screening in PT Flashcards
The Screening Process
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
red flags of systemic illness
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
Bilateral Symptoms
- Pigmentation changes
- Edema
- Rash
- Clubbing/nail bed changes
- Weakness
- Numbness/tingling
- Burning
Constitutional Symptoms
- 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
- Diaphoresis
sweating, especially to an unusual degree as a symptom of disease or a side effect of a drug.
Red Flag- Vital Signs
Correlate unusual vital signs with other signs and symptoms, such as:
* Pallor
* Perspiration
* Fatigue
* Palpitations
bad Resting heart rate
120 to 130 bpm
Anemic individuals may have increased normal resting pulse that
should be monitored
bad Resting systolic pressure
180 to 200 mm Hg
Precautions/Contraindications to Therapy
bad Resting diastolic pressure
105 to 110 mm Hg
Precautions/Contraindications to Therapy
other Precautions/Contraindications to Therapy
Marked dyspnea
Loss of palpable pulse or irregular pulse with symptoms of dizziness, nausea, or SOB
Pain of cardiac and diaphragmatic origin is often felt where
in the shoulder
because the heart and the diaphragm are supplied by the C5–6 spinal segment
Diaphragmatic irritation referral site
Shoulder, low back
Heart referral site
Shoulder, neck, upper back, TMJ
risk factor for heart disease
HTN
smoking
elevated cholesterol
family history
stress
sedentary lifestyle
older age
obesity
diabetes
classic cardiac symptoms
chest pain
tightness/pressure
SOB
palpations
indigestion
burning
classic pulmonary symptoms
SOB
dyspnea - labored breathing
wheezing
cough
increased work of breathing
sputum
what is the well criteria looking was
risk of DVT
what to look at when a pt is on oxygen
delivery of oxygen
amount of oxygen being delivered
can ECG tell you about the future
no
ECG and coronary anatomy
ECG does not tell you anything about coronary anatomy
Cardiac catheterization provides information about what
information about the coronary arteries and provides a dynamic assessment of cardiac muscle
risk factors for cardiovascular disease
age, gender, ethnicity
clinical presentation of cardiac issue
pain that is worse with exercise
cardiac pain pattern - shoulder, neck, upper back, and TMJ
absence of the 3p’s
what are the 3 P’s
palpation
pleura pain
postion
palpation of the 3P’s
if there is pain with palpation it could be skeletal
pleura pain of the 3P’s
pain when you are breathing and have to cough
Position of the 3P’s
change in position of the neck, truck, or shoulder - MSK pain
Stable angina and nitroglycerin
Relieved by nitroglycerin (30 sec to 1 min)
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
is stable angina palpable
no
stable angina effect on ECG
Often seen with ST-segment
Nonanginal discomfort (chest wall pain) Nitroglycerin
Nitroglycerin generally has no effect
Nonanginal discomfort (chest wall pain) timing
Occurs any time; lasts for hours
Nonanginal discomfort (chest wall pain) palpation
Muscle soreness, joint soreness, evoked by palpation or deep breaths
Nonanginal discomfort (chest wall pain) effect on ECG
No ST-segment depression
- 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
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
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.
Orthopnea
sensation of breathlessness while living down horizontally, relieved by sitting or standing
PND and sudden, unexplained episodes of SOB often accompany
heart failure
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)
what is Syncope
Sudden loss of consciousness accompanied by an inability to maintain postural tone
cause of Syncope
Can be related to reduced oxygen delivery to brain
- Cardiac and non-cardiac causes
- Related to side effects of medications
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
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
A Cough can be associated with what
Usually associated with pulmonary disease, but can be pulmonary complication of cardiac disease
A cough, especially at night, can be associated with
heart failure and / or a side effect of calcium channel blockers
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
Cyanosis suggest what
Suggests inadequate blood oxygen levels
Most often associated with cardiac and pulmonary problems
Central cyanosis
oxygen levels reduced in arterial
blood
Peripheral cyanosis
normal blood oxygenation but decreased or slow blood flow
Edema
An accumulation of fluid
red flag and a referral
PVD related pain
Pain in limb, pelvis, or buttock may be result of ischemia related to PVD
Deep vein thrombosis after surgery may develop and will present with
enlarged, warm, and painful leg
Vascular pain
often throbbing in nature and exacerbated by activity.
Vascular pain risk factors
older
personal or family history of heart disease.
hyperlipidemia
tobacco use
diabetes.
pleuropulmonary Causes of Chest, Breast or Rib Pain - past medical history
- Cancer
- Recent pulmonary infection
- Recent accident or hospitalization
Red Flags for pleuropulmonary issues
Pain exacerbated by deep breathing and activity or a productive cough with bloody or rust-colored sputum
clinical presentation of Pain relief of pleuropulmonary issues
- Pain is relieved by restricting expansion of the chest wall
Symptoms that do not increase with pulmonary movements is indicative of
a MSK issue
Symptoms increase with pulmonary movements and cannot be reproduced with palpation
a pleuropulmonary issues
sign of asthma
ncreased chest pain with exercise
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)
CP system systems review
heart rate, respiratory rate, blood pressure, and presence of edema
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”
MSK system system review
gross symmetry, gross ROM, gross strength, height, and weight
NM system systems review
gross movement involving balance, gait, locomotion, transfers, and transition as well as motor control and motor learning
Integumentary system systems review
pliability (texture), presence of scar formation, skin color, and skin integrity
sternocleidomastoid muscles often hypertrophy with what
in chronic obstructive pulmonary disease owing to increased work of the accessory muscles to assist with breathing.
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.
barrel Chets wall is seen with what disease
COPD
Semi-Fowler’sPosition
defined as a body position at 30° head-of-bed elevation
ProfessorialPosition
taken by people who have COPD
Jugular venous distention ( JVD) observed with what
heart failure
Apnea
absence of ventilation
Bradypnea
slowrate, regular rhythm
Tachypnea
fast rate, shallow depth, regular rhythm
Cheyne-Stokes
increasing then decreasing depth, period of apnea interspersed, seen in critically ill
Apneustic
slow rate, deep inspiration followed by apnea, irregular rhythm, brainstem disorders
- Dyspnea
rapid rate, shallow depth ,regular, accessory muscle use
Digital clubbing due to what
chronic tissue hypoxia
Arterial BP is general indicator of what
function of
heart as a pump (systolic/diastolic)
Evaluation of oxygen saturation should be done in what kind of patients
Should be evaluated in patients with heart
failure, pulmonary HTN, pulmonary disease
warmth in a area is indicative of
inflammation or infection
cool is indicative of
reduced blood flow
assess the 5P’s
- Pain,
- paresthesia’s,
- paralysis,
- pulse,
- pallor
indicative of blood flow
Capillary Refill Time Test (CRTT) purpose
screen for poor peripheral circulation
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
grade 0 of pulse
absent
grade 1+ of pulse
palpable but diminished
grade 2+ of pulse
palpable and brisk (normal)
grade 3+ of pulse
increased
grade 4+ of pulse
increased and bounding
Cardiac Palpation Sites purpose
Assess for visible pulsations outside of
the norms
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
Cardiac Palpation - * Thrills
Murmur
Cardiac Palpation - Heaves
Cardiac Hypertrophy
Cardiac Palpation - Pain
MSK origin
Cardiac Palpation - Deformities
pectus cranium or excavatum
Aortic Area
- 2nd R intercostal space
Pulmonary Area
2nd L intercostal space
- Right Ventricular Area
3-5th intercostal space, L sternal
border
Left Ventricular Area
4-5th intercostal space, medial to midclavicular line
- Apical Region
right below the nipple
S1
1st heart sound
closing of the mitral and tricuspid valve leaflets “lub”
Marks the beginning of systole
rate is comparable to palpable pulse
systole
when the heart muscle contracts and pumps blood from the chambers into the arteries.
S2
2nd heart sound
produced by the closing of the aortic and pulmonic valve leaflets “dub”
*Marks the beginning of diastole
S2 location
Aortic valve @ 2nd R interspace
Pulmonic Valve @ 2nd L interspace
S1 location
Tricuspid Valve @ Lower L
sternal border 4-5th ICS
Mitral Valve @Apex of heart, 5th ICS midclavicular line
S3
- Additional “dub” (lub, dub, dub)
- Heard early in ventricular filling
- Normal in children
- Cardiomyopathy or CHF in adults
S4
Additional “la” (la, lub, dub)
Heard during atrial contraction
Associated with stiff, low compliant ventricle
Systolic murmur
- “lub” whoosh “dub”
- associated with aortic stenosis
Murmurs
Turbulence of blood flow through
- Diastolic murmur
“lub” “dub” whoosh
- associated with aortic and pulmonic regurgitation & mitral stenosis
where do we find the apical pulse
Apex of heart, 5th ICS midclavicular line
Palpated or auscultated
what is the apical pulse a good representation of
measure of heart rate
Edema - Pitting examination
Apply digital pressure of or 15-30s over
bony prominence
Release and determine soft (pitting) vs indurated (non-pitting) edema
Edema resolving > 40s suggestive of what issue
heart failure
Carotid Artery Auscultation purpose
Screen for possible carotid artery blockage
sites for Carotid Artery Auscultation
Angle of jaw, Carotid bifurcation, Base of neck, Subclavian artery
Carotid Artery Auscultation positive finding
(+) carotid, systolic bruit, is a blowing or swishing sound
Tracheal Shift Purpose
assess for the presence of a tracheal shift
Tracheal Shift procedure
examiner would palpate the position of the trachea with their index finger
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
Tracheal Shift- what cause the trachea to shift towards from the primary abnormality
collapse of a lung caused by bronchial obstruction
Chest Wall Motion examination purpose
Note symmetry, superior, A/P & Lat motion
Normal finding with Chest Wall Motion
3-5 cm expansion from midline
Chest Wall Motion - COPD
reduction in expansion or movement bilaterally
Chest Wall Motion - unilateral lung collapse
non-symmetrical movement
Chest Wall Motion - unilateral delay suggests
atelectasis, pneumonia, post- operative guarding or poor chest wall muscle function
Diaphragmatic Motion examination purpose
Asses the integrity and capability for the
diaphragm to engage in inspiration
Diaphragmatic Motion normal motion
normal = 2-3 inches separation
Tactile Fremitus purpose
Assess areas of increased or decreased fremitus
A vibration felt when an examiner palpates a body part
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
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
when do Lung sounds increase
in areas of increased tissue density
Ex. Consolidation-lung tissue becomes firm and solid due to exudates
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
Bronchovesicular
Softer vs bronchial, and in 2nd intercoastal space
No pause between inspiration and expiration
Vesicular sounds
Soft rustling sounds over more distal
airways in the peripheral lung fields
Inspiration longer than expiration
Bronchial heard where vesicular sounds should be
Fluid or secretion
Decreased breath sounds
Hypoventilation or severe congestion
Absent breath sound
- Collapsed lung or severe consolidation
Wheeze/ Rhonchi
Airway obstruction from bronchoconstriction or retained secretions with expiration
- Present with inspiration indicates significant obstruction
Stridor
tremely high-pitched wheeze with upper airway obstruction heard both inspiration and expiration
* medical emergency
Crackles/ Rales
Discontinuous sound of
- bubbling or popping sound with
presence of fluid or sudden open/closing of airway
Voice Transmission Tests
to discover if consolidation is present in the lungs
