What is AAA?
abdominal aortic aneurysm
An enlarged area in the lower part of the aorta. AAA often grows slowly and usually without symptoms, making them difficult to detect.
Symptoms: A pulsating feeling near the navel, deep and constant pain in your abdomen or on the side of your abdomen, Back pain
In the context of screening for referral the primary purpose of a diagnosis is a. to obtain reimbursement b. to guide the plan of care and intervention strategies c. to practice within the scope of physical therapy d. to meet the established standards for accreditation
A patient gives you a written prescription from a physician, chiropractor, or dentist. The first screening question to ask is a. What did that person say is the problem b. Did they examine you? c. When d you go back d. How many times per week did they suggest I see you??
True or False: Physical therapy evaluation and intervention may be part of the physician's differential diagnosis.
What is the difference between a yellow and red flag?
Red – warning of something more serious
Yellow – caution – slow down and think about possible further screening/referral
You are looking for a pattern that suggests a viscerogenic or systemic origin of pain and/or symptoms
6 red flags that suggest the need for further screening (what class said during class)
- Night pain
- Change in weight
- Bowel and bladder issues
- Intractable pain
- Difficulty swallowing
- No change with conservative treatment
What are the levels of disease prevention? (4)
- Primary prevention – stopping the processes that lead to disease and illness through identification, education, risk factor reduction, health promotion
- Secondary prevention – medical screening tests (blood work, colonoscopy)
- Tertiary prevention – limiting degree of disability, improving function
- Health promotion and wellness – giving people greater awareness and control in making health choices
6 guidelines for effective communication
- Information giving – explain as you go. Why are you asking personal questions, or questions that seem unrelated to the CC?
- Information seeking – your patient is there because they have a health concern
- Partnership building – your care/advice must persist after the patient leaves you. Do they understand what they need to do to get better?
- Never speak badly about other providers to patients
- Being disrespectful and condescending to patients results in high malpractice rates
- Speaking positively reassures patient of good care
The 5 elements of patient/client management for PTs
- Examination- history, systems review, tests, and measures
- Evaluation- assessment or judgement of the data
- Diagnosis- determined within the scope of practice
- Prognosis- projected outcome
- Intervention- coordination, communication, and documentation of an appropriate treatment plan for the diagnosis based on the previous 4 elements.
When does a PT screen their patient for differential diagnosis and/or red flags?
It is an ongoing process throughout the patient's course of care
Definition of primary care
the coordinated, comprehensive, and personal care provided on a first-contact and continuous basis
Guidelines for immediate medical attention (10)
- Anginal pain not relieved by medication with 20 min
- Angina with nausea, vomiting, profuse sweating
- bowel/bladder incontinence and/or saddle anesthesia
- anaphylactic shock
- inadequate ventilation or CO2 retention
- diabetic who is confused or lethargic or has changes in mentation
- Positive McBurney's point or rebound tenderness
- worsening symptoms of intermittent claudication
- Throbbing chest, back, or abdominal pain that increases with exertion accompanied by a sensation of a heartbeat when lying down and a palpable pulsating abdominal mass
- changes in size, shape, tenderness, and consistency of lymph nodes.
What are the major decision making tools used in the screening process? (5)
- Past medical Hx
- Risk Factor Assessment
- Clinical Presentation (pain types and pain patterns)
- Associated signs and symptoms
- Review of systems
*Each client can be framed by these 5 components.
5 F's associated with gall stones
What is the effect of NSAIDs on blood pressure?
a. no effect
b. increases blood pressure
c. decreases blood pressure
With what final question should you always end your interview?
- Are any other symptoms of any kind anywhere else in your body that we haven't discussed yet?
- Is there anything else you think is important about your condition that we have not discussed yet?
- Is there anything else you think I should know?
What is the significance of night sweats?
a. a sign of systemic disease
b. side effect of chemotherapy or other medications
c. poor ventilation while sleeping
d. all of the above
e. none of the above
6 components of patient centered interview
- Explore patient's disease/diagnosis and its effect on his or her life
- Understanding the whole person (patient's goals)
- Finding common ground for intervention and/or management
- advocate prevention and health promotion (patient's perception)
- Enhancing patient- provider relationship (improves outcomes)
- Providing realistic expectations
Common interview deficiencies
- Low therapeutic content
- Inattention to primary data (symptoms)
- High control style by provider
- Incomplete database usually omitting patient centered problems
True or False: Spontaneous uterine bleeding after 12 consecutive months without menstrual bleeding requires medical referral.
Which of the following are red flags to consider when screening for systemic or viscerogenic causes of neuromuscular and musculoskeletal signs and symptoms: a. fever, night sweats, dizziness
b. symptoms are out of proportion to the injury
c. insidious outset
d. no position is comfortable
e. all of the above
You should assess patients who are receiving NSAIDS for which physiologic effect associated with increased risk of hypertension?
a. decreased heart rate
b. increased diuresis (peeing too much)
c. slowed peristalsis (the contraction/relaxation of intestines)
d. water retention
d Water retention. look for sacral and pedal edema
Instruct patients with a history of hypertension and arthritis to:
a.limit physical activity and exercise
b. avoid OTC meds
c. Inform PCP provider of both conditions
d. drink plenty of fluids to avoid edema
Alcohol screening tools should be:
a. used with every client some time during the episode of care
b. brief, easy to administer, and non-threatening
c. deferred when the client has been drinking or has the smell of alcohol on his breath
d. conducted with one other family member present as a witness
What is the best follow up question for someone who tells you their pain is constant?
a. Can you use one finger to point to the pain location?
b. Do you have that pain right now?
c. Does the pain wake you up at night after you have fallen asleep?
d. Is there anything that makes the pain better or worse?
52-year old woman has difficulty falling asleep due to pain and wakes as soon as she rolls to the painful side. What is the most likely explanation for this pain behavior?
a. minimal distractions heighten a person's awareness of musculoskeletal discomfort.
b. This is a systemic pattern that is associated with a neoplasm
c. It is impossible to tell
d. This represents a chronic clinical presentation of a musculoskeletal problem
Pain with neoplasm will most likely wake a patient up after having fallen asleep Chronic musculoskeletal conditions will often allow patient to fall asleep if properly positioned for up to an hour or two before pressure and ischemia to the tissue develop and cause pain.
Referred pain patterns associated with impairment of the spleen can produce musculoskeletal in:
b. right shoulder
c. mid or upper back, scapular, and right shoulder areas
d. thorax, scapulae, right, or left shoulder areas
Kehr's sign with pain referred to left shoulder
True or False: Associated signs and symptoms are a major red flag fr pain of a systemic or visceral origin compared to musculoskeletal pain.
Words used to describe neurogenic pain often include:
a. throbbing, pounding, beating
b. crushing, shooting, pricking
c. aching, heavy, sore
d. agonizing, heavy, sore
Pain (especially intense bone pain) that is disproportionately relieved by aspirin can be a symptom of:
b. assault or trauma
c. drug dependence
in particular bone cancer
Joint pain can be reactive, delayed, or allergic response to:
d. artificial sweeteners
e. all of the above
Bone pain associated with neoplasm is characterized by:
a. increases with weight bearin
b. negative heel strike
c. relieved by Tume or other antacid in women
d. goes away after eating
- bone pain would be accompanied by a positive heel strike test
- symptoms of angina are sometimes relieved by antacids in women
True or False: Pain of a viscerogenic nature is not relieved by a change in position.
True or False: Referred pain from the viscera can occur alone, but is usually preceded by visceral pain when an organ is involved.