Changes with Age
Muscle Atrophy
Decreased Bone Density
Cartilage degeneration
Increased bone prominence
Kyphosis
Decreased ROM
Slowed Movement
Decreased bone density
Teach safety tips to prevent falls.
Porous bones are more likely to fracture.
Reinforce need to exercise, especially weight-bearing exercise.
Exercise slows bone loss.
Increased bone prominence
Prevent pressure on bone prominences.
There is less soft tissue to prevent skin breakdown.
Kyphotic posture:
widened gait, shift in the center of gravity
Teach proper body mechanics; instruct the patient to sit in supportive chairs with arms.
Correction of posture problems prevents further deformity; the patient should have support for bony structures.
Cartilage degeneration
Provide moist heat, such as a shower or warm, moist compresses.
Moist heat increases blood flow to the area.
Decreased range of motion (ROM)
Assess the patient's ability to perform ADLs and mobility.
The patient may need assistance with selfcare skills.
Muscle atrophy
, decreased strength
Teach isometric exercises.
Exercises increase muscle strength
Slowed movement
Do not rush the patient; be patient.
The patient may become frustrated if hurried.
Diagnostic Assessment
Laboratory tests:
serum calcium
Serum phosphorus
alkaline phosphatase (ALP)
serum muscle enzymes
Creatine Kinase (CK)
Lactate dehydrogenase (LDH)
Aspartate aminotransferase (AST)
Aldolase (ALD)
Serum calcium
9.0-10.5 mg/dL (2.25-2.75 mmol/L)
Older adults: decreased
Hypercalcemia (increased calcium)
�Metastatic cancers of the bone
�Paget's disease
�Bone fractures in healing stage
Hypocalcemia (decreased calcium)
�Osteoporosis
�Osteomalacia
Serum phosphorus
3.0-4.5 mg/dL (0.97-1.45 mmol/L)
Older adults: decreased
Hyperphosphatemia (increased phosphorus)
�Bone fractures in healing stage
�Bone tumors
�Acromegaly
Hypophosphatemia (decreased phosphorus)
�Osteomalacia
Alkaline phosphatase (ALP)
30-120 units/L
Older adults: slightly increased
Elevations may indicate:
*Metastatic cancers of the bone
�Paget's disease
�Osteomalacia
Creatine kinase (CK)
Total CK:
Men: 55-170 units/L
Women: 30-135 units/L
Elevations may indicate:
�Muscle trauma
�Progressive muscular dystrophy
�Effects of electromyography
Lactate dehydrogenase (LDH)
Total LDH: 100-190 units/L
LDH1: 17%-27%
LDH2: 27%-37%
LDH3: 18%-25%
LDH4: 3%-8%
LDH5: 0% to 5%
Elevations may indicate:
�Skeletal muscle necrosis
�Extensive cancer
�Progressive muscular dystrophy
Aspartate aminotransferase (AST)
0-35 units/L
Older adults: increased
Elevations may indicate:
�Skeletal muscle trauma
�Progressive muscular dystrophy
Aldolase (ALD)
3.0-8.2 units/Dl
Elevations may indicate:
�Polymyositis and dermatomyositis
�Muscular dystrophy
Diagnostic Assessment
Radiographic examinations�
standard radiography,
bone density,
tomography and
xeroradiography,
myelography,
arthrography
Computerized Tomography CT
Other diagnostic tests�bone and muscle biopsy
Nuclear Scans
Bone
Gallium/Thallium
Radiographic examination:
Standard radiography
Anteroposterior and lateral projections are initial screening view
� Observations of bone density, alignment, swelling, and intactness are made.
� Other determinations: size of joint space, smoothness of synovial swelling
Radiographic examination:
bone density test- DEXA
low energy x-rays are taken of bones in the spinal column, pelvis, and wrist to determine bone density; also called dual energy x-ray absorptiometry (DEXA or DXA)
Radiographic examination:
tomography
radiographic technique that produces an image representing a detailed cross-section, or slice, of an area, tissue, or organ at a predetermined depth
Radiographic examination:
xeroradiography
A diagnostic X-ray technique in which an image is produced electrically rather than chemically. It permits shorter exposure times and lower radiation levels than ordinary X-rays. It is also called xerography. Xeroradiography is used primarily for mammogra
Radiographic examination:
myleography
a type of a x-ray of the interior of the interior of the spinal chord used to detect growth or displacement of the verbal column
Radiographic examination:
arthrography
Radiography of a joint with or without injection of a radiolucent or radiopaque contrast medium.
Radiographic examination:
Computerized Tomography CT
A noninvasive technique for examining brain structure in humans through computer analysis of X-ray absorption at several positions around the head.
Other diagnostic tests:
bone biopsy
Surgical procedure in which bone marrow is removed and examined
Other diagnostic tests:
muscle biopsy
Removal of muscle tissue for microscopic examination
Nuclear Bone Scan:
ionizing imaging technique using radioactive isotopes
Nuclear Gallium Thallium Scan
SIMILAR to bone scan; Isotope is injected 1-2 days before scan, isotope deteriorates in the body
Magnetic Resonance Imaging (MRI)
With or without contrast
Contraindications
Patient Teaching
Electromyography
EMG aids in the diagnosis of neuromuscular, lower motor neuron, and peripheral nerve disorders; usually with nerve conduction studies.
Low electrical currents are passed through flat electrodes placed along the nerve.
If needles are used, inspect needle s
Arthroscopy
Fiberoptic tube is inserted into a joint for direct visualization.
Patient must be able to flex the knee; exercises are prescribed for ROM.
Evaluate the neurovascular status of the affected limb frequently.
Analgesics are prescribed.
Monitor for complicat
The charge nurse in the hospital-based day surgery center is making client assignments for the staff. Which client is most appropriate to assign to a nurse who has floated from the general surgical unit?
A. Young adult who has just been admitted for surge
Older adult who has undergone arthroscopic surgery of the shoulder under local anesthesia
The ambulatory surgery postanesthesia care unit (PACU) nurse has just received report about clients who had arthroscopic surgery. Which client will the nurse plan to assess first?
A. Young adult client who has been in the PACU for 30 minutes after left kn
Middle-aged adult client who returned to the PACU 25 minutes ago after left knee arthroscopic surgery under epidural anesthesia.
The nurse is completing an admission assessment on a client scheduled for arthroscopic knee surgery. Which information will be most essential for the nurse to report to the health care provider?
A. Knee pain at a level 9 (0 to 10 scale)
B. Warm, red, and
Warm, red, and swollen knee
The nurse is reviewing the medication history for a client scheduled for a left total hip replacement. The nurse plans to contact the physician if the client is taking which medication?
A. Acetaminophen (Tylenol) for pain relief
B. Bupropion (Wellbutrin)
Prednisone (Deltasone) to treat asthma
A diabetic older adult client who had arthroscopic surgery on the right knee the previous day has a red, swollen, and painful right knee. The nurse anticipates that the physician will request which medication?
A. Levofloxacin (Levaquin)
B. Enoxaparin (Lov
Levofloxacin (Levaquin)
When assessing a female client, the nurse learns that the client has several risk factors for osteoporosis. Which risk factor will be the priority for client teaching?
A. Low calcium intake
B. Postmenopausal status
C. Positive family history
D. Previous u
Low calcium intake
Which client information is most essential for the nurse to report to the physician before a client with knee pain undergoes magnetic resonance imaging (MRI)?
A. Daily use of aspirin (Ecotrin)
B. Swollen and tender knee
C. The client has a permanent pacem
The client has a permanent pacemaker.
Which aspect of a musculoskeletal assessment will the physical therapist and the nurse plan to collaborate on?
A. The need for ambulatory devices
B. Medication that the client is currently taking
C. Nutritional intake of the client before admission
D. Cur
The need for ambulatory devices
Which diagnostic test requires the nurse to know whether the client is allergic to iodine-based contrast?
A. Arthroscopy
B. Computed tomography (CT)
C. Electromyography (EMG)
D. Tomography
Computed tomography (CT)
The client is suspected of having muscular dystrophy (MD). For which laboratory test does the nurse anticipate seeing an abnormal result?
A. Decreased serum creatine kinase (CK) level
B. Moderately elevated aspartate aminotransferase (AST)
C. Decreased al
Moderately elevated aspartate aminotransferase (AST)
The client is scheduled to undergo closed magnetic resonance imaging (MRI) without contrast medium. Which information does the nurse give to the client before the test?
A. "It will be important to lie still in a reclined position for 20 minutes."
B. "Do n
All jewelry and clothing with zippers or metal fasteners must be removed.
The client recently has had an amputation of the right hand. Which statement by the client, who was right-handed, indicates that he or she is coping effectively?
A. "I can learn to write with my left hand."
B. "I'll need help with all my personal care."
C
I can learn to write with my left hand.
The client experiencing kyphosis appears withdrawn and does not initiate any conversation with the nurse when medications are given each day. Which statement by the nurse is most supportive of this client?
A. "It is normal to feel depressed at times about
How do you feel about the pain in your spine? I am here if you want to talk.
The nursing student is studying the skeletal system. Which statement indicates to the nursing instructor that the student understands a normal physiologic function of the skeletal system?
A. "Volkmann's canals connect osteoblasts and osteoclasts."
B. "In
Hematopoiesis occurs in the red marrow, which is where blood cells are produced.
The nurse understands that care of the older adult may be affected by which physiologic change in the musculoskeletal system?
A. Regeneration of cartilage
B. Decreased range of motion (ROM)
C. Increased bone density
D. Narrower gait
Decreased range of motion (ROM)
The nurse is conducting a musculoskeletal history in the older adult client who requires a caregiver to perform all activities of daily living. Which level of functioning does the nurse record in the client's history using Gordon's Functional Health Patte
Level IV-is dependent and does not participate
The nurse plans to use which tool to measure joint range of motion (ROM)?
A. Doppler
B. Goniometer
C. Reflex hammer
D. Tonometer
Goniometer
The 65-year-old female client has chronic hip pain and muscle atrophy from an arthritic disorder. Which musculoskeletal assessment finding does the nurse expect to see in the client?
A. Antalgic gait
B. Midswing gait
C. Narrow-based stance
D. No lurch in
Antalgic gait
The nurse is using Lovett's scale to grade a client's muscle strength. The client is able to complete range of motion (ROM) with gravity eliminated. Which grade will the nurse document in this client's record?
A. 0
B. 1
C. 2
D. 3
2