week 3: primary, secondary & focused assessment Flashcards
Disability: AVPU
A__
r__ to V__ s__
r__ to P__ s__
U__ & U__
alert
responsive to verbal stimulus
responsive to painful stimulus
unconscious & unresponsive
Breathing Assess for e\_\_ r\_\_ - assess air entry to the l\_\_ - assess s\_\_ & m\_\_ m\_\_ c\_\_ - check c\_\_ w\_\_: m\_\_, e\_\_, s\_\_
effective respirations
lungs
skin & mucous membrane colour
chest wall movement, expansion, symmetry
Send for help if you cannot elicit a r__ OR there is d__
response OR there is danger
Disability: assessment of (C\_\_) function
what are the 2 acronyms for disability?
CNS
AVPU
PEARL
when is a primary assessment performed?
s__ after the person is a__ to a h__ s__
or
when you f__ e__ their r__
shortly, admitted, healthcare service
first enter their room
Airway & c-spine
ensure airway is p__
- perform a h__ t__ & c__ l__ m__ to open airways
assess for airway c__
Use a j__-t__ m__ if you suspect a spinal injury
patent
head tilt & chin lift manoeuvre
compromise
jaw-thrust manoeuvre
Circulation: check for signs of i\_\_ c\_\_ c\_\_ - assess c\_\_ pulses - assess pulse r\_\_ & q\_\_ - assess skin c\_\_ & w\_\_ - assess c\_\_ r\_\_ - assess/manage internal & external h\_\_ - a\_\_ to hear the \_\_ & \_\_ h\_\_ s\_\_
impending cardiovascular collapse central rate & quality colour & warmth capillary refill haemorrhage auscultate, S1 & S2 heart sounds
what acronym is used for a primary assessment?
DRS ABCDE
Primary assessment:
D__
R__
S__ for h__
A\_\_ & c-s\_\_ B\_\_ C\_\_ D\_\_ E\_\_ & E\_\_
danger
response
send for help
airway & c-spine breathing circulation disability exposure & environment
Disability: PEARL
check p__ r__ & c__ r__
pupil response & consensual reaction
a primary assessment:
is r__ & used to identify l__ t__ conditions, to allow for p__ m__
enables care to be p__
helps recognise when m__ s__ nursing & medical help is required
rapid, life threatening, prompt management
prioritised
more senior
Disability:
limb assessment for s__ & s__
ask about p__
check for r__ causes of r__ c__
strength & sensation
pain
reversible causes of reduced consciousness
Exposure & environment
remove c__ to e__ patient as r__
- maintain b__ t__
- assess for signs of i__, t__ or i__
ensure e__ e__ is available at b__
remove clothing to expose patient as required
body temperature
assess for signs of injury, trauma or illness
ensure emergency equipment is available at bedspace
Primary assessment:
i__ > c__ > r__-a__
identify > correct > re-assess
