General Survey Flashcards
What must you do first when u see the patient
Observe and Assess
It begins with the opening moments of patient encounter. First impression of your patient
General Survey
What should we Assess?
- Apparent Health Status
- Signs of Consciousness
- Facial Characteristics
- Skin Color and Obvious Lesions
- Dress, Grooming, and Personal Hygiene
- Odors of Body and Breath
- Body type, Posture, Gait, and Motor Activity
- Speech
- Cultural Considerations
- Developmental Considerations
Identify what factors during assessment these questions belong to:
- Is the patient acutely or chronically ill?
- Is the patient frail?
- Is the patient fit or robust?
- Is the patient overweight or underweight?
Apparent State of Health
Identify what factors during assessment these questions belong to:
- Is the patient awake, alert, and responsive to you and others in the environment?
- Is the patient drowsy, lethargic, or stuporous
- Is the patient unconscious
Level Of Consciousness
Identify Signs of Distress :
- clutching the chest
- has pallor, cyanosis, or diaphoresis
- labored breathing, wheezing, or coughing
Cardiac or Respiratory Distress
Identify Signs of Distress :
- wincing, diaphoresis, protectiveness of painful area, unusual posture favoring one limb or region of body
Pain
Identify Signs of Distress :
- anxious facial expressions, fidgety movements, cold moist palms, inexpressive or flat effect, poor eye contact, or psychomotor slowing
Anxiety of Depression
Identify the Facial Characteristics:
- drooping of eyelid
Ptosis
Identify what factors during assessment these questions belong to:
- do you see pain, fear, anxiety
- does patient maintain eye contact
- is his or her facial expression happy or sad
- is the facial features symmetrical
Facial Characteristics
Identify the Facial Characteristics:
- indicates a transient ischemic attack or stroke
Drooping of one side of the face
Identify the Facial Characteristics:
- bulging or protruding eyeballs
- may suggest hyperthyroidism
Exophthalmos
Identify Skin color and Obvious Lesions:
- pale complexion or unusual lightness of skin color; may
indicate anemia, malnutrition, vitamin deficiency
Pallor
Identify Skin color and Obvious Lesions:
- bluish discoloration of the skin or mucous membrane; may indicate poor oxygenation
Cyanosis
Identify Skin color and Obvious Lesions:
- yellowish discoloration of the skin or mucous membranes
- may suggest underlying hepatobiliary tract disease
Jaundice
Identify Skin color and Obvious Lesions:
- medical term for mole
- common benign skin lesion but some may be malignant
Nevus
Identify what factors during assessment these questions belong to:
- how is patient dressed based on the environment
- how worn out is the patient’s shoes and clothing
- does patient have jewelry or tattoos
- does patients nails show signs of biting
- does the patient practice personal hygiene well
Dress, Grooming, and Personal Hygiene
Identify what factors during assessment these questions or facts belong to:
- can be important diagnostic clues
- fruity odor/ acetone breath may suggest high level of ketones
- other breath odors may suggest alcohol, presence of pulmonary infections, uremia, or liver failure
Odors of Body and Breath
Identify what factors during assessment these questions or facts belong to:
- the body type, posture, gait, and motor activity of the patient
Body type, posture, gait, and motor activity
Identify what these statements identify:
- patient’s body size and build in respect of his or her gender and age
- is patient stocky, slender, or average build
- Does patient have abnormal fat distribution?
- Does patient’s hand have clubbing, edema, and deformities
Body Type
A disorder where body makes to much cortisol. results in truncal obesity and buffalo hump
Cushing’s Syndrome
Excessive Abdominal fat
Truncal Obesity
Collection of excess fat behind the neck
Buffalo Hump
May reflect cardiopulmonary problem. they are found when observing the hands
Nail clubbing and edema
Athritic changes
Deformities
Identify the problem by the posture of the patient:
- Sitting upright
Left sided heart failure
Identify the problem by the posture of the patient:
- leans forward with arms braced
COPD
Identify the problem by the posture of the patient:
- agitated and restless
anxious
Identify the problem by the posture of the patient:
- often avoid movement
patients in pain
Identify the problem by the posture of the patient:
- abnormal thoracic curve of spine
Kyphosis
Identify the problem by the posture of the patient:
- abnormal Lumbar curve of spine
Lordosis
Manner of walking of a person. Has following questions
- how patient enters room
- are the patient’s movement smooth and coordinated
- does he or she need a cane or walker
- do u see a wide base of support with short stride
- It suggests musculoskeletal, or neurological problem
Gait
Identify what the questions and facts point to:
- is there any involuntary motor activity
- are some parts immobile
- observe for tremors, involuntary movement, or paralysis
- can bedridden patient move from side to side, sit up in bed, and change positions
- how much assistance does the patient need to move
Motor activity
Rhythmic oscillatory movements and can be subdivided into 3 sub groups
Tremors
Identify which tremor sub group:
- most prominent at rest and may decrease or disappear with voluntary movement
Resting or static tremors
Identify which tremor sub group:
- appear when affected part is actively maintaining a posture
Postural Tremors
Identify which tremor sub group:
- absent at rest, appear with movement and often gets worse as the target gets closer
- causes include cerebellar disorders
Intention Tremors
Movement that is not done consciously
Involuntary Movement
They are arrhythmic, repetitive,bizarre movements that chiefly involve face, mouth, jaw, and tongue. Person does grimacing, pursing of lips, protrusions of tongue, and opening and closing of mouth.
Oral Facial Dyskinesias
These are brief repetitive, stereotyped, coordinated movements occurring at irregular intervals
Tics
Its similar to athetoid movements but involve larger parts of the body. Results in grotesque twisted postures of body
Dystonia
Causes more slower and more twisting and writhing that choreiform movements and have larger amplitude. Commonly involves face and the distal extremities
Athetosis
Choreiform movements are brief, rapid, jerky, irregular, and unpredictable. Occurs at rest or interrupt normal coordinated movements. Seldom repeats. Involves face, head, lower arms, and hands
Chorea
Identify what factors during assessment these questions or facts belong to:
- what is your patient’s speech pattern and pace
- is your patient’s response appropriate
- Note the tone and quality of patient’s voice
- Patients vocabulary and sentence structure offer clues to his or her educational level
Speech
what can we conclude with from a patients speech:
- pressured, inappropriate response, and illogical or incoherent
may be associated with psychiatric disorders
what can we conclude with from a patients speech:
- pressured and hurried
may also be seen as hyperthyroidism
what can we conclude with from a patients speech:
- changes in voice quality
Cranial nerve IX lesion may be present
what can we conclude with from a patients speech:
- garbled
- indicates problem on language centers of the brain
associated with strokes
Identify what factors during assessment these facts or questions belong to:
- note down any cultural influences that affect physical characteristics, response to pain, dress, and grooming, and hygiene.
- it also influences person’s verbal and non verbal communication
Cultural Considerations
Identify what factors during assessment these questions belong to:
- how we interact and assess patient must be appropriate with their condition, experience, or age
Developmental Considerations
Developmental Considerations
- Children
- Behavior should correspond with the child’s developmental level
- Children tend to regress when ill
- Take note of the relationship between child and parent
Developmental Considerations
- Pregnant
- General appearance should reflect gestational age
- Look for normal changes that occur with
pregnancy, such as wide base of support
and lordosis - Look for swelling
- Note patient’s affect and response to
pregnancy
Developmental Considerations
- OLDER ADULTS
- Look for normal changes that occur with
aging - Look for clues of decreasing ability to
function, especially dressing and grooming
problems - Pay attention to affect
- Note changes in mental status
