{"id":3734,"date":"2018-11-12T22:14:15","date_gmt":"2018-11-13T03:14:15","guid":{"rendered":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/?post_type=chapter&#038;p=3734"},"modified":"2024-10-24T18:16:36","modified_gmt":"2024-10-24T22:16:36","slug":"2-11-head-to-toe-assessment-musculoskeletal-assessment","status":"publish","type":"chapter","link":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/2-11-head-to-toe-assessment-musculoskeletal-assessment\/","title":{"raw":"2.11 Head-to-Toe Assessment: Musculoskeletal Assessment","rendered":"2.11 Head-to-Toe Assessment: Musculoskeletal Assessment"},"content":{"raw":"Checklist 21 provides a guide for objective and subjective data collection in a musculoskeletal assessment\r\n<table style=\"border-collapse: collapse; width: 99.9268%;\" border=\"1\">\r\n<tbody>\r\n<tr>\r\n<td style=\"border: 1px solid #000000; width: 49.9634%; text-align: center;\" colspan=\"2\"><strong>\r\n<\/strong>\r\n<h3 style=\"text-align: center;\"><a id=\"checklist21\"><\/a>Checklist 21: Musculoskeletal Assessment<\/h3>\r\n<table style=\"border-collapse: collapse; width: 100%; border: 0px solid #000000;\">\r\n<tbody>\r\n<tr style=\"border: 0px solid #000000;\">\r\n<td style=\"width: 50%; border: none;\">\r\n\r\n[caption id=\"attachment_3685\" align=\"aligncenter\" width=\"178\"]<a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/11\/Muscular_system_svg.jpg\" target=\"_blank\" rel=\"noopener\"><img class=\"wp-image-3685 size-full\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/11\/Muscular_system_svg.jpg\" alt=\"\" width=\"178\" height=\"250\" \/><\/a> Figure 2.26 Muscular system[\/caption]<\/td>\r\n<td style=\"width: 50%; border: none;\">\r\n\r\n[caption id=\"attachment_3687\" align=\"aligncenter\" width=\"129\"]<a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/11\/skeletal-system.jpg\" target=\"_blank\" rel=\"noopener\"><img class=\"wp-image-3687 size-full\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/11\/skeletal-system.jpg\" alt=\"\" width=\"129\" height=\"250\" \/><\/a> Figure 2.27 Skeletal system[\/caption]<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<h5 style=\"text-align: center;\"><em>Disclaimer: Always review and follow your agency policies and guidelines regarding this specific skill.<\/em><\/h5>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"border: 1px solid #000000; width: 49.9634%; text-align: center;\" colspan=\"2\">\r\n<h5><span style=\"color: #000000;\">Safety considerations:<\/span><\/h5>\r\n<ul>\r\n \t<li style=\"text-align: left;\"><span style=\"color: #333333;\">Perform hand hygiene.<\/span><\/li>\r\n \t<li style=\"text-align: left;\"><span style=\"color: #333333;\">Introduce yourself to patient.<\/span><\/li>\r\n \t<li style=\"text-align: left;\"><span style=\"color: #333333;\">Confirm patient ID using two patient identifiers (e.g., name and date of birth).<\/span><\/li>\r\n \t<li style=\"text-align: left;\"><span style=\"color: #333333;\">Explain process to patient.<\/span><\/li>\r\n \t<li style=\"text-align: left;\"><span style=\"color: #333333;\">Be organized and systematic in your assessment.<\/span><\/li>\r\n \t<li style=\"text-align: left;\"><span style=\"color: #333333;\">Use appropriate listening and questioning skills.<\/span><\/li>\r\n \t<li style=\"text-align: left;\"><span style=\"color: #333333;\">Listen and attend to patient cues.<\/span><\/li>\r\n \t<li style=\"text-align: left;\"><span style=\"color: #333333;\">Ensure patient's privacy and dignity.<\/span><\/li>\r\n \t<li style=\"text-align: left;\">Document according to agency guidelines<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<table style=\"border-collapse: collapse; width: 99.9268%;\" border=\"1\">\r\n<tbody>\r\n<tr>\r\n<td style=\"border: 1px solid #000000; width: 49.9634%; text-align: center;\" colspan=\"2\">\r\n<h3 style=\"text-align: center;\">Objective Data<\/h3>\r\n<h5 style=\"text-align: center;\">Consider the following observations.<\/h5>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"border: 1px solid #000000; width: 49.9634%; text-align: center;\">\r\n<h4 style=\"text-align: center;\">Steps<\/h4>\r\n<\/td>\r\n<td style=\"border: 1px solid #000000; width: 49.9634%; text-align: center;\">\r\n<h4 style=\"text-align: center;\">Additional Information<\/h4>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"border: 1px solid #000000; width: 49.9634%;\"><strong>Observe<\/strong>\u00a0ability to maintain trunk in upright position, mobility, assistive devices, bruising, curvature or abnormalities of the spine, presence of casts, braces, or splints.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 49.9634%;\">General ability to move one's body and maintain upright position reveals information about muscle strength and need for assistance with mobility needs.\r\n\r\nAssistive devices should be in safe working order. Observe the patient's ability to use these safely. See <a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/3-5-assistive-devices\/\">Chapter 3.5 Assistive Devices.<\/a>\r\n\r\nAny need for assistance, including mobility aids, should be included in the plan of care.<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"border: 1px solid #000000; width: 49.9634%;\"><strong>Observe<\/strong>\u00a0range of motion (ROM) of upper and lower extremities.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 49.9634%;\">Limitations in ROM may suggest articular disease or injury.\r\n\r\nCWMS (colour, warmth, movement, sensation) assessment encompasses many systems and is a quick way to rule out concern(s).\r\n\r\n&nbsp;\r\n\r\nView <a href=\"https:\/\/barabus.tru.ca\/nursing\/assessing_ROM.html\">Assessing Range of Motion and Strength<\/a> by Candace Walker and Wendy McKenzie Thompson Rivers University.<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"border: 1px solid #000000; width: 49.9634%;\"><strong>Inspect<\/strong>\u00a0arms and legs for pain, deformity, edema, pressure areas, and bruises.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 49.9634%;\">Unexpected findings should be followed with more detailed history and assessment, and reported to the appropriate healthcare provider.\r\n\r\nCompare limbs bilaterally.<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"border: 1px solid #000000; width: 49.9634%;\">Assess motor power through hand grips, dorsi and plantar flexion, and knee and hip flexion against resistance.\r\n\r\n&nbsp;\r\n\r\nGeneral arm and hand strength can be assessed by asking the patient to extend their arms and grip the nurse\u2019s hands simultaneously.\r\n\r\n&nbsp;\r\n\r\nApply slight resistance to top surface and ask patient to push against resistance.\r\n\r\n&nbsp;\r\n\r\nApply slight resistance to bottom of arms and ask patient to push against resistance.\r\n\r\n&nbsp;\r\n\r\nRepeat with other arm<\/td>\r\n<td style=\"border: 1px solid #000000; width: 49.9634%;\">&nbsp;\r\n\r\n[caption id=\"attachment_4567\" align=\"alignleft\" width=\"257\"]<img class=\"wp-image-4567\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2019\/06\/assessing-arm-strength-300x241.jpg\" alt=\"\" width=\"257\" height=\"207\" \/> Figure 2.28 Assessing arm strength using resistance[\/caption]\r\n\r\n[caption id=\"attachment_4569\" align=\"alignright\" width=\"300\"]<img class=\"wp-image-4569 size-medium\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/11\/assessing-leg-strength-against-resistance-300x225.jpg\" alt=\"\" width=\"300\" height=\"225\" \/> Figure 2.29 Assess leg strength using resistance[\/caption]\r\n\r\n&nbsp;\r\n\r\n&nbsp;\r\n\r\n&nbsp;\r\n\r\n&nbsp;\r\n\r\n&nbsp;\r\n\r\n&nbsp;\r\n\r\n&nbsp;\r\n\r\n&nbsp;\r\n\r\n&nbsp;\r\n\r\n&nbsp;\r\n\r\n&nbsp;\r\n\r\n&nbsp;\r\n\r\n&nbsp;\r\n\r\n&nbsp;\r\n\r\n&nbsp;\r\n<p style=\"margin-right: 6.5pt;\">Asymmetrical findings may suggest underlying conditions, injury, effects of some medications, or post surgical complications.<\/p>\r\n&nbsp;<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"border: 1px solid #000000; width: 49.9634%;\">General leg strength can be assessed by asking the patient to plantar flex while the nurse applies some resistance to the bottom of the feet. Dorsiflexion strength can be assessed by asking the patient to pull-up on their feet while the nurse applies some resistance to the top of the feet. Have the patient elevate one leg to 30 degrees and hold. Apply slight resistance to top surface and ask patient to push against resistance. Apply resistance to the bottom surface and ask the patient to push against resistance. Repeat with other leg.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 49.9634%;\"><img class=\"wp-image-327 size-medium\" style=\"font-weight: bold; font-family: inherit; font-size: 1.125rem;\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/DSC_2277-1-300x199.jpg\" alt=\"\" width=\"300\" height=\"199\" \/>\r\n\r\nFigure 2.30 assess strength of plantar flexion\r\n\r\n[caption id=\"attachment_4568\" align=\"alignright\" width=\"300\"]<img class=\"wp-image-4568 size-medium\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2019\/06\/assessing-leg-strength-300x209.jpg\" alt=\"\" width=\"300\" height=\"209\" \/> Figure 2.31 Assess leg strength against resistance[\/caption]<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"border: 1px solid #000000; width: 49.9634%;\"><strong>Palpate<\/strong> limbs for abnormality.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 49.9634%;\">Signs and symptoms of DVT include unilateral edema, pain, redness, and warmth at the site.\r\n\r\nAny abnormalities or concerns should be reported to the appropriate healthcare provider.<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<table style=\"width: 99.9268%;\" border=\"1\">\r\n<tbody>\r\n<tr>\r\n<td style=\"border: 1px solid #000000; width: 49.9634%;\" colspan=\"2\">\r\n<h3 style=\"text-align: center;\">Subjective Data<\/h3>\r\n<h5 style=\"text-align: center;\">Ask about pain function, activity\u00a0levels, joint problems, medications, and previous injury to extremities that may influence assessment findings.<\/h5>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"border: 1px solid #000000; width: 49.9634%;\" colspan=\"2\">\r\n<h4 style=\"text-align: left;\">Focused musculoskeletal assessment may include:<\/h4>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"border: 1px solid #000000; width: 49.9634%;\"><strong>Determine\u00a0Weight Bearing Status<\/strong><\/td>\r\n<td style=\"border: 1px solid #000000; width: 49.9634%;\">Check orders for weight bearing status if applicable. Some surgeries require the patient to be non- or partial weight bearing afterward to optimize healing.\r\n\r\nFor example: non-weight bearing, partial weight bearing, feather weight bearing.<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"border: 1px solid #000000; width: 49.9634%;\"><strong>Falls Risk Assessment<\/strong>:\u00a0Falls occur as a result of losing balance or inability to regain balance. A number of risk factors can be considered when predicting risk some of which are not modifiable (age) and others modifiable (diet, exercise, poor vision). Risk assessment tools help healthcare providers to predict risk and are the starting point of\u00a0 implementing strategies to reduce risk as much as possible.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 49.9634%;\">\u00a0Falls risk assessment is a routine part of nursing care in residential and acute settings. Communicate risk and appropriate interventions with the healthcare team and according to agency guidelines.\r\n\r\nSee:\r\n<ul>\r\n \t<li>Safer Health Care Now. (2015). <em><a href=\"http:\/\/www.patientsafetyinstitute.ca\/en\/toolsResources\/Documents\/Interventions\/Reducing%20Falls%20and%20Injury%20from%20Falls\/Falls%20Getting%20Started%20Kit.pdf\">Reducing falls and injuries from falls<\/a><\/em> (p. 131).<\/li>\r\n<\/ul>\r\nBe aware of your agency\u2019s guidelines to reduce risk of falls and injury related to falls.<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"border: 1px solid #000000; width: 49.9634%;\"><strong>Mobility Risk Assessment<\/strong><\/td>\r\n<td style=\"border: 1px solid #000000; width: 49.9634%;\">See <a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/3-3-risk-assessment-for-safer-patient-handling\/\">Chapter 3.3 Risk Assessment for Safer Patient Handling<\/a><\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"border: 1px solid #000000; width: 49.9634%;\"><strong>Motor Strength<\/strong>: Using an objective scale<\/td>\r\n<td style=\"border: 1px solid #000000; width: 49.9634%;\">\r\n<table style=\"border-collapse: collapse; width: 99.8496%;\" border=\"1\">\r\n<tbody>\r\n<tr>\r\n<td style=\"border: 1px solid #000000; width: 7.06767%; text-align: center;\" colspan=\"2\"><strong>Sample Motor Assessment Associated with Epidural Analgesia<\/strong><\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"border: 1px solid #000000; width: 7.06767%; text-align: center;\">0<\/td>\r\n<td style=\"border: 1px solid #000000; width: 92.782%;\">No motor block: No intervention required.<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"border: 1px solid #000000; width: 7.06767%; text-align: center;\">1<\/td>\r\n<td style=\"border: 1px solid #000000; width: 92.782%;\">Able to flex knees, but weak<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"border: 1px solid #000000; width: 7.06767%; text-align: center;\">2<\/td>\r\n<td style=\"border: 1px solid #000000; width: 92.782%;\">Able to flex ankles. Can not flex knees<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"border: 1px solid #000000; width: 7.06767%; text-align: center;\">3<\/td>\r\n<td style=\"border: 1px solid #000000; width: 92.782%;\">Cannot move ankles or knees<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"border: 1px solid #000000; width: 99.8497%; text-align: left;\" colspan=\"2\">Adapted from OLCHC, 2016<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\nFollow your agency guideline for the specific motor strength assessment scale used at your facility.<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"border: 1px solid #000000; width: 49.9634%;\" colspan=\"2\">Potential nursing diagnoses:\r\n<ul>\r\n \t<li>Deconditioning related to immobility<\/li>\r\n \t<li>Risk of falls<\/li>\r\n \t<li>Altered mobility<\/li>\r\n<\/ul>\r\n<strong>\u00a0<\/strong><\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"border: 1px solid #000000; width: 49.9634%;\" colspan=\"2\">Data Source: Assessment Skill Checklists, 2014; Jarvis et al., 2014; OLCH, 2016; Perry et al., 2018; Potter et al, 2019;\u00a0 Safer Health Care Now, 2015; Stephen et al., 2012; Wilson &amp; Giddens, 2013<strong>\r\n<\/strong><strong>\r\n<\/strong><\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<table style=\"border-collapse: collapse; width: 99.9268%;\" border=\"1\">\r\n<tbody>\r\n<tr>\r\n<td style=\"border: 1px solid #000000; width: 99.9268%;\">Potential musculoskeletal related nursing diagnoses:\r\n<ul>\r\n \t<li>Deconditioning related to immobility<\/li>\r\n \t<li>Risk of falls<\/li>\r\n \t<li>altered mobility due to<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"border: 1px solid #000000; width: 99.9268%;\">Data sources: Assessment Skill Checklists, 2014; Jarvis, Browne, MacDonald-Jenkins, &amp; Luctkar-Flude, 2014; OLCHC, 2016; Perry et al., 2018; Potter, Potter, &amp; Ostendorf, 2019; Safer Health Care Now, 2015; Stephen, Skillen, Day, &amp; Jensen, 2012; Wilson &amp; Giddens, 2013<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<div class=\"bcc-box bcc-info\">\r\n<h3 style=\"text-align: center;\">Critical Thinking Exercises<\/h3>\r\n<ol>\r\n \t<li>Identify three strategies to reduce falls risk in a client with unlimited mobility.<\/li>\r\n \t<li>Besides nursing, identify interdisciplinary roles that can assist patients with mobility issues.<\/li>\r\n<\/ol>\r\n<\/div>\r\n<h2>Attributions:<\/h2>\r\nFigure 2.26\u00a0<a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Muscular_system.svg\">Muscular System<\/a> by <a href=\"https:\/\/commons.wikimedia.org\/wiki\/User:Termininja\">Termininja<\/a> is used under a\u00a0 <a href=\"https:\/\/en.wikipedia.org\/wiki\/en:Creative_Commons\">Creative Commons<\/a> <a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/3.0\/deed.en\">Attribution-Share Alike 3.0 Unported<\/a> license.\r\n\r\nFigure 2.27\u00a0<a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Human_skeleton_front_en.svg\">Diagram of a Human Female Skeleton<\/a> by <a href=\"https:\/\/commons.wikimedia.org\/wiki\/User:LadyofHats\">LadyofHats<\/a>\u00a0Mariana Ruiz Villarreal has been released into the public domain by its author via Wikimedia.","rendered":"<p>Checklist 21 provides a guide for objective and subjective data collection in a musculoskeletal assessment<\/p>\n<table style=\"border-collapse: collapse; width: 99.9268%;\">\n<tbody>\n<tr>\n<td style=\"border: 1px solid #000000; width: 49.9634%; text-align: center;\" colspan=\"2\"><strong><br \/>\n<\/strong><\/p>\n<h3 style=\"text-align: center;\"><a id=\"checklist21\"><\/a>Checklist 21: Musculoskeletal Assessment<\/h3>\n<table style=\"border-collapse: collapse; width: 100%; border: 0px solid #000000;\">\n<tbody>\n<tr style=\"border: 0px solid #000000;\">\n<td style=\"width: 50%; border: none;\">\n<figure id=\"attachment_3685\" aria-describedby=\"caption-attachment-3685\" style=\"width: 178px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/11\/Muscular_system_svg.jpg\" target=\"_blank\" rel=\"noopener\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-3685 size-full\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/11\/Muscular_system_svg.jpg\" alt=\"\" width=\"178\" height=\"250\" srcset=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/11\/Muscular_system_svg.jpg 178w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/11\/Muscular_system_svg-65x91.jpg 65w\" sizes=\"auto, (max-width: 178px) 100vw, 178px\" \/><\/a><figcaption id=\"caption-attachment-3685\" class=\"wp-caption-text\">Figure 2.26 Muscular system<\/figcaption><\/figure>\n<\/td>\n<td style=\"width: 50%; border: none;\">\n<figure id=\"attachment_3687\" aria-describedby=\"caption-attachment-3687\" style=\"width: 129px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/11\/skeletal-system.jpg\" target=\"_blank\" rel=\"noopener\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-3687 size-full\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/11\/skeletal-system.jpg\" alt=\"\" width=\"129\" height=\"250\" srcset=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/11\/skeletal-system.jpg 129w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/11\/skeletal-system-65x126.jpg 65w\" sizes=\"auto, (max-width: 129px) 100vw, 129px\" \/><\/a><figcaption id=\"caption-attachment-3687\" class=\"wp-caption-text\">Figure 2.27 Skeletal system<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h5 style=\"text-align: center;\"><em>Disclaimer: Always review and follow your agency policies and guidelines regarding this specific skill.<\/em><\/h5>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #000000; width: 49.9634%; text-align: center;\" colspan=\"2\">\n<h5><span style=\"color: #000000;\">Safety considerations:<\/span><\/h5>\n<ul>\n<li style=\"text-align: left;\"><span style=\"color: #333333;\">Perform hand hygiene.<\/span><\/li>\n<li style=\"text-align: left;\"><span style=\"color: #333333;\">Introduce yourself to patient.<\/span><\/li>\n<li style=\"text-align: left;\"><span style=\"color: #333333;\">Confirm patient ID using two patient identifiers (e.g., name and date of birth).<\/span><\/li>\n<li style=\"text-align: left;\"><span style=\"color: #333333;\">Explain process to patient.<\/span><\/li>\n<li style=\"text-align: left;\"><span style=\"color: #333333;\">Be organized and systematic in your assessment.<\/span><\/li>\n<li style=\"text-align: left;\"><span style=\"color: #333333;\">Use appropriate listening and questioning skills.<\/span><\/li>\n<li style=\"text-align: left;\"><span style=\"color: #333333;\">Listen and attend to patient cues.<\/span><\/li>\n<li style=\"text-align: left;\"><span style=\"color: #333333;\">Ensure patient&#8217;s privacy and dignity.<\/span><\/li>\n<li style=\"text-align: left;\">Document according to agency guidelines<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<table style=\"border-collapse: collapse; width: 99.9268%;\">\n<tbody>\n<tr>\n<td style=\"border: 1px solid #000000; width: 49.9634%; text-align: center;\" colspan=\"2\">\n<h3 style=\"text-align: center;\">Objective Data<\/h3>\n<h5 style=\"text-align: center;\">Consider the following observations.<\/h5>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #000000; width: 49.9634%; text-align: center;\">\n<h4 style=\"text-align: center;\">Steps<\/h4>\n<\/td>\n<td style=\"border: 1px solid #000000; width: 49.9634%; text-align: center;\">\n<h4 style=\"text-align: center;\">Additional Information<\/h4>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #000000; width: 49.9634%;\"><strong>Observe<\/strong>\u00a0ability to maintain trunk in upright position, mobility, assistive devices, bruising, curvature or abnormalities of the spine, presence of casts, braces, or splints.<\/td>\n<td style=\"border: 1px solid #000000; width: 49.9634%;\">General ability to move one&#8217;s body and maintain upright position reveals information about muscle strength and need for assistance with mobility needs.<\/p>\n<p>Assistive devices should be in safe working order. Observe the patient&#8217;s ability to use these safely. See <a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/3-5-assistive-devices\/\">Chapter 3.5 Assistive Devices.<\/a><\/p>\n<p>Any need for assistance, including mobility aids, should be included in the plan of care.<\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #000000; width: 49.9634%;\"><strong>Observe<\/strong>\u00a0range of motion (ROM) of upper and lower extremities.<\/td>\n<td style=\"border: 1px solid #000000; width: 49.9634%;\">Limitations in ROM may suggest articular disease or injury.<\/p>\n<p>CWMS (colour, warmth, movement, sensation) assessment encompasses many systems and is a quick way to rule out concern(s).<\/p>\n<p>&nbsp;<\/p>\n<p>View <a href=\"https:\/\/barabus.tru.ca\/nursing\/assessing_ROM.html\">Assessing Range of Motion and Strength<\/a> by Candace Walker and Wendy McKenzie Thompson Rivers University.<\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #000000; width: 49.9634%;\"><strong>Inspect<\/strong>\u00a0arms and legs for pain, deformity, edema, pressure areas, and bruises.<\/td>\n<td style=\"border: 1px solid #000000; width: 49.9634%;\">Unexpected findings should be followed with more detailed history and assessment, and reported to the appropriate healthcare provider.<\/p>\n<p>Compare limbs bilaterally.<\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #000000; width: 49.9634%;\">Assess motor power through hand grips, dorsi and plantar flexion, and knee and hip flexion against resistance.<\/p>\n<p>&nbsp;<\/p>\n<p>General arm and hand strength can be assessed by asking the patient to extend their arms and grip the nurse\u2019s hands simultaneously.<\/p>\n<p>&nbsp;<\/p>\n<p>Apply slight resistance to top surface and ask patient to push against resistance.<\/p>\n<p>&nbsp;<\/p>\n<p>Apply slight resistance to bottom of arms and ask patient to push against resistance.<\/p>\n<p>&nbsp;<\/p>\n<p>Repeat with other arm<\/td>\n<td style=\"border: 1px solid #000000; width: 49.9634%;\">&nbsp;<\/p>\n<figure id=\"attachment_4567\" aria-describedby=\"caption-attachment-4567\" style=\"width: 257px\" class=\"wp-caption alignleft\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-4567\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2019\/06\/assessing-arm-strength-300x241.jpg\" alt=\"\" width=\"257\" height=\"207\" srcset=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2019\/06\/assessing-arm-strength-300x241.jpg 300w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2019\/06\/assessing-arm-strength-65x52.jpg 65w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2019\/06\/assessing-arm-strength-225x181.jpg 225w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2019\/06\/assessing-arm-strength.jpg 350w\" sizes=\"auto, (max-width: 257px) 100vw, 257px\" \/><figcaption id=\"caption-attachment-4567\" class=\"wp-caption-text\">Figure 2.28 Assessing arm strength using resistance<\/figcaption><\/figure>\n<figure id=\"attachment_4569\" aria-describedby=\"caption-attachment-4569\" style=\"width: 300px\" class=\"wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-4569 size-medium\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/11\/assessing-leg-strength-against-resistance-300x225.jpg\" alt=\"\" width=\"300\" height=\"225\" srcset=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/11\/assessing-leg-strength-against-resistance-300x225.jpg 300w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/11\/assessing-leg-strength-against-resistance-65x49.jpg 65w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/11\/assessing-leg-strength-against-resistance-225x168.jpg 225w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/11\/assessing-leg-strength-against-resistance.jpg 350w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-4569\" class=\"wp-caption-text\">Figure 2.29 Assess leg strength using resistance<\/figcaption><\/figure>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p style=\"margin-right: 6.5pt;\">Asymmetrical findings may suggest underlying conditions, injury, effects of some medications, or post surgical complications.<\/p>\n<p>&nbsp;<\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #000000; width: 49.9634%;\">General leg strength can be assessed by asking the patient to plantar flex while the nurse applies some resistance to the bottom of the feet. Dorsiflexion strength can be assessed by asking the patient to pull-up on their feet while the nurse applies some resistance to the top of the feet. Have the patient elevate one leg to 30 degrees and hold. Apply slight resistance to top surface and ask patient to push against resistance. Apply resistance to the bottom surface and ask the patient to push against resistance. Repeat with other leg.<\/td>\n<td style=\"border: 1px solid #000000; width: 49.9634%;\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-327 size-medium\" style=\"font-weight: bold; font-family: inherit; font-size: 1.125rem;\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/DSC_2277-1-300x199.jpg\" alt=\"\" width=\"300\" height=\"199\" srcset=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/DSC_2277-1-300x199.jpg 300w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/DSC_2277-1-768x509.jpg 768w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/DSC_2277-1-1024x678.jpg 1024w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/DSC_2277-1-65x43.jpg 65w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/DSC_2277-1-225x149.jpg 225w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/DSC_2277-1-350x232.jpg 350w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/p>\n<p>Figure 2.30 assess strength of plantar flexion<\/p>\n<figure id=\"attachment_4568\" aria-describedby=\"caption-attachment-4568\" style=\"width: 300px\" class=\"wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-4568 size-medium\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2019\/06\/assessing-leg-strength-300x209.jpg\" alt=\"\" width=\"300\" height=\"209\" srcset=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2019\/06\/assessing-leg-strength-300x209.jpg 300w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2019\/06\/assessing-leg-strength-65x45.jpg 65w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2019\/06\/assessing-leg-strength-225x157.jpg 225w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2019\/06\/assessing-leg-strength.jpg 350w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-4568\" class=\"wp-caption-text\">Figure 2.31 Assess leg strength against resistance<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #000000; width: 49.9634%;\"><strong>Palpate<\/strong> limbs for abnormality.<\/td>\n<td style=\"border: 1px solid #000000; width: 49.9634%;\">Signs and symptoms of DVT include unilateral edema, pain, redness, and warmth at the site.<\/p>\n<p>Any abnormalities or concerns should be reported to the appropriate healthcare provider.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<table style=\"width: 99.9268%;\">\n<tbody>\n<tr>\n<td style=\"border: 1px solid #000000; width: 49.9634%;\" colspan=\"2\">\n<h3 style=\"text-align: center;\">Subjective Data<\/h3>\n<h5 style=\"text-align: center;\">Ask about pain function, activity\u00a0levels, joint problems, medications, and previous injury to extremities that may influence assessment findings.<\/h5>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #000000; width: 49.9634%;\" colspan=\"2\">\n<h4 style=\"text-align: left;\">Focused musculoskeletal assessment may include:<\/h4>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #000000; width: 49.9634%;\"><strong>Determine\u00a0Weight Bearing Status<\/strong><\/td>\n<td style=\"border: 1px solid #000000; width: 49.9634%;\">Check orders for weight bearing status if applicable. Some surgeries require the patient to be non- or partial weight bearing afterward to optimize healing.<\/p>\n<p>For example: non-weight bearing, partial weight bearing, feather weight bearing.<\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #000000; width: 49.9634%;\"><strong>Falls Risk Assessment<\/strong>:\u00a0Falls occur as a result of losing balance or inability to regain balance. A number of risk factors can be considered when predicting risk some of which are not modifiable (age) and others modifiable (diet, exercise, poor vision). Risk assessment tools help healthcare providers to predict risk and are the starting point of\u00a0 implementing strategies to reduce risk as much as possible.<\/td>\n<td style=\"border: 1px solid #000000; width: 49.9634%;\">\u00a0Falls risk assessment is a routine part of nursing care in residential and acute settings. Communicate risk and appropriate interventions with the healthcare team and according to agency guidelines.<\/p>\n<p>See:<\/p>\n<ul>\n<li>Safer Health Care Now. (2015). <em><a href=\"http:\/\/www.patientsafetyinstitute.ca\/en\/toolsResources\/Documents\/Interventions\/Reducing%20Falls%20and%20Injury%20from%20Falls\/Falls%20Getting%20Started%20Kit.pdf\">Reducing falls and injuries from falls<\/a><\/em> (p. 131).<\/li>\n<\/ul>\n<p>Be aware of your agency\u2019s guidelines to reduce risk of falls and injury related to falls.<\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #000000; width: 49.9634%;\"><strong>Mobility Risk Assessment<\/strong><\/td>\n<td style=\"border: 1px solid #000000; width: 49.9634%;\">See <a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/3-3-risk-assessment-for-safer-patient-handling\/\">Chapter 3.3 Risk Assessment for Safer Patient Handling<\/a><\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #000000; width: 49.9634%;\"><strong>Motor Strength<\/strong>: Using an objective scale<\/td>\n<td style=\"border: 1px solid #000000; width: 49.9634%;\">\n<table style=\"border-collapse: collapse; width: 99.8496%;\">\n<tbody>\n<tr>\n<td style=\"border: 1px solid #000000; width: 7.06767%; text-align: center;\" colspan=\"2\"><strong>Sample Motor Assessment Associated with Epidural Analgesia<\/strong><\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #000000; width: 7.06767%; text-align: center;\">0<\/td>\n<td style=\"border: 1px solid #000000; width: 92.782%;\">No motor block: No intervention required.<\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #000000; width: 7.06767%; text-align: center;\">1<\/td>\n<td style=\"border: 1px solid #000000; width: 92.782%;\">Able to flex knees, but weak<\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #000000; width: 7.06767%; text-align: center;\">2<\/td>\n<td style=\"border: 1px solid #000000; width: 92.782%;\">Able to flex ankles. Can not flex knees<\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #000000; width: 7.06767%; text-align: center;\">3<\/td>\n<td style=\"border: 1px solid #000000; width: 92.782%;\">Cannot move ankles or knees<\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #000000; width: 99.8497%; text-align: left;\" colspan=\"2\">Adapted from OLCHC, 2016<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>Follow your agency guideline for the specific motor strength assessment scale used at your facility.<\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #000000; width: 49.9634%;\" colspan=\"2\">Potential nursing diagnoses:<\/p>\n<ul>\n<li>Deconditioning related to immobility<\/li>\n<li>Risk of falls<\/li>\n<li>Altered mobility<\/li>\n<\/ul>\n<p><strong>\u00a0<\/strong><\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #000000; width: 49.9634%;\" colspan=\"2\">Data Source: Assessment Skill Checklists, 2014; Jarvis et al., 2014; OLCH, 2016; Perry et al., 2018; Potter et al, 2019;\u00a0 Safer Health Care Now, 2015; Stephen et al., 2012; Wilson &amp; Giddens, 2013<strong><br \/>\n<\/strong><strong><br \/>\n<\/strong><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<table style=\"border-collapse: collapse; width: 99.9268%;\">\n<tbody>\n<tr>\n<td style=\"border: 1px solid #000000; width: 99.9268%;\">Potential musculoskeletal related nursing diagnoses:<\/p>\n<ul>\n<li>Deconditioning related to immobility<\/li>\n<li>Risk of falls<\/li>\n<li>altered mobility due to<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #000000; width: 99.9268%;\">Data sources: Assessment Skill Checklists, 2014; Jarvis, Browne, MacDonald-Jenkins, &amp; Luctkar-Flude, 2014; OLCHC, 2016; Perry et al., 2018; Potter, Potter, &amp; Ostendorf, 2019; Safer Health Care Now, 2015; Stephen, Skillen, Day, &amp; Jensen, 2012; Wilson &amp; Giddens, 2013<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<div class=\"bcc-box bcc-info\">\n<h3 style=\"text-align: center;\">Critical Thinking Exercises<\/h3>\n<ol>\n<li>Identify three strategies to reduce falls risk in a client with unlimited mobility.<\/li>\n<li>Besides nursing, identify interdisciplinary roles that can assist patients with mobility issues.<\/li>\n<\/ol>\n<\/div>\n<h2>Attributions:<\/h2>\n<p>Figure 2.26\u00a0<a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Muscular_system.svg\">Muscular System<\/a> by <a href=\"https:\/\/commons.wikimedia.org\/wiki\/User:Termininja\">Termininja<\/a> is used under a\u00a0 <a href=\"https:\/\/en.wikipedia.org\/wiki\/en:Creative_Commons\">Creative Commons<\/a> <a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/3.0\/deed.en\">Attribution-Share Alike 3.0 Unported<\/a> license.<\/p>\n<p>Figure 2.27\u00a0<a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Human_skeleton_front_en.svg\">Diagram of a Human Female Skeleton<\/a> by <a href=\"https:\/\/commons.wikimedia.org\/wiki\/User:LadyofHats\">LadyofHats<\/a>\u00a0Mariana Ruiz Villarreal has been released into the public domain by its author via Wikimedia.<\/p>\n","protected":false},"author":397,"menu_order":11,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[],"contributor":[],"license":[],"class_list":["post-3734","chapter","type-chapter","status-publish","hentry"],"part":102,"_links":{"self":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapters\/3734","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/wp\/v2\/users\/397"}],"version-history":[{"count":27,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapters\/3734\/revisions"}],"predecessor-version":[{"id":5227,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapters\/3734\/revisions\/5227"}],"part":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/parts\/102"}],"metadata":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapters\/3734\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/wp\/v2\/media?parent=3734"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapter-type?post=3734"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/wp\/v2\/contributor?post=3734"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/wp\/v2\/license?post=3734"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}