118 Mod 1 (Patient Assessment) Flashcards
(218 cards)
1
Q
Steps of Patient Assessment (5)
A
- Scene SIZE UP
- PRIMARY ASSESSMENT
(ABC, DE, PRIORITY, TRANSPORT) - HISTORY Taking
(OPQRST, SAMPLE) - SECONDARY Assessment
(Vitals, Full Body Exam) - RE - assessment
(Every 5 or 15)
2
Q
Glasgow Coma Scale
A
Eye - 1 (doesn’t open) - 4 (Opens)
Verbal - 1 (no sound) - 5 (Normal)
Motor - 1 (no movement) - 6 (Obeys)
Less than 8 is severe
3
Q
What is the order of motor development for 0-2 years old
A
lift head, sits up, crawl, walk
4
Q
The Denver Developmental Growth Chart is
A
used to identify special needs children
5
Q
Define Pain Threshold
A
LOWEST amount of stim that will causes a sense of pain
6
Q
Define Pain Tolerance
A
HIGHEST level of pain tolerated
7
Q
Define Nociceptors?
A
Sensory receptor for pain
8
Q
Define Visceral Pain
A
Usually felt in abdominal area (not localized)
Internal pain
can radiate
9
Q
Define Allodynia?
A
Pain due to a stimulus that normally doesn’t provoke pain
10
Q
Define Fibromyalgia?
A
Widespread muscle pain, triggered by stressful event physical or emotional
11
Q
Define Peripheral Neuropathy?
What causes it?
A
Weakness, numbness, and pain from nerve damage usually in hands and feet.
Commonly caused by diabetes.
12
Q
Define Minute Volume?
A
Amount of air in and out of LUNGS each minute
13
Q
How to you calculate minute volume?
____ x ____ = Minute Volume
A
RESP rate x TIDAL volume = MINUTE volume
14
Q
Define Tidal Volume
A
Volume of air inspired with each breath
(ex. 500mL / breath)
15
Q
Sign of Arterial Bleeding
and how/soon do you take care.
A
Usually spurting blood,
Life threat
Tourniquet in less than 30 seconds
16
Q
Otoscope vs
Ophthalmoscope
A
OTOscope - used to look at the EARS
Ophthalmoscope - used to view the EYES
17
Q
Anisocoria
A
Asymmetric (unequal pupils)
18
Q
Mydryasis
A
Wide open pupils (DIALATED)
also stimulants
midbrain injury
19
Q
Miosis
A
CONSTRICTED - small pupils
also Opioids
pontine injury - affecting pons of the brain hemorrhage
20
Q
Define Erythema
A
Reddening of the skin (usually patches)
from injury
21
Q
Postauricular ECCHYMOSIS
A
Battle Signs
22
Q
Halo Sign
A
CSF
23
Q
PeriORBITAL Ecchymosis
A
Racoon eyes
24
Q
JVD indicates
A
Right or Left Ventricular HEART Failure
25
Tracheal Deviation indicates
Late indication of tension pneumothorax
26
5 parts of the spine
1. Cervical ( 7 )
2. Thoracic ( 12 )
3. Lumbar (5)
4. Sacral
5. Coccygeal
27
Define Paresthesia
Abnormal sensation (pins and needles)
28
Not normal breath
Adventitious Lung sounds
(no adventitious = normal)
29
CN1
OLFACTORY - Sensory, Smell NOSE
30
CN2
OPTIC - Sensory & Vision TWO EYES 00
31
CN 3 , CN 4, CN 6
Eye Movements EYES
III 3 - OCCULAR Motor - Motor, Eye movement, pupil
IV 4 - TROUCULAR - Eye movement
VI 6 - ABducens - Motor, eye movement
32
CN 5
V 5 - TRIGEMinal - Sensory and Motor - Facial, Tongue, Bitting Chewing (Mastication) MOUTH
33
CN 7
VII 7 - FACIAL - Sensory - Taste, Motor - Facial, Salvation FACE
34
CN 8
VIII 8 - VESTibulocochelear - Auditory - Sensory - Balance and Hearing EARS
35
CN 9
IX 9 - MEDulla OBlongata, Sensory - Taste and Sensation, TOUNGE
Motor - Swallowing and Salvation
36
CN 10
X 10 - VAGUS - Sensory - Throat, and Abdominal
Motor - Swallow and Speech, Cough (Rest and Digest)
37
CN 11
XI 11 - SPINAL - Motor - Head Turn, SHOULDERS
38
CN 12
XII 12 - HypoGLOSSAL - Under tongue Movement - TOUNGE
39
Afterent vs Efferent
Afferent - sensory, signals BACK to the brain
Efferent - motor, signals AWAY from the brain
40
AAO x 4
Person
Place
Time
and EVENTS
41
What do we use in place of Sternum Rubs for Unresponsive Patients
Trapezius Pinch
42
Define Levine Sign?
Clenched fist held over the chest to describe ischemic CHEST PAIN
43
Stroke vs Bells Palsy Sign
Bells - Complete disassociation of facial nerve (no forehead movement)
Stroke - the forehead will still move, upper face even with facial droop
44
The first set of vitals...
should be completed manual
and with Lifepak first set should not be trusted (calibration only)
45
Signs vs Symptoms
Signs - measurable, what you see, Objective
Symptoms - Non measurable, what the patient tells you, their complaints
46
Vitals should be included in what part of your SOAPE notes?
Objective
47
Hypothermic and Hyperthermic Patients get temp taken?
Rectal, for CBT (Core Body Temp)
48
Normal Body Temp?
98.6F or 37C
49
Carotid Pulse
atleast 60 mmHg
50
Femoral Pulse
atleast 70 mmHg
51
Radial Pulse
at least 80 mmHg
52
Check _______ for unresponsive patient
Carotid (at least 60 sys mmHg) and compair to Femoral Pulse
53
What Systolic Pressure indicates Hypotension
Less than 90 Sys
54
Define Systolic
How much pressure exerted against your artery walls when the heart CONTRACTS
55
Define Diastolic
How much pressure exerted against your artery walls when the heart RELAXES
56
Define MAP (what is normal)
Mean Arterial Pressure
Diastolic + 1/3 (Systolic - Diastolic) = MAP
Normal MAP = 70 -100 mmHg
57
Define STROKE Volume
Volume of blood pumped out of the LEFT ventricle (cant be calculated)
(FROM THE HEART)
58
Define Cardiac Output
Amount of blood pumped each minute
STROKE Vol x Heart RATE = Cardiac Output
59
Define Hypertension Stage 1
130-139 Sys or 80-89
60
Define Hypertension Stage 2
Sys 140 (or higher) or Dia 90 (or higher)
61
Define Hypertension Crisis
Sys Higher than 180 and/or Dia higher than 120
62
Normal SpO2 %
94-99
63
What SpO2 do you give oxygen
Anything below 94%
64
Pulse Oximetry measures
How saturated (oxygen) the hemoglobin
Carbon Monoxide can also saturate hemoglobin
65
What does Pleth Waveform measure
STRENGTH of pulse (how hard the pulse)
also irregular heart beat
(Well defined waves = good perfusion)
66
What does Capnography Measure
Measures the CO2 being released using exhalation
Cellular respiration - how well cells are functioning
Body PH
Ventilation Status
Measured in mmHg
67
What is a normal Blood Glucose,
what 4 people do you check
70 - 120 mg/dL
Decaliter
Check all:
1. post seizure,
2. CVA,
3. altered,
4. Peds with Altered, sleepy
68
What is PERRLA (and how do you check)
Pupils , Equal, Round, Reactive, Light, Accomodating (checking one eye, the other does the same)
Check in H pattern for Range of Motion
69
Pin point pupils indicate
OPIATE
or
Pons Section (lower base) of brain injury
70
Normal Pupil Size?
3-5 mm
71
In the SOAPE notes where would you put Pain Scale
Subjective
72
Patient is having asthma attack, you hear whimsical whistling, What sound do you expect?
Wheezing
73
Listen to lung sounds atleast ____ places
8
74
You listen for Sound over the 2nd intercostal space at the midclavicular line (One of the 8 places)
Bronchovesicular
75
For head trauma what manuver would you use to open airway
jaw thrust, OPA
76
GCS ___ or less is a Trauma
13
77
Asking if anything makes pain worse is "OPQRST"
Provocation
78
Where is your spleen
LUQ
79
Patient is in shock and has inadequate tissue perfussion this is called
Hypoperfusion
80
What are the places for breath sounds
Tracheal - over trachea
Bronchial - just over the clavicles (2)
Bronchovesticular - 1st and 2nd intercostal spaces and back
Vesticular - lower, most of the lung field, front and back
81
Define Rales
Crackles, fluid in the lungs
CHF and Pneumonia
82
Define Rhonchi
Snoring (low pitch sound)
Fluid in larger airway
COPD, Pneumonia
83
Define Stridor
High pitched, Squeaking or whistling sound
in or just below voice box
(occurs during BOTH inspiration and expiration)
Due to obstruction in upper airway
84
Define Wheezing
High pitched whistling sound made while breathing
(DURING EXPIRATION)
Asthma or Bronchitis
85
Define difference between Authoritarian and Authoritative Parenting
Authoritarian - no freedom
Authoritative - sets rules but also allows freedom
86
Define Barotrauma
increased pressure, too much pressure in lungs
87
Define Hypercapnia
Increased carbon dioxide levels in bloodstream
88
13 - 17 years of age
Adolescents
89
Define Aneurysm
A swelling or enlargement of part of a blood vessel, resulting from weakening of the vessel wall
90
What type of Reasoning looking for approval from peers
Conventional reasoning
91
18-40 years old
Early Adult
92
Define Atherosclerosis
Disorder in which cholesterol and calcium build up in walks of blood vessels, forms plaque and may lead to blockage of blood flow
93
Define Postconventional Reasoning
Child bases descisions on own conscience
94
Define PRE conventional reasoning
child acts PRE to punishment to get what they want
95
3-5 years old
pre schoolers (after toddlers 1-3)
96
Define Withdraw
final phase of infants response to situation crisis, signs of apathy and bordom
97
Trust and mistrust
from birth to 18 months, gain trust of parents if world is organized and routine
98
1 - 3 years of age
Toddlers
99
Define Moro Reflex
when infant is caught off guard, opening arms wide
100
Define Rooting Reflex
When newborns cheek is touched, they turn toward the touch
101
What part of fontanelles indicate dehydration
Anterior
102
Infant becomes scared of strangers at ____ months
7
103
Filtration of kidneys declines by _____ between 20 and 90
50%
104
Bleeding can empty into voids in older brain, which is what type of hemorrhage
Subdural
105
Define Hypercapnia
capacity of lung decrease, residual volume increase
106
What type of reasoning is learned by school age children
Conventional
107
Name and Define the 4 Infant Reflexes
Moro - startled infant, wide arms
Palmar - Grabs when placed in PALM
Rooting - Turns head when cheek is touched
Sucking - Touch lips, infant will suck
108
SAMPLE
Signs and Symptoms
Allergies
Medications
Pertinent Medical History
Last Oral Intake
Event
109
Two substances responsible for the buildup of plaque
Calcium and Cholesterol
causing Atherosclerosis (buildup in coronary vessels)
110
2 most Common infections for toddlers and school age
Gastro distress
Upper resp tract infection
111
Another word for Double Vision
Diplopia
112
Define Iatrogenic
Related to a side effect or complication of medications or other medical treatment
drug side effect
113
Define Korotkoff Sounds
Sounds related to blood pressure measurement that are heard by stethoscope
114
Define Kyphosis
Outward curve of the thoracic Spine (hump back)
115
Define Mottling
A blotchy pattern of the skin, sign of severe hypofusion and shock
116
Define Murmur
An abnormal whooshing sound heard over the heart that indicates turbulent blood flow around a CARDIAC VALVE
117
Guarding indicates ________
Peritoneal irritation
tissues in abdomen wall
118
Define Cerumen
Ear Wax
119
Define Bruit
An abnormal whooshing sound of turbulent blood flow,
through narrow CAROTID arteries usually
120
Define Beck Triad
Narrow pulse pressure with
muffled heart tones with
JVD with cardiac tamponade (compression of the heart with fluid surrounding) bp drop
usually caused by penetrating chest trauma
121
2 Signs of Cardiac Arrest
Cyanosis and Absent pulse
122
3 Signs of Heart Failure
Edema of both ankles
JVD while sitting
S3 gallop sound
123
3 Signs of Skull Fracture
Ecchymosis around eyes
Battle Signs
CSF around ear
124
Define Lordosis
Exaggerated inward curve of the lumbar area (lower back)
125
What are the parts of History Taking from Alert Patient
Age Weight, who called
CC - why, duration
OPQRST - onset, prov, quality, radiate, sevr, time
SAMPLE - signs, aller, meds, past hx, LOI, Events
Surgeries, Nutritional status, Drugs, Family Hx, Psych
126
Organs in
RUQ
LUQ
RUQ - GALLBLADDER, Intestines, LIVER (RIGHT) - GIL
LUQ - Pancreas, Intestines, STOMACH, SLEEN - PISS
127
What's the difference between
Stroke Volume
Minute Volume
Cardiac Output
Tidal Volume
Stroke vol - volume of BLOOD pumped out of the left ventricle
Min Vol - amount of AIR in and out of sungs each min
Cardiac Out - amount of BLOOD pumped each min
Tidal Vol - amount of AIR moved in/out of lungs each resp cycle
128
What are the valves of the heart
Aortic Valve
Mitral Valve
Pulmonary Valve
Tricuspid Valve
129
Veins flow blood ________ the heart
De-Oxygenated blood TO the heart
130
Arteries flow blood ________ heart
Away from the heart
131
Where does blood come into the heart first (upper)
The superior vena cava,
head neck, upper limbs, and chest
132
What is the goal of the primary assessment
and 4 parts
to identify and treat immediate life threats
General Impression
Mental Status
ABC
Priority and Transport possible
133
What is the standard of care
what a reasonable paramedic would do in the same situation
134
From the Vena Cava where does blood go?
To the Right Atrium
135
from the Right Atrium the blood goes
through which valve first?
to where?
The. tricuspid valve, (it has 3 flaps)
to the. Right ventricle
136
After the lungs, the blood comes back to the heart through
______________
the pulmonary veins
137
From the pulmonary veins blood enters the ________
Left atrium
138
From the LEFT Atrium the blood then goes through ___________ to the __________
Left Ventricle through the MITRAL (BI-CUSPID) VALVE
139
Leaving the heart the blood leaves the Left Ventricle through the ______________ entering the _________
Aortic Semilunar Valve, entering AORTIC Arch
140
What are the Steps of the Heart
from veins Deoxygenated blood enters the RIGHT ATRIUM, through vena cava
Blood enters right ventricle through TRICUSPID VALVE
Blood then goes through Pulmonary valve and enters Pulmonary artery
Blood is then sent to lungs for gas exchange
Oxygenated blood returns to the heart via PULMONARY VEINS entering the Left Atrium
Blood enters Left Ventricle through MITRAL VALVE
Blood exits left ventricle through the AORTIC SEMILUNAR VALVE
AORTA distributes oxygenated blood to the body arteries
141
Define Somatic Pain
Localized pain,
usually felt deeply
142
Define Referred Pain
Pain perceived in one place, other than true source
143
When do you give a NON REBREATHER and how much oxygen
Signs of inadequate breathing,
cool, clammy,
short of breath,
chest pain,
Severe injuries
ALTERED
12-15 Ltrs
144
Indication for BVM
Very Diaphoretic
Unresponsive
Shallow ventilation
Diminished lung sounds
CYNOTIC
Noises
RESP over 30
15lts
145
When would you CPAP a patient? 7 reasons
Fluid in lungs (pulmonary edema)
COPD
Bronchospasms - ASTHMA
Toxic Inhalation
Drowning
Flail Chest
Pneumonia
Should be used on ALERT Patients who can follow commands, rapid breathing and a pulse ox less that 90%, no airway compromise, no nausea, no facial trauma. Hypotension less than SYS 90.
PEEP Set to 5-10cm
15ltrs?
146
Babinski Reflex
Reflex stimulated on plantar of foot
147
Anisocoria
Unequal pupils
148
Diplopia
Double Vision
149
Erythema
Redness due to capillary dilation
150
Consensual Response
Contralateral pupil responds
151
Intraperitoneal
Inside the abdominal cavity
152
Ascites
Fluid build up in the abdominal cavity
153
Peristalsis
Rhythmic movement of food through alimentary canal
154
Adolescents
13-18 years old
155
Middle Adult
41-60 years old
156
Early Adult
19-40 years old
157
Olfactory
Sense of smell
158
Optic
Sense of sight
159
Oculomotor
Movement of eye, pupil & eyelid
160
Trochlear
Movement of eye downward & inward
161
Trigeminal
Touch of mouth & face/chewing
162
Abducens
Movement of eye lateral
163
Facial
Movement of Face/Tears/Saliva
164
Vestibulocochlear (Auditory)
Sound/Hearing/Balance
165
Glossopharyngeal
Swallowing/Sensation of Mouth & Pharynx
166
Vagus
Sensation and Movement of Pharynx, Larynx, Parasympathetic innervation of Thorax and GI System
167
Spinal Accessory
Movement of Head Shoulders
168
Hypoglossal
Movement of Tongue
169
Arteries and Veins explain
Arteries (red) carry oxygen and nutrients AWAY from your heart, to your body's tissues.
The veins (blue) take oxygen-poor blood back to the heart.
170
How would you modify a ped assessment? ( 3 ways)
Toe to Head
Involving Parent to hold
Use toys
171
Name 5 Hollow Organs
1.Gall Bladder
2. Esophagus
3. Large Intestines
4. Stomach
5. Duodenum
GELS-D
172
Name 4 Solid Organs
1. Liver
2. Spleen
3. Pancreas
4. Kidneys
173
Define Ortho-Static Hypotension
A fall in blood pressure when changing to a standing position.
Also known as posteral hypotension (Dehydration)
Drop in 20 Systolic
and
Increase in 10 Diastolic
and
Increase in 20 HR
174
When Left Ventricle Contracts it gives blood to _________
The Carotid Pulse (The Body)
175
When Right Ventricle Contracts it gives blood to _________
The Lungs
176
S2 Heart sound
is the Dub Sound
The SEMI LUNAR VALVE closing
Aortic and Pulmonic
177
When a Patient Denies or Doesn't Exhibit. This is a _____________
Pertinent Negative
178
What is the First Vital Sign Change in Hemorrhagic Shock
The HR goes up to compensate for fluid loss
179
Name 4 Parts of the Circulator Assessment
1. BP
2. Skin/Temp
3. Cap Refill
4. Pulses
180
What does Pale Skin Indicate?
Poor Perfusion
(Blood shunting to go to core)
181
What lung sound would you expect with Croup
Stridor - High Pitched Crowing Sound
182
Define Difference between Delirium vs Dementia
Delirium - Sudden onset
Dementia - Over time
183
What does checking eyes in a H pattern show?
Extra ocular movement, Cardinal gaze
184
What 2 lung sounds would you expect with Pneumonia
either Rhonchi or Rhales
185
How would a child react to a Babinski test on feet
Foot would extend (backward)
ADULT: Grasp (if not then suspect spinal injury)
186
As we get older what happens to your
BP, HR, and Resp
BP - goes up
HR - goes down
Resp - goes down
187
What is the formula (trick) to know good SYSTOLIC for a 9 year old?
70 + (AGE x 2)
188
What GCS score for: Opens eyes to Pain
2
189
What GCS score for: Incomprehensible Speech
2
190
What GCS score for: Grabbing Hand (Localizing pain)
5
191
Patient in supine and snoring. How would you fix airway
Head Tilt Chin Lift
(TRAUMA: Modified Jaw Thrust)
192
Sleen is where
LUQ (far Left)
PISS
193
Duodenum
The first part of the small intestine leading to the jejunum (connected to the stomach) then the ileum
Duodenum
Jejunum
Ileum
194
What sound do you expect for Asthma
Wheezing
195
What sound do you expect for COPD
Rhonchi
196
What sound do you expect for CHF
Rhales
197
3 Measurements for Lungs
Minute Volume - amount lungs in/ex hale in 1 min
Resp Rate - number of breaths in 1 min
Tidal Volume- the volume of air with each breath
198
3 Measurements for Heart
Stroke Volume - vol of blood from left vent each sys contraction
Cardiac Output - amt of blood pumped in a min
Heart Rate - heart beats per min
199
Decorticate vs Deceribate
DeCORticate - flexing the ARMS (toward core), extending the legs
Decerebrate - extension of BOTH arms and legs
200
Name/Define 7 Breathing Patterns
1. KUSSMUAL's - tachypnea, DKA, Renal failure
2. CHEYNE STOKES - increase and decrease with periods of apnea - ICP, brain injury
3. Ticipnic/ Tachypnic - Fast - Fever, Anxiety, SHOCK
4 . BIOTS - rapid, deep resp, with short pause - CNS, head injury, spinal meningitis
5. APNIC - Absence of breathing - Head injury, stroke, Dead
6. AP NEU STIC - prolonged inspire with short expire - Brain stem lesion
7. EUPNEA - NORMAL
201
What's the worst Score you can give a LAMS test
5
(0-5)
202
6 Parts of the Primary Survey
1. Gen Impression
2. LOC (GCS)
3. ABC (Disability, Exposure)
4. CC, Life Threats
5. Priority
6. Transport
203
CAB before ABC when
CAB for unresponsive patients
204
AVPU
Alert and oriented
Verbal stimuli
Pain
Unresponsive
205
What does the Gall Bladder do
Stores bile
(under liver, RUQ)
206
Where is the Appendix
RLQ
(bottom Right)
207
What does the Liver do
Makes Bile, Filters Blood (clotting)
208
What does the Pancreas do
Makes enzymes for digestion (and hormones)
(under stomach LUQ)
209
Define S1 Sound
LUB
Closure of the mitral and tricuspid valves
210
What cavity stores the Bladder
Pelvic Cavity
211
What is responsible for fight or flight
Adrenal Glands (sits on kidneys)
212
Another word for Abdominal
Peritoneal
213
Normal respiratory for a (healthy) newborn
40
214
Normal systolic BP for (healthy) newborn
70
215
Normal HR for newborn
130
216
Normal HR for 6 y/o
100
217
Normal respiratory for a 6 y/o
20
218
Normal systolic BP for a 6 y/o
