MUSCULAR ASSESSMENT

• Common Subjective Complaints


  • Pain
  • Tenderness
  • Altered Sensations
  • Inability to move body parts
  • Edema
• Bone pain


  Dull, deep ache "boring" in nature
• Fracture pain


  Sharp and piercing relieved by immobility
• Muscular pain


  Soreness of arching
• Specific Questions


  • Is the body in proper alignment?
  • Is there any inflammation or arthritis, swelling, warmth, tenderness or swollen?
  • Is there pressure from traction, bed linens, a cast or other appliances?
  • Is there tension on the skin at a pain site?
• Paresthesia


  Burning, tingling sensation or numbness
• Paresthesia causes


  Pressure on nerves or by circulatory impairments
• Family History


  • Osteoporosis
  • Allergy
• Postural Abnormalities


  • Kyphosis: increased convexity or roundness of the spine's thoracic curve
  • Lordosis: swayback, exaggeration of the lumbar spine curve
  • Scoliosis: a lateral curvature of the spine
• Gait


  Smoothness and rhythm
• Shuffling gait


  Ataxic gait is an unsteady, uncoordinated walk with a wide base of support and the feet thrown outward
• Festinating gait


  Antalgic gait consists of a limp adopted so as to avoid pain on weight-bearing structures (as in hip, knee, or ankle injuries)
• Normal Walking Gait


  • Has upright posture and steady
  • Gait with opposing arm swing; walks unaided, maintains balance
• Deviation from Normal Walking Gait


  • Has poor posture and unsteady; irregular staggering gait with wide stance, bends legs only from hips; has rigid or no arm movements
• Waddling gait


  A distinctive duck-like walk that may appear in childhood or later in life
• Propulsive gait


  A stooped, rigid posture, with the head and neck bent forward
• Scissors gait


  Legs flexed slightly at the hips and knees giving the appearance of crouching, with the knees and thighs hitting or crossing in a scissors like movement
• Spastic gait


  A stiff, foot-dragging walk caused by one-sided, long term, muscle contraction
• Steppage gait


  Foot drop where the foot hangs with the toes pointing down, causing the toes to scrape the ground while walking
• Causes of Abnormal Gait

  • Central nervous system disorders of the brain that cause muscular problems resulting in gait disturbance
  • Spinal cord abnormalities
  • Degenerative muscle diseases
  • Neurodegenerative illnesses
  • Skeletal abnormalities and disease
  • Toxic reactions
• Assessment of CMS


  • Circulation
  • Motion
  • Sensation
• Indicators of Peripheral Neurovascular Dysfunction - Circulation

  • Color: Pale or cyanotic
  • Temperature: Cool
  • Capillary refill: more than 3 seconds
• Indicators of Peripheral Neurovascular Dysfunction - Motion


  • Weakness
  • Paralysis
• Indicators of Peripheral Neurovascular Dysfunction - Sensation

  • Paresthesia
  • Pain
  • Pain on passive stretch
  • Absence of feeling (apathetic)
• 6 P's


  • Pain – signals the beginning of muscle ischemic
  • Pulses -pulselessness indicates disruption of arterial blood flow
  • Pallor – indicates disruption of arterial blood flow
  • Paresthesia – nerve function may be disrupted nerve compression
  • Paralysis – increasing edema causes nerve compression
  • Polar – indicates disrupted arterial blood flow
• Bone Integrity Assessment


  • Deformities and alignment
  • Symmetrical or asymmetrical
  • Fracture findings
  • Crepitus (grating or crackling sound or sensation)
• Assessing Joints


  • Inspect size, shape, color, and symmetry. Note any masses, deformities, or muscle atrophy
  • Palpate for edema, heat, tenderness, pain, nodules, or crepitus
  • Test each joint's range of motion (ROM)
  • Range of motion (limited?)
  • Effusion (presence of fluid)
  • Crepitus (abnormal sound)
• Assessing Muscles


  • Test muscle strength by asking the client to move each extremity through its full ROM against resistance
• Muscle Strength Rating


  • 5 - Active motion against full resistance (Normal)
  • 4 - Active motion against some resistance (Slight weakness)
  • 3 - Active motion against gravity (Average weakness)
  • 2 - Passive ROM (gravity removed and assisted by examiner) (Poor ROM)
  • 1 - Slight flicker of contraction (Severe weakness)
  • 0 - No muscular contraction (Paralysis)
• Common Nursing Diagnoses


  • Pain
  • Impaired Physical Mobility
  • Self-Care Deficit
  • Altered growth & development
• MUSCULOSKELETAL SYSTEM ARE COMPOSED OF:

  • Bones
  • Joints
  • Muscles
  • Tendons
  • Ligaments
  • Cartilage
  • Bursae
• MUSCULOSKELETAL SYSTEM FUNCTIONS:

  • Serves as a framework of the body to support organs & structures of the body (EX. Muscles & Tendons hold bones together)
  • Foster movement or mobility of extremities
  • Weight bearing
  • Sites for hematopoiesis and bone formation
  • Serve as a reservoir for immature blood cells and essential minerals (Calcium, Phosphorus, Magnesium and Fluoride)
  • Protection for vital organs (Brain, Heart and Lungs)
• ACTIVE ANG BONE GROWTH

  • During childhood and adolescence
  • No blood vessels just a tough tissue
• RECOMMENDED CALCIUM INTAKE FOR YOUNG ADULTS TO MAINTAIN THE BONE MASS

  • 1,000 MG - 1,200 MG/DAY
• RECOMMEND INTAKE OF ACTIVE FORM OF VITAMIN D

  • 400-800 IU
• WHILE TAKING CALCIUM SUPPLEMENTS

  • Drink a lot of water to avoid renal stones
• RECOMMEND INTAKE OF VITAMIN D FOR ADULTS LESS THAN 50 YEARS OLD

  • 600 IU
• RECOMMEND INTAKE OF VITAMIN D FOR ADULTS MORE THAN 50 YEARS OLD

  • 800 - 1,000 IU
• RECOMMEND INTAKE OF VITAMIN D

  • 400-1,000 IU
• TOTAL BONES IN THE HUMAN BODY

  • 206