运动状态的观察

,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,Capital Medical University School of Nursing,*,单击此处编辑母版标题样式,LOGO,护理学院内科护理学教研室 王艳玲,运动,状态,观察,Observation of Exercise Status/Function,课堂目标,说出骨骼肌肉系统的结构与功能,描述运动状态观察的主要内容,说出如何通过问诊进行运动状态异常症状观察,识别运动状态的正常与异常体征,判断引起运动状态体征改变的各种因素,讨论运动状态异常的主要护理问题,病例,患者，男性，,65,岁，双膝乏力、疼痛，下蹲受限,8,年，加重伴行动困难,6,月。,查体：,双膝关节畸形，压痛，,左膝屈曲,70,，外旋,5,，,右膝屈曲,80,，外旋,10,，下蹲明显受限。,一、肌肉骨骼的结构与功能,Structure,Bones-Flat, Short, Long, Irregular,Muscles, visceral, cardiac, skeletal,Joints,slight moveable or freely,，,synovial fluid,Cartilage, Ligaments, Tendons, Fascia,Bursae,Function,（一）,S & F of Skeletal,（一）,S & F of Skeletal,支持,保护,造血,贮存,运动,骨骼的功能,（二）,S & F of Muscle,Smooth Muscle Involuntary,Cardiac Muscle - Involuntary,Skeletal Muscle - Voluntary,（三）,S & F of Joints,Nonsynovial,Immovable,Slightly movable,Synovial,Cartilage,Ligament,（三）,S & F of Joints,Joints Movements,Flexion,（屈）,Extension,（伸）,Abduction,（外展）,Adduction,（内收）,Eversion,（外翻）,Inversion,（内翻）,Protraction,（前伸）,Retraction,（回缩）,Pronation,（旋前）,Supination,（旋后）,Rotation,（旋转）,Circumduction,（环转）,Elevation,（提）,Depression,（缩）,1. Limbs,Shoulder,Elbow,Wrist and Carpals,Hip,Knee,Ankle and foot,2. Spine,脊柱的标志与定位,C2,：第一个棘突,C7：,隆突,Between T7 & T8：,肩胛下角连线,L3：,最长横突,L4：,双侧髂嵴最高点连线,二、主观资料,Joints,Muscles,Bones,Functional assessment( ADL),Self-Care behaviors,病例,患者，男性，,65,岁，双膝乏力、疼痛，下蹲受限,8,年，加重伴行动困难,6,月。,查体：,双膝关节畸形，压痛，,左膝屈曲,70,，外旋,5,，,右膝屈曲,80,，外旋,10,，下蹲明显受限。,二、主观资料,1. Joints,Pain,Stiffness,（僵硬）,Swelling, Heat, redness,Limitation of movement,二、主观资料,2. Muscles,Pain (Cramps),Weakness,Atrophy,3. Bones,Pain,Deformity,（畸形）,Trauma,Fractures,Sprains,（扭伤）,Dislocations,COLDSPA Example,C,haracter: Describe the sign or symptoms.,O,nset,：,When,did it begin,？,L,ocation: Where is it? Radiate?,D,uration: How long,S,everity: How bad is it?,P,attern: What makes it better or worse?,A,ssociated factors/How it,A,ffects the client,Capital Medical University School of Nursing,二、主观资料,Functional assessment,activities of daily living,（,ADLs,）,Bathing,，,toileting,，,dressing,，,grooming,，,eating,，,mobility,，,communicating,Self-Care behaviors,Exercise program, Weight gain,Medication,Affected: family, friends, yourself,病例,患者，男性，,65,岁，双膝乏力、疼痛，下蹲受限,8,年，加重伴行动困难,6,月。,查体：,双膝关节畸形，压痛，,左膝屈曲,70,，外旋,5,，,右膝屈曲,80,，外旋,10,，下蹲明显受限。,三、客观资料,Capital Medical University School of Nursing,肌肉骨骼检查,动,量,触,视,三、客观资料,Inspection,：,size and contour,Palpation,：,temperature,，,muscles,，,bony articulations,，,area of joints capsule,Range of Motion (ROM),Muscle Testing: strength,Capital Medical University School of Nursing,（一）,Spine,Curve,Convex thoracic curve /,Kyphosis,Concave lumbar curve /,Lordosis,Motion and Expected Range,Palpate the,spinous,1.,Curve,（1）脊柱后凸,：,驼背,，,多发生于胸段,佝偻病,;,脊柱结核,;,强直性脊柱炎,;,老年人,;,发育期姿势不良、外伤压缩性骨折、脊椎骨软骨炎,（2）脊柱前凸：多发生于腰椎,妊娠晚期、大量腹水、腹腔巨大肿瘤、髋关节结核及先天性髋关节后脱位,1. Curve,Kyphosis,1. Curve,1.,Curve,（3）脊柱侧凸（,scoliosis,）：胸、腰段或胸、腰段联合发生,1）姿势性侧凸,：,无结构的异常，平卧或向前弯腰时可使侧凸消失。,2,）颈段脊柱侧凸,3,）胸段脊柱侧凸,4,）腰段脊柱侧凸,1. Curve,1. Curve,。,2. Motion and Expected Range,（,1,）,Cervical Spine,Flexion & Extension,Lateral bending,Rotation,（,2,）,Lumbar Spine,Lateral bending,Hyperextension,Rotation ( bilaterally),3. Palpate the,spinous,（,1,）脊柱压痛：提示压痛部位的脊柱或肌肉可能有病变或损伤,（,2,）脊柱叩击痛：提示该处有病变，如脊柱结核、脊椎骨折、脊椎肿瘤、椎间盘突出,（二）四肢,1.,形态异常,匙状甲（,koilonychia,),（二）四肢,1.,形态异常,杵状指（,clubbing),（二）四肢,1.,形态异常,指关节变形,（1）梭形关节,：,类风湿关节炎,（2）爪形手,：,进行性肌萎缩、脊髓空洞症，尺神经损伤,（3）其他：老年性骨关节炎,（二）四肢,1.,形态异常,腕关节变形,（1）滑膜炎,：,类风湿关节炎,（2）腱鞘囊肿,：,肌腱过度活动,（3）其他：如腱鞘纤维脂肪瘤、软组织炎症、外伤与骨折,（二）四肢,1.,形态异常,肩关节变形,正常呈弧形,方肩：肩关节脱位或三角肌萎缩,（二）四肢,1.,形态异常,膝关节变形,“,O”,形腿 、“,X”,形腿,关节炎,关节积液,（二）四肢,1.,形态异常,骨折与关节脱位,（二）四肢的异常体征,（二）四肢,2.,活动异常（,ROM,）,关节各方向的主,动运动；被动运动,观察其活动范围及,有无疼痛,病例,患者，男性，,65,岁，双膝乏力、疼痛，下蹲受限,8,年，加重伴行动困难,6,月。,查体：,双膝关节畸形，压痛，,左膝屈曲,70,，外旋,5,，,右膝屈曲,80,，外旋,10,，下蹲明显受限。,四、护理问题,躯体移动障碍,自理缺陷,废用综合征,疼痛,损伤的危险,活动无耐力,自我形象紊乱,皮肤完整性受损,Capital Medical University School of Nursing,Thank You !,