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Nursing Assessment-History and Physical assessment - Musculoskelatal System/ Disorders , Diagnostic Tests
This document provides information on diagnostic tests and nursing interventions for musculoskeletal function assessment. It discusses tests such as arthrocentesis, arthroscopy, bone density tests, bone scans, CT scans, EMGs, MRIs, x-rays, and biopsies. For each test, it describes the purpose and relevant nursing interventions such as dressing care, activity restrictions, dietary restrictions, and monitoring for complications. It also discusses subjective and objective assessments including categories like history, symptoms, and physical exams of muscles, nerves, and vascular structures.
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Nursing Assessment-History and Physical assessment - Musculoskelatal System/ Disorders , Diagnostic Tests
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- 2. Diagnostic Tests Test Purpose Nursing Interventions Arthroc entesis Obtain synovial fluidfrom a joint for diagnosis or to remove excess fluid. After the procedure, apply a compression dressing and tell the patient to report any bleeding and leakage of fluid.
- 3. Diagnostic Tests Test Purpose Nursing Interventions Arthrosc opy Usedto perform surgery and diagnose diseases of the patella, meniscus, and synovial and extrasynovial membranes. Fluid may be drained from the joint and tissue removed for biopsy. If general anesthesia is used, tell the patient not to eat or drink fluids after midnight prior to the procedure. Following the procedure, assess for bleeding and swelling, apply ice to the area if prescribed, and instruct patient to avoid excessive use of the joint for 2 to 3 days.
- 4. Diagnostic Tests Test Purpose Bonedensity (BD) Dual energy x-ray absorptiome try (DEXA) Quantitative ultrasound (QUS) Bone mineral density (BMD) Bone absorptiometry Evaluate bone mineral density and to evaluate degree of osteoporosis. DEXA can calculate the size and thickness of bone. Normal Value: 1 standard deviation below peak bone mass. Nursing Interventions Instruct patient to remove all metal objects from the area to be scanned.
- 5. Diagnostic Tests Test Purpose Bonescan (Nuclear medicine scans) Uptake is increased in osteomyelitis, osteoporosis, cancers of the bone, and in some fractures. Uptake is decreased in avascular necrosis. Nursing Interventions No special preparation is needed; tell patient to increase oral fluids after the test to aid in excretion of the radioisotope.
- 6. Diagnostic Tests Test Purpose Computed tomography (CT)scan— long bones and joints, spine Provides a three dimensional picture used to evaluate musculoskeletal trauma and bony abnormalities. CT of the spine can identify tumors, cysts, vascular malformations, and herniated intervertebral disk. Nursing Interventions If contrast dye is used, assess for allergy to iodine, seafood, or x-ray dye. Assess medications: oral hypoglycemic agents are contraindicated for use with iodinated contrast. Have spine x-rays available. If scheduling myelogram and spine CT, patient should have myelogram first.
- 7. Diagnostic Tests Test Purpose Nursing Interventions Computed tomography (CT)scan— long bones and joints, spine If long-bone and joint CT, nuclear medicine tests to locate “hot spots” should be done before CT. After the test, if contrast dye was used, monitor for delayed allergic reaction (rash, itching, headache, vomiting) and instruct patient to increase fluid intake.
- 8. Diagnostic Tests Test Purpose NursingInterventions Electromyog ram (EMG) Measures the electrical activity of skeletal muscles at rest and during contractio n. Tell the patient not to drink fluids containing caffeine or to smoke for 3 hours before the test, and not to take medications such as muscle relaxants, anticholinergics, or cholinergics. If serum enzymes such as SGOT, CPK, or LDH are ordered, the specimen should be drawn before the EMG or 5 to 10 days after the EMG.
- 9. Diagnostic Tests Test Purpose NursingInterventions Magnetic resonance imaging (MRI) Used in diagnosis and evaluation of avascular necrosis, osteomyelitis, tumors, disk abnormalities, and tears in ligament or cartilage. Inform patient of need to lie still during the examination. Assess for any metallic implants (such as pacemakers, clips on brain aneurysms, body piercings, tattoos, shrapnel). If present, notify imaging physician. Remove transdermal medication patches (both OTC and prescribed) unless otherwise ordered (FDA,
- 10. Diagnostic Tests Test Purpose NursingInterventions Magnetic resonance imaging (MRI) Replace the patch following the procedure. Tell the patient to inform the staff about the patch when making the appointment and when completing the admission information. Ask if patient is pregnant; if so the test is not performed. Ask about claustrophobia; if a problem request patient to ask for a relaxing medication to take prior to the MRI.
- 11. Diagnostic Tests Test Purpose NursingInterventions Skeletal x- ray Identify and evaluate bone density and structure. Ask women if they are pregnant; x-rays should be avoided during the first trimester. No special preparation is needed for skeletal x-rays.
- 12. Diagnostic Tests Test Purpose Bone or Muscle Biopsy Involves needle aspiration (closed) or surgical extraction (open) of bone or muscle tissue. Nursing Interventions Monitor site of biopsy for bleeding. Provide normal wound care for open biopsy. Perform neurovascular assessments as needed.
- 13. Subjective Health Assessment CategoryWhat to Ask Rationale Demographi cs Age, gender, socioeconomic status Increased age, being female, and lower socioeconomic status increase risk of musculoskeletal injury/problems. Occupation Enables nurse to begin planning for discharge teaching if the patient has to alter his or her employment.
- 14. Subjective Health Assessment Category Whatto Ask Rationale Previous Health History Allergies Activities patient participates in Prevents exposure to medication or compounds used in diagnostic tests, treatments, and therapies. Provides information regarding level of activity the patient had before the concern. Smoking and a sedentary lifestyle are risk factors for musculoskeletal problems.
- 15. Subjective Health Assessment Category Whatto Ask Rationale Previous Health History Diet history Dietary intake such as calcium and vitamin D influences some musculoskeletal disorders. Family history Some musculoskeletal conditions have genetic and familial tendencies.
- 16. Subjective Health Assessment CategoryWhat to Ask Rationale History of Injury or Present Concern one) History of the Provides information that helps in the injury (if there was diagnosis of the problem, as well as making you aware of possible complications of the injury. Pain (use pain assessment scale) Provides information about severity of the condition and effectiveness of the treatment and therapy.
- 17. Subjective Health Assessment CategoryWhat to Ask Rationale Psychosocial Assessment Determine if deformities, changes in body image, self- concept, socialization, or employment are present. The patient may need assistance with strategies to cope with the stress of a possible chronic musculoskeletal condition. Determine coping skills. Some musculoskeletal conditions require lifestyle alterations that can cause increased stress and difficulties in coping.
- 18. Objective Health Assessment Category Physical Examination Whatto Ask Inspect, palpate, and observe range of motion (ROM) of affected areas. and posture, effects on ADLs can be contractures, Assess color, warmth, circulation, and movement of affected areas. Nerve function, sensation, movement, weakness, and the potential development of compartment syndrome can be determined. Palpate all pulses below involved area. Alterations may indicate altered vascular integrity of affected area or demonstrate developing compartment syndrome. Altered gait, tone, size, shape, Rationale deformities, ROM, pain, determined.
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- 20. Muscle Grading Scale Scale AssessmentDescription 0 (No visible) contraction; paralysis 1 Can feel contraction of muscle but there is no movement of limb 2 Passive ROM 3 Full ROM against gravity 4 5 Full ROM against some resistance Full ROM against full resistance
- 25. Neurovascular Assessment Monitor Report Color Pallor,cyanosis, redness, or discoloration Temperature Unusual coolness or warmth Pain Pain that is worse on passive motion; pain that no longer responds to analgesics Movement Alterations in movement Sensation Alterations in feeling; tingling or paresthesias Pulses Diminished or absent distal pulses Capillary refill Nail bed that does not blanch in 3–5 seconds