Chapter 26
Assessing Musculoskeletal
System
Structure of the Bones
Axial (head and trunk) and
appendicular (extremities,
shoulders, and hips) skeleton
Compact and spongy bones
Osteoblasts, osteoclasts
Structure of the Muscles
Three types:
Skeletal voluntary, smooth,
cardiac
Movements: abduction,
adduction, circumduction,
inversion, eversion,
extension (hyperextension),
flexion (dorsi and plantar),
pronation, supination,
protraction, retraction,
rotation (internal and
external)
Fibrous, cartilaginous,
Structure of and synovial
the Joints
Ligaments
Bursae
Osteoporosis
One in three women and one in five men will have a fractured
bone, with hip, forearm, and vertebral fractures predominating.
Europeans and Americans accounted for 51% of osteoporosis-
related fractures in the year 2000, followed by people from the
Western Pacific and Southeast Asia.
Osteoporosis
Uncontrollable risk factors
Modifiable risk factors
Risk Reduction: Osteoporosis
Ensure a nutritious diet with adequate calcium
intake.
Avoid protein malnutrition and undernutrition.
Maintain an adequate supply of vitamin D.
Participate in regular physical activity.
Avoid the effects of second-hand smoke.
Collection of Subjective Data
History of present health concern
Past health history
Family history
Lifestyle and health practices
Collection of Objective Data
Preparing the client
Equipments required:
Tape measure
Goniometer
Skin marking pencil
Gait: observe gait; assess for risk of falling
Temporomandibular joint:
Inspect and palpate the TMJ
Test range of motion
Sternoclavicular joint
Collection of Objective Data
Cervical, thoracic, and lumbar spine:
Observe the cervical, thoracic, lumbar curves.
Palpate the spinous processes and paravertebral muscles
for tenderness or pain.
Test ROM of the cervical, thoracic, lumbar spine.
Collection of Objective Data
Shoulders, arms, and elbows; inspection, palpation, ROM
Elbows:
Inspect for size, shape, deformities, redness, or swelling.
Test ROM.
Wrists: inspection, palpation, test ROM, test for carpel tunnel
syndrome
Hands and fingers: inspection, palpation, test ROM
Hips: inspection, palpation, test ROM
Collection of Objective Data
Knees: inspection, palpation
Test for swelling.
Perform ballottement test.
Test for ROM.
Test for pain and injury.
Ankles and feet:
Inspect position, alignment, shape, and skin.
Palpate ankles and feet for tenderness, heat, swelling, or nodules.
Test ROM.
Wrist and Hand Abnormalities
Rheumatoid
arthritis
Ganglion
Feet and Toes Abnormalities
Acute gouty arthritis
Hallux valgus
Older Clients
Older clients usually have slower movements, reduced
flexibility, and decreased muscle strength because of age-
related muscle fiber and joint degeneration, reduced
elasticity of the tendons, and joint capsule calcification.
Bones lose their density with age, putting the older client at
risk for bone fractures, especially of the wrists, hips, and
vertebrae. Older clients who have osteoporosis are at an
even greater risk for fractures.
Joint-stiffening conditions may be misdiagnosed as arthritis,
especially in the older adult.
Some older clients have an impaired sense of position in space,
which may contribute to the risks of falling.
Analysis of Data
Selected nursing diagnoses:
Wellness diagnoses
Risk diagnoses
Actual diagnoses
Selected collaborative problems