Clinical Reasoning Flashcards
Definition of Clinical Reasoning
cognitive process of thinking used in the evaluation and management of patients
what would be the processes of assessment?
- Carry out subjective assessment and find out about patient history
- Plan out the objective
- Carry out objective assessment/examination
- Find out a diagnosis
how would you manage a problem?
- decide what treatments to use
- carry out appropriate reassessments when needed
3, evaluate against prognosis/initial diagnosis
why do we carry out a subjective assessment?
- to analyse and generate possible hypotheses
- to rule in possible diagnoses and rule out less likely diagnoses
- also used to plan out what might need to be assessed in objective examinations
what are the stages in clinical reasoning?
- acquire data from patients (ask them questions)
- intepret and organise information given by patients
- generate hypothesis/multiple hypotheses
- test out hypotheses (does it support? does it go against?) by doing tests
- raise/lower probability of hypothesis
what do we need to consider in our objective assessment, with information from subjective assessment?
- what to test (to increase or decrease likelihood of certain conditions)
- in what order (from SIN)
- what must/should/could be tested
- helps with hypothesis generation
at the end of examination, what do we analyse all information gathered for?
- establish a working hypothesis/hypotheses -> main things we think might be diagnosis of our patients
- create a list of possible problems and treatment plans
- find out what can be used to measure effectiveness and progress of treatment
- what will be the likely prognosis/future of the condition
- find out what we can do for patients
what are the aims of objective assessment?
- test hypotheses generated in subjective assessment
- generate new hypotheses/refute any old hypotheses
- identify biopsychosocial sources of patients symptoms
- reach a diagnosis and/or problems list
- identify comparable signs to take forward as markers of progress of treatment
- clinically reason all the findings
what are the components of objective assessment?
- observation
- myogenic, arthrogenic, neurological, movement testing
- special tests?
what are the different orders of testing?
1 - structured approach
- allows information to be obtained in an organised manner
- facilitates novice to remember components so a full assessment is carried out
- less likely that important information is missed out
2- varying in order
- allows a diagnosis to be quickly ruled out/ruled in
- accommodates to the SIN factor -> less physical tests can be carried out if patient is highly irritable and patients will be put in less pain and discomfort.
what defines a healthy posture?
the correct body position supported by the right amount of muscle tension working against gravity
How would a postural change occur?
- when antagonist and agonist muscles are not in a neutral position, they can become permanantly lengthened/shortened over time.
- if the muscle is shortened, it would be at an physiological advantage to contract as the muscle is able to form more cross-bridges
- if the muscle is lengthened, it would be at a physiological disadvantage to contract as the muscles cannot form many cross-bridges
- over time, mobile posture can become permanant posture.
what are the different types of gait?
- antalgic gait (injury - pain relieving gait)
- arthrogenic gait (joint which can’t move properly)
- trendelenberg gait (drop hip - hip adductor weakness/abnormality)
- drop foot gait (ankle can plantarflex but weak dorsiflex)
- short leg gait
- high step gait (neurological condition)
