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NSG 200 VCCS Physical Examination Skills Check List Musculoskeletal System Paper

NSG 200

Virginia Community College System

NSG

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Physical Examination Skills Check List: Musculoskeletal System

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The following is a Physical Examination Skills Check List intended to guide your independent skills practice on Musculoskeletal System Assessment. Do not start the practice, until after you have read the assigned textbook chapter and completed the Module 9 activities, including watching the Evolve Skills Videos. Here you are asked to practice the examination techniques outlined below on a partner at home*. You should expect to practice the skills multiple times, in order to attain adequate level of proficiency and successfully complete the attestation at the end of the semester. Once you have become proficient with the skills, you must document your findings by filling out the sections below. Do not copy and paste phrases from the textbook. Rather, use your own words to address each of the categories. Once completed, save the file as follows: LastName_FirstName_Musculoskeletal_NSG_200. Submit the completed document onto your Canvas Laboratory (not didactic) course shell titled NV280.NSG.200.0L1H.SP20, under the Musculoskeletal System Lab Assignments module by 11:59 pm on Tuesday, March 24th. Grading is Pass/Fail, whereby Pass equates to 85%. Completion of this assignment is mandatory.

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NSG 200 LAB CONCEPT REVIEW: MOBILITY Instructions: For each body part listed below, document the following 1) Describe the type of joint for each of the following, 2) Demonstrate the type of motion to be tested, 3) Using lay terminology, write down your patient instructions to secure their cooperation with performing the ROM. Come prepared to discuss your findings at the group concept review session. Body part Neck & Cervical spine Type of Joint Example: Pivotal Shoulder Glenohumeral Elbow Hinge Wrist Fingers Rev. 3/2020 Synovial Interphalangeal Type of Movement Flexion: bring chin to rest on chest Extension: return head to erect position Lateral flexion: tilt head as far as possible toward each shoulder Rotation: Turn head as far as possible to right and left Flexion-180 degrees Abduction-180 degree frontal plane Adduction- 60 degree Extension -45-50 degree Patient Instructions Look at your belly button Look at my eyes Bring your chin to your shoulder; now do the same with the other shoulder Turn your head to the side Flexion-involves compression of soft tissues round the elbow joint. Extension –it is the backward movement of hands and fingers. Move your hand up and down Flexion-involves moving the palm towards the front of forearm Extension-involves moving the back of a hand towards the back of forearm. Adduction- involves moving pinky side of hand towards outer side of the forearm Abduction-moving thumb side of the hand towards the inner side of forearm. move the palm towards the front of forearm Flexion-involves movement of the base of the Move the base finger towards the palm Rise your hand from top to the hip Move your hand from the trunk Move your hand from the right to the left side Bring your hand from top to middle Move your hand front to back move the back of a hand towards the back of forearm. move pinky side of hand towards outer side of the forearm move thumb side of the hand towards the inner side of forearm NSG 200 LAB CONCEPT REVIEW: MOBILITY Body part Type of Joint Type of Movement finger towards the palm Extension-this is the movement of the base of finger away from the palm Adduction-it involves the fingers towards the middle finger Flexion- moving the last finger segments towards the base of the fingers Extension- it involves movements of finger segments away from the base of the finger. Patient Instructions Move base finger away from palm Move fingers towards middle finger Move finger segments towards the base of the fingers Move finger segments away from the base of the finger. Thumb Carpometacarpal • Abduction- Moving the bone below the thumb towards the palm of the hand. • Extension- Moving the bone below the thumb away from the hand. • Adduction- Moving the bone below the thumb towards the back of the wrist. • Abduction- Moving the bone below the thumb towards the front of the wrist. • Opposition-Moving the thumb across the palm of• the hand touching the other fingers. Move the bone below the thumb towards the palm of the hand. Move the bone below the thumb away from the hand Move the bone below the thumb towards the back of the wrist Move the bone below the thumb towards the front of the wrist. Move the thumb across the palm of the hand touching the other fingers. Hip Synovial Flexion and extension -Soft tissue apposition of thigh & abdomen, tension in post. hip joint capsule & glut max Abduction and adduction- Tension in ishiofemoral - & pubo-femoral ligaments. Raise leg 30-120 degrees External and lateral rotation- Tension in ishiofemoral ligaments Raise leg 0-45 degrees Extension-produced by quadriceps femoris Flexion – produced by popliteus and gracilis swing the leg in the air while sitting in a chair sitting position from a standing position Knee Rev. 3/2020 Synovial Raise leg from 0-45 degrees NSG 200 LAB CONCEPT REVIEW: MOBILITY Body part Type of Joint Type of Movement Patient Instructions Ankle Synovial Dorsiflexion- upward movement of the foot towards the anterior leg Plantarflexion-downward movement of the foot Inversion- medial (inward) movement of the foot at the subtalar joint Eversion- lateral (outward) movement of the foot at the subtalar joint Move upwards foot towards the anterior leg Straighten your leg Turn foot sole outward Move foot down Move foot inward Move foot outward Foot synovial Extension-increase angle of joint Eversion-turning sole of the foot Toes Interphalangeal Flexion -Movement that decreases the angle at a Lower your leg joint Raise your leg Extension- Movement that increases the angle at a joint Rev. 3/2020 ...
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Student Name: ______________________________

Date: ________

Physical Examination Skills Check List: Musculoskeletal System.
Essential Skills
1. Review appropriate medical history, allergies, contraindications, pain
2. Perform hand hygiene before and after client interactions, before putting on gloves, and after gloves are removed
3. Knock prior to entering client space and introduce self to client (name and NVCC student nurse)
4. Provide client privacy
5. Explain the procedure/purpose to the client using language they will understand
6. Verify client’s identity using 2 identifiers (ask them to state name and assess MR# or DOB)
7. Assist client into the proper position for assessment/procedure
8. Complete assessment as indicated
Examination Techniques
Rationale
Patient
Expected Findings
Unexpected
Instructions/Technique
Findings
Used
To disinfect the hands
Introduce the patient and
No health history of
Perform hand hygiene
before conducting the
Ask patient about
joint disease or
assessment.
musculoskeletal
health
arthritis.
Introduce Self
history, allergies, and pain in
No problems with
Patient Verification
To introduce the examiner joints and muscle.
joints and muscle
and review patients
pain.
Allergies
medical history.

Inspect skeleton and
extremities for alignment and
symmetry
Inspect muscles for
symmetry and size

To evaluate the patients
daily functioning levels.
To determine posture and
alignment
To determine the
musculature symmetry.
To determine the
temperature, pain and

Ask the patient to stand erect;
observe from post-ant-lateral
view

Shoulders have even
contour, scapulae and
iliac crest are level

Ask the patient to perform a
movements (ROM) actively
and with passive help.

Muscles have
symmetry and have
equal sizes

Palpate bones for pain,
temperature, and edema; and
muscles for pain,
temperature, edema, and
tone.
Observe the ROM (ROM) for
major joints and adjacent
muscles, for pain on
movement, joint stability, and
deformity

edema in the bone and
muscle.
To examine presence of
deformity, joint stability,
and pain on muscle
movement.
To test the muscles
movement and bilaterally
strength. Evaluate the
nature of resistance.

Test muscle strength and
compare sides
Observe gait for conformity,
symmetry, and rhythm

To observe the gait and
symmetry when in motion.

Head and neck

To check for facial
symmetry with and
without expression.

Inspect musculature of the
face and neck for symmetry

To examine the joint
tenderness, clicking

The patient should to move
and flex the muscle under
evaluation while you apply an
opposite force to muscle
movement.

The muscle and
bones are firm and
not tender. No
temperature
abnormalities. No
pain during palpation
of bones and muscles.
Skin tone is even
without noticeable
variations.

The ROM is full for
each joint. No pain
on passive and active
movement, deformity
and crepitus.
Ask the patient to walk four
The patient has gait
steps forward towards and
conformity.
away from you; observe the
The patient strides
sway and movement
with a consistent
smooth rhythm with
symmetry of steps
and arm swing.
The patient has
smooth, swaying
movements.
Ask patient to close mouth,
The patient has a
smile and open mouth; check symmetrical face
the symmetry of the face in all with or without facial
actions.
expression. The
Ask the patient to move his
patient’s neck
jaw side by side; notice any
muscles are
clicking sounds.
symmetrical.

Palpate each
temporomandibular joint for
movement, pain, and sounds
Observe jaw for ROM
Open and close
Side to side
Protrude and retract
Palpate the neck for tone
Observe the neck for ROM
Flexion and Hyperextension
La...

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New York University

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