EMT 128 Ch. 12

Describe the methods used to assess blood pressure (BP).

1. By auscultation (listening) using a BP cuff and a stethoscope to listen at the brachial artery. 2. By palpation, using a blood pressure cuff and feeling the pulse at the radial artery. (See directions in book. Too long)

Describe the methods used to assess respirations.

1. Grasp patient's wrist as if you were going to count the pulse rate. Hold their arm firmly against their upper abdomen. Do this because many patients will unknowingly alter their RR when someone is watching them breathe. 2. Observe the patient's chest move in and out. Listen for abnormal sounds. 3. Count number of breaths taken in 15 or 30 seconds. Multiply by 4 or 2, respectively. 4. While counting, note depth and ease of breathing 5. Record findings of rate, depth, and ease.

State the characteristics that are obtained and measured when assessing respirations, pulse, blood pressure, skin signs, and pupils.

1. Respirations - rate, depth, sound, and ease. 2. Pulse - rate, strength, and rhythm 3. Blood pressure - ratio of systolic to diastolic pressures 4. Skin Signs - color, temperature, and moisture (and capillary refill for perfusion) 5. Eyes - emotion, pupils (size, shape, equality of pupil size, reactivity to light.) Use the acronym PERRL which stands for (pupils equal round reactive light)

Differentiate between a sign and a symptom.

A sign is something you can see and observe about your patient, but a symptom is the patient experiences that may be difficult to discover, and something subjective to the patient such as pain or dizziness.

Explain the importance of a thorough medical history.

A thorough medical history will allow you to discover information about the patient that may be important but not immediately obvious, to assist in giving the best care possible.

At what age patient should you not attempt to take blood pressure?

Attempting to obtain blood pressure in children can be challenging due to their small size and difficulty sitting still. It may not be practical to attempt to obtain a blood pressure in children under the age of three. Special equipment is required to take BP in infants.

What are the pros and cons of using auscultation vs. palpation to take a blood pressure reading?

Auscultation allows you to record both systolic and diastolic BP, while palpation only allows you to record systolic BP. However, in noisy environments where auscultation cannot be used, palpation is the preferred method. Palpation also only requires the BP cuff and not a stethoscope.

Briefly describe what blood pressure is, and specifically what is happening when you observe systolic and diastolic blood pressure.

Blood pressure (BP) is determined by measuring the pressure changes in the arteries. BP generated within the arteries when the heart contracts is called the systolic BP. After the left ventricle contracts, it relaxes and refills. This is called diastole, and the BP in the arteries falls.This is called diastolic BP.

Describe the methods used to assess the eyes/pupils.

Check using the following acronym: P — Pupils E — Equal (When you encounter a patient with unequal pupils, ask if this is a normal condition for them.) R — Round R — Reactive L — Light (test constriction/dilation by covering the eyes or shining a penlight or flashlight into the eyes. Patient should look straight ahead as you hold the light outside their field of vision.)

Describe the methods used to assess pulse.

For checking a radial pulse: 1. Use 2-3 fingers to locate the pulse. Don't use your thumb because it has its own pulse. 2. Place fingertips on lateral side of patient's anterior wrist, just above the crease between the hand and wrist. Slide your fingers from this position toward the thumb (lateral) side of the wrist. 3. Apply moderate pressure until you feel the pulse. If the pulse is weak, you may need to apply more pressure. Applying too much pressure can also cause the pulse to fade. 4. Once pulse is felt, count the beats for either 15 or 30 seconds, then multiply by 4 or 2, respectively. 5. While counting, note strength and rhythm of the pulse. 6. Record findings of rate, strength, and rhythm.

Differentiate the techniques used to assess a pulse in an infant, child, and adult patient.

For infants under 1 year old, use brachial pulse instead of radial or carotid.This is due to difficulty in isolating the radial and carotid pulses given the underdeveloped anatomy of these small children. Place index and middle fingers over the brachial artery on the inside of the baby's upper arm, between the elbow and armpit. Press gently until you feel a pulse.

How are blood pressure and perfusion related?

Good perfusion requires good blood pressure. The lower the blood pressure drops below normal, the less effective perfusion is.

Describe the components of the OPQRST assessment tool.

O — Onset. What the patient was doing when the pain or symptoms began. P — Provocation. What might make the pain or symptoms better or worse. Q — Quality. What the pain or symptom actually feels like. R — Region/Radiate. Where the pain may be moving or radiating to. S — Severity. The severity of the pain or discomfort. A standard 1-to-10 scale is typically used. T — Time. How long the patient may have been experiencing pain or discomfort.

Describe the components of the SAMPLE history tool.

S — Signs/symptoms A — Allergies M — Medications P — Past pertinent medical history L — Last oral intake E — Events leading to the illness or injury

perfusion

The adequate delivery of well-oxygenated blood and nutrients to all parts of the body, and the elimination of waste products.

Describe the methods used to assess skin signs.

The skin signs of color, temperature, and moisture can be assessed by observing the patient's face and feeling the forehead. In light-skinned patients, observe the face and in dark-skinned patients, observe the palms, nail beds, and inside of the lips to look for pink appearance. Pull the glove away from the back of your hand and hold it skin-to-skin against the patient's forehead to check temperature and for moisture (diaphoresis).

Describe the methods used to assess mental status or LOC (level of consciousness)

Use the AVPU scale: A - Alert. Patient is aware and spontaneously interacting with the environment around them. V - Verbal. The patient is responsive to verbal stimuli. This patient appears unconscious but wakes up or responds when you speak to them. They may not provide meaningful info. P - Pain. Patient is responsive only to painful stimuli. Appears unconscious and does not respond to verbal commands.May groan or pull away in response to painful stimulus. U - Unresponsive. Patient is completely unresponsive to any verbal or painful stimuli.

stethoscope

a device used to auscultate sounds within the body. Most commonly used to obtain blood pressure.

jaundice

a medical condition that causes yellowing of the skin and whites of the eyes. Typically caused by liver failure or obstruction of the bile duct.

OPQRST tool

a mnemonic used during a secondary assessment to help assess the patient's chief complaint; the letters stand for onset, provocation, quality, region/ radiate, severity, time.

The term trending is best defined as the: a. ability to record changes in a patient's condition over time. b. name given to the last set of vital signs taken on a patient. c. transfer of care from one level of care to another. d. ability to improve a patient's condition over time.

a. ability to record changes in a patient's condition over time.

When assessing the pulse, you should assess: a. rate, strength, and rhythm. b. strength and regularity. c. rate and volume. d. rate and quality.

a. rate, strength, and rhythm.

SAMPLE history tool

an acronym used to obtain a patient history during the secondary assessment; the letters stand for signs/ symptoms, allergies, medications, past pertinent medical history, last oral intake, and events leading to the problem today.

What are the two pulse points that are referred to as central pulses?: a. Radial and tibial b. Carotid and femoral c. Femoral and brachial d. Brachial and carotid

b. Carotid and femoral

Which of the following BEST describes the reason for obtaining an accurate medical history?: a. It allows insurance to properly bill the patient. b. It allows you to better understand what is happening with the patient. c. It helps paramedics complete accurate documentation. d. It tells you if the patient is not being truthful in their complaints.

b. It allows you to better understand what is happening with the patient.

As blood pressure drops, perfusion is most likely to: a. increase b. decrease c. fluctuate d. remain the same

b. decrease

When going from a well-lit room to a dark one, you would expect the normal pupil to: a. not react. b. dilate. c. constrict. d. fluctuate.

b. dilate.

The five common vital signs are pulse, respirations, blood pressure, pupils, and: a. oxygen saturation. b. skin signs. c. mental status. d. capillary refill.

b. skin signs.

You are caring for an adult patient who appears unconscious. When you tap on his shoulder and call out his name, he opens his eyes and attempts to respond. This patient would be classified as _______ on the AVPU scale: a. alert b. verbal c. painful d. unresponsive

b. verbal

Which of the following would best be described as a symptom?: a. Bruising to the arm b. A laceration on the lip c. Headache d. Diaphoretic skin

c. Headache

Which one of the following is most accurate when describing a palpated blood pressure?: a. It provides only the diastolic pressure. b. It must be taken on a responsive patient. c. It can be obtained without a stethoscope. d. It can be obtained without a BP cuff.

c. It can be obtained without a stethoscope.

Which of the following would be described as a SIGN?: a. Chest pain b. Headache c. Pale skin d. Abdominal cramping

c. Pale skin

Skin that is bluish in color is called: a. pale b. flushed c. cyanotic d. jaundiced

c. cyanotic

When assessing a patient's respirations, you must determine rate, depth, and: a. regularity. b. count of expirations. c. ease. d. count of inspirations.

c. ease.

In a SAMPLE history, the E represents: a. EKG results. b. evaluation of the neck and spine. c. events leading to the illness or injury. d. evidence of airway obstruction.

c. events leading to the illness or injury.

When assessing circulation for a responsive adult patient, you should assess the: a. carotid pulse. b. brachial pulse. c. radial pulse. d. pedal pulse.

c. radial pulse.

The pressure inside the arteries each time the heart con-tracts is referred to as the _______ pressure: a. diastolic b. pulse c. systolic d. mean

c. systolic

A respiratory rate that is lower than _______ for an adult should be considered inadequate: a. 4 b. 6 c. 8 d. 10

d. 10

What can be assessed by watching and feeling the chest and abdomen move during breathing?: a. Pulse rate b. Blood pressure c. Skin signs d. Respiratory rate

d. Respiratory rate

The "R" in the OPQRST pneumonic refers to: a. respirations. b. radial. c. remote. d. radiate.

d. radiate.

The term diaphoretic refers to: a. pupil reaction b. skin temperature c. heart rhythm d. skin moisture

d. skin moisture

diaphoretic

excessively sweaty. Commonly caused by exertion or some medical problem, such as heart attack or shock.

medical history

previous medical conditions and events for a patient.

sign

something that can be observed or measured when assessing a patient.

symptom

something the patient complains of or describes during the secondary assessment.

respiration

the act of breathing in and out; also, the exchange of oxygen and carbon dioxide within the cells.

trending

the act of comparing multiple sets of signs and symptoms over time to determine if the patient's condition is worsening, improving, or remaining the same.

auscultation

the act of listening to internal sounds of the body, typically with a stethoscope.

palpation

the act of using one's hands to touch or feel the body.

cyanotic

the bluish coloration of the skin caused by an inadequate supply of oxygen. Typically seen at the mucous membranes and nail beds.

work of breathing

the effort a patient must exert to breathe.

vital signs

the five most common signs used to evaluate a patient's condition (respirations, pulse, blood pressure, skin, and pupils).

mental status

the general condition of a patient's level of consciousness and awareness.

chief complaint

the main medical complaint as described by the patient.

blood pressure

the measurement of the pressure inside the arteries, both during and between contractions of the heart.

diastolic

the pressure that remains in the arteries when the heart is at rest; the resting phase of the heart.

systolic

the pressure within the arteries when the heart beats; the contraction phase of the heart.

pulse

the pulsation of the arteries that is felt with each heartbeat.

capillary refill

the time it takes for the capillaries to refill after being blanched. Normal capillary refill time is two seconds or less.

baseline vital signs

the very first set of vital signs obtained on a patient.