Patient Examination (ASAN001/2) Flashcards
Why should a complete ‘Head to Tail’ examination be performed? (1)
To determine the status of the patient.
What knowledge should a Vet Nurse possess to perform an accurate & detailed physical examination? (2)
- Must be aware of what is considered normal findings / parameters.
- What are considered abnormal findings and what they may indicate.
What might determine the order in which a Detailed Physical Examination is performed? (3)
Order depends on the patient’s presentation:
- acute/serious
- chronic/mild.
What should a General Physical Exam include? (9)
- 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
Why is Body Scoring important?(2)
- 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.
Hills Body Scoring Chart:
Why is Patient Demeanour important? (1)
Demeanour is a great indicator of how the patient is feeling.
What might impact your expectations of the patient’s demeanour? (1)
Circumstances around the reason for examination.
ie if here for routine visit (Vx) or if patient is unwell.
Why is frequent assessment of patient demeanour of hospitalised patients important? (2)
- Important part of overall clinical picture.
- Can help determine if the patient is improving or not.
What can the patient’s reactions to it’s environment indicate? (2)
The patient’s mental status.
- We must also be able to determine if the patient is in pain.
How does assessment of Patient Demeanour relate to analgesia? (1)
Helps to determine if the patient is in pain and to what extent.
What questions can we ask ourselves to assess the Patient’s Demeanour? (4)
- 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?
BAR
BAR – Bright, Alert & Responsive
What are the characteristics of BAR? (3)
- Bright & happy in themselves (wagging tail, moving well etc.)
- Aware of surroundings and activity
- Responsive to name calling, touch and other stimuli
BAR Image
QAR
QAR – Quiet, Alert & Responsive
What are the characteristics of QAR? (6)
- 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.
QAR Image
What are the characteristics of a Depressed / Withdrawn patient? (4)
- 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.
Depressed / Withdrawn Image
What are the characteristics of a Flat patient? (3)
- 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.
What are the characteristics of a Nervous patient? (3)
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.
Nervous Image
What are some important things to know about Aggressive patients? (3)
- 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.
Aggressive Dog Image
Aggressive Cat Image
Terms used to describe Demeanour (8)
- Bright
- Quiet
- Alert
- Dull
- Responsive
- Unresponsive
- Sedate
- Depressed
How would you describe a Bright patient? (4)
- Out–going
- Seeks interaction with examiner
- Moves about enclosure
- Is inquisitive
How would you describe a Quiet patient? (3)
- Withdrawn
- May be crouched or hunched in back of enclosure
- Is not interactive with examiner
How would you describe an Alert patient? (2)
- Watchful
- Ready to respond to the changing situation around it
How would you describe a Dull patient? (1)
Lacking in liveliness or animation
How would you describe a Responsive patient? (1)
Responds to stimuli ie. calling it’s name or sudden movements in the room
How would you describe an Unresponsive patient? (1)
Does not respond to stimuli around it, incl direct stimuli eg. touching
How would you describe a Sedate patient? (3)
- Sleepy & difficult to arouse
- Will eventually respond if examiner persists.
- Take into consideration if they are recovering from sedation or under sedation.
How would you describe a Depressed patient? (3)
- Withdrawn
- No interest in surroundings
- Unable to arouse even with strong stimuli
BAR
Bright, Alert & Responsive
QAR
Quiet, Alert & Responsive
SED
the patient is sedate
DEP
the patient is depressed
What are you observing when assessing the patient’s Posture & Gait? (4)
- Posture
- Gait
- Movement
- Ease of rising or laying down etc
What questions can we ask ourselves to assess the Patient’s Posture & Gait? (6)
- 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?
What else can we observe to get an Overall View of the Patient? (4)
- Any wounds present?
- Signs of heamorrage?
- Obvious changes / abnormalities in their coat?
- Noticeable respiratory effort?
What do we need to note about any wounds present? (4)
- Single or multiple wounds
- Approximate Size
- Location
- Do they appear fresh or old?
What do we need to note about signs of haemorrage? (3)
- Location
- Active bleeding?
- Clots in coat?
What observations can we make about the patient’s coat? (3)
- Shiny & sleek?
- Dull & unkempt?
- Matted fur? Wounds or lesions may be underneath.
What do we need to note about the patient’s respiratory effort? (2)
- Any noticeable respiratory effort?
- Gasping?
What would indicate seeking immediate vet attention & implementing first aid for the patient? (3)
Any signs of:
- Respiratory effort
- Active bleeding
- Large wounds
IMAGE – Fresh wounds from a dog fight
What do we need to note in our General Assessment of the Head & Neck of the patient? (4)
The overall appearance of head.
- Any wounds or skin lesions
- Areas of hair loss
- Droopiness of face
- Swelling
What are the three basic Head Shapes? (3)
- Dolichocephalic
- Mesaticephalic
- Brachycephalic
What are the characteristics of a Dolichocephalic head shape? (3)
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)
IMAGE – Dolichocephalic skull
What are the characteristics of a Mesaticephalic head shape? (3)
Medium length and width
- eg. Labrador, Domestic Short Hair
- The teeth have some spaces between and minimal crowding.
IMAGE – Mesaticephalic skull
What are the characteristics of a Brachycephalic head shape? (3)
Short, wide head
- eg. Boxer, Pug and Persian
- There is often considerable overcrowding and displacement of the canines.
IMAGE – Brachycephalic skull
What is important to remember about Eyes? (2)
- Eyes are very delicate & sensitive organs.
- They must always be treated gently.
What do we need to note in our General Assessment of the Eyes of the patient? (5)
- Do the eyes look clear & bright?
- Are both eyes open?
- Are eyelids swollen?
- Is there any discharge?
- Are pupils normal?
Why is it important to assess if both eyes are open? (3)
- 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.
What is important to note if there is any discharge from eyes? (3)
- Type of discharge.
- Note the colour
- Record the amount – copious or scant.
What are the different types of occular discharge? (4)
- Serous (watery)
- Mucoid (gelatinous)
- Purulent (pus)
- Mucopurulent (mix of mucus & pus)
What does the different colours of occular discharge indicate? (3)
- Yellow or green - Purulent
- Pinkish - Blood present
- Grey through to rust brown - Mucoid
What to note when examining the patient’s pupils? (4)
- Note size of pupils
- Wide open or closed pupils?
- Normal – both pupils equal in size.
- If pupils are different sizes (anisocoria)
What are the characteristics of normal pupils? (2)
- Both pupils equal in size.
- Size is usually somewhere midway (depending on ambient light).
What are wide open pupils referred to as?
Dilated pupils
What are closed pupils referred to as?
Constricted pupils
What is a completely closed pupil called?
Pinpoint pupil.
What can Dilated or Constricted pupils indicate? (1)
A range of problems from neurological to poisonings.
Anisocoria
Pupils are different sizes.
What can Anisocoria indicate? (1)
Neurological disfunction
IMAGE – Anisocoria following head trauma
IMAGE – Pupil Size
What is important to assess when examining the patient’s Eyeballs? (5)
- 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
Nystagmus
Involuntary flicking movement of eyeball from side–to–side or up–to–down.
What is important to remember before examining a patient’s Ears? (1)
Some patients are particularly sensitive to having their ears touched.
What do we need to note in our General Assessment of the Ears of the patient? (5)
- Normal confirmation for breed?
- Are they bothered by the ear(s)?
- Swelling?
- Smell?
- Wax, discharge, exudates or blood?
Are the ears normal confirmation for their breed? (3)
- 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.
Is the patient bothered by the ear(s)? (3)
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.
Is there any swelling? (3)
Swelling can be caused by:
- Haematoma
- Abscess
- Cellulitis
Is there any smell? (2)
Normal ears smell the same as the rest of the dog.
- Odours can indicate infection and should be assessed. (eg. yeast/Malassezia)
Is there any wax, discharge, exudates or blood? (3)
- 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.
What do we need to note in our General Assessment of the Nose of the patient? (2)
- Clean & moist?
- Discharge?
Is the nose clean and moist? (3)
Normal nose is clean and moist.
- During hot/dry weather the moisture evaporates quickly.
- A dry nose does not necessarily indicate an abnormality.
What do most normal dogs have a moist nose? (2)
It’s kept moist by normal tear overflow.
– drains down nasolacrimal ducts to just inside the nasal openings.
What is important to note about any nasal discharge? (4)
- 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.
Epistaxis
Bleeding from nose
What do we need to note in our General Assessment of the Mouth of the patient? (6)
Gently examine the mouth and note:
- Malocclusions
- Dental Disease
- Lips
- Neck
- Mucous Membranes (MM)
- Capillary Refill Time (CRT)
What are the different types of Malocclusions? (4)
- Overshot bite (Brachygnathism)
- Undershot bite (Prognathism)
- Wry bite
- Open bite
Brachygnathism (3)
Overshot bite
- Maxilla (upper) is too long compared to mandible (lower jaw).
- Extremely rare in cat