COLLEGE OF ST.

JOHN - ROXAS Member: Association of

LASSAI- Accredited Superschools (ALAS) Atila Balgos St.

Banica, Roxas City

NCM 116

Care Of The Clients With Problems In Nutrition, And Gastro-internal,

Metabolism  And Endocrine, Perception And Coordination, Acute And Chronic

CASE STUDY IN ASSESSMENT OF MUSCULOSKELETAL FUNCTION/

MUSCULOSKELETAL MODALITIES

Crisha Ann Bacuta BSN-3

College of St. John – Roxas

10/29/21
 COLLEGE OF ST. JOHN - ROXAS  Member: Association of
LASSAI- Accredited Superschools (ALAS)  Atila Balgos St. Banica,
Roxas City 

NCM 116 
Care of Clients With Problems in Nutrition, and Gastro-internal, Metabolism and 
Endocrine, Perception and Coordination, Acute and Chronic 

CASE STUDY 

Assessment of Musculoskeletal Function 

1. The nurse in the outpatient orthopedic clinic is reviewing the medical records of  several
patients being seen in the clinic today. In the most recent note by the  primary provider,
the nurse reads the following: 

“67-year-old, moderately obese woman examined today for increasing back and  left
shoulder pain. Limited circumduction of left arm noted in comparison with  right arm.
Strength of left arm is less than right, with less muscle definition in the  left arm.
Examination of back indicates significant kyphosis, and the patient  states that she is
‘shrinking.’ Bone density testing of the hip is ordered.”  

a. How does the nurse interpret “limited circumduction”? 

The patient is unable to move the arm at the shoulder joint in a circular manor through
360 degrees of range of motion. The patient is unable to fully move the arm in a circle
around the shoulder.Thus the nurse interpret limited circumduction.

b. When the patient arrives, the nurse correlates the “kyphosis” with what  physical
finding? What causes kyphosis in the older adult? 

When the patient arrives, the nurse correlates the “kyphosis” with the  physical
finding of osteoarthritis. Kyphosis is causes by decreased intervertebral disc
 height as we age and loss of bone density as well as poor posture/muscle weakness
and injuries to the spine over time

c. How should the nurse explain the patient’s decreasing height? 

Loss of height is normal process of aging, intervertebral discs contain water and nutrients
and as we age combined with the prolonged effect of gravity along with lifestyle/injuries
the discs become dehydrated and start to compress

d. What is the rationale for prescribing bone density testing of the hip in this  patient?

e. Bone densitometry is used

to evaluate bone mineral
density, estimate
f. the extent of osteoporosis,
and monitor a patient's
response to
g. treatment for osteoporosis.
Hip bone mineral density
(BMD) testing is
h. considered the most
accurate test for osteoporosis
and for predicting
i. risk of hip fractures. For
this reason, evidence-based
guidelines
j. recommend hip BMD as
first-line test for osteoporosis
Bone densitometry is used to evaluate bone mineral density, estimate the extent of
osteoporosis, and monitor a patient's response to treatment for osteoporosis. Hip bone
mineral density (BMD) testing is considered the most accurate test for osteoporosis and for
predicting risk of hip fractures. For this reason, evidence-based guidelines recommend hip
BMD as first-line test for osteoporosis
COLLEGE OF ST. JOHN - ROXAS  Member: Association of LASSAI- Accredited Superschools
(ALAS)  Atila Balgos St. Banica, Roxas City 

Musculoskeletal Care Modalities 

1. June Frankel, a 23-year-old patient, presents to the emergency department with a  sports-
related fracture injury to her right arm and receives a long-arm fiberglass  cast.  

a. What nursing assessment should the nurse provide after the cast has been  applied?

The nursing assessment after the cast application:

1. skin around the cast edges should be observed for damage on swelling.

2. Hot spot areas of the cast that fed warmer than other section may indicates tissue
necrosis or infection under the cast.
 3. Wet spot may indicate drainage under the cast.

4. Assess for 5 P’s: Pain, pallor, paresthesis, paralysis, pulselessness.

5. Thorough cleaning of the skin.

6. Presence of unremovable particle or dust should be reported to the physician.

7. Cast should be uncovered and exposed to the air to dry.

8. Cast takes 24 to 72 hours to dry completely.

9. Assess circulation, movement and sensitivity.

10. Assess color, warmth, circulation and movement.

b. What nursing interventions should the nurse provide?

The nursing intervention that should provide of the nurse to the patient are the following:

1. Assist in cast application.

2. Teach about cast care.

3. Keep casted extremities elevated above the head level.

4. Check the peripheral pulse in the casted extremities.

5. Observe for drainage and bleeding.

6. Monitor for increase pain and paresthesia.

7. Assess cast edges for irritation.

8. Monitor neurovascular status continuously.

9. Provide range of motion exercise to the patient.

10. Prevent from complications which usually occur due to immobility.