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The nurse in the outpatient orthopedic clinic is reviewing the medical records o

by | Jul 31, 2021 | Nursing | 0 comments

 

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The nurse in the outpatient orthopedic clinic is reviewing the medical records of several patients being seen in the clinic today. In the most recent note by the provider, the nurse reads the following:
‘A 67-year-old, moderately obese woman examined today for increasing back and left shoulder pain. Limited circumduction of left arm noted in comparison with right arm. Strength of left arm is less than right, with less muscle definition in the left arm. Examination of back indicates significant kyphosis, and the patient states that she is ‘shrinking.’ Bone density testing of the hip is ordered.”
1. How does the nurse interpret “limited circumduction”
2. When the patient arrives, the nurse correlates the “kyphosis” with what physical finding? What causes kyphosis in the older adult?
3. How should the nurse explain the patient’s decreasing height?
4. What is the rationale for ordering bone density testing of the hip in this patient?
Chapter Reading for assignment
Chapter 40
Assessment of Musculoskeletal Function
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question #1
What is atrophy?
A.Shrinkage-like decrease in the size of the muscle
B.Fluid-filled sac found in connective tissue
C.Rhythmic contraction of muscle
D.Grating or crackling sound or sensation
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Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer to Question #1
A.Shrinkage-like decrease in the size of the muscle.
Atrophy is shrinkage-like decrease in the size of the muscle. Bursa is a fluid-filled sac found in connective tissue. Clonus is rhythmic contraction of muscle. Crepitus is a grating or crackling sound or sensation.
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Functions of the Musculoskeletal System
●Protection of vital organs
●Mobility and movement
●Facilitate return of blood to the heart
●Production of blood cells (hematopoiesis)
●Reservoir for immature blood cells
●Reservoir for vital minerals
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Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Structure
●206 bones in the body
oLong bones
oShort bones
oFlat bones
oIrregular bones
●Joints
●Muscles
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Structure of a Long Bone; Composition of Compact Bone
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Bone Cells
●Osteoblasts
oFunction in bone formation
●Osteocytes
oMature bone cells that function in bone maintenance
oLocated in the lacunae
●Osteoclasts
oMultinuclear cells function in destroying, resorbing, and remodeling bone
oLocated in Howship’s lacunae
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Bone Formation and Maintenance
●Osteogenesis: process of bone formation
oOssification: the process of formation of the bone matrix and deposition of minerals
●Bone is in constant state of turnover
●Regulating factors
oStress and weight bearing
oVitamin D
oParathyroid hormone and calcitonin
oBlood supply
●Role of calcium
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Bone Healing
●Hematoma and inflammation
●Angiogenesis and cartilage formation
●Cartilage calcification
●Cartilage removal
●Bone formation
●Remodeling
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question #2
Is the following statement true or false?
Epiphysis is the bone-forming cell.
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Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer to Question #2
False
Epiphysis is the end of a long bone. Osteoblast is a bone-forming cell.
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Joints (Articulation): Junction of Two or More Bones
●Synarthrosis: immovable joints
●Amphiarthrosis: allow limited movement
●Diarthrosis: freely movable
oBall and socket
oHinge
oSaddle
oPivot
oGliding
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Hinge Joint of the Knee
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Muscles
●Attached to bones and other structures by tendons
●Encased in a fibrous tissue—fascia
●Contraction of muscle causes movement
●Sarcomere: the contractile unit of skeletal muscle that contains actin and myosin
●Muscle cell fibers react to electrical stimulation
●Contraction uses energy in the form of ATP
●Anaerobic pathways using glucose metabolized from stored glycogen provide energy for more strenuous muscle activity
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Muscle Maintenance
●Muscle tone
●Muscle actions
●Exercise, disuse, and repair
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question #3
Is the following statement true or false?
Bone is in a constant state of turnover.
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer to Question #3
True
Bone is in a constant state of turnover.
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Assessment of the Musculoskeletal System
●Include data related to function ability; ADLs, IADLS, and ability to perform various activities; note any problems related to mobility
●Health history: family history, general health maintenance, nutrition, occupation, learning needs, socioeconomic factors, and medications (include OTC)
●Assessment of pain and altered sensations
●Physical assessment: posture, gait, bone integrity, joint function, muscle strength and size, skin, neurovascular status
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Normal Spine and Three Abnormalities
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Detecting Fluid in the Knee
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Rheumatoid Arthritis—Ulnar Deviation and “Swan-Neck” Deformity
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Diagnostic Evaluation
●Radiographs
●Computed tomography
●MRI
●Arthrography
●Bone densitometry
●Bone scan
●Arthroscopy
●Arthrocentesis
●Electromyography
●Biopsy
●Laboratory studies
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question #4
Which statement is false about magnetic resonance imaging?
A. Credit cards with magnetic strips may be erased.
B. Nonremovable cochlear implant devices can become inoperable.
C. Transdermal patches that have a thin layer of aluminized back must be covered with gauze.
D. Jewelry and hair clips must be removed before the MRI is performed.

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