Day 4: Dr. Zahra Kanji’s ADS was about conducting a patient assessment with a head-to-toe approach. I found this session very useful as it gave me a better idea of what to look for under each system. Dr. Kanji also provided several examples on how to use a head-to-toe approach (e.g. to assess volume status). The examples elucidated how this approach can be useful in drawing connections between each system, and the patient’s overall picture and therapy.
Some points that I took away from this session were:
- Being able to effectively use a head-to-toe approach requires ongoing practice!
- The approach may differ depending on the rotation and individual patient
- MAP = (2*DBP+SBP)/3 as the heart spends twice the time in diastole than in systole
- For cardiac murmurs, also consider the timing within the cycle, intensity over time, location, radiation, grade, pitch and quality
- Troponin-I can be detectable for up to 5-9 days after an acute event, making it difficult to assess the onset of the heart muscle damage
- Important to consider what could have caused any abnormal labs, signs and symptoms (e.g. a high blood pressure –> could it be due to a small cuff? white coat syndrome? timing of medications? patient’s activity?)
In my future clinical orientations, I will:
- Work-up all my patients from a head-to-toe approach
- Look for connections between trends in their lab values/conditions and the information I have gathered from systematically going from head-to-toe
- When planning my monitoring parameters, systematically go from head to toe to ensure that my monitoring plan is comprehensive
- Ask my preceptor how they conduct patient assessments and understand how it is appropriate for the field they are working in
- Take opportunities to learn about physical assessment and diagnostic tools