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CHIR13007 Clinical Assessment and Diagnosis (CAD 3) UNIT INTRODUCTION UNIT COORDINATOR- BIANCA ZIETSMAN MChiro  A CQUniversity chiropractic statement supporting reconciliation...

CHIR13007 Clinical Assessment and Diagnosis (CAD 3) UNIT INTRODUCTION UNIT COORDINATOR- BIANCA ZIETSMAN MChiro  A CQUniversity chiropractic statement supporting reconciliation We acknowledge the Traditional Owners of the lands from across Australia. We pay our respects to the Elders past, present and emerging, for they hold the memories, the traditions, the culture and hopes of Aboriginal and Torres Strait Islander peoples across the state. A better understanding and respect for Aboriginal and Torres Strait Islander cultures develops an enriched appreciation of Australia’s cultural heritage and can lead to reconciliation. This is essential to the maturity of Australia as a nation and fundamental to the development of an Australian identity. Source: https://indigenousportal.eq.edu.au/SiteCollectionDocuments/acknowledgment-of-country-poster.pdf DISCIPLINE RETREAT- BRISBANE 2019 Central Queensland University Chiropractic Discipline, School of Health, Medical & Applied Sciences. Presenter: Andrew L. Vitiello Thank you- Farouk Badawi! OVERVIEW Course Learning Introduction overview Objectives Important dates Course layout Concepts of connecting Useful material (Articles, FAQ books, videos)  WHERE DOES IT FIT? CHIR13007 CAD CHIR13010 MPAT12001 Medical Systems and Pathophysiology Pathology MBIO12013 BMSC11002 Human BIOH12008 Human Microbiology for Health Body Systems 2 Pathophysiology Care  WHY IS IT IMPORTANT CLINIC PCP1 PCP2 CAD3  Unit Outcomes On successful completion of this unit, you will be able to: 1. Integrate your knowledge of anatomy, physiology, biochemistry and pathology with the clinical assessment of disease states 2. Explain the pathophysiological basis for a range of symptoms and signs 3. Demonstrate competent history taking skills and physical examination procedures 4. Develop a differential diagnosis based on history and examination findings 5. Apply the appropriate examination protocol to pathological disease states. DELIVERY Lectures- Online Practicals- On Campus- BNE Wednesday 11:00-13:00 Practical Assessment Case discussions & questions  ASSESMENTS Online Quiz OSCE End of term test 10% each 15% each 50% (20% in total) (30% in total) Wk 13 2 quizzes: 2 OSCE week TBC weeks 5,9 6 and 12 Based on all 30 mins each practical times* 12 weeks of MCQ a schedule will content Open from be released in Refer to campus Thursday advance timetable. 14:00- 21:00 specific to your AEST campus 50% pass rate in each section required and a further 50% overall to pass the unit (calculated from all above) Week Topic Practical Assessment Week 1 Introduction + Welcome Hx taking and physical skills History taking and physical exam Week 2 Vital Signs and clinical investigations Vital signs Week 3 Clinical Examination of the Cardiovascular system Clinical Examination of the Cardiovascular system Week 4 Clinical Examination of the Respiratory System Clinical Examination of the Respiratory System Week 5 Clinical Investigations and Overview of Management Options of the OSCE Review QUIZ 1: Thursday 14:00- Cardiovascular and Respiratory Systems 21:00 Vacation Week Week 6 Clinical Examination of the Gastrointestinal System OSCE 1 OSCE 1 Week 7 Clinical Examination of the Genitourinary System Clinical Examination of the Gastrointestinal System and Abdomen Week 8 Clinical Investigations and Overview of Management Options of the Clinical Examination of the Gastrointestinal Gastrointestinal and Genitourinary Systems System and Genitourinary system. Week 9 Clinical Examination, Investigations and Overview of Management Clinical Examination of Endocrine system QUIZ 2: Thursday 14:00- Options of the of the Endocrine System 21:00 Week 10 Clinical Examination, Investigations and Overview of Management Clinical examination of the Lymphatic and Options of the Hematopoietic and Lymphatic Systems Hematopoietic Systems Week 11 Clinical Examination, Investigations and Overview of Management Eyes, Ears, Skin examination + Revision for Options of the Ears and Eyes OSCE 2 Clinical Examination, Investigations and overview of management options of the Integumentary system Week 12 Review week OSCE 2 OSCE Week 13 In Class test-: all the content covered in lectures AND TUTORIALS Please check your timetable for specific campus In class test: Week 13 TBC location ACADEMIC INTEGRITY REMEMBER  KEYS FOR SUCCESS 01 02 03 04 ATTEND Then Work weekly Enjoy the subject- think of it as PRACTICALS ENGAGE in on the advanced the Activities subject puzzling in the and reading human form list  “Tea with B” For those of you that would like a more informal chat, I have introduced a face-face option for those that prefer. It can be on anything module related/chiro/ research / personal growth/mentoring. Monday at 13:00 Wednesday at 13:00 Thursday at 13:00 Note: I will provide the tea, grab a mug and you might get a baked delight from my toddler! CHIR13007 Clinical Assessment and Diagnosis (CAD 3) Vitals UNIT COORDINATOR- BIANCA ZIETSMAN MChiro  A CQUniversity chiropractic statement supporting reconciliation We acknowledge the Traditional Owners of the lands from across Australia. We pay our respects to the Elders past, present and emerging, for they hold the memories, the traditions, the culture and hopes of Aboriginal and Torres Strait Islander peoples across the state. A better understanding and respect for Aboriginal and Torres Strait Islander cultures develops an enriched appreciation of Australia’s cultural heritage and can lead to reconciliation. This is essential to the maturity of Australia as a nation and fundamental to the development of an Australian identity. Source: https://indigenousportal.eq.edu.au/SiteCollectionDocuments/acknowledgment-of-country-poster.pdf DISCIPLINE RETREAT- BRISBANE 2019 Central Queensland University Chiropractic Discipline, School of Health, Medical & Applied Sciences. Presenter: Andrew L. Vitiello  Lecture outline 1. Clinical importance of vitals signs 2. Measuring weight and height 3. Assessment of the vital signs 1. Temperature 2. Pulse 3. Respiration 4. Blood Pressure 4. Other essential clinical measures 1. Blood sugar level 2. Oxygen saturation 3. Mental Status 4. Pain Status 5. Interpretation of vital signs and other clinical measurements findings. Clinical importance of vitals signs Assessing Vital signs is part of the patient work up routine. The body regulates itself through homeostasis. It is the body’s natural ability to maintain stable internal environment by balancing physiological processes. Vital signs reflect the status of several body processes and indicate the body’s state of homeostasis. Vital signs, as the name suggests, convey vital information about the person’s health state and wellbeing, and therefore, they are an integral part of patient clinical assessment, diagnosis and follow up process.  Measuring Height and Weight Measuring height and weight are not considered part of the vital signs monitoring protocol, however they are routinely done in clinical setting and that reveal the patient’s size and proportion. Deviation in height and weight measurements from the average or the person’s baseline are sometimes associated with underlying clinical conditions. Height, unlike weight, does not fluctuate, however it may in certain circumstances change. Height is monitored over time and is checked if there is noticeable change in the adult patient stature or unusual growth pattern in young and pediatric patients. Clinical signs of height change are: Increase Decrease Increased or decreased rate of height change during growth years Body Temperature Measurement Body temperature is a product of metabolism, it is maintained through process of thermoregulation. Thermoregulation is controlled by the Hypothalamus which regulates the body temperature by adjusting the body’s heat production. Heat loss from the body can occur through several process (Beaman 2018): Radiation: heat given off to cooler surrounding air (65% of body heat loss) Convection: body heat dispersed by air current (15% of body heat loss) Conduction: direct transfer of heat from body to another medium Evaporation: heat lost through evaporation of perspiration or breathing Types of thermometers 1- Contact Thermometers: Method: The rely on direct contact with body surface or inner wall of a body cavity. Uses: Body cavity: mouth or rectum Body surface: forehead, axillary, groin Types: Mercury (or alcohol) Electronic: electronic probe and display. Liquid Crystal strip: liquid crystal strip with colour indicator Normal temperature levels: There is no consensus on a value for a normal body temperature. The normal temperature also varies during the 24 cycle with it being lowest in early morning and highest in afternoon. The normal ranges also varies for different body regions (Bickley, 2016; Beaman 2018). Oral Temperature: Usually quoted at 37°C but varies. Early morning can be as low as 35.8°C Late afternoon or evening it may rise as high as 37.3°C Recording accurate temperature requires: – thermometer sensor tip to make contact with the mucous membranes and tongue. – air-tight seal with lips around the thermometer It is best placed under the tongue in the posterior sublingual pocket. Bodhi health Education. https://www.youtube.com/watch?v=AVHR485D HmA Axillary temperatures Normal average temperature is lower than the oral temperatures by approximately 1 degree Method: Contact thermometer Tympanic membrane temperature: It uses infrared sensor to calculate the core body temperature from detecting heat waves from the tympanic membrane and middle ear It yields a temp reading that is usually higher than the normal oral temperature by approximately 0.8°C. It is quick, safe, and reliable if performed properly. Method: It is a form of non-contact thermometer. Quick reading within 2 to 3 seconds Uses a disposable plastic cover Non-contact Infrared Thermometer Uses infrared technology. It is usually aimed from a certain distance (1 - 6cm) the skin that is set/calibrated by the manufacturer Measures skin surface temperature. Extrapolates body core temperature using an algorithm. Usually, temp measurement skin surfaces used are: Forehead, Temporal skin area (temporal artery region) Skin behind the ear TASK: Factors affecting body temperature: Factor Increase in temp Decrease in temp Age Gender Physical Exercise Pregnancy Environmental Factors Infection Food High Body temperature (Pyrexia) Fever is when body temp >38 C A condition caused by fever is referred to as febrile e.g: febrile seizures. Clinical signs and symptoms of fever (Beaman et al 2018): Increased heart rate Increased respiratory rate Shivering, Chills Decreased appetite Headache Facial flushing Sweating Fever Elevated body temperature > 37.8° C orally or > 38.2° C rectally (Bush l, 2018) Temp > 39.5° C is high fever Hyper-pyrexia or Hyper-thermia: Develops when body temperature exceeding 41.5° C. Can be caused by conditions such as infections or environmental factors. Signs of hyperthermia include: Muscle cramps, confusion, convulsions; it can lead to death Hypothermia Is a body temp < 35° C caused by exposure to cold temp Signs of hypothermia include: Lack of muscle coordination, slurred speech, decreased PR and RR Pale skin Temp < 33.3° C can be life-threatening Pulse Assessment Arterial pulse is a wave of blood passing through the artery at the time of left ventricular contraction. The examiner feels the force of the dilation of the radial artery during systole of the heartbeat. Assessment of pulse gives valuable information regarding the cardiovascular hemodynamics. When the pulse is assessed, it is described in relation to 3 of its characteristics: 1. Rate 2. Rhythm 3. Volume The examiner feels the force of the dilation of the radial artery during systole of the cardiac cycle. The pulse is counted for 30sec and then multiplied by 2 to calculate the rate in beats per minute (bpm). If the radial pulse is not palpable other arteries could be palpated. When assessing the pulse: 1 Patient is seated and arm supported on stable surface. 2 Examiner palpates the artery lightly and gently increases finger pad pressure until pulse is palpable. 3 The patient arm should be supported, it should not be held as shown below (left) as this will require applying firm pressure with fingers to hold the weight of the arm and this will affect sensation of the pulse. Use the palm of the hand to rest arm on Do not lift arm by gripping it using it if needed. This allows palpation fingers the palpation fingers. to be free to apply and vary palpation pressure.  Sites for palpating the arterial pulse: If radial pulse is not palpable, other arteries could be palpated. Artery Location Radial Thumb side of wrist, distal forearm, 1 inch from wrist crease; (Most commonly used). Brachial distal medial forearm medial to the bicep tendon Carotid anterior to the SCM muscle at level of cricoid cartilage Temporal At side of head just above the ear Femoral In the groin along a line joining the pubic symphysis and ASIS Popliteal Behind the knee Posterior Tibial behind the medial malleolus Dorsalis Pedis dorsum of foot lateral to extensor hallucis longus Apical Left of sternum, 5th intercostal space mid-clavicular line CFCF. https://commons.wikimedia.or g/wiki/File:Pul se_sites-en.svg Pulse rate: Reflects the heart rate. It increases and decreases consistently with the heart rate. Normal and Abnormal pulse rates: The adult normal heart rate range is 60-100bpm Below is the pulse rate average ranges for different age groups (Beaman et al, 2018): Less than 1 year: 120–160 bpm 2–6 years: 80–120 bpm Tachycardia: 7–10 years: 80–100 bpm Pulse rate > 11–16 years: 70–90 bpm 100 bpm Adult: Bradycardia: 60–80 bpm Pulse rate Older adult: 50–65 bpm