2008 musculo-skelatal assessment lecture

7/31/2019 2008 Musculo-Skelatal Assessment Lecture

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MusculoskeletalAssessment

By Adrienne Carlson RN MS


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Assigned Readings:

Berman Chapter 44

1105-1117

General information

(Skip 1117-1121)

1122-1127

Assessment/NP

1127 skills

Body mechanics/positioning

1158-9 case study

Lewis et al. Chapter 62

Structure

1614-1618

Assessment

1618-1624

Diagnostic Studies

1624-1628

Jarvis reinforces in detailall assessment skills

Chapter 22


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Assessment Lecture template

1st hour

Overview of

appropriate

Physiologicalstructure

Terminology

and Concepts

2nd hour

Assessment process

Subjective

Objective

and then

Application to the

Nursing Process Case study


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Mobility vs Activity

Mobility:

The basic life process for activitywhereby one moves or is moved.

Activity:

Body movement that serves various

purposes, such as, carrying out dailyliving chores and protecting self andothers from injury.


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Activity Tolerance

A state in which an individual hasinsufficient physiologic or psychologicalenergy to endure or complete required or

desired daily activities.


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The main functions of theMusculoskeletal System are:

1) Support

2) Protection of Vital Organs 3) Mineral Storage

4) Movement

5) Blood Cell Production


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Movement.

Results from contractions of musclesapplied to bones which act as levers andjoints which act as fulcrums.


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Components of theMusculoskeletal System:

Bone: Cancellous, Compact.

Joints: Classified by degree ofmovement.

Cartilage: Hyaline, Elastic, Fibrous.

Muscle: Cardiac, Smooth, Skeletal.

Tendons and Ligaments Fascia

Bursae


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Normal movement and stabilityare the result of

An intact Musculoskeletal system

An intact nervous system and

An intact inner ear structure(equilibrium).

Body movement requires coordinatedmuscle activity and neurologicintegration.


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There are 5 basic elementsinvolved in normal movement:

Posture

Joint Mobility Balance

Coordination

Gait


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Factors affecting Body Alignmentand Activity:

Growth and Development

Physical Health

Mental Illness Nutrition

Personal Values and Attitudes

External (environmental) Factors Prescribed Limitations


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The National Institute of Healthdefines:

Physical Activity as bodily movementproduced by skeletal muscles thatrequires energy expenditure and

produces progressive health benefits.

Exercise as the type of physical activitythat is planned, structured and repetitive

bodily movement done to improve ormaintain physical fitness.


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Exercise:

Involves the active contraction and relaxationof muscles.

Exercise can be classified according to: typeof muscle contraction and source of energy.

Activity tolerance is the type and amount ofexercise or daily living activities an individual isable to perform


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Types of Exercise

Isotonic:

Dynamic exercise

Isometric:

Static exercise

Isokinetic:

Resistive exercise

Areobic:

O2 taken into body

is > or equal to

requirement.

Anaerobic:

Requires O2 > thatthe body can drawin.


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The Benefits of Exercise

The size, shape, tone & strength ofmuscle is maintained or increased.

Increases joint mobility.

Increases strength & rate of heart

= > CO.

Respiratory ventilation is increased and

there is decreased pooling of secretions.It increases diaphragmatic excursion anddecreases breathing effort.


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The Benefits of Exercise cont

Bone density is maintained.

It improves appetite and increases GItract tone, improving digestion and

elimination. It increases metabolic rate, production of

body heat and wastes and increases use

of triglycerides and fatty acids. It increases blood flow, promoting

effective excretion of wastes.


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The Benefits of Exercise cont

There is decreases stasis of UA inbladder.

It produces a sense of well being andimproves tolerance to stress.

It may improve self-concept by reducingdepression and improving body image.

Energy levels increase and quality ofsleep is enhanced.


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Assessment of theMuculoskeletal System

Correct diagnosis depends on anaccurate Patient history and a thoroughexamination.

MS assessment can be made on aspecific body part, as part of a generalphysical exam or as a examination initself.


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Complaintsthat should alert a nurse are:

Joint or muscle pain, joint swelling,decreased strength or function, changein size of extremity or muscle, deformity,

spasm, crepitation, changes insensation, stiffness and changes in gait.

Accidents often result in trauma to the

MS system and require a thoroughexamination.


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Subjective Data Collection:(Nursing History)

Past Medical History:

Take a detailed hx of disease course &also question p/c re: possible 2ndaryinfection.

Medications: Prescribed and OTCs.

Surgery or treatments Functional Health Patterns

(see next slide)


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Functional Health Patterns

Health perception / Health Management Nutrition / Metabolic Elimination

Activity / Exercise Sleep / Rest Cognitive /Perceptual Self-perception / Self-concept

Role / Relationship Sexual / Reproductive Coping / Stress-tolerance


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Objective Data Collection:The physical examination

Inspection

Palpation

Movement

Measurement

Muscle-strengthtesting

Gait

Posture

Joint mobility

Balance and

Coordination

Gait

(Includes all 4 above)

G i


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GaitDisorders ROM

Ataxia

Normal PressureHydrocephalus

Parkinsons Disease Spondylotic Cervical

Myelopathy

Senile Gait

Hemiplegia Osteomalacia

Flexion

Extension

Hyperextention

Abduction

Adduction

Pronation

Supination

Circumduction

Rotation

Inversion

Eversion


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Muscle Strength Scale

O No detection of muscular contraction.

1 A barely detectable trace of contraction.

2 Active movement of body part with

elimination of gravity. 3 Active movement against gravity.

4 Active movement against gravity

and some resistance

5 Active movement against full resistance

without evident fatigue.

(normal muscle strength).

A N l Ph i l A


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A Normal Physical Assessmentof Musculoskeletal System

Full range of motion

No joint swelling, deformity orcrepetation

Normal spinal curvatures

No tenderness on palpation of spine

No muscle atrophy or asymmetry Muscle strength of 5


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Impaired Physical Mobility

Limited in independent, purposeful physical movement of the body orone or more extremities.

Decreased reaction time, difficulty turning, engages in substitutions,exertional dyspnea, gait changes, jerky movements, limited gross motorskills, limited fine motor skills, limited ROM, movement induced tremor,

postural instability, slow movement, uncoordinated movement.

Activity intolerance, altered metabolism, anxiety, inc BMI, cognitiveimpairment, contractures, cultural beliefs, deconditioning, decendurance, depressive mood, dec muscle control, mass, musclestrength, knowledge deficit, dev delay, discomfort, disuse, joint stiffness,environment, CV, bone loss, malnutrition, medications, MS impairment,

pain, prescribed limitations, reluctance, sedentary lifestyle,sensoriperceptual impairments

M bilit P bl th


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Mobility Problems as theEtiology (a cause)

Fear (of falling)

Risk for Injury

Powerlessness

Self-Care Deficit (s)

Self Esteem Disturbance

Ineffective Individual Coping

Ineffective Airway Clearance

Risk for Infection

A l i h N i P


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Applying the Nursing Processto a case study

1) obtain a Nursing History ASSESSMENT 2) perform a physical examination

3) analyze your data 4) list possible Nsg dx Nursing Diagnosis 5) choose a Nsg dx for intervention

6) write a PDR statement 7) set an expected outcome

8) choose an appropriate intervention Planning

9) write a Care Plan and then . 10) carry it out your Care Plan Intervention

10) evaluate ..the success of your care planby judging whether you were able to meet Evaluationyour expected outcomes.


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PDR Statement

P: Problem or

Diagnostic label________________

D: Defining Characteristics orS/S__________________________

R: Related Factors or

Etiology /causative factor_____________________________


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Expected Outcome

E.O.:______________________________________

Should have an action verb and a measurable criteria

It should relate to the resolution of the D

defining characteristics or

the mitigation of the R the related factors.

There may be appropriate conditional clauses includedto narrow /define the intended outcome.

It should be: S.M.A.R.T. Specific, measurable, achievable, realistic and timed.

(have a deadline)


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Picking an Approach (NIC)

Nursing Interventions Classification

Nursing Outcomes Classification

Doing it on your own

Cook book references are not the onlyway ..

2008 musculo-skelatal assessment lecture

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