 Welcome to Nursing School Explained and this demonstration of the assessment of a focused musculoskeletal assessment. Keep in mind that when we do a focused assessment, we'll still follow all the steps in a heterotow fashion and always assess the most important parts of the patient that we do in every assessment. But in this particular case, we're going to focus on the musculoskeletal system of the patient's lower leg injury. So let's take a look at this here. Hi, how are you today? I'm all right. My name is Petra. I'll be your nurse today. We'll do an assessment focusing on your injury. Can you tell me your name please? Steve Jones. Okay. And what day is it today? Wednesday. Okay. And why are you here? I broke my ankle. All right. And where are you at right now? At the hospital. Okay. Excellent. So let's get started. I'll perform my hand hygiene here. And wear some gloves. First, I'm going to shine a bright light into your eyes. What I would like to do is for you to look straight at the tip of my nose here, bright light coming. Very nice. Other side. Okay. Good. Open your mouth. Say, ah. Okay. Good. Thank you. I'm going to take a listen to your hardened lungs now. So let me remove your gown or just lower it a little bit. And you can relax your arms there. Thank you. So first, I'll listen to the patient's heart by listening to the cardiac landmarks. Sorry. Here we go. And now I'll listen to your lungs. Every time I touch my stethoscope to your skin, will you take a nice deep breath in and out through your nose, please? A couple more here. And one more. Okay. So I start by the, at the very top of the patient's lungs in this triangle here between the top of the shoulder and the clavicle, the collar bone here because the lungs actually when he takes a deep breath are inflating all the way up here. So I want to make sure I don't miss anything. And then I work my way down comparing left to right all the way to the bottom of the lungs and then also to the mid axillary line. Now, I also need to take a listen to the patient's backside. In this case, he doesn't have any limitations in his back. So I can ask him if it's easier for him to sit up or to roll over to his side. So in this case, I'm actually going to ask you to sit up please. Thank you. So with the patient sitting up now, it's actually a nice opportunity to inspect the back to see if there are any injuries or wounds. In this case, it actually, the skin looks nice and clear. And so then I'll auscultate the lungs again, starting at the top actually on the very top of the back here and then working my way down, staying between the scapula and the spine so that I can hear the actual lungs and not listen over the bone which might make it a little bit more dull. And I'll do the same thing comparing left to right, working my way from the top to the bottom. So please again, every time I touch my stethoscope to your chest, take a nice deep breath in and out through the nose. Okay, very good. You can go ahead and relax back now. Thank you. Let's get you covered up here. Next, I'm going to check the patient's upper extremities. So let me see your hands here please. Squeeze my fingers as hard as you can, both sides. Make a nice fist. There you go. Thank you. And then pull me towards you. And let me see your hands and push away. Excellent. Good. And then I'll check his pulses and I always want to compare left to right, same as with those extremity strengths. They're nice and equal here. And then I'll check cabri fill on all of his fingers. Check in for circulation. And at the same time also, I'm taking a look at his skin to see if there are any injuries. There's a little abrasion right here. And this would also be a perfect opportunity to take a look at any IV side that the patient has in the inpatient setting. So now that we're complete with the upper extremities, we'll make our way down and assess the patient's abdomen, making sure that we keep him covered in protectors privacy. So now with the abdomen assessment, we always want to auscultate first. Actually, we want to inspect first for any scars, injuries, bruises, but that all looks nice. And so now when I listen to the abdomen, I listen for bowel sounds in all four quadrants. And it really doesn't matter where you start. Some schools that should you should listen to the right lower quadrant last, but I actually don't really have any preference here. And so the bowel sounds are nice and active. Next, I'm going to palpate light palpation. First, I like to use one hand for light palpation. Just let me know if that hurts at all. Any pain at all? So once the patient is not tended to light palpation, I can use both hands and use a little bit of deeper palpation here. Any pain? It's always good to take a look at the patient's face too, see if there's any grimacing or anything that would indicate that there's pain. And last, we're going to palpate over the bladder, assessing if it's distended. Okay. And then when was your last bowel movement? Okay, very good. So now we'll cover him back up and now we'll make our way down to the lower extremities. So now I'm going to assess the lower extremities. And it's very similar to the upper extremities in just in this case now we have an injury here that we need to focus on. So first, first of all, I'm going to take off your socks so I can assess distally. And in this injured extremity here, I'm going to assist making sure that I'm not causing him any pain. And first again, I'm going to inspect the lower extremities, notice any bruising, any swelling anywhere. And clearly he has this A-srap here for that lower extremity injury. And so I'm going to first focus on the non-injured extremity. Typically, just like we did in the upper extremities, I would want to compare left to right. In this case, I'm not going to make him push down on this foot because I noted his ankle here has an injury. So I want to be extra mindful of any injuries that I might encounter here. But what I can do is I can compare and check the cab refill on both toes, or both feet actually. And then in this case, can you push down here like on a gas pedal? Excellent. Pull your toes up to your nose, nice and strong. Okay. And then I'll check the pedal pulse here. Very nice. And then the posterior tibialis. Sometimes these are a little bit harder to find. And there it is. Okay. So I've assessed the right lower extremity first. The other thing that I want to do is I want to check for edema. And to check for edema, always make sure that you use a bony prominence. I typically like to use the shin. And you have to put a good amount of pressure here with two fingers against the skin. And then once you hold it for about five seconds, you run your fingers over it and you see if there's any indentation. And in this case, there's just a very mild indentation. So this would just be a trace of an edema, depending on how bad the edema is or how deep the indentation gets. That'll be the degree of the edema. And that's kind of to be expected because he's been in bed. Now for the injured extremity, I really don't want him to push and pull here because he has this ankle injury here. But I already did check the cab refill, which tells me the circulation status. So that would be the pulse. If I know that there's no open wound or injury right here, I can actually slide my fingers in there and find the pedipulse and assess it here. If I'm not sure if there's any injury or if there's any contraindications, I certainly don't want to do that. But then the other thing that I can do to assess the circulation is check the cab refill in all five toes like I just did. And then, so for muscular skeletal injuries, we always want to assess the five Ps, which is pain, pallor, pulse, paralysis, and peristasia. So I already checked for the pulse or the cab refill in this case. And then pallor, the sort of left foot compared to the right, they have the same color, so there's not pale. And then, can you wiggle your toes on both sides for me? Okay, excellent. Can you feel me touch you here? Yes. And here? Yeah. And here? Yeah. And here? Yeah. And here? Yeah. And here? Yeah. Good. Any numbness or tingling? No. So that would be the peristasia that I just checked with numbness and tingling and the sensation. I checked the paralysis by having him wiggle the toes and the pallor and the pain is the last thing that I need to check. So now the last P we need to assess is the pain assessment. Do you currently have pain in your left foot or ankle? Yes. Okay. And what caused the pain? I was in a soccer injury. Okay. Does it stay right there at the ankle? Does it radiate anywhere else? No, it's just at the ankle. Okay. And what does it feel like? It kind of drops. All right. And on a scale zero to 10, with 10 being the worst pain you ever had, how bad is it right now? I'm five to three. So that's not too bad. And then what typically makes it better? Okay. Excellent. And then in this case, I would check and see if the patient had any Tylenol last time he had that and make sure that I give it to him on a scheduled basis so that the pain doesn't get out of control. And of course, also ask him if he wants to take some Tylenol. Okay. So in this case, we have concluded the assessment. We'll put a socks back on, always taking care of our patient. Be an extra careful with that injured extremity. I'm going to lift your leg here. Does it feel okay? Like it's on, right? Okay. So then we'll cover our patient up and this concludes the focused assessment of the musculoskeletal system. Please also watch the other body systems assessments that I have in a head to toe fashion, but focusing on a different body part or reason that the patient is at the hospital so that you can always follow the steps in the head to toe fashion so that you never forget an important step. Thanks for watching Nursing School Explained. See you soon.