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Flashcards in Patient Assesment Deck (131):
0

What are the four steps of medical patient assessments?

Scene size up
Initial assessment
Focused history/physical exam Ongoing assessment

1

What are five steps of patient assessment for trauma patients?

Scene size up
Initial assessment
Focused history/physical exam
Detailed physical exam
Ongoing assessment

2

What are five objectives of scene size up?

BSI/Scene Safety
Mechanism of injury/nature of illness
Number of patients
Request additional assistance
Consider C-spine immobilization

3

What are three factors to evaluate the mechanism of injury of the patient?

The amount of force applied to the body
The length of time the force was applied
The area of the body involved

4

What are four objectives of initial assessments?

Form a general impression of the patient
Assess mental status
Assess ABCs
Identify priority patients

5

What does obtunded mean?

The patient does not perceive the environment fully and responds to stimuli appropriately but slowly

6

What does stuporous mean?

The patient is aroused by intense stimuli only. Motor response and reflex reactions are usually intact unless the patient is paralyzed

7

For alert patients, what four things do you check to assess the patient's orientation?

Memory of:
Person (who they are)
Place (where they are)
Time (day,month,year)
Event (what happened)

8

What three things do you check for when assessing circulation?

Pulse
Bleeding
Skin condition (temp, moisture, color)

9

What is the lining of the eyelid called?

Conjunctiva

10

What are the three steps in a focused history/physical exam for trauma patients with a significant mechanism of injury?

Rapid trauma assessment
Baseline vitals/SAMPLE
Transport

11

What are the three steps of focused history/physical exam for patients with no significant mechanism of injury?

Focused assessment based on chief complaint
Baseline vitals/SAMPLE
Transport

12

What are three goals of focused history/physical exam?

Identify the patient's chief complaint
Understand the specific circumstances surrounding the chief complaint
Direct further physical examination

13

What are occult injuries?

Injuries you can't see with your eyes

14

What does DCAP-BTLS stand for?

Deformities
Contusions
Abrasions
Puncture/penetration
Burns
Tenderness
Laceration
Swelling

15

What is subcutaneous emphysema?

Air under the skin

16

What are retractions?

When the skin pulls around the ribs during inspiration

17

What is paradoxical motion?

When one section of the chest falls on inspiration while the remainder of the chest rises

18

What is paradoxical motion associated with?

Flail chest

19

What causes Rales (crackles)?

Oxygen passing through moisture in the bronchoalveolar system or from closed alveoli opening abruptly

FLUID IN SMALLER AIRWAYS

20

What two things are Rales associated with?

Congestive heart failure
Bronchitis

21

What is Rhonchi?

Continuous sounds with a lower pitch and a rattling quality

22

What four things is Rhonchi associated with?

Congestive heart failure
Pulmonary edema
Bronchitis
Pneumonia

FLUID IN LARGER AIRWAYS

23

When is Rhonchi usually heard?

During exhalation

24

What four things cause stridor?

Bacterial epiglottitis
Viral croup
Swelling from upper airway burns
Partial foreign body airway obstruction

25

What is wheezing?

A high-pitched whistling noise that is usually more prominent during exhalation

26

What three things is wheezing associated with?

Asthma
Bronchitis
Other processes that cause constriction of the bronchioles (bronchospasm)

27

When is mild wheezing typically heard?

Expiration

28

When is moderate wheezing typically heard?

Inspiration and expiration

29

What is severe wheezing?

Wheezing that is often faint or difficult to hear indicating severe bronchospasm

30

What is pleural friction rub?

A low pitched, dry, rubbing sound caused by movement of inflamed pleural surfaces as they slide against one another during breathing

31

What four things is pleural friction rub associated with?

Pleurisy
Viral infection
Tuberculosis
Pulmonary embolism

32

What five things do you assess the abdomen for?

Tenderness
Rigidity
Swelling
Guarding
Distention

33

What is ecchymosis?

Bruising of the skin

34

What are two causes of ashen or pale skin?

Hypovolemia
Hypoxia

35

What are six possible causes of red/flushed skin?

High blood pressure
CO poisoning (late)
Significant fever
Heatstroke
Sunburn
Allergic reaction

36

What is a cause of jaundice skin?

Liver disease/dysfunction

37

What are four possible causes for hot skin?

Significant fever
Sunburn
Hyperthermia
Heavy excercise

38

What are two causes for cool skin?

Early shock
Heat exhaustion

39

What are three causes for cold skin?

Profound shock
Hypothermia
Frostbite

40

What is a possible causes for clammy/moist skin?

Shock

41

What is a cause for pupils that are fixed with no reaction to light?

Depressed brain function (head injury/stroke)

42

What is a cause for pupils that are fully dialated and fixed (brown pupil)?

Increased intracranial pressure

43

What is a cause for constricted pupils?

Drugs (opiates)

44

What is a cause for dilated pupils?

Drugs (barbiturates)

45

What is a cause for pupils with a sluggish reaction?

Severe increase in intracranial pressure

46

What are four causes of unequal pupil size?

Depressed brain function
Medication placed in eye
Injury or condition of the eye
Congenital anisocoria

47

What is focal pain?

Pain that is only in a single location

48

What is diffuse pain?

Generalized area of pain

49

In trauma patients what 2 steps occur during detailed physical exams?

Detailed head to toe looking for DCAP-BTLS
Reassess vitals

50

What is petechia?

Small red or purple spot on the skin, caused by a minor hemorrhage (broken capillary blood vessels)

51

What are battle signs?

Bruising behind the ear associated with skull fractures

52

What is called when blood or foreign objects are in the anterior chamber of the eye?

Hyphema

53

What is peri-orbital ecchymosis?

Bruising/discoloration around eyes (raccoon eyes)

54

What are loud, high-pitched, and hallow sounds noted over the menubrium also known as?

Bronchial sounds

55

What are soft, breezy, and lower pitch sounds found at the midclavicular line also known as?

Bronchovesicular sounds

56

What are the finer and somewhat fainter breath sounds noted in the lateral wall of the chest that are from the smaller bronchioles and alveoli also known as?

Vesicular sounds

57

What is pleurisy?

Inflammation of the pleura

58

What is the point of maximal impulse (PMI)?

The location of the mitral valve
It is the best place to listen for heart sounds

59

Where is the point of maximal impulse located?

Normally found at the fifth intercostal space, just medial to the midclavicular line

60

What is Cullen's sign?

Bruising in or around the belly button

61

What is Grey-Turner's sign?

Bruising along the sides of the abdomen

62

What is ascites?

The accumulation of serous fluid in the peritoneal cavity

63

What is hives also called?

Urticaria

64

What is caput medusa?

Distended veins spreading upward from navel, analogous to varicose vein's

65

What does the presence of caput medusa result in the possibility of?

Severe ongoing back up of pressure in the hepatic portal system and should alert you to the possibility of esophageal varices

66

What is the term called when a patient tenses the abdomen as you touch it?

Guarding

67

What is Raynaud's syndrome?

One or more fingers or toes may be strikingly pale/cyanotic and cold to the touch

68

What three things do you assess with the Cincinnati stroke scale?

Facial symmetry
Pronator drift
Clarity of speech

69

In Cincinnati stroke scale, how do you test facial symmetry?

Have the patient grin and show teeth
Should be equal on both sides.

70

In Cincinnati stroke scale, how do you assess pronator drift?

Have the patient close eyes and outstretch their arms with palms face up

Should be equal and not drift away

71

In Cincinnati stroke scale, how do you assess clarity of speech?

Have pt repeat a phrase you say
"The sky is blue in Cincinnati"
Pt should be able to say it correctly

72

What nerve is CN 1?

Olfactory nerve

73

How do you check CN 2 and 3?

Check pupil response to light

74

How do you check CN 3,4, and 6?

Test for extraocular movement by using the "H" method

75

What is the "H" method test?

Holding a finger in front of a pts face and moving it in the shape of an H. The pts eyes should follow your fingers

76

How do you assess CN 5?

Have pt clench teeth and check sensation to forehead,cheek, and chin

77

How do you assess CN 7?

Have pt smile wide and show teeth

78

How do you assess CN 9 and 10?

While pt says ah-h-h, watch the uvula for movement, check for gag reflex

79

How do you assess CN 11?

Have pt shrug shoulders and turn head against resistance

80

How do you assess CN 8?

Test by checking for ability to maintain upright position for 15-20 seconds with eyes closed

81

Hypotension with tachycardia is a sign of what?

Some states of shock

82

Hypertension, bradycardia, and irregular respirations is a sign of what?

Increased intracranial pressure

83

What are the five steps of ongoing assessment?

Repeat the initial assessment
Reassess vital signs
Repeat focused assessment
Check interventions
Modify treatment is necessary

84

What are the six R's of clinical decision-making?

Read the patient
Read the scene
React
Reevaluate
Revise the management plan
Review performance at the run critique

85

What are clubbed fingers a sign of?

COPD

86

What is decorticate posture?

An abnormal posturing in which a person is stiff with bent arms, clenched fists, and legs held out straight. The arms are bent in toward the body and the wrists and fingers are bent and held on the chest.

87

What is decerebrate posture?

Arms and legs being held straight out, the toes being pointed downward, and the head and neck being arched backwards. The muscles are tightened and held rigidly.

88

What is a cause of decorticate and decerebrate posture?

A severe injury to the brain

89

What is dysarthria?

Difficulty speaking because of problems with the muscles in speech

90

What is it called if a patients tongue comes out to the side?

Tongue deviation

91

What side does the tongue usually deviate to if the patient is have a nerve problem?

The strong side

92

What is crepitus?

The sound or feeling of bones rubbing together

93

What is dystonic reaction?

Reaction to medications causing abnormal muscle movement

94

What is dysconjugate gaze?

Failure of the eyes to turn together in the same direction

95

What is dolls eyes?

If you turn your head your eyes look in the direction you move you're head

96

What does erythema mean?

Redness

97

What is the mastoid process?

The bone behind the ear

98

What does a scar over the throat usually indicate?

A carotid endarterectomy

99

What is barrel chest?

Pt having a rounded chest. Being wide as you are thick

100

What is it called when the stomach rise then the chest rises?

Seesaw respirations

101

What are four normal breath sounds in the chest?

Tracheal
Bronchial
Bronchiovesicular
Vesicular

102

What causes absent breath sounds?

Tension pneumothorax

103

When you percuss a chest why would you hear a dull sound?

A solid object underneath (fluid in lungs)

104

When percussing a pt what does hyperresonance mean.

Air underneath (echos)

105

What is costovertebral?

Where the ribs meet the spine

106

What is the spinal process?

The tip of vertebrae

107

Where is the posterior tibial artery?

Medial bump in ankle

108

Where is the popliteal artery?

Behind the knee

109

What does protuberant mean?

Bulging outward

110

What does scaphoid mean?

Concave rather than convex (goes inward)

111

To assess for life threats in chest what does IPASSAV stand for?

Inspect
Palate
Auscultate
Seal holes
Stabilize flail segments
Administer oxygen
Ventilate if necessary

112

What is the systolic BPof a patient with a radial pulse?

At least 80

113

What is the systolic BP of a patient with a femoral pulse?

At least 70

114

What is the systolic BP of a patient with a carotid pulse?

At least 60

115

What is orthostatic vitals?

Taking vitals while patient is supine, then sitting up, then standing

116

Why do you assess orthostatic vitals?

To determine if pt becomes dizzy, HR decreases by 20, or systolic BP decreases by 20 or more while changing position

117

How are bronchial sounds described like?

Full inspiratory and expiratory phase with the inspiratory phase usually being louder that are normally heard over the trachea

118

How are bronchovesicular sounds described like?

Full inspiratory phase with a shortened and softer expiratory phase and heard in the hilar region

119

How are vesicular sounds described like?

Quiet, wispy inspiratory phase followed by a short, almost silent expiratory phase normally found in lung field

120

What is anisocoria?

State of normally unequal pupil size usually less than 1 mm in approximately 20% of population

121

What is referred pain?

Pain in two separate locations of the body, without a trail of pain between the two locations

122

Where do you hear s1 sounds?

At the fifth intercostal space at the left sternal border (tricuspid valve)

123

What is rhinorreah?

Runny nose

124

Where are two places that you listen to s2 sounds?

The second intercostal space at the right sternal border (aortic valve)

The left sternal border (pulmonic valve)

125

What valve is located at the fifth intercostal space at the left sternal border?

Tricuspid valve

126

What valve is located at the second intercostal space at the right sternal border?

Aortic valve

127

What valve is located at the second intercostal space at the left sternal border?

Pulmonic valve

128

What valve is located at the fifth intercostal space, just medial to the mid-clavicular line?

Mitral valve

129

What is dyplopia?

Double vision

130

When is strider usually heard during ventilation?

During inspiration