Look, Listen and Feel

musculoskeletal look for

presentations consistent with trauma or repetitive stress with local inflammation, redness/swelling unilaterally, restriction in motion or strength or accessory motion, stresses reproduce complaint, self-splinting at injured region, tolerance of postures/mechanics

musculoskeletal listen for

pain response to movement, activity, load and rest (24 hour pain cycle), history of direct blunt trauma to tissue (compartment syndrome, myotropic ossification, fracture)

physical stress theory

tissues react relative to the amount of stress they receive, more stress can increase the functional zone, and permit a more excessive amount of load that is tolerable

prolonged low stress can

lose the capacity to hand high stress and reduce the functional zone, making previous normal loads too extreme or excessive and increasing risk of injury

facet joint profile, feel

non-radicular referred pain, mechanical/chemical stimulation of deep facet structures, pain is typically localized but can be on anterior or posterior chest wall and can be provoked with direct stimulation to joint (probability is high if we can replicate the pain)

myofascial pain profile, feel

muscle trigger points that when stimulated, produce pain patterns - provoked with direct stimulation to muscle (neck and headache example_

cardiovascular system common signs

diaphoresis, skin color changes, dyspnea, peripheral edema, weakness, ascites, anxious, clubbing, jugular distension

arterial insufficiency features

ischemic ulcers, dry scaly skin, hair loss, dependent rubor, blanching with elevation

venous insufficiency features

shallow exudative ulcer, unilateral swelling, hyperpigmentation (hemosiderian staining)

cardiac angina with MI

can present with chest, arm and neck pain in various locations and combinations - 42% of women having an MI will have no chest pain

angina

related to predictable emotional/physical stress

vascular claudication

predictable amount of walking causes leg pain

duration of cardiac pain onset

angina - stable 1-5 minutes, unstable 20-30min; MI - anginal pain >30min; vascular claudication pain - goes away after short rest

description of pain for cardiac

throbbing, pounding, pulsing, beating, crushing/viselike, heavy, squeezing, abnormally severe, gripping, burning, cramping

pulmonary system signs

skin color, orthopnea (emphysema), dyspnea, shallow breathing, labored breathing (bronchitis), cough (bronch - wet, pneumothorax - dry), forward leaning posture (COPD), pursed lip breathing (emphysema), peripheral edema, anxious, fatigue, flared nostrils (asthma)

GI system primary pain locations

epigastric at heart, esophagus, stomach, duodenum, gallbladder and liver; periumbilicar at small intestine, pancreas and appendix; lower midabdominal at large intestine and colon

description of GI system complications

deep, aching, boring, gnawing, vague burning, deep grinding, relationship to food

gallbladder common factors

reports of sudden excruciating/midepigastric referral to back and right shoulder or low back, 1-3 hours after eating, especially fatty foods (repeated episodes common, stool can be fatty)

gall stone risk factors

age, women, elevated estrogen levels - pregnancy, contraceptives, obesity, diet, diabetes, fasting, genetics, rapid weight loss

nervous system, look for

characteristic signs that the body is having difficulty receiving, interpreting/processing and acting upon information

consideration of nervous system

mental status (a/O), facial appearance (eye movement, symmetry, lesions), motor/sensory function (one sided - brain, bilateral - SC, nerve distribution - peripheral), coordination/gait - are any of these new to them

nervous system listening

pain as a feature for differential diagnosis during acute phases (worst headache of my life), constitutional symptoms, symptoms of communication disruption - motor/sensory, history of fall/trauma - TBI, brain bleed, cervical cord injury

endocrine system - look

neuromuscular signs of weakness, pain, nail changes, arthralgia (pseudo gout), systemic signs of excessive/delayed growth, changes in hair and skin, RR, dehydration/excessive water retention, moon face, vision loss

endocrine system - listen for

clinical signs and symptoms across multiple body systems, fatigue and weakness, multiple joint pain, reports of bilateral carpal tunnel or muscle cramping/twitching, generalized depression of body metabolism, thick/slurred speech, dry mouth, cold intolerance

metabolic/immune/inflammatory systems look for

spinal kyphosis, joint pain/swelling, lumps under skin, temporal arteritis, rib/spinal deformity, redness/warmth of joint, loss of spinal curves or cervical ROM, butterfly rash, raynauds, many conditions worse first few hours of morning

psychophysiologic anxiety, look for

increased saighing, respirations, SOB, sweating/clammy hands, chest pain, pacing/irritability

psychophysiological depression, look for

fatigue, insomnia, difficulty concentrating and making decisions, problems with memory, esophageal dysmotility, anorexia, overeating, nonulcer dyspepsia

psychophysiologic pain,look for

difficulty breathing, sweats/chills, weakness, tingly/numb hands, chest pain, racing heart, stomach pain

anxiety, listen for

expressions of fear, restlessness, irritability, reports of life stressors or chest pain associated with hyperventilation and claustrophobia

depression, listen for

expressions of sadness, loss of interests/pleasure, reports of dizziness, intolerance of temp, expression of hopelessness, reports of fatigue

symptoms manifest in ways that can

provide us with clues to the origin of the presenting complaint

skin cancer screening

asymmetry, border, color, diameter

basal cell carcinoma

most common malignant tumor, on head or neck of older adults, risk with fair skin and UV exposure, wounds, inflammation, arsenic, immunosuppression (45% risk developing basal cell within 5 years)

squamous cell carcinoma

often starts as rough patch of dry skin, affects fair skinned individuals with excessive sun exposure, >50y/o, common on back of hands/forearms

acral lentiginous melanoma

predominant type seen in pigmented races, diagnosis delayed leading to higher mortality, sole of foot or palm of hand grows

melanoma

most lethal skin cancer, sun exposure is major risk, common in women 25-34 (avg age is 65), lifetime risk is 2.2%