbow make | flexion and extension pronation and supination - radioulnar joints |
| to what degree can the elbow move flexion extension pronation supination | 150-160 0 90 90 |
| olecranon bursitis | inflammation and swelling behind the elbow student's elbow |
| subcutaneous nodules | slightly elevated lesions on or in the skin |
| lateral epicondylitis | outer part of the elbow becomes sore and tender caused by overuse of arm, forearm and hand muscles that results in elbow pain |
| To what degree can the hip move flexion extension hyperextension\abduction adduction internal rotation external rotation | 90; 120 with knee flexed 0 15 45 30 40 45 |
| what is a fss, bruising, swellingractured hip | inability to move after fall inability to weight bare weight severe pain in hip/ groin stiffne |
| sinovitis | inflammation of the synovial membrane |
| what is the expected degree of movement in the knee flexion extension hyperextension | 130 0 15 |
| prepatellar bursitis | carpet layer's knee - swelling of the bursa in the patellar |
| swelling of menisci | tear in the cartilage in the middle of the knee that causes swelling |
| post-polio muscle atrophy | affects polio survivors that causes muscle death |
| chrondromalacia patella | overuse, injury and other factors that lead to damage to the cartilage under thte kneecap |
| what are the expected degrees of movement in the ankle and foot dorsifelxion plantar flexion inversion eversion | 20 45 30 20 |
| achilles tenosynovitis | inflammatory condition of the sheath of the achilles tendon (paratenonitis) |
| Tophi | deposit of monosodium urate crystals in people with longstanding high levels of uric acid in the blood |
| hallux valgus with bunion and hammer toes | deformity in the foot, deformity of the big toe where it curves in towards the middle of the foot and the bone protrudes out on the outside (bunion) hammer toe is when the toes look contracted |
| ingrown toenail | when the toenails grows into the nail fold |
| plantar wart | wart caused by HPV occuring on the sole |
| ankylosing spondylitis | inflammatory disease the can cause some of the vertebrae in your spine to fuse together |
| osteoarthritis vs rheumatoid | oste: most common, overuse, wear and tear rheu: autoimmune disease, snynovial joints - ankylosis |
| osteoporosis | porous, spongy, weak bones risk: menopausal women, smoking, increased alcohol intake, decreased calcium, sedentary lifestyle |
| bulge sign knee | fluid wave presents medially |
| ballottement of the patella | palpable click as patella strikes teh trochlea |
| mcmurray test | click hear or palpated on above maneuvers |
| what test should you use for: carpal tunnel | phalen's test Tinel's test |
| what test should you use for: rotator cuff | arm drop test - patient can not hold arm at 90 degrees |
| what test should you use for: lumbar spine disc herniation | straight leg raising (lasegue test) pain with leg raise |
| what test should you use for: knee ligaments | mcmurray's test drawer sign |
| what test should you use for: effusion | bulge test ballottement |
| What are the 4 quadrants of the breast | upper outer; upper inner; lower outer lower inner |
| gynecomastia | benign enlargement of breast tissue in males usually occurs during puberty temporary usually only in one breast impact is related to body image |
| what are abnormal findings in a breast exam | dimpling nipple retraction edema - peau d'orange deviation in nipple pointing fixation |
| what is fixation of the breast | asymmetry, distortion, or decreased mobility of the breast |
| what are abnormal findings in a breast exam during lactation | plugged duct breast abscess mastitis |
| what are the axillary nodes | central pectoral subscapular lateral |
| what are developmental considerations for adolescents (Rectum, Anus, reproductive structures) | puberty asymmetry/ tenderness thelarche and menarche |
| thelarche | onset of secondary breast development usually occuring at the beginning of puberty |
| menarche | first menstrual cycle |
| what are developmental considerations for pregnant women | breast changes/ early sign of pregnancy colostrum (first milk)/ lactation |
| what is the developmental considerations for older women (Rectum, Anus, reproductive structures) | menopause and atrophy of glandular tissue replaced by fibrous connective tissue decrease in size and elasticity |
| what are the developmental considerations for males (Rectum, Anus, reproductive structures) | gynecomastia - enlargement of the male breast tissue |
| what are causes of a breast lump | benign breast disease - fibroscystic breast disease cancer fibroadenoma |
| Gail Model | calculate individual risk for breast cancer calculates 5 year and lifetime cumulative lifetime risk takes into account age, family history, age at menarche, age at first live birth |
| what are different forms of breast cancer screening | self breast exam clinical breast examination mammography breast cancer gene test |
| sensitivity | ability to test to correctly identify those patiens with the disease (false negatives) |
| Specificity | ability of the test to correctly identify those patients without the disease (false positive) |
| what are abnormal findings in urinary | urethritis (urethral discharge and dysuria) STIs renal calculi (kidney stone) bladder stones (vesico calculus/cystolith) urethral stricture acute urinary retention |
| abnormal characteristics of urine | cloudy, pale yellow, dark amber, bright yellow, orange, pink or red, tea, dark grey, blue |
| adnexa | appendages of an organ ex fallopian tubes, ovaries, ligaments and supporting tissues |
| squamocolumnar junction | area in the cervix where squamous vaginal tissue meet columnar epithelial uterine tissue and is a common site for neoplastic changes |
| rectouterine pouch (cul-de-sac of Douglas) | indicative of a ruptured follicle, ovarian cyst or ectopic pregnancy |
| goodell's sign | It is a significant softening of the vaginal portion of the cervix from increased vascularization. This vascularization is a result of hypertrophy and engorgement of the vessels below the growing uterus. 4-6 weeks |
| Chadwick's sign | bluish discoloration of the cervix, vagina, and labia resulting from increased blood flow. 6-8 weeks |
| Hegar's sign | isthmus of uterus softens 6-8 weeks |
| mucus plug | A jellylike plug that seals off the cervix and is expelled before delivery |
| sanguineous or leukorrhea (mucoid discharge) | thick whitish or yellow vaginal discharge that may be normal around puberty |
| Pedersen speculum | |
| Pediculosis | crab lice |
| hepes simplex virus | type 2 (herpes genitalis) |
| syphilitic chancre | firm, painless, non-itchy skin ulcerations |
| what are abnormal findings on the external genitalia | crab lice, Herpes, Syphilis, contact dermatitis, HPV, abscess of Bartholin's gland, urethritis, urethral caruncle, tumors of vulva |
| what are abnormal findings on the pelvic musculature | cystocele - herniation of the bladder through a weakened pelvic wall into the vagina (Kegel) rectocele - herniation of the rectal tissue into the vagina uterine prolapse |
| what are common causes of vulvovaginal inflammations | atrophic vaginitis candidiasis (moniliasis) trichomoniasis bacterial vaginosis chlamydia Gonorrhea |
| what are common conditions of uterine enlargment | pregnancy, myomas (leiomyomas, uterine fibroids) carcinoma of endometrium endometriosis |
| what are abnormal findings (adnexal enlargement) | fallopian tube acute salpingitis; pelvic inflammatory disease ectopic pregnancy fluctuant ovarian mass ovarian cyst solid ovarian mass ovarian cancer |
| what are abnormal findings in the scrotum | cryptorchidism testicular tortion epididymitis varicocele diffuse tumour hydrocele scrotal hernia orchitis scrotal edema |
| what are the different types of inguinal and femoral hernias | indirect - failure of embryonic closure of teh deep inguinal ring after the testicle has passed through direct - protrusion through a weakened area in the transversalis fascia near the medial inguinal fossa femoral |
| what are abnormal findings in the prostate gland | benign prostatic hypertrophy (BPH) prostatitis carcinoma |
| what are abnormal findings of the anal region | pilonidal cyst or sinus anorectal fistula fissure hemorrhoids rectal prolapse pruitus ani |
| what are abnormal findings of the rectum | abscess rectal polyp fecal impaction carcinoma |
| what are the arteries in the arm | ulnar radial brachial axiallary |
| what are the arteries in the leg | femoral popliteal dorsalis pedis posterior tibial |
| what are the 2 peripheral artery diseases | occlusions aneurysms |
| what is an occlusion | caused by atherosclerosis or ateriosclerosis (diabetes) chronic buildup of fatty streaks, fibroid plagues, calcification of vessel wall, trombus formation reduces blood flow (oxygen and nutrients) may results in aterial (ischemic ulcer) |
| what is an aneurysm | sac formed by dilation in artery wall; most common in aorta vessel wall weakened by atherosclerosis ballloon-like enlargement from effect of blood pressure |
| what is the venous system made up of | venins, venules, perforators (connecting veins) - have thinner walls than arteries |
| what are key components of venous flow | pressure gradient caused by breathing contraction ofskeletal muscles intraluminal valves |
| what are the veins in the arm? | basilic cephalic median antebrachial median cubital |
| what are the deep veins in the ary subclavianarm | ulnar radial brachial axiallary |
| what are the deep veins in the leg | femoral popliteal tibial |
| what are the superficial veins in the leg | great saphenous small saphenous |
| what is peripheral venous disease | interruption in venous flow acute or chronic obstruction, incompetence, trauma |
| what are examples of peripheral venous disease | varicose veins deep vein thrombosis thrombophlebitis venous (stasis) ulcer |
| what is lymphedema | interruption of lymphatic flow due to scarring (sergery, trauma) removal of lymph nodes radiation therapy chronic infection |
| what organs are related to lymphatic systems | spleen, tonsils, thymus gland |
| what are cardiovascular risk factors | smoking hyperchlesterolemia diet high in saturated fats sedentary lifestyle hypertension diabetes obesity genetics |
| what are pre-existing diseases that attribute to CVD | peripheral artery disease venous disease lymphatic disorders medications surgery |
| what type of pain is this deep usually in calf or lower intermittent claudication (cramp) chronic, aggrivated by activity, walking and elevation of limb pain relieved with rest cool pale limbs/ feet/ toes ulcers on toes, heels | aterial |
| what type of pain is this? arterial/ venous intermittent claudication (cramp) | arterial |
| what type of pain is this? arterial/ venous chronic, aggravated by activity, walking (stairs and distance), and elevation of limb | arterial |
| what type of pain is this? arterial/ venous pain relieved with rest, if not (dangling - indicates severe disease) | arterial |
| what type of pain is this? arterial/ venous risk factors: aging, genetic predisposition, hx of HTX, smoking diabetes, hypercholestermia, obesity vascular disease | arterial |
| what type of pain is this? arterial/ venous pain: calf and lower leg | venous |
| what type of pain is this? arterial/ venous aching tired, feeling heavy or full | venous |
| what type of pain is this? arterial/ venous chronic , increases at end of day | venous |
| what type of pain is this? arterial/ venous exacerbated by prolonged standing or sitting | venous |
| what type of pain is this? arterial/ venous relieved by elevation of limbs, lying or walking | venous |
| what type of pain is this? arterial/ venous associated with varicosities, edema, weeping ulcers (often on lower legs | venous |
| what type of pain is this? arterial/ venous risk factors: work environment, pregnancy, prolonged bedrest, trauma, trhbophebitis | venous |
| how do you quantify edema? | 1+ 2mm 2+ 4mm 3+ 6mm 4+ 8mm |
| deep vein thrombosis | acute blood clot in deep vein (usually leg) immediate intervention to start anticoagulants is necessary |
| pulmonary embolism | acute, life threatening emergency blockage of the main artery of the lung or one of its branches by a substance that has travelled from elsewhere in the body |
| compartment syndrome | acute , life threatening condition of the limbs which occurs after an injury, when there is insufficient blood supply to muscles and nerves |
| what are the 6 Ps of acute assessment for the death of distal tissues | pain, pallor, pulselessness, poikilothermia/polar senstation, paresthesia, paralysis |
| poikilothermia | cold to touch |
| paresthesia | burning, tingling, or numbness |
| what are developmental considerations in infants and children (cardio vascualar and peripheral) | transient acrocyanosis and skin mottling |
| what are developmental considereations in pregnant women(cardio vascualar and peripheral) | varicose veins, growing uterus obstructs drainage of iliac vein and inferior vena cava, dependent edema |
| what are developmental considerations in older adults (cardio vascualar and peripheral) | dosalis pedis, posterior tibial pulses more difficult to find, trophic changes associated with arterial insufficiency, arteriosclerosis, atherosclerosis, increased risk of DVT |
| arteriorsclerosis | thickening, hardening and loss of elasticity of the walls of arteries |
| atherosclerosis | thickening of the artery wall as a result of the accumulation of calcium and fatty materials (cholesterol and triglyceride) |
| ankle-brachial index | ratio of the blood pressure in the lower legs to the blood pressure in the arms |
| modified allen test | can you make the hand turn white |
| manual compression test for varicosities | compress vein, feel for wave – no wave felt competent valves, wave felt incompetent valves |
| what are peripheral vascular diseases in the arms | raynaud’s phenomenon, lymphedema |
| what are abnormal heart rhythms | bradycardia, tachycardia, sinus arrhythmia, av blocks, BBB, ectopic beats, Afib, Vfib |
| what are developmental considerations in cardio for infants and children | foramen ovale, ductus arteriosus, murmurs more common in first days, normal heart rates, position of heart in chest, innocent heart murmurs |
| what are developmental considerations in pregnant women (cardio) | increase in BV, increase in SV and CO, heart sound changes |
| diaphoresis | excessive sweating |
| what are murmurs caused by valvular defects | midsystolic ejection murmurs, pansystolic regurgitant murmurs, diastolic rumbles of atrioventricular valves, early diastolic murmurs |
| paresis | weakness of involuntary movement or impaired movement |
| paralysis | loss of motor function as a result of a lesion |
| dysmetria | inability to control range of motion muscles |
| paraesthesia | abnormal sensation, such as burning, tingling |
| dysarthria | difficulty forming words |
| dysphasia | difficulty with language comprehension or expression |
| midsystolic ejection murmurs | aortic senosis, pulmonic stenosis |
| pansystolic regurgitant murmurs | mitral regurgitation, tricuspid regurgitation |
| diastolic rumbles of atrioventricular valves | mitral stenosis, tricuspid stenosis |
| early diastolic murmurs | aortic regurgitation, pulmonic regurgitation |
| list the congenital heart defects | patent ductus arteriosus, atrial septal defect, ventricular septal defect, tetralogy of fallot, coarctation of the aorta |
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