Patient Observation Flashcards
When does initial observation begin?
as soon as the patient enters the practice
What should be allowed for when the patient first arrives in practice?
adjustment time and understanding of behavior of animals in unfamiliar environments
What distance away from the patient should your first impressions be gained?
further away to observe
What sort of environment should be stimulated as much as possible?
normal
What information can be vital in supporting the patient and understanding what brought them to the practice?
owner history
What is an admission questionnaire?
short questionnaire completed by owner at the same time as admission consent form
What is the aim of an admission questionnaire?
to provide a tailored approach to hospital stay and try to reduce patient stress.
what sort of things may be asked on an admission questionnaire?
preferred food and feed times, walking schedule, an specific individual needs
What measures can be put in place within a kennel to reduce cat stress?
hiding places and pheromones like Feliway
What is SOAP used for?
assessing the patient
What does SOAP stand for?
subjective, objective, assessment, planning
What is involved in subjective assessment?
from afar gaining initial thoughts on patient (e.g. are they happy, depressed, scared, relaxed?), your first impressions
What is involved in an objective assessment?
an examination, findings are measured and recorded
What are two things to consider before beginning an objective assessment?
how will the assessment be carried out?
how will the patient be restrained?
What are the 13 areas to be examined in an objective assessment?
head nares and upper respiratory tract oral cavity mucous membranes eyes ears skin and hair thorax abdomen pelvis and hind limb tail anus and perineum reproductive organs
What are you looking for during an objective assessment of the head?
posture: is it normal for breed and species
musculature: is it symmetrical and normal
general palpation: are there lumps or enlarged lymph nodes
What are you looking for during an objective assessment of the nares and upper respiratory tract?
no discharge: note presence and colour if there is any
moist
adequate airflow: particularly in cats and rabbits
any respiratory noise (stertor or stridor)
What is stertor?
noise on inspiration
What is stridor?
noise on expiration
What are you looking for during an objective assessment of the oral cavity?
mouth jaw movement and alignment tongue teeth hard and soft palettes skin and hair
What are you looking for during an objective assessment of the mucous membranes (mms)?
moist: if not indicative of dehydration
colour
What do mucous membranes show?
state of perfusion and therefore the state of circulation
What would pale mucous membranes indicate?
poor perfusion/circulation
e.g. hemorrhage or anemia
what would congested (red) mucous membranes indicate?
sepsis/fever
What would hypoxic or cyanotic (blue) mucous membranes indicate?
respiratory difficulty
What would icteric (jaundiced) mucous membranes indicate?
liver disease, RBC destruction, bile problems
what is normal capillary refill time?
less than 2 seconds
What is capillary refill time?
time taken for capillaries to refill with blood after compression for a short period
What are you looking for during an objective assessment of the eyes?
are they open blephrospasm eyes the same size discharge: note colour if present entropian ectropian nictating membrane pupil assessment: arisocoria, pupillary light reflex, sclera assessment (colour of white of the eye)
What is blephrospasm?
squinting
What is entropian?
internal rotation of eyelid margin
what is ectropian?
external rotation of eyelid margin
What is the nictating membrane also known as?
3rd eyelid
What is arisocoria?
unequal pupil size
What are you looking for during an objective assessment of the ear?
normal pinnae: presence of aural haematoma
vertical ear canal: and discharge, strange smell, foreign bodies, ectoparasites
What are you looking for during an objective assessment of the skin and hair?
alopecia coat condition skin condition ectoparasites (e.g. ticks and fleas) skin elasticity (tenting indicative of dehydration)
What is alopecia?
hair loss
What are you looking for during an objective assessment of the forelimbs?
movement and gait
rage of movement
flexion and extension: any pain or crepitus
visual changes: lumps, lacerations, bumps etc
Proprioception: if limb is displaced can patient replace limb back in normal position?
What is crepitus?
crunching/ clicking of cartilage
What are you looking for during an objective assessment of the thorax?
respiration rate and effort examine vertebra, ribs and sternum Auscultation visual abnormalities sounds mouth breathing: particularly in obligate nasal breathers
What are you looking for during an objective assessment of the abdomen?
visual abnormalities: is abdomen enlarged
palpation: can anything be felt inside
posture: pain may change a patients posture
internal organs: stomach/kidneys
What are you looking for during an objective assessment of the pelvis and hindlimbs?
as with forelimbs: movement musculature flexion and extension visual abnormalities gait propreoception femoral pulse
What are you looking for during an objective assessment of the tail?
presence of tail
voluntary movement
damage: drooped tail could indicate a fractured pelvis
What are you looking for during an objective assessment of the anus and perineum?
soiling discharge presence of mass? anal gland problems prolapse perineal ruptures
What are you looking for during an objective assessment of the reproductive organs?
check animal is the correct sex
two descended testicles
penis: any injuries or discharge
vulval discharge or swelling
What should be considered when observing urine/urination?
colour, smell, turbidity, volume
What is the turbidity of urine?
presence of sediment or clouding of urine
What is the accepted urine output for dogs and cats per hour?
1-2ml per kg of body weight per hour
What is anuria?
failure to produce urine
what is dysuria?
abnormal, painful or difficult urination
what is haematouria?
presence of blood in urine
what is polyuria?
excessive or abnormally large increase in volume of urine production
What is the accepted maintenance water requirement for cats and dogs?
50ml per kg of body weight over 24 hours
what is polydipsia?
excessive or abnormally increased thirst
What is an indication of polydipsia?
excessive drinking and urination
What should be observed when looking at faeces or defecation?
colour, shape, smell, consistency
What is diarrhoea?
increase in loose and watery stool
what is tenesmus?
excessive straining to urinate/defecate
what is melaena?
partially digested blood in faeces that makes them appear black/slimy
what is haemtochezia?
fresh blood in faeces or from anus
What does the bristol stool chart do?
classifies the shape/consistancy of faeces produced by patient
What does 1 on the bristol stool chart mean?
hard lumps that are difficult to pass
what does 7 on the bristol stool chart mean?
watery with no solid, passed rapidly
What is the ideal rating on the bristol stool chart?
number 4: smooth and soft
What does inappetance mean?
lack of appetite
What does dysphagia mean?
swallowing difficulties or inability to swallow
What is pica?
consumption of non-nutritional substances that provide no physical benefit
what is coprophagia?
eating faeces
What is vomiting?
ejection of matter from the stomach and upper GI tract through the mouth
What is regurgitation?
bringing swallowed food from the oesophegus up again into the mouth
What is the difference between regurgitation and vomiting?
regurgitation only occurs with matter in the oesophegus whereas vomiting affects the stomach and upper GI tract
What should be noted when a patient vomits?
contents, volume, number of episodes
What should be observed if a patient is coughing?
is it contagious
moist and productive or dry and harsh
what could the cough mean? infectious disease, respiratory distress or cardiovascular damage
What should be noted on the patients chart about coughing?
saliva or discharge produced
What is the issue with pain assessment?
it is subjective and challenging
Why is pain assessment necessary?
welfare of the animal and ethical choices
What are the 8 general signs of pain?
reluctance to move altered body posture restlessness, anxiety, fear depressed or altered mentation aggression guarding of the area abnormal urination/defecation inappetance
What is an example of a pain scoring method?
glasgow composite pain scoring chart
What does the Glasgow composite pain scoring chart show?
pain and tracks changes
What can be done to alleviate pain?
analgesia, improved/altered bedding and kennel
