Case Study, Chapter 39, Assessment of Musculoskeletal Function (Tristan)
1. Martha Smitty, an 81-year-old patient, is admitted to the medical-surgical unit after a
recent fall resulting in a fracture of the right hip. (Learning Objective 2)
a. What areas of information need to be gathered by the nurse during the
patient’s history?
The nurse should gather information on the patient’s medical history. This includes current
and past medical conditions, surgeries, allergies, current medications, family history of disease
and cancer, history of falls, how the patient ambulates, any gait or steadiness issues,
ambulation devices used. The nurse should also ask the patient what lead up to the fall and the
proceeding events that followed.
2. The nurse in the outpatient orthopedic clinic is reviewing the medical records of several
patients being seen in the clinic today. In the most recent note by the primary provider, the
nurse reads the following:
“67-year-old, moderately obese woman examined today for increasing back and left shoulder
pain. Limited circumduction of left arm noted in comparison with right arm. Strength of left arm
is less than right, with less muscle definition in the left arm. Examination of back indicates
significant kyphosis, and the patient states that she is ‘shrinking.’ Bone density testing of the hip
is ordered.” (Learning Objectives 3 and 4)
a. How does the nurse interpret “limited circumduction”?
Circumduction is the movement of the distal end of a limb in a circular motion while the
, proximal end remains fixed. The nurse interprets that the patient is unable to make her arm move
in a wide circular motion.
b. When the patient arrives, the nurse correlates the “kyphosis” with what
physical finding? What causes kyphosis in the older adult?
Kyphosis creates a forward curvature of the thoracic spine. This is caused by bone thinning
caused by osteoporosis in older adults.
c. How should the nurse explain the patient’s decreasing height?
Older adults can develop osteoporosis that can result in a decrease in height. Osteoporosis is
abnormal excessive bone loss (Hinkle, 2018, p.1119)
d. What is the rationale for prescribing bone density testing of the hip in this patient?
1. Martha Smitty, an 81-year-old patient, is admitted to the medical-surgical unit after a
recent fall resulting in a fracture of the right hip. (Learning Objective 2)
a. What areas of information need to be gathered by the nurse during the
patient’s history?
The nurse should gather information on the patient’s medical history. This includes current
and past medical conditions, surgeries, allergies, current medications, family history of disease
and cancer, history of falls, how the patient ambulates, any gait or steadiness issues,
ambulation devices used. The nurse should also ask the patient what lead up to the fall and the
proceeding events that followed.
2. The nurse in the outpatient orthopedic clinic is reviewing the medical records of several
patients being seen in the clinic today. In the most recent note by the primary provider, the
nurse reads the following:
“67-year-old, moderately obese woman examined today for increasing back and left shoulder
pain. Limited circumduction of left arm noted in comparison with right arm. Strength of left arm
is less than right, with less muscle definition in the left arm. Examination of back indicates
significant kyphosis, and the patient states that she is ‘shrinking.’ Bone density testing of the hip
is ordered.” (Learning Objectives 3 and 4)
a. How does the nurse interpret “limited circumduction”?
Circumduction is the movement of the distal end of a limb in a circular motion while the
, proximal end remains fixed. The nurse interprets that the patient is unable to make her arm move
in a wide circular motion.
b. When the patient arrives, the nurse correlates the “kyphosis” with what
physical finding? What causes kyphosis in the older adult?
Kyphosis creates a forward curvature of the thoracic spine. This is caused by bone thinning
caused by osteoporosis in older adults.
c. How should the nurse explain the patient’s decreasing height?
Older adults can develop osteoporosis that can result in a decrease in height. Osteoporosis is
abnormal excessive bone loss (Hinkle, 2018, p.1119)
d. What is the rationale for prescribing bone density testing of the hip in this patient?
