BLOCK 4: PATIENT ASSESSMENT Flashcards
(196 cards)
1
Q
differential vs. working diagnosis
A
differential: list of possible diagnoses based on patient assessment findings
working: one diagnosis from differential list that you are basing your treatment plan on
2
Q
most of your assessment and physical exam can be in any order AFTER ____
A
primary survey and life threats have been addressed
3
Q
what sequence does primary survey use and what’s the exception to it
A
ABCDE (airway, breathing, circulation, disability, exposure)
exception: patient appears lifeless or severe external bleeding, use CABDE
4
Q
what two things make up the history taking part of a patient assessment
A
history of PRESENT illness (OPQRST)
past medical history (SAMPLE)
5
Q
what two things make up the secondary assessment during a patient assessment
A
baseline vitals and monitoring devices (ECG)
systematic physical examination
6
Q
what make up the primary assessment during a patient assessment
A
general impression, mental status
ABCDE
chief complaint
priority decision
7
Q
what is SOAP for an assessment
A
Subjective info (symptoms)
Objective info (signs)
Assessment (differential diagnosis)
Plan (working diagnosis)
8
Q
what is CTC in an assessment
A
skin color, temperature, condition
9
Q
what three systems are the critical systems that balance the body
A
respiratory, cardiovascular, neurological
10
Q
you must ____ whether the patient is sick or not sick, then _____ how sick the patient is
A
qualify
quantify
11
Q
what is a field impression
A
initial summary of the patient’s condition based on presentation and exclusion of other possible causes based on the differential diagnoses
12
Q
two basic patient classifications in prehospital care
A
medical and trauma
13
Q
injury rate of EMS is how many times greater than general workforce
A
3
14
Q
what is it called when a motorist is distracted by trying to view the incident scene
A
“rubbernecking”
15
Q
safety vests must have what
A
a five-point breakaway feature
16
Q
what is delirium and who are at high risk of experiencing this
A
sudden acute change in mental status secondary to a significant underlying factor
meth and crack users
17
Q
MOI vs NOI
A
MOI: mechanism of injury - forces that act on body to cause injury/how a traumatic injury occurs
NOI: nature of illness - general type of illness patient is experiencing
18
Q
if multiple patients have similar symptoms/complaints, suspect what two things
A
carbon monoxide or other noxious agent, or food poisoning
19
Q
applying a cervical collar and backboarding do or do not completely immobilize the spine
A
do not completely immobilize the spine
20
Q
what is the best way to prevent transmission of most diseases
A
hand washing
21
Q
definition of patient safety
A
reduction of risk of unnecessary harm associated with EMS care - best available medical evidence, equipment, technology, and human skill
22
Q
the three exam techniques in patient assessment
A
inspection: looking over patient for abnormalities
palpation: touching to feel for abnormalities
auscultation: listening to sounds within body
23
Q
how long should it take to form a general impression
A
60-90 seconds
24
Q
what do you do with patients who may have no complaints and may not be in any distress
A
give them a “well-patient exam” which is more comprehensive and takes more time
25
the two types of questions on a medical or trauma call
question 1: qualification (is this person sick/hurt?)
question 2: quantification (how sick/injured are they?)
26
what is one of the primary indicators of how sick a patient is
mental status
27
AVPU
alert (responds appropriately)
verbal (responsive to verbal stimuli)
pain (responsive to pain)
unresponsive
28
alert and oriented is measured in what four areas
person, place, time, and event
29
in what order of the A/Os do patients generally exhibit disorientation
forget events, the time, where they are, and then who they are
30
snoring respirations think ____ problem
gurgling sounds think ____ problem
position problem (obstruction by tongue)
blood or vomit in mouth (suction)
31
when patient appears lifeless, how does the ABCDE approach change
CABDE
32
when patient has life threatening bleeding, how does the ABCDE approach change
XABCDE
33
what is considered bradycardia
less than 60bpm
34
what is considered tachycardia
faster than 100bpm
35
what is pallor and what causes it
paleness occurring if arterial blood flow ceases to part of body and from hypothermia
excessive blood loss, anaphylaxis, hypoglycemia, anxiety
36
what is cyanosis
dusky gray or blue skin from low oxygen levels
37
how is the temp of the skin related to the vessels
vasodilation causes temp to rise (fever/hot weather)
vasoconstriction causes temp to drop (shock)
38
what is diaphoresis and how is it caused
excessive/intense sweating caused by stimulation of the SNS
39
what is minute volume in regards to breathing
amount of air move in/out of lungs each minute
multiplying the respiratory rate and tidal volume
40
best measure of breathing adequacy
minute volume
40
general respiration rate for adult patients before treatment is needed
8-24
41
what is jaundice and what causes it
yellow skin
liver dysfunction
42
what is flushed skin and what causes it
red skin
fever, hypertension, allergic reaction, alcohol intake, late sign of CO poisoning
43
what causes mottled skin
cardiovascular shock and disseminated intravascular coagulopathy
44
skin conditions and their possible causes
hot, dry
hot, wet
warm, dry
cool, dry
cool, wet
hot, dry: excessive body heat (heatstroke)
hot, wet: increased internal/external temperature
warm, dry: fever
cool, dry: exposure to cold
cool, wet: shock
45
absence of a palpable pulse in a responsive patient indicates what?
low cardiac output, not cardiac arrest
46
4 medical conditions that cause sudden death
airway obstruction, respiratory arrest, cardiac arrest, severe bleeding
47
components of a mini neuro exam
AVPU scale, pupils, assessment for neurologic deficits (sensation, movement, and grip strength in limbs), GCS
48
glasgow coma scale eye opening scoring
4 - spontaneous
3 - to verbal command
2 - to pain
1 - no response
49
glasgow coma scale verbal response scoring
5 - oriented conversation
4- disoriented conversation
3 - nonsensical speech
2 - unintelligible sounds
1 - no response
50
glasgow coma scale best motor response scoring
6 - follows commands
5 - localizes pain
4 - withdraws to pain
3 - abnormal flexion
2 - abnormal extension
1 - no response
51
what does GCS of 15 indicate
no neurologic disabilities
52
what does GCS of 13-14 indicate
mild dysfunction
53
what does GCS of 9-12 indicate
moderate to severe dysfunction
54
what does GCS of less than 8 indicate
severe dysfunction
55
lowest and highest GCS score possible
lowest: 3
highest: 15
56
what is an apparent life threatening event
episode of combination of apnea, color change, change in muscle tone, and choking/gagging
57
six quality aims that health care should embrace
(STEEEP)
safety, timeliness, effectiveness, efficiency, equity, patient centeredness
58
what type of questions yield more information
open-ended
59
two most important pieces of patient history to obtain
name and chief complaint
60
one of the most critical elements of the interview process is _____
being a great listener
61
what is facilitation communication technique
encouraging patient to feel open to give you any info you need
62
what is reflection communication technique
pause to consider something significant your patient has told you
63
what is clarification communication technique
ask for more info when some aspect of patient history is vague or unclear
64
what is confrontation communication technique
make patient aware of inconsistencies between behavior and your findings
65
what is interpretation communication technique
infer the cause of patient's distress and then ask the patient if you are right
66
what are social history examples
tobacco/alcohol/drug use, sexual behavior, diet, travel history, occupation, housing environment
67
what to do if patient denies neck/back pain after trauma but smells of alcohol
apple manual stabilization anyway
68
what condition causes the patient to be sweaty and restless and often misinterpreted as anxiety or panic
hypoxia
69
situational vs chronic depression
situational: normal reaction to stressful event
chronic: ongoing with no apparent cause
70
confusing behavior is often related to lack of ___ or ___
oxygen, glucose
71
most pediatric problems encountered in the field are ___ or ___ related
respiratory, fluid
72
two types of history important during neonate and infant exams
maternal health history
birth history
73
any patient taking five or more drugs likely has some form of ___
drug interaction
74
what is an iatrogenic condition
caused by medications or other medical treatment and can mask other illnesses that may need immediate medical attention
75
signs vs symptoms
signs: objective observations or measurements
symptoms: subjective information that the patient tells you
76
travel history is useful when suspecting a ____ because people on long flights are susceptible to ____
pulmonary embolism
blood clots
77
when are falls considered a high-energy impact? (adult and children)
adults: greater than 20ft
children: greater than 10ft or 2-3x their height
78
when are MVAs considered a high-energy impact? (6)
intrusion greater than 12in on occupant site or 18in on any site
ejection
death in the same passenger compartment
vehicle telemetry data
vehicle vs. pedestrian greater than 20mph
ATV or motorcycle over 20mph
79
what are pertinent negatives
absence or lack of certain signs/symptoms characteristic of particular illness
80
what is diplopia
double vision
81
what is photophobia
sensitivity to light
82
what is tinnitus
ringing in the ears
83
what is vertigo
sensation of the room spinning
84
what is rhinorrhea
runny nose
85
what is epistaxis
nose bleed
86
what is polyuria
increased frequency of urination
87
what is polydipsia
increased thirst
88
what is polyphagia
increased appetite
89
what is dyspnea
shortness of breath
90
orthopnea
difficulty breathing when lying down
91
hemoptysis
coughing up blood
92
atraumatic bruising is usually an indication of what
a clotting disorder
93
what is hematemesis
blood in vomit
94
what is dysuria
painful urination
95
what is nocturia
waking up in middle of sleep to urinate
96
what is hematuria
blood in urine
97
what is dysmenorrhea
menstrual pain
98
five aspects of critical thinking
concept formation
data interpretation
application of principles
reflection in action (changing course as needed)
reflection on action (debriefing)
99
5 steps of patient assessment starting with scene size up
scene size up
primary assessment
history taking
secondary assessment
reassessment
100
what is a rapid full body scan
60-90second nonsystematic review of patient's body to identify injuries that must be managed immediately
101
open vs. closed injury types
open: abrasions, amputations, avulsions, punctures, penetrations, lacerations
closed: deformities, swelling, burns, contusions, crush injuries
102
inspection vs palpation
inspection: looking at patient
palpating: touching patient
103
what is percussion
gently striking surface of body where it overlies various body cavities
104
what are the additional sets of vital signs after the first set called
serial vital signs
105
what is vital signs trending
trends based on vitals showing patient improvement or deterioration
106
what is blood pressure
measurement of force exerted against walls of blood vessels
107
systolic vs diastolic pressure
systolic: left ventricle contracting (systole)
diastolic: residual pressure in system when left ventricle is relaxing (diastole)
108
what does a drop in diastolic pressure mean
less myocardial perfusion
109
BP cuff should be how big in comparison to the size of the upper arm
1/2 or 2/3rds
110
cuffs that are too small or tight yield ___ pressures and too large or too loose cuffs yield ____ pressures
artificially high
inaccurately low
111
cerumen in the ear canal has what affect on temperature reading
lowers it
112
what is the eupnea waveform and causes
normal breathing
113
what is the tachypnea waveform and causes
rapid, shallow, regular pattern respirations caused by stimulants, exercise, pulmonary/heart disease, anxiety
114
what is bradypnea waveform and causes
decreased rate, regular pattern respirations caused by opioids, sedatives, CO exposure
115
what is apnea waveform and causes
absence of breathing caused by hypoxia, MI, submersion
116
what is hyperpnea waveform and causes
rapid, regular, deep respirations caused by stimulants, overdose, and exercise
117
what is cheyne-stokes waveform and causes
gradual increase/decrease in rate and depth with intermittent periods of apnea caused by pre-death and brain stem injury
118
what is biot-ataxic waveform and causes
irregular pattern, rate, and depth with periods of apnea caused by brainstem injury and increased intracranial pressure
119
what is kussmaul waveform and causes
deep, gasping respiration(extreme tachypnea and hyperpnea) caused by acidosis and diabetic detoacidosis
120
what is apneustic waveforms and causes
prolonged inspiratory phase with shortened expiratory phase and bradypnea caused by brainstem injury
121
oxygen is applied to patients with SpO2 of less than ___
94%
122
what is a sphygmomanometer
BP cuff
123
two pieces to the chest piece of a stethoscope and their different uses
diaphragm (plastic disk) placed FIRMLY on skin to listen to high-pitched sounds like breathing
bell (hollow cup) placed LIGHTLY on skin to listen to low pitched sounds like heart sounds
124
degrees of distress (5)
no apparent distress
mild (slight)
moderate (average)
acute (very great/bad)
severe (dangerous/difficult to endure)
125
who is a focused exam performed on and what is it based on
patients who sustained insignificant MOIs and on responsive medical patients
it is based on the chief complaint
126
two methods commonly used to assess patient's attention
serial 7s (counting backward from 100 by 7s) and spelling backward
127
which two forms of memory to assess and how
remote memory (birthdays, schools attended)
recent memory (today's events)
128
how to assess skin turgor in an older patient
skin of the upper chest
129
what to pay attention to when assessing the skin
CTC (color, temperature, condition)
130
what is ecchymosis
localized bruising or blood collection within or under the skin
131
in what conditions is flushing usually seen
(vasodilation) fever and allergic reactions
132
in what conditions is pallor usually seen
(vasoconstriction) anemia, cardiac events, shock states, hypothermia
133
what are beau lines and what cause them
transverse depressions in nails indicating period of growth inhibition caused by systemic illness, severe infection, or nail injury
134
what is clubbing and what causes it
angle between nail and nail base approaches or exceeds 180 caused by chronic respiratory disease
135
what is psoriasis and what causes it
pitting, discoloration, and subungual thickening of the nail caused by autoimmune disease
136
what is splinter hemorrhages and what causes it
red or brown linear streaks in the nail bed caused by bacterial endocarditis or trichinosis
137
what is Terry nails and what causes it
transverse white bands covering the nail except for the distal tip caused by cirrhosis
138
overly thick nails or nails that have lines running parallel to the finger often suggest ____
fungal infection
139
blood or CSF from ears or nose after trauma suggests what
basilar skull fracture
140
if wheezing is unilateral, suspect ____
if wheezing is bilateral, suspect ____
aspirated foreign body or infection
asthma
141
what does crackles or rales may indicate
heart failure, pneumonia, pulmonary diseases, asthma
142
what does rhonchi indicate and what is usually associated with it
fluid in the larger airways, pneumonia, bronchitis
often associated with a productive cough
143
what is stridor and what does stridor indicate
narrowing, swelling, or obstruction of the upper airway by 85% and is caused by epiglottitis, croup, airway burns, or foreign body obstruction
144
what are pleural friction rubs caused by and what are they associated with
pleural inflammation associated with pain on inspiration
145
what conditions cause decreased breath sounds
pneumothorax, hemothorax, pleural effusion, PE, COPD, opiate intoxication
146
continuous lung sounds suggest ____ process but intermittent sounds suggest ____ process
pathological process
reversible process
147
S3 sound is associated with what
heart failure in patients over 35
148
S4 sound represents what
decreased compliance of left ventricle or increased pressure in atria
149
what are Korotkoff sounds
related to a patient's BP, only 1st and 5th phase are important
150
1st and 5th phase of Korotkoff sounds
Phase 1: tapping sounds increasing in intensity correlating to systolic contraction
Phase 5: all sounds disappear correlating to diastolic pressure
151
what is a lift/heave
perception of heart beating strongly that suggests hypertrophy
152
what is thrill
humming vibration that suggests a bruit or murmur
153
what is a bruit
whooshing sounds heard in carotid arteries that indicates turbulent blood flow in arteries
154
what is a murmur
whooshing sounds heard over heart that indicated turbulent blood flow around a cardiac valve
155
how are murmurs graded
1 (softest) to 6 (loudest)
156
three basic mechanisms producing abdominal pain
1: visceral pain -
2: inflammation -
3: referred pain -
1. when hollow organs are obstructed, causes cramping and diffuse pain
2. inflammation that produces sharp, localized pain
3. originates in a particular organ but is felt in a different location
157
when is an orthostatic change considered positive
systolic BP decreased up to 20
diastolic BP increases more than 10
pulse increases by 20
158
what is ascites
collection of fluid within peritoneal cavity
159
what is rebound tenderness and what is it a symptom of
pain on release of pressure
indicative of inflammation like appendicitis
160
LUQ pain should always be assumed to be ____
the spleen
161
LLQ pain should be suspected of having ____
diverticulitis
162
RLQ pain should be suspect of having ____
appendicitis
163
generalized abdominal pain in women should be suspect of ____
ectopic pregnancy, ruptured ovarian cyst
164
tendons vs ligaments
tendons: muscle to bone
ligaments: bone to bone
165
pathologic vs traumatic fracture
pathologic: normal forces applied to an abnormal bone structure
traumatic: abnormal forces are applied to a normal bone structure
166
bilateral pitting edema occurs with ____ conditions like ____
unilateral edema occurs with ____ conditions like ____
systemic, heart failure
local, deep vein occlusion
167
5 P's of acute arterial insufficiency
pain, pallor, paresthesia, paresis, pulselessness
168
lordosis vs kyphosis vs scoliosis
lordosis: inward curve of lumbar spine above butt
kyphosis: outward curve of thoracic spine
scoliosis: sideways curve of the spine
169
what is the Babinski reflex test
running a pen along the length of the sole of the foot will cause the big toe to flex
170
COASTMAP mnemonic
used for assessing mental status
consciousness, orientation, activity, speech, thought, memory, affect, perception
171
how to assess cranial nerve 1
olfactory - smell - not usually assessed by use ammonia inhalant
172
how to assess cranial nerve 2
optic - vision - ask if they can see your finger in front of their face
173
how to assess cranial nerve 3
oculomotor - movement of eye/eyelid - blinking and follow your finger
174
how to assess cranial nerve 4
trochlear - eye movement - same as nerve 3
175
how to assess cranial nerve 5
trigeminal - chewing, touch of face - patient to smile
176
how to assess cranial nerve 6
abducens - eye movement - same as nerve 3
177
how to assess cranial nerve 7
facial - movement of face/tears - same as nerve 5
178
how to assess cranial nerve 8
(vestibocochlear) auditory - hearing/balance - ask patient to follow spoken commands
179
how to assess cranial nerve 9 and 10
vagus and glossopharyngeal - swallowing - ask patient to smile and swallow
180
how to assess cranial nerve 11
accessory - movement of head/shoulders - ask patient to shrug shoulders
181
how to assess cranial nerve 12
hypoglossal - movement of tongue - ask patient to stick tongue out
182
manual muscle testing scale
scale 0-5
0: no muscle activation
1: twitch
2: without gravity full range
3: against gravity full range
4: against some resistance full range
5: against full resistance full range
183
what is pronator drift
patient closes eyes and holds arms out palms up, if it drifts
184
scoring of deep tendon reflexes
0: no response
1: sluggish
2: active
3: slightly hyperactive
4: hyperactive
185
what is expressive aphasia
difficulty speaking
186
what is paresthesia
tingling or sensory changes
187
two categories of trauma patients
isolated and multisystem
188
which ECG lead is often sufficient for rhythm interpretation
lead 2
189
what is the first set of vital signs called
baseline
190
pupil size is regulated by which cranial nerve
oculomotor (third)
190
what is anisocoria
pupils are asymmetric by greater than 1mm
191
what are Battle signs
discoloration and tenderness of the mastoid process of the skull
192
how often to reassess vitals on stable and non-stable patients
stable: 15 mins
unstable: every 5 mins if possible
193
what is the Cushing reflex indicative of and what are the symptoms of it
head trauma
slow pulse, rising BP, erratic respiratory pattern
194
what is the Beck triad indicative of and what are the symptoms of it
cardiac tamponade
narrowed pulse pressure, muffled heart tones, JVD
