Question

A client complains of pain and swelling in the knee after a fall while playing basketball. The client shows decreased range of motion in the knee.

What areas should the nurse focus on when performing a physical examination for this client?

Answer 1

INTRODUCTION

Physical examination is nothing but head to foot examination used to assess the patients general conditions and it is the process of assessing anatomical impairement through the use of;

-INSPECTION

-PALAPATION

-PERCUSSION

-AUSCULTATION

MEANING

- It is the careful study of the body by the health care provider by using INSPECTION,PALAPATION,PERCUSSION AND AUSCULTATIONS

INSPECTION-

-First step of physical exaination

-it is the process of observing the body parts for discolouration,soft tissue swelling,bony enlargment,wasting,deformities etc

PALPATION

-It is the process of feeling with the fingers or hands,the health care provider touches and feels the ;

-SHAPE

-SIZE

-CONSISTANCY

-TEXTURE

-LOCATION

-TENDERNESS OF A BODY PARTS OR ORGANS

PERCUSSION

-It is the method of taping body parts with the fingers,hands,small instruments to assess the----

-THE LUNG SOUNDS

-THE ABDOMEN SOUNDS

-BONES ,JOINTS,SOLID ORGANS FOR ABNORMAL SOUND AND THE SIZE

-AUSCULTATIONS

It is the process of hearing to the sounds of the body by using stethescope,usually assessing the lung sounds,heart sounds and intestines to assess for;

-FREQUENCY

-INTENSITY

-DURATION

-NUMBER AND QUALITY

PHYSICAL EXAMINATION OF THE KNEES

-To perform an exmintion of the muscles,bones and jionts,the health care providers should using the three classical techniques such as INSPECTION,PALPATIONS AND MANIPULATIONS

-Before starting physical examination we have to take the full history about;

-PERSONAL HOSTORY

-PAST MEDICAL AND SURGICAL HISTORY

-PAST HEALTH HISTORY

-PRESENT HEALTH HISTORY

-PRESENT CHIEF COMPLAINTS

PRE PREPARATIONS OF THE PATIENTS

-explain the procedures

-complete history collection

-provide comfortable positions

-safety and privacy

-informed consent

-assess for the chief compliants such as -PAIN

SWELLING

STIFFNESS

DEFORMITIES

  LOCKING

LOSS OF FUNCTIONS

LUMB

MECHANICAL DISORDERS

POSITIONS USED FOR PHYSICAL EXAMINATIONS

-The knee ,the largest joint in the body and is composed of condylar joints (an ovoid articular surface)

-The thoruogh knowledge of specific anatomy of the knees are required

-The positions used for knee examination ;

-STANDING POSITIONS

-SITTING POSITIONS

-LYING SUPINE IN BED

-PRONE ON EXAMINATION TABLE

1-STANDING POSITIONS-

While standing positions we are going to asess the following things'

-alignment

-shortening

-baker'cyst(it is a fluid filled space)

-antalgic gait9movement abnormality)

- patellar rotation

-foot rotation

-the presence of scars

-wasting of the quadriceps muscles (consist of four muscles)

-swelling around the knees

-assess side for any flexion deformities

-look poplitial area for swelling,baker"s cyst,lymphadenopathy,popliteal artery aneurysms,soft tissue damage and wasting of muscles

SITTING POSITIONS

-Knee shoul be flexed at 90 degree to assess the positions of patella

-displacement of the patella high riding and low riding patella

-

SUPINE POSITIONS

-feel temperature

  -soft tissue and bony tenderness

-synovial thickening

-distal pulsation in dorsalis pedis artery and posterior tibila artery

-passive and active movement

-normal range of motion-extension,flexion,abduction,adduction,internal rotation,external rotation

-position and shape of patella

OTHER SPECIAL TESTS INCLUDES

-CROSS FLUCTUATION TESTS-detect grading of joint effusion

-PATELLAR TAP -testing for intra articular fluid

-BULGE TEST-testing very little fluid in the joints

-JUXTA PATELLAR HOLLOW TESTS-assess intra articular fluid

-ANTERIOR AND POSTERIOR DRAWER TEST-anterior and posterior movement laxicity

-LACHMAN TEST-to asess the knee stability

-SAG TEST- to assess posterior ligament

-MACINTOSH 'S PIVOTS SHIFT TESTS-to assess the stability

-VARUS VALGUS STRESS TEST IN FLEXION-assess the movement capability

-VARUS VALGUS STRESS TEST IN EXTENSION assess the movement capability

-APLEY'S GRINDING TESTS -assess muscle injury

-APLEY'S DISTRACTION TEST-assess movements of ligaments

-THESSALY TEST-assessing the muscle tearing

LOCALIZATION OF PAIN

Is depends on the location of the pain and the age of the patients

Location of the pain consists of---

-ANTERIOR

-MEDIAL

-LATERAL

-POSTERIOR

-NON-SPECIFIC

NURSING DIAGNOSIS

-Acute pain related to muscle injury

Activity intolerance relataed to extreme pain

-Sleep pattern disturbances related to pain

-Imapired range of motion doe to joint pain

-High risk for injuyr

-High risk for complications

-Body image disturbances

-