1. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Chapter 11 Patient Assessment: History and Vital Signs Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer

2. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer OBJECTIVES DIRECTORY 1.Define key terms introduced in this chapter. 3030 2.Prioritize the history and vital signs with scene safety and the primary assessment. 66 3.Describe principles of good communication with patients. 8-98-9 4.Determine a patient’s chief complaint, symptoms, nature of illness or mechanism of injury, and pertinent medical history. 10-1110-11 5.Summarize the patient’s history in communication with other health care providers. 1111 6.Measure a patient’s blood pressure, pulse, respirations, and pulse oximetry value. 13-17, 19-2613-1719-26

3. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer OBJECTIVES DIRECTORY 7.Record a patient’s vital signs. 13-2813-28 8.Compare a patient’s vital signs with the expected values for his age. 16-19, 2716-1927 9.Assess a patient’s skin color, temperature, quality, and capillary refill time. 1818 10.Relate abnormal findings in assessment of the skin to possible problems, such as poor perfusion or oxygenation. 1818 11.Assess a patient’s pupils to determine their equality, reaction to light, and size. 2727

4. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer MULTIMEDIA DIRECTORY Slide 28Vital Sign Assessment Video

5. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer TOPICS Patient History Vital Signs

6. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer INTRODUCTION After the primary assessment Reason for call History Vital signs Physical assessment Back to Objectives

7. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Case Study: The Call Environment –Cold winter evening –Middle class neighborhood –You have responded to this address before and know the patient has serious respiratory problems Dispatch –Responding to a difficulty breathing call –Dispatch advises the patient “is not feeling well.”

8. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Patient History Back to Topics

9. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Photo: © Mark C. Ide Back to Objectives

10. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Chief Complaint Why you were called Symptom Sign Clues Nature of the illness Mechanism of injury

11. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Sample History Signs and symptoms Allergies Medications Past medical history Last oral intake Events leading up to situation Back to Objectives

12. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Case Study: The Response Patient is sitting up in respiratory distress She is awake but cannot speak Her lips are blue The patient’s daughter tells you the patient was “sick all day yesterday” Patient complained of being tired and nauseated Tonight she became short of breath, and it got worse fast Patient has a history of pulmonary edema Your partner begins assisting ventilations

13. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Vital Signs Back to Topics

14. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer

15. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Vital Signs Senses Sphygmomanometer Pen light

16. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Respirations Breaths per minute Count for 30 seconds and multiply by 2 Observe the patient’s chest rise and fall Assess for – Rate – Quality – Sounds

17. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Pulse Radial artery Carotid artery Brachial artery Femoral artery Beats per minute Count for 30 seconds and multiply by 2 Assess for rate, quality, and regularity Back to Objectives

18. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Skin Color Temperature Quality Capillary refill time – Less than two seconds Back to Objectives

19. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Blood Pressure Systolic Diastolic Sphygmomanometer (blood pressure cuff) Normal blood pressure –Child = 80 + (2 x patient's age in years) for systolic and 50–80 mmHg for diastolic –Adult = 100 + patient’s age in years (up to 150 mmHg) for systolic and 65–90 mmHg for diastolic Back to Objectives

20. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Blood Pressure How to auscultate a blood pressure –Apply an appropriately sized blood pressure cuff on the patient’s arm –Find the brachial artery, and place the bell of your stethoscope over it –Inflate the cuff and listen for sounds –As you inflate, you will lose the sound –Once the sound is lost, inflate 30 mmHg more

21. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Blood Pressure How to auscultate a blood pressure –Deflate the cuff slowly and listen –When you hear two consecutive beats return, record the systolic pressure –Continue deflating, listening to the pulse –When you lose the sound of the pulse, record the diastolic pressure CONTINUED

22. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Blood Pressure How to auscultate a blood pressure

23. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Blood Pressure Palpating a blood pressure –Apply an appropriately sized cuff to the patient’s arm –Find the radial pulse and palpate it as you inflate the cuff –Once you lose the pulse, inflate the cuff 30 mmHg more

24. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Blood Pressure Palpating a blood pressure –Deflate the cuff slowly, feeling for the pulse –When you feel the pulse return, record the systolic pressure –You cannot palpate a diastolic pressure, so the pressure is recorded 120/P

25. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Blood Pressure Palpating a blood pressure

26. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Pulse Oximetry Saturation of hemoglobin Normal is 95– 100 percent Sensor CO poisoning will give a false reading Back to Objectives

27. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Pupils Shine a penlight into the patient’s pupil Assess for reactivity Abnormal pupil findings –Nonreactive Back to Objectives

28. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Vital Sign Assessment Click on the screenshot to view a video on vital sign assessment. Back to DirectoryBack to Objectives

29. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Case Study: Transition As your partner bags the patient, EMS arrives The pulse is rapid, weak, and regular Skin is cool and wet Fingernails are blue Blood pressure is 92/50 Paramedics attach a CPAP device to the patient to treat pulmonary edema Paramedics transport patient to the ED

30. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer REVIEW Define the following terms –Chief complaint –Symptom –Mechanism of injury –Sphygmomanometer –Pulse –Capillary refill –Systolic pressure –Diastolic pressure –Hemoglobin Back to Objectives

31. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer STOP, REVIEW, REMEMBER Which of the following is considered a symptom? a)The patient tells you that he is having chest pain. b)The patient’s blood pressure is 120/80. c)Your partner notes severe bleeding. d)Your partner tells you that the patient has stopped breathing. CONTINUED

32. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer STOP, REVIEW, REMEMBER The “S” in SAMPLE history stands for a)signs and symptoms. b)seriousness and severity. c)situation. d)single patient. CONTINUED

33. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer STOP, REVIEW, REMEMBER The “A” in SAMPLE history stands for a)alert. b)aggravation. c)alleviation. d)allergies.

34. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer REVIEW Discussion 1.Discuss the process for palpating a blood pressure. 2.What should be considered when assessing a patient’s breathing? 3.What should be considered when assessing a patient’s pulse? 4.Describe the process of calculating a pulse rate.

35. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Please visit www.bradybooks.com www.bradybooks.com and click on the mykit links to access content for this text. REINFORCE AND REVIEW