Obtaining a Medical History and Vital Signs Chapter 11 Flashcards
Define medical history.
Previous medical conditions and events for patient.
Describe a patient sign.
Signs or something you can see and observe about your patient. Think of signs much like those along the road that are telling you to stop or yield, or, worse yet, that you were going the wrong way.
The same applies to patient care. A sign can be pale skin or a rapid pulse or an open wound to the chest. All signs or are obvious if you’re alert and properly trained on how to look for them.
Define sign.
Something that can be observed or measured when assessing the patient.
Describe a patient symptom.
A symptom is something the patient feels and may complain about. Symptoms are most commonly discovered through asking questions about what they are explaining at the time. Symptoms can be obvious or very subtle. One of the most common symptoms that a patient can experience is pain. Another common symptom is nausea.
Define symptom.
Something that the patient complains or describes during the secondary assessment.
Define chief complaint.
The main medical complaint as described by the patient.
Is pain a sign or symptom?
Symptom
Shortness of breath, sign or symptom?
Symptom
Pulse, sign or symptom?
Sign
Nausea, sign or symptom?
Symptom
Blood-pressure, sign or symptom?
Sign
Respirations, sign or symptom?
Sign
Skin color, sign or symptom?
Sign
Temperature, sign or symptom?
Sign
Chest pressure, sign or symptom?
Symptom
Headache, sign or symptom?
Symptom
Moisture, sign or symptom?
Sign
Bleeding, sign or symptom?
Sign
Dizziness, sign or symptom?
Symptom
Pupils, sign or symptom?
Sign
Bruising, sign or symptom?
Sign
Blurred vision, sign or symptom?
Symptom
Unresponsiveness, sign or symptom?
Sign
Fatigue, sign or symptom?
Symptom
Cough, sign or symptom?
Symptom
Disoriented, sign or symptom?
Sign
Anxiety, sign or symptom?
Symptom
Deformity, sign or symptom?
Sign
What is one of the most common tools used for obtaining a patient’s medical history at all levels of EMS?
The sample history
Define sample history.
An acronym used to obtain a patient history during the secondary assessment.
What are the six (6) key reminders of the sample history?
S - signs and symptoms A - allergies M - medications P - past pertinent medical history L - last oral intake E - events leading to the illness or injury
Define OPQRST and what it stands for.
A pneumonic used during a secondary assessment to help assess pain. The letters stand for:
O - onset (what were you doing when it began?)
P - provocation (does anything make it feel better/worse?)
Q - quality (describe the pain - is it dull, sharp, etc?)
R - region (where did it start and does it radiate?)
S - severity (on a scale of 1-10)
T - time (when did you first notice it?)
Define vital signs.
The five most common signs used to evaluate the patient’s condition.
Name the five most common signs used to evaluate the patient’s condition.
Called Vital Signs, they are:
Respirations Pulse Blood-pressure Skin Pupils
Describe perfusion.
Perfusion is the adequate supply of well oxygenated blood to all parts of the body. Each of the five vital signs serves as a window into the patient’s perfusion status.
Define mental status.
The general condition of the patient’s level of consciousness and awareness. It is also referred to as level of consciousness (LOC).
What is the AVPU scale?
The AVPU scale is used to assess the level of consciousness and patient’s mental status.
A - Alert
V - Verbal, responsive to verbal stimuli
P - Pain, responsive only to painful stimuli
U - Unresponsive, unconscious, or completely unresponsive
Define baseline vital signs.
The very first set of vital signs obtained on a patient.
How are baseline vital signs used?
To compare subsequent vital signs in an effort to determine if the patient is stable or unstable, improving or growing worse, and benefiting or not benefiting from the care that you are providing.
Define trending.
The act of comparing multiple sets of signs and symptoms over time to determine patient condition.
What does the presence of cool, moist skin along with a rapid pulse and increased breathing rate indicate a possibility of?
Possible shock in the presence of a significant mechanism of injury.
What does the presence of hot, dry skin with a rapid pulse may indicate the possibility of?
A serious heat related emergency.
You observe a patient with rapid shallow breaths. This could indicate what types of problems?
Shock Heart problems Heat emergency Diabetic emergency Heart failure Pneumonia
You observe a patient with deep, gasping, labored breaths. This could indicate what types of problems?
Airway obstruction Heart failure Heart attack Lung disease Chest injury Diabetic emergency
You observe a patient with slowed breathing. This could indicate what types of problems?
Head injury
Stroke
Chest injury
Certain drugs
You observe a patient making snoring sounds. This could indicate what types of problems?
Stroke
Fractured skull
Drug or alcohol abuse
Partial airway obstruction
You observe a patient making crowing sounds. This could indicate what types of problems?
Airway obstruction
Airway injury due to heat
You observe a patient making gurgling sounds. This could indicate what types of problems?
Airway obstruction
Lung disease
Lung injury due to heat
You observe a patient making wheezing sounds. This could indicate what types of problems?
Asthma
Emphysema
Airway obstruction
Heart failure
You observe a patient coughing blood. This could indicate what types of problems?
Chest wound Chest infection Fractured rib Punctured lung Internal injuries
What are the 4 characteristics used when assessing a patient’s respirations?
Rate
Depth
Sound
Ease
Describe a single respiratory rate.
One inhalation plus one exhalation is defined as a single respiratory rate.
What are the three (3) classifications of respiratory rate?
Normal
Rapid
Slow
What are the three (3) classifications of respiratory depth?
Normal (good tidal volume or GTV)
Shallow
Deep
What are some examples of respiratory sounds?
Snoring
Gurgling
Gasping
Wheezing
What are the three (3) classifications of respiratory ease?
Easy
Labored
Difficult
Describe work of breathing.
The effort that a patient must exert to breathe.
What is the normal respiratory rate at rest for an adult?
12 to 20
What is considered a seriously high respiratory rate at rest for an adult?
Above 24
What is considered a seriously low respiratory rate at rest for an adult?
Below 10
What is the normal respiratory rate at rest for an adolescent 11 to 14 years?
12 to 20
What is the normal respiratory rate at rest for a school age child 6 to 10 years?
15 to 30
What is the normal respiratory rate at rest for a preschooler 3 to 5 years?
20 to 30
What is the normal respiratory rate at rest for a toddler 1 to 3 years?
20 to 30
What is the normal respiratory rate at rest for an infant 6 to 12 months?
20 to 30
What is the normal respiratory rate at rest for an infant 0 to 5 months?
20 to 30
What is the normal respiratory rate at rest for a newborn?
30 to 50
The normal respiratory rate for infant to 5 years is 20 to 30. true or false?
True
The normal respiratory rate for 11 years through adulthood is 12 to 20. true or false?
True
Define pulse.
The pulsation of the arteries that is felt with each heartbeat.
The carotid and femoral are referred to as what type of pulses?
Central pulses because they are in close proximity to the heart.
Name the peripheral pulses.
Brachial
Radial
Pedal
Named peripheral pulses because they are farther out on the body.
What 3 characteristics do you rate when taking a patient’s pulse?
Rate
Strength
Rhythm
What three (3) characteristics make up the pulse rate?
Normal
Rapid
Slow
What two (2) characteristics make up the pulse strength?
Strong
Weak
What two (2) characteristics make up the pulse rhythm?
Regular
Irregular
When caring for a responsive patient you should check which pulse site?
Radial pulse at the patients wrist.
When caring for an unresponsive patient you should check which pulse site?
Carotid pulse in the neck.
You’re caring for a responsive patient and unable to palpate a radial pulse, what should you do?
Assess the carotid pulse.
The absence of a radial pulse when there is a carotid pulse indicates a possibility of what?
Abnormally low blood pressure
Possible shock
An extremity injury that is interrupting bloodflow
An adult with a pulse rate of 60 to 100 bpm is considered what?
Normal
An adult with a pulse rate over 100 is considered what?
Abnormally rapid (tachycardia)
An adult with a pulse rate below 60 is considered what?
Abnormally slow (bradycardia)
A well conditioned athlete with a pulse of 50 beats per minutes or less is considered what?
If this is their normal it would be considered normal.
Where is the primary pulse point for infants under the age of one year?
Brachial pulse in the upper arm.
What is the normal pulse rate of an adult at rest?
60 to 100 bpm
What is the normal pulse rate of an adolescent 11 to 14 years at rest?
60 to 105 bpm
What is the normal pulse rate of a School age child 6 to 10 years at rest?
70 to 110 bpm
What is the normal pulse rate of a preschooler 3 to 5 years at rest?
80 to 120 bpm
What is the normal pulse rate of a toddler 1 to 3 years at rest?
80 to 130 bpm
What is the normal pulse rate of an infant 6 to 12 months at rest?
80 to 140 bpm
What is the normal pulse rate of an infant 0 to 5 months at rest?
90 to 140 bpm
What is the normal pulse rate of a newborn at rest?
120 to 160 bpm
What is the significance or possible cause of a rapid pulse?
Exertion Anxiety Pain Fever Dehydration Blood loss Shock
What is the significance or possible cause of a slow pulse?
Head injury Drugs Some poisons Some heart problems Lack of oxygen in children
What is the significance or possible cause of an irregular pulse?
Possible abnormal electrical heart activity (arrhythmia).
What is the significance or possible cause of an absent pulse?
Cardiac arrest (clinical death)
Define capillary refill.
The time it takes for the capillaries to refill after being blanched; normal capillary refill time is two seconds or less.
A delayed capillary refill time may be a sign of what?
Impaired circulation due to injury.
Poor perfusion due to shock.
Define blood pressure.
The measurement of the pressure inside the arteries, both during contractions of the heart and between contractions.
Define systolic.
The pressure within the arteries when the heart beats; the contraction phase of the heart.
Define diastolic.
The pressure that remains in the arteries when the heart is at rest; the resting phase of the heart.
What happens after the left ventricle of the heart contracts?
It relaxes and refills.
What is the relaxation phase of the heart called?
Diastole
What happens during the diastole phase in the heart?
The heart relaxes and the pressure in the arteries falls.
When measuring the resting phase of the heart it is called:
Diastolic blood pressure
What is the unit of measurement used to measure blood pressure?
Millimeters of mercury (mmHg)
What are some of the factors that impact the systolic blood pressure?
The force of the heart’s pumping action, the resistance and elasticity of the arteries, blood volume (blood loss means lower pressure), blood thickness or viscosity, and the amount of other fluids in the cells.
Which blood pressure measurement symbolizes the top number?
Systolic
Which blood pressure measurement symbolizes the top number?
Diastolic
What is the general rule for estimating what a patients normal blood pressure should be?
Systolic:
male adult = 100 + age in years up to age 40
female adult = 90 + age in years up to age 40
adolescent = 90 is the lower limit of normal
children = 80 + 2x age in years up to age 10 for average
(90 + 2x age =upper limit ; 70 + 2x age =lower limit)
Diastolic:
adults = 60 to 90
adolescent and under estimate 2/3 of the systolic measurement
What systolic blood pressure would be considered high blood pressure or hypertension?
140 and above
Define auscultation.
The act of listening to internal sounds of the body, typically with a stethoscope.
Define stethoscope.
A device used to auscultate sounds within the body; most commonly used to obtain blood pressure.
Define palpation.
The act of using one’s hands to touch or feel the body.
Define cyanotic.
The bluish coloration of the skin caused by inadequate supply of oxygen. It is typically seen at the mucous membranes and nail beds.
Define diaphoretic.
Excessive sweating; commonly caused by exertion or some medical problem, such as heart attack and shock.
What is the possible cause or significance of a pink skin color?
Normal in light-skinned patients; normal in inner eyelids, lips, and nailbeds of dark skinned patients.
What is the possible cause or significance of a pale skin color?
Constricted blood vessels possibly resulting from blood loss, shock, decreased blood pressure, emotional distress.
What is the possible cause or significance of a blue (cyanotic) skin color?
Lack of oxygen and blood cells and tissues resulting from inadequate breathing or heart function.
What is the possible cause or significance of a red (flushed) skin color?
Heat exposure, high blood pressure, emotional excitement; cherry red indicates late stages of carbon monoxide poisoning.
What is the possible cause or significance of a yellow (jaundiced) skin color?
Liver abnormalities
What is the possible cause or significance of a blotchiness (mottling) skin color?
Occasionally seen in patients in shock.
What is the possible cause or significance of a cool, moist (clammy) temperature or condition?
Shock, heart attack, anxiety
What is the possible cause or significance of a cold, dry temperature or condition?
Exposure to cold, diabetic emergency
What is the possible cause or significance of a hot, dry temperature or condition?
High fever, heat emergency, spine injury
What is the possible cause or significance of a hot, moist temperature or condition?
High fever, heat emergency, diabetic emergency
What is the possible cause or significance of goosebumps accompanied by shivering, chattering teeth, blue lips, and pale skin?
Chills, communicable disease, exposure to cold, pain, or fear
When evaluating pupils using the PERL method what does PERL stand for?
P - Pupils
E - Equal
R - Reactive
L - Light
Describe how you would use the P in the PERL method?
You would note the size and shape of the pupils.
Describe how you would use the E in the PERL method.
Observe both pupils to ensure they are the same size or equal.
Describe how you would use the R and L in the PERL method.
You would observe the profusion of the pupils - how they respond to the presence or absence of light. Both pupils should react to the change in light with the same speed.
You observe a patient with dilated or nonreactive pupils. What is the possible problem?
Shock, cardiac arrest, bleeding, certain medications, head injury
You observe a patient with constricted nonreactive pupils. What is the possible problem?
Central nervous system damage, certain medications
You observe a patient with unequal pupils. What is the possible problem?
Stroke, head injury
A common tool used in EMS to classify a patient's mental status is the \_\_\_\_\_\_\_ scale. A. AVPU B. ABC C. QRS D. TUV
A. AVPU
In a sample history the E represents: A. EKG results B. evaluation of the neck and spine C. events leading to illness or injury D. evidence of airway obstruction
C. events leading to illness or injury
When assessing circulation for a responsible adult patient, you should assess:
A. the carotid pulse
B. radial pulses on both sides of the body
C. the radial pulse on one side
D. the distal pulse
C. the radial pulse on one side
The adequate flow of oxygen blood to all cells of the body is called: A. circulation B. perfusion C. compensation D. systole
B. perfusion
When assessing a patient's respirations, you must determine rate, depth, and: A. regularity B. count of expirations C. ease D. count of inspirations
C. ease
The five most important vital signs are polls, respirations, blood pressure, pupils, and: A. oxygen saturation B. skin signs C. mental status D. capillary refill
B. skin signs
The first set of vital signs obtained on any patient is referred to as the \_\_\_\_\_\_ set. A. historical B. ongoing C. baseline D. serial
C. baseline
What can be assessed by watching and feeling the chest and abdomen move during breathing? A. pulse rate B. blood-pressure C. skin signs D. respiratory rate
D. respiratory rate
Characteristics of a pulse include: A. rate, depth, and ease B. rate, strength, and rhythm C. rate, depth, and strength D. rate, ease, and quality
B. rate, strength, and rhythm
The most appropriate location to obtain a pulse for an unresponsive adult is the \_\_\_\_\_\_ artery. A. brachial B. femoral C. carotid D. radial
C. carotid
What are the two (2) pulse points that are referred to as central pulses? A. radial and tibial B. carotid and femoral C. femoral and brachial D. brachial and carotid
B. carotid and femoral
As blood pressure drops, perfusion is most likely to: A. increase B. decrease C. fluctuate D. remain the same
B. decrease
Skin that is bluish in color is called: A. pale B. flushed C. cyanotic D. jaundice
C. cyanotic
The term diaphoretic refers to: A. pupil reaction B. skin temperature C. heart rhythm D. skin moisture
D. skin moisture
When going from a well lit room to a dark one, you would expect the normal pupil to: A. not react B. dilate C. constrict D. fluctuate
B. dilate
Which one of the following is most accurate when describing a palpated blood pressure?
A. it provides only the diastolic pressure
B. it must be taken on a responsive patient
C. it can be obtained without a stethoscope
D. it can be obtained without a BP cuff
C. it can be obtained without a stethoscope
A respiratory rate that is less than \_\_\_\_\_\_for an adult should be considered in adequate. A. 4 B. 6 C. 8 D. 10
D. 10
The pressure inside the arteries each time the heart contracts is referred to as the \_\_\_\_\_\_\_\_ pressure. A. diastolic B. pulse C. systolic D. mean
C. systolic
A \_\_\_\_\_\_ is something the emergency medical responder can see or measure during the patient assessment. A. symptom B. history C. sign D. chief complaint
C. sign
The term trending is best defined as the:
A. ability to spot changes in a patient’s condition over time
B. name given to the last set of vital signs taken on a patient
C. transfer of care from one level of care to another
D. the ability to improve a patient’s condition over time
A. ability to spot changes in a patient’s condition over time
