Exam 5 Study Guide
Assessment
Six P’s
A. Pain
B. Pulselessness
C. Pallor
D. Parathesia
E. Paralysis
F. Pokliothermia
i. neurovascular assessment of injury
ii. key for compartment syndrome – one or more of 6 P’s will be present in Compartment Syndrome
ABC’s first
G. In all critical situations and in any assessment Airway, Breathing, Circulation ALWAYS is the order of
priority
H. The airway is always your first priority in any emergency situation. If an airway is blocked, oxygen cannot
reach the lungs. The second priority is to assess whether the patient is actually breathing. Then the patient’s
circulation is assessed by determining if they have a pulse
Causes/exacerbation of musculoskeletal problems
Subjective data for assessment – past health hx- diseases that directly or indirectly affect: TB,
poliomyelitis, parathyroid problems, hemophilia, rickets, soft tissue infection, & neuromuscular disabilities
– also ? about s/sx of arthritis, connective tissue diseases, osteomalacia, osteomyelitis, bacterial or fungal
infections
o Meds that can affect musculoskeletal – antiseizure drugs (osteomalacia), phenothiazines (gait disturbances),
corticosteroids (avascular necrosis, decreased bane and muscle mass), potassium-depleting diuretics (muscle cramps
weakness)
o Period of prolonged immobilization – development of osteoporosis and muscle atrophy
Acute low back pain:
- causes- usu. some type of activity that causes undue stress (usu. hyperextension) of tissues of lower back – straight leg raise
test. exacerbation – obesity, improper body mechanics, sleeping in prone position, smoking,
Chronic low back pain:
- causes – degenerative disk disease, lack of physical exercise, prior injury, obesity, structural and postural abnormalities,
systemic disease, osteoarthritis
- Exacerbation- cold, damp weather, same as acute lower back pain
Intervertebral Disk Disease:
causes: degenerative: aging – losing elasticity, flexibility, shock-absorbing capabilities – herniated – can be
result of natural degeneration with age or repeated stress
Foot Disorders:
causes- congenital conditions, structural weakness, traumatic injuries, systemic conditions: diabetes and RA
–
exacerbations- improperly fitting shoes causing crowding and angulation of the toes and inhibition of the
normal movement of the muscles
Osteomalacia:
- causes- vitamin D deficiency causing a decalcification and softening of the bone, lack of exposure to UV rays, GI
malabsorption on D, extensive burns, chronic diarrhea, pregnancy, kidney disease, meds: phenytonin (Dilantin)
Osteoporosis:
- causes- chronic, progressive metabolic bone disease
- exacerbation- female, over 65, inadequate calcium intake, pregnancy and breastfeeding, asian or Caucasian
Paget’s disease:
- causes- genetic or viral – not fully known
- exacerbation- poor body mechanics, poor muscle strength and tone, improper nutrition (D, calcium, protein), activities
involving lifting and twisting
Geriatric changes
o Aging may result in complications that cause mild pain or could be severe enough to interfere with ADLs.
o Risks for falls increases: loss of strength, change in balance-alters gait and proprioception
o Bone remodeling – increased bone resorption and decreased bone formation = loss of bone density osteopenia,
osteoporosis
o Loss of muscle mass and muscle strength – 30% of muscle mass lost by 70
o Loss of motor neurons
o Tendons and ligaments = less flexible, movement= more rigid
o Joints more likely to be affected by osteoarthritis
o Perform assessment c emphasis on exercise practices
, o Assess impact age-related changes on musculoskeletal func.
o TABLE 62-1 pg 1573 Lewis
o Other info on gerontological considerations not related to assessment: pg1607 hip fracture; pg1614 amputation;
pg1634 foot disorders; pg 1638 metabolic bone disorders
Immobility
Transfers
o Maintain an erect trunk posture
o Get pt as close to you as possible and squat instead and bend
o Get chairs as high as they can be to help with pt mobility/transfers
High toilet seats/bedside commodes
Extended tub bench
Wheelchairs
o Sit-to-Stand
Position chair at an angle instead of parallel to the bed
Put the pt’s strong side by the bedside
Make sure that the bed is flat (Be extra cautious when moving pt to an air mattress)
Position pt to the edge of the seat
DON’T pull pt’s up by their arms. Pull them up by their trunk by a gait belt (or diaper, etc if necessary)
DON’T let them put their arms around your neck to pull up
Make sure the pt can see where they are moving
Use Low-Bottom or Standing Pivot transfers
Tell pt to lean forward and push with arms and legs to push back on bed
Make sure catheters, IV’s, etc move with the pt
o Sitting
Make sure the pt feels the back of their legs on what they are about sit on before they sit
Make sure hips are positioned all the way back into the chair
There should be a few finger-widths between the back of the knees and the chair
Put pillows in/around the seat if the pt is very small and the chair is very large
Ok for pt to use feet to move around
TO STAND
Make sure brakes work
Tell pt to put feet behind knees and to lean forward when getting up
Increasing activity precautions
o Assess for Orthostatic HTN when pt gets up suddenly
o Tell pt’s not to do more than they are capable of doing
Crutch walking
o Usually for younger adults or active older adults
o When going to sit, put both crutches to the side then reach back and touch what you are going to sit on to guide you
down
o Position crutches at 15-30° angle, have 3 finger-widths below the armpits to get the correct length, and have a 30°
bend in the elbow
o Improper crutch usage and position can cause nerve damage
o Pull into the ribcage from arms
o TTWB – Toe touch weight bearing
o WBAT – Weight bearing as tolerated
o When using one crutch – put it on the unaffected side of the body
o STAIRS
Up with good leg first
Down with bad leg first
Bring crutches down first
It’s harder to go down than up
Cane
- Straight cane
Make sure the pt has enough balance to use it
Use the bend in the wrist to greater trochanter to guide where the top of the cane should hit
Not used often in acute care settings
o 4-Prong cane
Place the longer legs facing away from feet so the pt doesn’t trip over them
Assessment
Six P’s
A. Pain
B. Pulselessness
C. Pallor
D. Parathesia
E. Paralysis
F. Pokliothermia
i. neurovascular assessment of injury
ii. key for compartment syndrome – one or more of 6 P’s will be present in Compartment Syndrome
ABC’s first
G. In all critical situations and in any assessment Airway, Breathing, Circulation ALWAYS is the order of
priority
H. The airway is always your first priority in any emergency situation. If an airway is blocked, oxygen cannot
reach the lungs. The second priority is to assess whether the patient is actually breathing. Then the patient’s
circulation is assessed by determining if they have a pulse
Causes/exacerbation of musculoskeletal problems
Subjective data for assessment – past health hx- diseases that directly or indirectly affect: TB,
poliomyelitis, parathyroid problems, hemophilia, rickets, soft tissue infection, & neuromuscular disabilities
– also ? about s/sx of arthritis, connective tissue diseases, osteomalacia, osteomyelitis, bacterial or fungal
infections
o Meds that can affect musculoskeletal – antiseizure drugs (osteomalacia), phenothiazines (gait disturbances),
corticosteroids (avascular necrosis, decreased bane and muscle mass), potassium-depleting diuretics (muscle cramps
weakness)
o Period of prolonged immobilization – development of osteoporosis and muscle atrophy
Acute low back pain:
- causes- usu. some type of activity that causes undue stress (usu. hyperextension) of tissues of lower back – straight leg raise
test. exacerbation – obesity, improper body mechanics, sleeping in prone position, smoking,
Chronic low back pain:
- causes – degenerative disk disease, lack of physical exercise, prior injury, obesity, structural and postural abnormalities,
systemic disease, osteoarthritis
- Exacerbation- cold, damp weather, same as acute lower back pain
Intervertebral Disk Disease:
causes: degenerative: aging – losing elasticity, flexibility, shock-absorbing capabilities – herniated – can be
result of natural degeneration with age or repeated stress
Foot Disorders:
causes- congenital conditions, structural weakness, traumatic injuries, systemic conditions: diabetes and RA
–
exacerbations- improperly fitting shoes causing crowding and angulation of the toes and inhibition of the
normal movement of the muscles
Osteomalacia:
- causes- vitamin D deficiency causing a decalcification and softening of the bone, lack of exposure to UV rays, GI
malabsorption on D, extensive burns, chronic diarrhea, pregnancy, kidney disease, meds: phenytonin (Dilantin)
Osteoporosis:
- causes- chronic, progressive metabolic bone disease
- exacerbation- female, over 65, inadequate calcium intake, pregnancy and breastfeeding, asian or Caucasian
Paget’s disease:
- causes- genetic or viral – not fully known
- exacerbation- poor body mechanics, poor muscle strength and tone, improper nutrition (D, calcium, protein), activities
involving lifting and twisting
Geriatric changes
o Aging may result in complications that cause mild pain or could be severe enough to interfere with ADLs.
o Risks for falls increases: loss of strength, change in balance-alters gait and proprioception
o Bone remodeling – increased bone resorption and decreased bone formation = loss of bone density osteopenia,
osteoporosis
o Loss of muscle mass and muscle strength – 30% of muscle mass lost by 70
o Loss of motor neurons
o Tendons and ligaments = less flexible, movement= more rigid
o Joints more likely to be affected by osteoarthritis
o Perform assessment c emphasis on exercise practices
, o Assess impact age-related changes on musculoskeletal func.
o TABLE 62-1 pg 1573 Lewis
o Other info on gerontological considerations not related to assessment: pg1607 hip fracture; pg1614 amputation;
pg1634 foot disorders; pg 1638 metabolic bone disorders
Immobility
Transfers
o Maintain an erect trunk posture
o Get pt as close to you as possible and squat instead and bend
o Get chairs as high as they can be to help with pt mobility/transfers
High toilet seats/bedside commodes
Extended tub bench
Wheelchairs
o Sit-to-Stand
Position chair at an angle instead of parallel to the bed
Put the pt’s strong side by the bedside
Make sure that the bed is flat (Be extra cautious when moving pt to an air mattress)
Position pt to the edge of the seat
DON’T pull pt’s up by their arms. Pull them up by their trunk by a gait belt (or diaper, etc if necessary)
DON’T let them put their arms around your neck to pull up
Make sure the pt can see where they are moving
Use Low-Bottom or Standing Pivot transfers
Tell pt to lean forward and push with arms and legs to push back on bed
Make sure catheters, IV’s, etc move with the pt
o Sitting
Make sure the pt feels the back of their legs on what they are about sit on before they sit
Make sure hips are positioned all the way back into the chair
There should be a few finger-widths between the back of the knees and the chair
Put pillows in/around the seat if the pt is very small and the chair is very large
Ok for pt to use feet to move around
TO STAND
Make sure brakes work
Tell pt to put feet behind knees and to lean forward when getting up
Increasing activity precautions
o Assess for Orthostatic HTN when pt gets up suddenly
o Tell pt’s not to do more than they are capable of doing
Crutch walking
o Usually for younger adults or active older adults
o When going to sit, put both crutches to the side then reach back and touch what you are going to sit on to guide you
down
o Position crutches at 15-30° angle, have 3 finger-widths below the armpits to get the correct length, and have a 30°
bend in the elbow
o Improper crutch usage and position can cause nerve damage
o Pull into the ribcage from arms
o TTWB – Toe touch weight bearing
o WBAT – Weight bearing as tolerated
o When using one crutch – put it on the unaffected side of the body
o STAIRS
Up with good leg first
Down with bad leg first
Bring crutches down first
It’s harder to go down than up
Cane
- Straight cane
Make sure the pt has enough balance to use it
Use the bend in the wrist to greater trochanter to guide where the top of the cane should hit
Not used often in acute care settings
o 4-Prong cane
Place the longer legs facing away from feet so the pt doesn’t trip over them
