Patient Examination (ASAN001/2) Flashcards
1
Q
Why should a complete ‘Head to Tail’ examination be performed? (1)
A
To determine the status of the patient.
2
Q
What knowledge should a Vet Nurse possess to perform an accurate & detailed physical examination? (2)
A
- Must be aware of what is considered normal findings / parameters.
- What are considered abnormal findings and what they may indicate.
3
Q
What might determine the order in which a Detailed Physical Examination is performed? (3)
A
Order depends on the patient’s presentation:
- acute/serious
- chronic/mild.
4
Q
What should a General Physical Exam include? (9)
A
- Body Condition Score
- Demeanour
- Mucous Membranes (MM)
- Capillary Refill Time (CRT)
- Heart Rate (HR)
- Respiratory Rate (RR)
- Femoral Pulse
- Temperature
- General: Mobility, Eyes, Nose, Skin, Posture, Wounds / Haemorrhage
5
Q
Why is Body Scoring important?(2)
A
- Assists with recognizing weight loss or weight gain between visits or during hospitalisation.
- Important everyone uses the same scale and is ‘scoring’ in the same way.
6
Q
Hills Body Scoring Chart:
A
7
Q
Why is Patient Demeanour important? (1)
A
Demeanour is a great indicator of how the patient is feeling.
8
Q
What might impact your expectations of the patient’s demeanour? (1)
A
Circumstances around the reason for examination.
ie if here for routine visit (Vx) or if patient is unwell.
9
Q
Why is frequent assessment of patient demeanour of hospitalised patients important? (2)
A
- Important part of overall clinical picture.
- Can help determine if the patient is improving or not.
10
Q
What can the patient’s reactions to it’s environment indicate? (2)
A
The patient’s mental status.
- We must also be able to determine if the patient is in pain.
11
Q
How does assessment of Patient Demeanour relate to analgesia? (1)
A
Helps to determine if the patient is in pain and to what extent.
12
Q
What questions can we ask ourselves to assess the Patient’s Demeanour? (4)
A
- Is the animal bright, alert & responsive (BAR)?
- Is it behaving normally for it’s species?
- Is it behaving normally for the individual animal?
- If that problem were affecting me, how would I be feeling?
13
Q
BAR
A
BAR – Bright, Alert & Responsive
14
Q
What are the characteristics of BAR? (3)
A
- Bright & happy in themselves (wagging tail, moving well etc.)
- Aware of surroundings and activity
- Responsive to name calling, touch and other stimuli
15
Q
BAR Image
A
16
Q
QAR
A
QAR – Quiet, Alert & Responsive
17
Q
What are the characteristics of QAR? (6)
A
- Alert & aware of surroundings
- Responsive to name calling, patting etc.
- Very quiet in themselves.
- May be due to their unusual surroundings or due to their medical/surgical condition.
- Does not automatically indicate patient is depressed
- Patient must be assessed for pain, medications and their effects.
18
Q
QAR Image
A
19
Q
What are the characteristics of a Depressed / Withdrawn patient? (4)
A
- Patient is aware of surroundings, name calling & petting.
- They are not inclined to respond although they can, but they don’t want to.
- When a patient is depressed it can impede it’s recovery.
- Depression is a significant clinical finding and must not be ignored.
20
Q
Depressed / Withdrawn Image
A
21
Q
What are the characteristics of a Flat patient? (3)
A
- These patients are conscious but very ‘flat’.
- In response to stimuli they may just move their eyes or slightly ‘twitch’ their ears.
- Their ability to interact may be impeded due to their illness or disease.
22
Q
What are the characteristics of a Nervous patient? (3)
A
It may be difficult to correctly assess demeanour if the patient is nervous.
- They become nervous / frightened when approached.
- They may try and hide under blankets, huddle in back of cage etc.
23
Q
Nervous Image
A
24
Q
What are some important things to know about Aggressive patients? (3)
A
- Some animals will become aggressive just by entering the clinic.
- Difficult to correctly assess demeanour in regards to how they are feeling, pain, lethargy etc.
- Learn to recognize the signs of an aggressive patient and take measures to protect yourself and the patient.
25
Aggressive Dog Image
26
Aggressive Cat Image
27
Terms used to describe Demeanour (8)
- Bright
- Quiet
- Alert
- Dull
- Responsive
- Unresponsive
- Sedate
- Depressed
28
How would you describe a Bright patient? (4)
- Out–going
- Seeks interaction with examiner
- Moves about enclosure
- Is inquisitive
29
How would you describe a Quiet patient? (3)
- Withdrawn
- May be crouched or hunched in back of enclosure
- Is not interactive with examiner
30
How would you describe an Alert patient? (2)
- Watchful
- Ready to respond to the changing situation around it
31
How would you describe a Dull patient? (1)
Lacking in liveliness or animation
32
How would you describe a Responsive patient? (1)
Responds to stimuli ie. calling it's name or sudden movements in the room
33
How would you describe an Unresponsive patient? (1)
Does not respond to stimuli around it, incl direct stimuli eg. touching
34
How would you describe a Sedate patient? (3)
- Sleepy & difficult to arouse
- Will eventually respond if examiner persists.
- Take into consideration if they are recovering from sedation or under sedation.
35
How would you describe a Depressed patient? (3)
- Withdrawn
- No interest in surroundings
- Unable to arouse even with strong stimuli
36
BAR
Bright, Alert & Responsive
37
QAR
Quiet, Alert & Responsive
38
SED
the patient is sedate
39
DEP
the patient is depressed
40
What are you observing when assessing the patient's Posture & Gait? (4)
- Posture
- Gait
- Movement
- Ease of rising or laying down etc
41
What questions can we ask ourselves to assess the Patient's Posture & Gait? (6)
- Does the patient seem comfortable in its current position?
- Does the patient prefer to stand or lay down?
- Is the patient 'guarding' any area?
- Is the patient 'hunched'?
- Is there any stiffness?
- Is the patient reluctant to move?
42
What else can we observe to get an Overall View of the Patient? (4)
- Any wounds present?
- Signs of heamorrage?
- Obvious changes / abnormalities in their coat?
- Noticeable respiratory effort?
43
What do we need to note about any wounds present? (4)
- Single or multiple wounds
- Approximate Size
- Location
- Do they appear fresh or old?
44
What do we need to note about signs of haemorrage? (3)
- Location
- Active bleeding?
- Clots in coat?
45
What observations can we make about the patient's coat? (3)
- Shiny & sleek?
- Dull & unkempt?
- Matted fur? Wounds or lesions may be underneath.
46
What do we need to note about the patient's respiratory effort? (2)
- Any noticeable respiratory effort?
- Gasping?
47
What would indicate seeking immediate vet attention & implementing first aid for the patient? (3)
Any signs of:
- Respiratory effort
- Active bleeding
- Large wounds
48
IMAGE – Fresh wounds from a dog fight
49
What do we need to note in our General Assessment of the Head & Neck of the patient? (4)
The overall appearance of head.
- Any wounds or skin lesions
- Areas of hair loss
- Droopiness of face
- Swelling
50
What are the three basic Head Shapes? (3)
- Dolichocephalic
- Mesaticephalic
- Brachycephalic
51
What are the characteristics of a Dolichocephalic head shape? (3)
Long, thin head
- eg. Saluki, Siamese
- There is good spacing between the individual premolar teeth (which reduces the collection of food and debris hence reducing plaque build–up)
52
IMAGE – Dolichocephalic skull
53
What are the characteristics of a Mesaticephalic head shape? (3)
Medium length and width
- eg. Labrador, Domestic Short Hair
- The teeth have some spaces between and minimal crowding.
54
IMAGE – Mesaticephalic skull
55
What are the characteristics of a Brachycephalic head shape? (3)
Short, wide head
- eg. Boxer, Pug and Persian
- There is often considerable overcrowding and displacement of the canines.
56
IMAGE – Brachycephalic skull
57
What is important to remember about Eyes? (2)
- Eyes are very delicate & sensitive organs.
- They must always be treated gently.
58
What do we need to note in our General Assessment of the Eyes of the patient? (5)
- Do the eyes look clear & bright?
- Are both eyes open?
- Are eyelids swollen?
- Is there any discharge?
- Are pupils normal?
59
Why is it important to assess if both eyes are open? (3)
- If one or both eyes are closed this can indicate that the lids &/or conjunctiva are swollen causing the eye to close.
- Patients may hold eyelids closed (Blepharospasm) if there is pain of the cornea or conjunctiva.
- Damage to the muscles or nerves controlling eyelids may cause them to droop & close.
60
What is important to note if there is any discharge from eyes? (3)
- Type of discharge.
- Note the colour
- Record the amount – copious or scant.
61
What are the different types of occular discharge? (4)
- Serous (watery)
- Mucoid (gelatinous)
- Purulent (pus)
- Mucopurulent (mix of mucus & pus)
62
What does the different colours of occular discharge indicate? (3)
- Yellow or green - Purulent
- Pinkish - Blood present
- Grey through to rust brown - Mucoid
63
What to note when examining the patient's pupils? (4)
- Note size of pupils
- Wide open or closed pupils?
- Normal – both pupils equal in size.
- If pupils are different sizes (anisocoria)
64
What are the characteristics of normal pupils? (2)
- Both pupils equal in size.
- Size is usually somewhere midway (depending on ambient light).
65
What are wide open pupils referred to as?
Dilated pupils
66
What are closed pupils referred to as?
Constricted pupils
67
What is a completely closed pupil called?
Pinpoint pupil.
68
What can Dilated or Constricted pupils indicate? (1)
A range of problems from neurological to poisonings.
69
Anisocoria
Pupils are different sizes.
70
What can Anisocoria indicate? (1)
Neurological disfunction
71
IMAGE – Anisocoria following head trauma
72
IMAGE – Pupil Size
73
What is important to assess when examining the patient's Eyeballs? (5)
- Check for any haemorrhage or bruising to the sclera (white of the eye).
- Unusual protrusion of eyeball or 'global' look to eyeball.
- Unusual protrusion or swelling of the conjunctiva.
- Position of the eyeball in relation to the eye socket.
- Nystagmus
74
Nystagmus
Involuntary flicking movement of eyeball from side–to–side or up–to–down.
75
What is important to remember before examining a patient's Ears? (1)
Some patients are particularly sensitive to having their ears touched.
76
What do we need to note in our General Assessment of the Ears of the patient? (5)
- Normal confirmation for breed?
- Are they bothered by the ear(s)?
- Swelling?
- Smell?
- Wax, discharge, exudates or blood?
77
Are the ears normal confirmation for their breed? (3)
- Lots of variations of what is normal.
- Know what is usual for that breed and individual animal.
- Changes in the way they are holding their ear(s) can indicate swelling somewhere or possible neurological problem.
78
Is the patient bothered by the ear(s)? (3)
Scratching, pawing or flicking of the ear?
- Indicates the patient is irritated by something to do with the ears.
- May indicate pain in that area.
79
Is there any swelling? (3)
Swelling can be caused by:
- Haematoma
- Abscess
- Cellulitis
80
Is there any smell? (2)
Normal ears smell the same as the rest of the dog.
- Odours can indicate infection and should be assessed. (eg. yeast/Malassezia)
81
Is there any wax, discharge, exudates or blood? (3)
- Any irritation (eg. allergies) to the ear canal start with an accumulation of wax.
- Infections cause exudates and discharge (described as waxy or purulent).
- Ulceration or trauma to the ear may result in bleeding.
82
What do we need to note in our General Assessment of the Nose of the patient? (2)
- Clean & moist?
- Discharge?
83
Is the nose clean and moist? (3)
Normal nose is clean and moist.
- During hot/dry weather the moisture evaporates quickly.
- A dry nose does not necessarily indicate an abnormality.
84
What do most normal dogs have a moist nose? (2)
It's kept moist by normal tear overflow.
– drains down nasolacrimal ducts to just inside the nasal openings.
85
What is important to note about any nasal discharge? (4)
- Type of discharge – serous, mucoid, purulent or mycopurulent?
- Colour – clear, greyish, yellow, green or blood?
- Does it come from one (unilateral) or both (bilateral) nostrils?
- Any dry discharge should be gently cleaned with moistened swabs.
86
Epistaxis
Bleeding from nose
87
What do we need to note in our General Assessment of the Mouth of the patient? (6)
Gently examine the mouth and note:
- Malocclusions
- Dental Disease
- Lips
- Neck
- Mucous Membranes (MM)
- Capillary Refill Time (CRT)
88
What are the different types of Malocclusions? (4)
- Overshot bite (Brachygnathism)
- Undershot bite (Prognathism)
- Wry bite
- Open bite
89
Brachygnathism (3)
Overshot bite
- Maxilla (upper) is too long compared to mandible (lower jaw).
- Extremely rare in cat
90
Prognathism (5)
Undershot bite
- Maxilla (upper) is too short compared to mandible (lower jaw).
- Accepted bite in breeds such as Boxers and Persians.
- Problems can occur mostly when the mandibular canine sits outside the upper lip or into it.
- Can lead to eosinophilic granuloma formation.
91
Wry bite (2)
Where one quadrant of jaw grows out of proportion with the rest.
- There is usually an 'open bite' associated with this.
92
Open bite (2)
Where the mouth cannot be closed completely.
- Often seen in brachycephalic cats and dogs when upper and lower canines 'meet' at their tips.
93
What do we need to note to assess the presence and severity of Dental Disease in the patient? (4)
- Plaque
- Tartar or calculus
- Gingivitis
- Bleeding gums
94
What is Plaque? (3)
Thin film covering teeth.
- Composed of bacteria, saliva, food particles and sloughed epithelial cells.
- Easily brushed off.
95
What is Tartar or Calculus? (2)
Hard, mineralized plaque that has formed on the surface of the tooth.
- Takes some force with a dental instrument to remove.
96
What is Gingivitis? (4)
Inflammation of the gums.
- Evident as a reddened gum line that extends down towards the jaw.
- May be swelling and bleeding.
- Indicates periodontal disease.
97
Why is it important to note the presence of Bleeding gums? (1)
If present without reddening or swelling, it can indicate a problem with the body's blood clotting function.
98
What do we need to note in our assessment of the Lips of the patient? (2)
- Are they swollen?
- Any wounds or lesions from teeth rubbing into them?
99
What do we need to note in our assessment of the Neck of the patient? (4)
- Feel for wounds, scabs, ticks etc – check under collar too.
- Palpation of submandibular lymph nodes – they shouldn't be enlarged.
- Observe the patient has no pain or discomfort on movement of neck or how they hold it.
- Visual assessment of any external parasites eg. fleas.
100
How to assess for Pain or discomfort in neck? (5)
- Observe them moving their neck
- Observe how they 'hold' their neck.
- Tightness?
- Drooping of head and neck?
- Turned towards one side?
101
IMAGE – Palpation of Submandibular Lymph Nodes
102
What do we need to note in our assessment of the Mucous Membranes (MM) of the patient? (3)
- Colour
- Pigmentation
- Feel
103
What to note about Colour & Pigmentation of Mucous Membranes (MM). (6)
- Normally pink
- Abnormal – pale, red, grey, white & yellow.
- Certain breeds (eg. Chow) have pigmented mucosa – gums will appear black.
- Some breeds have areas of pink and black due to pigmentation.
- If difficult to assess gum colour – look at conjunctiva of eye.
- MM colour can indicate peripheral circulation – blood flow & oxygenation.
104
IMAGE – Mucous Membrane colours & indications
105
What is Petechiation? (5)
Reddish–purple dots of pinpoint to pinhead size.
- Occur when capillaries break, and blood pours into the skin.
- Petechiae do not blanch under pressure.
- They are flush with the surface of the skin.
- Indicate disturbance of blood clotting function.
106
What is Ecchymosis? (5)
Discolouration of the skin.
- Resulting from bleeding underneath skin.
- Typically caused by bruising.
- Commonly has a 'paintbrush' appearance.
- Often indicates a disturbance of blood clotting function.
107
How should normal Mucous Membranes (MM) Feel? (1)
MM's should feel moist.
108
What might dry or tacky MM's indicate? (2)
Hydration is not sufficient.
Dehydration
109
How do we assess Capillary Refill Time (CRT)? (1)
Gently press down on MM's and count how long it takes colour to flood back.
110
What information does CRT tell us about the patient? (1)
Indicates how the peripheral blood is circulating.
111
1 – 2 seconds CRT (2)
Normal – adequate peripheral perfusion.
112
> 2 seconds CRT (3)
Decreased peripheral perfusion.
Examples:
- Shock
- Heart failure.
113
< 1 second CRT (4)
Hyperdynamic – vasodilation
Examples:
- High blood pressure
- Pyrexia
- Local irritation (toxins)
114
What do we need to note in our General Assessment of the Chest of the patient? (2)
- Wounds or injuries to chest area.
- Any lumps or swellings.
115
What would indicate immediate assessment by Vet when examining a patient's chest. (1)
Wounds or injuries to chest area.
116
What do we need to note when assessing the Respiration of a patient? (3)
- RR usually increased in vet clinic due to stress & nervousness.
- Assess RR prior to approaching patient.
- Watch respiration and note character of breathing.
117
Panting (3)
Rapid, shallow breathing
- Mouth open
- Tongue usually hanging out
118
Tachypnoea
Rapid, shallow breathing
119
Hyperpnoea
Rapid, deep breaths
120
Bradypnoea (1)
Slow breathing
121
Laboured
Deep, abdominal breathing
122
Dyspnoea (1)
Difficulty breathing
123
What is BPM (in relation to respiration)?
Breaths per minute
124
What is the normal RR of a dog?
12 - 25 BPM
125
What is the normal RR of a cat?
20 - 30 BPM
126
What is the normal RR of a Rat?
70 – 140 BPM
127
What is the normal RR of a Guinea Pig?
40 – 80 BPM
128
Abdominal Respiration (2)
When the animal uses it's abdominal muscles to assist with breathing.
- A sign of respiratory distress.
129
Paradoxical Respiration (3)
Where instead of the chest expanding during inspiration, an area of the chest moves inwards.
- Can happen when a series of ribs are broken in 2 places.
(Flail chest)
130
What is Flail Chest? (1)
When a series of ribs are broken in 2 places.
131
What is important to note when assessing the Chest Sounds of a patient? (3)
Listen to lungs with stethoscope.
- Usually hear some sounds in healthy lungs too.
- Absence of any sounds over a particular area may indicate that the lung is abnormal.
132
Breath sounds (2)
Normal respiratory sounds.
- Caused by movement of air through airways.
133
Wheeze (2)
High pitched inspiratory or expiratory noise.
- Caused by narrowed airways.
134
Crackle (2)
High pitched inspiratory noise.
- Made by increased secretion in small airways.
135
Stertor (2)
Noise from nasal passages.
- Eg. Snoring / snuffling noises.
136
Stridor (2)
High pitched inspiratory sounds.
- Caused by turbulent air flow in pharynx & trachea (upper airways)
137
What is important to note when assessing the Heart Rate of a patient? (5)
Listen to heart sounds with stethoscope.
- Normal sound – 'lub, dub'.
- Sound is made by snapping closed of certain heart valves as chambers contract & eject blood.
- Beat should be regular.
- Rhythm – beats should have the same interval between them or sinus arrhythmia.
138
Sinus Arrhythmia (2)
A 'regular' irregularity.
- Heart speeds up slightly during inhalation & slows slightly with exhalation.
139
Abnormal Arrhythmia (2)
Irregular gaps between heart beats.
- Can easily be heard.
140
What does a heart murmur sound like? (2)
Abnormal wooshing sounds superimposed over 'lub, dub' sounds.
- Sometimes replaces normal sounds altogether.
141
What causes the sound of a heart murmur? (1)
Sound is the vibrations caused when blood squirts through narrow openings as the heart contracts.
142
What are Heart Murumurs caused by? (1)
Heart abnormalities.
143
What are some Heart abnormalities that cause Heart Murmurs? (3)
- Faulty Valves
- Ventricular Septal Defect (Faulty heart wall)
- Patent Ductus Arteriosis (Faulty blood vessel)
144
What are Faulty Valves in the heart? (2)
Valves of the heart that don't close properly.
- Blood is forced backwards through the gap in the valve when heart contracts.
145
What is a Ventricular Septal Defect in the heart? (2)
Faulty part of the wall between ventricles.
- Allows blood to cross between ventricles when they contract.
146
What is Patent Ductus Arteriosis? (2)
Faulty communication between major blood vessel near the heart.
- Allows blood to squirt between the vessels.
147
What is the normal HR of a dog < 25kg?
65 - 120 bpm
148
What is the normal HR of a dog > 25kg?
65 - 80 bpm
149
What is the normal HR of a cat?
110 - 180 bpm
150
What is the normal HR of a guinea pig?
240 - 310 bpm
151
What is the normal HR of a rat?
310 – 500 bpm
152
What do we need to note in our General Assessment of the Abdomen of the patient? (6)
Visually assess abdomen & note any abnormalities such as:
- Wounds
- Bruising
- Abnormal lumps, skin growths etc (esp. around nipples)
- Skin inflammation / irritation
- Penile discharge on abdomen
153
Can palpation of the patient's abdomen be performed by any member of the veterinary team? (2)
No
- Palpation of abdomen should only be performed by Vet
154
What is a Pulse? (1)
Pressure wave travelling through arterial walls.
155
What causes a pulse to occur? (2)
- Wave is initiated by contraction of the ventricles and ejection of blood into the aorta.
- Travels at high speed along arterial walls.
156
Where does an artery need to be located in order to palpate a pulse? (1)
Artery must run close to the body surface.
157
Where are the main pulse sites? (4)
- Femoral
- Digital
- Coccygeal
- Lingual
158
Where can you find the Femoral pulse? (1)
Femoral artery on the medial (inner) side of the femur (thigh).
159
Where can you find the Digital pulse? (1)
Digital artery on the palmer (underside) aspect of the carpus (front leg).
160
Where can you find the Coccygeal pulse? (1)
Coccygeal (tail) artery on the ventral (under) side of the tail.
161
What does Pulse Quality indicate? (2)
It is an indication of cardiac output and blood pressure.
162
What is a Normal Pulse? (2)
- Rate & 'feel' is even.
- Matches heart rate.
163
What is a Pulse Deficit? (2)
Pulse rate is less than heart rate.
- Caused by ineffectual heart beats (dysrhythmia).
164
What is a Weak Pulse? (3)
Softer pulse.
- Not forceful under fingers.
- Diminished cardiac output, shock.
165
What is a Bounding Pulse? (3)
Pulse is strong, forceful & sometimes jerky.
- Increased cardiac output.
- Occurs normally with heavy exercise.
166
What is a Bounding Pulse often associated with? (3)
- High blood pressure
- Certain valvular problems
- Early heart failure.
167
What is most important to remember when examining a patient's limbs? (2)
If a patient is obviously lame or showing signs of pain in a limb, do not move or palpate this area.
It will cause more pain!
168
What do we need to note in our General Assessment of the Limbs of the patient? (6)
- Lameness
- Swelling
- Wounds
- 'Holding' of the limb – flaccid, when the limb is 'dangling', rigidity, when the muscles are tightly contracted.
- Growths / lumps
- Skin irritation / inflammation
169
What areas do we need to examine to assess the Claws & Digits? (2)
Examine both the forepaws and the hind paws.
170
Where are the patient's pads located? (4)
- Digital
- Metatarsal
- Metacarpal
- Carpal
171
What do we need to note when examining the patient's pads? (3)
- Wounds
- Swelling
- 'Hard' pad areas (overgrowth of the pad tissue)
172
Why must we check in–between digital pads? (1)
This is a common area for skin to become moist and inflammed.
173
What questions do we need to ask ourselves when examining the patient's claws & dew claws? (4)
- Are they too long?
- Is there sign of damage?
- Is there any discolouration?
- Is there inflammation or discharge around the nail?
174
Are the patient's claws too long? (2)
- Some will grow in tight circle (esp. dew claws)
- They dig into the pad and cause a painful wound.
175
Is there signs of damage to the claws? (2)
- Look for frayed nail ends – particularly in cats.
- Look for splitting, loose or broken nails.
176
What can split or frayed nails indicate? (3)
May indicate recent trauma:
– HBC
- Fall
177
Is there any discolouration of the claws? (2)
See–through nails you should be able to see the pink 'quick' area – indicates a healthy claw.
- Red or creamy discolouration – may indicate haemorrhage or infection.
178
Is there inflammation or discharge around the nail? (2)
May indicate and infection of the nail and bone underneath.
179
What makes up the Anogenital Area of the patient? (3)
- Female genitals
- Male genitals
- Tail
180
What do we need to note about Female Genitals? (3)
- Is the vulva swollen?
- Are they desexed or not?
- Any other discharge from vulva?
181
What do we need to note if the patient is entire (not desexed)? (2)
- Any signs of oestrus.
- Ask client when last heat was.
182
What are common signs of oestrus / heat? (2)
- Vulval swelling
- Watery/bloody discharge
183
What do we need to note if there is any discharge from vulva? (3)
- Colour
- Consistency
- Amt of discharge.
184
What might a bloody, purulent (pus) discharge from vulva indicate? (1)
Infection
185
What is a green discharge from vulva associated with? (2)
Impending or recent birth.
186
What do we need to note about Male Genitals? (4)
- Any discharge from penis?
- Check scrotal area
- How old are they?
- Are testes the same size?
187
What do we need to note if there is any discharge from penis? (4)
- Colour
- Consistency
- Amt of discharge.
- Is there any dried discharge on abdomen?
188
What do we need to check in the scrotal area? (5)
- Are they entire?
- If yes – are both testes present?
- Any areas of inflammation /irritation?
- Wounds?
- Abnormal growths?
189
What does the age of the patient have to do with examination of male genitals? (2)
If young dog – check both testes have descended.
If old dog and entire – may have issues with prostate.
190
Are testes the same size? (2)
Both testes should be about the same size.
- Testes can vary is size – if one is much larger than the other it may be abnormal.
191
What do we need to note about the assessement of the patient's Tail? (3)
- Tail appearance.
- Don't forget to check the underneath (ventral) side of tail!
- Voluntary movement of the tail.
192
What do we need to note about the patient's voluntary tail movements? (3)
- Are they wagging?
- Moving the tail freely with no signs of discomfort?
- Gently raise the tail and release it – Observe how the tail falls & if the patient has control over it's movement.
193
What do we need to note about the appearance of the patient's Tail? (4)
- Wounds (base of tail is a common area for cat fight wounds).
- Swelling
- Hair loss (base of tail common area)
- Deformity (kinking of tail).
194
What do we need to do before taking the patient's temperature? (1)
Check anal area.
195
What do we need to note about the anal area? (3)
- Discharge?
- Skin
- Odour?
196
What do we need to note about Discharge from anal area? (4)
- Colour
- Consistency
- Amt
- Is it coming from anus or structures surrounding anus?
197
What might discharge from anal sac (gland) indicate? (2)
Impaction or infection of anal sac (gland).
198
How do anal sac abscesses usually appear/present? (2)
- Swelling over the anal sac.
- Purulent discharge from opening over the anal sac.
199
What might discharge from the anus indicate? (2)
Profuse diarrhoea
- Small amts will drip from anus, even between bouts of diarrhoea.
200
Why do we look at the mucosa of the anus and surrounding skin? (2)
Checking for any signs of irritation or inflammation.
201
Why would we note the Odour from the anal area? (2)
- Particular odours can indicate certain illnesses.
- eg. Haemorrhagic diarrhoea smell
202
IMAGE – Anal area
203
When is the best time to take the patient's temperature? (1)
Always take temperature last.
204
Why is it important to always take the patient's temperature at the end of the physical examination? (1)
Often causes the patient anxiety which may raise HR & RR.
205
What is the normal Temp range of a dog?
38.0 – 39.0 ℃
206
What is the normal Temp range of a cat?
38.0 – 39.2 ℃
207
What is the normal Temp range of a guinea pig?
37.2 – 39.5 ℃
208
What is the normal Temp range of a rat?
37.7 ℃
209
Hypothermia (2)
A lower than normal body temp.
- In dogs & cats – when temp is below 37.5 ℃
210
Hyperthermia (2)
A higher than normal body temp.
- In dogs & cats – when temp is above 39.5 ℃
211
Pyrexia (1)
Raised body temp caused by an internal process (eg. infection).
212
Heat Stress (3)
Temps above 41 ℃
- Life threatening
- Immediate first aid must be implemented.
213
How to assess the patient's Hydration? (2)
- Feel mucous membranes.
- Perform the 'skin tenting' test.
214
How should Mucous Membranes feel? (1)
Normally moist
215
How do MM's feel if the patient is dehydrated? (2)
Dry, tacky mucosa indicates hydration is not adequate.
216
How to perform a Skin Tenting' test? (3)
- Gently lift the skin
- Twist
- Observe how long it takes to return to normal position.
217
IMAGE – 'Skin Tenting'
218
What Percentages is patient Dehydration commonly measured in? (5)
- <5%
- 5%
- 5 – 8%
- 10 – 12%
- 12 – 15%
219
What are the clinical signs of < 5% dehydration? (1)
Not detectable on clinical examination.
220
What are the clinical signs of 5% dehydration? (2)
- Slight decrease in skin turgor
- Slightly tacky MM's
221
What are the clinical signs of 5 – 8% dehydration? (4)
- Delay in skin 'tent' to normal
- Tacky, dry MM's
- Increase in CRT
- Eyes may appear slightly sunken
222
What are the clinical signs of 10 – 12% dehydration? (6)
- Tenting of skin
- Dry, tacky MM's
- Increased CRT
- Tachycardia
- Sunken eyes
- Cold extremities
223
What are the clinical signs of 12 – 15% dehydration? (8)
- Tachycardia
- Pale MM's
- Weak pulse
- Hypothermia
- Weakness
- Severe dehydration
- Clinical signs of shock are apparent
- Life threatening
224
What percentage of dehydration is considered life threatening? (1)
12 - 15% dehydration
