Musculoskeletal
System
Assessment
Christine Dunn MSN, RN
Musculoskeletal System
What Is It?
 Consists of muscle, bone, tendons,ligaments
cartilage, and joints
 Primary function: mobility
 Bone tissue helps regulate blood calcium levels
 Rapid muscular contraction generates internal
heat
 Produces RBC’s and hemoglobin
Skeletal Muscles
 Move by the actions of muscles on bones
 Tendons attach skeletal muscles across joints,
allowing muscle contraction to move the bones
across the joint. Ligaments- bone to bone.
 Muscles generally work in pairs to produce
movement
 When one muscle flexes (or contracts) the other
relaxes, a process known as antagonism.
Changes Related to Aging
 Loss of bone mass- women especially
 Decreased physical activity
 Hormonal changes
 Gait is slower, smaller steps
 Coordination not always as good- stiff, ROM
decreases.
 Risk for falls increases
 Effects of medications
 Immobilization increases functional loss
 Loss of muscle mass/ ACTIVITY increase
needed and exercises; weight train.
Effects of Immobility
Systemic
Metabolic
Respiratory
Cardiovascular
Musculoskeletal
Gastrointestinal
Urinary
Integumentary
Psychosocial
Musculoskeletal Effects
 Loss of strength
 About 12% a week
 Ultimate: atrophy (shortening of muscles)
 First muscles affected are lower extremities as tone is
maintained by resisting gravity
 Takes about four weeks to recover
 Muscle wasting results in imbalance between protein
synthesis and breakdown
 Nitrogen in urine
 The more breakdown exceed synthesis, the greater the atrophy
 Final result of disuse is contracture of the muscles – this
can be permanent
 Foot drop
Psychosocial Impact of
Immobility
 Threatens person’s values of self-worth
achieved through work and hobbies
 Can lead to depression
 Limits interactions with friends and family
 Creates a dependency on others
 Alters sleep patterns
 Can result in functional decline in the older
adult
Assessment: Overview
 Gait
 Posture
 Palpation of
 Joints
 Muscles
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Range of motion
Strength
Symmetry
Activity tolerance
Assessment: Subjective
Medical history
Neuromuscular diseases
Arthritis
Connective tissue disease
Lupus
Gout
Pain/limited mobility – often the reason
to seek care
Diagnostic Test
Look at your text and discuss.
Possible Nursing Diagnoses
 Risk for Falls
 Impaired Physical Mobility
 Impaired Home Maintenance
 Risk for Disuse Syndrome
 Sedentary Lifestyle
 Self-Care Deficit
 Impaired Transfer Ability
 Impaired Walking
 Impaired Wheelchair Mobility
NCLEX Questions
 A nurse is
 A. a 25 year old
conducting health
woman who jogs
screening for
 B. a 36 year old man
osteoporosis. Which who has asthma
of the following
 C. a 70 year old man who
clients is at greatest consumes excess alcohol
risk of developing
 D. a sedentary 65 year old
woman who smokes cig.
this disorder?
NCLEX Questions
 A nurse witnesses a client sustain a fall and suspects
that the right leg may be broken. The nurse takes
which priority action?
 A. Take a set of vital signs
 B. Call the radiology department
 C. Reassure the client that everything will be fine
 D. Immobilize the right leg before moving
NCLEX Questions
 A nurse is obtaining a health history from a client and
is assessing for risk factors associated with
osteoporosis. Which of the following assessment
findings is an unassociated risk factor?
 A. High-calcium diet
 B. Postmenopausal age
 C. Long-term use of corticosteroids
 D. Family history of osteoporosis