NURS 261 Musculoskeletal system 2020 – Virginia Commonwealth University | NURS261 Musculoskeletal system 2020

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NURS 261 Musculoskeletal system 2020 – Virginia Commonwealth University 
 MUSCULOSKELETAL SYSTEM Muscles: - Smooth - Cardiac - Skeletal Non-Synovial and Synovial joints: - Temporma... ndivular joint - Spine - Shoulder - Elbow - Wrist and carpal - Hip - Knee - Ankle and foot Movements: - Inversion: - Eversion: - Rotation: - Protraction: - Retraction: - Elevation: - Depression: HEALTH Hx: - Any chronic diseases? Loss of bone density? Osteoporosis? - Taking medications? Pain meds? - Changes in ability to move/participant in usual activities? - Changes in muscle strength? How did you adapt to changes? - Accidents? Trauma? Surgery on bones or joints? - if yes, outcome? FAMILY Hx: - Arthritis? Rheumatoid? Gout? Osteoarthritis? Assess risk factors - Curvature of spine? - Back problems? PERSONAL/PSYCH Hx: - Exercise? Sports? Lift, push, bend, pull or stoop frequently as part of daily routine? PROBLEM-BASED: PAIN - Where was the pain felt? First noticed? related to a specific movement? - Did pain occur suddenly or gradually? During day? When do you feel pain? - Does pain move from one joint to another? Any injury? Overuse? Strain? - What makes pain worse? General movement? Lack of mov? Weather? - What was done to relive pain? How effective? How severe? PROBLEMS W/ MOVEMENT: - How long have you had movements problems? Joints swollen? Red? Hot? - Have you had recent sore throat? If yes, and it was 10-14 days prior, think of rheumatic fever - Muscle weakness? Which ones? Does it get worse? - Do knees or ankles give away with pressure? What makes it happen? PROBLEMS w/ ADLs: - Are activities limited by M/S disorder? - To what extent? How do you compensate? - How has illness affected interactions with family? Friends? INFANTS/CHILDREN: - Trauma during labor and delivery - Achievement of motor milestones - Fractures or distortions - Bone deformity or spinal curvature ADOLESCENTS: - Are you involved in any sports at school or afterschool? How frequently? - Do you use special equipment? Any training program exist for your sport? - Treatment of injuries AGING ADULT: - Uses functional assessment hx questions to elicit any loss function, self-care deficit, or safety risk - Have you had any change in weakness over past months? - Have you had any increase in falls or stumbling in past months? - Do you use any mobility aids to help you get aoud such as a cane or walker? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ROM c-t-l spine: - Observe ROM of thoracic and lumbar spine (safety: spot your pt!!) SHOULDER: - Inspect shoulders and shoulder girdle for equality of height and contour - Inspect ROM of shoulders - Assess strengths of trapezius muscle with shoulder shrugs ELBOW: - Inspect for size and contour in flexed and extended positions - Palpate elbow flexed - ROM - Test muscle strength WRIST AND HAND: - Inspect dorsal and palmar sides - Palpate joints in wrist and hands - Test ROM - Test muscle strength HIP: - Inspect hip joint together with spine as person stands - Help person into supine positions and palpate hip joints - Assess ROM ANKLE AND FOOT: - Inspect sitting, standing, and walking - Palpate - Test ROM - Assess muscle strength COMMON PROBLEMS: - Bones and fractures - CLINICAL FINDINGS: - pain caused by muscle spasms is common - Deformity or loss of function caused by tissue shortening around bone and localized edema - Osteoporosis - CLINICAL FINDINGS: - Osteoporosis occurs without signs or symptoms; patients may not know until they realize loss of height, have spontaneous fracture from brittle bones, or develop kyphosis (convex curvature of the thoracic spine). - Osteoarthritis: - CLINICAL FINDINGS: - Symptoms include joint edema and aching pain. - Joint deformities of fingers develop: - Heberden’s nodes in distal interphalangeal joints. - Bouchard’s nodes in peripheral interphalangeal joints. - RA: - CLINICAL FINDINGS: - Joint involvement is bilateral. - Symptoms are pain, edema, and stiffness of fingers, wrists, ankles, feet, and knees. - Systemic symptoms caused by autoimmune response include low-grade fever and fatigue. - As disease continues, ulnar deviation, swan-neck deformity, and boutonnière deformity may be observed. - Gout: - Clinical FINDINGS: - Manifestations include erythema and edema of joints that are very painful to move and limit range of motion. - Tophi, a sign of gout, are round, pea-like deposits of uric acid in ear cartilage, or large, irregularly shaped deposits in subcutaneous tissue or other joints. - Kidney stones from uric acid crystals can cause manifestations of flank pain, and costovertebral angle tenderness. - Supine HNP - CLINICAL FINDINGS: - Depends on the location of the affected disk. - Patient may complain of numbness and radiating pain in extremity from herniated lumbar disk. - Straight leg raises cause pain in involved leg by putting pressure on spinal nerve. - Cervical herniated nucleus pulposus causes arm pain and paresthesia. - Deep tendon reflexes may be depressed or absent, depending on spinal nerve root involved. - Spine - scoliosis - CLINICAL FINDINGS: - Produces uneven shoulders and hip levels. - Curvature less than 10% considered normal variation; between 10% and 20% mild. - Rotation deformity may also cause rib hump and flank asymmetry on forward flexion. - Depending on severity of curve, physiologic function of lungs, spine, and pelvis may be compromised. 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