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Share this: Facebook Twitter Reddit LinkedIn WhatsApp The musculoskeletal and integumentary systems are the last two systems a nurse considers during their observation and assessment of a patient. It is important that nurses are able to accurately and comprehensively assess these systems, and this chapter introduces the fundamental knowledge and skills nurses require to do so. This chapter explores the fundamental anatomy and physiology of the musculoskeletal and integumentary systems. This chapter also explains the processes involved in collecting a general health history for the musculoskeletal and integumentary systems, and in performing a physical examination of these systems. This chapter also considers a number of special observation and assessment techniques which may be used in the physical examination of the musculoskeletal and integumentary systems, and it discusses performing differential diagnosis relevant to these systems.
By the end of this chapter, we would like you:
Important noteThis section of the chapter assumes a basic knowledge of human anatomy and physiology. If you feel you need to revise these concepts, you are encouraged to consult a quality nursing textbook.
Get Help With Your Nursing Essay If you need assistance with writing your essay, our professional nursing essay writing service is here to help! Find out moreMusculoskeletal SystemFundamental anatomy and physiology of the musculoskeletal systemThe musculoskeletal system provides the body with support, enables mobility and protects the internal organs. The musculoskeletal system is comprised of:
Joints are areas where two or more bones meet; they act to allow movement between these bones. Joints are classified in two ways: (1) by the type of material between them (e.g. synovial, cartilaginous, fibrous), and (2) by the type of movement they allow (e.g. immoveable - synarthrodial, slightly moveable - amphiarthrodial, freely moveable - diarthrodial). Diarthrodial joints are further classified by their type of movement (e.g. hinge joints, pivot joints, condyloid / ellipsoidal joints; ball-and-socket joints, gliding joints, etc.). The musculoskeletal system is supported by:
Other key structures in the musculoskeletal system are cartilage and bursae. Cartilage is a smooth, gel-like, avascular tissue that is highly flexible, and allows some degree of movement in the bones. Bursae are sacs in the connective tissue adjacent to some joints (e.g. the shoulders), which contain synovial fluid and act as a lubricant to reduce friction between bones, muscles and associated structures. Musculoskeletal system - focused health historyAs you have seen in previous chapters of this module, health observation and assessment involves three concurrent steps:
When assessing a patient's musculoskeletal system, the nurse must commence by collecting a health history. This involves collecting data about:
In some cases, a person will present with a specific problem related to their musculoskeletal system (e.g. pain, problems with movement and difficulties with activities of daily living [which may be generalised or specific], etc.). Remember, nurses assess a patient's symptoms using the strategy remembered by the 'OLD CARTS' mnemonic (introduced in a previous chapter of this module). Musculoskeletal systems - physical examinationOnce a health history of the musculoskeletal system has been obtained, as described in the previous section of this chapter, a nurse may commence a physical examination of the patient's musculoskeletal system. A stepwise process of physically examining the patient's musculoskeletal system, with normal (expected) and common abnormal findings, is presented in the following table:
Special assessment techniques for the musculoskeletal systemThere are a number of special assessment techniques particular to the musculoskeletal system:
Differential diagnosis in the musculoskeletal systemWhen assessing a patient's musculoskeletal system, there are a number of common problems and conditions a nurse may identify. Consider the conditions and their key clinical findings, outlined in the following table. This information can be useful in assisting a nurse to make a differential diagnosis of a condition affecting the musculoskeletal system:
Integumentary SystemFundamental anatomy and physiology of the integumentary systemThe integumentary system is comprised of the skin and accessory structures - the hair, the nails and the sweat and sebaceous glands. The skin is the main organ in the integumentary system. Its primary function is to protect the body from external pathogens, and to protect the internal structures from water loss and physical trauma. The skin also provides sensory input, regulates body temperature, produces vitamin D and excretes some substances (e.g. urea, lactic acid, etc.). It is comprised of three layers:
The integumentary system also includes a number of accessory structures:
Integumentary system - focused health historyAs always, when assessing a patient's integumentary system, the nurse must commence by collecting a health history. This involves collecting data about:
In some cases, a person will present with a specific problem related to their reproductive system (e.g. pruritus, rashes, pain / discomfort, lesions, wounds, changes in colour / texture of the skin / hair / nails, etc.). Remember, nurses assess a patient's symptoms using the strategy remembered by the 'OLD CARTS' mnemonic (introduced in a previous chapter of this module). Integumentary system - physical examinationOnce a health history of the integumentary system has been obtained, as described in the previous section of this chapter, a nurse may commence a physical examination of the patient's integumentary system. A stepwise process of physically examining the integumentary, with normal (expected) and common abnormal findings, is presented in the following table:
As described in the above table, when performing a physical examination of the integumentary system, it is important that nurses inspect the skin for colour. There are a number of abnormal findings associated with skin colour:
Also described in the above table, when performing a physical examination of the integumentary system, it is important that nurses inspect the skin for lesions. There are a number of abnormal findings associated with lesions:
Get Help With Your Nursing Essay If you need assistance with writing your essay, our professional nursing essay writing service is here to help! Find out moreSpecial assessment techniques for the integumentary systemThere is one special assessment technique particular to the integumentary system - assessing skin turgor. This is done by gently pinching the skin on the forearm or under the clavicle, lifting it away from the underlying tissues, and releasing it; the skin should move easily when lifted and should return to its original place immediately when released. Skin turgor may be poor if 'tenting' occurs (i.e. skin returns to its original place very slowly). Differential diagnosis in the integumentary systemWhen assessing a patient's integumentary system, there are a number of common problems and conditions a nurse may identify. Consider the conditions and their key clinical findings, outlined in the following table. This information can be useful in assisting a nurse to make a differential diagnosis of a condition affecting the integumentary system:
ConclusionThe musculoskeletal and integumentary systems are the last two systems a nurse considers during their observation and assessment of a patient. It is important that nurses are able to accurately and comprehensively assess these systems, and this chapter has introduced the fundamental knowledge and skills nurses require to do so. This chapter has explored the fundamental anatomy and physiology of the musculoskeletal and integumentary systems. This chapter has also explained the processes involved in collecting a general health history for the musculoskeletal and integumentary systems, and in performing a physical examination of these systems. This chapter also considered a number of special observation and assessment techniques which may be used in the physical examination of the musculoskeletal and integumentary systems, and it discussed performing differential diagnosis relevant to these systems. In completing this chapter, you have equipped yourself with the skills and knowledge necessary to comprehensively assess the musculoskeletal and integumentary systems.
Now we have reached the end of this chapter, you should be able:
'Hands-on scenario'Assessment of a pressure ulcerJack is a graduate nurse working in an acute ward in a large tertiary hospital. During one shift, he cares for a patient named Mary. Mary is a sixty-eight-year-old woman who has advanced metastatic cancer and is bedbound. Mary has recently developed a large pressure ulcer on her sacrum. Jack knows that pressure ulcers occur when there is unrelieved pressure on an area of the body, resulting in progressive tissue ischaemia and necrosis. Jack also knows that pressure ulcers are entirely preventable; however, when they do occur, they can be effectively managed. The first step in the management of Mary's pressure ulcer is to assess it.
You are encouraged to read the National Institute for Health and Clinical Excellence's (NICE) Pressure Ulcers: Prevention and Management (2014) guideline, or the current equivalent. This guideline can be obtained online, by searching for its title. Jack refers to the National Institute for Health and Clinical Excellence's (NICE) Pressure Ulcers: Prevention and Management (2014) guideline. This guideline states that pressure ulcers must be assessed in three different ways:
Jack refers to his organisation's wound care management team, and discovers that transparency tracing is the
standard measurement technique used to assess pressure ulcers.
While completing the wound tracing, Jack also estimates the depth of Mary's pressure ulcer at 6 millimetres (at the deepest point). He records this in Mary's notes. Jack assesses for areas of undermining, where the ulcer has tunnelled - or forms a tract - into the tissues beneath and around it; he does so by carefully exploring the edges of the wound with the end of a sterile probe to identify areas of weakness. No undermining is noted, and Jack again records this in Mary's notes.
You are encouraged to read the National Pressure Ulcer Advisory Panel's (NPUAP) Pressure Ulcer Stages / Categories (2009) document, or the current equivalent. This document can be accessed online, by searching for its title. Jack accesses the National Pressure Ulcer Advisory Panel's (NPUAP) Pressure Ulcer Stages / Categories (2009) document. He learns that pressure ulcers are staged as follows:
Based on the NPUAP guidelines, Jack classifies Mary's ulcer as a Stage II ulcer. Jack observes a partial thickness loss of the dermis. There is a shallow, open ulcer with a pink wound bed, and no slough. Jack records this in Mary's notes. Now that his assessment of the ulcer is complete, he can discuss the findings with Mary and her interdisciplinary care team, and plan for management of her ulcer. As well as assessing a pre-existing ulcer, as described in this hands-on scenario, nurses like Jack must be aware of the importance of carrying out a pressure ulcer risk assessment. The aim of a pressure ulcer risk assessment is: (1) to identify a patient at particular risk of developing a pressure ulcer, and (2) to enable strategies to be implemented to prevent the development of a pressure ulcer in that patient. Remember: all patients are potentially at risk of developing a pressure ulcer; however, some experience a greater risk than others. The National Institute for Health and Clinical Excellence's (NICE) Pressure Ulcers: Prevention and Management (2014) guideline suggests that people are at particular risk of the development of pressure ulcers if they:
Get Help With Your Nursing Essay If you need assistance with writing your essay, our professional nursing essay writing service is here to help! Find out moreWhen assessing the risk of a patient developing a pressure ulcer, nurses should "consider using a validated scale to support [their] clinical judgement" (National Institute for Health and Clinical Excellence, 2014: p. 13). There are two validated pressure ulcer risk assessment tools which may be used in clinical settings in the UK:
Reference listCox, C. (2009). Physical Assessment for Nurses (2nd edn.). West Sussex, UK: Blackwell Publishing, Ltd. Jensen, S. (2014). Nursing Health Assessment: A Best Practice Approach. London, UK: Wolters Kluwer Publishing. National Institute for Health and Clinical Excellence. (2014). Pressure Ulcers: Prevention and Management. Retrieved from: https://www.nice.org.uk/guidance/cg179/resources/pressure-ulcers-prevention-and-management-35109760631749 National Pressure Ulcer Advisory Panel (NPUAP). (2009). Pressure Ulcer Stages / Categories. Retrieved from: http://www.npuap.org/wp-content/uploads/2012/01/NPUAP-Pressure-Ulcer-Stages-Categories.pdf Wilson, S.F. & Giddens, J.F. (2005). Health Assessment for Nursing Practice (4th edn.). St Louis, MI: Mosby Elsevier. Share this: Facebook Twitter Reddit LinkedIn WhatsApp Cite This WorkTo export a reference to this article please select a referencing style below:
NursingAnswers.net. (November 2018). Assessment and Observation of the Musculoskeletal and Integumentary Systems. Retrieved from https://nursinganswers.net/lectures/nursing/health-observation/8-detailed.php?vref=1 Reference Copied to Clipboard. "Assessment and Observation of the Musculoskeletal and Integumentary Systems." NursingAnswers.net. 11 2018. Business Bliss Consultants FZE. 09 2022 <https://nursinganswers.net/lectures/nursing/health-observation/8-detailed.php?vref=1>. Reference Copied to Clipboard. "Assessment and Observation of the Musculoskeletal and Integumentary Systems." Business Bliss Consultants FZE. business-bliss.com, November 2018. Web. 17 September 2022. <https://nursinganswers.net/lectures/nursing/health-observation/8-detailed.php?vref=1>. Reference Copied to Clipboard. NursingAnswers.net. November 2018. Assessment and Observation of the Musculoskeletal and Integumentary Systems. [online]. Available from: https://nursinganswers.net/lectures/nursing/health-observation/8-detailed.php?vref=1 [Accessed 17 September 2022]. Reference Copied to Clipboard. NursingAnswers.net. Assessment and Observation of the Musculoskeletal and Integumentary Systems [Internet]. November 2018. [Accessed 17 September 2022]; Available from: https://nursinganswers.net/lectures/nursing/health-observation/8-detailed.php?vref=1. Reference Copied to Clipboard. <ref>{{cite web|last=Answers |first=All |url=https://nursinganswers.net/lectures/nursing/health-observation/8-detailed.php?vref=1 |title=Assessment and Observation of the Musculoskeletal and Integumentary Systems |publisher=Business Bliss Consultants FZE |date=November 2013 |accessdate=17 September 2022 |location=Fujairah, UAE}}</ref> Reference Copied to Clipboard. Business Bliss Consultants FZE, 'Assessment and Observation of the Musculoskeletal and Integumentary Systems' (NursingAnswers.net, September 2022) <https://nursinganswers.net/lectures/nursing/health-observation/8-detailed.php?vref=1> accessed 17 September 2022 Reference Copied to Clipboard. Content relating to: "observation" Assessing behaviour through observation can be vital in understanding the cause and the impact certain behaviours are having on an individual as well as those around them. In addition, observation can determine what behaviour is the issue if the issue has not been predetermined. Related Articles Nursing Lectures Related Services Other Lectures
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