Objective Assessment

Question 1

End-o-bed-o-gram

Answer 1

While the patient is still in the bed
First initial look and impression of the patient
Look well or sick?
Conscious/ alert?
Doing something?
Change how they present with a medical professional in the room, might become distressed

Question 2

Observation charts and NEWS2

Answer 2

Higher the number the more unwell the patient
Tracts the patients vitals like oxygen saturation, respirations, blood pressure, pulse, consciousness, temperature

Question 3

Normal values: oxygen saturation (SpO2)

Answer 3

94-98%

Question 4

Normal values: respiratory rate (RR)

Answer 4

12-16

Question 5

Normal values: pH

Answer 5

7.35-7.45

Question 6

Normal values: pCO2

Answer 6

4.7-6.0 kPA

Question 7

Normal values: pO2

Answer 7

10.7-13.3 kPA

Question 8

Normal values: HCO3

Answer 8

22-26 mmols

Question 9

Normal values: BE

Answer 9

-2 to +2 mmols

Question 10

Normal values: heart rate (HR)

Answer 10

60-100 bpm

Question 11

Normal values: blood pressure (BP)

Answer 11

120/80

Question 12

Normal values: systolic blood pressure

Answer 12

95-140

Question 13

Normal values: diastolic blood pressure

Answer 13

60-90

Question 14

Normal values: urine output

Answer 14

0.5-1 ml per kg/hour (ml/kg/hour)

Question 15

Normal values: ear temperature

Answer 15

35.7-38 centigrade

Question 16

Normal values: capillary refill test (CRT)

Answer 16

Less than 2 seconds

Question 17

Consent

Answer 17

Related to the individual activities so needs to be sought at each stage of the assessment process
Relevant again when it comes to treating the patient

Question 18

A-E assessment

Answer 18

Airway
Breathing
Circulation
Disability (conscious state)
Exposure

Question 19

Airway: look

Answer 19

Type - own; nose or moth, adjunct, artificial
Patient - can air flow through, not obstructed e.g. tongue, food, mucus or secretion

Question 20

Airway: listen

Answer 20

Abnormal sounds - stridor, gurgling, wheeze, snoring
No sound - completely obstructed, air wont pass

Question 21

Airway: feel

Answer 21

Air movement - feel air out through mouth, feel the lungs expand

Question 22

Breathing: look

Answer 22

Colour - cyanosis; blue tinge, lack of oxygen
Mode of ventilation - self, non-invasive, ventilated
SpO2 and FiO2 - oxygen saturation and fraction of inspired oxygen
Pattern of breathing - how chest expanding
Accessory muscles
Sputum - dark, blood, thickness
ABGs
Chest x rays

Question 23

Breathing: listen

Answer 23

Able to speak
Auscultation - 10 points on the front and 12 points on the back
Cough - strong, productive
Percussion note - middle finger on rib space then tap, lots of air then a louder sound, fluid than a stony dull sound, consolidation than a dull sound

Question 24

Breathing: feel

Answer 24

Chest wall movement - apical vs diaphragmatic, expansion
Tactile fremitus - feeling sputum, bubbling

Question 25

Circulation: look

Answer 25

Colour - loss blood to the toes and fingers, blue Heat rate and rhythm - ECG Blood pressure Capillary refill time - colour return to the nail bed Temperature - core, 37.5 Urine output and colour Fluid balance - in and out, heart failure restrict Limb oedema - heart failure, long standing

Question 26

Circulation: listen

Answer 26

Blood pressure - manual, hearing for heart beat

Question 27

Circulation: feel

Answer 27

Pulse - heart rate, strength and regularity Skin temperature - cold peripherally Asses for pitting oedema - swelling, DVT, press hand on the swelling and it leaves a mark/imprint

Question 28

Disability - look

Answer 28

Level of consciousness - high CO2 levels to become drowsy, ACVPU; alert, confused, voice, pain, unresponsive Pupils Blood sugars - very low means they might be unresponsive

Question 29

Disability: listen

Answer 29

Verbal responses - appropriate, add up to the conversation Agitation Pain - VAS

Question 30

Exposure: look

Answer 30

Patient position - slump, sitting, lying, leaning forwards, changing position so function better Body habitus - physiological state, size, body shape; scoliosis Muscle wasting Attachments - e.g. drugs, drips, catheters Wounds/ dressings Signs of infection or bleeding Finger clubbing Nicotine stains Mobility aids General condition of the patient

Question 31

Exposure: listen

Answer 31

Chest drains - bubbling, swinging Alarms - attached to monitoring, check with others, may need medical assistance

Question 32

Exposure: feel

Answer 32

Skin temperature - wound, infection ROM/ muscle strength - can they actually do what we want them to do

Question 33

What are the problems that we are hoping to identify

Answer 33

Loss of lung volume Sputum retention Increased work of breathing Respiratory failure - type 1 or type 2 Reduced exercise tolerance Pain Fatigue Or a combination of the above

Question 34

Documentation

Answer 34

SOAP - Consent; subjective findings. Objective findings. Interpretation of those findings. Plan Add further as we progress into treatment Must have legal identifiers - patients name an date of birth, date when writing, printed your name, designation; student physio