The nurse takes a 4-year-temperature old's in order to use a electronic infrared thermometer. Play-based methods are employed to assess toddlers and preschoolers.
Describe a little child?A few examples of developmental milestones are learning to walk, smiling for the first time, and waving good-bye.
A child has accomplished a significant developmental step in their growth as just a player, student, speaker, and human when they can walk, run, or leap.
During their second year of life, toddlers walk around more and grow more aware of their surroundings. Tooler is a young toddler who walks.
What is a milestone?A milestone is a place of reference that marks a significant event or a turning point in a project. The beginning or conclusion of a crucial project phase, such as the "planning phase" or "designing phase.
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the nurse is assisting with the end-of-life care of a client. which activity is performed when the nurse views family as context?
The nurse primarily concentrates on the client's comfort, hygiene, and dietary needs when considering family as backdrop. Focusing on a client's health and development includes using the family as a setting.
Health is "a condition of total physical, mental, and social well-being and not only the absence of disease or disability," according to the World Health Organization. Over time, several definitions have been employed for various objectives. Healthy behaviors can be encouraged, such as regular exercise and getting enough sleep, while unhealthy behaviors, such as smoking or high levels of stress, can be reduced or avoided.
Some factors that affect health are caused by personal decisions, such as whether to engage in a high-risk habit, while others are the result of structural factors, such as how society is structured and how easy or difficult it is for individuals to get essential healthcare services.
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When a nurse views family as context in end-of-life care, they may take a holistic approach to ensure that the physical, emotional, and spiritual needs of the client and their family are met.
This might include providing emotional support for the family, helping them to understand the process, and providing resources to assist them in their grief. The nurse may also coordinate care with other healthcare providers to ensure that the client's wishes are respected.
The nurse may also provide education to the family on the stages of dying, how to recognize signs of decline, and how to care for the client. Lastly, the nurse may provide resources for family members to help them cope with the loss.
By viewing family as context, the nurse can provide comprehensive and compassionate care for the client and their family during the end-of-life journey.
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how would you administer a drug if you wanted to avoid all natural barriers that can slow absorption?
To avoid all the natural barriers that slow down the absorption, drug should be administered intravenously.
Drug refers to the chemical substances that are used as medication to treat several body conditions and diseases. Although drugs are broadly used as medication, however they have the potential to overpower the body and mind when consumed in more quantities.
Intravenous refers to the administration of drugs, medicines or fluids into the body by the means of veins. A needle or tube is inserted inside the vein for the administration. Intravenous in literal meaning is into or within the veins. Intravenous is abbreviated as IV.
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on admission of an older dehydrated adult from the extended care facility, the nurse notes a history of liquid fecal incontinence. which nursing intervention will facilitate identifying the cause of the client's incontinence?
The nursing intervention will facilitate identifying the cause of the client's incontinence is perform a digital rectal examination.
Which intervention would be a part of the treatment strategy for preventing pressure injuries?The analysis found that the best approaches for reducing pressure injuries fall into four categories: PI prevention bundles, surface support, repositioning, preventing pressure injuries caused by medical devices, and access to expertise are only a few examples.
Which discoveries in the older client are connected to urethritis?Burning discomfort that is either new or worsens with urine, frequency, or urgency. new discomfort or pain in the suprapubic region. Urine's characteristics change. deterioration of mental or functional condition (includes new or increased incontinence).
What nursing practice is crucial for the prevention and management of pressure ulcers?A patient repositioning plan, keeping the head of the bed at the lowest safe elevation to reduce shear, utilizing pressure-reducing surfaces, monitoring nutrition, and administering supplements as necessary are just a few examples of the preventative actions that can be taken.
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(ATI Pharmacology Made Easy 4.0 Cardiovascular System)
A nurse is caring for a client who is taking a diuretic. The nurse should instruct the client to include which of the following foods in their diet to increase potassium intake?
A) Raisins
B) Cabbage
C) Cheese
D) Eggs
The response that is accurate is (A) Raisins.
What is the purpose of a diuretic?Diuretics, often known as water pills, aid in the removal of salt (salt) and the body's retention of water. The majority of these drugs stimulate your kidneys to excrete more salt in your urine. By assisting in the removal of water from your circulation, salt aids to reduce the volume of fluid moving throughout the arteries and veins. Blood pressure falls as a result.
A diuretics, is coconut water?When used to treat hypertension, coconut water can considerably lower blood pressure and increase urine, which suggests that it may have diuretic effects without causing an electrolyte imbalance. Diuretics may need to be taken once or twice each day at the same time every day.
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which professional association was founded to improve the quality of medical records and current advances toward an electronic and global environment, such as the implementation of icd-10-cm?
The initial objective of the Society of Record Library professionals of North America, founded in 1928, was to raise the requirements for healthcare information in healthcare organizations.
What system of coding do diseases and disorders currently employ in an outpatient setting?Physicians and other healthcare professionals use the ICD-10-CM International Classification, Tenth Revision, Clinical Standard system to categorize and code all diagnoses, symptoms, and procedures documented in connection with hospital in the United States.
What kinds of codes are employed to report the supplies that patients receive in a hospital setting?The Healthcare Common Practice Compression Algorithm (HCPCS) is a set of codes that denotes treatments, products, and services that may be given to Eligible individuals and people enrolled in Medicaid.
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which characteristics of the nursing process allow the nurse to effectively apply critical thinking to patient care?
The characteristics of the nursing process that allow the nurse to effectively apply critical thinking to patient care are:
Think analyticallyFlexibleOpen mindedApply the knowledgeOrganizedWhy the nurse has to have critical thinking to patient care?Nurse is autonomous and collaborative care for individuals of all ages, groups, families and communities, well or sick and in all settings. When facing a patient in patient care, nurse has to think that patient has no knowledge in their health condition so that they has to start explain and question them in a way that they could understand. Because this process is critical to determine their sickness and their healing process, the nurse is demand to have critical thinking to avoid wrong diagnosis.
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Which of the following is not required by the employer following an exposure incident to human blood or OPIM?
After an exposure episode involving human blood or OPIM, the employer does not demand a yearly physical. The exposed employee must be referred to a qualified healthcare provider by the dental employer.
This refers to a person who is authorized to independently offer the post-exposure evaluation and follow-up services demanded by the standard and is in possession of the necessary licensing under the laws of the state where they conduct business. The medical practitioner will provide the patient advice on what happened and how to stop any potential illness from spreading further. The qualified healthcare provider will also assess any disease that has been reported to see if the signs and symptoms could point to an infection with the HIV virus or the hepatitis B virus.
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The complete question is:
Which of the following is not required by the employer following an exposure incident to human blood or OPIM?
An annual medical physical.
Immediately wash the exposed area with soap and water (or use an eye wash for 15 minutes).
Seek medical follow-up at the designated emergency healthcare location.
Despite direct pressure, a large laceration continues to spurt large amounts of bright red blood. You should:
If a large laceration continues to spurt large amounts of bright red blood despite direct pressure, it is likely that an artery is involved.
In this case, when artery is ruptured the right course of action would be to:
Keep applying direct pressure to the wound, and if at all feasible, elevate the leg.If there are no other options, apply a tourniquet close to the wound.Make an urgent call for medical aid.To be transported to the closest emergency facility, the patient should be prepared.It's crucial to keep in mind that placing a tourniquet should only be done as a last resort and for a brief period of time because, if left on for too long, it might harm the limb.
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which food would the nurse determine is appropriate for an 8-month-old infant? select all that apply. one, some, or all responses may be correct.
Formula or breast milk (as the primary source of nutrition).
Iron. Enriched cereals, purified veggies and fruits.
Puréed poultry or meats like turkey or lentils Puréed legumes like peas or lentils.
Blended avocado.
Simple yogurt.
Miniscule quantities of pasteurized cheese.
It's crucial to remember that 8-month-old babies are still nursing or receiving formula as their primary source of nourishment, so the quantity of solid food they ingest should start off small and be progressively increased as they become bigger and learn to chew and swallow. The meal should be suitable for their developmental stage, soft, simple to swallow, and free of salt, sugar, or honey additions. For individualized treatment, the parents ought to speak with a pediatrician or a dietician.
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The given question is incorrect, the correct question is:
A nurse is discussing the diet of an 8-month-old infant with the parents. Which foods can an infant of this age on a regular diet safely be fed? Select all that apply.
1 Whole milk
2 Pureed pears
3 Pureed carrots
4 Soft-boiled eggs
5 Mashed sweet potatoes
a client with stomach cancer expresses a lack of interest in food and consumes only small amounts. which nursing intervention is best for meeting the dietary needs for this client?
A client with a diagnosis of stomach cancer expresses a lack of interest in food and consumes only small amounts.
What's the difference between diagnosis and diagnoses?The plural form is diagnoses, pronounced [ dahy-uhg-noh-seez ]. The verb form is diagnose. A doctor can be said to diagnose an illness or a patient but the meaning is the same—to diagnose is to give a diagnosis of what specific condition is affecting the patient.
What are the two types of diagnosis?Clinical diagnosis. A diagnosis made on the basis of medical signs and reported symptoms, rather than diagnostic tests. Laboratory diagnosis. A diagnosis based significantly on laboratory reports or test results, rather than the physical examination of the patient.
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isotretinoin is prescribed for a client to treat severe cystic acne. the nurse tells the client that the length of the usual prescribed course of treatment is which?
For a patient with severe acne, tetracycline is administered. The nurse informs the patient of the significance of reporting any findings if they are brought on by persistent diarrhea.
As well as a number of other bacterial illnesses carried through ticks, lice, mites, infected animals, and the lymphatic, intestinal, vaginal, and urinary systems, tetracycline is used to treat them. Pneumonia and other respiratory tract infections are among these illnesses. Negative side effects frequently include nausea, diarrhea, rash, and lack of appetite. Your body is made up of your skin, hair, nails, and the glands and nerves that are found directly beneath your surface. The integumentary system of your body acts as a physical barrier to ward off pathogens, infections, damage, and sunlight.
This system not only acts as a barrier, but also manages the body's temperature and keeps cell fluid at a certain level.
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a community nurse is planning fall prevention education in a local community. the nurse would present the educational plan in what order?
The nurse would offer the educational strategy by first creating a multilingual questionnaire that evaluates the necessity for a falls prevention program, as well as participant demographics and other challenges.
A nurse will take blood pressure and provide participants a fall efficacy scale to provide data and information to measure immediately following intervention. Before advocating new solutions and behaviour, the nurse will explain about medication side effects, proper food, or health resource information. Nurse unwell with demonstrations of tai chi, yoga, and swimming.
All therapies should contain an appraisal for process improvement, as well as a collection of follow-up suggestions. Community health needs assessment is critical in helping practitioners, managers and policymakers to identify people in most need and to guarantee that they get assistance that health-care resources be used to the greatest extent possible to improve health. It is an essential health care planning tool for families, communities, and populations.
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a client who smokes heavily is prescribed a high-calorie, high-protein diet. the nurse would encourage the client to eat foods that are high in which vitamin?
It would be suggested to a customer who smokes a lot and is on a high-calorie, high-protein diet to consume foods high in vitamin C. Vitamin C levels in smokers are lower than in non-smokers, according to study, since smoking depletes vitamin C levels in the body.
Collagen, a substance required for the growth and repair of tissues including skin, tendons, ligaments, cartilage, and blood vessels, is produced in part by the antioxidant vitamin C. Additionally, iron, which is necessary for the creation of red blood cells and the transportation of oxygen to the body's tissues, may be absorbed more easily with the help of vitamin C. Citrus fruits, berries, kiwis, melons, tomatoes, and bell peppers are all excellent sources of vitamin C in the diet.
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the nurse is preparing discharge instructions for a client who acquired a nosocomial clostridium difficile infection. which would the nurse include in the instructions?
the nurse is preparing discharge instructions for a client who acquired a nosocomial clostridium difficile infection: The infection causes diarrhea accompanied by flatus and abdominal discomfort.
What is clostridium difficile infection?Feces include spores and germs from the Clostridium difficile bacterium. When feces-contaminated surfaces are touched and subsequently the mouth is touched, people can become ill. If healthcare workers' hands are infected, they risk passing the infection to their patients.
Most Clostridium diff infections take place while you are taking antibiotics or shortly after you stop taking them. Additional risk factors include ageing 65 or more. recent stay at a nursing home or hospital The most prevalent cause of nosocomial infectious diarrhea is now understood to be C difficile. Up to 25% of instances of diarrhea brought on by antibiotics are caused by it.
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The complete question is as follows:
The nurse is preparing discharge instructions for a client that acquired a nosocomial infection, Clostridium difficile. What should the nurse include in the instructions?
1.Anticipate that nausea and vomiting will continue until the infection is no longer present.
2.The infection causes diarrhea accompanied by flatus and abdominal discomfort.
3.Consume a diet that is high in fiber and low in fat.
4.Other than routine handwashing, it is not necessary to perform special disinfection procedures
which process allows glycolysis to continue in the absence of oxygen?
Answer: Fermentation :)
a client with a methicillin-resistant staphylococcus aureus (mrsa) infected wound is scheduled for a computed tomography (ct) scan. to ensure client and visitor safety during transport, the nurse would implement which precaution?
Put a dressing over the affected area. A computed tomography (ct) scan is arranged for a patient who has a wound infection caused by methicillin-resistant staphylococcus aureus (mrsa).
How can one get MRSA?MRSA often spreads throughout a community through contact with infected individuals or objects. This includes coming into contact with an infected wound or sharing private things like towels or razors that have come into contact with diseased skin.
Can MRSA spread quickly?MRSA may infect anyone. The severity of infections can range from minor to extremely serious or even fatal. Skin-to-skin contact is how MRSA gets transmitted to other people since it is infectious. A family may get MRSA if one member of the group has the disease.
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the nurse is providing hygiene education for a family who will soon take an older adult client home from the hospital. which statement by a family member requires further nursing instruction?
Bathing modifications should be made for a patient who is incontinent if the nurse is teaching a family about hygiene Utilize specific moisturizing barriers and cleaners for perineal skin.
Which nursing procedure is suitable when giving a client foot care?Nursing procedure is suitable when giving a client foot care After completely drying the feet, moisturize both the top and bottoms. Preventing excessive dryness and skin cracking on the feet by completely rinsing, drying them off, and applying moisturizer to a tops and bottoms of the feet.
What should a nurse do initially when treating a patient who has symptoms of tuberculosis?Patients who are originally thought to have active TB should indeed be given an airborne TB prevention isolation room for safety. A private area and a negative air air distribution system that burns up to the outside are necessary for airborne precautions. The door must be kept shut.
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sam was admitted due to a loss of consciousness. after workup it was determined that he has a benign neoplasm of the temporal lobe of his brain. the principal diagnosis for this case is reported with code .
The ICD-10-CM code D32.0, "Benign neoplasm of brain, specified as temporal lobe," would probably be used to describe the main diagnosis in this case of a benign tumour of the temporal lobe of the brain.
This number is used to identify the primary reason for Sam's hospital admission and provides a detailed description of the type of benign tumour /neoplasm that Sam has been diagnosed with.
It's significant to note that the specifics of the case may affect the code used to report the diagnosis, and additional codes may be used to reflect any additional conditions that are present or that contribute to the admission.
Proper diagnosis and assigning code of conduct can help the patient get the treatment needed and help in successful remission of the disease.
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Which one of these test systems can be used to evaluate the adequacy of fibrinogen in heparinized patients?
The test system that can be used to evaluate the adequacy of fibrinogen in heparinized patients is the Reptilase time test. A blood test called the reptilase time is used to identify fibrinogen deficiencies or other abnormalities, particularly when heparin contamination is present.
Who are heparinized patients?
Patients who are getting heparin treatment are said to be heparinized. Heparin is an anticoagulant, which means it is a drug that aids in preventing the formation of blood clots. It is frequently administered to patients who have particular medical disorders, such as deep vein thrombosis or pulmonary embolism, have recently undergone surgery, or are otherwise at danger of blood clot development.
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Given above is an incomplete question, here is the complete question -
Which one of these test systems can be used to evaluate the adequacy of fibrinogen in heparinized patients?
a) Prothrombin time test.
b) Thrombin time test.
c) Reptilase time test.
d) Partial thromboplastin time test.
the nurse is caring for a child with congestive heart failure (chf). which clinical manifestations does the nurse anticipate when assessing this child?
When examining this child for congestive heart failure , the nurse expects to see the following clinical manifestations: A) Excessive sweating D) Difficulty breathing.
Heart failure symptoms in children are typically different from those in adults. Children with this condition may experience breathing difficulties, excessive perspiration, low blood pressure (not hypertension), and poor feeding or growth (not increased appetite). Bradycardia is an uncommon observation in kids with heart failure. Dyspnea, fatigue, and exercise intolerance — As HF worsens, patients frequently experience symptoms that restrict their ability to exercise, such as dyspnea, lightheadedness, or fatigue at rest or after light exertion.
Breathlessness, a racing heartbeat, low blood pressure, difficulty sleeping, extreme fatigue, and weakness are some of the early symptoms. Heart failure occasionally manifests as an abrupt onset of severe shortness of breath, rapid or irregular heartbeat, and foamy, pink mucus-producing cough.
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the nurse is caring for a client who demonstrates a health literacy concern. the nurse adjusts client teaching in which way?
Option B is correct. The nurse is caring for a client who has a health literacy issue. Instead of focusing on verbal training, the nurse adapts client instruction by employing videos, diagrams, and drawings.
Everyone interested in health protection and promotion illness prevention and early detection, health treatment and maintenance, or policy formulation is concerned about health literacy. Health literacy skills are required for dialogue and discussion, having read health information, analysing charts, deciding whether to participate in research studies, and using medical instruments for personal or familial health care, such as a peak flow metre or thermometer to calculate a timing or dosage of medicine, as well as voting on or environmental issues.
When organisations or individuals develop and distribute health information that is too complex for others to grasp, we create an health literacy problem. We create an health literacy problem when we expect people to figure through health services with numerous unfamiliar, unclear, or even contradictory processes.
The complete Question:
The nurse is caring for a client who demonstrates a health literacy concern. The nurse adjusts client teaching in which way?
A. uses medical terminology to help the client feel smarter
B. uses videos, diagrams, and pictures rather than focusing on verbal teaching
C. gives instructions in multiple ways so the client will understand
D. provides general teaching instead of specificity regarding diagnosis
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the registered nursing teaching a nursing student about the guidelines for measuring vital signs. which statement by the nursing student indications the need for further teaching
A nursing student is being taught by a qualified nurse about the standards for taking vital signs. A healthy individual with no lung conditions will have a result below 95%.
What fundamental tenet does pulse oximetry adhere to?The difference between both the Tr and R configurations' light emission and absorption is the basis for how oximeters work. The oximeter makes use of an electronic processor, two tiny light-emitting diodes (LEDs), and a photodiode that is visible through a translucent area of the patient's body, typically an earlobe or fingertip.
Which of the following best describes atypical respiration?While resting, an abnormal respiration rate is one that is less than 12 or greater than 25 breaths per minute. Asthma, anxiety, pneumonia, and congestive heart failure are a some of the disorders that might alter a normal respiratory rate.
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mary smith has gone to her doctor to discuss her current medical conditions, what is the legal term that best describes the type of communication that has occurred between mary and her physician?
Mary smith has gone to her doctor to discuss her current medical conditions, privileged communication is the legal term that best describes the type of communication that has occurred between Mary and her physician.
What is privileged communication?All information shared between a patient and a medical practitioner regarding the patient's diagnosis and care is referred to as "privileged communications." Talk that occurs in the course of a privileged relationship, such as one between a lawyer and a client, a spouse and wife, a priest and a penitent, or a doctor and a patient. Legal safeguards frequently prevent the compulsory revelation of such communications.
Relationships involving privileged communication are frequently mentioned, including those between an attorney and a client, a doctor or therapist and a patient, and a priest and a parishioner.
Thus, privileged communication is the legal term that best describes the type of communication that has occurred between Mary and her physician.
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regional anesthesia is accomplished through nerve, or field, blocking. question 3 options: true false
The given statement, "regional anesthesia is accomplished by nerve or field blocking," is true because it stops the signal transmission from reaching the brain.
Anesthesia is the use of medication to achieve a state of temporary loss of sensation. The process is used during surgeries to prevent the feeling of pain in the patients. There are three types of anesthesia administered into the patients: local, regional and general.
Nerve refers to the nerve cell or neuron present inside the body that functions in transmission of signals to and from the brain. Nerve block is an important action during regional anesthesia to prevent the feeling of pain. A very small sized needle is inserted into the target nerves during nerve block that hinders the signal transmission.
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which actions will the nurse take when preparing a client before thoracentesis? select all that apply. one, some, or all responses may be correct.
First she will inform the client that consent is needed before thoracentesis is the actions will the nurse take when preparing a client before thoracentesis.
What do you know about Thoracentesis ?Thoracentesis is a technique that is generally used in draining air or fluid from the area around the lungs in our body. The pleural space is the little opening between the inner chest wall and the pleura of the lung.
Pleural effusion, or extra fluid in the space between your lungs and your chest wall, is treated with thoracentesis. It aids in symptom relief and helps identify potential causes of the fluid so that your healthcare professional can administer the proper treatment. Pleural effusion can result from a variety of underlying diseases, such as congestive heart failure.
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a patient diagnosed with crohn's disease is beginning treatment with azathioprine (imuran). which information should the nurse include when teaching about this medication?
During the first two weeks, nausea and vomiting are frequently experienced. During the first few weeks of treatment, nausea and vomiting are frequently side effects of azathioprine. Skin darkening is not a side effect of azathioprine.
What is the purpose of the medicine azathioprine?To stop the rejection of a transplanted kidney, azathioprine is utilized. It is a member of the class of drugs known as immunosuppressive agents. Azathioprine will reduce a patient's natural immunity after transplantation in order to prevent rejection of the new kidney.
How can you tell whether azathioprine is effective?Your arthritis may not start to get better for 8 to 12 weeks after you start taking azathioprine. Your blood counts will need to be checked every 4 to 8 weeks with blood work.
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the client is a 20-year-old college student attending school away from home. he is playing football with some of his friends in the park. he jumps up in the air to catch the football and is tackled by another player. the client flips in midair and feels something pop in his neck as he lands hard on the ground. he does not have any pain, but when he tries to get up, he cannot move his legs or arms. the client is alert and is talking to his friends.
Patients with suspected cervical spine injuries or cervical neck disorders frequently undergo the jaw-thrust technique.
How do you stabilize using the jaw thrust technique?
Grab the jaw bones on either side of the jaw using the index fingers of each hand. As if giving them an extremely nasty underbite, slide the jaw upward. While their top teeth stay in place, their bottom teeth will move forward. You run the risk of dislocating the jaw while you do this.
Bring your chin to your chest and raise your head about two inches off the floor. Maintain a downward chin and avoid elevating your stomach.Start with three sets of 10 repetitions and work your way up.Take your time because if you try to do too much too soon, these muscles, which are frequently undeveloped, can strain your neck.To learn more about jaw-thrust technique refer to:
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the following information is documented on the assessment form for an older adult: kyphosis dry mucous membranes decreased respiratory excursion urinary incontinence the nurse is reviewing the information and reports which finding to the physician?
Incontinence during urinating is not a typical aging-related development. Normal aging-related alterations include kyphosis, dry mucous membranes, & decreased respiratory excursion. Hence option d is right.
Urinary incontinence: what is it?A person with urinary incontinence accidentally releases pee. Urinary incontinence, commonly known an overactive bladder, can affect anybody, but it is more prevalent in older individuals, particularly women. Bladder control problems can be humiliating and make people refrain from participating in daily activities.
What are incontinence's initial warning signs?Difficulties passing pee, including a sluggish stream, straining to do so, or stopping and starting. issues after urinating, such as the impression that your bladder is still partially full or spilling some few droplets of urine again when you think you've finished
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The complete question is -
The following information is documented on the assessment form for an older adult:
a) Kyphosis
b) Dry mucous membranes
c) Decreased respiratory excursion
d) Urinary incontinence
The nurse is reviewing the information and reports which finding to the physician?
which instructions are given to a patient with genital herpes simplex virus infection? select all that apply
The following instructions are given to a patient with genital herpes simplex virus: infection antiviral medications can reduce the frequency, duration, and severity of outbreaks. Ibuprofen and other pain relievers can help reduce pain and fever. Antiviral medications such as acyclovir, valacyclovir, famciclovir, and penciclovir.
Antiviral medications, such as acyclovir, famciclovir, and valacyclovir, are the most effective treatments for HSV (herpes simplex virus) infection. These medications can help to reduce the severity and frequency of symptoms, but they cannot cure the infection.
Acyclovir, famciclovir, and valacyclovir appear to be equally effective for episodic genital herpes treatment (466–470). * Acyclovir 400 mg orally three times per day is also effective, but it is not recommended due to the frequency of dosing.
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Fetal alcohol syndrome is characterized by
A low birth weight,a small head, and bodily effects
B an increase risk of developing albinism
C genetic defects
D fluid on the brain and a slight paralysis of the muscles of the extremities