principles of patient assessment in ems l.
Download
Skip this Video
Download Presentation
Principles of Patient Assessment in EMS

Loading in 2 Seconds...

play fullscreen
1 / 54

Principles of Patient Assessment in EMS - PowerPoint PPT Presentation


  • 109 Views
  • Uploaded on

Principles of Patient Assessment in EMS . By: Bob Elling, MPA, EMT-P & Kirsten Elling, BS, EMT-P. Chapter 19 – Assessment Approach to The Elderly . © 2003 Delmar Learning, a Division of Thomson Learning, Inc . . Objectives.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Principles of Patient Assessment in EMS' - jera


Download Now An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
principles of patient assessment in ems

Principles of Patient Assessment in EMS

By:

Bob Elling, MPA, EMT-P

&

Kirsten Elling, BS, EMT-P

chapter 19 assessment approach to the elderly

Chapter 19 – Assessment Approach to The Elderly

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

objectives
Objectives
  • Discuss how anticipating the potential for deficits and modifying the approach to the patient will ease the assessment process for both patient and EMS provider.
  • Describe the physiological changes of aging that relate to the body senses including vision and hearing, taste, smell, and pain response.

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

objectives continued
Objectives (continued)
  • Describe the physiological changes of aging that relate to the following body systems including immune, endocrine, GI/GU, renal, cardiovascular, respiratory, nervous, integumentary, musculoskeletal systems
  • Discuss the affects of aging as they relate to vital signs.

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

objectives continued5
Objectives (continued)
  • Explain why body temperature is an important vital sign in the late adult.
  • List the factors that lead to concern about the psychological status relating to aging.
  • Describe how the approach to obtaining a focused history from the late adult is different from that of a younger adult.

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

objectives continued6
Objectives (continued)
  • Describe how the approach to performing the physical exam on the late adult is different than that of a younger adult.
  • Describe why the assessment and management of the elderly patient includes evaluation of MS, physical functional status, emotional functional status and social functional status.

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

objectives continued7
Objectives (continued)
  • List the common diseases found in the elderly and discuss specific factors and the signs and symptoms associated with each.
  • Discuss specific types of trauma that are more prevalent in the elderly populations and explain why traumatic injury is so devastating to the late adult population.

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

introduction
Introduction
  • The overall health status of the elderly patient is often difficult to determine.
  • Components to consider:
    • Medical and psychosocial
    • Functional problems
    • Daily living conditions

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

introduction continued
Introduction (continued)
  • Normal physiological changes that occur with aging makes assessment dynamic.
  • Hearing and vision loss contribute to difficulty in assessment.

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

introduction continued10
Introduction (continued)
  • Anticipating the potential for deficits can help to modify your assessment approach.
  • Too many people asking too many questions too fast can overwhelm the patient.
  • Be prepared to slow things down.
  • Utilize family/caretakers to clarify or verify info after speaking with the patient.

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

physiological changes of aging
Physiological Changes of Aging
  • Everyone ages at a different pace, but ultimately the aging process affects all body organs and systems.
  • It is important to consider these changes when performing an assessment on an elderly patient.

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

the senses
The Senses
  • Hearing loss (presbycusis) – difficulty hearing whispered words and consonants.
  • Speak in a normal tone. Never shout.
  • Look at the patient’s face when speaking (lip reading).
  • Assess for hearing aides. Have the patient adjust them.

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

the senses continued
The Senses (continued)
  • Kinesthetic (body position) sense – affects balance which contributes to falls.
  • Visual sense – decreased acuity, loss of accommodation and cataract opacification.
    • Contributes to falls and injuries
    • Let the patient wear glasses
    • Explain what you are doing
  • Pain response – decreases contributing to atypical and vague complaints to medical conditions or traumatic injury.

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

the senses continued14
The Senses (continued)
  • Taste and smell – decreased sensations can lead to loss of appetite.
    • Decreased sense of thirst is common and leads to a persistent state of mild, moderate or severe dehydration
    • Routinely ask about PO intake and recent changes, especially when a patient is taking diuretics

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

the immune system
The Immune System
  • Loss of T-cell function effects the inflammatory response.
  • Increased susceptibility to infection.
  • The EMS providers must minimize the risk of cross contamination.

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

the endocrine system
The Endocrine System
  • Decreased insulin production leads to abnormal glucose metabolism.
  • Decreased Cortisol production (needed to cope with stresses on the body).
  • Decreased thyroid hormone predisposes to hypothyroidism.
  • Reproductive organs atrophy.
  • Pituitary or “master gland” decreases effectiveness resulting in generalized decrease in all endocrine function.

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

the renal system
The Renal System
  • Decreased blood flow and waste elimination.
  • 50% loss of nephrons – decreased excretion of fluid, salts, and waste products.
  • Reproductive organs atrophy.
  • Pituitary “master gland” - decreases effectiveness resulting in generalized decrease in all endocrine functions.

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

the cardiovascular system
The Cardiovascular System
  • Changes affect blood cells, blood vessels, and the heart.
  • Coronary artery disease predominates in the elderly.
  • Decreased cardiac output and decreased catecholamine affects rate response to stress and exercise.
  • Decreased blood volume.
  • Decreased production of red blood cells and platelets.

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

cardiovascular system continued
Cardiovascular System (continued)
  • Low grade anemia is common.
  • Walls of blood vessels thicken causing increased peripheral vascular resistance.
  • Baroreceptors lose sensitivity and increase orthostatic changes. Posterior hypotension from inadequate compensatory mechanisms develops.
  • Myocardium is less elastic causing increased work load. Reserves become limited so tachycardia is not well tolerated.

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

cardiovascular system continued20
Cardiovascular System (continued)
  • Heart size can increase (cardiomegaly) due to disease which further increases the work load.
  • Conduction system develops fibrous tissue and loss of pacemaker cells leads to dysrhythmias.

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

the respiratory system
The Respiratory System
  • Changes occur in the mouth, nose, and lungs.
  • Tissue atrophy and loss of mucous membrane linings.
  • Decreased muscle mass and chest wall weakness.

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

the respiratory system22
The Respiratory System
  • Loss of elasticity affects lung compliance, ventilation and gas exchange.
  • Ineffective cough reflex and decreased cilia contributes to increased risk of respiratory infections.

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

the nervous system
The Nervous System
  • Loss of neurons and neurotransmitters.
  • Reflexes and reaction responses slow.
  • Sleep wake cycle is disturbed.
  • Brain atrophy increases the risk of brain injury.

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

the integumentary system
The Integumentary System
  • Skin thins and subcutaneous fat diminishes from extremities and redistributes to the hips and abdomen.
  • Loss of sebaceous glands and vascularity affects thermoregulation (increased risk of hypothermia).
  • Loss of elasticity causes sagging, wrinkles, and poor turgor.
  • Dry skin is common.

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

the musculoskeletal system
The Musculoskeletal System
  • Decreased muscle mass and height.
  • > 70 yrs. Spine shrinks and extremities become disproportionately longer.
  • Abdominal muscles are thin making palpation of organs easier.
  • Swallowing becomes impaired (dysphagia).

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

the vital signs
The Vital Signs
  • Changes vary depending upon patient’s physical and health status.
  • Pulses:
    • Distal pulses become more difficult to palpate
    • Ectopic beats are more common
  • Orthostatic changes occur easily with change of position.

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

the vital signs continued
The Vital Signs (continued)
  • Respiratory Rate:
    • Gradual deterioration of pulmonary function
    • Even mild dyspnea is a significant finding
    • Normal ranges are the same as a younger adult

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

the vital signs continued28
The Vital Signs (continued)
  • Blood Pressure:
    • A gradual rise in systolic pressure over the years is normal
    • Atrial HTC is currently the single greatest health problem in the U.S.A
    • Usually asymptomatic until severe complications (i.e. stroke) occur

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

the vital signs continued29
The Vital Signs (continued)
  • Body Temperature:
    • Slightly lower temp may be noted due to impaired control mechanisms
    • Temp is an important VS in the elderly
    • Decline in thermoregulatory function impairs homeostasis
    • Modest elevations or subnormal are indications for concern, especially when associated with confusion, loss of appetite, or other behavioral changes
    • Temp changes may indicate pneumonia, UTI, and sepsis

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

psychological status
Psychological Status
  • A decline in overall well being can occur from the effects of aging:
    • Increased health problems
    • Loss of self worth
    • Unproductive or unable to work
    • Increased financial burdens
    • Death and dying of spouse and friends
    • Loss of support system
    • Decreased independence
    • Increased alcohol or substance abuse
    • Depression

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

focused history
Focused History
  • Be prepared to spend more time obtaining a Hx.
  • When appropriate attempt to assess what the daily living activities consist of and how well the patient functions in the environment.
  • Note any new or recent changes.
  • Does the patient need help with daily living activities?

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

the opqrst history
The OPQRST History
  • O – Is this a new problem or preexisting one?
  • P – What was the patient doing at onset? Any trauma involved?
  • Q – What does the pain feel like and where is it located? (beware subtle signs!)
  • R – Any radiation/ Any attempted interventions and what were their effect?
  • S – compare baseline to serial assessments to see if it is improving.
  • T – When did the symptoms begin?

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

the sample history
The SAMPLE History
  • S – What are the associated symptoms?
  • A – Any allergies or sensitivity to meds?
  • M – Watch for polypharmacy. Include over-the-counter meds, herbals and home remedies.
  • P – Ask a family member and find out who the primary care / specialist physicians are.
  • L – Any changes in appetite or problems eating or drinking?
  • E – What events led up to the call for EMS? Is this related to a chronic condition or new?

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

physical exam challenges
Physical Exam: Challenges
  • Patient often has concurrent illnesses.
  • Loss of pain sensation may obscure findings.
  • Patient often ears several layers of clothing.
  • Must be handled gently to avoid additional injury.

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

physical exam challenges35
Physical Exam: Challenges
  • Explaining steps and assuring modesty can take extra time.
  • Serious problems are often underestimated due to vague complaints.
  • Recognizing subtle clues is a key component.

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

medical assessment
Medical Assessment
  • Make an introduction and begin the IA (MS-ABC).
  • Be respectful courteous, and ask permission prior to touching.
  • Explain the steps being taken.
  • Consider support services when appropriate.

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

psychological social assessment
Psychological & Social Assessment
  • Psychological:
    • Consider MS and affect while obtaining a FH.
    • Note signs of healthy well being, loneliness or depression.
    • Consider support services.
  • Social:
    • Determine the patient’s support system.
    • Consider support services.

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

functional physical limitation assessment
Functional/Physical Limitation Assessment
  • Inspect the patient’s surroundings.
  • Does the patient appear to be able to perform daily living activities:
    • Eating
    • Bathing
    • Dressing
    • Toileting
  • Does the home need improvements to make the daily routine easier?
  • Can you help the patient get support services?

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

use of diagnostic tools
Use of Diagnostic Tools
  • Obtain an ECG on any patient with:
    • An irregular pulse
    • Orthostatic changes (dizzy, weak)
    • Dyspnea (often cardiac related)
    • AMS
    • Typical and atypical chest pain
  • Obtain a glucose reading with suspected AMS.
  • Obtain a temperature reading with suspected AMS, loss of appetite or other behavioral changes.

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

common diseases in the elderly
Common Diseases in the Elderly
  • Heart disease – signs/symptoms can be vague and misdiagnosed.
  • Subtle findings include:
    • AMS, fever, weakness or fatigue
    • Mild dyspnea, especially with excersion
    • Irregular heart beat/dysrhythmias
    • Epigastric, back or neck pain
  • More obvious findings include:
    • Severe dyspnea
    • Nausea and or vomiting
    • Dizziness or syncope
    • Heart burn indigestion
    • Diaphoresis, tingling and numbness

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

hypertension
Hypertension
  • Defined as > 140/90, affects nearly 50 million in the U.S.A.
  • Prevention helps reduce risk of developing heart disease, but HTH is often asymptomatic.

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

pulmonary disease
Pulmonary Disease
  • Emergencies usually associated with complications of COPD.
  • COPD patients are at increased risk for respiratory infections.
  • C/C is usually dyspnea, exertional dyspnea, orthopnea, or tachycardia.
  • Lung sounds can vary throughout the chest.
  • Respiratory emergencies are often complicated by concurrent disease processes such as CHF or pneumonia.
  • Getting an accurate Hx. Is key to making a working diagnosis.

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

pulmonary disease continued
Pulmonary Disease (continued)
  • Chronic Bronchitis – Hx. of infections, coughing and smoking.
  • Emphysema – Hx. of smoking, clubbed digits, barrel chest, signs of right heart failure, cough, possible weight loss.
  • Pneumonia – Hx. of recent respiratory infection, coughing, fever, subnormal temp., unilateral adventitious or diminished breath sounds.
  • Pulmonary embolism – Hx. of heart failure, recent surgery, immobilization, or estrogen use. C/c progressive worsening dyspnea, pleuritic chest pain, leg pain, anxiety and no cough or fever.

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

diabetes
Diabetes
  • High prevalence in the elderly.
  • Physical/cognitive impairment makes this disease difficult to manage.
  • Increased prevalence of neuropathy causing an increased chance of infection and slower healing.

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

thyroid disease
Thyroid Disease
  • Thyroid hormones tell the body how fast to work and use energy.
  • Signs/symptoms are vague and are similar to many different conditions:
    • Non-acute confusion
    • Muscle aches and pains
    • Weakness and falling
    • Incontinence
    • Changes in appetite
    • Weight loss or gain

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

alzheimer s disease
Alzheimer’s Disease
  • A progressive neurological condition that robs memory and intellect. The 4th leading cause of death in American adults.
  • Emergencies fall into 3 categories:
    • Behavioral – patient wandering around, uncooperative, acute anxiety, hostility or paranoia
    • Metabolic – dehydration, infection and drug toxicity
    • Psychiatric - depression

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

parkinson s disease
Parkinson’s Disease
  • A disease that damages nerve cells.
  • Average age of onset is 57.
  • Emergencies associated with falls, dementia, dysphagia, and drug toxicity.

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

cancer
Cancer
  • More than 60% of cancer patients are age 65 and older.
  • Assessment is symptom based.

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

non acute causes of confusion
Non-Acute Causes of Confusion
  • Dementia – gradual onset (months to years).
  • Delirium – mildly acute onset (hours to days). Most causes are reversible.
  • Depression – may cause impaired memory, inability to concentrate, and decreased cognitive functions.

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

trauma abuse and falls
Trauma: Abuse and Falls
  • Abuse or neglect often underreported. Most common abusers are family.
  • Fear of increased abuse or being moved to a nursing home.
  • Major problem – falls are the 6th leading cause of death >65 years of age.
  • Common injuries include hip and upper limb fractures and TBIs.

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

trauma hip femur
Trauma: Hip / Femur
  • Associated with high mortality rates in the first year following injury.
  • Decreased quality of life.
  • Complications from surgery and lengthy immobilization.

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

trauma tbi burns
Trauma: TBI & Burns
  • TBI:
    • Often result in poor outcome
    • Increased risk of bleeding and swelling
  • Burns:
    • Often result in poor outcome due to skin changes, decreased immune response, and preexisting illnesses

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

conclusion
Conclusion
  • Assessment & management includes evaluation of MS, physical functional status, emotional status, and social functional status.
  • EMS providers get to see the home environment, and can relay that info to help complete an integral part of the total health assessment.

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

conclusion54
Conclusion
  • EMS providers rarely have time to complete all 4 components.
  • Be prepared to spend more time gathering a Hx. and performing a PE.
  • Helping a patient get the appropriate support services can make a significant difference in quality of life.

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

ad