Lecture 1: systems review Flashcards
what should you look for in terms of red flags and signs and symptoms of other underlying issues
look for combos
few are informative on their own
what are the constitutional symptoms or general health components that require a systems review (x9)
Fever/sweats/chill (prolonged; >102 may require hospital)
weight changes (i.e. more than 5% or unexplained)
N&V
dizzy/lightheaded
prolonged/limiting fatigue
limiting weakness
paresthesias/numbness
ill feeling
mentation/cognitive changes
what are some more subtle/atypical symptoms in the older adults that may be more subtle and atypical
mentation changes
subnormal temp
bradycardia/tachycardia
tachypnea (excessive respiration)
fatigue
lethargy
decreased appetite
abnormal lymph node signs
> 2cm
firm
immobile
tender
what might you palpate in an infection systems review
lymph nodes
heat
swelling
possible abdominal quadrant assessment
some symptoms common to auto immune conditions
GI pain/dysfunction
inflammation
myalgia/arthalgia
skin/weight changes
swollen lymph nodes (tender with acuity; non-tender if chronic)
fatigue
fever
typically affects more than one part of the body
emotional changes
cancer symptoms
history of cancer
pain- local/referred
N&V
loss of appetite
unexplained weight loss
fever/chills/sweats (night)
swollen non tender lymph nodes
fatigue
secondary infections due to low immunity
why might cancer patients have a fever in the absence of an infection
increased circulating WBC or production of pyrogen agent
why might cancer patients lymph nodes be not tender
due to limited inflammation with typical slow growth of most cancer
functions of integumentary system
protect underlying structures
insulator
regulates temp
assist fluid balance
synthesis of vitamin D
sensory detection of stimuli
itchy/dry/rough texture of skin indicates what
impaired circulation/oxygenation
associated with conditions like diabetes
hives or rash indicate
possible allergic reaction or systemic disease
callus indicates
excess friction
blisters indicate
increased friction
may indicate systemic condition
edema indicates
locally = possible inflammation, infection, or allergic reaction
generalized = likely systemic condition
what are the ABCDEs of melanoma
asymmetry
border - not well defined or regular
color - multiple shade
diameter- larger than a pencil eraser
evolution - change over time
what is a cafe au lait
may indicate underlying genetic condition
mostly benign but a concern if there are multiple spots
what conditions might abnormal hair indicate
a patch (especially on spine) may indicate underlying genetic condition
a bare patch may indicate impaired circulation
cyanosis discoloration of skin may indicate
impaired circulation/oxygenation
redness or red streaks on skin may indicate
acute inflammation, stage 1 pressure ulcer, infection, or allergic reaction
varicose veins indicate what
venous congestion
functions of endocrine system
differentiation of reproductive and nervous systems in fetus
stimulates growth/development
coordination of reproductive systems
maintains optimal internal environment/homeostasis
initiation of corrective and adaptive responses in emergency situations
where does the endocrine system meet the nervous system
at hypothalamus-pituitary interface
function of the hypothalamus in regards to the endocrine system
main integrative center of endocrine and autonomic nervous system functions by hormonal and neural pathways
how might an endocrine system initially present
with a MSK problem that regresses in response to hormonal changes or is not progressing
what are some MSK conditions that may be associated with endocrine problems
rheumatoid arthritis
osteoarthritis (particularly hands and spine)
adhesive capsulitis
bilateral carpal tunnel syndrome
osteoporosis
persistent MSK symptoms that may indicate endocrine issues
muscle weakness/atrophy /pain
fatigue
stiffness
joint P!
systemic symptoms of endocrine issues
growth alterations
excessive thirst - polydipsia
excessive urination - polyuria
heart palpitations
increased perspiration
deep, rapid breathing
fluid imbalance
changes in:
mention
hair quality/distribution
skin pigmentation
body fat distribution
elevated vital signs
why is there possible pain in the upper extremity with cardiovascular issues
shared C4-T4 innervation
UE pain is in ulnar nerve distribution medially into little finger
what are the peripheral vascular signs and symptoms that indicate a cardiovascular issue
LE edema including weight gain indicates impaired R ventricle
P! in LE due to claudication, particularly with activity and area may lose color or become Cold
diminished pulses
what are the standard vital signs
temp
HR
BP
respiratory rate
what are the components of a cardiovascular review
Hx and observation
standard vital signs
ankle-brachial index (ABI)
what is the ankle-brachial index
pt. in supine 5-10 min
ABI = LE systolic BP/UE systolic BP
greater than or equal to 0.9 can be used for prediction of a CV event
lymph system develops from what
embryologically from venous system
functions of lymphatic system
moves fluid form periphery to central circulation
lymph fluid returns to R side fo the hear via subclavian veins
absorbs macromolecules like proteins and fatty acids
fluid balance
immunity
remove cellular debris and waste
symptoms of lymphatic problems
pain in local area
full/heavy and or tight sensation (particularly with clothing/jewelry)
impaired ROM
paresthesias/numbness
increased extremity size
weight gain
swollen lymph nodes
advanced cases of lymphatic issues may include what addition to symptoms
skin breakdowns/wounds from swelling
infection signs and symptoms
head/neck edema that interferes with speech, swallowing, and breathing
lymphatic review consists of
Hx/observatin
ROM
girth measurement
palpation of lymph nodes
temp
signs and symptoms of respiratory issues
P! IN NECK/UPPER SHOULDER
thorax P! (shared T2-4 innervation)
cyanosis
digital clubbing
SOB, wheezing, altered breathing pattern
cough
dercreased breath sounds
possible pleura rub of lung and rib connective tissue during respiration
hyper resonance with percussion
respiratory review consists of
Hx and observation
standard vitals
breath sounds with stethoscope or auscultations
percussions
how does the GI tract contribute to protection
all major categories of immune cells are in gut
70-80% of immune cells in gut
signs of a GI issue
pain in neck, trunk, pelvic, and/or shoulder region (due to multiple levels of shared innervation)
dysphagia (swallowing difficulties)
N&V
food aversion/intolerances
indigestion or heart burn
full feeling
GI review consists of
Hx and observation
abdominal quadrant assessment
hepatic system functions
assist nearly every body system
GI/endocrine assist
lipid processling and lipoproteins
assist hematologic system with clotting/protien synthesis
assist reproductive system sex hormone metabolism/distribution
houses immune system cells - largest number of phagocytic cells
hepatic system signs and symptoms are usually due to what
bilirubin increase
symptoms of hepatic issues
P! in R upper quadrant
GI signs/symptoms
edema
skin changes (i.e. jaundice, spider angioma, palmar erthyema)
dark urine
discolored stool
why might there be neurological involvement with hepatic issues? what might the symptoms be?
due to increase neurotoxin build up of ammonia/bile
symptoms like confusion, sleep issues, muscle tremors, and asterisks (paresthesias/numbness from ammonia build up and inability to maintain wrist extension with shoulder flexion)
what is hepatic osteodystrophy
metabolic bone disease due to suppression of bile flow
may manifest as osteoporosis
hepatic review consists of
Hx and observation
abdominal quadrant assessment
neurological tests
components of LMN
cranial nerves
anterior gray column of spinal cord
cauda equina
spinal nerves and distal to terminal nerves
components of UMN
anterior horn of spinal cord
brain and most of spinal cord
what is the superficial abdominal reflex
light strokes applied in each quadrant around the umbilicus
WNL = umbilicus moves in direction of stroke
hypoactive = decreased/lack of umbilical movement
other possible symptoms that may occur with UMN or LMN injuries
N&V
dizziness
visual/auditory dysfunction
worst HA ever may be impending stroke
neurological review consists of what
Hx and observation
neurological tests specific to region
