Chapter 13: Patient Assessment

paramedic studies

170 cards·by nasonrumfield

2017

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What must you do if you encounter a "life threatening condition?"

Treat immediately before continuing with any other steps

What is the tilt test used for?

To assess volume depletion

Unconscious, unresponsive medical patients are always considered:

unstable and a high risk

Physical examination is the process by which information is obtained using which two types of information?

Objective and subjective

When faced with an unstable scene, what should you do if law enforcement is not present?

Retreat to a safe distance

What is the physical touching as a means of assessing a patient known as?

Palpation

When should gathering a patient's medical history and performing a secondary assessment should occur?

after life threats have been identified and corrected in the primary assessment

In prehospital care, the priorities of evaluation and treatment are based on:

the degree of threat to the patient's life

When determining whether a patient is sick, your MOST effective tool is often:

a quick visual assessment

You will MOST likely develop your field impression of a patient based on the:

chief complaint and patient history

What is the best and most accurate place to take the pulse of an infant under 1 year of age?

Brachial artery

DCAP-BTLS helps you to remember the steps in a focused physical exam. What do these letters stand for?

Deformities, Contusions, Abrasions, Punctures/penetrations, Burns, Tenderness, Lacerations, Swelling

The chest produces a hyporesonance during percussion when the thorax is full of what?

blood

What unspoken signs may affect a frightened patient?

Body language

Jugular Venous distention is most often present in which medical condition?

Right-sided heart failure

If a patient has no response whatsoever, what is the patient's Glasgow Coma Scale score?

Which of the following breath sounds indicates an upper airway obstruction?

Stridor

When assessing a patient's airway, what should be done first when you hear snoring, gurgling, or bubbling sounds?

reposition the airway

A blood pressure cuff that is too small or too tight will give what type of reading?

False high

What is the best form of questioning to use when interviewing a patient?

Open ended

What are the two most important pieces of information to obtain during a history taking?

Name and chief complaint

What are the two most important aspects of the primary assessment?

Identify and correct any life threats

Assessing a patient's pulse gives a rapid check of what important things?

Heart rate and rhythm

When performing a primary assessment, quickly determine the patient's

Respiratory status

If the patient is sick, what is the next most important factor?

If the condition is life threatening

What are the steps of a scene size-up?

1: standard precautions - 2: scene hazards - 3: mechanism & nature of condition/trauma - 4: number of pts - 5: need for additional resources

What does AVPU stand for?

ALERT - responds to VERBAL stimulus - responds to PAINFUL stimulus - UNRESPONSIVE

Which of the following significant mechanisms of injury is unique to the infant and child?

Fall from greater than 10 ft

What does having hypercarbia lead to?

confusion and sleepiness

What painful procedures are most effective in testing patient response?

central: trapezius pinch, supraorbital pressure, sternal rub, earlobe pinch, armpit pinch - peripheral: nail bed pressure

What are sounds of partial airway obstruction?

snoring: obstructed airway by tongue - crowing: muscles around larynx/trachea narrow - gurgling: liquid in airway - stridor: swollen larynx

What do the chemoreceptors in our brain do?

sense carbon dioxide and stimulate breathing

If you have found CSF on a patient, what have you found?

Cerebral spinal fluid

What are the numeric ratings on the Glasgow Coma Scale in relation to a patient's "eye opening?"

spontaneous: 4 - to verbal: 3 - to pain: 2 - none: 1

What are the numeric ratings on the Glasgow Coma Scale in relation to a patient's "verbal response?"

orientated and converse: 5 - disoriented and converse: 4 - inappropriate words: 3 -incomprehensible sounds: 2 - none: 1

What are the numeric ratings on the Glasgow Coma Scale in relation to a patient's "motor response?"

obey commands: 6 - localize pain: 5 - withdraws from pain: 4 - abnormal flexion to pain: 3 -extension to pain: 2 - none: 1

What is "orthopnea?"

difficulty breathing while lying flat

Your patient will MOST likely develop a good first impression of you if you:

look and act professional and confident

After determining that the scene is safe, the FIRST step in approaching a patient is to:

introduce yourself to the patient

When a patient presents with two seemingly unrelated complaints, it is MOST important for the paramedic to determine:

which complaint has a higher priority

The paramedic should address a patient:

as the patient wishes to be addressed

Paying attention, making eye contact, and repeating key information from the patient's answers are examples of:

facilitation

Pausing to consider something significant that you have just been told is called:

reflection

An empathetic attitude:

puts you in your patient's shoes

Your patient says, "I can't catch my breath." In response, you state, "That's very helpful. Let me think about that for a moment." This is:

reflection

If you suspect that a patient has been abused, it is MOST important that you:

request law enforcement personnel if necessary

When asking questions pertaining to a patient's sexual history, it is important to remember that:

obtaining the history in a private setting is essential

A patient who is overly talkative during your assessment:

may have abused methamphetamines

The paramedic must always keep in mind that the information he or she fails to obtain:

may be the information needed to provide appropriate care

If a patient's family member is hostile and begins shouting at you, you should:

tell the person that if he or she continues to shout, you will not feel safe and will need to call law enforcement

Which of the following statements regarding an intoxicated patient is correct?

While the patient is trying to explain things to you, his or her anger can escalate faster than if he or she were not intoxicated

What is "Situational depression?"

a reaction to a stressful event in a patient's life

A patient who gives the emergency department physician completely different informationthan he or she gave to you in the field:

may have an organic condition, such as a brain tumor

When your patient is a non-English-speaking person, his or her child is often able to function as an interpreter because:

children quickly absorb a new language in school

What is Objective patient information based on?

fact or observation

A conscious patient's respiratory rate should be measured:

for a minimum of 30 seconds

What factor would likely NOT skew a pulse oximetry reading?

Hypertension

Which of the following statements regarding your general survey of the patient is correct?

It is not uncommon for patients in severe pain to present with a quiet and still affect

A patient who does not respond to verbal or tactile stimuli is:

unresponsive

Poor skin turgor in an infant or child is MOST indicative of:

dehydration

The pulse of the superficial temporal artery can be felt:

just anterior to the ear, in the temporal region

Bulging of a child's anterior fontanelle is:

pathologic when observed in a quiet child

When assessing visual acuity in the prehospital setting, you should:

examine each eye in isolation

Asymmetry of the pupils:

must be correlated with the patient's overall presentation

An opaque black area against the red reflex of the eye is indicative of:

cataracts

Swollen lymph nodes in the anterior neck usually indicate:

an infection

What does percussion of the chest produce if the pleural space is full of blood?

A dull sound

What does S1 (the first heart sound) represent?

closure of the mitral and tricuspid valves

When auscultating heart sounds, you should place your stethoscope where?

fifth intercostal space, over the apex of the heart

To appreciate the S1 sound, you should...

ask the patient to breathe normally and hold his or her breath on expiration

Distention of the jugular veins indicates:

increased venous capacitance

A patient who is absolutely still and resists any movement should be suspected of having:

peritonitis

What is often less localized on palpation and usually poorly described by the patient?

Visceral abdominal pain

A pathologic fracture occurs when:

normal forces are applied to abnormal bone structures

Structural integrity of the pelvis should be assessed by:

gently pushing in and down on the iliac crests

Lower extremity shortening and/or internal or external rotation are findings often associated with:

proximal lower extremity injury

You would MOST likely encounter bilateral dependent edema in a patient with:

heart failure

At its worst, kyphosis can become a source of:

restrictive lung disease

If a patient is able to sense smell, his or her _____ nerve is intact.

olfactory

The vestibulocochlear nerve is responsible for the functions of:

hearing and balance perception

If a patient's trigeminal nerve is intact, he or she should be able to:

clench his or her jaw

In contrast to dementia, delirium is:

an ACUTE change in mental status

Proper documentation of your physical examination of a patient is MOST important because it:

ensures an accurate historical accounting of the patient's problems prior to entering the hospital

What hazard would you LEAST likely encounter at the scene of a motor vehicle crash?

Unruly patient

The general type of illness a patient is experiencing is called the:

nature of illness

Whether your patient's problem is medical or traumatic in origin, you must:

qualify and quantify the patient's condition

After performing your primary assessment of a patient, your next action should be to:

decide what care is needed at the scene versus en route to the hospital

Cognitive function can be MOST accurately defined as:

the ability to use reasoning

Sonorous respirations are MOST likely caused by:

an anatomic airway obstruction

If manual positioning of a patient's head is required to keep his or her airway open, you should:

insert an airway adjunct

A patient with a blood pressure of 210/100 mm Hg would be expected to have a pulse that is:

bounding

An unresponsive patient who has been breathing slowly and shallowly for an extended period of time would MOST likely have ________ skin.

cyanotic

The body's reaction to increased internal or external temperature would MOST likely cause the skin to become:

hot and moist

The history of present illness is MOST accurately described as:

an elaboration of the chief complaint

The presence of rhonchi during auscultation of the lungs is MOST suggestive of:

pneumonia

Diffuse pain caused by hollow organ obstruction and stretching of the smooth muscle wall is called __________ pain.

visceral

A patient is generally considered to have orthostatic vital signs when:

the heart rate increases by 20 beats/min or more when going from a supine to a standing position

What is an example of a pertinent negative?

A patient with chest discomfort denies shortness of breath

Upon completing your rapid exam of an unresponsive trauma patient's head and neck, you should next:

apply a properly sized rigid cervical collar

Any time you encounter jugular venous distention in a patient, you should determine:

where the venous obstruction is that is impeding blood return to the heart

When assessing the head and face during the full-body exam, you should:

avoid palpating any cranial depressions

The soft, breezy, and lower pitched sounds found at the midclavicular line are called:

bronchovesicular sounds

Vascular compromise in a lower extremity is characterized by:

unilateral pulse deficit and pallor

During a 20-minute transport of a critical patient, you should make a concerted effort to reassess the patient ___ times.

four

You're assessing a patient who complains of fever, chills, & coughing up blood. In addition to donning gloves & eye protection, you should:

wear a properly fitted HEPA or N-95 mask (as this is suspected TB in the patient)

A trauma pt opens his eyes in response to pain, moans when his name is asked, & withdraws from painful stimuli. This is MOST likely:

Symptoms of severe neurologic dysfunction

A 29-year-old woman is in active labor. During your visual exam, you see a limb protruding from her vagina. What should you do?

prepare for immediate transport

What are the 6 areas of the neurologic exam?

1. Mental status - 2. Speech - 3. Cranial nerves - 4. Motor System - 5. Sensory System - 6. Reflexes

What is "Aphasia?"

A language deficit caused by neurologic damage to the brain that can be either receptive or expressive

What is the "Babinski response?"

Toe flexion when the sole of the foot is stimulated (negative plantar flexion)

Define "hemoptysis"...

Coughing up blood

Define "referred pain"...

Pain that is away from its source

Define "Grey Turner sign"...

Discoloration over the FLANKS suggestive of intra-abdominal hemorrhage

Define "Cullen sign"...

Discoloration around the UMBILICUS suggestive of intra-abdominal hemorrhage

Define "bruit"...

Sound of turbulent blood flow around a partial obstruction

What does the mnemonic "OPQRST" stand for?

O = onset, P = provocation, Q = quality, R = radiation, S = severity, T = time

What does the mnemonic CSMT stand for?

C = color, S = sensation, M = range of MOTION, T = temperature

What do you check on when assessing the "skeletal-muscle system" specifically?

Document pain, crepitation & sensations - test muscle strength & symmetry - test flexion -check grip and assess spine

What do you check on when assessing the "abdomen" specifically?

Inspect for cleanliness, skin color, sweating, inflammation, herniation - listen for bowel sounds - palpate for tenderness or masses

Where is the apical pulse palpated strongest?

PMI = Point of maximal impulse (in the 5th intercostal space of the thorax, just medial to the left midclavicular line)

Define "primary assessment"...

A type of assessment utilized to identify life-threatening problems

What does assessment of the extremities include?

Checking the radial/brachial pulses, popliteal, dorsalis pedis, posterior tibial, and determine range of motion

What does assessment of the head and neck include?

Inspect general symmetry and movement, inspect jugular veins, palpate trachea and carotid pulses

For cardiac cases, patients should be asked if they have a history of what?

High blood pressure, rheumatic fever, heart murmurs, chest pain/discomfort, palpitations, dyspnea, orthopnea, edema

For endocrine cases, patients should be asked if they have a history of what?

Thyroid trouble, heat or cold intolerance, excessive sweating, diabetes, excessive thirst/hunger, polyuria

For gastrointestinal cases, patients should be asked if they have a history of what?

trouble swallowing, heartburn, appetite, nausea, vomiting, bowel movement frequency, pain, gas, jaundice, hepatitis

For genitourinary cases, patients should be asked if they have a history of what?

Frequency of urination, polyuria, nocturia, pain when urinating, hematuria, urinary infection, or kidney stones

For hematologic cases, patients should be asked if they have a history of what?

Anemia, easy bruising or bleeding, past transfusions and any reactions to them

For musculoskeletal cases, patients should be asked if they have a history of what?

Muscle/joint pains, stiffness, arthritis, gout, backache

For peripheral vascular cases, patients should be asked if they have a history of what?

Intermittent claudication (a complex of symptoms, including pain, tension, and limb weakness), leg cramps, varicose veins, past blood clots

For psychiatric cases, patients should be asked if they have a history of what?

Nervousness, tension, mood including depression; and memory loss

For respiratory cases, patients should be asked if they have a history of what?

Cough, sputum, hemoptysis, wheezing, asthma, bronchitis, emphysema, pneumonia, tuberculosis, pleurisy

What is a "Field Impression?"

A determination of what you think is the patient's current problem

What step comes before you ever even assess the patient?

Scene Size-Up

Any patient with whom you come into contact should be treated as...

Potentially Infectious

"Primary" Assessment consists of what order of steps?

Forming a General impression, assess LOC, Assess ABC's, preform rapid exam, determine priority patients

Approx. how long should your Primary Assessment take?

60-90 seconds

If you hear gurgling or bubbling sounds with your patient, what should you prepare for?

Suction

Assessment of capillary refill is most often used in...

Pediatric patients

Fever, Hypertension, Allergic reactions, Carbon monoxide poisoning all present with _____ color skin

Red

Excessive blood loss and fright present with _____ color skin

White

Hypoxemia, oxygen desaturation present with ______ color skin

Blue

Cardiovascular embarrassment (as in Shock), disseminated intravascular coagulopathy present with _______ skin

Mottled

The dryness or moisture of the skin is largely determined by the...

Sympathetic Nervous System

Stimulation of the sympathetic nervous system (shock or pain) causes...

Sweating

Depression of the sympathetic nervous system (spine injury) can cause the skin in the affected area to become abnormally...

Dry and Cool

Regarding documentation, what is different between "signs" and "symptoms?"

Signs are OBJECTIVE (observed by you), Symptoms are SUBJECTIVE (told to you)

Roughly ____% of elderly who fall and break a hip will not survive the event

50%

What is a "differential diagnosis?"

a working hypothesis of the nature of the problem

Around the age of ___ to ___ children become very capable of providing history of the current problem

3 - 5

What does "iatrogenic" mean?

illnesses caused by medications can mask other conditions that may need immediate medical attention

What is the "secondary assessment" made up of?

obtaining vital signs that measure overall body function and performing a head to toe survey that evaluates the workings of specific organs

What does COASTMAP stand for?

consciousness, orientation, activity, speech, thought, memory, affect, perception

What are the 12 cranial nerves?

olfactory- optic- oculomotor- trochlear- trigeminal- abducens- facial-vestibulocochlear-glossopharyngeal-vagus-spinal accessory-hypoglossal

What are the four lobes of the cerebrum?

frontal, temporal, parietal, and occipital

Where is the tricuspid valve is auscultated?

over the lower left sternal border

Where can the mitral valve be assessed?

over the cardiac apex

stridor often indications a life threatening problem and approx _____% reduction in airway size

85%

Cranial Nerve 1? Name and function...

Olfactory - smell

Cranial Nerve 2? Name and function...

Optic - light perception and vision

Cranial Nerve 3? Name and function...

Oculometer - pupil constriction

Cranial Nerve 4? Name and function...

Trochlear - eye movements

Cranial Nerve 5? Name and function...

Trigeminal - Motor: chewing, Sensory: face, sinuses, teeth

Cranial Nerve 6? Name and function...

Abducens - ALSO eye movements

Cranial Nerve 7? Name and function...

Facial - facial movements

Cranial Nerve 8? Name and function...

Vestibulocochlear - hearing, balance perception

Cranial Nerve 9? Name and function...

Glossopharyngeal - Motor: throat and swallowing, gland secretion, Sensory: tongue, throat, ear

Cranial Nerve 10? Name and function...

Vagus - heart, lungs, palate, pharynx, larynx, trachea, bronchi, GI tract, external ear

Cranial Nerve 11? Name and function...

Spinal accessory - shoulder and neck movements

Cranial Nerve 12? Name and function...

Hypoglossal - Tongue, throat, and neck movements