32.4b Primary Assessment

position, color, mental status, ability to speak, and respiratory effort

To get a general imnpression of respiratory status, consider the patient's ①.

upright posture

Consider the patient’s position. Patients with respiratory diseases tend to tolerate an ① better than lying flat.

sitting upright with feet dangling over the side of the bed

An indication of severe respiratory distress is a patient who is ①

“tripod” position

In the most severe cases, the patient will assume the ① in which the patient leans forward and supports the patient’s weight with extended arms.

pallor and diaphoresis

Patients with severe respiratory distress display ①.

cyanosis

① is a late finding in respiratory distress and can be absent even with significant hypoxia.

peripheral cyanosis

① (bluish discoloration involving only the distal extremities) is not a specific finding and is also found in patients with poor circulation.

slowing blood flow and increased extraction of oxygen from red blood cells

Peripheral cyanosis reflects ①.

central cyanosis

① (involving the lips, tongue, and truncal skin) is a more ominous finding seen in hypoxia.

① restless and agitated

② lethargic

Briefly assess the patient’s mental status. Generally, a hypoxic patient will become ① while a patient with excess carbon dioxide levels (hypercapnia) will become ②.

① hypoxia

② hypercarbia

Confusion is seen with both ① (deficiency of oxygen) and ② (excess of carbon dioxide).

lethargic and somnolent

When respiratory failure is imminent, the patient will appear severely ①.

① droop

② bob

The patient’s eyelids will begin to ① and the patient’s head will ② with each respiratory effort.

speak in full, coherent sentences

Assess the patient’s ability to ①.

ease

Determine the ① with which the patient can discuss symptoms.

only one to two words

Patients with respiratory distress will be able to speak ① before they need to pause to catch their breath.

fear, anxiety, or hypoxia

Rambling, incoherent speech indicates ①.

active

Normal ventilation is an ① process.

① acessory muscles in the neck ② intercostal muscles

The use of ① and visible contractions of the ② indicate significant breathing effort.

respiratory distress

Nasal flaring, intercostal muscle retraction, accessory muscle use, cyanosis, pursed lips, and tracheal tugging are signs of ①.

airway, breathing, or circulation (ABCs)

Your primary assessment of the patient is to identify any life-threatening conditions resulting from compromise of ①.

circulation

Remember that in presumed cardiac arrest, ① comes before airway and breathing.

oxygen

① is one of the most basic necessities for life, and the respiratory system is responsible for supplying it to the body tissues.

potentially life threatening

Any significant abnormality in the respiratory tract must be viewed as ①.

airway

After quickly forming your general impression, immediately focus on the patient’s ①.

partial airway obstruction

Noisy breathing nearly always means ①.

noisy

Obstructed breathing is not always ①.

asphyxia

The brain can survive only a few minutes in ①.

blocked

Artificial respiration is useless if the airway is ①.

apneic

A patent airway is useless if the patient is ①.

looking for help or equipment

If you note airway obstruction, do not waste time ①. Act immediately.

basic airway management techniques

If the airway is compromised, quickly institute ①.

ventilation

Once you have secured a patent airway, ensure that the patient has adequate ①.

brief and directed

Your primary assessment of the respiratory system should be ①.

immediate threat to life

A more detailed examination should be conducted once you have been able to establish that a(n) ① does not exist.

possible life-threatening respiratory problem

The following signs should suggest a ① in adults: AMS changes, audible stridor, severe central cyanosis, absent breath sounds, 1-2 word dyspnea, tachycardia, pallor and diaphoresis, intercostal & sternocleidomastoid retractions, and use of accessory muscles.