Patient observation Flashcards
When should your initial patient observation take place?
When client enters the practice before you make any approach to the animal
What is the purpose of admission questionaires?
Allow owners to tell you what is normal behaviour and routine
What are the 4 stages of patient assessment?
Subjective assessment
Objective assessment
Assessment
Planning
What is a subjective assessment?
Initial thoughts recorded on how patient is
What are signs of stress in dogs and cats?
Dogs- panting, tucked tail, shaking
Cats- pacing, hissing, vomiting
What order should you carry out the objective assessment?
Head Upper respiratory tract/nose Oral cavity Mucus membranes Eyes Ears Skin and hair Forelimbs Thorax Abdomen Pelvis and hind limbs Tail Anus and perineum Reproductive organs
What should you observe in terms of head assessment?
Posture and carrying position- should be upright and no tilt
Musculature- should have symmetry, palpate and look
General appearance
Lymph nodes- palpate in neck for enlargement
What should you observe for upper respiratory tract?
Discharge- should be none, if present not colour and consistency
Moisture- should be moist
Adequate air flow- in cats and rabbits mouth breathing shows severe respiratory distress
Respiratory noise- should be none
Define stertor
Noise on expiration
Define stridor
Noise on inspiration
What should you observe in the oral cavity?
Outside and inside the mouth
Jaw movement and alignment
Tongue- check for any marks, cuts or ulcers
Teeth- any missing, wear, gum disease, plaque, smell
Hard and soft palettes- any abnormalities, wounds
Skin and hair around mouth- excess salivation
What should you observe with mucus membranes?
Moisture- should be moist when hydrated
Colour- should be pink
CRT- should be less than 2 seconds
What are possible causes of pale MMs?
Poor perfusion
Haemorrhage
Anaemia
What are possible causes of red MMs?
Sepsis
Fever
Congested tissues
What are possible causes of blue/hypoxic MMs?
Hypoxaemia
Respiratory issues
What are possible causes of yellow MMs?
Liver disease
RBC destruction
Bile issues
What needs to be observed for eyes?
Openness
Compare both eyes for size, protrusion etc
Discharge- should be none, not colour and consistency
Eyelids- third eyelid coming across, upper or lower eyelid rotation
Pupils- general assessment, light reflex, pupil size, ulcers, scratches
Sclera colour
Define blepharospasm
Squinting eyes
Define entropion
Internal rotation of eyelid margin
Define ectropion
External rotation of eyelid margin
Define anicosia
Unequal pupil size
What should you observe in the ears?
Ear pinnae- check for aural haematoma, injuries
Ear canal- should be no discharge, smell, foreign bodies, or inflammation
What should you observe for skin and hair?
Coat- condition- should be shiny, check for alopecia and thickness
Skin condition- should be no redness, flaking or wounds, check colour, elasticity
Ectoparasites- should be no fleas or ticks
What should you observe for forelimbs?
Movement, gait and range of motion- flex and extend for pain or crepitus
Muscles- any wastage
Proprioception- can limbs be replaced
Visuals- lumps, changes or injuries, symmetry
Define crepitus
Bone crunching
What should you observe for thorax?
Respiratory rate and effort- auscultate chest
Vertebrae, sternum and ribs- palpate and looks, observe weight score
What should you observe for the abodomen?
Visual and palpate- check for lumps, foreign bodies, injuries, check internal organs
Posture
What should you observe for pelvis and hind limbs?
Movement, gait and range of motion- observe and flex and extend
Visual check of bones and musculature
Proprioception
Femoral pulse- circulation status
What should you observe for the tail?
Palpate length and check for movement- normal and voluntary , observe any pain or damage
What should you observe for anus and perineum?
Soiling, discharge or anal gland problems
Masses, prolapse or perineal ruptures
Temperature
What should you observe for reproductive organs?
Check sex
Males- 2 descending testicles, no penis injury or discharge
Females- no vulval discharge or swelling
What are further parameters which should be assessed in pateints?
Urination Water intake Vomiting Defecation Appetite Coughing Pain
How should you assess urination status?
Appearence- colour, blood present, darkness, cloudiness, sediments
Smell
Volume- 1-2ml/kg/hr, should be passed easily
Define anuira
Absence of urine
Define dysuria
Painful urination
Define haematuria
Blood in urine
Define polyuria
Frequent large urine volumes passed
Define oliguria
Reduce urine production
What should you observe for vomiting?
Colour Consistency Contents Frequency Volume
What are signs of vomiting?
Retching
Hyperventilation
Lipsmacking
Define haematemesis
Blood in vomit
Define stercoaceous
Vomiting faecal matter
Define regurgitation
Bringing up swallowed food into the mouth
What should you observe for water intake and what effects volume needed?
Volume taken in
Factors that effect water intake- diabetes, exercise, food types
Define polydipsia and what are signs?
Excessive thirst
Signs- dry mouth, loss of skin elasticity, drinking over maintainance
What causes changes to appetite?
Stress
Illness
Exercise
Food
Define inappetence
Lack of appetite
Define dysphagia
Swallowing difficulty
Define pica
Eating non food items compulsively
Define anorexia
Not eating
Define coprophagia
Eating faeces
What should be observed when patient is coughing?
Nature- dry, harsh, moist, discharge
If infectious or respiratory/CV problem
What are signs of pain?
Reluctance to move Changed posture Restlessness Anxiety Altered mental state Aggression Guarding Inappetence
What should you observe for defecation?
Colour
Smell
Shape
Consistency
Define constipation
Hard and dry stool
Define tenesmus
Straining to defecate
Define melaena
Fresh blood in faeces
Define haematochezia
Dark faeces containing partially digested blood
