Chapter 9 - Patient Assessment

Question 1

accessory muscles

Answer 1

the secondary muscles of respiration. They include the neck muscles (sternocleidomastoids), the chest pectoralis major muscles, and the abdominal muscles.

Question 2

altered mental status

Answer 2

Any deviation from alert and oriented to person, place, time and event, or any deviation from a patient’s normal baseline mental status.

Question 3

auscultate

Answer 3

to listen to sounds within an organ with a stethoscope

Question 4

AVPU scale

Answer 4

a method of assessing the level of consciousness by determining whether the patient is awake and alert, responsive to verbal stimuli or pain, or unresponsive, used principally early in the assessment process

Question 5

blood pressure

Answer 5

the pressure that the blood exerts against the wall of the arteries as it passes through them

Question 6

bradycardia

Answer 6

a slow heart rate, less than 60 beats/min.

Question 7

breath sounds

Answer 7

an indication of air movement in the lungs, usually assessed with a stethoscope

Question 8

capillary refill

Answer 8

a test that evaluates distal circulatory system function by squeezing (blanching) blood from an area such as a nail bed and watching the speed of its return after releasing the pressure.

Question 9

capnography

Answer 9

a noninvasive method to quickly and efficiently provide information on a patient’s ventilatory status, circulation, and metabolism; effectively measures the concentration of carbon dioxide in the expired air over time.

Question 10

carbon dioxide

Answer 10

carbon dioxide is a component of air and typically makes up 0.3% of air at sea level; also a waste product exhaled during expiration by the respiratory system

Question 11

chief complaint

Answer 11

the reason a patient called for help; also, the patient’s response to the question “what’s wrong?”

Question 12

coagulate

Answer 12

to form a clot to plug an opening in an injured blood vessel and stop bleeding

Question 13

conjunctiva

Answer 13

the delicate membrane that lines the eyelids and covers the exposed surface of the eye

Question 14

crackles

Answer 14

a crackling, rattling breath sound that signals fluid in the airspace of the lungs

Question 15

crepitus

Answer 15

a grating or grinding sensation caused by fractured bone ends or joints rubbing together; also air bubbles under the skin that produce a crackling sound or crinkly feelings.

Question 16

cyanosis

Answer 16

a blue-grey skin color that is caused by a reduced level of oxygen in the blood

Question 17

DCAP-BTLS

Answer 17

a mnemonic for assessments in which each area of the body is evaluated for Deformities, Contusions, Abrasions, Punctures, Punctures/penetrations, Burns, Tenderness, Lacerations, and Swelling

Question 18

diaphoretic

Answer 18

characterized by light or profuse sweating

Question 19

diastolic pressure

Answer 19

the pressure that remains in the arteries during the relaxing phase of the heart’s cycle (diastole)

Question 20

distracting injury

Answer 20

any injury that prevents the patient from noticing other injuries he or she may have, even severe injuries; for example, a painful femur or tibia fracture that prevents the patient from noticing back pain associated with spinal injury

Question 21

focused assessment

Answer 21

a type of physical assessment typically performed on patients who have sustained nonsignificant mechanisms of injury or on responsive medical patients. This type of examination is based on chief complaint and focuses on one body system or part.

Question 22

frostbite

Answer 22

damage to tissues as the result of exposure to cold; frozen or partially frozen body parts are frostbitten

Question 23

general impression

Answer 23

the overall initial impression that determines the priority for patient care; based on the patient’s surroundings, the mechanism of injury, signs and symptoms, and the chief complaint.

Question 24

Golden Hour

Answer 24

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

Question 25

guarding

Answer 25

Involuntary muscle contraction of the abdominal wall to minimize the pain of abdominal movement; a sign of peritonitis

Question 26

history taking

Answer 26

a step within the patient assessment process that provides detail about the patient’s chief complaint and an account of the patient’s signs and symptoms

Question 27

hypertension

Answer 27

blood pressure that is higher than normal range

Question 28

hypotension

Answer 28

blood pressure that is lower than the normal range

Question 29

hypothermia

Answer 29

a condition in which the internal body temperature falls below 95 degrees F after exposure to a cold environment

Question 30

incident command system

Answer 30

a system implemented to manage disasters in which section chiefs, including finance, logistics, operation, and planning report to the incident commander. Also referred to as the incident management system.

Question 31

jaundice

Answer 31

yellow skin or sclera that is caused by liver disease or dysfunction

Question 32

labored breathing

Answer 32

breathing that requires greater than normal effort; may be slower or faster than normal and characterized by grunting, stridor, and use of accessory muscles

Question 33

mechanism of injury (MOI)

Answer 33

the forces, or energy transmission, applied to the body that cause injury.

Question 34

metabolism

Answer 34

the biochemical processes that results in production of energy from nutrients within the cells.

Question 35

nasal flaring

Answer 35

widening of the nostrils, indicating that there is an airway obstruction

Question 36

nature of illness (NOI)

Answer 36

the general type of illness a patient is experiencing

Question 37

OPQRST

Answer 37

a mnemonic used in evaluating a patient’s pain: Onset, Provocation/palliation, Quality, Region/radiation, Severity, Time

Question 38

orientation

Answer 38

the mental status of a patient as measured by memory of person (name), place (current location), time (current year, month, and approx. date), and event (what happened)

Question 39

palpate

Answer 39

to examine by touch