Clinical Examination Flashcards
SOAP?
Subjective
Objective
Assessment
Plan
Subjective?
personal assessment of immeasurable observations
- eg demeanour, behaviour, posture
- so different for everyone
objective?
factual assessment of measurable observations
- eg TPR
- so same for everyone
assessment?
involves progress comparison of the patient
- may include both subjective and objective observations
easy to see changes
plan?
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
beginning of an examination?
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
what to remember when observing a patient?
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
assessment of patient?
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
physical examination
head area considerations?
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
physical examination
mouth considerations?
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
physical examination
mucous membrane considerations?
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
physical examination
mucous membrane pettechiae?
small pinpoint haemorrhages
seen in patients with clotting disorders
often seen those poisoned with rodenticides (warfin)
physical examination
mucous membrane colour - pale, grey or white?
poor perfusion
shock circulatory collapse haemorrhage anaemia severe vasoconstriction dehydration
physical examination
mucous membrane colour - red?
congestion - over oxygenation of tissues
sepsis
fever
congestion
extensive tissue damage
or because of post-exercise or excitement
physical examination
mucous membrane colour - blue or purple?
blue = cyanosis
from severe hypoxaemia - low blood oxygen
respiratory difficulty
poisonings
severe dehydration
physical examination
mucous membrane colour - yellow?
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
physical examination
mucous membrane colour - orange?
jaundice disease
blood cell disorders
synthetic haemoglobin products
physical examination
mucous membrane colour - chocolate brown?
paracetamol poisoning in cats and dogs
- cats cant have any
- dogs can have small amount
physical examination
mucous membrane colour - cherry red
poisoning
heatstroke
physical examination
eyes considerations?
Ulcers? Opaque? Ocular discharge? Conjunctivitis? Foreign bodies? Scratching? Increased vascularity?
May become disorientated
Make room dark
physical examination
eyes - blepharospasm?
Involuntary blinking or twitching
physical examination
eyes - anisocoria
Unequal pupil size
Caused by:
- glaucoma - damaged optic nerve
- chemosis - swelling of conjunctiva
physical examination
eyes - exophthalmos?
Abnormal protrusion od eyeball
physical examination
eyes - proptosis?
Prolapsed eyeball
physical examination
eyes - entropion?
Inversion of eyelids
physical examination
eyes - ectropion?
Eversion of eyelids
physical examination
Ears considerations?
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
physical examination
Lymph node considerations?
Will be enlarged in cases of neoplasia (tumour) or infection
physical examination
Skin and coat?
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
physical examination
forelimbs considerations?
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
physical examination
thorax considerations?
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
physical examination
abdomen considerations?
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
physical examination
pelvis and hindlimbs?
Pelvis and hindlimbs same way as forelimbs
Femoral pulse can be assessed
- medial aspect of proximal femur
physical examination
tail and anus?
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
physical examination
male reproductive organs?
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
physical examination
female reproductive organs?
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
vulval discharge in bitches?
blood red = pro-oestrus straw-coloured = oestrus dark green/brown = parturition is soon black = death of foetus purulent green or pale coffee-coloured = pyometra
normal vital signs in dogs?
temp - 38-39
pulse - 60-120
resps - 10-30
normal signs in cats?
temp - 38-39
pulse - 110-180
resps - 20-30
normal vital signs in rabbits?
temp - 38-40
pulse - 130-325
resps - 30-60
normal vital signs in horses?
temp - 37-39
pulse - 36-42
resps - 8-15
how and where to know pulse?
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
TPR terminology
pyrexic?
high temperature
TPR terminology
tachycardia/bradycardia
fast heart rate/slow heart rate
TPR terminology
bradypnoea/tachypnoea?
slow breathing/fast breathing
TPR terminology
apnoea?
no breathing
TPR terminology
dyspnoea?
difficulty breathing
TPR terminology
paradoxical breathing?
diaphragm moves in the opposite direction than it should
- ribs move in when breathing
physiological changes?
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
physiological change examination
reason for changes in appetite?
change in routine
change in environment
change in diet - presence of disease
medication - either side effect or require to eat (eg pain relief)
physiological change examination
different abnormalities of appetite?
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
how can you ensure adequate nutrition?
talk to owners about diet and nutrition - educate
provide food supplements (fluids)
ensure balanced diet
test, check and support any illness
physiological changes examination
thirst
requirements? polydipsia/adipsia?
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
physiological changes examination
urination
monitoring? normal? appearance?
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
physiological changes examination
abnormalities or urination?
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
physiological changes examination
changes in defecation?
appearance varies between species and diet
- eg grass or hay
what to monitor in faecal output?
must be daily
- amount
- frequency
- colour
- shape
- soft or hard
- colour
- blood
- parasites
physiological changes examination
abnormalities of bowel activity?
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
physiological changes examination
vomiting? types? risks
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
physiological changes examination
vomiting definitions?
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
physiological changes examination
coughing?
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
physiological changes examination
why important to recognise pain?
ethical perspective
no positive effects for the patient
- however sometimes stop movement and further damage
impedes recovery
physiological changes examination
signs of pain?
vocalising - predators do, pray don't - pray species often hide pain until too late tense eyes - look sad/in pain teeth grinding
physiological changes examination
colic pain signs?
flank watching lip curling stretching as if to urinate inappetane teeth grinding sweating lying down grunting/groaning
physiological changes examination
lameness pain signs?
inability to bear weight
weight shifting
persistent resting of limbs
standing abnormally
physiological changes examination
how to reduce pain?
analgesia increase comfort - raising food and water bowls - padding area keep clean
physiological changes examination
how to reduce stress?
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
