Musculoskeletal and Neurological Assessment

1. Musculoskeletal and Neurological Assessment

2. Objectives • Define Gait, Stance, Posture • Discuss assessment of joints and muscles • Outline a Neuro Exam • Identify reflexes • Identify function of the cranial nerves

3. Musculoskeletal Assessment

4. Musculoskeletal System • Bones, joints, and muscles • Needed for Support, Movement, Protection, and production of red blood cells, and storage for essential minerals • Fall Precaution • Do No Harm!

5. Gait • The base is as wide as the shoulder width • Foot placement is accurate • Walk is smooth, even and well-balanced • Associated movements, such as arm swing, are present.

6. Gait Abnomalities • Unusual and uncontrollable walking patterns, usually caused by disease or injury. • Propulsive • Scissors • Spastic • Steppage • Waddling

7. Stance • Symmetrical • Width • Steady • Assistive Devices

8. Posture • Normal - Comfortably erect Look for straight lines across body parts • Normal Aging

9. Lordosis - Increased Curvature of the Spine

10. Kyphosis is a curving of the spine that causes a bowing of the back, which leads to a hunchback or slouching posture.

11. Scoliosis – curvature of the spine away from middle or sideways

12. Examination of Joints • Inspection Size and contour: redness, atrophy, deformity, swelling • Palpation Crepitious, thickening, swelling, or tenderness

13. Range of Motion • Full Mobility of each joint • Deliberate, accurate, smooth, and coordinated • No involuntary movement

14. Muscle Atrophy

15. Subluxation • A partial or incomplete dislocation

16. Contractures • A contracture is a fixed tightening of muscle, tendons, ligaments, or skin. Shortening of longest or strongest muscle. • Prevents normal movement of the associated body part. Impaired ROM • Skin becomes scarred and nonelastic which limits the range of movement of the affected area.

17. Neurological Assessment

18. General appearance, Personal Hygiene • Appropriately dressed • Well-Groomed • Odor • Eye contact • Posture

19. Orientation • Person • Place • Time • Can a person be oriented and still be confused?

20. Level of Consciousness: response to environmental stimuli • Awake, alert • lethargic-stuporous-comatose-coma • If not fully alert, may need increased stimulus • Note any change in Level of Consciousness • Variety of Questions • One part or two part commands

21. Glascow Coma Scale • Quantitative tool • Eye opening, verbal response, motor response • Fully alert score is 15 • Coma is 7 or less

22. 12 Cranial Nerve

23. Motor • Observation • Muscle Tone • Muscle Strength • Squeeze hands • Pronator Drift

24. Deep Tendon Reflex • Biceps C5, C6 • Brachioradialis C6 • Triceps C7 • Patellar L4 • Babinski Abnormal Reflex Toes Fan • Achilles Tendon S1 Rated from 0 to 5+

25. Rating Scale • 0: absent reflex • 1+: trace, or seen only with reinforcement • 2+: normal • 3+: brisk • 4+: nonsustained clonus (i.e., repetitive vibratory movements) • 5+: sustained clonus

26. Motor Abnormalities • Spasticity • Flaccidity • Tremor

27. Coordination and Gait • Point to Point Movements • Romberg • Gait

28. Reflexes • Deep Tendon Reflexes • Clonus • Babinski

29. Sensory • General • Soft/Sharp Touch • Discrimination

30. NCLEX Question • A nurse is assessing the motor function of an unconscious client. The nurse would plan to use which of the following to test the client’s peripheral response to pain. • Sternal rub • Pressure on the Orbital rim • Squeezing of the sternocleidomastoid muscle • Nail bed pressure

31. NCLEX Question • A client has an impairment of cranial nerve II. Specific to this impairment, the nurse would plan to do which of the following to ensure client safety? • Provide a clear path for ambulation without obstacles • Test the temperature of the shower water • Speak Loudly to the client • Check the temperature of the food on the dietary tray.