Transcript Musculoskeletal HO

Musculoskeletal Lecture
NUR 216
Professor Shugart
Structures







Bones
Joints
Ligaments
Bursae
Muscles
Tendons
Cartilage
Functions



What are the functions of the…………
Bones (206)
Structure; protection; produce red
blood cell; act as levers; stores calcium
Muscles (650)
Allow for movement and position;
produce heat
Functions



What are the functions of the…………
Joints:
Point of articulation of two bones;
provide ROM
Tendons:
Connect muscle to bone
Functions



What are the functions of the…………
Ligaments:
Connect bone to bone
Cartilage:
Support and shapes; acts as a shock
absorber
Functions


What are the functions of the…………
Bursae:
Sacs filled with synovial fluid; cushions
and reduce friction between joints
Movements


Range of Motion: (ROM)
The degree of movement of a joint is
called the range of motion. Diarthrotic,
or freely movable, joints are the only
joints that have one or more ranges of
motion.
Movements




Flexion: Is the bending forward of the
joint to decrease the angle between the
bones that it connects.
Extension: Is the straightening of a
limb to increase the joint angle.
Abduction: Is the movement of the
limb away from the midline of the body.
Adduction: Is the movement of the
limb toward the central axis of the
body.
Movements


Internal Rotation: Is the turning of
the body part inward toward the central
axis of the body.
External Rotation: Is the turning of
the body part away from the midline
History
What can a history tell you about the
musculoskeletal system?.............

Health History
1.
Occupational or recreational activity
2.
Previous occurrence of the following:
Musculoskeletal or systemic disease,
Injury, Difficulty with joint movement,
Tenderness, Erythema, Difficutly with
ADL
History
3.
4.
5.
6.
Family History
Developmental Considerations
Health promotion and protection
patterns
Abilities to perform ADLs
History

Subjective Data
*For any symptom the person has you
should ask about ………….
1.
2.
3.
4.
5.
Location
Quality
Quantity
Timing
Aggravating Factors
History

Subjective Data
*For any symptom the person has you
should ask about ………….
6.
7.
8.
Relieving Factors
Associated Symptoms
Effects on ADLs
Symptoms
What symptoms would signal a problem
with the musculoskeletal
system?...........
 Joints: pain, stiffness, heat or limitation
of movement
 Bones: pain, deformity, or trauma
 Muscles: pain, weakness
 Balance and coordination problems
Physical Assessment

Inspection is first:
Physical Assessment
1.
Posture: The position the body parts
assume in relationship to other body
parts. The client/patient posture is
upright with good alignment of the
head, shoulders, and hips.
2.
Spine: Includes having the person
stand up straight and then bend
forward at the waist.
Physical Assessment

1.
2.
3.
Common Abnormalities:
Lordosis (swayback): exaggerated
concave curvature of the lumbar
spine.
Kyposis (hunchback): excessively
convex (backward curvature of the
thoracic spine).
Scoloiosis: abnormal lateral
curvature of the spine. Best detected
when a person bends at the waist.
Common Abnormalities:
Physical Assessment

Inspection
3. Gait: observe
person walking,
turning and
returning.
Physical Assessment



Inspect Joints: Size,
shape, redness, or
masses.
Inspect Muscles:
Involuntary movement,
mass, size, symmetry.
Measure Length and
Circumference:
Arms and Legs
Physical Assessment

Palpation is next:
Physical Assessment

1.
2.
3.
4.
5.
Palpate the bones, joints and spine
for…..
Temperature
Tenderness
Swelling
Masses
Crepitus: Grating feeling or sound in
joint during ROM
Physical Assessment
6.

Palpate joint during ROM
Active ROM is voluntary movement of
the joints by the person. Should be
done first, before testing for muscle
strength.

Passive ROM is movement of the
relaxed joint of the patient by the
examiner through the limits of its
movement.
Physical Assessment
7.
8.
9.
7.
Hand grips
Foot push/leg raise
Muscle Strength
(0-5)
Muscle Tone
Physical Assessment
Muscle strength is tested against
resistance of the examiner.
Grade
5
4
3
2
1
0
Description
Full ROM against gravity with extreme resistance
Full Rom against gravity with some resistance
Full ROM against gravity with no resistance
Full Rom with gravity eliminated
Slight contraction visible
No contraction
Physical Assessment

Documentation is
next
Physical Assessment

Musculoskeletal
Muscles developed without atrophy/
hypertrophy. Arms and legs symmetrical. No
edema, varicosity’s, or tenderness. Joints
non-tender, without swelling, and with full
ROM. Muscle tone and strength 5/5
bilaterally. Spine has full Rom and is without
tenderness or deformities.
Nursing Diagnosis






Pain
Activity Intolerance
Self-Care Deficit
Body Image Disturbances
Injury, risk for
Impaired physical mobility
Assistive Devices

1.
2.
3.

1.
2.
Canes
Standard
T-handle
Quad
Crutches
Axillary
Lofstrand

1.
2.
3.
Walker
Standard
Foldable
Wheels
Terms



Weight bearing
Partial weight bearing
No weight bearing
Remember Safety






Review health status
Assess V/S
Assess level of orientation
Assess ROM
Assess environment
Assess level of understanding
Cane Assisted Ambulation
1.
2.
3.
4.


Used with partial weight bearing
Assess balance, strength, and confidence
Usually used unilaterally
Instruct client to hold cane on uninvolved
side.
The cane and weaker leg work together
while ambulating
Allow 15-30 degrees elbow flexion with the
cane
Cane Assisted Ambulation
5. Move cane forward 6-10 inches, while keeping
weight on both legs
6. Move affected leg forward so it is even with the
cane
7. Bring the unaffected leg past the cane
8. Move affected leg even with the unaffected leg
9. Repeat steps

Do not use words like good or bad; instead, use
involved/uninvolved, affected/unaffected, right/left
Crutches Assisted Ambulation






What disorders necessitate the use of
crutches?
REMEMBER SAFETY
Assess arm and shoulder strength
Assess balance
Assess endurance
Proper measurement is important
Crutches Assisted Ambulation





Standing measurements:
Two or three fingers should fit between the
top of the crutch and the axilla and/or
Crutch pads should be 1 1/2- 2 inches below
axilla
Rubber tips on crutch should reach 4 - 6
inches to side of client's feet
(Handgrip) Elbow should be flexed 15-30
degrees
Ambulation-4 Point Gate



1. Begin with feet comfortably apart and
crutches 6 inches in front and 6 inches to
side of each foot. (Be sure body is in
alignment) [tripod position]
2. Keeping feet together, move right crutch
forward 4-6 inches
3. (Crutch and foot move in opposition)
Move left foot forward to be equal level
with left cane
Ambulation-4 Point Gate



4. Move left crutch forward 4-6 inches
5. (Crutch and foot move in opposition)
Move right foot forward to be equal level
with right crutch
6. Repeat
Ambulation-3 Point Gate




1. Begin in tripod position (above)
2. Bring both crutches and affected leg
forward
3. Move unaffected leg forward
4. Repeat
Ambulation-2 Point Gate





1. Begin in tripod position (above)
2. (Crutch and foot move together in
opposition)
Move left crutch and right foot forward
(together)
3. Move right crutch and left foot
forward (together)
4. Repeat
Swing-to gait



1. Move both crutches forward
2. Lift and swing legs to crutches
3. Repeat
Swing-through gait



1. Move both crutches forward
2. Lift and swing legs through and past
the crutches
3. Repeat
Walker Assisted
Ambulation





1. Position- Upper bar of walker is slightly
below client's waist.
Elbows are flexed 15-30 degrees (with hands
on hand grips)
2. Lift walker and move forward 6-8 inches.
Step forward. Follow-through
with opposite foot. (If one side is affected,
step forward with affected leg first)
3. Repeat
Guidelines for ROM











1.
2.
3.
4.
5.
6
7.
8.
9.
10.
11.
Wash hands
Explain/teach
Use proper body mechanics
Provide privacy
ROM- Support joint and limb
Move smoothly, slowly, rhythmically
Move to resistance (not pain)
Return joint to neutral alignment
Perform 2-3 times per day
Assess client
Document
Suggested order for
performing ROM






1.
2.
3.
4.
5.
Wash hands
Explain ROM
Raise bed (body mechanics)
Position client close to side of bed
Neck- flexion, extension, rotation,
hyperextension
6. Shoulder- flexion, extension,
hyperextension, abduction, adduction
external rotation, internal rotation,
circumduction
Suggested order for
performing ROM





7. Elbow- flexion, extension
8. Forearm- supination, pronation
9. Wrist- flexion, extension, hyperextension,
radial deviation, ulnar deviation
10. Hands/fingers- flexion, extension,
hyperextension, abduction, adduction
11. Thumb- flexion, extension, abduction,
adduction, opposition
Suggested order for
performing ROM







12. Hip-flexion, -extension, abduction,
adduction, external rotation, internal rotation,
circumduction, hyperextension
13. Knee- flexion, extension
14. Ankle- dorsiflexion, plantar flexion
15. Foot- inversion, eversion
16. Toes- flexion, extension, abduction,
adduction
17. Documentation
18. Nursing diagnosis- Impaired Mobility