2] Screening For Medical Referral Flashcards
“Responsible for decisions regarding the physical therapy needs of our patients”
Autonomous practice
“Physical therapists and physical therapist assistants consistently demonstrate core values by aspiring to
and wisely applying principles of altruism,
excellence, caring, ethics, respect, communication
and accountability, and by working together with
other professionals to achieve optimal health and
wellness in individuals and communities.”
Professionalism
3 choices for PT with patients
Refer/consult
Dx and treat
Dx, treat and refer
“to determine thecause and nature of a
pathological condition; to
recognize a disease”
MD Dx
Process and end result of evaluating exam/data which the therapist organizes to help determine the prognosis and most appropriate intervention
PT Dx
“diagnosis based on comparison of
symptoms of two or more similar diseases to
determine which the patient is suffering from”
Differential Dx
Classification of a specific mvmt impairment
PT differential Dx
What is medical screening?
Process of evaluating pt exam data to decide if they should be referred
When does the medical screen occur?
Initial exam but its also an ongoing process
Risk factors are specific to
Certain conditions
Important for disease prevention
• Possible factors indicating referral to physician is appropriate
• Educational opportunity
Risk factors
Most common risk factors
Age Sex Race FH PMH SH Self assessment Work/living environment
A brief exam of anatomical and physiological status
Systems review
What is a review of systems?
Tool to recognize a cluster of associated signs and Sx and need for medical referral
Identify potential health problems
• Decision-making
• Communication with physician – signs & symptoms
What review of systems is useful for
Warning history
Signs
Sx
Red flags
Cautionary history
Signs
Sx
Yellow flags
Red flag: medical referral is based on
Presence of cluster of red flags OR both red flags and risk factors
Why is it important to screen for medical disease?
Direct access Pts get sick fast Referral Red/yellow flags Pt and doc disclosure
Most important tool in screening for medical disease/need for referral
Client interview
How much % is necessary to determine cause of Sx is gathered from the interview
80%
Interviewing technique
Funnel sequence
Open ended
Paraphrase
Pain can be due to (3)
NM
Visceral
Neuropathic
Visceral pain define
Cerebral cortex is unable to distinguish site of pain
- Pain from internal organs not necessarily felt over involved organ
- Ex: liver – may cause pain at right shoulder
Visceral pain
Direct pressure on diaphragm
Visceral pain
What type of innervation is visceral pain?
Multisegmental
Onset of systemic vs MSK pain
S: insidious
M: insidious or MOI
Feeling of systemic pain
Knife
Feeling of MSK pain
Achy
Tender
Stiff
Constant, unrelieved by rest/position change
Systemic pain
Organ dependent Sx
Systemic pain
Constant or intermittent, position and mvmt change pain
MSK pain
Unilateral, referred pain
MSK pain
Bilateral Sx
Systemic pain
Night pain and unusual vital signs
Systemic pain
Where is the gall bladder, which quadrant?
RUQ
Innervation of gallbladder
T7-T9
Pain location:
• Right upper abdominal
• Right middle & lower thoracic spine
• Right scapula – inferior angle
Gall bladder
Possible right shoulder pain – pressure on diaphragm
Referred visceral pain
Neuropathic damage is to?
PNS or CNS
Pain secondary to nervous system malfunction
• NOT stimulation of nociceptors
Neuropathic pain
Description: sharp, shooting, electric shock-like
Neuropathic pain
May be induced by stimuli not normally painful: light touch
Neuropathic pain
Some causes of neuropathic pain (6)
MS CVA Herpes zoster CRPS Carpal tunnel Thoracic outlet
Cause of radical rpain
Irritation of spinal nerve or dorsal root
Experiences in Dermatomes, myotome, or sclerotome associated with affecte dnerve
Radicular pain
Difficult to differentiate b/w
Radicular vs visceral pain
Pain present for more than 3 months
Chronic pain
mediated by physiological factors – levelof nociceptive input
Pain perception - sensory component
Mediated by psychological factors related to fear of pain
Pain perception- emotional reaction component
- Assesses pain-related fear associated with movement, physical activity, and reinjury
- Condition-specific: LBP
FABQ
