NUR 2221 Lecture 10 (Musculoskeletal A&P / Soft Tissue Injuries / Fractures / Complications / Amputations / Surgeries) | Broward College

Lecture 10
(Musculoskeletal A&P / Soft Tissue Injuries / Fractures / Complications /
Amputations / Surgeries)

 Assessment of the Musculoskeletal System
 Subjective Data
 Important Health Information
 The most common symptoms of musculoskeletal impairment
○ Pain
○ Weakness
○ Deformity
○ Limitation of movement
○ Stiffness
○ Joint crepitation
 Ask about changes in sensation or in the size of a muscle
 Past Health History
 Certain illnesses are known to affect the musculoskeletal system
either directly or indirectly
 Question the patient about past medical problems
○ Tuberculosis
○ Poliomyelitis
○ Diabetes mellitus
○ Parathyroid problems
○ Hemophilia
○ Rickets
○ Soft tissue infection
○ Neuromuscular disabilities
 Focus on symptoms of arthritic and connective tissue diseases
○ Gout
○ Psoriatic arthritis
○ Systemic lupus erythematosus
○ Osteomalacia
○ Osteomyelitis
○ Fungal infection of the bones or joints
 Ask the patient about possible sources of a secondary bacterial
infection
○ Ears
○ Tonsils
○ Teeth
○ Sinuses
○ Lungs
○ GI tract
○ These infections can enter the bones, resulting in osteomyelitis
or joint destruction
 Medications

,  Question the patient regarding prescription and over-the-counter
drugs and herbal products
 Obtain detailed information about each treatment
○ Name
○ Dose and frequency
○ Length of time it was taken
○ Effects
○ Possible side effects
 Inquire about the use of
○ Skeletal muscle relaxants
○ Opioids
○ NSAID’s
○ Systemic and topical corticosteroids
○ Question the patient who has taken anti-inflammatory drugs
about GI distress or signs of bleeding
 Drugs that can have detrimental effects on this system
○ Antiseizure drugs
 Osteomalacia
○ Phenothiazines
 Gait disturbances
○ Corticosteroids
 Avascular necrosis
 ↓ Bone and muscle mass
○ Potassium-depleting diuretics
 Muscle cramps and weakness
 Question women about their menstrual history
○ Episodes of premenopausal amenorrhea can contribute to the
development of osteoporosis
 ↓ Estrogen levels
○ Ask postmenopausal women about their use of hormone
replacement therapy
 Inquire about calcium and vitamin D supplements for both women
and men
 Surgery or Treatments
 Obtain information about past hospitalizations because of a
musculoskeletal problem
 Document
○ Reason for hospitalization
○ Date and duration
○ Treatment
○ Ongoing rehabilitation
 Record details of emergency treatment for musculoskeletal injuries
 Obtain specific information regarding any surgical procedure
○ Post-op course

, ○ Complications
 Health Perception/Health Management
 Health practices related to the musculoskeletal system
○ Maintenance of a normal body weight
○ Avoidance of excessive stress on muscles and joints
○ Use of proper body mechanics when lifting objects
 Question the patient specifically about tetanus and polio
immunizations
○ Obtain the most current date and reaction to a tuberculin skin
test
 General malaise often associated with allergic reactions may
manifest in musculoskeletal stiffness and lethargy
 Allergic reactions to drugs used to treat musculoskeletal problems
can be significant if they interfere with therapy
 Minor and major injuries of the musculoskeletal system
○ Record information chronologically and include the following:
 Mechanism of the injury
 Twist
 Crush
 Stretch
 Circumstances related to the injury
 Diagnostic evaluations
 Methods of treatment
 Duration of treatment
 Current status related to the injury
 Need for assistive devices
 Interference with activities of daily living
 Family history
○ Rheumatoid arthritis
○ Systemic lupus erythematosus
○ Osteoarthritis
○ Gout
○ Osteoporosis
○ Scoliosis
 Ask the patient about safety practices
○ Work environment
○ Home life
○ Recreation
○ Exercise
 Describe your usual daily activities
 Do you experience any difficulties performing these activities?
 Describe what you do if you experience difficulty in dressing,
preparing meals and feeding yourself, performing basic hygiene, or
maintaining your home

,  Do you have to lift heavy objects?
○ Describe any specialized equipment you use or wear when you
work or exercise that helps protect you from injury
 Do you take any drugs or herbal products to manage your
musculoskeletal problem?
○ If so, what are their names and what are the expected effects?
 Nutritional/Metabolic
 Adequate amounts of vitamins C and D, calcium, and protein are
essential for a healthy, intact musculoskeletal system
 Maintenance of normal weight is an important nutritional goal
 Obesity places additional stress on weight-bearing joints
○ Knees
○ Hips
○ Spine
○ Predisposes individuals to ligamentous instability
 Obtain a 24-hour diet recall
 What dietary supplements do you take?
○ Ask specifically about calcium, vitamin D supplements, and
herbal products
 What is your weight?
○ Describe any recent weight loss or gain
 Elimination
 Difficulty with ambulating to the toilet
 Ask the patient if an assistive device is necessary to accomplish
toileting
○ Elevated toilet seat
○ Grab bar
 Decreased mobility secondary to a musculoskeletal problem can
lead to constipation
 Musculoskeletal problems can contribute to bowel or bladder
incontinence
 Does your musculoskeletal problem make it difficult for you to reach
the toilet in time?
 Do you need any assistive devices or equipment to achieve
satisfactory toileting?
 Do you experience constipation related to decreased mobility or to
drugs taken for your musculoskeletal problem
 Activity/Exercise
 Detailed account of the type, duration, and frequency of exercise
and recreational activities
 Daily, weekend, and seasonal patterns should be compared
○ Occasional or sporadic exercise can be more problematic than
regular exercise