subjective assessment MSK week 1 Flashcards
what is the most important part of patient history
Social history - gives insight towards ADLs, living conditions, support system, hobbies or activities they would like to get back to, things they struggle with, etc
What is the body/symptom chart
chart of the body where Pt can point to areas of pain
helps with describing area of pain accurately
determines consistancy of pain
quality of symptoms
intensity of symptoms so you know what to prioritize
relationship between the symptoms (could be compensatory)
What are some qs you would ask for HPC
when/how did pain start
how long has it been going on for/is it getting better or worse (progression)
24hr pattern of symptoms
duration of symptoms
visual analogue scale 0-10
What are some qs you would ask for DH
what are you prescribed and how long have you been taking
have they made a difference
NSAIDS = nociceptive pain
Analgesics = neuropathic
sleeping tablets/muscle relaxants = muscle pain
anticoagulants = be gentle (bruise easily and cuts means lots of bleeding
what is MJTHREADS Ca and when should it be used
past medical history
Myocardiac infarction
Jaundice
Tuberculosis
Hypertension
Rheumatic fever
Epilepsy
Asthma
Diabetes
Stroke
Cancer (and treatment if so)
What are the red flag qs that should be asked for all pts
History of malignancy - cancer
unexplained weight loss
unremitting pain
biological or disperse neurological Signs or Symptoms
cauda equina symptoms (bladder disturbance and/or saddle anaesthesia)
What are yellow flags
psychological or behavioural factors
includes beliefs, coping strategies, willingness to change
what are blue flags
social/economic factors
includes family reinforcement, work status, health benefits
what are black flags
occupational factors
includes work satisfaction, working conditions, social policy
what are orange flags
relating to mental health
what are pink flags
factors that contribute to a good and healthy recovery
what are the 3 factors to treatment of a pt
biological (pathology, tissues, pain, sensation)
social (support, status, education)
Psychosocial (anxiety, depression, fear avoidance)
all 3 should be used, and often some pts are lacking/needing additional support in different areas than others
What is catastrophising
fearing the worst, and creating increased anxiety
What is the fear avoidance model
people get hurt, then they spend time catastrophising about it, leading to fear of the movement due to fear of reinjury, and this causes disuse/disability
they then get hurt again due to this and reinforces their fear
ideally want to lower fear and get them exposure to recover fully
what is self efficacy
perception that an individual can be effective in a certain task or action
believing that you can do something
What is the S in SIN
severity of symptoms
does it cause sleep disturbance, functional restrictions, how often
What is the I in SIN
most important
Irritability
how long to aggravate symptoms and how long to ease them
latency of symptoms?
high irritabilty results in less tests being able to be performed physically
What is the N in SIN
Nature
what is the source of the symptoms and what kind of pain do they feel
How many hypotheses should you have after the subjective assessment
on average, 4
How should your objective assessment be planned out
subjective and background info make up info, and this info after analysis creates a hypothesis
the hypothesis should then be tested, and then the results analyzed
if correct, you have your diagnosis, if incorrect, go back to initial analysis and come up with another hypothesis
What is clinical reasoning
cognitive processes used in the evaluation and management of a patient
what are the components of clinical reasoning
knowledge
metacognition (thinking about ur own biases/self-reflection)
clinical reasoning processes
What are the 3 types of knowledge
personal - life experience
propositional - knowing what (academic knowledge)
professional - practical clinical skills
What are the different clinical reasoning processes
hypothetico-deductive - testing around hypothesis
pattern recognition - diagnosing based on symptoms that fit a pattern of a pathology (high bias and lots of potential error)
diagnostic - interpretation of pt data
collaborative - working with other healthcare workers
narrative - listening to the story of the pt
What kind of notes should be used for subsequent visits
SOAP
Subjective reassessment
Objective reassessment
Assessment/analysis of pt problem
Plan for management/treatment
What are you supposed to ask and in what order during the subjective assessment
Introduce
identity confirmation
explain the plan/ask for consent
demographics
why they here (present complaint)
HPC
PMH
DH
SH
FH
