Health Assessment Quiz

PMRS111 - Week 9: Patient Assessment

• Learning Objectives: Explain relevant patient assessment and response; gather objective and subjective data to perform patient assessment; explain the purpose of common tests and assessments; define vital signs; document vital signs; relate physiological and measurement factors that influence vital signs; identify normal and abnormal characteristics of various assessments; discuss appropriate responses to normal and abnormal characteristics of various assessments; identify unique patient care needs; discuss appropriate responses to unique patient care needs

Patient Assessment: Critical Thinking

• Critical thinking process: Interpret → Evaluate → Infer → Explain → Reflect

Patient Assessment: Problem Solving

• Patient and procedure present problems ranging from simple to complex
• MRTs must decide how to perform the assessment quickly, efficiently, safely and comfortably for the patient
• Process: Data collection → Data analysis → Implementation → Evaluation

Patient Assessment - ADPIE

• Stages: Assessment → Diagnosis → Planning → Implementation → Evaluation

ADPIE - Assessment

• Collect subjective and objective data by: interviewing patient/family members; observing behavior; performing examinations; checking the chart

ADPIE - Diagnosis

• Using information collected during the assessment phase, determine unique patient care considerations/needs
• Questions to consider: immediate concerns (if any); modifications needed to accommodate the patient; risks present; changes in patient status to look for

ADPIE - Planning

• Plan the procedure for this patient that takes into account the goal
• Examples: completing imaging/therapy procedure with patient comfort, safety, and best practice guidelines in mind; taking into account unique patient care considerations/needs; procedural modifications according to situational factors

ADPIE - Implementation

• Implement the actionable part of the process

ADPIE - Evaluation

• Evaluate success of planning and implementation processes
• Questions to consider: did the plan/implementation work?; did you provide optimal patient care?; is patient status improving?; if not, necessary changes. Review the steps; any errors?; areas for improvement?

Assessment: Signs and Symptoms

• Signs: Objective findings perceived by the examiner (e.g., swelling, high blood pressure, low blood sugar); things you can see, hear, feel or read on the patient chart, or information given by another health care worker
• Symptoms: Subjective indications as perceived by the patient (e.g., headache, fatigue, weakness, pain, nausea); things you can't see

Sign or Symptom? (Examples)

• (Images A, B, C, and D are shown; descriptions are omitted)

Patient Assessment

• Categories: Physiological Assessment; Neurocognitive Assessment; Comfort & Safety Assessment; Psychosocial Assessment; Diversity/Cultural Assessment

Patient Assessment: Examples

• Physiological: Skin colour/temperature; allergies; pregnancy status; DNR; pain assessment; verbal and non-verbal cues; quality, region, severity, time, onset, duration, frequency of symptoms; vital signs; ECG; bloodwork

Patient Assessment - Skin

• Skin Colour: Cyanotic skin, change will be apparent; requires immediate medical attention (Oxygen)
• Skin Temperature: Touch provides information; pale, cool, diaphoretic, acutely ill/pain; "cold sweat"; hot, dry skin; warm, moist skin ; weather/room temp; cool, moist skin, wet palms, shaky hands → acute anxiety

Visual Alerts for Caregivers

• Colour-coded bracelets indicate DNR, allergy, fall risk, limb alert and latex allergy

History Taking

• Key elements: Localization; Chronology; Quality; Severity; Onset; Aggravating or alleviating factors; Associated manifestations

Vital Signs (aka Cardinal Signs)

• Primary mechanisms adapting to responses within or outside the body to maintain homeostasis
• Objective, non-invasive evidence of patient condition and response to therapy
• Physician's order not required
• Monitored continuously or intermittently

Vital Signs

• Body Temperature (BT); Pulse (HR); Respiration Rate (RR); Blood Pressure (BP)

Vital Signs in the Imaging/Therapy Department

• When are vital signs done? Patient's general condition changes; patient reports non-specific symptoms (e.g., not feeling well); RN not available; prior to an invasive procedure; before, during, and after stress testing

• When to notify the physician? If assessment reveals abnormal/change to skin colour, skin temperature, level of consciousness, or ability to breathe; if it is a new problem, what could have caused it?; sudden change in cardinal signs can be life threatening → notify physician immediately

Body Temperature

• Physiologic balance between heat produced in body tissue and heat lost to the environment
• Controlled by the hypothalamus
• Changes in body physiology with fluctuations of 2-3 degrees
• Metabolic rate changes affect body temps
• Body temp affects demands on the CV system
• ↑ metabolic rate = ↑ demands on CV to provide more O2 and eliminate CO2 = ↑ temp

Normal Body Temperatures

• Adult (14 years and over): 97.8°F to 99.0°F (36.5°C to 37.2°C)
• Child (5 to 13 years): 97.8°F to 98.6°F (36.5°C to 37°C)
• Infant (3 months to 3 years): 99.0°F to 99.7°F(37.2°C to 37.6°C)
• Temperatures above 105.8°F to 111.2°F (41°C to 44°C) or below 93.2°F (34°C) can be life-threatening

Factors Influencing Temperature

• Digestion of food, Emotion, Time of day, Temperature measurement site, Physical activity, Weight, Hormone, Trauma/Injury, Disease, Environment, Medications

Measuring Body Temperature

• Four areas for measurement: Oral (O); Tympanic (T); Rectum (R); Axillary (A)

Body Temperature - Conversion

• To convert from Fahrenheit to Celsius: C= (F-32)/1.8
• To convert from Celsius to Fahrenheit: F= (C x 1.8)+ 32

Fever/Pyrexia/Febrile Patient

• Fever: anything above 38°C or 100.4°F, usually accompanied by illness/infection
• Symptoms: increased pulse, increased respiration, aches and pains, flushed skin, diaphoresis, chills, loss of appetite, etc.
• Hyperthermia: heat exhaustion/heat stroke

Fever Treatments

• Keep patient hydrated
• Keep patient cool with compresses and/or cool baths/showers
• Antipyretic treatment

Hypothermia

• Temperature significantly below normal (less than 35°C or 95°F)

Vitals Documentation

• Example scenario: A 6-year-old male patient's temperature taken using a device shows 98.4°F; convert to Celsius; how to document on the chart; is this within normal range?

Pulse

• Rhythmic dilation of an artery caused by heart beat
• Results in throbbing/pulsating felt through superficial skin
• Pulse rate is rapid if blood pressure is lower; pulse is lower if blood pressure is higher

Most Common Locations for Pulse

• (Images demonstrating location of pulse)

How to Assess/Record Pulse

• Rate: Palpate selected site, count beats per minute (bpm). Normal: Adult: 60–100 bpm; Child (4–10): 90–100; Infant: 120–140 bpm. Tachycardia: >100; Bradycardia <60 bpm
• Strength/Volume: Strong/bounding? Weak/thready?
• Regularity: Equal time interval between beats?

Factors Affecting Pulse

• Position; Age; Gender; Weight; Hypovolemia; Fever; Pathology; Medication; Emotion; Fitness Level

Patient Assessment: Heart Attack (Myocardial Infarction)

• Possible signs and symptoms: Sudden development of irregular pulse; patient feels faint, weak, or nauseous; sudden onset of pain in the chest, shoulder, or jaw
• Notify physician immediately

Respiration

• Function: Exchange oxygen and carbon dioxide between the external environment and circulating blood

• Assessment: Rate, Depth, Quality, Pattern, Symmetry

• Eupnea (normal); Tachypnea (>20 bpm); Bradypnea (<12 bpm)

Respiration Terminology

• Orthopnea: Difficulty breathing when laying down, often related to cardiac/lung disease
• Apnea: Cessation of breathing
• Cheyne-Stokes: Irregular breathing pattern
• SOB: Shortness of breath
• Cyanosis: Bluish discoloration of skin due to low oxygen
• Stridor: Difficult breathing with a harsh sound

Factors Influencing Respiration

• Exercise; Hemoglobin function; Acute pain; Anxiety/emotion; Age; Neurological injury; Medications; Body position; Smoking

Blood Pressure

• Amount of blood flow ejected from the left ventricle during systole and the amount of resistance the blood meets due to systemic vascular resistance

Why is BP Measurement Important?

• Silent killer; Increase workload on heart; Damage to heart, brain, kidneys, lungs, and other organs

Factors Affecting BP

• Position; Time of day; Temperature; Pregnancy; Weight; Exercise; Stress; Ethnicity; Gender; Pathology; Medications

Blood Pressure Measurement

• Systolic Pressure: Pressure during ventricular contraction
• Diastolic Pressure: Pressure during ventricular relaxation
• Pulse Pressure: Difference between systolic & diastolic pressures

Blood Pressure Categories

• Normal Range: Different ranges for adults, adolescents, and children

• Abnormal Range: Hypertension (high blood pressure); Hypotension (low blood pressure)

• See next chart for detailed ranges

Blood Pressure Measurement

• Detailed Categories: Normal; Elevated; High Blood Pressure (Stage 1); High Blood Pressure (Stage 2); Hypertensive Crisis

Pulse Oximetry

• Monitors oxygen saturation in hemoglobin
• Normal SaO2: 95% to 100%
• Values less than 85% indicate insufficient oxygen to tissues
• Hypoxemia: low oxygen in arterial blood

Unique Patient Care Considerations: Vital Signs for Older Adults

• Temperature: Normal range; Increased sensitivity to environmental temperature changes; loss of subcutaneous fat; sweat glands
• Pulse Rate: Palpation may be difficult; Decreased resting heart rate; Longer recovery time
• BP: Cuff size; Reading may elevate with age
• Respiration: Rib cage rigidity-ossification of costal cartilage; Kyphosis and scoliosis - restrict chest expansion

Unique Patient Care Considerations: Pediatric Variations

• (Images demonstrating pediatric measurements)

Height / Weight/ BMI

• Why acquire information in MRT? Ideal body weight (IBW): optimal weight for optimal health; Body mass index (BMI): indicator of body fat stores and whether weight is appropriate for height

Body Mass Index (BMI)

• Weight Classification: Underweight; Healthy weight; Overweight; Obese
• BMI Values: Corresponding values for each classification

ECG

• Electrocardiograph monitor; Display and record heart rate and rhythm; Continuous monitoring or diagnostic

Patient Assessment: Blood Tests

• Provide information about person's general health; medical conditions or diseases; potential risks to treatment/contraindications; areas needing further investigation

Blood Tests

• Measures levels of components in blood; certain chemicals; how well blood/bone marrow/organs function; Ca treatment effect; baseline for further tests during/after treatments

Specific Blood Tests

• Complete Blood Count (CBC), Blood Chemistry (Serum electrolytes, Enzymes: LDH, CK, AST, ALT, ALP, Serum glucose, Hormones, Metabolic waste products, Cholesterol and triglycerides)

Complete Blood Count (CBC)

• Hemoglobin (Hgb); Hematocrit (Hct); Red blood cell count (RBC); White blood count (WBC); Platelet count

Blood Coagulation Tests

• INR: International Normalized Ratio - standardized reporting system for clotting time; Higher INR= longer clot time; Normal value is 1.0; For patients on anticoagulant Therapy range is 2.0–3.0

Measuring "Blood Sugar"

• Serum or Plasma Glucose; HbA1c; Hyperglycemia; Hypoglycemia

Patients with Diabetes Mellitus

• Low Blood Sugar: Shaky/light-headed/nauseated; nervous/irritable/anxious; confused/unable to concentrate; hungry; increased heart rate; sweaty; headache; weak/drowsy; Numbness/tingling-tongue or lips; very low blood sugar- confused/disoriented/loss of consciousness/seizure
• High Blood Sugar: Thirsty; Urinate more frequently; Fatigue

Blood Tests: Liver & Renal

• Liver Function Test: ALP (alkaline phosphatase); ALT (alanine transaminase); AST (aspartate transaminase); bilirubin; Alpha-fetoprotein (AFP)
• Renal Function Test: BUN (blood urea nitrogen/urea); Creatinine

Tumour Markers

• Proteins/biochemicals/enzymes from tumor cells or body in response to tumor cells; Presence indicates possible undiagnosed or treated cancer.
• Examples: AFP, CA125, CEA, HCG, PSA

Patient Assessment: Sensory Deficits

• Hearing impairment/visually impaired
• Level of consciousness
• Orientation, memory, hallucinations, speech patterns
• Developmental delays
• Substance abuse

Level of Consciousness (LOC)

• Conscious; Decreased consciousness; Unconscious. Establish baseline; Observe patient's eyes; Look at you when you speak; Respond appropriately

Unresponsive Patients

• Communicate verbally and by touch; Call them by name; Explain procedure; Avoid saying anything they would not hear if conscious.

Patient Assessment - Hearing Impairment

• Ask what works best; Get patient's attention; Do not talk down; Reduce environmental noise; Speak clearly, but don't shout; Rephrase; Use pantomime/demonstrations; Face person for lip reading; Sign language interpreter; Be patient.

Patient Assessment - Visual Impairment

• Categories: Partially sighted; Low vision; Legally blind; Totally blind
• Best Practices: Volunteers; Braille; Verbal communication; Assess level of impairment; Adjust light levels; Notify when coming/going; Large print

Patient Assessment — Mental or Cognitive Impairment

• Assess ability to understand and follow directions; Clear, simple directions; Develop trust/rapport; Respect & dignity; Be patient

Patient Assessment — Substance Abuse

• May not be aware of their actions; Require close supervision; Be hyperactive/irrational or calm/quiet; Assess capabilities and attempt communication; Some will respond to direction; Some may need to return when more cooperative.

Patient Assessment — Falls Risk

• Universal Fall Precautions (S.A.F.E. - Safe environment; Assist with mobility; Fall-risk reduction; Engage client and family)
• Related risk factors (biological, behavioural, social & economic, environmental)

Patient Assessment — Mobility

• Determine patient's need for assistance; Assess getting on/off table; Assess bathroom assistance (urinal/bedpan); Ensure privacy

Patient Assessment — Comfort

• Offer warm blanket if needed; Elevate knees/use pillows; Support person nearby

Patient Assessment — Anxiety

• Assess patient emotions; Recognize verbal/non-verbal cues; Be present, calm, and reassuring; Communicate regularly; Provide clear instructions; Offer assistance; Encourage slow breathing; Consider related factors like ethnicity, religion, cultural beliefs, traditions

Patient Assessment — Emotional State

• Active listening; Therapeutic communication; Show empathy; Create sustainable connection; Self-awareness; Recognize and address patient anxieties

Patient Assessment — Anxiety (Sources)

• Fear of upcoming procedure; Fear of diagnosis; Concerns about illness effects on family or self/life; Fear of touching; Inaccurate info about the procedure; Fear of radiation; Fear of needles; Claustrophobia; Modesty

Patient Assessment Emotional State (Specific behaviors/interventions)

• Fidgety/nervous/restless; Irritable/frustrated/upset; May express worry or concern; May ask questions/seek reassurance; Quiet/withdrawn; Difficult concentrating; Anxious patient may hyperventilate (resulting in faint/dizzy/tingling in extremities); Encourage slow breathing

Patient Assessment (Diversity/Cultural Considerations)

• Ethnicity, religion/cultural beliefs; Touch/eye contact; Language needs (interpreter); Diversity communities
• Support systems

Use of a Trained Interpreter

• Allow extra time for interview; Speak directly to the patient, not the interpreter; Short sentences/thought groups; Ask only one question at a time; Avoid acronyms/jargon; Use "teach back/show me techniques" to ensure patient comprehension

Reflection of the Week

• What stood out in this week's session?

Questions?

• Open-ended question for discussion