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Clinical skills > objective assessment > Flashcards

objective assessment Flashcards

1
Q

what is an objective assessment?

A
  • involves collecting observable and measurable data about a patient’s health
  • observing client’s gait and vital signs
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2
Q

what is an objective assessment an assessment of and what is it informed by?

A
  • physical assessment of the patient
  • informed by subjective assessment
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3
Q

what are the three aspects you should ensure in an objective assessment?

A
  • ensure patient/ model is comfortable
  • ensure own posture and position is optimal
  • ensure the body part you are examining is visible
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4
Q

what should you seek before assessment?

A
  • consent
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5
Q

what does objective assessment vary with?

A
  • speciality
  • patient cohort
  • individual patient presentation
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6
Q

what are some general observations? (11)

A
  • age
  • gender
  • build
  • walking aids
  • glasses/ hearing aids
  • facial expression e.g., pain
  • posture
  • involuntary movements
  • function
  • balance
  • other aspects e.g., speech, behaviour
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7
Q

what are some of the specific observations?

A
  • posture
  • muscle bulk e.g., same on each side
  • soft tissues e.g., swelling
  • gait
  • function e.g., sit to stand
  • patients attitude
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8
Q

what is posture?

A
  • position of the body in space
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9
Q

what does posture allow?

A
  • function and most efficient movement to occur
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10
Q

describe postural dysfunction

A
  • leads to altered loading increasing risk of pain and injury
  • increasing effort of movement
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11
Q

what aspects affect posture?

A
  • pain
  • fatigue
  • strength
  • ROM
  • muscle stiffness e.g., spasticity
  • emotions
  • occupations e.g., office jobs
  • hobbies
  • age and maternity
  • handedness
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12
Q

what is the ideal alignment ?

A
  • plumb line
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13
Q

describe the position of the plumb line

A
  • through external auditory meatus
  • through odontoid process of axis
  • midway through shoulder
  • through bodies of lumbar vertebrae
  • through sacral promontory
  • slightly posterior to centre of hip joint
  • slightly anterior to axis of knee joint
  • slightly anterior to lateral malleolus
  • through calcaneocuboid joint
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14
Q

describe head/ neck in ideal alignment

A
  • no rotation or side flexion of cervical spine
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15
Q

describe shoulder/ upper limb of ideal alignment

A
  • should be level
  • palms facing sides
  • scapula should be flat against back and lie between T2 and T7
  • distance from spine to scapula should be equal
  • look at space between arms and trunks> should be equal on each side
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16
Q

describe thoracic spine in ideal alignment

A
  • slight kyphosis
  • no scoliosis
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17
Q

describe lumbar spine in ideal alignment

A
  • slight lordosis
  • no scoliosis
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18
Q

describe pelvis in ideal alignment

A
  • no lateral tilt
  • no protraction/ retraction
19
Q

describe hip in ideal alignment

A
  • neutral
  • not flexed or extended
20
Q

describe knees in ideal alignment

A
  • not flexed or hyperextended
  • no valgus/ varus
21
Q

describe ankles/ feet in ideal alignment

A
  • foot position
  • equal toe- out angle (8-10 degrees)
  • plantigrade
  • no over pronation/ supination
22
Q

describe ‘other’ features of ideal posture alignment

A
  • equal weight bearing between left and right feet
23
Q

describe kyphosis

A
  • curving of the spine that causes bowing or rounding og the back
  • skouding position
24
Q

describe lordosis

A
  • posture where the pelvis is titled forward, causing hip flexion
25
Q

describe flat back posture

A
  • lower spine loses its natural curvature and becomes flat over time
26
Q

describe sway back position

A
  • exaggerated curves in the spine
  • forward tilting hips so appearance of leaning back when standing
27
Q

what can you find from soft tissue

A
  • colour and texture of skin e.g., pallor or redness
  • presence of scars
  • abnormal skin creases
  • swelling of soft tissues/ joint
28
Q

what does callus of feat give an idea of?

A
  • pressure of walking
29
Q

how can you measure muscle bulk if abnormality suspected?

A
  • using a tape measure
30
Q

what are the two main benefits of measuring range of motion?

A

+ aids clinical reasoning
+ acts as baseline measure> tells us if patient’s ROM deteriorates over time or improves with treatment

31
Q

what is active range of motion? what questions can be raised?

A
  • voluntary and unassisted
  • looks at quality of movement
  • are there compensations? is the movement well controlled
32
Q

what is passive range of motion? what can it differentiate between?

A
  • no/ minimal muscle activity
  • may use as a diagnostic tool to differentiate non- contractile vs contractile components of clinical posture
33
Q

what are the three ways of measuring range of motion in clinical posture?

A
  • goniometry
  • visual estimation ‘eye balling’
  • tape measures
34
Q

what are contra- indications?

A
  • measuring ROM causes disruption to healing so its inappropriate
35
Q

what are the three main contra- indications?

A
  • interrupting healing process after injury/ surgery
  • suspected fracture/ dislocation/ subluxation
  • suspected myositis ossificans or ectopic ossification
36
Q

what are cautions?

A
  • should take extra care when dealing with people with cautions
37
Q

what are some cautions?

A
  • pain
  • inflammation
  • medication for pain/ muscle relaxants
  • osteoporosis
  • hypermobility
  • haemophilia
  • region of a haematoma
  • suspected bony ankylosis
  • soft tissue disruption e.g., sprain
  • recently healed fracture
  • after prolonged immobilisation
38
Q

what else is important when measuring knee extension and why?

A
  • position of hip as muscles cross over both e.g., hamstrings
39
Q

what is passive insufficiency?

A
  • shortness of a two joint or multi joint muscle, length of muscle is not sufficient to permit normal elongation over both joints simultaneously
40
Q

what is an example of passive insufficiency?

A
  • short hamstrings
41
Q

what is muscle lag?

A
  • active extension lag (quadriceps lag) is a function of a quadriceps weakness
  • Q lag presents itself in patients who maintain full passive ROM but are limited in active extension ROM
42
Q

what is muscle lag due to? what else can it be called?

A
  • due to weakness
  • patient may not have the strength to reach full ROM
  • extensor lag
43
Q

what is contractures?

A
  • lack of full passive ROM of a joint resulting from structural changes of non- bony tissues such as muscles, tendons, ligaments, joint capsules and/ or skin

Clinical skills (13 decks)

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