NSB103 Health Assessment PDF

NSB103 Health Assessment Assessment of the Musculoskeletal System Associate Professor Christina Parker  Learning This Week Ø Overview of the Musculoskeletal system Ø General approach to patient assessment when undertaking a musculoskeletal assessment Ø Person Centred...

NSB103 Health Assessment Assessment of the Musculoskeletal System Associate Professor Christina Parker  Learning This Week Ø Overview of the Musculoskeletal system Ø General approach to patient assessment when undertaking a musculoskeletal assessment Ø Person Centred Care Ø Clinical Reasoning Cycle en-la-computadora-portatil-grande_1253706.htm  Overview of the Musculoskeletal System Your musculoskeletal system includes bones, muscles, tendons, ligaments and soft tissues. They work together to support your body’s weight and help you move. Injuries, disease and aging can cause pain, stiffness and other problems with movement and function. Musculoskeletal Changes Associated with Ageing Type of Problem Ø Reduced muscle strength Ø Reduced mass and ROM Ø Weakened bone  Musculoskeletal System Aim of assessment: ØTo differentiate between inflammatory and degenerative/mechanical problems ØTo identify patterns that may help with diagnosis, and to assess the impact of any problem on a patient When should we assess? http://www.co.uk/muscles Ø When patient reports pain or loss of function in a joint or muscle Ø After injury Ø Part of mobility or falls risk assessment Prepare the Environment Ensure the room is appropriately set up for the patient to walk around  Gather the Relevant Information Ø Past Medical History Ø Family history (i.e. Osteoporosis) Ø Past surgical history (scars) Ø Medications (topical, systemic, over-the-counter) Ø Exposure to environmental or occupation hazards (cigarette smoking, alcohol use) Ø Substance abuse Ø Calcium intake less than 500mg daily Ø Thin and light body frame Ø Problems with the musculoskeletal system https://www.emaze.com/@ALZLWFRC Musculoskeletal Assessment Fundamentals of Nursing Clinical Skill 17.7: Focused Musculoskeletal Assessment Ø Review baseline assessment data Ø Perform hand hygiene Ø Comfort/Privacy/Explain procedure Ø Ensure appropriate positioning for examination Ø Observe patient’s ability to safely stand, transfer and mobilise. Note how much assistance is necessary Ø Observe gait Ø Inspect and gently palpate major joints for range of motion in arms, legs and spine (when possible). Note any pain, swelling, warmth or crepitus Ø Assess muscle strength. Compare the right and left of paired muscle groups. Note any involuntary movements Ø Determine frequency of musculoskeletal assessment based on patients condition  Musculoskeletal Assessment: Inspection Inspection Ø Observe patients ability to safely stand, transfer and mobilise. Ø Note how much assistance is required Ø Observe gait https://www.edmonton.ca/transportation/walk-edmonton.aspx Ø Look for symmetry (atrophic muscles may indicate chronic disuse)  Activity: Musculoskeletal Watch different people around you walk or mobilise? Assessment: Inspection What differences to do you notice in different people? Why might these differences occur? https://www.edmonton.ca/transportation/walk-edmonton.aspx Musculoskeletal Assessment: Palpation Palpation Ø Inspect and gently palpate major joints for range of motion in arms, legs and (when possible) spine. Ø Note any pain, swelling, warmth or crepitus http://autoprac.com/pulse  Musculoskeletal Assessment Ø Assess muscle strength, compare right and left sides. Note involuntary movements Ø Assess pain Ø Measurement Ø Walking assistive device Ø Range of motion Ø Gait analysis  Musculoskeletal Assessment Clinical terminology that you need to be aware of: Ø Abduction Ø Adduction Ø Dorsiflexion Ø Eversion Ø Extension Ø External rotation Ø Flexion Ø Hyperextension Ø Internal rotation Ø Inversion Ø Plantar flexion Ø Pronation Ø Supination Musculoskeletal Assessment Across the Lifespan http://slideplayer.com/slide/2376401 Musculoskeleta l Assessment Across the Lifespan: Pregnancy Musculoskeleta l Assessment Across the Lifespan: Ageing  National Health Priority National health priority Ø Arthritis, osteoporosis and other musculoskeletal conditions Ø Injury Prevention and control https://ncphn.org.au/archives/news/falls-risk-assessment-and-management  Take 5 minutes to review this website Click on the link to this website and review the information: Arthritis and osteoporosis in Australia Ø How many Australians have arthritis and osteoporosis? National Ø What impacts do arthritis and osteoporosis have on health and Health functioning? Priority Ø What types of health services do people with arthritis and osteoporosis use? Ø Are all Australians equally affected? Ø How much money is spent on these conditions? Falls Risk Assessment Tool (FRAT)  Intrinsic General (age, fatigue) Mental status Urinary issues Mobility issues Risk factors Comorbidities (hypertension, anaemia) for falling in Medications (digoxin, antidepressants, polypharmacy) hospital Extrinsic Environmental factors (flooring, cords) Organisation and people factors (staffing, footwear) Socioeconomic factors (literacy, dependency) Clay et al. (2018) Risk factors for hospital falls: Evidence Review  Number of medications Risk factors Sedatives Antidepressants for falling in Walking aids Disability residential History of falls Vision impairment aged care Incontinence Parkinson’s disease Clay et al. (2018) Risk factors for hospital falls: Evidence Review  Common diagnostic tests for musculoskeletal disorders Ø Laboratory Tests For example, the erythrocyte sedimentation rate (ESR) is a test that measures the rate at which red blood cells settle to the bottom of a test tube containing blood. The ESR is usually increased when inflammation is present. However, because inflammation occurs in so many conditions, the ESR alone does not establish a diagnosis. Ø Imaging Tests Ø X-rays Ø Arthrography Ø Bone Scanning Ø Computed tomography (CT) and magnetic resonance imaging (MRI) Ø Dual-energy x-ray absorptiometry (DXA) Ø Ultrasonography Arthroscopy Joint aspiration (arthrocentesis) Other diagnostic procedures Nerve and muscle tests Clinical Reasoning Cycle Subjective Objective Data Compare the data against normal parameters Identify Health Problems Realistic goals (collaborative))  Risk for Impaired Skin Activity Intolerance related to pain, weakness, and Integrity related to: fatigue related to: Goal. To increase activity ØImmobility Ø Pain Ø Trauma by reducing the ØPresence of pain Ø Osteoarthritis experienced. mobility aids Chronic Pain related to: Ø Joint inflammation, overuse of joint, Ø Ineffective pain and/or comfort Goals: realistic, timely, measures Goal. To improve pain by using achievable, collaborative. Impaired Physical Mobility related to: pharmacological and Use the ‘related to’ factor to Ø Ineffective use of walking aids non-pharmacological Ø Decreased muscle strength due to direct your goals and ultimately methods pain, stiffness, Osteoarthritis the intervention. May need to address other Chronic Pain related to: health problems to solve one. Ø Joint inflammation, overuse of joint Eg. An improvement in pain Ø Ineffective pain and/or comfort measures levels would be necessary to address activity intolerance. Documentation Ø Regularly assess and document Ø Note any new abnormal findings or investigations Ø Communicate abnormal findings https://nurseslabs.com/tips-improve-clinical-documentation/ Case Study Mr Brown, aged 78 years, is a widower and lives at home. His daughter lives nearby. Mr Brown usually uses a wheelie walker to mobilise because he often becomes unsteady on his feet. Since he was only going out to collect the mail he decided to leave it inside feeling confident that he wouldn’t be walking very far. On his way to the letter box he tripped and fell sustaining a large skin tea on his left arm. What musculoskeletal assessment would you do for this patient?  Consider the person and the context. Who is the person? Where are they living? Who supports them? What is their experience? Present, past, family history. Collect Cues and Information. Subjective and objective Data Processing the Information. Compare the data against normal parameters. Analyse, organise, categorising. Identify potential health issues/problems. Relate back to the data for relevance and direction. Set goals in collaboration with the person and their family Each goal is aligned with each potential health issue or problem.  Fiona Clay, Gillian Yapand Angela Melder. 2018. Risk factors for in hospital falls: Evidence Review. 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