Chapter 39 nursing care of the adult

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Sings the patient has circulation impairment

-Pale, cyanotic, or mottled color -cool temp of extremity -more than 3-second capillary refill

Which is a circulatory indicator of peripheral neurovascular dysfunction

Cool skin

Endosteum

Covers the marrow cavity of long bones

Kyphosis

Curve in thoracic spine

Skull sutures are an example of which type of joint?

Synarthrosis

paresthesia

abnormal sensation

contracture

abnormal shortening of muscle

What factors would the nurse need to keep in mind about the focus of the initial history when assessing a new client with a musculoskeletal problem?

any chronic disorder or recent injury

Which nursing action is most important in caring for the client following an arthrogram?

apply ice

osteogenesis

bone formation

osteoblast:

bone forming cell

Bone densitometry:

bone mass density, dual energy x-ray most common

osteoclast

bone resorption cell

lordosis

curvature of the lumbar spine

Lordosis

curve in lumbar spine

atrophy

decrease in muscle size

bone scan -nursing interventions

detect bone tumors -assess for allergies, injection of radioisotope and performed 2-3 hours after. encourage fluids to distribute isotope

joint history and physical findings

diminished range of motion, stiffness, loss of height

arthroscopy -nursing interventions

direct visualization of joint -wrap joint to control swelling, monitor neuro status, educate family to monitor for signs and symptoms of complications

electromyography

electrical potential of the muscles -assess for use of anticoagulants, may cause bleeding, active skin infection

joint capsule

encloses bone ends

epiphysis

end of long bone

FRAX assessment tool

predicts patient's 10 year risk of fracturing a bone

What assessments indicate client has a normal gait

smoothness, knee flexion

What to anticipate finding when inspecting rheumatoid arthritis fingers

soft, subcutaneous nodules along the tendons

periosteum

tissue covering bone

fasicculation

twitch of muscle

MRI nursing interventions

use radio waves for high quality imaging -may hear knocking sound, assess for contradictions, assess for allergies

endosteum

vascular membrane covering the marrow cavity of long bones

Ligament structural changes

weakness

Bone -structural changes -functional changes -history and physical findings

-loss of bone mass after 30 years of age -fragile -loss of height, flexibility, flexion of hips and knees, osteoporosis

Gradual loss of bone after a peak of bone mass at age

30

When assessing the reflexes in the ankle, the nurse observes rhythmic contractions of the muscle when dorsiflexing the foot. What would the nurse document this finding as?

Clonus

Fibrous sheath that surrounds the articulating bones

Joint capsule

What laboratory study indicates the rate of bone turnover

Serum osteocalcin

Reason for older adult's risk for skeletal fractures

bone resorption is more rapid than bone formation

Osteoclasts

born resorption

trabeculae

cancellous bone

example of a gliding joint

carpal bones in the wrist

what is an example of gliding joint

carpal bones in the wrist

Joint structural changes

cartilage deterioration, thinning of intervertebral discs

ligament

collagen fibrils connecting bones

cortical bone

compact bone

tendon

connects muscle to bone

kyphosis

convex curvature of the thoracic spine

fascia

covers, supports, and separates muscles

crepitus

cracking sound

hypertrophy

enlargement of muscle

remodeling

ensures bone maintenance

effusion

excess fluid in joint

osteon

functional bone unit

spastic

having greater-than-normal muscle tone

Muscle structural changes

increase of collagen results in diminished size

Muscle tension being unchanged with muscle shortening and joint motion

isotonic contraction

history and physical findings with ligaments:

joint pain with motion, resolves with rest, osteoarthritis, swelling

Diminished range of motion, loss of flexibility, stiffness, and loss of height is related to

joints

Example of a hinge joint

knee

flaccid

limp

muscle history and physical findings

loss of strength, decreased endurance, longed response time, no tone

Muscle function changes

loss of strength, flexibility, weakness, fatigue, falls

osteocyte

mature bone cell

isotonic contraction

muscle being shortened without a change in its tension

isometric contraction

muscle tension increased without changing its length

Why are older adults at risk for falls

muscles atrophy with aging

tone

normal tension

arthrocentesis

obtain synovia fluid -remove hair from cite, administer analgesics, apply ice

Responsible for the process of ossification

osteoblasts

ossification

process calcium is deposited in bone matrix

osteopenic

reduction in bone mass

Osteoclasts are involved in the destruction and

remodeling of bone

resorption

removal/ destruction of tissue

lamellae

rings of bone matrix

synovium

secretes lubricating fluid

diaphysis

shaft of long bone

functional changes

stiffness, reduced flexibility, pain with daily activities

Best way to maintain strong bones

weight-bearing exercises

joint

where bone ends meet

Atonic

without tone


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