Physical Assessment


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Vital assessments for emergencies with interventions

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Physical Assessment

  1. 1. ASSESSMENT  Mental Status  Respiration  Skin Color  Sensory Evaluation & Pain  Musculoskeletal  Patient Mobility
  2. 2. Mental Status  Level of Consciousness (LOC) 1. Ask the patient to state his or her name, name, date, address, and the reason for coming to the radiographic imaging department. 2. As you instruct the patient in positioning for your examinations, note his or her ability to follow directions. Also take note of any movement that causes pain or other difficulty in movement, as well as any alterations in behavior or lack of response. Report these to the physician in charge of caring for the patient. 3. Assess the patient‟s vital signs at this time if current readings are not on the chart.
  3. 3.  Glasgow Coma Scale  Eye Opening Spontaneously 4 To voice 3 To painful stimuli 2 No response 1  Motor Response Obeys command 6 Localizes pain 5 Withdraws from painful stimuli 4 Abnormal flexion 3 Extension 2 No response 1  Verbal Response Oriented 5 Confused speech 4 Inappropriate words 3 Incomprehensible sounds 2 None 1
  4. 4. Respiration  Characteristic of breathing  Rate  Pattern Type Description  Eupnea Normal breathing  Tachypnea Rapid, shallow breathing  Bradypnea Regular breathing but decreased rate  Kussmaul’s respiration Rapid, deep breathing without pauses  Cheyne-Stokes respiration Breaths that gradually become faster, and deeper than normal, followed by periods of apnea  Biot’s respiration Rapid deep breathing, with abrupt periods of apnea between each breath
  5. 5. Skin Color  Pallor  Cyanosis  Central cyanosis  Peripheral cyanosis Pain  Location  Intensity  Quality  Pattern
  6. 6. Musculoskeletal / Mobility  Observe for ROM, swelling, deformity, or atrophy  Inspect for stance - Base of support - Weight-bearing stability - Posture  Inspect the gait for the following - Position of feet - Posture - Arm swing  Observe movement of patient during procedure
  7. 7. SHOCK The body‟s pathological reaction to illness, trauma, or severe physiologic or emotional stress. Causes:  Body fluid loss  Cardiac failure  Decreased tone of cardiac vessels  Obstruction of blood flow to the vital body organs
  8. 8. SHOCK CONTINUUM 1.Compensatory Stage Clinical Manifestations:  Cold clammy skin  Decreased urine output  Increased respiration  Hypoactive bowel sound  Normal blood pressure  Increased anxiety level (client may begin to be uncooperative)
  9. 9. 2. Progressive Stage Clinical Manifestations: Blood pressure falls  Tachypnea  Severe pulmonary edema (Acute Respiratory Distress Syndrome)  Tachycardia (as high as 150 beats/min)  Chest pain  Changes in mental status ( alteration from confusion to lethargy, and loss of consciousness.  Renal, hepatic, gastrointestinal, and hematologic disorders occurs
  10. 10. 3. Irreversible Stage Clinical manifestations:  Blood pressure remains low  Renal and liver failure  Release of necrotic tissue toxins  Lactic acidosis
  11. 11. Types of Shock: 1.Hypovolemic Shock 2.Cardiogenic Shock 3.Distributive Shock 3.1. Neurogenic Shock 3.2. Septic Shock 3.3. Anaphylactic Shock 4. Obstructive Shock
  12. 12. Hypovolemic Shock a condition where the amount of intravascular fluid decreases by 15% – 25% or blood loss of 750 ml – 1,300 ml.
  13. 13. Class I Class II Class III Class IV Blood Loss 15% 15% – 30% 30% - 40% > 40% BP Normal Normal Decreased Severely Decreased Cardiac rate < 100 BPM >100 BPM >120 BPM >140 BPM, weak & thready Mental Status Slightly anxious Increasingly anxious Anxious and confused Confused & lethargic RR Normal 20 – 30 CPM 30 – 40 CPM >40 CPM Urine Output Normal Decreased Greatly decreased Diminished or ceases Clinical Manifestations:
  14. 14. Radiographer‟s Responsibilities: 1. Stop the ongoing imaging procedure; place the patient in supine position with legs elevated 30 degrees (unless there is a head or spinal cord injury). Do not place the patient in Trendelenburg position. 2. Notify the physician in charge of the patient and call for emergency assistance. 3. Make certain that the patient is able to breathe w/o obstruction caused by positioning or blood or mucus in the airway. 4. If the patient has blood loss from an open wound, don gloves and apply pressure directly to the wound with several thickness of dry, sterile dressing. 5. Have the emergency cart brought to the patient‟s side. 6. Prepare to assist with oxygen, intravenous fluids, and medications. Have large gauge intravenous catheters on hand.
  15. 15. 7. Keep the patient warm and dry. Do not overheat the patient; to do so will increase body metabolism and increase the need for oxygen. 8. Assess pulse, respirations, and blood pressure every 5 minutes until the emergency team assumes this role. 9. Do not leave the patient unattended. Inform him or her as appropriate of what is happening to alleviate anxiety. 10. Do not offer fluids to the patient, even if requested. Explain that he or she may need examinations or treatment that requires and empty stomach.
  16. 16. Cardiogenic shock caused by a failure of the heart to pump adequate amount of blood to the vital organs. Clinical Manifestations: • Complaint of chest pain that may radiate to jaws and arms. • Dizziness and respiratory distress • Cyanosis • Restlessness and anxiety • Rapid change in level of consciousness • Pulse may be irregular and slow, may have tachycardia and tachypnea • Difficult-to-find carotid pulse indicates decreased stroke volume of the heart. • Decreasing blood pressure • Decreasing urinary output • Cool, clammy skin
  17. 17. Radiographer‟s Response 1. Summon the emergency team and have the emergency cart placed at the patient‟s side. 2. Notify the physician in charge of the patient. 3. Place the patient in semi-Fowler‟s position or in another position that will facilitate respiration. 4. Prepare to assist with oxygen, intravenous fluid, and medication administration, Chest pain must be controlled. 5. Do not leave the patient alone; offer an explanation of treatment as appropriate; alleviate the patients anxiety. 6. Assess pulse, respiration, and blood pressure every 5 minutes until the emergency team arrives. 7. Do not offer fluids. 8. Be prepared to administer cardiopulmonary resuscitation (CPR), if indicated.
  18. 18. Distributive Shock occurs when a pooling of blood in the peripheral blood vessels results in decreased venous return of blood to the heart. 1. Neurogenic Shock results from loss of sympathetic tone causing vasodilation of peripheral vessels. Causes:  Spinal cord injury  Severe pain  Neurologic damage  Depressant action of medication  Lack of glucose  Adverse effects of anesthesia
  19. 19. Clinical Manifestations of Neurogenic Shock • Hypotension • Bradycardia • Warm, dry skin • Initial alertness if not unconscious because of head injury • Cool extremities and diminishing peripheral pulses Radiographer‟s Response 1. Summon emergency assistance 2. Notify the physician in charge of the patient. 3. Keep the patient in supine position, legs may be elevated with physician‟s order. 4. Have the emergency cart brought to the patient‟s side. 5. If spinal injury is possible, do not move the patient. 6. Stay with the patient and offer support. 7. Monitor pulse, respirations, and blood pressure every 5 minutes. 8. Prepare to assist with oxygen, intravenous fluids, and medications.
  20. 20. 2. Septic Shock caused by the reaction of immune response against bacteria or viruses and release chemicals that increase capillary permeability and vasodilation. Clinical Manifestations First Phase • Hot, dry, and flushed skin • Increase in heart rate and respiratory rate • Fever, but possibly not in elderly patients • Nausea, vomiting, and diarrhea • Normal-to-excessive urine output • Possible confusion, most commonly in the elderly patients
  21. 21. Second Phase • Cool, pale skin • Normal or subnormal temperature • Drop in blood pressure • Rapid heart rate and respiratory rate • Oliguria or anuria • Seizures and organ failure if syndrome is not reverse Radiographer‟s Response 1. Stop the procedure; notify the physician in charge of the patient. 2. Notify the emergency team & have the emergency cart available. 3. Place the patient in a supine position. 4. Keep the patient as quiet and calm as possible. 5. Do not leave the patient unattended. 6. If the skin is very warm, cover patient w/ a lightweight blanket. 7. Monitor vital signs every 5 minutes. 8. Prepare for O2, intravenous fluid, & medication administration. 9. Keep the patient in comfortable position.
  22. 22. 3. Anaphylactic Shock a result of an exaggerated hypersensitivity reaction (allergic reactions) to re-expose to an antigen that was previously encountered by the body‟s immune system. Common Causes:  Medications  Iodinated contrast medium  Insect venoms Portal of Entry  Skin  Respiratory tract  Gastrointestinal tract  Injections
  23. 23. Clinical Manifestations 1. Mild Systemic Reaction  Symptoms beginning within 2 hours of exposure to antigen  Nasal congestion, periorbital swelling, itching, sneezing, and tearing of eyes  Peripheral tingling or itching at the site of injection  Feeling of fullness or tightness of the chest, mouth or throat. 2. Moderate Systemic Reaction  All symptoms listed above with rapid onset.  Flushing, feeling of warmth, itching, & urticaria  Anxiety  Bronchospasm and edema of the airways or larynx.  Dyspnea, cough, and wheezing
  24. 24. 3. Severe Systemic Reaction  All symptoms listed in previous reactions with an abrupt onset.  Decreasing blood pressure, weak, thready pulse, either rapid or shallow.  Rapid progression to bronchospasm, laryngeal edema, severe dyspnea, and cyanosis.  Dysphasia, abdominal cramping, vomiting, and diarrhea.  Seizures, respiratory and cardiac arrest. Radiographer‟s Response 1. Before beginning a procedure that require administration of an iodinized contrast agent, make certain that the emergency cart has been monitored and that all emergency medications and equipment are up-to-date and in working order.
  25. 25. 2. Before starting any procedure that involves the use of iodinated contrast medium, ask the patient the ff questions:  “Are you allergic to any food or medicine? Which one?”  “Do you have asthma or hay fever?”  “Have you ever have hives or other allergic skin reactions?”  “Have you ever had an x-ray examination that involved the use of contrast medium? If so, did you have reaction during or following that examination?”
  26. 26. 3. Do not leave the patient who is receiving an iodinated contrast agent alone. Stop the infusion or injection immediately, and notify the radiologist if any of the ff occurs: the patient complains of itching, redness, or swelling of the skin, or the patient seems unduly anxious. 4. If the patient complains of respiratory distress or has any of the later symptoms listed previously, call the emergency team. 5. Place the patient in semi-Fowler‟s position or in a sitting position to facilitate respiration. 6. Monitor pulse, respiration, and blood pressure every 5 minutes until the emergency team arrives to assume responsibility. 7. Prepare to assist with oxygen, intravenous fluid, and medication administration. Have large-gauge venous catheters available. 8. Prepare to administer CPR.
  27. 27. Obstructive Shock results from pathological conditions that interfere with the normal pumping action of the heart, however, the heart itself may be free of pathologic condition. Causes:  Pulmonary embolism  Pulmonary hypertension  Arterial stenosis  Constrictive pericarditis  Tumors that interfere with blood flow through the heart.
  28. 28. Pulmonary Embolus an occlusion in one or more pulmonary arteries by a thrombus or thrombi. Causes:  Trauma  Orthopedic and abdominal surgical procedures  Pregnancy  Congestive Heart Failure  Prolonged immobility  Hypercoagulable sites
  29. 29. Clinical Manifestations:  Rapid, weak pulse  Hyperventilation  Dyspnea and tachypnea  Tachycardia  Apprehension  Cough and Hemoptysis  Diaphoresis  Hypotension Syncope  Cyanosis  Rapidly changing levels of consciousness  Coma, sudden death may result
  30. 30. Radiographer‟s Response: 1. Stop the procedure immediately, and call for emergency assistance. 2. Notify the physician, and bring the emergency cart to the patient‟s side. 3. Monitor vital signs. 4. Do not leave the patient alone; reassure the patient. 5. Prepare to assist with oxygen administration, administration of intravenous medication, and fluids.
  31. 31. Diabetic Emergencies Diabetes Mellitus a group of metabolic diseases resulting from a chronic disorder of carbohydrate metabolism. Causes: 1.An absolute insulin deficiency 2.Impaired release of insulin by the pancreatic beta cells 3.Inadequate or defective insulin receptors 4.Production of inactive insulin or insulin that is destroyed before it can carry out its action
  32. 32. Acute Complications of Diabetes Mellitus 1. Hypoglycemia occurs when there is an excess amount of insulin or oral hypoglycemic drug in their bloodstream, an increased metabolism of glucose, or an inadequate food intake with which to utilize the insulin. Clinical Manifestations:  Mild reaction: mild tremor, sweating, complaint of hunger, tachycardia, nervousness, and irritability.  Moderate reaction: Dizziness, headache, numbness of lips or tongue, confusion, profuse perspiration, cold clammy skin, blurred or double vision, incoordination, irrational behavior, slurred speech  Severe reaction: disorientation, difficulty arousing from sleep, impaired motor function, diminishing level of consciousness, seizures and rapid lapse into coma.
  33. 33. Radiographer‟s Response: 1. If the patient is conscious and complains of any early or moderate symptoms or says that he or she is diabetic, has not eaten, and feels shaky or weak, notify the physician and administer some type of sugar immediately. 2. If there is nothing else available, the packets of sugar kept in most coffee rooms are acceptable. If the patient is carrying glucose tablets, 2 – 4 commercially prepared glucose tablets should be taken. If orange juice is available, you may offer it. Hard candy or 6 – 10 Lifesaver- type hard candies are also acceptable. 3. If the patient complains of any of the latter symptoms, check the chart or look for a bracelet that identifies the patient as diabetic.
  34. 34. 4. If the patient is having trouble swallowing or is unconscious, place 2 teaspoons of granulated sugar, corn syrup, or jelly into his mouth under his tongue. It will be absorbed through the mucous membrane. 5. Stop the diagnostic imaging procedure immediately, and call for emergency assistance. 6. Do not leave the patient unattended. 7. Monitor vital signs every 5 minutes. 8. Prepare to assist with administration of oxygen, intravenous medications, and fluids.
  35. 35. 2. Diabetic Ketoacidosis a condition caused by an absence or markedly inadequate amount of insulin resulting to accumulation of ketone bodies. Clinical Manifestations: • Weakness, drowsiness, headache, blurred vision, abdominal pain, nausea, and vomiting. • Sweet odor to the breath & orthostatic hypotension. • Warm, dry skin; dry mucous membranes, extreme thirst, and polyuria. • General weakness, lethargy, and fatigue. • Flushed face, deep and rapid respirations. • Tachycardia, weak, thready, pulse, and coma.
  36. 36. Radiographer‟s Response: 1. Check patient chart or look for a bracelet identifying the patient as a diabetic. Remember that patient‟s with this condition may not be identified as diabetic. 2. Stop treatment and notify the patient. 3. Call for emergency assistance. 4. Do not leave patient unattended. 5. Monitor vital signs,. 6. Prepare to assist with administration of intravenous fluids, medications, and oxygen.
  37. 37. Cerebral Vascular Accident (Stroke) Caused by occlusion of the blood supply to the brain, rupture of the blood supply to the brain, or rupture of the cerebral artery, resulting in hemorrhage directly into the brain tissue or into the spaces surrounding the brain. Clinical Manifestations: • Possible severe headache • Numbness • Muscle weakness of flaccidity of face or extremities, usually one-sided • Eye deviation, usually one-sided; possible loss of vision • Confusion • Dizziness • Difficulty in speech (dysphasia) or no speech (aphasia) • Ataxia • May complain of stiff neck • Nausea or vomiting may occur • Loss of consciousness
  38. 38. Cardiac Arrest a condition when the heart ceases to beat effectively and the blood can no longer circulate throughout the body, and the person no longer has effective pulse Clinical Manifestations:  Loss of consciousness, pulse and blood pressure  Dilation of the pupils within seconds  Possibility of seizures
  39. 39. Respiratory Arrest a condition where the lungs ceases to function. Clinical Manifestations:  The patient stops responding  The pulse continues to beat briefly and quickly becomes weak and stops Chest movement stops and no air is detectable moving through the patient‟s mouth
  40. 40. Radiographer‟s Response to Cardiac & Respiratory Arrest 1. If the patient is an adult and is found to be unresponsive, shake the patient and ask, “Are you all right?” If no response, call immediately for emergency medical services. In a hospital, this would be calling a CODE. If you are not near a telephone, shout for help, stating your location. “I need help STAT in room 102.” Do not leave the patient. 2. Assess the carotid pulse of an adult patient. Do not waste time taking the blood pressure or listening for a heartbeat! Do not asses the electrocardiogram contact if one is in place. 3. If the adult patient is pulseless and the emergency medical team has been summoned, place the patient in a supine position on a hard surface. A backboard is available for use in hospital rooms. In the diagnostic imaging area, the tables have a hard surface and this may not be an issue.
  41. 41. 4. If a neck or spinal cord injury is suspected, the patient must be log rolled into a supine position. Begin Cardiopulmonary Resuscitation in the Clinical Area 1. Open the airway. Don gloves; remove any obvious material in the mouth or throat. If the patient has dentures that are loose, remove them. Avoid pushing a foreign object farther back in the mouth or throat. Do not perform blind fingersweeps! Direct the chin up and back. Never sweep the mouth of an infant or small child unless the object is clearly visible!
  42. 42. 2. If you suspect a neck injury, use the jaw thrust maneuver. Do not extend the neck.
  43. 43. 3. Look, listen and feel for airway movement. If you don‟t feel or hear air or see movement of breathing, tightly place the bag- or mouth- mask over the patient‟s mouth and nose. Take a deep breath and slowly, over 2 full seconds, with the least amount of your breath needed to make the chest rise, exhale into the mouth-mask. Allow the patient to exhale as you take in another deep breath and repeat this maneuver. The rationale for this sequence is to reduce the amount of air that enters the stomach of the patient to prevent the complication of regurgitation, aspiration, and pneumonia.
  44. 44. 4. If the patient is not breathing and initial ventilations attempts are not successful, assess for foreign body in airway. If you are unable to administer successful rescue ventilations and if you suspect airway obstruction, use abdominal thrusts to remove obstruction. Recheck for breathing. 5. If patient is breathing, place him or her in a recovery position.
  45. 45. 6. Assess for signs of circulation by checking carotid pulse, and evaluate for coughing, movement, and breathing. 7. If no signs of circulation or breathing are present, and AED is not readily available, and the emergency team has not arrived, begin chest compression.
  46. 46. Head-tilt, chin-lift maneuver
  47. 47. Chest Compression 1. Move fingers up the lower margin of the patient‟s rib cage to the area where the ribs and sternum meet. When the area is located, place index finger above it and place the heel of your hand beside the index finger with your second hand on top of it. 2. Your hands should be located 1.5 inches from the tip of the xiphoid process towards the patient „s head. The finger should not touch the chest wall. Use the weight of your body for compression of the chest wall, and keep elbows straight. 3. Compress the sternum 1.5 – 2 inches directly downward; then release the compression completely. 4. Keeping elbows straight, give 15 compressions in a smooth, even rhythm. 5. Inflate the patient‟s lungs two or more times.
  48. 48. 6. Reassess the patient‟s carotid pulse and respiratory status. If the patient has no pulse or respiration, continue with 15 compressions followed by 2 inflations until the emergency team arrives. 7. Allow them to take over at a time specified for the change.