chest & lungs

• Musculoskeletal system assessment


  • Assess range of joint motion, muscle strength, tone, joint & muscle condition
  • Focus on this system while bathing or positioning
• Muscular disorders may result from neurological disease
• Simultaneous muscular & neurological examination is required
• Visualize during assessment


  • Bone anatomy
  • Muscle placement
  • Joint structure
• Nursing history to determine

  • Involvement in competitive sports
  • Alcohol or caffeine use, cigarette smoking, constant dieting
  • Menopause before age 45, estrogen deficiency
  • Family history of osteoporosis
  • Chronic diseases
• History to determine


  • Problems in bone, muscle or joint function
  • Nature and extent of pain
  • Normal activity pattern
  • Height loss in women over age 50
• Inspection


  • Observe client's gait
  • Note how client walks, sits & rises from a sitting position
  • Note foot dragging, limping, shuffling & position of legs in relation to trunk
• Inspection


  • Check for kyphosis, lordosis & scoliosis
  • Assess for signs of osteoporosis
  • Observe extremities: overall size, gross deformity, bony enlargement, alignment & symmetry
• Palpation


  • Gentle palpation of bones, joints, surrounding muscles
  • Note heat, tenderness, edema or resistance to pressure
  • Muscles should be firm
• Terminology


  • Flexion
  • Extension
  • Hyperextension
  • Pronation
  • Supination
  • Abduction
  • Adduction
  • Internal rotation
  • External rotation
  • Eversion
  • Inversion
  • Dorsiflexion
  • Plantar flexion
• Range of motion


  • Includes both active & passive ROM
  • Put each major joint through active and passive full ROM
• Goniometer


  • Measures precise degree of motion in a particular joint
• Muscle tone and strength

  • Check for hypertonicity & hypotonicity
  • In case of pain: support the extremity
• Maneuvers to assess muscle strength

  1. Neck (sternocleidomastoid muscle)

  2. Shoulder (trapezius)

  3. Elbow (biceps, triceps)

  4. Hip (quadriceps, gastrocnemius)
• Muscle strength grading


  • 0 (zero) - No evidence of contractility
  • T (trace) - Slight contractility, no movement
  • P (poor) - Full range of motion, gravity eliminated
  • F (fair) - Full range of motion with gravity
  • G (good) - Full range of motion against gravity, some resistance
  • N (normal) - Full range of motion against gravity, full resistance