health assessment exam: MS

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health assessment exam: MS
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2013-03-07 02:34:21
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health assessment exam: MS
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  1. types of bones
    • - long bones
    • - short bones
    • - flat bones
    • - irregular bones
  2. Ligament
    • attach bone to bone
    • - strong bands
    • - elastic
    • - maintain joint in normal ROM
  3. tendon
    • - attach muscle to bone and muscle to muscle to muscle
    • - muscle contraction- tendon pulls on bone
  4. tendon sheath
    covers the tendon
  5. Tendonitis
    Inflammation of the tendon
  6. Bursa
    • fluid-filled cavities located at tissue sites where tendons or muscle pass over bony prominences near joints
    • - facilitates movement
    • - reduces friction
  7. bursitis
    • inflammation of the bursa. which can cause
    • - limitation of movement
    • - pain upon movement
  8. joints
    • also called articulations
    • - point where two bones meet
    • - three types of joints
  9. what are the three types of joints
    • - fibrous
    • - cartilaginous
    • - synovial
  10. fibrous joint
    skull sutures
  11. cartilaginous joints
    vertebrae
  12. synovial joints
    • - mast majority of out bones
    • - ankle, shoulder, knee
    • - contains synovial fuid
  13. synovial fluid
    - acts as a cushion and protects from wear and tear
  14. common chief complaints
    • - pain 
    • - weakness
    • - limited movement
    • - stiffness
    • - deformity
  15. what is the most common complaint
    pain
  16. chronic vs acute pain
    • chronic 
    • - what have they been doing? long term

    • acute
    • - caused by trauma? came without external forces?
  17. medical history: specific musculoskeletal specific
    • - joint disorder 
    • - bone or skeletal disorders: fractures
    • - neuromuscular disorders
  18. neuromuscular disorders
    multiple sclerosis, multiple muscular dystrophy
  19. Joint disorders
    osteo arthritis or rheumatoid arthritis
  20. medical history: Nonmusculoskeletal specific
    • Infections
    • Blood disorders
    • Peripheral vascular disorders
  21. Nonmusculoskeletal specific: Infections
    limes disease(cutaneous manifestations that can cause muscular problems if left untreated)
  22. Nonmusculoskeletal specific: Blood disorders
    hemophilia - injury casing bleeding into the joint which could cause pain
  23. Nonmusculoskeletal specific: Peripheral vascular disorders
    cancers that metastasize
  24. Surgical History
    • Arthroscopy
    • Arthroplasty
    • Diskectomy or Laminectomy
    • Internal fixation
    • External fixation
    • Amputation
    • Reattachment of a limb
  25. Arthroscopy
    Joint examination
  26. Arthroplasty
    Joint repair/reconstruction
  27. Diskectomy or Laminectomy
    surgical fixation
  28. Common medications
    • Anti-inflammatory agents - NSAIDS
    • Analgesics: narcotic or non-narcotic
    • Muscle relaxants
    • Steroids
    • Calcium supplements
    • Biphosphonates – Fosamax®, - Evista®, Boniva® - inhibit osteoclastic activity
    • Hormone therapy – used less for bone health
  29. health history for bone examination includes?
    • Injuries/accidents
    • Special needs
    • Childhood illnesses
    • Family history
    • Social history
    • Hobbies/leisure activities
    • Exercise – Is it F. I. T. ??
    • Diet Intake
  30. Health History: Special needs include
    • Amputation
    • Use of assistive devices
    • Hemiplegia, quadriplegia, paraplegia
  31. Health Hsitory: Childhood illnesses include
    • - Post Polio Syndrome
    • - Juvenile Arthritis
  32. Health History: Family history
    • Rheumatoid arthritis
    • Paget’s disease
    • Osteoporosis
  33. Paget’s disease
    softens, thickens, and deforms bone
  34. Rheumatoid arthritis
    a chronic, systemic inflammatory disease of joints and surrounding connective tissue. Inflammation of synovial membrane leads to thickening; then to fibrosis, which limits motion; and finally to bony ankylosis
  35. Osteoporosis
    bones can become “spongy,” weak, and more likely to break with even the slightest twist or bump
  36. Health History:
    • Alcohol or tobacco use
    • Work environment: role of repetitious movements
    • Home environment: physical layout/barriers
  37. Assessment: Equipment
    • Goniometer (measure joint range of motion )
    • Tape measure and felt tip marker
    • Sphygmomanometer (measure blood pressure)
  38. Assessment: General approach
    • Patient comfort
    • Compare non-affected to affected - symmetry
    • Proceed in cephalocaudal (head to toe) order
  39. General Assessment includes
    • Overall appearance
    • Posture
    • Gait and mobility
  40. Gait and mobility includes
    • Weight-bearing status
    • Gait patterns
    • Transfer ability
  41. what is transfer ability
    • able to 
    • Sitting to standing
    • Sitting to sitting
    • Laying to sitting
  42. what are some normal findings for general assessment?
    • Height and weight are proportionate
    • Full ROM
    • Ambulate independently
    • No structural defects
    • Shoulders and hips are level
    • Head and torso are upright
    • Stable gait
    • Transfers independently
  43. what should you inspect?
    • - muscle size and shape
    • - joint contour and peri-articular tissue
  44. what are some abnormal findings when inspecting patients muscle size and shape?
    • Hypertrophy (increase in mass or girth)
    • Atrophy (partial or complete wasting away of a part of the body)
    • Involuntary muscle movements (tics, tremors)
  45. what are some normal findings during inspection
    • Symmetrical muscle contour
    • No involuntary muscle movements
    • Bilateral limb circumference is within 1–3 cm of each other
    • Joints are flat when extended, and smooth/rounded during flexion
    • No joint enlargement or deformity
  46. we should palpate for what?
    - muscle tone and strength
  47. what should occur during palpation for muscle tone
    - slight resistance to passive stretch
  48. muscle tone abnormal findings
    • - Spasticity (stiff or rigid muscles) 
    • - Hypotonicity (Having less than normal tone or tension)
  49. muscle strength scale
    • 0: no muscle contraction is detected
    • 1: a trace contraction is noted in the muscle by palpating the muscle while the patient attempts to contract it
    • 2: the patient is ale to actively move the muscle when gravity is eliminated 
    • 3: the patient may move the muscle against gravity but not against resistance from the examiner
    • 4: the patient may move the muscle group against some resistance from the examiner 
    • 5: the patients moves the muscle group and overcomes the resistance of the examiner. this is normal muscle strength
  50. General Joint Assessment
    • Check symmetry
    • Do painful ones LAST
    • Apply light pressure with fingerpads
    • Start in the periphery of the joint and move to center of the joint
    • Move it through the ROM
    • Note swelling, pain, tenderness, warmth, nodules, erythema, ecchymosis
  51. Active ROM
    performed independently by the patient
  52. Passive ROM
    performed by the examiner
  53. Tempromandibular Joint TMJ
    • Articulation between mandible and temporal bone
    • Open and close jaw
    • Protraction and retraction
    • Side to side movement
  54. TMJ Range of Motion
    • (1) hinge action to open and close the jaws;
    • (2) gliding action for protrusion and retraction; and
    • (3) gliding for side-to-side movement of the lower jaw.
  55. Neck ROM
    • Flexion
    • Extension
    • Lateral flexion (bending)
    • Rotation
  56. Spine
    • 33 Irregular bones--vertebrae
    • 7 Cervical
    • 12 Thoracic articulate with ribs
    • 5 Lumbar
    • Sacrum shapes the posterior wall of the pelvis
    • Coccyx
  57. Inspection & Palpation of the Spine
    • Note curvature
    • Check symmetry
    • Check alinement byPalpating spinousprocesses
  58. Spine ROM
    • - hyper-extension 
    • - lateral left to right
    • - rotation 
    • - flexion
  59. Kyphosis
    An exaggerated posterior curvature of the thoracic spine (humpback) that causes significant back pain and limited mobility.
  60. Lordosis
    A genetic disorder in converting cartilage to bone results in normal trunk size, short arms and legs, and short stature
  61. Scoliosis
    A lateral S-shaped curvature of the thoracic and lumbar spine, usually with involved vertebrae rotation
  62. Shoulders ROM
    • Ball and socket joint
    • Abduction 
    • Adduction
    • Horizontal forward Flexion
    • Horizontal Backward Flexion(hyperextension)
    • Circumduction
    • External and internal rotation
  63. Inspection & Palpation of the Shoulder
    • Shoulders =in height
    • No swelling
    • No tenderness
    • No crepitus
    • Full ROM
  64. Rotator Cuff Tear
    • Arm extended and abducted from the body
    • Instruct patient to slowly lower the arm while maintaining arm extended
    • Arm quickly drops
    • Severe pain
  65. Elbow ROM
    • Hinge Joint between humerus, radius and ulna
    • Flexion of Forearm-160 º
    • Extension of forearm-0 º--Flat
    • Supination of forearm-90 º: Palm up
    • Pronation of forearm-90 °: Palm down
  66. Palpation of the Elbow
    • Palpate for warmth, swelling, tenderness, nodules, crepitus
    • Tennis Elbow:Lateral epicondylitis
    • Golfer’s ElbowMedial epicondylitis
  67. Wrist and Hand ROM
    • Eight carpal bones connected by ligaments to the metacarpals distal and to the scaphoid and lunate bones proximally
    • Hyperextension - 70 º
    • Flexion - 90 º
    • Radial deviation - 20 º
    • Ulnar deviation - 55 º
  68. Hand and Fingers ROM
    • Metacarpophalangeal and Interphalangeal joints
    • Abduction - 20 º
    • Extension
    • Hyperextension - 30 º
    • Flexion - 90 º
    • Circumduction
  69. Thumb ROM
    •  Extension
    •  Flexion-80 º
    •  Opposition
  70. Phalen Test
    Ask the person to hold both hands back to back while flexing the wrists 90 degrees. Acute flexion of the wrist for 60 seconds produces no symptoms in the normal hand
  71. Grip Strength
    • Roll B/P cuff up
    • Inflate to 20 mm Hg
    • Have patient squeeze
    • Normal: 150 mm Hg
    • Check for symmetry
  72. how can oyu test for carpal tunnel syndrome?
    • - tinel's sign 
    • - phalen's sign
  73. Hip Joints
    Ball and socket joint between head of femur and acetabulum
  74. Hip ROM
    • - flexion 
    • - flexion with knee flexion 
    • - internal and external rotation 
    • - abduction 
    • - adduction 
    • - hyperextention
  75. Fractured Hip
    • Pain
    • Inability to bear weight
    • Affected leg is shorter
    • Affected leg:Internal rotation and External rotation
  76. Knee Joints ROM
    • Complex joint!!
    • Patella, femur and tibia
    • Extension
    • Flexion - 130 º
  77. Common Knee Disorders: Younger adult
    • Ligament tears
    • Traumatic
    • Athletes – female (?)
  78. Common Knee Disorders: Older adults
    • Osteoarthritis
    • Wear and Tear
  79. Ankle
    • Hinge Joint
    • Tibia, Fibula and Talus
  80. Ankle ROM
    • - doriflexion 
    • - planter flexion
    • - eversion
    • - inversion
  81. Toes ROM
    • Extension
    • Flexion
    • Abduction - 10 º
    • Adduction - 20 º
  82. Anthropometric Measurements
    • Height/Weight
    • Waist to Hip Ratio
    • Body Proportions
    • Growth Patterns in Children
    • Changes in Nutritional Status in Adults
  83. Ideal Body Weight: female
    • 100 Lb for 5 feet then add 5 Lb for every inch above 5 feet.
    • + or – 10% for small or large frame
  84. Ideal Body Weight: males
    • 106 Lb for 5 feet then add 6 Lb for every inch over 5 feet
    • + or – 10% for small or large frame
  85. % IBW = ?
    Actual Wt ÷ IBW x 100
  86. moderate malnutrition IBW
    70-80% IBW
  87. severe malnutrition IBW
    < 70% IBW
  88. overweight IBW
    110% IBW
  89. obesity IBW
    >120 % IBW
  90. Risk for Obesity Related Diseases
    Waist to Hip Ratio
  91. Waist to Hip Ratio: Males
    >1.0
  92. Waist to Hip Ratio: Females
    >0.8
  93. Body Mass Index values
    • < 18.5 - Underweight
    • 18.5 – 24.9 - Normal
    • 25.0 – 29.9 - Overweight
    • 30.0 – 34.9 - Obesity Class I
    • 35.0 – 39.9 - Obesity Class II
    • >40.0 - Obesity Class III
  94. Skin Fold Thickness
    • Determines Body Fat Stores & Nutritional Status
    • - use triceps skin fold (TSF) to determine
  95. Mid-Arm Circumference (MAC)
    • Skeletal Muscle Mass
    • Measure in mm
    • Normal: 5-95th% tilebased on age/gender
    • Used to calculate the Mid-Arm Muscle Circumference

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