Assessing Patients and Managing Acute Situations

1. Assessing Patients and Managing Acute Situations By Stacy Heim Nicole Walz Lisa Anderson Amy Lindgren

2. Overview In this chapter we will discuss the basics of patient care including the patients basic needs and how we can meet them. It is important to have a history of the care of the patient and to obtain one when a new patient is being given medical care. We can help the patient more effectively if we have a history of illnesses and care that they have had. When you first help a patient it is important to establish a bases of the patients condition this includes an evaluation of the patients physical condition and their vital signs. We also discussed how important it is to know what to do and how to use the equipment necessary in various acute/emergency situations.

3. Determine Patient Needs (Page 488) Observation Evaluation Assessment

4. Assessing the Personal Concerns of Patients (Page 488) Fear Anger Anxiety Need to talk constantly Become quiet and withdrawn Fidgeting Physical Discomfort

5. Physical Needswater (Page 488) Dry mouth can result from anxiety or medication Offering water may be comforting to the patient Make sure water is permitted

6. Physical NeedsElimination (Page 488 to 489) Urgent need to void can be distressing to a patient Full bladder can cause discomfort, irritability, and difficulty remaining still If incontinence results, it would cause embarrassment Before patient uses bathroom, make sure no specimen is needed Use bedpan if needed

7. Physical NeedsSanitary Supplies (Page 489) Make sure you know where sanitary napkins are kept Direct patient to properly dispose of the sanitary napkin

8. Taking a History (Page 489 to 490) Provide complete and accurate information about patient’s history and condition Introduce yourself, call patient by their name, and deal with their concerns right away Gain patient’s confidence

9. Taking HistoryOnset (Page 490) How did it start? What happened? When did it first trouble you? Was it sudden or a complaint that gradually got worse?

10. Taking HistoryDuration (Page 490) Have you ever had it before? If so, when? Has it been continuous? Does it bother you al the time? How long has this attack been bothering you?

11. Taking HistorySpecific Location (Page 490) Where does it hurt? Where is the problem? Can you put your finger on where it hurts the most? Does it hurt anywhere else?

12. Taking HistoryQuality of Pain (Page 490) What does it feel like? Sharp, stabbing, dull ache, throbbing pain? How severe is it? Mild, moderate, severe? (you could use a scale from 1 to 10, 1 being no pain and 10 being the worst pain you could ever feel) Does it wake you up at night?

13. Taking HistoryWhat Aggraviates (Page 490) When is it worse? What seems to aggravate it? Is it worse after meals, at night, when you walk?

14. Taking HistoryWhat Alleviates (Page 490) What has helped in the past? Does that still help? What seems to help now? Does the time of day, amount of rest or change is position make a difference?

15. Taking a History (Page 490) Anxious patients may read too much into your questions Taking a history may seem complex and confusing, but this skill improves with practice Use role play with other students to improve your ability to take histories They will become accurate and pertinent

16. Assessing Current Physical Status Establishing a Baseline (Page 490) Review Requisition Read Diagnosis and progress notes Allergies Patient history

17. Physical Evaluation (Beaman & Fleming-McPhillips, 2007) (Page 490 and 491) • Observation • Six methods of observation • Inspection • Palpation • Percussion • Auscultation • Mensuration • Manipulation • Assessment • Measurement • Changes in patient condition

18. Vital SignsTemperature (Beaman & Fleming-McPhillips, 2007) • Normal body temperature is 98.6 degrees F • Hyperthermia • Over 105. 8 Degrees F • Hypothermia • Below 97 Degrees F • Methods of taking a temperature • Oral • Axillary • Rectal • Ear (aural) • Thermometer types • Non-mercury glass • Electronic or digital • Tympanic • Disposable • Fever types • Intermittent Fever • Remittent Fever • Relapsing Fever • Constant Fever

19. Vital SignsPulse (Beaman & Fleming-McPhillips, 2007) • Normal Pulse rate for adults • 60 – 80 bpm • 50 – 65 bpm for older adults • Normal pulse rate for children • 120 – 160 bpm for 1 year or younger • 80 – 120 bpm for 2 – 6 years • 80 – 100 bpm for 6 – 10 years • 70 – 90 bpm for 11 – 16 years • Characteristics of pulse • Rate • Volume • Rhythm • Compliance

20. Vital SignsPulse (Beaman & Fleming-McPhillips, 2007) • The 9 Pulse Sites • Temporal • Carotid • Apical • Brachial • Radial • Femoral • Popiteal • Posterior Tibial • Dorsalis Pedis

21. Vital SignRespiration (Beaman & Fleming-McPhillips, 2007) • Normal range for Adults • 14 – 20 Cycles per minute • Normal range for Children • Average of 30 – 50 cycles per minute • Characteristics of Respiration • Rate • Rhythm • Depth • Quality • Breathing Sound • Stridor • Stertorous • Crackles • Rhonchi • Wheezes • Cheyne-Stokes • Bubbling

22. Vital SignsBlood Pressure (Beaman & Fleming-McPhillips, 2007) (Page 496) • Normal reading for Adults • 120/80 or below • Normal readings for children • Newborn 75/55 • 6 – 9 years 90/55 • 10 – 15 years 100/65 • 16 years 118/76 • Hypertension • 140/90 or above • Prehypertension • 120/80 to 139/89 • Hypotension • Systolic less than 50 mm Hg • Tools used to take blood pressure • Stethoscope • Sphygmomanometer • Korotkoff Sounds

23. Vital SignsPain (Beaman & Fleming-McPhillips, 2007) • Considered the fifth vital sign • Not easy to see or measure • Types of pain • Acute • Chronic • Radiating • Referred • Intractable • Phantom

24. Vital SignsBlood Oxygen Saturation (Page 497) • Not considered one of the vital signs • Is included when doing vital signs • Pulse Oximeter • Has sensor that attaches to finger or earlobe • Measures oxygen saturation in blood • Measures pulse rate • Normal Oxygen Saturation levels • Ranges between 95% and 100%

25. Acute Situations (Page 497) It is important to be able to evaluate a patients condition in a short amount of time. Notice the changes in their symptoms and conditions is crucial. Knowing what equipment and supplies is needed in a emergency can help save a persons life. Every situation is different and must be handled in a carefully and remain calm under pressure.

26. Emergency Supplies (Page 497 to 499) Basic supplies emergency that should be kept in a clinic : -Airways, Emergency Medications, BP cuff, and Stethoscope. Some clinics have a more extensive emergency supplies. It is important to know what is apart of the emergency supplies and to never use them for routine use.

27. Oxygen and Suction (Page 499 to 500) Oxygen -It is important to know how to effectively operate Oxygen and Suction systems in the Facility. Oxygen Administration - Face Mask: Oxygen concentrations 30%-50% -Portable tank with nasal cannula: Delivers a constant rate of Oxygen flow for Long-term Oxygen Therapy.

28. Oxygen and Suction Continued… (Page 499 to 500) Suction -Suction is used when a patient is unable to clear the mouth and throat of secretions, blood, or vomit. - Ensure that the suction system is in operational condition. - Help place the patient into the recovery position once their airway is clear and stand to the side.

29. Respiratory Emergencies (Page 500 to 501) Asthma - Bronchospasm that causes difficulty in breathing. - Treatments include a nebulizer with bronchodilating medication for chronic asthmas and epinephrine for asthma attacks.

30. Respiratory Emergencies Continued… (Page 501) Bronchial Obstruction - Occurs when food or other objects lodge in the larynx blocking the airway. - Signs include: unable to talk, cough, become agitated, and make the universal choking sign. - Heimlich Maneuver or Abdominal thrusts should be used to dislodge the object.

31. Cardiac Emergencies (Page 501 to 502) Angina Pectoris -Chest pain that occurs when the coronary arteries are unable to supply the heart with sufficient Oxygen. -Precipitated by stress or exertion. -Relieved by rest and/or nitroglycerin tablets.

32. Cardiac Emergencies Continued… (Page 502) Heart Attack - A portion of the heart starts lacking oxygen. - Sudden intense chest pain that can radiate to the left arm, shoulder, and neck. Can appear pale. - Prevent exertion. - Assist them with oxygen administration and help them to a comfortable position. Call 911 or emergency help.

33. Cardiac Emergencies Continued… (Page 502) Cardiac Arrest - If you are certified in CPR and the person is not breathing and has no pulse call for help and start CPR. -If an AED is near and you are able to use it do so. It will guide you and help monitor the persons’ vitals. - Stay with the patient until help arrives and can take over.

34. Trauma (Page 502 to 503) • Head injuries • Four levels of consciousness • Extremity fractures • Eight common types of fractures • Special care required and to observe • Wounds • Control the bleeding and maintain dressing • hemorrhaging

35. Medical Emergencies (Page 503 to 504) • Drug Reactions • Allergic reactions and anaphylaxis • Early symptoms of anaphylaxis • Diabetic Emergencies • Disease • What does the body do to compensate? • How is it diagnosed?

36. Medical Emergencies Continued… (Page 504 to 505) • Cerebrovascular Accident • Warning signs • Three questions to test for a stroke • How to respond to a stroke • Seizure Disorders • Why do they occur and what are the different types? • What to do if someone is having a seizure

37. Medical Emergencies Continued… (Page 505) • Hyperventilation • What happens during hyperventilation? • What can be done to prevent it? • Vertigo and Postural Hypotension • What is vertigo? • What is postural hypotension? • How can they be avoided?

38. Medical Emergencies Continued… (Page 506) • Epistaxis • Usually not serious • How to stop epistaxis • When to inform the physician • Nausea and vomiting • What do you do if your patient is nauseated or vomiting and how to control it? • loss consciousness

39. Medical Emergencies Continued… (Page 506) • Shock • What is shock? • Potentially fatal • What is syncope? • Dorsal recumbent position • Symptoms of shock • The role of the limited operator if shock is suspected.

40. Conclusion A limited operator must be able to assess and respond to situations in a proper and concise manner. They also must be able to recognize signs and symptoms that are emergent and life threatening. When one is trained well they will be more alert and have a more positive outcome.

41. Works Sited Beaman, N. & Fleming-McPhillips, L. (2007)Pearson’s Comprehensive Medical Assisting. New Jersey: Person Education, Inc. Long, B., Frank, E. D., & Ehrlich, R. A. (2010) Radiography Essentials For Limited Practice. Missouri: Saunders Elsevier Inc.