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Patient Care 1 > Clinical Examination > Flashcards

Clinical Examination Flashcards

1
Q

SOAP?

A

Subjective
Objective
Assessment
Plan

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2
Q

Subjective?

A

personal assessment of immeasurable observations

  • eg demeanour, behaviour, posture
  • so different for everyone
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3
Q

objective?

A

factual assessment of measurable observations

  • eg TPR
  • so same for everyone
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4
Q

assessment?

A

involves progress comparison of the patient
- may include both subjective and objective observations

easy to see changes

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5
Q

plan?

A

how to treat the patient

may include specific treatment protocol
- eg medication or physical intervention
or an observation protocol
- eg frequency of TPR monitoring

vet will want to know any changes

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6
Q

beginning of an examination?

A

head to toe

observe the patient from distance 
- demeanour and posture will change when near 
examine overall coat condition
examine general condition 
- may see something not originally there for 
check respiratory rate 
- will change when near
- give time to calm down 
provide physical examination
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7
Q

what to remember when observing a patient?

A

each patient is an individual
signs that may be normal for one patient may not be normal for another
- eg frequency of eating/toileting
signs seen may be abnormal for an individual patient due to environmental factors
- eg cat + rabbit = stressed
important to ensure that the natural environment and routine of each species is maintained as closely as possible
- to minimise stress

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8
Q

assessment of patient?

A

on admission a routine health check should be carried out
- should be done regularly so a comparison is possible

general demeanour, temperament and overall condition can be assessed before completing a physical exam
- eg BAR, QAR or respiration

a routine check should be done daily through hospitalisation
- so health is recorded and charted

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9
Q

physical examination

head area considerations?

A

posture
- looking around, lifting head, alert?
moist nares
patient airway
- noisy is normal for some species/breeds
nasal discharge
- causes can be allergies, foreign body, virus, infection, abscess
epistaxis
- nose bleed
- caused by trauma, foreign body, tumour
sneezing or dyspnoea

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10
Q

physical examination

mouth considerations?

A

signs of dental disease
- bad breath, inflamed/red gums, avoid playing with mouth, tarter
tongue
breath
- from uraemia (urine in blood) caused by kidney disease
- from diabetes mellitus with pear drops smell
jaw misaligned
- caused by trauma - fractured/dislocated?
- can they open without difficulty?
any congenital deformities
- deformities from birth

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11
Q

physical examination

mucous membrane considerations?

A

should be moist and pink
- cats naturally paler
indicates adequate blood flow and therefore oxygenation of tissues
- so any change may indicate an issue
capillary refill time
- should be less than 2 seconds in a healthy animal

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12
Q

physical examination

mucous membrane pettechiae?

A

small pinpoint haemorrhages

seen in patients with clotting disorders

often seen those poisoned with rodenticides (warfin)

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13
Q

physical examination

mucous membrane colour - pale, grey or white?

A

poor perfusion

shock
circulatory collapse
haemorrhage 
anaemia 
severe vasoconstriction 
dehydration
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14
Q

physical examination

mucous membrane colour - red?

A

congestion - over oxygenation of tissues

sepsis
fever
congestion
extensive tissue damage

or because of post-exercise or excitement

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15
Q

physical examination

mucous membrane colour - blue or purple?

A

blue = cyanosis
from severe hypoxaemia - low blood oxygen

respiratory difficulty
poisonings
severe dehydration

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16
Q

physical examination

mucous membrane colour - yellow?

A

jaundice

liver disease - bile flow obstruction
increase in red blood cell destruction 
- increased amount of bilirubin  
neonatal isoerythrolysis 
- antibodies in mare fighting RBCs in foetus
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17
Q

physical examination

mucous membrane colour - orange?

A

jaundice disease
blood cell disorders
synthetic haemoglobin products

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18
Q

physical examination

mucous membrane colour - chocolate brown?

A

paracetamol poisoning in cats and dogs

  • cats cant have any
  • dogs can have small amount
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19
Q

physical examination

mucous membrane colour - cherry red

A

poisoning

heatstroke

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20
Q

physical examination

eyes considerations?

A 
Ulcers?
Opaque? 
Ocular discharge?
Conjunctivitis?
Foreign bodies? 
Scratching?
Increased vascularity?

May become disorientated
Make room dark

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21
Q

physical examination

eyes - blepharospasm?

A

Involuntary blinking or twitching

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22
Q

physical examination

eyes - anisocoria

A

Unequal pupil size

Caused by:

  • glaucoma - damaged optic nerve
  • chemosis - swelling of conjunctiva
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23
Q

physical examination

eyes - exophthalmos?

A

Abnormal protrusion od eyeball

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24
Q

physical examination

eyes - proptosis?

A

Prolapsed eyeball

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25
Q

physical examination

eyes - entropion?

A

Inversion of eyelids

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26
Q

physical examination

eyes - ectropion?

A

Eversion of eyelids

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27
Q

physical examination

Ears considerations?

A

Check pinnae for inflammation and wounds
Check ear canal for foreign bodies, erythema (redness of skin) or infection

If fur clipped away from arears infection is likely as less protection from foreign bodies

28
Q

physical examination

Lymph node considerations?

A

Will be enlarged in cases of neoplasia (tumour) or infection

29
Q

physical examination

Skin and coat?

A 
Dryness
Scaliness
Greasiness
Pyoderma 
- skin infection 
Urticaria (hives)
Alopecia (hair loss)
Tenting
- indication of dehydration 
Ectoparasutes 
- eg ticks, flies, mites 
- itching, hair loss, lumps
Wounds 
- open or closed?
- may be more than 1
Allergies
30
Q

physical examination

forelimbs considerations?

A 
Range of motion
Weight bearing 
Atrophy (shrinkage of muscle)
Lameness
Wounds
Crepitus (popping, clicking or crunching sounds of bones)
Fractures 
Dicomfort
Heat or swelling
Foreign bodies
- can't remove until x-ray shows where goes
31
Q

physical examination

thorax considerations?

A

Gently feel ribs and thoracic vertebra for any fractures or swelling

Heart best can be felt more easily on the left side of the ventral chest
- between ribs 3 and 6
- just below elbow
Allows for assessment of rate, strength and quality

Crackles and rales (clicking/bubbling) when listening to chest suggests:

  • pulmonary oedema
  • pneumonia
  • bronchitis
32
Q

physical examination

abdomen considerations?

A

Assess for distension (dilation)
Gently palpate checking for tenderness, pain or swelling
- using ends of fingers
- not fingertips

Kidneys, bladder, spleen and intestines may be felt
- but difficult to locate in tense or obese patients

33
Q

physical examination

pelvis and hindlimbs?

A

Pelvis and hindlimbs same way as forelimbs
Femoral pulse can be assessed
- medial aspect of proximal femur

34
Q

physical examination

tail and anus?

A

Ensure tail can move voluntary
Tail should be assessed for wounds or damage
Check coxygeal vertebrae

Anus should be checked for signs of: 
- soiling
- trauma 
- discharge 
Anal glands may become infected and/or impacted 
- signs include scooting and fishy smell
35
Q

physical examination

male reproductive organs?

A

penis and testicles should be check for signs of trauma or abnormal swelling
entire dogs should have two descended testicles
- if young and only 1 give time
- if doesn’t descend surgery needed to remove
entire horses and cats should have two palpable testicles
check sheath of geldings (castrated male horse)
- need frequent cleaning
- may attract flies and magots

36
Q

physical examination

female reproductive organs?

A

check for swelling of the vulva
check for vulval discharge in bitches
- discharge unlikely in cats and horses
check if breeding mares may have undergone caslicks surgery
- surgery to correct conformation on the vulva
- stops faeces entering so no infection
- stitches need to be removed when partuition is close
teats should be checked
- lactation
- mastitis - inflammation from infection

37
Q

vulval discharge in bitches?

A 
blood red = pro-oestrus 
straw-coloured = oestrus 
dark green/brown = parturition is soon 
black = death of foetus 
purulent green or pale coffee-coloured = pyometra
38
Q

normal vital signs in dogs?

A

temp - 38-39
pulse - 60-120
resps - 10-30

39
Q

normal signs in cats?

A

temp - 38-39
pulse - 110-180
resps - 20-30

40
Q

normal vital signs in rabbits?

A

temp - 38-40
pulse - 130-325
resps - 30-60

41
Q

normal vital signs in horses?

A

temp - 37-39
pulse - 36-42
resps - 8-15

42
Q

how and where to know pulse?

A

manual palpate and count
stethoscope
ultrasound
ECG

femoral artery - medial aspect of femur
digital arteries - palmar and plantar surfaces
coccygeal artery - ventral aspect of base of tail
lingual artery - ventral aspect of tongue

43
Q

TPR terminology

pyrexic?

A

high temperature

44
Q

TPR terminology

tachycardia/bradycardia

A

fast heart rate/slow heart rate

45
Q

TPR terminology

bradypnoea/tachypnoea?

A

slow breathing/fast breathing

46
Q

TPR terminology

apnoea?

A

no breathing

47
Q

TPR terminology

dyspnoea?

A

difficulty breathing

48
Q

TPR terminology

paradoxical breathing?

A

diaphragm moves in the opposite direction than it should

- ribs move in when breathing

49
Q

physiological changes?

A

as well as a physical examination the following should be monitored

  • appetite changes
  • urination patterns
  • defecation patterns
  • vomiting
  • coughing
  • signs of pain
  • stress and behavioural changes
  • mobility
50
Q

physiological change examination

reason for changes in appetite?

A

change in routine
change in environment
change in diet - presence of disease
medication - either side effect or require to eat (eg pain relief)

51
Q

physiological change examination

different abnormalities of appetite?

A

dysphagia - difficulty eating, especially swallowing
anorexia - loss of appetite for food
pica - craving for natural articles of food
capricious - irregular/picky eater
coprophagia - eating of faecal material
inappetence - lose of desire to eat

52
Q

how can you ensure adequate nutrition?

A

talk to owners about diet and nutrition - educate
provide food supplements (fluids)
ensure balanced diet
test, check and support any illness

53
Q

physiological changes examination
thirst
requirements? polydipsia/adipsia?

A

voluntary water intake varies with species, individual and diet

requirement 50ml/kg/24hr
- young may need more

polydipsia - increased thirst
- cushings cause thirst
adipsia - lack of first

54
Q

physiological changes examination
urination
monitoring? normal? appearance?

A

daily monitoring of urine is important

  • can catheterise to measure amount
  • use non-absorbent cat litter and pippet

normal urine output - 1-2ml/kg/hr

should be clear, pale, yellow
- cloudier in rabbits and horses - carbonate crystals
no red
- sign of cystitis (inflammation of bladder) or trauma

55
Q

physiological changes examination

abnormalities or urination?

A

micturition - passing urine
dysuria - passing of urine is difficult and uncomfortable
polyuria - passing larger volumes or more frequently
oliguria - reduction in daily production of urine
haematuria - blood in urine
stranguria - passing of urine is painful
anuria - no urine produced

56
Q

physiological changes examination

changes in defecation?

A

appearance varies between species and diet

- eg grass or hay

57
Q

what to monitor in faecal output?

A

must be daily

  • amount
  • frequency
  • colour
  • shape
  • soft or hard
  • colour
  • blood
  • parasites
58
Q

physiological changes examination

abnormalities of bowel activity?

A

tenesmus - painful, ineffectual straining
constipation - hardened faeces and difficulty emptying
diarrhoea - rapid expulsion of soft non-formed material
melaena - dark, tarry faeces sometimes with music
(evidence of blood loss in upper GI tract)
haematochezia - fresh, red blood

59
Q

physiological changes examination

vomiting? types? risks

A 
emesis 
types 
- projectile without retching (pyloric obstruction)
- bilious (bile)
- cyclic (keeps happening 
- retching (ineffective attempts)

risk of patient aspirating food particles or fluid causing pneumonia
can cause serious electrolyte imbalances

60
Q

physiological changes examination

vomiting definitions?

A

vomiting

  • forceful removal of stomach contents via mouth
  • often along with retching, abdominal contractions, hypersalivation and licking lips

regurgitating

  • passive movement of food/liquid from trachea to mouth
  • without warning

haematemesis
- vomiting material containing blood

stercoraceous
- vomiting a faecal matter

61
Q

physiological changes examination

coughing?

A 
distinguish type/reason 
- allergies or disease
think about possibly being contagious 
- isolation and barrier nursing 
- kennel cough, influenza, strangles, equine asthma
consider when developed

provide management
- eg inhalers, antihistamines, vaccines

62
Q

physiological changes examination

why important to recognise pain?

A

ethical perspective
no positive effects for the patient
- however sometimes stop movement and further damage
impedes recovery

63
Q

physiological changes examination

signs of pain?

A 
vocalising - predators do, pray don't
- pray species often hide pain until too late 
tense
eyes - look sad/in pain 
teeth grinding
64
Q

physiological changes examination

colic pain signs?

A 
flank watching 
lip curling 
stretching as if to urinate 
inappetane 
teeth grinding 
sweating 
lying down 
grunting/groaning
65
Q

physiological changes examination

lameness pain signs?

A

inability to bear weight
weight shifting
persistent resting of limbs
standing abnormally

66
Q

physiological changes examination

how to reduce pain?

A 
analgesia 
increase comfort 
- raising food and water bowls 
- padding area
keep clean
67
Q

physiological changes examination

how to reduce stress?

A 
quiet area 
blanket or t-shirt from home 
sit with them - provide TLC 
keep away from other species 
have home buddy if beneficial 
provide hides for prey species 
provide pheromone sprays and diffusers

Patient Care 1 (22 decks)

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