Vitals and Sensory Testing Flashcards
Purposes of Sensory Testing
- Assess extent of sensory loss
- Evaluate/document sensory recovery
- Assist in diagnosis
- Provide prognostic info (hard to do accurately; use odds/averages)
- Determine impairment and func limitation
- Provide direction to OT tx
Who benefits from sensory testing?
- CNS dysfunction patients: loss of sensation over generalized areas (ie: left side)
- PNS dysfunction patients: loss of sensation over specific areas (ie: individual nerve injuries, such as radial nerve)
Factors to recovery of sensory dysfunction
- Etiology (type of injury)
- Severity
- Location of lesion
- Learning to use alternative strategies (alternate motor pathways?)
- Motivation (was there trauma?)
- Cognitive level
General Tips for Sensory Testing
- Patient should be comfortable/relaxed
- Room temp should be comfortable to pt.
- Decrease distractions (ie: spouses talking for pt., etc.)
- Understanding language (provide interpreter if needed)
Touch receptors
- used to assess nerve function
- based on skin stimulus, brain interprets impulses like heat, pain, light/heavy touch
- distribution of touch sensors varies on parts of body (ie: Palmar surface of finger has 60 pain receptors/100 touch. Back of finger has 100 pain/9 touch)
Why touch sensation is needed?
- Used in early learning
- Affects motor performance
- Essential for effective movement
- ANY loss in HAND sensation impairs tactile feedback
Static Two Point Discrimination
One method of evaluating nervous system function.
1) Pt’s vision occluded (look away/close eyes)
2) Area of normal sensation tested as ref using calipers (ie: check right side on pt. with left side neglect)
• Have pt describe what feels normal to them
3) Set calipers 10 mm apart to start.
• Place 2 points simultaneously on skin randomly, starting at fingertips and move proximally
• Skin should not blanch from caliper
• Ask if they feel “One” or “Two” pricks
4) Distance is decreased until the pt no longer feels 2 points; record that distance.
Discrimination Index
The measurement taken from a static two-point discrimination test. This is the distance between the points that the pt stops feeling both points.
Scoring Static Two Point Discrimination
- Normal score at fingertips is 6 mm
- 3 to 4 seconds should be allowed between applications
- The pt. should have 4/5 correct responses
- Score is “discrimination index” – the distance between the points where pt stops feeling it as 2 points.
Monofilament Testing
This is used to determine loss of protective sensation in feet. Monofilament testers come in different gauges.
1) Show pt. what it is/what you’re doing.
2) Test foot at various locations.
3) Place monofilament at perimeter, never over callous, scar, ulcer or necrotic tissue.
4) Hold filament perpendicular to skin.
5) Use a smooth motion in a 3-step sequence:
• Touch the skin
• Bend the filament
• Lift from skin
6) Ask if pt. could feel it.
Peripheral Neuropathy
Decreased sensation in the feet.
Monofilament Testing of Hand
Occlude pt’s view of test. Position hand comfortably, palm up. Start with thinnest filament and work toward thicker. Test (poke) 3 times at one location until pt. indicates it’s felt, increasing filament thickness as needed until felt. Move unpredictably over hand. Mark guage(s) of filament felt and location(s) of hand.
Screening of Diabetic Foot
Assess 10 places on diabetic’s foot: 6 on plantar side, 3 toes, and 1 dorsal side. Vary rate of pokes, and sites so it’s not predictable. Have client indicate when he feels filament. A failed test is when the pt. has 3+ failed sites. 1-2 filed sites is normal (bc foot has rough patches, etc.).
Pulse Oximeter
Provides easy way of assessing breathing by measuring OXYGEN saturation of arterial blood (called SpO2sub level) plus PULSE
• Shines 2 beams of light through finger (earlobe, etc.), one is red and one is infrared.
• 2 beams can detect color of arterial blood and work out oxygen saturation
• works best where there is a good strong pulse
• Also measures pulse rate.
Normal range of SpO2sub (blood oxygen saturation)
90-100, but varies by person.
* Someone with COPD may have lower oxygen after exercising, etc.
Pulse
Taking a pulse tells you the person’s heartrate, rhythm and regularity.DOES NOT tell you if heart is healthy
STRONG/REGULAR = even beats, good force WEAK/REGULAR = even beats, poor force IRREGULAR = strong and weak beats occur THREADY = irregular beats, weak force TACHYCARDIA = rapid heart rate over 100bpm (may be a rested/calm person) BRADYCARDIA = slow heart rate less than 60bpm (may be a stressed/just exercised)
Steps to measure Pulse
1) Wash hands!
2) Select site to take pulse
3) Place 2-3 fingers over site, avoid using thumb as you can feel your own pulse
4) Watch a clock
5) Count beats for 6-10 seconds
6) Multiply by 10/6 (should equal 60 seconds)
7) Record data in beats per minute (BPM)
Locations to find Pulse
1) Temporal: anterior/adjacent to ear
2) Carotid: inferior to angle of mandible and anterior to sternocleidomastoid
3) Brachial: medial to biceps in antecubital fossa, or on medial aspect of midshaft of humerus
4) Radial: at wrist in volar forearm medial to radial stylus
5) Femoral: at femoral triangle, slightly lateral and anterior to inguinal crease
6) Popliteal: in midline of posterior knee crease, betw tendons of hamstrings
7) Dorsal Pedal: along midline or slightly medial on dorsum of foot
8) Posterior Tibial: on medial aspect of foot inferior to medial malleolus
Blood Pressure
Measured to check blood flow.
• If too low, pt may not receive adequate blood flow to brain/heart
• If too high, pt can become unstable and may experience heart failure/stroke
Normal: less than 120 systolic, less than 80 distolic (lower ok, but not by a lot)
High: 140+ / 90+
Emergency high: >180 / >110
Digital Blood Pressure
Monitors with cuff/gauge that automatically records the pressure as cuff deflates. Can be fitted to upper arm, wrist or finger. Wrist and finger are not as accurate, but may be used for those who can’t use their upper arm. Finger ones not recommended.
* Be sure arm is at heart level if using a wrist!
Manual Blood Pressure (Steps)
1) Use fingers to find pulse at brachial artery, and place cuff over it on upper arm, 1” above bend of elbow and tighten so 2 fingers fit into the top of cuff
2) Insert ear pieces of stethoscope (angled toward nose; listen for echo)
3) Insert head of stethoscope under cuff at medial side of elbow, where pulse was found
4) Tighten the screw and pump bulb of cuff up to about 160
5) Very slowly release the air and listen for heartbeat
6) Record number where you begin to hear heartbeat (this is Systolic number)
7) Record number where heart beat stops (this is Distolic number)
- *Wait at least 1 minute between trials.
- *Pt should not cross legs.
Considered a “normal” blood pressure
Systolic 110, Diastolic 70
Base normal: 120/80, but slightly lower ok
Troubleshooting Manual Blood Pressure
- Make sure earpieces face nose
- Make sure cuff is 2 fingers above arm crease, hoses facing arm crease.
- Place steth head medial to hoses, near pulse point.
- If air leaks, ensure parts are connected properly.
- Do not cross legs during reading.
Normal Manual Blood Pressure Reading
Systolic 120 or less, Distolic 80 or less
(Slightly lower ok; 115 or less may be concern for LOB, etc.
High is 140+/90+. ER high >180/>110)
