General Assessment Flashcards
What do you say at the beginning of the general assessment?
I have washed my hands and donned the correct PPE.
“Hi, my name is Kayleigh from the ambulance service, what’s your name?”
Today, we are going to do a general examination, which involves me asking you some questions and generally looking at your overall health status.”
“This will lead me into doing a specific systems examination which might involve me looking at your chest or abdomen.”
“Does this sound ok with you?”
After introducing yourself and gaining consent, what do you do next in the general assessment?
- Observe the patient for any pain / discomfort / agitation / distress / guarding / anxiety / tripoding
- Alert? Conversing?
- Ask the patient to report any pain / pain score
- Record vital signs:
- HR between 60-100bpm resting
- RR between 12-20
- SpO2 between 94-98%
- Temp between 36.1 - 37.8
- ECG to show NSR
- BP preferably 120/80
- HGT between 4-8mmol/L
What are you looking for in general appearance of a patient (general assessment)?
- Colour
- Dressed
- Weight
- Odours
- Posture
What could a pale or flushed complexion indicate?
Pale - shock, anaemia
Flushed - alcohol dependency
Yellow - jaundice - liver failure
What could being overdressed or underdressed indicate?
Overdressed - Hiding an ED, track marks, bruising, scarring, confusion
Underdressed - Confusion
What could being underweight or overweight indicate?
Underweight - malnourished, an eating disorder
Overweight - more risk for heart disease or diabetes
What are you looking for in terms of odours?
- Foul odours could indicate self neglect or confusion
- Ammonia or urine smells could indicate a UTI
- Alcohol and cigarette odours could tell you if someone has not been truthful in their history, and more risky for illnesses
How do you assess posture and what are you looking for?
Ask the patient to stand up and walk a short distance to assess their gait.
Any kyphosis or scoliosis?
Any Parkinson’s shuffle?
Any left or right sided weakness - CVA/TIA?
What is kyphosis and scoliosis?
Curves of the spine - kyphosis is leaning forward and scoliosis is leaning sideways
What are you looking for in the hand assessment?
- Condition - hydration (skin turgor test) / warm / cold
- Size - large hands (marfan’s syndrome)
- Palms - Reddening of the palms (Palmar erythema)
- Contractures - Dupuytren’s contracture
- Muscle wastage - Carpal tunnel syndrome
What is Marfan’s Syndrome?
A connective tissue disorder
What is Palmar Erythema?
A skin condition causing the reddening of the palms. Usually normal in pregnancy, however this could indicate liver disease
What is Dupuytren’s contracture?
When one or more fingers bend in towards the palm, can be caused by smoking, alcoholism, or diabetes.
Nodules form in the hand, causing the fingers to bend inwwards.
What are you assessing in the fingers and nails assessment?
- Finger staining (nicotine)
- Nails and nail beds
- Cyanosis
- Clubbing
- Deformities of fingers (arthritis)
- Heberden’s node (end) and Bouchard’s node (mid)
What are you looking for in the nails and nail beds?
- Splinter haemorrhage - blood spots under nail - occurs when capillaries along the nail bed are damaged due to trauma or due to bacterial endocarditis
- Spoon nails - iron deficiency anaemia
- Terry’s nails - white nails - liver failure or diabetes
- Clubbing
What does cyanosis mean?
Poor blood circulation
What does clubbing of the fingernails mean?
CO2 retention, usually found in COPD patients
What are heberden’s node and bouchard’s node?
Small swollen bumps on the joints of the fingers.
Bouchard’s - proximal interphalangeal joint
Heberden’s - distal interphalangeal joint
Indicative of osteoarthritis
Check on both hands
What are you assessing in the forearm and wrists?
- Forearm nodes
- Tendonitis
- Xanthomas (lesions)
- Asterixis
- Tremors
- Skin condition
What are the arm nodes called?
Cubital nodes
How would you know if there was tendonitis (arm)?
Inflammation and pain around the elbow, wrist and hand
What is asterixis and how do you test for it?
The flapping tremor
Ask patients to hold out hands as if stopping a bus, hands would be flapping back and forth
How would you test for tremors and what does this indicate?
Ask patient to hold arms out straight, palms down, and look for a tremor
Indicative of Parkinson’s Disease
What can asterixis indicate?
Impaired liver function, CO2 retention, electrolyte imbalance
What are you looking at when looking at skin condition?
- Condition - sun damage / rashes / urticaria / bruising / mottling
- Sweat
- Dehydration
- Eczema/Psoriasis
- Skin lesions
- Hair distribution
What do you look at during the mouth assessment?
- Lips - hydrated? cyanosed?
- Tongue - size? colour? hydration? thrush? smoothness?
- Teeth - decay? erosion? infection?
- Gums - condition? infection? ulcers?
- Buccal mucosa - hydration? ulcers?
- Tonsils - swollen? infected? intact?
- Odours - smoke? alcohol? pear drop? faecal?
What are you looking for in the eyes and eye lid assesssment?
- Scelera - white? bloodshot? yellow (jaundice)?
- Conjunctiva - white? - anaemia
- Eye twitching / nystagmus / squinting
- Corneal arcus - hyperlipidaemia
- Xathalasma - hypercholesterolemia
- Eye lids - in turning? out-turning?
What are splinter hemorrhages indicative of?
Splinter haemorrhages are small clots that break off and block/ settle in narrow vessels – seen in the nails, they are caused by bacterial endocarditis.
What can cold hands or warm hands indicate?
- Cold hands - low cardiac output, Raynaud’s disease, poor peripheral circulation
- Warm hands - High cardiac output
What can in-turning or out-turning eyelids indicate?
- In-turning = Entropion - ageing/muscle wastage
- Out-turning = Ectropion - ageing/muscle wastage
Tachycardia could indicate…..
Pain, infection, AF, anxiety
Bradycardia could indicate…..
Heart block, medication, athlete
Bradypnoea (low RR) could indicate…..
Opioid usage, COPD, pneumonia
Tachypnoea (high RR) could indicate…..
Anxiety attack, sepsis, DKA, asthma
Systolic BP >140 could indicate…..
Atherosclerosis, obesity
Low blood pressure could indicate……
Fluid loss (sepsis), dehydration
Sats below 94% could indicate?
Hypoxemia - caused by COPD, asthma
High temp could indicate?
Infection
Low temp could indicate?
Hypothermia, cold environment
