1) General Survey Flashcards
When does the general survey begin?
- When the nurse first meets the patient
- Observing behavior, appearance, and mobility
What is the general survey?
- The first step in physical examination
- Provides information about illness characteristics, hygiene, body image, emotional state, weight changes, developmental status
What should the nurse do if abnormalities are noted in the general survey?
- Closely assess the affected body system later during physical examination
What should be assessed when interacting with the patient?
- General appearance
- Behavior
How do age and gender affect the examination?
- They affect the type of examination performed
- They affect the manner assessments are made
- Certain conditions are more likely based on gender/characteristics
What signs of distress should be noted?
- Signs indicating pain (grimacing, splinting area)
- Signs of breathing difficulty (shortness of breath, retractions)
- Signs of anxiety (fidgeting, pacing)
What should be observed about the patient’s body type?
- If they appear trim/muscular, obese, or excessively thin
- Body type reflects health level, age, and lifestyle
How should normal standing and sitting posture be observed?
- Standing: upright, parallel hips/shoulders
- Sitting: some shoulder rounding
- Note if slumped, erect, or bent posture
What should be noted about an older person’s posture?
- May have stooped, forward-bent posture
- Hips/knees flexed, arms bent raising arm level
How should gait be observed?
- If ambulatory, observe walking into room/bedside
- Note if movements coordinated or uncoordinated
- Arms normally swing freely, head/face lead body
What body movements should be observed?
- If movements purposeful
- Any tremors in extremities
- Any body parts immobile
How should hygiene and grooming be assessed?
- Note cleanliness of hair, skin, nails
- If clothes are clean
- Amount/type of cosmetics used
What factors affect the type of clothes a person wears?
- Culture
- Lifestyle
- Socioeconomic level
- Personal preference
How should clothing appropriateness be assessed?
- Note if clothing is appropriate for temperature/weather conditions
- Depressed or cognitively impaired may not choose proper clothing
- Older persons tend to wear extra layers due to cold sensitivity
What can cause an unpleasant body odor?
- Physical exercise
- Poor hygiene
- Certain disease states
What is affect?
- A person’s feelings as they appear to others
- Expressed verbally and nonverbally
How should mood be assessed?
- Note if verbal expressions match nonverbal behavior
- Observe if mood is appropriate for the situation
- Observe facial expressions while asking questions
How should speech be assessed?
- Normal speech is understandable and moderately paced
- Associated with the person’s thoughts
- Note if abnormally rapid or slow
- Note tone and clarity of word inflection
What are signs of possible violence/intimidation?
- Obvious physical injury or neglect
- Evidence of malnutrition
- Presence of bruising on extremities or trunk
What should be assessed regarding potential abusers?
- Patient’s fear of spouse/partner/caregiver
- History of violence, alcoholism, drug abuse in partner/caregiver
- If partner/caregiver is unemployed, ill, or frustrated as caregiver
What should be done if violence is suspected?
- Most provinces mandate reporting to social services
- Interview patient privately without suspected abuser
- Victims often don’t report abuse
What safety precaution should be taken for victims of violence?
- The risk for further violence is high once reported or trying to leave
- Provide counseling options for these individuals
What groups does substance use and misuse affect?
- It affects all socioeconomic groups
- A single clinic visit may not reveal the problem
- Several visits can reveal behaviors to confirm with history/exam
How should patients with suspected substance misuse be approached?
- In a caring and non-judgmental way
- Issues involve emotional and lifestyle factors
What are the CAGE questions to assess for substance misuse?
- Cut down: Need to cut down on drinking/drug use?
- Annoyed: People annoyed by criticizing your use?
- Guilty: Felt guilty about your use?
- Eye-opener: Used first thing in morning to steady nerves?
What are physical indicators of child sexual abuse?
- Vaginal or penile discharge
- Blood on underclothing
- Pain, itching, or unusual odor in genital area
- Genital injuries
- Difficulty sitting or walking
- Pain while urinating; recurrent UTIs
- Foreign bodies in rectum, urethra, or vagina
- Sexually transmitted infections
- Pregnancy in a young adolescent
What are behavioral indicators of child sexual abuse?
- Difficulty sleeping or eating
- Fear of certain people or places
- Play activities recreating the abuse
- Regressed behavior
- Sexual acting out
- Knowledge of explicit sexual matters
- Preoccupation with genitals
- Profound personality changes
- Declining school performance
- Poor peer relationships
What are physical indicators of intimate partner violence?
- Injuries inconsistent with reported cause
- Multiple injuries to head, face, neck, breasts, abdomen, genitalia
- X-rays showing old and new fractures
- Abrasions, lacerations, bruises/welts
- Burns
- Human bites
- Attempted suicide
What are behavioral indicators of intimate partner violence?
- Eating or sleeping disorders
- Anxiety
- Panic attacks
- Substance abuse following abuse
- Low self-esteem
- Depression
- Helplessness
- Guilt
- Forgetfulness
- Stress symptoms like headaches
What are physical indicators of elder abuse?
- Injuries inconsistent with reported cause
- Hematomas
- Bruises at various stages
- Bruises from restraints
- Burns
- Fractures inconsistent with cause
- Dried blood
- Prolonged delay in treatment
What are behavioral indicators of elder abuse?
- Dependent on caregiver
- Physically or cognitively impaired
- Combative
- Wandering
- Verbally aggressive
- Minimal social support
What are red flags for suspecting substance use/misuse?
- Frequently missing appointments
- Frequently requesting work excuse notes
- Complaints of insomnia, “bad nerves,” or atypical pain
- Reporting lost prescriptions or requesting early refills
- Frequent emergency department visits
- Changing healthcare providers frequently
- History of medication bottles from multiple providers
What medical histories suggest substance use/misuse?
- Gastrointestinal bleeds, ulcers, pancreatitis, cellulitis
- Frequent pulmonary infections
- Frequent STIs, complicated pregnancies, abortions, sexual dysfunction
- Chest pains, palpitations, admissions to rule out MI
- Activities placing patient at risk for HIV (multiple partners, rapes)
What personal histories suggest substance use/misuse?
- Family history of addiction
- History of childhood abuse (sexual, physical, emotional)
- Social, financial or marital problems
How can the CAGE questionnaire identify substance use disorder?
- If 2 or more CAGE questions are positive, strongly suspect substance use disorder
- Consider motivating patient to seek treatment
