lOMoARcPSD|21646696
lOMoARcPSD|21646696N
Med Surg 2 Notes well Summarized
m m m m m
Assessment of Musculoskeletal Function Chapter 39
m m m m m
• Functions m o fm them M usculoskeletalm System
o Protectionmofm vitalmorgans
▪ Kidney,mliver, mheart
o Mobilitymandmmovement
o Facilitatemreturnmo fmbloodmto mthemheart
o Production mo fm bloodm cells m (hem atopoiesis)
o Reservoirm for mim mature mbloodm cells
o Reservoirm for mvitalm minerals
o Always m thinkm aboutm ptm safetym whenm itm com es m to m them m uscularm system
• Assessmentm ofm them Musculoskeletalm System
o Include mdata mrelatedmto mfunctionmability
▪ ADLs
• Wemneedm to m knowm this m to m knowm howm m uch ma m ptm canmaccom plishm o
nmtheirmownm(depends mo fm whatm theirm conditionmis)
▪ IADLS
o Healthmhisto ry
▪ nursingm assessmentm o fm them patientm with m m usculoskeletal m dysfunction
mincludes m a m health m history m andm physicalm examination m thatm evaluate m th
emeffects mofm them m usculoskeletalm diso rdermonm them patient
▪ Familymhistory
• Youmneedmto mknowm theirmgenetics
▪ healthm maintenance
• nursemmustm promotem a m healthy m lifestylem bym discussing m themim
portancemofmnutritionmandmnutritionalm supplem ents,m regular
exercise,mandm maintaining manmappropriate m weight
▪ nutrition
• Dailym intakem o fm approximatelym 1000m to m 1200 m m gm o fm calcium m i
s messentialm to mmaintainingmadultm bonemm ass
• VitaminmDm plays m a m majo rm ro le minm calcium m absorption mand m bon
emhealth
• Promotemmilk,myogurt,m nuts
▪ occupation
▪ socioeconomicm factors
▪ medications m(includem OTC)
▪ evaluatem them effects mo fm them musculoskeletalm disordermonm them patient
▪ address m problems m asso ciatedm withm immobilitym andm advocatem fo
rmevidence m basedm periodicm m usculoskeletal m healthm screenings
o Pain
▪ Bonempainmis mtypicallym described mas ma m dull,m deepm achem thatmis m “boring” mi
nmnature
• painmis mnotmtypicallym relatedm to mmovementmandmm ayminterferem wit
hmsleep
▪ Muscularm painm is m describedm as m soreness m o rm achingm andm is m referredm to m a
s m“musclem cram ps.”
▪ Fracturem pain mis msharpmandm piercingmandmis mrelievedm bymimmobilization
1
, lOMoARcPSD|21646696
▪ Sharpmpainmmaymalsomresultmfrommboneminfectionmwithmmusclemspasmmo
rmpressuremonmamsensorymnerve
▪ Jointmpainmis mfelt maroundmor min mthe mjointmand mtypicallym worsens mwit
hmmovement
▪ Restmrelieves mmostmmusculoskeletalmpain
▪ Painmthatmincreases m withm activitymm aymindicatem jointmsprain,m musclem
strain,m orm compartmentm syndrom e,m whereas m steadilym increasingm pai
n
points mto m them progressionm o fm an minfectious m pro cess m(osteomyelitis), ma mm al
ignantmtumo r,mo rmneurovascularm com plications.
▪ Radiating mpainm occurs m inm conditions m inm whichm pressurem is m exertedm onm
a mnervemroot
▪ painmwithm a m rheum atic m disorder mis m wo rse min m the mmorning,m especiallym upo
nmwaking
▪ Tendonitis m worsens m duringm them early m morning m andm eases m bym midday
▪ osteoarthritis mworsens mas mthemdaymprogresses
▪ Radiatingm pain,m wem thinkm cardiac
▪ Wemassess mtheirm pain.m Wem needm to m kno wm whatm kindmo fm painm the m patie
ntmhas mto mleft mside.mDoes m them painmoccurm withmmo vement?
o Altered m sensations
▪ patientm maym describem paresthesia’s,m whichm arem sensations m o fm burning
,mtingling,morm num bness
• maymbemcausedmbympressuremonmnerves mormbymcirculator
ymimpairment
o Physicalmassessm ent:m posture,m gait,m bonemintegrity, mjointm function,m muscl
emstrengthmandmsize,mskin,m neurovascularmstatus
▪ normalmcurvature mo fm themspinem is m convex m throughm the m tho racic mpo rtio
nmandmconcavem throughm themcervicalmandm lum barm portions
▪ deformities mofm themspineminclude:
• kyphosis,mwhich mis manmincreasedm forwardm curvature mo fm the m tho raci
cmspinemthat mcauses ma m bo wingm orm roundingm ofm the mback,m leadingm to
ma
hunchbackmormslouchingmposture
• lordosis,m orm swayback,m anm exaggeratedm curvature m o fm them lum ba
rmspine
• scoliosis,mwhichmis ma m lateralmcurvingm deviationmo fm the mspine
▪ Gaitm is m assessedm bym havingm them patientm walkm awaym from m the m examine
rmforma mshortmdistance
▪ bonym skeleton m is m assessedm fo rm deformities m andm alignment
• Fracturem findings m maym includem abno rmalm angulationm o fm longm bones
,mmotionmatmpoints motherm thanmjoints,mandm crepitus
▪ patientm with ma m musculoskeletal mdisorderm maym repo rtm pain, m tenderness
,mandmalteredmsensations
▪ articularmsystem mis m evaluated mbym no tingm rangemo fmmo tion, mdefo rmity
,mstability,m tenderness,mandmnodularm form ation
▪ muscularm system m is m assessedm bym notingm m uscularm strengthm andm coordina
tion,mthemsizemofmindividualmm uscles,mandmthem patient’s mabilitym to mchangem
position.
▪ inspectmthemskinm fo rmedem a,m tem perature,m andm co lor
2
, lOMoARcPSD|21646696
▪ nursem mustm perform m frequentm neurovascularm assessm ents m ofm patient
s mwithmmusculoskeletalm disorders m(especially mo fm thosem with m fractures)m
becausemofm them riskmo fm tissue mandm nervem damage
• nursem needs m to m bem particularlym awarem o fm signs m andm sym ptoms m o
fmcompartmentmsyndrome
• Age-relatedm m usculoskeletalm functional m changes m include?
o Fragilembones
o Musclemweakness
o Stiffm andm painfulm joints
o All mofmthe mabove
o Fragilem bones m –
m bones m maymbecom e m fragile m andm prone m to m fracture m includingm the mvertebrae,mhi
pmandmwrist.
o Musclemweakness m–
mtheremmaymbema mloss mofmmusclemstrengthmandmflexibilitym resultingminmweak
ness,mfatigue,mandmamhighmriskmformstumblingmandmfalls
o Stiffmandmpainfulm joints m–
m joints mmaymbecom e mstiffmwith m reduced m flexibility mandm painful,m whichmmaymint
erferem withmADLs
• Diagnosticm Evaluation
o X-RaymStudies
▪ determinem bonem density,m texture,m erosion, mand mchanges minm bon
emrelationships
▪ revealm fluid,mirregularity,mspur m formation,mnarro wing,mand mchanges minm th
emjointmstructure
o CT
▪ maymbemperform ed m withmo rm withoutm the musemo fmo ralmo rmintravenous m (I
V)mcontrastmagents
3
, lOMoARcPSD|21646696
▪ usedmto mvisualizem andm assess m tumors;minjury m to mthemso ftm tissue,m liga
ments,m orm tendons;m andm severem trauma m to m them chest,m abdomen,mpe
lvis,mhead,mormspinalm cord
▪ usedmto midentifym them lo cationmandmextentmo fm fractures minmareas m thatma r
emdifficultm to mevaluatemAKA mcan’tmbemseenmonmXRAY
o MRI
▪ noninvasive m imaging m technique m that m uses m m agnetic m fields m and m radi
o mwaves mto m createm high-reso lutionm pictures mo fm bones mandmso ft m tissues
▪ usedm to m visualize m and m assess m tornm muscles, m ligam ents,m andm cartilage
;mherniatedm discs;mandma m varietymo fmhipmo rmpelvicmconditions
▪ REMOVE m allm metal,m jewelry,m hairclips,m aids,m andm creditm cards.
▪ IVmcontrastmmaymbemused
o Arthrography
▪ usedmto midentify m them causemo fm anym unexplainedm jointm painman
dmprogressionmofm jointmdisease
▪ radiopaquemcontrastmagentmorm airmis minjectedminto mthemjointm cavity
▪ jointmis mputmthroughm its m rangemo fm motionm to m distributem them contrastmagen
tmwhilema mseries mo fmx-rays maremobtained
• ifmcontrastm leakmis mpresentm theremis ma mtearminm themjoint
▪ maymfeelmsomem discom fortm orm tingling m duringm them procedure
▪ jointmis musuallym restedm for m 12m hours
▪ Strenuous mactivitymshouldmbemavoidedmuntilmapprovedmbymthemprimar
ymprovider
o Bonemdensitometry
▪ usedm to m evaluatem BMD m (bone m mineralm density)
▪ canm bem perform edm throughm them usem o fm x-rays m orm ultraso und
o Bonemscan
▪ detects m m etastaticm andm primarym bo nem tumors,m osteom yelitis,m som
emfractures, mand maseptic mnecrosis, mand m to mmonitor m them progressionm
ofmdegenerative m bonem diseases
▪ requires mtheminjectionmo fma m radioisotope m throughmanmIV m line
• scanmis mperformedm2mto m3mhours mafterward
▪ patientm may m experience m slightm discom fo rt
▪ ptmshouldm emptym their m bladderm befo re m themscan
o Arthroscopy
▪ allows mdirectmvisualization mo fma mjointm throughmthem usemo fma m fiberopti
cmendoscope
▪ takes mplaceminm the moperating mroom m undermsterilem conditions
o Arthrocentesis
▪ obtains msynovialm fluid m fo rm purposes m o fm examination morm to m relievem pai
nmduemto meffusion
o Electromyography
▪ provides minform ationmaboutm them electrical mpo tentialmo fm them muscles ma n
dmthemnerves m leadingm to m them
▪ determines manymabno rm ality mo fm functio nmandm to mdifferentiate m musclema n
dmnervemproblems
▪ Beforemthe m patient mundergoes m an mEMG,m the mnurseminquires mifm the mpatien
tmis m takingm anym anticoagulantm medications m andm assesses m form anym activem
skinminfection
4
lOMoARcPSD|21646696N
Med Surg 2 Notes well Summarized
m m m m m
Assessment of Musculoskeletal Function Chapter 39
m m m m m
• Functions m o fm them M usculoskeletalm System
o Protectionmofm vitalmorgans
▪ Kidney,mliver, mheart
o Mobilitymandmmovement
o Facilitatemreturnmo fmbloodmto mthemheart
o Production mo fm bloodm cells m (hem atopoiesis)
o Reservoirm for mim mature mbloodm cells
o Reservoirm for mvitalm minerals
o Always m thinkm aboutm ptm safetym whenm itm com es m to m them m uscularm system
• Assessmentm ofm them Musculoskeletalm System
o Include mdata mrelatedmto mfunctionmability
▪ ADLs
• Wemneedm to m knowm this m to m knowm howm m uch ma m ptm canmaccom plishm o
nmtheirmownm(depends mo fm whatm theirm conditionmis)
▪ IADLS
o Healthmhisto ry
▪ nursingm assessmentm o fm them patientm with m m usculoskeletal m dysfunction
mincludes m a m health m history m andm physicalm examination m thatm evaluate m th
emeffects mofm them m usculoskeletalm diso rdermonm them patient
▪ Familymhistory
• Youmneedmto mknowm theirmgenetics
▪ healthm maintenance
• nursemmustm promotem a m healthy m lifestylem bym discussing m themim
portancemofmnutritionmandmnutritionalm supplem ents,m regular
exercise,mandm maintaining manmappropriate m weight
▪ nutrition
• Dailym intakem o fm approximatelym 1000m to m 1200 m m gm o fm calcium m i
s messentialm to mmaintainingmadultm bonemm ass
• VitaminmDm plays m a m majo rm ro le minm calcium m absorption mand m bon
emhealth
• Promotemmilk,myogurt,m nuts
▪ occupation
▪ socioeconomicm factors
▪ medications m(includem OTC)
▪ evaluatem them effects mo fm them musculoskeletalm disordermonm them patient
▪ address m problems m asso ciatedm withm immobilitym andm advocatem fo
rmevidence m basedm periodicm m usculoskeletal m healthm screenings
o Pain
▪ Bonempainmis mtypicallym described mas ma m dull,m deepm achem thatmis m “boring” mi
nmnature
• painmis mnotmtypicallym relatedm to mmovementmandmm ayminterferem wit
hmsleep
▪ Muscularm painm is m describedm as m soreness m o rm achingm andm is m referredm to m a
s m“musclem cram ps.”
▪ Fracturem pain mis msharpmandm piercingmandmis mrelievedm bymimmobilization
1
, lOMoARcPSD|21646696
▪ Sharpmpainmmaymalsomresultmfrommboneminfectionmwithmmusclemspasmmo
rmpressuremonmamsensorymnerve
▪ Jointmpainmis mfelt maroundmor min mthe mjointmand mtypicallym worsens mwit
hmmovement
▪ Restmrelieves mmostmmusculoskeletalmpain
▪ Painmthatmincreases m withm activitymm aymindicatem jointmsprain,m musclem
strain,m orm compartmentm syndrom e,m whereas m steadilym increasingm pai
n
points mto m them progressionm o fm an minfectious m pro cess m(osteomyelitis), ma mm al
ignantmtumo r,mo rmneurovascularm com plications.
▪ Radiating mpainm occurs m inm conditions m inm whichm pressurem is m exertedm onm
a mnervemroot
▪ painmwithm a m rheum atic m disorder mis m wo rse min m the mmorning,m especiallym upo
nmwaking
▪ Tendonitis m worsens m duringm them early m morning m andm eases m bym midday
▪ osteoarthritis mworsens mas mthemdaymprogresses
▪ Radiatingm pain,m wem thinkm cardiac
▪ Wemassess mtheirm pain.m Wem needm to m kno wm whatm kindmo fm painm the m patie
ntmhas mto mleft mside.mDoes m them painmoccurm withmmo vement?
o Altered m sensations
▪ patientm maym describem paresthesia’s,m whichm arem sensations m o fm burning
,mtingling,morm num bness
• maymbemcausedmbympressuremonmnerves mormbymcirculator
ymimpairment
o Physicalmassessm ent:m posture,m gait,m bonemintegrity, mjointm function,m muscl
emstrengthmandmsize,mskin,m neurovascularmstatus
▪ normalmcurvature mo fm themspinem is m convex m throughm the m tho racic mpo rtio
nmandmconcavem throughm themcervicalmandm lum barm portions
▪ deformities mofm themspineminclude:
• kyphosis,mwhich mis manmincreasedm forwardm curvature mo fm the m tho raci
cmspinemthat mcauses ma m bo wingm orm roundingm ofm the mback,m leadingm to
ma
hunchbackmormslouchingmposture
• lordosis,m orm swayback,m anm exaggeratedm curvature m o fm them lum ba
rmspine
• scoliosis,mwhichmis ma m lateralmcurvingm deviationmo fm the mspine
▪ Gaitm is m assessedm bym havingm them patientm walkm awaym from m the m examine
rmforma mshortmdistance
▪ bonym skeleton m is m assessedm fo rm deformities m andm alignment
• Fracturem findings m maym includem abno rmalm angulationm o fm longm bones
,mmotionmatmpoints motherm thanmjoints,mandm crepitus
▪ patientm with ma m musculoskeletal mdisorderm maym repo rtm pain, m tenderness
,mandmalteredmsensations
▪ articularmsystem mis m evaluated mbym no tingm rangemo fmmo tion, mdefo rmity
,mstability,m tenderness,mandmnodularm form ation
▪ muscularm system m is m assessedm bym notingm m uscularm strengthm andm coordina
tion,mthemsizemofmindividualmm uscles,mandmthem patient’s mabilitym to mchangem
position.
▪ inspectmthemskinm fo rmedem a,m tem perature,m andm co lor
2
, lOMoARcPSD|21646696
▪ nursem mustm perform m frequentm neurovascularm assessm ents m ofm patient
s mwithmmusculoskeletalm disorders m(especially mo fm thosem with m fractures)m
becausemofm them riskmo fm tissue mandm nervem damage
• nursem needs m to m bem particularlym awarem o fm signs m andm sym ptoms m o
fmcompartmentmsyndrome
• Age-relatedm m usculoskeletalm functional m changes m include?
o Fragilembones
o Musclemweakness
o Stiffm andm painfulm joints
o All mofmthe mabove
o Fragilem bones m –
m bones m maymbecom e m fragile m andm prone m to m fracture m includingm the mvertebrae,mhi
pmandmwrist.
o Musclemweakness m–
mtheremmaymbema mloss mofmmusclemstrengthmandmflexibilitym resultingminmweak
ness,mfatigue,mandmamhighmriskmformstumblingmandmfalls
o Stiffmandmpainfulm joints m–
m joints mmaymbecom e mstiffmwith m reduced m flexibility mandm painful,m whichmmaymint
erferem withmADLs
• Diagnosticm Evaluation
o X-RaymStudies
▪ determinem bonem density,m texture,m erosion, mand mchanges minm bon
emrelationships
▪ revealm fluid,mirregularity,mspur m formation,mnarro wing,mand mchanges minm th
emjointmstructure
o CT
▪ maymbemperform ed m withmo rm withoutm the musemo fmo ralmo rmintravenous m (I
V)mcontrastmagents
3
, lOMoARcPSD|21646696
▪ usedmto mvisualizem andm assess m tumors;minjury m to mthemso ftm tissue,m liga
ments,m orm tendons;m andm severem trauma m to m them chest,m abdomen,mpe
lvis,mhead,mormspinalm cord
▪ usedmto midentifym them lo cationmandmextentmo fm fractures minmareas m thatma r
emdifficultm to mevaluatemAKA mcan’tmbemseenmonmXRAY
o MRI
▪ noninvasive m imaging m technique m that m uses m m agnetic m fields m and m radi
o mwaves mto m createm high-reso lutionm pictures mo fm bones mandmso ft m tissues
▪ usedm to m visualize m and m assess m tornm muscles, m ligam ents,m andm cartilage
;mherniatedm discs;mandma m varietymo fmhipmo rmpelvicmconditions
▪ REMOVE m allm metal,m jewelry,m hairclips,m aids,m andm creditm cards.
▪ IVmcontrastmmaymbemused
o Arthrography
▪ usedmto midentify m them causemo fm anym unexplainedm jointm painman
dmprogressionmofm jointmdisease
▪ radiopaquemcontrastmagentmorm airmis minjectedminto mthemjointm cavity
▪ jointmis mputmthroughm its m rangemo fm motionm to m distributem them contrastmagen
tmwhilema mseries mo fmx-rays maremobtained
• ifmcontrastm leakmis mpresentm theremis ma mtearminm themjoint
▪ maymfeelmsomem discom fortm orm tingling m duringm them procedure
▪ jointmis musuallym restedm for m 12m hours
▪ Strenuous mactivitymshouldmbemavoidedmuntilmapprovedmbymthemprimar
ymprovider
o Bonemdensitometry
▪ usedm to m evaluatem BMD m (bone m mineralm density)
▪ canm bem perform edm throughm them usem o fm x-rays m orm ultraso und
o Bonemscan
▪ detects m m etastaticm andm primarym bo nem tumors,m osteom yelitis,m som
emfractures, mand maseptic mnecrosis, mand m to mmonitor m them progressionm
ofmdegenerative m bonem diseases
▪ requires mtheminjectionmo fma m radioisotope m throughmanmIV m line
• scanmis mperformedm2mto m3mhours mafterward
▪ patientm may m experience m slightm discom fo rt
▪ ptmshouldm emptym their m bladderm befo re m themscan
o Arthroscopy
▪ allows mdirectmvisualization mo fma mjointm throughmthem usemo fma m fiberopti
cmendoscope
▪ takes mplaceminm the moperating mroom m undermsterilem conditions
o Arthrocentesis
▪ obtains msynovialm fluid m fo rm purposes m o fm examination morm to m relievem pai
nmduemto meffusion
o Electromyography
▪ provides minform ationmaboutm them electrical mpo tentialmo fm them muscles ma n
dmthemnerves m leadingm to m them
▪ determines manymabno rm ality mo fm functio nmandm to mdifferentiate m musclema n
dmnervemproblems
▪ Beforemthe m patient mundergoes m an mEMG,m the mnurseminquires mifm the mpatien
tmis m takingm anym anticoagulantm medications m andm assesses m form anym activem
skinminfection
4
