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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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ROM’s
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
Swan neck deformity
Boutinniere Deformity
Ulnar Shift
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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.
Heberdens Nodes
Bouchards Nodes
Hard, nontender 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.