Patient Assessment Beginning the Physical Examination: Scene Size-Up, General Survey, Vital Signs, and Pain.
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Transcript Patient Assessment Beginning the Physical Examination: Scene Size-Up, General Survey, Vital Signs, and Pain.
Patient Assessment
Beginning the
Physical Examination:
Scene Size-Up, General Survey, Vital Signs,
and Pain
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Scene Size-Up
1.
2.
3.
4.
5.
6.
Scene Safety
BSI
MOI/NOI
# Patients
Additional Help?
C-Spine?
2
Initial Assessment
3
Initial /Primary Assessment
1. General Impression
2. Mental Status
AVPU
3. Airway (C-Spine)
4. Breathing
5. Circulation
Age, Sex, Race, CC, Environment
Pulse – Skin - Bleeds
6. Determine Priority
4
Components of General Survey
General
Appearance/Impression
Height and Weight
5
General Appearance - Description
Apparent state of health
Appropriate to weather
and temperature
Clean, properly
buttoned/zipped
Facial expression
Cardiac or respiratory; pain;
anxiety/depression
Skin color and obvious
lesions
Dress, grooming, and
personal hygiene
Awake, alert, responsive or
lethargic, obtunded,
comatose
Signs of distress
Acute or chronically ill, frail
Level of consciousness
Eye contact, appropriate
changes in facial expression
Odors of body and breath
Posture, gait, and motor
activity
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Mental Status and Behavior
Terminology
To appreciate the differences in mental
status and behavior, you must learn the
terminology
Level of consciousness: how aware the person is of
his environment
Attention: the ability to focus or concentrate
o
o
o
o
o
Alert: the patient is awake and aware
Lethargic: you must speak to the patient in a
loud forceful manner to get a response
Obtunded: you must shake a patient to get a response
Stuporous: the patient is unarousable except
by painful stimuli (sternal rub)
Coma: the patient is completely unarousable
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Height and Weight
Height
Weight
Short or tall
Build: slender and lanky, muscular, or stocky
Body symmetry
Note general body proportions and any deformities
Emaciated, slender, plump, obese
If obese, is fat distributed evenly or concentrated
over trunk, upper torso, or around the hips?
small – medium – large?
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Initial Assessment?
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What next
Health form
History
Secondary Assessment:
http://videos.med.wisc.edu/videos/33744
Detailed exam
Focused exam
Ongoing exam
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Health History: subjective
Changes in weight
Rapid or gradual
o
Rapid changes over a few days suggest changes in fluid, not
tissue
Weight gain: nutrition vs. medical causes
Weight loss: medical vs. psychosocial causes
Fatigue and weakness
Fatigue: a sense of weariness or loss of energy
Weakness: a demonstrable loss of muscle power
Medical vs. psychosocial causes
Fever, chills, and night sweats
Ask about exposure to illness or any recent travel
Some medications may cause elevated temperature
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Question
A patient presents with a 6-day history
of rapid weight gain, and increasing
fatigue. The most likely explanation is:
a.
Dysphagia
b.
Excessive absorption of nutrients
c.
Diabetes mellitus
d.
Accumulation of body fluids
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Answer
d.
Accumulation of body fluids
Rapid changes over a few days
suggest changes in fluid.
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Vital Signs
Blood pressure
Heart rate and rhythm
Respiratory rate and rhythm
Temperature
Pain
SaO2
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Question
A patient’s vital signs are recorded as
follows:
T 98.4 F, HR 74, R 18, BP 180/98
What would be the MOST appropriate action
related to this patient’s vital signs?
a.
b.
c.
d.
The blood pressure should not be repeated
Repeat the blood pressure and verify in contralateral arm
Check the heart rate again to see if it is regular
Listen to the patient’s lungs for adventitious sounds
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Answer
b.
Repeat the blood pressure measurement
and verify in the contralateral arm
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Pain
Assess
OPQRST
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Pain
Types of pain
Nociceptive or somatic – related to tissue damage
Neuropathic – resulting from direct trauma to the peripheral or
central nervous system
Psychogenic – relates to factors that influence the patient’s
report of pain
o
o
o
o
Psychiatric conditions
Personality and coping style
Cultural norms
Social support systems
Idiopathic – no identifiable etiology
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Examination Techniques
Inspection
Palpation
Percussion
Auscultation
System with cc: function / physiology
System above and below
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Thoracic Landmarks—Anterior Chest
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Shoulders and Related Structures
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Percussion and Auscultation of Chest
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Thoracic Landmarks—Posterior Chest
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Spine
Inspection
Cervical, thoracic, and
lumbar curves
Lordosis (swayback)
Kyphosis (hunchback)
Scoliosis (razorback)
Height differences of
shoulders
Height differences of
iliac crest
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Breath Sounds
Fig. 11-26
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Pulse
Auscultate for:
Frequency (pitch)
Intensity (loudness)
Duration
Timing in cardiac
cycle
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Abdomen
four quadrants
Inspect
Auscultate
Percuss
Palpate
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Abdomen—Inspection
Skin
Umbilicus
Contour
Abdominal
movement
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Pelvis
Pelvic structural
integrity
Hands on anterior iliac
crests
Press down and out
Heel of hand on
symphysis pubis
Press down
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Ankles and Feet
Range of motion
Dorsiflexion
Plantar flexion
Inversion
Eversion
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Ongoing Assessment
Components
Repeat initial assessment
Stable patient: every 15 minutes
Unstable patient: every 5 minutes (minimum)
Reassess mental status
Reassess airway
Monitor breathing for rate and quality
Reassess circulation
Reestablish patient priorities
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