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ASAN001 - Patient Evaluation & Triage > Patient Examination (ASAN001/2) > Flashcards

Patient Examination (ASAN001/2) Flashcards

1
Q

Why should a complete ‘Head to Tail’ examination be performed? (1)

A

To determine the status of the patient.

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2
Q

What knowledge should a Vet Nurse possess to perform an accurate & detailed physical examination? (2)

A
  • Must be aware of what is considered normal findings / parameters.
  • What are considered abnormal findings and what they may indicate.
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3
Q

What might determine the order in which a Detailed Physical Examination is performed? (3)

A

Order depends on the patient’s presentation:
- acute/serious
- chronic/mild.

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4
Q

What should a General Physical Exam include? (9)

A
  • Body Condition Score
  • Demeanour
  • Mucous Membranes (MM)
  • Capillary Refill Time (CRT)
  • Heart Rate (HR)
  • Respiratory Rate (RR)
  • Femoral Pulse
  • Temperature
  • General: Mobility, Eyes, Nose, Skin, Posture, Wounds / Haemorrhage
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5
Q

Why is Body Scoring important?(2)

A
  • Assists with recognizing weight loss or weight gain between visits or during hospitalisation.
  • Important everyone uses the same scale and is ‘scoring’ in the same way.
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6
Q

Hills Body Scoring Chart:

A
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7
Q

Why is Patient Demeanour important? (1)

A

Demeanour is a great indicator of how the patient is feeling.

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8
Q

What might impact your expectations of the patient’s demeanour? (1)

A

Circumstances around the reason for examination.
ie if here for routine visit (Vx) or if patient is unwell.

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9
Q

Why is frequent assessment of patient demeanour of hospitalised patients important? (2)

A
  • Important part of overall clinical picture.
  • Can help determine if the patient is improving or not.
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10
Q

What can the patient’s reactions to it’s environment indicate? (2)

A

The patient’s mental status.
- We must also be able to determine if the patient is in pain.

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11
Q

How does assessment of Patient Demeanour relate to analgesia? (1)

A

Helps to determine if the patient is in pain and to what extent.

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12
Q

What questions can we ask ourselves to assess the Patient’s Demeanour? (4)

A
  • Is the animal bright, alert & responsive (BAR)?
  • Is it behaving normally for it’s species?
  • Is it behaving normally for the individual animal?
  • If that problem were affecting me, how would I be feeling?
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13
Q

BAR

A

BAR – Bright, Alert & Responsive

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14
Q

What are the characteristics of BAR? (3)

A
  • Bright & happy in themselves (wagging tail, moving well etc.)
  • Aware of surroundings and activity
  • Responsive to name calling, touch and other stimuli
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15
Q

BAR Image

A
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16
Q

QAR

A

QAR – Quiet, Alert & Responsive

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17
Q

What are the characteristics of QAR? (6)

A
  • Alert & aware of surroundings
  • Responsive to name calling, patting etc.
  • Very quiet in themselves.
  • May be due to their unusual surroundings or due to their medical/surgical condition.
  • Does not automatically indicate patient is depressed
  • Patient must be assessed for pain, medications and their effects.
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18
Q

QAR Image

A
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19
Q

What are the characteristics of a Depressed / Withdrawn patient? (4)

A
  • Patient is aware of surroundings, name calling & petting.
  • They are not inclined to respond although they can, but they don’t want to.
  • When a patient is depressed it can impede it’s recovery.
  • Depression is a significant clinical finding and must not be ignored.
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20
Q

Depressed / Withdrawn Image

A
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21
Q

What are the characteristics of a Flat patient? (3)

A
  • These patients are conscious but very ‘flat’.
  • In response to stimuli they may just move their eyes or slightly ‘twitch’ their ears.
  • Their ability to interact may be impeded due to their illness or disease.
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22
Q

What are the characteristics of a Nervous patient? (3)

A

It may be difficult to correctly assess demeanour if the patient is nervous.
- They become nervous / frightened when approached.
- They may try and hide under blankets, huddle in back of cage etc.

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23
Q

Nervous Image

A
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24
Q

What are some important things to know about Aggressive patients? (3)

A
  • Some animals will become aggressive just by entering the clinic.
  • Difficult to correctly assess demeanour in regards to how they are feeling, pain, lethargy etc.
  • Learn to recognize the signs of an aggressive patient and take measures to protect yourself and the patient.
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25
Q

Aggressive Dog Image

A
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26
Q

Aggressive Cat Image

A
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27
Q

Terms used to describe Demeanour (8)

A
  • Bright
  • Quiet
  • Alert
  • Dull
  • Responsive
  • Unresponsive
  • Sedate
  • Depressed
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28
Q

How would you describe a Bright patient? (4)

A
  • Out–going
  • Seeks interaction with examiner
  • Moves about enclosure
  • Is inquisitive
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29
Q

How would you describe a Quiet patient? (3)

A
  • Withdrawn
  • May be crouched or hunched in back of enclosure
  • Is not interactive with examiner
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30
Q

How would you describe an Alert patient? (2)

A
  • Watchful
  • Ready to respond to the changing situation around it
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31
Q

How would you describe a Dull patient? (1)

A

Lacking in liveliness or animation

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32
Q

How would you describe a Responsive patient? (1)

A

Responds to stimuli ie. calling it’s name or sudden movements in the room

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33
Q

How would you describe an Unresponsive patient? (1)

A

Does not respond to stimuli around it, incl direct stimuli eg. touching

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34
Q

How would you describe a Sedate patient? (3)

A
  • Sleepy & difficult to arouse
  • Will eventually respond if examiner persists.
  • Take into consideration if they are recovering from sedation or under sedation.
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35
Q

How would you describe a Depressed patient? (3)

A
  • Withdrawn
  • No interest in surroundings
  • Unable to arouse even with strong stimuli
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36
Q

BAR

A

Bright, Alert & Responsive

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37
Q

QAR

A

Quiet, Alert & Responsive

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38
Q

SED

A

the patient is sedate

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39
Q

DEP

A

the patient is depressed

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40
Q

What are you observing when assessing the patient’s Posture & Gait? (4)

A
  • Posture
  • Gait
  • Movement
  • Ease of rising or laying down etc
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41
Q

What questions can we ask ourselves to assess the Patient’s Posture & Gait? (6)

A
  • Does the patient seem comfortable in its current position?
  • Does the patient prefer to stand or lay down?
  • Is the patient ‘guarding’ any area?
  • Is the patient ‘hunched’?
  • Is there any stiffness?
  • Is the patient reluctant to move?
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42
Q

What else can we observe to get an Overall View of the Patient? (4)

A
  • Any wounds present?
  • Signs of heamorrage?
  • Obvious changes / abnormalities in their coat?
  • Noticeable respiratory effort?
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43
Q

What do we need to note about any wounds present? (4)

A
  • Single or multiple wounds
  • Approximate Size
  • Location
  • Do they appear fresh or old?
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44
Q

What do we need to note about signs of haemorrage? (3)

A
  • Location
  • Active bleeding?
  • Clots in coat?
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45
Q

What observations can we make about the patient’s coat? (3)

A
  • Shiny & sleek?
  • Dull & unkempt?
  • Matted fur? Wounds or lesions may be underneath.
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46
Q

What do we need to note about the patient’s respiratory effort? (2)

A
  • Any noticeable respiratory effort?
  • Gasping?
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47
Q

What would indicate seeking immediate vet attention & implementing first aid for the patient? (3)

A

Any signs of:
- Respiratory effort
- Active bleeding
- Large wounds

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48
Q

IMAGE – Fresh wounds from a dog fight

A
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49
Q

What do we need to note in our General Assessment of the Head & Neck of the patient? (4)

A

The overall appearance of head.
- Any wounds or skin lesions
- Areas of hair loss
- Droopiness of face
- Swelling

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50
Q

What are the three basic Head Shapes? (3)

A
  • Dolichocephalic
  • Mesaticephalic
  • Brachycephalic
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51
Q

What are the characteristics of a Dolichocephalic head shape? (3)

A

Long, thin head
- eg. Saluki, Siamese
- There is good spacing between the individual premolar teeth (which reduces the collection of food and debris hence reducing plaque build–up)

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52
Q

IMAGE – Dolichocephalic skull

A
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53
Q

What are the characteristics of a Mesaticephalic head shape? (3)

A

Medium length and width
- eg. Labrador, Domestic Short Hair
- The teeth have some spaces between and minimal crowding.

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54
Q

IMAGE – Mesaticephalic skull

A
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55
Q

What are the characteristics of a Brachycephalic head shape? (3)

A

Short, wide head
- eg. Boxer, Pug and Persian
- There is often considerable overcrowding and displacement of the canines.

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56
Q

IMAGE – Brachycephalic skull

A
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57
Q

What is important to remember about Eyes? (2)

A
  • Eyes are very delicate & sensitive organs.
  • They must always be treated gently.
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58
Q

What do we need to note in our General Assessment of the Eyes of the patient? (5)

A
  • Do the eyes look clear & bright?
  • Are both eyes open?
  • Are eyelids swollen?
  • Is there any discharge?
  • Are pupils normal?
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59
Q

Why is it important to assess if both eyes are open? (3)

A
  • If one or both eyes are closed this can indicate that the lids &/or conjunctiva are swollen causing the eye to close.
  • Patients may hold eyelids closed (Blepharospasm) if there is pain of the cornea or conjunctiva.
  • Damage to the muscles or nerves controlling eyelids may cause them to droop & close.
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60
Q

What is important to note if there is any discharge from eyes? (3)

A
  • Type of discharge.
  • Note the colour
  • Record the amount – copious or scant.
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61
Q

What are the different types of occular discharge? (4)

A
  • Serous (watery)
  • Mucoid (gelatinous)
  • Purulent (pus)
  • Mucopurulent (mix of mucus & pus)
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62
Q

What does the different colours of occular discharge indicate? (3)

A
  • Yellow or green - Purulent
  • Pinkish - Blood present
  • Grey through to rust brown - Mucoid
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63
Q

What to note when examining the patient’s pupils? (4)

A
  • Note size of pupils
  • Wide open or closed pupils?
  • Normal – both pupils equal in size.
  • If pupils are different sizes (anisocoria)
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64
Q

What are the characteristics of normal pupils? (2)

A
  • Both pupils equal in size.
  • Size is usually somewhere midway (depending on ambient light).
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65
Q

What are wide open pupils referred to as?

A

Dilated pupils

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66
Q

What are closed pupils referred to as?

A

Constricted pupils

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67
Q

What is a completely closed pupil called?

A

Pinpoint pupil.

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68
Q

What can Dilated or Constricted pupils indicate? (1)

A

A range of problems from neurological to poisonings.

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69
Q

Anisocoria

A

Pupils are different sizes.

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70
Q

What can Anisocoria indicate? (1)

A

Neurological disfunction

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71
Q

IMAGE – Anisocoria following head trauma

A
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72
Q

IMAGE – Pupil Size

A
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73
Q

What is important to assess when examining the patient’s Eyeballs? (5)

A
  • Check for any haemorrhage or bruising to the sclera (white of the eye).
  • Unusual protrusion of eyeball or ‘global’ look to eyeball.
  • Unusual protrusion or swelling of the conjunctiva.
  • Position of the eyeball in relation to the eye socket.
  • Nystagmus
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74
Q

Nystagmus

A

Involuntary flicking movement of eyeball from side–to–side or up–to–down.

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75
Q

What is important to remember before examining a patient’s Ears? (1)

A

Some patients are particularly sensitive to having their ears touched.

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76
Q

What do we need to note in our General Assessment of the Ears of the patient? (5)

A
  • Normal confirmation for breed?
  • Are they bothered by the ear(s)?
  • Swelling?
  • Smell?
  • Wax, discharge, exudates or blood?
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77
Q

Are the ears normal confirmation for their breed? (3)

A
  • Lots of variations of what is normal.
  • Know what is usual for that breed and individual animal.
  • Changes in the way they are holding their ear(s) can indicate swelling somewhere or possible neurological problem.
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78
Q

Is the patient bothered by the ear(s)? (3)

A

Scratching, pawing or flicking of the ear?
- Indicates the patient is irritated by something to do with the ears.
- May indicate pain in that area.

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79
Q

Is there any swelling? (3)

A

Swelling can be caused by:
- Haematoma
- Abscess
- Cellulitis

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80
Q

Is there any smell? (2)

A

Normal ears smell the same as the rest of the dog.
- Odours can indicate infection and should be assessed. (eg. yeast/Malassezia)

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81
Q

Is there any wax, discharge, exudates or blood? (3)

A
  • Any irritation (eg. allergies) to the ear canal start with an accumulation of wax.
  • Infections cause exudates and discharge (described as waxy or purulent).
  • Ulceration or trauma to the ear may result in bleeding.
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82
Q

What do we need to note in our General Assessment of the Nose of the patient? (2)

A
  • Clean & moist?
  • Discharge?
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83
Q

Is the nose clean and moist? (3)

A

Normal nose is clean and moist.
- During hot/dry weather the moisture evaporates quickly.
- A dry nose does not necessarily indicate an abnormality.

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84
Q

What do most normal dogs have a moist nose? (2)

A

It’s kept moist by normal tear overflow.
– drains down nasolacrimal ducts to just inside the nasal openings.

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85
Q

What is important to note about any nasal discharge? (4)

A
  • Type of discharge – serous, mucoid, purulent or mycopurulent?
  • Colour – clear, greyish, yellow, green or blood?
  • Does it come from one (unilateral) or both (bilateral) nostrils?
  • Any dry discharge should be gently cleaned with moistened swabs.
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86
Q

Epistaxis

A

Bleeding from nose

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87
Q

What do we need to note in our General Assessment of the Mouth of the patient? (6)

A

Gently examine the mouth and note:
- Malocclusions
- Dental Disease
- Lips
- Neck
- Mucous Membranes (MM)
- Capillary Refill Time (CRT)

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88
Q

What are the different types of Malocclusions? (4)

A
  • Overshot bite (Brachygnathism)
  • Undershot bite (Prognathism)
  • Wry bite
  • Open bite
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89
Q

Brachygnathism (3)

A

Overshot bite
- Maxilla (upper) is too long compared to mandible (lower jaw).
- Extremely rare in cat

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90
Q

Prognathism (5)

A

Undershot bite
- Maxilla (upper) is too short compared to mandible (lower jaw).
- Accepted bite in breeds such as Boxers and Persians.
- Problems can occur mostly when the mandibular canine sits outside the upper lip or into it.
- Can lead to eosinophilic granuloma formation.

91
Q

Wry bite (2)

A

Where one quadrant of jaw grows out of proportion with the rest.
- There is usually an ‘open bite’ associated with this.

92
Q

Open bite (2)

A

Where the mouth cannot be closed completely.
- Often seen in brachycephalic cats and dogs when upper and lower canines ‘meet’ at their tips.

93
Q

What do we need to note to assess the presence and severity of Dental Disease in the patient? (4)

A
  • Plaque
  • Tartar or calculus
  • Gingivitis
  • Bleeding gums
94
Q

What is Plaque? (3)

A

Thin film covering teeth.
- Composed of bacteria, saliva, food particles and sloughed epithelial cells.
- Easily brushed off.

95
Q

What is Tartar or Calculus? (2)

A

Hard, mineralized plaque that has formed on the surface of the tooth.
- Takes some force with a dental instrument to remove.

96
Q

What is Gingivitis? (4)

A

Inflammation of the gums.
- Evident as a reddened gum line that extends down towards the jaw.
- May be swelling and bleeding.
- Indicates periodontal disease.

97
Q

Why is it important to note the presence of Bleeding gums? (1)

A

If present without reddening or swelling, it can indicate a problem with the body’s blood clotting function.

98
Q

What do we need to note in our assessment of the Lips of the patient? (2)

A
  • Are they swollen?
  • Any wounds or lesions from teeth rubbing into them?
99
Q

What do we need to note in our assessment of the Neck of the patient? (4)

A
  • Feel for wounds, scabs, ticks etc – check under collar too.
  • Palpation of submandibular lymph nodes – they shouldn’t be enlarged.
  • Observe the patient has no pain or discomfort on movement of neck or how they hold it.
  • Visual assessment of any external parasites eg. fleas.
100
Q

How to assess for Pain or discomfort in neck? (5)

A
  • Observe them moving their neck
  • Observe how they ‘hold’ their neck.
  • Tightness?
  • Drooping of head and neck?
  • Turned towards one side?
101
Q

IMAGE – Palpation of Submandibular Lymph Nodes

A
102
Q

What do we need to note in our assessment of the Mucous Membranes (MM) of the patient? (3)

A
  • Colour
  • Pigmentation
  • Feel
103
Q

What to note about Colour & Pigmentation of Mucous Membranes (MM). (6)

A
  • Normally pink
  • Abnormal – pale, red, grey, white & yellow.
  • Certain breeds (eg. Chow) have pigmented mucosa – gums will appear black.
  • Some breeds have areas of pink and black due to pigmentation.
  • If difficult to assess gum colour – look at conjunctiva of eye.
  • MM colour can indicate peripheral circulation – blood flow & oxygenation.
104
Q

IMAGE – Mucous Membrane colours & indications

A
105
Q

What is Petechiation? (5)

A

Reddish–purple dots of pinpoint to pinhead size.
- Occur when capillaries break, and blood pours into the skin.
- Petechiae do not blanch under pressure.
- They are flush with the surface of the skin.
- Indicate disturbance of blood clotting function.

106
Q

What is Ecchymosis? (5)

A

Discolouration of the skin.
- Resulting from bleeding underneath skin.
- Typically caused by bruising.
- Commonly has a ‘paintbrush’ appearance.
- Often indicates a disturbance of blood clotting function.

107
Q

How should normal Mucous Membranes (MM) Feel? (1)

A

MM’s should feel moist.

108
Q

What might dry or tacky MM’s indicate? (2)

A

Hydration is not sufficient.
Dehydration

109
Q

How do we assess Capillary Refill Time (CRT)? (1)

A

Gently press down on MM’s and count how long it takes colour to flood back.

110
Q

What information does CRT tell us about the patient? (1)

A

Indicates how the peripheral blood is circulating.

111
Q

1 – 2 seconds CRT (2)

A

Normal – adequate peripheral perfusion.

112
Q

> 2 seconds CRT (3)

A

Decreased peripheral perfusion.

Examples:
- Shock
- Heart failure.

113
Q

< 1 second CRT (4)

A

Hyperdynamic – vasodilation

Examples:
- High blood pressure
- Pyrexia
- Local irritation (toxins)

114
Q

What do we need to note in our General Assessment of the Chest of the patient? (2)

A
  • Wounds or injuries to chest area.
  • Any lumps or swellings.
115
Q

What would indicate immediate assessment by Vet when examining a patient’s chest. (1)

A

Wounds or injuries to chest area.

116
Q

What do we need to note when assessing the Respiration of a patient? (3)

A
  • RR usually increased in vet clinic due to stress & nervousness.
  • Assess RR prior to approaching patient.
  • Watch respiration and note character of breathing.
117
Q

Panting (3)

A

Rapid, shallow breathing
- Mouth open
- Tongue usually hanging out

118
Q

Tachypnoea

A

Rapid, shallow breathing

119
Q

Hyperpnoea

A

Rapid, deep breaths

120
Q

Bradypnoea (1)

A

Slow breathing

121
Q

Laboured

A

Deep, abdominal breathing

122
Q

Dyspnoea (1)

A

Difficulty breathing

123
Q

What is BPM (in relation to respiration)?

A

Breaths per minute

124
Q

What is the normal RR of a dog?

A

12 - 25 BPM

125
Q

What is the normal RR of a cat?

A

20 - 30 BPM

126
Q

What is the normal RR of a Rat?

A

70 – 140 BPM

127
Q

What is the normal RR of a Guinea Pig?

A

40 – 80 BPM

128
Q

Abdominal Respiration (2)

A

When the animal uses it’s abdominal muscles to assist with breathing.
- A sign of respiratory distress.

129
Q

Paradoxical Respiration (3)

A

Where instead of the chest expanding during inspiration, an area of the chest moves inwards.
- Can happen when a series of ribs are broken in 2 places.
(Flail chest)

130
Q

What is Flail Chest? (1)

A

When a series of ribs are broken in 2 places.

131
Q

What is important to note when assessing the Chest Sounds of a patient? (3)

A

Listen to lungs with stethoscope.
- Usually hear some sounds in healthy lungs too.
- Absence of any sounds over a particular area may indicate that the lung is abnormal.

132
Q

Breath sounds (2)

A

Normal respiratory sounds.
- Caused by movement of air through airways.

133
Q

Wheeze (2)

A

High pitched inspiratory or expiratory noise.
- Caused by narrowed airways.

134
Q

Crackle (2)

A

High pitched inspiratory noise.
- Made by increased secretion in small airways.

135
Q

Stertor (2)

A

Noise from nasal passages.
- Eg. Snoring / snuffling noises.

136
Q

Stridor (2)

A

High pitched inspiratory sounds.
- Caused by turbulent air flow in pharynx & trachea (upper airways)

137
Q

What is important to note when assessing the Heart Rate of a patient? (5)

A

Listen to heart sounds with stethoscope.
- Normal sound – ‘lub, dub’.
- Sound is made by snapping closed of certain heart valves as chambers contract & eject blood.
- Beat should be regular.
- Rhythm – beats should have the same interval between them or sinus arrhythmia.

138
Q

Sinus Arrhythmia (2)

A

A ‘regular’ irregularity.
- Heart speeds up slightly during inhalation & slows slightly with exhalation.

139
Q

Abnormal Arrhythmia (2)

A

Irregular gaps between heart beats.
- Can easily be heard.

140
Q

What does a heart murmur sound like? (2)

A

Abnormal wooshing sounds superimposed over ‘lub, dub’ sounds.
- Sometimes replaces normal sounds altogether.

141
Q

What causes the sound of a heart murmur? (1)

A

Sound is the vibrations caused when blood squirts through narrow openings as the heart contracts.

142
Q

What are Heart Murumurs caused by? (1)

A

Heart abnormalities.

143
Q

What are some Heart abnormalities that cause Heart Murmurs? (3)

A
  • Faulty Valves
  • Ventricular Septal Defect (Faulty heart wall)
  • Patent Ductus Arteriosis (Faulty blood vessel)
144
Q

What are Faulty Valves in the heart? (2)

A

Valves of the heart that don’t close properly.
- Blood is forced backwards through the gap in the valve when heart contracts.

145
Q

What is a Ventricular Septal Defect in the heart? (2)

A

Faulty part of the wall between ventricles.
- Allows blood to cross between ventricles when they contract.

146
Q

What is Patent Ductus Arteriosis? (2)

A

Faulty communication between major blood vessel near the heart.
- Allows blood to squirt between the vessels.

147
Q

What is the normal HR of a dog < 25kg?

A

65 - 120 bpm

148
Q

What is the normal HR of a dog > 25kg?

A

65 - 80 bpm

149
Q

What is the normal HR of a cat?

A

110 - 180 bpm

150
Q

What is the normal HR of a guinea pig?

A

240 - 310 bpm

151
Q

What is the normal HR of a rat?

A

310 – 500 bpm

152
Q

What do we need to note in our General Assessment of the Abdomen of the patient? (6)

A

Visually assess abdomen & note any abnormalities such as:
- Wounds
- Bruising
- Abnormal lumps, skin growths etc (esp. around nipples)
- Skin inflammation / irritation
- Penile discharge on abdomen

153
Q

Can palpation of the patient’s abdomen be performed by any member of the veterinary team? (2)

A

No
- Palpation of abdomen should only be performed by Vet

154
Q

What is a Pulse? (1)

A

Pressure wave travelling through arterial walls.

155
Q

What causes a pulse to occur? (2)

A
  • Wave is initiated by contraction of the ventricles and ejection of blood into the aorta.
  • Travels at high speed along arterial walls.
156
Q

Where does an artery need to be located in order to palpate a pulse? (1)

A

Artery must run close to the body surface.

157
Q

Where are the main pulse sites? (4)

A
  • Femoral
  • Digital
  • Coccygeal
  • Lingual
158
Q

Where can you find the Femoral pulse? (1)

A

Femoral artery on the medial (inner) side of the femur (thigh).

159
Q

Where can you find the Digital pulse? (1)

A

Digital artery on the palmer (underside) aspect of the carpus (front leg).

160
Q

Where can you find the Coccygeal pulse? (1)

A

Coccygeal (tail) artery on the ventral (under) side of the tail.

161
Q

What does Pulse Quality indicate? (2)

A

It is an indication of cardiac output and blood pressure.

162
Q

What is a Normal Pulse? (2)

A
  • Rate & ‘feel’ is even.
  • Matches heart rate.
163
Q

What is a Pulse Deficit? (2)

A

Pulse rate is less than heart rate.
- Caused by ineffectual heart beats (dysrhythmia).

164
Q

What is a Weak Pulse? (3)

A

Softer pulse.
- Not forceful under fingers.
- Diminished cardiac output, shock.

165
Q

What is a Bounding Pulse? (3)

A

Pulse is strong, forceful & sometimes jerky.
- Increased cardiac output.
- Occurs normally with heavy exercise.

166
Q

What is a Bounding Pulse often associated with? (3)

A
  • High blood pressure
  • Certain valvular problems
  • Early heart failure.
167
Q

What is most important to remember when examining a patient’s limbs? (2)

A

If a patient is obviously lame or showing signs of pain in a limb, do not move or palpate this area.
It will cause more pain!

168
Q

What do we need to note in our General Assessment of the Limbs of the patient? (6)

A
  • Lameness
  • Swelling
  • Wounds
  • ‘Holding’ of the limb – flaccid, when the limb is ‘dangling’, rigidity, when the muscles are tightly contracted.
  • Growths / lumps
  • Skin irritation / inflammation
169
Q

What areas do we need to examine to assess the Claws & Digits? (2)

A

Examine both the forepaws and the hind paws.

170
Q

Where are the patient’s pads located? (4)

A
  • Digital
  • Metatarsal
  • Metacarpal
  • Carpal
171
Q

What do we need to note when examining the patient’s pads? (3)

A
  • Wounds
  • Swelling
  • ‘Hard’ pad areas (overgrowth of the pad tissue)
172
Q

Why must we check in–between digital pads? (1)

A

This is a common area for skin to become moist and inflammed.

173
Q

What questions do we need to ask ourselves when examining the patient’s claws & dew claws? (4)

A
  • Are they too long?
  • Is there sign of damage?
  • Is there any discolouration?
  • Is there inflammation or discharge around the nail?
174
Q

Are the patient’s claws too long? (2)

A
  • Some will grow in tight circle (esp. dew claws)
  • They dig into the pad and cause a painful wound.
175
Q

Is there signs of damage to the claws? (2)

A
  • Look for frayed nail ends – particularly in cats.
  • Look for splitting, loose or broken nails.
176
Q

What can split or frayed nails indicate? (3)

A

May indicate recent trauma:
– HBC
- Fall

177
Q

Is there any discolouration of the claws? (2)

A

See–through nails you should be able to see the pink ‘quick’ area – indicates a healthy claw.
- Red or creamy discolouration – may indicate haemorrhage or infection.

178
Q

Is there inflammation or discharge around the nail? (2)

A

May indicate and infection of the nail and bone underneath.

179
Q

What makes up the Anogenital Area of the patient? (3)

A
  • Female genitals
  • Male genitals
  • Tail
180
Q

What do we need to note about Female Genitals? (3)

A
  • Is the vulva swollen?
  • Are they desexed or not?
  • Any other discharge from vulva?
181
Q

What do we need to note if the patient is entire (not desexed)? (2)

A
  • Any signs of oestrus.
  • Ask client when last heat was.
182
Q

What are common signs of oestrus / heat? (2)

A
  • Vulval swelling
  • Watery/bloody discharge
183
Q

What do we need to note if there is any discharge from vulva? (3)

A
  • Colour
  • Consistency
  • Amt of discharge.
184
Q

What might a bloody, purulent (pus) discharge from vulva indicate? (1)

A

Infection

185
Q

What is a green discharge from vulva associated with? (2)

A

Impending or recent birth.

186
Q

What do we need to note about Male Genitals? (4)

A
  • Any discharge from penis?
  • Check scrotal area
  • How old are they?
  • Are testes the same size?
187
Q

What do we need to note if there is any discharge from penis? (4)

A
  • Colour
  • Consistency
  • Amt of discharge.
  • Is there any dried discharge on abdomen?
188
Q

What do we need to check in the scrotal area? (5)

A
  • Are they entire?
  • If yes – are both testes present?
  • Any areas of inflammation /irritation?
  • Wounds?
  • Abnormal growths?
189
Q

What does the age of the patient have to do with examination of male genitals? (2)

A

If young dog – check both testes have descended.
If old dog and entire – may have issues with prostate.

190
Q

Are testes the same size? (2)

A

Both testes should be about the same size.
- Testes can vary is size – if one is much larger than the other it may be abnormal.

191
Q

What do we need to note about the assessement of the patient’s Tail? (3)

A
  • Tail appearance.
  • Don’t forget to check the underneath (ventral) side of tail!
  • Voluntary movement of the tail.
192
Q

What do we need to note about the patient’s voluntary tail movements? (3)

A
  • Are they wagging?
  • Moving the tail freely with no signs of discomfort?
  • Gently raise the tail and release it – Observe how the tail falls & if the patient has control over it’s movement.
193
Q

What do we need to note about the appearance of the patient’s Tail? (4)

A
  • Wounds (base of tail is a common area for cat fight wounds).
  • Swelling
  • Hair loss (base of tail common area)
  • Deformity (kinking of tail).
194
Q

What do we need to do before taking the patient’s temperature? (1)

A

Check anal area.

195
Q

What do we need to note about the anal area? (3)

A
  • Discharge?
  • Skin
  • Odour?
196
Q

What do we need to note about Discharge from anal area? (4)

A
  • Colour
  • Consistency
  • Amt
  • Is it coming from anus or structures surrounding anus?
197
Q

What might discharge from anal sac (gland) indicate? (2)

A

Impaction or infection of anal sac (gland).

198
Q

How do anal sac abscesses usually appear/present? (2)

A
  • Swelling over the anal sac.
  • Purulent discharge from opening over the anal sac.
199
Q

What might discharge from the anus indicate? (2)

A

Profuse diarrhoea
- Small amts will drip from anus, even between bouts of diarrhoea.

200
Q

Why do we look at the mucosa of the anus and surrounding skin? (2)

A

Checking for any signs of irritation or inflammation.

201
Q

Why would we note the Odour from the anal area? (2)

A
  • Particular odours can indicate certain illnesses.
  • eg. Haemorrhagic diarrhoea smell
202
Q

IMAGE – Anal area

A
203
Q

When is the best time to take the patient’s temperature? (1)

A

Always take temperature last.

204
Q

Why is it important to always take the patient’s temperature at the end of the physical examination? (1)

A

Often causes the patient anxiety which may raise HR & RR.

205
Q

What is the normal Temp range of a dog?

A

38.0 – 39.0 ℃

206
Q

What is the normal Temp range of a cat?

A

38.0 – 39.2 ℃

207
Q

What is the normal Temp range of a guinea pig?

A

37.2 – 39.5 ℃

208
Q

What is the normal Temp range of a rat?

A

37.7 ℃

209
Q

Hypothermia (2)

A

A lower than normal body temp.
- In dogs & cats – when temp is below 37.5 ℃

210
Q

Hyperthermia (2)

A

A higher than normal body temp.
- In dogs & cats – when temp is above 39.5 ℃

211
Q

Pyrexia (1)

A

Raised body temp caused by an internal process (eg. infection).

212
Q

Heat Stress (3)

A

Temps above 41 ℃
- Life threatening
- Immediate first aid must be implemented.

213
Q

How to assess the patient’s Hydration? (2)

A
  • Feel mucous membranes.
  • Perform the ‘skin tenting’ test.
214
Q

How should Mucous Membranes feel? (1)

A

Normally moist

215
Q

How do MM’s feel if the patient is dehydrated? (2)

A

Dry, tacky mucosa indicates hydration is not adequate.

216
Q

How to perform a Skin Tenting’ test? (3)

A
  • Gently lift the skin
  • Twist
  • Observe how long it takes to return to normal position.
217
Q

IMAGE – ‘Skin Tenting’

A
218
Q

What Percentages is patient Dehydration commonly measured in? (5)

A
  • <5%
  • 5%
  • 5 – 8%
  • 10 – 12%
  • 12 – 15%
219
Q

What are the clinical signs of < 5% dehydration? (1)

A

Not detectable on clinical examination.

220
Q

What are the clinical signs of 5% dehydration? (2)

A
  • Slight decrease in skin turgor
  • Slightly tacky MM’s
221
Q

What are the clinical signs of 5 – 8% dehydration? (4)

A
  • Delay in skin ‘tent’ to normal
  • Tacky, dry MM’s
  • Increase in CRT
  • Eyes may appear slightly sunken
222
Q

What are the clinical signs of 10 – 12% dehydration? (6)

A
  • Tenting of skin
  • Dry, tacky MM’s
  • Increased CRT
  • Tachycardia
  • Sunken eyes
  • Cold extremities
223
Q

What are the clinical signs of 12 – 15% dehydration? (8)

A
  • Tachycardia
  • Pale MM’s
  • Weak pulse
  • Hypothermia
  • Weakness
  • Severe dehydration
  • Clinical signs of shock are apparent
  • Life threatening
224
Q

What percentage of dehydration is considered life threatening? (1)

A

12 - 15% dehydration

ASAN001 - Patient Evaluation & Triage (4 decks)

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