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Diagnostic Tests for Anemia
Home Diagnostic Testing
These home medical tests may be relevant to Anemia:
- Fatigue: Related Home Tests:
- Thyroid: Home Testing:
- Home Anemia Diagnostic Tests
- Menopause: Related Home Testing:
- Vaginal Health: Home Testing:
- Adrenal Gland Health: Home Testing:
- Breast Cancer: Related Home Tests:
Tests and diagnosis discussion for Anemia:
Anemia in Kidney Disease and Dialysis: NIDDK (Excerpt)
A complete blood count (CBC), a laboratory test performed on a sample of your blood, includes a determination of your hematocrit (Hct), the percentage of the blood that consists of red blood cells. The CBC also measures the amount of Hgb in your blood. The range of normal Hct and Hgb in women who menstruate is slightly lower than for healthy men or healthy postmenopausal women. The Hgb is usually about one-third the value of the Hct. (Source: excerpt from Anemia in Kidney Disease and Dialysis: NIDDK)
Anemia in Kidney Disease and Dialysis: NIDDK (Excerpt)
If you have lost at least
half of normal kidney function (serum creatinine greater than 2
mg/dL) and have a low Hct, the most likely cause of anemia is
decreased EPO production. The National Kidney Foundation's Dialysis
Outcomes Quality Initiative (DOQI) recommends that doctors begin a
detailed evaluation of anemia in men and postmenopausal women on
dialysis when the Hct value falls below 37 percent. For women of
childbearing age, evaluation should begin when the Hct falls below
33 percent. The evaluation will include tests for iron deficiency
and blood loss in the stool to be certain there are no other reasons
for the anemia.
| Hematocrit (Hct) | Hemoglobin (Hgb) | |
|---|---|---|
| Women who menstruate | less than 33% | less than 11 g/dL |
| All men and postmenopausal women | less than 37% | less than 12 g/dL |
Anemia: NWHIC (Excerpt)
Anemia is diagnosed by a blood test, either by a fingerstick in a physician's office, or by a blood test done in a laboratory. (Source: excerpt from Anemia: NWHIC)
Diagnosis of Anemia: medical news summaries:
The following medical news items are relevant to diagnosis of Anemia:
- About Blackfan Diamond anemia
- Celiac disease is a chronically undiagnosed and misdiagnosed condition
- Celiac disease more common than thought
- Kidney disease is a seriously underdiagnosed condition in Australia
- Lupus awareness increasing
- Lupus can be difficult to diagnose because of it's multitude of symptoms
- Lupus often misdiagnosed as MS or rheumatoid arthritis
- Simple treatments exist for menorrhagia
- Single use anemia test available free of cost to people at risk of chronic kidney disease
- Symptoms of old age may be similar to many other treatable conditions
- Test for iron overload disease received FDA approval
- Treatment options are available for excessive menstrual bleeding
- More news »
Diagnostic Tests for Anemia: Online Medical Books
16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about the diagnostic tests for Anemia.
FATIGUE:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
All patients should have routine laboratory studies, including CBC, sedimentation rate, chemistry panel, VDRL test, and a urinalysis including analysis for myoglobin. CPK, LDH, AST, and urine creatine and creatinine should be done to rule out muscle disease. A thyroid profile should be done to rule out hyperthyroidism. Further endocrine workup including serum cortisol will help differentiate Addison's disease and hypopituitarism. Because fatigue is associated with aldosteronism, a 24-hr urine aldosterone determination should be done.
Tests for chronic infectious disease, such as febrile agglutinins, brucellin antibody titer, heterophile antibody titer or Monospot test, sputum for AFB, and various skin tests for tuberculosis and fungi, can be done. HIV testing may be appropriate if there is a history of high-risk sexual behavior. Serial blood cultures also would be of value if there is significant fever. Tests for chronic organ failure such as BUN, creatinine, serum electrolytes, and liver function tests should be done. A workup of anemia including a workup of malabsorption syndrome may be necessary. Consequently, stool analysis for fat content as well as d -xylose absorption testing may be done.
A search for neoplasm will include chest x-rays, x-rays of the skull and long bones, a bone scan, an upper GI series, and small bowel follow-through as well as a barium enema and intravenous pyelogram. A muscle biopsy will help differentiate certain collagen diseases, muscular dystrophy, and trichinosis. An ANA test and serum complement to screen for collagen disease should be done. A Tensilon test may be necessary to differentiate myasthenia gravis. If a neurologic disease is suspected, referral to a neurologist would be in order. Consider EMG also. If sleep apnea is a possibility, overnight polysomnography is indicated.
If all the tests prove negative, referral to a psychiatrist would be appropriate. On the other hand, it may be appropriate to refer the patient to a psychiatrist earlier in the course of the workup. The diagnosis of chronic fatigue syndrome is sometimes made when all the diagnostic tests are negative, but whether it is truly a disease is questionable.
Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
ANEMIA:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
The most important thing to do initially is to examine a blood smear for red cell morphology. If the anemia is microcytic, one would consider iron deficiency or chronic blood loss. If it is microcytic, consideration should be given to pernicious anemia or folate deficiency. Further workup should include a chemistry panel, stool for occult blood, liver function tests, reticulocyte count, serum iron and iron-binding capacity, serum B 12 and folic acid, serum haptoglobin, and platelet count. If these studies are inconclusive, a hematologist should be consulted. A hematologist will perform a bone marrow examination for a more definitive diagnosis. Perhaps a liver-spleen scan, CT scan of the abdomen, or therapeutic trial of iron, B 12 , or folic acid is indicated.
Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
Fatigue:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
Obtain a careful history to identify the patient’s fatigue pattern. Fatigue that worsens with activity and improves with rest generally indicates a physical disorder; the opposite pattern, a psychological disorder. Fatigue lasting longer than 4 months, constant fatigue that’s unrelieved by rest, and transient exhaustion that quickly gives way to bursts of energy are other findings associated with psychological disorders.
Ask about related symptoms and recent viral or bacterial illness or stressful changes in lifestyle. Explore nutritional habits and appetite or weight changes. Carefully review the patient’s medical and psychiatric history for chronic disorders that commonly produce fatigue. Ask about a family history of such disorders.
Obtain a thorough drug history, noting the use of any drug with fatigue as an adverse effect. Ask about alcohol and drug use patterns. Determine the patient’s risk for carbon monoxide poisoning, and inquire as to whether the patient has a carbon monoxide detector.
Observe the patient’s general appearance for overt signs of depression or organic illness. Is he unkempt or expressionless? Does he appear tired or sickly, or have a slumped posture? If warranted, evaluate his mental status, noting especially mental clouding, attention deficits, agitation, or psychomotor retardation.
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Pallor:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
If the patient’s condition permits, take a complete history. Does the patient or anyone in his family have a history of anemia or of a chronic disorder that might lead to pallor, such as renal failure, heart failure, or diabetes? Ask about the patient’s diet, particularly his intake of red meat and green vegetables.
Then explore the pallor more fully. Find out when the patient first noticed it. Is it constant or intermittent? Does it occur when he’s exposed to the cold? Does it occur when he’s under emotional stress? Explore associated signs and symptoms, such as dizziness, fainting, orthostasis, weakness and fatigue on exertion, dyspnea, chest pain, palpitations, menstrual irregularities, or loss of libido. If pallor is confined to one or both legs, ask the patient if walking is painful. Do his legs feel cold or numb? If pallor is confined to his fingers, ask about tingling and numbness.
Start the physical examination by taking the patient’s vital signs. Make sure to check for orthostatic hypotension. Auscultate the heart for gallops and murmurs and the lungs for crackles. Check the patient’s skin temperature — cold extremities commonly occur with vasoconstriction or arterial occlusion. Also, note skin ulceration. Examine the abdomen for splenomegaly. Finally, palpate peripheral pulses. An absent pulse in a pale extremity may indicate arterial occlusion, whereas a weak pulse may indicate low cardiac output.
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Low birth weight:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
As soon as possible, evaluate the neonate’s neuromuscular and physical maturity to determine gestational age. (See Ballard Scale for calculating gestational age, pages 382 and 383.) Follow with a routine neonatal examination.
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Fatigue:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
Obtain a careful history to identify the patient’s fatigue pattern. Fatigue that worsens with activity and improves with rest generally indicates a physical disorder; the opposite pattern, a psychological disorder. Fatigue lasting longer than 4 months, constant fatigue that’s unrelieved by rest, and transient exhaustion that quickly gives way to bursts of energy are findings associated with psychological disorders.
Ask about related symptoms and any recent viral or bacterial illness or stressful changes in lifestyle. Explore nutritional habits and any appetite or weight changes. Carefully review the patient’s medical and psychiatric history for any chronic disorders that commonly produce fatigue, and ask about a family history of such disorders.
Obtain a thorough drug history, noting use of any narcotic or drug with fatigue as an adverse effect. Ask about alcohol and drug use patterns. Determine the patient’s risk of carbon monoxide poisoning, and ask whether the patient has a carbon monoxide detector.
Observe the patient’s general appearance for overt signs of depression or organic illness. Is he unkempt or expressionless? Does he appear tired or sickly, or have a slumped posture? If warranted, evaluate his mental status, noting especially mental clouding, attention deficits, agitation, or psychomotor retardation.
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Pallor:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
If the patient’s condition permits, take a complete history. Does the patient or anyone in his family have a history of anemia or of a chronic disorder that might lead to pallor, such as renal failure, heart failure, or diabetes? Ask about the patient’s diet, particularly his intake of green vegetables.
Explore the pallor more fully. Find out when the patient first noticed it. Is pallor constant or intermittent? Does it occur when he’s exposed to the cold? Does it occur when he’s under emotional stress? Explore associated signs and symptoms, such as dizziness, fainting, orthostasis, weakness and fatigue on exertion, dyspnea, chest pain, palpitations, menstrual irregularities, or loss of libido. If the pallor is confined to one or both legs, ask the patient if walking is painful. Do his legs feel cold or numb? If the pallor is confined to his fingers, ask about tingling and numbness.
Start the physical examination by taking the patient’s vital signs. Be sure to check for orthostatic hypotension. Auscultate the heart for gallops and murmurs and the lungs for crackles. Check the patient’s skin temperature—cold extremities commonly occur with vasoconstriction or arterial occlusion. Note skin ulceration. Examine the abdomen for splenomegaly. Palpate peripheral pulses. An absent pulse in a pale extremity may indicate arterial occlusion, whereas a weak pulse may indicate low cardiac output.
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Low birth weight:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
As soon as possible, evaluate the neonate’s neuromuscular and physical maturity to determine gestational age. (See Ballard Scale for calculating gestational age, pages 488 and 489.) Follow with a routine neonatal examination.
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Fatigue:
Physical examination
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
A thorough physical examination should be done to investigate findings of underlying disease. This is also an important prerequisite to satisfy the patient’s concern regarding the possibility of an organic cause if a psychiatric diagnosis is made. Particular attention should be given to the presence of pallor, cardiac arrhythmia, dyspnea, fever or other indication of infection; weight loss; lymphadenopathy; evidence of inflammatory arthritis, occult blood loss, organomegaly, or abdominal masses; neurologic signs of impaired coordination; hypertension; edema; generalized pruritus; obesity; peripheral neuropathy; goiter; dry hair or skin; hemoptysis; or pregnancy. Conduct a mental status examination to identify abnormalities in mood, intellectual function, memory, and personality. Pay special attention to assessment of symptoms of depression or anxiety, suicidal ideation, and psychomotor retardation.
Testing.
If diagnostic or patient concerns remain following the history and physical examination, a minimum battery of laboratory screening tests should be performed in the evaluation of fatigue. This should include a complete blood count with leukocyte differential, serum levels of alanine aminotransferase, total protein, albumin, globulin, alkaline phosphatase, calcium, phosphorus, glucose, blood urea nitrogen, creatinine, electrolytes, thyroid-stimulating hormone, erythrocyte sedimentation rate, and urinalysis. The choice of any further investigations should be guided by clinical assessment of the patient to confirm or exclude other causative possibilities; for example, obtain a chest x-ray study in the case of exposure to tuberculosis or a magnetic resonance imaging study of the brain if multiple sclerosis is suspected. In such cases, further investigation should be conducted according to accepted clinical standards. In particular, the use of other screening tests to diagnose CFS is not recommended in the clinical setting, but should be reserved for investigation in the setting of protocol-based research (4).
Diagnostic assessment
A. Organic and psychogenic causes. If the evaluation through history, physical examination, and laboratory studies reveals an organic or psychogenic cause, the diagnosis of “fatigue” should be replaced with a more precise etiologic diagnosis. The most common biomedical causes of fatigue are psychogenic (57%), usually depression or anxiety, and organic causes (37%) with infection representing the largest subgroup followed by cardiovascular and endocrine abnormalities. Cases of cancer and connective tissue disease first presenting as fatigue are rare at 1% each (5). In the case that environmental factors are identified that contribute to fatigue, a trial of behavior modification may eliminate the complaint. Prolonged fatigue is defined as self-reported, persistent fatigue lasting 1 month or longer.
B. Chronic fatigue syndrome. A diagnosis of CFS is made by two criteria:
(a) severe chronic fatigue of 6 months or longer duration with other known medical conditions excluded by clinical diagnosis; and (b) concurrent presence of four or more of the following symptoms: substantial impairment in short-term memory or concentration; sore throat; tender lymph nodes; muscle pain, multiple joint pain without swelling or redness; headaches of a new type, pattern, or severity; unrefreshing sleep and postexertional malaise lasting more than 24 hours. The conditions must have persisted or recurred during 6 or more consecutive months of illness and must not have predated the fatigue (4). For fatigue of undetermined cause present for 6 or more months that does not meet criteria for CFS, a diagnosis of idiopathic chronic fatigue is made.
References
1. Kroenke K, Wood DR, Mangelsdorff AD, Meier NJ, Powell JB. Chronic fatigue in primary care: prevalence, patient characteristics, and outcome. JAMA 1988;
260(7):929–934.
2. Komaroff AL, Buchwal DS. Chronic fatigue syndrome: an update. Annu Rev Med 1998;49:1–13.
3. Godwin M, Delva D, Miller K, et al. Investigating fatigue of less than six month’s duration. Guidelines for family physicians. Can Fam Physician 1999;45:373–379.
4. Fukuda K, Strauss S, Hickie I, Sharpe MC, Dobbins JG, Komaroff AL, and the International Chronic Fatigue Syndrome Study Group. The chronic fatigue syndrome: a comprehensive approach to its definition and study. Ann Intern Med 1994;
121:953–959.
5. Valdini AF. Fatigue of unknown etiology—a review. Fam Pract 1985;2(1):48–53.
Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Low Back Pain:
Physical examination
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
Evaluation should be both general and specific. It is prudent to leave the potentially most painful parts of the examination to the end.
A. General. Examination includes auscultation of the heart and assessment of peripheral pulses and blood pressure. Abdominal examination should focus on possible causes of back pain (Table 12.5). Assess gait.
B. Neurologic. The lower extremity examination includes motor strength, deep tendon reflexes, sensation, proprioception, and certain functional maneuvers (Table 12.6). Romberg and Babinski reflexes should also be assessed. Rectal examination should assess sphincter tone, which can be compromised in sacral root dysfunction. In the primary care setting, most clinically significant disc herniations will be detected by the following limited examination: dorsiflexion of the great toe and ankle, Achilles reflex, light touch sensation of the medial (L
C. Musculoskeletal. Assess range of motion of the spine and lower extremities. Perform the SLR test passively with the patient supine. Note the angle of leg elevation precipitating pain. A positive test for sciatica is buttock pain radiating to the posterior thigh, and perhaps to the lower leg and foot. Sciatica, with pain and resistance on internal rotation of the hip, can indicate piriformis muscle spasm or strain. The SLR test is usually negative in spinal stenosis (2). Percussion of the spine and upper pelvis helps to identify areas of localized tenderness, as in fracture, metastatic disease, and some rheumatologic conditions. Palpate standard trigger points looking for fibromyalgia. Check for paraspinal muscle spasm. Measure thigh and calf circumferences to look for muscular atrophy.
Testing
A. Clinical laboratory tests. Testing will be guided by the differential diagnosis as determined by the history and physical examination. If the back pain is felt to be of musculoskeletal origin, no test may be indicated. A urinalysis can help rule out hematuria or infection, if the pain is thought to be urologic or as a result of trauma. If the history suggests a medical problem, the considered diagnoses will determine the laboratory work. Extensive medical workup may be needed for a primary or metastatic malignancy. A calcium level should always be measured to identify a potentially lethal hypercalcemia. Rheumatologic studies may be indicated if a connective tissue disease (e.g., ankylosing spondylitis or rheumatoid arthritis) is suspected. If the pain is thought to be secondary to an urgent or life-threatening condition, have pertinent tests done expeditiously.
B. Diagnostic imaging. In the absence of “red flags,” lumbar spine films are not indicated for musculoskeletal sounding low back pain of less than 1 month duration (1). Neurologic emergencies (e.g., major spine trauma, cauda equina syndrome) require magnetic resonance imaging (MRI) studies. It is usually unproductive to order an MRI for straightforward lumbar muscular strain or for initial evaluation of simple disc herniation, as the prevalence rate of nonsignificant abnormal findings is high. A bone scan may be helpful when tumor, infection, or occult fracture is suspected. Electromyography may be useful to assess for nerve root dysfunction when symptoms are questionable.
Diagnostic assessment
The most common cause of low back pain in the outpatient setting is musculoskeletal strain. Although temporarily very debilitating, muscle strain can be conservatively treated and usually has few long-term complications. Variations from this basic presentation must be recognized to identify more structurally significant or medically threatening problems. Clues to these other diagnoses, which are found in the history, are reinforced by abnormalities in the physical examination; they are found less often by diagnostic testing.
The following “red flags” suggest possible urgent diagnoses. A history of recent trauma or motor vehicle accident can signify a vertebral fracture or subluxation. Fever can indicate an infection of the spine or pyelonephritis (Chapter 2.6). Recent genitourinary instrumentation or other invasive procedure can precede this presentation. Weight loss, other constitutional symptoms, or pain at rest (or at night) may suggest cancer (Chapter 2.13). Neurologic abnormalities can signify nerve dysfunction or cord compression. Urinary or fecal incontinence or retention, saddle area perineal numbness, or anal sphincter incompetence suggests cauda equina syndrome. A sudden tearing sensation in the back with associated hypotension can be caused by a rupturing abdominal aortic aneurysm.
References
1. Bigos SJ. Acute low back problems in adults. Clinical Practice Guideline. No. 14. AHCPR Publication No. 95-0642. Rockville, MD: Agency for Health Care Policy and Research, Public Health Service, US Department of Health and Human Services; December 1994.
2. Alvarez JA, Hardy Jr. RH. Lumbar spine stenosis: a common cause of back and leg pain. Am Fam Physician 1998;57:1825–1834.
Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Fatigue:
Diagnostic Approach
(Field Guide to Bedside Diagnosis)
Organic fatigue is characterized by physical weakness or exhaustion, which is exacerbated by activity and partially relieved by sleep, short duration (,2 months), unintentional weight loss of greater than 10%, and an ill appearance. Most organic causes have associated signs and symptoms, specific and few in number.
Psychological fatigue is characterized by a primary inertia to initiation of physical activity, which when undertaken, can be performed. The patient is tired all the time, but fatigue is not exacerbated by exertion or relieved by rest. A protracted course, multiple and nonspecific associated symptoms, relation to stressful life events, and an anxious or depressed appearance are other clues. The sick role response to prior minor illness can indicate likely response to the current illness.
A medical or psychiatric diagnosis can be found in over two-thirds of patients with more than one month of fatigue. Psychiatric diagnoses, especially depression, panic disorder, or somatization disorder are the most common.
A diagnostic approach that involves careful history-taking and physical examination, assiduous avoidance of early closure, and a clear orientation to the reality of the patient’s perceptions whatever the cause (i.e., never implying “It’s all in your head”), is most rewarding. The differential is wide, and identification of the unusual organic causes among the many psychophysiological ones takes great skill.
| Sign | Sensitivity | Specificity | Likelihood Ratio |
| Hypothyroidism | |||
| Coarse skin | 29 | 95 | 5.6 |
| Cool dry skin | 16 | 97 | 4.7 |
| Periorbital puffiness | 53 | 81 | 2.8 |
| Enlarged thyroid | 46 | 84 | 2.8 |
| Lateral eyebrow hair loss | 29 | 85 | 1.9 |
Source: Field Guide to Bedside Diagnosis, 2007
Anemia:
Diagnostic Approach
(Field Guide to Bedside Diagnosis)
Symptoms include dyspnea on exertion, fatigue, headache, palpitations, difficulty concentrating, and tinnitus. When blood loss occurs gradually, oxygen delivery can be maintained at rest to a hemoglobin as low as 5 g/dL.
Tachycardia and a systolic flow murmur occur when hemoglobin is less than 7.5 g/dL. Pallor is found in the conjunctivae and notably in the palmar creases with hand extension (they normally flush). Press the base of the nail to observe blanching and flushing, comparing with the color of your own nailbeds. Always test for orthostatic blood pressure changes to assess acuteness of blood loss. Check stools for occult blood. Splenomegaly is found in hemolysis, pernicious anemia, liver diseases, infection, and thalassemia. In chronic anemia, there will be bounding pulses with a wide pulse pressure and a midsystolic
murmur.
Heavy menses are recognized by clots and gushing of blood with tampon removal. A family history of anemia suggests hemoglobinopathy (e.g., sickle cell anemia or thalassemia). Drug or toxin exposure suggests aplastic anemia, myelodysplasia, or G6PD hemolysis. Glossitis is seen with iron, folate, or vitamin B12 deficiency. Lymphadenopathy is seen with marrow infiltration or infection.
Source: Field Guide to Bedside Diagnosis, 2007
Low Back Pain:
Diagnostic Approach
(Field Guide to Bedside Diagnosis)
Radicular pain has such a high sensitivity for nerve root compression that its absence makes important disc herniation unlikely. Not all radicular pain is due to a herniated disc however. Other causes include spinal stenosis, ligamentous hypertrophy, deep lumbar muscle spasm, and deep trochanteric bursitis.
Back pain at rest or unassociated with posture/movement should increase the suspicion of tumor, fracture, infection, or referred visceral pain. Spinal tenderness is a sensitive but not specific indicator. Clues to metastatic cancer include a history of cancer, unexplained weight loss, and signs of cord compression, such as motor weakness of the legs, urinary or fecal incontinence, and absent anal reflex. Recent bacterial infection, injection drug use, or immune suppression (from steroids, chemotherapy, or HIV) should raise suspicion for infection. Fever occurs in osteomyelitis (50%), epidural abscess (83%), and tuberculosis (27%).
A red flag for fracture in a young adult is major trauma, such as a fall from a height or a motor vehicle accident. In older adults, minor trauma or strenuous lifting can cause a compression fracture.
Source: Field Guide to Bedside Diagnosis, 2007
Fatigue:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Begin your physical assessment by observing the patient’s general appearance for overt signs of depression or organic illness. Is he unkempt or expressionless? Does he appear tired or sickly, or have a slumped posture? If warranted, evaluate his mental status, noting especially mental clouding, attention deficits, agitation, or psychomotor retardation. Then, take your patient’s vital signs and perform a complete physical examination.
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Pallor:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Start the physical assessment by taking the patient’s vital signs. Be sure to check for orthostatic hypotension. Auscultate the heart for gallops and murmurs and the lungs for crackles. Check the patient’s skin temperature — cold extremities commonly occur with vasoconstriction or arterial occlusion. Also, note skin ulceration. Examine the abdomen for splenomegaly. Finally, palpate peripheral pulses. An absent pulse in a pale extremity may indicate arterial occlusion, whereas a weak pulse may indicate low cardiac output.
CULTURAL CUE:Because skin color varies according to race and ethnic background, establish a baseline skin color so that changes can be more readily detected.
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Fatigue:
Diagnostic Approach
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006
Pallor (Anemia):
Diagnostic Approach
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
Age
Severity of Illness
Most important first step is to assess severityof illness. For anyone with hypovolemia from blood loss or cardiacfailure from severe anemia, immediate treatment is mandatory.Type of Onset
Associated Physical Findings
Lab Tests
Complete Blood Count
CBC, including platelet count, provides crucialinformation about all blood cell lines (e.g., presence of pancytopeniasuggests leukemia or aplastic anemia).Mean Corpuscular Volume
Measurement of MCV, which varies with ageand gender, is useful in the classification of anemias [seeDallman and Simes (1979) for normal values of mean corpuscular volume].Low MCV signifies microcytic anemia, whereas high MCV (101–160fL) signifies macrocytic anemia. Table45.2 lists common causes of anemia based on values ofMCV.Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006
Fatigue:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
Obtain a careful history to identify the patient's fatigue pattern. Fatigue that worsens with activity and improves with rest generally indicates a physical disorder; the opposite pattern, a psychological disorder. Fatigue lasting longer than 4 months, constant fatigue that's unrelieved by rest, and transient exhaustion that quickly gives way to bursts of energy are other findings associated with psychological disorders.
Ask about related symptoms and recent viral or bacterial illness or stressful changes in lifestyle. Explore nutritional habits and appetite or weight changes. Carefully review the patient's medical and psychiatric history for chronic disorders that commonly produce fatigue. Ask about a family history of such disorders.
Obtain a thorough drug history, noting the use of any drug with fatigue as an adverse effect. Ask about alcohol and drug use patterns. Determine the patient's risk of carbon monoxide poisoning, and inquire as to whether the patient has a carbon monoxide detector in the home.
Observe the patient's general appearance for overt signs of depression or organic illness. Is he unkempt or expressionless? Does he appear tired or sickly, or have a slumped posture? If warranted, evaluate his mental status, noting especially mental clouding, attention deficits, agitation, or psychomotor retardation.
Source: Nursing: Interpreting Signs and Symptoms, 2007
Pallor:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
If the patient's condition permits, take a complete history. Does the patient or anyone in his family have a history of anemia or of a chronic disorder that might lead to pallor, such as renal failure, heart failure, or diabetes? Ask about the patient's diet, particularly his intake of red meat and green leafy vegetables.
Then explore the pallor more fully. Find out when the patient first noticed it. Is it constant or intermittent? Does it occur when he's exposed to the cold? Does it occur when he's under emotional stress? Explore associated signs and symptoms, such as dizziness, fainting, orthostasis, weakness and fatigue on exertion, dyspnea, chest pain, palpitations, menstrual irregularities, or loss of libido. If pallor is confined to one or both legs, ask the patient if walking is painful. Do his legs feel cold or numb? If pallor is confined to his fingers, ask about tingling and numbness.
Start the physical examination by taking the patient's vital signs. Be sure to check for orthostatic hypotension. Auscultate the heart for gallops and murmurs and the lungs for crackles. Check the patient's skin temperature—cold extremities commonly occur with vasoconstriction or arterial occlusion. Also, note skin ulceration. Examine the abdomen for splenomegaly. Finally, palpate peripheral pulses. An absent pulse in a pale extremity may indicate arterial occlusion, whereas a weak pulse may indicate low cardiac output.
Source: Nursing: Interpreting Signs and Symptoms, 2007
Low birth weight:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
As soon as possible, evaluate the neonate's neuromuscular and physical maturity to determine gestational age. (See Ballard Scale for calculating gestational age.) Follow with a routine neonatal examination.
Source: Nursing: Interpreting Signs and Symptoms, 2007
It's been estimated that up to 95% of people infected with HIV will experience anemia at some point. Unfortunately, it is often overlooked, and...
It's been estimated that up to 95% of people infected with HIV will experience anemia at some point. Unfortunately, it is often overlooked, and...
Heart failure affects approximately 5 million people in the United States. It can be caused by a number of conditions and treatment options may vary...
As many as 20 to 50 percent of all women develop fibroids. These benign muscle tumors usually grow in the uterus, and can cause pain, and in some...» Next page: Diagnosis of Anemia
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