Patient Assessment and Ethics Review

Exam 2 Review

• Mostly: ethics, morals, patient care equipment
• Legal Terms: assault, negligence, battery
• Vital Signs: temperature (adult vs. pediatric), respiratory chart
• Glasgow Coma Scale
• Legal terms: tachycardia, bradycardia (used in teams)
• Code of ethics: Standard/Code
• Lines/tubes: where to place them, how they enter body, use of thumb
• Hospital Departments: NICU, ICU
• Bedside Equip: portable, things to watch out for in beds (e.g., for orthopedic traction)
• Suction equipment: major reasons to have it nearby (decompression for post-op or bowel obstruction)

Patient Assessment

• Introduction: Acknowledge, introduce self, duration of exam, best time for history
• History: Onset, duration/chronology, specific location, quality of symptoms, severity (1-10), aggravation/alleviation, associated manifestations.
• Physical Exam: Observation, comparison, measurement of condition before, during & after; Skin color/temp (cyanotic, diaphoretic), dry/hot/sweaty, pale/cool/diaphoretic, anxiety, additional instructions (written).
• Checking Chart: Review order before procedure, allergies, fall risk, DNR
• Levels of Consciousness (LOC): Alert, drowsy, unresponsive, reactive to painful stimuli, comatose.
• Glasgow Coma Scale: Numerical scale used to objectively assess LOC changes over time; scored on Eyes, Verbal, Motor Response.

Vitals

• Respiration: count breaths/min (normal is 12-20), bradypnea (<12), tachypnea (>20), orthopnea (inability to breathe when laying flat), dyspnea, hyperventilation.
• Temperature: methods (oral, axillary, rectal, tympanic) and information provided about metabolic state
• Pulse: measured in beats per minute (60-100 bpm average); tachycardia (>100), bradycardia (<60); weak/thready pulse indicates not pumping enough blood
• Blood Pressure: measured by sphygmomanometer and stethoscope; systolic and diastolic, normal ranges. Hypertension: 140-159/90-99, Stage 2: 160+/100+, Hypotension: <50
• Use Charts to look at age-related norms.

Common Lab Tests

• Complete blood cell count (CBC): information about blood cell types & numbers.
• Erythrocyte Sedimentation Rate (ESR): measures inflammation.

Electronic Monitoring

• Oximeter: measures pulse rate and oxygen levels (normal: 95-100%).
• ECG (Electrocardiograph): measures the electrical activity of the heart; graphical display of waves (asystole, sinus rhythm).

Special Care Units

• PACU (Postanesthesia Care Unit): Recovery room for post-surgery patients
• Emergency Trauma Unit: assessment for injuries of spine, pelvis, chest; protection of patient & staff.
• ICU & CCU: Intensive Care Units, for critically ill
• NICU (Neonatal Intensive Care Unit): care for premature, low-weight or health issue infants.

Ethics

• Personal Morality: based on lessons of right/wrong from early age (examples)
• Group Morality: Moral principles for groups.
• Kohlberg's Theory: individuals learn morality through experience (obedience, punishment).
• Professional Ethics: defines correct moral behavior in a professional context.
• Codes of Ethics & Ethical analysis: method of evaluating situations/conflicting values (identifying the problem, developing alternate solutions, selecting best solution, defending your selection) Ethical analysis (problem, solutions, selection, defense)

Patient Rights

• Considerate and Respectful Care
• Information: names, qualifications, copies of records, procedures explained by physician
• Privacy and Confidentiality: protection of dignity and modesty; chaperone presence; same sex, patient consent, HIPAA
• Informed Consent: explanation of risks/benefits of procedure.
• Right to Refuse: patient can revoke consent at any time.