lOMoARcPSD|3013804
NR 304 Exam 2 Notes
Health Assessment II (Chamberlain
University)
, lOMoARcPSD|3013804
NR 304 Exam 2 Notes
Musculoskeletal System
• Muscle movements:
o Abduction – moving a limb away from the midline of the body
o Adduction – moving a limb toward the midline of the body
o Circumduction – moving the arm in a circle around the shoulder
o Protraction – moving a body part forward and parallel to the ground (e.g. movement
jaw outward)
o Retraction – moving a body part backward and parallel to the ground
Subjective
• Location of pain:
o Rheumatoid arthritis involves symmetric joints
• Timing of pain:
o RA pain is worse in the morning when arising
o OA pain is worse later in the day
o Tendinitis is worse in morning; improves during the day
• Movement increases most joint pain except RA in which movement decreases pain
• Joint pain 10-14 days after an untreated strep throat suggests rheumatic fever
• Stiffness:
o RA stiffness occurs in the morning and after rest periods
• Myalgia is usually felt as cramping or aching
• Viral illness often includes myalgia
• Bone pain:
o Fracture causes bone pain that increases with movement
o Other bone pain usually feels “dull” and “deep” and is unrelated to movement
• Functional assessment – screens the safety of independent living, the need for home
health services, and quality of life
• Knee Joint:
o Inside knee injury can strain or rupture medial ligament
o outside injury can strain or rupture lateral ligament
o abrupt twisting can injure anterior cruciate ligament
o Pop may mean tear in ligament or fracture.
o With direct knee trauma, obtain x-ray if the patient:
▪ is unable to flex knee to 90 degrees or unable to bear weight for 4 steps
▪ if pain is experienced at fibula head or patella
▪ if patient is over age 55 years (Ottawa knee rules).
Objective
• Note the size and contour of every joint.
• Inspect the skin and tissues over the joints for color, swelling,
and any masses or deformity.
• Presence of swelling is significant and signals joint irritation
o Swelling may be:
, lOMoARcPSD|3013804
▪ excess joint fluid (effusion)
▪ thickening of the synovial lining
▪ inflammation of surrounding soft tissue (bursae, tendons)
▪ bony enlargement.
• The synovial membrane normally is not palpable.
o When thickened, it feels “doughy” or “boggy.”
o A small amount of fluid is present in the normal joint, but it is not palpable.
• ROM:
o Articular disease (inside the joint capsule [e.g., arthritis]) produces swelling and
tenderness around the whole joint
▪ limits all planes of ROM in both active and passive motion
o Extra-articular disease (injury to a specific tendon, ligament, nerve) produces swelling
and tenderness to that one spot in the joint
▪ affects only certain planes of ROM, especially during active (voluntary) motion.
o Do not confuse crepitation with the normal discrete “crack” heard as a tendon or ligament
slips over bone during motion, such as when you do a knee bend.
▪ Crepitation is an audible and palpable crunching or grating that
accompanies movement
o Cervical Spine
o Touch chin to chest
▪ Expected motion and range - flexion of 45˚
o Lift chin towards ceiling
▪ Expected motion and range – hyperextension of 55˚
o Touch each ear towards the corresponding shoulder
▪ Expected motion and range - Lateral bending of 40˚
NR 304 Exam 2 Notes
Health Assessment II (Chamberlain
University)
, lOMoARcPSD|3013804
NR 304 Exam 2 Notes
Musculoskeletal System
• Muscle movements:
o Abduction – moving a limb away from the midline of the body
o Adduction – moving a limb toward the midline of the body
o Circumduction – moving the arm in a circle around the shoulder
o Protraction – moving a body part forward and parallel to the ground (e.g. movement
jaw outward)
o Retraction – moving a body part backward and parallel to the ground
Subjective
• Location of pain:
o Rheumatoid arthritis involves symmetric joints
• Timing of pain:
o RA pain is worse in the morning when arising
o OA pain is worse later in the day
o Tendinitis is worse in morning; improves during the day
• Movement increases most joint pain except RA in which movement decreases pain
• Joint pain 10-14 days after an untreated strep throat suggests rheumatic fever
• Stiffness:
o RA stiffness occurs in the morning and after rest periods
• Myalgia is usually felt as cramping or aching
• Viral illness often includes myalgia
• Bone pain:
o Fracture causes bone pain that increases with movement
o Other bone pain usually feels “dull” and “deep” and is unrelated to movement
• Functional assessment – screens the safety of independent living, the need for home
health services, and quality of life
• Knee Joint:
o Inside knee injury can strain or rupture medial ligament
o outside injury can strain or rupture lateral ligament
o abrupt twisting can injure anterior cruciate ligament
o Pop may mean tear in ligament or fracture.
o With direct knee trauma, obtain x-ray if the patient:
▪ is unable to flex knee to 90 degrees or unable to bear weight for 4 steps
▪ if pain is experienced at fibula head or patella
▪ if patient is over age 55 years (Ottawa knee rules).
Objective
• Note the size and contour of every joint.
• Inspect the skin and tissues over the joints for color, swelling,
and any masses or deformity.
• Presence of swelling is significant and signals joint irritation
o Swelling may be:
, lOMoARcPSD|3013804
▪ excess joint fluid (effusion)
▪ thickening of the synovial lining
▪ inflammation of surrounding soft tissue (bursae, tendons)
▪ bony enlargement.
• The synovial membrane normally is not palpable.
o When thickened, it feels “doughy” or “boggy.”
o A small amount of fluid is present in the normal joint, but it is not palpable.
• ROM:
o Articular disease (inside the joint capsule [e.g., arthritis]) produces swelling and
tenderness around the whole joint
▪ limits all planes of ROM in both active and passive motion
o Extra-articular disease (injury to a specific tendon, ligament, nerve) produces swelling
and tenderness to that one spot in the joint
▪ affects only certain planes of ROM, especially during active (voluntary) motion.
o Do not confuse crepitation with the normal discrete “crack” heard as a tendon or ligament
slips over bone during motion, such as when you do a knee bend.
▪ Crepitation is an audible and palpable crunching or grating that
accompanies movement
o Cervical Spine
o Touch chin to chest
▪ Expected motion and range - flexion of 45˚
o Lift chin towards ceiling
▪ Expected motion and range – hyperextension of 55˚
o Touch each ear towards the corresponding shoulder
▪ Expected motion and range - Lateral bending of 40˚
