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    Examination of Uncooperative Patients: General Reaction and Posture

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    Saroja Roy
    The method involves observing the patient's spontaneous acts, behavior, facial expressions, eyes/pupils, and muscular reactions. It also examines how the patient responds to questions, tests, and stimuli. All observations are recorded over time without gaps, including indicators of cooperativeness and vital signs. The goal is to assess uncooperative patients in a systematic way.

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    Examination of Uncooperative Patients: General Reaction and Posture

    Uploaded by

    Saroja Roy
    20K views2 pages
    The method involves observing the patient's spontaneous acts, behavior, facial expressions, eyes/pupils, and muscular reactions. It also examines how the patient responds to questions, tests, and stimuli. All observations are recorded over time without gaps, including indicators of cooperativeness and vital signs. The goal is to assess uncooperative patients in a systematic way.

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    PROFORMA-FOR-EXAMINATION-OF-UNCOOPERATIVE-PATIENTS

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    The method involves observing the patient's spontaneous acts, behavior, facial expressions, eyes/pupils, and muscular reactions. It also examines how the patient responds to questions, tests, and stimuli. All observations are recorded over time without gaps, including indicators of cooperativeness and vital signs. The goal is to assess uncooperative patients in a systematic way.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    20K views2 pages

    Examination of Uncooperative Patients: General Reaction and Posture

    Uploaded by

    Saroja Roy
    The method involves observing the patient's spontaneous acts, behavior, facial expressions, eyes/pupils, and muscular reactions. It also examines how the patient responds to questions, tests, and stimuli. All observations are recorded over time without gaps, including indicators of cooperativeness and vital signs. The goal is to assess uncooperative patients in a systematic way.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
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    EXAMINATION OF UNCOOPERATIVE PATIENTS

    When patients are uncooperative for examination we need to record the observations till the patients
    become cooperative, without leaving any gap in clinical observation. Kirby’s method for
    examination of uncooperative patient is used in such situations, usual situations are when the
    patient is in stupor or in catatonia. The examination is recorded under the following headings:
    General reaction and posture

     Spontaneous acts:
    o Any occasional show of activities or assaultiveness.
    o Is the patient tidy or untidy?
    o Does the patient eat voluntarily or should be fed.
    o Does the patient dress himself or require assistance.
    o Does the actions show initial slowness or consistent slowness throughout?
     Behavior towards the examiners:
    o Resistive or evasive, irritable or apathetic or complaint.
     Voluntary postures:
    o Comfortable, natural or awkward or constrained.
    o What does the patient do when placed in an awkward position?
     Is the behavior constant or changing with time?

    Facial movement and expression

     Is the expression being alert, aware, smiling, mask like, placid, sulky, anxious, perplexed,
    distressed, tearful
     Is the facial expression constant or changing with time?

    Eyes and pupils

     Are the eyes open or closed: Is there resistance to open the patients eyes by examiner
     Does he gives attention to examiner and move his eyes with that of object or light source
     Does he have fixed gaze or evasive gaze
     Is there blinking of eyes or flickering of eye lids
     Response to sudden movement of hand towards the patients eyes
     Response of pupils to painful sensory stimulus and corneal reflex

    Reaction to examiners questions and tests

     What is the response to simple commands: asking to show tongue, lift the hands
     Presence of negativism – either active or passive uncooperativeness
     Check for presence of automatic obedience, echolalia and echopraxia
     Are the movements of limbs being slow or fast or interrupted

    TIPPS – Training Initiative for Psychiatry Postgraduates


    Muscular reactions

     Check for tone of muscles: look for rigidity - lead pipe or cog wheel type, waxy flexibility,
    gagenhalten, mitgehen and mitmachen
     Is there urinary or fecal incontinence

    Emotional responsiveness:

     Emotional Response when family members speak or when personal facts are told
     Response to unexpected stimulus like clapping sound or by switching on lights

    Speech:

     Is there any spontaneous speech


     Is the patient mute, if so whether it is consistent present or not
     Is there any effort to speak or make sounds or whisper

    Writing:

     Offer the patient a pencil and paper to write his wishes

    Vitals:

     Patients Pulse rate, blood pressure, temperature and respirator rate needs to be
    measured at regular intervals

    TIPS: Kirby’s method for examination of uncooperative patient

    Observe for - Spontaneous movements, speech and emotional response


    Examine for – degree of Un-cooperativeness of patients like Negativism, gegenhalten,
    rigidity, automatic obedience, mitgehen and mitmachen
    Record for - Mutism, echo phenomenon, vital parameters including pulse, BP, temperature
    and respiratory rate

    TIPPS – Training Initiative for Psychiatry Postgraduates

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