Unit 3 - Musculoskeletal, Neuro, HEENT Flashcards
(18 cards)
Subjective questions for musculoskeletal assessment:
- Ask about a personal/family history of injuries to joints, muscles, and bones; chronic conditions (muscular dystrophy, osteoporosis, autoimmune disorders, etc.); or musculoskeletal related procedures (repairs and replacements).
- Ask about personal history of pain or injuries. OLDCARTS.
- Ask about Personal history of changes in strength or ROM.
Objective assessment for musculoskeletal:
- Inspect gait, spinal alignment, and posture.
- Inspect/test ROM of upper & lower extremities and neck. Include hips (lift leg up and out - standing or sitting depending on patient’s abilities).
- Ask if there are any areas of pain or injury, and if there are, you will inspect those areas for swelling, color, deformity and palpate for warmth, tenderness, or crepitus.
Decorticate vs decerebrate posturing
Decorticate - The patient is rigid and everything is flexed towards the body with clenched fists pulled towards the chest
Decerebrate - The patient is rigid and everything is flexed outward/extended (this one is worse)
Subjective questions for neurologic assessment:
- Ask about personal/family history of neurological diagnoses or procedures (stroke, seizures, Parkinson’s, light sensitivity, etc.)
- Ask about personal history of neurologic injuries (concussions, TBI, stroke, etc.). Ask MOI for every injury, and use OLDCARTS if there is current pain.
- Ask about numbness (cannot feel), tingling, or loss of sensation (can barely feel). Make sure to differentiate between these ones. If yes, OLDCARTS.
- Ask about change in strength, weakness, or change in ROM.
- Ask about changes in hearing, smell, taste, or vision. **Can ask about dizziness or light-headedness here too.
Objective assessment for neurologic:
- Inspect for ticks, fasciculations, tremors and check the facial symmetry by asking them to smile for you.
- Test: strength & grips bilaterally for upper and lower extremities, by asking them to Pull towards you and push away from you (arms) or push down/up for legs.
- Test: sensory system.
How to assess: Have the patient close their eyes and use the reflex hammer sides to test if they can differentiate between dull and sharp on their hands and feet. Also test the patellar reflex. (Back or front side of the hammer doesn’t matter).
-Note: if you do not get a reflex on the patellar reflex, have the patients interlock their hands and that somehow increases their patellar reflex. - Normally you would test for LOC (Name + place + time year/date/day/month + the reason they’re there), but we won’t have that on our check-off.
Priority assessments for CVA (stroke):
Priority is to assess BEFAST and call for help. Also assess (find out) their last known well and report that to the provider.
Priority assessments for Meningitis:
Assess the client’s mobility because balance/coordination issues can indicate worsening of the condition.
Priority assessments for Parkinson’s:
Assess their gait and fall risk. Is it worse than the last time / how fast is it progressing & should we update their fall risk category? How can I keep them safe?
Cranial Nerves
Mnemonics: On old Olympus’ towering tops a Finn and German viewed some hops
- O - olfactory (sensory - smell; nose)
- O - optic (sensory - vision; eyes)
- O - oculomotor (motor - upward eye movement; eyebrows)
- T - trochlear (motor - inward eye movement; in between the eyes)
- T - trigeminal (sensory & motor functions - sensations from the face -> brain; all over the face)
- A - abducens (motor - lateral eye movements; outsides of the eyes).
- F - facial (sensory - lacrimal & salivary glands; on both sides of the face).
- A - acoustic (sensory - hearing & balance; on both ears).
- G - glossopharyngeal (sensory - taste on the inside of the tongue).
- V - vagus (sensory & motor functions - swallowing, talking, and carry sensations from every internal organ -> brain; inside of the mouth).
- S - spinal accessory (motor - moves neck muscles; along the arms).
- H - hypoglossal (motor - moves the tongue; the outside of the tongue).
Expected vs abnormal findings on musculoskeletal or neurological assessments:
Expected: A&O x 4. Patient is balanced and able to walk on their own with a steady gait. Their posture is erect, and they have full ROM in all extremities. They demonstrate There are no discolorations, masses, atrophies, deformities, or injuries. They have full sensations, reflexes, and can differentiate between sharp & dull. 2+ on deep tendon reflex scale, unless they have a different baseline.
Abnormal: Deformities such as kyphosis, lordosis, or scoliosis or any dislocations. Injuries such as torn ACLs, replaced hips/knees, concussions, TBIs. Diminished or absent reflexes or sensory loss. Unsteady gait. Any of the BEFAST signs of a stroke.
BEFAST Stroke Signs
B - balance
E - eyes (blurred vision or vision loss; abnormal pupil reacitivity)
F - face (drooping)
A - arms (shifting to one side or the other, or weakness in them)
S - speech (any type of aphasia)
T - time to call for help! (Rapid response team in a hospital, or 911 if out in the wild)
T/F: You treat a stroke more seriously than Bell’s Palsy
False. You would treat both as an emergency because a stroke can be mistaken for Bell’s Palsy.
Subjective questions for HEENT:
- Personal or family h/o eye related diagnosis or procedures
- Personal or family h/o ear, nose, throat related diagnosis or procedures. (tinnitus, ear infections, tonsil removals, last hearing test, hearing aids, etc.)
- Personal or family h/o dental related diagnosis or procedures (braces, dentures, etc.).
- Ask about audio/visual deficits. Do you wear glasses or contacts? Do you sleep in them? Difficulty reading or seeing at distances? Sudden or gradual vision loss? Any blind spots, floaters, halos, rings, night vision, double vision, etc.
- Ask about swallowing difficulties.
Objective assessment for HEENT:
- Assess skin (hair and nails - mainly inspection, but you can also feel around the scalp and separate the hair from scalp). For kids: look for lice.
- Assess PERRLA bilaterally.
- Assess ears, nose, mouth, and throat with an otoscope. Use a tongue depressor.
- Perform a whisper test / DOORWAY test in a hospital.
- Palpate temporomandibular joint.
- Palpate sinuses/lymph nodes/thyroid. Watch the thyroid to make sure it moves up and down when they swallow too.
- Assess swallowing ability / tracheal alignment.
- Perform a Romberg test.
How to perform a whisper test
“I’m gonna tell you something, and you’ll repeat it back to me.” And you’ll stand behind them and whisper something and make sure they can repeat it clearly. Choose a 2 syllable word.
How to perform a Romberg test
Have the patient close their eyes and assess if they can stand straight up and still (be ready to catch them!).
What’s important to note on the skin?
Lines, drains, or tubes.
Expected vs abnormal findings for HEENT:
Hair, skin, nails:
Expected: Hair - Even distribution, loss/unusual growth. Nails adhere to the nail bed and are pink and non-tender. Abnormal findings: brittle, dry, or oily hair. Lesions or tenderness. Alopecia (hair loss) vs alopecia areata (bald spots), folliculitis (look like zits), hirsutism (hair growing where it shouldn’t, like the bearded lady), dermatitis (cradle cap in babies), tinea capitis (ringworm), tinea versicolor (fungal infection).
Eyes/head:
Expected: Pupils = equal, round, reactive to light, and accommodate. Symmetrical eyelids. No protruding or sinking. The eyes close evenly. No drainage or tenderness. Abnormal: Swelling. Inability to close one or both eyes. Asymmetrical or drooping of one of the lids. Protrusions or sinking. Discolorations or integrity issues (redness, jaundice, lesions, drainage, inflammation). Exudate or foreign bodies. Asymmetry of eyebrows. Pupils are not equal.
Palpate temporomandibular joint.
Expected: No clicking, grating, or popping. No edema. Skin is smooth and clear. No involuntary movements. Abnormal: any of those things I just mentioned + modules/lumps.
Neck/throat:
Expected: The thyroid moves up and down. Patient can swallow. No crepitus under the skin. Tracheal is aligned.
Abnormal: enlarged, asymmetrical, firm, goiter, tenderness, nodules/lumps, gland does not move when they swallow. You can auscultate it for a bruit (with the bell of the stethoscope). Crepitus under the skin!! Deviated trachea.
Ears, nose, mouth, throat:
Expected: pink, smooth, moist membranes. Ears are bilaterally equal in size, shape, and position. Expected septum alignment. Intact, present, white teeth. No lesions/ulcers. No inflammation, odor or exudate. Tonsils 1+ with no lesions or swelling and pink/moist. Gag reflex is present. Odorless ears. Abnormal: pain/soreness, injuries, swelling/lumps (especially on thyroid), xerostomia (dry mouth), bleeding, thrush, abscesses or cavities in the mouth, missing teeth, inconsistent skin color, asymmetry/deviated septum, occlusions in the nostrils, canker/cold sores, deviated or swollen uvula, unusual odor, red/pale/blue color of lips/throat/mucosa/palates. Tonsillitis (2-3+), lesions. No deformities, discharge, lesions, nodules, cysts, or swelling/bulging in the ears. Odors in the ear.
