musculoskeletal and neurological assessment
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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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Presentation Transcript
objectives
Objectives
  • Define Gait, Stance, Posture
  • Discuss assessment of joints and muscles
  • Outline a Neuro Exam
  • Identify reflexes
  • Identify function of the cranial nerves
musculoskeletal system
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!
slide5
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.
gait abnomalities
Gait Abnomalities
  • Unusual and uncontrollable walking patterns, usually caused by disease or injury.
    • Propulsive
    • Scissors
    • Spastic
    • Steppage
    • Waddling
stance
Stance
  • Symmetrical
  • Width
  • Steady
  • Assistive Devices
posture
Posture
  • Normal - Comfortably erect

Look for straight lines across body parts

  • Normal Aging
slide10
Kyphosis is a curving of the spine that causes a bowing of the back, which leads to a hunchback or slouching posture.
examination of joints
Examination of Joints
  • Inspection

Size and contour: redness, atrophy, deformity, swelling

  • Palpation

Crepitious, thickening, swelling, or tenderness

range of motion
Range of Motion
  • Full Mobility of each joint
  • Deliberate, accurate, smooth, and coordinated
  • No involuntary movement
subluxation
Subluxation
  • A partial or incomplete dislocation
contractures
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.
general appearance personal hygiene
General appearance, Personal Hygiene
  • Appropriately dressed
  • Well-Groomed
  • Odor
  • Eye contact
  • Posture
orientation
Orientation
  • Person
  • Place
  • Time
  • Can a person be oriented and still be confused?
level of consciousness response to environmental stimuli
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
glascow coma scale
Glascow Coma Scale
  • Quantitative tool
  • Eye opening, verbal response, motor response
  • Fully alert score is 15
  • Coma is 7 or less
motor
Motor
  • Observation
  • Muscle Tone
  • Muscle Strength
    • Squeeze hands
    • Pronator Drift
deep tendon reflex
Deep Tendon Reflex
  • Biceps C5, C6
  • Brachioradialis C6
  • Triceps C7
  • Patellar L4
    • Babinski Abnormal Reflex Toes Fan
  • Achilles Tendon S1

Rated from 0 to 5+

rating scale
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
motor abnormalities
Motor Abnormalities
  • Spasticity
  • Flaccidity
  • Tremor
coordination and gait
Coordination and Gait
  • Point to Point Movements
  • Romberg
  • Gait
reflexes
Reflexes
  • Deep Tendon Reflexes
  • Clonus
  • Babinski
sensory
Sensory
  • General
  • Soft/Sharp Touch
  • Discrimination
nclex question
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
nclex question31
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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