Musculoskeletal System (copy)

Nur152 PVCC Exam 4

Skeletal

Bones, cartilagage, ligaments, and tendons

Movement

___________ occurs when the muscles contract

GI tract, BV, Bladder

smooth muscle is found in the

body alignment, balance, coordination, joint mobility

the way people move involves

Factors affecting mobillity

developmental stage

nutrition

lifestyle

stress

external environment

culture

presence of disease

supporting structure of the musculoskeletal system

ligaments, tendons, cartilage

Joints

where 2 or more bones come together and allow specific movements in relation to one another

2 types: synovial and nonsynovial

hinge joint

allow for flexion and extension

ex. elbow joints, interphalangeal joins, knee joints

spheroidal ( ball and socket)

allow for flexion, extension, adduction, abduction, circumduction

ex. shooulder, hip

pivot (rotary)

rotation

ex. proximal radial joint

condyloid

allows for flexion, extension; abduction, adduction; circumduction

ex. wrist joints btwn radial and carpals shown

saddle

allows for flexion, extension, abduction, adduction; circumduction, thumb-finger opposition

gliding

allows one surface to move over another surface

tendons

_________ connects muscle to bone

ligaments

__________ connect bone to bone

kyphotic

an abnormally rounded upper back

lordosis

an inward curvature of the lower back

musculoskeletal pain assessment

P = Provoking incident

Q = quality of pain

R = Region, radiation, and releif

S = Severity of pain

T = Time

serum calcium

9-11

serum phosphate

2.5 - 4.5

alkaline phosphatase

42-136

an enzyme produced in osteoblast

erythrocyte sedimentation rate

less than 30

serum muscle enzyme (creatine kinase)

_________ _________ ________ will be elevated in people with muscle damage it is also known as creatine kinase

osteoclast

bone destructor

osteoblast

bone reconstruction

rheumatoid factor

____________ _____________ assessed for the presence of autoimmune arthritis. It will be elevated in arthiritis

dexa

a ______ scan measures the bone mass and can be used to check for osteoporosis

arthroscopy

a fiber optic tube for direct visualization of knees, ankles, and shoulders can be used to take out bone fragments following a traumatic incident

osteoporosis

structural deterioration of bone tissue, increased bone fragility, low bone mass and porous bones are all characteristics of ____________

20

peak bone mass occurs before the age of __

true

(T OR F) The rate at which a person experiences bone loss after midlife can altered

osteopenia

low bone mass, the reversible form of osteoporosis

osteoporosis risk factors pneumonic

A - alcohol use

C - corticosteroid use

C - Calcium low

E - estrogen low

S - smoking

S - Sedentary lifestyle

first sign of osteoporosis

back pain, spontaneous fractures

bone vitamins

calcium, vitamin D

1000mg/day of vitamin D can help calcium absorb

osteoporosis drug therapy

calcium supplements, vitamin D, calcitonin, Hormone Replacement therapy, Biphosphonates

degenerative joint disease

aka osteoarthritis

most common type of arthritis

causes loss of cartilage in the joints, joint pain, loss of function

crepitus

creaking joints

osteoarthritis medication

tylenol

topical salicylates

NSAIDS

COX-2 Inhibitors

Arthroplasty

reconstruction or replacement of a joint

hemiarthroplasty

replacement of part of a joint

30-60

for osteoporosis to be visible via an x-ray __- __% of bone density must have been lost

total Hip Arthroplasty lateral Approach

slide 49

Bisphosphonates

_________________ will cause a rapid increase in bone marrow during yr1 of use but will be followed by a plateau in effectiveness after 2-3 years of use

evista

inhibits bone reabsorption

a Selective Estrogen Receptor modulator

bisphosphonates

Fosamax and Boniva

reverse bone loss and reduce fracture risk

Fosamax, Boniva SE

Esophageal irritation, N/V, bone pain

Fosamax, Boniva directions

take with full glass of water

remain sitting up for at least 30 minutes (to avoid irritating esophagus)

take 2 hours before breakfast

Fosamax, Boniva contraindications (do not use if)

allergic

esophageal dysfunction

inability to stand/sit upright for 30 min

hypocalcemia

evista (SERM)

Prevents osteoporosis by stimulating estrogen receptors in the bone, uterus and breast.

the stimulation/boost of estrogen leads to an increase in bone density

evista (SERM) SE

Hot flashes, Leg cramps, weight gain

increased thromboembolism risk

increased risk of death after a stroke (in women)

Miacalcin (calcitonin)

directly stops osteoclastic bone resorption by counteracting parathyroid hormone

promotes the excretion of calcium

salmon

miacalcin shouldn’t be given to anyone allergic to

miacalcin SE

face flushed

nausea

diarrhea

reduced appetite

irritated nasal mucosa

calcium, calcitonin. Calcitonin promotes renal excretion of calcium

_________ and ___________ should be taken together, why?

hypocalcemic tetany

A patient on calcitonin should be monitored for _____________ _________

signs of this include;

Nervousness/irritability

muscle twitching

paresthesia (burning or prickling sensation)

numbness/tingling around mouth

estrogen, calcium

Hormone replacement therapy in the form of __________ is most effective when ___________ is given in tandem

types of calcium supplements

tums, Os-cal

D

homebound older adults usually struggle to get enough vitamin __. This can negatively affect their bone density

ETOH, Opioids, other CNS depressants

muscle relaxants shouldn’t be used with

Flexeril, lioresal, zanaflex

_____________, ___________, ____________ are central acting skeletal muscle relaxants. The are CNS depressants

dantrium

__________ is a direct acting skeletal muscle relaxants

muscle relaxants SE

Drowsiness

dry mouth

dizziness

light headedness

bradycardia

hypotension

gastric lavage

the only reversal for a muscle relaxant OD is _______ _________

BP, RR, Neuro, muscle strength

pts on muscle relaxants should have ___, ___, _______, _________ _______ routinely assessed

Somatic, voluntary

The _________ nervous system controls ________ muscles

alignment

Places spine in neutral or resting position, posture

Balance

Achieved when the body is alignment

Coordination

Nervous system working together with musculoskeletal system to produce movement

Joint mobility

Allows us to sit stand walk and bend

Protein

_________ is important in muscle retention

GU effects on immobility

More prone to infection because supine position isn't good for drainage, immobility could also lead to calcium in urine

Metabolism effects on immobility

Glucose intolerance, increased fat stores

Psychology effects of immobility

Depression,mood Changes, sleep disturbances

4-6

To test for ROM move all joints _-_x each

PT, OT, CPM (continuous passive motion)

Passive range of motion is done by ___/___ or a _____ machine

Phosphorus

Bones store calcium and __________

Epiphysis

Blood cell production occurs in the ___________ of the bone

Metaphysis

Growth plate

Yellow bone marrow, diaphysis

Cartilage, fat, and bone

Irregular bones

Face bones, spinal cord, sacrum

Complex in their shape

Flat bones

Rib bones, sternum, skull, scapulae

Protection of internal organs

Long bone

Bones of the extremities also includes the metacarpals, metatarsals, and phalanges

Support weight and facilitate movement

Short bones

Cube shaped

Carpals and tarsals

Osteocytes

Mature bone cells

Parathyroid hormone

_____________ brings calcium out of bone and into the bloodstream

Synovial fluid

Acts as a shock absorber

Nonsynovial, skull

_________ joints are nonmovable and usually found in the _______

Nursing measured to promote mobility

Accepting current activity level

Proper alignment/positioning

ROM exercises

Positioning devices

Assist pts out of bed

Assist ambulation

Encourage exercise

Bones

Provide a framework for weight bearing

Support surrounding tissues/muscles

Assist in movement

Protect organs and tissues

Manufacture blood cells

Store minerals

Circulation, motion, sensation

A neurovascular assessment assess for _________, __________, _________ (C.M.S)

Musculoskeletal pain assessment

P = provoking incident

Q = quality of pain

R = region, radiation, relief

S = severity of pain

T = time

Inverse

Serum calcium found in blood has an ________ relationship to serum phosphate

statin

Drugs that end in ________ can cause muscle pain

Forward

Kyphosis brings ones center of gravity ________

Lordosis, pregnancy

___________ posture (inward curvature of the lower back) can be caused by _________

Arthroscopy

Following a traumatic incident where bone has been fragmented a ___________ can be conducted to remove the bone fragments

Senile

_________ osteoporosis refers to someone who develops osteoporosis after the age of 70

True

T or F: long term sedatives, anti seizure and steroid use can cause osteoporosis

Noncemented procedure

For younger/more active people, a porous mesh will be used so the bone can grow into/around the prosthetic making it more mobile/weight bearing