Nursing Assessment of the Musculoskeletal System

by Samantha Rhea, MSN, RN

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    00:01 Now next, let's move on to our musculoskeletal assessment.

    00:05 Now, anytime we're assessing the musculoskeletal piece, we're looking at the patient's balance, their posture, their strength, and also their range of motion, like you see here in this image.

    00:19 So we're talking about musculoskeletal.

    00:22 Here's some really important points to note when we're talking about the abilities of our patient.

    00:26 So as you see here, in this image with gait and posture, as you see the man in purple, he needs some assistance with his gait.

    00:35 Why using a cane, you see his postures a little bit slumped.

    00:39 So for me assessing this as a nurse, it makes me think that this patient is a particular fall risk and something I need to assess and intervene appropriately.

    00:49 And next, think about the range of motion for your patients.

    00:52 Now, this can vary depending on if the patient's called arthritis, or even if they've had knee surgery, hip surgery, for example.

    00:59 So many times, we'll use our physical therapist, for example, and help us give key exercises and also help us assess this range of motion.

    01:09 And don't forget about muscular tone and strength.

    01:12 Now, this is really important to support in our patients.

    01:16 As you can imagine, when patients are ill, they've been in the intensive care unit or they've been a mobile for some time, they're going to lose a lot of their muscle tone and strength.

    01:27 Now, this is key for the patient to be able to take care of themselves, or ambulate down the hallway.

    01:33 So as much as possible, we want to try to support their musculoskeletal system.

    01:38 Now, when we're assessing this, think about comparing sides.

    01:42 Going back to those organizational tips about a head to toe assessment.

    01:47 So especially in this system, we want to check one side versus the other.

    01:52 So one way we can check strength is how the client hold their hands out and ask them to squeeze our hands.

    01:59 So especially in your stroke patient or maybe an affected limb, you're going to feel the difference when the patient grips your hands.

    02:07 Also, notice what I did here, if you have the patient hold their hands out, you can see that the patient's able to raise their arms, which is also a plus.

    02:16 Next, you can have the client take their feet and push against your hands with both of their feet at the same time.

    02:23 Now here you're gonna know any difference in strength as well and tone.

    02:28 So sometimes you may hear or I may cue my patient, "Hey, I want you to take your feet and with both and push on what I say, push on the gas.

    02:36 meaningful push forward.

    02:38 Sometimes, I'll have them hold their feet and have them pull towards their face.

    02:43 These are good ways to check bilateral strength with your patient.

    02:48 Now, discussing additional levels of assistance, you may see a one person assist.

    02:54 Now this is just commonly that we're supervising a patient going to the bathroom or ambulating down the hall.

    03:00 And we're really there because the patient may have some maybe balance or coordination issues.

    03:06 So we're really just there for supervision and safety.

    03:10 Now, two-person assist, usually means that the patient may be able to bear some weight on their legs, but they definitely can't go all the way to the bathroom, or they can't get very far.

    03:21 This may mean that the patient can bear weight, but may need someone on each side and move them safely to bed or chair.

    03:28 But again, it's usually a really short distance.

    03:31 And of course, it's ambulatory, which is a level of assistance that nurses we sometimes call a walkie talkie meaning they can ambulate all the way down the hall independently and safely.

    03:42 And they do not it need any assistance for ambulation or mobility.

    03:48 So let's talk about some really great devices that's been created for safety of the patient and really for nursing.

    03:56 So if you take a look at this image with the client in bed, you see this sheet underneath the patient or this dark sheet with handles.

    04:03 So this is great to move the patient up in the bed or to slide them onto a stretcher for example.

    04:09 We kind of call this like a slider sheet.

    04:12 Now this is really great because it offers additional grips to help move the patient safely.

    04:18 Now in the middle here, you see a specialized bed.

    04:22 So there's different specialized bed in regards to helping turn a patient, different pressured, and move the patient around to help prevent pressure ulcers.

    04:30 Some of these also the head of the bed raises and it sets more like a chair to promote lung expansion and health in our patient.

    04:39 Now you see this last device here on this screen.

    04:42 this is what we call a total lift.

    04:45 Now these are for the guys that are bed bound or they need max assistance.

    04:51 Meaning they can't help get up or bear weight.

    04:54 Many times this could be a patient that's completely debilitated and they need this lift to hook on with the sling on these little hooks that you see.

    05:03 They'll set in the sling, the machine will raise them up and take them out of the bed to maybe a chair, for example.

    05:12 Now, there's a few other additional assistive devices for the more mobile patient.

    05:16 So one of these being just an assistive cane, just to help steady the patient on one side.

    05:22 Now, sometimes it's important that the patient may need a walker.

    05:25 Now there's different kinds of variations with walkers, but this is really great to study the patient.

    05:31 And it's important for safety that you teach the patient how they use this appropriately.

    05:35 Sometimes patient gets the walker route way out in front, but really, it should be close to their side when they walk.

    05:42 But walkers are great to steady patients and they have both sides and usually this can come in two or four wheels.

    05:50 So next is our wheelchair.

    05:51 Now this is for clients that may be a two-person assist and we need to transfer them from one place to the other.

    05:58 Usually they may be able to bear weight on their legs, but we need to get them to another piece of the hospital or the facility.

    06:06 Wheelchairs are great for that.

    06:09 Now next, you may see this in a patient's room.

    06:12 This is called a bedside commode.

    06:14 This is going to be great for either a two-person assist, for example, that can't make it all the way to the bathroom.

    06:21 This assistive device is placed right next to the patient's bed, that way they can get to this promptly and quickly if they need it.

    About the Lecture

    The lecture Nursing Assessment of the Musculoskeletal System by Samantha Rhea, MSN, RN is from the course Assessment of the Musculoskeletal System (Nursing).

    Included Quiz Questions

    1. By having the client squeeze the nurse’s hands
    2. By having the client walk the length of the room
    3. By having the client raise their hands above their head
    4. By having the client lift a chair or other moderately heavy object with both hands
    1. Two-person assist
    2. One-person assist
    3. Ambulatory
    4. Maxi-assist lift
    1. Patient lift
    2. Cane
    3. Walker
    4. Bedside commode

    Author of lecture Nursing Assessment of the Musculoskeletal System

     Samantha Rhea, MSN, RN

    Samantha Rhea, MSN, RN

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