review of systems and medical screening Flashcards
what are the steps in reviewing systems and med screening?
gather info from
- past med hx
- med screening
- social hx
- Current Health Behaviors
what are important details for collecting info an nausea/ vomiting?
- 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
a patient has coffee ground vomit, what does this mean?
coffee ground vomitus represents blood
(hematemesis)
When shoudl N/V be reported to phys?
- persistant
- nausea that needs med use
what are possible reasons for N/V
- GI disorders
- Infection (hepatitis,influenza)
- MI
- Cancer
- Vestibular disorders
- Migraines
- Pregnancy
- Adverse drug reactions
Fever/Sweats/Chills are a response to
a systemic response to a systemic illness
if a patient reports Fever/Sweats/Chills, what should you ask them ?
- see if they have been taking temp,
- have they noted excess sweating, are they feverish ect.
what is a significant temp?
significant if 99.5 or higher for >2wks
- this could be a self limiting virus
At what point is a temp an urgent referral?
over 102
T/F if the pt does not have an temperature, then they must not have an infection
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
when are night sweats a concern?
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
what can be some causes for Fever/Sweats/Chills?
•Infections •Metastatic cancers •Rheumatic disorders •Menopause
when is weight changes considered a red flag?
-5-10% change over 4-6 months that is unexplained or unintentional (diet or activity)
a pregnant woman has gained 7 lbs in 1 week, what shoudl you do?
refer.
->5 lb wt gain in 1wk or>5 lb loss in first trimester shoudl be reffered
-
Why is weight monitoring important in CHF?
fluid accumulation is a sign of CHF exacerbation
> 2‐3 lbs in a day = referral
What could cause weight changes?
- Metastatic cancers (unexplained,>10lbsover6mo)
- Depression
- GI disorders
- Infections
- Anorexia nervosa
- Chronic pulmonary,cardiac or renal failure
- Rheumatic disorders
- Endocrine disorders, thyroiddysfunction, DM
Can Paresthesia, Weakness or Balance Problems be a cause for concern?
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
when is weakness a concern?
•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.
What could balance problems be related to?
If present with
Dizziness or lightheadedness:
•Vestibular issues
•Vascular insufficiency
possibly 2/2
•Neurologic disorders
•Adverse drug reactions
•Musculoskeletal injury/disease
When is a night pain a concern?
- 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
What is the difference btwn normal fatigue and concerning fatigue ?
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
what could cause fatigue?
- Psychosocial
- Endocrine/Metabolic
- Infections
- Neoplasms
- Cardiopulmonary
- Connective Tissue Disease
- Sleep Disturbances
- Medication Use
what is malaise?
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
Consider that the patients issues could have Mentation or Cognition influences? what type of flag is this considered?
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
what is a medication checkpoint?
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
you are performing a med check point, what do statin drugs control ?
control of high cholesterol. Pt should have high cholesterol
you are performing a med check point, what are opiods for?
excessive pain correlating to diagnosis, condition
What are important details to bring up with your pt and their meds?
- 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?
if you find a possible issue with meds, what should you do?
May need to consult with physician about meds
•Encourage patient to discuss with physician
what are possible SE of NSAIDS?
•GI bleeds,fatigue,death
- excess use is bad
what are SE of Statin drugs ?
complaints of fatigue, weakness, myalgias
what are SE of steroids ?
can cause fatty infiltrates into bone marrow leading to bone death
•osteoporosis
what are SE of Anticoagulants?
•aggressive exercise or mobilization or manipulation should warrant precaution/contraindication–may cause bleeding
what is the additional Q you should ask when screening depressed pts ?
“would you like help”
What should be collected in the social hx?
•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
Current Health Behaviors include ?
- etoh habbits smoking habbits nurtirtion/ diet patterns sleep physical activity stress level
what are details of activty and particpation we would like to know?
- 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
What do we do 1st after gathering all this info from med screen?
does this pt belong in my clinc?
what is my DD, and go from there
What are examples of red flags?
•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
What are examples of yellow flags?
•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
If a patient reports numbness or weakness, is it a red or yellow flag?
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
what is light headedness most often associated with?
vascular or cardiac insufficiency or
