1. UNIVERSITY OF EASTERN AFRICA, BARATON
SCHOOL OF HEALTH SCIENCES
DEPARTMENT OF NURSING
HEALTH ASSESSMENT
ASSIGNMENT DONE IN PARTIAL FULLFILMENT OF THE
COURSE; HEALTH ASSESMENT
COURSE CODE; NRSG 212
INSTRUCTOR: MD AKURU EDNA
NAME: AMOS KIPROTICH MELI
ID NO: SAMOME2111
DATE DUE .11TH October , 2021
2. Anatomy Review
The skeleton is made up of 206 bones. Most of them are connected by joints, which allow mobility.
Nonsynovial joints unite bones by fibrous tissue or cartilage. They may be immovable sutures in the
skull, or only slightly movable, like the vertebrae. Synovial joints are freely movable they separate bones
from each other and are enclosed in a joint cavity filled with a lubricant called synovial fluid. In these
joints cartilage covers the surface of the opposing bones, the joint is surrounded by a fibrous capsule,
and is supported by ligament, and a bursa is an enclosed sac filled with synovial fluid found in potential
friction areas, such as the knees and shoulders. Skeletal muscles contract to produce a wide range of
movement.
Musculoskeletal Exam
Order of assessment
You inspect the joint and noting joint size and contours and skin color and characteristics. Palpate each
joint, including its temperature muscles, bony articulations and joint capsule. Test Range of motion to
detect any limitation. Test muscle strength by applying an opposing force as the person performs range
of motion.
Temporomandibular joint
Have the person seated, examine the temporomandibular joints, and inspect the area anterior to the
ear. Place your fingertips in front of each ear, and ask the patient to open and close his mouth then to
open his mouth maximally. Normally the space between the upper and lower incisors, is three to six
centimeters then ask him to open his mouth, partially, and move his lower jaw from side to side.
Normally, he can move in one to two centimeters. Also ask him to stick out his lower jaw. It should
protrude without deviation. With the person clenching his teeth, Palpate the temporalis and masseter
muscles, compare the right and left sides, which should be the same size, firmness and strength. Ask
the person to move this jaw forward, and laterally against your resistance which he should be able to
overcome.
Cervical spine
Inspect the patients head and neck alignment, the cervical spine should be straight, and the head erect
.an older adults neck may show an increased concave curvature and a backward head to compensate for
spinal kyphosis. Palpate the spine as processes, sternomastoid, trapezius and paravertebral muscles,
they should feel firm and non-tender. Check range of motion by asking the person to move his head in
different directions. You should see flexion of 45 degrees extension of 55 degrees lateral bending over
40 degrees from the right and left and rotation of 70 degrees to the right hand left. Each movement,
pretty smooth and controlled. Test muscle strength by applying resistance as the person repeats these
motions. He should be able to resist your hand pressure equally in all directions.
Shoulders
Inspect the shoulders, posteriorly and anteriorly, checking the joint size and contour and the shoulders
bony landmarks. There should be no redness atrophy deformity asymmetry, or swelling. Next, palpate
both shoulders, starting at the clavicle. Explore the acromial clavicular joint subacromial bursa greater
3. tubercle of the humerus. Now test shoulder range of motion, by asking the patient to perform six
movements cup your hands over his shoulders to detect which should not be present during range of
motion testing, you should see forward flexion of 180 degrees hyperextension up to 50 degrees. Internal
rotation of 90 degrees Abduction at 180 degrees. Adduction of 50 degrees. External rotation of 90
degrees then test the strength of the shoulder muscles by having the person shrug against your
resistance, which he should be able to overcome.
Elbows
Inspect the elbows in the extended and flexed position, particularly noting the olecranon versa and
olecranon process, you should see no deformities redness or swelling with the person's elbow relaxed
and flexed about 70 degrees. Use your thumb and finger to palpate the olecranon process and the
medial and lateral epicondyles of the humerus, normal tissues and fat pads should feel fairly solid. They
should have no synovial thickening swelling nodules or tenderness. Also palpate the olecranon Bursa,
which normally is not hot, swollen or nodular. Test Range of motion. By having the person perform
elbow movements, you should see flexion of 160 degree extension at zero degrees. Pronation of 90
degrees and supination of 90 degrees. To test muscle strength, stabilize the person's arm with one hand.
Then having flexes elbow against your resistance also asking to extend his elbow against your resistance.
The patient should be able to overcome.
Wrists and Hands
Inspect the wrists and hands which normally the wrists are in slight extension, the fingers lie in the same
axis as the forearm, and no swelling, redness, deformities or nodules are present. The skin should look
smooth with knuckle, wrinkles and full muscle. Note the thinner eminence should be around mound on
the palm next to the thumb. Support the patient hand with your fingers. Relax and straighten his wrist,
and palpate firmly from side to side with both thumbs. Normally the joint surfaces feel smooth with no
swelling bagginess nodules or tenderness. Palpate the metatarsophalangeal joint with your thumb just
distal to and on either side of the knuckles. Using your thumb and index finger in a pinching motion
Palpate the sides of the inter phalangeal joint normally no synovial thickening and tenderness, or
nodules are present, next test range of motion sign asking the person to perform wrist and hand
movements. You should see a wrist extension of 70 degrees. Wrist flexion of 90 degrees. Finger
hyperextension of 30 degrees at the metacarpal phalangeal joint finger flexion of 90 degrees. Ulnar
deviation of 55 degrees, radial deviation of 20 degrees and finger abduction of 20 degrees also ask the
person to make a tight fist, and then touch the thumb to each fingertip and for the base of the little
finger. The response to be equal bilateral. For muscle strength test, stabilize the person supine ask him
to flex his wrist against your resistance at the point. Next, perform Phalen’s test, have the person hold
both hands back to back, flexing his wrists 90 degrees. When held for 60 seconds, this position should
cause no numbness or burning.
Hips
Palpate the hip points while he is supine, they should feel stable and symmetrical with no tenderness
and assess range of motion by having the person perform certain movements. You should see hip
flexion of 90 degrees with a straightening, hip flection of 120 degrees with a flexed knee, internal
rotation of 40 degrees, external rotation of 45 degrees, and abduction of 40 to 45 degrees and
adduction of 20 to 30 degrees.
4. Knees
Inspect the patient skin which should be smooth, even color and free of lesions. Assess lower leg
alignment which should extend in the same axis as the thigh. Observe the knee shape and contour you
should see concavities on each side of the patella no fullness or swelling. Check the quadriceps muscles
for atrophy, which should not be present with the quadriceps relaxed, palpate the knee, starting about
10 centimeters above the patella. Use the thumb and fingers palpate down towards the knee exploiting
super patellar pouch, the muscles and soft tissues should feel solid, and the joints should feel smooth
with no warmth, tenderness, thickening or nodularity.
If you notice swelling test for the Bulge sign. Firmly stroke up on the medial aspect of the knee, two or
three times, then tap the lateral aspect. Watch the hollow in the medial side for a bulge from the fluid
wave. Normally none is present. . Now continue by palpating the tibial femoral, which should have
smooth margins and no pain. Also palpate the infrapatellar fat part and the patella. To test muscle
strength, have the person rise from a squat or a chair He should be able to rise without using his hands
for support. Them with the person seated ask him to maintain knee flexion, while you try to pull his leg
forward.
Ankles and Feet
Inspect the patient ankles and feet in a non-weight bearing position, compare both feet, noting the
position of feet and toes also Joint contours characteristics. The feet should align with the long axis of
the lower legs. Most feet have a longitudinal arch, the toes should point straightforward and lie flat, and
the ankles should be smooth bony prominences with even colored skin. You should see no lesions
calluses or reversal reactions
To palpate the grasp the heel with your fingers and palpate with your thumbs. The joint spaces should
feel smooth and depressed, with no fullness swelling or tenderness. Palpate the metatarsal phalangeal
joints between your thumb on the dorsum and fingers on the plantar surface also palpate the inter
phalangeal joints on the medial and lateral sides of the toes Using your thumb and forefinger.
Test ankle range of motion by having a person performing various movements. You should see plantar
flexion of 45 degrees, dorsiflexion of 20 degrees eversion of 20 degrees and inversion of 30 degrees also
ask the person to flex and straighten his toes, which the patient should be able to do.
To assess muscle strength Apply resistance as the person Dorsa flexes, and then plantar flexes his foot.
He should be able to overcome your resistance.
Spine
With the patient standing inspect the spine as well as the hips by imagine a line of his head down
through the spine as processes and gluteal clap. The shoulders scapula iliac crests and gluteal folds
should be symmetrical and equal horizontally. The buttocks should be equal in size. The spaces between
the arms and the lateral thorax should also be equal the knees and feet should be aligned with the trunk
and point forward. Note the thoracic curve, which should be convex and lumbar which should be
concave, in pregnant women, watch for lordosis anterior cervical flexion kyphosis and Slumped
Shoulders in postmenopausal women, especially white women be alert for a rounded thoracic curve and
decreased height, which suggest osteoporosis. Palpate the spinous processes, which normally are
5. straight and nontender also palpate the paravertebral muscles, they should feel firm with no
tenderness. Check spinal range of motion, by having the person bend forward and touch his toes. Look
for flexion of 75 to 90 degrees. Smooth symmetrical movement and a C shaped curve of the spine. In an
adolescent girl screen for scoliosis by observing from behind as she plans to touch her toes. Normally
the spine is straight and bending forward and standing. Also the ribs scapula and iliac crest should be
symmetrical and equal in height. Continue to assess range of motion by having the person performs final
movement. You should see lateral bending of 35 degrees to the right and left and left, expansion of 30
degree, rotation of 30 degrees to the right and left and leg hyperextension of degree.
Review of findings after examining the musculoskeletal system. Discuss your findings with the person,
answer his question, and teach him how to promote health and perform self-care using the results you
obtained.
