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

Test your knowledge on key concepts of health assessment, including Ideal Body Weight, Body Mass Index, and Falls Risk Assessment. This quiz also covers important factors that affect patient communication and comfort during care, alongside considerations for developmental delays and sensory deficits.