General Assessment and Vital Signs Flashcards
what is the traditional examination position?
patients right side
-for JVD assessment, PMI, and hidden left kidney
PMI
point of maximal impulse of the heart
two types of exams?
comprehensive and problem-focused
comprehensive exam?
new patient, annual PE, general exam of all alreas
problem-focused exam?
established patients, specific concerns, routine or urgent exam
subjective
what the patient tells you
-history, from chief complaint through ROS
objective
what you collect during your physical exam of the patient
-inspect, palpate, auscultate, percuss
core vitals?
blood pressure
heart rate and rhythm
respiratory rate and rhythm
temperature
additional vitals
height and weight
BMI
SaO2
Pain Level
BMI?
body mass index
weight (kg) / height (m*2)
what does the bell of the stethoscope hear?
low frequency
what does the diaphragm of the stethoscope hear?
high frequency
size of BP cuff?
width 40% of upper arm
length 80% of upper arm circumference
where to take blood pressure?
left arm at heart level
-patient sits at least 5 minutes
**patient should avoid smoking and caffeine (30 minutes)
exception for changing side of BP?
history of axillary node dissection on left side
where should the blood pressure cuff be?
one inch above antecubital crease
two types of blood pressures?
palpatory and ausculatory
palpatory blood pressure?
brachial or radial artery
palpatory pressure is when inflate cuff and pulse disappears
-can also deflate and return pulse return
add 30 to the number and use as future inflation target**
-avoids pain and auscultatory gap
auscultatory gap
silent episode between systolic and diastolic endpoints
might get a silent systolic
auscultory blood pressure
can use bell or diaphragm
kortokoff sounds
low pitched and are the turbulent flow during BP measure
average BP?
two measurements and 2 minutes between readings
more than 10mm difference - check again
pathology in bilateral BP?
difference greater than 10-15 mmHg
normal BP?
less than 120 / less than 80
pre-hypertension, stage 1, and stage 2 BP?
pre-HTN - 120-139 / 80-89
stage 1 - 140-159 / 90-99
stage 2 - greater 160 / greater 100
orthostatic BP?
postural hypotension
2 or three positions
-supine - sitting - standing
within 3 minutes
drop of 20mm systolic or 10mm diastolic
-pathologic
radial pulse
15 seconds x 4
also, pay attention to rhythm
normal HR?
60-100
respiratory rate
be sneaky
should be regular
normal RR?
14-20
prolonged exhalation?
in COPD patients
bradypnea
slow rate
tachypnea
fast rate and shallow
hypernea
deep and fast
cheyne-stokes
growing and diminishing depths
peripheral oxygen saturation
SpO2
measure of oxygen in blood
want greater than 92 (normal 97-99)
low O2 look for signs of cyanosis
normal temperature?
98.6 and 37
range 96.4-99.1
axillary temp?
lower by 1 degree
tympanic temp?
higher by 0.8 with no wax
oral temp?
gold standard?
rectal temp?
higher by o.4
underweight BMI?
less than 18.5
normal BMI?
18.5 - 24.9
overweight BMI?
25-29.9
obese BMI?
greater than 30
extremely obese BMI?
greater than 40
pain level
is subjective, but can be used objectively
why head to to physical exam?
encourage systemic approach (more efficient)
more hygienic
facilitate relationship before more sensitive areas
percussion?
striking or plexor finger (3rd)
general assessment
first part of physical exam (9 parts)
apparent state of health LOC signs of distress height, build, weight skin color and easily seen lesions dress/personal hygiene, body breath odor odors are clues to diagnosis facial expression and eye contact posture, gait, motor activity
