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Chapter: Medical Surgical Nursing: Assessment of Musculoskeletal Function

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Assessment of Musculoskeletal Function: Health History

The nursing assessment of the patient with musculoskeletal dysfunction includes an evaluation of the effects of the musculo-skeletal problem on the patient.

Assessment

HEALTH HISTORY

 

The nursing assessment of the patient with musculoskeletal dys-function includes an evaluation of the effects of the musculo-skeletal problem on the patient. The nurse is concerned with assisting patients who have musculoskeletal problems to maintain their general health, accomplish their activities of daily living, and manage their treatment programs. The nurse ensures systemic homeostasis, encourages optimal nutrition, and prevents problems related to immobility. Through an individualized plan of nursing care, the nurse helps the patient achieve maximum health.

Initial Interview

 

In the initial interview, the nurse obtains a general impression of the patient’s health status, gathering subjective data from the pa-tient concerning the onset of the problem and how it has been managed, as well as the patient’s perceptions and expectations re-lated to health. Concurrent health conditions (eg, diabetes, heart disease, chronic obstructive pulmonary disease, infection, preex-isting disability) and related problems, such as familial or genetic abnormalities, also need to be considered when developing the plan of care. A history of medication use and response to pain medication aids in designing medication management regimens.

 

The nurse notes allergies and describes them in terms of the reactions they produce in the patient. The nurse also assesses the patient’s use of tobacco, alcohol, and other drugs to evaluate how these agents may affect patient care. Information concerning the patient’s learning ability, economic status, and current occupa-tion is needed for rehabilitation and discharge planning. Addi-tions to the initial interview data are made as the nurse interacts with the patient. Such data assist the nurse to adjust the individ-ualized plan of care as needed.

Assessment Data

During the interview and physical assessment, the patient may re-port pain, tenderness, tightness, and abnormal sensations. The nurse assesses and documents this information.

PAIN

 

Most patients with diseases and traumatic conditions or disorders of muscles, bones, and joints experience pain. Bone pain is charac-teristically described as a dull, deep ache that is “boring” in nature, whereas muscular pain is described as soreness or aching and is re-ferred to as “muscle cramps.” 

Fracture pain is sharp and piercing and is relieved by immobilization. Sharp pain may also result from bone infection with muscle spasm or pressure on a sensory nerve.

Rest relieves most musculoskeletal pain. Pain that increases with activity may indicate joint sprain or muscle strain, whereas steadily increasing pain points to the progression of an infectious process (osteomyelitis), a malignant tumor, or neurovascular com-plications. Radiating pain occurs in conditions in which pressure is exerted on a nerve root. Pain is variable, and its assessment and nursing management must be individualized.

Questions that the nurse can ask regarding pain include the following:

 

How does the patient describe the pain?

Is the pain localized?

Does the pain radiate? If so, in which direction and to which body parts?

Is there pain in any other part of the body?

How intense is the pain on a scale of 0 to 10 (with 10 being the worst possible pain)?

What is the character of the pain (sharp, dull, boring, shoot-ing, throbbing, cramping)?

Is it constant? Is it increasing or decreasing in intensity?

What relieves it?

What makes it worse?

What was the patient doing before the pain occurred?

What was the manner of onset?

Is the body in proper alignment?

Is there pressure from traction, bed linens, a cast, or other appliances?

Is there tension on the skin at a pin site?

Does the patient experience increased discomfort when overly tired from lack of sleep, exciting stimuli, or too much activity?

 

It is important that the patient’s pain and discomfort be man-aged successfully. Not only is pain exhausting, but, if prolonged, it can force the patient to become increasingly preoccupied and dependent.

 

ALTERED SENSATIONS

 

Sensory disturbances are frequently associated with musculoskele-tal problems. The patient may describe paresthesias, which are burning, tingling sensations or numbness. These sensations may be caused by pressure on nerves or by circulatory impairment. Soft tissue swelling or direct trauma to these structures can im-pair their function. The nurse assesses the neurovascular status of the involved musculoskeletal area.

 

Questions that the nurse can ask regarding altered sensations include the following:

 

Is the patient experiencing any abnormal sensations or numb-ness?

When did this begin? Is it getting worse?

Does the patient also have pain?

Can the patient move the affected part?

What is the color of the part distal to the affected area? Is it pale? Dusky?Cyanotic?

Does rapid capillary refill occur? (The nurse can gently squeeze a nail until it blanches, then release thepressure. The amount of time for the color under the nail to return to normal is noted. Color normally returns within 3 seconds. The return of color is evidence of capillary refill.)

Is a pulse palpable distal to the affected area?

Is edema present?

Is any constrictive device or clothing causing nerve or vascu-lar compression?

Does elevating the affected part or modifying its position affect the symptoms?

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