physical assessment part ii musculoskeletal, mental status, & neurological assessment
DESCRIPTION
Physical Assessment Part II Musculoskeletal, Mental Status, & Neurological Assessment. PHCL 326 Hadeel Alkofide April 2011. Musculoskeletal System. Musculoskeletal System. Its evaluated mainly by two methods : Inspection Palpation. Musculoskeletal System. Inspection. - PowerPoint PPT PresentationTRANSCRIPT
Physical Assessment Part IIMusculoskeletal, Mental Status, & Neurological
Assessment
PHCL 326Hadeel Alkofide
April 2011
Musculoskeletal System
Musculoskeletal System
Its evaluated mainly by two methods :
1. Inspection
2. Palpation
Inspection
Purpose: Assess function for ability to perform ADL’s
Inspect for symmetry, proportion, & muscular development
Observe gait, & ability to stand, sit, rise from sitting position, & grasp objects
Musculoskeletal System
ADLs: Activities of Daily Living
Routine activities such as getting dressed, cleaning the
teeth, combing or brushing the hair, bathing & feeding oneself
Gait:The way a person walks
Inspection
Inspect joints for symmetry, swelling, tenderness, & crepitation
Test muscle strength upper & lower extremities utilizing opposing force
Musculoskeletal System
Crepitation:Audible or palpable crackling
sound
Palpation
Palpate large & small joints Assess range of motion (ROM) Decreased ROM: Arthritis, fibrosis, tissue
inflammation, & fixed joints Increased ROM: Increased joint mobility &
joint instability
Musculoskeletal System
Palpation
Limitation in ROM are expressed in degrees
Palpate joints & surrounding area for tenderness
Assess for warmth, crepitation, & deformities
Musculoskeletal System
Neurological System
Neurological System
Mental status
Cranial nerve function
Sensory & motor function
Reflexes
Mental Status
PHYSICALAppearance Motor Activity
BehaviorEMOTIONAL
Attitude Mood & AffectCOGNITIVE
Orientation Attention & ConcentrationMemory Speech & Language
Thought (Form & Content) PerceptionInsight & Judgment Intelligence & Abstraction
Mental Status
Physical: 1. Appearance A summary of the physical presentation Dress, facial expression Posture, eye contact Hygiene & Grooming
“Disheveled”- ruffled appearance“Unkempt”- poor attention to grooming
Body habits, nourishment status General description of body type/ build, &
nutritional status
Mental Status
Physical: 2. Motor Activity Quality & the types of actions observed Reduction in the level of movement
(psychomotor retardation) Slowed movement (bradykinesia) Decreased movement (hypokinesia) Absence of movement (akinesia) Increases in the overall level of movement
(psychomotor agitation) Tremor
Mental Status
Physical: 3. Behavior Range & Frequency of Spontaneous Movements Psychomotor activity Abnormal movements Psychomotor refers to movements that appear
driven from within, by one’s internal emotions at the time
Psychomotor Agitation, vs. Psychomotor Retardation
Mental Status
Physical: 3. Behavior Abnormal Movements Automatisms- “automatic” involuntary
movements; form of seizure Ex. Lip-smacking, eye-blinking, staring
Mannerisms: goal-directed, complex behaviors carried out in an odd way or inappropriate context
Mental Status
Emotional: 1. Attitude Patients may be: Open, friendly, cooperative, willing, &
responsive Closed, guarded, hostile, suspicious & passive Describe responses to questions, expression,
posture, eye contact, tone of voice
Mental Status
Emotional: 2. Mood & Affect
Affect: an external expression of an emotional state is potentially observable
Mood: an internal emotional experience that influences perception of the world & behavioral responses
Mental Status
Emotional: 2. Mood & Affect
Mood Is the patient’s mood appropriate to situation? Sad, Angry, Depressed, Anxious Appropriate/Inappropriate
Mental Status
Emotional: 2. Mood & Affect
Mood Descriptors: euphoric, dysphoric, hostile, fearful,
anxious, or suspicious Stability of mood can also be noted, with the
alternation between extreme emotional states being referred to as emotional lability
Mental Status
Emotional: 2. Mood & Affect
Affect Range, intensity, & variability of affect can be
variously portrayed: Restricted (i.e., low intensity or range of
emotional expression) Flat (i.e., absence of emotional expression) Exaggerated (i.e., an overly strong emotional
reaction)
Mental Status
Cognitive Alertness Attention & Cooperation Orientation Speech & Vocabulary Memory Insight & Judgment Abstract Thinking Calculation Object Recognition Praxis
Mental Status
AlertnessLevel of Consciousness – LOC Alert: Awake, answers questions Lethargic: Sleeps when undisturbed, arouses to normal
voice, answers questions appropriately –may be “fuzzy”
Obtunded: Sleeps most of time. Loud shout or vigorous shake to arouse. Mumbles
Stupor/Semi-coma: Responds only to pain stimuli. Mumbles, moves restlessly. Withdraws to avoid pain/noxious stimuli
Coma: Un-responsive to any stimulus
Mental Status.. Cognitive
Attention & Cooperation Test attention by seeing if the patient can
remain focused on a simple task, such as spelling a short word forward & backward (W-O-R-L-D / D-L-R-O-W is a standard)
These tests of attention depend on language, memory, & some logic functions as well
Degree of cooperation should be noted, especially if it is abnormal, since this will influence many aspects of the exam
Mental Status.. Cognitive
Orientation Person, place, date/time, event Time is the first to go, person the last. Normal: Expressed as oriented x3 Disoriented? All parameters or 1 or 2? Does the patient re-orient? Is this a change from baseline?
Mental Status.. Cognitive
Speech & Vocabulary Have the patient repeat a specific phrase Note his speech during the whole exam process Clear, Slurred Minimal (mostly "yes" and "no" answers, little
volunteered information) Talkative
Rapid/Pressured (as in possible hypomania or mania)
Mental Status.. Cognitive
MemoryImmediate Say a list of single digit numbers & ask patient to
repeat themShort term Have the patient memorize 3 unrelated words &
ask him to repeat them laterLong-term memory Ask the patient about a known historical event
that happened in his life time
Mental Status.. Cognitive
Insight & Judgment Insight: a dimension that describes the extent
to which patients are aware that they have a problem
Refers to an awareness of the nature & extent of the problem, the effects of their problem on others, & how it is a departure from normal
A strong lack of insight can be an important indicator of unwillingness to accept treatment
Mental Status.. Cognitive
Insight & Judgment Judgment: The ability to make sound decisions
can be compromised for a number of reasons Ascertain if poor decisions are the result of
problems in the cognitive processes involved in the decision making process, motivational issues, or failures to execute a planned course of action
Mental Status.. Cognitive
Professionalism Six Tenets of Professionalism:
1. Altruism 2. Accountability3. Excellence4. Duty5. Honor and Integrity6. Respect for Others
Accountability is the acknowledgment and
assumption of responsibility for actions, products,
decisions, and policies
Neurological System
Mental status
Cranial nerve function
Sensory & motor function
Reflexes
Cranial Nerve Function There are 12 cranial nerves Please refer to table 4-9 page 93 for assistance
Neurological Assessment
Cranial Nerve FunctionI - OLFACTORY Don’t assess unless patient complains of loss of sense of
smell or patient has a head injury Don’t use a noxious stimulus Ask him to close eyes & identify familiar odor one nostril
at a time (Coffee, lemon)II - OPTIC Visual acuity Visual fields Fundoscopic exam ( eye exam)
Neurological Assessment
Cranial Nerve FunctionIII/IV/VI Oculomotor, Trochlear, Abducens Size, shape of pupils, pupillary response Eye movements 9 cardinal positionsV - Trigeminal Motor - jaw strength: ask patient to clench teeth Sense – ability to sense sharp, dull, hot cold,
over front half of the face
Neurological Assessment
Cranial Nerve FunctionVII - Facial Observe for facial asymmetry Observe facial movements when the patient
frowns, smiles, whistle, puffs out the cheeks & raises eyebrows
Test patient's ability to identify sweet, sour & salty tastes
VIII – Acoustic Test hearing
Neurological Assessment
Cranial Nerve FunctionIX/X - Glossopharyngeal, Vagus Assess quality of speech Assess gag reflexXI - Spinal Accessory Test ability to shrug shoulders & turn the chin from
side to side against resistanceXII - Hypoglossal Tongue strength (Stick out tongue) Note abnormalities, asymmetry, deviation or atrophy
Neurological Assessment
Cranial Nerve Function
Cranial Nerve Function Video
Neurological Assessment
Cranial Nerve Function
For further assistancePlease visit
http://neuroexam.med.utoronto.ca/
Neurological Assessment
Neurological System
Mental status
Cranial nerve function
Sensory & motor function
Reflexes
They will not be covered here