1 00:00:02,252 --> 00:00:03,085 - All right. 2 00:00:06,870 --> 00:00:09,720 This is why it's nice to have a co-teacher, (chuckles), 3 00:00:09,720 --> 00:00:11,200 in Zoom. 4 00:00:11,200 --> 00:00:13,010 Okay. Symptoms of stroke. 5 00:00:13,010 --> 00:00:16,883 So potentially, you've heard of the FAST assessment. 6 00:00:17,929 --> 00:00:20,230 You patient, if you suspect that they have a stroke, 7 00:00:20,230 --> 00:00:23,810 you would have them smile, you're looking for asymmetry, 8 00:00:23,810 --> 00:00:26,910 or symmetry of the face when they're smiling, 9 00:00:26,910 --> 00:00:29,260 you would have them have their hands up 10 00:00:29,260 --> 00:00:30,093 and you wanna make sure 11 00:00:30,093 --> 00:00:33,123 that one is not kind of falling down. 12 00:00:33,970 --> 00:00:36,690 Speech, is their speech clear or slurred? 13 00:00:36,690 --> 00:00:39,560 Sometimes people who have dentures 14 00:00:39,560 --> 00:00:41,420 sound like they have slurred speech. 15 00:00:41,420 --> 00:00:42,480 So you wanna say it like, 16 00:00:42,480 --> 00:00:44,610 is this their baseline or not? 17 00:00:44,610 --> 00:00:45,780 And then time. 18 00:00:45,780 --> 00:00:47,440 So as soon as you see those symptoms, 19 00:00:47,440 --> 00:00:49,523 you wanna call the, 20 00:00:51,008 --> 00:00:53,600 at UVMMC, we have a stroke team 21 00:00:53,600 --> 00:00:55,520 and you call a stroke code. 22 00:00:55,520 --> 00:00:59,630 Another acronym that I'm seeing more often now 23 00:00:59,630 --> 00:01:01,570 is called BE FAST. 24 00:01:01,570 --> 00:01:03,620 So is their balance equal? 25 00:01:03,620 --> 00:01:05,180 Have they lost some of their balance 26 00:01:05,180 --> 00:01:07,780 whether in bed or standing up? 27 00:01:07,780 --> 00:01:12,633 And then, or have they lost vision in one of their eyes? 28 00:01:13,650 --> 00:01:15,383 So looking at that as well. 29 00:01:16,310 --> 00:01:18,960 Do you guys know what can mimic the signs of a stroke 30 00:01:18,960 --> 00:01:19,793 a little bit? 31 00:01:22,990 --> 00:01:23,823 Anybody? 32 00:01:28,600 --> 00:01:30,930 - [Student] Their face like droops? 33 00:01:30,930 --> 00:01:33,580 - Yes. That's a good one. 34 00:01:33,580 --> 00:01:37,200 But what can, like, maybe it's not a stroke, 35 00:01:37,200 --> 00:01:40,180 but it's something else that's occurring 36 00:01:40,180 --> 00:01:42,613 that could mimic a stroke. 37 00:01:47,220 --> 00:01:50,649 - We got Bell's palsy and tumor on the chat. 38 00:01:50,649 --> 00:01:52,670 - Those are good. Yeah. 39 00:01:52,670 --> 00:01:53,503 Good. 40 00:01:54,370 --> 00:01:57,770 - Migraine, drug overdose, heart attack, seizure. 41 00:01:57,770 --> 00:02:00,390 - Wow guys. You are... 42 00:02:00,390 --> 00:02:01,700 Wow. 43 00:02:01,700 --> 00:02:02,560 It's good. 44 00:02:02,560 --> 00:02:06,023 So what I'm thinking is low blood sugar. 45 00:02:07,000 --> 00:02:08,530 Low blood sugar can cause someone 46 00:02:08,530 --> 00:02:10,290 to have like slurred speech, 47 00:02:10,290 --> 00:02:13,920 kind of, you know, be a little off or unresponsive. 48 00:02:13,920 --> 00:02:16,110 So always checking a blood sugar, too. 49 00:02:16,110 --> 00:02:17,750 You still wanna call the stroke team 50 00:02:17,750 --> 00:02:20,980 if they don't pass the FAST assessment 51 00:02:20,980 --> 00:02:22,290 or BE FAST assessment, 52 00:02:22,290 --> 00:02:23,500 but in the meantime, 53 00:02:23,500 --> 00:02:25,760 when you're waiting for that stroke team to come, 54 00:02:25,760 --> 00:02:28,230 someone should be doing a blood sugar check. 55 00:02:28,230 --> 00:02:29,560 Risk factors for stroke. 56 00:02:29,560 --> 00:02:32,830 There's unmodifiable versus modifiable. 57 00:02:32,830 --> 00:02:35,800 So it's talking about the modifiable like hypertension, 58 00:02:35,800 --> 00:02:39,140 hyperlipidemia, diabetes. 59 00:02:39,140 --> 00:02:40,710 Modifiable for diabetes, 60 00:02:40,710 --> 00:02:43,500 just, it depends if they're type one or type two, 61 00:02:43,500 --> 00:02:47,090 but type two is like managing their blood sugar, 62 00:02:47,090 --> 00:02:51,170 overweight, smoking, heavy alcohol use, 63 00:02:51,170 --> 00:02:55,643 drug use, and lack of physical activity. 64 00:02:57,410 --> 00:03:01,120 We look at mental status, cranial nerves, motor sensor, 65 00:03:01,120 --> 00:03:03,590 sorry, sensory, and then reflexes, 66 00:03:03,590 --> 00:03:05,920 sorry, that should be fixed, reflexes, 67 00:03:05,920 --> 00:03:07,560 coordination tests, gait. 68 00:03:07,560 --> 00:03:11,500 We're not doing all of this in the lab, 69 00:03:11,500 --> 00:03:13,940 but I'm gonna talk about some of them 70 00:03:13,940 --> 00:03:15,340 that we're not doing in lab. 71 00:03:16,520 --> 00:03:18,580 And I see, is there something? 72 00:03:18,580 --> 00:03:20,080 - Yeah, there's a quick question. They ask, 73 00:03:20,080 --> 00:03:24,040 do they need to have a certain number of the BE FAST test 74 00:03:24,040 --> 00:03:25,400 for you to call a stroke team, 75 00:03:25,400 --> 00:03:27,200 or does it only take one? 76 00:03:27,200 --> 00:03:28,390 It only takes one. 77 00:03:28,390 --> 00:03:29,570 - Yeah. It only takes one. 78 00:03:29,570 --> 00:03:30,403 Agreed. 79 00:03:31,900 --> 00:03:36,430 It's better to call a false stroke code 80 00:03:36,430 --> 00:03:38,130 than to have someone stroke 81 00:03:38,130 --> 00:03:41,500 because you're like waiting and thinking, hmm, 82 00:03:41,500 --> 00:03:43,100 are they stroking? Are they not? 83 00:03:45,670 --> 00:03:47,460 It could be false and that's fine. 84 00:03:47,460 --> 00:03:49,310 Like maybe it wasn't really a stroke. 85 00:03:52,730 --> 00:03:53,860 Oh, I could talk more about this, 86 00:03:53,860 --> 00:03:55,840 but I'm not going to, I'm trying not to like talk, 87 00:03:55,840 --> 00:03:57,400 I've seen a lot of things, 88 00:03:57,400 --> 00:04:01,760 so I gotta keep it simple for you. 89 00:04:01,760 --> 00:04:02,910 Reflexes, coordination tests. 90 00:04:02,910 --> 00:04:03,940 Okay. Cranial nerves. 91 00:04:03,940 --> 00:04:04,840 I don't know... 92 00:04:08,530 --> 00:04:11,150 You've had the nervous system in anatomy, I believe, 93 00:04:11,150 --> 00:04:14,090 but there's different mnemonics to help you remember 94 00:04:14,090 --> 00:04:15,790 all the cranial nerves, 95 00:04:15,790 --> 00:04:17,163 this is some of them. 96 00:04:18,930 --> 00:04:19,763 Okay. 97 00:04:20,750 --> 00:04:23,070 You should know the cranial nerves, 98 00:04:23,070 --> 00:04:25,070 what each cranial nerve does, 99 00:04:25,070 --> 00:04:28,230 what each cranial nerve is responsible for. 100 00:04:28,230 --> 00:04:29,630 This is really important, 101 00:04:29,630 --> 00:04:32,170 especially if you're wanting to become an ED nurse 102 00:04:32,170 --> 00:04:34,550 or an ICU nurse or any nurse in general. 103 00:04:34,550 --> 00:04:39,550 But why I say ICU and ED is because, 104 00:04:39,650 --> 00:04:40,483 especially ED, 105 00:04:42,080 --> 00:04:45,410 you're like at the forefront of the assessment of the care 106 00:04:45,410 --> 00:04:50,120 and you really wanna be able to pick out problems quickly. 107 00:04:53,840 --> 00:04:56,677 And again, just other different tables 108 00:04:58,590 --> 00:05:01,960 to help everybody learn the different nerves. 109 00:05:01,960 --> 00:05:03,910 Some learn through mnemonics, 110 00:05:03,910 --> 00:05:06,000 some learn through pictures, 111 00:05:06,000 --> 00:05:07,983 some learn through tables. 112 00:05:09,020 --> 00:05:11,110 I don't really learn well with mnemonics 113 00:05:11,110 --> 00:05:13,900 but I know some students learn really well with mnemonics. 114 00:05:13,900 --> 00:05:18,840 So we have that there as well. 115 00:05:18,840 --> 00:05:19,760 Okay. 116 00:05:19,760 --> 00:05:22,700 So you could have a focused neuro assessment, 117 00:05:22,700 --> 00:05:25,583 like a stroke assessment is a focused neuro assessment. 118 00:05:28,700 --> 00:05:30,730 You can have a comprehensive, 119 00:05:30,730 --> 00:05:34,020 well, focus, and it also is comprehensive, too, 120 00:05:34,020 --> 00:05:37,040 but you can have like a focus versus a comprehensive. 121 00:05:37,040 --> 00:05:38,960 I wanna talk about motor function. 122 00:05:38,960 --> 00:05:39,810 This is something, 123 00:05:39,810 --> 00:05:41,880 so I'm gonna park here for a second, 124 00:05:41,880 --> 00:05:46,313 this is something you should really, really, really learn, 125 00:05:47,870 --> 00:05:48,960 especially 'cause you're gonna go 126 00:05:48,960 --> 00:05:50,497 in a clinical setting shortly 127 00:05:50,497 --> 00:05:52,400 and you'll be on the med surg unit, 128 00:05:52,400 --> 00:05:55,503 some of you will be on the neuro units. 129 00:05:56,530 --> 00:05:58,980 When you're talking about muscle strength, 130 00:05:58,980 --> 00:06:01,060 you're talking about arms and legs, 131 00:06:01,060 --> 00:06:03,200 okay, we're looking at the arms and legs, 132 00:06:03,200 --> 00:06:06,720 and you're assessing each arm, each leg individually. 133 00:06:06,720 --> 00:06:10,450 So zero would be no muscle contraction. 134 00:06:10,450 --> 00:06:11,330 Sorry. 135 00:06:11,330 --> 00:06:12,640 They're on the bed, 136 00:06:12,640 --> 00:06:15,430 okay, they're in the bed and there's no movement. 137 00:06:15,430 --> 00:06:18,453 You tell them to lift their arm and there's no movement. 138 00:06:20,300 --> 00:06:23,160 One would be, you ask them to move their arm, 139 00:06:23,160 --> 00:06:24,900 and maybe they're able to like, 140 00:06:24,900 --> 00:06:27,690 there's some muscle contraction in that extremity. 141 00:06:27,690 --> 00:06:29,890 Maybe you can see them tightening. 142 00:06:29,890 --> 00:06:32,223 They're trying, but they can't do it. 143 00:06:35,360 --> 00:06:39,430 Active movement of body part with gravity eliminated. 144 00:06:39,430 --> 00:06:44,260 So that would be like they're able to move around, 145 00:06:44,260 --> 00:06:46,500 but they can't go up against gravity. 146 00:06:46,500 --> 00:06:48,010 They can move like this. 147 00:06:48,010 --> 00:06:49,830 If you lift up their arm, 148 00:06:49,830 --> 00:06:51,950 they can't stay up there. 149 00:06:51,950 --> 00:06:54,323 There's none of that movement. 150 00:06:55,810 --> 00:06:57,530 Active movement against gravity. 151 00:06:57,530 --> 00:06:59,520 So they're able to lift up, 152 00:06:59,520 --> 00:07:03,570 but if you your hand on their arm, they go right back down. 153 00:07:03,570 --> 00:07:04,820 So that would be a three. 154 00:07:06,060 --> 00:07:09,670 Active movement against gravity and some resistance. 155 00:07:09,670 --> 00:07:12,430 So maybe they are able to lift up, 156 00:07:12,430 --> 00:07:17,180 they can resist a little bit, but not a whole lot. 157 00:07:17,180 --> 00:07:18,220 And then five, 158 00:07:18,220 --> 00:07:20,320 which all of you should have a five 159 00:07:20,320 --> 00:07:23,193 in both your arms and both your legs. 160 00:07:26,159 --> 00:07:26,992 That's like, 161 00:07:28,270 --> 00:07:31,530 I have you raise your arms and I push down 162 00:07:31,530 --> 00:07:34,080 and you are still able to stay up 163 00:07:34,080 --> 00:07:36,640 against gravity and against resistance. 164 00:07:36,640 --> 00:07:40,510 So typically you're gonna see five 165 00:07:40,510 --> 00:07:43,530 in someone who doesn't have any issues, 166 00:07:43,530 --> 00:07:45,480 you know, they're strong, they're healthy. 167 00:07:45,480 --> 00:07:47,993 You might see four in someone who's tired, 168 00:07:49,860 --> 00:07:51,950 depending, maybe a little bit of sedation, 169 00:07:51,950 --> 00:07:53,503 a little bit of medication. 170 00:07:55,440 --> 00:07:57,630 You might have someone who has a stroke 171 00:07:57,630 --> 00:07:59,870 and on the left side of their body, 172 00:07:59,870 --> 00:08:02,140 they have a full five, 173 00:08:02,140 --> 00:08:03,500 but then on the right side, 174 00:08:03,500 --> 00:08:06,200 maybe in their arm, they have a two, 175 00:08:06,200 --> 00:08:08,913 and in their leg, they have a one potentially. 176 00:08:10,141 --> 00:08:12,740 So that's really important to note. 177 00:08:12,740 --> 00:08:14,590 What is their strength level? 178 00:08:14,590 --> 00:08:15,660 Has it changed? 179 00:08:15,660 --> 00:08:18,210 Is it symmetrical, asymmetrical? 180 00:08:18,210 --> 00:08:19,153 What is it? 181 00:08:20,600 --> 00:08:21,460 That's really important. 182 00:08:21,460 --> 00:08:24,430 So five out of five is typically what we see. 183 00:08:24,430 --> 00:08:26,923 Normal variations in the young or elderly. 184 00:08:28,180 --> 00:08:30,520 Elderly just might be strength-related, 185 00:08:30,520 --> 00:08:32,010 but what is their baseline? 186 00:08:32,010 --> 00:08:33,633 Is this a new change? 187 00:08:35,628 --> 00:08:37,140 Did they have a previous stroke 188 00:08:37,140 --> 00:08:40,500 and that's why they have a plus three in their right arm? 189 00:08:40,500 --> 00:08:42,253 Or is it like a new change? 190 00:08:45,070 --> 00:08:45,903 Pronator drift. 191 00:08:45,903 --> 00:08:47,440 This is something we often look at 192 00:08:47,440 --> 00:08:49,130 in someone who's had a stroke 193 00:08:49,130 --> 00:08:51,190 or assessing to see if 194 00:08:53,065 --> 00:08:54,840 the stroke's getting worse or whatever. 195 00:08:54,840 --> 00:08:57,950 You have them lift up their hands and close their eyes. 196 00:08:57,950 --> 00:09:01,850 And all of you should be able to raise your arms up 197 00:09:01,850 --> 00:09:03,600 with no drift, 198 00:09:03,600 --> 00:09:05,460 but someone who's had a stroke, 199 00:09:05,460 --> 00:09:07,210 they might have a little bit of drift. 200 00:09:07,210 --> 00:09:10,423 So the arm or the leg drifts down. 201 00:09:11,340 --> 00:09:13,270 They should really be able to, 202 00:09:13,270 --> 00:09:16,653 what we say is hold pizza box with their eyes closed. 203 00:09:23,540 --> 00:09:25,460 Sensation is another thing we can talk. 204 00:09:25,460 --> 00:09:27,720 I'm not gonna go into great detail about that, 205 00:09:27,720 --> 00:09:30,660 but basically your patient, 206 00:09:30,660 --> 00:09:32,090 depending on the type of stroke, 207 00:09:32,090 --> 00:09:34,070 depending where the injury is, 208 00:09:34,070 --> 00:09:37,500 might have decreased sensation to light touch, 209 00:09:37,500 --> 00:09:41,620 temperature changes, position sense changes, 210 00:09:41,620 --> 00:09:46,440 vibration changes, discriminative sensational changes. 211 00:09:46,440 --> 00:09:47,950 That means they're not able to, 212 00:09:47,950 --> 00:09:49,290 if I touch their right arm, 213 00:09:49,290 --> 00:09:52,160 they don't know I'm touching their right arm. 214 00:09:52,160 --> 00:09:54,010 They might have temperature changes. 215 00:09:54,010 --> 00:09:57,000 It may vary from arm to arm, leg to leg, 216 00:09:57,000 --> 00:10:00,460 or maybe here they have good sensation, 217 00:10:00,460 --> 00:10:02,520 and then here, it kind of becomes weaker. 218 00:10:02,520 --> 00:10:04,443 And the same for the legs as well. 219 00:10:05,290 --> 00:10:08,230 So basically when you do any kind of sensation test, 220 00:10:08,230 --> 00:10:10,620 whether you're assessing for light touch, 221 00:10:10,620 --> 00:10:13,310 temperature changes, any of those things, 222 00:10:13,310 --> 00:10:15,660 you wanna make sure that their eyes are closed. 223 00:10:19,380 --> 00:10:20,213 All right. 224 00:10:21,860 --> 00:10:23,980 Was there a question the box, Dan? 225 00:10:23,980 --> 00:10:26,593 I saw the little thing flash. 226 00:10:30,360 --> 00:10:31,613 - No questions. 227 00:10:33,220 --> 00:10:34,480 - Cortical sensory testing. 228 00:10:34,480 --> 00:10:35,313 When to test? 229 00:10:35,313 --> 00:10:38,220 Possible cortical lesion and simple sensation. 230 00:10:38,220 --> 00:10:41,750 I'm not testing temperature changes in all my patients. 231 00:10:41,750 --> 00:10:45,070 This is like, very like stroke-specific, 232 00:10:45,070 --> 00:10:48,650 and it would be ordered by the doctor. 233 00:10:48,650 --> 00:10:51,600 You wouldn't just do this out of the blue, 234 00:10:51,600 --> 00:10:54,390 but it would be very like you suspect they have a stroke 235 00:10:54,390 --> 00:10:57,720 or they've had a stroke and we're just monitoring to see 236 00:10:57,720 --> 00:11:01,243 if the damage is getting worse or staying the same. 237 00:11:02,860 --> 00:11:06,710 You could use a two-point sensation. 238 00:11:06,710 --> 00:11:10,030 So you can use a paperclip, compare bilaterally, 239 00:11:10,030 --> 00:11:12,490 will be less sensitive proximally. 240 00:11:12,490 --> 00:11:14,260 Do you feel one or two? 241 00:11:14,260 --> 00:11:16,150 Which one do you feel more? 242 00:11:16,150 --> 00:11:18,120 So you're taking that paperclip, 243 00:11:18,120 --> 00:11:19,373 which I have right here, 244 00:11:21,210 --> 00:11:25,470 you're two taking the pointy in and you're saying, 245 00:11:25,470 --> 00:11:28,983 okay, do you feel here or here? 246 00:11:30,960 --> 00:11:32,290 Here or here, 247 00:11:32,290 --> 00:11:33,750 what do you feel more? 248 00:11:33,750 --> 00:11:34,853 What's sharper? 249 00:11:36,220 --> 00:11:37,630 Or what do you feel? 250 00:11:37,630 --> 00:11:38,703 What's stronger? 251 00:11:40,000 --> 00:11:41,623 What's not as noticeable? 252 00:11:51,180 --> 00:11:53,273 So this stereognosis. 253 00:11:59,693 --> 00:12:04,060 This is like if you put something in their hand, 254 00:12:04,060 --> 00:12:06,480 could they tell you what it is? 255 00:12:06,480 --> 00:12:08,610 Graphesthesia is, 256 00:12:08,610 --> 00:12:12,570 I'm not having you practice this in lab, 257 00:12:12,570 --> 00:12:15,450 but that it would be like if you wrote on their hand, 258 00:12:15,450 --> 00:12:16,810 like if you did a circle, 259 00:12:16,810 --> 00:12:19,943 could they distinguish whether there's a circle, 260 00:12:21,327 --> 00:12:23,340 or you drawing a circle in their hand? 261 00:12:23,340 --> 00:12:26,290 And you'll see like SLP do a lot of this, 262 00:12:26,290 --> 00:12:28,040 speech language pathology, 263 00:12:28,040 --> 00:12:33,040 OT, they do a lot of like sensory assessment in more detail. 264 00:12:33,770 --> 00:12:38,260 And then you'll see it with your neurologist. 265 00:12:38,260 --> 00:12:41,943 They have really specific tests. 266 00:12:43,130 --> 00:12:45,830 Reflexes, I'm not gonna go into great detail about this. 267 00:12:45,830 --> 00:12:48,010 I'm gonna let you practice this in lab, 268 00:12:48,010 --> 00:12:52,440 but we assess the biceps, the brachioradialis, 269 00:12:52,440 --> 00:12:53,950 the triceps, the knee jerk, 270 00:12:53,950 --> 00:12:57,310 especially the knee jerk, ankle jerk, 271 00:12:57,310 --> 00:12:59,570 and you'll get to practice this in lab. 272 00:12:59,570 --> 00:13:00,403 And then, 273 00:13:02,000 --> 00:13:06,200 it tells you what part of the spinal column 274 00:13:06,200 --> 00:13:08,350 this is assessing. 275 00:13:08,350 --> 00:13:12,200 The Babinski or the plantar reflex, 276 00:13:12,200 --> 00:13:14,470 it gives you a grade right here. 277 00:13:14,470 --> 00:13:16,540 You don't see this in a, 278 00:13:16,540 --> 00:13:17,620 you see this in a baby, 279 00:13:17,620 --> 00:13:18,610 like, so for example, 280 00:13:18,610 --> 00:13:20,750 when we go to clinical in the fall 281 00:13:20,750 --> 00:13:23,390 and we're assessing the little newborns 282 00:13:23,390 --> 00:13:26,330 that are like a day, two days old, 283 00:13:26,330 --> 00:13:28,780 a Babinski response, and that's when you, 284 00:13:28,780 --> 00:13:32,090 so if you have the big toe right here, 285 00:13:32,090 --> 00:13:34,800 you stroke the outside of the foot 286 00:13:34,800 --> 00:13:39,280 and what will happen is their toes will expand out. 287 00:13:39,280 --> 00:13:41,440 And that's normal in an infant, 288 00:13:41,440 --> 00:13:45,220 but it's not normal, I forget one that reflex leaves them, 289 00:13:45,220 --> 00:13:47,053 it's pretty, it's under a year old, 290 00:13:49,070 --> 00:13:52,250 but it wouldn't be normal in a adult. 291 00:13:52,250 --> 00:13:53,830 It would only be normal in a baby 292 00:13:53,830 --> 00:13:57,840 because their brain is not fully developed yet. 293 00:13:57,840 --> 00:14:01,050 So if you saw that in a patient who had a head injury, 294 00:14:01,050 --> 00:14:02,963 it would not be a good sign. 295 00:14:06,660 --> 00:14:09,223 You'll use a reflex hammer when you're doing this. 296 00:14:10,230 --> 00:14:12,810 I think reflexes are hard to talk about. 297 00:14:12,810 --> 00:14:14,400 And what will make more sense 298 00:14:14,400 --> 00:14:16,930 is when you get into the clinical setting 299 00:14:16,930 --> 00:14:18,293 and you practice it. 300 00:14:21,510 --> 00:14:22,620 The Babinski, like I said, 301 00:14:22,620 --> 00:14:25,470 is when you stroke the outside of the foot, 302 00:14:25,470 --> 00:14:28,003 and the toes fan out. 303 00:14:31,010 --> 00:14:33,450 Assessing coordination and cerebellar function. 304 00:14:33,450 --> 00:14:34,553 Upper extremities, 305 00:14:35,656 --> 00:14:36,830 RAMs of the hands. 306 00:14:36,830 --> 00:14:41,830 So that's if you take your hands and you go like this, 307 00:14:43,640 --> 00:14:46,730 are they able to, is there that coordination there? 308 00:14:46,730 --> 00:14:49,750 Finger to thumb, can you do this 309 00:14:49,750 --> 00:14:51,373 quickly both sides? 310 00:14:54,800 --> 00:14:56,010 Finger to nose. 311 00:14:56,010 --> 00:14:57,550 So if you have your finger here, 312 00:14:57,550 --> 00:15:00,030 are they able to take their finger, 313 00:15:00,030 --> 00:15:01,673 and if you're moving around, 314 00:15:03,508 --> 00:15:04,358 can they do that? 315 00:15:06,500 --> 00:15:07,973 Finger nose finger. 316 00:15:08,910 --> 00:15:10,220 Well, it's the same thing. 317 00:15:10,220 --> 00:15:12,100 Finger to nose, 318 00:15:12,100 --> 00:15:14,350 or are they able to put their finger on their nose? 319 00:15:14,350 --> 00:15:15,400 That's the other one. 320 00:15:16,850 --> 00:15:19,043 I know a lot of times we know these, 321 00:15:20,320 --> 00:15:23,980 we know these tests because of alcohol. 322 00:15:23,980 --> 00:15:26,743 People test to see if someone's drunk or whatnot, 323 00:15:28,540 --> 00:15:31,150 but they're also used to 324 00:15:31,150 --> 00:15:33,620 assess coordination and cerebellar function. 325 00:15:33,620 --> 00:15:35,593 And then, heel to shin. 326 00:15:36,840 --> 00:15:38,870 I'm gonna let the teachers show you this in lab, 327 00:15:38,870 --> 00:15:42,773 but it's basically taking the heel and rubbing. 328 00:15:44,150 --> 00:15:47,940 So I take my right heel and I rub it from my foot, 329 00:15:47,940 --> 00:15:52,600 the top of my foot to my left. 330 00:15:52,600 --> 00:15:55,278 So I take my right heel, 331 00:15:55,278 --> 00:15:58,280 and I put it over my left foot, 332 00:15:58,280 --> 00:16:03,280 and I rub, like, I go across my foot up to my left knee, 333 00:16:04,030 --> 00:16:05,620 and then I come back down. 334 00:16:05,620 --> 00:16:07,590 And it's the same for the other side. 335 00:16:07,590 --> 00:16:09,590 We do this a lot with stroke patients too 336 00:16:09,590 --> 00:16:12,013 to assess coordination while they're in the bed. 337 00:16:13,940 --> 00:16:15,020 Gait. 338 00:16:15,020 --> 00:16:17,880 This one, you ask someone to stand and walk 339 00:16:17,880 --> 00:16:20,440 and you just assess their gait. 340 00:16:20,440 --> 00:16:23,570 Are their arms swinging symmetrically? 341 00:16:23,570 --> 00:16:25,650 Are they erect? 342 00:16:25,650 --> 00:16:26,650 As they're walking, 343 00:16:26,650 --> 00:16:28,090 are they able to, 344 00:16:28,090 --> 00:16:29,990 are they coordinated as they're walking? 345 00:16:29,990 --> 00:16:31,633 Is there any like limping, 346 00:16:32,530 --> 00:16:36,240 kind of a sway to one side versus the other? 347 00:16:36,240 --> 00:16:38,440 You can do the heel, toe, tandem test. 348 00:16:38,440 --> 00:16:43,020 So heel to toe, heel to toe as they're walking, 349 00:16:43,020 --> 00:16:45,300 like can they put their heel to the toe, 350 00:16:45,300 --> 00:16:47,640 heel to the toe, heel to the toe? 351 00:16:47,640 --> 00:16:48,770 Or the Romberg test, 352 00:16:48,770 --> 00:16:49,603 which you've learned about 353 00:16:49,603 --> 00:16:52,160 where they stand up straight, arms to the side, 354 00:16:52,160 --> 00:16:54,820 eyes closed for 20 seconds, 355 00:16:54,820 --> 00:16:57,110 and are they swaying or not? 356 00:16:57,110 --> 00:16:58,442 They shouldn't be swaying, 357 00:16:58,442 --> 00:16:59,275 but... 358 00:17:02,350 --> 00:17:04,810 Real quick. Abnormal muscle movements. 359 00:17:04,810 --> 00:17:07,890 Atrophy, fasciculation of the tongue. 360 00:17:07,890 --> 00:17:10,250 So it's like these quick movements of the tongue. 361 00:17:10,250 --> 00:17:12,080 Eye tics, 362 00:17:12,080 --> 00:17:15,670 chorea choreiform movements, 363 00:17:15,670 --> 00:17:16,650 resting tremors, 364 00:17:16,650 --> 00:17:19,000 postural tremors, intention tremors, 365 00:17:19,000 --> 00:17:22,170 congenital unilateral athetosis. 366 00:17:22,170 --> 00:17:23,860 I'm not gonna go into detail about this. 367 00:17:23,860 --> 00:17:27,763 I'm just exposing you to all the names. 368 00:17:28,750 --> 00:17:31,400 These are, these warrant assessment, 369 00:17:31,400 --> 00:17:33,000 especially if they're brand-new, 370 00:17:33,000 --> 00:17:34,400 they're bugging the patient 371 00:17:36,230 --> 00:17:38,040 and you'd wanna investigate, 372 00:17:38,040 --> 00:17:39,570 like, is it a stroke causing this, 373 00:17:39,570 --> 00:17:41,000 is this something, 374 00:17:41,000 --> 00:17:44,400 a neurological problem causing this? 375 00:17:44,400 --> 00:17:45,980 So it's not you investigating, 376 00:17:45,980 --> 00:17:48,923 but it's you reporting it to the clinician. 377 00:17:50,780 --> 00:17:54,380 Some older client considerations. 378 00:17:54,380 --> 00:17:58,913 They may have a decreased taste and scent sensation. 379 00:17:59,760 --> 00:18:01,730 There's normal decrease in the older person's ability 380 00:18:01,730 --> 00:18:03,083 to hear potentially, 381 00:18:04,550 --> 00:18:06,670 decreased ability to see potentially, 382 00:18:06,670 --> 00:18:08,430 depending on the patient. 383 00:18:08,430 --> 00:18:11,960 Remember we always have to compare to baseline. 384 00:18:11,960 --> 00:18:14,400 But sometimes in the older client, 385 00:18:14,400 --> 00:18:16,920 you might see these changes. 386 00:18:16,920 --> 00:18:19,233 They might have intentional tremors, 387 00:18:20,300 --> 00:18:23,030 tremors that are not like caused by a tumor 388 00:18:23,030 --> 00:18:26,490 or a pathophysiological process, 389 00:18:26,490 --> 00:18:29,023 but it's just normal part of aging. 390 00:18:29,940 --> 00:18:31,580 They might have reduced muscle mass 391 00:18:31,580 --> 00:18:33,280 from degeneration of muscle fiber. 392 00:18:33,280 --> 00:18:35,980 So these patients are definitely more at risk for bed sores 393 00:18:35,980 --> 00:18:39,810 because of that decreased subcutaneous tissue. 394 00:18:39,810 --> 00:18:42,700 They might be slower uncertain gait. 395 00:18:42,700 --> 00:18:44,390 That just means like, 396 00:18:44,390 --> 00:18:48,733 they take more time to walk, which is not a bad thing. 397 00:18:53,830 --> 00:18:55,270 And then it talks about 398 00:18:55,270 --> 00:18:57,100 rapid alternating movements are difficult 399 00:18:57,100 --> 00:18:59,940 because of decreased reaction to time and flexibility. 400 00:18:59,940 --> 00:19:02,130 So just, you know, with your older patients, 401 00:19:02,130 --> 00:19:04,340 you wanna be take more time. 402 00:19:05,370 --> 00:19:07,330 It's hard because as nurses we wanna rush, 403 00:19:07,330 --> 00:19:09,170 we wanna get things done, 404 00:19:09,170 --> 00:19:11,820 but you have to remember when you who have an older patient, 405 00:19:11,820 --> 00:19:15,710 you need to meet them where they're at and not rush them. 406 00:19:15,710 --> 00:19:18,890 'Cause oftentimes it causes more anxiety on their part 407 00:19:18,890 --> 00:19:20,530 if they're being rushed. 408 00:19:20,530 --> 00:19:21,963 So keep that in mind. 409 00:19:23,180 --> 00:19:24,270 There's a YouTube video. 410 00:19:24,270 --> 00:19:27,890 You're welcome to watch at a later time. 411 00:19:27,890 --> 00:19:31,543 I'm gonna go to the musculoskeletal lecture. 412 00:19:33,590 --> 00:19:35,533 Now, the musculoskeletal lecture. 413 00:19:52,228 --> 00:19:54,680 So as you know, the musculoskeletal system 414 00:19:54,680 --> 00:19:57,053 consists of bones, muscles, joints. 415 00:19:58,700 --> 00:20:01,913 If one is affected, the other might be affected as well. 416 00:20:03,400 --> 00:20:05,863 It's controlled by the nervous system. 417 00:20:07,750 --> 00:20:10,360 It provides structure to the body, which is super simple, 418 00:20:10,360 --> 00:20:12,150 but it does. 419 00:20:12,150 --> 00:20:15,700 Some subjective data that could indicate a problem 420 00:20:15,700 --> 00:20:18,330 with the musculoskeletal system 421 00:20:18,330 --> 00:20:20,503 is pain, stiffness, 422 00:20:21,422 --> 00:20:24,370 ROM means range of motion. 423 00:20:24,370 --> 00:20:28,970 So if your patient has full range of motion of a joint, 424 00:20:28,970 --> 00:20:32,300 you can write full range of motion of the left shoulder 425 00:20:32,300 --> 00:20:36,350 or a full range of motion of the left and right shoulder. 426 00:20:36,350 --> 00:20:37,920 That's it. Right? 427 00:20:37,920 --> 00:20:41,060 But your patient might have had 428 00:20:41,060 --> 00:20:43,760 a previous surgery or an accident. 429 00:20:43,760 --> 00:20:45,690 For example, my right leg. 430 00:20:45,690 --> 00:20:48,993 I had this freak accident after Elise was born. 431 00:20:50,400 --> 00:20:52,810 And for some reason, it's not okay there, 432 00:20:52,810 --> 00:20:55,080 just a freak accident. 433 00:20:55,080 --> 00:20:58,020 And right now my right leg, it's better than it was, 434 00:20:58,020 --> 00:21:01,050 but I have a really decreased range of motion of that leg. 435 00:21:01,050 --> 00:21:03,590 So for example, someone would document 436 00:21:03,590 --> 00:21:08,590 Sarah has decreased range of motion of her right knee, okay. 437 00:21:11,030 --> 00:21:13,430 Impact on ADLS. 438 00:21:13,430 --> 00:21:15,330 Do you know what ADLS means? 439 00:21:15,330 --> 00:21:17,883 It's activity of daily living. 440 00:21:19,950 --> 00:21:22,680 So if they have pain, stiffness, 441 00:21:22,680 --> 00:21:24,580 or decreased range of motion, 442 00:21:24,580 --> 00:21:26,970 that can affect how they function. 443 00:21:26,970 --> 00:21:28,860 It can affect their job, 444 00:21:28,860 --> 00:21:33,490 it could affect their lifestyle, 445 00:21:33,490 --> 00:21:36,240 it can affect their social economic lifestyle, 446 00:21:36,240 --> 00:21:38,930 it can affect their mental status. 447 00:21:38,930 --> 00:21:40,520 Chronic pain, 448 00:21:40,520 --> 00:21:42,240 you're gonna learn more about this in the future, 449 00:21:42,240 --> 00:21:45,273 but chronic pain can really affect someone. 450 00:21:46,836 --> 00:21:48,810 These are the bones, 451 00:21:48,810 --> 00:21:50,893 and then the structure of the bones. 452 00:21:52,810 --> 00:21:54,280 Skeletal system. 453 00:21:54,280 --> 00:21:55,810 I'm not gonna... 454 00:21:55,810 --> 00:21:57,373 Skeletal muscle system. 455 00:21:59,010 --> 00:22:00,080 They're all interconnected. 456 00:22:00,080 --> 00:22:03,350 So if a bone is broken, the muscles might be affected. 457 00:22:03,350 --> 00:22:05,710 Maybe if they're in a car accident, 458 00:22:05,710 --> 00:22:07,070 the bones would be broken. 459 00:22:07,070 --> 00:22:09,700 So that's why it's important to know bones. 460 00:22:09,700 --> 00:22:10,770 Because if you're, 461 00:22:10,770 --> 00:22:14,250 if you've hear, oh my patient's sacrum's fractured, 462 00:22:14,250 --> 00:22:17,070 or my patient's humerus is fractured, 463 00:22:17,070 --> 00:22:19,240 you wanna know which one is fractured, right? 464 00:22:19,240 --> 00:22:20,940 How badly is it fractured? 465 00:22:20,940 --> 00:22:24,800 And was there any ligament or muscle involvement? 466 00:22:24,800 --> 00:22:26,700 'Cause that tells you like, 467 00:22:26,700 --> 00:22:28,700 are they gonna have decreased range of motion? 468 00:22:28,700 --> 00:22:30,973 Are they at risk for other complications? 469 00:22:32,850 --> 00:22:33,960 And again, muscles as well, 470 00:22:33,960 --> 00:22:36,223 were the ligaments affected? 471 00:22:36,223 --> 00:22:37,843 Was the muscle affected? 472 00:22:39,260 --> 00:22:41,640 Were the nerves affected? 473 00:22:41,640 --> 00:22:44,603 And when you get report from a nurse or from the doctor, 474 00:22:46,400 --> 00:22:49,170 all of that should be said to you or told to you, 475 00:22:49,170 --> 00:22:50,993 or you can ask that question. 476 00:22:53,070 --> 00:22:56,530 Okay, skeletal, I'm not gonna go into detail about all that. 477 00:22:56,530 --> 00:23:00,100 But when we look at the muscular skeletal system, 478 00:23:00,100 --> 00:23:04,240 we're looking at each joint individually. 479 00:23:04,240 --> 00:23:07,560 So the neck, the shoulders, the elbows, 480 00:23:07,560 --> 00:23:09,820 the wrists, the fingers, right? 481 00:23:09,820 --> 00:23:14,410 We're looking at the hips, the legs, 482 00:23:14,410 --> 00:23:17,333 the knees, the ankles, the toes, 483 00:23:19,640 --> 00:23:21,460 can that specific joint, 484 00:23:21,460 --> 00:23:25,470 can it abduct or adduct or circumduct? 485 00:23:25,470 --> 00:23:29,580 We talk about inversion, eversion of the feet, 486 00:23:29,580 --> 00:23:34,100 extension, flexion, pronation, supination, 487 00:23:34,100 --> 00:23:35,900 these are all terms you should know, 488 00:23:36,880 --> 00:23:39,470 protraction, retraction, rotation, 489 00:23:39,470 --> 00:23:42,283 internal rotation, external rotation. 490 00:23:43,540 --> 00:23:45,890 When you go into lab today, 491 00:23:45,890 --> 00:23:48,180 we look at each joint individually, is there any swelling? 492 00:23:48,180 --> 00:23:49,570 Is there any redness? 493 00:23:49,570 --> 00:23:51,630 Is there any pain, stiffness? 494 00:23:51,630 --> 00:23:56,630 What's that subjective information/my objective observation? 495 00:23:57,210 --> 00:24:01,330 And then if it does look swollen and I feel it, 496 00:24:01,330 --> 00:24:03,830 is it warm to the touch? 497 00:24:03,830 --> 00:24:05,663 Is it tender to the touch? 498 00:24:07,620 --> 00:24:11,180 I was reading lab sheets this week and people, 499 00:24:11,180 --> 00:24:12,250 last week, I mean, 500 00:24:12,250 --> 00:24:13,733 and people would write like, 501 00:24:15,340 --> 00:24:17,610 if they were touching the abdomen, they would say like, 502 00:24:17,610 --> 00:24:19,970 oh, no pain. 503 00:24:19,970 --> 00:24:21,590 No patient had no pain, 504 00:24:21,590 --> 00:24:24,400 or something like patient had no pain when I touched them. 505 00:24:24,400 --> 00:24:25,890 It's really like saying, 506 00:24:25,890 --> 00:24:27,450 when I touched that joint, 507 00:24:27,450 --> 00:24:29,070 did the patient complain a pain? 508 00:24:29,070 --> 00:24:33,493 So patient denied pains to palpation, 509 00:24:35,320 --> 00:24:38,883 or patient reports pain to palpation, or not. 510 00:24:41,680 --> 00:24:43,860 Joints where two or more bones meet, 511 00:24:43,860 --> 00:24:48,340 classified as fibrous, cartilage, or synovial. 512 00:24:48,340 --> 00:24:49,173 Ligaments. 513 00:24:49,173 --> 00:24:53,680 Look at all of this, like ligaments, tendons, the muscle, 514 00:24:53,680 --> 00:24:54,760 the bursae. 515 00:24:54,760 --> 00:24:58,700 My mom had one of the bursae of her shoulder burst. 516 00:24:58,700 --> 00:25:02,270 And she said it was so bad. 517 00:25:02,270 --> 00:25:04,360 She's a nurse, and she couldn't go to work. 518 00:25:04,360 --> 00:25:06,240 Her arm was like, 519 00:25:06,240 --> 00:25:07,250 she couldn't lift her arm. 520 00:25:07,250 --> 00:25:08,730 And as nurses, 521 00:25:08,730 --> 00:25:11,210 we need to be very protective of our arms and legs. 522 00:25:11,210 --> 00:25:12,220 Because if we don't, 523 00:25:12,220 --> 00:25:15,670 we can't use our hands or shoulders or our legs, 524 00:25:15,670 --> 00:25:16,750 we can't really work. 525 00:25:16,750 --> 00:25:20,253 So she said it hurt really badly. 526 00:25:22,570 --> 00:25:26,050 Patients may report pain, stiffness, redness, swelling, 527 00:25:26,050 --> 00:25:27,500 popping, clicking, locking. 528 00:25:27,500 --> 00:25:28,650 Some of you might have that, 529 00:25:28,650 --> 00:25:30,720 I know when I move my shoulder, 530 00:25:30,720 --> 00:25:34,240 I feel clicking, but it doesn't hurt me. 531 00:25:34,240 --> 00:25:37,280 They might felt changes in weight. 532 00:25:37,280 --> 00:25:40,090 When my knee was really bad, 533 00:25:40,090 --> 00:25:44,880 I felt like I was walking around with lead around my knee. 534 00:25:44,880 --> 00:25:47,330 It was so uncomfortable. 535 00:25:47,330 --> 00:25:49,150 It's a lot better now. 536 00:25:49,150 --> 00:25:51,350 But when it's really swollen, 537 00:25:51,350 --> 00:25:53,400 it feels like I'm just whole, 538 00:25:53,400 --> 00:25:56,140 I have this extra weight on that joint. 539 00:25:56,140 --> 00:25:58,270 Can you imagine, like as a student, 540 00:25:58,270 --> 00:25:59,157 you're going into clinicals, 541 00:25:59,157 --> 00:26:02,440 and one of your joints hurts and you're trying to learn, 542 00:26:02,440 --> 00:26:04,723 but your joint really hurts you. 543 00:26:05,771 --> 00:26:09,543 And it can affect your mental status as well. 544 00:26:10,780 --> 00:26:12,430 Muscle wasting. 545 00:26:12,430 --> 00:26:15,170 If they're not using that particular arm or leg 546 00:26:15,170 --> 00:26:16,800 because of the pain, 547 00:26:16,800 --> 00:26:18,400 they'll lose muscle function. 548 00:26:18,400 --> 00:26:21,290 So they might have to have PT, 549 00:26:21,290 --> 00:26:23,360 loss of voluntary control sometimes, 550 00:26:23,360 --> 00:26:24,823 which can be very, 551 00:26:27,910 --> 00:26:30,420 can be disheartening sometimes. 552 00:26:30,420 --> 00:26:31,510 What else? 553 00:26:31,510 --> 00:26:33,370 What else is the patient saying about that joint? 554 00:26:33,370 --> 00:26:34,563 What's affecting them? 555 00:26:35,560 --> 00:26:36,440 Ask your patient. 556 00:26:36,440 --> 00:26:38,930 What are they able to do independently? 557 00:26:38,930 --> 00:26:40,393 Where do they need help? 558 00:26:41,430 --> 00:26:43,680 Tell me about your recent changes 559 00:26:45,520 --> 00:26:46,913 related to that joint. 560 00:26:48,190 --> 00:26:51,450 And again identifying patients who are at risk for falls, 561 00:26:51,450 --> 00:26:54,040 especially again, your older patients. 562 00:26:54,040 --> 00:26:57,430 Because remember if that patient has a joint problem, 563 00:26:57,430 --> 00:26:58,750 or a muscle problem, 564 00:26:58,750 --> 00:27:03,750 or a bone problem that causes them to fall, 565 00:27:04,770 --> 00:27:06,170 they could hit their heads, right? 566 00:27:06,170 --> 00:27:08,620 And then they're in a worse situation. 567 00:27:08,620 --> 00:27:11,790 So that's a big thing that we look at in the hospital. 568 00:27:11,790 --> 00:27:13,210 We don't want anybody falling, 569 00:27:13,210 --> 00:27:14,500 we don't want them hitting their head, 570 00:27:14,500 --> 00:27:16,870 or sustaining any kind of injury. 571 00:27:16,870 --> 00:27:20,620 So these are the patients that we watch very closely. 572 00:27:20,620 --> 00:27:23,723 They probably have PT, OT to help them out. 573 00:27:26,340 --> 00:27:27,320 Personal health history. 574 00:27:27,320 --> 00:27:28,830 Past problems or injuries, 575 00:27:28,830 --> 00:27:33,430 chronic diseases that might affect their joints, 576 00:27:33,430 --> 00:27:34,900 menopause, I'm not gonna tell you 577 00:27:34,900 --> 00:27:36,530 how all of this affects the joints, 578 00:27:36,530 --> 00:27:39,233 but just know that it can. 579 00:27:41,080 --> 00:27:42,250 Self image, 580 00:27:42,250 --> 00:27:44,360 if they're not able to exercise like they used to, 581 00:27:44,360 --> 00:27:45,740 they're not able to run at all. 582 00:27:45,740 --> 00:27:47,500 I don't know if any of you are runners, 583 00:27:47,500 --> 00:27:49,360 but what if one day you hurt yourself 584 00:27:49,360 --> 00:27:51,240 and you weren't able to run, 585 00:27:51,240 --> 00:27:52,853 how would that affect you? 586 00:27:54,040 --> 00:27:55,880 Or you weren't able to do a certain activity 587 00:27:55,880 --> 00:28:00,220 that you really love because of your muscle or bone injury. 588 00:28:00,220 --> 00:28:02,210 I don't know. Some of you are skiers, too. 589 00:28:02,210 --> 00:28:03,890 What if you were told you couldn't ski anymore 590 00:28:03,890 --> 00:28:05,800 because of that injury? 591 00:28:05,800 --> 00:28:08,160 It can affect self image. 592 00:28:08,160 --> 00:28:10,340 It can impact your social status, 593 00:28:10,340 --> 00:28:12,773 your sexual function, potentially. 594 00:28:14,190 --> 00:28:15,770 Family history. 595 00:28:15,770 --> 00:28:20,440 So joints can be affected by like RA, rheumatoid arthritis, 596 00:28:20,440 --> 00:28:23,460 gout, osteoporosis. 597 00:28:23,460 --> 00:28:24,693 I have RA. 598 00:28:25,910 --> 00:28:28,333 I developed RA after having Elise. 599 00:28:30,859 --> 00:28:33,850 And I'm just telling you a personal story, a personal thing, 600 00:28:33,850 --> 00:28:35,570 because it helps us learn, 601 00:28:35,570 --> 00:28:38,270 but it really did affect my joints. 602 00:28:38,270 --> 00:28:40,380 It's a lot better now 'cause I'm being treated for it. 603 00:28:40,380 --> 00:28:42,160 But before that, it was just like, 604 00:28:42,160 --> 00:28:45,080 I was in constant pain every time I did anything. 605 00:28:45,080 --> 00:28:46,733 And I wasn't like that before, 606 00:28:48,117 --> 00:28:49,563 I used to be really active. 607 00:28:50,740 --> 00:28:51,930 I even ran. 608 00:28:51,930 --> 00:28:53,430 I don't even know if you guys know what this is, 609 00:28:53,430 --> 00:28:54,923 but a Spartan Beast. 610 00:28:56,640 --> 00:28:58,350 So I was quite active 611 00:28:58,350 --> 00:29:02,130 and because of the RA and because of my knee injury, 612 00:29:02,130 --> 00:29:03,970 I haven't been able to be as active. 613 00:29:03,970 --> 00:29:06,783 So it does, you know, it can affect that person, 614 00:29:09,660 --> 00:29:11,370 their lifestyle, and all that. 615 00:29:11,370 --> 00:29:12,203 Medications. 616 00:29:12,203 --> 00:29:14,350 What medications are they on to help this? 617 00:29:14,350 --> 00:29:15,363 Do they smoke? 618 00:29:16,530 --> 00:29:18,390 Some medications can affect the joints, too. 619 00:29:18,390 --> 00:29:20,440 That's the other thing to note. 620 00:29:20,440 --> 00:29:22,093 Some of the chemo, 621 00:29:23,580 --> 00:29:26,070 medications for like cancer, breast cancer 622 00:29:26,070 --> 00:29:27,130 can really affect joints, 623 00:29:27,130 --> 00:29:29,690 can make their joints more uncomfortable. 624 00:29:29,690 --> 00:29:32,200 Caffeine, recreational drug use. 625 00:29:32,200 --> 00:29:33,340 24 hour diet. 626 00:29:33,340 --> 00:29:34,580 What kind of diet do they have? 627 00:29:34,580 --> 00:29:37,220 Is the diet affecting their joints? 628 00:29:37,220 --> 00:29:38,053 Exercise. 629 00:29:38,053 --> 00:29:40,327 Do they exercise on a regular basis, or not? 630 00:29:42,520 --> 00:29:43,763 Sunlight exposure. 631 00:29:44,700 --> 00:29:46,820 That is more related to medication 632 00:29:46,820 --> 00:29:48,410 'cause that can, 633 00:29:48,410 --> 00:29:49,490 some medications 634 00:29:51,560 --> 00:29:53,910 that are used for gout and RA and all that 635 00:29:53,910 --> 00:29:56,726 can make them more prone to burning 636 00:29:56,726 --> 00:29:58,180 when they're in the sunlight 637 00:29:58,180 --> 00:30:02,180 and that can make them more prone to skin cancer. 638 00:30:02,180 --> 00:30:03,700 So you gotta be careful with that. 639 00:30:03,700 --> 00:30:05,483 Occupation, hobbies. 640 00:30:06,810 --> 00:30:08,510 So understanding skeletal movement, 641 00:30:08,510 --> 00:30:09,920 and this will make more sense 642 00:30:09,920 --> 00:30:11,290 when you get into the clinical setting, 643 00:30:11,290 --> 00:30:13,460 when you're looking at the lab sheet, 644 00:30:13,460 --> 00:30:18,460 can they abduct or adduct their arms, their legs? 645 00:30:18,900 --> 00:30:21,244 Are they able to do circumduction, 646 00:30:21,244 --> 00:30:24,993 eversion, inversion of the feet, 647 00:30:25,910 --> 00:30:28,393 flexion, extension of the knees, for example, 648 00:30:29,510 --> 00:30:30,797 supination. 649 00:30:30,797 --> 00:30:31,670 So I think of supination, 650 00:30:31,670 --> 00:30:34,450 I'm holding a bowl of soup 651 00:30:34,450 --> 00:30:35,973 versus pronation. 652 00:30:37,560 --> 00:30:40,410 Protraction versus retraction. 653 00:30:40,410 --> 00:30:43,433 We're gonna do all of this in lab this week. 654 00:30:44,520 --> 00:30:46,540 And then just the pictures of the various joints 655 00:30:46,540 --> 00:30:48,660 that we're gonna be assessing. 656 00:30:48,660 --> 00:30:51,523 The jaw, the shoulders, 657 00:30:53,730 --> 00:30:55,763 the arms, the knees, 658 00:30:56,780 --> 00:30:59,130 the hands, the hips, 659 00:30:59,130 --> 00:31:01,113 the back, the neck, 660 00:31:02,750 --> 00:31:03,993 again, the knees. 661 00:31:05,250 --> 00:31:06,520 So just to tell you a story 662 00:31:06,520 --> 00:31:08,290 'cause I can see I have some time, 663 00:31:08,290 --> 00:31:10,043 but I, freak accident, 664 00:31:11,240 --> 00:31:12,770 this is when I had, 665 00:31:12,770 --> 00:31:13,603 after I had Elise, 666 00:31:13,603 --> 00:31:15,570 it was about a year after I had Elise, 667 00:31:15,570 --> 00:31:16,840 I was dealing with the RA. 668 00:31:16,840 --> 00:31:18,980 We didn't really know it was RA yet. 669 00:31:18,980 --> 00:31:23,980 And I put my knee, my right knee on the couch 670 00:31:24,240 --> 00:31:26,330 to go close the blind, 671 00:31:26,330 --> 00:31:28,590 like I was just reaching to close the blind, 672 00:31:28,590 --> 00:31:33,120 and I felt a tear from my knee up. 673 00:31:33,120 --> 00:31:35,630 And what happened was the ligaments 674 00:31:35,630 --> 00:31:38,890 that hold this portion of the patella 675 00:31:38,890 --> 00:31:41,260 caused a shift in the patella, 676 00:31:41,260 --> 00:31:45,283 so it was rubbing against the femur for a while, 677 00:31:46,560 --> 00:31:50,240 and I couldn't walk, I was so painful. 678 00:31:50,240 --> 00:31:52,430 And so I went to the doctors, 679 00:31:52,430 --> 00:31:54,410 they ordered physical therapy. 680 00:31:54,410 --> 00:31:56,930 It helped to some degree, 681 00:31:56,930 --> 00:31:58,700 but I got to the fall 682 00:31:58,700 --> 00:32:00,680 and I was in so much pain, 683 00:32:00,680 --> 00:32:02,930 like it was uncomfortable. 684 00:32:02,930 --> 00:32:06,500 And so the doctor didn't really believe me, (laughs). 685 00:32:07,480 --> 00:32:09,960 And he was like, but you know, 686 00:32:09,960 --> 00:32:13,370 let's just do an MRI of your knee just to see. 687 00:32:13,370 --> 00:32:17,480 And I was like, okay, maybe I'm imagining this pain. 688 00:32:17,480 --> 00:32:20,400 And after we got the MRI, 689 00:32:20,400 --> 00:32:21,770 basically what he told me 690 00:32:21,770 --> 00:32:25,230 is all the cartilage behind my patella is gone. 691 00:32:25,230 --> 00:32:26,820 There's no more cartilage. 692 00:32:26,820 --> 00:32:31,820 So if my patella shifts 693 00:32:31,960 --> 00:32:34,653 or if I'm like having a day where I'm not, 694 00:32:36,050 --> 00:32:39,280 maybe I'm tired 695 00:32:39,280 --> 00:32:44,120 or I can't put a lot of stress on my patella, 696 00:32:44,120 --> 00:32:46,503 meaning I have to be kind of careful with it, 697 00:32:48,200 --> 00:32:51,910 otherwise I have a lot of pain related to that area. 698 00:32:51,910 --> 00:32:54,380 So it's not like, whoa is me, 699 00:32:54,380 --> 00:32:57,580 but it's just like, FYI, if you ever see me limping, 700 00:32:57,580 --> 00:33:02,123 it's probably because it's a little inflamed on that day. 701 00:33:06,480 --> 00:33:08,380 So osteoporosis, 702 00:33:08,380 --> 00:33:11,120 I don't wanna go into great detail about osteoporosis, 703 00:33:11,120 --> 00:33:13,070 but I want you to understand 704 00:33:13,070 --> 00:33:16,970 that it does change the structure of the bones, 705 00:33:16,970 --> 00:33:21,373 makes this patient more at risk for bone fractures. 706 00:33:23,420 --> 00:33:26,670 This is again in your older patients, potentially, 707 00:33:26,670 --> 00:33:28,363 patients who are in menopause. 708 00:33:29,460 --> 00:33:32,320 Often no symptoms until first fracture. 709 00:33:32,320 --> 00:33:35,810 Fracture typically occur in the spine, wrist, and hip, 710 00:33:35,810 --> 00:33:38,980 affects one out of 10 women aged 60, 711 00:33:38,980 --> 00:33:40,550 one out of five age 70, 712 00:33:40,550 --> 00:33:43,150 two out of five of woman 80, 713 00:33:43,150 --> 00:33:46,560 and two out of three of woman age 90. 714 00:33:46,560 --> 00:33:48,030 So this is in your older patients. 715 00:33:48,030 --> 00:33:49,330 Think of your grandmother. 716 00:33:51,597 --> 00:33:52,430 Think of them, 717 00:33:52,430 --> 00:33:54,470 they falls in that age group. 718 00:33:54,470 --> 00:33:57,370 So those are the ones that you really wanna make sure that 719 00:33:57,370 --> 00:33:59,140 they're being careful when they walk, 720 00:33:59,140 --> 00:34:01,840 they're getting seen by their doctors. 721 00:34:01,840 --> 00:34:04,230 Osteoporosis is lowest in black males, 722 00:34:04,230 --> 00:34:06,170 highest in white females. 723 00:34:06,170 --> 00:34:08,700 Safety fall precautions are a must. 724 00:34:08,700 --> 00:34:11,900 So again, this is a patient that you wanna make sure that, 725 00:34:11,900 --> 00:34:13,803 are they being careful at home? 726 00:34:14,670 --> 00:34:15,503 If they fall, 727 00:34:15,503 --> 00:34:19,163 would someone be able to check on them pretty quickly? 728 00:34:20,320 --> 00:34:22,290 I think especially in Vermont, 729 00:34:22,290 --> 00:34:24,223 any area that there's ice, 730 00:34:25,940 --> 00:34:29,230 we wanna make sure that these patients are not going out 731 00:34:29,230 --> 00:34:30,340 in icy conditions 732 00:34:30,340 --> 00:34:33,180 because they're the ones who would probably fall 733 00:34:33,180 --> 00:34:35,253 and fracture their hips. 734 00:34:37,270 --> 00:34:40,030 Modifiable versus non-modifiable. 735 00:34:40,030 --> 00:34:42,203 I'm gonna let you read that on your own. 736 00:34:44,050 --> 00:34:45,420 A word about older clients. 737 00:34:45,420 --> 00:34:47,890 Again, usually slower movements, 738 00:34:47,890 --> 00:34:51,200 reduced flexibility, decreased muscle strength. 739 00:34:51,200 --> 00:34:53,023 They might have some kyphosis. 740 00:34:55,572 --> 00:34:57,620 Their bones are less dense. 741 00:34:57,620 --> 00:34:59,100 They're usually stiffer. 742 00:34:59,100 --> 00:35:01,890 So it takes them a little bit longer to get out of bed. 743 00:35:01,890 --> 00:35:03,760 So just be mindful of that 744 00:35:03,760 --> 00:35:08,760 when you're helping them move and get around, 745 00:35:09,107 --> 00:35:11,057 it's gonna take a little bit more time. 746 00:35:13,009 --> 00:35:15,120 I'll let you read the rest. 747 00:35:15,120 --> 00:35:16,810 So inspecting, palpating, 748 00:35:16,810 --> 00:35:18,550 know the exam, special techniques, 749 00:35:18,550 --> 00:35:21,900 inspect for size, shape, color, symmetry of your joints, 750 00:35:21,900 --> 00:35:23,510 assess muscle, 751 00:35:23,510 --> 00:35:26,240 not your joints but your patients' joints, 752 00:35:26,240 --> 00:35:29,460 assess for muscle strength, both in the arms and the legs, 753 00:35:29,460 --> 00:35:30,723 range of motion. 754 00:35:31,570 --> 00:35:33,670 If I have a patient that I suspect 755 00:35:33,670 --> 00:35:35,420 has decreased range of motion, 756 00:35:35,420 --> 00:35:38,830 especially in their feet, knees or hips, 757 00:35:38,830 --> 00:35:40,670 I'm gonna really be attentive 758 00:35:40,670 --> 00:35:44,350 to their movement and their strength 759 00:35:44,350 --> 00:35:46,230 before I get them out of bed 760 00:35:46,230 --> 00:35:48,540 'cause I don't want them falling. 761 00:35:48,540 --> 00:35:50,680 Palpate and note any edema, heat, 762 00:35:50,680 --> 00:35:52,853 pain, tenderness, nodules, crepitus. 763 00:35:54,070 --> 00:35:55,210 And then the GALS exam. 764 00:35:55,210 --> 00:35:57,360 It just means like assessing their gait, 765 00:35:57,360 --> 00:35:59,600 their ability to move their arms, 766 00:35:59,600 --> 00:36:02,940 'cause you wanna know if they can move their arms well. 767 00:36:02,940 --> 00:36:05,210 Because if they lose balance 768 00:36:05,210 --> 00:36:07,730 and they're not able to catch themselves, 769 00:36:07,730 --> 00:36:11,770 that would be more at risk for injury. 770 00:36:11,770 --> 00:36:16,260 Legs, can they raise one leg at a time and keep it up? 771 00:36:16,260 --> 00:36:19,160 That will tell me if they're able to hold weight 772 00:36:19,160 --> 00:36:20,450 on their legs. 773 00:36:20,450 --> 00:36:21,350 And then their spine. 774 00:36:21,350 --> 00:36:23,720 If they're a little bit curved to the side 775 00:36:23,720 --> 00:36:26,570 or they're not centered, 776 00:36:26,570 --> 00:36:29,220 they are again more at risk for falls 777 00:36:29,220 --> 00:36:33,533 because their center of gravity has changed. 778 00:36:35,100 --> 00:36:36,510 So again, inspection. 779 00:36:36,510 --> 00:36:37,980 I think you get the drift 780 00:36:37,980 --> 00:36:38,930 that every time you look at a joint, 781 00:36:38,930 --> 00:36:41,430 you have to inspect it for symmetry, swelling, 782 00:36:41,430 --> 00:36:43,900 size, redness, lumps, bumps, 783 00:36:43,900 --> 00:36:47,030 obvious deformities, and any scarring. 784 00:36:47,030 --> 00:36:48,003 We palpate, 785 00:36:49,150 --> 00:36:50,630 and we assess range of motion. 786 00:36:50,630 --> 00:36:55,630 Passive range of motion is me moving a patient's arm, 787 00:36:56,430 --> 00:36:59,200 like I am assessing, they're not doing anything. 788 00:36:59,200 --> 00:37:00,033 I'm assessing 789 00:37:01,543 --> 00:37:03,430 can I move that joint. 790 00:37:03,430 --> 00:37:06,473 Active range of motion is when you, 791 00:37:07,600 --> 00:37:11,383 no, not you, the patient moves their joint on their own. 792 00:37:13,480 --> 00:37:15,590 What might influence range of motion? 793 00:37:15,590 --> 00:37:18,223 Again, strokes, trauma, 794 00:37:19,520 --> 00:37:22,630 previous injuries that might have left them 795 00:37:22,630 --> 00:37:24,423 with decreased range of motion, 796 00:37:26,450 --> 00:37:31,390 illness, sedation, fractured arms, legs. 797 00:37:34,068 --> 00:37:36,390 And I see a couple questions popping up. 798 00:37:36,390 --> 00:37:38,020 I don't know if you can read it, Dan? 799 00:37:38,020 --> 00:37:39,070 If not, I'll read it. 800 00:37:45,930 --> 00:37:49,569 - What is the best way to catch yourself if you fall? 801 00:37:49,569 --> 00:37:52,713 Isn't it really easy to break a wrist if you use your hands? 802 00:37:55,010 --> 00:37:56,160 - You could. 803 00:37:56,160 --> 00:37:57,280 You're right. You could. 804 00:37:57,280 --> 00:37:59,790 But if they have no ability to use their arms... 805 00:37:59,790 --> 00:38:01,350 So let's say they're sitting in the... 806 00:38:01,350 --> 00:38:02,460 One thing we look at 807 00:38:02,460 --> 00:38:03,660 when they're in the bed, 808 00:38:04,660 --> 00:38:07,180 can they hold themselves up? 809 00:38:07,180 --> 00:38:09,770 If they're not able to hold themselves up, 810 00:38:09,770 --> 00:38:11,230 they're gonna do this in the bed, 811 00:38:11,230 --> 00:38:13,193 they're gonna fall to the side. 812 00:38:14,200 --> 00:38:16,460 And you're right. They could injure their wrists, 813 00:38:16,460 --> 00:38:17,523 but that's, 814 00:38:18,860 --> 00:38:20,080 it does help, 815 00:38:20,080 --> 00:38:22,700 if they are able to hold themselves up, 816 00:38:22,700 --> 00:38:24,050 especially in a chair, 817 00:38:24,050 --> 00:38:26,490 you don't wanna put someone in a chair like, 818 00:38:26,490 --> 00:38:28,080 'cause there's different types of chairs, 819 00:38:28,080 --> 00:38:29,950 that's gonna always go to the side, 820 00:38:29,950 --> 00:38:32,150 and then fall out of the chair. 821 00:38:32,150 --> 00:38:34,743 Can they hold themselves up to some degree? 822 00:38:37,330 --> 00:38:41,400 So again, elderly patients, older patients, 823 00:38:41,400 --> 00:38:44,300 these are the ones that you really wanna be like mindful, 824 00:38:44,300 --> 00:38:45,740 like what's their range of motion, 825 00:38:45,740 --> 00:38:48,363 what's their ability to move. 826 00:38:49,670 --> 00:38:51,000 And we talked about this already, 827 00:38:51,000 --> 00:38:53,320 assessing muscle strength, 828 00:38:53,320 --> 00:38:54,790 actually didn't, we talked about, 829 00:38:54,790 --> 00:38:57,280 yeah, it's strength, it's the same thing. 830 00:38:57,280 --> 00:38:59,810 You already saw this slide, but in a different format, 831 00:38:59,810 --> 00:39:01,013 it was flipped. 832 00:39:02,310 --> 00:39:04,980 So full resistance, some resistance, 833 00:39:04,980 --> 00:39:06,910 active motion against gravity, 834 00:39:06,910 --> 00:39:08,423 passive range of motion, 835 00:39:10,150 --> 00:39:12,800 and then slight flicker of contraction, 836 00:39:12,800 --> 00:39:14,373 no muscle contraction. 837 00:39:15,530 --> 00:39:17,850 Again, gait, we've talked a little about it, 838 00:39:17,850 --> 00:39:21,086 but are they able to support themselves? 839 00:39:21,086 --> 00:39:24,370 And if they're in the bed, 840 00:39:24,370 --> 00:39:25,250 are they able to put, 841 00:39:25,250 --> 00:39:27,080 I can't show you, I'm gonna have to show you in lab, 842 00:39:27,080 --> 00:39:29,020 but your teachers will have to show you in lab, 843 00:39:29,020 --> 00:39:31,930 but are they able to support themselves? 844 00:39:31,930 --> 00:39:34,470 Can they put their feet flat on the ground 845 00:39:34,470 --> 00:39:36,390 and stay in that kind of that position? 846 00:39:36,390 --> 00:39:38,080 Can they stand up? 847 00:39:38,080 --> 00:39:41,380 Like if you stand them up and they kind of buckle, 848 00:39:41,380 --> 00:39:42,913 they probably can't walk. 849 00:39:44,410 --> 00:39:46,723 Stability at rest, during ambulation. 850 00:39:48,090 --> 00:39:50,180 How stable are they in the bed? 851 00:39:50,180 --> 00:39:51,130 How stable are they 852 00:39:51,130 --> 00:39:53,340 when they are sitting at the side of the bed, 853 00:39:53,340 --> 00:39:55,290 we call that dangling? 854 00:39:55,290 --> 00:39:57,443 How stable are they when they just stand up? 855 00:39:57,443 --> 00:39:59,060 That to tells me, 856 00:39:59,060 --> 00:40:00,930 will this patient be able to walk? 857 00:40:00,930 --> 00:40:01,790 Foot position. 858 00:40:01,790 --> 00:40:04,380 Sometimes your patients, especially your diabetic patients, 859 00:40:04,380 --> 00:40:06,660 they lose sensation in the feet 860 00:40:06,660 --> 00:40:09,570 and they might invert, evert their feet, 861 00:40:09,570 --> 00:40:12,700 and then they don't have a good foundation to stand on. 862 00:40:12,700 --> 00:40:15,570 So they kind of lose their balance, potentially. 863 00:40:15,570 --> 00:40:16,730 Stride. 864 00:40:16,730 --> 00:40:18,520 That's like you're walking, 865 00:40:18,520 --> 00:40:19,863 what's your stride? 866 00:40:21,970 --> 00:40:24,640 Is it like a narrow stride? 867 00:40:24,640 --> 00:40:27,083 Is it a wide stride? 868 00:40:28,360 --> 00:40:30,270 Is it not balanced? 869 00:40:30,270 --> 00:40:34,580 Are they putting weight towards one side versus the other? 870 00:40:34,580 --> 00:40:37,370 Can they even swing their arms? 871 00:40:37,370 --> 00:40:38,710 What's their posture like? 872 00:40:38,710 --> 00:40:39,850 Is it it erect? 873 00:40:39,850 --> 00:40:41,483 Is it kyphotic? 874 00:40:42,460 --> 00:40:44,070 Do they have some lordosis? 875 00:40:44,070 --> 00:40:45,783 You know, just depends. 876 00:40:47,420 --> 00:40:51,733 Do they have some changes due to Parkinson's? 877 00:40:53,520 --> 00:40:55,160 Foot drop is another one. 878 00:40:55,160 --> 00:40:56,510 Foot drop is when they lose 879 00:40:58,170 --> 00:41:00,110 some of the neurological function, 880 00:41:00,110 --> 00:41:04,343 there's some muscle atrophy that can occur as well. 881 00:41:05,350 --> 00:41:08,193 And they lose some of the function of their foot. 882 00:41:09,388 --> 00:41:11,960 A patient who's at risk for foot drop 883 00:41:11,960 --> 00:41:13,623 is someone who's like bedridden. 884 00:41:15,400 --> 00:41:18,714 And then there's another video there for you to watch. 885 00:41:18,714 --> 00:41:19,547 I'm gonna stop.