Clinical Exams. Terms. Arrhythmia – a fluctuation in the heart rate Auscultation – the use of a stethoscope to listen to sounds produced by the functions of the respiratory , circulatory, and digestive systems - PowerPoint PPT Presentation
Clinical ExamsTermsArrhythmia a fluctuation in the heart rateAuscultation the use of a stethoscope to listen to sounds produced by the functions of the respiratory, circulatory, and digestive systemsBradycardia a decreased pulse rate seen most commonly with electrolyte imbalances or heart diseaseCyanosis a bluish discoloration of the skin, resulting from inadequate oxygen concentrations in the bloodDyspnea difficulty breathing, characterized by shallow rapid breaths with abdominal effortEupnea normal breathingGastrointestinal a term used to describe the stomach and intestines as one unitMurmur any abnormal heart sounds produced by improper blood flow through the heartPalpation using touch to determine the character of deeper, underlying body structuresOphthalmoscope instrument used to examine the interior eyeOtoscope instrument used to examine the interior earTachycardia an increased pulse rate seen often with fear, pain, exercise, and certainheart diseasesTachypnea rapid breathing
Importance of Physical ExamsPhysical exams are also important because animals that are unhealthy cannot undergo many general procedures, such as vaccinating and spaying or neutering.A healthy animal has the followingcharacteristics:
1. Clear bright eyes with pink membranes around the eyes.2. An appearance of contentment.3. An alert attitude and interest in surroundings.4. A good appetite.5. A sleek, shiny coat with hair that is pliable, not dry and brittle.6. Feces and urine that are easily passed and normal in appearance.7. Temperature, pulse, and respiration in normalrange.Taking a Patients HistoryA patient history is a written documentation of the problem(s) the animal is having. A history should not be confused with the basic statistics on an animal such as age, name, breed, sex, etc. This information is usually taken by the hospital secretary and is recorded before the veterinarian looks at the animal.When taking a history, be sure to ask questions that cannot be answered with a yes or no. For example, ask, How much water does Fluffy drink daily?rather than Is Fluffy drinking more water now?Also, keep in mind that certain breeds are predisposed to certain illnesses and the age or sex of the animal may be a clue to determining what is wrong.REPEATEquipment Needed for ExampleThere are several basic pieces of equipment needed to complete a physical exam. Stethoscope used to auscult (listen to) theheart, lungs, and gastrointestinal sounds Thermometer and petroleum jelly Ophthalmoscope Otoscope Watch with second hand MuzzleStethscope
Temperature, Pulse, & Respiration:
TPR is a basic component of the physical exam.TPR is different for every species of animal and varies with ageSizeenvironmental temperatureStressactivity levelmost importantly, health.Average ValuesNormal TempPulse/Beat per min.Respiration/ Breaths per min.Cat101.5110-13020-30Cattle101.060-7010-30Chicken107.0200-40015-30Dog102.070-12010-30Goat102.540-6012-20Horse100.030-608-16Rabbit103.0123-30430-45Sheep102.060-9012-20SnakeRoom Temp121-2How to Take TemperatureTemperature is taken rectally on the dog and cat and all species of livestock. Variations in temperature may occur due to: Infection/disease Excitement/stress Environment
Procedure:1. Wipe the thermometer with alcohol and shake it down till the mercury is below 98 degrees.2. Lubricate the tip with petroleum jelly.3. Gently insert the thermometer into the rectum and hold it securely in place for three minutes.4. Remove the thermometer and wipe with a paper towel.5. Slowly rotate the thermometer until the mercury is visible and take the reading.Pulse Pulse is evaluated using the femoral artery on dogs and cats. The femoral artery is located on the inside hind leg at the top of the thigh. Use the maxillary artery for large animals. It is located under the jaw of the horse and on the outside of jaw on the cow. The ventral tail vein and lower jaw (mandibular) are used to take a pulse in cattle and sheep. There are many variations in pulse such as abnormal rhythms, weak, and bounding pulses. Variations may occur due to: Anxiety Exercise Pain Disease Shock
An increased pulse is called tachycardia. A pulse thatis slower than normal is called bradycardia.Pulse ProcedureUsing your index and middle fingers, gently roll them over the artery feeling for the pulse.
2. Count the number of pulses for 15 seconds.
3. Multiply the number of pulses in 15 seconds by 4 to get beats/minute.RespirationRespiration is evaluated by looking at three parameters:1. Rate of respiration2. Depth degree of chest effort needed to take abreath (deep, shallow)3. Character (slow, rapid, normal)Several terms are commonly used to describe the character of respiration.
Eupnea normal breathing Dyspnea difficulty breathing (shallow, rapid breaths with increased chest effort) Tachypnea rapid breathingRespiration Procedure:1. Observe the rise and fall of the chest.2. Count the number of breaths for 15 seconds.3. Multiply the number of respirations by 4 toget breaths/minute.Note in small or sick animals it may be necessaryto place a hand lightly on the chest or observe thenostrils for signs of respiration.The Physical ExamWhen examining an animal, it is best to use aregional approach. Begin at the head of the animal and progress to the tail examining thoroughly all the external areas and all body cavities (eyes, ears, mouth, etc). Examination of underlying structures should also be done at this time.PalpationPalpation is used to inspect underlying muscle and skeletal structure, and locate abnormalities.
Structures should be gently traced with the fingertips and not grabbed.
Improper handling is painful to the animal and could damage internal organs.AuscultationAuscultation is the use of a stethoscope to listen to sounds produced by the respiratory, circulatory, and digestive systems.
In large animals, auscultation is used to evaluate gastrointestinal sounds.LungsNormal lung sounds are louder during inspiration and like rustling leaves.
Two main types of abnormal sounds: Crackles most often heard in connection with fluid accumulation in the lungs and pneumonia Wheezes the result of decreased airflow from an obstruction or asthmaHeart Detects fluctuations in the heart rate (arrhythmia), and abnormal heart sounds (murmurs). Heart sounds are most easily heard on the left side of the animal due to the placement of the heart. Dogs have a normal arrhythmia where the heart rate increases on inspiration and decreases on expiration.Murmurs occur due to an abnormal flow of blood through the heart.12 Areas to ExamGeneral appearance is there a healthy overall appearance? Are eyes bright and coat shiny? Is animal obese or very thin?
2. Integumentary (skin) is the coat shiny andfull or is it dull and brittle? Are there any bald patches, rashes, or flaking skin?
3. Muscoskeletal (muscles and skeletal structure) is there a history of lameness or any visible lameness? Broken bones?
4. Circulatory coughing, fainting, dyspnea, and murmurs are all signs of circulatory problems.5. Respiratory coughing, sneezing, nasal discharge, exercise intolerance, and cyanosis are signs of possible respiratory problems.
6. Digestive is the animal eating normally? Have there been diet changes? Was a toxin (rat poison, antifreeze) ingested? Vomiting and diarrhea are signs of digestive upset.
7. Genitourinary (genitals and urinary system) abnormal discharge, smell, or color as well as swelling and inability or difficulty in urinating and defecating are signs of a problem.8. Nervous system seizures, changes in behavior, difficulty walking, head tilt.
9. Lymph nodes enlarged?
10. Ears discharge, unusual odor, or head shaking?
11. Eyes is there excessive tearing or discharge? Are there any visual deficits?
12. Mouth are gums and teeth healthy? Are mucous membranes moist and pink? Very red, cyanotic, or pale membranes are abnormal. A Capillary Refill Time (CRT) is done to check for circulatory problems.