From Web sites to Web applications, Part 1: Web site or Web app?
WEB Muscoloskeletal
-
Upload
jessa-borre -
Category
Documents
-
view
213 -
download
0
Transcript of WEB Muscoloskeletal
7/23/2019 WEB Muscoloskeletal
http://slidepdf.com/reader/full/web-muscoloskeletal 1/31
Musculoskeletal
AssessmentNUR123 Spring 2009
K. Burger, MS!, MSN, RN, "N
PPP by:
Victoria Siegel RN, CNS, MSN
Sharon Niggemeier RN MSN
Revised by: Kathleen Burger
7/23/2019 WEB Muscoloskeletal
http://slidepdf.com/reader/full/web-muscoloskeletal 2/31
Musculoskeletal# Re$ie%
Anatom&' ()&siolog&• Seleton: !"# bones
• $ong: %emur, humerus, radius• Short: car&als, tarsals
• 'rregular: vertebrae
• Bones &rotect, su&&ort, allo( %orlocomotion and mineral storage )Ca,Mg*
7/23/2019 WEB Muscoloskeletal
http://slidepdf.com/reader/full/web-muscoloskeletal 3/31
Musculoskeletal
• +oints: Range %rom oints that don-t move
to oints that %reely move.
• $igaments and tendons: stabili/e oints
• $igaments: attached %rom bone to bone
• 0endons: attached %rom muscle to bone
• Cartilage: ends on bones
7/23/2019 WEB Muscoloskeletal
http://slidepdf.com/reader/full/web-muscoloskeletal 4/31
Musculoskeletal
• Muscles: controlled by nervous system
• 1ascia: surrounds muscles, divides muscles,
main blood vessels and nerves.
• Bursae: cushions moving &arts
• Muscle tone: ability to resist %orce2 graded
"34
• 5tro&hy: decrease si/e
7/23/2019 WEB Muscoloskeletal
http://slidepdf.com/reader/full/web-muscoloskeletal 5/31
Assessing# Su*+ecti$e ata
• -oint pain#
• S$'65: Severity, ocation, /ntensity,
uration, Aggravating %actors )alleviating
%actors, associated sym&toms*
• Sti%%ness
• $imited movement
7/23/2019 WEB Muscoloskeletal
http://slidepdf.com/reader/full/web-muscoloskeletal 6/31
Assessing# Su*+ecti$e ata
• R)eumatoi! Art)ritis )RA* chronicsystemic in%lammatory disease involves
symmetric oints. 7ther MS disordersinvolve isolated or unilateral oints.
• Rheumatoid arthritis
Sti%%ness
S(elling
$imited R7M
Movement decreases &ain
7/23/2019 WEB Muscoloskeletal
http://slidepdf.com/reader/full/web-muscoloskeletal 7/31
Assessing# Su*+ecti$e ata
• steoart)ritis: chronic degeneration o%
oint cartilage caused by aging or trauma
• Sti%%ness
• S(elling
• $imited R7M
• 8eberden-s and Bouchard-s nodules
• May be unilateral
7/23/2019 WEB Muscoloskeletal
http://slidepdf.com/reader/full/web-muscoloskeletal 8/31
Assessing# Su*+ecti$e ata
• Muscle (ain#
• S$'65
• 5ching9cram&s
• eaness
• Resistance "34• 5tro&hy
7/23/2019 WEB Muscoloskeletal
http://slidepdf.com/reader/full/web-muscoloskeletal 9/31
Assessing# Su*+ecti$e ata
• Bone pain:
• S$'65
• 8;
• 6e%ormity
• 0rauma3 limitations as a result o% trauma
7/23/2019 WEB Muscoloskeletal
http://slidepdf.com/reader/full/web-muscoloskeletal 10/31
Assessing# Su*+ecti$e ata
• unctional Assessment#
• 56$-s3 does MS &roblem create limits:
• Bathing3 getting in and out o% tub, turning %aucets
• 0oileting3 getting on9o%% toilet, (i&ing sel%
• 6ressing3 buttons, /i&&ers, tying shoes
• <rooming3 shaving, brushing teeth, &utting onmaeu&
• =ating3 cutting %ood, &reå meals etc>
7/23/2019 WEB Muscoloskeletal
http://slidepdf.com/reader/full/web-muscoloskeletal 11/31
Assessing# Su*+ecti$e ata
• unctional Assessment#
• Mobility3 (aling u&9do(n stairs,
in and out o% car, out o% house
• Communicating3 taling, using &hone or
com&uter, (riting
• 7ccu&ational9=nvironmental3 heavy li%ting,
re&etitive motions etc.
7/23/2019 WEB Muscoloskeletal
http://slidepdf.com/reader/full/web-muscoloskeletal 12/31
Assessing# Su*+ecti$e ata
• Sel care *e)a$iors#
• =;ercise3 ty&e, %re?uency, (arm u&
• Pain during e;ercise@ 8o( t;@
• Recent (eight gain ) &uts stress on
musculoseletal system* >usual daily diet
• 5ny meds3 anti in%lammatory, muscle
rela;ants, &ain relievers
7/23/2019 WEB Muscoloskeletal
http://slidepdf.com/reader/full/web-muscoloskeletal 13/31
Assessing# Su*+ecti$e ata
• A!!itional ). or Aging a!ult#
• Ase %unctional assessment to elicit any loss
o% %unction, sel% care de%icit or sa%ety ris:
• eaness
• 1alls9 Stumbling
• Mobility aids used
7/23/2019 WEB Muscoloskeletal
http://slidepdf.com/reader/full/web-muscoloskeletal 14/31
Assessing# *+ecti$e ata
• ()&sical eam &rovides the nurse (ith
obective data
• <uidelines %or Physical =;am include:
• 1ull visuali/ation o% &art being e;amined
• 6ra&e other &arts %or &rivacy
• 7rderly a&&roach: head to toe and &ro;imal
to distal.
7/23/2019 WEB Muscoloskeletal
http://slidepdf.com/reader/full/web-muscoloskeletal 15/31
()&sical amination 4ui!elines
• +oint being e;amined should be su&&orted.
• Com&are &aired oints, e;&ect symmetry.
• hen e;amining a &ain%ul area, use %irm
su&&ort, gentle movement.
• 5ssess Range o% Motion )R7M* o% each
oint
7/23/2019 WEB Muscoloskeletal
http://slidepdf.com/reader/full/web-muscoloskeletal 16/31
()&sical amination
• 5ssess gross motor movement and &osture
• Note &atient-s gait
• Note any %oot dragging, lim&ing, shu%%ling
• Note any s&inal de%ormities
• 'ns&ect sin and subcutaneous tissues
7/23/2019 WEB Muscoloskeletal
http://slidepdf.com/reader/full/web-muscoloskeletal 17/31
()&sical amination
• 5ssess u&&er and lo(er e;tremities %or:
• 7verall si/e, symmetry
• <ross de%ormity
• Bony enlargement
• 5lignment• Symmetry o% length and &osition
7/23/2019 WEB Muscoloskeletal
http://slidepdf.com/reader/full/web-muscoloskeletal 18/31
()&sical amination
Bones, +oints, muscles:
• 'ns&ect s(elling, de%ormity, condition
• 5ssess %or sti%%ness, instability, &ain, cre&itus,
unusual oint movement, bogginess, (armth
• 5ssess R7M
• Muscle strength
• 5ssess symmetry
7/23/2019 WEB Muscoloskeletal
http://slidepdf.com/reader/full/web-muscoloskeletal 19/31
()&sical amination
5ea!
• 0em&oromandibular +oint3 cre&itus and &ain(ith 0M+ disorder
• 7&en mouth: 3# cm
• Move lo(er a( %rom side to side
• Stic out lo(er a(
• Pal&ate tem&oralis and masseter muscles
• 0est muscle strength2 a( thrust, a( lateralmovement
7/23/2019 WEB Muscoloskeletal
http://slidepdf.com/reader/full/web-muscoloskeletal 20/31
Physical =;amination
• Neck :
• R7M and muscle strength:
• 1le;ion3 touch chin to chest
• =;tension3 tilt head bac(ard
• Cervical rotation3 turn head to R and $.• $ateral bending3 touch ear to R. and $.
shoulders
• Re&eat against resistance
7/23/2019 WEB Muscoloskeletal
http://slidepdf.com/reader/full/web-muscoloskeletal 21/31
()&sical amination
S)oul!er# Note &osture erect, hunched.
• 5ssess symmetry and &osition o% clavicles.
• Pal&ate clavicles to(ard shoulders, &al&atedeltoid muscle.
• R7M and muscle strength:
1le;ion,=;tension,8y&ere;tension 5bduction,5dduction,Rotation
• 0est muscle strength: shrug, %le;ion,
abduction
7/23/2019 WEB Muscoloskeletal
http://slidepdf.com/reader/full/web-muscoloskeletal 22/31
()&sical amination
l*o%3 bend elbo( " degrees, ins&ect and
&al&ate &osterior sur%ace
• Note3 medial and lateral condyles o%
humerus and olecranon &rocess o% ulna
• R7M and muscle strength:
1le;ion and =;tension
Su&ination and Pronation
•0est muscle strength2 %le;ion9e;tension
7/23/2019 WEB Muscoloskeletal
http://slidepdf.com/reader/full/web-muscoloskeletal 23/31
()&sical amination
6rist3 <ras& (rists, assess body &rocesses o%radius )thumb side* and the ulna. Pal&ate
radiocar&al oint and remaining (rist oints.• R7M and muscle strength:
1le;ion and =;tension and 8y&ere;tension
Radial and ulnar (rist deviationCircumduction
• 0est strength2 %le;ion o% (rist
7/23/2019 WEB Muscoloskeletal
http://slidepdf.com/reader/full/web-muscoloskeletal 24/31
()&sical amination
5an!3 Ase thumb and %ore%inger to &al&ate
the metacar&o&halangeal and
inter&halangeal oints.
• R7M and muscle strength:
1le;ion and =;tension and 8y&ere;tension
5bduction3 have &atient s&read %ingers a&art5dduction3 have &t. hold %ingers together.
0humb91inger 7&&osition
7/23/2019 WEB Muscoloskeletal
http://slidepdf.com/reader/full/web-muscoloskeletal 25/31
()&sical amination
5ip3 &al&ate hi& oint and surrounding
structures. Position &t. side lying and
&al&ate iliac crest, greater trochanter, hi&,thigh and buttoc muscles
• R7M and muscle strength:
1le;ion,=;tension, 8y&ere;tension
5dduction and 5bduction
=;ternal rotation and 'nternal rotation
7/23/2019 WEB Muscoloskeletal
http://slidepdf.com/reader/full/web-muscoloskeletal 26/31
()&sical amination
Knee3 have &t. sitting, dangling. 'ns&ect3 note
alignment, de%ormity, contour o% ?uadrice&
muscle.• Pal&ate the su&ra&atellar &ouch and note
any tenderness, edema.
• R7M and muscle strength:
• 1le;ion and =;tension
7/23/2019 WEB Muscoloskeletal
http://slidepdf.com/reader/full/web-muscoloskeletal 27/31
()&sical amination
• Ankle# Com&are the contour o% R. and $.anles. Pal&ate anle and achilles tendons.
• R7M and muscle strength:6orsi%le;ion3 &oint toes u&(ard.
Plantar 1le;ion3 &oint toes do(n(ard.
'nversion3 turn soles o% %eet in(ard.=version3 turn soles o% %eet out(ard.
Circumduction
• 0est muscle strength2 &lantarDdorsi%le;ion
7/23/2019 WEB Muscoloskeletal
http://slidepdf.com/reader/full/web-muscoloskeletal 28/31
()&sical amination
oot# ins&ect sin integrity, condition o% nails
and any de%ormities.
• Pal&ate the metatarsal bones and oints,
s?uee/e each %oot.
• R7M and muscle strength:
1le;ion and =;tension
5bduction and 5dduction
7/23/2019 WEB Muscoloskeletal
http://slidepdf.com/reader/full/web-muscoloskeletal 29/31
()&sical amination
Spine: 8ave &t. bend a (aist, note curvature,ease o% mobility.
• Pal&ate vertebral column (ith %ingerti&s,note tenderness or bony de%ormities.
• R7M
1le;ion and e;tension
$ateral bending
S&inal rotation.
7/23/2019 WEB Muscoloskeletal
http://slidepdf.com/reader/full/web-muscoloskeletal 30/31
5dditional 5ssessment %or
7lder 5dult• Chec %unctional status
• 5s &atient to:
al (ith shoes onClimb stairs 9 u& D do(n
Pic u& an obect %rom the %loor
Rise %rom sitting in chair Rise %rom lying in bed
7/23/2019 WEB Muscoloskeletal
http://slidepdf.com/reader/full/web-muscoloskeletal 31/31
Summar& Musculoskelatal am
• 'ns&ect body &arts
• Pal&ate each oint
• 5ssess R7M o% each oint
• 5ssess muscle strength