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ASSESSING THE MOTOR-MUSCULOSKELETAL SYSTEM

ASSESSING THE MOTOR-MUSCULOSKELETAL SYSTEM. Structures. Bones  Muscles Joints  Tendons Ligaments  Cartilage Bursae. Functions. Bones (206): Structure; protection; act as levers; produce blood cells; store calcium Muscles (650):

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ASSESSING THE MOTOR-MUSCULOSKELETAL SYSTEM

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  1. ASSESSING THE MOTOR-MUSCULOSKELETAL SYSTEM

  2. Structures • Bones  Muscles • Joints  Tendons • Ligaments  Cartilage • Bursae

  3. Functions Bones (206): Structure; protection; act as levers; produce blood cells; store calcium Muscles (650): Allow for movement and position; produce heat (Continued)

  4. Functions Joints: Point of articulation of two bones; provide ROM Tendons: Connect muscle to bone Ligament: Connects bone to bone (Continued)

  5. Functions Cartilage: Supports and shapes; acts as a shock absorber Bursae: Sacs filled with synovial fluid; cushion and reduce friction between joints

  6. Types Of Joints • Pivot • Hinge • Condyloid • Plane/gliding • Ball and socket • Saddle

  7. Movements • Extension Flexion  Hyperextension • Abduction Adduction  Circumduction • Internal rotation  External rotation • Pronation  Supination • Protraction  Retraction • Depression  Elevation • Opposition  Reposition • Inversion  Eversion • Ulnar deviation  Radial deviation

  8. Ulnar Deviation: a progressive malformation of the joints at the bottom of the fingers. The knuckles begin to become malformed and tend to make the fingers shift toward the outside of the hand, toward the pinkie. Often seen in patients with rheumatoid arthritis. Radial Deviation: malformation in other direction “club hand”

  9. Relationship to Other Systems  Genitourinary • Lymphatic  Neurological • Cardiovascular  Endocrine • Hematological  Gastrointestinal • Integumentary  Respiratory

  10. DevelopmentalVariations • Older Adults • Osteopenia • Osteoporosis • Kyphosis • Atrophy

  11. Cultural Variations New text: 694 Old text: Pg 597 • African Americans • Asians • Native Americans • Whites

  12. Maria O’Malley, 68-year-old, widow, parish housekeeper Post-menopausal Concerned about osteoporosis; feel she is “shrinking” “Aching joints in evening after working all day” for several years Case Study

  13. SymptomsWhat symptoms would signal a problem with the musculoskeletal system? • Pain • Weakness • Stiffness • Balance and coordination problems • Other related symptoms

  14. Pertinent History Findings • Aching joints after working all day for past several years; back and neck • Some relief with OTC analgesics • + HTN treated with Zestril • + Fractured wrist r/t fall; 2 adult children; hysterectomy at age 35 • + Family history of HTN & osteoporosis (Continued)

  15. Pertinent History Findings • Yearly physical exam; B/P checked every 3 months; hasn’t had gynecological exam since hysterectomy • No formal exercise program • Lives alone; children, sister, and friends are supports • Polish; Catholic; Medicare/Medicaid

  16. Physical Assessment Approach: inspection, palpation, percussion Position: Standing, sitting, supine Tools: tape measure, goniometer General Survey and head-to-toe scan

  17. Inspection Posture: head position, alignment Normal spinal curves: cervical, thoracic, lumbar, sacral, Spinal deformities: kyphosis, scoliosis, lordosis Gait: phase, cadence, arm swing, toeing, base of support, stride length

  18. Assessing for kyphosis & scoliosis

  19. Cerebellar Function Balance: • Gait • Tandem walk (heel to toe) • Toe and heel walking • Deep knee bend • Hop on one foot • Romberg Test (Continued)

  20. Cerebellar Function Coordination: • Rapid alternating movements • Finger thumb opposition • Toe tapping • Heel down shin Accuracy of movements: • Finger to nose • Point to point localization

  21. Abnormal Gaits Propulsive Scissors Spastic Stepping Waddling

  22. Palpation Muscle tone:upper and lower extremities Muscle strength: upper & lower extremities • Hand grips • Foot push/leg raise • Grade strength 0 to 5

  23. Joint Assessment For all joints note: • ROM  Redness • Condition of skin  Warmth • Deformity  Stability • Swelling  Pain • Crepitus

  24. Pertinent Physical Findings • 1 1/2 inch loss since menopause • Mild kyphosis • Mild atrophy in quadriceps • Full ROM joints, muscle strength +5/5 • + S4

  25. What actual or potential problems can you identify for Mrs.O’Malley? Nursing Diagnosis

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