General Survey and Vital Signs Flashcards
3 types of cardiac rhythms
Regular
Irregular
Irregularly irregular
Irregularly irregular is an example of what disease?
A. Fib
Amplitude of 0 in pulse is __
absent
Amplitude of +1 in pulse is __
diminshed
Amplitude of +2 in pulse is __
normal
Amplitude of +3 in pulse is __
increased
Amplitude of +4 in pulse is __
bounding
Small weak pulses maybe a sign of - - - -
Hypovolemia
Aortic Stenosis
Cold
CHF
Large, bounding pulses maybe a sign of - - - - - -
Fever Anemia Hyperthyroidism PDA Heart Block Atherosclerosis
Varies in amplitude from beat to beat (Big pulse, little pulse) In patients with LV failure, usually associated with S3
Pulses Alternans
It ALTERNATES!!!
Normal/Premature/Normal/Premature Pulse
Bigeminal Pulse
It likes it both ways - BI
Decreases with inspiration, pericardial tamponade, obstructive lung disease (COPD), constrictive pericarditis
Paradoxical Pulse
Kentucky is associated with what heart sound?
S3
Tennessee is associated with what heart sound?
S4
pulse that is found in the groin, just medial to quadriceps
Femoral
pulse that is found in the middle of the popliteal fossa, it is palpated better when the knee is flexed 30 degrees
Popliteal
pulse that is posterior to medial malleolus, in the ankle
Posterior Tibial
pulse that is on the dorsal food, lateral to extensor hallucis longus
Dorsalis pedis
pulse that is found in the nexk, medial to and below the angle of jaw
carotid
pulse that is ventral wrist, proximal to the base of the thumb
radial
pulse that is antecubital fossa, medial to the biceps tendon
brachial
in what disease will there be an absent or diminished dorsalis pedis and posterior tibial pulse?
Peripheral vascular disease
What are the reasons you need to be able to find a pulse?
- obtaining arterial blood for blood gas measurement
- finding femoral vein for emergency access
Normal pulse for Adults
60 to 100
Normal pulse of newborns
120-170
Normal pulse for 1 year olds
80-160
Normal pulse for 3 year olds
80-120
Normal pulse for 6 year olds
75-115
Normal pulse for 10 year olds
70-110
What characterictics do you use when assessing the respirations?
- Depth
- Effort of breathing
- ratE
- Rhythm
DEER
how long do you want to count the respirations for infants?
60
Do this BEFORE you take a rectal temp on an infant, they ALL scream when you take a rectal temp and then they will really be huffing and puffing. Its easiest to count the respirations while the baby is sleeping and you haven’t touched them yet! Just watch their chest go up and down!!!
How long do you want to count the respirations for adults?
15 or 30 seconds
15 x 4 to get your 60 seconds or 30 x 2
Normal respiration rate for Adults
12-20
Every normal breathing ER patient I took care of had 18 has their rate!! Bahahaha
Normal respiration rate for newborns
30-80
Normal respiration rate for 1 year olds
20-40
Normal respiration rate for 3 year olds
20-30
Normal respiration rate for 6 year olds
16-22
respiration rate under 12
bradynpea
Possible causes of bradynpea
- Coma
- Medications
- Deep Sleep
Possible causes of tachynpea
- Anxiety
- Heart/Lung Disease
- Pain
respiration rate over 20
tachynpea
respiration rate over 20 AND DEEP
hyperpnea
Possible causes of hypernea
- Exercise
- Anxiety
- Metabolic
What are the 4 respiration patterns we talked about?
- Sighing
- Cheyne- Stokes
- Kussmaul
- Stridor
What respiration pattern is normal if occasionally, anxiety if frequent?
sighing
What respiration pattern is caused by drugs or CNS damage?
Cheyne-Stokes
What respiration pattern is rapid, deep, labored (metabolic acidosis)?
Kussmaul
These are BAD! Pt is circling the drain fast ..
What respiration rate is harsh, high pitched inspiration, airway obstruction?
Stridor
Only heard during INSPIRATION
Normal oral temperature
37 Degrees C / 98.6 Degrees F
Normal early AM Oral temperature
35.8/96.4
Normal late PM Oral temperature
37.3/99.1
Equation to convert F to C
Tc = (5/9) x (Tf - 32)
Tc- Temp in C
Tf- Temp in F
Equation to convert C to F
Tf= ((9/5) x Tc) + 32
Um yea, they have an App for that..
Preferred temperature taking method
Oral
What method of taking a temperature is not recommended if the patient is unconscious, restless, or unable to close mouth?
Oral
Unconscious patients - ALWAYS take rectal
Technique of taking a temperature
Oral
Rectal
Tympanic Membrane
Temporal Scanner
lie on side with hip flexed, use lube and insert 3-4 cm towards umbilicus
Rectal technique
position so beam aims at TM, wait 2-3 seconds
Tympanic membrane technique
Thermometer under tongue, with probe cover, wait 3 minutes if mercury, 10 seconds if electronic, wait 10 minutes after hot or cold liquids
I have no idea how to ask that on a flash card so just read that again!
what technique to taking a temperature reads 0.4 - 0.5 Degrees C/0.7 - 0.8 Degrees F HIGHER than oral
Rectal
Because this method is closer to core temp and isn’t really exposed to the air like your mouth is. Fun Fact!
What technique to taking a temperature is poor correlation with rectal temperature, lower than oral temperatures by 1 degree, considered less accurate than others
Axillary
What technique of taking a temperature is quick, safe, reliable if performed properly, no cerumen in canal, measures core body temperature ( Higher than oral by approx. 0.8 degrees C/1.4 degrees F
Tympanic
what is the most accurate way to take a temperature?
tympanic
What is considered an elevated body temperature (fever)?
greater than 100.5
Holly and I learned it as 100.4 in the ER but he says .5
Excessive heat exposure and/or poor heat dissipation (heat stroke) and elevation of the hypothalamic thermoregulatory set points are possible causes of
pyrexia (fever)
Pyro- means fire
A pyromaniac loves to set fires.
I’m not listing the million causes of a differential disgnosis of a fever
AINT NOONE GOT TIME FOR THAT!
The 5 W’s Philpot came up with for causes of a Fever
When? Water (urine) Wound Wonder drugs Weird disease
extreme elevation of temp
greater than 41.1 C or 106 F
hyperpyrexia
abnormally low temp
less than 35 C or 95 F rectally
Hypothermia
To assess ___ properly, press down firmly on the patients finger or toe nail so its blanches and then release the pressure and observe how long it takes the nail bed to “pink” up
capillary refill
What is an abnormal capillary refill time?
greater than 3 seconds
Abnormal capillary refill time is possibiliy caused by: - - - - -
Peripheral vascular disease Arterial blockage Heart Failure Hypoperfusion Shock
Noninvasive measurement of gas exchange and red blood cell oxygen carrying capacity
imperfect and has limitations
oxygen saturation
what vital sign provides important information about cardiopulmonary dysfunction and helps quantify the degree of impairment?
oxygen saturation
detects hypoxia before the patient becomes clinically cyanotic (IE DEAD)
oxygen saturation
t/f oxygen saturation can have a value greater than 100.
FALSE!!
It’s a percentage so 100 % is the best
Which part of the general survey would the question “is the patient acutely or chronically ill, frail, or fit and robust?” fall under?
Apparent State of Health
Which part of the general survey would the question “is the patient awake, alert, and responsive to you and others in the environment?” fall under?
Level of Consciousness
what are the signs of distress for cardiac or respiratory distress?
is there clutching of the chest, pallor, diaphoresis, or labored breathing, wheezing, and coughing?
what are the sins of distress for pain?
is there wincing, sweating, protectiveness of a painful area, facial grimacing, or an unusual posture favoring one limb or body area?
what are the signs of distress for anxiety or depression?
are there anxious facial expressions, fidgety movements, cold and moist palms, inexpressive or flat affect, poor eye contact, or psychomotor slowing?
T/F Sweating is a sign of distress for depression or anxiety.
FALSE!
sweating = pain
cold and moist palms = anxiety or depression
what do you measure a patients height in?
stocking feet
Is the patient short or tall?
Is the build slender, muscular, or stocky?
Is the body symmetric?
General Body Proportions?
Any Deformities?
Are ALL associated with which part of the general survey?
height & weight
calculate:
5ft 5in = ______ cm
165.1 cm
1 inch = 2.54 cm
calculate:
165.1 cm = _____ m
1.65 meters
100 cm = 1 meter
T/F You should always weigh the patent with their shoes on so they look taller.
NO NO NO DUHHHHH
ALWAYS WEIGH WITH SHOES OFF!!!!!!!
T/F Weighing a patient is the only index of caloric intake in that patient.
FALSE! - weighing the patient is ONLY ONE index of caloric intake ; there are many others
T/F The most valuable data about a patients weight loss is to take it once and trust the patient when they say promise they weigh that weight all year round.
FALSE!!!! Changes OVER TIME show valuable data!!!!!
Changes in weight can be due to what two changes in the body?
- changes in body fluid status
2. changes in fat or muscle mass
the loss of body mass that cannot be reversed nutritionally is _______. This should also be noted in the heigh & weight portion of your general survey if present
cachexia
calculate:
105 lb = ______ kg
- 73
2. 2 lbs = 1 kg
calculate:
50 kg = _______ pounds
110 lbs
2.2lbs = 1 kg
what is the more accurate measurement of body fat?
BMI
how do you calculate body mass index
weight (kg) / Height^2 (m^2)
in a healthy adult, their BMI will be between _____ - ______.
18.5 - 24.9
If BMI is above 25 : assess ______ , ______.
nutrition, screen
If BMI is below 18.5 : ______.
concern
BMI is significant because it is vital for ______ ______.
promoting health
What fraction of the US adults are overweight? What is their BMI?
2/3 … BMI > 25
What fraction of the US are obese? What is their BMI?
1/3 … BMI > 30
What percentage of the US are morbidly obese? What is their BMI?
5% … BMI > 40
What are the risk factors for being obese?
DM, Heart disease, stroke, HTN, Osteoarthritis, & some forms of Ca.
Measuring the patients waist circumference- the patient may have excess body fat if the waist measures greater than or equal to _____ inches in women & ____ inches in men.
35 inches in women
40 inches in men
Who has a higher risk of under nutrition than younger adults?
elderly
What are the two examples of medical conditions associated with weight loss that were given in our notes?
Anorexia, bulimia
T/F Diet, physical activity, waist circumference, blood pressure, blood sugar level, cholesterol level, family history of diseases, smoking, and BMI are all indicators of health risks associated with obesity.
True
When looking at skin color & obvious lesions during the general survey what should u look for? What should u observe?
look for pallor, cyanosis, jaundice, rashes, bruising
observe diaphoresis
How are they dressed? Appropriate? Clean, buttoned, zipped? Properly? Shoes? Jewelry? Piercings? Cleanliness? Grooming? - are all questions associated with which part of the general survey?
dress, grooming & hygiene
T/F you should always assume that alcohol on a patients breath explains changes in mental status or neurologic findings.
FALSE. NEVER DO THIS
what are the two things that are used as diagnostic clues for a patients odors?
body & breath odors
What are the questions you should ask during the posture, gait, motor activity of the general survey?
preferred posture?
resless?
change of position?
fast/slow?
What are you observing about the patient when observing their facial expression?
eye contact, affect, expression, involuntary movements, immobility, gait, blanche movement disorders?
What are the 5 vital signs?
- Blood Pressure
- Heart Rate
- Respiratory Rate
- Temperature
- Pulse Ox
force of the blood pushing against the walls of the arteries
arterial blood pressure
Systolic or Diastolic is highest when the heart beats?
Systolic
Systolic or Diastolic is lowest when the heart beats?
Diastolic
How is arterial blood pressure written?
Systolic / Diastolic
T/F Blood pressure is static.
false - it varies with position circadian rhythm, stress, nutritional status, drugs, & disease
How do you calculate pulse pressure?
Systolic BP - Diastolic BP
What is a normal pulse pressure?
40
120 - 80 = 40
Isolated systolic hypertension = widened or narrow pulse pressure
widened - >40
Tachycardia = widened or narrowed pulse pressure?
narrowed - <30
Aortic regurgitation = widened or narrowed pulse pressure?
widened - >40
Thyrotoxicosis = widened or narrowed pulse pressure?
widened - > 40
Patent Ductus Arteriosus = widened or narrowed pulse pressure?
widened - >40
Arteriorvenous fistula = widened or narrowed pulse pressure?
widened - >40
Beiberi heart - widened or narrowed pulse pressure?
widened - >40
Severe Aortic Stenosis = widened or narrowed pulse pressure?
narrowed - < 30
Constrictive pericarditis = widened or narrowed pulse pressure?
narrowed - <30
Aortic Coarctation = widened or narrowed pulse pressure?
widened - >40
Anemia = widened or narrowed pulse pressure?
widened - >40
Pericardial effusion - widened or narrowed pulse pressure?
narrowed - < 30
Anemia - widened or narrowed pulse pressure?
widened - >40
Emotional State - widened or narrowed pulse pressure
widened - >40
Ascites = widened or narrowed pulse pressure?
narrowed - <30
What is normal BP classification?
SBP <80 mmHg
What is the BP classification for prehypertension?
SBP 120-139 mmHg or DBP 80-89 mmHg
What is the BP classification of stage 1 HTN?
SBP = 140-159 mmHg or DBP = 90-99 mmHg
What is the BP classification of Stage 2 HTN?
SBP = >160 mmHg or DBP >100 mmHg
What is the HTN prevalence in the US?
~50 million ppl
T/F: The BP relationship to risk of CVD is continuous, consistent, and independent of other risk factors.
TRUE
T/F: Each increment of 10/5 mmHg doubles the risk of CVD across the entire BP range starting from 115/75 mmHg.
FALSE: (each increment of 20/10 doubles the risk)
What signals the need for increased education to reduce BP in order to prevent HTN?
prehypertension
HTN is the most important modifiable risk factor for which diseases?
- Coronary Heart dz
- Stroke
- CHF
- End-stage renal dz
- Peripheral vascular dz
What complications can occur to the CNS due to HTN?
- intracerebral hemorrhage
- lacunar infarcts
- encephalopathy
- thrombotic stroke
- transient ischemic attack
What ophthalmologic complications arise due to HTN?
- fundal hemorrhages
- exudates
- papilledema
What cardiac complications arise due to HTN?
- LVH
- CHF
- angina pectoris
- MI
What vascular complications arise due to HTN?
- aortic dissection
2. diffuse athrosclerosis
What renal complications arise due to HTN?
- nephrosclerosis
2. renal artery stenosis
What should the width of the sphygmomanometer cuff be?
~40% upper arm circumference
What should the length of the sphygmomanometer cuff be?
~80% upper arm circumference
What happens if the sphygmomanometer cuff is too short or narrow?
will receive a falsely high reading
What are the 3 types of sphygmomanometer?
- aneroid
- mercury
- electronic
T/F: It’s ok if the pt. drinks coffee right before getting ready to measure their BP.
FALSE: (NO smoking /drinking caffeine for 30 MIN BEFORE
T/F: While getting ready to measure the pts BP, you should allow them to rest for 5 min and wait quietly, in a comfortably cold room.
FALSE: (rest for 5 min, & wait in a WARM room)
When getting ready to measure BP, what should you check the arm for?
- to make sure it is free of clothing
- no AV fistulas present
- no scarring, or lymphedema
After you have checked the arm, what is the next step in measuring BP?
palpate the brachial artery, position the arm with the antecubital crease close to the heart, & rest or support the arm
Once the are is rested in antecubital crease: heart position, what is the next step in measuring BP?
center the bladder to and make the cuff lower border be ~2.5 cm above the antecubital crease, secure snugly, and flex elbow slightly.
After the cuff has been secured in the proper position, what is the next step in measuring BP?
estimate the systolic BP by radial palpation
Why is there a need to palpate the radial artery before using the sphygmomanometer?
in order to know how high to pump the cuff for an accurate reading
after palpating the radial artery what is the next step in measuring BP?
- place the bell over the brachial artery
- inflate cuff rapidly to level determined (radial pulse + 30mmHg)
- deflate slowly (~2-3 mmHg/sec)
- listen for Korotkoff sounds
silent interval present between the systolic & diastolic pressures
auscultatory gap
What may auscultatory gap be related to?
carotid atherosclerosis and to increased arterial stiffness in hypertensive pts, independent of age
T/F: Auscultatory gaps may have prognostic relevance.
TRUE
Which pressure is present during Korotkoff phase 1?
systolic pressure
Which pressure is korotkoff phase 5?
diastolic pressure
Which pressure is determined by the onset of consecutive sounds during BP reading?
systolic pressure
which pressure is marked by the disappearance of sounds during a BP reading?
diastolic pressure
T/F: anxiety can cause a false high BP reading
TRUE
T/F: Improper cuff size (too small), can cause a false high BP reading.
TRUE
T/F: The arm being placed too high can cause a false high BP reading.
FALSE (too low)
T/F: Muscle relaxation can cause a false high BP reading.
FALSE (muscle contraction)
What can cause a false low BP reading?
- arm too high
- improper cuff size (too large)
- bell pressed too firmly, or touching cuff
- failure to recognize an auscultatory gap
What can cause weak or inaudible sounds during a BP reading?
- technical problem
- SHOCK!!!
- arrhythmias
- ambient noise
Which position works best for measuring leg pressures?
having the patient PRONE, leg flexed slightly, heel resting on bed
Where do you apply the BP cuff to measure a leg pressure?
midthigh (center over posterior, wrap securely)
Which artery do you listen over to measure a leg pressure?
popliteal artery
a narrowing of the aorta, typically found just after the vessels are given off to the left arm.
coarctation of the aorta
What does coarctation of the aorta lead to?
leads to HTN due to kidneys detecting low BP and initiating RAAS
What is the key finding of coarctation of the aorta?
elevated BP in the arms, with low BP in the legs
T/F: You should wait til the end of the exam to record the BP readings.
FALSE (record IMMEDIATELY after reading!!)
T/F: the arm in which the pressure is being recorded and the position of the subject should be noted
TRUE
T/F: pressures should be recorded in both arm on the first visit.
TRUE
T/F: In obese pts the bladder size should be indicated.
TRUE
T/F: If the pt. is anxious, restless or distressed, a note should be made with the BP.
TRUE
T/F: The presence of an auscultatory gap should sometimes be indicated.
FALSE (ALWAYS)
Number of heart beats per minute
heart rate
How do you measure pulse?
- apply gentle pressure to radial artery
- use pads of index & long fingers
- count beats for 15 sec & multiply by 4
normal blood pressure =
< 80
prehypertension
120-139 & 80-89
stage 1 hypertension
140-159 & 90-99
Stage 2 hypertension
greater than or equal to
160 & 100
What is HTN prevalence for CVD risk?
50 million people in the USA
The _____ relationship to risk of CVD is continuous, consistent, and independent of other risk factors.
blood pressure
Each increment of _____ mmHg doubles the risk of CVD across the entire BP range starting from _____.
20/10
115/75
______ signals the need for increased education to reduce BP in order to prevent hypertension
Prehypertension
What is the most modifiable risk factor
- coronary heart disease
- stroke
- congestive heart failure
- end stage renal disease
- peripheral vascular disesase
Hypertension
the leading cause of death in north america
coronary heart disease
the third leading cause of death
stroke
what are the 5 systemic complications associated with hypertension?
- central nervous system
- opthalmologic
- cardiac
- vascular
- renal
Intracerebral hemorrhage, lacunar infarcts, encephaolophathy, thrombotic stroke, transient ischemic attack are associated with what “general” complication of hypertension?
central nervous system
fundal hemorrhages, exudates, papilledema are associated with what “general” complication of hypertension
opthalmologic
LVH, congestive heart failure, angina pectorals, myocardial infarction are associated with what general complication of hypertension
cardiac
aortic dissection, diffuse arteriosclerosis are associated with what “general” complication of hypertension?
vascular
nephrosclerosis & renal artery stenosis are associated with what general complication of hypertension?
renal
the beating of the heart or the pulse
sphygmost
a device for measuring pressure or tension
manometer
