Musculoskeletal System Assessment Guidelines

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Lecturer
Dr. Firas A. Jasim
(MBChB-ABMS-FM)
 2023
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Functional Assessment:
  ADLs (activity of daily living) :
 
1. Toileting.
2. Dressing - buttons - tying shoes.
3. Shaving - brushing teeth.
4. Eating - preparing meals etc…
5. Mobility - walking up/down stairs, in and out of car, out of
house.
6. Communicating -  talking using phone or computer, writing.
7. Occupational / Environmental - heavy lifting, repetitive
motions etc.
 
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1.
 
Observe gait and posture.
2. 
Inspect joints, muscles, and extremities for size,
symmetry, and color.
3
.
Palpate joints, muscles, and extremities for
tenderness, edema, heat, nodules, or crepitus.
   (
Ask painful area, start palpation away from pain, look to
patient).
4
.
Test muscle strength and ROM 
)
 range of motion ) of joints.
5. 
Compare bilateral findings of joints and muscles.
Spine exam:
 
   
Have patient bend a waist, note curvature, ease of
mobility. Note any spinal deformities.
 
   
Palpate vertebral column 
with fingertips, note
tenderness or bony deformities.
 
ROM:
Flexion and extension.
Lateral bending.
Spinal rotation.
Neck exam:
ROM and muscle strength:
Flexion.
Extension.
Cervical rotation- turn head to Right and Left.
Lateral bending- tilt the head to R. and L. shoulders.
Repeat against resistance.
Shoulder exam:
 
Assess symmetry and position of clavicles.
Palpate clavicles toward shoulders, palpate deltoid muscle.
 
ROM and muscle strength:
Flexion
   Extension
   Abduction
   Adduction,
   Rotation
Test muscle strength:
    shrug
Elbow exam :
   bend elbow 
70 
degrees, inspect and palpate posterior
surface.
Note medial and lateral condyles of humerus and
olecranon process of ulna.
 
ROM and muscle strength:
Flexion and Extension
Supination and Pronation
 
Test muscle strength;
    flexion/extension
Wrist exam:
   Grasp wrists, assess body processes of radius (thumb
side) and the ulna.
Palpate radiocarpal joint and remaining wrist joints.
 
ROM and muscle strength:
Flexion.
Extension.
Radial and ulnar wrist
Deviation.
Circumduction.
 
Test strength.
Hand exam :
 
   Use thumb and forefinger to palpate the
metacarpophalangeal and interphalangeal joints.
 
ROM and muscle strength:
Flexion
Extension
Abduction- have patient spread fingers apart
Adduction- have pt. hold fingers together
Thumb/Finger Opposition
Hip exam
   Palpate hip joint and surrounding structures.
Palpate iliac crest, greater trochanter, hip, thigh and
buttock muscles.
 
ROM and muscle strength:
Flexion
Extension
Adduction and Abduction
External rotation and Internal rotation
Symmetry of length and position
Knee exam:
have pt. sitting, dangling.
Inspect- note alignment, deformity, contour of
quadricep muscle.
Palpate the suprapatellar pouch and note any
tenderness, edema.
 
ROM and muscle strength:
Flexion and Extension
Ankle exam:
Compare the contour of R. and L. ankles.
Palpate ankle and achilles tendons.
 
ROM and muscle strength:
Dorsiflexion
Plantar Flexion
Inversion
Eversion
Circumduction
 
Test muscle strength;
Plantar & dorsiflexion
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Q1/ What are the 
ADLs (activity of daily living) 
?
 
Q2/ Write short notes about
 Implementation
 in
nursing process?
 
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Learn how to conduct a thorough musculoskeletal system assessment, including functional assessments and physical examination guidelines. Explore assessment techniques for ADLs, gait observation, joint palpation, muscle strength testing, and more in nursing practice.


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  1. University of Basrah College of Nursing Health Promotion Course Fourth Year Students First Semester 2023

  2. Lecture no. 8 Nursing Process Part 2 Lecturer Dr. FirasA. Jasim (MBChB-ABMS-FM) 2023

  3. Musculoskeletal system assessment Functional Assessment: ADLs (activity of daily living) : 1. Toileting. 2. Dressing - buttons - tying shoes. 3. Shaving - brushing teeth. 4. Eating - preparing meals etc 5. Mobility - walking up/down stairs, in and out of car, out of house. 6. Communicating - talking using phone or computer, writing. 7. Occupational / Environmental - heavy lifting, repetitive motions etc.

  4. Physical Assessment Guidelines 1. Observe gait and posture. 2. Inspect joints, muscles, and extremities for size, symmetry, and color. 3.Palpate joints, muscles, and extremities for tenderness, edema, heat, nodules, or crepitus. (Ask painful area, start palpation away from pain, look to patient). 4.Test muscle strength and ROM ) range of motion ) of joints. 5. Compare bilateral findings of joints and muscles.

  5. Spine exam: Have patient bend a waist, note curvature, ease of mobility. Note any spinal deformities. Palpate vertebral column with fingertips, note tenderness or bony deformities. ROM: Flexion and extension. Lateral bending. Spinal rotation.

  6. Neck exam: ROM and muscle strength: Flexion. Extension. Cervical rotation- turn head to Right and Left. Lateral bending- tilt the head to R. and L. shoulders. Repeat against resistance.

  7. Shoulder exam: Assess symmetry and position of clavicles. Palpate clavicles toward shoulders, palpate deltoid muscle. ROM and muscle strength: Flexion Extension Abduction Adduction, Rotation Test muscle strength: shrug

  8. Elbow exam : bend elbow 70 degrees, inspect and palpate posterior surface. Note medial and lateral condyles of humerus and olecranon process of ulna. ROM and muscle strength: Flexion and Extension Supination and Pronation Test muscle strength; flexion/extension

  9. Wrist exam: Grasp wrists, assess body processes of radius (thumb side) and the ulna. Palpate radiocarpal joint and remaining wrist joints. ROM and muscle strength: Flexion. Extension. Radial and ulnar wrist Deviation. Circumduction. Test strength.

  10. Hand exam : Use thumb and forefinger to palpate the metacarpophalangeal and interphalangeal joints. ROM and muscle strength: Flexion Extension Abduction- have patient spread fingers apart Adduction- have pt. hold fingers together Thumb/Finger Opposition

  11. Hip exam Palpate hip joint and surrounding structures. Palpate iliac crest, greater trochanter, hip, thigh and buttock muscles. ROM and muscle strength: Flexion Extension Adduction and Abduction External rotation and Internal rotation Symmetry of length and position

  12. Knee exam: have pt. sitting, dangling. Inspect- note alignment, deformity, contour of quadricep muscle. Palpate the suprapatellarpouch and note any tenderness, edema. ROM and muscle strength: Flexion and Extension

  13. Ankle exam: Compare the contour of R. and L. ankles. Palpate ankle and achilles tendons. ROM and muscle strength: Dorsiflexion Plantar Flexion Inversion Eversion Circumduction Test muscle strength; Plantar & dorsiflexion

  14. Nursing Diagnosis : Is a clinical judgment concerning human response to health conditions. Nursing diagnoses are developed based on data obtained during the nursing assessment and enable the nurse to develop the care plan. Nursing diagnosis is commonly written in (P) , (E) format: # P = Problem. Planning : planning step is aimed to provide consistent, continuous care that will meet the patient s needs. # E = Etiology.

  15. Implementation : Carry out the care plan. - Reassess the patient. - Validate that the care plan is accurate. - Carry out nurses orders. - Document on patient s chart. Evaluation: Compare the patient s current status with the stated patient goals. - Were the goals achieved? Why not?

  16. HOMEWORK Q1/ What are the ADLs (activity of daily living) ? Q2/ Write short notes about Implementation in nursing process?

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