System Screening

describe primary prevention

• health promotion

• advisory, counseling services, educational programs to drive lifestyle changes for prevention of chronic diseases

• prevent people from getting sick in the first place

• for populations with no diagnoses

describe secondary prevention

• health assessment and screening to facilitate early identification of chronic diseases

• identifying asymptomatic disease

• disease is under control

describe tertiary prevention

• management of chronic diseases

• rehabilitation support services to slow down the progression of diseases

define screening

detecting disease or body dysfunction before person would seek care

define surveillance

analysis of health information to look for problems occurring in general population, specific groups, workplace; involves targeted prevention

components of past medical history

• history of cancer

• recent infection

• recurrent cold/flu

• history of trauma/fracture

• history of immunosuppression (from steroids, organ transplant, HIV)

• history of injected drug use

describe guillian-barre syndrome

acute inflammatory demyelination that can progress to paralysis

clinical presentation red flags

• no known cause for problem

• symptoms unrelieved or worsened by PT

• symptoms return after successful pT

• significant weight loss or gain without effort

• gradual, progressive, cyclical presentation of symptoms

• unrelieved by rest

• symptoms out of proportion to injury

• symptoms persist longer than expected

• unable to alter symptoms during exam

• does not fit expected neuromuscular or musculoskeletal pattern

• no discernible patternof symtpoms

• growing mass/tumor

• postmenopausal bleeding

• bilateral edema

• bilateral clubbing

• bilateral nail bed changes

• bilateral skin pigmentation changers

• bilateral skin rashes

• change in muscle torn or ROM

define clubbing

swelling of fingers and toes around all sides of nails

no muscle tone indicates

paralysis

neurological conditions related to lack of muscle tone

cerebropalsy, multiple sclerosis, traumatic brain injury, spinal cord injury

red flags regarding pain patterns

• back or shoulder pain

• constant night pain

• pain worsened from activity and better with rest

• throbbing, deep aching pain

• poorly localized pain

• pain accompanied by signs and symptoms associated with gastrointestinal, genitourinary, gyn, cardiac, pulmonary, endocrine

why could back or shoulder pain be a red flag

common location of referred pain from heart and kidneys

describe intermittent claudication

muscle pain, cramping, aching, or heaviness in the legs that is triggered by physical activity and quickly relieved by a short period of rest; it does not have to be bilateral

what does intermittent claudication point to

cardiac problem

list of constitutional symptoms

• diaphoresis

• night sweats

• nausea, vomit, diarrhea

• pallor, dizziness

• fatigue, malaise

• unexplained weight loss

• fever

• decreased appetite

define diaphoresis

unexplained perspiration

what are constitutional symptoms

nonspecific symptoms that may indicate an underlying systemic illness, does not directly identify a condition but points to possible existence of a condition

factors to consider when reviewing cardiovascular system

• hypertension

• atrial fibrillation

• risk factors for cardiovascular disease

• obesity

how to identify atrial fibrillation from ECG

base line of heart rate reading is not flat between P and T waves

factors to consider when reviewing pulmonary system

chronic obstructive pulmonary disease

factors to consider when reviewing integumentary system

• skin integrity

• would repair

factors to consider when reviewing musculoskeletal system

• degenerative arthritis

• rheumatoid arthritis

factors to consider when reviewing neuromuscular system

• history of falls

• balance issues

• gastrointestinal condition

• genitourinary condition

factors to consider when reviewing psychosocial system

• ability to communicate

• affect

• cognition

• language

• learning styles

define affect

outward, observable manifestation of an emotion or mood

factors to consider when reviewing falls

• when the fall took place

• where the fall took place

• recovery from falls

• causes of falls

• loss of consciousness from fall

• injuries from fall

typical list of systems considered in past medical history

• cardiovascular

• pulmonary disease

• tuberculosis

• cancer

• diabetes

• hypertension

• infection

• recent surgery

• trauma

• pregnancy

• psychosocial

• medication

factors to note in regard to pregnancy in past medical history

birth, miscarriage, abortion

factors to note in regard to psychosocial in past medical history

orientation, anxiety, depression, panic disorder

define orientation

awareness of self, place, time

general risk factors

• substance use/abuse

• age

• BMI

• gender

• alcohol use/abuse

• occupation

• environmental exposures

• domestic violence

• hysterectomy

• oophorectomy

• ovariectomy

• race/ethnicity

• tobacco use

• overseas travel

• sedentary lifestyle

• multiple sex partners

define hysterectomy

surgical removal of uterus

define oophorectomy

surgical removal of one or two ovaries

oophorectomy also known as

ovariectomy

risk factors for nutritional deficiency

• economic status

• living alone

• older age

• depression, anxiety

• eating disorder

• lactose intolerance

• alcohol/drug addiction

• chronic diarrhea

• nausa

• GI impairment

• chronic endocrine/metaboic disorders

• liver disease

• dialysis

• medications

• chronic disability

• burns

• difficulty chewing or swallowing

key signs and symptoms of malnutrition

• muscle wasting

• alopecia

• dermatitis

• chapped lips

• brittle nails

• abdominal distention

• decreased physical activity due to fatigue

associated signs and symptoms of malnutrition

• blood in urine, stool, vomit

• changes in bowel and bladder

• confusion

• cough

• dizziness, fainting, blackouts

• dribbling

• fever, chills, sweats

• headaches

• heart palpitations

• joint pain

• memory loss

• nausea, vomit, loss of appetite

• numbness

• problems with vision or hearing

• trouble breathing

• trouble sleeping

define dribbling

leaking urine

purpose of screening process

guides PT to choose correct test and measure, recognize cluster of associated signs and symptoms for differential diagnosis

typical PT screening kit

• stethoscope

• sphygmomanometer

• thermometer

• pulse oximeter

• reflex hammer

• penlight

• cotton tipped swab

• 2 test tubes

• familiar objects

• tuning fork

• analog watch

• gloves

• tape measure

• goniometer

• safety pin

reason for using test tubes as PT

fill each with hot and cold water to test sensation

PT screening for body/breath odors

• fruity breath

• scent of alcohol

• halitosis

what might fruity breath indicate

diabetic ketoacidosis, acetone

define halitosis

dental decay due to pulmonary infection, throat/sinus infection, liver failure, uremia

define uremia

damaged kidneys failing to filter waste causing buildup of toxins to build up in blood

PT screening for vital signs

pulse, blood pressure, temperature, respiration, pulse oximetry, skin temperature, pain

typical PT examination components

posture, strength, balance, flexibility, vision, hearing, mini-mental state scale, skin check

pulse intensity abnormality

• weak pulse with strong beats

• thready pulse

• bounding pulse

describe thready pulse

weak and rapid pulse

describe bounding pulse

pulse is so strong that it is seemingly visible with throbbing seen at palpation signs

pulse regularity abnormality

irregular rhythm, tachycardia, bradycardia

define tachycardia

pulse rate too fast, greater than 100 bpm

define bradycardia

pulse rate too slow, less than 60 bpm

normal oral temperature

96.4 to 99.1 degrees fahrenheit, 37 degrees celsius

normal rectal temperature

0.7 to 0.9 degrees fahrenheit greater than oral temperature

normal axillary temperature

1 degree fahrenheit lower than oral temperature

define hypothermia

rectal temperature is less than 35 degrees celsius or 95 degrees fahrenheit

what is mini mental status scale used for

cognition screening

maximum score for MMSS

30

MMSS score indicating impaired cognition

less than 24

MMSS score indicating mild cognitive impairment

21 to 23

MMSS score indicating moderate cognitive impairment

16 to 20

MMSS score indicating severe cognitive impairment

less than 16

beck depression inventory score indicating minimal depression

0 to 13

beck depression inventory score indicating mild depression

14 to 19

beck depression inventory score indicating moderate depression

20-28

beck depression inventory score indicating severe depression

29 to 63

purpose of karnofsky performance scale

assess ability to carry out ADL

100% karnofsky performance scale indicated by

normal, no complaints, no signs of disease

which percentage of karnofsky performance scale indicated by caring for self, not capable of normal activity/work

70%

50% karnofsky performance scale indicated by

requires help often, requires frequent medical care

40% karnofsky performance scale indicated by

disabled, requires special care and help

signs of mild dehydration

thirsty, dry mouth, dry lips

signs of moderate dehydration

very dry mouth, cracked lips, sunken eyes, swollen fontanelle, poor skin turgor, postural hypotension, headache

define fontanelle

membrane-covered gap between the bones of an infant's skull that allows the head to mold during birth and the brain to grow rapidly

signs of severe dehydration

moderate signs, rapid and weak pulse, rapid breathing, confusion, lethargy, irritability, cold hands/feet, unable to cry, unable to urinate

define sensitivity of test

ability to rule out disease for negative results, true positive

define specificity of test

ability to rule in disease for positive results, true negative

equation for sensitivity

number of people testing true positive/(number of people testing true positive and false negative)

equation for specificity

number of people testing true negative/(number of people testing true negative and false positive)

equation for positive predicted value

number of people testing true positive/(number of people testing true positive and false positive)

equation for negative predicted value

number of people testing true negative/(number of people testing true negative and false negative)

components of posture screen at lateral view

• midline is between mastoid process

• vertical line of gravity is just in front of shoulder joints

• vertical line of gravity is at hip joints or just behind it

• vertical line of gravity is just in front of center of knee joints

• vertical line of gravity is slightly anterior to ankle joint

which muscles keep posture at ankle

plantar flexors

which muscles keep posture at shoulder

upper back

which muscles keep posture at hip

psoas major

which muscles keep posture at knee

hamstrings

describe romberg balance test

feet together for 30 seconds, eyes open, eyes closed

describe sharpened romberg balance test

heel to toe for 30 seconds, eyes open, eyes closed

describe single leg stance balance test

on one leg for 30 seconds, eyes opened and closed