tailieunhanh - CLINICAL SKILLS - PART 6

Tấm 6: võng mạc, palsies, môi (a) cao huyết áp bệnh lý võng mạc - hẹp động mạch, xuất huyết ngọn lửa và phù gai thị một đầu với một biên độ đĩa không rõ ràng. (b) bệnh võng mạc tiểu đường - dịch tiết cứng trong một chiếc nhẫn | a c b d e f Plate 6 Retinae palsies lips a Hypertensive retinopathy narrow arteries flame haemorrhages and an early papilloedema with an indistinct disc margin. b Diabetic retinopathy hard exudates in a ring circinate . c Left sixth nerve lesion the patient is looking to the left but there is no lateral movement of the left eye. d Wasted interossei and hypothenar eminence from an ulna nerve or T1 lesion. e Osler-Weber-Rendu syndrome telangiectasia on the lip in a patient with haematemasis. f Herpes simplex on lips cold sores these can erupt with other illnesses. System-oriented Examination 153 o Romberg test o gait and tandem gait Examine the arms or legs o inspect colour skin nail changes ulcers wasting are both arms and legs involved joints o palpate temperature pulses lumps see above joints active movements feel for crepitus . hand over knee during flexion passive movements do not hurt patient reflexes sensation CHAPTER 8 Assessment of Disability Including Care of the Elderly Introduction It is important particularly in the elderly to assess whether the patient has a disability which interferes with normal life and aspirations which makes the patient dependent on others requires temporary assistance for specific problems occasional or regular assistance long-term supervised accommodation nursing home with 24-hour care It is necessary to assess the following in a patient o ability to do day-to-day functions o mental ability including confusion or dementia o emotional state and drive The descriptive terms used for disability have specific definitions in a World Health Organization classification. Impairment any loss or abnormality of anatomical physiological or psychological function . systems or parts of body that do not work. Disability any restrictions or lack of ability due to an impairment to perform an activity within the range considered normal . activities that cannot be done. Handicap a limitation of normal occupation because of impairment or .