Term
| What is the purpose of the musculoskeletal system and how is it controlled? |
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Definition
| the bodies bones, muscles & joints compose the musculoskeletal system. It is controlled and innervated by the nervous system, the musculoskeletal systems overall purpose is to provide structure and movement for body parts. |
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Term
| Describe the prevalance of osteoporosis? |
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Definition
| 30-40% of women and 13% of men. affects more then 28 million americans, 80% if them are women. about 1.5 million actually have it and 15 million have the forerunner of low bone mass. |
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Term
| Identify uncontrollably and modifiable risk reduction. ID methods of risk reduction. |
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Definition
| Women who begin menarche late or begin menopause early are at greater risk b/c of decreased estrogen levels, which tend to decrease the density of bone mass. Osteoporosis is more common as a person ages b/c bone resorption increases, calcium absorption decreases and production of osteoblasts decreases as well. |
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Term
| What kind of lifestyle increases risk for osteoporosis? |
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Definition
| A sedentary lifestyle. Regular exercise increases bone density. |
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Term
| Uncontrollable risk factors for osteoporosis: |
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Definition
| gender (women), age: 70 yrs old female, 80 yrs old male, body size: small boned, thin, Ethnicity: caucasians are at the highest risk, African Americans + Latino are lower, but still have significant risk. Family history or personal history of bone fractures as adult. |
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Term
| Modifiable risk factors for osteoporosis: |
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Definition
| little or no physical exercise, low calcium intake, for women: low estrogen levels, postmenopausal women not on estrogen replacement therapy, smoking |
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Term
| Methods for reducing risk of osteoporosis: |
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Definition
| increase activity or activity esp weight bearing exercises 3x's a week, increase calcium intake through supplements, get adequate vit. D to absorb calcium, avoid excessive caffeine or alcohol consumption, stop smoking, stop steroid use, consider estrogen replacement therapy if postmenopausal or approaching it, protective meds for bone density with doc talk, if diagnosed with osteoporosis: explore ways to prevent falls. |
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Term
| Peak bone mass is achieved at __ - __ in both sexes bone density decreases with age. Men have denser bones then women after puberty and blacks have denser bones then whites. |
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Definition
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Term
| Bone density by population: do chinese, japanese and eskimos have less bone density then caucasians? |
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Definition
| Yes they do (chinese, japanese & eskimos have less bone density then whites), but polynesians have 20% more then whites. |
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Term
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Definition
| 5 = Active Motion against full resistance = normal. 4=active motion against some resistance=slight weakness. 3=active motion against gravity=average weakness. 2=passive ROM=poor ROM. 1=slight flicker of contraction=severe weakness. 0=no muscular contraction=paralysis. |
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Term
| What can cause ROM problems in cervical spine? |
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Definition
| tumors or disc degeneration, serious infection life meningitis can cause assoc. neck pain. |
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Term
| If client expresses pain during ROM, do you continue? |
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Definition
| no, do not force them beyond their normal range. stop if discomforted or feeling pain. |
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Term
| What do you do when assessing them bending sideways and backward, twisting? |
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Definition
| sit down behind the client & stabilize them so not to fall |
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Term
| Jaw muscle's ability to clench is what CN? |
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Definition
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Term
| Which CN is used resisting and ROM of shoulders? |
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Definition
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Term
| What is abduction? adduction? |
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Definition
| abduction=moving AWAY from midline of body. adduction=moving TOWARD the midline of the body. |
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Term
| ___________ is bending the extremity at the joint and decreasing the angle of the joint. |
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Definition
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Term
| _________ is straightening of the extremity at the joint and increasing the angle of the joint. |
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Definition
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Term
| _________________ is extension of a limb or part beyond the normal limit (bending hand backward). |
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Definition
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Term
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Definition
| Pronation: turning or facing downward (hand), Supination: turning or facing upward. |
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Term
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Definition
| turning head to right shoulder & back to midline and the opposite on left shoulder & back to midline. |
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Term
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Definition
| bringing arms and hands (bent) behind back + bending knee and rotating towards midline of the body |
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Term
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Definition
| hands together behind head, bending knee and rotating away from body |
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Term
| radial and ulnar deviation |
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Definition
| Radial: bending hand to side of thumb. Ulnar: bending hand to sd of pinky |
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Term
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Definition
| bending foot up (towards body) |
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Term
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Definition
| bending foot down (away from body) |
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Term
| Describe the occurence of cerebrovascular accident (CVA) in the US. What ethnicity has highest incidence? |
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Definition
| CVA is theleading neurological problem in the US. It is ranked 3rd overall in cause of death. African Americans have highest incidence at earlier age and are twice as likely to die of stroke as whites or hispanics are. About 5.4 million people live with some type of disability b/c of strokes. |
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Term
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Definition
| older adulthood, risks dbl each decade after 55, MALES, history of stroke or TIA, HTN, smoking chronic alcohol intake, history of cardiovascular disease, sleep apnea, diabetes, high serum levels of fibrinogen, cholesterol, high doses of oral contraceptives, high estrogen levels, postmenopausal women, overweight, African American, newly industrialized environment. |
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Term
| Risk Reduction techniques for CVA: |
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Definition
| monitor BO, exercise, stop smoking, limit alcohol intake, regular health care checks, low fat & cholesterol diet, regular blood cholesterol tests, regular blood sugar checks, avoid drugs such as cocaine. |
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Term
| ______ AMerican men have highest rate of CVA, twice that of white men. |
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Definition
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Term
| Reflex Response Scale: (to reflex hammer) |
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Definition
| Grade 4+ = hyperactive, very brisk, rhythmic oscillations, abnormal and indicate disorder Grade 3+ = more brisk r active then normal, but not indicative of a disorder 2+ = NORMAL, Usual Response 1+ = Decreased, less active then normal 0+ = No response |
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Term
| Orientation is 3 fold. Normal is being oriented to time, place and person. You start with specific! If specific is not known though, move to more general. Use Time as an example... |
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Definition
| Going Specific to general with time you may go... Start with time of day, then day of week, the month and then the year. |
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Term
| Assess Place (go specific to general) |
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Definition
| specific: where are they currently? What CITY? what STATE? What COUNTRY? |
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Term
| What order of questions work for assessing specific to general with PERSON? |
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Definition
| Ask first for their full name, then their last name and first name. Often they will forget their last name first b/c it changes in their lifetime. |
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Term
| ____ Memory is in the last 24 hrs. ______ memory is recalling an event more then 24 horus ago. WHich one is usually lost first? |
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Definition
| Recent, Remote. Recent memory is usually lost first. Often elderly can recall their youth, but loses track of current memories easily. |
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Term
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Definition
| heel should strike the ground first. move to ball of foot and push off from there, go up on the tow and opposite arm swing. Tey should have a fluid start & stop. |
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Term
| What is the tandem walk test? what's it checking? |
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Definition
| It is heel to toe w/o arms out (arms are at side!). checks balance. |
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Term
| The Romberg test checks Fx of what CN? What is this test performed? |
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Definition
| CN VII (8). Person stands with feet together, arms at sd, eyes open and test for swaying. close eyes and test for any swaying. Be sure to stand right behind elderly patients b/c you will need to catch them if they fall over. |
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Term
| What is the finger to nose test assessing? |
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Definition
| Coordination. Want them to take index finger & touch nose alternately, increasing speed and close their eyes. DOcument what % of time they touch their nose w/ eyes open & w/ eyes closed. |
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Term
| What patients might struggle with sensory perception tests (sharp, dull and soft sensation)? They are who you really want to perform it with though. |
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Definition
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Term
| If patient does not have sensation ability in their feet, what should you do? |
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Definition
| move centrally. go up higher & see where sensation stops. |
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Term
| Rapid Alternating Movements are what tests? |
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Definition
| finger to thumb, alternating fingers quickly. Or flip hands back & forth on thighs quickly. For some older clients rapid alternating movements are difficult b/c of decreased reaction time and flexibility. |
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Term
| WHen assessing coordination of movements, bear in mind that the client's __________ side will likely be more coordinated. |
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Definition
| dominant. and this is normal |
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Term
| We know that DM patients may have decreased peripheral neuropathies. Alcoholism and folic acid deficiencies also decrease peripheral feeling. Also lesions of the spinal cord, brain stem, CN and cerebral cortex. Those are all abnormal findings. What if an older client has decreased light touch and pain sensations? Is this normal or abnormal? |
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Definition
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Term
| What Fluid & Electrolyte problem causes hyperreflexia? |
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Definition
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Term
| We test vibratory sensation by striking a tuning fork on the heel of hand and hold the base on a bony surface of hand or big toe. Ask the client to say what they feel. Normally they can correctly identify the sensation. SHould the patients eyes be closed to correctly know??? |
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Definition
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Term
| Can we assume that checking for vibratory sense distally means that vibratory sense proximally is intact? |
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Definition
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Term
| Vibratory sensation at the ankles decreases after age 70. Is this normal? |
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Definition
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Term
| When do we test for temperature sensation in peripheral areas? |
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Definition
| Only if abnormalities are found in client's ability to perceive light touch & pain sensations. If pain is intact, do not need to test for temperature... they both travel on the lateral spinothalamic tract. |
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Term
| Normal reflex reactions range where on the deep tendon reflex scale? |
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Definition
| 1+ - 3+. 1+=diminshed, present but decreased. 2+=normal. 3+=slightly increased but not pathologic. |
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Term
| Is it normal for the achilles reflex to be absent or difficult to elicit? |
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Definition
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Term
| How do you test the bicep reflex? |
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Definition
| ask client to bend arm at elbow with palm up. place your thumb over the biceps tendon and strike your thumb with the reflex hammer. repeat on other side. contraction of bicep muscle is normally seen or felt. Ranges from 1+ - 3+ |
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Term
| How do you assess brachioradialis reflex? |
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Definition
| ask client to flex elbow with palm down and hand resing on abdomen or lap. tap the tendon at the radius about 2 inches above wrist. THe forearm will flex and supinate. ranges from 1+ - 3+ |
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Term
| How do you assess the triceps reflex? |
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Definition
| hang arm freely, like a clothes hanging on a clothesline & you hold it up with ND hand. With elbow bent, tap the tendon above the olecranon process. |
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Term
| How do we assess patellar reflex? |
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Definition
| ask client to let both legs hang freely off side of exam table. tap patellar tendon, which is located just below the patella. can do on client who can't sit up too. |
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Term
| How do we assess achilles reflex? |
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Definition
| with leg hanging freely, dorsiflex the foot. tap the achilles tendon with reflex hammer. Normal response is PLANTAR FLEXION of foot from 1+ - 3+. In some older clients the achilles reflec may be absent or difficult to elicit. |
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Term
| Which reflex tests do we use the point part of the hammer? |
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Definition
| All the arm tests... So bicep, tricep and brachioradialis reflex tests. |
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Term
| Which reflex tests do we use the back of the hammer? |
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Definition
| On the leg reflex tests. So the patellar refelx and the achilles reflex. |
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Term
| What tests the superficial reflexes? |
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Definition
| The plantar reflex, use handle end of hammer to stroke lateral aspect of heel up to ball to assess function of spinal nerves. Normal response to plantar flexion: toes curl in. |
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Term
| Except in infancy, anything but a plantar response where the toes curl in is really bad. This is called a Positive ________ Repsonse when the toes fan out or extend (dorsiflexion) at big toe. What conditions might a positive ______ response occur to plantar refelex test. |
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Definition
| Babinsky. Unconscious states resulting from drug alcohol toxicity, alcohol intoxication, brain injury, or subsequent to ann epileptic seizure may also cause it. |
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Term
| ABdominal reflex test is what? |
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Definition
| lightly stroke abdomen on each side, above & below umbilicus. This evaluates the fx of spinal levels. Normally the abdominal muscles contract, umbilicus deviates toward the sd being stimulated. Abdominal reflex may be absent or concealed b/c of obesity or muscular stretching from pregnancies. this is not an abnormality. |
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Term
| What test uses a blunt instrument to write a number, on client's hand & hope they can correctly id? |
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Definition
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Term
| What test identifies familiar object with eyes closed? |
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Definition
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Term
| WHat is the position sense assessment? |
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Definition
| Move fingers on hand up or down (when their eyes are closed) and have them correctly identify which direction. |
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Term
| Is it normal for older clients to have reduced muscle mass? WHy does this happen? |
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Definition
| Yes, degeneration of muscle fibers |
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Term
| Assessment of normal muscle tone finds what? |
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Definition
| relaxed muscles contract voluntarily and show mild, smooth resistance to passive movement. All muscle groups equally strong against resistance, with out flaccidity, spasicity, or rigidity. Soft limp flat muslces are seen with lower motor neuron involvement. spastic muscles involve the corticospinal motor tract. Rigid muscles resist passive movement are abnormalities of pyramidal tract. |
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Term
| What 2 reinforcement techniques can be used to enhance response when attempting to elicit deep tendon reflexes? |
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Definition
| if deep tendon reflexes are diminished or absent-use these reinforcement techniques. When assessing arm reflexes, have client clench their teeth. WHen assessing leg reflexes, have them interlock their hands. Reinforcement techniques may also helo the older client who has difficulty relaxing. |
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Term
| Use the ______ of the hammer to elicit receptors in the skin rather than in the muscles. |
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Definition
| handle, lateral, bigger/back end of reflex hammer |
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Term
| With aging, the lympatic tissue is lost. This results in _____ and _____ lymph nodes in elderly clients. |
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Definition
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Term
| THe presence of peripheral vascular disease varies with geographic location w/ highest in elderly ________ and lowest in Danes. There is intermediate prevalance in americans. |
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Definition
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Term
| Who has less vericose veins, blacks or whites? |
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Definition
| Blacks - have fewer valves in the external iliac veins but considerably more valves in lower legs compared to Caucasians. |
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Term
| Inaccurate findings for capillary refill could be due to: |
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Definition
| room being too cool, patient with anemia, edema or if the client recently smoked a cigarette. it is a vasoconstrictor. |
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Term
| What do you use if you're unable to palpate peripheral pulses? |
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Definition
| A doppler Ultrasound advice |
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Term
| You could cause a false positive in the Allen test by doing what? |
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Definition
| opening the hand into an exaggerated extension that cauess persistent pallor |
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Term
| Hair loss on the lower extremities and is not an absolute sign of arterial insufficiency in an older client. true or false? |
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Definition
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Term
| Bilateral coolness of the feet and legs suggests one of the following... |
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Definition
| room is too cold, client may have recently smoked a cigartette, client is anemic or anxious... they all cause vasoconstriction that cools skin. |
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Term
| If you have difficulty palpating the popliteal pulse, try palpating with the client in the _____ position. Partially raise the leg and place your fingers deep in the knee. |
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Definition
| prone - have them flip over! |
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Term
| It is difficult or impossible to palpate a pulse in an edematous foot or ankle. what do you do? |
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Definition
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Term
| are variscosities common in an older client + normal? |
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Definition
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Term
| When testing for the Homan's sign - what can you do to eliminate confusion btwn calf pain and Achilles tendon pain? |
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Definition
| flex the knee. A second method calls for putting hand under knee, slightly flex it and sharply dorsiflexing the foot. This is controversial b/c if patient could have DVT and could dislodge a clot with this test. we do not perform in HA anymore. |
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Term
| Testing for arterial or venous insufficiency will not be accurate if the patient has _________ ____________ disease of the veins with incompetent valves. |
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Definition
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