Analysis of Signs and Symptoms
Accurate description and analysis of presenting complaint is essential. Patient should be asked to point out symptomatic areas.
Pain is most common presenting symptom and is always subjective and has an emotional component.
Analyse pain as to:
• Location – determine site and structure(s) involved
• Onset – gradual/sudden; temporal relationship to a particular event; other signs/symptoms at onset
• Description/nature – eg ‘burning’, ‘aching’, ‘deep’, ‘pinching’, ‘crushing’ etc
• How Severe - ? interferes with activities
• How long present
• How frequent?/Constant?/Intermittent?
• Any special times of occurrence?
• What aggravates it?
• What relieves it?
• Is it associated with any other symptoms?
‘PQRST’ approach to describing pain:
P Palliative (what relieves it) and Provocative (what makes it worse) factors
Q Quality or Quantity – pain description of what pain is like
R Radiation or Region
T Timing – when begin, constant, intermittent, frequency?
U Understanding the problem from the patient’s perception
Visual analogue pain scales:
Patient places a line on a linear scale to indicate the severity of pain or gives it a number from 1 to 10 with 1 being no pain and 10 being worse pain imaginable. A series of faces with different expressions can be used with children.
Analyse as to:
• Location/position/anatomical structure
• When swelling appeared – eg at onset of pain?
• Size and shape
• Tenderness/pain – radiating?
• Diffuse or localised
• Movement (is it attached to skin, soft tissue or bone?)
• Confined to joint?
• Associated with muscle wasting?
• Check contralateral limb
Affect/impact of symptoms
Assessment of the impact of presenting complaint on functional ability, activities of daily living (ADL’s), quality of life, work requirements, recreational, sporting and social activities.