(9) Assess muscle strength and joint ROM. Have the patient perform active
ROM as you apply resistance. Normally, the patient can move joints a certain distance
(measured in degrees) and can easily resist pressure applied against movement.
Strength is normally symmetrical. If the patient cannot perform active ROM, put the joints
through passive ROM. Use a goniometer (figure 6-9) to measure the angle achieved.
Place the center or zero point on the patient's joint. Place the fixed arm perpendicular to
the plane of motion. As the patient moves the joint, the movable arm indicates the angle in
Figure 6-9. Goniometer.
j. Assessment of the Integument. Physical assessment of the skin, hair, and
nails requires inspection and palpation. Be sure the room is warm to prevent cold-induced
vasoconstriction, which may affect skin color.
(1) Systematically, assess the entire skin surface as you expose each area for
inspection and palpation of other systems. Observe the patient from a distance, noting
complexion, general color, and overall appearance. A bluish discoloration is due to lack of
oxygen in the blood. A yellow skin tone (jaundice) indicates liver dysfunction. Note
pigmentation (light and dark areas compared to the rest of the skin), freckles, and moles.
(2) Assess skin texture, consistency, temperature, moisture, and turgor. Skin
texture refers to smoothness or coarseness. Consistency refers to changes in skin
thickness or firmness and relates more to changes associated with lesions. The skin
should feel warm to cool, and areas should feel the same bilaterally. Assess turgor by
gently grasping and pulling up a fold of skin, releasing it, and observing how quickly it
returns to normal shape. Normal skin usually resumes its flat shape immediately. Poor
turgor may indicate dehydration and connective tissue disorders.
(3) Note the quantity, texture, color, and distribution of hair. Rub a few strands
of the patient's hair between you index finger and thumb. Feel for dryness, brittleness,
oiliness, and thickness.