Manual - Non-Specific Evaluation Flashcards
skipped past all the introduction and set up bullshit portion of the manual (page 17-25)
what the fuck are we even doing in this class? who knows? maybe this helps? probably wont
sequential steps of non-specific evaluations
assess vitals
assess hinderances / deficits
evaluate gross ROM
evaluate gross strength
evaluate trunk stability in sitting
assess functional ability
assess transfer ability
assess gait
assess sensation
when assessing vitals, which vitals are being observed
HR
BP
O2 sat
RR
temperature
when assessing vitals, what are we looking to observe
various trends in vitals
how to assess vision in a very general sense
have patient track object in H test
how to assess hearing in a general sense
rub fingers near one ear and compare to the other
how to assess cognition/communication in a general sense
alert and oriented questions
what is important to document when assessing ROM
if active or passive
when assessing bed mobility, which motions should be tested
scooting up / down
rolling side to side
supine to sit or side to sit
sitting to supine
when assessing gait, what should be observed before actually walking
assistance needed for sit to stand
static standing ability (need for assistance)
pre-gait activities (marching or weight shifts)
upon general survey of patient, what are you looking for observationally
signs of distress
facial expressions of pain
splinting/guarding of body parts
skin color
stature / posture
weight
grooming personal hygiene
speech/ state of awareness
when observing breathing, what can be noted
accessory muscles recruited
irregular breathing
labored breathing
frequent positional changes
when observing obesity, what can you ask that is more sensitive
asking what types of activities that individual is involved in
when observing cachexia, what can be asked that is more sensitive
labored breathing
signs of cancer? unexplained weight loss
diet or food availabilty
what can indicate cushing’s disease
central obesity
fatty pads near collar bone or back of the neck
what could diaphoresis indicate
extra breath work to compensate for reduced cardiac output
what could asymmetry indicate in breathing
atrophy/hypertrophy mismatch
impaired motor function
underlying pathology
explain head sizes
normocephalic = normal
microcephalic = smaller
hydrocephalic = larger
skin colors and their indications
- pale
- yellow
- ruddy
- dusky
anemic
jaundice (liver disorder, alcoholism)
elevated temperature, polycythemia, sun exposure
anoxic
when testing visual tracking, how can normal vs abnormal be documented
norm = EOMI–> extra-oculomotion intact
abnormal = EOML –> extra-oculomotion limited
PEARL means and indicates
pupils equal and reactive to light
normalcy
doll’s eyes means and indicates
pupils remain fixed and dilated
hypoxia
pinpoint pupils mean and indicate
pupils remain fixed and constricted
decreased neuro function
xanthelasma means and indicates
small flat yellow fat deposit on upper/lower eyelid
hyperlipidemia / premature heart disease
corneal arcus means and indicates what? and is common in which populations
grayish white ring at junction of cornea and sclera caused by lipid deposits
associated with hyperlipidemia
common in elders and black people (she says Blacks, which seems aggressive)
cataracts are described as
an opacity of the crystalline eye lens, sometimes with a bluish tint
jaundice is detected where? and can indicate what
sclera due to increased destruction of RBCs
can be caused by liver congestion, hepatitis, gall bladder disease of bile duct obstruction
what is strabismus
where the eyes do not align properly when focusing on an object
exophthalmos is ____ and indicates
outward bulging of entire orbit
indicates hyperthyroidism
what to ask about when observing hearing ability
tinnitus
earaches
infections
hearing aid
when observing the nose, what to look for
nasal flaring
deviated septum
evidence of trauma
epistaxis, nosebleeds
when observing someone’s breath, what can be found? what do these indicate
halitosis via
- ketosis = sugary smell, possible DM2
- alcohol, you guessed it! being a drunk
abnormalities of the tongue and their indications
black - dehydration
white - fungal infection
bluish - cyanosis, anemia, respiratory distress
decreased skin turgor may indicate
dehydration
pallor of skin color can indicate
systemic chronic disease, possible anemia
flushed skin color can indicate
fever
polycythemia
emotion
exertion
what color skin can be seen in those with CHF
cyanotic discoloration
how to estimate anemia
color of fingernail beds
– more reliable than skin color
where can pallor be seen best? why is this?
palms of hands
– hemoglobin levels falling will affect palms
what is presence of cyanosis dependent upon
absolute amount of un-oxygenated hemoglobin
- not the ratio of oxygenated to un-oxgenated hemoglobin
explain presence of cyanosis in an anoxic patient vs polycythemic patient
anoxic patient may be impossible to be cyanotic
polycythemic patient may appear cyanotic even though the O2 content of blood is normal
what causes peripheral cyanosis
slowed circulation through peripheral vascular beds
capillaries will give away more oxygen than normal
what are the most frequent causes of cyanosis
cold and nervous tension
low cardiac output
– possible peripheral vascular disease or deep vein thrombosis
why does central cyanosis occur? what can cause this?
low arterial oxygen saturation causing face and mucous membranes to be blue
congenital heart disease / emphysema
petechiae is described as
tiny red or purple hemmorhagic spots caused by capillary bleeding with leakage of blood into the skin
how does petechiae occur / where does it typically occur? what can it indicate
in clusters / ankles and feet most often
can be a sign of thrombocytopenia (low platelet count)
explain the pathophys of petechiae
low platelet counts = no clotting
no clotting = blood escaping from capillaries
blood from cap = blood into skin
what medications / disorders can cause petechiae
meds:
anticoagulants
aspirin
steroids
disorders:
infection
leukemia
lupus
scleroderma
jugular vein distension indicates
lying at 45° or higher indicates high venous pressure
via
CHF
cor pulmonale
vena cava obstructions
how to screen for increased venous pressure
observe veins in dorsum of hands with arms in dependent position
- lying at angle of 30° or greater
one arm is gradually and passively elevated to height of angle of louis
note the point at which veins collapse in hands
interpretation of increased venous pressure screen
venous pressure increased if veins do not collapse when raised to angle of louis
explain transverse diameter to Anterior Posterior relationship of the chest
2:1
should be more laterally than depth
explain the normal angle of the ribs and abnormal angle
norm - 45° between ribs and spine
ab - anything above that will indicate flattening of the ribs
paradoxical vs normal breathing
normal - inhalation will cause growth in size, exhalation will cause decrease in size
paradoxical - inhalation causes decrease, exhalation causes increase
what is the point of maximal impulse? vital sign associated?
movement of heart against the chest wall where a rhythmic sharply localized thrust can be visualized
best place of pulse rate
where is the point of maximal impact
mid clavicular line in 5th ICS
what is a quick screen for clubbing of the nails
having patient put DIP of contralateral fingers together and noting the shape of the space between
should make a diamond, if not clubbing may be indicated
what is the pathophys of clubbing? where is it generally seen
cardiopulm disease
tissue hypoxia and increased blood flow to extremities out of proportion to the needs of the issue
increased blood will produce accelerated tissue growth
thumb and index finger
explain angular differences in digital clubbing screen
angle between base of nail and skin next to cuticle
normal = obtuse angle of 160°
abnormal = angle of ≥180°
heberden’s nodes are described as and indicate
firm fibrous nodules about DIP joints causing mushrooming of joints
OA
what may indicate rheumatoid arthritis
bony disfigurement / displacement of MP and PIPs
tophi-fibrous node is described as and can indicate
articulation of great toe joints
gout
