Objective datat is important to conduct a systematic examination of the patient from head to toe. Ensure this is done in privacy and in a comfortable environment. Begin with a general overview, consisting mainly of inspection, followed by a local assessment, including palpation and measurement of abnormalities.
Posture - observe for incorrect/abnormal posture including spine curvatures, ie, the presence of kyphosis, lordosis, scoliosis or torticollis, and observe flexion of the knee and clawing of toes and fingers.
Gait. Gait changes occur with age and become more obvious in the aged (over 65). Observe for normal gait in relation to the stance and rhythm. There may be a limp, as a result of pain, weak muscles or one limb shorter than the other. The patient may drag him/herself as is the case with those recovering from stroke, or shuffle in cases of neurological diseases, eg, Parkinson's disease. Limited joint movement may affect the gait.
Tumours . Soft tissue and bone tumours such as multiple myeloma, osteogenic sarcoma, osteoclasma, Ewings sarcoma
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Disorders of the musculoskeletal system often present with pain. Observations must always be in relation to pain, and the nurse should specifically look at:
Movement and signs of pain, for example, joint pain characterised by limping, poor posture, awkward gait, difficulty in arising or walking and facial expression such as wincing upon movement.
General appearance, for example, body build, alignment and symmetry, displacement or enlargement of bony structures or joints, lumps - it is also important to watch the patient's face for signs of distress when tender areas are examined.
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Activities of daily living. Observe whether the patient is able to perform activities for daily living unassisted, eg, bathing, feeding.
Weakness of muscles. Observe if the patient appears to be wobbling, needing support to walk.
Supportive devices. Note if any support is utilised, such as a walking stick or cane, brace or elastic bandage.
Swelling. The presence of swelling, especially in the dependent parts, such as the lower limbs or the sacral region or over the painful area.
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Activities of daily living. Observe whether the patient is able to perform activities for daily living unassisted, eg, bathing, feeding.
Weakness of muscles. Observe if the patient appears to be wobbling, needing support to walk.
Supportive devices. Note if any support is utilised, such as a walking stick or cane, brace or elastic bandage.