CH 11.4 Secondary Assessment & Reassessment

What is the purpose of the secondary assessment?

To obtain quantifiable, objective information about a patient's overall state of health.

What are the two main elements of the secondary assessment?

Obtaining vital signs and performing a systematic physical exam.

What factors can influence how the secondary assessment is performed?

Conditions in the prehospital setting.

What must you understand to appreciate abnormalities during examination?

The wide variety of normal presentations.

What factors determine the start of the physical exam?

Patient stability, chief complaint, history, communication ability, and potential for unrecognized illness or injury.

What is a rapid full-body scan?

A 60- to 90-second nonsystematic review and palpation of the patient's body.

What types of injuries should be evaluated during a physical exam?

Open injuries (abrasions, amputations, punctures) and closed injuries (deformities, burns, contusions).

What is the technique of inspection in assessment?

Visually examining the patient for signs of distress or abnormalities.

What does palpation involve?

Using fingers to check pulses and assess areas of pain or tenderness.

What is percussion in a physical exam?

Gently striking the surface of the body to detect changes in the densities of underlying structures.

What is auscultation?

Listening to body sounds with a stethoscope.

What are vital signs?

Measurements that provide information about the patient's physiological status.

What is the significance of baseline vital signs?

They help establish trends showing patient improvement or deterioration.

How can pulse be assessed?

By evaluating rate, presence, location, quality, and regularity.

What factors can affect blood pressure readings?

Cuff size and positioning, as well as the patient's size and habitus.

What does the tympanic membrane temperature measure?

Core body temperature.

What can pulse oximetry indicate?

The percentage of hemoglobin saturation, but should not be used as an absolute indicator of the need for oxygen.

What equipment is typically used in the secondary assessment?

Stethoscope, blood pressure cuff, pulse oximeter, capnography, glucometry equipment, reflex hammer, light source, gloves, and sheets.

What is the role of the stethoscope in patient assessment?

To listen to body sounds and assess physiological functions.

What is the purpose of the full-body exam?

To identify hidden injuries or causes not found during the primary survey.

What signs indicate significant distress in a patient?

Mental status changes, anxiousness, labored breathing, difficulty speaking, diaphoresis, obvious pain, and deformity.

What terms describe the degree of distress in a patient?

No apparent distress, mild, moderate, acute, and severe.

What terms describe the general state of a patient's health?

Chronically ill, frail, feeble, robust, and vigorous.

Why is the physical exam considered the most important skill for healthcare providers?

It helps in gaining critical information regarding the patient's overall presentation.

What should be noted about a patient's hygiene and appearance during assessment?

It can provide insights into their overall health status.

What is the importance of reevaluating the patient's situation during assessment?

To ensure all patient issues have been addressed.

What is the significance of communication ability in starting a physical exam?

It affects how effectively the provider can gather information from the patient.

What type of exam should be performed on patients with significant MOI, unresponsiveness, or critical condition?

A full-body exam.

What is a focused exam?

An exam performed on patients with insignificant MOIs who are responsive, based on the chief complaint.

What are the most common complaints in a focused exam?

Head, heart, lungs, abdomen.

What should you assess in a patient with a head-related problem?

Palpate the head for signs of trauma, check for facial asymmetry, and assess pupil response.

What does the AVPU scale assess?

Level of consciousness.

What are the four areas to assess for alertness and orientation?

Person, place, day of the week, the event.

What scale is used to assess mental status?

The Glasgow Coma Scale.

What does skin examination assess?

Color, temperature, condition, turgor, and significant lesions.

What does pallor indicate?

Poor red blood cell perfusion to capillary beds.

What is cyanosis a sign of?

Low arterial oxygen saturation.

What should be examined in hair and nails?

Quantity, distribution, texture, color, shape, and presence of lesions.

What does mottling indicate?

Severe protracted hypoperfusion and shock.

What should be assessed in the head during an examination?

Deformity, asymmetry, tenderness, shape, and contour.

What is assessed in the eyes during an examination?

Visual acuity, pupil size and reaction, and muscle movement.

What should be checked for in the ears?

Changes in hearing perception, wounds, swelling, and drainage.

What is the nasal cavity divided by?

The nasal septum.

What should be inspected in the throat?

Mouth, pharynx, neck, and signs of foreign body aspiration.

What are the indications for spinal immobilization?

Tenderness on palpation, complaint of pain, altered mental status, inability to communicate, GCS less than 15, distracting injury, paralysis.

What is the most reliable indicator of a spine injury?

Pain.

What should be done if manipulation causes pain during a spinal exam?

Stop the exam immediately and place the patient in a properly sized collar.

What does the assessment of cognitive function include?

Attention, memory, and reasoning abilities.

What are signs of dehydration in skin assessment?

Tenting of the skin and poor turgor.

What should be noted about the nails during examination?

Color, shape, texture, and presence of lesions.

What is the significance of checking for facial asymmetry?

It may indicate neurological issues or trauma.

What does elevated blood pressure often accompany?

Headaches.

What is assessed in the neck during an examination?

Symmetry, masses, venous distention, and carotid pulses.

What is the purpose of examining the conjunctivae?

To assess for pallor or cyanosis indicating circulatory issues.

When should continued assessment of a patient's range of motion take place?

Only when there is no potential for serious injury.

What are the two types of motion assessed in range of motion?

Passive motion and active motion.

What are the three phases of a chest exam?

Chest wall exam, pulmonary evaluation, and cardiovascular assessment.

What should be checked for during a chest examination?

Signs of abnormal breathing movements, ventilatory fatigue, accessory muscle use, and chest deformities.

What technique is used to palpate abnormal areas of the chest wall?

Chest wall percussion.

What is the normal characteristic of breath sounds?

Clear and quiet.

What are bronchial sounds?

Hollow, tubular sounds with a lower pitch, heard over the trachea.

What are adventitious breath sounds?

Abnormal sounds such as wheezing, crackles, rhonchi, stridor, and pleural friction rubs.

What does wheezing sound like?

A high-pitched whistling sound.

What is a bruit?

An abnormal 'whooshing' sound that indicates turbulent blood flow through a narrowed artery.

What is a murmur?

An abnormal 'whooshing' sound heard over the heart indicating turbulent blood flow around a cardiac valve.

What are Korotkoff sounds?

Sounds related to a patient's blood pressure, with the first and fifth phases being clinically significant.

What does Phase I of Korotkoff sounds indicate?

Clear, faint, tapping sounds that correlate to systolic contraction.

What is the point of maximum impulse (PMI)?

The location on the chest wall where the heart's apical pulse is felt most strongly.

What are signs of venous obstruction or insufficiency?

Venous engorgement, palpable edema, swelling, hyperpigmentation, mild erythema, painful superficial veins, heaviness in extremities, and changes in skin color.

What does jugular venous distention (JVD) indicate in a patient with left chest trauma?

It may indicate cardiac tamponade.

What are the three basic mechanisms that produce abdominal pain?

Visceral pain, inflammation, and referred pain.

What characterizes visceral pain?

It results from obstruction of hollow organs, producing cramping and diffuse pain.

What is referred pain?

Pain that originates in a particular organ but is felt in a different location.

What organs are considered intraperitoneal?

Stomach, proximal duodenum, pancreas, jejunum, ileum, appendix, cecum, transverse colon, sigmoid colon, proximal rectum, liver, gallbladder, spleen, omentum, and female internal genitalia.

What organs are considered extraperitoneal?

Mid- and distal duodenum, abdominal aorta, mid- and lower rectum, kidneys, pancreatic tail, adrenal glands, ureters, renal blood vessels, gonadal blood vessels, ascending colon, descending colon, and urinary bladder.

What should be assessed when evaluating the cardiovascular system?

Pulse for regularity and strength, skin for signs of hypoperfusion, breath sounds, baseline vital signs, and extremities for peripheral edema.

What is the significance of assessing arterial pulses?

It provides information on location, rate, rhythm, quality, and amplitude.

What is the role of auscultation in assessing heart sounds?

To detect characteristic heart sounds during the cardiac cycle.

What does S1 heart sound indicate?

Closure of atrioventricular valves, marking the onset of ventricular contraction (systole).

What does S2 heart sound signify?

Closure of the semilunar valves, marking the onset of ventricular relaxation (diastole).

What is a 'gallop' rhythm associated with?

S4 heart sound, indicating decreased stretching of the left ventricle or increased pressure in the atria.

What is the importance of obtaining an accurate blood pressure?

To assess the patient's cardiovascular status and monitor for hypertension.

What are extraperitoneal organs?

Organs located outside the peritoneal cavity, including the mid- and distal duodenum, abdominal aorta, mid- and lower rectum, kidneys, pancreatic tail, adrenal glands, ureters, renal blood vessels, gonadal blood vessels, ascending colon, descending colon, and urinary bladder.

What is inflammation in the context of abdominal pain?

Irritation of somatic pain fibers in the skin, abdominal wall, and musculature, producing sharp, localized pain.

Why is it important to obtain baseline vital signs?

To determine the seriousness of the patient's condition and the function of internal organs.

What does orthostatic vital signs assessment involve?

Measuring blood pressure and pulse in supine and sitting or standing positions to assess volume depletion.

What is considered a positive orthostatic vital signs test?

A decrease in systolic pressure by up to 20 mm Hg, an increase in diastolic pressure of 10 mm Hg, and an increase in pulse rate by 20 beats/min.

What should be documented during an orthostatic vital signs assessment?

Whether the pulse was regular, if the patient is being monitored with an ECG, and any other symptoms experienced.

What is the recommended position for examining the abdomen?

The patient should be in a supine position for comfort.

What is the order of examination techniques for the abdomen?

Inspection, auscultation, percussion, and palpation, performed systematically quadrant by quadrant.

What are the possible descriptions of the abdomen during inspection?

Flat, rounded, protuberant, scaphoid, or pulsatile.

What is ascites?

Fluid accumulation within the peritoneal cavity, leading to a distended abdomen and possible visible fluid wave.

What do Cullen sign and Grey Turner sign indicate?

They are indicative of ruptured ectopic pregnancy or acute pancreatitis.

What are the types of bowel sounds that can be auscultated?

Hyperactive, hypoactive, or absent.

What is guarding in abdominal examination?

Voluntary or involuntary contraction of abdominal muscles in response to pain.

What does rebound tenderness indicate?

Peritoneal irritation, noted when pain occurs upon rapid release after pressing down on the abdomen.

What is a hernia?

A localized weakening of the abdominal wall musculature that may not always be visible.

What is the technique for palpating the liver?

Support the right ribs with the left hand and press down with the right hand as the patient takes a deep breath.

What indicates possible inflammation of the gallbladder during palpation?

Patient response indicating pain when the gallbladder is palpated under the liver edge.

What is the significance of palpating the spleen?

The spleen may only be palpable if inflamed; otherwise, it is generally not felt.