Chapter 8: Patient Assessment Flashcards
Auscultate
To listen to sounds within an organ with a stethoscope.
AVPU Scale
Method of assessing the level of consciousness by determining whether a patient is:
- Awake and alert
- Responsive to verbal stimuli
- Responsive to painful stimuli
- Unresponsive
What is Blood pressure?
The pressure of circulating blood against the walls of the arteries.
What is Bradycardia?
A slow heart rate, less than 60 beats/min
What are breath sounds?
An indication of air movement in the lungs, usually assessed with a stethoscope.
Accessory Muscle
The secondary muscles of respiration. Include: Neck muscles Chest pectoralis major muscles Abdominal muscles
What is the Glasgow Coma Scale?
Measures: Eye opening: 1- none 2- pain 3- speech 4- spontaneous
Best verbal response 1- none 2- incomprehensible 3- confused 4- oriented
Best Motor Response 1- none 2- abnormal extension 3- abnormal reflexion 4- withdraws to pain 5- localized pain 6- obeys commands
What are the signs of respiratory distress?
Agitation, anxiety, restlessness
Stridor and wheezing
Accessory muscle use; intercostal muscle retractions
Tachypnea
Mild tachycardia
Nasal flaring, seesaw breathing, head bobbing
What are the signs of respiratory failure?
Lethargy; difficulty to rouse Tachypnea with periods of bradypnea or agonal Respirations. Inadequate chest rise/poor excursion Inadequate respiratory rate or effort Bradycardia Diminished muscle tone.
Who factors determine a high priority patient?
Difficulty breathing Poor general impression Unresponsive with no gag or cough reflex Severe chest pain Pale skin or other signs of poor perfusion Complicated childbirth
What does SAMPLE stand for?
Signs and Symptoms Allergies Medication Pertinent medical history Last oral intake Events leading up to illness/injury
What does OPQRSTI stand for?
Onset Provocation Quality Radiation Severity Timing Intervention
What does DECAP-BLS stand for
Deformities
Contusions
Abrasions
Puncture/penetration
Burns
Tenderness
Lacerations
Swelling
What things does a decrease in blood pressure indicate?
Loss of blood or its fluid components
Loss of vascular tone and diffident arterial constriction to maintain the necessary pressure even without any fluid or blood loss
A cardiac pumping problem
What is conjunctiva?
The delicate membrane that lines the eyelids and covers the exposed surface of the eye.
What is crepitus?
A grating or grinding sensation caused by fractured bone ends or joints rubbing together.
Air bubbles under the skin that produce a crackling sound or crinkly feeling.
What is end tidal carbon dioxide?
The amount of carbon dioxide present in exhaled breaths.
What is the golden period?
The time from injury to definitive care.
Normally within an hour. I
What is jaudice?
Yellow skin or sclera that is caused by liver disease or dysfunction.
What is paradoxical motion?
The motion of the chest wall section that is detached in a flail chest, and is the exact opposite of a normal breathing motion.
What are rales?
A crackling, rattling breath sound that signals fluid in the air spaces of the lungs
What are retractions?
Movements in which the skin pulls in around the ribs during inspiration.
What are rhonchi?
Coarse, low-pitched breath sounds heard in patients with chronic mucus in the upper airways
What is stridor?
A harsh, high-pitched, crowing inspiration sound.
May sound like crowing.
What is subcutaneous emphysema?
The presence of air in soft tissues, causing a characteristic crackling sensation on palpitation.
What is tidal volume?
The amount of air that is moved in or out of the lungs during one breath.
Palliating factors regarding a patient’s pain involved those that…?
Alleviate the pain
After performing a head tilt-chin lift maneuver to pen the airway of an unresponsive patient who has a pulse, you should…?
Suction as needed and insert an airway adjunct
What finding indicates a patient airway in a patient?
Forceful coughing
While en route to the scene of a shooting, the displayed advises you that the caller states that the perpetrator has fled the scene. You should…?
Confirm this information with law enforcement personnel at the scene.
