Chapter 8 Patient Assessment and Vitals

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hiker0001
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262835
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Chapter 8 Patient Assessment and Vitals
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2014-02-19 19:19:13
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Chapter Patient Assessment Vitals
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Chapter 8 Patient Assessment and Vitals
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  1. A ____ is a subjective condition the patient feels and tells you about.
    symptom
  2. A ____ is an objective condition you can observe about the patient.
    sign
  3. Fragile and easily injured areas include the (three things):
    • brain
    • spinal cord
    • eyes
  4. The concept of standard precautions assumes that all blood, body fluids (except ____), nonintact skin, and mucous membranes may pose a substantial risk of infection.
    sweat
  5. When there are multiple patients, you should use the ____ ____ ____, call for additional units, and then begin triage.
    incident command system
  6. A system implemented to manage disasters and mass-casualty incidents in which section chiefs report to the incident commander.
    incident command system
  7. The process of sorting patients based on the severity of each patient’s condition.
    Triage
  8. To determine if you require additional resources, ask yourself (four things):
    • How many patients are there?
    • What is the nature of their condition?
    • Who contacted EMS?
    • Does the scene pose a threat to you, your patient, or others?
  9. The goal of the ____ ____ is to identify and initiate treatment of immediate or potential life threats.
    primary assessment
  10. The initial ____ ____ is formed to determine the priority of care and is based on your immediate assessment of the patient.
    general impression
  11. Five things that make up a general impression:
    • Age
    • Sex
    • Raced
    • Level of distress
    • Overall appearance
  12. Conscious with an altered LOC may be due to inadequate ____; can also be caused by medications, drugs, alcohol, or poisoning
    perfusion
  13. The circulation of blood within an organ or tissue.
    Perfusion
  14. Assessment of an unconscious patient focuses first on (three things):
    airway, breathing, and circulation (ABCs).
  15. To assess for responsiveness, use the mnemonic:
    • AVPU
    • Awake and alert
    • Responsive to Verbal stimuli
    • Responsive to Pain
    • Unresponsive
  16. ____ tests mental status by checking a patient’s memory and thinking ability.
    Orientation
  17. Orientation evaluates a person’s ability to remember (four things):
    • Person—remembers his or her name
    • Place—identifies the current location
    • Time—the current year, month, and approximate date
    • Event—describes what happened
  18. The ____ ____ ____ (___) score can be helpful in providing additional information on patients with mental status changes.
    Glasgow Coma Scale (GCS)
  19. The diameter and reactivity to light of the patient’s pupils reflect the status of the brain’s ____, ____, and ____.
    • perfusion
    • oxygenation
    • condition
  20. A small number of the population exhibit unequal pupils.
    anisocoria
  21. ____, which are one category of central nervous system depressants, cause the pupils to constrict so significantly, regardless of light, that they become so small as to be described as pinpoint.
    Opiates
  22. Mnemonic to assess pupils
    • PEARRL
    • Pupils
    • Equal
    • And
    • Round
    • Regular in size
    • React to Light
  23. An open airway is:
    patent
  24. Consider providing positive-pressure ventilations with an airway adjunct whenr espirations exceed __ breaths/min and when respirations are fewer than __ breaths/min.
    24, 8
  25. A normal respiratory rate varies widely in adults, ranging from:
    12 to 20 breaths/min.
  26. You can almost always hear a patient’s breath sounds better from the patient’s ____.
    back
  27. Three areas to auscultate the lungs:
    • upper lungs (apices)
    • lower lungs (bases)
    • major airways (midclavicular and midaxillary lines)
  28. A moist crackling, usually on both inspiration and expiration.
    Rales
  29. Low-pitched, noisy sounds that are most prominent on expiration.
    Rhonchi
  30. A brassy, crowing sound that is most prominent on inspiration.
    Stridor
  31. Measure of the depth of breathing and is the amount of air in milliliters that is moved into or out of the lungs during one breath.
    Tidal volume
  32. Condition where a patient can speak only two or three words without pausing to take a breath.
    two- to three-word dyspnea
  33. In responsive patients who are older than __ year, you should palpate the radial pulse at the wrist.
    1
  34. In unresponsive patients older than 1 year, you should palpate the:
    carotid pulse in the neck.
  35. Palpate the ____ pulse, located at the medial area (inside) of the upper arm, in children younger than 1 year.
    brachial
  36. If the patient has a pulse but is not breathing, provide ventilations at a rate of at least __  breaths/min for adults and at least __ breaths/min for an infant or a child.
    10, 12
  37. For an adult, the normal resting pulse rate should be between __ and ___ beats/min and could be as much as ___ beats/min in geriatric patients.
    • 60 and 100
    • 100
  38. You should describe a stronger than normal pulse as:
    bounding
  39. A pulse that is weak and difficult to feel is described as “weak” or:
    “thready.”
  40. Perfusion is assessed by evaluating a patient’s skin (four things):
    • color
    • temperature
    • moisture
    • capillary refill
  41. Poor peripheral circulation will cause the skin to appear:
    pale, white, ashen, or gray.
  42. When the blood is not properly saturated with oxygen, it appears ____.
    bluish
  43. High blood pressure may cause the skin to be abnormally flushed and ____.
    red
  44. Skin that is wet, moist (often called ____), or excessively dry and hot suggests a problem.
    diaphoretic
  45. With adequate perfusion, the color in the nail bed should be restored to its normal pink color within __ seconds.
    2
  46. Lifesaving interventions begin with:
    opening the airway.
  47. Perform a ____ ____ of the patient’s body to identify injuries that must be managed or protected immediately.
    rapid scan
  48. Take __ to __ seconds to perform the rapid scan.
    60 to 90
  49. The rapid scan assists in determining:
    transport priority.
  50. The time from injury to definitive care, during which treatment of shock and traumatic injuries should occur because survival potential is best.
    The Golden Period
  51. Aim to assess, stabilize, package, and begin transport to the appropriate facility within __ minutes (often referred to as the “____ __”) after arrival on scene.
    • 10
    • Platinum 10
  52. Use the mnemonic SAMPLE to obtain the following information:
    • Signs and symptoms—What signs and symptoms occurred at the onset?
    • Allergies—Is the patient allergic to any medication, food, or other substances? Medications—What medications is the patient taking?
    • Pertinent past medical history—Does the patient have any medical history?
    • Last oral intake—When did the patient last eat or drink?
    • Events leading up to injury or illness—What events led to this incident?
  53. Use the OPQRST mnemonic to assess:
    • pain
    • Onset—When did the problem begin and what caused it?
    • Provocation or palliation—Does anything make it feel better or worse?
    • Quality—What is the pain like?
    • Region/radiation—Where does it hurt?
    • Severity—On a scale of 1 to 10, how would you rate your pain?
    • Timing—Has the pain been constant or does it come and go?
  54. Negative findings that warrant no care or intervention.
    Pertinent negatives
  55. The most common cause of confusion:
    Hypoxia
  56. Use a ____ to function as a hearing aid for the patient.
    stethoscope
  57. ____ ____ is performed at the scene or in the back of the ambulance en route to the hospital.
    Secondary assessment
  58. The purpose of the ____ ____ is to perform a systematic physical examination of the patient.
    secondary assessment
  59. The mnemonic DCAP-BTLS reminds you what to look for in a ____ ____:
    • secondary assessment
    • Deformities
    • Contusions
    • Abrasions
    • Punctures/penetrations
    • Burns
    • Tenderness
    • Lacerations
    • Swelling
  60. Measures the oxygen saturation of hemoglobin in the capillary beds.
    Pulse oximetry
  61. In most patients, a pulse oximetry reading will fall between:
    95% and 100%
  62. Several conditions can give false pulse oximetry values (five things):
    • Hypoperfusion
    • Hypothermia
    • Bleeding
    • Anemia
    • Carbon monoxide exposure
  63. ____ ____, or electronic measurement, is another method of obtaining blood pressure readings.
    Oscillometric measurement
  64. A noninvasive method that can quickly and efficiently provide information on a patient’s ventilatory status, circulation, and metabolism.
    Capnography
  65. The partial pressure or maximal concentration of CO2 at the end of an exhaled breath.
    End-tidal CO2
  66. The normal range for end-tidal CO2 is __ to __ mm Hg, or _% to _% CO2.
    • 35 to 45
    • 5% to 6%
  67. The goal of the ____-____ ____ is to identify injuries or causes missed during the primary assessment’s 60- to 90-second rapid scan.
    full-body scan
  68. A ____ ____ is performed on patients who have sustained nonsignificant MOIs or on responsive medical patients and is based on the chief complaint.
    focused assessment
  69. The goal of a ____ ____ is to focus your attention on the immediate problem.
    focused assessment
  70. The purpose of ____ is to identify and treat changes in a patient’s condition.
    reassessment
  71. A patient in unstable condition should be reassessed every __ minutes.
    5
  72. A patient in stable condition should be reassessed every __ minutes.
    15
  73. The primary assessment is performed on all patients. It includes forming an initial ____ ____ of the patient, including the LOC, and identifies any life-threatening conditions to the ABCs.
    general impression
  74. History taking includes an investigation of the patient’s chief complaint or history of present illness.  A ____ history is generally taken during this step of the assessment process. This information may be obtained from the patient, family, friends, or bystanders.
    SAMPLE
  75. A systematic head-to-toe examination that is performed during the secondary assessment on a patient who has sustained a significant mechanism of injury, in unconscious, or is in critical condition.
    full-body scan
  76. A grating or grinding sensation caused by fractured bone ends or joints rubbing together; also air bubbles under the skin that produce a crackling sound or crinkly feeling.
    crepitus
  77. The delicate membrane that lines the eyelids and covers the exposed surface of the eye.
    conjunctiva
  78. A step within the patient assessment process that identifies and initiates treatment of immediate and potential life threats.
    primary assessment
  79. In patients with deeply pigmented skin, changes in color may be apparent only in certain areas, such as the:
    lips
  80. When interviewing a patient, you can show him or her that you understand the situation by:
    A. interrupting him or her as needed for clarification.
    B. using medical terminology whenever possible.
    C. maintaining constant eye contact with him or her.
    D. repeating statements back to him or her.
    D. repeating statements back to him or her.
    (this multiple choice question has been scrambled)
  81. A patient with spontaneous respirations is breathing:
    A. at a normal rate.
    B. without difficulty.
    C. without assistance.
    D. with shallow depth.
    C. without assistance.
    (this multiple choice question has been scrambled)
  82. Which of the following abnormal breath sounds indicates obstruction of the upper airway?
    A. stridor
    B. rales
    C. rhonchi
    D. crackles
    A. stridor
    (this multiple choice question has been scrambled)
  83. When assessing motor function in a conscious patient's lower extremities, you should expect the patient to:
    A. feel you touching the extremity.
    B. note any changes in temperature.
    C. identify different types of stimuli.
    D. wiggle his or her toes on command.
    D. wiggle his or her toes on command.
    (this multiple choice question has been scrambled)
  84. You are assessing a 72-year-old man with abdominal pain.  The patient is sitting in a chair; he is conscious, alert, and calm.  As you are talking to the patient, your partner discreetly directs your attention to a handgun, which is located on a nearby table.  You should:
    A. direct your partner to move the gun to a safe area and then advise the patient that his weapon has been secured.
    B. document the presence of the weapon, including its specific location, and continue your assessment of the patient.
    C. immediately cease all patient care, carefully back out of the residence, and request law enforcement assistance.
    D. position yourself in between the patient and the gun and ask your partner to request law enforcement assistance.
    D. position yourself in between the patient and the gun and ask your partner to request law enforcement assistance.
    (this multiple choice question has been scrambled)
  85. After performing a primary assessment, a rapid scan of the body should be performed in order to:
    A. determine the need for spinal motion restriction precautions.
    B. look specifically for signs and symptoms of inadequate perfusion.
    C. identify less obvious injuries that require immediate transport.
    D. find and treat injuries or conditions that do not pose a threat to life.
    C. identify less obvious injuries that require immediate transport.
    (this multiple choice question has been scrambled)
  86. Upon arriving at the scene of a patient with difficulty breathing, you determine that the scene is safe. You enter the residence and find the patient sitting in a chair in obvious distress. Your first action should be to:
    A. assess the patient's airway status.
    B. introduce yourself to the patient.
    C. ask the patient what's wrong.
    D. obtain a set of baseline vital signs
    B. introduce yourself to the patient.
    (this multiple choice question has been scrambled)

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