Ems207 week2-chap7

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Advanced Assessment for the Paramedic Class Week 1 - Text Chapter 10

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  • Ems207 week2-chap7

    1. 1. Health & Physical Assessment in Nursing First Edition Chapter 7 General Survey Donita D’Amico and Colleen Barbarito
    2. 2. The General Survey <ul><li>General Survey </li></ul><ul><li>a.k.a. The Size Up </li></ul>
    3. 3. Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Ed’s S 3 Sixth Sense of Sickness Sick or Not Sick? a.k.a = BS factor
    4. 4. Size It Up <ul><li>Dispatch: See the Woman, Chest Pain, corner of Williams and 42 nd </li></ul><ul><li>Size up the Scene and the patient.. Looking for? </li></ul><ul><li>Your “Initial Impression is?... </li></ul>Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ
    5. 5. Case Study <ul><li>8y/o male fell down a flight of stairs </li></ul>Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment © 2006 by Pearson Education, Inc. Upper Saddle River, NJ <ul><ul><li>c/o buttock pain, right forearm deformity, headache with possible short +LOC. </li></ul></ul><ul><ul><li>Pt is very calm, constantly asking if his Mom is there, GCS 15 </li></ul></ul><ul><ul><li>Vitals WNL, C-collar, LBB, right arm splinted +PMS </li></ul></ul>
    6. 6. <ul><ul><li>Airway clear – Name is Oliver </li></ul></ul><ul><ul><li>Multiple head contusions </li></ul></ul><ul><ul><li>Right forearm deformity </li></ul></ul><ul><ul><li>Circumferential contusion (some old some new) both wrists </li></ul></ul><ul><ul><li>Bilateral knee abrasions with full ROM </li></ul></ul><ul><ul><li>Contusions to anterior/superior chest wall, spaced at either side of sternum </li></ul></ul><ul><ul><li>Multi layer contusions to the buttock </li></ul></ul>The Size Up www.philosophyblog.com.au http://www.fordarlieroutier.org http://www.fordarlieroutier.org
    7. 7. General Survey = The Size Up <ul><li>Use of Senses During General Survey </li></ul><ul><ul><li>Vision </li></ul></ul><ul><ul><li>Hearing </li></ul></ul><ul><ul><li>Smell </li></ul></ul><ul><ul><li>Taste(?) </li></ul></ul><ul><ul><li>Gut </li></ul></ul>
    8. 8. General Survey = The Size Up Class Exercise: Partner up and size up the person next to you for: 15 seconds then 90 seconds
    9. 9. General Survey = The Size Up <ul><li>What did you learn? </li></ul><0:90 Size Up The Purpose of the general survey is to obtain information to guide your physical assessment & examination. Getting you to your version of the “ Differential Diagnosis (DDx)”
    10. 10. The General Survey
    11. 11. Components of the General Survey <ul><li>Physical appearance </li></ul><ul><li>Mental status </li></ul><ul><li>Mobility </li></ul><ul><li>Behavior </li></ul>
    12. 12. Components of the General Survey <ul><li>Physical Appearance </li></ul><ul><ul><li>Body shape </li></ul></ul><ul><ul><li>Build </li></ul></ul><ul><ul><li>Assessment of function and symmetry </li></ul></ul>
    13. 13. Components of the General Survey <ul><li>Mental Status </li></ul><ul><ul><li>Orientation </li></ul></ul><ul><ul><li>Affect </li></ul></ul><ul><ul><li>Mood </li></ul></ul><ul><ul><li>Anxiety </li></ul></ul><ul><ul><li>Speech </li></ul></ul><ul><ul><li>Self awareness </li></ul></ul><ul><ul><ul><li>Own presence, medical hx, etc.. </li></ul></ul></ul>Other than visual observation how do you assess mental status?
    14. 14. Components of the General Survey <ul><li>Mobility </li></ul><ul><ul><li>Posture </li></ul></ul><ul><ul><li>Gait </li></ul></ul><ul><ul><ul><li>Stumbling </li></ul></ul></ul><ul><ul><ul><li>Shuffling </li></ul></ul></ul><ul><ul><ul><li>Limping </li></ul></ul></ul><ul><ul><li>Range of motion </li></ul></ul>
    15. 15. Components of the General Survey <ul><li>Behavior </li></ul><ul><ul><li>Grooming </li></ul></ul><ul><ul><li>Bodily odors </li></ul></ul><ul><ul><li>Hygiene </li></ul></ul><ul><ul><li>Facial expression </li></ul></ul><ul><ul><li>Mood </li></ul></ul><ul><ul><li>Level of anxiety </li></ul></ul>
    16. 16. <ul><li>Age Related Considerations </li></ul><ul><li>Developmental stage </li></ul><ul><li>Regression from current stage </li></ul><ul><li>Interaction with caretakers </li></ul>Components of the General Survey
    17. 17. Components of the General Survey <ul><li>Height and Weight </li></ul><ul><li>Ask the patient? </li></ul><ul><li>Proportionate? </li></ul><ul><li>Estimated? </li></ul>
    18. 18. Figure 7.2 Measuring the client’s height with a platform scale.
    19. 19. Figure 7.4 Measuring the client’s weight with a standard platform scale.
    20. 20. Table 7.1 1999 Metropolitan Height and Weight Tables, Men and Women, Ages 25 to 59
    21. 21. <ul><ul><li>Length of infants </li></ul></ul><ul><ul><li>Consider proportion </li></ul></ul><ul><ul><li>“ Length based measuring device” </li></ul></ul><ul><ul><li>Actual Weight (when possible) </li></ul></ul>Components of the General Survey <ul><ul><li>Chronological Age and Developmental Stage Considerations </li></ul></ul>
    22. 22. Vitals
    23. 23. The Signs <ul><ul><li>Temperature </li></ul></ul><ul><ul><li>Pulse </li></ul></ul><ul><ul><li>Respiratory rate </li></ul></ul><ul><ul><li>Blood pressure </li></ul></ul><ul><ul><li>Pain </li></ul></ul><ul><ul><li>Oxygen saturation </li></ul></ul><ul><ul><li>(newest) End tidal CO2 </li></ul></ul>
    24. 24. Vitals <ul><li>Use of Vital Signs </li></ul><ul><ul><li>Obtain baseline data </li></ul></ul><ul><ul><li>Detect or monitor a change </li></ul></ul><ul><ul><li>Monitor clients at risk </li></ul></ul>
    25. 25. Going “Ye Ol’ Schoole”
    26. 26. Temperature <ul><li>Temperature Routes </li></ul><ul><li>Oral </li></ul><ul><li>Rectal </li></ul><ul><li>Tympanic </li></ul><ul><li>Temporal </li></ul><ul><li>Also works (if all else fails): </li></ul><ul><li>“ Warm and Dry” </li></ul><ul><li>“ Cold and Wet” </li></ul>
    27. 27. Temperature <ul><li>Factors affecting Body Temperature </li></ul><ul><li>Age </li></ul><ul><li>Diurnal variation </li></ul><ul><li>Exercise </li></ul><ul><li>Hormones </li></ul><ul><li>Stress </li></ul><ul><li>Illness </li></ul>
    28. 28. Pulse and Pulse Points <ul><li>Pulse rates is affected by: </li></ul><ul><li>Age </li></ul><ul><li>Gender </li></ul><ul><li>Exercise </li></ul><ul><li>Stress (stressors) </li></ul><ul><li>Fever </li></ul><ul><li>Hemorrhage </li></ul><ul><li>Medications </li></ul><ul><li>Positional changes </li></ul>
    29. 29. Pulse and Pulse Points <ul><li>What do we look for when palpating a pulse? </li></ul><ul><li>Common locations? </li></ul>
    30. 30. Pulse and Pulse Points <ul><li>The value of auscultation of an Apical HR? </li></ul>
    31. 31. Respirations <ul><li>Rate </li></ul><ul><li>Quality </li></ul><ul><li>Effort </li></ul><ul><li>Sounds </li></ul>
    32. 32. Blood Pressure <ul><li>Mechanical vs Manual  When? </li></ul>
    33. 33. Blood Pressure <ul><li>Factors affecting BP: </li></ul><ul><li>Cardiac Output </li></ul><ul><li>Volume </li></ul><ul><li>Peripheral Vascular resistance </li></ul><ul><li>Viscosity (Crit) </li></ul><ul><li>Vessel compliance </li></ul><ul><li>What else?... </li></ul>
    34. 34. Blood Pressure <ul><li>Orthostatic BP </li></ul><ul><li>Clinical Indications </li></ul><ul><li>>20/10mmHG Change </li></ul><ul><li>>20 points HR Change </li></ul><ul><li>Pause in each stages </li></ul><ul><ul><li>Supine </li></ul></ul><ul><ul><li>Sitting, feet dangle </li></ul></ul><ul><ul><li>Standing </li></ul></ul>
    35. 35. Box 7.1 Korotkoff’s Sounds
    36. 36. Box 7.1 (continued) Korotkoff’s Sounds
    37. 37. Pain – Yes it’s a Vital Sign <ul><li>Pain Assessment </li></ul><ul><ul><li>Pain history </li></ul></ul><ul><ul><li>Observations of behaviors </li></ul></ul><ul><ul><li>Physiological changes </li></ul></ul><ul><ul><li>Pain history </li></ul></ul><ul><ul><li>Location </li></ul></ul><ul><ul><li>Intensity </li></ul></ul>
    38. 38. Pain – Yes it’s a Vital Sign <ul><li>How do you ask the pain question? </li></ul><ul><li>What is appropriate? </li></ul><ul><li>Cultural considerations </li></ul>
    39. 39. Figure 7.15 The Wong-Baker “Faces” pain rating scale. Source: From Hockenberry, MJ, Wilson D., Winkelstein ML:Wong’s Essentials of Pediatric Nursing, ed.7, St.Louis, 2005, p.1259. Used with permission. Copyright Mosby.
    40. 40. Pain – Yes it’s a Vital Sign <ul><li>Pain Assessment </li></ul><ul><ul><li>Quality </li></ul></ul><ul><ul><li>Pattern </li></ul></ul><ul><ul><li>Precipitating factors </li></ul></ul><ul><ul><li>Methods to relieve pain </li></ul></ul><ul><ul><li>Impact on ADLs </li></ul></ul><ul><ul><li>Coping strategies </li></ul></ul><ul><ul><li>Emotional responses </li></ul></ul>
    41. 41. Pain – Yes it’s a Vital Sign <ul><li>Physiological Responses to Pain </li></ul><ul><ul><li>Sympathetic </li></ul></ul><ul><ul><li>Parasympathetic </li></ul></ul>
    42. 42. Oxygen Saturation <ul><li>The noninvasive pulse oximeter uses light pulses to measure percent of oxygenated hemoglobin based on calculations associated with the oxyhemoglobin dissociation curve (simplified) </li></ul>95-100%
    43. 43. Oxygen Saturation <ul><li>Factors affecting Noninvasive O2 saturation? </li></ul><ul><li>Circulation </li></ul><ul><li>Hemoconcentration </li></ul><ul><li>Temperature </li></ul><ul><li>Nail polish </li></ul>
    44. 44. End Tidal CO 2 Detection <ul><li>The concentration (measured as partial pressure) of carbon dioxide (CO 2 ) at the end of an exhaled breath </li></ul><ul><li>Expressed as a percentage of CO 2 or mmHg. </li></ul><ul><li>The normal values are 5% to 6% CO 2 </li></ul><ul><ul><li>Equivalent to 35-45 mmHg (pressure) </li></ul></ul><ul><li>CO 2 reflects cardiac output and pulmonary blood flow as it is transported by the venous system to the right side of the heart and then pumped to the lungs by the right ventricles. </li></ul><ul><li>When CO 2 diffuses out of the lungs into the exhaled air, we measure it through a capnometer </li></ul><ul><ul><li>A Capnometer measures the partial pressure or maximal concentration of CO 2 at the end of exhalation. </li></ul></ul><ul><li>Tip: </li></ul><ul><ul><li>During CPR, the amount of CO 2 excreted by the lungs is proportional to the amount of pulmonary blood flow. </li></ul></ul>
    45. 45. End Tidal CO 2 Detection <ul><li>Easy Cap II CO2 Detector </li></ul><ul><li>The normal values are 5% to 6% CO 2 </li></ul><ul><ul><li>Equivalent to 35-45 mmHg (pressure) </li></ul></ul>
    46. 46. End Tidal CO 2 Detection Capnography Wave Form
    47. 47. Break

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