Physical assessment - musculoskeletal & abdomen Flashcards by Lauren Walker

What are the bone’s function?

Bones (206) 
 Support and protect organs and tissues 
 Provide leverage 
 Store minerals (calcium) 
 Contain bone marrow

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What are the joint’s structure and function?

 Junction of 2 or more bones
 Allow movement
 Synovial joint: ball & socket / hinge
 Non synovial joint: fibrous tissue or cartilage

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What are skeletal muscle’s structure and functions?

Skeletal Muscle (>600) 
Voluntary 
Muscle fibres 
Connective tissue 
Tendons  
Posture 
Body movement

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What are examples of range of motion?

 Abduction 
 Adduction 
 Circumduction 
 Flexion 
 Extension 
 Dorsi flexion 
 Plantar flexion 
 Rotation (internal/external) 
 Eversion 
 Inversion 
 Pronation 
 Supination

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What is past health history in muscoskeletal assessment?

– Medical: injuries, menopause, osteoporosis, HRT, scoliosis, lordosis, kyphosis
– Surgical: fractured bones, muscle damage, joint replacements
– Medications: calcium supplements

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What is family history in muscoskeletal assessment?

Rheumatoid arthritis, gout, osteoporosis

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What is Environmental and psychosocial history in muscoskeletal assessment?

– Diet: constant dieting, low calcium intake.
– Environment: occupation, posture at work/leisure, ADLs, sport
– Psychosocial: self-esteem, coping mechanisms, support system

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What equipment is used in musckoskeletal assessment?

 Maintain privacy & dignity
 Ensure room is quiet, warm and with good lighting
 Test equipment: pen torch, goniometer, tape measure

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What should you do before you start the examination?

 Overall appearance: height & weight
 Posture: erect & upright
 Gait: coordinated & rhythmic

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What should you palpate in muscokskeletal examination?

With each body area, palpate: 
 Muscle tone 
 Joints 
 Passive ROM 
 Muscle strength 
- Normal 
- Good 
- Fair 
- Poor 
- None

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Which major skeletal joints should you examine?

 TMJ 
 Cervical spine 
 Spine 
 Shoulders 
 Elbows 
 Wrists 
 Hands 
 Hips 
 Knees 
 Ankles 
 Feet

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What should you inspect for shoulders?

anterior & posterior

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What should you palpate for shoulders?

sternoclavicular joint to shoulders

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What ROM should you do for shoulders?

 Flex: raise arms forward 
 Extend: move behind body 
 Abduct/adduct: raise arm 
sideways/lower arm past midline 
 Internal/external rotation: flex elbow 
and rotate shoulder up (external) & down 
(internal) 
 Raise shoulders (shrug)

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What should you inspect for elbows?

flexed & extended

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What should you palpate for elbows?

olecranon & tissue

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What ROM should you do for elbows?

 Flex: bend elbow & move up
 Extend: straighten elbow
 Pronate: palm down
 Supinate: palms up

How would you test muscle strength for elbows?

 Stabilise elbow & grasp wrist
 Instruct to flex against opposite force
 Instruct to extend against opposite force

What should you inspect for wrists and hands?

wrists, palms & dorsum

What should you palpate for wrists and hands?

wrists, metacarpophalangeal & interphalangeal joints

What ROM should you do for wrists?

 Flex/extend: bend wrist down & up
 Hyperextend: move up
 Ulnar deviation: outward
 Radial deviation: inward

What ROM should you do for hands?

 Flex/extend: bend down & up
 Abduct/adduct: open/close fist
 Thumb: away & to base of little finger

What should you inspect for hips?

alignment & symmetry

What should you palpate for hips?

hip joints in supine position

What ROM should you do for hips?

```  Flex/extend: bend down & up  Abduct: away from midline  Adduct: toward midline  Internal rotation: move medially  External rotation: move laterally  Hyperextend: prone position ```

What should you inspect for knees?

position standing, contour sitting

What should you palpate for knees?

thigh down suprapatellar pouch; tibial margins, collateral ligaments

What should you inspect for ankles and toes?

alignment, shape, position

What should you palpate for ankles and toes?

heel, tendon, ankle, feet, toes

What is past health history for abdominal assessment?

– Medical: indigestion, cancer, allergies, constipation/diarrhea, ulcers, kidney disease – Surgical: gastric banding, cosmetics, bowel resections, stoma – Medications: anti- inflammatories, antibiotics

What is family history for abdominal assessment?

Cancer, IBS, polyps, kidney disease

What is Environmental and psychosocial history for abdominal assessment?

– Diet: food allergies, alcohol, smoking – Environment: occupation, travel hx – Psychosocial: self-esteem, coping mechanisms, support system, body image

What equipment do you need for abdominal examination?

 Maintain privacy & dignity  Ensure room is quiet, warm and with good lighting  Test equipment: stethoscope with diaphragm & bell, blanket, light & gloves

What do you inspect for abdominal examination?

``` Skin:  colour, scars, striae, venous pattern  lesions, integrity, masses Contour & symmetry:  Side of bed at level of abdomen  Foot of bed Abdominal movements:  Respiratory: smooth & even  Peristalsis: only if very thin  Pulsations: slight only – ALERT if vigorous Umbilicus:  Skin  Contour ```

How to auscultate bowel sounds?

```  Warm diaphragm, place lightly  Begin RLQ, proceed clock wise  Confirm bowel sounds in each quadrant  5-30 intermittent gurgles per minute  Note intensity, pitch and frequency ```

How to auscultate vascular sounds?

```  Warm bell, no pressure  Begin midline over aorta  Move side to side  Renal arteries  Iliac arteries  Femoral arteries  Listen for bruits - low-pitched murmur-like sound ```

How to percuss abdomen?

 Systematically percuss all quadrants for tone  Begin in RLQ  Generalised tympany over air in intestines and abdomen  Dullness over liver, spleen and distended bladder

How to percuss the bladder?

 Begin at the symphysis pubis  Percuss midline upwards to the umbilicus  Normal bladder is not percussable therefore tympany is heard  Dullness indicates bladder distention

How to palpate abdomen?

 All quadrants to identify areas of tenderness, masses and muscular resistance  Assess painful or tender area/s last  Use finger pads & apply light (1cm) pressure

How to palpate the liver?

 Stand on right side  Curl fingers of both hands over edge of right costal margin  Ask patient to take deep breath  Gently but firmly pull inwards and upwards  Palpate liver’s edge as it descends  Normal liver not palpable, unless very thin: firm, smooth & even