health assessement(musculoskeletal system)

7/28/2019 Health Assessement(Musculoskeletal System)

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----CHAPTER 26----Group 3


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BONESProvide structure

Give protectionServes as levers

Store calciumProduce blood cells


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HARD

DENSE

MAKES UP THE

SHAFT & OUTER

LAYER

CONTAINS

NUMEROUS SPACES

MAKES UP ENDS

AND CENTER OF

BONES

2 TYPES OF BONES:

COMPACT BONE: SPONGY BONE:


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BONES OSTEOBLASTS- active cells in w/c bone tissue is formed.

OSTEOCLASTS - active cells in w/c bone tissue is broken

down.

RED MARROW - produces blood cells.

YELLOW MARROW- composed mostly of fats.

PERIOSTEUM- covers the bones & contains osteoblasts &

blood vessels that promote nourishment &

formation of new bony tissues.


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--OSTEOBLASTS--


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--OSTEOCLASTS--


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--RED MARROW--


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--YELLOW MARROW--


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--PERIOSTEUM--


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VARIATION OFBONES :SHORT BONES

e.g., carpals

LONG BONES

e.g., humerus, femur

FLAT BONES

e.g., sternum, ribs

IRREGULAR SHAPE BONES

e.g., hips, vertebrae


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SHORT BONE


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LONG BONES


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FLAT BONE


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IRREGULAR SHAPE

BONE


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SKELETAL MUSCLES

made up of 650 skeletal (voluntary) muscles, w/c are under

conscious control.

Made up of long muscle fibers (fasciculi)that are arranged

together in bundles & joined by connective tissue, skeletal muscles

attach to bones by way of strong , fibrous cords called tendons.

Assist withposture, produce body heat& allow body to

move.


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JOINTS is the place where 2 or more bones meet

Provide a variety of (ROM) for the body parts and may be classified as:

Fibrous( sutures b/n skull bones ) are joined by fibrous connective tissue andare immovable.

Cartilaginous ( joints b/n vertebrae) are joined by cartilage.

Synovial (shoulder, hips, knees, ankles) contain a space b/n the bones that

is filled with synovial fluid ( a lubricant that promotes a sliding movement at

the end of the bones.

LIGAMENTS- strong dense bands of fibrous connective tissue

BURSAE- small sacs filled w/ synovial fluid that serves to cushion the joint


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Have you had any recent weight gain?

Describe any difficulty that you have

chewing. Is it associated w/ tenderness or

pain?

Describe any joint , muscle or bone pain

you have . Where is the pain? What does the

pain feel like (stab, ache) ? When did the

pain start? When does it occur? How longdoes it last ? any stiffness, swelling,

limitation of movement?

Weight gain can increase physical stress & strain on

the musculoskeletal system. Clients w/ TMJ dysfunction may have difficulty

chewing and may describe their jaws as getting

locked or stuck Jaw tenderness, pain, or a clicking

sound may also be present w/ ROM

Bone pain is often dull, deep, & throbbing. Joint or

muscle pain is described as aching. Sharp, knife like

pain occurs w/ most fractures & increases w/ motion

of the affected body part. Motion increases painassociated w/ many joint problems but decreases pain

associated w/ rheumatoid arthritis

H I S T O RY OF PRE S E N T HE ALT H C ONC E RN

QUESTION RATIONALE


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Do you have a family history

of rheumatoid arthritis, gout

or osteoporosis?

These condition tend to be

familial & can increase the

clients risk of development of

these diseases.

FAMILY HISTORY

QUESTION RATIONALE


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RHEUMATOID ARTHRITIS


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OSTEOPOROSIS


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What activities you engage in to

promote the health of your

muscles & bones ( e.g., exercise,

diet, weight reduction )

The question provides the

examiner w/ knowledge of how much

the client understands & actively

participates in trying to promote the

health of the musculoskeletal system.

LIFESTYLE & HEALTHPRACTICES

QUESTION RATIONALE


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What medication are you

taking?

Do you smoke tobacco? How

much & how often?

Some medications can affect

musculoskeletal function. Diuretics, for

example, can alter electrolyte levels

leading to muscle weakness. Steroids

can deplete bone mass, thereby

contributing to osteoporosis.

Smoking increases the risk of

osteoporosis.

RATIONALE


QUESTION


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Do you drink alcohol or

caffeinated beverages? How

much and how often.

Describe your typical 24-hour

diet. Are you able to consume

milk or milk-containing products.Do you take any calcium

supplements.

Excessive consumption of alcohol

or caffeine can increase the risk ofosteoporosis.

Adequate protein in the diet

promotes muscle tone and bone

growth; vitamin C promotes healing

of tissues and bones. A calcium

deficiency increases thee risk ofosteoporosis. A diet high in

purine(e.g. liver, sardines).


QUESTION RATION ALE


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Describe your activities

during a typical day. How

much time do you spend in

the sunlight.

Describe any routine

exercise that you do.

A sedentary lifestyle increases the risk of

osteoporosis. Prolonged immobility leads to muscleatrophy. Exposure to 20 min. of sunlight per day

promotes the production of vitamin D in the body.

Vitamin D deficiency can cause osteomalacia.

Regular exercise promotes flexibility, bone density,

and muscle tone and strength, and can help to slow the

usual musculoskeletal changes(progressive loss of totalbone mass and degeneration of skeletal muscle fibres)

that occur with aging.

LIFESTYLE & HEALTH

PRACTICES

Question Rationale


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--OSTEOMALACIA--


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Describe your

occupation?

Certain job-related activities increase

the risk for development of

musculoskeletal problems. For example,

incorrect body mechanics, heavy lifting,

or poor posture can contribute to back

problems; consistent, repetitive wrist

and hand movements can lead to the

development of carpal tunnel syndrome.

LIFESTYLE & HEALTH

PRACTICES

QUESTION RATIONALE


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- -CARPAL TUNNEL SYNDROME-

-


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Describe your posture

at work & at leisure.What type of shoes do

you usually wear? Do you

use any special footwear

(i.e., orthotics)?

QUESTION RATIONALE

Poor posture prolonged

forward bending ( as in sitting)

or backward leaning (as inworking overhead. Or long

term carrying of heavy objects

on the shoulders can result in

back problems. Contracture of

the achilles tendon can occur

w/ prolonged use of high

heeled shoes.


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--ACHILLES TENDON--


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Do you have difficulty

performing normal activities of

daily living (bathing, dressing,

grooming, eating)? Do you use

assistive devices (e.g., walker,

cane braces) to promote your

mobility?

QUESTION RATIONALE

Impairment of the musculoskeletal

system may impair the clients ability

to perform normal activities of daily

living. Correct use of assistive

devices can promote safety &

independence. Some clients may feel

embarrassed & & not use their

prescribed or needed assistivedevice.


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How have your

musculoskeletal problems

interfered w/ your ability to

interact or socialize w/ others?

Have they interfered w/ your

usual sexual activity?

QUESTION--RATIONALE

Musculoskeletal problems,

especially chronic ones, can

disable & cripple the client,

w/c may impair socialization &

prevent the client from

performing the same roles asin the past.


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P H Y S I C A L A S S E S S M E N T( G A I T )Assessment Procedure Normal Findings Abnormal Findings

Inspection:Observe gait: Observe theclients gait as the client enters and

walks around the room. Note-Base of support-Weight-bearing stability

-Foot position- Stride and length and

cadence of stride

- Arm swing- Posture

Assess for the risk of falling

backward in the older orhandicapped client by performingthe nudge test. Stand behind

the client and put your armsaround the client while you gentlynudge the sternum.

Evenly distributed weight. Clientable to stand on heels and toes.

Toes point straight ahead. Equalon both sides. Posture erect,movements coordinated andrhythmic, arm swing in opposition,

stride length appropriate .

Client does not fall backward.

Uneven weight bearing is evident. Clientcannot stand on heels or toes. Toespoint in or out. Client limps, shuffles,propels forward, or has wide-based gait.

Falling backward easily is seen withcervical spondylosis and Parkinsonsdisease.


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PHYSICAL ASSESSMENT(TEMPOROMANDIBULAR JOINT)

Assessment Procedure Normal Findings Abnormal Findings

Inspection and PalpationInspect and palpate the TMJ.

Have the client sit; put your

index and middle fingers justanterior to the external to theexternal ear openings. Ask to:- Open the mouth as widely as

possible.( The tips of yourfingers should drop into thejoint spaces as the mouthopen.)

- Move the jaw from side to

side.- Protrude(push out) andretract(pull in ) jaw.

Jaw moves laterally 1 to 2 cm.snapping and clicking may be feltand heard in the normal client.

Mouth opens 1 to 2 inches(distance between upper and lowerteeth).

Jaw protrudes and retracts easily.The clients mouth opens and

closes smoothly.

Decreased ROM, swelling, tenderness, orcrepitus may be seen in arthritis.

Decreased muscle strength with muscleand joint disease, ROM, and a clicking,popping, or grating sound may be noted

with TMJ dysfunction.


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PHYSICAL ASSESSMENT ( C E R V I C A L T H O R A C I C , A N D L U M B A R

S P I N E )

Assessment Procedure Normal Findings Abnormal Findings

Inspection and PalpationObserve the Cervical, Thoracic,

Lumbar curves from the side thefrom behind. Have the client standingerect with the gownpositioned to allow an adequate view ofthe spine. Observe for symmetry, notingdifferences in height of the shoulders,the iliac crests and the buttocks creases

Cervical and Lumbar spine areconcave; Thoracic spine is

convex. Spine is straight ( whenobserved from behind).

An exaggerated thoracic curve(kyphosis) is common withaging.

Some finding that appear to beabnormalities are, in fact

variations related to cultures orsex. For example, some africanamericans have a large glutealprominenece, making the spineappear to have lumbar lordosis.

a flattened lumbar curvature may beseen w/ a herniated lumbar disc or

ankylosing spondylitis. Lateral curvatureof the thoracic spine w/ an increase inthe convexity on the curve side is seenin scoiliosis an exaggerated lumbarcurve (lordosis) is often seen inpregnancy or obesity. Unequal heightsof the hips suggests unequal leg lengths.


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ABNORMALITIES OFTHE FEET AND

TOES

THE FOLLOWING ABNORMALITIES AFFECT THE FEET AND

TOES, TYPICALLY CAUSING DISCOMFORT AND IMPENDING

MOBILITY. EARLY DETECTION AND TREATMENT CAN HELP TO

RESTORE OR MAXIMIZE FUNCTION.


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I. ACUTE GOUTY

ARTHRITIS

In gouty arthritis,

metatarsophalangeal

joint of the great

toe is tender,

painful, reddened,

hot, and swollen.


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II. CALLUS

Calluses are non

painful, thickened

skin that occur at

pressure points.


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III. CORN

Corn are painful

thickenings of the

skin that occur over

bony prominences and

at pressure points.


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IV. PLANTARWARTS

Plantar warts are

painful warts

( veruca vulgaris) that

often occur under

callus, appearing as a

tiny dark spots


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V. FLAT FEET

A flat foot (pes

planus) has no arch

and may cause pain

and swelling of the

foot surface.


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VI. HALLUXVALGUS

Hallux valgus is an

abnormality in which the

great toe is deviated laterally

and may overlap the 2nd toe.

An enlarged, painful, inflamed

bursa (bunion) may form on

the medial side.


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VII. HAMMERTOE

Hyperextension at the

metarsophalangeal joint

with flexion at theproximal interphalangeal

joint (hammer toe)

commonly occurs with the

second toe.


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--THE END--

SEMBRANO

NALES

CUEVA

CAMACHO

DELOS REYES

health assessement(musculoskeletal system)

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