1. Muskuloskeletal Assessment  Health History  Physical Assessment  Inspection  Palpation  Range of Motion  Muscular Strength Rachel S. Natividad, RN, MSN

2. Physical Assessment- Cont.  Cervical spine  Shoulders  Elbows  Wrists/hands  Hips  Knees  Ankles/feet  Spine  Functional assessment

3. Inspection/Palpation  Note size and symmetry color, swelling, masses & deformities of joints, limbs and body regions  Palpate for temperature, pain, tenderness,

4. Spine

5. ROM’s  Have the pt perform active ROM  If unable to, use passive ROM

6. Assessing Muscles  Strength against gravity, full resistance  note as 0/5-5/5  “5/5” = normal

7. Rheumatoid arthritis  Chronic, systemic, inflammatory disease that attacks the joints, and surrounding tissues, hand, knees, hips, and feet

8. Deformities of RA Swan neck deformity Boutinniere Deformity Ulnar Shift

9. Osteoarthritis  A chronic degeneration of joint cartilage caused by aging or trauma

10. Osteoarthritis Heberden’s nodes on distal interphalangeal joints (DIP’s ) Bouchards nodes on proximal interphalangeal joints (PIPs) as disease progresses

11. Osteoporosis  A decrease in bone mass, porous, brittle, and prone to fracture

12. Contractures

13. Assessment Guide: Activity & Rest  Objective Data  Activity Level and Tolerance:  ambulates with walker independently/ with minimal assistance; bedrest; up in wheelchair

14. Assessment Guide: Activity & Rest Muscles and joints  Description: fair muscle tone, no atrophy; atrophy to RLE. No stiffness or contractures; R wrist contracted  Movement: limited ROM to RUE; FROM all extremities  Strength: strong UE, LE; weak RUE & RLE  Coordination: able to perform most ADLs; can comb hair and reach for water glass

15. Assessment Guide: Activity & Rest  Posture/Gait  Slumped, kyphosis, erect; gait unsteady, shuffling, ataxia

16. Assessment Guide: Activity & Rest  Circulation, Sensation, and Movement  Describe:  CSM intact;  no sensation to R big toe and second toe;  numbness and tingling to LEs;  Decreased ROM to LUE due to contractures

17. Assessment Guide: Activity & Rest  Rest/Sleep Patterns  Sleeps most of the day  Takes midday naps

18. Assessment Guide: Activity & Rest Interventions in use:  Assistive device, equipment  Cast, trapeze, foot cradle,  Special beds  Air bed, eggcrate mattress  Med List:  Glucosamine, Allopurinol, NSAIDS, etc.