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
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
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
During the interview and
physical assessment, the patient may re-port pain, tenderness, tightness, and
abnormal sensations. The nurse assesses and documents this information.
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
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
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
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
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.
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
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
Does elevating the affected part or modifying its
position affect the symptoms?