Chapter 9-patient Assessment Flashcards
Name the components of a scene size up
- ensure scene safety
- determine MOI or NOI
- take standard precautions
- determine number of patient
- consider additional/special resources
Name the components of the primary assessment
- form a general impression
- assess level of consciousness
- ABC (see below)
- assess the airway (identify and treat life threats)
- assess breathing (identify and treat life threats)
- assess circulation (identify and treat life threats)
- perform primary assessment
- determine of patient care and transport
Name the five steps in patient assessment
- Scene size up
- Primary assessment
- History taking
- Secondary assessment: (medical or trauma)
- Reassessment
List components of the history taking portion of a patient assessment
Investigate the chief complaint (history or present illness)
Obtain SAMPLE history
List components of secondary assessment: medical or trauma
Systematically assess patient
Secondary assessment and focused assessment, assess vital signs using the appropriate monitoring device
List the components of the reassessment portion of the patient assessment
Repeat the primary assessment Reassess vital signs Reassess the chief complaint Recheck interventions Identify and treat changes in the patient's condition Reassess the patient * unstable patients: every five minutes * stable patients: every 15 minutes
Symptom
A subjective condition that the patient feels and tells you about
Sign
And objective finding that you can observe or measure
Scene size up
your evaluation of the conditions in which you will be operating. This is what you focus on when you first approach a scene
Situational awareness
Paying attention to the conditions and people around you at all times and the potential risks these conditions or people pose
What do you do if a scene is unsafe to enter?
Do what you can to make it safe, or call for additional resources
Mechanism of injury (MOI)
The type of outside force, how long it was applied and where it was applied to.
The MOI can be used as a guide to help you focus your assessment
Nature of illness (NOI)
The general type of illness that a patient is experiencing
Chief complaint
The most serious thing the patient is concerned about, the reason EMS was activated
personal protective equipment (PPE)
Clothing or equipment that protects the wearer. Generally gloves and safety glasses are worn at all scenes
Standard precautions
Protective measures that have been recommended from the CDC (centers for disease control and prevention for use in dealing with objects, blood, body fluids, and other potential exposure risks or communicable disease
Incident command system
A flexible system implemented to manage a variety of emergency scenes
Triage
The process of sorting patients based on the severity of their conditions
What questions can you ask yourself to know whether to call for additional resources?
- Does the scene pose a threat to you, your patients, or others?
- how many patients are there?
- do we have the resources to respond to their conditions?
Primary assessment
To identify and begin treatment of immediate or imminent life threats.
Identify LOC, and ABC (airway, breathing, circulation)
General impression
The general impression is formed to determine the priority of care and is the first part of your primary assessment. It includes noting things like age, sex, race, level of distress and overall appearance.
Overall visual assessment while approaching patient
Make sure to introduce yourself after and ask about the chief complaint once your at the patient
What are the theee categories to place patients in while determining loc
- unconscious
- conscious with an altered loc
- consious with unaltered loc
Perfusion
The circulation of blood within an organ or tissue to provide necessary oxygen and nutrients and to remove waste
AVPU scale (assessing LOC)
A-awake and alert: watch the patients eyes as they track you, and there awareness of the situation
V-response to verbal stimuli: the patient is not alert and awake, and they don’t respond to normal voice, but they respond to loud yelling
P-response to painful stimuli: the patient doesn’t respond to questions, but the patient moans or twitches when you cause pain to them
U-unresponsive: the patient doesn’t respond to verbal or painful stimuli. Usually no cough or gag reflex and lack ability to protect their airway
Orientation
If a patient is alert and can respond to verbal stimuli, evaluate orientation. This tests patients mental status
*person (the patient is able to remember his or her name)
*place (the patient knows where they are
*time (the patient is able to tell you the year date and month
*event (the patient can describe what happened)
You note this as the amount of questions they get correct by saying “alert and oriented times n) for example, if someone knew three of these, you would say “alert and oriented times three”
Altered mental status
Any deviation from alert and oriented regarding person place time and event or from a patients normal baseline
Distracting injury
Any injury that distracts the patients attention from other injuries he or she may have, even if they are severe injuries
What are signs of airway obstruction in an unconscious patient?
- obvious trauma, blood, or other obstruction
- noisy breathing such as snoring, bubbling, gurgling, crowing, stridor, or other abnormal sounds
- extremely shallow or absent breathing
Spontaneous respirations
A patient who is breathing without assistance is said to have spontaneous restorations
What are questions you can ask yourself as you assess a patient’s breathing?
- Is the patient breathing
- Is the patient breathing adequately?
- Is the patient hypoxic?
Shallow respirations
Little movement of the chest wall or poor chest excursion
Retractions
Indentations above the clavicles and the spaces In between ribs
Accessory muscles
Accessory muscles include the neck muscles, the chest pectoralis major muscles, and the abdominal muscles. Using accessory muscles is a sign of inadequate breathing
Nasal flaring
Flaring of the nostrils usually in pediatrics is a sign of inadequate breathing
Two to three word dyspnea
When a person can’t speak more than 2 to 3 words without having to pause to take a breath
Tripod position
A position where a patient is sitting and leaning forward on outstretched arms with the head and chin trust slightly forwards. This indicates that a patient is trying to increase airflow
Sniffing position
Usually seen in children, the patient sits upright with the head and chin thrust slightly forwards and the patient appears to be sniffing. This shows that a patient is trying to increase airflow
Labored breathing
Labored breathing is characterized by the patient’s position, concentration on breathing, and the increased effort and depth of each breath
Pulse
The pressure wave that occurs as each heart beat creates surge in the blood circulating through the arteries
Palpate
To feel
What three things should you assess when you are looking at skin condition
Skin color, skin temperature, skin Moisture
Conjunctiva
The delicate membrane lining of the eyelids, and it covers the exposed surface of the eye
Cyanosis
A patient with insufficient air exchange and low levels of oxygen in the blood, the blood and vessels become blue, and the lips, mucous membranes, nail beds, and skin over the blood vessels appear blue or gray
Jaundice
Liver disease or dysfunction may cause Jaundice, resulting in the patient’s skin or sclera turning yellow
Sclera
Is normally the white portion of the eye and may show color changes even before skin color change is visible
What is normal body temperature?
98.6°F
Diaphoretic
When the skin is bathed in sweat, like if the patient is in shock, then the skin is described as a wet or diaphoretic
Capillary refill
Is often evaluated in pediatric patients to assess the ability of the capillary system to perfuse the capillary system in the fingers and toes
Hypothermia
Exposure to a cold environment, including frozen tissue (frostbite) and vasoconstriction
Frostbite
Frozen tissue
Vasoconstriction
Narrowing of a blood vessel
Coagulate
To clot (for example, direct pressure stops the bleeding and helps the blood to coagulate)
DCAP-BTLS
Mnemonic to help you remember deformities, contusions, abrasions, punctures, burns, tenderness, lacerations, and swelling
Crepitus
The sound or feeling a fractured bone ends rubbing or grinding together
Golden hour
Is the time during which treatment of shock or traumatic injuries is most critical and the potential for survival is the best
History taking
Provides details about the patient’s chief complaint and account of the patient signs and symptoms
What information should you document while history taking?
- date of the incident
- patient’s age, gender and race
- past medical history, including any pertinent information about the patient’s condition, such as medical problems, traumatic injuries, and surgical procedures
- patient’s current health status, including diet, medications, drug use, living environment and hazards, physician visits, and family history
what’s the purpose of OPQRST
It’s a pneumonic for gathering additional information about a patient’s history of present illness and current symptoms
OPQRST
Onset-what were you doing when the symptoms began?
Provocation. Does anything make the symptoms better or worse? How are you most comfortable?
Quality – what does the symptom feel like? Is it sharp, dull, crushing, tearing? Does it come in waves?
Region-where do you feel the symptom? Does it move anywhere?
Severity- on a scale of 0 to 10, how would you rate your symptoms?
Timing-has the symptom been constant or does it come and go? How long have you had the symptoms, when did it start?
Pertinent negatives
The signs and symptoms that a patient does not have That would be expected from their chief complaint
What is the Purpose of a SAMPLE history
A mnemonic used to help question patience to gather information from them
SAMPLE
Signs and symptoms: what signs and symptoms occurred at the onset of the incident? Does the patient report pain?
Allergies,: is the patient allergic to any medication, food, or other substance? What reactions did the patient have to any of them? If the patient has no known allergies you should note it
Medications. What medication is the patient prescribed? What is the dosage? How’s the patient taking it in the last 12 hours? Recreational drugs?
Pertinent past medical history: does the patient have any history of medical, surgical, or trauma occurrences? Is the patient had a recent injury? Important family history that I should know?
Last oral intake. When did the patient last eat or drink? What did the patient eat or drink, and how much was consumed? Did the patient take any drugs or drink alcohol? Has there been any other oral intake in the last four hours?
Events leading up to the injury or illness: what are the key events that led up to this? What occurred between the onset of the incident in your arrival? What was the patient doing when the illness started? What was the patient doing with this injury happened?
What are the three components to critical thinking
Gathering: gather information that involves finding facts to help your decision making seen management
evaluating: what the information gathered means
synthesizing: putting together the information that you have gathered and synthesizing it into a plan to manage the scene and care for the patient
What do you do during a physical examination?
- inspection-look at your patient for abnormalities
- palpation- touching or feeling your patient for abnormalities
- Auscultation- The process of listening to sounds the body makes by using a stethoscope
Auscultate
To listen
Focused assessment
Generally performed on patients who have sustained nine significant mechanism of injury’s or on responsive medical patients. Your assessment can focus on a particular body part that has been affected, such as abrasions to the elbow, or a particular body system that has been affected such is the cardiovascular system
Wheezing
A high-pitched whistling sound that is most prominent on expiration
Crackles
Wet, crackling breath sounds (usually on inspirations and expirations) indicate fluid in the lungs
Rhonchi
Congested breath sounds may suggest the presence of mucus in the lungs. Expect to hear a little pitched, noisy sounds that are most prominent on expiration
Stridor
May indicate that the patient has an airway obstruction in the neck or upper part of the chest. Expect to hear a crowing sound that is most prominent on inspiration
Tachycardia
A pulse rate that is greater than 100 bpm
Bradycardia
A pulse rate that is less than 60 bpm
Blood pressure
The pressure of circulating blood against the walls of the arteries
Systolic blood pressure
The increased pressure that is caused along the artery with each contraction of the heart
Diastolic blood pressure
The pressure that remains in the arteries during the relaxing phase of the heart cycle
What is the medical term for a Blood pressure cuff with a gauge
Sphygmomanometer
Hypotension
When the blood pressure is lower than normal range
Hypertension
When the blood pressure is higher than the normal range
What is the mnemonic PEARRL and what is it used for
Pupils Equal And Round Regular in size React to LIGHT
This mnemonic is a useful guide in assessing the pupils
Subcutaneous emphysema
air bubbles under the skin
Paradoxical motion
when only one section of the chest rises on inspiration while another area of the chest Falls
Pulse oximetry
Pulse oximetry an assessment tool used to evaluate the effectiveness of oxygenationp
Metabolism
Metabolism refers to the chemical reactions that occur in the body or cells to maintain life
Carbon dioxide (cO2)
The byproduct of aerobic cellular metabolism reflects the amount of oxygen being consumed during the process
Capnography
Shows a graph that indicates out easily, how frequently, and how much the patient is exhaling carbon dioxide
You are assessing a 72-year-old man with abdominal pain. The patient is sitting in a chair, he is conscious alert and calm. As you’re talking to the patient your partner discreetly direct your attention to a handgun, which is located on a nearby table. What should you do
Position yourself in between the patient and the gun and ask your partner to request law enforcement assist
When approaching somebody who is complaining of Trumatic neck pain, what should you do
Ensure that the patient can see you approaching him or her
An elderly patient has fallen and hit her head. Your initial care should focus on
Airway, breathing, and circulation
You should expect that a patient is experiencing respiratory fail if he or she
Has BradyCardia and diminished muscle tone
