Republic of the Philippines

TARLAC STATE UNIVERSITY

COLLEGE OF SCIENCE
NURSING DEPARTMENT
Lucinda Campus, Brgy. Ungot, Tarlac City Philippines 2300
Tel. No.: (045) 493-1865 Fax: (045) 982-0110 website: www/tsu.edu.ph
Performance Evaluation Checklist
NCM 101 Health Assessment - Musculoskeletal System Assessment
Name of Student: Year & Section: RLE Group:
Term: __First Sem __Second Sem __Summer School Year: Inclusive Dates of Clinical Rotation

SCORE
PREPARATION
2 1 0
Greet the client. Introduce yourself and verify the client’s identity using at least 2 verifiers or
1.
as per agency protocol.
Explain the procedure to the client, what you are going to do, why it is necessary and how
2.
the client can cooperate.
3. Place the patient in a comfortable position.
4. Perform hand hygiene and observe other infection control procedures.
5. Provide for client privacy.
Assess the pain free side first and start from head to toe.
Inquire if the client has any history of:
6. a. Muscle pain
b. Limitations to movement or inability to perform ADL
c. Previous sports injuries
d. Loss of function without pain
EQUIPMENT:
7. Examination Gown
Tape measure
Clean, Nonsterile Examination Gloves
PROCEDURAL STEPS
MUSCLES
Inspect the muscles for size. Compare the muscles on one side of the body (e.g., of the arm,
8. thigh, calf) to the same muscle on the other side. For any discrepancies, measure the
muscles with a tape
9. Inspect the muscles and tendons for contractures (shortening).
Inspect the muscles for tremors, for example by having the client hold the arms out in front of
10.
the body.
11. Test muscle strength. Compare the right side with the left side.
8.a. Sternocleidomastoid: Client turns the head to one side against the resistance of your
12. hand. Repeat with the other side.
13. 8.b. Trapezius: Client shrugs the shoulders against the resistance of your hands.

8.c. Deltoid: Client holds arms up and tries to flex it while you attempt to hold arm in
14. extension.
8.d. Biceps: Client fully extends each arm and tries to flex it while you attempt to hold arm in
15. extension.
16. 8.e. Triceps: Client flexes each arm and then tries to extend it against your attempt to keep
arm in flexion.
17. 8.f. Wrist and finger muscles: Clients spread the fingers and resists as you attempt to push
the fingers together.
8.g. Grip strength: Client grasps your index and middle fingers while you try to pull the
18. fingers out.

19. 8.h. Hip muscles: Client is supine, both legs extended; client raises one leg at a time while
you attempt to hold it down.

20. 8.i. Hip abduction: Client is supine, both legs extended. Place your hands on the lateral
surface of each knee; client spreads the legs apart against your resistance.

21. 8.j. Hip adduction: Client is in the same position as for hip abduction. Place your hands
between the knees; client brings the legs together against your resistance.

8.k. Hamstrings: Client is supine, both knees bent. Client resists while you attempt to
22.
straighten the legs.

23. 8.l. Quadriceps: Client is supine, knee partially extended; client resist while you attempt to
flex the knee.
8.m. Muscle of the ankles and feet: Client resists while you attempt to dorsiflex the foot and
24. again resists while you attempt to flex the foot.

BONES
 25. Inspect the skeleton for structure.
26. Palpate the bones to locate any areas of edema or tenderness.

JOINTS:
Inspect the joint for swelling. Palpate each joint for tenderness, smoothness of movement,
27. swelling, crepitation and presence of nodules.
DOCUMENTATION
28. Document the findings in the client record using printer or electronic forms or checklists.

EVALUATION:
Perform detailed follow – up examination of other systems based on findings that deviated
29.
from expected or normal for the client. Relate findings to previous assessment date if
available.
TOTAL POINTS
GRADE