NUR 202 Exam 2

Purpose of the Musculoskeletal System

• Support

• Movement

• Internal organ encasement and protection

• Bone marrow production of the red blood cell (RBC), white blood cells (WBC) and platelets

• Storage reservoir of minerals (calcium, phosphorus)

Hematopoiesis

bone marrow production of the red blood cell (RBC), white blood cell (WBC) and platelets

Cartilage

• Layer covering surface between opposing bones in a synovial joint

• Avascular (no blood)

Ligaments

• Fibrous banding connecting bone to bone

• Provides strength to the joint

Bursa

Fluid filled sac of synovial fluid

Skeletal muscle (voluntary)

tendon - attachment of muscle to bone

Smooth muscle

lines body organs

Flexion

limb bending at a joint

Extension

Straightening of limb at a joint

Abduction

movement away from body midline

Adduction

movement towards body midline

Pronation

forearm turn and palm down

Supination

forearm turn with palm up

Circumduction

circular arm movement of the shoulder

Inversion

foot sole movement inward of the ankle

Eversion

foot sole movement outward of the ankle

Rotation

head movement around a central axis

Elevation

body part elevation

Depression

body part lowering

Temporomandibular Joint (TMJ)

• Articulation of mandible and temporal bone

• Can feel it in depression anterior to tragus of ear

• permits jaw function of speaking and chewing

• Allows three motions

Three motions of the Temporomandibular Joint (TMJ)

• Hinge action to open and close jaw

• gliding action for protrusion and retraction

• Gliding for side-to-side movement of lower jaw

Shoulder girdle

Humerus, scapula, clavicle, joints and muscle

Glenohumeral joint

articulation of humerus with glenoid fossa of scapula

• Ball-and-socket action allows mobility of arm on many axes

Rotator cuff

Group of four (SITS) muscles and tendons support and stabilize shoulder

Subacromial bursa

Assists with abduction of the arm

Elbow

• Elbow joint contains three bony articulations - humerus, radius, & ulna of forearm

• Palpable landmarks - medial and lateral epicondyles of humerus and large olecranon process of ulna between them

• Radius and ulna - articulate with each other at two radioulnar joints, one at elbow and one at wrist

Radiocarpal Joint (wrist)

• Condyloid joint

• Rotation of the radius

• Proximal interphalangeal (PIP) joint

• Distal interphalangeal (DIP) joint

Hip joint is what kind of joint?

Ball and Socket

Hip

articulation between acetabulum and femoral head

• More stability for weight-bearing function

Palpation of the hip joint bony landmarks

• Iliac crest - anterior superior spine to posterior

• Ischial tuberosity

• Greater trochanter of the femur

Knee Joint

• Movement of the femur, tibia and patella (kneecap)

• Largest joint in the body

• Synovial membrane is largest in body

• Hinge joint (flexion/extension)

Foot and Ankle (Tibiotalar joint)

• Movement of the fibula, tibia and talus

• Hinge joint (flexion/extension)

Systematic approach

head to toe, proximal to distal, and from midline outward

Inspection of Musculoskeletal system

Note size and contour of joint; inspect skin and tissues over joints for color, swelling, and any masses or deformity

Palpation of Musculoskeletal System

• look at each joint, including skin for temperature, muscles, bony articulations, and area of the joint capsule; notice any heat, tenderness, swelling, or masses which signal inflammation

• Joints are normally not tender

• If tenderness occurs, localize to specific anatomic structures

Range of Motion Musculoskeletal System

• ask patient for active voluntary ROM while stabilizing the body area proximal to that being moved

• Ig you see a limitation, gently use passive ROM

Phalen Test

An orthopedic test used to diagnose carpal tunnel syndrome, involving flexing the wrists and holding the position for a minute to check for symptoms like tingling or numbness in the fingers.

Doriflexion

lift toes towards the nose

Plantar flexion

push foot downward in a similar fashion to an automobile accelerator or brake pedal

Swan-neck deformity

A type of finger deformity characterized by hyperextension at the proximal interphalangeal joint and flexion at the distal interphalangeal joint, often associated with rheumatoid arthritis.

Bouchard & Heberden nodes

bony swellings that develop on the proximal or distal interphalangeal joints of fingers, commonly associated with osteoarthritis.

Greater toe pain is an early sign of what?

Acute Gout

Central Nervous System (CNS)

Brain & Spinal cord

Peripheral Nervous System (PNS) consists of what

12 cranial nerves, 31 spinal nerves, & branches

Cerebral Cortex

cerebrum’s outer layer of nerve cells

Center of functions governing thought, memory, reasoning, sensation, and voluntary movement

Hemisphere

each half of cerebrum

Frontal lobe

concerned with personality, behavior, emotions, and intellectual function

Parietal Lobe

Postcentral gyrus is primary center for sensation

Occipital Lobe

primary visual receptor center

Temporal Lobe

behind ear, has primary auditory reception center, hearing, taste, & smell

Wernicke’s area

In the temporal lobe and is associated with language comprehension

Receptive Aphasia

damage to Wernicke’s area leading to the person being able to hear sounds, but it has no meaning, like hearing a foreign language

Broca’a area

area within the frontal lobe that mediates motor speech

Expressive Aphasia

occurs when broca’s area is injured, a person cannot talk; person cannot understand language and knows what they want to say but produces only a garbled sound

Basal Ganglia

Gray matter in two cerebral hemispheres that form subcortical associated motor system (extrapyramidal system)

Thalamus

Main relay station where sensory pathways of spinal cord, cerebellum, & brainstem form synapses

Hypothalamus

major respiratory center with basic function control and coordination

Cerebellum

concerned with motor coordination and muscle tone of voluntary movements

Brainstem

Central core of brain - contains midbrain, pons and medulla

Regulates autonomic functions including heart rate & ventilation

Spinal Cord

Main pathway for ascending and descending fiber tracts that connect brain to spinal cord

Deep tendon/stretch

such as knee jerk

Superficial (cutaneous)

such as plantar reflex

Visceral (organic)

such as pupillary response

Headache subjective data

Ask about

• onset, frequency, and severity

• location, quality description, and associated factors

Head Injury subjective data

Ask about

• event history, type and description

• loss of consciousness and recall of event

Dizziness/vertigo subjective data

Ask about

• onset, duration, description, and frequency

• associated with change in position

• vertigo characteristics - objective or subjective vertigo

Seizures subjective data

Ask about

• course and duration

• motor activity in body

• associated clinical presentations

• posticial phase

• precipitating factors

• medication therapy

• coping strategies

Tremors subjective data

Ask about

• onset, type, duration, and frequency

• precipitating and alleviating factors

Weakness subjective data

Ask about

• localized or generalized, distal or proximal

• impact on mobility or ADLs

Incoordination subjective data

Ask about

• problems with balance while standing or ambulating

• lateral drifting, stumbling, or falling

• legs giving way and/or clumsy movements

Numbness or tingling subjective data

Ask about

• onset, duration, and location

• whether it occurs with activity

Difficulty swallowing subjective data

Ask about

• with solids or liquids

• drooling

Difficulty speaking subjective data

Ask about

• onset, pattern, and duration

• forming words or saying what you want to say

Patient-centered care subjective data

Ask about

• Information regarding past pertinent medical history

Environmental and occupational hazards subjective data

Ask about

• exposure history

• medication history: Rx and OTC

• alcohol history

• substance abuse/drug history

Dizziness in Older adults

Ask about

• Association with positional change or activity medication

• impact on ADLs

• safety modification

Memory in older adults

• decrease in mental function or confusion

• onset, duration, and frequency

Tremor in Older adults

Ask about

• location

• precipitating and alleviating factors

• impact on ADLs

Sudden vision change in Older Adults

Ask about

• onset, duration, and frequency

• loss of consciousness and safety

• impact on ADLs

Screening neurologic examination

perform on well persons with no significant findings from history

Complete neurological examination

perform on persona with neurolgoic concerns

Neurologic recheck

perform examination on persons with demonstrated neurologic deficits who require periodic assessment

Recommended sequence for Complete Neurological Examination

• Mental Status

• Cranial Nerves

• Motor System

• Sensory System

• Reflexes

Seizure Assessment

Be able to distinguish between Simple Partial, Complete Partial/Tonic-Clonic, and Status Epilepticus

Simple Partial Seizure

Full awareness with not loss of consciousness; may include aura (prodrome)

Complete Partial Seizures

Altered Awareness seizure that the patent may not even remember

Tonic-Clonic Seizure (Grand Mal Seizure)

Most common major seizure; sharp muscle contraction w/ extension of extremities and immediate loss of consciousness followed by rhythmic bilateral contraction and relaxation of extremities’ person remains unconscious until RAS begins functioning again

Status Epilepticus

Repetitive, conscious, and non-stop seizure that does not stop spontaneously; if untreated can lead to death or respiratory failure

Mental Status Evaluation

• Orientation to person, place, time, and situation

• Glasgow Coma Scale assessment

Cranial Nerve 1

Olfactory - Smell

Cranial Nerve 2

Optic - Vision

Cranial Nerve 3

Oculomotor - Eyelid movement and pupil constriction

Cranial Nerve 4

Trochlear - down/inward eye movement

Cranial Nerve 5

Trigeminal - Mastication (chewing) and face sensation

Cranial Nerve 6

Abducens - Lateral eye movement

Cranial Nerve 7

Facial - Facial muscle, taste of portion of the tongue, saliva/tear secretion

Cranial Nerve 8

Acoustic -Hearing and equilibrium

Cranial Nerve 9

Glossopharyngeal - swallowing, portion of tongue taste sensation and pharynx so-called gag reflex

Cranial Nerve 10

Vagus - Swallowing and talking, carotid reflex

Cranial Nerve 11

Spinal accessory - trapezius and sternomastoid muscle movement