General Survey and Vital Signs Flashcards
Order of Basic Exam Technique (unless otherwise specified)
- Inspection (synonymous with Assessment)
- Palpation
- Percussion
- Auscultation
Basic Exam Techniques
Perform a thorough, accurate exam
- Develop a routine sequence, usually head to toe order
- Examine from right-hand side
- Speak to pt during the PE - let them know what you are doing & why
General Survey
-Overall impression of the patient based on clinical observation = objective findings
Components of General Survey
- Apparent state of health
- Level of consciousness
- Signs of distress
- Dress, grooming & personal hygiene
- Facial expression
- Breath & body odors
- Posture, gait & motor activity
- Body habitus
Apparent State of Health
Fit, frail, healthy, appearing, WD/WN, robust
Level of Consciousness
Alert, oriented, confused, drowsy, sleepy, responsive
Signs of Distress
Labored breathing, seems anxious, positio (exam table, chair), pallor, sitting comfortably, tripoding, curled up on table
Grooming and Hygiene
Condition of clothes/shoes, personal cleanliness
Facial Expression
Appropriate to conversation, eye contact, flat affect
Breathe/Body Odors
Alcohol, fruity/sweet, tobacco, halitosis
Posture, Gait, and Motor Activity
Invountary Movements, tremors, fidgets, non-movement, limps, uneven gait, gait intact
Body Habitus
Morbidly obese, overweight, emaciated, muscular
General Survey
- Objective
- Clinical observation
- Physical signs= PE
- Clinician’s impression of patient
General ROS
- Subjective
- Patient based history
- Symptom based information obtained through question/answers
- weight change
- fatigue
- Weakness
- Fever/Chills, night sweats
Weight Gain Causes
- tissue vs. body fluids
- tissue–> fat; takes months
- body fluids –> edema, hours/days
Weight Loss Causes
- Decreased intake of food (anorexia, dysphagia, vomiting, insufficient food supply, eating disorder, need dental work)
- increased caloric intake (hyperthyroid, malignancy, eating disorders, malabsorption)
Fatigue
- relatively non-specific complaint
- a sense of weariness of loss of energy
- consider context of symptom (response to hard work/stress/grief or unrelated to specific factor)
Weakness
- not synonymous with fatigue
- denotes a demonstrated loss of muscle strength
- localized to a neuro-anatomic pattern (suggests a disorder of nervous system or muscles)
- Need MSS, CNS & Psych ROS
Fever/Chills, Night Sweats
- Ask pt to clarify what they mean by having a fever (subjective vs. pt used thermometer)
- Has the pt. noted excessive sweating or felt chilly & cold? (+ response: is it night time or throughout day)
- Distinguish between subjective chilliness verses a shaking chill
Vital Signs
BP, Pulse, Respiration, Temperature, Height, Weight
BP
- Patients should avoid exercise, smoking, caffeine before BP reading
- Width of inflatable cuff = 40% of upper arm circumference
- Length = 80% of upper arm circumference
- Support pt’s arm so brachial artery at heart level
- pt should be sitting, legs uncrossed
How long do you wait if you need to repeat BP?
Wait 2 minutes for same arm or use other arm
Normal Blood Pressure
Systolic: 90-119
Diastolic: 60-79
Pre-Hypertension
Systolic: 120-139
Diastolic: 80-90
Hypertension Stage 1
Systolic: 140-159
Diastolic: 90-99
Hypertension Stage 2
Systolic: 160+
Diastolic: 100+
White Coat Hypertension
- Systolic BP may go up because of anxiety/nervousness
- may want to recheck at the end of visit
Masked Hypertension
- Ambulatory is elevated
- Fine clinically
Hypertensive Urgency/Emergency
diastolic BP above 150
Coarctation of the Aorta
- narrowing of the aorta
- need to check for this when someone is diagnosed with hypertension
Orthostatic (Postural) Hypotension
- Measure BP in 3 positions for pt on HTN medication or with a history of fainting, postural dizziness, possible depletion of BV
- Wait 1-5 minutes between sitting and standing
- Fall in Systolic Pressure is 20mm Hg or more from supine or sitting to standing
Positive Response for Orthostatic Hypotension
- Fall in Systolic Pressure is 20mm Hg or more from supine or sitting to standing
- Fall in Diastolic pressure is 10mm Hg or more
Special Considerations for BP
- Coarctation of the aorta
- Orthostatic (Postural) Hypotension
- Very obese, very thin, weak Korotkoff sounds
Pulse
- rate (bpm), rhythm (pattern), amplitude (strength, bounding), and contour (speed of upstroke)
- Sites: Radial, carotid, brachial (infants)
Pulse Rate
Fast (>100, tachycardia), Normal (60-100), slow (<60, bradycardia)
Rhythm of Pulse
- Regular
- Regularly irregular or irregularly irregular (evaluate by auscultation)
Respiration
-Observe signs of respiratory alteration
-Count while patient is distracted and not talking
-Observe one complete respiratory cycle
-Regular- count for 30 sec x 2
Irregular- count for full minute
Patterns of Respiration
Bradypnea, Tachypnea, hyperventilation, obstructive breathing, Cheyne-Stokes, Ataxac (Biot’s) breating
Bradypnea
abnormally slow breathing rate
Tachypnea
rapid and shallow breathing
Hyperventilation (hyperpnea)
rapid and deep breathing
Obstructive breathing
prolonged expiration (such as COPD, Asthma attack)
Cheyne-Stokes
deep alternating breathing with apneic
-take slow or rapid deep breaths and then stop
Ataxic (Biot’s) breathing
- unpredictable and irregular
- no real pattern
Normal Oral Temperature
- 37 C or 98.6 F
- lower in arm and higher in PM
Normal Rectal Temperature
higher by 0.4-0.5C (0.7.-0.9F)
Normal Axillary Temperature
lower than oral by 1 degree, less accurate
Normal Tympanic Temperature
higher by 0.8°C (1.4°F)
refers to extreme elevations in temperature, above 41.1° C (106°F)
Hyperpyrexia
refers to an abnormally low temperature, below 35°C (95°F) rectally
Hypothermia
What are two terms that mean elevated temperature?
Hyperpyrexia and Hypothermia
Pulse Oximetry
- Indirect measurement of oxygen saturation
- % of hemoglobin in the oxyhemoglobin configuration
- Normal range = 95 to 100%
- Does not determine: metabolism of oxygen or amount of oxygen used
Pulse Oximetry Normal
95-100%
Healthy Lifestyles Motivational Interview
Optimal weight & nutrition (Obesity in the population; Variables to promote and/or evaluate)
Nicotine cessation
Dealing w/pain
Assess Healthy Lifestyle (5 R’s)
Relevance change or cessation Risks Rewards Roadblocks Repetition
Assessing readiness to change to Healthy Lifestyle
- Ask about use, exercise, foods
- Advise (Be clear about why a change is in pt best interests)
- Assess (w/readiness for change)
- Assist (Develop realistic & attainable plan)
- Arrange (Follow up visit to review pt success or reassess readiness cessation/change)
5 A’s
Ask, Advise, Assess, Assist, Arrange
Types of Pain
Nociceptive (somatic)
Neuropathic
Central sensitization
Psychogenic & idiopathic
Normal Pulse for Adults
60-100 bpm
Normal Respiratory Rate
14-20 breathes per minute
