General Physical Examination

The first step in the evaluation is to record the patient's height, weight, and vital signs (e.g., body temperature, heart rate, blood pressure, respiratory rate). Observation should include the individual's general appearance, with an assessment of the patient's grooming and nutrition. The patient's facial expressions, signs of flushing or paleness, sweating, tears, tremors, muscular tension, or psychiatric manifestations, such as anxiety, fear, or depression, should be noted.

The physician should also be attentive to the patient's posture and evaluate lordosis, kyphosis, and pelvic posturing. The examination room should then be scanned for the presence of any assistive devices used by the patient.

Starting with the head, the patient should be examined for any signs of trauma. Careful attention should be paid to the patient's sclera and pupils. An examination ofthe patient's oral cavity may uncover dental issues or other oral processes. The practitioner should next inspect the patient's head and neck for lymphadenopathy. While examining the patient's neck, the patient's thyroid should be noted for signs of abnormal enlargement, goiter, or nodules.

During examination of the chest, back, and abdomen, careful auscultation of the lungs can help uncover pulmonary co-morbidities [e.g., pneumonia, chronic obstructive pulmonary disease (COPD), or heart failure]. While examining the patient's lungs, the patient's back should be observed for structural abnormalities like scoliosis. Auscultation of the heart should include signs of irregular rhythms, tachycardia, and murmurs. Systolic murmurs suggest the possibility of aortic stenosis which restricts the types of treatment possible for a patient. Any irregular cardiac rhythms, like atrial fibrillation, should raise the suspicion of anticoagulation in the patient. Finally the abdomen should be methodically inspected, with the practitioner first visually inspecting the patient's belly. Auscultation of the abdomen should then be performed before any attempts at palpation or percussion. Abnormalities in bowel sounds or sensitivity to palpation and percussion may indicate underlying intraabdominal issues.

The patient's skin should then be evaluated for color, temperature, and signs of rashes or edema. The practitioner should also be attentive to a patient's hair and nails, as patients with complex regional pain syndrome may present with hair loss over the affected extremity and the nails may show abnormalities in texture and smoothness. The skin's color and temperature allow the physician to assess the vascular status of a patient, as poorly perfused regions may appear cyanotic and cool to the touch. Often times, patients with vascular abnormalities will suffer from concurrent neuropathic pain.

Anxiety and Depression 101

Anxiety and Depression 101

Everything you ever wanted to know about. We have been discussing depression and anxiety and how different information that is out on the market only seems to target one particular cure for these two common conditions that seem to walk hand in hand.

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