Musculoskeletal Physical Exam
Head to toe
When collecting common concerning symptoms for Mental Status, we do not want the questions/assessment to seem like a ___________.
Interrogation
What is a "mini stroke called"
TIA
Explain the Rhombergs test and normal finding.
Feet together standing erect with eyes closed 30 seconds
minimal swaying
When does the nurse start assessing mental status?
When they first meet the client
When inspecting the joints we are looking for which of the following?
What are we palpating for?
Inspect: symmetry, alignment, bone deformities
palpate: nodules, atrophy, crepitus
Two most common concerning symptoms for the neurological system?
Headaches
Dizziness/Vertigo
What is a trauma and stress related disorder?
PTSD
Explain "normal" gait
arms swing in opposition, head/spine in line, smooth fluid turns/movement, knee flexes and extends, heel strikes the ground, even weight on heel/toes, toes pointed towards walking
What is the first sign of neurologic deterioration?
Loss of Consciousness
Explain two types of ROM for the following:
TMJ
Neck
Shoulder
TMJ: Have patient open and close jaw, protrusion/retraction, side-side
Neck: Chin to chest, look up at ceiling, ear on shoulder, look over shoulder
Shoulder:
Flexion-“raise your arms in front of you and overhead”
Hyperextension-“raise your arms behind you”
Abduction-“raise your arms out to the side and overhead”
Adduction-“lower your arms to your sides, then bring them across your body”
Internal rotation-“place one hand behind your back and touch your shoulder blade”
External rotation-“raise your arm to shoulder level’ bend you elbow and rotate your forearm toward the ceiling”OR “ place one hand behind head/neck like you are brushing your hair”
2 Leading complaints for client seeking healthcare for musculoskeletal system
Joint pain
Low back pain
What are risk factors for stroke?
Hypertenion
Smoking
Dyslipidemia
Diabetes
Excess Weight
Diet and nutrition
Physical inactivity
Heavy alcohol use
How is a deep tendon reflex assessed? What tool is used?
Briskly tapping the tendon of a partially stretched muscle with a reflex hammer
Explain the difference between remote and recent memory. Give examples.
-Recent: events of the day, what was eaten for the last meal, weather, appt time, labs taken at appt.
-Remote: birthdays, SSN, anniversaries, first jobs, historical events
Explain kyphosis, lordosis, scoliosis
Demonstrate ROM for the spine, knee, ankle
Kyphosis: thoracic curvature
Lordosis: Lumbar curavture
Scoliosis: lateral curvature of spine with pelvis/shoulders uneven
Spine: touch toes, bend back, rotate side to side, lateral bend to touch toes
knee: squat, stand back up, sitting move lower leg from midline and bring it back
Ankle: plantar flexion, dorsiflexion, inversion, eversion
List common concerning symptoms for Mental Status
Changes in attention, mood, and speech
Changes in orientation or insight
changes in memory
Medical symptoms without explanation
List risk factors for osteoporosis.
-Low dietary calcium
-Low vitamin D
-Sedentary lifestyle
-Older than 50
-Postmenopausal
-love body mass index
-Family history
-previous fracture
-High alcohol use
-Tobacco use
-Medications such as methotrexate
-Inflammatory conditions such as RA
1. What are the components of GCS
2. What are the ABCs for unconscious client (what do you assess/look for?)
3. What is your fully alert score of GCS
4. Explain what happens for a fully alert client
1. Motor response, Verbal response, Eye opening
2. Airway: color, pattern of breathing, review posterior pharynx and listen over trachea for stridor
Breathing: Observe rate, rhythm, and pattern of respirations
Circulation: Pulse, BP, rectal temp
LOC
3. 15
4. Opens eyes, responds fully and appropriately, looks at you
What do we assess when completing a physical exam for mental status and explain some of what we are assessing.
-Appearance and behavior: level of consciousness, grooming, dress, hygiene, posture, motor function, facial expression
-speech and language: fluency, rate, quantity, articulation, aphasia
-mood and affect: appropriate for circumstances, ask them to describe mood, body gestures, outword facial expression
-thought process and content: logic, coherent, relative, organization, insight, judgment
-cognition: orientation, memory, attention, information, vocabulary, calculations, abstract thinking, constructional ability
Explain how to assess strength for upper extremities and ankles
explain how to assess hand grips
Explain a "normal posture"
Explain a "normal gait"
1. Push and pull and pedal push and pull
2. Ask client to squeeze two fingers and assess bilaterally at the same time.
3. Head midline with spine, feet together, arms hanging at sides, shoulder and pelvis level
4. smooth and continuous, knee flexed until heel strikes the ground, posture erect, arms swing in opposition, even weight on toes and heels, toes pointed straight
List common concerning symptoms for musculoskeletal system
-Joint pain
-Low back pain
-neck pain
-Bone pain
-muscle pain/cramps
-muscle weakness
List prevention or treatment options for Osteoporosis
-Adequate calcium intake: Calcium carbonate
-Adequate Vitamin D
-Antiresorptive agents-Calcitonin
-Anabolic agents-Parathyroid stimulant
-Weight bearing and and resistance training
-Limit alcohol and caffeine
Final Jeopardy: Name (in correct order) all 12 cranial nerves and include how to assess each.
1. Olfactory: test smell with familiar scent
2. Optic: visual acuity/PERRLA
3. Occulomotor-EOMs
4. Trochlear-EOMs
5. Trigeminal-Chewing, palpating masseter/temporal, corneal reflex
6. Abducens- EOMs
7. Facial: Smile, frown, raise eyebrows
8. Acoustic-Rub fingers by ear, whisper test, check balance
9. Glossopharyngeal-Gag/swallow reflex
10. Vagus-Gag/Swallow reflex
11.Spinous Accessory-Shrug shoulders with resistance
12. Hypoglossal-Tongue alignment and movement, Speak articulation
Explain the difference between Alert, Lethargic, Obtunded, Stupor, and Coma.
-Alert: awake, opens eyes, responds to normal voice, responds appropriately and fully
-Lethargic: drowsy, opens eyes and looks at person talking, answers question and falls asleep
-Obtunded: open eyes, looks at person talking, responds slowly and somewhat confused
-Stupor: Arouse from sleep only to painful stimuli, goes back to not responsive once stimulus is no more, Verbal response slow/absent, minimal awareness of surroundings
-Coma: unconscious, do not open eyes, does not respond to pain or voice.