ence of pain when pressure is removed from the abdomen, rather than when it is applied) indicating inflamed peritoneum. ● Sudden worsening of intermittent claudication. ● Throbbing chest, back, or abdominal pain that increases with exertion accompanied by a sense of a heartbeat when lying Vital signs Vital signs are an important part of physical therapy assessment because they can serve as early indicators for systemic illness and disease (Heick et al., 2023). In addition, they provide important information about the pulmonary and cardiovascular systems, two systems that are often challenged through the course of physical therapy treatment. Blood pressure Normal blood pressure for adults is systolic less than 120 mm Hg and diastolic less than 80 mm Hg. If systolic is greater than 180 mm Hg and/or diastolic is greater than 120 mm Hg, this is consid- ered a hypertensive crisis (Heick et al., 2023). Pulse Normal pulse rate for adults, assessed via either the carotid or radial arteries, is 60 to 100 beats per minute. The normal response to physical activity is an increase of approximately 10 beats per minute for each MET (metabolic equivalent) of increased activity (Heick et al., 2023). Normal recovery is a decrease of greater than 12 beats per minute following one minute of seated rest and a return to baseline after three minutes. Respiratory rate Normal respirations are 12 to 20 breaths per minute (Heick et al., 2023). Temperature An increase in core body temperature is usually an indication of an infection. Normal temperature is 30 to 37.5 degrees Celsius (with an average of 37 degrees Celsius) or 96.8 to 99.5 degrees Fahrenheit (with an average of 98.6 degrees Fahrenheit). Older adults are less likely than younger adults to develop a fever in the presence of an infection (Heick et al., 2023). Relevant statistics in differential diagnosis Differential diagnosis frequently involves the application of spe- cial tests that are used to rule in or rule out a condition. Several of those tests are presented in this course. To use special tests effectively, the statistical properties of sensitivity, specificity, and likelihood ratios should be understood. Sensitivity Sensitivity is the ability of a test to correctly identify patients who have a disease or a condition (Swift et al., 2020). A test that is highly sensitive will identify a very high number of people who have a disease or condition (known as true positives ) while gener- ating a minimal number of false negatives. ( False negatives refers to people who have the disease and should have tested posi - tive; health (Swift et al., 2020). A test with 100% sensitivity would correctly identify all the patients with a disease or condition. A test with 80% sensitivity would detect 80% of the people with the disease, but 20% or people with the test would go undetected (Lalkhen et al., 2008). Specificity Specificity is the ability of a test to identify people who do not have a disease or condition (Swift et al., 2020). A test with high specificity will rule out the maximum number of people who do not have a disease or condition while minimizing the number of false positives. ( False positives refers to people who do not have a disease or condition and should have tested negative (Swift et al., 2020). A test with 100% specificity correctly detects all the patients without a disease or condition. A test with 80% specificity
down and palpable pulsating abdominal mass (consistent with an aneurysm). ● Change in size, shape, tenderness, and consistency of lymph nodes; detection of a mass in the breast or axilla in the pres- ence of a previous history of cancer. Oximetry An oximeter can be used to measure the oxygen level (oxygen saturation) of the blood. Values between 95% and 99% are con- sidered normal. Oxygen saturation less than 90% is a cause for concern (Heick et al., 2023). Self-Assessment Quiz Question #3 A client presents to your clinic complaining of right-sided shoul- der pain that came on two weeks ago. The client is a 65-year- old retired male who is also an avid golfer. Which of the follow- ing pain descriptions might be considered a red flag for this situation? a. The client reports that the onset of pain is related to a day when he played 36 holes of golf, which was far more than his usual routine of 9 holes. b. The client reports that the pain is sharp, almost knifelike; that it wakes him up at night; and that he is unable to find a position that relieves his pain. c. The client reports that the pain is worst in the morning when he awakens with stiffness in his shoulder but that it lessens as he “gets moving.” d. The client reports that he had this same thing a few years ago and that it improved greatly with physical therapy exercises. Self-Assessment Quiz Question #4 Pain at night is considered a red flag finding and further medical evaluation is indicated. According to the Agency for Healthcare Policy and Research, night pain might be an indication of: a. Tumor or infection. would correctly detect that 80% of people who do not have the disease but would identify 20% of patients as having the disease when they actually do not. Sensitivity and specificity are inversely related. As sensitivity in- creases, specificity tends to decrease and vice versa. The sensi- tivity and specificity of a test should be considered together to provide a holistic picture of the test’s usefulness (Shreffler et al., 2022). Both sensitivity and specificity are expressed as decimals, so that a sensitivity of 0.80 is the equivalent of 80% test effective- ness. Likelihood ratios Likelihood ratios allow the clinician to determine how using a par- ticular test will alter the probability of a disease or condition be- ing present (Shreffler et al., 2022). The higher the likelihood ratio, the more likely the disease or condition is present. The lower the ratio, the more likely it is that the patient does not have the con- dition (Shreffler et al., 2022). Likelihood ratios range from zero to infinity. The higher the value of the likelihood ration, the more likely the patient has the condition. For example, if a positive test result has a likelihood ratio of 9.3, this means this result is 9.3 times more likely to happen in a patient with the condition than it would be in a patient without the condition. b. Psychiatric disorder or tumor. c. Immunosuppression or tumor. d. Immunosuppression or infection.
EliteLearning.com/ Physical-Therapy
Book Code: PTCA2624
Page 95
Powered by FlippingBook