General Survey & Vital Signs Flashcards
State of Health
Is the patient acutely or chronically ill?
Alert
Lucid and responds to commands
Confused
Awake but may not respond correctly to stimuli
Lethargic
drowsy, opens eyes, and follows commands to loud voice
Obtundation
will awaken to touch but slow to respond, somewhat confused
Stupor
only arouses to pain
Comatose
unresponsive
Delirious
confused, agitated, may be hallucinating
Cardiac/Pulmonary Signs of Distress
clutching chest, pallor, diaphoresis, labored breathing, wheezing, coughing
Pain Signs of Distress
wincing, sweating, facial grimace, posture preference
Anxiety/Depression signs of distress
fidgety movements, cold/moist palms, poor eye contact, flat affect
Unkempt appearance may suggest…
depression or dementia
breath odors can indicate…
alcohol use, uremia, liver failure, fruity breath of metabolic acidosis (DKA), ammonia (renal disease or urinary incontinence)
Holes in shoes may suggest…
gout, bunions, other painful foot conditions, or lower extremity edema
Is the patient articulate? If not, think…
expressive aphasia, TIA, receptive aphasia, aphonia
Proptosis
Stare of Hyperthyroidism
Myxedema is indicative of…
Severe Hypothyroidism
Myxedema is…
Edema around the eyes does not pit with pressure, dry skin, thinning hair
Immobile face is indicative of…
Parkinsonism
Flat or sad affect is indicative of…
Depression
A moon face with red cheeks and excessive facial hair growth is indicative of…
Cushing’s Syndrome
Acromegaly is…
increased growth hormone production leads to prominent jaw and brow, enlarged nose, lips, ears
Tripod posture indicates…
COPD
Parkinsonian Gait
Shuffle Step
Spastic hemiparesis
Pt. with stroke or brain tumor may drag foot
Antalgic gait
Painful or limping gait
Obvious tremors can secondary to
Liver failure, alcoholism, Parkinson’s
Athetosis
Writhing snakelike movements of cerebral palsy
Kleinfelter’s
Lacking secondary sexual characteristics in a male
Reasons for an abnormally short patient
Turner’s syndrome, achondroplastic and hypopituitary dwarfism
Reasons for an abnormally tall patient
Marfan’s syndrome
Height loss can be due to…
osteoporosis and vertebral compression fxs
Generalized fat
Simple obesity
Truncal fat
Cushing’s Syndrome
Sthenic
Muscular
Asthenic
Thin
Hypersthenic
Stocky, high fat distribution
Cachexia
Wasting
BMI
underweight
BMI 18.5-24.9
normal
BMI 25-29.9
overweight
BMI 30-34.9
Obese I
BMI 35-39.9
Obese II
BMI > 40
Obese III (morbid)
Calculation for BMI
Weight (kg)/Height (m2) or (Weight (lbs) x 700)/Height (in)2
Width of the BP cuff bladder should be
approx 40% of the upper arm circumference
Length of BP cuff bladder should be
approx 80% of upper arm circumference
If the BP cuff is too SMALL
will artificially RAISE BP
If the BP cuff is too LARGE
will artificially LOWER BP in a small arm and will artificially RAISE BP in a large arm
Normal BP
90-120 (systolic) / 60-80 (diastolic) with pulse pressure between 30-40 mmHg
Prehypertension
120-139 (systolic) / 80-89 (diastolic)
Stage 1 Hypertension
140-159 (systolic) / 90-99 (diastolic)
Stage 2 Hypertension
> 160 (systolic) / >90 (diastolic)
Body temperature is controlled by
Hypothalamus
What part of stethoscope should be used for auscultating BP?
Bell
An auscultatory gap may be indicative of…
arterial stiffness and atherosclerotic disease
Orthostatic Hypotension
Drop in BP 20 mmHg
Causes of Orthostatic Hypertension
drugs, moderate or severe blood loss, prolonged bed rest, diseases of ANS
Oral Temp Norm
37.0 C / 98.6 F
Aural/Rectal/Temporal Temp Norm
37.5 C / 99.6 F
Axillary Temp Norm
36.4 C / 97.6 F
Convert Celsius to Fahrenheit
(C x 1.8) + 32
Convert Fahrenheit to Celsius
(F - 32) x .55
Normal Heart Rate
50-90 BPM
Respiratory rate controlled by
Medulla Oblongata
3 Characteristics of Respiration
Rate, Rhythm, Quality
Bradypnea
Slow breathing may be secondary to
diabetic coma, drug-induced respiratory depression, and increased intracranial pressure.
Normal Respiratory Rate
The respiratory rate is about 14–20 per min in normal adults and up to 44 per min in infants.
Sighing Respiration
Breathing punctuated by frequent sighs should alert you to the possibility of hyperventilation syndrome—a common cause of dyspnea and dizziness. Occasional sighs are normal.
Tachypnea
Rapid shallow breathing has a number of
causes, including restrictive lung disease, pleuritic chest pain, and an elevated diaphragm.
Cheyne-Stokes Breathing
Periods of deep breathing alternate with periods of apnea (no breathing). Children and aging people normally may show this pattern in sleep. Other causes include heart failure, uremia, drug-induced respiratory depression, and brain damage (typically on both sides of the cerebral hemispheres or diencephalon)
Obstructive Breathing
In obstructive lung disease, expiration is prolonged because narrowed airways increase the resistance to air flow. Causes include asthma, chronic bronchitis, and COPD.
Hyperpnea, Hyperventilation
Rapid deep breathing has several causes, including exercise, anxiety, and metabolic acidosis. In the comatose patient, consider infarction, hypoxia, or hypoglycemia affecting the midbrain or pons.
Kussmaul breathing
deep breathing due to metabolic acidosis. It may be fast,
normal in rate, or slow.
Ataxic Breathing (Biot’s Breathing)
characterized by unpredictable irregularity. Breaths may be shallow or deep, and stop for short periods. Causes include respiratory depression and brain damage, typically at the medullary level.
Hyperpyrexia
extreme elevation in temperature, above 41.1°C (106°F)
hypothermia
Abnormally low temperature, below 35°C (95°F) rectally
Fever or Pyrexia
37.4 C, 100F
Causes of fever
- Microbial infection
- Inflammatory disorders
- Cancer/malignancy
- Autoimmune response
- Drug reactions
- Fever of unknown origin
- Trauma/surgery
- Blood disorders (hemolytic anemia)
Heat stroke
Core temp > or = 105F/41C with altered mental status and hot/dry skin (anhydrosis)
Difference of BP in both arms should be no more than…
10mmHg
If BP is more than 10mmHg different between arms what can be the cause?
Aortic dissection or subclavian steal syndrome
Laying down should cause BP to…
Decrease
Lower extremities should have ________ BP than upper.
Equal or Higher
If lower extremities have lower BP than upper extremities expect…
PAD or Aortic Dissection
How should an orthostatic BP be taken?
After resting 3 min measure supine, then within 3 min of standing
Hypertension accounts for what percent of MIs and strokes?
35%
Hypertension accounts for what percent of heart failures?
49%
Hypertension accounts for what percent of premature deaths?
24%
Dyspnea
difficulty breathing, use of accessory muscles
Apnea
lack of breathing
Stridor
“crouping sound” – suggests problem is not with in lungs but with in Upper Airways (May indicate inspiration of Foreign Body in infant)
Orthopnea
can breathe OK sitting UPRIGHT, but can’t breathe lying down (supine)
Orthopnea is indicative of…
Cardio/Pulmonary disease (i.e. CHF, pulmonary edema)
Paroxysmal Nocturnal Dyspnea (PND)
SOB and coughing at night
Paroxysmal Nocturnal Dyspnea (PND) is indicative of…
CHF (fluid from extremities begins to pool in lungs when lying)
Ataxic Breathing
irregular but without a pattern
Ataxic Breathing is indicative of…
Disorder/trauma affecting medulla
Prolonged expiration
seen with COPD (takes longer to get air out than to get air in)
Tachycardia
> 100
sinus tachycardia
100-180
supraventricular (atrial or nodal) tachycardia
150-250
Sporadic (Arrhythmia)
premature or extra beats at random intervals but normal underlying rhythm
Regularly Irregular (Arrhythmia)
regular pattern of cadences (i.e. ventricular trigeminy)
Irregularly Irregular (Arrhythmia)
No discernible regularity (i.e. a-fib, a-flutter)
Pulsus Alterans
strong pulse alternating with weak pulse pulse, regular rhythm.
Cause: Heart failure
Bisferiens Pulse
increased arterial pulse w/ double systolic peak
Cause: aortic stenosis, aortic regurgitation
Bigeminal Pulse
Irregular rhythm may mimic pulsus alterans.
Cause: normal beat alternating w/ premature contraction
Paradoxial Pulse
rapid fall in systolic BP when pt inspires
Causes: Pericardial Tamponade, pulmonary hypertension, asthma & COPD
Large, Bounding Pulses
pulse pressure is increased/feels strong and bounding. Rise & Fall may feel rapid.
Causes: increased stroke volume, hyperthyroidism, aortic regurgitation, patent ductus arteriosis; seen more commonly with elderly patients.
Small, Weak pulses
pulse pressure is diminished, feels weak and small.
Causes: decreased stroke volume as in heart failure, PAD, shock, hypovolemia, aortic stenosis
Nociceptive (somatic) (Pain)
linked to tissue damage to skin
Neuropathic (Pain)
consequence of a lesion or dx affecting the somatosensory system
Central Sensitization (Pain)
alteration of CNS processing of sensation leading to amplification of pain signals (i.e. fibromyalgia).
Bradycardia
HR
BP should be maintained at…. for patients with diabetes or renal failure
