UNIT 06: Assessment Of Peripheral Vascular · Vascular System (PVS) and Musculoskeletal System (MS)...
Transcript of UNIT 06: Assessment Of Peripheral Vascular · Vascular System (PVS) and Musculoskeletal System (MS)...
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UNIT 06:
Assessment Of Peripheral Vascular
&Musculoskeletal system Shahzad Bashir
RN, BScN, DCHN
Instructor
New Life College of Nursing
December 07, 2015
In The Name of God
(A PROJECT OF NEW LIFE COLLEGE OF NURSING KARACHI)
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Objectives
• By the end of the unit, learners will be able to:
•
• Discuss the pertinent health history question necessary to perform the assessment of Peripheral Vascular System (PVS) and Musculoskeletal System (MS) system.
• Discuss critical observations to assess PVS.
• Assess musculo - skeletal functions including muscles strength, symmetry, size, contour, ROM and its characteristics.
• Document findings.
• List the changes in the given systems that are characteristics of aging process
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Musculoskeletal: Review Anatomy&
Physiology
• Skeleton: 206 bones
• Long: femur, humerus, radius
• Short: carpals, tarsals
• Irregular: vertebrae
• Bones protect, support, allow for
locomotion and mineral storage (Ca, Mg)
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Structure and Function (cont.)
• Components of musculoskeletal system:
• Nonsynovial or synovial joints
• Muscles
• Temporomandibular joint
• Spine
• Shoulder
• Elbow
• Wrist and Carpals
• Hip
• Knee
• Ankle and Foot
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Musculoskeletal
• Joints: Range from joints that don’t move to joints that freely move.
• Ligaments and tendons: stabilize joints
• Ligaments: attached from bone to bone
• Tendons: attached from muscle to bone
• Cartilage: ends on bones
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Synovial Joint
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Shoulder
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Musculoskeletal
• Muscles: controlled by nervous system
• Fascia: surrounds muscles, divides
muscles, main blood vessels and nerves.
• Bursae: cushions moving parts
• Muscle tone: ability to resist force;
graded 0-5
• Atrophy: decrease size
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Skeletal Muscle Movements
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Assessing: Subjective Data
• Joint pain:
• SLIDA: Severity, Location, Intensity,
Duration, Aggravating factors (alleviating
factors, associated symptoms)
• Stiffness
• Limited movement
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Assessing: Subjective Data
• Rheumatoid Arthritis (RA) chronic systemic
inflammatory disease involves symmetric
joints. Other MS disorders involve isolated or
unilateral joints.
– Rheumatoid arthritis
– Stiffness
– Swelling
– Limited ROM
– Movement decreases pain
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Assessing: Subjective Data
•Osteoarthritis: chronic degeneration
of joint cartilage caused by aging or
trauma
–Stiffness
–Swelling
–Limited ROM
–Heberden’s and Bouchard’s nodules
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Assessing: Subjective Data
• Muscle Pain:
• SLIDA
• Aching/cramps
• Weakness
• Resistance 0-5
• Atrophy
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Assessing: Subjective Data
• Bones pain:
• SLIDA
• Hx
• Deformity
• Trauma- limitations
as a result of trauma
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Assessing: Subjective Data
• Functional Assessment:
• ADL’s- does MS problem create limits:
• Bathing- getting in and out of tub, turning
faucets
• Toileting- getting on/off toilet, wiping self
• Dressing- buttons, zippers, tying shoes
• Grooming- shaving, brushing teeth, putting on
makeup
• Eating- cutting food, preparing meals etc…
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Assessing: Subjective Data
• Functional Assessment:
• Mobility- walking up/down stairs,
in and out of car, out of house
• Communicating- talking, using
phone or computer, writing
• Occupational/Environmental- heavy
lifting, repetitive motions etc.
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Assessing: Subjective Data
• Self care behaviors:
• Exercise- type, frequency, warm up
• Pain during exercise? How tx?
• Recent weight gain ( puts stress on
musculoskeletal system) …usual daily diet • Any meds- anti inflammatory, muscle
relaxants, pain relievers
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Assessing: Subjective Data
• Additional hx.- Infants and
Children:
• Birth trauma
• Resuscitation at birth
• Motor milestones
• Bone deformity/spinal curvature
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Assessing: Subjective Data
• Additional hx. for Adolescents:
• Sports (Assess safety)
• Special equipment? Training? Warm up?
• What does client do if injured/ ill
• How does sport fit in with other
demands/ activities
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Assessing: Subjective Data
•Additional hx. for Aging adult:
•Use functional assessment to elicit any
loss of function, self care deficit or
safety risk:
•Weakness
•Falls/ Stumbling
•Mobility aids used
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Assessing: Objective Data
•Physical exam provides the nurse
with objective data
•Guidelines for Physical Exam include:
•Full visualization of part being examined
•Drape other parts for privacy
•Orderly approach: head to toe and
proximal to distal.
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Physical Examination Guidelines
•Joint being examined should be
supported.
•Compare paired joints, expect symmetry.
•When examining a painful area, use
firm support, gentle movement.
•Assess Range of Motion (ROM) of
each joint
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Physical Examination
•Assess gross motor movement and
posture
•Note patient’s gait
•Note any foot dragging, limping,
shuffling
•Note any spinal deformities
•Inspect skin and subcutaneous tissues
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Physical Examination
•Assess upper and lower extremities for:
•Overall size, symmetry
•Gross deformity
•Bony enlargement
•Alignment
•Symmetry of length and position
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Physical Examination
•Bones, joints, muscles:
•Inspect swelling, deformity, condition
•Assess for stiffness, instability, pain,
crepitus, unusual joint movement
•Assess ROM
•Muscle strength
•Assess symmetry
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Physical Examination
•Head
•Temporomandibular Joint- crepitus and
pain with TMJ disorder
•Open mouth: 3-6 cm
•Move lower jaw from side to side
•Stick out lower jaw
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Physical Examination
•Neck:
•ROM and muscle strength:
•Flexion- touch chin to chest
•Extension- tilt head backward
•Cervical rotation- turn head to R and L.
•Lateral bending- touch ear to R. and
L. shoulders
•Retraction and Protraction
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Physical Examination
•Shoulder: Note posture erect, hunched.
•Assess symmetry and position of clavicles.
•Palpate clavicles toward shoulders,
palpate deltoid muscle.
•ROM and muscle strength:
•Flexion and Extension and Hyperextension
•Abduction and Adduction
•Rotation
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Physical Examination
•Elbow- bend elbow 70 degrees, inspect
and palpate posterior surface
•Note- medial and lateral condyles of
humerus and olecranon process of ulna
•ROM and muscle strength:
•Flexion and Extension
•Supination and Pronation
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Bones of Hand
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Physical Examination
•Wrist- Grasp wrists, assess body
processes of radius (thumb side)
and the ulna. Palpate radio - carpal
joint and remaining wrist joints.
•ROM and muscle strength:
•Flexion and Extension and Hyperextension
•Radial and ulnar wrist deviation
•Circumduction
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Phalen’s Test
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Physical Examination
•Hand- Use thumb and forefinger to palpate the metacarpophalangeal and interphalangeal joints.
•ROM and muscle strength:
•Flexion and Extension and Hyperextension
•Abduction- have patient spread fingers apart
•Adduction- have pt. hold fingers together.
•Thumb/Finger Opposition
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Arthritis: Heberdens nodules &
Bouchards nodules
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Physical Examination
•Hip- palpate hip joint and surrounding structures. Position pt. side lying and palpate iliac crest, greater trochanter, hip, thigh and buttock muscles
•ROM and muscle strength:
•Flexion and Extension and Hyperextension
•Adduction and Abduction
•External rotation and Internal rotation
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Landmarks of Knee
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Physical Examination
•Knee- have pt. sitting, dangling.
Inspect- note alignment, deformity,
contour of quadricep muscle.
•Palpate the suprapatellar pouch and
note any tenderness, edema.
•ROM and muscle strength:
•Flexion and Extension
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Patella ballottement
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Bulge sign
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Ankle and Foot
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Physical Examination
•Ankle: Compare the contour of R. and L.
ankles. Palpate ankle and achilles tendons.
•ROM and muscle strength:
• Dorsiflexion- point toes upward.
•Plantar Flexion- point toes downward.
•Inversion- turn soles of feet inward.
• Eversion- turn soles of feet outward.
•Circumduction
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Physical Examination
•Foot: inspect skin integrity, condition
of nails and any deformities.
•Palpate the metatarsal bones and
joints, squeeze each foot.
•ROM and muscle strength:
•Flexion and Extension
•Abduction and Adduction
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Landmarks of Spine
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Physical Examination
•Spine: Have pt. bend a waist, note
curvature, ease of mobility.
•Palpate vertebral column with
fingertips, note tenderness or bony
deformities.
•Lightly fist palpate length of spine
(ulnar surface of hand) Note any
tenderness.
•Lateral bending and spinal rotation.
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Summary Musculoskelatal Exam
•Inspect body parts
•Palpate each joint
•Assess ROM of each joint
•Assess muscle strength
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Sample Charting
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References
1. Bickley, L. S., Szilagyi, P. G., & Bates, B. (2007). Bates' guide to physical examination and history taking (11th Edi). Philadelphia: Lippincott Williams & Wilkins. Chapter No.06 & 07 p.n 171-250
2. Weber, Kelley's. (2007). Health Assessment in Nursing, 3rd Ed: North American Edition. Lippincott Williams & Wilkins. Chapter No.14 &15 p.n 239-294
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