the full body assessment Flashcards
ACLS
PALS
advanced cardiovascular life support
pediatric advance life support
list the different systems
- cns
- cvs
- respiratory system
- gastrointestinal system
- genitourinary system
- infectious disease
CNS sensorium
gives us a basic picture of mental status
recent and older events recalled- memory loss
rational and coherent communication ?
CNS med review
intentional and unintentional OD ?
sedation or NMB (neuromuscular blocking) involved ?
-when were meds last given and dose?
can we reverse it ?
CNS basic neurologic test
-pain
-gag/cough
-touch
commands
observation
CNS assessment tools
physical exam
Glasgow coma scale (1-15)
observation- how patient looks
CT- two dimensional, resembles anatomic slices
x-rays- analyze and compare density and placement of tissue and bone
MRI- Magnetic field produces detailed anatomic images
EEG (electroencephalography)
ICP- intracranial pressure
full consciousness
patient is alert and attentive, follows commands, responds promptly to external stimulation if asleep, and once awake remains attentive.
lethargy
the patient is drowsy but partially awakens to stimulation, will follow commands slowly and inattentively
obtundation
patient is hard to arouse and needs constant stimuli. may verbally response with only one to two words. patient drift back to sleep
stupor
only arouses to vigorous and continuous stimuli. typically to pain stimulation. only response is to withdraw from or remove pain
coma
patient is not responsive to anything, no movement, only possible by reflex
what does Glasgow coma scale measure
- motor response
-verbal response- poorly suited for patients with impaired verbal response ( aphasia, hearing loss)
eye opening
Glasgow coma scale
scale goes from 1-15 3- deep coma 15- fully awake 12-15= non icu 9-12= significant insult less than 9- severe coma= requires endotracheal intubation
CVS history review
hereditary cardiovascular disease ? - does this run in you family
Acute vs chronic
CVS med review
chrono tropes- affects heart rate
anti-arrhythmias- controls contractility
anti hypertensive- controls BP
assesment of CVS
vital signs- HR,BP
signs- JVD, edema, urine output heart sounds
testing- ecg
lab data- cardiac enzimes, lactate, electrolytes etc
PMI (point of maximum impulse)
this is found on the fifth intercoastal space on the left side midclavicular line. this point is created by a healthy left ventricular systole. space is called precordium
explain what the S1 sound is
S1 sound is produced by closures AV valves systole
S2
sounds produced by closure of semilunar valves during diastole.
s3 and s4 sounds
might be audible in patients
with ventricular hypertrophy
this is called a gallop sounds
P2
suggestive of pulmonary hypertension and is common in COPD patients with chronic hypoxemia.
cardiac murmurs
- systolic murmurs occur when blood passes through narrowed semilunar valves or back flows through incompetent AV valves
- diastolic murmurs occur with stenotic AV valves or incompetent semilunar valves.
why are we assessing CVS
picture of patient stability
close correlation with (RS,renal system) CNS system
respiratory history
patient/ family interview
reports
chart reviews
actions plans
resp; assessment tools
PEFR
Peak flow measured on exhalation for Asthmatic and COPD
Spirometry
More detailed assessment of volumes and flows
V/Q scans
Radioactive radionuclide injected into pt blood then X-ray completed, as well pt breathes in and x-ray done
Done to establish presence of pulmonary emboli compares areas of ventilation and perfusion of the lung
Sputum for C&S(culture and sensitivity), also determine if gram + or -
Cytology (what cells are growing)
AFB (acid fast bacilli) test for TB
Bronchoscopy – procedure where physician enters airway with a bronchoscope to visualize airways and determine any anomalies
Drug levels
Physiologic calculations Qs/Qt – shunt & Vd/Vt - deadspace
GI; hx and medications
last meal
chronic vs acute pain (stomach)
nausea, vomiting and diarrhea
GERD( gastroesophageal reflux disease)
examination of the abdomen
Performed to inspect and palpate for distention or tenderness
An enlarged or tender abdomen can negatively influence breathing
A large liver is known as hepatomegaly; common in patients with cor pulmonale
An abnormal collection of fluid in the peritoneal cavity is known as ascites
GERD
Heartburn and regurgitation Extraesophageal manifestations Laryngitis, asthma, chronic and nocturnal dry cough, chest pain, and dental erosion GER more than twice a week = GERD Risk factors Obesity, cigarette smoking, pregnancy
why assess GI system
The pts. Nutritional status will directly affect their ability to support ventilation
Aspiration (i.e. - due to distention) may cause a Gm - pneumonia.
GI bleeds (i.e. NG drainage, distention) will decrease Hb and reduce oxygenation
urinary hx and med review
hx of transplant or surgery
meds
diuretic
CVS meds
why assess renal system ?
Plays a key role in balance of:
circulating fluid volume
waste product elimination
acid/base status
Therefore, it has a huge impact on most major organ functions especially Respiratory & CV
infectious disease
History of infections or reoccurring Antibiotics, Antifungal or Antiviral medication review Immunocompromised? Precautions PPE
