Chapter 024

Musculoskeletal System
Chapter 24
Copyright © 2005, Mosby, Inc. All rights reserved.

Health History: Risk Factors related to
Musculoskeletal system
• Gout- increase in serum uric acid levels, tophi
– Gender: men higher risk
– Age: (30 to 50 years)
– Family history: positive family history
– Thyroid dysfunction: higher prevalence with
hypothyroidism
– Obesity: link between high uric acid levels and body weight
– Hypertension: clients with gout also hypertension
• Use of diuretics highly associated with gout
– Alcohol: alcohol use (bingeing) highly associated with gout
– Earliest signs acute onset pain in Great Toe- classic

Gout tophi

Health History: Risk Factors
• Osteoporosis
– Age: bone density decreases beginning at age 35
– Gender: women less bone tissue, lose it more readily
than men
– Race: Whites/Asians have increased risk
– Bone structures/body weight: small-boned, thin
women (<127 lb) at greater risk
– Family history: positive history increases risk
– Lifestyle: smoking, alcohol intake, inadequate
calcium, inadequate weight-bearing increase risk
– Medications-glucocorticoids, methotrexate, thyroid
hormone, heparin
Health History: Risk Factors
• Hip fracture
– Age: most occur after age 75
– Genetics: maternal hip fracture increases risk
– Body size: tall at young age, thin, losing >10% of
body weight since age 25
– Osteoporosis: porous bone decreases bone strength
– Fluoride: fluoride deficit weakens bone
– Medications: sedatives, long-acting benzodiazepines
increase risk
– Caffeine: consumption of any form increases risk

Problem-Based History: Pain
• Where was pain felt? First noticed?
Related to movement? Describe how it
feels. Severity (0 to 10)?
• Did pain occur suddenly? During day
when do you feel pain?
• Does pain move one joint to another? Any
injury, overuse, or strain of muscles/joints?
Ill before onset?

Problem-Based History: Pain
• What makes pain worse? Change with
weather? Does pain shoot to another part
of your body?
• What was done to relieve the pain? How
effective was that?
• Pain that reduces with movement and as
the day goes on, associated with the joints
could be rheumatoid arthritis.

Examination: Overview
• To examine the musculoskeletal system,
use a cephalocaudal organization with
side-to-side comparisons for examining
bones, muscles, and joints
• Because there are often no “normals” for
the musculoskeletal system, to establish
normality, it is best to compare with other
side

Normal position for inspection

Examination
• Techniques used depend on reason for exam,
setting, condition and age of the client, skill of
the nurse
• Findings during exam may warrant use of
additional techniques
• Nurse determines which techniques should be
indicated for each exam

Examination:
Procedures and Techniques
• Inspect axial skeleton/extremities—alignment,
contour, symmetry, size, and gross deformities
– Body symmetric, straight spine (normal curves), knees
straight line (hips – ankles), feet flat, forward
– Have them bend over and touch their knees, this will
help you evaluate the straightness of the spine.
• Inspect muscles—size and symmetry

– Bilateral symmetry,

Inspection for Spine- Scolosis

Examination:
• Test muscle strength and compare
contralateral sides
– Part of MS/neuro exam
– Flex muscle, then resist when force applied
– Bilaterally symmetric with full resistance to
opposition

Testing for Upper arm strength

Examination:
Specific regions
• Observe gait—conformity, symmetry, and
rhythm
– Conformity, regular smooth rhythm, leg swing length
symmetry, smooth swaying/symmetric arm swing
• Inspect face/neck musculature—symmetry
• Palpate temporomandibular joint—movement,
sounds, tenderness
– Smooth jaw movement, without pain
(audible/palpable snap ok)

Examination:
Specific regions
• Inspect hips for symmetry
– Hips equal height/symmetric
• Test hips—muscle strength

– Raise leg from supine position—able to overcome resistance-
this will test normal range of hyperextension of the hip.
– Extend leg from sitting position—able to maintain extension
– Bend knee—able to maintain flexion

Age-Related Variations:
Older Adults
Anatomy and physiology
• Aging accompanied by number of
musculoskeletal changes
– Decrease in bone mass—increasingly
vulnerable to stress in weight-bearing areas
and resultant fractures
– Intervertebral disks lose water—narrowing of
disk space; loss of 1.5 to 3 inches in height
– Lordotic or convex curve of back flattens;
flexion/extension of back decrease
Older Adults
Health history
• What daily activities: bathing, dressing, eating,
exercising? Need assistance? Who provides
care?
• Any gadgets to help? Describe.
• What have they done to prevent falls in their
residence? Adequate lighting, particularly over
steps? Grab bars where needed (steps/beside
bathtub)? Throw rugs in residence? Intrinsic vs
Extrinsic risk factors
Older Adults
Examination: procedures and techniques
• Examination—same as that of younger adult
• May be slower at performing range-of-motion
exercises, and muscle-strength assessments
may be below 5/5
• Observe gait of older client
– Observation of mobility is single most important
determinant of client’s risk of falling

Older Adults
Normal and abnormal findings
• Normal findings same as for younger adult
• Abnormal findings include:
– Osteoarthritic changes in joints; muscle
atrophy from disuse
– Many joints may not have expected degree of
movement or range of motion
– Deep tendon reflexes such as Achilles tendon
reflexes may be diminished
Common Disorders of the Joints-
Rheumatoid Arthritis

Common Problems and Conditions:
Bones
Fracture
• Partial/complete break in continuity of a bone
– Skin intact in closed fracture, and skin broken in open
fracture
– Pathologic fracture—results from weakness in bone,
(osteoporosis or neoplasm)
– Clinical findings
• Pain caused by muscle spasm is common
• Deformity/loss of function—tissue shortening
around bone and localized edema

Fractures

Chapter 024

Uploaded by

Copyright:

Available Formats

Chapter 024

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Chapter 024

Uploaded by

Copyright:

Available Formats

Musculoskeletal System

Copyright © 2005, Mosby, Inc. All rights reserved.

Copyright © 2005, Mosby, Inc. All rights reserved.

Copyright © 2005, Mosby, Inc. All rights reserved.

Copyright © 2005, Mosby, Inc. All rights reserved.

Copyright © 2005, Mosby, Inc. All rights reserved.

Copyright © 2005, Mosby, Inc. All rights reserved.

Copyright © 2005, Mosby, Inc. All rights reserved.

Copyright © 2005, Mosby, Inc. All rights reserved.

Copyright © 2005, Mosby, Inc. All rights reserved.

• Inspect muscles—size and symmetry

Copyright © 2005, Mosby, Inc. All rights reserved.

Copyright © 2005, Mosby, Inc. All rights reserved.

Copyright © 2005, Mosby, Inc. All rights reserved.

Copyright © 2005, Mosby, Inc. All rights reserved.

Copyright © 2005, Mosby, Inc. All rights reserved.

• Test hips—muscle strength

Copyright © 2005, Mosby, Inc. All rights reserved.

Copyright © 2005, Mosby, Inc. All rights reserved.

Copyright © 2005, Mosby, Inc. All rights reserved.

Copyright © 2005, Mosby, Inc. All rights reserved.

Copyright © 2005, Mosby, Inc. All rights reserved.

You might also like