Module 1

Testing for Meningeal Irritation/Inflammation

> Brudzinski > Kernig's

A client presents to the health care facility for a routine health checkup. The nurse learns that the client has a long history of cardiovascular disease, including hypertension and carotid artery disease. When assessing this client for potential problems in the nervous system, which question by the nurse is appropriate?

"Are you having any dizziness or lightheadedness?"

A nurse conducts a physical examination of the musculoskeletal system of a client who reports upper arm pain. Which instruction should the nurse provide the client when assessing flexion of the elbow?

"Bend your elbow."

The nurse is providing teaching to a client with type 1 diabetes. When providing information about reducing the risk of diabetic neuropathy, the nurse should be sure to include which point?

"Effective blood glucose regulation can prevent this problem."

The nurse is doing a neurologic screening examination. The nurse should include some aspect of which areas? Select all that apply.

> Cranial nerves > Reflexes > Sensory system > Mental status > Motor system

Abnormal Spinal Curvatures

> Flattening of the lumbar curve > Kyphosis > Lumbar lordosis > Scoliosis

Examples of Subjective Data

> History of present health concern > Past health history > Family history > Lifestyle and health practices

Reduce Reduction of Osteoporosis

> Increase physical activity; increase calcium and vitamin D intake. > Avoid excessive caffeine, alcohol, steroids, smoking. > Estrogen replacement therapy; prevent falls

Objective Data on Elbows

> Inspect for size, shape deformities, redness, or swelling > Test ROM: Flexion, extension, pronation, supination > Full ROM of elbows bilaterally

Collecting Objective Data Ankles and Feet

> Inspect position, alignment, shape, and skin. > Palpate ankles and feet for tenderness, heat, swelling, or nodules > Test ROM > Dorsiflexion, plantar flexion, inversion, eversion, circumduction

Collecting Objective Data Hands and Fingers

> Inspection, palpation, ROM, grasp strength > Flexion, extension, hyperextension

Collecting Objective Data Hips

> Inspection, palpation, test ROM > Flexion, extension, circumduction

Test ROM of the Cervical, thoracic, lumbar spine

> Leaning side-side, front, back > Full ROM of cervical, thoracic, and lumbar spine

Lifestyle can play a big part in developing risk factors for stroke. Which of the following can greatly reduce a client's risk for stroke? Select all that apply.

> Maintaining a healthy weight > Quitting smoking > Regularly exercising

Assessment

> Observe gait and posture. > Inspect joints, muscles, and extremities for size, symmetry, and color. > Palpate joints, muscles, and extremities for tenderness, edema, heat, nodules, or crepitus. > Test muscle strength and ROM of joints. > Compare bilateral findings of joints and muscles. > Perform special tests for carpal tunnel syndrome. > Perform the "bulge," "ballottement," and McMurray knee tests.

Collecting Objective Data

> Observe gait, assess risk of falling > Observe for obvious tremors or abnormal findings

Objective Data About the Spine

> Observe the cervical, thoracic, lumbar curves (no abnormal curves) > Palpate the spinous processes and paravertebral muscles for tenderness or pain (no vertebral tenderness) > Test ROM of cervical, thoracic, and lumbar spine > Observe leg length (legs equal length)

Lifestyle can play a big part in developing risk factors for stroke. Which of the following can greatly reduce a client's risk for stroke? Select all that apply

> Quitting smoking > Regularly exercising > Maintaining a healthy weight

Wrist and Hand Abnormalities

> Rheumatoid arthritis > Swan neck deformities > Ganglion > Osteoarthritis > Tenosynovitis > Thenar atrophy

Objective Data Shoulders, arms, elbows

> Shoulders, arms, and Elbows; Inspection, palpation, ROM > Elbows

Observe Gait, assess Risk of Fall

> Weight evenly distributed > Arms should swing in opposite direction of step > Client should be able to stand on toes or heels without staggering > No shuffling > Coordinated > Balanced

Inspect the following for symmetry, color and mobility:

>Temporomandibular joint (TMJ) > Sternoclavicular joint > Cervical, thoracic, and lumbar spine > Shoulders, arms, and elbows > Wrists, hands, and fingers > Hips, knees, ankles, and feet

Palpate the following for tenderness, heat, swelling, or nodules

>Temporomandibular joint (TMJ) > Sternoclavicular joint > Cervical, thoracic, and lumbar spine > Shoulders, arms, and elbows > Wrists, hands, and fingers > Hips, knees, ankles, and feet > Test for carpal tunnel syndrome. > Test for thumb weakness. > Observe for the "flick" signal. > Perform "squeeze test" of hand and foot. > Measure leg length. Perform the bulge test. > Perform the ballottement test.

Absence of Reflex

May indicate motor neuron disorder

A client expresses to the nurse that he has a "giving in" or "locking" sensation in the knee. Which test should the nurse perform to elicit related findings of a possible tear in the meniscus of the client's knee?

McMurray's

A nurse notices that a client's flexibility of the right elbow is less than the left elbow. What is an appropriate action by the nurse in regard to this finding?

Measure movement with a goniometer

Observe Posture and Gait

Measure the ROM with a goniometer of each of the following: >Temporomandibular joint (TMJ) > Cervical and lumbar spine > Shoulders > Elbows, wrists, and fingers > Hips, knees, ankles, and toes

Observe posture

Observe the client's posture while standing with the feet together, noting alignment of the head, trunk, pelvis, and extremities. Also observe client's posture while sitting. > Erect posture and comfortable

Spinal Accessory (XI)

Motor: turn head, shrug shoulders, some actions for phonation

What task should a nurse ask a client to perform to assess the function of cranial nerve XII?

Move the tongue from side to side

Abduction

Moving away from the midline of the body

Retraction

Moving backward

Protraction

Moving forward

Inversion

Moving inward

Eversion

Moving outward

Adduction

Moving toward midline of the body

Client Teaching with Musculoskeletal System

Regarding exercise, diet, positioning, posture, and safety habits

When providing teaching to clients in the community, a nurse is accurate in stating that the musculoskeletal system is most closely aligned with which other body system?

neurological system

While assessing the range of motion in an adult client's shoulders, the client expresses pain and exhibits limited abduction and muscle weakness. The nurse plans to refer the client to a physician for possible

rotator cuff tear.

The subacromial bursae are contained in the

shoulder joint

The diencephalon of the brain consists of the

thalamus and hypothalamus

Reflexes Scale

0- No response 1+ Decreased, less active than normal 2+ Normal, usual response 3+ More brisk than normal; not indicative of a disorder 4+ Hyperactive, very brisk; indicative of a disorder

How many bones?

206

How many vertebrae make up the spinal column?

33

How would the nurse document normal muscle strength?

5/5

Parkinson's Disease

A disorder of the central nervous system that affects movement, often including tremors.

Lordosis

Abnormal anterior curvature of the lumbar spine (sway-back condition)

Scoliosis

Abnormal lateral curvature of the spine

Knee

Articulation of the femur, tibia, and patella; contains fibrocartilaginous discs (medial and lateral menisci) and many bursae.

The nurse has completed a Glasgow Coma Scale assessment and assigns the client a score of three. Which is the best way for the nurse to assess pain in this client?

Assess for nonverbal signs

Tendons

Attaches skeletal muscles to bones; strong, fibrous cords

Osteoclasts

Degrades bone tissue

Osteoporosis Fractures most Commonly Occur

In spine, wrist, and hip

Motion of Foot

Inversion Eversion

Ganglion

Nontender, round, enlarged, swollen, fluid-filled cyst (ganglion) is commonly seen at the dorsum of the wrist.

Bones are composed of

Osseous Tissue

Active Bone Tissue Cells

Osteoblasts and osetoclasts

Which nutrient deficiency should a nurse recognize as placing a client at risk for osteoporosis?

Calcium

Red Marrow

Produces blood cells

Callus

Calluses are nonpainful, thickened skin that occurs at pressure points.

Have you had any recent weight gain?

Weight gain can increase physical stress and strain on the musculoskeletal system

A nurse is assessing a client for abnormalities of gait due to a concern that the client is at increased risk for a fall. Which instruction should the nurse give the client first?

"Walk across the room and back."

Bones Lose Their

Density with age, putting the older client at risk for bone fractures, especially of the wrists, hips, and vertebrae. Older clients who have osteomalacia or osteoporosis are at an even greater risk for fractures.

Muscle Strength

0- 0% of normal strength; complete paralysis 1- 10% of normal strength; no movement, but muscle contraction is palpable or visible 2- 25% of normal strength; muscle movement against gravity WITH SUPPORT 3- 50% of normal strength; normal movement against gravity 4- 75% of normal strength; full movement against gravity and minimal resistance 5- 100% of normal strength, full movement against gravity, and can push/pull against resistance

Rating Muscle Strength (0-5)

0: No muscular contraction (paralysis) 1: Slight flicker of contraction (severe weakness) 2: Passive ROM (gravity removed and assisted by examiner) (poor ROM) 3: Active motion against gravity (average weakness) 4: Active motion against some resistance (slight weakness) 5: Active motion against full resistance (normal)

Inspecting Joints

1. Inspect size, shape, color, and symmetry. Note any masses, deformities, or muscle atrophy. Compare bilateral joint findings. 2. Palpate for edema, heat, tenderness, pain, nodules, or crepitus. Compare bilateral joint findings. 3. Test each joint's range of motion (ROM). Demonstrate how to move each joint through its normal ROM, then ask the client to actively move the joint through the same motions. Compare bilateral joint findings.

Skeletal Bones

206

Musculoskeletal System is made up of

650 skeletal (voluntary) muscles

Range of Motion

> Abduction vs Adduction > Flexion vs. extension > Circumduction > Inversion vs Eversion > Pronation vs Supination > Internal vs External Rotation

Feet and Toe Abnormalities

> Acute Gouty Arthritis > Hallux valgus > Flat feet > Corn > Hammer Toe > Plantar Wart

Osteoporosis

A disease in which bones demineralize and become porous and fragile, making them susceptible to fractures. The bone loss occurs silently and progressively, and often no symptoms are noted until the first fracture occurs. > When bone resorption outpaces reformation

Fibromyalgia

A disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory, and mood changes, or cognitive disorders, is hard to diagnose; causes seem to be genetic or from triggers like infection or physical/emotional trauma > Females, those with family history, or those with rheumatic disease are at risk > Widespread pain for 3 months with no underlying cause

Flat Feet

A flat foot (pes planus) has no arch and may cause pain and swelling of the foot surface.

Ankylosing Spondylitis

A form of rheumatoid arthritis that primarily causes inflammation of the joints between the vertebrae

Stroke

A sudden attack of weakness or paralysis that occurs when blood flow to an area of the brain is interrupted

A 7-year-old boy is performing poorly in school. His teacher is frustrated because he is frequently seen "staring off into space" and not paying attention. If this is a seizure, it most likely represents which type?

Absence

Fixed Risk Factors for Osteoporosis

Age Female gender Family history of osteoporosis Previous fracture Ethnicity Menopause/hysterectomy Long-term glucocorticoid therapy Rheumatoid arthritis Primary/secondary hypogonadism in men

Risk Factors for Fracture

Age 65 or older Vertebral compression fracture Fracture with minimal trauma after age 40 Family history of osteoporotic fracture (especially parental hip fracture) Long-term (more than 3 months continuously) use of glucocorticoid therapy such as prednisone Medical conditions (such as celiac disease, Crohn disease) that inhibit absorption of nutrients Primary hyperparathyroidism Tendency to fall Spinal fracture apparent on x-ray Hypogonadism (low testosterone in men, loss of menstrual periods in younger women) Early menopause (before age 45) Rheumatoid arthritis Hyperthyroidism Low body weight (<60 kg) If present weight is more than 10% below weight at age 25 Low calcium intake Excess alcohol (consistently more than 2 drinks a day) Smoking Low bone mineral density (BMD)

Modifiable Risk Factors for Osteoporosis

Alcohol (greater than 2 drinks a day) Smoking (past or current history) Low body mass index (<20 kg/m2) Poor nutrition (low calcium intake and low protein intake) Vitamin D deficiency Eating disorders (leading to nutrition deficiencies) Low dietary calcium intake Insufficient exercise (especially sedentary lifestyle) Frequent falls

Hallux Valgus

An abnormality in which the great toe is deviated laterally and may overlap the second toe. An enlarged, painful, inflamed bursa (bunion) may form on the medial side.

A client visits the clinic and tells the nurse that she has joint pain in her hands, especially in the morning. The nurse should assess the client further for signs and symptoms of

Arthritis

Wrist, Fingers, Thumb

Articulation between the distal radius, ulnar bone, carpals, and metacarpals. Contains ligaments and is lined with a synovial membrane

Hip

Articulation between the head of the femur and the acetabulum. Contains a fibrous capsule.

Ankle and Foot

Articulation between the talus (large posterior foot tarsal), tibia, and fibula. The talus also articulates with the navicular bones. The heel (calcaneus bone) is connected to the tibia and fibula by ligaments.

Temporomandibular Joint

Articulation between the temporal bone and mandible

Elbow

Articulation between the ulna and radius of the lower arm and the humerus of the upper arm; contains a synovial membrane and several bursae.

Shoulder

Articulation of the head of the humerus in the glenoid cavity of the scapula. The acromioclavicular joint includes the clavicle and acromion process of the scapula. It contains the subacromial and subscapular bursae

A nurse is testing a client's corneal reflex but notices that the reflex appears to be reduced. The client is otherwise alert and oriented, with no signs of neurologic degeneration. What is an appropriate action by the nurse?

Ask the client about the presence of contact lenses

After a physical assessment, the nurse determines that a client has full range of motion of the temporomandibular joint. Which of the following assessments did the nurse complete with the client? (Select all that apply.)

Asked the client to open and close the mouth Asked the client to jut the jaw forward Asked the client to rock the jaw laterally

Flexion

Bending the extremity at the joint and decreasing the angle of the joint

Describe any joint, muscle, or bone pain you have. Where is the pain? What does the pain feel like (stab, ache)? When did the pain start? When does it occur? How long does it last? Any stiffness, swelling, limitation of movement?

Bone pain is often dull, deep, and throbbing. Joint or muscle pain is described as aching, but has been differentiated between mechanical- and inflammatory-type pains. Sharp, knife-like pain occurs with most fractures and increases with motion of the affected body part.

A nurse observes a client's gait and notes it to be wide based and staggering. The Romberg test results were positive. The nurse recognizes this as what type of abnormal gait?

Cerebellar ataxia

The nurse is assessing the client's coordination and finds that her movements are clumsy, unsteady, and inappropriately varying in their speed, force, and direction. The nurse notes that client has dysmetria. What would the nurse know this client has?

Cerebellar disease

The husband of a 65-year-old female tells the nurse, "My wife is having trouble navigating the steps in our home and needs my help to step down off a curb." What part of the nervous system should the nurse assess for a potential source of the problem?

Cerebellum

A client presents to the emergency department after falling off a ladder while doing some outside painting at home. The client's ankle appears swollen, out of alignment, and is painful to touch. What is the nurse's first action?

Check for pulse, color, temperature, and capillary refill.

Chronic Rheumatoid Arthritis

Chronic swelling and thickening of the metacarpophalangeal and proximal interphalangeal joints, limited range of motion, and finger deviation toward the ulnar side are seen in chronic rheumatoid arthritis.

Circumduction

Circular motion

The nurse is performing the Romberg test. Which of the following indicate a normal finding?

Client stands erect with minimal swaying

Describe any difficulty that you have chewing. Is it associated with tenderness or pain?

Clients with temporomandibular joint (TMJ) dysfunction may have difficulty chewing and may describe their jaws as "getting locked or stuck." Jaw tenderness, pain, or a clicking sound may also be present with TMJ

Two Types of Bones

Compact and Spongy

A nurse notices that a client has decreased range of motion with lateral bending of the cervical spine to the left side. What should the nurse do next in relation to this finding?

Compare this finding to the range of motion to the right side

Yellow Marrow

Composed mostly of fat

Synovial Joints

Contain a space between the bones that is filled with synovial fluid, a lubricant that promotes a sliding movement of the ends of the bones (Ex. Shoulders, wrists, hips, knees, ankles)

Spongy Bone

Contains numerous spaces and makes up the end and centers of the bones

A client has sustained an injury to the cerebellum. Which area would be the primary area for assessment?

Coordination

Flattening of Lumbar Curvature

Could be herniated disc or ankylosing spondylitis

Periosteum

Covers the bones and contains osteoblasts and blood vessels that promote nourishment and formation of new bone tissues

Swan Neck Deformity

Deformed position of the finger, in which the joint closest to the fingertip is permanently bent toward the palm while the nearest joint to the palm is bent away from it

The nurse is caring for a client in the hospital and identifies the client to be experiencing acute confusion after cardiac surgery. The nurse recognizes this as what?

Delirium

African Americans have

Denser bones than Caucasians

Men have

Denser bones than women

Goniometer

Device that measures movement in degrees

Bones are Densest During

Early 20s

When testing the biceps reflex, what type of response should the nurse expect if normal?

Elbow flexes and muscle contracts

Synovial Joints are

Enclosed by fibrous capsule made of connective tissue and connected to the periosteum of the bone

Teach Clients to Prevent Bone Loss

Ensure a nutritious diet and adequate calcium intake. Avoid undernutrition, particularly the effects of severe weight-loss diets and eating disorders. Maintain an adequate supply of vitamin D. Participate in regular weight-bearing activity. Avoid smoking and second-hand smoking. Avoid heavy drinking.

Teach Parents of Children and Adolescents to Help Their Children

Ensure a nutritious diet with adequate calcium intake. Avoid protein malnutrition and undernutrition. Maintain an adequate supply of vitamin D. Participate in regular physical activity. Avoid the effects of second-hand smoke.

Thenar Atrophy

Erosion of the muscles that make up the thick pad underneath the thumb.

Preparing Client for Musculoskeletal Assessment

Examination is lengthy, be sure that the room is at a comfortable temperature and provide rest periods as necessary > Provide adequate draping to avoid unnecessary exposure of the client yet adequate visualization of the part being examined > Explain that you will ask the client frequently to change positions and to move various body parts against resistance and gravity > Clear, simple directions need to be given throughout the examination to help the client understand how to move body parts to allow you to assess the musculoskeletal system. > Demonstrating to the client how to move the various body parts and providing verbal directions facilitate examination

Kyphosis

Excessive outward curvature of the spine, causing hunching of the back.

A nurse is planning care for a client who has been diagnosed with restless leg syndrome. Which intervention is the most effective for temporary relief of the symptoms?

Exercising the legs

Appendicular Skeleton

Extremities, shoulders, and hips

Trochlear (IV)

Eye movement (Down and in)

Oculomotor (III)

Eye movement (UP, DOWN)

After testing deep tendon reflexes, the nurse documents 2+. The nurse should evaluate further.

False

The nurse instructs the client to raise his arm out to the side and overhead. The nurse is asking the client to adduct his arm.

False

Joints are Classified as

Fibrous, cartilaginous, synovial

Motion of Fingers

Fingers: Flexion, extension, hyperextension, abduction, and circumduction

A client has osteoarthritis of the elbow. Which assessment approach should the nurse expect to be impacted by this health problem?

Flexion

What range of motion is the nurse testing by asking a client to stoop to pick an object off the floor?

Flexion

Motion of Toes

Flexion Extension Abduction Adduction

Motion of Vertebrae

Flexion Hyperextension Lateral bending Rotation

Motion of Knee

Flexion Extenson

Motions of Shoulder

Flexion and extension Abduction and adduction Circumduction Rotation (internal and external)

Motion of Elbow

Flexion and extension of the forearm Supination and pronation of the forearm

Motion of Hip

Flexion with knee flexed and with knee extended Extension and hyperextension Circumduction Rotation (internal and external) Abduction Adduction

Motion of Thumb

Flexion, extension, and opposition

Shoulders, Arms, Elbows ROM

Flexion, extension, circumduction, rotation

Osteoblasts

Forms bone tissue

Unmodifiable Factors of Osteoporosis

Gender, age, body size, ethnicity, history of bone fractures

Only Client can

Give you data regarding pain, stiffness, and levels of movement and how ADLs are affected

The cranial nerve that has sensory fibers for taste and fibers that result in the "gag reflex" is the

Glossopharyngeal

A client who was injured by a fall at a construction site has been admitted to the hospital. He has suffered nerve damage such that his gag reflex is no longer intact, requiring him to receive intravenous total parenteral nutrition. Which nerve should the nurse suspect to be involved in this client's injury?

Glossopharyngeal (IX)

The nurse is assessing the range of motion (ROM) of a client's joints. What would the nurse use to assess flexion and extension of a joint if the client complains of pain on examination?

Goniometer

Compact bone

Hard and dense and makes up the shaft and outer layers

Some Older Clients

Have an impaired sense of position in space, which may contribute to the risks of falling.

Joint stiffening and other musculoskeletal symptoms may be a transient effect of the tetanus, whooping cough, diphtheria, or polio vaccines

Having diabetes mellitus, sickle cell anemia, or SLE places the client at risk for development of musculoskeletal problems such as osteoporosis and osteomyelitis. Type 1 diabetes increases risk of low bone density, and may increase fracture risk, but fractures may be related to poor vision and nerve damage, which are likely to produce falls. Although clients with type 2 diabetes often have increased body weight and thereby increased bone density, they too are likely to have an increased risk of fractures due to vision and nerve damage

Axial Skeleton

Head and trunk

Acoustic (VIII)

Hearing equilibrium

Assessment of Musculoskeletal System

Helps to evaluate the client's level of functioning with activities of daily living (ADLs); system affects the entire body from head to toe > Will provide nurse with information about client's daily activity and exercise patterns that promote either healthy or unhealthy functioning of the system

When the client performs straight leg flexion, the client complains of pain that radiates down his leg. The nurse understands that this may indicate what?

Herniated disc

Lumbar Hyperlordosis

Hip flexion contracture and hip extensor weakness drive the lumbar spine into increasing lordosis to balance head over pelvis. Note the use of the hands for stability

The nurse is preparing to assess balance in an older adult client. Which test would the nurse plan on possibly omitting from the exam?

Hop on one foot

Hammer Toe

Hyperextension at the metatarsophalangeal joint with flexion at the proximal interphalangeal joint (hammer toe) commonly occurs with the second toe.

Which part of the brain controls the vital functions of temperature, heart rate, blood pressure, sleep, the anterior and posterior pituitary, the autonomic nervous system, and emotions and maintains overall autonomic control?

Hypothalamus

Clients more Prone to Osteoporosis

Immobile or have reduced intake of calcium and vitamin D

Actual Diagnoses

Impaired Physical Mobility related to impaired joint movement, decreased muscle strength, or fractured bone Activity Intolerance related to muscle weakness or joint pain Constipation related to decreased gastric motility and muscle tone secondary to immobility Ineffective Sexuality Pattern related to lower back pain Acute (or Chronic) Pain related to joint, muscle, or bone problems Impaired Skin Integrity related to prolonged pressure on the skin secondary to immobility Impaired Social Interaction related to depression or immobility Disturbed Body Image related to skeletal deformities

The nurse is developing a plan of care for a client found to have a strength problem. What would be an appropriate nursing diagnosis for this client?

Impaired physical mobility

Acute Gouty Arthritis

In gouty arthritis, the metatarsophalangeal joint of the great toe is tender, painful, reddened, hot, and swollen

A nurse is reviewing a client's health record while interviewing her. The nurse sees in the client's record a score of 3+ on the biceps reflex test from her previous visit. The nurse understands that this finding indicates which of the following?

Increased or brisk, but not pathologic

Subjective Data

Information the patient gives us

Objective Data

Information we collect with evidentiary support

Physical Assessment Includes

Inspecting and palpating the joints, muscles, and bones, testing ROM, and assessing muscle strength

Collecting Objective Data Knees

Inspection, palpation > Assess for swelling > Test for ROM > Assess for pain and injury

Collecting Objective Data Wrist

Inspection, palpation, test ROM > Flexion, extension, hyperextension > Full ROM of wrists bilaterally

Bone Density of Chinese & Japanese

Is below that of caucasians

Cartilaginous Joints

Joined by cartilage (Ex. Joints between vertebrae)

Fibrous Joints

Joined by fibrous connective tissue and are immovable (Ex. Sutures between skull bones)

Bones in Synovial Joints

Joined by ligaments

Hyperextension

Joint bends greater than 180 degrees

When were your last tetanus and polio immunizations?

Joint stiffening and other musculoskeletal symptoms may be a transient effect of the tetanus, whooping cough, diphtheria, or polio vaccines

Sternoclavicular Joint

Junction between the manubrium of the sternum and the clavicle; has no obvious movements.

The nurse is assessing an elderly client and finds an exaggerated thoracic curve. This would be documented as what?

Kyphosis

Modifiable Factors of Osteoporosis

Lack of exercise, low calcium, anorexia nervosa, low estrogen levels, smoking, caffeine, alcohol, medication intake

Spinal Fractures

Lead to loss in height and development of a curved upper back

Kernig's

Leg cannot be completely extended after flexion....+ Kernig

A client makes this movement when the nurse assesses for the plantar response. What should this movement indicate to the nurse?

Lesion of the corticospinal tract

Fasciculi

Long muscle fibers arranged together in bundles and joined by connective tissue

Abducens (VI)

Look side to side

Ankle X-Ray Indicators

Malleolar-area pain and bone tenderness at the tips of 6-cm edges of the lateral malleolus or medial malleolus, or the inability to bear weight immediately or during examination indicate the need for an ankle x-ray

Joint-Stiffening Conditions

May be misdiagnosed as arthritis especially in older adults

The nurse is planning a presentation on osteoporosis to a group of high school students. Which of the following should the nurse plan to include in the presentation?

Moderate strenuous exercise tends to increase bone density.

Information Regarding Client's

Nutrition, activities, and exercise is a significant part of the musculoskeletal assessment

Observe Gait

Observe the client's gait as the client enters and walks around the room. Note: Base of support Weight-bearing stability Foot position Stride and length and cadence of stride Arm swing Posture > Evenly distributed, can stand on heels and toes, toes point straight, rhythmic arm swings

Motion of Temporomandibular Joint

Opens and closes mouth Projects and retracts jaw Moves jaw from side to side

Osteoarthritis

Osteoarthritis (degenerative joint disease) nodules on the dorsolateral aspects of the distal interphalangeal joints (Heberden nodes) are due to the bony overgrowth of osteoarthritis. Usually hard and painless, they may affect middle-aged or older adults and often, although not always, are associated with arthritic changes in other joints. Flexion and deviation deformities may develop.

Foot x-ray indicators

Pain in the midfoot area and bone tenderness at the base of the fifth metatarsal or the navicular bone area, or the inability to bear weight immediately or during examination, indicate the need for a foot x-ray

Often chief concern with Musculoskeletal Problems

Pain or stiffness

Tenosynovitis

Painful extension of a finger may be seen in acute tenosynovitis (infection of the flexor tendon sheaths)

Corn

Painful thickenings of the skin that occur over bony prominences and at pressure points. The circular, central, translucent core resembles a kernel of corn

Plantar Wart

Painful warts (verruca vulgaris) that often occur under a callus, appearing as tiny dark spots.

Health Promotion Diagnoses

Readiness for Enhanced Health Management: activity and exercise patterns related to expressed desire to improve status

Assess for the risk of falling backward in the older or handicapped client by

Performing the "nudge test." Stand behind the client and put your arms around the client while you gently nudge the sternum.

The nurse is testing a client for carpal tunnel syndrome. The client flexes the wrists at an angle of 90° and holds the backs of the hands to each other for 60 seconds. The client tells the nurse that he is experiencing a burning pain as a result. Which test is the nurse performing on this client?

Phalen's

Joint (Articulation)

Place where two bones meet

Motion of Ankle

Plantar flexion Dorsiflexion

Glossopharyngeal (IX)

Posterior 1/3 of the tongue; speech

Skeletal Muscles Assist With

Posture, produce body heat, and allow the body to move

Cerebellum

Primary function is coordination and smoothing of voluntary movements, maintenance of equilibrium, and maintenance of muscle tone

Bones

Provide structure and protection, serve as levers, store calcium, and produce blood cells

Physical assessment of the musculoskeletal system

Provides data regarding the client's posture, gait, bone structure, muscle strength, and joint mobility, as well as the client's ability to perform ADLs.

Collaborative problems that may be identified when obtaining a general impression (Risk for Complication)

RC: Osteoporosis RC: Joint dislocation RC: Compartmental syndrome RC: Pathologic fractures

What finding should a nurse expect when performing Phalen's test on a client with suspected carpal tunnel syndrome?

Reports of tingling, numbness, and pain in the involved wrist

Neurologic System

Responsible for coordinating the functions of the skeleton and muscles

Risk Diagnoses

Risk for Trauma related to repetitive movements of wrists or elbows with recreation or occupation Risk for Injury: Pathologic fractures related to osteoporosis Risk for Injury to joints, muscles, or bones related to environmental hazards Risk for Disuse Syndrome Risk for Urinary Retention related to urine stasis secondary to immobility

A high school football player injured his wrist in a game. He is tender between the two tendons at the base of the thumb. Which of the following should be considered?

Scaphoid fracture

A client has uneven height of the shoulders and hips. What should the nurse suspect this client is demonstrating?

Scoliosis

The nurse is assessing the spine of an adult client and detects lateral curvature of the thoracic spine with an increase in convexity on the left curved side. The nurse suspects that the client is experiencing

Scoliosis

The school nurse notes that the client carries her left shoulder higher than her right shoulder. You should recognize the likely presence of what health problem?

Scoliosis

Bone Shapes Include

Short bones (carpals) Long bones (humerus, femur) Flat bones (sternum, ribs) Irregular (hips, vertebrae)

Investigate

Signs and symptoms reported by the client

Three Types of Muscles

Skeletal, smooth, cardiac

Vagus (X)

Slowing the heart; increasing motility of the digestive tract

Bursae

Small sacs filled with synovial fluid that serve to cushion the joint

Olfactory Nerve (I)

Smell

When the nurse is assessing the motor function of cranial nerve VII as part of the neurological examination, what should the nurse instruct the client to do?

Smile

Do you smoke tobacco? How much and how often?

Smoking increases risk of osteoporosis

Articular Cartilage

Smooths and protects the bones that articulate with each other

What medications are you taking?

Some medications can affect musculoskeletal function. Diuretics, for example, can alter electrolyte levels, leading to muscle weakness. Steroids can deplete bone mass, thereby contributing to osteoporosis. Adverse reactions to HMG-CoA reductase inhibitors (statins) can include myopathy, which can cause muscle pain, soreness, tiredness, or weakness

Extension

Straightening the extremity at the joint and increasing the angle of the joint

Ligaments

Strong, dense bands of fibrous connective tissue

The client is facing the nurse with his forearm turned so that his palm is up. What movement is the client exhibiting?

Supination

A nurse is preparing to offer a community education session on anxiety. Which part of the nervous system should the nurse include in the discussion?

Sympathetic nervous system

Inspecting Muscles

Test muscle strength by asking the client to move each extremity through its full ROM against resistance. Do this by applying some resistance against the part being moved. Document muscle strength by using a standard scale (see the following Rating Scale for Muscle Strength). If the client cannot move the part against your resistance, ask the client to move the part against gravity. If this is not possible, then attempt to move the part passively through its full ROM. If this is not possible, then inspect and feel for a palpable contraction of the muscle while the client attempts to move it. Compare bilateral joint findings.

Which of the following assessments is most likely to provide insight into the function of the client's CN VIII?

Test the client's hearing for lateralization and bone and air conduction

Equipment for Musculoskeletal Assessment

Tape Measure Goniometer Skin Marking pen

Facial (VII)

Taste for the anterior 2/3 of tongue; smile

The client presents to the nurse stating that his jaws feel "stuck". What joint should the nurse assess?

Temporomandibular

Acute Rheumatoid Arthritis

Tender, painful, swollen, stiff joints are seen in acute rheumatoid arthritis.

A high school soccer player "blew out his knee" when the opposing goalie's head and shoulder struck his flexed knee while the goalie was diving for the ball. All of the following structures were involved in some way in his injury, but which of the following is a nonarticular structure?

Tendons

Hypoglossal (XII)

Tongue movement

Validate

The musculoskeletal assessment data you have collected. This is necessary to verify that the data are reliable and accurate.

Peripheral Nervous System (PNS)

The sensory and motor neurons that connect the central nervous system (CNS) to the rest of the body.

Vertebrae

Thirty-three bones: 7 concave-shaped cervical (C); 12 convex-shaped thoracic (T); 5 concave-shaped lumbar (L); 5 sacral (S); and 3-4 coccygeal, connected in a vertical column. Bones are cushioned by elastic fibrocartilaginous plates (intervertebral discs) that provide flexibility and posture to the spine. Paravertebral muscles are positioned on both sides of vertebrae.

Describe any past problems or injuries you have had to your joints, muscles, or bones. What treatment was given? Do you have any aftereffects from the injury or problem?

This information provides baseline data for the physical examination. Past injuries may affect the client's current ROM and level of function in affected joints and extremities. A history of recurrent fractures may be seen with osteomalacia but should also raise the question of possible physical abuse.

Trigeminal (V)

Touch, pain: skin of face, chewing

What activities do you engage in to promote the health of your muscles and bones (e.g., exercise, diet, weight reduction)?

This question provides the examiner with knowledge of how much the client understands and actively participates in activities to promote the health of the musculoskeletal system.

Dorsiflexion

Toes draw upward to ankle

Plantar Flexion

Toes point away from ankle

External Rotation

Turning of a bone away from the center of the body

Rotation

Turning of a bone on its own long axis

Internal Rotation

Turning of a bone toward the center of the body

Pronation

Turning or facing downward

Supination

Turning or facing upward

Osteoarthritis Pain

Usually begins in one set of joints and on one side of the body, with a feeling of pain deep in the joint, improving with rest but worsening with rainy weather, perhaps a sensation of bones grating together, with stiffness early in the morning improving with movement.

Rheumatoid Arthritis Pain

Varied and may feel burning, throbbing, occurs on both sides of the body, worsens after sitting for long periods, has inconsistent pattern of worse and less pain, and with a feeling of heat and soreness in joints

Optic Nerve (II)

Vision

The nurse is caring for an adult client who is in a cast because of a fractured arm. To promote healing of the bone and tissue, the nurse should instruct the client to eat a diet that is high in

Vitamin C

Musculoskeletal Muscles are

Voluntary (conscious control)

Brudzinski

When neck is flexed, hips & knees should remain relaxed and motionless.

Which tests are appropriate for a nurse to perform to test cranial nerve VIII?

Whisper, Rinne, and Weber tests

Which assessment procedure should a nurse institute to test a client for stereognosis?

With eyes closed, ask the client to identify a familiar object that is placed in their hand

For middle-aged women: Have you started menopause? Are you taking estrogen or hormone replacement therapy?

Women who begin menarche late or begin menopause early are at greater risk for development of osteoporosis because of decreased estrogen levels, which tend to decrease the density of bone mass

Motion of Wrist

Wrists: Flexion, extension, hyperextension, adduction, radial and ulnar deviation

Osteoporosis is more common as

a person ages because bone resorption increases, calcium absorption decreases, and production of osteoblasts decreases as well.

Bones contain yellow marrow that is composed mainly of

fat

While examining the spine of an adult client, the nurse notes that the client has a flattened lumbar curvature. The nurse should refer the client to a physician for possible

herniated disc.

An older adult client visits the clinic and tells the nurse that she has had shooting pain in both of her legs. The nurse should assess the client for signs and symptoms of

herniated intervertebral disc.

Swan Neck Deformity

hyperextension of PIP joint and flexion of DIP joint