Ch.10patientassessment Flashcards
The assessment process is divided into five main parts
Scene size up
Primary assessment
History taking
Secondary assessment
Reassessment
A__is a subjective condition that the patient feels and tells you about
Symptom
A_is an objective condition that you can observe or measure
Sign
Therefore, it is essential to have a basic understanding of the causes and presentations of commonly encountered emergencies, as this information can help you formulate a___ (conclusion about the cause of the patient’s condition after considering the situation, history, and examination findings) that will help you determine your priorities of care.
field impression
__refers to your evaluation of the conditions in which you will be operating. Although this will be the focus of your attention when you first arrive on scene, continuous situational awareness is necessary throughout the entire call to ensure safety. Situational awareness is paying attention to the conditions and people around you at all times and the potential risks those conditions or people pose.
Scene size-up
Scene size up refers to your evaluation of the conditions in which you will be operating. Although this will be the focus of your attention when you first arrive on scene, continuous situational awareness is necessary throughout the entire call to ensure safety.__\ is paying attention to the conditions and people around you at all times and the potential risks those conditions or people pose.
Situational awareness
Make sure you place yourself ___ the patient and the potential danger, thus preventing possible access to the object
Between
These are generally classified according to the type or amount of force, how long it was applied, and where it was applied to the body. This is described as the___. The___ can be used as a guide to help you focus your assessment.
mechanism of injury (MOl)
Terms commonly associated with MOl include___\ and penetrating trauma. With ___, the force of the injury occurs over a broad area, and the skin is sometimes not broken. However, the tissues and organs underneath the area of impact may be damaged. With penetrating trauma, the force of the injury occurs at the specific point of contact between the skin and the object. The object pierces the skin and creates an open wound that carries a higher potential for infection
blunt trauma
Terms commonly associated with MOl include blunt trauma and__. With blunt trauma, the force of the injury occurs over a broad area, and the skin is sometimes not broken. However, the tissues and organs underneath the area of impact may be damaged. With __, the force of the injury occurs at the specific point of contact between the skin and the object. The object pierces the skin and creates an open wound that carries a higher potential for infection
penetrating trauma
As an emt you will also care for patients who require ems attention because of illnesses or conditions not caused by an outside force. For these patients with medical problems,you must examine the general type of illness the patient is experiencing,or the ____.
Nature of illness (NOI)
The most serious thing a patient is concerned about and the reasons ems was called
Chief complaint
Protective equipment that blocks exposure to a pathogen or a hazardous material
Personal protective equipment (PPE)
Are protective measures that have traditionally been recommended by the centers for disease control and prevention(CDC) for use in dealing with objects,blood,body fluids,and other potential exposure risks of communicable disease
Standard precautions
Is a flexible system implemented to manage a variety of emergency scenes . Emergency responders work in groups according to their function or assigned area, with the leader of each group reporting to the person in charge of the incident,the incident commander
Incident command system
Is the process of sorting patients based in the severity of their condition
Triage
identify and begin treatment of immediate or imminent life threats. To do this, you must physically examine the patient and assess level of consciousness (LOC) and airway, breathing, and circulation (ABCs); however, this is not an in-depth physical exam or assessment of vital signs. These will be addressed later in the secondary assessment.
Primary assessment
Forming the___ of a patient is a similar process, but the focus is on rapid identification of potentially life-threatening problems. The____ is formed to determine the priority of care and is the first part of your primary assessment. This includes noting things such as the person’s age, sex, race, level of distress, and overall appearance, which may lead you to anticipate different problems.
general impression
The ___ is used to assess a patients LOC depending on how well he or she responds to external stimuli,including verbal stimuli(sound) and painful stimuli(such as pinching the trapezius muscle on top of the patients shoulder)
The avpu scale
The avpu scale tests a patients responsiveness based on the following criteria
Awake and alert. The patient’s eves open spontaneously as you approach, and the patient appears to be aware of you and responsive to the environment. The patient is awake, appears to follow commands, and the eyes visually track people and objects.
V. Responsive to verbal stimuli. The patient is not alert and awake. The patient’s eyes do not open spontaneously.
However, the patient’s eyes do open when you speak to him or her, or the patient is able to respond in some meaningful way when spoken to-for example, by moaning, speaking, or moving. A patient who does not respond to your normal speaking voice but who responds when you speak loudly is responding to loud verbal stimuli.
P . Responsive to pain. The patient does not respond to your questions but moves or cries out in response to painful stimulus. There are appropriate and inappropriate methods of applying a painful stimulus (FIGURE 10-9).
Be aware that some methods may not give an accurate result if a spinal cord injury is present.
U. Unresponsive. The patient does not respond spontaneously or to a verbal or painful stimulus. Unresponsive patients usually have no cough or gag reflex and lack the ability to protect their airway.
For a patient who is alert or responsive to verbal stimuli , next evaluate ___. ___ test a patients mental status by checking his or her memory and thinking ability.
Orientation
Orientation tests a patient’s mental status by checking his or her memory and thinking ability. The most common test evaluated a patients ability to remember four things :
Person. The patient is able to remember his or her name
Place. The patient is able to identify his or her current location
Time. The patient is able to tell you the current year,month,and day of the week .
Event. The patient is able to describe what happened (the moi or noi)
Any deviation from alert and oriented to person,place,time,and event or from a patients normal baseline is considered an
Altered mental status
An airway obstruction can result in partial or complete blockage of air movement into and out of the lungs and therefore inadequate ___ of the entire body
Perfusion
The flow of blood through body tissues and vessels
Perfusion
A patient who is breathing without assistance is said to have __ or __
Spontaneous respirations or spontaneous breathing
_____ ventilations should be performed for patients who are not breathing or whose breathing is too slow or too shallow. If the patient is breathing adequately but remains hypoxic,administer oxygen.
Positive pressure ventilations
The goal for oxygenation for most patients is an oxygen saturation of greater that __
94%
When respirations exceed 28 breaths/min with signs of distress or a fewer than 8 breaths/min,or are too shallow to provide adequate air exchange,consider providing ___ ventilations with an airway adjunct.
Positive pressure ventilations
Respirations characterized by little movement of the chest wall (reduced tidal volume ) or poor chest excursion
Shallow respirations
Movements in which the skin pulls in around the ribs during inspiration
Retractions
The secondary muscles of respiration. They include the neck muscles (sternocleidomastoids),the chest pectoralis major muscles , and the abdominal muscles
Accessory muscles
Widening of the nostrils, indicating that there is an airway obstruction
Nasal flaring
There are two common postures that indicate the patient is trying to increase air flow. The first position is called the __.in this position a patient sitting and leaning forward on outstretched arms with the head and chin thrust slightly forward;significant conscious effort or required for breathing. The second position is most commonly seen in children—-the ____.the patient sits upright with the head and chin thrust slightly forward, and the patient appears to be sniffing
Tripod position
Sniffing position
Breathing that becomes progressively more difficult requires progressively more effort. When you can see that effort, the patients breathing is described as
Labored breathing
The use of muscles of the chest,back, and abdomen to assist in expanding the chest;occurs when air movement is impaired
Labored breathing
__is evaluated by assessing the patients mental status,pulse, and skin condition
Circulation
With each heartbeat,the ventricles contract,forcefully ejecting blood from the heart and propelling it into the arteries. Often referred to as a heartbeat, the __ is the pressure wave that occurs as each heartbeat causes a surge in the blood circulating through the arteries.
Pulse
In responsive patients who are older than 1 year, palpate the ___ pulse at the wrist
Radial
In unresponsive patients older than 1 year, palpate the___ pulse in the neck
Carotid
Palpate the ___ pulse, located at the medial area (inside) of the upper arm, in children younger than 1 year
Brachial
The delicate membrane that lines the eyelids and covers the exposed surface of the eye
Conjunctiva
A blue skin discoloration that is caused by a reduced level of oxygen in the blood. Although paleness,or a decrease in blood flow,can be difficult to detect in dark skinned people, it may be observed by examining mucous membranes inside the inner lower eyelid and capillary refill. In general observation, the patient may appear ashen or gray
Cyanosis
Yellow skin or sclera that is caused by liver disease or dysfunction
Jaundice
The tough,fibrous , white portion of the eye that protects the more delicate inner structures
Sclera
Normal body temperature is
98.6 F (37 C)
With poor perfusion the body ____ from the surface of the skin and diverts it to the core of the body. The result is cool,pale, clammy skin;in your primary assessment this is a good indication of hypoperfusion and shock
The body pulls blood away
Dry skin is normal. Skin that is moist or wet from sweat,or excessively dry and hot suggests a problem. In the early stages of shock,the skin will become slightly moist. Skin that is only slightly moist but not covered excessively with sweat is described as clammy,damp, or moist. When the skin is bathed in sweat,such as after strenuous exercise or when the patient is in shock,the skin is described as wet or __
Diaphoretic
__is often evaluated in pediatric patients to assess the ability of the circulatory system to peruse the capillary system in the fingers and toes. When evaluated in an uninjured limb,____ mayb provide an indication of the pediatrics patients level of perfusion
Capillary refill
To assess capillary refill in newborns and young infants , press on the __,__,or__
Forehead ,chin,or sternum
With adequate perfusion ,the color in the infants or child nail bed should be restored to its normal pink color within __
2 seconds
Serious bleeding from a large vein may be characterized by __blood flow. Bleeding from an artery is characterized by a ___ of blood
Steady blood flow
Spurting flow of blood
A ___ is performed following the primary assessment. This exam is used to find any additional injuries. It is not a focused assessment and should take no more that 90 seconds. This assessment can identify other injuries that must be managed prior to transport
A rapid head to toe exam
What does DCAP-BTLS stand for
Deformity (misshapen body part)
Contusions ( bruising ; a collection of blood under the skin)
Abrasions (loss or damage to the surface of the skin from rubbing or scraping)
Punctures (a small penetration through the skin into soft tissue)
Burns (redness,blisters,or white areas of skin)
Tenderness (pain when an area is palpated)
Lacerations(a deep cut in the skin)
Swelling (a raised or enlarged area of soft tissue on the surface of the body)
The time from injury to definitive care,during which treatment of shock and traumatic injuries should occur because survival potential is best;also called the golden period
Golden hour
A step within the patient assessment process that provides details about the patients chief complaint and an account of the patients signs and symptoms
History taking
What does the OPQRST stand for
Onset. What were you doing when the symptoms began
PROVACATION/palliation. Does anything make the symptoms better or worse? How are you most comfortable?
Quality. What does the symptom feel like?
Region/radiation.where do you feel the symptom?does it move anywhere?
Severity. On a scale of 0-10,with 0 being nothing at all to 10 being the worst you can imagine
Timing. How long have you had the symptom? When did it start?
Negative findings that warrant no care or intervention. The absence of these findings is relevant ,and should be reported and documented.
Pertinent negatives
What does SAMPLE stand for
Signs and symptoms. What signs and symptoms occurred at the onset of the incident?
Allergies. Is the patient allergic to anything?
Medications. What medication is the patient prescribed?
Pertinent past medical history. Any medical history?
Last oral intake. When and what did the patient last eat or drink? In women of childbearing age, the “L” in SAMPLE also represents last menstrual period
Events leading up to the injury or illness. What are the key events that led up to this incident?
The first step in __ involves seeking facts to help your clinical decision making and scene management
gathering information
Evaluating means to
Consider what the information gathered means
_means when the plan is put together and synthesizing it into a plan to manage the scene and/ care for the patient
Synthesizing
Critical thinking in assessment
__,___,__
Gathering,evaluating,synthesizing
The purpose of the __assessment is to perform a systematic physical examination of the patient. The physical examination may be a systematic head-to-toe secondary assessment or an assessment that focuses on a certain area or system of the body, often determined by the chief complaint (a focused assessment).
secondary
A____ is generally performed on patients who have sustained nonsignificant MOls or on responsive medical patients. This type of examination is typically based on the chief complaint. Your assessment can focus on a specific body part that has been affected, such as abrasions to the elbow, or to a particular body system that has been affected, such as the cardiovascular, respiratory, neurologic, musculoskeletal, integumentary, or genitourinary system.
For example, a person with a laceration to the arm may need to have direct pressure applied. For a person reporting a headache, carefully and systematically assess the head and/or the neurologic system. The goal of a___ is to focus your attention on the body part or systems affected by the priority problem or problems.
focused assessment
A harsh,high pitched respiratory sound,generally heard during inspiration,that is caused by partial blockage or narrowing of the upper airway;may be audible without a stethoscope
Stridor
A Brady crowing sound prominent on inspiration ,suggest a partially occluded upper airway caused by swelling
Stridor
Each complete breath includes two distinct phases :
Inspiration and expiration
During__, the diaphragm and intercostal muscles contract and the chest rises up and out, drawing oxygenated air into the lungs.
During___, the muscles relax and the chest returns to its original position, releasing air with an increased carbon dioxide level out of the lungs. Inhalation and exhalation occur in a 1:3 ratio over their duration; the active inhalation phase lasts one-third the amount of time of the passive exhalation phase.
inspiration (inhalation)
Expiration (exhalation)
Normal ranges for respirations
Adults
Adolescents (13 to 18)
School age children (6 to 12)
Preschoolers(4 to 5)
Toddlers (1 to 3 )
Infants
12 to 20
12 to 16
18 to 30
22 to 34
24 to 40
30 to 60
Is a measure of the amount of air that is moved into or out of the lungs during one breath
Tidal volume
What do normal breath sounds sound like
These are clear and relatively quiet during inspiration and expiration. You will hear the air moving into and out of the lungs freely without obstruction
What do snoring breath sounds indicate
Upper airway obstruction, usually caused by the tongue or a foreign body
Identify Stridor
Often heard before listening with a stethoscope.may indicate that the patient has an airway obstruction in the neck or upper part of chest.. expect to hear a brassy,creeping sound that is most prominent on inspiration
Identify wheezing sounds
These suggest an obstruction or narrowing of the lower airways. Is a high pitched whistling sound that is most prominent on expiration . Is a lower airway sound that is typically heard through auscultation
Identify crackles
Wet, crackling breath sounds (usually in both inspiration and expiration) may indicate fluid in the lungs. Sound similar to the sound by Rice Krispies when added to milk as the alveoli are popped open .
Identify rhonchi
Congested breath sounds may suggest the presence of mucus or fluid in the lungs. Expect to hear low pitched noisy sounds that are most prominent on expiration. These lung songs may be similar to those of blowing bubbles under water . The patient often reports a productive cough associated with these sounds
For an adult the normal resting pulse rate should be between __ and __ and could be as much as ___ in older patients
60 and 100
100
Normal ranges for pulse rate
Adults and children (older than 10)
Preschools and school aged children (2 to 10)
Infants and toddlers (3 months to 2 years)
Infants (up to 3 months of age)
60 to 100
60 to 140
100 to 190
85 to 205
Health care practitioners often describe a stronger than normal pulse as
Bounding
Health care practitioners often describe a pulse that is weak and difficult to feel as
Weak or thready
Is the pressure of circulating blood against the walls of the arteries
Blood pressure
Is the increased pressure that is caused along the artery with each contraction of the ventricles and the pulse wave that it produces
Systolic pressure
Is the residual pressure that remains in the arteries during the relaxing phase of the hearts cycle, when the left ventricle is at rest
Diastolic pressure
Normal range for blood pressure
Adults
Adolescents (15)
Child (7)
Child(2)
Infant (1-12 months)
Neonate(96 hours)
ALL SYSTOLIC
90 to 120
110 to 131
97 to 115
86 to 106
72 to 104
67 to 84
A map greater than__ is needed to adequately peruse the vital organs in an adult
65
Use of the__ can be helpful in providing additional information on patients with changes in mental status. The__uses parameters that test a patient’s eve opening, best verbal response, and best motor response. The scale provides a numeric score that is associated with the relative severity of a patient’s brain dysfunction
Glasgow Coma Scale (GCS) score
When a brighter light is introduced into one eye, both pupils should
Constrict equally to the appropriate size for the pupil receiving the most light
In the absence of light the pupils will become
Fully relaxed and dilated
In normal room light the pupil should appear to be about midsize. With less light the pupils__ to allow more light to enter the eye
dilate
PEARRL is a useful guide in assessing the pupils . What does it stand for
Pupils
Equal
And
Round
Regular in size
React to light
Is an assessment tool used to evaluate the effectiveness of oxygenation. The _ is a photoelectric device that monitors the oxygen saturation of hemoglobin (the iron containing portion of the red blood cell to which oxygen attaches) in the capillary beds
Pulse oximetry
Normally pulse ox values in ambient air will vary depending on the altitude with most values falling between
94% and 99%
Refers to the chemical reactions that occur in the body or cells to maintain life
Metabolism
Is a noninvasive method that can quickly and efficiently provide information on a patients ventilation circulation and metabolism
Capnography
Measure the level of glucose in the patients bloodstream
Blood glucometry
Is performed at regular intervals during the assessment process and it’s purpose is to identify and treat changes in a patients condition
Reassessment
A properly sized blood pressure cuff should cover
Two thirds the length from the armpit to the crease at the elbow
The systematic head to toe assessment should be performed on
Patients with a significant MOI and unresponsive medical patients
Evaluates long term memory
Person. The patient is able to remember his or her name
Evaluates intermediate memory
Place. The patient is able to identify his or her current location
Evaluates intermediate memory when asking year or month
Evaluates short term memory when asking approximate date and event
Time. The patient is able to tell you the current year,month,and approximate date
The patient is able to describe what happened (the moi or noi)
Event
