Islamic University of Gaza Faculty of Nursing

1. Islamic University of GazaFaculty of Nursing Chapter (10) Assessment of musculo-skeletal system

2. Subjective data: ask about: • Pain: at rest, with exercise, changes in shape or size of an extremity, changes in mobility to carry out activities of daily living, sports, and works. • Stiffness: time of day, relation to weight," bearing or exercise". • Decreased or altered or absent sensations. • Redness or swelling of joints. • History of fractures and orthopedic surgery. • Occupational history.

3. Assessment of musculo-skeletal system done firstly when the client walks, moves in bed or performs any type of physical activity. • - Determine Range of motion, muscle strength and tone, joint and muscle condition. • N.B: muscle problems commonly are manifestations of neurological disease, so you must do neurological assessment simultaneously. • Joints vary in their degree of mobility, range from freely movable e.g. knee, to slightly movable joints e.g. the spinal vertebra.

4. During assessment of muscle groups: assess muscle weakness, or swelling, and size, then compare between sides. Joints should not be forced into painful positions. • * Observer gait and posture as client walks into room. • Normally the client walks with arms swinging freely at sides and the head and the face leading the body.

5. * Loss of height is frequently the first clinical sign of osteoporosis. • Small amount of height loss expected with aging. • Ask client to put each joint through its full range of motion, if there is weakness, gently supporting & moving extremities through their Range of motion, to assess abnormalities. • * Normal joints are non tender, without swelling and move freely. • N.B:“You must assess these points”: In elderly joints often become swollen & stiff, with reduced Range of motion, resulting from cartilage erosion and fibrosis of synovial membranes

6. Assessment of Neurological system • You can assess this systemwhen doing physical examination e.g. cranial nerve function can be testing during the survey of the head and neck. • * The neurological assessment consists of six parts: (mental status, cranial nerves, sensory functions, motor function, cerebellar function, reflexes).

7. Subjective data: ask about: • Loss of consciousness, dizziness, and fainting. • Headache: precipitating factors and duration. • Numbness and tingling or paralysis or neuralgia. • Loss of memory, confusion, visual loss, blurring, and pain. • Facial pain, weakness, twitching, speech problems e.g. aphasia. • Swallowing problems and drooling. • Neck weakness or spasm

8. Mental and emotional status is observed as the nursing history is collected, and by simply interacting with client, e.g. “Nursing care plan” • * Level of consciousness, which ranges from full a wakening, “alertness” to unresponsiveness to any form of external stimuli. • * Alert client responds to questions spontaneously. • * You can assess Level of consciousness by using Glasgow coma scale

9. Glasgow coma scale

10. Assessment of behavior and Appearance • * Behavior, mood, hygiene, grooming and choice of dress reveal pertinent information about client’s mental status. • * Appearance reflects how a client feels about the self. • * Personal hygiene such as unkempt hair, a dirty body, or broken, dirty fingernails should be noted. • * Language: Assess ability of individual to understand spoken or written words & how he speak or writes.

11. Assess intellectual function, which includes: memory “recent, immediate, past”, knowledge, abstract thinking, association and judgment. • * Assess for sensory function: • - Assess sensitivity to light touch “cotton” • - Assess sensitivity to pain “pinprick” • - Assess sensitivity to vibrations “tuning fork” • - Assess sensitivity to positions. • Don’t forget comparing both sides of body

12. Assessment of the breast Subjective data: ask about: • Tenderness, pain, swelling, or change in size of breasts. • Change in position of nipple or nipple discharge. • Presence of cysts, lumps, and lesions. • History of prior breast surgery

13. Female breast: • Inspection: with the client sitting, arms relaxed at sides. Inspect Areola and nipples for position, pigmentation, inversion, discharge, crusting & masses. • Examine the breast tissue for size, shape, color, symmetry, surface, contour, skin characteristics, • Assess level of breasts, notes any retractions or dimpling of the skin. • Ask client to elevate her hands over her head, repeat the observation. • Ask client to press her hands to her hips and repeat observation.

14. Palpation: Best done in recumbent position: • * Raise the arm of client on the side of the breast being palpated above clients head. • * palpate the breast from less painful or less diseased area * Use on palpation palmer aspects of the fingers in a rotating motion, compressing the breast tissue against the chest wall, this is done quadrant by until the entire breast has been palpated. • *Note skin texture, moisture, temperature, or masses. • *Gently squeeze the nipple and note any expressible discharge. "Normally not present in non lactating women". • *Repeat examination on the opposite breast & compare findings. • N.B: If mass is palpated, its location, size, shape, consistency, mobility and associated tenderness are reported

15. Male Breast: • * Examination of male breast can be brief and should never be omitted. • *observe nipple & Arcola for ulceration, nodules, swelling or discharge "normally not present" • *Palpate the Areola for nodules or tenderness • Genitourinary and reproductive Assessment • you must focus you’re your questions on the following: • Any bulges or pain when straining or lifting heavy objects. • Unusual drainage. • Pain with urination or incontinence. • Lower abdominal pain.