Week 1 Visual Appraisal, Vitals, and Gross Screening

visual appraisal

examination skill that can be used to collect baseline information and other information that may be difficult to gather otherwise

unreliable and low validity

drawback of visual appraisal

affective traits

component of visual appraisal that included non verbal cues, facial expression, emotional expression, gestures, interactions with others/environment, vocal characteristics, eye contact

physical traits

component of visual appraisal that includes any equipment, sweating, body configuration, alignment, dressing, skin color, symmetry

motor traits

component of visual appraisal that included arm and leg movements, breathing patterns, walking, posture in upper body and head, intentional and unintentional movements

surroundings, visitors, other team members, urgent needs of the patient

additional things to note during a visual appraisal

sign

an observable, objective measure that can be quantified by using valid and reliable measurement instruments

symptom

how a person experiences a condition, subjective and often difficult to measure directly (ie pain, dizziness, nausea)

All PT patients at every session

Who does APTA recommend we take the vitals of, and how often?

+3 bounding

HR that is readily palpable, forceful, not easily obliterated by finger pressure

+2 normal

HR that is easily palpable and obliterated only by strong finger pressure

+1 weak/thready

hard to feel and easily obliterated by slight finger pressure

+0 absent

not discernible HR

circulation

What is HR an indicator of?

factors that affect HR

age, sex, activity, autonomic nervous system, environment, drugs

monitoring methods of HR

electronic monitoring (EKG), pulse oximeter, manual palpation

radial a and carotid a

2 most common palpation sites

60 seconds

standard interval for manual HR

cardiovascular system health

key indicator of bloodd pressure

prognostic and diagnostic information

information that BP provides to the clinician

90-140/60-90

normative BP value for adults

left arm

arm that blood pressure is generally taken on, if not that must be noted and documented

pressure in the aorta

Indirect BP measurements estimate pressure in this vessel

between 12-20

normative respiratory rate for adults

between 25-50

normative respiratory rate for newborns

factors that influence respiratory rate

age, body size and stature, exercise, body position, environment, emotional stress, pharmacologic agents

rectal

standard test for temperature, considered the most accurate

dark skin, nail polish

features that can affect accuracy of pulse oximeter readings

hypoxia

saturation values that fall below 85%

visual analog scale

pain assessment tool in which patients mark their pain intensity along a scale

pictorial pain scales

drawings of progressively distressed facial expressions corresponding to pain level of varying intensities

borg’s rate of perceived exertion (RPE) scale

self reported exertion scale

gait speed

vital sign that may be indicative of functional ability and balance confidence, predictor of falls, mortality, hospitalization, and location of residence after discharge, easy to measure

Gross screen of ROM aspects

procedures should involve as few position changes as possible, unaffected side first, ensure patient is in best position/posture, typically performed in sitting but may be performed in supine

1 above, 1 below

joint-specific precaution when testing- test the join immediately proximal and immediately distal

gross muscle testing aspects

“break test”, may hold the patient in test position , asses ROM first to ensure that resistance is appropriate. must be indicated (no precautions in place), uses a 0-5 scale

muscle grade 5

muscle contracts normally agains full resistance (against gravity)

muscle grade 4

holds the test position against moderate resistance (against gravity)

muscle grade 3

holds the test positive against gravity with no added resistance, nearly full ROM

muscle grade 2

able to move through full ROM only in the horizontal plane

muscle grade 1

palpable or observable flicker/contraction in horizontal plane position, no visible movement

muscle grade 0

no palpable or observable contraction

contraindications or precautions of GMMT

unhealed fractures, unstable joints, post-operative precautions, advanced osteoporosis, metastatic cancer, osteogenesis imperfecta

reliability 

consistency of measurements- when you take something more than once, it gives the same result, there is agreement amongst observers- improves with training 

validity

is what you measure actually measuring what you think it is, if high the test gives an accurate reflection of the thing we want to know

goniometry

test measure that is both accurate and reliable

bilateral simultaneously when possible

how palpation of HR should ideally be

holter monitor

portable ECG monitor

thumb 

digit that should never be used to palpate HR 

palpation site commonly used in infants and prior to assessing an adult’s BP with stethoscope and cuff

brachial, temporal, femoral, popliteal, dorsalis pedis, posterior tibial

other sites in which palpation of HR can occur

systole

ventricular contraction- pushes blood into the aorta, increasing pressure within the vessel- is the palpable pulse as it pushes blood through the body 

diastole

ventricular relaxation- blood refills the heart chambers

low (hypothensive) BP

BP level that may cause a pt to faint

high (hypertensive) BP

BP that may cause a pt to have a stroke or myocardial infarcation

changes in body position 

BP in relation to changes in this are extremely important 

anxiety, tobacco use, recent food consumption, temperature, exertion, alcohol consumption, time of day, pain, valsalva

factors that may influence physiological BP

>60/variable 

normative resting BP of neonates (1-28 days)

70-95/variable

normative resting rate of infants (1-12 mo)

80-110/variable

normative resting rate of BP for children

ausculation 

most common method of percieving BP changes- performed with stethoscope over artery and sphygmomanometer- detect change in turbulence associated with changes in arterior pressure- listen for Karotkoff’s sounds 

labored, difficult, painful

levels of ease of respiration

tympanic

popular form of measuring temperature because quick and accessible, but has accuracy concerns

oral and axillary

other forms of taking temperature but less accurate

pain assessment

assessment of this vital “sign” (is really a symptom) is considered an element of standard care

acute pain

recent onset associated with tissue damage, resolves when tissue heals

chronic pain

persistent or recurring for more than 3 months, pain is real, but unreliable indicator of tissue damage, therapeutic alliance is crucial

numeric rating scale 

scale of 0-10, with 0 corresponding to no pain and 10 indicated greatest possible level of pain 

verbal descriptor of pain

description of pain can help with diagnosis and prognosis

factors that a may cause limited range of motion 

pain, structural blocks, joint effusion, edema, capsular tightness, lack of muscle length, excessive adipose or musclar tissue, inadequate force production 

severely limited

ROM is less than 50% expected

moderately limited 

ROM is 50-75% of expected 

slightly limited

75% or greater than expected

passive ROM (note joint end feel)

what should be tested for joints that are below the normal range of motion or have pain with active ROM 

peripheral nervous system, central nervous system, muscle degeneration, inadequate circulation, pain

things that may affect gross muscle strength