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Screening
- The process of obtaining info from patient to determine medical condition (Chief Complaint C.C.)
- Has replaced word Triage
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Triage
- French word for sort
- Developed by the military
- Used to help prioritize by injury
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Triage Order
- 1. Breathing is most important, then most severe injured (chest pain, severe bleeding, poisoning, etc)
- 2. Next less severe (major / multi fractures, 2nd burns, back injury, severe eye injury)
- 3. All others saved for last
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Subjective
- Information received from patient they feel, not measureable
- (Pain, dizziness, itchy)
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Objective
- Measureable by any other person
- (Swelling, bruising, rash, vital signs)
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SOAP
- Used by Dr's to obtain patient info during visit
- Subjective, Objective (MA does)
- Assessment, Plan (Dr does)
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11 Factors Influencing Screening
- Privacy, Biases, Relaxed Atmosphere
- Non-verbals, Understands, Patient Talking
- Listening Skills, Patient non-verbals
- Open ?'s, Focus Interview, Summary
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History of Present Illness (HPI)
- Self treatment, effects of treatment
- Other symptoms of CC
- What helps / aggrivates
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LASTSAQ
- Location
- Association
- Setting
- Timing
- Severity
- Alleviation / Aggrivation
- Quality
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Medication
- All current medications
- All over the counter drugs
- All suppliments
- All vitimins
- All home remedies
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NKDA
No Known Drug Allergies
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Genogram
- A diagram of family and their diseases
- Both sides
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Over The Counter
- OTC
- Meds, vitimins, suppliments
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Review of Body Systems
- ROS
- Helps patient remember previous illness / symptoms
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UCHD
Usual Childhood Disease
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Initial Measurements / Vital Signs
Become baseline for new patients
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4 Vital Signs
- Temperature
- Pulse
- Respiration
- Blood Pressure
- (TPR & BP)
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Temperature
- Condition's that affect include
- Metabolism, time of day, amount of activity
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Above Normal Temperature
Febrile
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No High Temperature
Afebrile
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Normal Temperature
97.6-99.6
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Below Normal Temperature
- Subnormal
- Hypothermia
- Collapse will occur at 96.0deg
- Death at 93.0deg
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Axillary Temperature
- -1deg from normal Oral
- 97.6
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Rectal Temperature
- +1deg from normal Oral
- 99.6
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Fever Temp Ranges
- Slight --------99.6-101.0
- Moderate ---101.0-102.0
- Severe ------102.0-104.0
- Dangerous -104.0-105.0
- Fatal over ---106.0
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5 Types Thermometers
- 1. Disposable (avoids cross contam)
- 2. Digital (quick and easy)
- 3. Electronic (quick and easy)
- 4. Tympanic (no mucous concerns) BEST
- 5. Temporal (no mucous)
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When Temp from Other Than Oral
- 98.6
- (R) for Rectal
- (Ax) for Axillary
- (TA) for Temporal Artery
- (T or TC) for Tympanic / Tympanic Core
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Formula Conversion
C = F-32 / 1.8
F = (C * 1.8) + 32
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Known Temps
- Freezing ----------32F ----0C
- Body Temp -------98.6F --37C
- Pasteurization --145F ---63C
- Boiling ------------212F ---100C
- Sterilization ------250F ---121C
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Tachycardia
- Constant pulse rate over 100
- Means Fast / High
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Bradycardia
- Constant pulse rate below 60
- Means Low / Slow
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Apex
Left 5th intercostal space in line with middle of left clavical
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Counting Respiration
Improtant patient unaware of counting / measuring (can scew reading)
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Adult Normal Resp Rate
16-20 per minute
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Maintain Blood Pressure
- The heart (pump)
- The Brain (controls autonomic nervous system)
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Blood Pressure Phases
- Contraction - Systole (max pressure)
- Relax / Fill - Diastole (least pressure)
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Blood Pressure Classifications
- Normal ---------------------<120 / <80
- Prehypertension ----------120-139 / 80-89
- Stage 1 Hypertension ---140-159 / 90-99
- Stage 2 Hypertension ------->160 / >100
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Hypotension
Blood pressure below 90/60
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Phrenic Nerve
Controlls Diaphram
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Inhalation
Flatens Diaphram
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Exhalation
Domes Diaphram
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Sphygmomanometer
Blood Pressure Cuff, gauge
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Types Sphygmomanometer
- 1. Aneroid (dial)
- 2. Digital
- 3. Mercury
- 4. Wall Mount
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12 Examination Positions
- 1. Anatomical - standing, arms to side, palms forward
- 2. Horizontal Recumbant / Supine - on back flat
- 3. Dorsal Recumbant - on back, knees bent
- 4. Prone - on stomach, head turned to one side
- 5. Sim's - on stomach, to side, knee bent (sleeping) rectal exam
- 6. Knee Chest - on knees, face on bed
- 7. Fowler's - sitting at end of table
- 8. High Fowler's - sitting, 90deg
- 9. Lithotomy - pap test, stirrups
- 10. Trendelenburg - shock, head down, on back, feet up
- 11. Jacknife - in chair, leaned back
- 12. Proctological - like knee chest, in special chair
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NPO
- Non-per-os
- Nothing by mouth
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CPE
Complete Physical Exam
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6 Techniques Evaluate Patient
- 1. Inspection - sight
- 2. Palpation - touch
- 3. Percussion - tapping
- 4. Auscultation - listening
- 5. Mensuration - measure
- 6. Manipulation - movement of joints
- 6a. Passive - Dr moves
- 6b. Active - Patient moves
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PERRLA
- Pupils
- Equil
- Round
- Responds to light
- Accommedations
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Chronic
More than 6 months
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Child under 3 Years Old
- Measure lying down
- Push gently on knees to straighten
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Child Over 3 Years Old
Can stand and measure as normal
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Papanicolaou (pap)
Cytologic screening test to detect cervical cancer
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When Pap Due
- 3yrs after start sex or by 21yrs old
- every year or 2 with liquid-based pap
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EDD
- Estimated day/date of delivery
- Nagele Rule
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Premature
Born before 37 weeks
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