1. Musculoskeletal and Neurological Assessment

2. Objectives Define Gait, Stance, Posture Discuss assessment of joints and muscles Outline a Neuro Exam Identify reflexes Identify function of the cranial nerves

3. Musculoskeletal Assessment

4. Musculoskeletal System Bones, joints, and muscles Needed for Support, Movement, Protection, and production of red blood cells, and storage for essential minerals Fall Precaution Do No Harm!

5. Gait 1. The base is as wide as the shoulder width 2. Foot placement is accurate 3. Walk is smooth, even and well-balanced 4. Associated movements, such as arm swing, are present.

6. Gait Abnomalities Unusual and uncontrollable walking patterns, usually caused by disease or injury.  Propulsive  Scissors  Spastic  Steppage  Waddling

7. Stance Symmetrical Width Steady Assistive Devices

8. Posture Normal - Comfortably erect Look for straight lines across body parts Normal Aging

9. Lordosis - Increased Curvature of the Spine

10. Kyphosis is a curving of the spine that causes a bowing of the back, which leads to a hunchback or slouching posture.

11. Scoliosis – curvature of the spine away from middle or sideways

12. Examination of Joints Inspection Size and contour: redness, atrophy, deformity, swelling Palpation Crepitious, thickening, swelling, or tenderness

13. Range of Motion Full Mobility of each joint Deliberate, accurate, smooth, and coordinated No involuntary movement

14. Muscle Atrophy

15. Subluxation A partial or incomplete dislocation

16. Contractures A contracture is a fixed tightening of muscle, tendons, ligaments, or skin. Shortening of longest or strongest muscle. Prevents normal movement of the associated body part. Impaired ROM Skin becomes scarred and nonelastic which limits the range of movement of the affected area.

17. Neurological Assessment

18. General appearance, Personal Hygiene Appropriately dressed Well-Groomed Odor Eye contact Posture

19. Orientation Person Place Time Can a person be oriented and still be confused?

20. Level of Consciousness: response to environmental stimuli Awake, alert lethargic-stuporous-comatose-coma If not fully alert, may need increased stimulus Note any change in Level of Consciousness Variety of Questions One part or two part commands

21. Glascow Coma Scale Quantitative tool Eye opening, verbal response, motor response Fully alert score is 15 Coma is 7 or less

22. 12 Cranial Nerve Cranial NerveAssessment I olfactorySmell II opticVision III oculomotorEye movements, PERRLA, eyelids IV trochlear V trigeminalFacial sensations, corneal reflex VI abducensAssessed with III and VI VII facialTaste, smile, frown, close eyes tightly VIII acoustichearing IX glossopharnxgealGag reflex, swallowing, taste; X vagus XI spinal accessoryShrug shoulders, turn head against resistance XII hypoglossalStick out tongue, move tongue side to side

23. Motor Observation Muscle Tone Muscle Strength  Squeeze hands  Pronator Drift

24. Deep Tendon Reflex BicepsC5, C6 BrachioradialisC6 TricepsC7 PatellarL4  BabinskiAbnormal Reflex Toes Fan Achilles TendonS1 Rated from 0 to 5+

25. Rating Scale 0: absent reflex 1+: trace, or seen only with reinforcement 2+: normal 3+: brisk 4+: nonsustained clonus (i.e., repetitive vibratory movements) 5+: sustained clonus

26. Motor Abnormalities Spasticity Flaccidity Tremor

27. Coordination and Gait Point to Point Movements Romberg Gait

28. Reflexes Deep Tendon Reflexes Clonus Babinski

29. Sensory General Soft/Sharp Touch Discrimination

30. NCLEX Question A nurse is assessing the motor function of an unconscious client. The nurse would plan to use which of the following to test the client’s peripheral response to pain. A. Sternal rub B. Pressure on the Orbital rim C. Squeezing of the sternocleidomastoid muscle D. Nail bed pressure

31. NCLEX Question A client has an impairment of cranial nerve II. Specific to this impairment, the nurse would plan to do which of the following to ensure client safety? A. Provide a clear path for ambulation without obstacles B. Test the temperature of the shower water C. Speak Loudly to the client D. Check the temperature of the food on the dietary tray.