Medical Patient Assessment Flashcards
(81 cards)
1
Q
introduction to patient assessment
A
- one of the most important skills you will develop is the ability to assess a patient
- identify your patients problems -> always do CC first**
- set your care priorities
- develop a differential diagnosis
- develop a patient care plan
- execute your plan
2
Q
sick versus not sick
A
- determine whether the patient is sick or not sick
- if the patient is sick -> determine how sick
- every time you assess a patient…:
- ask yourself whether your patient is sick or not sick
- quantify how sick the patient is
3
Q
scene size-up
A
- evaluate overall safety and stability of the scene
- important to protect yourself first
- safe and secure access into the scene
- ready egress out of the scene
- specialty resources needed
- is PPE requires?
- first step of patient assessment process is the scene size up
- during the size up you also make a determination of the mechanism of injury or nature of the patients illness
4
Q
mechanism of injury (MOI)
A
- forces that act on the body to cause damage
- is it a medical complaint?
- is a traumatic complaint?
5
Q
nature of illness (NOI)
A
- general type of illness a patient is experiencing
- what is their chief complaint?**
- the patient is the most knowledgeable about what’s going on with them and how they have been treated in the past
6
Q
standard precautions
A
- treat all patients as potentially infectious
- wear: gloves (wash hands* after removal), eye protection, gown, HEPA or N95 mask
- personal protective equipment (PPE)
- clothing/equipment that provide protection against substances posing health/safety risk
- ex. steel toe boots, helmets, heat-resistant outerwear, self-contained breathing apparatus
7
Q
primary assessment: form a general impression
A
- based on initial presentation and CC
- first step is to form a general impression of the pts condition
- identify threats to the ABCs -> these life threats should be addressed immediately
- make conscious, objective, and systematic observations
- is patient stable or unstable, sick or not sick
- observe level of consciousness
- determine your priorities of care
- is the situation an emergency
- are they sick or not sick
- is the patient conscious and alert -> (this is different from if they are answering questions appropriately)
- once life threats have been addressed in the primary assessment move onto history taking
8
Q
assess the airway
A
- is airway open and patent
- listen for noisy breathing
- if they are talking the airway must be fairly open
- open the airway and position the patient properly
- move from simple to complex: position**, obstruction
- people with trouble breathing want to lay down bc they are tired but sitting up straight will help them
- fore all unresponsive patients:
- establish responsiveness and assess breathing
- if ineffective or absent, open the airway
- mechanical means require an airway adjunct
9
Q
assess breathing
A
- is the patient breathing?
- if not -> you must breathe for him or her
- if so -> is he or she breathing adequately
- consider minute volume -> respiratory rate multiplied by the tidal volume
- assess breathing/respiratory rate (normal 12-20/min)
- look for chest rise and fall
- assess for breathe sounds and air movement
10
Q
assess circulation
A
- palpate the pulse: count # of beats in 15 seconds and multiply times 4 (normal 60-100)
- less than 60 -> bradycardia
- more than 100 -> tachycardia
- what other symptoms do they have if they are bradycardic or tachycardic
- force: normal feels “full”
- rhythm: normal is regular
- report your findings:
- rate, force, and rhythm
- inspect skin for obvious signs of bleeding
11
Q
capillary refill
A
- evaluates ability to restore blood
- assessing circulation
- low blood pressure and low hydration status is slow capillary refill
- to test:
- place thumb on patients finger and compress
- remove pressure
- adequate perfusion: color restored within 2 seconds
12
Q
assess and control external bleeding
A
- perform a rapid exam
- venous bleeding -> is steady dark red blood flow
- arterial bleeding: spurting flow of bright red blood -> pulsating flow
- capillaries bleeding: slow flow of blood
- evaluate unresponsive patients by running your gloved hands from head to toe
- use a tourniquet
13
Q
identify and treat life threats
A
- conditions that can cause sudden death: airway obstruction, respiratory arrest, severe bleeding
- determine if a life threat is present and, if so, immediately address it
- a patient who is dying will…:
- become less aware of surroundings
- stop making attempts to communicate
- lose consciousness
- have inadequate respiratory pattern
- become unresponsive to external stimuli
- muscles of the jaw will become slack
- life threat > CC
14
Q
perform a rapid exam
A
- guidelines:
- inspect
- palpate
- auscultate- process of listening with stethoscope
- history taking:
- gain information about the patient and the events: surrounding the incident
- ask open ended questions, avoid leading
- ask age appropriate questions (normal language)
- be patient
15
Q
techniques for history taking
A
- appearance and demeanor:
- clean, neat, and professional
- good attitude
- ID your service and certification level
- try to interview in a private setting
- make eye contact
16
Q
responsive medical patients
A
- chief complaint (CC)
- should be recorded in patients own words
- should include:
- what is wrong
- why treatment is being sought
- how long have they had this CC
17
Q
OPQRST (for responsive patients)
A
- onset- when did it start
- provocation- does anything you do make it better or worse
- quality- what does it feel like (tight, pressure)
- region/radiation/referral- does (pain) it go anywhere else
- severity- pain on a scale of 1-10
- time- how long has this been occurring
18
Q
SAMPLER (for responsive patients)
A
- signs and symptoms
- allergies
- medications
- pertinent past history- medical history
- last oral intake- what did they eat
- events that led to injury or illness
- risk factors- histories of disease
19
Q
past medical history should include (for responsive patients)
A
- current medications and dosages
- allergies
- childhood illnesses
- adult illnesses
- past surgeries
- past hospitalization and disabilities
- any prior history of this particular condition
- family history
- travel history
20
Q
unresponsive patients
A
- rely on…
- head-to-toe physical examination
- normal diagnostic tools
- family and friends
- look for clues -> pill containers, medical jewelry
21
Q
communication techniques
A
- pay attention to signs or symptoms that are inconsistent with working diagnosis
- differential diagnosis
- what could it alternately be?
- encourage dialogue- use layperson terminology
22
Q
differential diagnosis
A
- a working hypothesis of the nature of the problem (what could it alternately be?)
- multiple diagnosis that could be true for your patient
23
Q
getting history on sensitive topics
A
- alcohol and drug abuse
- alcohol and drugs can mask symptoms they are having
- patients may give an unreliable history
- alcohol can mask signs and symptoms
- keep a professional attitude
- domestic violence
24
Q
special challenges in history taking
A
- limited education or intelligence
- language barriers
- hearing problems
- visual impairment/ blindness
- go to family and friends
25
secondary assessment
- process by which quantifiable, objective information is obtained from a patient about his or her overall state of health
- including obtaining vital signs and performing head to toe survey
- if the patient is stable take vital signs every 15 minutes
- if the pt is unstable take vitals every 5 minutes
- inspection, palpation, percussion, and auscultation
- consists of two elements:
- 1. obtaining vital signs
- 2. performing a head to toe survey
26
inspection
-looking at a patient
27
palpation
- touching to obtain information
- pulses- use finger
- skull- use palms
- skin- use back of hand
28
percussion
- striking surface of the body, typically where it overlies various body cavities
- detects changes in the densities of the underlying structures
- density of organs
29
auscultation
- listening with a stethoscope
- you listen to belly, lungs
- requires:
- keen attention
- understanding of what "normal" sounds like
- lots of practice
30
vital signs: pulse
- assess rate, presence, location, quality, regularity
- to palpate, gently compress an artery against a bony prominence
- count for 15 seconds and multiply by four
- check for central pulse in unresponsive patients
- normal pulse rate between 60-100 for adults
- is quality ok? -> weak thready pulse -> circulation can be bad
31
vital signs: respiration
- assess rate by inspecting the patients chest
- quality:
- pathologic respiratory patterns or rhythms
- tripod positioning, accessory muscle use, retractions
- rate should be measured for 30 seconds and multiplied by two for pediatric patients
32
vital signs: blood pressure
- product of cardiac output and peripheral vascular resistance
- systolic pressure- top #
- diastolic pressure
- measured using a cuff
- ideally should be auscultated
- normal bp - 120/80
33
vital signs: pulse oximetry
- should never be used as an absolute indicator of the need for oxygen
- measure percentage of hemoglobin saturation
- measures how much oxygen is on the RBC
- oxygen saturation
- normal - 94 or greater (100)
34
physical examination
- looks for sings of significant distress
- other aspects:
- dress
- hygiene
- expression
- overall size
- posture
- untoward odors
- overall state of health
35
mental status
- for any patient with a "head" problem, assess and palpate for signs of trauma
- awake and alert doesn't mean the cognitive function is ok
- what the baseline - what is the normal mental status of the patient (maybe history of dementia)
- assess the patients in four areas:
- person
- place
- day of week
- the event
36
level of consciousness
- AVPU
- Alert
- Verbal stimuli
- painful stimuli
- unresponsive
37
pallor
- poor red blood cell perfusion to capillary beds
- pale
- duscy
- dehydrated
- hypoperfusion (losing blood)
38
vasocontriction
-indicated by pale skin
39
cyanosis
- low arterial oxygen saturation
- turning blue
- not enough oxygen
- may be hypoxic
40
mottling
severe hypoperfusion and shock
- intense pallor
- no more perfusion
- tissue necrosis
- no color
41
ecchymosis
- localized bruising or blood collection within or under the skin
- bruising of skin
42
turgor
relates to hydration
43
skin lesions
-may be only external evidence of a serious internal injury
44
cranium
- contains the brain
- occiput- posterior portion
- temporal regions- reach side of the cranium
- parietal regions- between temporal regions and occiput
- frontal region- forehead
- the scalp covers the cranium
45
meninges
-suspend the brain and spinal cord (dura matter, arachnoid, pia matter)
46
cerebrospinal fluid
fills between meninges
47
assessing pupils
- normally round and equal size
- pupils should react instantly to change in light level
- check for size, shape and symmetry, and reaction to light
- pinpoint pupils- overdoes
- fixed and dilated pupils- head trauma
- ones normal and the other is dilated- brain bleed
48
ABC's
- airway, breathing, and circulation
| - look at these to see if the patient is alive
49
normal respiratory rate
12-20 breaths per minute
| -check how many times the chest rises and falls for 30 seconds and multiply by 2
50
throat
- evaluate mouth, pharynx, and neck
- prompt assessment is mandatory in patients with altered mental status
- assess for a foreign body or aspiration
- aspiration- see if there is any fluid in the lungs (contents in the stomach go back up into the lungs) -> aspiration pneumonia
- be prepared to assist with manual techniques and suction
- inspect airway for obstruction
51
mouth/lips
- symmetry
- gums
- look for cyanosis around the lips
52
chest
- auscultate breath sounds
- normal
- tracheal
- bronchial
- bronchovesicular
- vesicular
- adventitious
- wheezing, rales, rhonci, stridor, pleural friction rubs
- are sounds:
- dry or moist? continuous or intermittent? course or fine?
- are breath sounds diminished or absent?
- in a portion of one lung entire chest?
- if localized, assess transmitted voice sounds
- absent lung sounds -> pneumothorax
53
cardiovascular system
- pay attention to arterial pulses
- obtain blood pressure and repeat
- note history and class of hypertension
54
tripod positioning
- sitting down
- leaning forward
- hands on legs
- may be panting
- shows respiratory distress
- maybe asthma
- pt is doing their best to breathe
- pursed lips
55
accessory muscle use
- you can see between the intercostal spaces
- pt with trouble breathing
- intercostal muscles are contracting and expanding
56
hypotensive
-systolic of 99 or lower
56
hypotensive
-99 or lower
57
hypertensive
-systolic greater than 140
58
GCS- glasgow coma scale****
- assessment tool
- used to measure the cognitive function of the pt
- looks at eye opening, verbal response, and motor response
- 1. eye opening- spontaneous (4), to verbal command (3), to pain (2), no response (1)
- 2. verbal response- oriented and converses (5), disoriented conversation (4), speaking but nonsensical (3), moans or makes unintelligible sounds (2), no response (1)
- 3. motor response- follows commands (6), localized pain (5), withdraws to pain (4) decorticate flexion (3), decerebrate extension (2), no response (1)
- higher GCS (15)- no neurologic disability
- 13-14- mild dysfunction
- 9-12- moderate to severe dysfunction
- 8 or less- severe dysfunction (lowest possible is 3)
59
wheezing
- lungs are constricted
- lower airway constriction
- COPD
- asthma
60
rales
- pneumonia
- congestive heart failure
- fluid that develops in the lung alveoli
- you can hear the fluid in the chest
- lower airway obsutrction
61
stridor
- high pitch lung sound (not really in the lungs)
- happen in the throat
- constriction of the upper airway
- may be an upper airway obstruction
62
aortic aneurysm
- may be seen pulsating in the upper midline
- do not palpate an obvious pulsatile mass -> could burst
- dilates -> aneurysm
- wall of aorta burst or starts to expand
- bursts -> dissection (once it starts penetrating the wall
63
100-139
normal blood pressure
64
hernia
- place patient in supine position and raise the head and shoulders
- bulge of hernia will usually appear
65
common musculoskeletal injuries
- fractures
- sprains
- strains
- dislocations
- contusions
- hematomas
- open wounds
66
musculoskeletal system
- structure and function
- check for pulse
- limitation or pain in range of motion
- bony "crepitus" -> broken ribs
- crepitus- you can feel the shattered bones -> indicates broken ribs
- inflammation or injury
- obvious deformity
- diminished strength
- atrophy
- asymmetry
- pain
67
spine
- consists of 33 individual vertebrae
- anchoring point for the skull, shoulders, ribs, and pelvis
- protects spinal cords
68
nervous system
- central nervous system: brain and spinal cord
- brain: cerebrum, cerebellum, and medulla
- except for cranial nerves, nerves are channeled to the brain via the spinal cord
- motor nerves control motion or movement
- sensory nerves send external signals to the brain
- peripheral nervous system: remaining motor and sensory nerves
69
cranial nerves* know them
- 1. olfactory
- 2. optic
- 3. oculomotor
- 4. trochlear
- 5. trigeminal
- 6. abducens
- 7. facial
- 8. vestibular/
70
delirium
- consistent with an acute sudden change in mental status
- happen right away
- can happen at any time
- can be treated
71
dementia
- chronic
- happen over time
- cant go away
- representative of deterioration of cognitive cortical functions
- chronic changes over time
72
capnography
- measures carbon dioxide output and provides a waveform
- normal value
- measure the CO2 you are breathing out
- capnometry- measure CO2 output
73
monitoring devices
- most take only a few seconds
- should be calibrated regularly
- continuous ECG monitoring, 12 lead ECG, carbon dioxide monitoring, blood chemistry analyses, and cardiac biomarkers
74
blood glucometer
- can obtain reading in 2 ways in the field:
- from the hub of an IV catheter
- from a finger stick
75
other blood tests
- basic and complete metabolic profile
- brain natriuretic peptide (BNP) test
- arterial blood gases
76
reassessment of mental status and ABCs
- Compare LOC with baseline assessment
- Review the airway
- Reassess breathing, circulation, pulse
- Response of pediatric and geriatric patients may differ
- Children decompensate very quickly
- Geriatric patients may not show signs of deterioration
77
summary
- patient assessment is the most important skill a provider has
- patient assessment has 5 components
- 1. scene size up
- 2. primary assessment
- 3. history taking
- 4. secondary assessment
- 5. reassessment
- another important step in protecting yourself is to take standard precautions
78
history taking
- after primary assessment (life threats are solved) you can ,move onto history taking
- primary means of diagnosing the chief complaint
- first part of a patients history also serves as a good mental status examination
- ask for the pts name, date, time, location, chief complaint, and events leading up to the request for assistance
79
infants and children
- alter your approach when dealing with infants and children
| - after primary assessment -> reassessment is the single most important assessment process you will perform
80
reassessment
- gives you opportunity to reevaluate the chief complain and to reassess interventions to ensure that they are still effective
- patient in stable condition should be reassessed every 15 minutes
- patient unstable condition should be reassessed every 5
