FINAL SCENARIOS Flashcards
WHAT IS PQRSTU? WHAT DOES IT STAND FOR?
P - PROVACTIVE (what brings it on? what makes it better?)
Q - QUALITY/QUANTITY (how does it feel? intensity?)
R - REGION/RADIATION (where is it? does it spread?)
S - SEVERITY SCALE (1-10)
T - TIMING (onset? duration? frequency?)
U - UNDERSTAND PATIENT’S PERCEPTION OF PROBLEM
MUSCULOSKELETAL ASSESSMENT - SUBJECTIVE ASSESSMENT
8 questions
HEALTH HISTORY: 1. Back pain? PQRSTU. 2. Stiffness? Swelling? Heat? Redness? 3. Limitations in movement? 4. Deformities of bone or joint? 5. Accidents or trauma to bones? 6. Problems with ADL? 7. Medications? 8 Family history of OA or RA?
MUSCULOSKELETAL (SPINE EXAM) ASSESSMENT - OBJECTIVE ASSESSMENT
ORDER OF ASSESSMENTS (3)
- INSPECTION
- PALPATION
- ROM OF SPINE
MUSCULOSKELETAL (SPINE EXAM) ASSESSMENT - OBJECTIVE ASSESSMENT
INSPECTION (5)
- STRAIGHT SPINOUS PROCESS
- EQUAL HORIZONTAL POSITIONS OF SHOULDERS, SCAPULAE, ILIAC CRESTS, GLUTEAL FOLDS.
- EQUAL SPACES OF ARMS AND LATERAL THORAX
- KNEES AND FEET ALIGN WITH TRUNK, POINT FORWARD
- FROM SIDE, NOTE CURVATURE OF SPINE: CERVICAL (CONCAVE) THORACIC (CONVEX) AND LUMBAR (CONCAVE)
MUSCULOSKELETAL (SPINE EXAM) ASSESSMENT - OBJECTIVE ASSESSMENT
PALPATION (3)
- SPINOUS PROCESSES
- PARAVERTEBRAL MUSCLES
- HIP ROM (TO CHECK FOR CREPITUS)
MUSCULOSKELETAL (SPINE EXAM) ASSESSMENT - OBJECTIVE ASSESSMENT
ROM OF SPINE, ACTIVE (5)
- FLEXION
- EXTENSION
- LATERAL BENDING (RIGHT & LEFT)
- ROTATION (RIGHT & LEFT)
- STRAIGHT LEG RAISING (LASEGUE’S TEST - PAIN = POSITIVE)
MUSCULOSKELETAL (SHOULDER EXAM) ASSESSMENT - OBJECTIVE ASSESSMENT
ORDER OF ASSESSMENTS (4)
- INSPECTION
- PALPATION
- ROM OF SHOULDER (ACTIVE OR PASSIVE)
- MUSCLE TESTING OF SHOULDER
MUSCULOSKELETAL (SHOULDER EXAM) ASSESSMENT - OBJECTIVE ASSESSMENT
INSPECTION (5)
- SIZE
- CONTOUR
- COLOR
- SWELLING
- MASS OR DEFORMITY
MUSCULOSKELETAL (SHOULDER EXAM) ASSESSMENT - OBJECTIVE ASSESSMENT
PALPATION (4)
- TEMPERATURE
- PAIN
- SWELLING OR MASS
- CREPITUS
MUSCULOSKELETAL (SHOULDER EXAM) ASSESSMENT - OBJECTIVE ASSESSMENT
ROM OF SHOULDER (5)
- FLEX, EXTEND & HYPER EXTEND ARMS
- TOUCH HANDS TO SCAPULAE BEHIND BACK
- ABDUCT ARMS ABOVE HEAD PALMS TOGETHER
- BRING ONE ARM DOWN AT A TIME AND SWING ACROSS ABDOMEN
- CLASP BOTH HANDS TOGETHER BEHIND HEAD
MUSCULOSKELETAL ASSESSMENT - OBJECTIVE ASSESSMENT
MUSCLE TESTING OF SHOULDER (3)
- SHRUG THE SHOULDER
- FLEX THEM FORWARD AND UP
- ABDUCT THEM AGAINST RESISTANCE
ABDOMINAL ASSESSMENT - SUBJECTIVE ASSESSMENT
9
- APPETITE (CHANGE OR LOSS OF)
- SWALLOWING (DIFFICULTY)
- FOODS YOU CANNOT TOLERATE
- ABDOMINAL PAIN - PQRSTU
- BM (FREQUENCY OF)
- NAUSEA OR VOMITING
- HISTORY OF GI DISEASE
- MEDICATIONS
- ALL FOOD IN LAST 24 HOURS.
ABDOMINAL ASSESSMENT - OBJECTIVE ASSESSMENT
ORDER OF ASSESSMENTS (4)
- INSPECTION
- AUSCULTATION
- PERCUSSION
- PALPATION
ABDOMINAL ASSESSMENT - OBJECTIVE ASSESSMENT
INSPECTION (8)
- CONTOUR OF ABDOMEN
- GENERAL SYMMETRY
- SKIN COLOUR & CONDITION
- PULSATION & MOVEMENT
- UMBILICUS
- HAIR DISTRIBUTION
- STATE OF HYDRATION & NUTRITION
- FACIAL EXPRESSION & POSITION
ABDOMINAL ASSESSMENT - OBJECTIVE ASSESSMENT
AUSCULTATION (2)
- BOWEL SOUNDS
- NOTE ANY VASCULAR SOUNDS
(AORTIC, RENAL, ILLIAC, INGUINAL/FEMORAL)
ABDOMINAL ASSESSMENT - OBJECTIVE ASSESSMENT
PERCUSSION (3 AREAS, 1 ADDITIONAL)
- PERCUSS ALL 4 Qs
- PERCUSS BORDERS OF LIVER SPAN
- PERCUSS SPLEEN
- IF SUSPECT ASCITES, TEST FLUID WAVE AND SHIFTING DULLNESS
ABDOMINAL ASSESSMENT - OBJECTIVE ASSESSMENT
4 THINGS TO LOOK FOR WITH LIGHT PALPATION:
- MUSCLE WALL
- TENDERNESS
- ENLARGED ORGANS
- MASSES
ABDOMINAL ASSESSMENT - OBJECTIVE ASSESSMENT
7 THINGS TO LOOK FOR WITH DEEP PALPATION:
- MASSES
- CONTOUR OF LIVER
- SPLEEN
- KIDNEYS (DUCK BILL)
- AORTA
- REBOUND TENDERNESS
- CVA TENDERNESS
ABDOMINAL ASSESSMENT - OBJECTIVE ASSESSMENT
ADDITIONAL TESTS IF INDICATED
- INSPIRATORY ARREST (MURPHY’S SIGN)
- ILIOSOAS MUSCLE TEST (STRAIGHT LEG)
- OBTURATOR TEST (LEG BENT AT 90 DEGREES)
NEGATIVE = NO PAIN POSITIVE = PAIN
PERIPHERAL VASCULAR SYSTEM ASSESSMENT - SUBJECTIVE ASSESSMENT
(9 questions)
- Pain? PQRSTU
- Skin changes?
- Skin lesions or sores?
- Swelling?
- Swollen glands?
- Facial skin ever turn blue or ashen?
- Medication?
- Past history of hear/PV disease?
- Family history of heart, PV, disease?
PERIPHERAL VASCULAR SYSTEM ASSESSMENT - OBJECTIVE ASSESSMENT
ORDER OF ASSESSMENTS (4)
- INSPECTION
- PALPATE
- AUSCULTATE
- ADDITIONAL TESTS
PERIPHERAL VASCULAR SYSTEM ASSESSMENT - OBJECTIVE ASSESSMENT
INSPECTION (5)
- COLOUR
- HAIR DISTRIBUTION
- VENOUS PATTERN/VISCOSITIES
- SWELLING OR EDEMA OR ATROPHY - MEASURE CIRCUMFERENCE (R&L)
- SKIN LESIONS OR ULCERS
PERIPHERAL VASCULAR SYSTEM ASSESSMENT - OBJECTIVE ASSESSMENT
PALPATION (5)
- TEMP
- TENDERNESS
- LYMPH NODES
- LOCATE AND GRADE PULSES
- CHECK EDEMA (GRADE PITTING)
PERIPHERAL VASCULAR SYSTEM ASSESSMENT - OBJECTIVE ASSESSMENT
AUSCULTATION (1)
- BRUITS
PERIPHERAL VASCULAR SYSTEM ASSESSMENT - OBJECTIVE ASSESSMENT
ADDITIONAL TESTS
- MANUAL COMPRESSION TEST
- CHECK COLOUR CHANGE: ELEVATE THEN DANGLE, COLOUR RETURNS IN ______ SECS
- ANKLE BRACHIAL INDEX (ABI) - BP MEASURED AT ANKLE COMPARED TO BP MEASURED AT ARM.
THORAX & LUNG ASSESSMENT - SUBJECTIVE ASSESSMENT
8 questions
- PQRSTU
- DO YOU HAVE A COUGH
- SHORTNESS OF BREATH
- CHEST PAIN WITH BREATHING
- HISTORY OF LUNG DISEASE
- SMOKE
- LIVING OR WORK CONDITIONS THAT AFFECT YOUR BREATHING
- LAST TB SKIN TEST, CHEST X-RAY OR FLU VACCINE.
THORAX AND LUNG ASSESSMENT - OBJECTIVE ASSESSMENT
INSPECTION (6)
- THORACIC CAGE
- RESPIRATORY RATE & PATTERN
- SKIN
- POSITION
- FACIAL EXPRESSION
- LEVEL OF CONSCIOUSNESS
THORX & LUNG ASSESSMENT - OBJECTIVE ASSESSMENT
PALPATION (3)
- CONFIRM SYMMETRICAL CHEST EXPANSION
- TACTILE FREMITUS
- DETECT ANY LUMPS, MASSES, TENDERNESS
THORAX & LUNG ASSESSMENT - OBJECTIVE ASSESSMENT
PERCUSSION (2)
- PERCUSSION NOTE THAT PREDOMINATE OVER LUNG FIELDS (RESONNANCE)
- DIAPHRAGMATIC EXCURSION
THORAX & LUNG ASSESSMENT - OBJECTIVE ASSESSMENT
AUSCULTATION (3)
- LISTEN: POSTERIOR, LATERAL, ANTERIOR
- NOTE NORMAL BREATH SOUNDS
- ANY ABNORMAL BREATH (ADVENTAGIOUS) SOUNDS ~ IF YES, PERFORM BRONCHOPHONY, WHISPERED PECTORILOQUY, EGOPHONY
HEART & NECK VESSELS ASSESSMENT - SUBJECTIVE ASSESSMENT
9 questions
1) PQRSTU
2) Any chest pain
3) Do you have a cough
4) Do you tire easily?
5) Facial skin ever turn blue or ashen?
6) Any swelling of legs at feet?
7) History of heart disease?
8) Family history of heart disease?
9) Any shortness of breath?
HEART & NECK VESSELS ASSESSMENT - OBJECTIVE ASSESSMENT
ORDER OF ASSESSMENTS (4)
- CAROTID ARTERIES
- JUGULAR VENOUS SYSTEM
- PRECORDIUM - INSPECT & PALPATE
- AUSCULTATION
HEART & NECK VESSELS ASSESSMENT - OBJECTIVE ASSESSMENT
CAROTID ARTERIES (1)
- GRADE R & L (0, 1+, 2+, 3+ BOUNDING)
HEART & NECK VESSELS ASSESSMENT - OBJECTIVE ASSESSMENT
JUGULAR VENOUS SYSTEM (2)
- EXTERNAL JUGULAR VEINS
2. INTERNAL JUGULAR PULSATIONS - ESTIMATE VENOUS PRESSURE
HEART & NECK VESSELS ASSESSMENT - OBJECTIVE ASSESSMENT
PRECORDIUM - INSPECT & PALPATE (4)
- SKIN COLOUR AND CONDITION
- CHEST WALL PULSATIONS
- HEAVE OR LIFT
- APICAL IMPULSE IN THE 4TH/5TH INTERCOSTAL SPACE AT MIDCLAVICULAR LINE, SIZE (NORMALLY 1-2 CM), AMPLITUDE (ABSENT 0, 1+, 2+, 3+ BOUNDING)
HEART & NECK VESSELS ASSESSMENT - OBJECTIVE ASSESSMENT
AUSCULTATION (4)
- ANATOMICAL AREAS TO LISTEN (AORTIC VALVE AREA, PULMONIC VALVE AREA, ERB’S POINT, TRICUSPID VALVE AREA, MITRAL VALVE AREA)
- RATE & RHYTHM
- IDENTIFY S1 & S2, AND ANY VARIATIONS
- LISTEN FOR: A) EXTRA HEART SOUNDS B) MURMURS