1.2 General Survey and Vital Signs

Question 1

General Survey

Answer 1

Done before physical assessment and first impression when patient enters room.

1. Physical Appearance
2. Body Structure
3. Mobility
4. Behavior

Question 2

Physical Appearance

Answer 2

Age - Do they look the stated age

Sex - Does development appear appropriate for stated sex.

Level of Consciousness - Is the patient alert and oriented, attentive to questions with appropriate responses

Skin Color - Even color tone, skin intact with no obvious lesions, obvious abnormalities

Facial Features - Are features symmetric with movement, sign of distress.

Question 3

Body Structure

Answer 3

Stature - Normal posture and height for genetics

Nutritional Stature - Obese/malnourished

Symmetry - Limbs are symmetrical

Posture - Can patient stand and sit erect.

Body Build - Is patient proportionate

Question 4

Mobility

Answer 4

Hard to assess when sitting. Ask patient to stand and walk from one side of the room to the other

Gait - Wide as shoulder width is normal

Foot Placement - Accurate, smooth and well balanced walk. Symmetric arm swing

Range of motion - Full mobility for each joint. Movements are deliberate, accurate, smooth, and coordinated. No involuntary movement.

Question 5

Behavior

Answer 5

Facial Expressions - Maintain eye contact and appropriate behavior to situation

Mood and Affect - Comfortable and cooperative with examiner

Speech - Fluent and clear talking. Clear ideas.

Dress - Appropriately dressed for climate

Hygiene - Clean, body odors, oral hygiene

Question 6

Vital Signs

Answer 6

Temperature, Blood Pressure, Pulse, Rate of Respiration, Pulse Oximetry, Pain

Question 7

Temperature

Answer 7

Regulated in hypothalamus of brain. Difference between heat production and heat loss of body.

Oral - Taken in sublingual pockets. Accurate and convenient but patient should not eat 30 min prior

Rectal - Measures core temperature. Most invasive

Tympanic - Taken in ear

Axillary - Taken in armpit, will most likely be a degree less than actual temperature

Temporal - Taken on forehead and down to temporal artery.

Question 8

Blood Pressure

Answer 8

Force of blood pushing against side of vessel wall.

Systolic pressure - Maximum pressure felt on artery during left ventricle contraction (systole)

Diastolic pressure - Elastic recoil/resting pressure between contractions

Pulse pressure - Difference between systolic and diastolic pressure. Measures stroke volume

Mean Arterial Pressure (MAP) - Most accurate way to measure perfusion; >60 is adequate to major organs and tissue.

Question 9

Pulse

Answer 9

Measure of stroke volume. Normal heart rate is 60-100 bpm.

Rate - BPM
Rhythm - Regular (steady beats at regular pace)
Force - Strength. Strong and bouncy or weak and hard to palpate
Elasticity - How does artery feel under your finger

Question 10

Rate of Respirations (RR)

Answer 10

Ventilation and perfusion. Measured by rise and fall of chest. Should be relaxed, regular, automatic and relaxed. Normal is 12-20 BPM

Factors affecting RR

• Age (Babies have increased RR, Older adults have decreased RR)
• Activity (Exercise increases RR)
• Acid-Base Balance (Acidosis, increase in RR without oxygenation)
• Anxiety (Increased RR)
• Medications (Can increase/decrease)
• Pain (Increased RR)

Question 11

Pulse Oximetry

Answer 11

Non-invasive method to assess arterial oxygen saturation (SpO2).

Measured with light detector. Measures light absorbed by oxyhemoglobin (HbO2) and unoxygenated hemoglobin (O2)

Normal SpO2- 97-100%

Question 12

Pain

Answer 12

Originates from CNS and PNS (Nervous system)

Subjective Data

OLDCART - Used to assess pain further
O - Onset
L - Location
D - Duration
C - Characteristics 
A - Aggravate 
R - Relieve 
T - Time 

Can measure with non-verbal queues or chart with faces 1-10.

Question 13

Locations to Measure Pulse

Answer 13

Carotid - Neck (Below Jawline between Trachea and Sternomastoid Muscle)

Axillary - Armpit (Against head of Humerus in concavity of Axilla)

Brachial - Inner Elbow

Radial - Below thumb in wrist area when arm extended and palms facing up

Popliteal - Behind the knee. Flexed knee in middle

Posterior Tibial - Inside of ankle

Dorsalis Pedis - Big toe, follow tendon to top and move to side to feel for pulse point.

Question 14

Factors Affecting Vital Signs (Infants)

Answer 14

Respirations - Watch abdomen for movement.

Pulse - Under 2, use apical pulse for most accurate. Over 2 use radial or brachial.

Temperature - Rectal temp higher in infants and young children. (37.8C) at 18 months. Temp also elevated in late afternoon after play and eating.

Blood Pressure - Check annually for children over 3 and younger children at risk.

Common errors - Incorrect size cuff, width should be 2/3 upper arm

In children height correlates more strongly with BP than age.