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you have to be in the room with the doctor and the patients and assist the doctor and help him or her with exam and the assessments and stuff like that
Musculoskeletal assessment begins the instant you see the patient. Good observation skills will enable you to gain information about muscle strength, obvious physical or functional deformities or abnormalities, and movement symmetry. If the patient's chief complaint involves a different body system, the musculoskeletal assessment should represent only a small part of the overall assessment.
After completing this lesson you will:
Understand how to perform a Musculoskeletal Assessment.
Understand the procedure to apply conducting an inspection of the Spinal Curvature.
Understand how to assess Motor skills, Range of Motion, Muscle strength and Muscle mass.
Cite the procedure involved in an Assessment of the Integument.
If the health history or physical findings suggest musculoskeletal involvement, analyze the patient's complaints and perform a complete musculoskeletal assessment.
1.Observe the patient's general appearance, body symmetry, gait, posture, and coordination. Inspect and palpate his muscles, joints, and bones. Evaluate muscle and joint function of each body area as you proceed with the examination. Compare both sides of the body for size, strength, movement, and complaints of pain.
2.Position the patient to allow full range of motion (ROM), but avoid tiring the patient by allowing him to sit whenever possible.
3.Inspect spinal curvature. Have the patient stand as straight as possible and inspect the spine forment and the shoulders, iliac crests, and scapulae for symmetry of position and height. Normally, the thoracic spine is characterized by convex curvature and the lumbar spine is characterized by concave curvature in a standing patient. Have the patient bend forward from the waist with arms relaxed and dangling. Stand behind him and inspect the straightness of the spine, noting flank and thorax position and symmetry.
4. Have the patient stand with his feet together. Note the relation of one knee to the other. The knees should be symmetrical and located at the same height in a forward-facing position.
5. Ask the patient to walk away, turn around, and walk back. If the patient is elderly or infirmed, remain close and ready to help if he should stumble or start to fall. Observe and evaluate his posture, pace and length of stride, foot position, coordination, and balance. Normal findings include smooth, coordinated movements, erect posture, and 2 to 4 inches between the feet. Abnormal findings include a wide support base, arms held out to the side or in front, jerky or shuffling motions, toeing in or out, and the ball of the foot, rather than the heel, striking the floor first.
6. To assess gross motor skills, have the patient perform range-of-motion (ROM) exercises (see Nursing Fundamentals I, figure 5-1). To assess fine motor coordination, have the patient pick up a small object from a flat surface.
7. Assess muscle tone. Muscle tone is the tension in the resting muscle. Palpate the muscle at rest and during passive ROM from the muscle attachment at the bone to the edge of the muscle. A relaxed muscle should feel soft and pliable. A contracted muscle should feel firm.
(8) Assess muscle mass. Muscle mass is the actual size of a muscle. Assessment involves measuring the circumference of the thigh, the calf, and the upper arm. Measure at the same location on each area. Abnormal findings include circumferential differences of more than ½ inch between opposite thighs, calves and upper arms, decreased muscle size (atrophy), excessive muscle size (hypertrophy) without a history of muscle building exercises, flaccidity (atony), weakness (hypotonicity), spasticity (hypertonicity), and involuntary twitching of muscle fibers (fasciculations).
(9) Assess muscle strength and joint ROM. Have the patient perform active ROM as you apply resistance. Normally, the patient can move joints a certain distance (measured in degrees) and can easily resist pressure applied against movement. Strength is normally symmetrical. If the patient cannot perform active ROM, put the joints through passive ROM. Use a goniometer (figure 6-9) to measure the angle achieved. Place the center or zero point on the patient's joint. Place the fixed arm perpendicular to the plane of motion. As the patient moves the joint, the movable arm indicates the angle in degrees.
Figure 6-9. Goniometer.
Assessment of the Integument. Physical assessment of the skin, hair, and nails requires inspection and palpation. Be sure the room is warm to prevent cold-induced vasoconstriction, which may affect skin color.
1. Systematically, assess the entire skin surface as you expose each area for inspection and palpation of other systems. Observe the patient from a distance, noting complexion, general color, and overall appearance. A bluish discoloration is due to lack of oxygen in the blood. A yellow skin tone (jaundice) indicates liver dysfunction. Note pigmentation (light and dark areas compared to the rest of the skin), freckles, and moles.
2. Assess skin texture, consistency, temperature, moisture, and turgor. Skin texture refers to smoothness or coarseness. Consistency refers to changes in skin thickness or firmness and relates more to changes associated with lesions. The skin should feel warm to cool, and areas should feel the same bilaterally. Assess turgor by gently grasping and pulling up a fold of skin, releasing it, and observing how quickly it returns to normal shape. Normal skin usually resumes its flat shape immediately. Poor turgor may indicate dehydration and connective tissue disorders.
3. Note the quantity, texture, color, and distribution of hair. Rub a few strands of the patient's hair between you index finger and thumb. Feel for dryness, brittleness, oiliness, and thickness.
4. Assessment of the nails provides information about the patient's life-style, self-esteem, and level of self-care as well as health status. Inspect the nails for cleanliness, length, color, consistency, smoothness, symmetry, and for jagged or bitten edges.
5. Note any alterations in skin integrity such as scars, rashes, sores, lesions, bruises, and discoloration. If the patient has a dressing, note the type, location, any drainage, and the amount and character of the drainage.
(The practical nurse that is assigned to assist in the physical examination plays an important role in supporting both the patient and the physician or other health care providers. Upon completion, chart that the examination was done, by whom, the patient's reaction, and any specimens sent to the lab or special procedures to be followed.)
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