Subjective Assessment

Question 1

Why do we do an assessment (Ax)?

Answer 1

• Provides information of patient’s presenting problem/limitation/function i.e. why did they come and see us or why were they referred to us.
• To develop an effective management plan to address their problem, we need to understand what is contributing to or causing their problem.
• An accurate assessment helps identify the factors contributing to their problem.

Question 2

An accurate and thorough assessment helps the therapist formulate:

Answer 2

• Appropriate problem list
• Appropriate treatment aims
• Appropriate choice of treatment

Question 3

As we implement our management plan, ongoing assessment provides a guide to:

Answer 3

• Response to treatment (is the treatment working? or should we try something different? )
• Progress made (do exercises need to be progressed, are other interventions now appropriate? has the problem been addressed? )
• Discharge planning (is this patient ready for discharge? is a home programme needed and what should be included? )

Question 4

Background information

Answer 4

• patient’s main complaint
• history of present condition
• family history
• Social history (occupation, home environment)
• Smoking
• Physiotherapy
• main problems patient reports

Question 5

For each of the symptoms you need to establish:

Answer 5

• Onset – when did they begin
• Frequency and duration - how often and for how long
• Severity - affect ADL’s?
• Pattern
• Aggravating factors
• Relieving factors

Question 6

Dyspnoea?

Answer 6

Subjective awareness of increased work of breathing (WOB)
Difficulty breathing at a level of activity where it would not be expected
e.g. like walking at a slow pace on a flat surface or when getting dressed

Question 7

Causes of dyspnoea

Answer 7

• from either (or both) the cardiovascular or respiratory systems
• anaemia (so important to look at the Hb)
• neuromuscular disorders (where there is respiratory muscle dysfunction)
• psychological disorders (have you ever felt out of breath when you are anxious about something?)

Question 8

Different tools to measure breathlessness?

Answer 8

New York Heart Association Classification of Breathlessness;
Modified Medical Research Council Score;
Borg scale

Question 9

Orthopnoea?

Answer 9

Report feeling out of breath (dyspnoeic) when lying flat

Question 10

Paroxysmal nocturnal dyspnoea (PND):

Answer 10

Report being woken at night as a result of feeling out of breath