Unit 3 Neuro-Muscular Assessment 2024 PDF

NEURO-MUSKOLOSKELETAL ASSESSMENT PRESENTED BY: Mrs. KERON JONES-FRASER PhD Candidate ; MScN.; BScN.; Cert. Ed.; RN OBJECTIVES ▪ At the end of three hours adult learners will: ▪ Outline the preparation of the client for assessment ▪ Explain musculoskeletal and neurological systems of clien...

NEURO-MUSKOLOSKELETAL ASSESSMENT PRESENTED BY: Mrs. KERON JONES-FRASER PhD Candidate ; MScN.; BScN.; Cert. Ed.; RN OBJECTIVES ▪ At the end of three hours adult learners will: ▪ Outline the preparation of the client for assessment ▪ Explain musculoskeletal and neurological systems of clients are assessed ▪ View assessment videos that describe the assessment of the names systems. ▪ Discuss the abnormal findings of assessing the named systems. MUSKOLOSKELETAL ASSESSMENT Preparation ▪ Ensure that environment is appropriate and conducive (including privacy, lighting and ventilation) ▪ Have necessary equipment on hand at the start of the assessment ▪ Ensure client’s comfort (Kozier, Erb, Berman & Snyder, 2018) (Weber & Kelley, 2018) ▪ Assessment of the body systems involve the gathering of subjective and objective data. ▪ Interviewing the client seeks to garner subjective data HEART & NECK VESSELS, PERIPHERAL including: VASCULAR SYSTEM, ▪ History of present complaint (C THORAX & LUNGS, O L D S P A) ABDOMEN; ▪ Past health history MUSKOLOSKELETAL ASSESSMENT ▪ Family history ▪ Lifestyle and health practices (Kozier, Erb, Berman & Snyder, 2018) (Weber & Kelley, 2018)  MUSKOLOSKELETAL ASSESSMENT COLDSPA ▪ COLDSPA ▪ Character – Describe the ▪ Severity – How bad is it? sign/symptom. How does it feel, look, sound, smell? ▪ Pattern – What makes it better? What makes it worse? ▪ Onset – When did it begin? ▪ Associated ▪ Location – Where is it? Does it radiate? factors – What other symptoms occur with it? ▪ Duration – How long does it last? (Weber & Kelley, 2018) Does it recur? (Weber & Kelley, 2018) MUSKULOSKELETAL SYSTEM ▪ The musculoskeletal system consists of the body's’ bones, joints and muscles. The joint is the place of union of two or more bones. Joints are the functional units of the musculoskeletal system because they permit mobility. ▪ There are three primary types of joint articulation ▪ Synovial- the bones do not touch each other, and the joint articulations are freely moveable e.g., shoulder and knee ▪ Cartilaginous- allows only slight movement, such as those between vertebrae and the symphysis pubis ▪ Fibrous- allows no appreciable movement, such as the sutures of the skull. MUSKULOSKELETAL SYSTEM ▪ Each skeletal muscle is composed of bundles of muscle fibers. The skeletal muscle is attached to bone by tendon and produces different movements ▪ Flexion- bending a limb at a joint ▪ Extension- straightening a limb at a joint ▪ Abduction- moving a limb away from the midline of the body ▪ Adduction- moving a limb away toward the midline of the body ▪ Pronation- turning the forearm so the palm is down ▪ Supination- turning the forearm so the palm is up MUSKULOSKELETAL SYSTEM ASSESSMENT ▪ Inspect each joint for size, contour, masses & deformity. Palpate for musculature, crepitation; assess for temperature, swelling or tenderness. Start with pt. sitting upright: ▪ Procedure: ▪ Should start at TMJ then do neck… 1. Shoulders – inspect anteriorly and posteriorly while palpate the sterno-clavicular areas and acromio-clavicular joint. ▪ ROM ✓ Flexion & extension – raise arms above head and extend backward. ✓ External rotation – place both hands at posterior neck. ✓ Internal rotation – place both hand at the small of the back ✓ Abduction & adduction – with arms straight lift slowly laterally then brings arm down slowly medially. MUSKULOSKELETAL SYSTEM ASSESSMENT 2. Elbows – inspect elbow while it is flexed, palpate the olecranon process and the lateral and medial epicondyle. ▪ ROM ✓ Flexion & extension – bend elbow then straighten elbow. ✓ Pronation & supination – with the arm at 90o have client turn palm up and then down. ▪ 3. Wrist & hand – inspect and palpate. ▪ ROM of wrist ✓ Flexion & extension – have client bend wrist with fingers pointed downward then upward. ✓ Radial and ulnar deviation – support client wrist with one hand use other to move extended fingers medially and laterally. ▪ ROM of fingers ✓ Flexion & extension – have client make fist and open fist.  MUSKULOSKELETAL SYSTEM ASSESSMENT 4. Hip – inspect and palpate the hip while pt. in lateral position. ROM (while pt. lie supine then/and standing) ✓ Flexion – have client bend knee against abdomen. [Examiner can place arm beneath back and palpate during the flexion of hip] ✓ Extension – have pt. move to one side of the bed and with one leg off bed, bend knee backward. ✓ Adduction & abduction – stabilize opposite hip/iliac then move other leg laterally and medially across the midline of body. ✓ External rotation and internal rotation – flex leg at knee off bed, stabilize knee with one hand at popliteal area then grasp ankle, move limb medially (external) and laterally (internal). MUSKULOSKELETAL SYSTEM ASSESSMENT Knee – inspect with knee ROM: flex and extend the flexed, then straighten limb knee and palpate patella anterior Ankle & Foot – inspect and and lateral. Flex knees and palpate ankle foot & small joints of palpate medial and lateral the toes, compress forefoot joint between fingers. along the joint line for tenderness. ROM Plantar flexion and dorsiflexion Inversion & eversion place heel in one hand, use other hand to grasp toes and move laterally and medially. MUSKULOSKELETAL SYSTEM ASSESSMENT 7. Back & spine – inspect vertebral alignment while pt. is standing and on flexion for profile of spine and lateral curvature then palpate spinal column. ▪ ROM of spine ✓ Flexion & extension – bend forward then backward ✓ Lateral bending – stabilize hip and have client bend to right and left ✓ Rotation – client twist shoulders to right and left ▪ 8. Straight leg raising test (bilateral) MUSKULOSKELETAL SYSTEM ASSESSMENT VIDEO NEUROLOGICAL ASSESSMENT ▪ Equipment: − Tuning fork − Reflex hammer − Cotton − Needles − Coin/paper clip/key ▪ ▪ Procedure: ▪ Mental status 1. Orientation (people, place and time) 2. Memory of 3 objects at 5 minutes 3. Digit retention forward and reverse (count from 1-10 & then 10-1) 4. Simple calculation NEUROLOGICAL ASSESSMENT ▪ Cerebellar function (assessing balance) 1. Gait (include tandem walking – heel to toe on a straight line) 2. Walk on heels and toes 3. Hop on one foot 4. Rapid alternating movements (pronate-supinate or finger-thumb) 5. Finger to nose test (bilateral) 6. Heel to shin test (bilateral) NEUROLOGICAL ASSESSMENT ▪ Motor function 1. Muscle tone (upper & lower extremities) 2. Drift in upper extremities (pronator drift) – hold out arms for 20-30 second. There should be no drifting of the arm downward. 3. Motor strength (upper & lower extremities) a. Strength of the biceps b. Strength of the c. Hand grasps should also be assessed. NEUROLOGICAL ASSESSMENT Sensory function Light touch (all 4 extremities) [Assess distal and proximal areas of all extremities]. Vibration sense (all 4 extremities) [Have client close eyes and ask what they feel and when the vibration stops while applying tuning fork to fingers & toes] Pain by pin prick (all 4 extremities) [Assess distal and proximal areas of all extremities. Two-point discrimination [use clients finger/hand move slowly from two points to one. The point at which client starts feeling one point should be less than 5mm for finger pad] Kinesthesia - position sense (all 4 extremities) [Have client close eyes then ask them to identify the position of the finger, move finger up, down, right and left] Graphesthesia (bilateral) [identify letter/number drawn in palm] Stereognosis (bilateral) [identify objects placed in palm] NEUROLOGICAL ASSESSMENT ▪ Deep tendon reflex ▪ ▪ Reflex scoring ▪ 0-absent ▪ 1+ present but decreased ▪ 2+ normal ▪ 3+ increased or brisk ▪ 4+ brisk ▪ ▪ Biceps ▪ With the patient sitting, flex his arm at the elbow and rest his forearm on his thigh with the palm up. Place your thumb firmly on the biceps tendon in the antecubital fossa. Strike your thumb with the hammer. The elbow and forearm should flex, and the biceps muscle should contract. NEUROLOGICAL ASSESSMENT Triceps With the patient’s arm flexed at a 90° angle. Supporting the arm with your hand, strike the triceps tendon on the posterior arm just above the elbow. The tendon should contract, and the elbow extend. Brachioradialis Have the patient rest his slightly flexed arm on his lap with the palm facing downward. Strike the posterior arm about two inches above the wrist on the thumb side. The forearm should rotate laterally, and the palm turns upward. Patellar Dangle the patient’s legs over the side of the bed. Place your hand on the patient’s thigh and strike the distal patellar tendon just below the kneecap. (If the patient must remain supine, flex each leg to a 45° angle and place your dominant hand behind his knee to support it.) The normal response is contraction of the quadriceps muscle with extension of the knee. Achilles Have the patient dorsiflex (point downward) his foot, and lightly tap the Achilles’s tendon on the posterior ankle area. A slight jerking of the foot should be seen.  NEUROLOGICAL ASSESSMENT Nerves Type Functions I. Olfactory S Carries smell impulse from nasal mucous membrane to brain II. Optic S Carries visual impulses from eye to brain III. Occulomotor M Extraocular muscles – Eyelid elevation; Constrict pupils IV. Trochlear M Extraocular muscles – Controls infero-medial eye movement V. Trigeminal S Carries sensory impulses of pain, touch, & temperature from face to brain M Influences clenching and lateral jaw movement (biting & chewing) VI. Abducens M Extraocular muscles – Controls lateral eye movements VII. Facial S Controls sensory fibers for taste on anterior 2/3 of tongue and stimulates secretions from salivary glands (submaxillary and sublingual) and tears from lacrimal glands Supplies facial muscles and affects facial expression (smiling, frowning & closing eyes) M VIII. Vestibulocochlear S Controls sensory fibers for hearing and balance (equilibrium) IX. Glossopharyngeal S Controls sensory fibers for taste on posterior 2/3 of tongue & pharynx resulting in ‘gag reflex’ Provides secretory fibers to parotid salivary glands; promotes swallowing movement M X. Vagus S Carries sensation from throat, larynx, heart, lungs, bronchi, GI tract & abdominal viscera Promotes swallowing, talking, and production of digestive juices M XI. Spinal Accessory M Controls trapezius & sternocleidomastoid; promotes movement of shoulders, rotation & larynx XII. Hypoglossal M Controls tongue movements and promotes movement of tongue and talking REFERENCES Bickley, L. S. (2018). Guide to physical examination and history taking Philadelphia: Lippincott Kozier, B., Erb, G., Berman, A, & Snyder, S. (2018). Fundamentals of nursing: Concepts, processes, and practice. Upper Saddle River: Pearson Prentice Hall. Weber, J., & Kelley, J. (2018). Health assessment in nursing. Philadelphia: Lippincott, Williams & Wilkinson