Question 1

Components of primary assessment

Accepted Answer

``` Form general impression of pt Assess level of consciousness Assess the airway Assess breathing Assess oxygenation Assess circulation Establish patient priorities ```

Question 2

The main purpose of the primary assessment is to:

Accepted Answer

Identify and manage immediately life threatening conditions to the airway, breathing, oxygenation, or circulation.

Question 3

Chief complaint

Accepted Answer

What the patient tells you is wrong with him

Question 4

Forming general impression:

Accepted Answer

``` Estimate pt age Note pt sex Determine trauma/medical Chief complaint Identify and manage immediate life threats ```

Question 5

There are two types of trauma:

Accepted Answer

Blunt and penetrating

Question 6

Type of force that pierces the skin and body tissues.

Accepted Answer

Penetrating

Question 7

Steps of scene size-up:

Accepted Answer

``` Standard precautions Scene hazards/scene safety Moi Noi of patients Need for additional resources ```

Question 8

Bringing the patients head into a neutral in-line position and holding it there.

Accepted Answer

In-line stabilization

Question 9

In-line stabilization procedure:

Accepted Answer

Place one hand on each side of the patient's head. Gently bring the head into a position in which the nose is in line with the patient's navel. Position the head neutrally so the head is not extended (tipped backward) or flexed (tipped forward).

Question 10

AVPU

Accepted Answer

Alert Voice Pain Unresponsive

Question 11

Central painful stimulus:

Accepted Answer

``` Trapezius pinch Supraorbital pressure Sternal rub Earlobe pinch Armpit pinch ```

Question 12

Peripheral painful stimuli:

Accepted Answer

Nail bed pressure Pinch to the web between thumb and index finger Pinch to the finger, toe, hand or foot

Question 13

Purposeful movements

Accepted Answer

Attempts made by the patient to remove the painful stimulus or avoid the pain. Documented as "withdraws the stimulus" or "withdraws from pain"

Question 14

Nonpurposeful movements:

Accepted Answer

Flexion posturing and extension posturing. Both signs of a serious head injury.

Question 15

Flexion posturing

Accepted Answer

(Decorticate posturing) The patient arches the back and flexes the arms inward toward the chest.

Question 16

Extension posturing

Accepted Answer

(Decerebrate posturing) Patient arches back and extends the arms straight out parallel to the body.

Question 17

Occluded

Accepted Answer

Closed or blocked

Question 18

Patent

Accepted Answer

Open

Question 19

Sounds that may indicate partial airway obstruction:

Accepted Answer

Snoring-a rough, snoring-type sound on inspiration and/or exhalation Gurgling-a sound similar to air rushing through water on inspiration and/or exhalation Crowing-a sound like a cawing crow on inspiration Stridor-harsh, high pitched sound on inspiration

Question 20

Airway sound heard that is an indication that the tongue and likely the epiglottis are partially blocking the airway.

Accepted Answer

Snoring

Question 21

Airway sound that is an indication that a liquid substance is in the airway.

Accepted Answer

Gurgling

Question 22

High-pitched sounds produced on inspiration. Commonly associated with the swelling or muscle spasms that can result from conditions such as airway infections, allergic reactions, or burns to the upper airway.

Accepted Answer

Crowing/Stridor

Question 23

Breathing assessment:

Accepted Answer

Determine if breathing is adequate or inadequate Determine the need for early oxygen therapy if breathing is adequate Provide positive pressure ventilation with supplemental oxygen for inadequate breathing

Question 24

Amount of air breathed in and out.

Accepted Answer

Tidal volume

Question 25

Best method to assess breathing:

Accepted Answer

Looking Listening Feeling

Question 26

Poor movement (rise) of the chest wall. Typically described as shallow respiration.

Accepted Answer

Inadequate tidal volume

Question 27

Breathing that is either too fast or too slow (outside the ranges of 8-24 per min for an adult, 15-30 per min for a child, 25-50 per min for an infant)

Accepted Answer

Abnormal respiratory rate

Question 28

Abnormally slow breathing. Respiratory rate that is too slow.

Accepted Answer

Bradypnea

Question 29

Conditions that may cause bradypnea:

Accepted Answer

Hypoxia (especially in young children and infants), drug O/D on depressant drugs, head injury, stroke, hypothermia (cold emergency), and toxic inhalation.

Question 30

A respiratory rate that is too fast

Accepted Answer

Tachypnea

Question 31

Conditions that may lead to tachypnea:

Accepted Answer

Hypoxia, fever, pain, drug overdose, stimulant drug use, shock, head injury, chest injury, stroke, and other medical conditions.

Question 32

Identified by a sunken-in appearance of tissues that are pulled inward on inhalation.

Accepted Answer

Retractions at: The suprasternal notch (above the sternum) Intercostal spaces (between ribs) Supraclavicular spaces (above the clavicles)

Question 33

Identified by no chest wall movement and no sensation or sound of air moving in and out of the nose or mouth

Accepted Answer

Absence of breathing (apnea)

Question 34

A bluish or blue-grey tone of the skin seen early around the lips, nose, and fingernail beds indicating inadequate oxygenation.

Accepted Answer

Cyanosis

Question 35

Dyspnea

Accepted Answer

Difficulty breathing

Question 36

An assessment of circulation includes:

Accepted Answer

Pulse Possible major bleeding Skin color, temp, and condition Capillary refill

Question 37

Bradycardia

Accepted Answer

Heart rate les than 60bpm

Question 38

Tachycardia

Accepted Answer

Heart rate greater than 100bpm

Brainscape's Knowledge GenomeTM

Chapter 13 - Patient Assessment Flashcards

Brainscape's Knowledge Genome^TM