Week 6 Mobility: Assessment

• Musculoskeletal assessment


  • Look for: Pain (OPQRSTU), Additional Symptoms like redness, swelling, stiffness, weakness, fever, heat? Recent trauma? And Look at soft tissues
• Crepitus

  Bones rubbing together
• Active motion


  Patient moves own joints without assistance
• Passive motion


  Someone else moves patient's joints without patient participation
• Goniometer


  Tool used to measure the angle of the joint (usually only measured if a problem is identified)
• Peripheral vascular assessment


  • Look for: colour, temp, edema and cap refill
• Peripheral neuro assessment


  • Assess for: sensation, motor function, and pain
• Nursing priorities for ortho fractures and trauma

  • Pain assessment
  • Preventing reinjury
  • Functional ability
• Complications of immobility

  • Pressure injuries
  • Impaired tissue integrity (ulcers)
  • Blood stasis (DVT)
  • Contractures
  • Falls
  • Pneumonia
  • UTI
  • Constipation
  • Contractures
  • Muscle atrophy
• Complications of swelling


  • Losing pulse
  • Compartment syndromes
  • Pain
• Compartment syndrome


  If nerves and blood supply are compromised bc of hella pressure, then it can lead to hypoxia
• The 6 P's of compartment syndrome

  • Pallor
  • Pain
  • Pressure
  • Pulselessness
  • Paralysis
  • Paresthesia
• How to determine degree of injury to a leg

  1. Injury and palpation

  2. Neurovascular assessment
• What are we looking for when palpating a leg for injury?

  • Alignment
  • Symmetry
  • Size
  • Obvious deformities
• Neurovascular assessment of injury to a leg

  • Colour
  • Warmth
  • Cap refill
  • Peripheral pulses
  • Edema
  • Sensation
  • Motor function
  • Pain
• In cases of compartment syndrome: Try to check for cap refill or find a doppler
• Signs of compartment syndrome in the case study

  • Pain increasing
  • Feels tight
  • Toes cool to the touch
  • Pale
  • Unable to palpate pulse
  • Pins and needles
• Slow

  Insidious
• Signs of rheumatoid arthritis

  • Bilateral
  • Anorexic
  • Emaciated
  • Pain a 6 out of 10 in the morning and subsides to a 4 out of 10 in the evening
  • Elevated ESR and positive for rheumatoid factor
  • Joints warm red and edematous
• Drugs for rheumatoid arthritis symptom control

  • Corticosteroid
  • Glucocorticoid ex prednisone
  • NSAID ex. naproxen, celecoxib
• Drugs for rheumatoid arthritis disease progression


  • Methotrexate
  • Infliximab (depending on disease severity)
• Osteoarthritis (OA)


  • Unilateral
  • Associated with wear & tear
  • Not systemic
  • Pain improves with rest & worse with use
  • Causes joint deformities (Heberden Nodes, Bouchard Nodes)
• Rheumatoid Arthritis (RA)


  • Systemic symptoms
  • Bilateral multiple joint involvement
  • Warm, red, & inflamed joints
  • Pain worse in the AM and improves with use
  • Joint deformities (ulnar drift, rheumatoid nodules, boutonniere deformity, hallux valgus/bunion, swan neck deformities)
• Gout


  • Most common site of inflammation big toe (Podagra)
  • Sudden onset of intense pain
  • Can be triggered by risk factors (male, obesity, hypertension, stress/trauma, diuretic use, excessive alcohol, diet high in purine rich foods, kidney disease)
  • Joint deformities (Tophi)
• Rheumatoid Arthritis (RA) causes these deformities

  • Ulnar drift
  • Rheumatoid nodules
  • Boutonniere deformity
  • Hallux valgus/bunion
  • Swan neck deformities
• Gout causes these deformities

  • Tophi
  • Podagra
• Osteoarthritis (OA) causes these deformities

  • Heberden Nodes
  • Bouchard Nodes
• Osteoarthritis (OA) is diagnosed by

  1. Xray

  2. CT scan

  3. Rule out infectious cause for joint pain: Joint aspirate – negative, blood work – normal
• Rheumatoid Arthritis (RA) is diagnosed by

  1. Positive rheumatoid factor

  2. Elevations in ESR and C-reactive protein

  3. Joint aspirate – may contain inflammatory markers

  4. Xray – more so with advanced disease
• Gout is diagnosed by

  1. Increased serum uric acid levels – non-specific

  2. Clinical symptoms: Joint aspirate – may show presence of uric acid crystals

  3. X-ray – more so for chronic cases
• Arthrocentesis


  Needle is inserted into joint cavity to aspirate synovial fluid, blood, pus<|>Diagnosis of joint inflammation, infection depending on aspirate appearance & lab results
• Methotrexate


  • Disease modifying antirheumatic drug that works against the body's Immunity and Inflammation
  • Contraindications and precautions include active infection, and pregnancy
  • The nurse should monitor the following blood work after administration: Liver enzymes (leads to liver dysfunction), CBC (Can lead to low WBC, RBC and everything else), Urea/creatinine (hard on kidneys)
• Risk Factors for OP

  • Post menopausal
  • Female
  • Rheumatoid arthritis
  • Prednisone
  • Methotrexate
• Diagnostics for osteoporosis


  • Serum calcium and vitamin D3 levels should be routinely monitored (women >50 or high risk of OP)
  • X Rays for osteoporosis = Show decreased bone density (porous appearance) only in advanced disease
  • Dual X-ray absorptiometry DEXA - used to assess BMD, often done for women in their 40s as a baseline to compare - noninvasive, painless and less radioactive than a CXR
• Pathological/fragility fracture


  Fractures not caused by trauma
• Drugs for preventative treatment of pathological/fragility fracture

  • A) NSAID (Naproxen)
  • B) Prednisone (Deltasone)
  • C) Methotrexate (Rheumatrex)
  • D) Allopurinol (Zyloprim)
• Clinical Manifestations of a fracture

  • Localized pain or bony tenderness
  • Decreased function of the bone – think about weight bearing
  • Edema/swelling
  • Crepitus
  • Bruising
• INFECTION


  Open fracture high risk, open wound, surgery opens the wound to potential contaminants
• Signs of inflammation

  • Warmth
  • Redness
  • Swelling
  • Increased pain
  • Fever
• What causes RA?

  Environmental triggers or genetics