Clinical Exams

1. Clinical Exams

2. 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 • Bradycardia– a decreased pulse rate seen most commonly with electrolyte imbalances or heart disease • Cyanosis – a bluish discoloration of the skin, resulting from inadequate oxygen concentrations in the blood • Dyspnea – difficulty breathing, characterized by shallow rapid breaths with abdominal effort

3. Eupnea – normal breathing • Gastrointestinal – a term used to describe the stomach and intestines as one unit • Murmur – any abnormal heart sounds produced by improper blood flow through the heart • Palpation – using touch to determine the character of deeper, underlying body structures • Ophthalmoscope – instrument used to examine the interior eye • Otoscope– instrument used to examine the interior ear • Tachycardia – an increased pulse rate seen often with fear, pain, exercise, and certain • heart diseases • Tachypnea– rapid breathing

4. Importance of Physical Exams Physical exams are also important because animals that are unhealthy cannot undergo many general procedures, such as vaccinating and spayingor neutering.

5. 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 normal range.

6. Taking a Patients History REPEAT • A 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.

7. Equipment Needed for Example There are several basic pieces of equipment needed to complete a physical exam. • Stethoscope – used to auscult (listen to) the heart, lungs, and gastrointestinal sounds • Thermometer and petroleum jelly • Ophthalmoscope • Otoscope • Watch with second hand • Muzzle

8. Stethscope

9. Ophthalmoscope

10. Otoscope

11. Temperature, Pulse, & Respiration: • TPR is a basic component of the physical exam. • TPR is different for every species of animal and varies with • age • Size • environmental temperature • Stress • activity level • most importantly, health.

12. Average Values

13. How to Take Temperature Temperature 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.

14. 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 that is slower than normal is called bradycardia.

15. Pulse Procedure • Using 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.

16. Respiration Respiration is evaluated by looking at three parameters: 1. Rate of respiration 2. Depth – degree of chest effort needed to take a breath (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 breathing

17. Respiration 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 to get breaths/minute. Note – in small or sick animals it may be necessary to place a hand lightly on the chest or observe the nostrils for signs of respiration.

18. The Physical Exam When examining an animal, it is best to use a regional 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.

19. Palpation Palpation 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.

20. Auscultation Auscultation 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.

21. Lungs Normal 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 asthma

22. Heart • 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.

23. 12 Areas to Exam • General 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 and full 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.

24. 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.

25. 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.