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Primary Care for the PT > review of systems and medical screening > Flashcards

review of systems and medical screening Flashcards

1
Q

what are the steps in reviewing systems and med screening?

A

gather info from

  • past med hx
  • med screening
  • social hx
  • Current Health Behaviors
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2
Q

what are important details for collecting info an nausea/ vomiting?

A
  • Is there a reason for nausea?
  • how often?
  • what does it look liek- coffee grounds
  • ask if there are any other signs with the n/v
  • is the vomiting with nausea or without
  • taking any meds
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3
Q

a patient has coffee ground vomit, what does this mean?

A

coffee ground vomitus represents blood

(hematemesis)

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4
Q

When shoudl N/V be reported to phys?

A
  • persistant

- nausea that needs med use

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5
Q

what are possible reasons for N/V

A
  • GI disorders
  • Infection (hepatitis,influenza)
  • MI
  • Cancer
  • Vestibular disorders
  • Migraines
  • Pregnancy
  • Adverse drug reactions
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6
Q

Fever/Sweats/Chills are a response to

A

a systemic response to a systemic illness

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7
Q

if a patient reports Fever/Sweats/Chills, what should you ask them ?

A
  • see if they have been taking temp,

- have they noted excess sweating, are they feverish ect.

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8
Q

what is a significant temp?

A

significant if 99.5 or higher for >2wks

- this could be a self limiting virus

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9
Q

At what point is a temp an urgent referral?

A

over 102

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10
Q

T/F if the pt does not have an temperature, then they must not have an infection

A

false, dotn need to have a temp to have an infection.
Good way to rule in, not a good way to rule out.
- get a full picture, does the pt present with (fatigue,malaise,decreased thermoregulation in elderly

  • post op pts are also at risk for infection
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11
Q

when are night sweats a concern?

A

when they are:

  • regular
  • inturupt sleep
  • have other symps
  • fever
  • wt loss
  • important to note that night sweats can occur with menopause, some meds, warm rooms, many other reasons
  • population to be on the look out for, post op and elderly
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12
Q

what can be some causes for Fever/Sweats/Chills?

A 
•Infections
•Metastatic cancers
•Rheumatic
disorders
•Menopause
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13
Q

when is weight changes considered a red flag?

A

-5-10% change over 4-6 months that is unexplained or unintentional (diet or activity)

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14
Q

a pregnant woman has gained 7 lbs in 1 week, what shoudl you do?

A

refer.
->5 lb wt gain in 1wk or>5 lb loss in first trimester shoudl be reffered
-

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15
Q

Why is weight monitoring important in CHF?

A

fluid accumulation is a sign of CHF exacerbation

> 2‐3 lbs in a day = referral

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16
Q

What could cause weight changes?

A
  • Metastatic cancers (unexplained,>10lbsover6mo)
  • Depression
  • GI disorders
  • Infections
  • Anorexia nervosa
  • Chronic pulmonary,cardiac or renal failure
  • Rheumatic disorders
  • Endocrine disorders, thyroiddysfunction, DM
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17
Q

Can Paresthesia, Weakness or Balance Problems be a cause for concern?

A

yes.
there is a concern if it is a: -bilateral
-atypical pattern
- UE/LE together
-other neuro sxs present (vision,taste,smell,hearing)
- saddle anethesia
- we should determine if a referral is needed. we-re often the ones txign paraethesia, so we need to make sure it is not coming from a sinister source and it can indeed by intreated by PT

18
Q

when is weakness a concern?

A

•Concern if non‐myotomal
•Concern if any other neuro sx present(vision,taste,smell,hearing)?
•Urinary retention,increased frequency,overflow incontinence
- Weakness complaint with negative neuro exam (balance, sensation, strength ,reflexes)–consider it a yellow flag and monitor through course of care.

19
Q

What could balance problems be related to?

A

If present with
Dizziness or lightheadedness:
•Vestibular issues
•Vascular insufficiency

possibly 2/2
•Neurologic disorders
•Adverse drug reactions
•Musculoskeletal injury/disease

20
Q

When is a night pain a concern?

A
  • Difficulty sleeping or falling asleep due to sxs
  • Wakes at night due to sxs and unable to easily (i.e.change position)fall back to sleep
  • Pain not relieved by lying down
  • Pain unchanged w/ position change,food
  • Frequency(x/wk,x/night) duration
  • Due to possible:
  • Infection
  • Neoplasm
  • Other…inflammation,OA
21
Q

What is the difference btwn normal fatigue and concerning fatigue ?

A

fatigue thats normal can be caused by life, grief, or work
- Concern if interfering with function for more than 2 to 4 wks •Especially if not related to above factors
•Presentation maybe subtle
•Description of pts fatigue •Explanation? - have pt explain to you why they are feeling that way

22
Q

what could cause fatigue?

A
  • Psychosocial
  • Endocrine/Metabolic
  • Infections
  • Neoplasms
  • Cardiopulmonary
  • Connective Tissue Disease
  • Sleep Disturbances
  • Medication Use
23
Q

what is malaise?

A

a feeling of general discomfort- feeling off or nto well

  • “like im coming down with something”
  • usually associated with fever
  • what my mom always says
  • often pts reveal this in convo, not in a questionaire
24
Q

Consider that the patients issues could have Mentation or Cognition influences? what type of flag is this considered?

A

perform a medical screen on Mentation or Cognition through observation

  • alertness, orientation, attention , thought process, good historian
  • yellow flag - phys shoudl be aware if not, monitor this
  • get sufficient detail for discussion w/ physician
25
Q

what is a medication checkpoint?

A

As PTs, we should be checking pt safety.

  • for every medication listed,there should be a corresponding current or past medical history that can be related.
  • reason why they are taking it , should be current or correlate with diagnosis
26
Q

you are performing a med check point, what do statin drugs control ?

A

control of high cholesterol. Pt should have high cholesterol

27
Q

you are performing a med check point, what are opiods for?

A

excessive pain correlating to diagnosis, condition

28
Q

What are important details to bring up with your pt and their meds?

A
  • Any recent change in meds/dosage?
  • Are they taking the meds regularly? are they in possession of meds
  • Over the counter medications/supplements
  • Do they feel the meds are causing any adverse symptoms?
29
Q

if you find a possible issue with meds, what should you do?

A

May need to consult with physician about meds

•Encourage patient to discuss with physician

30
Q

what are possible SE of NSAIDS?

A

•GI bleeds,fatigue,death

- excess use is bad

31
Q

what are SE of Statin drugs ?

A

complaints of fatigue, weakness, myalgias

32
Q

what are SE of steroids ?

A

can cause fatty infiltrates into bone marrow leading to bone death
•osteoporosis

33
Q

what are SE of Anticoagulants?

A

•aggressive exercise or mobilization or manipulation should warrant precaution/contraindication–may cause bleeding

34
Q

what is the additional Q you should ask when screening depressed pts ?

A

“would you like help”

35
Q

What should be collected in the social hx?

A 
•Occupation/former occupation
•Home environment
•City or rural location
•Single or multiple level
•How many steps or stairs,location,handrails
•Tub/shower design,grabbars
•Other specifics PRN
•Religious beliefs
- be mindful of pts willingness to engage
36
Q

Current Health Behaviors include ?

A 
- etoh habbits 
smoking habbits 
nurtirtion/ diet patterns 
sleep 
physical activity 
stress level
37
Q

what are details of activty and particpation we would like to know?

A
  • Prior level of function
  • Patient goals ‐what patient would like to be able to do
  • Key information:
  • Justification for skilled PT intervention an dPOC
  • Reimbursement for services
38
Q

What do we do 1st after gathering all this info from med screen?

A

does this pt belong in my clinc?

what is my DD, and go from there

39
Q

What are examples of red flags?

A

•Unexplained weight loss
•Symptoms that awaken the patient at night
•Severe pain that is unchanged by position or movement
•Alterations in bowel/bladder function•
Recent history of fever, chills, night sweats, nausea, vomiting

40
Q

What are examples of yellow flags?

A

•Factors that increase risk of poor prognosis
•Developing/perpetuating long‐term disability
•Examples:
•Psychosocial stress/
Fear avoidance behavior
•Anxiety
•Depression
•Pain catastrophizing
- we can refer and treat with yellow flags, or treat and monitor

41
Q

If a patient reports numbness or weakness, is it a red or yellow flag?

A

some patient may report weakness and mean fatigue, this is not a red flag
- if neuro exam reveals no findings, the weakness becomes a yellow flag, not red.
true weakness is like foot drop

42
Q

what is light headedness most often associated with?

A

vascular or cardiac insufficiency or

Primary Care for the PT (6 decks)

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