screening in PT Flashcards
1
Q
The Screening Process
A
Take vital signs
- Review the pain body chart
- Review medications and their potential side effects against current signs and symptoms
- Watch for red flag histories, risk factors, and associated signs and symptoms
- Always ask a broad, open-ended question
- Conduct the medical chart review
2
Q
red flags of systemic illness
A
Gradual onset with no known cause
- Gradual, progressive, cyclical onset
- Constant/intense pain
- Symptoms unrelieved by rest or
change in position - Bilateral symptoms
- Constitutional symptoms
3
Q
Bilateral Symptoms
A
- Pigmentation changes
- Edema
- Rash
- Clubbing/nail bed changes
- Weakness
- Numbness/tingling
- Burning
4
Q
Constitutional Symptoms
A
- Fever
- Diaphoresis
- Night sweats
- Pallor
- Fatigue
- Nausea
- Vomiting
- Diarrhea
- Dizziness/syncope
- Weight loss
- Headache
- Visual changes
- Bowel/bladder
- Unusual vital signs
- Warning signs of cancer * Dyspnea
- Orthostatic hypotension
5
Q
- Diaphoresis
A
sweating, especially to an unusual degree as a symptom of disease or a side effect of a drug.
6
Q
Red Flag- Vital Signs
A
Correlate unusual vital signs with other signs and symptoms, such as:
* Pallor
* Perspiration
* Fatigue
* Palpitations
7
Q
bad Resting heart rate
A
120 to 130 bpm
Anemic individuals may have increased normal resting pulse that
should be monitored
8
Q
bad Resting systolic pressure
A
180 to 200 mm Hg
Precautions/Contraindications to Therapy
9
Q
bad Resting diastolic pressure
A
105 to 110 mm Hg
Precautions/Contraindications to Therapy
10
Q
other Precautions/Contraindications to Therapy
A
Marked dyspnea
Loss of palpable pulse or irregular pulse with symptoms of dizziness, nausea, or SOB
11
Q
Pain of cardiac and diaphragmatic origin is often felt where
A
in the shoulder
because the heart and the diaphragm are supplied by the C5–6 spinal segment
12
Q
Diaphragmatic irritation referral site
A
Shoulder, low back
13
Q
Heart referral site
A
Shoulder, neck, upper back, TMJ
14
Q
risk factor for heart disease
A
HTN
smoking
elevated cholesterol
family history
stress
sedentary lifestyle
older age
obesity
diabetes
15
Q
classic cardiac symptoms
A
chest pain
tightness/pressure
SOB
palpations
indigestion
burning
16
Q
classic pulmonary symptoms
A
SOB
dyspnea - labored breathing
wheezing
cough
increased work of breathing
sputum
17
Q
what is the well criteria looking was
A
risk of DVT
18
Q
what to look at when a pt is on oxygen
A
delivery of oxygen
amount of oxygen being delivered
19
Q
can ECG tell you about the future
A
no
20
Q
ECG and coronary anatomy
A
ECG does not tell you anything about coronary anatomy
21
Q
Cardiac catheterization provides information about what
A
information about the coronary arteries and provides a dynamic assessment of cardiac muscle
22
Q
risk factors for cardiovascular disease
A
age, gender, ethnicity
23
Q
clinical presentation of cardiac issue
A
pain that is worse with exercise
cardiac pain pattern - shoulder, neck, upper back, and TMJ
absence of the 3p’s
24
Q
what are the 3 P’s
A
palpation
pleura pain
postion
25
palpation of the 3P's
if there is pain with palpation it could be skeletal
26
pleura pain of the 3P's
pain when you are breathing and have to cough
27
Position of the 3P's
change in position of the neck, truck, or shoulder - MSK pain
28
Stable angina and nitroglycerin
Relieved by nitroglycerin (30 sec to 1 min)
29
Stable angina presentation
Comes on at the same heart rate and blood pressure and is relieved by rest (lasts only a few minutes)
Associated with feelings of doom, cold sweats, shortness of breath
30
is stable angina palpable
no
31
stable angina effect on ECG
Often seen with ST-segment
32
Nonanginal discomfort (chest wall pain) Nitroglycerin
Nitroglycerin generally has no effect
33
Nonanginal discomfort (chest wall pain) timing
Occurs any time; lasts for hours
34
Nonanginal discomfort (chest wall pain) palpation
Muscle soreness, joint soreness, evoked by palpation or deep breaths
35
Nonanginal discomfort (chest wall pain) effect on ECG
No ST-segment depression
36
* Angina and/or myocardial infarction (MI) pain location and presenstion
can appear as arm and shoulder pain
can be misdiagnosed as arthritis or other musculoskeletal pathologic conditions.- but this can be localized and reproduced
this is unaffected by position, movement, or breathing
37
Dyspnea on exertion is normally a result of what
* Often the result of left ventricle dysfunction, failure to clear all blood from lungs resulting in pulmonary congestion and SOB
38
Paroxysmal nocturnal dyspnea
a sensation of shortness of breath that awakens the patient, often after 1 or 2 hours of sleep, and is usually relieved in the upright position.
39
Orthopnea
sensation of breathlessness while living down horizontally, relieved by sitting or standing
40
PND and sudden, unexplained episodes of SOB often accompany
heart failure
41
Dyspnea caused by pulmonary disease not cardiac is often relieved by what
by specific breathing (pursed-lip breathing) or by specific body position (leaning forward on arms)
42
what is Syncope
Sudden loss of consciousness accompanied by an inability to maintain postural tone
43
cause of Syncope
Can be related to reduced oxygen delivery to brain
* Cardiac and non-cardiac causes
* Related to side effects of medications
44
Medical referral recommended for what kind of syncope
unexplained syncope
especially in presence of heart or circulatory problems or if risk factors for heart attack or stroke are present
45
Fatigue of cardiac nature often accompanied by what
associated symptoms
Fatigue beyond expectations during or after exercise is red flag, especially with no other explanation
46
A Cough can be associated with what
Usually associated with pulmonary disease, but can be pulmonary complication of cardiac disease
47
A cough, especially at night, can be associated with
heart failure and / or a side effect of calcium channel blockers
48
Cough specific associations with the heart
Left ventricular dysfunction, mitral valve dysfunction resulting in pulmonary edema or left ventricular heart failure-may also result in cough
49
Cyanosis suggest what
Suggests inadequate blood oxygen levels
Most often associated with cardiac and pulmonary problems
50
Central cyanosis
oxygen levels reduced in arterial
blood
51
Peripheral cyanosis
normal blood oxygenation but decreased or slow blood flow
52
Edema
An accumulation of fluid
red flag and a referral
53
PVD related pain
Pain in limb, pelvis, or buttock may be result of ischemia related to PVD
54
Deep vein thrombosis after surgery may develop and will present with
enlarged, warm, and painful leg
55
Vascular pain
often throbbing in nature and exacerbated by activity.
56
Vascular pain risk factors
older
personal or family history of heart disease.
hyperlipidemia
tobacco use
diabetes.
57
pleuropulmonary Causes of Chest, Breast or Rib Pain - past medical history
* Cancer
* Recent pulmonary infection
* Recent accident or hospitalization
58
Red Flags for pleuropulmonary issues
Pain exacerbated by deep breathing and activity or a productive cough with bloody or rust-colored sputum
59
clinical presentation of Pain relief of pleuropulmonary issues
* Pain is relieved by restricting expansion of the chest wall
60
Symptoms that do not increase with pulmonary movements is indicative of
a MSK issue
61
Symptoms increase with pulmonary movements and cannot be reproduced with palpation
a pleuropulmonary issues
62
sign of asthma
ncreased chest pain with exercise
63
Pain referred from the pulmonary system presents as
aggravated by respiratory movements
aggravated by supine position (may be pleuritic in origin b/c abdominal contents push up against the diaphragm)
64
CP system systems review
heart rate, respiratory rate, blood pressure, and presence of edema
65
what is a systems review
Brief examination of all systems that would affect the ability of the patient to “initiate, sustain, and modify purposeful movement for the performance of actions, tasks or activities that are important for function”
66
MSK system system review
gross symmetry, gross ROM, gross strength, height, and weight
67
NM system systems review
gross movement involving balance, gait, locomotion, transfers, and transition as well as motor control and motor learning
68
Integumentary system systems review
pliability (texture), presence of scar formation, skin color, and skin integrity
69
sternocleidomastoid muscles often hypertrophy with what
in chronic obstructive pulmonary disease owing to increased work of the accessory muscles to assist with breathing.
70
The increased size of the abdomen in obesity (or pregnancy) restricts what in breathing
the full downward movement of the diaphragm during inspiration and restricts lung tissue at rest, therefore creating a restrictive effect on the lung.
71
barrel Chets wall is seen with what disease
COPD
72
Semi-Fowler’sPosition
defined as a body position at 30° head-of-bed elevation
73
ProfessorialPosition
taken by people who have COPD
74
Jugular venous distention ( JVD) observed with what
heart failure
75
Apnea
absence of ventilation
76
Bradypnea
slowrate, regular rhythm
77
Tachypnea
fast rate, shallow depth, regular rhythm
78
Cheyne-Stokes
increasing then decreasing depth, period of apnea interspersed, seen in critically ill
79
Apneustic
slow rate, deep inspiration followed by apnea, irregular rhythm, brainstem disorders
80
* Dyspnea
rapid rate, shallow depth ,regular, accessory muscle use
81
Digital clubbing due to what
chronic tissue hypoxia
82
Arterial BP is general indicator of what
function of
heart as a pump (systolic/diastolic)
83
Evaluation of oxygen saturation should be done in what kind of patients
Should be evaluated in patients with heart
failure, pulmonary HTN, pulmonary disease
84
warmth in a area is indicative of
inflammation or infection
85
cool is indicative of
reduced blood flow
86
assess the 5P's
1. Pain,
2. paresthesia's,
3. paralysis,
4. pulse,
5. pallor
indicative of blood flow
87
Capillary Refill Time Test (CRTT) purpose
screen for poor peripheral circulation
88
Capillary Refill Time Test (CRTT) procedure
Depress nail bed for 5 seconds so they blanch or turn white
Positive findings for poor circulation include:
a. Finger ≥ 3 seconds
b.Toe ≥ 5seconds
89
grade 0 of pulse
absent
90
grade 1+ of pulse
palpable but diminished
91
grade 2+ of pulse
palpable and brisk (normal)
92
grade 3+ of pulse
increased
93
grade 4+ of pulse
increased and bounding
94
Cardiac Palpation Sites purpose
Assess for visible pulsations outside of
the norms
95
Cardiac Palpation Sites procedure
Supine with bed elevated to 30 degrees OR Left lateral decubitus position
Palpate all areas with pads of fingers, followed by heel of hand
96
Cardiac Palpation - * Thrills
Murmur
97
Cardiac Palpation - Heaves
Cardiac Hypertrophy
98
Cardiac Palpation - Pain
MSK origin
99
Cardiac Palpation - Deformities
pectus cranium or excavatum
100
Aortic Area
* 2nd R intercostal space
101
Pulmonary Area
2nd L intercostal space
102
* Right Ventricular Area
3-5th intercostal space, L sternal
border
103
Left Ventricular Area
4-5th intercostal space, medial to midclavicular line
* Apical Region
right below the nipple
104
S1
1st heart sound
closing of the mitral and tricuspid valve leaflets “lub”
Marks the beginning of systole
rate is comparable to palpable pulse
105
systole
when the heart muscle contracts and pumps blood from the chambers into the arteries.
106
S2
2nd heart sound
produced by the closing of the aortic and pulmonic valve leaflets “dub”
*Marks the beginning of diastole
107
S2 location
Aortic valve @ 2nd R interspace
Pulmonic Valve @ 2nd L interspace
108
S1 location
Tricuspid Valve @ Lower L
sternal border 4-5th ICS
Mitral Valve @Apex of heart, 5th ICS midclavicular line
109
S3
* Additional “dub” (lub, dub, dub)
* Heard early in ventricular filling
* Normal in children
* Cardiomyopathy or CHF in adults
110
S4
Additional “la” (la, lub, dub)
Heard during atrial contraction
Associated with stiff, low compliant ventricle
111
Systolic murmur
* “lub” whoosh “dub”
* associated with aortic stenosis
112
Murmurs
Turbulence of blood flow through
113
* Diastolic murmur
“lub” “dub” whoosh
* associated with aortic and pulmonic regurgitation & mitral stenosis
114
where do we find the apical pulse
Apex of heart, 5th ICS midclavicular line
Palpated or auscultated
115
what is the apical pulse a good representation of
measure of heart rate
116
Edema - Pitting examination
Apply digital pressure of or 15-30s over
bony prominence
Release and determine soft (pitting) vs indurated (non-pitting) edema
117
Edema resolving > 40s suggestive of what issue
heart failure
118
Carotid Artery Auscultation purpose
Screen for possible carotid artery blockage
119
sites for Carotid Artery Auscultation
Angle of jaw, Carotid bifurcation, Base of neck, Subclavian artery
120
Carotid Artery Auscultation positive finding
(+) carotid, systolic bruit, is a blowing or swishing sound
121
Tracheal Shift Purpose
assess for the presence of a tracheal shift
122
Tracheal Shift procedure
examiner would palpate the position of the trachea with their index finger
123
Tracheal Shift- what cause the trachea to shift away from the primary abnormality
mass effect of a large pleural effusion, pneumothorax, or intrathoracic mass will
124
Tracheal Shift- what cause the trachea to shift towards from the primary abnormality
collapse of a lung caused by bronchial obstruction
125
Chest Wall Motion examination purpose
Note symmetry, superior, A/P & Lat motion
126
Normal finding with Chest Wall Motion
3-5 cm expansion from midline
127
Chest Wall Motion - COPD
reduction in expansion or movement bilaterally
128
Chest Wall Motion - unilateral lung collapse
non-symmetrical movement
129
Chest Wall Motion - unilateral delay suggests
atelectasis, pneumonia, post- operative guarding or poor chest wall muscle function
130
Diaphragmatic Motion examination purpose
Asses the integrity and capability for the
diaphragm to engage in inspiration
131
Diaphragmatic Motion normal motion
normal = 2-3 inches separation
132
Tactile Fremitus purpose
Assess areas of increased or decreased fremitus
A vibration felt when an examiner palpates a body part
133
Tactile Fremitus positive finding
+) increased to decreased fremitus or sound transmission during contralateral comparison
* warrants further investigation, as may have consolidation or poor ventilation in area
134
Mediate Percussion purpose
Evaluate changes in lung density by
sounds produced
* Be aware of other areas outside the lungs, such as organ tissue or bowel regions
135
when do Lung sounds increase
in areas of increased tissue density
Ex. Consolidation-lung tissue becomes firm and solid due to exudates
136
Bronchial/Tracheal lung sounds
Loud tubular sounds over the trachea and manubrium
Pause will be heard from inspiration and expiration
Equal inspiratory and expiratory phase
137
Bronchovesicular
Softer vs bronchial, and in 2nd intercoastal space
No pause between inspiration and expiration
138
Vesicular sounds
Soft rustling sounds over more distal
airways in the peripheral lung fields
Inspiration longer than expiration
139
Bronchial heard where vesicular sounds should be
Fluid or secretion
140
Decreased breath sounds
Hypoventilation or severe congestion
141
Absent breath sound
* Collapsed lung or severe consolidation
142
Wheeze/ Rhonchi
Airway obstruction from bronchoconstriction or retained secretions with expiration
* Present with inspiration indicates significant obstruction
143
Stridor
tremely high-pitched wheeze with upper airway obstruction heard both inspiration and expiration
* *medical emergency*
144
Crackles/ Rales
Discontinuous sound of
* bubbling or popping sound with
presence of fluid or sudden open/closing of airway
145
Voice Transmission Tests
to discover if consolidation is present in the lungs
