Musculoskeletal & Neurological

Assessment Details ● Support the joint at rest to avoid hyperextension ● Avoid rapid, jerky movements ● Manipulation can cause muscle spasms Inspection & Palpation ● ● ● ● Inspect the joints, muscles, and bone structure Determine size, symmetry, alignment, ROM, and deformities/inflammation Observe gait for balance and symmetry Burning pain or feeling pins and needles usually indicate neurological involvement Unexpected Findings ● Contracture: A joint deformity, primarily unilateral, resulting in a limited ROM ○ Result of disuse atrophy, and shortening of the muscles caused by injury or neurological damage Range of Motion ● The muscle tone and strength should be able to support movements with minimal effort ● Active ROM: Client can move that joint without assistance ● Passive ROM (PROM): Moving the muscle for the client ○ Do not extend past the point of resistance or when pain is shown ● As a client completes each motion, cup your hand over the joint and feel for crepitus Expected Findings ● Movement without discomfort, hesitancy, obstruction, or crepitation ● Symmetrical movement Unexpected Findings ● Limited ability to maneuver, joint deformity, asymmetry, pain, hesitancy, crepitus, or muscle spasm ● Hesistancy: Resistance to movement of the joint Muscle Testing ● Test the strength of the muscle group associated with each joint ● Perform the same ROM the client actively did while applying opposing force ROM Scale ● ● ● ● ● ● Grade 5: Full ROM against gravity, full resistance Grade 4: Full ROM against gravity, some resistance Grade 3: Full ROM with gravity Grade 2: Full ROM with gravity eliminated (passive motion) Grade 1: Slight contraction Grade 0: No contraction Expected Findings ● Maintaining joint position against resistance ● Exertion of equal resistance on both sides ● Muscle testing grade above 3 Unexpected Findings ● Muscle testing grade of 3 or less ● Discomfort while maintaining resistance ● Asymmetrical muscle testing grade Tools ● Paper tape measure ○ Used if one extremity looks larger than the other ○ Measure at the largest point; use same point at other Anatomy Neurological System CNS ● Brain and spinal cord ● Voluntary movement and sensory information PNS ● 31 pairs of spinal nerves ● Both sensory and motor functions ● 12 cranial nerves Neurological & Musculoskeletal ● Voluntary and involuntary movement ● Conditions can impair (ex. Injury to spine eliminates movement below injury site) Musculoskeletal System ● Consists of bones, joints, ligaments, tendons, and muscles ● Functions include mobility, internal organ protection, calcium storage, and hematopoiesis ● Bone types: Long, short, flat, irregular Joint Types ● Fibrous: Immovable (ex. Those which hold the bones of the skull together) ● Cartilaginous: Slightly movable (ex. Those that connect the ribs to the sternum) ● Synovial: Freely movable due to synovial fluid and cartilage ○ Hinge joints ○ Ball and socket joints ○ Condyloid joints Ligaments and Tendons ● Ligaments: Strong, flexible bands of CT ○ Support the joints and connect bones ○ Allow for a degree of movement ● Tendons ○ Nonelastic CT (collagen) ○ Connect the muscles ot the bones themselves, allowing bones to move ● Periosteum: Membrane covering the bones providing nourishment ○ Contains blood vessels, nerves, and lymphatic tissues Muscles ● Skeletal, smooth, and cardiac ● Skeletal muscles contract, resulting in movement, when stimulated by a neurotransmitter ○ Between the nerve ending and muscle ● Give form and contour, determining posture Head and Neck ● Cervical vertebrae and ligaments support ● SCM and trapezius muscles provide movement Shoulders ● Ball and socket joint; wide ROM ● Made up of the humerus, clavicle, scapula, and multiple muscles/tendons ○ Make up rotator cuff, allowing for lateral rotation of the shoulder and humerus ● Trapezius and several muscles allow shoulder elevation, scapular rotation, and posterior movement of the shoulder ● Subacromial bursa: Enclosed sac at the proximal end of the humerus and underneath the acromion process; allows for smooth abduction ● Glenohumeral joint: Where the humeral head connects with the glenoid fossa of the scapula; can be palpate on the anterior aspect of the shoulder Elbow ● Hinge joint that involves the humerus, radius, and ulna ○ Articulate to move the forearm ● Bony landmarks include the medial and lateral epicondyles and olecranon process ● Ulnar nerve goes between medial epicondyle and olecranon process ● Radial nerve runs along lateral epicondyle ● Median nerve is on the ventral aspect of the forearm at the antecubital fossa ● Surrounded by olecranon bursa to protect from trauma ● Radius and ulna articulate at proximal radioulnar joint ○ With distal radioulnar joint, allows supination and pronation ● ● ● ● Flexion: Biceps and brachioradialis Extension: Brachialis and triceps Pronation: Pronator teres Supination: Supinator Wrist and Hands ● ● ● ● Wrist contains the distal aspects of the radius and ulnar at the distal radioulnar joint Eight small carpal bones make up the base of the palm Five metacarpals compose the remainder of the palm Phalanges extend from the metacarpals to make up the fingers Joints in the Wrist ● Radiocarpal, distal radioulnar, and intercarpal joints Joints in the Hand ● Metacarpophalangeal (MCP), proximal interphalangeal (PIP), and distal interphalangeal (DIP) joints Nerves ● Three major nerves supply the wrist and hand with sensation ● The median nerve is associated with carpal tunnel disorder ○ Causes numbness, tingling, and discomfort Spine ● 33 vertebrae; 7 cervical, 12 thoracic, 5 lumbar, 5 sacral, 3-4 coccygeal ○ Sacral and coccygeal vertebrae are fused together ● Four curves can be seen laterally: ○ Cervical and lumbar curves are concave ○ Thoracic and sacrococcygeal curves are convex ○ Assist with distribution of weight to the pelvis and lower extremities ● Fibrocartilaginous discs acts as shock absorbers and allow joints to glide over each other ● Major associated muscles are the trapezius and latissimus ● Spinal cord is made of nerve tissue extending from the medulla to the lumbar vertebrae (L1 & L2) Hips ● Ball and socket joint encased in an articular capsule ● Consists of the head of the femur, acetabulum (concave socket of the pelvis), and multiple muscles/ ligaments ● Associated with two principal bursae ○ One on articular surface and other on the greater trochanter of the femur ● Flexion: Iliopsoas ● Extension: Gluteus maximus ● Adduction: Muscles on the posterior medial portion of the femur ● Abduction: Gluteus medius and minimus Knees ● Hinge joint formed by the femur, tibia, and patella articulation ● Quadriceps femoris and hamstrings suppor the knee and allow movement ● Bursae reduces friction, and the meniscus and ligaments provide support Ankles and Feet ● ● ● ● ● The tibiotalar joint is a hinge joint that makes up the ankle Made up of tibia, fibula, and talus articulation Supported by medial and lateral ligaments Metatarsophalangeal joints move the toes Landmarks include the medial/lateral malleolus and calcaneus Musculoskeletal Disorders Question Subjects ● Scoliosis, kyphosis, lordosis ● Pain or spasms (back) ● Difficulty breathing ● ● ● ● ● ● ● ● ● ● ● Neurologic disorders; injury to the head/spinal cord, stroke, seizures History of a neuromuscular disorder Recent tremors or inability to control movements Affected ADLs, involving heavy lifting and repetition Exercise participated in and safety Immediate family members with a neuromuscular or musculoskeletal disorder Function of the musculoskeletal and neuromuscular systems Loss of function or weakness within a joint or muscle Difficulty balancing or with coordination Recent falls Joint pain, sensory loss, and any trauma/injury ○ Fracture, sprain, contusion ● Swelling, erythema, change in pigmentation, or warmth ● Numbness or tingling ● Diabetes history (can cause peripheral neuropathy) Head and Neck Inspection ● ● ● ● Inspect the face musculature Ask the client to open and close their mouth to inspect jaw movement Observe the neck from all sides, paying attention to the muscles Inspect the alignment of the vertebrae in the neck and of the head with the trunk Expected Findings ● ● ● ● Equal movement on both sides of the face Opening and closing the jaw without difficulty Muscles in neck should be symmetrical Vertebrae in neck aligned with head; erect and in line with trunk Unexpected Findings ● Asymmetry in the muscles ● Measure each side and note differences greater than 1 cm Palpation ● Place your index, ring, and middle fingers on the TMJ ○ Ask the client to open and close their jaw ● Stand behind the client and palpate the vertebrae in their neck ○ Client should flex their neck forward, placing their chin on their chest ○ Look for alignment of the vertebrae ● Palpate the SCM, trapezius, and paravertebral muscles on either side of the vertebrae Expected Findings ● Spinous processes of the vertebrae should be in alignment without massess/deformity ● Muscles of the neck should be full and firm, without tenderness or masses ● Symmetrical muscles bilaterally Expected Variations ● Clicking in the jaw is not uncommon ● Should be no pain or locking of the joint Unexpected Findings ● Inflammation of the muscles can cause pain/discomfrot with palpation ● Muscle spasms can indicate nerve compression ● Decreased or unequal sensation of light touch may indicate neurological damage Assess ROM ● ● ● ● Move the jaw laterally, then thrust it forward (protrusion) Lower chin to the chest (flexion) and raise it back up to its normal position (extension) Tilt the head back (hyperextension), should be able to look at the ceiling Bend the neck to one side, bringing the ear closer to the shoulder (lateral flexion) ○ Repeat on the other side ● Turn their head side to side, looking over one shoulder and then the other Shoulders Inspection ● Compare both shoulders from all sides, observing for symmetry in height and contour ● Inspect the trapezius muscles and symmetry of bone landmarks, acromion process, scapulae, and clavicles ● If the client experiences pain, have them point ot the area ● Shoulder pain can be caused by another condition, like a gallbladder disease, hiatal hernia, or heart/lung condition Expected Findings ● Shoulders should be symmetrical in height with equal bone landmarks ● Contour of the muscles should be symmetrical Unexpected Findings ● Unusual appearance, like erythema or changes in pigmentation, atrophy of the muscles, deformities, irregularities, or swelling present in the shoulders ● Muscles should not spasm or have tenderness/discomfort ● Swelling of the subacromial bursa, can get worse with arm abduction Palpation ● Stand facing the client and palpate both of their shoulders ● Begin in the upper chest by palpating along the clavicle then the acromioclavicular joint ○ Where the clavicle and scapula come together ● Move to the back to palpate the scapula ● Then, palpate the greater tubercle of the humerus ● Finally, palpate the trapezius and deltoid muscles Expected Findings ● Shoulder should feel firm and full ● Muscles should be relaxed and symmetrical on both the R and L sides Expected Variations ● Muscle in the dominant arm may appear slightly larger than the nondominant arm Unexpected Findings ● Swelling, heat, or tenderness ● Atrophy or unilateral swelling ● Shoulder lacking an expected rounded shape, appearing flattened ○ Indicates a dislocation of the humerus from the glenoid fossa Assess ROM & Muscle Strength Extension, Flexion, and Hyperextension 1. Instruct the client to rest their arms and elbows at their sides to demonstrate extension. 2. Tell the client to move their arms forward from 0 to 90 degrees, and then up to their ears at 180 degrees; demonstrates flexion. 3. Have the client move their arms back to the side of their body. Instruct them to move their arms back 60 degrees with their palms up to demonstrate hyperextension. Abduction and Adduction 1. Instruct the client to raise their arms from the extension position out to their sides in a large arc, ending with the palms of their hands meeting over their head. This demonstrates abduction of the shoulder. 2. Have the client lower their arms back to the extension position, and have them bring one arm up to shoulder height. Ask them to cross their arm over the upper chest past the shoulder laterally to demonstrate adduction. 3. Tell the client to lower their arms back, and repeat with the opposite arm. Internal Rotation and External Rotation 1. Instruct them to move one arm from the extension position with their palm facing outward behind their lower baack. Try to raise the back of their hand to touch the shoulder blade to demonstrate internal rotation. a. Repeat for the opposite shoulder 2. Direct the client to raise both arms from the extension position with elbows bent and place their hands behind their head to demonstrate external rotation. 3. Tell them to rotate their arms posteriorly. Observe the scapula moving closer together. Muscle Strength 1. Ask the client to shrug their shoulders by raising their shoulders in an upward motion. 2. Press down at the same time to observe if they can resist the action. Elbows Inspection ● Inspect the elbows in both flexed and extended positions, providing support to the forearm with your opposite hand ● Assess the symmetry, alignment, color, size, muscle tone, and contour (bones, muscles, and joint capsule) ● Inspect the olecranon bursa for inflammation Expected Findings ● Depressions on both sides of the olecranon process (tip of elbow) ● Skin surrounding the joint should be even color and intact ○ No erythema, change in pigmentation, or swelling Unexpected Findings ● Swelling and erythema or change in pigmentation around the olecranon bursa ● Synovial joint thickness (fluid effusion) is a bulging area in the depressions on either side of the olecranon process groove location ○ May be seen in gouty arthritis ● Misalignment of the articular surfaces of the joint can indicate elbow dislocation Palpation ● Face the client and hold their elbows with your hands ● Ask them to flex their elbow about 70 degrees ● Use you rother hand to palpate th elateral and medial epiconyles, olecranon process, and hollows on either side Expected Findings ● Symmetry of the R and L elbows ● No pain or discomfort elicited with palpation ● The olecranon process should be easily palpable and without tenderness, swelling, warmth, nodules, or masses Unexpected Findings ● Erythema or change in pigmentation, heat, and edema (can indicate inflammation) ● Displacement of th eolecranon process can indicate elbow dislocation ● Subcutaneous nodules can occur on the olecranon bursa and the ulnar surface with rheumatoid arthritis (RA) ○ Noted as elevated, firm, nontender masses that are freely movable Assess ROM 1. Slowly bend (extension) and straighten (flexion) each elbow 2. Rotate the hands placing the palms up (supination) and the palms down (pronation), allowing their elbow to fully rotate Expected Variations ● Extension or hyperextension to 5-10 degrees rather than 0 degrees ● Both sides should still be symmetrical Assess Muscle Strength ● Hold the client’s arm with one hand, just above the wrist, and instruct them to flex the arm, bending at the elbow while you apply resistance ● Then, have them attempt to extend the elbow again while you apply resistance ● Should be able to flex without pain and demonstrate resistance Wrist and Hands Inspection ● ● ● ● ● Turn the hands and assess them on both sides Observe the palms, fingers, and dorsum of the hand and wrist Note the shape and form of the bones, joints, and muscles Assess the position of the fingers in relation to the wrist and forearm Turn the client’s palms up and check that the hand muscles are full Expected Findings ● ● ● ● Wrists and hands should be symmetrical to each other The wrist should have a slight extension, allowing fingers to flex Fingers should be relatively straight and in line with the wrist and forearm The palm should be rounded with a larger mound below the thumb and a smaller one below the smallest finger Unexpected Findings ● Presence of swelling or nodules on the joints (can indicate arthritis) ● Ulnar deviation, where the fingers are not aligned with the wrist and forearm ○ Instead deviate to the ulnar side of the arm (also indicates arthritis) ● Fingers that are nonlinear or unable to fully extend ● Any limitation in movement or asymmetry between the R and L wrists and hands ● Ganglion cyst; a circular, nontender nodule on the dorsal surface of the wrist Palpation ● Note muscle tone and any swelling/,asses ● ● ● ● Note palpation that elicits tenderness/pain Provide support to the hand and have the client relax their wrist Then, feel the dorsal and lateral sides of the wrist using your thumbs Move your thumbs down along each metacarpal bone one at a time ○ Note swelling, malformation, or masses ○ Finish with palpation of the metacarpophalangeal joints (knuckles) ● Use your index finger and thumb to palpate each phalange and interphalangeal joint Expected Findings ● The bones and joints should be smooth with nodules ● Should be symmetrical between R and L sides Unexpected Findings ● Presence of tenderness, swelling, or nodules on the joints (can indicate arthritis) Assess ROM 1. Slowly bend and straighten each wrist to perform flexion, extension, and hyperextension 2. Move the wrist side to side to determine radial and ulnar flexion 3. Make a fist with the thumb placed over the fingers (flexion), and then straighten the fingers (extension) 4. Spread the fingers apart (abduction) then back together (adduction) 5. Bend the thumb in toward the palm of the hand (flexion), return to the relaxed position next to the hand (extension), and then away from the hand (abduction) 6. Bend the thumb to touch the tip of each finger (opposition) Assess Muscle Strength ● ● ● ● Have the client place their arm and palm up on the exam table Place one hand at their mid-forearm to stabilize it Instruct them to flex their wrist while you provide resistance against their hand Have the client abduct their fingers and keep them separated while attempting to push them together (should be able to resist) ● Test the client’s grip by instructing them to grasp two of your fingers on each hand, noting the strength on both hands Symmetry, Shape, and Curvature Inspection 1. Have the client (wearing a gown) ambulate in the room and observe their gait/posture a. Note the position of their head and neck 2. With the client standing, stand at their side and observe the spinal curves 3. Open the client’s gown from the back, and stand behind them to observe the entire back a. Note the position of the head and spinal curvatures b. Observe the alignment of the shoulders, iliac crest, and gluteal folds skin creases c. Note the position and alignment of the knees and feet 4. Draw an imaginary line from the L to R iliac crest a. Should be horizontal and cross at the level of L4 b. Should be perpendicular to the posterior superior iliac spine c. Inspect the contour of the muscles Expected Findings ● Look for the head to be erect and aligned with the neck and back ● Symmetrical shoulders and hips ● Even and symmetrical iliac crests and gluteal folds ● Equal size and shape of buttocks ● Equal alignment of knees and feet; feet should face forward ● Spine should be concave at the cervical and lumbar areas; convex at the thoracic area ○ Spinous processes may protrude slightly ● Muscle movement should be smooth, coordinated with ambulation, and symmetrical Expected Variation ● With aging, intervertebral discs become more flattened, resulting in a loss of height Unexpected Findings ● ● ● ● Lateral deviation of the head in relation to the spine Lateral deviation of the spine Asymmetry of the shoulders or hips Exaggerated curvatures of the thoracic spine (kyphosis), lumbar spine (lordosis), or lateral curvature (scoliosis) ● Unstable, ataxic, or shuffling gait ● Inability to maintain posture Muscle Alignment and Spinous Process Palpation ● Palpate the spinous processes while behind the client ● Use your finger pads to palpate the paravertebral muscles and spine Expected Findings ● Firm paravertebral muscle without tenderness, pain, or spasms ● Spinous processes should be aligned straight without any tenderness Unexpected Findings ● Curvature, tenderness, or spasms of paravertebral muscles Assess ROM 1. Bend forward and attempt to touch their toes (flexion); have the client bend down only as far as they safely and comfortably can a. Observe to see if the concave lumbar curve disappears b. Back should have a single convex Cshaped curve c. Vertebrae should be in alignment d. Observe the height of the scapulae and ribs, which should be equal 2. Bend sideways, moving the torso to the right, and then to the left (lateral flexion) a. If needed, stabilize the client 3. Bend backwards (hyperextension); have the client bend down only as far as they safely and comfortably can 4. Twist the shoulders to one side (rotation), like they are looking over their shoulder a. Should be able to keep the hips straight with a 30-degree rotation Intervention Needed: Sensory Loss to Feet Subjective Data: Question Subjects ● Locations of numbness or tingling ● Paresthesia: Pins and needles sensation ○ Dysesthesia: Feeling of being itchy ● Side of manifestations ● Relation to activity and time of day ● Associated manifestations, like radiation ● Pain with sensations ● Impact on ADLs ● Perception of touch and temperature Inspection of Skin ● Breakdown or color changes ● Symmetry of tone on all extremities ● Inspect for erythema, change in pigmentation, warmth, or open areas Palpate Pulses ● Note the pulse and its force (dorsalis pedis) ● If it is easily palpable and strong, the cause is likely neurological Assess Sensory Functioning ● Check their ability to feel light touch and differentiate between dull and sharp sensations ○ Have the client close their eyes ● Compare bilaterally and move consistently from decreased to full sensation Additional Nursing Actions ● ● ● ● ● Observe the client’s gait when ambulating Ensure the surrounding area is free from obstructions Instruct them to wear well-fitting footwear whenever ambulating Teach them to avoid extreme temperatures in the foot area Instruct the client to inspect their feet daily Hips and Knees Inspection ● ● ● ● ● Observe the client’s gait and note their overall stance and swing Inspect the hip surfaces for ecchymosis Observe the alignment and contour of the knees and shins Alignment of the knee should be along the same axis as the femur, tibia, and ankle Inspect the quadriceps muscle, just proximal to the knee on the anterior thigh Expected Findings ● ● ● ● ● ● Smooth and coordinated gait The top of the iliac crests and the gluteal folds should be level bilaterally The surface of the hips should be without bruising Knees should be symmetrical; equal of landmarks/depressions on each side of the patella Symmetrical contour of muscles Straight and bilaterally equal shins Unexpected Findings ● Asymmetry of the hips can indicate spine curvature, hip deformity, or unequal leg length ● Pain with movement or gain could indicate neurological conditions, dislocation, or fractures (wide-based gait indicates neurological deficits) ● Presence in erythema, heat, swelling, or nodules on the knee can indicate arthritis ○ As can atrophy of the quadriceps muscle ● Deviation of alignment of the knee ● Limitation in movement or asymmetry between the R and L knees ● Absence of depressions on either side of the patella ● Misalignment of the shin, an angulation deformity, appears as a bowing out of the tibia and fibula (genu varum) or bowing in (genu valgum) ● A permanent state of flexion (contracture) of the knee Palpate ● Palpate the iliac crests and hip joints with varying pressure ○ Have the patient supine and note pain/tenderness ● Assist the client into a sitting position, and palpate the quadriceps muscle above the knee ○ Feel the consistency of the client’s tissues ● Palpate the hollows on either side of the patella with your thumbs ● Follow the lower edge of the patella, locating and palpating the tibiofemoral joint Expected Findings ● Joints should be stable and symmetrical without tenderness/pain ○ Patella should be rounded and smooth ● The bones and joints should be easily palpable without nodules or masses ● Firm and solid feeling to the soft tissues and muscles Unexpected Findings ● Tenderness, pain, swelling, or crepitus ● Swelling or nodules can indicate arthritis ● Movable and compressible or boggy and mushy knee Assess ROM 1. While supine, bend the knee and bring it up to the chest (hip and knee flexion), and then return it to its resting position (hip and knee extension); repeat with the other extremity 2. Raise the leg with the knee straight (hip flexion), then return it to resting (hip extension) 3. Flex the hip and knee, and place the heel of the foot across the opposite knee while letting the hip relax, allowing the flexed knee to move outward and down to the table; return the leg to its resting position and repeat with the other extremity (external rotation) 4. Flex the hip and knee while moving the heel of the foot laterally (internal rotation) 5. Relax the hip and allow the flexed knee to move inward, crossing the opposite leg; return the leg to its resting position and repeat with the other extremity 6. Keep the hip and knee in a neutral position while moving the leg laterally (abduction), followed by moving the leg medially across the midline (adduction) 7. Raise the legs upward one at a time while maintaining the knee in a neutral position (hyperextension); repeat with the other extremity (can also be done while standing) Assess Muscle Strength ● Place a hand on the client’s legs and apply light pressure; ask them to lift the leg ● Ask the client to keep their knee flexed while you try to pull their leg forward ● To test extension, have them try to stand up from a low chair or squatting position Ankles and Feet Inspection ● ● ● ● First as the client sits (no weight on ankles/feet), then while standing and ambulating Compare the client’s feet Observe the contour of the foot and presence of the medial/lateral malleoli Inspect for symmetry and alignment; should be aligned with the lower leg ○ Line from the middle of the knee to between the big and second toes ● While standing, weight should be held by the midfoot, not the heel, ball, or toes ● The toes should extend straight out from the foot and lay flat on the floor ● Observe the longitudinal arch along the foot Expected Findings ● The feet and toes should lie straight along the axis of the lower leg ● The malleoli at the ankles are smooth Expected Variations ● Some may have little to no longitudinal arch, while others have a high arch Unexpected Findings ● Swelling, inflammation, lesions, ulcers, corns, or calluses ○ Indicative of excessive friction or injury ● Misalignment of the toes ○ Hallux valgus: The distal aspect of the large toe sticks out, away from the body ○ Hammertoes: Involve remaining toes; consists of hyperextensino of the metatarsophalangeal and PIP joints Palpation ● Use the pads of the fingers and thumbs on one foot at a time (ankle, heel, and foot) ● Palpate the malleoli and joint surfaces ● Moving from proximal to distal, move your thumb to the dorsal foot, palpating the plantar surface and metatarsopalangeal joints ● Use your thumb and index finger to palpate the medial and lateral aspects of the toes Expected Findings ● The bones should feel smooth and firm ● Joint spaces should be slightly hollow with smooth surfaces Unexpected Findings ● Fullness or swelling of the joints ● Tenderness or pain with palpation Assess ROM 1. 2. 3. 4. Point their toes toward the floor (plantar flexion) Point their toes upward to their noes (dorsiflexion) Turn the soles out, away from the body (eversion), then toward midline (inversion) While holding their ankle with one hand and their heel with the other, bend (flexion) and straighten (extension) their toes, and raise their toes up while keeping the foot flat on the surface (hyperextension) Assess Muscle Strength ● Keep their foot and ankle flexed against the force of your hand and arm ● Should be able to maintain flexion without pain or weakness Intervention Needed: Extremity Trauma Strain ● Involves injury to a muscle or tendon ● The result of overuse or excessive stress Sprain ● Involves injury to ligaments and tendons that support a joint ● Results from a twisting motion or hyperextensino of the joint Fracture ● Involves a break or disruption of the integrity of th ebone ● May be complete, involving the entire bone width, or incomplete Neurovascular Compromise ● The result of an injury involving any of these conditions ● Injury to the bone, muscles, tendons, ligaments, or surrounding tissues causes edema, placing increased pressure on the nerves and vascular systems ● Results in increased discomfort and nerve damage (temporary or permanent) Subjective Data; Question Subjects ● ● ● ● ● Pain (extent, localization, quality, with movement) Numbness or tingling (can indicate neurovascular damage) How the injury occurred Popping at the time of injury (severe sprain or fracture) Difficulty completing ADLs Assessment Inspection ● ● ● ● Inspect the size and contour on the affected area and compare to the opposite side Make note of abrasions, lacerations, edema, contusions, ecchymosis, or deformities Inspect the extremity distal to the injury; skin color should be consistent Increased pallor or cyanosis can indicate neurovascular compromise Palpate ● Assess for tenderness, swelling, or unexpected bone alignment Neurovascular Assessment ● ● ● ● ● ● The temperature of the skin should be assessed at the injury site and distal to it Compare the findings on the same area on the opposite extremity; should be consistent Cooler temperature distal to the site can indicate neurovascular compromise Assess sensation at and distal to the site of injury Palpate th epulse distal to the injury; should be the same on the opposite extremity Assess capillary refill of the nail beds and compare to the other extremity ROM ● ● ● ● Ask the client to move joints distal to the injured area Support the area around the injury to avoid increased pain or injury Note hesitation, inability to move distal areas, or increased discomfort with movement Avoid ROM of the actual area of injury Additional Nursing Actions ● Protect: Apply a sling or immobilize the injured area ● Rest: Encourage limited use of the injured area ● Intermittent cold therapy: First 24-72 hours, no more than 20 minutes at a time ○ Minimizes swelling and bleeding into tissues ○ Promotes comfort (not directly on skin) ● Compress: Helps limit edema, provides support, and eases discomfort ● Elevate: Position the injured area above hearat level; limits edema Health Promotion Ergonomics ● Focus on reducing stress and eliminating injuries related to muscle overuse, repetitive movcements, and poor posture or lifting techniques ● Proper techniques while working at a desk include correct chair height, wrist support, eye level monitors, and good posture ● Proper techniques for lifting include weight assessment, getting needed help, maintaining spinal alignment, bending at the knees, and using the large muscles of the thigh Injury Prevention ● ● ● ● ● ● ● Use safety belts when riding or driving in a car Wear a helmet and protective gear when riding motorcycles or bicycles Avoid texting and driving Remove any hazards that can cause falls Wear a helmet and protective gear when participating in activities that could cause a fall Take periods of rest during and between activities requiring repetitive motions Follow proper bodoy mechanics (ex. Lifting with the legs, not the back) Exercise ● ● ● ● ● ● Improves muscle strength, reduces bone loss, and promotes joint ROM Ask about regular exercise type, frequency, and duration Warming up should be done beforehand (stretching and low-intensity aerobics) Should include a combination of activities that focus on different muscles Plan for a cool down period afterward (stretching or low impact activities) Wear supportive shoes and drink plenty of water Calcium and Vitamin D Calcium ● ● ● ● Builds and maintains bone mass; inform the client of foods high in calcium Helps prevent osteoporosis (low bone mass) Intake 1,000-1,200 mg daily Foods include broccoli, legumes, and milk Vitamin D ● Assists with calcium absorption in the GI tract; inform the client of foods ● Intake 600-800 IU daily ● Synthesis triggered by sunlight