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PARAMEDIC SCHOOL > BLOCK 4: PATIENT ASSESSMENT > Flashcards

BLOCK 4: PATIENT ASSESSMENT Flashcards

1
Q

differential vs. working diagnosis

A

differential: list of possible diagnoses based on patient assessment findings

working: one diagnosis from differential list that you are basing your treatment plan on

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2
Q

most of your assessment and physical exam can be in any order AFTER ____

A

primary survey and life threats have been addressed

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3
Q

what sequence does primary survey use and what’s the exception to it

A

ABCDE (airway, breathing, circulation, disability, exposure)

exception: patient appears lifeless or severe external bleeding, use CABDE

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4
Q

what two things make up the history taking part of a patient assessment

A

history of PRESENT illness (OPQRST)
past medical history (SAMPLE)

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5
Q

what two things make up the secondary assessment during a patient assessment

A

baseline vitals and monitoring devices (ECG)
systematic physical examination

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6
Q

what make up the primary assessment during a patient assessment

A

general impression, mental status
ABCDE
chief complaint
priority decision

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7
Q

what is SOAP for an assessment

A

Subjective info (symptoms)
Objective info (signs)
Assessment (differential diagnosis)
Plan (working diagnosis)

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8
Q

what is CTC in an assessment

A

skin color, temperature, condition

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9
Q

what three systems are the critical systems that balance the body

A

respiratory, cardiovascular, neurological

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10
Q

you must ____ whether the patient is sick or not sick, then _____ how sick the patient is

A

qualify
quantify

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11
Q

what is a field impression

A

initial summary of the patient’s condition based on presentation and exclusion of other possible causes based on the differential diagnoses

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12
Q

two basic patient classifications in prehospital care

A

medical and trauma

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13
Q

injury rate of EMS is how many times greater than general workforce

A

3

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14
Q

what is it called when a motorist is distracted by trying to view the incident scene

A

“rubbernecking”

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15
Q

safety vests must have what

A

a five-point breakaway feature

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16
Q

what is delirium and who are at high risk of experiencing this

A

sudden acute change in mental status secondary to a significant underlying factor

meth and crack users

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17
Q

MOI vs NOI

A

MOI: mechanism of injury - forces that act on body to cause injury/how a traumatic injury occurs

NOI: nature of illness - general type of illness patient is experiencing

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18
Q

if multiple patients have similar symptoms/complaints, suspect what two things

A

carbon monoxide or other noxious agent, or food poisoning

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19
Q

applying a cervical collar and backboarding do or do not completely immobilize the spine

A

do not completely immobilize the spine

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20
Q

what is the best way to prevent transmission of most diseases

A

hand washing

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21
Q

definition of patient safety

A

reduction of risk of unnecessary harm associated with EMS care - best available medical evidence, equipment, technology, and human skill

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22
Q

the three exam techniques in patient assessment

A

inspection: looking over patient for abnormalities
palpation: touching to feel for abnormalities
auscultation: listening to sounds within body

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23
Q

how long should it take to form a general impression

A

60-90 seconds

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24
Q

what do you do with patients who may have no complaints and may not be in any distress

A

give them a “well-patient exam” which is more comprehensive and takes more time

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25
Q

the two types of questions on a medical or trauma call

A

question 1: qualification (is this person sick/hurt?)
question 2: quantification (how sick/injured are they?)

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26
Q

what is one of the primary indicators of how sick a patient is

A

mental status

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27
Q

AVPU

A

alert (responds appropriately)
verbal (responsive to verbal stimuli)
pain (responsive to pain)
unresponsive

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28
Q

alert and oriented is measured in what four areas

A

person, place, time, and event

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29
Q

in what order of the A/Os do patients generally exhibit disorientation

A

forget events, the time, where they are, and then who they are

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30
Q

snoring respirations think ____ problem
gurgling sounds think ____ problem

A

position problem (obstruction by tongue)

blood or vomit in mouth (suction)

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31
Q

when patient appears lifeless, how does the ABCDE approach change

A

CABDE

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32
Q

when patient has life threatening bleeding, how does the ABCDE approach change

A

XABCDE

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33
Q

what is considered bradycardia

A

less than 60bpm

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34
Q

what is considered tachycardia

A

faster than 100bpm

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35
Q

what is pallor and what causes it

A

paleness occurring if arterial blood flow ceases to part of body and from hypothermia

excessive blood loss, anaphylaxis, hypoglycemia, anxiety

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36
Q

what is cyanosis

A

dusky gray or blue skin from low oxygen levels

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37
Q

how is the temp of the skin related to the vessels

A

vasodilation causes temp to rise (fever/hot weather)
vasoconstriction causes temp to drop (shock)

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38
Q

what is diaphoresis and how is it caused

A

excessive/intense sweating caused by stimulation of the SNS

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39
Q

what is minute volume in regards to breathing

A

amount of air move in/out of lungs each minute
multiplying the respiratory rate and tidal volume

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40
Q

best measure of breathing adequacy

A

minute volume

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40
Q

general respiration rate for adult patients before treatment is needed

A

8-24

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41
Q

what is jaundice and what causes it

A

yellow skin

liver dysfunction

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42
Q

what is flushed skin and what causes it

A

red skin

fever, hypertension, allergic reaction, alcohol intake, late sign of CO poisoning

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43
Q

what causes mottled skin

A

cardiovascular shock and disseminated intravascular coagulopathy

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44
Q

skin conditions and their possible causes

hot, dry
hot, wet
warm, dry
cool, dry
cool, wet

A

hot, dry: excessive body heat (heatstroke)
hot, wet: increased internal/external temperature
warm, dry: fever
cool, dry: exposure to cold
cool, wet: shock

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45
Q

absence of a palpable pulse in a responsive patient indicates what?

A

low cardiac output, not cardiac arrest

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46
Q

4 medical conditions that cause sudden death

A

airway obstruction, respiratory arrest, cardiac arrest, severe bleeding

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47
Q

components of a mini neuro exam

A

AVPU scale, pupils, assessment for neurologic deficits (sensation, movement, and grip strength in limbs), GCS

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48
Q

glasgow coma scale eye opening scoring

A

4 - spontaneous
3 - to verbal command
2 - to pain
1 - no response

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49
Q

glasgow coma scale verbal response scoring

A

5 - oriented conversation
4- disoriented conversation
3 - nonsensical speech
2 - unintelligible sounds
1 - no response

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50
Q

glasgow coma scale best motor response scoring

A

6 - follows commands
5 - localizes pain
4 - withdraws to pain
3 - abnormal flexion
2 - abnormal extension
1 - no response

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51
Q

what does GCS of 15 indicate

A

no neurologic disabilities

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52
Q

what does GCS of 13-14 indicate

A

mild dysfunction

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53
Q

what does GCS of 9-12 indicate

A

moderate to severe dysfunction

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54
Q

what does GCS of less than 8 indicate

A

severe dysfunction

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55
Q

lowest and highest GCS score possible

A

lowest: 3
highest: 15

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56
Q

what is an apparent life threatening event

A

episode of combination of apnea, color change, change in muscle tone, and choking/gagging

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57
Q

six quality aims that health care should embrace

A

(STEEEP)
safety, timeliness, effectiveness, efficiency, equity, patient centeredness

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58
Q

what type of questions yield more information

A

open-ended

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59
Q

two most important pieces of patient history to obtain

A

name and chief complaint

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60
Q

one of the most critical elements of the interview process is _____

A

being a great listener

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61
Q

what is facilitation communication technique

A

encouraging patient to feel open to give you any info you need

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62
Q

what is reflection communication technique

A

pause to consider something significant your patient has told you

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63
Q

what is clarification communication technique

A

ask for more info when some aspect of patient history is vague or unclear

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64
Q

what is confrontation communication technique

A

make patient aware of inconsistencies between behavior and your findings

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65
Q

what is interpretation communication technique

A

infer the cause of patient’s distress and then ask the patient if you are right

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66
Q

what are social history examples

A

tobacco/alcohol/drug use, sexual behavior, diet, travel history, occupation, housing environment

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67
Q

what to do if patient denies neck/back pain after trauma but smells of alcohol

A

apple manual stabilization anyway

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68
Q

what condition causes the patient to be sweaty and restless and often misinterpreted as anxiety or panic

A

hypoxia

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69
Q

situational vs chronic depression

A

situational: normal reaction to stressful event

chronic: ongoing with no apparent cause

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70
Q

confusing behavior is often related to lack of ___ or ___

A

oxygen, glucose

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71
Q

most pediatric problems encountered in the field are ___ or ___ related

A

respiratory, fluid

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72
Q

two types of history important during neonate and infant exams

A

maternal health history
birth history

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73
Q

any patient taking five or more drugs likely has some form of ___

A

drug interaction

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74
Q

what is an iatrogenic condition

A

caused by medications or other medical treatment and can mask other illnesses that may need immediate medical attention

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75
Q

signs vs symptoms

A

signs: objective observations or measurements
symptoms: subjective information that the patient tells you

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76
Q

travel history is useful when suspecting a ____ because people on long flights are susceptible to ____

A

pulmonary embolism
blood clots

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77
Q

when are falls considered a high-energy impact? (adult and children)

A

adults: greater than 20ft
children: greater than 10ft or 2-3x their height

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78
Q

when are MVAs considered a high-energy impact? (6)

A

intrusion greater than 12in on occupant site or 18in on any site
ejection
death in the same passenger compartment
vehicle telemetry data
vehicle vs. pedestrian greater than 20mph
ATV or motorcycle over 20mph

79
Q

what are pertinent negatives

A

absence or lack of certain signs/symptoms characteristic of particular illness

80
Q

what is diplopia

A

double vision

81
Q

what is photophobia

A

sensitivity to light

82
Q

what is tinnitus

A

ringing in the ears

83
Q

what is vertigo

A

sensation of the room spinning

84
Q

what is rhinorrhea

A

runny nose

85
Q

what is epistaxis

A

nose bleed

86
Q

what is polyuria

A

increased frequency of urination

87
Q

what is polydipsia

A

increased thirst

88
Q

what is polyphagia

A

increased appetite

89
Q

what is dyspnea

A

shortness of breath

90
Q

orthopnea

A

difficulty breathing when lying down

91
Q

hemoptysis

A

coughing up blood

92
Q

atraumatic bruising is usually an indication of what

A

a clotting disorder

93
Q

what is hematemesis

A

blood in vomit

94
Q

what is dysuria

A

painful urination

95
Q

what is nocturia

A

waking up in middle of sleep to urinate

96
Q

what is hematuria

A

blood in urine

97
Q

what is dysmenorrhea

A

menstrual pain

98
Q

five aspects of critical thinking

A

concept formation
data interpretation
application of principles
reflection in action (changing course as needed)
reflection on action (debriefing)

99
Q

5 steps of patient assessment starting with scene size up

A

scene size up
primary assessment
history taking
secondary assessment
reassessment

100
Q

what is a rapid full body scan

A

60-90second nonsystematic review of patient’s body to identify injuries that must be managed immediately

101
Q

open vs. closed injury types

A

open: abrasions, amputations, avulsions, punctures, penetrations, lacerations

closed: deformities, swelling, burns, contusions, crush injuries

102
Q

inspection vs palpation

A

inspection: looking at patient
palpating: touching patient

103
Q

what is percussion

A

gently striking surface of body where it overlies various body cavities

104
Q

what are the additional sets of vital signs after the first set called

A

serial vital signs

105
Q

what is vital signs trending

A

trends based on vitals showing patient improvement or deterioration

106
Q

what is blood pressure

A

measurement of force exerted against walls of blood vessels

107
Q

systolic vs diastolic pressure

A

systolic: left ventricle contracting (systole)
diastolic: residual pressure in system when left ventricle is relaxing (diastole)

108
Q

what does a drop in diastolic pressure mean

A

less myocardial perfusion

109
Q

BP cuff should be how big in comparison to the size of the upper arm

A

1/2 or 2/3rds

110
Q

cuffs that are too small or tight yield ___ pressures and too large or too loose cuffs yield ____ pressures

A

artificially high
inaccurately low

111
Q

cerumen in the ear canal has what affect on temperature reading

A

lowers it

112
Q

what is the eupnea waveform and causes

A

normal breathing

113
Q

what is the tachypnea waveform and causes

A

rapid, shallow, regular pattern respirations caused by stimulants, exercise, pulmonary/heart disease, anxiety

114
Q

what is bradypnea waveform and causes

A

decreased rate, regular pattern respirations caused by opioids, sedatives, CO exposure

115
Q

what is apnea waveform and causes

A

absence of breathing caused by hypoxia, MI, submersion

116
Q

what is hyperpnea waveform and causes

A

rapid, regular, deep respirations caused by stimulants, overdose, and exercise

117
Q

what is cheyne-stokes waveform and causes

A

gradual increase/decrease in rate and depth with intermittent periods of apnea caused by pre-death and brain stem injury

118
Q

what is biot-ataxic waveform and causes

A

irregular pattern, rate, and depth with periods of apnea caused by brainstem injury and increased intracranial pressure

119
Q

what is kussmaul waveform and causes

A

deep, gasping respiration(extreme tachypnea and hyperpnea) caused by acidosis and diabetic detoacidosis

120
Q

what is apneustic waveforms and causes

A

prolonged inspiratory phase with shortened expiratory phase and bradypnea caused by brainstem injury

121
Q

oxygen is applied to patients with SpO2 of less than ___

A

94%

122
Q

what is a sphygmomanometer

A

BP cuff

123
Q

two pieces to the chest piece of a stethoscope and their different uses

A

diaphragm (plastic disk) placed FIRMLY on skin to listen to high-pitched sounds like breathing
bell (hollow cup) placed LIGHTLY on skin to listen to low pitched sounds like heart sounds

124
Q

degrees of distress (5)

A

no apparent distress
mild (slight)
moderate (average)
acute (very great/bad)
severe (dangerous/difficult to endure)

125
Q

who is a focused exam performed on and what is it based on

A

patients who sustained insignificant MOIs and on responsive medical patients
it is based on the chief complaint

126
Q

two methods commonly used to assess patient’s attention

A

serial 7s (counting backward from 100 by 7s) and spelling backward

127
Q

which two forms of memory to assess and how

A

remote memory (birthdays, schools attended)
recent memory (today’s events)

128
Q

how to assess skin turgor in an older patient

A

skin of the upper chest

129
Q

what to pay attention to when assessing the skin

A

CTC (color, temperature, condition)

130
Q

what is ecchymosis

A

localized bruising or blood collection within or under the skin

131
Q

in what conditions is flushing usually seen

A

(vasodilation) fever and allergic reactions

132
Q

in what conditions is pallor usually seen

A

(vasoconstriction) anemia, cardiac events, shock states, hypothermia

133
Q

what are beau lines and what cause them

A

transverse depressions in nails indicating period of growth inhibition caused by systemic illness, severe infection, or nail injury

134
Q

what is clubbing and what causes it

A

angle between nail and nail base approaches or exceeds 180 caused by chronic respiratory disease

135
Q

what is psoriasis and what causes it

A

pitting, discoloration, and subungual thickening of the nail caused by autoimmune disease

136
Q

what is splinter hemorrhages and what causes it

A

red or brown linear streaks in the nail bed caused by bacterial endocarditis or trichinosis

137
Q

what is Terry nails and what causes it

A

transverse white bands covering the nail except for the distal tip caused by cirrhosis

138
Q

overly thick nails or nails that have lines running parallel to the finger often suggest ____

A

fungal infection

139
Q

blood or CSF from ears or nose after trauma suggests what

A

basilar skull fracture

140
Q

if wheezing is unilateral, suspect ____
if wheezing is bilateral, suspect ____

A

aspirated foreign body or infection
asthma

141
Q

what does crackles or rales may indicate

A

heart failure, pneumonia, pulmonary diseases, asthma

142
Q

what does rhonchi indicate and what is usually associated with it

A

fluid in the larger airways, pneumonia, bronchitis
often associated with a productive cough

143
Q

what is stridor and what does stridor indicate

A

narrowing, swelling, or obstruction of the upper airway by 85% and is caused by epiglottitis, croup, airway burns, or foreign body obstruction

144
Q

what are pleural friction rubs caused by and what are they associated with

A

pleural inflammation associated with pain on inspiration

145
Q

what conditions cause decreased breath sounds

A

pneumothorax, hemothorax, pleural effusion, PE, COPD, opiate intoxication

146
Q

continuous lung sounds suggest ____ process but intermittent sounds suggest ____ process

A

pathological process
reversible process

147
Q

S3 sound is associated with what

A

heart failure in patients over 35

148
Q

S4 sound represents what

A

decreased compliance of left ventricle or increased pressure in atria

149
Q

what are Korotkoff sounds

A

related to a patient’s BP, only 1st and 5th phase are important

150
Q

1st and 5th phase of Korotkoff sounds

A

Phase 1: tapping sounds increasing in intensity correlating to systolic contraction

Phase 5: all sounds disappear correlating to diastolic pressure

151
Q

what is a lift/heave

A

perception of heart beating strongly that suggests hypertrophy

152
Q

what is thrill

A

humming vibration that suggests a bruit or murmur

153
Q

what is a bruit

A

whooshing sounds heard in carotid arteries that indicates turbulent blood flow in arteries

154
Q

what is a murmur

A

whooshing sounds heard over heart that indicated turbulent blood flow around a cardiac valve

155
Q

how are murmurs graded

A

1 (softest) to 6 (loudest)

156
Q

three basic mechanisms producing abdominal pain
1: visceral pain -
2: inflammation -
3: referred pain -

A
  1. when hollow organs are obstructed, causes cramping and diffuse pain
  2. inflammation that produces sharp, localized pain
  3. originates in a particular organ but is felt in a different location
157
Q

when is an orthostatic change considered positive

A

systolic BP decreased up to 20
diastolic BP increases more than 10
pulse increases by 20

158
Q

what is ascites

A

collection of fluid within peritoneal cavity

159
Q

what is rebound tenderness and what is it a symptom of

A

pain on release of pressure
indicative of inflammation like appendicitis

160
Q

LUQ pain should always be assumed to be ____

A

the spleen

161
Q

LLQ pain should be suspected of having ____

A

diverticulitis

162
Q

RLQ pain should be suspect of having ____

A

appendicitis

163
Q

generalized abdominal pain in women should be suspect of ____

A

ectopic pregnancy, ruptured ovarian cyst

164
Q

tendons vs ligaments

A

tendons: muscle to bone
ligaments: bone to bone

165
Q

pathologic vs traumatic fracture

A

pathologic: normal forces applied to an abnormal bone structure

traumatic: abnormal forces are applied to a normal bone structure

166
Q

bilateral pitting edema occurs with ____ conditions like ____

unilateral edema occurs with ____ conditions like ____

A

systemic, heart failure

local, deep vein occlusion

167
Q

5 P’s of acute arterial insufficiency

A

pain, pallor, paresthesia, paresis, pulselessness

168
Q

lordosis vs kyphosis vs scoliosis

A

lordosis: inward curve of lumbar spine above butt
kyphosis: outward curve of thoracic spine
scoliosis: sideways curve of the spine

169
Q

what is the Babinski reflex test

A

running a pen along the length of the sole of the foot will cause the big toe to flex

170
Q

COASTMAP mnemonic

A

used for assessing mental status
consciousness, orientation, activity, speech, thought, memory, affect, perception

171
Q

how to assess cranial nerve 1

A

olfactory - smell - not usually assessed by use ammonia inhalant

172
Q

how to assess cranial nerve 2

A

optic - vision - ask if they can see your finger in front of their face

173
Q

how to assess cranial nerve 3

A

oculomotor - movement of eye/eyelid - blinking and follow your finger

174
Q

how to assess cranial nerve 4

A

trochlear - eye movement - same as nerve 3

175
Q

how to assess cranial nerve 5

A

trigeminal - chewing, touch of face - patient to smile

176
Q

how to assess cranial nerve 6

A

abducens - eye movement - same as nerve 3

177
Q

how to assess cranial nerve 7

A

facial - movement of face/tears - same as nerve 5

178
Q

how to assess cranial nerve 8

A

(vestibocochlear) auditory - hearing/balance - ask patient to follow spoken commands

179
Q

how to assess cranial nerve 9 and 10

A

vagus and glossopharyngeal - swallowing - ask patient to smile and swallow

180
Q

how to assess cranial nerve 11

A

accessory - movement of head/shoulders - ask patient to shrug shoulders

181
Q

how to assess cranial nerve 12

A

hypoglossal - movement of tongue - ask patient to stick tongue out

182
Q

manual muscle testing scale

A

scale 0-5
0: no muscle activation
1: twitch
2: without gravity full range
3: against gravity full range
4: against some resistance full range
5: against full resistance full range

183
Q

what is pronator drift

A

patient closes eyes and holds arms out palms up, if it drifts

184
Q

scoring of deep tendon reflexes

A

0: no response
1: sluggish
2: active
3: slightly hyperactive
4: hyperactive

185
Q

what is expressive aphasia

A

difficulty speaking

186
Q

what is paresthesia

A

tingling or sensory changes

187
Q

two categories of trauma patients

A

isolated and multisystem

188
Q

which ECG lead is often sufficient for rhythm interpretation

A

lead 2

189
Q

what is the first set of vital signs called

A

baseline

190
Q

pupil size is regulated by which cranial nerve

A

oculomotor (third)

190
Q

what is anisocoria

A

pupils are asymmetric by greater than 1mm

191
Q

what are Battle signs

A

discoloration and tenderness of the mastoid process of the skull

192
Q

how often to reassess vitals on stable and non-stable patients

A

stable: 15 mins
unstable: every 5 mins if possible

193
Q

what is the Cushing reflex indicative of and what are the symptoms of it

A

head trauma
slow pulse, rising BP, erratic respiratory pattern

194
Q

what is the Beck triad indicative of and what are the symptoms of it

A

cardiac tamponade
narrowed pulse pressure, muffled heart tones, JVD

PARAMEDIC SCHOOL (74 decks)

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