Objective Assessment Flashcards
End-o-bed-o-gram
While the patient is still in the bed
First initial look and impression of the patient
Look well or sick?
Conscious/ alert?
Doing something?
Change how they present with a medical professional in the room, might become distressed
Observation charts and NEWS2
Higher the number the more unwell the patient
Tracts the patients vitals like oxygen saturation, respirations, blood pressure, pulse, consciousness, temperature
Normal values: oxygen saturation (SpO2)
94-98%
Normal values: respiratory rate (RR)
12-16
Normal values: pH
7.35-7.45
Normal values: pCO2
4.7-6.0 kPA
Normal values: pO2
10.7-13.3 kPA
Normal values: HCO3
22-26 mmols
Normal values: BE
-2 to +2 mmols
Normal values: heart rate (HR)
60-100 bpm
Normal values: blood pressure (BP)
120/80
Normal values: systolic blood pressure
95-140
Normal values: diastolic blood pressure
60-90
Normal values: urine output
0.5-1 ml per kg/hour (ml/kg/hour)
Normal values: ear temperature
35.7-38 centigrade
Normal values: capillary refill test (CRT)
Less than 2 seconds
Consent
Related to the individual activities so needs to be sought at each stage of the assessment process
Relevant again when it comes to treating the patient
A-E assessment
Airway
Breathing
Circulation
Disability (conscious state)
Exposure
Airway: look
Type - own; nose or moth, adjunct, artificial
Patient - can air flow through, not obstructed e.g. tongue, food, mucus or secretion
Airway: listen
Abnormal sounds - stridor, gurgling, wheeze, snoring
No sound - completely obstructed, air wont pass
Airway: feel
Air movement - feel air out through mouth, feel the lungs expand
Breathing: look
Colour - cyanosis; blue tinge, lack of oxygen
Mode of ventilation - self, non-invasive, ventilated
SpO2 and FiO2 - oxygen saturation and fraction of inspired oxygen
Pattern of breathing - how chest expanding
Accessory muscles
Sputum - dark, blood, thickness
ABGs
Chest x rays
Breathing: listen
Able to speak
Auscultation - 10 points on the front and 12 points on the back
Cough - strong, productive
Percussion note - middle finger on rib space then tap, lots of air then a louder sound, fluid than a stony dull sound, consolidation than a dull sound
Breathing: feel
Chest wall movement - apical vs diaphragmatic, expansion
Tactile fremitus - feeling sputum, bubbling
Circulation: look
Colour - loss blood to the toes and fingers, blue
Heat rate and rhythm - ECG
Blood pressure
Capillary refill time - colour return to the nail bed
Temperature - core, 37.5
Urine output and colour
Fluid balance - in and out, heart failure restrict
Limb oedema - heart failure, long standing
Circulation: listen
Blood pressure - manual, hearing for heart beat
Circulation: feel
Pulse - heart rate, strength and regularity
Skin temperature - cold peripherally
Asses for pitting oedema - swelling, DVT, press hand on the swelling and it leaves a mark/imprint
Disability - look
Level of consciousness - high CO2 levels to become drowsy, ACVPU; alert, confused, voice, pain, unresponsive
Pupils
Blood sugars - very low means they might be unresponsive
Disability: listen
Verbal responses - appropriate, add up to the conversation
Agitation
Pain - VAS
Exposure: look
Patient position - slump, sitting, lying, leaning forwards, changing position so function better
Body habitus - physiological state, size, body shape; scoliosis
Muscle wasting
Attachments - e.g. drugs, drips, catheters
Wounds/ dressings
Signs of infection or bleeding
Finger clubbing
Nicotine stains
Mobility aids
General condition of the patient
Exposure: listen
Chest drains - bubbling, swinging
Alarms - attached to monitoring, check with others, may need medical assistance
Exposure: feel
Skin temperature - wound, infection
ROM/ muscle strength - can they actually do what we want them to do
What are the problems that we are hoping to identify
Loss of lung volume
Sputum retention
Increased work of breathing
Respiratory failure - type 1 or type 2
Reduced exercise tolerance
Pain
Fatigue
Or a combination of the above
Documentation
SOAP - Consent; subjective findings. Objective findings. Interpretation of those findings. Plan
Add further as we progress into treatment
Must have legal identifiers - patients name an date of birth, date when writing, printed your name, designation; student physio
