CHAPTE 39 Assessment of Musculoskeletal Function

A nurse is caring for a patient who has been scheduled for a bone scan. What should the nurse teach the patient about this diagnostic test? A) The test is brief and requires that you drink a calcium solution 2 hours before the test. B) You will not be allowed fluid for 2 hours before and 3 hours after the test. C) You'll be encouraged to drink water after the administration of the radioisotope injection. D) This is a common test that can be safely performed on anyone.

C It is important to encourage the patient to drink plenty of fluids to help distribute and eliminate the isotopic after it is injected. There are important contraindications to the procedure, include pregnancy or an allergy to the radioisotope. The test requires the injection of an intravenous radioisotope and the scan is preformed 2 to 3 hours after the isotope is injected.

If large amounts of fluid are present in the joint spaces beneath the patella, it may be identified by assessing for the _______________ and for ballottement of the knee

balloon sign

A deficiency of vitamin D results in

bone mineralization deficit, deformity, and fracture

A patient injured in a motor vehicle accident has sustained a fracture to the diaphysis of the right femur. Of what is the diaphysis of the femur mainly constructed? A) Epiphyses B) Cartilage C) Cortical bone D) Cancellous bone

c

examples of short bones

carpals and tarsals

Arthrocentesis

carried out to obtain synovial fluid for purposes of examination or to relieve pain due to effusion.

The ends of long bones are covered at the joints by articular ___________, which is tough, elastic, and avascular tissue

cartilage

rhythmic contractions of a muscle

clonus

shortening of surrounding joint structures

contracture

- grating or crackling sound or sensation - may occur with movement of ends of a broken bone or irregular joint surface

crepitus

Diarthrosis joints are

freely movable

A nurse is caring for a patient who has just had an arthroscopy as an outpatient and is getting ready to go home. The nurse should teach the patient to monitor closely for what postprocedure complication? A) Fever B) Crepitus C) Fasciculations D) Synovial fluid leakage

A Feedback: Following arthroscopy, the patient and family are informed of complications to watch for, including fever. Synovial fluid leakage is unlikely and crepitus would not develop as a postprocedure complication. Fasciculations are muscle twitches and do not involve joint integrity or function.

A nurse is caring for a patient whose cancer metastasis has resulted in bone pain. Which of the following are typical characteristics of bone pain? A) A dull, deep ache that is boring in nature B) Soreness or aching that may include cramping C) Sharp, piercing pain that is relieved by immobilization D) Spastic or sharp pain that radiates

A - Bone pain is characteristically described as a dull, deep ache that is boring in nature - muscular pain is described as soreness or aching and is referred to as muscle cramps. - Fracture pain is sharp and piercing and is relieved by immobilization. - Sharp pain may also result from bone infection with muscle spasm or pressure on a sensory nerve.

A nurse is explaining a patient's decreasing bone density in terms of the balance between bone resorption and formation. What dietary nutrients and hormones play a role in the resorption and formation of adult bones? Select all that apply. A) Thyroid hormone B) Growth hormone C) Estrogen D) Vitamin B12 E) Luteinizing hormone

A, B, C The balance between bone resorption and formation is influenced by the following factors: physical activity; dietary intake of certain nutrients, especially calcium; and several hormones, including calcitriol (i.e., activated vitamin D), parathyroid hormone (PTH), calcitonin, thyroid hormone, cortisol, growth hormone, and the sex hormones estrogen and testosterone. * Luteinizing hormone and vitamin B12 do not play a role in bone formation or resorption.

A bone biopsy has just been completed on a patient with suspected bone metastases. What assessment should the nurse prioritize in the immediate recovery period? A) Assessment for dehiscence at the biopsy site B) Assessment for pain C) Assessment for hematoma formation D) Assessment for infection

B Bone biopsy can be painful and the nurse should prioritize relevant assessments. * Signs and symptoms of infection would not be evident in the immediate recovery period and hematoma formation is not a common complication.

A nurse is assessing a patient who is experiencing peripheral neurovascular dysfunction. What assessment findings are most consistent with this diagnosis? A) Hot skin with a capillary refill of 1 to 2 seconds B) Absence of feeling, capillary refill of 4 to 5 seconds, and cool skin C) Pain, diaphoresis, and erythema D) Jaundiced skin, weakness, and capillary refill of 3 seconds

B Indicators of peripheral neurovascular dysfunction include pale, cyanotic, or mottled skin with a cool temperature; capillary refill greater than 3 seconds; weakness or paralysis with motion; and paresthesia, unrelenting pain, pain on passive stretch, or absence of feeling.

A nurse on the orthopedic unit is assessing a patient's peroneal nerve. The nurse will perform this assessment by doing which of the following actions? A) Pricking the skin between the great and second toe B) Stroking the skin on the sole of the patient's foot C) Pinching the skin between the thumb and index finger D) Stroking the distal fat pad of the small finger

A The nurse will evaluate the sensation of the peroneal nerve by pricking the skin centered between the great and second toe. None of the other listed actions elicits the function of one of the peripheral nerves.

peripheral neurovascular dysfunction

A state for which an individual is at risk of experiencing a disruption in circulation, sensation, or motion of an extremity.

A patient is scheduled for a bone scan to rule out osteosarcoma of the pelvic bones. What would be most important for the nurse to assess before the patient's scan? A) That the patient completed the bowel cleansing regimen B) That the patient emptied the bladder C) That the patient is not allergic to penicillins D) That the patient has fasted for at least 8 hours

B Before the scan, the nurse asks the patient to empty the bladder, because a full bladder interferes with accurate scanning of the pelvic bones.

A public health nurse is organizing a campaign that will address the leading cause of musculoskeletal-related disability in the United States. The nurse should focus on what health problem? A) Osteoporosis B) Arthritis C) Hip fractures D) Lower back pain

B The leading cause of musculoskeletal-related disability in the United States is arthritis.

The nurse's comprehensive assessment of an older adult involves the assessment of the patient's gait. How should the nurse best perform this assessment? A) Instruct the patient to walk heel-to-toe for 15 to 20 steps. B) Instruct the patient to walk in a straight line while not looking at the floor. C) Instruct the patient to walk away from the nurse for a short distance and then toward the nurse. D) Instruct the patient to balance on one foot for as long as possible and then walk in a circle around the room.

C Gait is assessed by having the patient walk away from the examiner for a short distance. The examiner observes the patient's gait for smoothness and rhythm.

The nurse's musculoskeletal assessment of a patient reveals involuntary twitching of muscle groups. How would the nurse document this observation in the patient's chart? A) Tetany B) Atony C) Clonus D) Fasciculations

D Fasciculation is involuntary twitching of muscle fiber groups. Clonus is a series of involuntary, rhythmic, muscular contractions and tetany is involuntary muscle contraction, but neither is characterized as twitching. Atony is a loss of muscle strength.

Hematopoiesis

blood cell formation; occurs in red bone marrow

cartilaginous/fibrous tissue at fracture site

callus

atrophy

decrease in muscle size

excessive fluid within the capsule

effusion

Those experiencing pain with a rheumatic disorder experience pain that is worse in the __________________

morning * especially upon waking.

isotonic contraction:

muscle is shortened without a change in its tension; a joint is moved as a result

isometric contraction

muscle tension is increased without changing its length; there is no associated joint motion

What is the bone forming cell?

osteoblast

how physical activity affects bone growth?

Physical activity, particularly weight-bearing activity, acts to stimulate bone formation and remodeling.

An Electromyography is usually contraindicated in patients receiving anticoagulant therapy (e.g., warfarin) WHY?

because the needle electrodes may cause bleeding within the muscle.

Normally, synovial fluid is

clear, pale, straw colored, and scanty in volume.

how do patients describe muscular pain?

described as soreness or aching and is referred to as "muscle cramps."

Electromyography may be contraindicated in patients with extensive skin infections. WHY?

due to the risk of spreading infection from the skin to the muscle. The nurse instructs the patient to avoid using any lotions or creams on the day of the test

Hinge joints permit movement in only two planes:

either flexion or extension (e.g., the elbow and the knee).

effusion

excess fluid in joint

bursa

fluid-filled sac found in connective tissue, usually in the area of joints

Muscle fatigue is thought to be caused by depletion of ________ and accumulation of lactic acid. As a result, the cycle of muscle contraction and relaxation cannot continue

glycogen

Stored muscle _________ is used to supply glucose during periods of activity.

glycogen

cortical bone

hard, dense, strong bone that forms the outer layer of bone; also called compact bone

Estrogen stimulates __________ and inhibits ______________; therefore, bone formation is enhanced and resorption is inhibited.

osteoblasts osteoclasts

_____________ refers to a reduction in bone mass to below normal levels

osteopenic

people who are unable to engage in regular weight-bearing activities, such as those on prolonged bed rest or those with some physical disabilities, have increased bone resorption from calcium loss, and their bones become ______________ (reduced in terms of mass) and weak.

osteopenic

6 P's of neurovascular assessment

pain, pulse,pallor,paresthesia, paralysis, pressure

The major hormonal regulators of calcium homeostasis are ________ and ________.

parathyroid hormone, calcitonin

The results of a nurse's musculoskeletal examination show an increase in the lumbar curvature of the spine. The nurse should recognize the presence of what health problem? A) Osteoporosis B) Kyphosis C) Lordosis D) Scoliosis

C The nurse documents the spinal abnormality as lordosis. Lordosis is an increase in lumbar curvature of the spine.

bone scan

- detect metastatic and primary bone tumors, osteomyelitis, some fractures, and aseptic necrosis, and to monitor the progression of degenerative bone diseases. * requires the injection of a radioisotope through an IV line

A nurse is taking a health history on a new patient who has been experiencing unexplained paresthesia. What question should guide the nurse's assessment of the patient's altered sensations? A) How does the strength in the affected extremity compare to the strength in the unaffected extremity? B) Does the color in the affected extremity match the color in the unaffected extremity? C) How does the feeling in the affected extremity compare with the feeling in the unaffected extremity? D) Does the patient have a family history of paresthesia or other forms of altered sensation?

C Questions that the nurse should ask regarding altered sensations include How does this feeling compare to sensation in the unaffected extremity? Asking questions about strength and color are not relevant and a family history is unlikely.

A nurse is providing care for a patient whose pattern of laboratory testing reveals longstanding hypocalcemia. What other laboratory result is most consistent with this finding? A) An elevated parathyroid hormone level B) An increased calcitonin level C) An elevated potassium level D) A decreased vitamin D level

A - In the response to low calcium levels in the blood, increased levels of parathyroid hormone prompt the mobilization of calcium and the demineralization of bone.

Contracture of muscle

- a tightening or shortening of muscles. - It causes joint stiffness and can happen in any joint. - patient may get contractures from having to stay in bed for a long time

Arthroscopy nursing considerations

- after procedure, joint is wrapped with a compression dressing to control swelling. - ice, to control edema and enhance comfort - kept joint extended and elevated to reduce swelling. - neurovascular status - avoid strenuous activity of the joint - monitor for signs and symptoms of complications (e.g., fever, excessive bleeding, swelling, numbness, cool skin)

Bone scan nursing interventions

- allergies to the radioisotope - assesses condition that would contraindicate performing the procedure (e.g., pregnancy, breast-feeding). - explain that patient may experience moments of discomfort from the isotope (e.g., flushing, warmth) but provide reassurance that the radionuclide poses no radioactive hazard - drink plenty of fluids to help distribute and eliminate the isotope. - Before empty the bladder

When assessing a patient's peripheral nerve function, the nurse uses an instrument to prick the fat pad at the top of the patient's small finger. This action will assess which of the following nerves? A) Radial B) Ulnar C) Median D) Tibial

B The ulnar nerve is assessed for sensation by pricking the fat pad at the top of the small finger.

a small, local, involuntary muscle contraction and relaxation which may be visible under the skin.

fasciculation of muscle

Joint pain

felt around or in the joint and typically worsens with movement

The nurse is performing an assessment of a patient's musculoskeletal system and is appraising the patient's bone integrity. What action should the nurse perform during this phase of assessment? A) Compare parts of the body symmetrically. B) Assess extremities when in motion rather than at rest. C) Percuss as many joints as are accessible. D) Administer analgesia 30 to 60 minutes before assessment.

A Feedback: When assessing bone integrity, symmetric parts of the body, such as extremities, are compared. Analgesia should not be necessary and percussion is not a clinically useful assessment technique. Bone integrity is best assessed when the patient is not moving.

An older adult patient has symptoms of osteoporosis and is being assessed during her annual physical examination. The assessment shows that the patient will require further testing related to a possible exacerbation of her osteoporosis. The nurse should anticipate what diagnostic test? A) Bone densitometry B) Hip bone radiography C) Computed tomography (CT) D) Magnetic resonance imaging (MRI)

A Bone densitometry is considered the most accurate test for osteoporosis and for predicting a fracture. As such, it is more likely to be used than CT, MRI, or x-rays.

A patient's fracture is healing and callus is being deposited in the bone matrix. This process characterizes what phase of the bone healing process? A) The reparative phase B) The reactive phase C) The remodeling phase D) The revascularization phase

A Callus formation takes place during the reparative phase of bone healing. The reactive phase occurs immediately after injury and the remodeling phase builds on the reparative phase. There is no discrete revascularization phase.

A patient has just had an arthroscopy performed to assess a knee injury. What nursing intervention should the nurse implement following this procedure? A) Wrap the joint in a compression dressing. B) Perform passive range of motion exercises. C) Maintain the knee in flexion for up to 30 minutes. D) Apply heat to the knee.

A Interventions to perform following an arthroscopy include: - wrapping the joint in a compression dressing - extending and elevating the joint - applying ice or cold packs

nurse is taking a health history on a patient with musculoskeletal dysfunction. What is the primary focus of this phase of the nurse's assessment? A) Evaluating the effects of the musculoskeletal disorder on the patient's function B) Evaluating the patient's adherence to the existing treatment regimen C) Evaluating the presence of genetic risk factors for further musculoskeletal disorders D) Evaluating the patient's active and passive range of motion

A The nursing assessment of the patient with musculoskeletal dysfunction includes an evaluation of the effects of the musculoskeletal disorder on the patient. This is a vital focus of the health history and supersedes the assessment of genetic risk factors and adherence to treatment, though these are both valid inclusions to the interview. Assessment of ROM occurs during the physical assessment, not the interview.

____________________, which may be performed with or without the use of oral or intravenous (IV) contrast agents, shows a more detailed cross-sectional image of the body. It may be used to visualize and assess tumors; injury to the soft tissue, ligaments, or tendons; and severe trauma to the chest, abdomen, pelvis, head, or spinal cord. It is also used to identify the location and extent of fractures in areas that are difficult to evaluate (e.g., acetabulum) and not visible on x-ra

A computed tomography (CT) scan

A patient has been experiencing progressive increases in knee pain and diagnostic imaging reveals a worsening effusion in the synovial capsule. The nurse should anticipate which of the following? A) Arthrography B) Knee biopsy C) Arthrocentesis D) Electromyography

C Arthrocentesis (joint aspiration) is carried out to obtain synovial fluid for purposes of examination or to relieve pain due to effusion. Arthrography, biopsy, and electromyography would not remove fluid and relieve pressure.

The human body is designed to protect its vital parts. A fracture of what type of bone may interfere with the protection of vital organs? A) Long bones B) Short bones C) Flat bones D) Irregular bones

C Flat bones, such as the sternum, provide vital organ protection. Fractures of the flat bones may lead to puncturing of the vital organs or may interfere with the protection of the vital organs.

hyaline cartilage

Most common type of cartilage; it is found on the ends of long bones, ribs, and nose

major hormonal regulators of calcium homeostasis

PTH and calcitonin

6 P's

Pain Pulse Pallor Paresthesia Paralysis Pressure

A _________ may accurately identify bone disease before it can be detected on x-ray; as such, it may diagnose a stress fracture in a patient who continues to experience pain after x-ray findings are negative

bone scan

___________ is a sac filled with synovial fluid that cushions the movement of tendons, ligaments, and bones over bones or other joint structures

bursa

examples of long bones

humerus, radius, ulna, femur, tibia, fibula

Excessive thyroid hormone production in adults (e.g., Graves' disease) can result in __________ bone resorption and decreased bone formation. Increased levels of cortisol have these same effects

increased

fasciculation

involuntary twitch of muscle fibers

During _____________ exercises, the muscle doesn't noticeably change length and the affected joint doesn't move. These exercises help maintain strength.

isometric

The junction of two or more bones is called a __________, or articulation

joint

area where bone ends meet; provides for motion and flexibility

joint

An effusion is suspected if the joint is swollen and the normal bony landmarks are obscured. The most common site for joint effusion is the _________

knee

increase in the convex curvature of the thoracic spine

kyphosis

normal capillary refill time

less than 2 seconds

ropelike bundles of collagen fibrils connecting bones

ligament

osteocyte

mature bone cell

synovium

membrane in joint that secretes lubricating fluid

process in which minerals (calcium) are deposited in bone matrix

ossification

abnormal sensation (e.g., burning, tingling, numbness)

paresthesia

Ball-and-socket joints

permit full freedom of movement. (shoulder and hip)

red bone marrow function

produce red blood cells, WBC and platelets (HEMATOPOIESIS )

Pivot joints allow one bone to move around a central axis without displacement. An example is:

radius and the ulna. * They permit rotation for such activities as turning a doorknob.

diaphysis

shaft of long bone

how do patients describe fracture pain?

sharp and piercing and is relieved by immobilization.

amphiarthrosis

slightly movable joint

Atonic muscle

soft and flabby

yellow marrow

soft, fatty material found in the medullary cavity of long bones

having greater-than-normal muscle tone

spastic

cancellous bone

spongy bone, not as dense as compact bone

There are three basic kinds of joints:

synarthrosis, amphiarthrosis, and diarthrosis joints.

cord of fibrous tissue connecting muscle to bone

tendon

how do patients describe bone pain?

typically described as a dull, deep ache that is "boring" in nature. *This pain is not typically related to movement and may interfere with sleep.

examples of irregular bones

vertebrae and facial bones

Physical activity, particularly _______________________, acts to stimulate bone formation and remodeling.

weight-bearing activity

Bone Densitometry

x-ray technique for determining density of bone

taking x-ray images after injection of contrast material into a joint

Arthrography

A patient is scheduled for a procedure that will allow the physician to visualize the knee joint in order to diagnose the patient's pain. What procedure will the nurse prepare the patient for? a. Arthrocentesis b. Bone scan c. Electromyography d. Arthroscopy

Arthroscopy

A patient is undergoing diagnostic testing for suspected Paget's disease. What assessment finding is most consistent with this diagnosis? A) Altered serum magnesium levels B) Altered serum calcium levels C) Altered serum potassium levels D) Altered serum sodium levels

B Feedback: Serum calcium levels are altered in patients with osteomalacia, parathyroid dysfunction, Paget's disease, metastatic bone tumors, or prolonged immobilization. Paget's disease is not directly associated with altered magnesium, potassium, or sodium levels.

A nurse is performing a nursing assessment of a patient suspected of having a musculoskeletal disorder. What is the primary focus of the nursing assessment with a patient who has a musculoskeletal disorder? A) Range of motion B) Activities of daily living C) Gait D) Strength

B Feedback: The nursing assessment is primarily a functional evaluation, focusing on the patient's ability to perform activities of daily living. The nurse also assesses strength, gait, and ROM, but these are assessed to identify their effect on functional status rather than to identify a medical diagnosis.

indicators of Peripheral Neurovascular Dysfunction. - circulation:

Color: Pale, cyanotic, or mottled Temperature: Cool Capillary refill: More than 3 seconds

Ligaments

Connect bone to bone

Tendon

Connects muscle to bone

cortisol function musculoskeletal system

Cortisol inhibits bone formation and decreases calcium absorption in the intestine

________ describes the grating, crackling sound heard over irregular joint surfaces like the knee.

Crepitus

A patient has had a cast placed for the treatment of a humeral fracture. The nurse's most recent assessment shows signs and symptoms of compartment syndrome. What is the nurse's most appropriate action? A) Arrange for a STAT assessment of the patient's serum calcium levels. B) Perform active range of motion exercises. C) Assess the patient's joint function symmetrically. D) Contact the primary care provider immediately.

D Feedback: This major neurovascular problem is caused by pressure within a muscle compartment that increases to such an extent that microcirculation diminishes, leading to nerve and muscle anoxia and necrosis. Function can be permanently lost if the anoxic situation continues for longer than 6 hours. Therefore, immediate medical care is a priority over further nursing assessment. Assessment of calcium levels is unnecessary.

A nurse is performing a musculoskeletal assessment of a patient with arthritis. During passive range-of-motion exercises, the nurse hears an audible grating sound. The nurse should document the presence of which of the following? A) Fasciculations B) Clonus C) Effusion D) Crepitus

D Crepitus is a grating, crackling sound or sensation that occurs as the irregular joint surfaces move across one another, as in arthritic conditions. - Fasciculations are involuntary twitching of muscle fiber groups. - Clonus is the rhythmic contractions of a muscle. - Effusion is the collection of excessive fluid within the capsule of a joint.

An older adult patient has come to the clinic for a regular check-up. The nurse's initial inspection reveals an increased thoracic curvature of the patient's spine. The nurse should document the presence of which of the following? A) Scoliosis B) Epiphyses C) Lordosis D) Kyphosis

D Kyphosis is the increase in thoracic curvature of the spine.

What is the difference between isotonic and isometric contractions?

During isometric contraction, almost all of the energy is released in the form of heat; during isotonic contraction, some of the energy is expended in mechanical work. In some situations (i.e., shivering), the need to generate heat is the primary stimulus for muscle contraction.

Nursing Interventions Arthrocentesis

- Hair may need to be removed from the site - Ice may be prescribed for the first 24 to 48 hours postprocedure - symptoms of complications, infection and bleeding

Tibial nerve assessment

- SENSATION: prick medial and lateral surfaces of sole of foot - MOTION: have patient planter flex ankle and toes

Radial nerve assessment

- SENSATION: prick web space between thumb and index finger - MOTION: Ask the patient to stretch out the thumb, then the wrist, and then the fingers at the metacarpal joints.

Arthroscopy

- A large-bore needle is inserted, and the joint is distended with saline. - allows direct visualization of a joint through the use of a fiberoptic endoscope. Thus, it is a useful adjunct to diagnosing joint disorders.

arthrography is used to identify the cause of any unexplained joint pain and progression of joint disease.

- A radiopaque contrast agent or air is injected into the joint cavity to visualize the joint structures, such as the ligaments, cartilage, tendons, and joint capsule. - The joint is put through its range of motion to distribute the contrast agent while a series of x-rays are obtained. - If a tear is present, the contrast agent leaks out of the joint and is evident on the x-ray image

diarthrosis joints:

- Ball-and-socket joints - Hinge joints permit - Saddle joints allow -Pivot joints - Gliding joints

indicators of Peripheral Neurovascular Dysfunction: sensation

- Paresthesia - Unrelenting pain - Pain on passive stretch - Absence of feeling

Ulnar nerve assessment

- SENSATION: prick distal fat pad of small finger - MOTION: have patient abduct all fingers

Median nerve assessment

- SENSATION: prick distal surface of index finger - MOTION: Ask the patient to touch the thumb to the little finger. In addition, observe whether the patient can flex the wrist.

Ballottement sign

- The medial and lateral aspects of the extended knee are milked firmly in a downward motion. - The examiner pushes the patella toward the femur and observes for fluid return to the region superior to the patella. - When larger amounts of fluid are present, the patella elevates, there is visible return of fluid to the region directly superior to the patella, and the ballottement test is positive

Weight-bearing activity vs weight-resistance exercise

- Weight-bearing activity, which supports bone maintenance, is any activity done while a person is on their feet that works a person's bones and muscles against gravity (e.g., walking, tennis). - Weight-resistance exercise uses weights or resistance to strengthen muscles.

Calcitriol functions

- increase the amount of calcium in the blood by promoting absorption of calcium from the gastrointestinal tract. - mineralization of osteoid tissue.

parathyroid hormone function bones

- parathyroid hormone stimulates the release of calcium from large calcium stores in the bones into the bloodstream. This increases bone destruction and decreases the formation of new bone. - Kidneys, parathyroid hormone reduces loss of calcium in urine.

patient having an arthrogram nursing interventions

- pt may feel some discomfort or tingling during the procedure. - After the arthrogram, a compression elastic bandage may be applied if prescribed - joint is usually rested for 12 hours. - Strenuous activity should be avoided until approved by the primary provider. - comfort measures (e.g., mild analgesia, ice) - explain patient that it is normal to experience clicking or crackling in the joint for 24 to 48 hours after the procedure until the contrast agent or air is absorbed

PTH function in bone

- regulates the concentration of calcium in the blood, in part by promoting movement of calcium from the bone. - In response to low calcium levels in the blood, increased levels of PTH prompt the mobilization of calcium, the demineralization of bone, and the formation of bone cysts.

Examination of synovial fluid is helpful in the diagnosis of

- septic arthritis and other inflammatory arthropathies and reveals the presence of hemarthrosis (bleeding into the joint cavity), which suggests trauma or a bleeding disorder.

Fracture healing process

1. hematoma formation 2. fibrocartilage callus formation 3. bony callus formation 4. bone remodeling

Daily intake of approximately _____________ to __________ mg of calcium is essential to maintaining adult bone mass.

1000 to 1200

How many bones are in the body?

206

Young adults need a daily vitamin D intake of____________ IU, whereas adults 50 years and older require a daily intake of ______________ to ___________IU to ensure good bone health

600 800 to 1000

More than _______ of total body calcium is present in bone

98%

A patient has been experiencing an unexplained decline in knee function and has consequently been scheduled for arthrography. The nurse should teach the patient about what process? A) Injection of a contrast agent into the knee joint prior to ROM exercises B) Aspiration of synovial fluid for serologic testing C) Injection of corticosteroids into the patient's knee joint to facilitate ROM D) Replacement of the patient's synovial fluid with a synthetic substitute

A Feedback: During arthrography, a radiopaque contrast agent or air is injected into the joint cavity to visualize the joint structures such as the ligaments, cartilage, tendons, and joint capsule. The joint is put through its range of motion to distribute the contrast agent while a series of x-rays are obtained. Synovial fluid is not aspirated or replaced and corticosteroids are not administered.

Diagnostic tests show that a patient's bone density has decreased over the past several years. The patient asks the nurse what factors contribute to bone density decreasing. What would be the nurse's best response? A) For many people, lack of nutrition can cause a loss of bone density. B) Progressive loss of bone density is mostly related to your genes. C) Stress is known to have many unhealthy effects, including reduced bone density. D) Bone density decreases with age, but scientists are not exactly sure why this is this

A - Nutrition has a profound effect on bone density, especially later life. -Genetics are also an important factor, but nutrition has a more pronounced effect.

A child is growing at a rate appropriate for his age. What cells are responsible for the secretion of bone matrix that eventually results in bone growth? A) Osteoblasts B) Osteocytes C) Osteoclasts D) Lamellae

A - Osteoblasts function in bone formation by secreting bone matrix.

Osteoporosis

A condition in which the body's bones become weak and break easily.

Meniscus tear

A tear in the meniscus which is the cartilage that acts as a cushion for the joint

The nurse is assessing a patient for dietary factors that may influence her risk for osteoporosis. The nurse should question the patient about her intake of what nutrients? Select all that apply. A) Calcium B) Simple carbohydrates C) Vitamin D D) Protein E) Soluble fiber

A, C A patient's risk for osteoporosis is strongly influenced by vitamin D and calcium intake. Carbohydrate, protein, and fiber intake do not have direct effect on the development of osteoporosis.

what patients are not candidates for a MRI?

Because an electromagnet is used, patients with any metal implants (i.e., cochlear implants), clips, or pacemakers are not candidates for MRI

A nurse is caring for a patient with a diagnosis of cancer that has metastasized. What laboratory value would the nurse expect to be elevated in this patient? A) Bilirubin B) Potassium C) Alkaline phosphatase D) Creatinine

C Feedback: Alkaline phosphatase is elevated during early fracture healing and in diseases with increased osteoblastic activity (e.g., metastatic bone tumors). Elevated bilirubin, potassium, and creatinine would not be expected in a patient with metastatic bone tumors.

A nurse's assessment of a teenage girl reveals that her shoulders are not level and that she has one prominent scapula that is accentuated by bending forward. The nurse should expect to read about what health problem in the patient's electronic health record? A) Lordosis B) Kyphosis C) Scoliosis D) Muscular dystrophy

C Feedback: Scoliosis is evidenced by an abnormal lateral curve in the spine, shoulders that are not level, an asymmetric waistline, and a prominent scapula, accentuated by bending forward. Lordosis is the curvature in the lower back; kyphosis is an exaggerated curvature of the upper back. This finding is not suggestive of muscular dystrophy.

___________, secreted by the thyroid gland in response to elevated blood calcium levels, inhibits bone resorption and increases the deposit of calcium in bone

Calcitonin

A patient tells the healthcare provider about shoulder pain that is present even without any strenuous movement. The healthcare provider identifies a sac filled with synovial fluid. What condition should the nurse educate the patient about? a. A fracture of the clavicle b. Osteoarthritis of the shoulder c. Chronic bursitis d. Ankylosing spondylitis

Chronic bursitis

epiphysis

End of a long bone

Electromyography nursing interventions

If the nurse finds that the patient is taking an anticoagulant or has a skin infection, the primary provider is notified.

peroneal nerve

Impulses to/from anterior leg and foot

The Fracture Risk Assessment Tool (FRAX®)

It is a tool that predicts a patient's 10-year risk of fracturing a hip or other major bone, which includes the spine, forearm, or shoulder

lamellae

Layers of bone matrix

CONTRACTION OF MUSCLE CAUSES __________

MOVEMENT

__________________ is a noninvasive imaging technique that uses magnetic fields and radio waves to create high-resolution pictures of bones and soft tissues. It can be used to visualize and assess torn muscles, ligaments, and cartilage; herniated discs; and a variety of hip or pelvic conditions. The patient does not experience any pain during the procedure.

Magnetic resonance imaging (MRI)

parathyroid hormone and calcitonin

Parathyroid hormone acts to INCREASE blood calcium levels, while calcitonin acts to DECREASE blood calcium levels.

A patient has a fracture that is being treated with open rigid compression plate fixation devices. How will the progress of bone healing be monitored?

Perform serial x-rays

detecting fluid in knee

Perform the patellar tap test or fluid displacement test to determine the presence of fluid in the knee joint.

What is the process of fracture healing, including the three stages of progression?

Phase I, reactive phase; phase II, reparative phase; phase III, remodelingphase

A patient has a fracture of the right femur sustained in a motor vehicle crash. What process of fracture healing does the nurse understand will occur with this patient? a. Reactive phase, reparative phase, remodeling phase b. Primary phase, secondary phase, third phase c. First intention, secondary intention, third intention d. Active phase, dormant phase, restructure phase

Reactive phase, reparative phase, remodeling phase

Balloon sign

TESTS FOR MAJOR EFFUSION 1. Compress subpatellar pouch with one hand 2. Rest other hand on sides of patella 3. BALLOONING out of SIDES of PATELLA = LARGE EFFUSION

The nurse assesses soft subcutaneous nodules along the line of the tendons in a patient's hand and wrist. What does this finding indicate to the nurse? a. The patient has osteoarthritis b. The patient has lupus erythematosus c. The patient has rheumatoid arthritis d. The patient has neurofibromatosis

The patient has rheumatoid arthritis

thyroid hormone function musculoskeletal system

Thyroid hormone (T3) is required for skeletal development during childhood and T3 regulates bone turnover and mineralisation in adults

How does vitamin D regulate the balance between bone formation and bone resorption?

Vitamin D increases calcium in the blood by promoting calcium absorptionfrom the gastrointestinal tract and by accelerating the mobilization of calcium from the bone.

indicators of Peripheral Neurovascular Dysfunction. motion:

Weakness Paralysis

Electromyography

a diagnostic test that measures the electrical activity within muscle fibers in response to nerve stimulation

A patient is having repeated tears of the joint capsule in the shoulder, and the physician prescribes an arthrogram. What intervention should the nurse provide after the procedure is completed? (Select all that apply.) a. Apply a compression bandage to the area b. Apply heat to the area for 48 hours c. Administer a mild analgesic d. Inform the patient that a clicking or crackling noise in the joint may persist for a couple of days e. Actively exercise the area immediately after the procedure

a. Apply a compression bandage to the area c. Administer a mild analgesic d. Inform the patient that a clicking or crackling noise in the joint may persist for a couple of days

The nurse is performing an assessment for a patient who may have peripheral neurovascular dysfunction. What signs does the patient present with that indicate circulation is impaired? (Select all that apply.) a. Pale, cyanotic, or mottled color b. Cool temperature of the extremity c. More than 3-second capillary refill d. Tenting skin turgor e. Limited range of motion

a. Pale, cyanotic, or mottled color b. Cool temperature of the extremity c. More than 3-second capillary refill

paresthesia

abnormal sensation of numbness and tingling without objective cause

contracture

abnormal shortening of muscle, joint, or both

Calcitriol

active form of vitamin D

Gliding joints

allow for limited movement in all directions and are represented by the joints of the carpal bones in the wrist.

Saddle joints

allow movement in two planes at right angles to each other. *The joint at the base of the thumb is a saddle, biaxial joint.

synarthrosis

an immovable joint

The leading cause of musculoskeletal-related disability in the United States is ________.

arthritis