The Musculoskeletal System

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The Musculoskeletal System
RACHEL S. Natividad, RN, MSN
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Subjective and Objective Data

• Obtaining a health history
• Assessment
• Inspection/Palpation
• Range of Motion
• passive and active
• Muscular strength

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Inspection/Palpation

• Inspect swelling, mass or deformities, stiffness
  or instability of joints, limbs and body regions
• Palpate for temperature, tenderness surrounding
  joint

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ROMs

• Have the pt perform active ROM
• If unable to, use passive ROM
• Palpate for unusual joint movement during ROM

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Measuring Range of Motion
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Assessing Muscles

• Assess muscle tone and strength
• Strength against gravity/full resistance
• note as 0/5-5/5
• 5/5 normal

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Rheumatoid arthritis

• Chronic, systemic, inflammatory disease that
  attacks the joints, and surrounding tissues,
  hand, knees, hips, and feet

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Deformitiesof RA
Ulnar Shift
Boutinniere Deformity
Swan neck deformity
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Osteoarthritis

• A chronic degeneration of joint cartilage caused
  by aging or trauma
• Pain, stiffness, swelling

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Osteoarthritis Cont.
Hard, nontender nodes
Bouchards Nodes
Heberdens Nodes
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Osteoporosis

• A decrease in bone mass, porous, brittle, and
  prone to fracture

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Contractures
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Assessment Guide Activity Rest

• Objective Data
• Activity Level and Tolerance
• ambulates with walker independently/ with minimal
  assistance bedrest up in wheelchair

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Assessment Guide Activity Rest Muscles and
joints

• Description fair muscle tone, no atrophy
  atrophy to RLE. No stiffness or contractures R
  wrist contracted
• Movement limited ROM to RUE FROM all
  extremities
• Strength strong UE, LE weak RUE RLE
• Coordination able to perform most ADLs can comb
  hair and reach for water glass

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Assessment Guide Activity Rest

• Posture/Gait
• Slumped, kyphosis, erect gait unsteady,
  shuffling, ataxia

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Assessment Guide Activity Rest

• Circulation, Sensation, and Movement
• Describe
• CSM intact
• no sensation to R big toe and second toe
• numbness and tingling to LEs
• Decreased ROM to LUE due to contractures

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Assessment Guide Activity Rest

• Rest/Sleep Patterns
• Sleeps most of the day
• Takes midday naps

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Assessment Guide Activity Rest

• Interventions in use
• Assistive device, equipment
• Cast, trapeze, foot cradle,
• Special beds
• Air bed, eggcrate mattress
• Med List
• Glucosamine, Allopurinol, NSAIDS, etc.