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Musculoskeletal and Neurological Assessment PowerPoint PPT Presentation


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Musculoskeletal and Neurological Assessment. Objectives. Define Gait, Stance, Posture Discuss assessment of joints and muscles Outline a Neuro Exam Identify reflexes Identify function of the cranial nerves. Musculoskeletal Assessment. Musculoskeletal System. Bones, joints, and muscles

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Musculoskeletal and Neurological Assessment

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Musculoskeletal and neurological assessment l.jpg

Musculoskeletal and Neurological Assessment


Objectives l.jpg

Objectives

  • Define Gait, Stance, Posture

  • Discuss assessment of joints and muscles

  • Outline a Neuro Exam

  • Identify reflexes

  • Identify function of the cranial nerves


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Musculoskeletal Assessment


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Musculoskeletal System

  • Bones, joints, and muscles

  • Needed for Support, Movement, Protection, and production of red blood cells, and storage for essential minerals

  • Fall Precaution

  • Do No Harm!


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Gait

  • The base is as wide as the shoulder width

  • Foot placement is accurate

  • Walk is smooth, even and well-balanced

  • Associated movements, such as arm swing, are present.


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Gait Abnomalities

  • Unusual and uncontrollable walking patterns, usually caused by disease or injury.

    • Propulsive

    • Scissors

    • Spastic

    • Steppage

    • Waddling


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Stance

  • Symmetrical

  • Width

  • Steady

  • Assistive Devices


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Posture

  • Normal - Comfortably erect

    Look for straight lines across body parts

  • Normal Aging


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Lordosis - Increased Curvature of the Spine


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Kyphosis is a curving of the spine that causes a bowing of the back, which leads to a hunchback or slouching posture.


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Scoliosis – curvature of the spine away from middle or sideways


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Examination of Joints

  • Inspection

    Size and contour: redness, atrophy, deformity, swelling

  • Palpation

    Crepitious, thickening, swelling, or tenderness


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Range of Motion

  • Full Mobility of each joint

  • Deliberate, accurate, smooth, and coordinated

  • No involuntary movement


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Muscle Atrophy


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Subluxation

  • A partial or incomplete dislocation


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Contractures

  • A contracture is a fixed tightening of muscle, tendons, ligaments, or skin. Shortening of longest or strongest muscle.

  • Prevents normal movement of the associated body part. Impaired ROM

  • Skin becomes scarred and nonelastic which limits the range of movement of the affected area.


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Neurological Assessment


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General appearance, Personal Hygiene

  • Appropriately dressed

  • Well-Groomed

  • Odor

  • Eye contact

  • Posture


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Orientation

  • Person

  • Place

  • Time

  • Can a person be oriented and still be confused?


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Level of Consciousness: response to environmental stimuli

  • Awake, alert

  • lethargic-stuporous-comatose-coma

  • If not fully alert, may need increased stimulus

  • Note any change in Level of Consciousness

  • Variety of Questions

  • One part or two part commands


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Glascow Coma Scale

  • Quantitative tool

  • Eye opening, verbal response, motor response

  • Fully alert score is 15

  • Coma is 7 or less


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12 Cranial Nerve


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Motor

  • Observation

  • Muscle Tone

  • Muscle Strength

    • Squeeze hands

    • Pronator Drift


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Deep Tendon Reflex

  • BicepsC5, C6

  • BrachioradialisC6

  • TricepsC7

  • PatellarL4

    • BabinskiAbnormal Reflex Toes Fan

  • Achilles TendonS1

    Rated from 0 to 5+


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Rating Scale

  • 0: absent reflex

  • 1+: trace, or seen only with reinforcement

  • 2+: normal

  • 3+: brisk

  • 4+: nonsustained clonus (i.e., repetitive vibratory movements)

  • 5+: sustained clonus


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Motor Abnormalities

  • Spasticity

  • Flaccidity

  • Tremor


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Coordination and Gait

  • Point to Point Movements

  • Romberg

  • Gait


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Reflexes

  • Deep Tendon Reflexes

  • Clonus

  • Babinski


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Sensory

  • General

  • Soft/Sharp Touch

  • Discrimination


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NCLEX Question

  • A nurse is assessing the motor function of an unconscious client. The nurse would plan to use which of the following to test the client’s peripheral response to pain.

    • Sternal rub

    • Pressure on the Orbital rim

    • Squeezing of the sternocleidomastoid muscle

    • Nail bed pressure


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NCLEX Question

  • A client has an impairment of cranial nerve II. Specific to this impairment, the nurse would plan to do which of the following to ensure client safety?

    • Provide a clear path for ambulation without obstacles

    • Test the temperature of the shower water

    • Speak Loudly to the client

    • Check the temperature of the food on the dietary tray.


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