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Physical Diagnosis > General Survey and Vital Signs > Flashcards

General Survey and Vital Signs Flashcards

1
Q

patient’s general appearance

A
  • posture and position of patient
  • gait/ambulation
  • gross assessment of nutritional status
  • body habitus
  • estimation of psychological status
  • apparent state of health (healthy, chronically ill, frail)
  • level of consciousness (awake, alert, responsive, lethargic, obtunded (hear you but respond slowly, confused))
  • height and build (short, tall, slender, stocky, lanky)
  • weight (cachectic, emaciated, slender, obese, morbidly obese)
  • dress, grooming, personal hygiene
  • facial expression (eye contact, level of attention, facial expression, affect)
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2
Q

signs of cardiac distress

A

clutching chest, diaphoretic (sweating heavily)

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3
Q

body odors and breath

A
  • fruity odor of diabetes
  • scent of alcohol, cigarettes, marijuana
  • body odors (homeless, nursing home, cancer)
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4
Q

Antalgic gait

A

Due to pain

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5
Q

6 primary vital signs

A
  • BMI, height, weight
  • blood pressure
  • heart rate (pulse)
  • respiratory rate
  • temperature
  • pain
  • pulse oximetry (oxygen saturation)
  • last menstrual period (LMP)
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6
Q

how to measure height and weight

A

without shoes or heavy clothing

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7
Q

body mass index

A
  • more accurate than height/weight charts
  • estimated measure of body fat
  • BMI = weight (kg) / height (m2) (target range between 19-25) (>25 = overweight, >30 = obese, <17 = underweight)
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8
Q

medical implications of obesity

A
  • diabetes, metabolic syndrome
  • hypertension
  • vascular disease
  • osteoarthritis
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9
Q

possible causes of low BMI

A
  • eating disorders
  • cancer
  • wasting syndrome
  • hyperthyroidism
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10
Q

BMI >25 or <17

A
  • indications for nutritional assessment, referral or counseling
  • counseling/education geared at optimal weight and nutrition
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11
Q

blood pressure

A
  • window into the CV system

- provides pressure readings of heart during contraction (systomle) and relaxation (diastole)

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12
Q

how to take blood pressure (patient position and setting)

A
  • patient seated and relaxed at least 5 min, feet on floor
  • no smoking, caffeine 30 min prior
  • arm resting with antecubital crease at heart level, free of clothing, and supported
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13
Q

blood pressure (cuff and cuff placement)

A
  • spyhgmomanometer
  • center of inflatable baldder at 2.5 cm above the antecubital crease in line with brachial artery
  • cuff should be tight around arm (use appropriate cuff size)
  • width of bladder 40% of upper arm circumference
  • length of bladder 80% upper arm circumference
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14
Q

blood pressure (inflating the cuff)

A
  • estimate systolic pressure by palpation
  • deflate and wait
  • apply bell of stethoscope over brachial artery
  • inflate cuff to 30 mmHg above pressure at which radial pulse disappeared on estimation check
  • slowly deflate at rate of 2-3mmHg/sec
  • listen closely until 10-20mmHg below where sounds disappear
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15
Q

Blood pressure sounds

A
  • Korotkoff sounds (low pitch heard when checking BP, 1st sound is SBP, last sound is DBP)
  • Auscultatory gap (silent interval that may be present between systolic and diastolic pressures, associated with atherosclerosis) ; sometimes noticed when taking manual blood pressure and can be misinterpreted leading to underestimations of systolic BP and overestimation of diastolic BP
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16
Q

Repeating blood pressure reading

A
  • wait at least 2 minutes to repeat BP if needed to confirm findings and average your readings (if >5mmHg difference, check agin before averaging readings)
  • BP should be taken both arms at least once (pressure differences 5-10mmHg btw arms is ok, pressure differences >10-15mmHg suggests cardiac or arterial problem on lower pressure side)
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17
Q

Blood pressure readings and their meanings

A
  • normal (SBP <120mmHg, DBP <80mmHg)
  • Prehypertensive (SBP 120-139, DBP 80-89)
  • Hypertension Stage 1 (SBP 140-159, DBP 90-99)
  • Hypertension Stage 2 (SBP >160, DBP >100)
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18
Q

orthostatic (postural) hypotension

A

-measure BP and HR supine, seated, standing
wait 2-3 mins between positions
Positive if drop in SBP > or = 22mmHg, drop in DBP > or =10mmHg, increase in HR > 10bpm, or dizziness

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19
Q

Pulsus paradoxus

A

SBP drop >10mmHg upon inspiration

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20
Q

Heart rate and rhythm

A
  • measured as beats per minute
  • 4 components to pulse (rate, rhythm, amplitude, contour)
  • -amplitude = how far it rises
  • -contour = how fast it rises and falls (or how slowly)
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21
Q

Measuring heart rate

A
  • locate radial pulse
  • palpate with pads of middle and index fingers
  • count beats for 15 secs and multiply by 4 (if irregular or very fast or slow, count for 60 secs)
  • note rhythm, contour and amplitude of pulse (regular or irregular, strong, bounding, weak, thready)
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22
Q

Heart Rate ranges

A
  • Normal 60-100 bpm
  • bradycardia <60 bpm
  • tachycardia >100 bpm
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23
Q

small weak pulse (low pulse pressure) indications

A

heart failure, hypovolemia, vascular disease

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24
Q

irregularly irregular pulse indication

A

indicates atrial fibrillation

25
Q

respiratory rate

A

-measured as breaths per minute

26
Q

measuring respirations

A
  • count the number of breaths in 1 minute
  • visual inspection (watch the patient breathe quietly)
  • auscultation (over trachea when examining other area)
27
Q

normal respiration rate

A

14-20 breaths/min (expiration should be longer than inspiration but not by a lot, and should be regular)

28
Q

cheyne-stokes breathing

A

periods of deep breathing alternate with apnea

29
Q

kussmaul breathing

A
  • “air hunger”

- rapid deep breathing due to metabolic acidosis

30
Q

ataxic (biot’s) breathing

A

unpredictable irregularity in breathing

31
Q

obstructive breathing

A

prolonged expiration due to narrowed airways

32
Q

temperature

A
  • measures core body temperature
  • not always necessary to check temp
  • normal range (oral 96-99F, 35-37C)
  • average (98.6F, 37C)
  • lower in AM, higher in PM
33
Q

rectal temperature

A

slightly higher than oral (closest to core temp, indicated in babies, unconscious or uncooperative pts in respiratory distress)

34
Q

glass thermometer

A
  • for checking oral or rectal temperature
  • can be affected by anything recently in the mouth
  • shake thermometer, insert under tongue, wait 3-5 minutes and read; reinsert 1 minute and read again
35
Q

digital (electronic) thermometer

A
  • for checking oral, rectal, or tympanic temperature depending on which machine is used
  • use disposable cover, insert under tongue
  • wait to readout, about 10 seconds
36
Q

fever (pyrexia)

A

> 100.5F (38C)

-abnormal, elevated core body temperature

37
Q

hyperpyrexia

A

> 106F (41C)

38
Q

hypothermia

A

<95F (35C)

39
Q

causes of fever

A

infection, trauma, cancer, drug reactions, etc.

40
Q

causes of hypothermia

A

exposure to cold, paralysis, starvation, etc.

41
Q

pain

A
  • newest vital sign
  • should be included whenever a patient complains of pain
  • scale of 0-10 or can use symbols for children or patients who do not understand number scale
  • 0 = no pain
  • 10 = most severe pain
42
Q

oxygen saturation

A
  • indicated in patients with respiratory complains or problems
  • pulse oximeter machine required (measures O2 saturation in capillaries, false negatives and positives)
  • normal is >95% saturation on room air (may be less for patients with COPD)
  • always note if patient is on room air or supplemental oxygen
43
Q

general survey and vital signs

A
  • introduce self, state name and title
  • wash hands
  • assess patient’s level of consciousness, posture, movements, grooming and hygiene, manner, affect, apparent state of health
  • check height and weight, and calculate BMI
  • check temperature
  • check BP bilaterally in seated position
  • check respiratory rate
  • check heart rate
44
Q

Tripod posture

A

Due to COPD

45
Q

Involuntary movements

A

Could be due to Parkinson’s

46
Q

signs of respiratory distress

A

labored breathing, sitting forward, using intercostal muscles for respiration

47
Q

signs of pain

A

wincing, writhing, rigid, protecting painful area

48
Q

signs of anxiety and depression

A

fidgeting, sweaty palms, poor eye contact, appears disheveled

49
Q

large bounding pulse (high pulse pressure) indications:

A

fever, anemia, hyperthyroidism, exercise, fear/anxiety

50
Q

pulsus alternans

A

pulse alternates in amplitude from beat to beat, but rhythm is regular

51
Q

bisferiens pulse

A

increased arterial pulse with double systolic peak

52
Q

bigeminal pulse

A

normal beat alternates with premature contraction, varying in amplitude

53
Q

bradypnea

A

<14 breaths per minute

54
Q

tachypnea

A

rapid shallow breathing

55
Q

hyperpnea (hyperventilation)

A

rapid deep breathing

56
Q

4 components of breathing

A

rate, depth, rhythm, effort

57
Q

axillary temperature

A

slightly lower than oral (less accurate)

58
Q

tympanic temperature

A

slightly higher than oral

Physical Diagnosis (13 decks)

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