Nursing Assessment: Musculoskeletal System

1. Nursing Assessment: Musculoskeletal System George Ann Daniels, MS, RN

2. Sitting and Standing Patient’s ability to perform ADL’s Skin- color, scars, overt signs of injury or operations Important to assess : motion, asymmetry of movement, swelling, deformity, masses, change in limb length Compare the opposite site of the body.Sitting and Standing Patient’s ability to perform ADL’s Skin- color, scars, overt signs of injury or operations Important to assess : motion, asymmetry of movement, swelling, deformity, masses, change in limb length Compare the opposite site of the body.

3. Palpation Skin temperature Tenderness Swelling Crepitation Examiners hands need to be warm to prevent abnormal muscle spasmExaminers hands need to be warm to prevent abnormal muscle spasm

4. Movement Range of motion active passive functional Goniometer Active patient can do Passive-someone else must do for the patient Gonimeter measures amount of bending or angles of a joint Functional- adl’s with or without assistance- what assistive devices are needed. Active patient can do Passive-someone else must do for the patient Gonimeter measures amount of bending or angles of a joint Functional- adl’s with or without assistance- what assistive devices are needed.

5. Measurement Limb length Gait disorders Circumferential measurement of muscle mass Largest area of muscle mass Record exact location

6. Muscle strength testing Resistance to force Compare with opposite side Muscle strength scale Table 58-5 page 1754 Scale of “5” is the best

7. Common Abnormalities Ankylosis Scarring within a joint leading to stiffness or fixation Atrophy Wasting of the muscle Decrease in size Flabby appearance Decreased function and muscle tone Contracture Resistance to movement of muscle or joint, fibrosis of soft tissue

8. Crepitus Crackling sound or grating sensation from friction between two bones Kyphosis Round back forward bending of spine

9. Lordosis Anteriorposterior curvature with concavity in posterior direction

10. Scoliosis Lateral curvature lf the spine

11. Diagnostic Studies X-ray Arthogram X-ray Bone Scan CT scan Arteriogram MRI Arthogram- injection of dye into joint CT 3 dimensional picture Arteriogram outlines the blood vessels R?T poor healing and compromised blood supply MRI- views soft tissue, remove all metal, no pacemakers, claaustrophicArthogram- injection of dye into joint CT 3 dimensional picture Arteriogram outlines the blood vessels R?T poor healing and compromised blood supply MRI- views soft tissue, remove all metal, no pacemakers, claaustrophic

12. Lab test CBC Infection ESR Inflammatory response, Rheumatoid arthritis Normal less than 20 mm/hr Calcium Normal 9-11mg/dl Alka Phos Normal 29-30 mg/dl UA Cancer of the bone has increased calcium levels Calcium/phos monitors bone activities-reapsorption, destruction and growthCalcium/phos monitors bone activities-reapsorption, destruction and growth

13. Arthrocentesis Aspirated fluid from the joint Infection and hemorrhage EMG Electrical activity of skeletal muscles and ability to response to stimuli Thermography Infrared camera detects amount of heat radiating from the soft tissue infection

14. Arthroscopy Endoscopy of the joint Direct visualization on interior joint cavity Knees, shoulders Tears in cartilage can be repaired

15. Arthrocentesis Ample of synovial fluid for examination Instill medication and remove fluid to relieve pain 1-3 mL