Health of Adults Assessments and OSCA Flashcards

Question

What does the L in the Neurological assessment mean and what should be done?

Answer 1

Limb Movement and strength In a person who obeys commands, assess their ability to move limbs against gravity and resistance in response to a verbal command (e.g. squeezing hands.) * Assess upper and lower limbs simultaneously, observing symmetry and noting differences. * In a person who does not obey commands, assess and document symmetry and strength of each un-restrained limb movement based on assessment of motor function for GCS (i.e. by observing patient’s spontaneous movements or patients response to central pain.) The limb movement categories on the neurological chart are usually ‘normal power’, ‘mild weakness’, ‘severe weakness’, ‘flexion’, ‘extension’, and ‘no movement.

Answer 2

Eye Pupillary Reaction Check pupillary size and response to light. * Pupil size is measured against a pupil gauge in millimetres. Up to 17% of the population normally have unequal pupils (aniscoria) * Check pupillary reaction to light using a concentrated light source (e.g. penlight) in a dimly lit room. * Record a “+” symbol if the pupil reacts and a “-“ symbol if is does not react

Answer 3

History Acute presentation * What symptoms does the patient have and when did they begin (e.g. abdominal pain, nausea / vomiting, diarrhoea, constipation, haematemesis, dark stools, jaundice, weight loss, reflux, etc.) * OPQRST Pain assessment Chronic conditions to consider * Age, gender (if female, pregnancy status), and family history * Surgical history (bowel resection, stoma, appendectomy, cholecystectomy) * Gastrointestinal specific history (Crohn’s, gallstones, pancreatitis, liver cirrhosis, diverticulitis, etc)

Answer 4

Assess Vital Signs Position the patient * Undress and drape for privacy * Supine position (lying on back) is best suited for abdominal assessment Perform a full set of vital signs * Relate the pulse, blood pressure, respirations, and pulse oximetry to the gastrointestinal system. * Identify and escalate any deterioration.

Answer 5

Inspection Identify landmarks * Identify the four anterior quadrants by mentally dividing into four using the umbilicus as the centre point. Torso inspection * Trauma, bruising, distention (ascites or build up of gas / fluid), masses or bulges (hernias), skin colour, scarring, visible peristalsis, visible pulsations (abdominal aortic aneurysm),

Answer 6

Auscultate Use the diaphragm of the stethoscope * Work systematically along the path of the large intestine – RLQ, RUQ, LUQ, LLQ. * Bowel sounds should be audible. They are caused by muscular contractions of peristalsis (Intestinal movement to move contents along). * Normal bowel sounds consist of clicks, rumbling, gurgles (5-30/min), and occasional borborygmus (loud prolonged gurgle.) * Decreased or absent bowel sounds may mean constipation. * Hyperactive bowel sound may occur with diarrhoea

Answer 7

Percussion - Follow the same path of the large intestine – RLQ, RUQ, LUQ, LLQ. * Listen for tympany (a drum-like sound) over hollow organs like the intestine and stomach due to their gas content. * Dullness (a flat, muffled sound) is normally heard over solid organs (e.g. the liver, spleen, or full bladder. * Percussion distinguishes between gas and fluid in the abdominal organs.

Answer 8

Palpation Use the palmar surface of straight fingers held horizontally to the abdomen, indenting the surface by 2cm. Feel for: * Warmth and moisture. * Tenderness, lumps, masses (especially pulsatile masses). * Rebound tenderness indicated inflamed peritoneum. Press slowly and deeply into the painful area, then quickly withdraw your hand. Increased pain means the test is positive. * Rovsing’s sign (referred rebound tenderness felt in the RLQ when palpating the LLQ) is indicative of appendicitis.

Answer 9

pain, sensation, movement, colour, pulse, capillary refill

Answer 10

The most important and earliest indicator of neurovascular compromise is pain disproportionate to the injury. Pain associated with compartment syndrome is generally constant, worse with passive movement and not relieved with opioid analgesia. In non-verbal patients, indications of pain may include restlessness, grimacing, guarding, tachycardia, or diaphoresis. Escalate to the medical team if disproportionate pain is suspected.

Answer 11

Ask the patient about any alteration in sensation in the distal digits. Symptoms of nerve compression include numbness, pins and needles, pressure, tightness, tingling, burning, or any other abnormal sensation. Be aware of lingering regional or spinal anaesthetic causing paraesthesia. Patients may use different words to describe changes in sensation such as tingly, fuzzy, or funny. Remember these words and use them again when you are reassessing. Specific nerves can be tested by assessing different dermatomes.

Answer 12

Assess motor function by asking the person to move their distal joints through a full range of motion. Movement may be restricted by a cast, bandage, or splint. Consideration must also be given to the injury and how the injury may affect movement of the limb.

Answer 13

Colour in both limbs should be a healthy, well-perfused pink in Caucasions. The palms, soles, and nail beds of people with darker skin are pink. Skin must be cleaned before assessing colour. Compartment syndrome usually causes pallor in arterial insufficiency or redness, mottled, or cyanotic (blue) if there is venous compromise.

Answer 14

Pulses should be at the same rate and volume of the same pulse point on the unaffected limb. Mark pulse points that are hard to find with a skin marker to ensure consistency among staff, or use a doppler if the pulse is faint.

Answer 15

The capillary refill test is a rapid test to assess the blood flow through peripheral tissues. Squeeze the person’s fingernail or toe long enough to cause blanching (about 4-5 seconds). Release pressure and observe how quickly normal colour returns. Colour normally returns in 2-3 seconds. Delayed capillary refill indicates poor peripheral perfusion.

Answer 16

brachial, radial, femoral, popliteal, posterior tibial, and dorsalis pedis.

Answer 17

airways The upper airway includesthe nose andmouth,soft palate, base oftongue, larynx, and pharynx. There are many causes for a compromised airway including: * Altered level of consciousness * Aspiration of foreign body (e.g. vomit, food, medication) * Trauma or burns to the neck or face * Chemical burns from ingestion * Throat / neck cancer * Swelling of the airway (e.g. oedema, haematoma, abscess) * Anaphylaxis

Answer 18

breathing Breathing is the normally involuntary chest wall movement whereby air enters and leaves the lungs and gas exchange occurs in the alveoli. The purpose of breathing is twofold: oxygen is delivered to the blood for distribution and waste products (in particular carbon dioxide) are expelled from the body. There are a number of causes for breathing abnormalities including: Breathing Assessment * Respiratory rate – ensure you count it! Respiratory rates are the most inaccurately documented vital signs despite being the earliest indicator of patient deterioration. * Oxygen saturation (SpO2.) * Bilateral chest wall expansion * Presence of subcutaneous emphysema * Auscultate lung fields * Ease and comfort of breathing / use of accessory muscles * Depth of respiration (shallow, deep) * Ability to breathe while speaking – inability to speak in sentences is a sign of extreme respiratory distress. * General colour and appearance (e.g. pallor, sweating, cyanosis) * Additional audible breath sounds (e.g. wheezing, stridor) * Use of accessory muscles

Answer 19

circulation Circulation describes tissue perfusion with nutrients. Inadequate tissue perfusion is described in medical terms asshock. There are four main types ofshock; hypovolemic (lack of volume), cardiogenic (inability of the heart to pump adequately), obstructive (blockage to flow) and distributive (lack of vascular tone). Circulation Assessment * Palpate a heart rate, including rhythm and regularity. The body’s normal compensatory response to circulatory compromise is to increase the heart rate. Tachycardia is commonly seen in shock unless the cause is a bradyarrhythmia. * Perform a manual blood pressure. A blood pressure measurement is a surrogate for cardiac output as it is the product of cardiac output and systemic vascularresistance. * Assess mucous membranes for signs of dehydration. * Monitor urine output and fluid balance. Urine output should be > 0.5ml/kg/hr. Ensure adequate fluid intake. * Monitor peripheral and central capillary refill, should return to normal colour in less than 2-3 seconds. * Assess wounds and drains for signs of haemorrhage. * Perform a 12-lead electrocardiograph (ECG.)

Answer 20

Disability (including Diabetes & Drugs) Disability refers to the function of the central nervous system. Common causes of central nervous dysfunction include head injury, hypo/hyperglycaemia, recent drug/sedative administration, profound hypoxia, or circulatory shock. Disability Assessment Assessment of disability involves evaluating the central nervous system, including hyo/hyperglycaemia and drugs/alcohol as potential causes of impairment. * A rapid initial assessment of the patient’s conscious level can be obtained using the AVPU method o A – the patient is alert. o V – the patient responds to verbalstimuli. o P – the patient responds to painful stimuli. o U – the patient is unresponsive. * Check a blood sugar level (BGL) to rule out hypoglycaemia/hyperglycaemia. * Check any recent drug administration and obtain a history of recreational drug use. * A more comprehensive neurological assessment involves a Glasgow Coma Score (GCS) that assesses the patient’s eye opening, verbal response and motor response as well as their limb power and pupillary response.

Answer 21

Exposure Fully expose the patient to assess their integumentary system. * Temperature – measure core temperature (e.g. tympanic). * Expose the patient front and back, checking for: o Trauma (e.g. fractures, penetrating objects, or bleeding) o Wounds, lesions, burns, orrashes. o Check drain sites to assess if they are dislodged or kinked.