NURS 3120 Lecture Notes - Lecture 8: Lumbar Vertebrae, Temporomandibular Joint, Shoulder Girdle

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31 Mar 2017
School
Department
Course
Musculoskeletal+Assessment++
+
Present+Health+Status++
Chronic(diseases?+
Osteoporosis+
Loss+of+bone+density+
Medications?+
Prescription++
Over+the+counter++
Changes(to(mobility?+
Changes(in(muscle(strength?+
What+has+the+patient+noticed/+how+have+they+adapted+to+the+changes?+
Past+Health++
Accidents+
Trauma+
Surgeries+on+joints+or+bone+
Why+was+surgery+indicated+
Rehab+post+surgery?+Or+allowed+to+go+right+home?++
Functioning+or+back+to+restorative+function+
Family+Health++
Back+problems+
Job?+(nurses)++
Scoliosis+
Types+of+arthritis+
Rheumatoid+
Osteoarthritis+
Gout+
Lack+of+purine+metabolism+(tuna,+salmon,+red+meat)++
Patient’s+Personal+and+Psychosocial+History++
Exercise?+
What+is+their+definition+of+exercise?+
Play+sports?+
What+kinds?+Contact?++
Heavy+lifting+as+part+of+job?+
How+do+they+protect+themselves?+
Pain++
Where+did+you+feel+it?++
Describe/locate+(show)+
Gradual/acute++
What+makes+it+worse/better+
Meds+for+relief?++
o Patches,+OTC++
Problem+Based+History+
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Movement+
How+long?++
Are+joints+swollen/hot/stiff?+
Muscle+weakness+
o One+sided,+depends+on+activity++
Knees/ankles+give+way++
Joints+lock++
ADL’s++
Do+your+musculoskeletal+issues+impact+daily+routine?+
o Shower+(walk-in)?+tub?+Can+you+get+in+alone+or+with+caregiver?+Can+you+
bathe+by+yourself?++
Self-care+deficit?+
Hygiene?+
Crippling?+
Depression?+
Isolation+from+friends+&+family?+
o Have+you+had+to+stop+work/volunteering?++
Overview+of+How+to+Perform+Exam++
Use+cephalocaudal(approach+with+side+to+side+comparisons+
o Head+to+toe+and+side+to+side++
Symmetry+usually+establishes+a+“normal”+pattern+to+exam+–+compare+right+to+left+sides+
INSPECT+skeleton+&+extremities+for+alignment,+symmetry,+and+deformities+
Spine+straight+with+NL+curves+
Do+knees/legs+look+straight+or+are+they+bowing+out?++
o Pigeon+toed++
Feet+facing+midline/forward+
o Flat+footed,+high+arch,+pointed+out++
Muscles?+Atrophy?+Measure+circumference+if+concerned+
o Atrophy:+generally+gradual,+may+not+notice+during+first+exam++
PALPATE(bones,+muscles+&+joints+for+tenderness,+heat,+swelling+–+tone?+Strong/weak?+
Knots,+aches,+pains++
Assess(ROM+with+major+joints?+Movement+easy?+Limited?+Painful?+
Rotator+cuff+injury+limits+ROM++
Notice+foot+has+tremors?+Tap+foot+often+when+nervous?++
Test(muscle+strength+–+is+one+side+stronger+than+the+other+or+the+same+strength+or+
weakness?+
Assessment+of+Musculoskeletal+Specific+Areas++
GAIT+
Stand,+walk+across+the+room++
Smoothly?+need+assistive+devices?++
One+foot+in+front+of+the+other?++
Face+
Temporomandibular(joint:(movement,+sounds+–+like+cracking/clicking+&+tenderness+
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Document Summary

Or allowed to go right home: functioning or back to restorative function. Job? (nurses: scoliosis, types of arthritis, rheumatoid, osteoarthritis, gout, lack of purine metabolism (tuna, salmon, red meat) Contact: heavy lifting as part of job, how do they protect themselves, pain, where did you feel it, describe/locate (show, gradual/acute, what makes it worse/better, meds for relief, patches, otc. Problem based history: movement, how long, are joints swollen/hot/stiff, muscle weakness, one sided, depends on activity, knees/ankles give way. Overview of how to perform exam: use cephalocaudal approach with side to side comparisons, head to toe and side to side, symmetry usually establishes a normal pattern to exam compare right to left sides. Jaw: palpate for neck, pain, any masses, rom, torticollis, shortening of neck muscles from head injury, illness, hospitalized. Shoulders at same level: muscle spasms with movement, rom of thoracic and lumbar spine, turn/twist side to side, touch their toes, hands on hips and bend to test lateral flexion.

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