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Objectives

• By the end of the unit, learners will be able to:
• Discuss the patient health history question necessary to perform the assessment of Peripheral Vascular System (PVS) and Musculoskeletal System (MS) system.
• Discuss critical observations to assess PVS.
• Assess musculoskeletal functions including muscles strength, symmetry, size, contour, ROM and its characteristics.
• Document findings.
• List the changes in the given systems that are characteristics of aging process.

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Discuss the patient health history question necessary to perform the assessment of Peripheral Vascular System (PVS) and Musculoskeletal System (MS) system.

Objective 01

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Questions for Peripheral Vascular System (PVS) Assessment:

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• To perform a comprehensive assessment of the peripheral vascular system, healthcare providers typically ask a series of patient health history questions.
• These questions help gather information about the patient's risk factors, symptoms, and overall vascular health.
• Here are the key patient health history questions necessary for assessing the peripheral vascular system

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• Presenting Complaints:
• Do you feel pain, heaviness, or swelling in your legs or arms?
• Do your legs hurt when you walk or exercise, and does the pain go away when you rest?
• Swelling:
• Do your legs, ankles, or feet swell?
• Is the swelling worse at the end of the day or better in the morning?
• Skin Changes:
• Have you noticed any changes in the color of your legs or feet (like pale, red, or dark skin)?
• Do you have sores or wounds on your legs or feet that take a long time to heal?
• Temperature Changes:
• Do your legs or arms feel unusually cold or hot?
• Does one leg or arm feel colder or warmer than the other?

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• Past Health Issues:
• Do you have diabetes, high blood pressure, or heart disease?
• Have you ever had blood clots (like deep vein thrombosis) or varicose veins?
• Family History:
• Does anyone in your family have problems with blood circulation, heart disease, or strokes?
• Lifestyle:
• Do you smoke or use tobacco?
• Are you physically active, or do you sit for long periods?

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Questions for Musculoskeletal System (MS) Assessment

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• Presenting Complaints:
• Do you feel pain or stiffness in your joints, muscles, or bones?
• Do you have trouble walking, standing, or doing daily activities?
• Swelling or Deformity:
• Do you notice swelling or changes in the shape of your joints?
• Is the swelling painful?
• Injury or Trauma:
• Have you ever had a fracture, dislocation, or serious injury?
• Do you still feel pain or have trouble moving after an injury?
• Range of Motion:
• Do you have trouble moving any joint (like bending your knee or elbow)?
• Do your joints feel stiff or hard to move?

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• Past Health Issues:
• Do you have arthritis, osteoporosis, or any autoimmune disease?
• Have you ever had surgery or physical therapy for your bones or joints?
• Family History:
• Does anyone in your family have arthritis, osteoporosis, or bone/joint problems?
• Lifestyle:
• Do you exercise regularly?
• Is your job physically demanding, or do you sit for long hours?

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Discuss critical observations to assess PVS

Objective 02

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• Critical observations during this examination can help identify potential issues, guide further diagnostic tests, and inform treatment decisions.
• Performing a physical examination of the peripheral vascular system is important for assessing a patient's vascular health.
• Here are the key critical observations to assess the peripheral vascular system

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Inspection

• Skin Color: Check for pallor, cyanosis or redness.
• Pallor may indicate poor blood flow.
• Cyanosis suggests low oxygen levels in the blood.
• Redness may indicate infection or inflammation.
• Skin Changes: Look for ulcers, sores, or gangrene.
• Non-healing ulcers are a sign of poor circulation.
• Hair Loss: Check for reduced hair growth on legs or feet, which may indicate reduced blood flow.
• Swelling (Edema): Observe for swelling in the legs, ankles, or feet.
• Unilateral swelling (one leg) may suggest deep vein thrombosis (DVT).
• Bilateral swelling (both legs) may indicate heart failure or venous insufficiency.

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Palpation

• Temperature: Feel the skin for temperature changes.
• Cold limbs may indicate arterial insufficiency.
• Warmth may suggest infection or inflammation.
• Pulses: Check pulses in the arms and legs.
• Weak or absent pulses may indicate arterial blockage.
• Capillary Refill: Press on the nail bed and observe how quickly color returns.
• Normal refill time is less than 2 seconds.
• Delayed refill suggests poor circulation.
• Tenderness: Palpate for tenderness, especially in the calves, which may indicate DVT.

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Auscultation

• Use a stethoscope to listen for abnormal sounds (bruits) over major arteries (e.g., carotid, femoral).
• Bruits suggest turbulent blood flow due to narrowing or blockage.

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• Ankle-Brachial Index (ABI): Compare blood pressure in the arms and legs to assess arterial blood flow.
• ABI < 0.9 indicates peripheral artery disease (PAD).

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• Allen's test is a simple medical procedure used to assess the arterial blood supply to the hand.
• The test ensures that both the radial and ulnar arteries are providing adequate blood flow to the hand, so that if one artery is compromised, the other can maintain circulation.

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Assess musculoskeletal functions including muscles strength, symmetry, size, contour, ROM and its characteristics

Objective 03

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• The assessment of the musculoskeletal system is essential to evaluate the health and functionality of bones, joints, muscles, ligaments, and tendons.
• This includes evaluating muscle strength, symmetry, size, contour, range of motion (ROM), and its characteristics.

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Muscle Strength Assessment

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• Muscle strength is assessed using Manual Muscle Testing (MMT). The patient is asked to perform specific movements, and resistance is applied to evaluate strength.
• Grading System (0-5 Scale):
• 0: No muscle contraction (complete paralysis).
• 1: Visible or palpable flicker of contraction, but no movement.
• 2: Movement possible, but not against gravity.
• 3: Movement possible against gravity, but not against resistance.
• 4: Movement possible against gravity and some resistance.
• 5: Normal strength (full movement against resistance).
• Example:
• To test shoulder muscle strength, ask the patient to raise their arm against gravity. If the patient can lift it and hold it against some resistance, the strength is graded as 4.

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Manual muscle testing

Symmetry Assessment

• Symmetry is evaluated by comparing both sides of the body (left and right). Asymmetry may indicate injury, swelling, or deformity.
• Example:
• If both shoulders appear equal in size and shape, symmetry is normal. If one shoulder appears raised or swollen compared to the other, this may indicate injury or inflammation.

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Shoulder asymmetry swelling

Size and Contour Assessment

• The size and contour of muscles and joints are assessed visually and through palpation. Look for swelling, atrophy (muscle wasting), or deformities.
• Example:
• If one thigh appears smaller or less developed than the other, this may indicate muscle atrophy due to nerve damage or disuse.

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Manual muscle testing

Range of Motion (ROM) Assessment

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• ROM stands for Range of Motion. It is a term used to describe the limit of movement in the joints of the body.
• ROM helps us understand how much a joint can move and in which direction.
• ROM is measured using a specific tool called a Goniometer. 
• It is commonly used in physiotherapy, fitness, and sports.

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ROM shoulder rotation

Characteristics of ROM (Range of Motion)

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• Flexibility:
• ROM measures the flexibility of a joint. If a joint has a greater ROM, it means the joint is more flexible and can move easily.
• Joint Health:
• ROM is an indicator of joint health. If a joint has limited ROM, it may suggest a problem such as injury, stiffness, or arthritis.
• Movement Directions:
• ROM is measured in different directions for each joint. For example:
• Flexion: Bending the joint (e.g., bending the elbow to bring the hand toward the shoulder).
• Extension: Straightening the joint (e.g., straightening the elbow).
• Rotation: Rotating the joint (e.g., rotating the shoulder).

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• Active vs Passive ROM:
• Active ROM: When you move the joint using your own muscles (e.g., lifting your arm yourself).
• Passive ROM: When someone else or a machine moves the joint for you (e.g., a physiotherapist lifting your arm).
• Individual Differences:
• ROM varies from person to person, depending on factors like age, fitness level, genetics, and lifestyle. For example, younger people tend to have a greater ROM, while older people may have a reduced ROM.

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Examples of ROM in Different Joints

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• Shoulder Joint:
• The shoulder has the greatest ROM. It can move forward, backward, upward, downward, and rotate.
• Knee Joint:
• The knee's ROM mainly involves flexion (bending) and extension (straightening). For example, bending the knee while sitting or straightening it while standing.
• Spine (Vertebral Column):
• The spine's ROM includes forward bending (flexion), backward bending (extension), and sideways bending (lateral flexion).

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Summary

• Assess Muscle Strength: Perform manual muscle testing.
• Inspect: Visually assess for symmetry, size, and contour.
• Palpate: Feel for swelling, tenderness, or deformities.
• Test ROM: Evaluate both active and passive range of motion.
• Note Characteristics: Observe for pain, stiffness, or crepitus during movement.

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Document findings

Objective 04

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• Document findings means accurately recording the results of a patient's assessment and physical examination in a clear, concise, and organized manner.
• Here are 4 (four) Step-by-Step Guide to Document Findings.

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• Step 1: Start with Patient Information Include:
• Patient's name, age, gender.
• Date and time of assessment.
• Your name and designation.
• Step 2: Document Subjective Data:
• Record what the patient tells you.
• Step 3: Document Objective Data
• Record what you observe, palpate, auscultate, or measure.
• Use a systematic approach (e.g., head-to-toe or system-wise).
• Step 4: Summarize Findings
• Provide a brief summary of your assessment.
• E.g. Peripheral Vascular System (PVS): Normal findings. No signs of arterial or venous insufficiency.

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Example Documentation of Peripheral Vascular System (PVS) Assessment

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Patient Information

• Name: Ali Khan
• Age: 45
• Gender: Male
• Date: 25/10/2023, 17:00
• Assessed By: Nurse Ayesha

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Subjective Data

• No pain, numbness, or tingling in extremities.
• denies history of swelling, ulcers, or varicose veins.
• No history of blood clots or vascular surgery.

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Objective Data

• Inspection:
• Skin color: Pink and even bilaterally.
• Swelling/Ulcers: None observed.
• Varicose veins: Absent.
• Hair distribution: Normal on lower extremities.
• Palpation:
• Skin temperature: Warm and equal bilaterally.
• Capillary refill: <2 seconds in all extremities.
• Peripheral pulses: Radial, brachial, femoral, popliteal, dorsalis pedis, posterior tibial – all 2+ bilaterally.
• Tenderness: None noted.
• Auscultation:
• Bruits: None auscultated over carotid, femoral, or abdominal arteries.

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Special Tests

• Allen's test: Normal capillary return in both hands.
• Ankle-Brachial Index (ABI): 1.0 bilaterally (within normal limits).

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Assessment

• Peripheral vascular system assessment is within normal limits. No signs of arterial or venous insufficiency noted.

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Example Documentation of Musculoskeletal System (MS) Assessment

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Patient Information

• Name: Mr. Khan
• Age: 40
• Gender: Male
• Date: 20/11/2023, 18:00
• Assessed By: Nurse Ayan

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Subjective Data

• No joint pain, stiffness, or swelling.
• No history of fractures, dislocations, or surgeries.
• No difficulty with mobility or activities of daily living (ADLs).

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Objective Data

• Inspection:
• Deformities: None observed.
• Swelling: Absent.
• Posture/Gait: Upright posture, steady gait.
• Skin changes: No redness or scars noted.
• Palpation:
• Tenderness: None noted in joints or muscles.
• Warmth/Swelling: Absent.
• Crepitus: None felt during movement.
• Muscle bulk/tone: Normal bilaterally.

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• Range of Motion (ROM):
• Active/Passive ROM: Full in all major joints (shoulders, elbows, wrists, hips, knees, ankles).
• Pain/Stiffness: None reported during movement.
• Muscle Strength:
• Grading: 5/5 in all extremities bilaterally.
• Resistance: Patient able to resist against full resistance without difficulty.

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Special Tests

• Tinel's sign: Negative bilaterally.

https://www.youtube.com/watch?v=U8cPjPeZgFw

• Phalen's test: Negative bilaterally.

https://www.youtube.com/watch?v=TMAD-dhT9PM

• Lachman test: Negative bilaterally.

https://www.youtube.com/watch?v=JFkbKNNa7xQ

• McMurray's test: Negative bilaterally.

https://www.youtube.com/watch?v=lwDFPAyGGgI

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Assessment

• Musculoskeletal system assessment is within normal limits. No signs of joint or muscle abnormalities noted. Patient demonstrates full strength and range of motion.

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List the changes in the given systems that are characteristics of aging process

Objective 05

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• As people grow older, their blood vessels (Vascular System) and bones, muscles, and joints (Musculoskeletal System) go through some natural changes.
• These changes are part of aging, but they can sometimes lead to health problems.
• Below is a simple explanation of these changes:

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Changes in the Vascular System (Blood Vessels)

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• Arteries Become Stiff:
• Blood vessels lose their flexibility and become harder.
• This can cause high blood pressure and make the heart work harder.
• Thicker Blood Vessel Walls:
• The walls of blood vessels become thicker, which makes them less flexible.
• Plaque Build-Up in Arteries:
• Fat and cholesterol can build up inside the blood vessels, making them narrower.
• This reduces blood flow and increases the risk of heart attack or stroke.

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• Less Blood Flow to Hands and Feet:
• Blood flow to the arms and legs decreases, which can make them feel cold and slow down wound healing.
• Varicose Veins:
• Veins, especially in the legs, can become swollen and twisted.
• This can cause pain, swelling, and discomfort.
• Dizziness When Standing Up:
• The body’s ability to control blood pressure decreases, which can cause dizziness when standing up quickly.

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Changes in the Musculoskeletal System (Bones, Muscles, and Joints)

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• Bones Become Weak (Osteoporosis):
• Bones lose density and become breakable, increasing the risk of fractures.
• Joint Cartilage Wears Down (Osteoarthritis):
• The cushioning between joints wears away, causing pain, stiffness, and swelling.
• Muscle Loss (Sarcopenia):
• Muscles shrink and become weaker, leading to less strength and poor balance.

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Osteoporosis Bone

Normal Bone

• Less Flexibility:
• Tendons and ligaments become stiffer, reducing the range of motion in joints.
• Changes in Posture:
• The backbone can bend, leading to a hunched back and shorter height.
• Slower Healing:
• Bones and muscles take longer to heal after an injury.
• Higher Risk of Falls:
• Weak muscles, stiff joints, and poor balance increase the risk of falls and injuries.

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Summary Table: Aging Changes in PVS and MS

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Reference

• Pathophysiology: The Biologic Basis for Disease" by McCance and Huether.
• Hazzard's Geriatric Medicine and Gerontology.”
• https://www.nia.nih.gov/
• https://medlineplus.gov/

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If you have any…!

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Questions…?

or

Confusion…?

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Good luck

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