Med Surg 2 Notes well Summarized
Assessment of Musculoskeletal Function Chapter 39
• Functions of the Musculoskeletal System
o Protection of vital organs
▪ Kidney, liver, heart
o Mobility and movement
o Facilitate return of blood to the heart
o Production of blood cells (hematopoiesi...
Assessment of Musculoskeletal Function Chapter 39
• Functions of the Musculoskeletal System
o Protection of vital organs
▪ Kidney, liver, heart
o Mobility and movement
o Facilitate return of blood to the heart
o Production of blood cells (hematopoiesis)
o Reservoir for immature blood cells
o Reservoir for vital minerals
o Always think about pt safety when it comes to the muscular system
• Assessment of the Musculoskeletal System
o Include data related to function ability
▪ ADLs
• We need to know this to know how much a pt can accomplish on
their own (depends of what their condition is)
▪ IADLS
o Health history
▪ nursing assessment of the patient with musculoskeletal dysfunction
includes a health history and physical examination that evaluate the
effects of the musculoskeletal disorder on the patient
▪ Family history
• You need to know their genetics
▪ health maintenance
• nurse must promote a healthy lifestyle by discussing the
importance of nutrition and nutritional supplements, regular
exercise, and maintaining an appropriate weight
▪ nutrition
• Daily intake of approximately 1000 to 1200 mg of calcium is
essential to maintaining adult bone mass
• Vitamin D plays a major role in calcium absorption and bone
health
• Promote milk, yogurt, nuts
▪ occupation
▪ socioeconomic factors
▪ medications (include OTC)
▪ evaluate the effects of the musculoskeletal disorder on the patient
▪ address problems associated with immobility and advocate for
evidence based periodic musculoskeletal health screenings
o Pain
▪ Bone pain is typically described as a dull, deep ache that is “boring” in
nature
• pain is not typically related to movement and may interfere with
sleep
▪ Muscular pain is described as soreness or aching and is referred to as
“muscle cramps.”
▪ Fracture pain is sharp and piercing and is relieved by immobilization
1
, lOMoARcPSD|21646696
▪ Sharp pain may also result from bone infection with muscle spasm
or pressure on a sensory nerve
▪ Joint pain is felt around or in the joint and typically worsens
with movement
▪ Rest relieves most musculoskeletal pain
▪ Pain that increases with activity may indicate joint sprain, muscle
strain, or compartment syndrome, whereas steadily increasing pain
points to the progression of an infectious process (osteomyelitis), a
malignant tumor, or neurovascular complications.
▪ Radiating pain occurs in conditions in which pressure is exerted on a
nerve root
▪ pain with a rheumatic disorder is worse in the morning, especially upon
waking
▪ Tendonitis worsens during the early morning and eases by midday
▪ osteoarthritis worsens as the day progresses
▪ Radiating pain, we think cardiac
▪ We assess their pain. We need to know what kind of pain the patient
has to left side. Does the pain occur with movement?
o Altered sensations
▪ patient may describe paresthesia’s, which are sensations of burning,
tingling, or numbness
• may be caused by pressure on nerves or by
circulatory impairment
o Physical assessment: posture, gait, bone integrity, joint function, muscle
strength and size, skin, neurovascular status
▪ normal curvature of the spine is convex through the thoracic portion
and concave through the cervical and lumbar portions
▪ deformities of the spine include:
• kyphosis, which is an increased forward curvature of the thoracic
spine that causes a bowing or rounding of the back, leading to a
hunchback or slouching posture
• lordosis, or swayback, an exaggerated curvature of the lumbar
spine
• scoliosis, which is a lateral curving deviation of the spine
▪ Gait is assessed by having the patient walk away from the examiner
for a short distance
▪ bony skeleton is assessed for deformities and alignment
• Fracture findings may include abnormal angulation of long bones,
motion at points other than joints, and crepitus
▪ patient with a musculoskeletal disorder may report pain, tenderness,
and altered sensations
▪ articular system is evaluated by noting range of motion, deformity,
stability, tenderness, and nodular formation
▪ muscular system is assessed by noting muscular strength and
coordination, the size of individual muscles, and the patient’s ability
to change position.
▪ inspect the skin for edema, temperature, and color
2
, lOMoARcPSD|21646696
▪ nurse must perform frequent neurovascular assessments of patients
with musculoskeletal disorders (especially of those with fractures)
because of the risk of tissue and nerve damage
• nurse needs to be particularly aware of signs and symptoms of
compartment syndrome
• Age-related musculoskeletal functional changes include?
o Fragile bones
o Muscle weakness
o Stiff and painful joints
o All of the above
o Fragile bones – bones may become fragile and prone to fracture including the
vertebrae, hip and wrist.
o Muscle weakness – there may be a loss of muscle strength and
flexibility resulting in weakness, fatigue, and a high risk for stumbling
and falls
o Stiff and painful joints – joints may become stiff with reduced flexibility
and painful, which may interfere with ADLs
• Diagnostic Evaluation
o X-Ray Studies
▪ determine bone density, texture, erosion, and changes in bone
relationships
▪ reveal fluid, irregularity, spur formation, narrowing, and changes in the
joint structure
o CT
▪ may be performed with or without the use of oral or intravenous (IV)
contrast agents
3
, lOMoARcPSD|21646696
▪ used to visualize and assess tumors; injury to the soft tissue,
ligaments, or tendons; and severe trauma to the chest, abdomen,
pelvis, head, or spinal cord
▪ used to identify the location and extent of fractures in areas that are
difficult to evaluate AKA can’t be seen on XRAY
o MRI
▪ noninvasive imaging technique that uses magnetic fields and radio
waves to create high-resolution pictures of bones and soft tissues
▪ used to visualize and assess torn muscles, ligaments, and cartilage;
herniated discs; and a variety of hip or pelvic conditions
▪ REMOVE all metal, jewelry, hairclips, aids, and credit cards.
▪ IV contrast may be used
o Arthrography
▪ used to identify the cause of any unexplained joint pain and
progression of joint disease
▪ radiopaque contrast agent or air is injected into the joint cavity
▪ joint is put through its range of motion to distribute the contrast agent
while a series of x-rays are obtained
• if contrast leak is present there is a tear in the joint
▪ may feel some discomfort or tingling during the procedure
▪ joint is usually rested for 12 hours
▪ Strenuous activity should be avoided until approved by the
primary provider
o Bone densitometry
▪ used to evaluate BMD (bone mineral density)
▪ can be performed through the use of x-rays or ultrasound
o Bone scan
▪ detects metastatic and primary bone tumors, osteomyelitis, some
fractures, and aseptic necrosis, and to monitor the progression of
degenerative bone diseases
▪ requires the injection of a radioisotope through an IV line
• scan is performed 2 to 3 hours afterward
▪ patient may experience slight discomfort
▪ pt should empty their bladder before the scan
o Arthroscopy
▪ allows direct visualization of a joint through the use of a
fiberoptic endoscope
▪ takes place in the operating room under sterile conditions
o Arthrocentesis
▪ obtains synovial fluid for purposes of examination or to relieve pain
due to effusion
o Electromyography
▪ provides information about the electrical potential of the muscles and
the nerves leading to them
▪ determines any abnormality of function and to differentiate muscle and
nerve problems
▪ Before the patient undergoes an EMG, the nurse inquires if the patient
is taking any anticoagulant medications and assesses for any active
skin infection
4
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller AcademicSuperScores. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $10.99. You're not tied to anything after your purchase.
