Principles of Patient Assessment Chapter 12 Flashcards Preview

EMR - First on Scene - 9th Edition La Baudour - Bergeron > Principles of Patient Assessment Chapter 12 > Flashcards

Flashcards in Principles of Patient Assessment Chapter 12 Deck (84):
1

Define signs.

Objective indications of illness or injury that can be seen, heard, felt, and smelled by another person.

2

Define symptoms.

Subjective indications of illness or injury that cannot be observed by another person but are felt and reported by the patient.

3

Define scene size up.

An overview of the scene to identify any obvious or potential hazards. It consists of taking BSI precautions, determining the safety of the scene, identifying the mechanism of injury or nature of illness, determining the number of patients, and identifying additional resources.

4

Define interventions.

Actions taken to correct or stabilize the patient's illness or injury.

5

Define patient assessment.

The gathering of information to determine a possible illness or injury; includes interviews and physical examinations.

6

What are the four major components of assessment based care?

1. Scene size up - the scene size up is an overview of the scene to identify any obvious or potential hazards

2. Primary assessment - this is a quick assessment of the patient's airway, breathing, circulation, and bleeding undertaken to detect and correct any immediate life-threatening problems.

3. Secondary assessment - the secondary assessment is a more thorough assessment of the patient and has two subcomponents.
A. History - includes all the information that you can gather regarding the patient's condition as well as any previous medical history.
B. Physical exam - includes using your hands and eyes to inspect the patient for any signs of illness and/or injury.

4. Reassessment -
monitoring the patient to detect any changes in their condition, (this component represents the primary assessment usually done in route to the hospital),
correct any additional life-threatening problems,
repeats vital signs, and
evaluates and adjusts as needed any interventions performed, such as repositioning the patient or increasing supplemental oxygen.

7

What does MOI stand for?

Mechanism of injury

8

What does NOI stand for?

Nature of injury

9

What are the four patient types in the primary assessment?

1. Responsive medical patients
2. Unresponsive medical patients
3. Trauma patients who have significant MOI
4. Trauma patients who do not have significant MOI

10

What are the four steps of assessment for a responsive medical patient?

1. Perform a scene size up and primary assessment.
2. Perform a secondary assessment based on the patient's chief complaint.
3. Obtain baseline vital signs.
4. Perform a reassessment, including the patient's vital signs, in order to identify any changes in the patient's condition.

11

What are the four steps of assessment for an unresponsive medical patient?

1. Perform a scene size up and primary assessment. Care for all immediate life threats first.
2. Perform a rapid secondary assessment to look for signs of illness.
3. Obtain baseline vital signs.
4. Attempt to interview the patient's family or bystanders to determine the patient's chief complaint and NOI.

12

What are the four steps of assessment for a trauma patient with no significant MOI?

1. Perform a scene size up and primary assessment. Include size up at the scene to determine the MOI.
2. Conduct a secondary assessment based on the patient's chief complaint.
3. Obtain baseline vital signs.
4. Perform a reassessment, including vital signs, to identify any changes in the patient's condition.

13

What are the four steps of assessment for a trauma patient with a significant MOI?

1. Perform a scene size up and primary assessment. Include size up at the scene and make note of the MOI.
2. Perform a primary assessment. Manually stabilize the patient's head and neck. Care for any life threats as you detect them.
3. Perform a rapid secondary assessment to look for obvious serious injuries. Simultaneously, begin family and bystanders about the incident. Obtain baseline vital signs.
4. Perform a reassessment, including vital signs, to identify any changes in the patient's condition.

14

What is the primary goal of the scene size up?

Safety

15

What are the six steps of scene size up?

1. BSI precautions
2. Determine if the scene is safe for you, other responders, the patient, and bystanders.
3. Identify the mechanism of injury or nature of illness.
4. Determine the number of patients.
5. Identify any additional resources needed.
6. Consider the need for spinal precautions.

16

Define MOI.

Mechanism of injury - the force or forces that may have caused injury.

17

Define NOI.

Nature of illness - what is medically wrong with the patient; a complaint not related to an injury.

18

After conducting the scene size up, what are the 2 upon arrival that you must do?

1. State your name and identify yourself as a trained emergency medical responder. Let the patient and bystanders know that you are with the EMS system.
2. Gain consent from the patient to provide care.

19

If you arrive on a scene where someone is already providing care to the patient, what should you do?

Identify yourself as an emergency medical responder. If the person's training is equal to or at a higher level than your own, ask if you may assist. You should still identify yourself to the patient and ask if he wishes you to help.

If you have more training than the person who has begun care, respectfully ask to take over care of the patient, and ask them to assist you. Never criticize or argue with anyone who may have initiated care.

20

Explain the purpose of the primary assessment.

The primary assessment is designed to help the EMR detect and correct all immediate threats to life.
Typically, the immediate life threats are the patient's airway, breathing, circulation, or bleeding. Each is corrected as it is found.

21

When does the primary assessment begin?

It is as soon as you reach the patient and gain the patient's consent to treat.

22

What are the 7 components of the primary assessment?

1. form a general impression of the patient.
2. assess the patient's mental status. Initially, this may mean determining if the patient is responsive or unresponsive.
3. assess the patient's airway.
4. assess the patient's breathing.
5. assess the patient circulation.
6. assesses for uncontrolled bleeding.
7. make a decision on a priority or urgency of the patient for transport.

23

What are the three major areas of life threatening problems you are looking for while conducting the primary assessment?

A- Airway
B - Breathing
C - Circulation

24

Define manual stabilization.

Using your hands to physically hold a body part and keep it from moving.

25

Define general impression.

The first informal assessment of the patient's overall condition.

26

What elements are included in the general impression?

Approximate age
Sex
Level of distress or responsiveness

Examples:
I have an approximately 30-year-old male in moderate distress.
I have an approximately 60-year-old female who appears to be unresponsive.

27

Define AVPU scale.

A memory aid for the classifications of mental status or level of responsiveness; the letters stand for:

A - Alert
V - Verbal
P - Painful
U - Unresponsive

28

What is the carotid pulse?

The pulse that can be felt on either side of the neck.

29

What is the radial pulse?

The pulse felt on the thumb side of either wrist.

30

What does assessing the circulation include?

Checking skin signs - color, temperature, and moisture.
(An abnormal finding such as pale, cool, moist skin could indicate a serious circulation problem, such as shock.)

31

Describe patients who are high priority for transport.

A high priority patient should be transported immediately, with little time spent on the scene. High priority conditions include: unresponsiveness, breathing difficulties, severe bleeding or shock, complicated childbirth, chest pain, and any severe pain.

32

Describe brachial pulse.

The pulse that can be felt in the medial side of the upper arm between the elbow and shoulder.

33

Describe capillary refill.

The return or refill of blood into the capillaries after it has been forced out (blanched) by fingertip pressure. Normal refill time is two seconds or less.

34

After you have called for additional resources such as an ambulance or helicopter, it may be helpful to give dispatch an update of the patient's condition, What update info should should be included?

Mental status
Age
Sex
Chief complaint
Airway and breathing status
Circulation status
Interventions and the results

35

When is the secondary assessment performed?

After the primary assessment and all immediately life-threatening issues been found and corrected.

If you have a patient with life-threatening problems where you must continually provide care (CPR) you may not get to complete a secondary assessment.

36

What is the purpose of the secondary assessment?

The main purpose of the secondary assessment is to discover and care for the patient's specific injuries or medical problems.

It is a very systematic approach to patient assessment. It may also tell the patient, family, and bystanders that there is a special concern for the patient and that something is being done for the patient immediately.

37

Describe the components of the secondary assessment.

It includes a physical examination that focuses in on a specific injury or medical complaint, or it may be a rapid exam of the entire body.
It includes obtaining a patient history and taking vital signs. The order in which the steps are accomplished is based on the type of patient emergency.

38

Describe patient history.

A patient history includes any information relating to the patient's current complaint or condition, as well as information about past medical problems that could be related to the current complaint.

39

Describe rapid secondary assessment.

This is a quick, less detailed head to toe assessment of the most critical patients.

40

Describe focused secondary assessment.

The focused secondary assessment is conducted on stable patients. It focuses on a specific injury or medical complaint.

41

Describe vital signs.

These include pulse, respirations, skin signs, and pupils. In some areas, EMR's also include assessment of blood pressure.

The first set of vital signs taken on any patient is referred to as the baseline vital signs. All subsequent vital signs should be compared to the baseline set to identify developing trends.

42

Describe symptoms.

Reported by the patient, symptoms such as chest pain, dizziness, and nausea are felt by the patient. There also called subjective findings.

43

Describe signs.

What you see, feel, hear, and smell as you examine the patient, such as cool, clammy skin or unequal pupils. There also called objective findings.

44

Name some signs of significant MOI for an adult.

Ejection from a vehicle
Death of one or more passengers in a motor vehicle crash
Falls greater than 15 feet
Rollover vehicle collision
High-speed vehicle collision
Vehicle pedestrian collision
Motorcycle crash
Unresponsive or altered mental status
Penetrations of the head, neck, chest, or abdomen

45

Some significant MOI for a child include:

Falls of more than 10 feet
Bicycle collision
Medium speed vehicle collision

46

What is a rapid secondary assessment?

A quick head to toe assessment of the most critical patients.

47

What question should you ask a patient who is alert as part of your patient history?

What is your name?
How old are you?
What is going on today?
How did this happen?
How long have you felt this way?
Are there any current medical problems?
Are any medications being taken?
Do you have any allergies?
When did you last eat?

These questions all focus on the sample report:
S - signs/symptoms
A - allergies
M - medications
P - pertinent past medical history
L - last oral intake
E - events leading to illness or injury

48

When interviewing bystanders, what questions should you ask?

What is the patients name?
If the patient is a minor, ask if the parents are there or if they have been contacted.
What happened?
Did you see anything else?
Did the patient complain of anything before this happened?
Does the patient have any known illness or problems?
Does the patient take any medications?

49

Define BP-DOC.

A memory aid used to recall what to look for in a physical exam. The letters stand for:
B- bleeding
P- pain
D- deformities
O- open wounds
C- Crepitus (grating noise or sensation)

50

Define DCAP-BTLS.

A memory aid used to work call what to look for in a physical exam. The letters stand for:
D- deformities
C- contusions
A- abrasions
P- punctures and penetrations

B- burns
T- tendersness
L- lacerations
S- swelling

51

How long should the rapid secondary assessment take?

No more than 90 seconds

52

Who do you perform a rapid secondary assessment on?

Patients with a significant mechanism of injury (MOI)

53

When is BP DOC checked for?

In a rapid secondary assessment for trauma patient

54

What is step one of the secondary assessment?

Check the head for bleeding or deformities.
Run your fingers through the patients hair looking for blood and check your gloves.
Check the face for pain, deformities, or discoloration.
Check for symmetry of facial muscles by asking the patient to smile or show his teeth.
Look for any fluids that may be coming from the ears, nose, and mouth.

55

What is step two of the secondary assessment?

Examine the patient's eyes for signs of injury. Check the pupils for size, quality, and reaction to light.
Observe the inner surface of the eyelids (conjunctiva). The tissue should be pink and moist. A pale color may indicate poor perfusion.

56

What is step three of the secondary assessment?

Inspect the ears and nose for drainage, either clear or bloody. Clear or bloody fluids in the ears or nose are strong indications of a skull fracture.
Also inspect the nose for singed nostrils, which may indicate the inhalation of toxic smoke. Flaring nostrils may be a sign of respiratory distress

57

What is step four of the secondary assessment?

Inspect the mouth for foreign material, bleeding, and tissue damage.
Look for broken teeth, bridges, dentures, and crowns.
Check for chewing gum, food, vomiting, and foreign objects.

58

What is step five of the secondary assessment?

Check the neck front and back for pain and deformity.
Look for any medical identification jewelry.
Notice if the patient has a stoma or evidence of a tracheal deviation (any shift of the trachea to one side or the other).
Observe for jugular vein distention (JVD) and accessory muscle use.

59

What is step six of the secondary assessment?

Use both hands to inspect the chest front and sides for pain and deformities. If necessary, bear the chest.
Gently apply pressure to all sides of the chest with your hands.
Observe for equal expansion of both sides of the chest.
Note any portion that appears to be floating or moving in opposite directions to the rest of the chest; this is called paradoxical movement. It could indicate an injury called a flail chest in which two or more ribs are fractured in two or more places. When bearing the chest of female patients, provide them with as much privacy as possible.

60

What is step seven of the secondary assessment?

Inspect the abdomen for any signs or symptoms of trauma such as pain, deformities, distention, rigidity, and guarding.
Gently press on each quadrant of the abdomen with the palm side of the fingers, noting any areas that are rigid, swollen, or painful. As you press on the area, ask the patient if it hurts more when you press down or let go.

61

What is step eight of the secondary assessment?

Inspect the pelvis for pain and deformity.
Note any obvious injury to the genital region.
Look for wetness caused by incontinence or bleeding and impaled objects. Do not expose the area unless you suspect there is an injury.
In male patients, check for Priapism, the persistent erection of the penis, which may be a sign of spinal cord injury.

62

What is step nine of the secondary assessment?

Feel the lower back for pain and deformity.
Take care not to move the patient.
Gently slide your gloved hands into the area of the lower back that is formed by the curve of the spine. Check your gloves for blood.
If possible, roll the patient to inspect the entire back for pain and deformity.

63

What is step ten of the secondary assessment?

Examine each leg and foot individually.
Compare one limb to the other in terms of length, shape, or deformity.

64

What is step eleven of the secondary assessment?

Check for distal circulation, sensation, and motor function.
Check the dorsalis pedis pulse, just lateral to the large tendon of the big toe.

65

What is step twelve of the secondary assessment?

Examine the upper extremities from the shoulders to the fingertips.
Examine each limb separately for pain and deformities.

66

What is step thirteen of the secondary assessment?

Check for distal circulation, sensation, and motor function in each hand.
Note any weakness, numbness, or tingling. Observe for evidence of track marks or medical identification jewelry.

67

Define tracheal deviation.

A shifting of the trachea to either side of the midline of the neck caused by the buildup of pressure inside the chest.

68

Define (JVD) jugular vein distention.

An abnormal bulging of the veins of the neck indicating possible injury to the chest or heart.

69

Define accessory muscle use.

The use of the muscles of the neck, chest, and abdomen to assist with breathing effort.

70

Define paradoxical movement.

Movement of an area of the chest wall in opposition to the rest of the chest during respiration.

71

Define guarding.

The protection of an area of injury or pain by the patient; the spasms of muscles to minimize movement that might cause pain.

72

Define track marks.

Small dots of infection that form a track along a vein. It may be an indication of IV drug use.

73

What is the acronym used on a responsive medical patient during secondary assessment and what does it stand for?

OPQRST

O - onset
P - provocation
Q - quality
R - region and radiate
S - severity
T - Time

74

What are the 10 rules of patient assessment?

1. do no further harm
2. if anything about the patient's awareness or behavior does not seem right, consider that something is seriously wrong
3. a patient to appear stable may worsen rapidly. You must be alert to all changes in a patient's condition
4. monitor the patient's skin color for changes
5. look over the entire patient and note anything that appears to be wrong
6. unless you are certain that the patient is free of spine injury, assume every trauma patient has a spine injury
7. tell the patient that you are going to examine him, what you will be doing, and why you are doing it. Stress the importance of the exam
8. monitor vital signs
9. conduct a head to toe exam. If anything looks, sounds, bills, smells, or seems wrong to you or the patient, assume that there is something seriously wrong with the patient
10. failure of the patient to respond properly on any test for sensation or motor function in the leg or arm must be considered a sign of spine injury

75

What are the 3 elements of reassessment?

1. ensure that ABCs are intact
2. reassess vital signs and compare with baseline
3. check and adjust interventions as appropriate, hand-off to EMTs.

76

What information should you communicate when EMTs arrive on scene?

Name and age of patient
Chief complaint
Mental status
ABC's
Physical findings
Patient history
Interventions applied and the patient's response to them

77

For most patients, and EMR's assessment begins with performing a scene size up followed by:
A. a secondary assessment
B. a primary assessment
C. obtaining vital signs
D. determining the nature of illness

B. a primary assessment

78

After arriving on scene, but before making patient contact, you should:
A. perform a primary assessment
B. contact medical direction
C. perform a secondary assessment
D. take BSI precautions

D. take BSI precautions

79

There are 6 components to the primary assessment, beginning with:
A. assessing the patient's mental status
B. assessing the patient's airway
C. forming a general impression
D. evaluating patient circulation

C. forming a general impression

80

The assessment of the patient's mental status or responsiveness include using what scale?
A. AVPU
B. ABC
C. SAMPLE
D. BP-DOC

A. AVPU

81

In a sample history, the E represents:
A. EKG
B. evaluation of the neck and spine
C. events leading to illness or injury
D. evidence of airway obstruction

C. events leading to illness or injury

82

When assessing circulation for a responsible adult patient, you should assess the:
A. carotid pulse
B. radial pulses on both sides of the body
C. the radial pulse on one side
D. distal pulse

C. the radial pulse on one side

83

When assessing a trauma patient with no significant mechanism of injury, perform a focused secondary assessment, followed by:
A. rapid physical exam
B. SAMPLE history
C. rapid trauma assessment
D. vital signs

C. rapid trauma assessment

84

There are 10 rules for a patient examination, the first of which is always:
A. if patient behavior does not seem right consider that something is seriously wrong
B. do no further harm
C. take vital signs
D. watch for skin color changes

B. do no further harm