RLE 20

• There are two things that you'd like to learn more about:
• One question you still have:
• Joint pain is a common complaint and can be associated with systemic symptoms such as fever, chills, rash, weakness, and weight loss.
• Low back pain, neck pain, bone pain, muscle pain or cramps, and muscle weakness are other common symptoms of the musculoskeletal system.
• This document and the information thereon is the property of PHINMA Education (Department of Nursing).
• The instructor rationalizes the answers to the students and encourages them to ask questions and discuss among their classmates.
• Disease of the peripheral nervous system is discussed during the face to face interaction with students.
• The instructor should discuss the assessment of the Breast and Axillae in the previous lesson.
• The review of anatomy of chest walls is identified and the structures are discussed with detailed illustrations.
• The nurse can utilize the OLD CART mnemonic to ask questions in order to obtain a full description of the condition.
• Joint pain is one of the leading complaints of patients seeking health care.
• Joint pain may also be extra-articular, involving bones, muscles, and tissues around the joint such as tendons, ligaments, bursae, or overlying skin.
• Spine: The patient should be standing, with gown on, open at the back, perform inspection and note for the following:
• An enhanced thoracic curve or kyphosis is common in elderly.
• Abnormal Findings: A difference in shoulder elevation and in level of scapulae and iliac crests indicate scoliosis (exaggerated lateral curvature of the spine), from the side, observe the normal convex thoracic curve and concave lumbar curve.
• Elbows: Inspect and compare both elbows, check the size and contour of the joints and compare elbows for equality of bony landmarks.
• Abnormal Findings: Redness, unequal bony landmarks, muscle atrophy, swelling from excess fluid.
• Normal Findings: No redness, muscular atrophy, deformity, or swelling is present.
• Shoulders: Inspect and compare both shoulders anteriorly and posteriorly, check the size and contour of the joints and compare shoulders for equality of bony landmarks.
• Abnormal Finding: The patient cannot hold flexion of the neck against resistance.
• Wrist and hands: Inspect and compare both wrists and hands, check the size and contour of the joints and compare wrists and hands for equality of bony landmarks.
• Normal Findings: The spine is straight following an imaginary vertical line from the head through the spinous processes and down through the gluteal cleft, equal horizontal positions for the shoulders, scapulae, iliac crests, and gluteal folds, equal spaces between arm and lateral thorax on two sides, knees and feet are aligned with the trunk and should be pointing forward.
• Generalized “aches and pains” are called myalgias if they occur in muscles, and arthralgias if there is pain in a joint but no evidence of arthritis.
• A pronounced lumbar curve or lordosis is common in obese people.
• The hip joint should feel stable and symmetric, with no tenderness or crepitus when palpated.
• The foot should align with the lower leg; an imaginary line would fall from midpatella to between the interphalangeal joints on the medial and lateral sides of the toes.
• The spinous process should be straight and not tender when palpated.
• The paravertebral muscles should feel firm with no tenderness or spasm when palpated.
• Lateral tilting and forward bending occur with herniated nucleus pulposus or slipped disc.
• The ROM of the spine and maneuvers should be assessed.
• Atrophy, which is the loss of muscle mass, indicates disuse or chronic disorders.
• The patient should be able to perform all ROM and muscle strength tests.
• The quadriceps muscles in the anterior thigh should feel firm and not tender when palpated.
• Pain on palpation and presence of crepitus indicate abnormal findings in the hip joint.
• The onset, location, duration, characteristics, associated manifestations, relieving/exacerbating factors, and treatment of joint pain should be documented in the health history.
• Birthmarks, port-wine stains, hairy patches, and lipomas often overlie bony defects, muscular defects, missing bursa, or malformed ligaments.
• Duchenne muscular dystrophy is a type of muscular dystrophy that primarily affects boys.
• Rheumatoid arthritis is a type of arthritis that is characterized by inflammation of the joints.
• The principal muscles used in opening the mouth are the Temporalis, Masseter, External pterygoids, and Internal pterygoids.
• The pitcher of the high school baseball team, 16 years old, with a complaint of pain in his right elbow, is likely to have tenderness distal to the right lateral epicondyle.