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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...
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
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▪ 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
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▪ 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
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▪ 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
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