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 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



Musculoskeletal system l.jpg
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.


Gait abnomalities l.jpg
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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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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Examination of Joints sideways

  • Inspection

    Size and contour: redness, atrophy, deformity, swelling

  • Palpation

    Crepitious, thickening, swelling, or tenderness


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Range of Motion sideways

  • Full Mobility of each joint

  • Deliberate, accurate, smooth, and coordinated

  • No involuntary movement


Muscle atrophy l.jpg
Muscle Atrophy sideways


Subluxation l.jpg
Subluxation sideways

  • A partial or incomplete dislocation


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Contractures sideways

  • 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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General appearance, Personal Hygiene sideways

  • Appropriately dressed

  • Well-Groomed

  • Odor

  • Eye contact

  • Posture


Orientation l.jpg
Orientation sideways

  • Person

  • Place

  • Time

  • Can a person be oriented and still be confused?


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Level of Consciousness: sidewaysresponse 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 sideways

  • Quantitative tool

  • Eye opening, verbal response, motor response

  • Fully alert score is 15

  • Coma is 7 or less



Motor l.jpg
Motor sideways

  • Observation

  • Muscle Tone

  • Muscle Strength

    • Squeeze hands

    • Pronator Drift


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Deep Tendon Reflex sideways

  • Biceps C5, C6

  • Brachioradialis C6

  • Triceps C7

  • Patellar L4

    • Babinski Abnormal Reflex Toes Fan

  • Achilles Tendon S1

    Rated from 0 to 5+


Rating scale l.jpg
Rating Scale sideways

  • 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 sideways

  • Spasticity

  • Flaccidity

  • Tremor


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Coordination and Gait sideways

  • Point to Point Movements

  • Romberg

  • Gait


Reflexes l.jpg
Reflexes sideways

  • Deep Tendon Reflexes

  • Clonus

  • Babinski


Sensory l.jpg
Sensory sideways

  • General

  • Soft/Sharp Touch

  • Discrimination


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NCLEX Question sideways

  • 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 sideways

  • 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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