system review and screening

types of prevention

stage of disease development. Primary, Secondary, Tertiary.

Primary Prevention

Preventing chronic diseases via health promotion, advisory, and counseling services

Secondary Prevention

Screening and assessments to diagnose chronic diseases early.

Tertiary Prevention

Management of disease and rehab to slow down disease progression.

screening definition

finding disease before person would seek care

surveillance definition

looking at health info for a specific population, group, or workplace.

components of medical history

• personal or family hx of cancer

• recent infection

  • neurological symptoms'

  • Gullian-Barre Syndrome

• Recurrent Colds or flu

• trauma

• immunosuppressants

• injected drug use

clinical presentation red flags

• no known cause for problem/no pattern

• unrelieved by PT or worse/gets better but then comes back

• significant wt loss or gain w/o effort

• gradual, progressive, or cyclical presentations of symptoms

• unrelieved by rest - no position is comfortable

  • symptoms out of proportion to injury.

• persisting and unaltering symptoms

• doesn’t fit Neuro/MSK pattern

• growing mass = tumor

• postmenopausal bleeding

• bilateral symptoms

• muscle tone (paralysis)

bilateral red flags

• edema

• clubbing

• numbness/tingling

• nailbed changes

• skin pigmentation changes

• skin rash

pain pattern

• back or shoulder pain

• night pain

• pain made worse by activity and better with rest (intermittent claudication)

• throbbing, boring, deep aching

• poorly localized = more systematic

  • S+S of GI, GU, GYN, Cardiac, pulm, endocrine

Constitutional Symptoms (red flags)

• diaphoresis

• night sweats

• nausea, vomiting, diarrhea

• pallor, dizziness/syncope

• fatigue, malaise

• wt loss

• fever

• dec appetite

What question should we ask for constitutional symptoms?

“Are there ANY OTHER symptoms or problems anywhere else in your body that might not seem related?”

Review of Systmes (ROS)

• CV - HTN, A-fib, risk factors for CVD

• Pulm - COPD

• Integumentary

• MSK - arthritis? (degenerative/rheumatoid)

• NM - history of falls, balance issues

• GI + GU

• pyshosocial

Interviews for Falls

• History

  • when, what time, where, task

  • why do they think they fell?

• Effects of fall

  • LOC (loss of consciousness)

  • injuries - fractures/lesions/bruises

Past Medical History

• CV

• Pulmonary

• Cancer

• Diabetes, Hypertension

• Infection

• Recent Srugery

• Trauma

• Prego, birth, miscarriage, abortion

• psychosocial screen

  • Orientation (time place person) x3

  • Anxiety, depression, panic

• Meds

Risk Factors (general)

• Substance use/abuse

• age

• BMI

• Gender

• Alc use/abuse

• occupation/environmental exposures

• domestic violence

• hysterectomy/oophorectomy (ovariectomy)

• race/ethnicity

• tobacco use

• overseas travel

• sedentary lifestlye

• exposure to ratiation

• multiple sexual partners

risk factors for nutritional deficiency

• economic status

• living alone

• older age

• depression, anxiety

• eating disorders

• lactose intolerance

• alc/drug addiction

• chronic diarrhea

• nausea

• GI impairments

• chronic endocrine/metabolic disorders

• liver disease

• dialysis

• meds

• chronic disability impacts ADLs

• Burns

• difficulty chewing/swallowing

signs and symptoms of malnutrition

• muscle wasting

• alopecia

• dematitis

• chapped lips

• lesions at corners of mouth

• brittle nails

• abdominal distention

• dec phys activity/energy level; fatigue, lethargy

PT Screening Kit

• stethoscope

• sphygomamnometer

• thermometer

• pulse oximeter

• reflex hammer

• penlight

• cotton-tipped swab

• 2 test tubes

• familiar objects

• tuning fork (128 Hz)

• watch, second hand

• gloves

• tape measure

• goniometer

• safety pin

components of PT screening

• Body + breath odors

  • fruity (diabetic ketoacidosis) (acetone)

  • scent of alcohol

  • halitosis (dental decay, pulm infection, throat or sinus infection, liver fail, uremia)

• Vital Signs

  • pulse, BP, Temp

  • Respiration

  • pulse oximetry

  • skin temp

  • pain

• posture

• strength

• balance

• flexibility

• hearing/vision

• MMSS (mini-mental state exam)

• skin check

pulse abnormality

• intensity

  • weak pulse mixed with strong beats

  • thready

  • bounding pulse

• Irregular

  • 2 quick beats followed by pulse

  • irregular rhythm

• Regular but doesn’t fit context

  • too fast (>100bpm)

  • too slow (<60 bpm)

Body Temperature Norms

• oral - 37C, 96.4-99.1F (98.6F)

• rectal - 0 0.7-0.9 higher than oral temp

• axillary - 1 deg than lower temp

• hypothermia = <35C, 95F rectally

• body temp varies over lifespan

mini mental status scale (MMSS)

1. what is the date today?

2. what day of the week is it?

3. what is the name of this place?

4. what is your telephone number? what is your address?

5. how old are you?

6. when were you born?

7. who is the president of the US now?

8. Who was the president before him?

9. What is your mother’s maiden name?

10. Subtract 3 from 100 and keep subtracting by 3

back depression inventory

21 questions

scoring depression

• minimal - 0-13

• mild - 14-19

• mod 20-28

• severe 29-63

karnofsky performance scale

100% - normal no signs of disease

70% - caring for self, not capable of normal activity/work

50% - need help often, need frequent med care

40% - disabled

0% death

dehydration signs

• mild

  • thirst

  • dry mouth/dry lips

• mod

  • very dry mouth, cracked lips

  • sunken eyes, swollen fontanelle

  • poor skin turgor

  • postural hypotension

  • headache

• severe

  • mod signs +

  • rapid weak pulse (>100bpm)

  • rapid breathing

  • confusion, lethargy, irritablity

  • cold hands + feet

  • unable to cry/urinate

integumentary screening

hands, arms, feet, legs

changes in

• texture

• color

• temp

• clubbing

• circulation

• edema

MSK System Screening

• obvious deformities, abnormalities, disabilties, asymmetries

• front, back, R/L

• upper quad/lower quad screen

• ROM

• muscle strength

• joint mobility

sensitivity

true positive rate - correctly identified as pos by a test

specificity

true negative rate - not disease found negative as test

posture screen

plum line

• mid line bw mastoid process

• point just in front of shoulder joints

• hip joints/just behind

• point just in front of center of knee joints

• slight anterior to ankle joint

balance screen

• romberg-feet together (30 sec)

  • eyes open and closed

• sharpened romberg (30 sec)

  • heel toe, eyes open and closed

• single leg stance (30 sec)

  • eyes open and closed

• TUG test

• Functional Reach

Timed Up and Go Test (TUG Test)

sitting chair → stand up → walk 3 meters → turn around → walk back → sit down

TUG Cognitive

ability for brain to coordinate movement and cognition at the same time

TUG manual

complete task while carrying a full cup of water

TUG Test Benefits

good correlation to other functional mobility

good interrater reliability

Cutoff levels of TUG Test

• TUG - 13.5s or longer (90%)

• TUG Manual - 14.5s (90%)

• TUG Cognitive - 15s (87%)

Predict Falls

• 87% sensitivity (greater than 87% time - likely fall)

Functional Reach

reach as far faorward as you can without taking a step

limited functional balance - <6-7 in

normal - >10 in more

gait screening

• gait assessment

• sit to stand

• stairs climbing

neurological screen

mental/emotional status

cranial nn.

motor function

sensory function

deep tendon reflexes (DTRs)