ppcm- health screening

Varieties of Screening

Pt with referral and dx from physician

Pt with referral, no MD dx

Pt without a referral

In search of particular dx or risk factor (Primary prevention)

Why Are We Screening?

Shifts in Practice Setting

Practitioner of Choice

Health Promotion/Disease Prevention

Better Patient Care!

Why Are We Screening for Mental Health?

Outcomes

Co-Morbidities

QOL

what are we screening for?

Undiagnosed

Existing Stable/Unstable

Masqueraders

PT Screening: Diabetes Complications

Heart Dx

Stroke

Blindness

Peripheral Neuropathy

Kidney Failure

Amputations

Screening as an Ongoing Process

Basic Screening: Review of Systems and Systems Review

Gross Screen, Every patient regardless of health condition, Every setting

Hands on and Observational

Baseline pt status

Quick and efficient

Advanced Screening

Subset of patients

Based on documentation,hx, ROS and Systems Review

Review of Systems Goals

Obtain info relevant to all bodysystems through observation, and questioning (screening).

Determine if the pt requires referral to another HCP

Is it urgent? Emergent?

Tx, Refer and Tx, Refer

Basic Screening: Review of Systems

Seek information relevant tomajor body systems through observation and questioning to help determine whether there are symptoms that suggest the need for referral for additional medical evaluation

Review of Systems

Cardiovascular system

Pulmonary system

Endocrine system

Eyes, ears, nose, and throat

Gastrointestinal system•

Genitourinary/reproductive systems• Hematologic/lymphaticsystems

Immune system

Integumentary system

Nervous system

Musculoskeletal system

Overall physical and psychological condition,such as unexplained weight change, fatigue, lethargy, and malaise; cognitive well-being; and emotional well-being, such as anxiety and feelings of hopelessness

Screening Goals

To Identify S&S within and outside of PT scope of practice

Determine Treat, Refer, Refer and Treat

Focus the examination, tests, and measures

Advanced Screening: Subset of Pts

When selecting screening tools, always consider:

Population for whom the screening is intended

Condition that the screen is intended to detec

When you are doing patient history what is it improtant to remember?

Psychological Wellbeing

Health Habits/Behavioral Risks

Social History: Culture/Religion/Spirituality, Live Alone/Socialization/Resources, Access to Care• Safety

Components of the Decision-Making Process: Focus on Screening

Pt/client history

RF Assessment

Pain Pattern and Type

Associated signs and symptoms of systemic disease

General Risk Factors

Age

Prior Personal or Family History

Race/Ethnicity

BMI

Etoh, Tobacco, Substanse Use

Sedentary Lifestyle

PT diagnosis is a

label encompassing a cluster of signs and symptoms commonly associated with a disorder or syndrome or category of impairments in body structures and function, activity limitations, or participation restrictions.

PT diagnosis is

ACTION oriented

Organize data into defined clusters to determine appropriate intervention strategies

Red flags...

are signs and symptoms found in the history and physical examination that suggest the presence of a serious pathology

Tx, Refer, Refer and T

Cautionary

prompts DPT to : "slow down"

Assess pain-associated psychological distress

Screen multiple system including psychological factors

signs for stroke

B: Balance difficulties

E: Eyesight changes

Face: Smile and see if one side of the face droops.•

Arms: Raise both arms. Does one arm drop?

Speech: Say a short phrase and check for slurred or strange speech.

Time: If the answer to any of these is yes, call 911 right away and write down the time when symptoms started

Signs & Symptoms Help Identify Pathological Conditions Detection Process

Perform screening process

Look for symptoms grouped together

Conduct a risk factor assessment

Primary and secondary prevention of disease Look for associated signs and symptoms

Categories of Red Flags

PMH• Risk Factors

Clinical Presentation

Pain Pattern

Associated signs/symptoms

Indicators of Systemic illness

Gradual onset with no known cause

Gradual, progressive, cyclical onset

Constant

Intense

Symptoms unrelieved by rest or change in position

Bilateral symptoms

Constitutional symptoms*

Bilateral symptoms that are indicators of systemic illness

Pigmentation changes

Edema

Rash

Clubbing/nail bed changes

Weakness

Numbness/tingling

Burning

Common Constitutional Symptoms

Fatigue

Malaise

Weakness

Headaches/Dizzy/Faint

Fever/Chills

Unexplained Weight Loss/Gain

Early Satiety

Nausea/Vomit

Bowel & Bladder Function

Numbness/Paresthesia

Constitutional Symptoms are

Potential Flags: In Context!

1.Fever

2. Diaphoresis (unexplained perspiration)

3. Night sweats (can occur during the day)

4. Nausea

5. Vomiting

6. Diarrhea

7. Pallor

8. Dizziness/Syncope (fainting)

9. Fatigue

10. Weight Loss

key POTENTIAL red/yellow flags

unexpected patterns

suspicious lymph nodes

trauma

recent infection

travel

multiple sexual patterns

severe constant night pain

recurrent colds/flu

the interview clinicans

Listen Well

Build on Pt Responses

Detect Confusion

Are Pt Centered

Shared Decision Making

Interview Goals

Rapport Building

Identify barriers

Establish the patient's goals

Determining the severity, irritability, nature, stage and stability of the patient's condition

Establish an early hypothesis regarding the source of symptoms

Interview Technique

Open-Ended

Close-Ended

Funnel Sequence

Paraphrasing

Open-ended questions

Responses: are not yes/no answers

Helps Clarify Details

Minimizes Grey Areas:Allows for Elaboration

Methods to Limit Excessive Elaboration: Redirect, Summarize, Circle Back to Core Issue

paraphrasing

Litmus Test

Repeat/rephrase

Bolsters Accuracy

What Constitutes GOOD MEDICAL History Taking?

HP

Thorough PMH: Use of systematic method, screening tools

Thorough PSH

Meds

Associated Signs and Symptoms

Medical History Taking HPI

OLDCARTS

Recurrent problem or new?

Seen any other provider?

Any treatments?

Imaging

Recent illnesses/infections

Medical History Taking PMH

When diagnosed?

How treated?

How managed?

MD Follow up

Stable/Unstable

Always Ask/Verify

Cardiac Dx

Hypertension,CVA, Neuro dx

Pulmonary Dx

DM

CA

PSH

Meds (Prescribed, OTC etc)

Trauma

Med History Taking PSH

Reason for surgery

Dates and Type of Surgery

Complications

Precautions

Impact

Questions to ask about medications

Prescribed: Taken as prescribed?Helping? Side effects?

MD Follow up

OTC: Taken as prescribed? Helping?MD aware?

Supplements: Recommendeddosage? MD aware

Alternative rxs: MD aware?