CH 9 & 10: General Survey, Measurement, & Vital Signs

Question 1

What is a general survey?

Answer 1

Inspecting general state of health and obvious physical characteristics of the whole person

Question 2

General survey component 1?

Answer 2

Physical appearance:
Age
Sex
Level of consciousness/alertness
Skin color
Facial features
Overall appearance

Question 3

General survey component 2?

Answer 3

Body structure:
Stature
Nutrition
Symmetry
Posture
Position
Body build & contour

Question 4

General survey component 3?

Answer 4

Mobility:
Gait
Foot placement
Range of motion
Note involuntary movements

Question 5

General survey component 4?

Answer 5

Behavior:
Facial expression
Mood and affect
Speech
Dress
Personal hygiene

Question 6

Speech terminology?

Answer 6

Dysarthria: slurred speech
Dysphonia: abnormal voice (hoarseness)
Aphasia: cannot understand or express speech
Dysphagia: difficulty swallowing
Dysphasia: difficulty speaking
Global aphasia: impaired receptive and expressive language
Expressive aphasia: (Broca’s) difficulty producing speech
Receptive aphasia: (Wernicke’s) speech does not make sense

Question 7

Measurements?

Answer 7

Height
Body Mass Index
Waist circumference

Question 8

Abnormalities in body height and proportion?

Answer 8

Dwarfism:
Hypopituitary- short stature, delayed dentition, delayed skeletal maturation
Achondroplasia- bone growth disorder, genetic mutation in arms and legs
Gigantism- hyper secretion of GH before long bone epiphysis fusion, characterized by tall stature
Acromegaly- GH hyper secretion after fusion of epiphysis, leads to large extremities and characteristic facies
Hyperpituitarism- excessive pituitary gland secretion
Anorexia Nervosa- eating disorder caused by obsession of weight, distorted body image
Bulimia Nervosa- eating disorder characterized by binging and purging
Cushing’s Syndrome- extended exposure to high cortisol levels (fatty deposits around face and weight gain in midsection)
Marfan Syndrome- inherited connective tissue disorder (tall and thin)

Question 9

Convert F to C?

Answer 9

(F-32)5/9=C
ex.
F= 97.6
(97.6-32)= 65.6
65.65= 328
328/9= 36.4
C= 36.4
Convenient equivalents:
104F = 40C
98.6F = 37C
95F = 35C

Question 10

Oral temperature?

Answer 10

Accurate and convenient (sublingual site blood supply from carotid arteries, quick response to inner core temp changes)
Blue tipped probe
Normal: 35.8 C - 37.3 C
Smoking: increases for 30 mins
Cold liquids: decreases for 10-15 mins
Hot liquids: affects for 35 mins
When respiratory rate increases, temperature decreases: tachypnea

Question 11

Rectal temperature?

Answer 11

Most accurate, as close to core temp as possible
(generally subtract 1 degree)
Red tipped probe
Procedure: pt on left lateral decubitus (on side). Gloves, probe cover, and lube, insert 2 to 3 cm (1in)
Normal: 0.4 - 0.5 C higher

Question 12

When not to give rectal?

Answer 12

Heart problems- stimulates vagus nerve and drops HR
Kids
Low WBC- neutropenic
Decrease platelets

Question 13

Tympanic membrane temperature? (TMT)

Answer 13

Senses infrared emissions of tympanic membrane (eardrum), accurate for core temp bc shares vascular supply with hypothalamus
Cerumen may lower temp

Question 14

Temporal artery temperature? (TAT)

Answer 14

Slide probe across forehead and behind ear, average of multiple infrared readings- questionable reliability and likely not as accurate

Question 15

Surface temperatures?

Answer 15

Oral, axilla (add 1 degree), skin surface

Question 16

Pulse rate parameters?

Answer 16

Normal adult: 60 - 100 bpm
Bradycardia: less than 50 bpm
Tachycardia: greater than 95-100 bpm

Question 17

Pulse descriptors?

Answer 17

Location
Force scale-
0: Absent
1+: Weak, thready
2+: Normal
3+: Bounding
Rhythm: regular even tempo

Question 18

Pulse effectors?

Answer 18

Fever, meds, anxiety, cardiac history, athlete, etc

Question 19

Respirations?

Answer 19

Normal: 10 or 12 - 20 per minute
*respiratory distress always 1st level priority

Question 20

Respiration descriptors?

Answer 20

Relaxed/regular/automatic
Sounds? wheezing, gurgling, etc
Effect? use of accessory muscles? (neck, abdomen, thorax)
Position

Question 21

Respiratory effectors?

Answer 21

Narcotics, head injury, heart failure, anesthesia, exercise, sleep

Question 22

Pulse oximetry?

Answer 22

Measures oxygen saturation
Normal: 97-99%
*always check hemoglobin to assess blood/bleeding

Question 23

Pulse ox effectors?

Answer 23

Anemia (not enough blood cells to transfer oxygen), heart disease, lung disease, inadequate O2

Question 24

Blood pressure?

Answer 24

Normal: less than 120/80
Systolic: max pressure on artery during left ventricular contraction (systole)
Diastolic: elastic recoil or resting pressure that blood exerts between contractions (diastole)
Pulse pressure: difference between systolic and diastolic (reflects stroke volume)
Mean arterial pressure (MAP): pressure forcing blood into tissues, average of cardiac cycle (can cause stroke or bleeding issues if too high)

Question 25

BP influencers?

Answer 25

Age, race, weight, sex, exercise, medication (steroids), pain, social/financial/emotional stress

Question 26

Blood pressure factors?

Answer 26

Cardiac output (how much blood your heart can squeeze out) : increase CO = increased BP Peripheral vascular resistance (vessels themselves): increased resistance (vasoconstriction) = increased BP Volume of circulating blood: fluid retention = increased BP, hemorrhages = decreased BP Viscosity (blood thickness): increase = increased BP Elasticity of vessel walls: increased rigidity = increased BP *hypertension and diabetes silent killers over time*

Question 27

BP parameters?

Answer 27

Normal: lower than 120/80 Elevated: 120-129 AND less than 80 Hypertension stage 1 (will definitely start treating if showing other symptoms/factors): 130-139 OR 80-89 Hypertension stage 2: 140+ OR 90+ Hypertensive crisis: higher than 180 AND/OR higher than 120 200+: stroke or heart attack *lower sodium in diet for elevated levels

Question 28

Korotkoff sounds?

Answer 28

Phase I: soft, clear tapping- systolic pressure Auscultatory Gap: silence for 30-40 mmHg Phase II: swooshing/softer murmur following tapping Phase III: crisp, high pitched knocking Phase IV: abrupt, low pitched murmur Phase V: silence- diastolic pressure

Question 29

What is orthostatic hypotension?

Answer 29

Drop in BP while rising from a seating or reclined position Drop in systolic BP by >20 mmHg and/or diastolic >10 mmHg

Question 30

How to measure orthostatic hypotension?

Answer 30

Patient lies down for 5 minutes- measure BP and pulse rate Have patient sit up/stand, repeat BP after 1 minute and 3 minutes

Question 31

OH common causes?

Answer 31

Fluid loss, aging, bedrest, changes in BP meds

Question 32

Where can you measure BP?

Answer 32

Upper arm/brachial artery: most common Lower arm/radial artery Upper leg/popliteal artery Lower leg/tibial artery

Question 33

Common BP assessment errors?

Answer 33

Arm placement Patient holds up arm Legs crossed Examiner not eye level Patient conversing Incorrect cuff size Failure to palpate for inflation level Deflate too fast or too slow