Transcript Neuromuscular and Neurological Systems

Musculoskeletal and
Neurological
Assessment
Objectives
Define Gait, Stance, Posture
 Discuss assessment of joints and muscles
 Outline a Neuro Exam
 Identify reflexes
 Identify function of the cranial nerves

Musculoskeletal
Assessment
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!
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Gait
1.
2.
3.
4.
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.
Gait Abnomalities
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Unusual and uncontrollable walking
patterns, usually caused by disease or
injury.
 Propulsive
 Scissors
 Spastic
 Steppage
 Waddling
Stance
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Symmetrical
Width
Steady
Assistive Devices
Posture
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Normal - Comfortably
erect
Look for straight lines
across body parts
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Normal Aging
Lordosis - Increased Curvature of the Spine
Kyphosis is a curving of the spine that
causes a bowing of the back, which leads to
a hunchback or slouching posture.
Scoliosis – curvature of the spine
away from middle or sideways
Examination of Joints
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Inspection
Size and contour: redness, atrophy, deformity,
swelling
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Palpation
Crepitious, thickening, swelling, or tenderness
Range of Motion
Full Mobility of each joint
 Deliberate, accurate, smooth, and
coordinated
 No involuntary movement
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Muscle Atrophy
Subluxation
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A partial or incomplete dislocation
Contractures
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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.
Neurological
Assessment
General appearance, Personal
Hygiene
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Appropriately dressed
Well-Groomed
Odor
Eye contact
Posture
Orientation
Person
 Place
 Time
 Can a person be oriented and still be
confused?
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Level of Consciousness: response
to environmental stimuli
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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
Glascow Coma Scale
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Quantitative tool
Eye opening, verbal
response, motor
response
Fully alert score is 15
Coma is 7 or less
12 Cranial Nerve
Cranial Nerve
Assessment
I olfactory
Smell
II
Vision
optic
III oculomotor
Eye movements, PERRLA, eyelids
IV trochlear
V
trigeminal
Facial sensations, corneal reflex
VI abducens
Assessed with III and VI
VII facial
Taste, smile, frown, close eyes tightly
VIII acoustic
hearing
IX
glossopharnxgeal
Gag reflex, swallowing, taste;
X
vagus
XI
spinal accessory
XII hypoglossal
Shrug shoulders, turn head against resistance
Stick out tongue, move tongue side to side
Motor
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Observation
Muscle Tone
Muscle Strength
 Squeeze
hands
 Pronator Drift
Deep Tendon Reflex
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Biceps
Brachioradialis
Triceps
Patellar
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Babinski
Achilles Tendon S1
Rated from 0 to 5+
C5, C6
C6
C7
L4
Abnormal Reflex Toes Fan
Rating Scale
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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
Motor Abnormalities
 Spasticity
 Flaccidity
 Tremor
Coordination and Gait
 Point
to Point
Movements
 Romberg
 Gait
Reflexes
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Deep Tendon
Reflexes
Clonus
Babinski
Sensory
General
 Soft/Sharp Touch
 Discrimination
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NCLEX Question
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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.
A.
B.
C.
D.
Sternal rub
Pressure on the Orbital rim
Squeezing of the sternocleidomastoid muscle
Nail bed pressure
NCLEX Question
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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?
A.
B.
C.
D.
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.