General Survey & Vital Signs

Question 1

What is the general survey?

Answer 1

Occurs during the first moments of the pt. encounter and includes a survey of the pts appearance, height, and weight. In addition, the pts mood, build, and behavior should also be observed.

Question 2

What should you observe for in a patient’s general appearance?

Answer 2

• Apparent state of health
• LOC - Is the pt. awake, alert, and responsive to you and others in the environment
• Distress - Cardiac/respiratory, pain, or anxiety/depression
• Skin color/lesions - Pallor/cyanosis/jaundice/rashes/bruises?
• Dress, grooming, and personal hygiene - How is the pt. dressed, clean and appropriate clothing? Any unusual jewelry?
• Facial Expression - Hyperthyroidism stare? Immobile facies of parkinsonism? Sad face?
• Odors of the body and breath - Alcohol/acetone?
• Posture, gait, and motor activity - Any agitation/restlessness? Pts in pain avoid movement. Any abnormal gait?
• Height & weight - Measure the pts height and weight, determine BMI. Any weight loss? DM/hyperthyroidisim/infection/depression

Question 3

What is the value of a normal blood pressure?

Answer 3

Normal is <120/80

Question 4

What is the range for prehypertension?

Answer 4

120-139/80-89

Question 5

What is the range for Stage I hypertension in people aged 18-60?

Answer 5

140-159/90-99

Question 6

What is the range for Stage I hypertension in people aged 60+?

Answer 6

150-159/90-99

Question 7

What is the range for Stage II hypertension?

Answer 7

>160/100

Question 8

What is orthostatic hypotension?

Answer 8

• Measure the patient’s BP lying/sitting/standing, waiting 3-10min between position changes.
• Orthostatic hypotension is a drop of SBP of 20mmHg or DBP of 10mmHg within 3 minutes of standing

Question 9

What is the normal heart rate?

Answer 9

60-100 bpm

Question 10

What is a normal respiratory rate?

Answer 10

• 12-20 respirations/min
• If the pt. is not showing any signs of respiratory distress/is talking clearly and normally/AOx3 a lower RR is not abnormal
• Older adults have higher respiratory rates b/c of decreases in tidal volume

Question 11

Define Tachypnea

Answer 11

• A faster than normal respiratory rate >20 BPM and usually indicates cellular hypoxia, acidosis, or conditions that interfere with gas exchange, ventilation, or perfusion. Ex: pulmonary edema, pneumonia, PE
• Tachypnea may also be a response to pain

Question 12

What does the quality of pulse indicate?

Answer 12

• A strong peripheral pulse usually indicates good left ventricular filling and contractility.
• A weak and thready pulse is usually an indication of an increased systemic vascular resistance, poor left ventricular filling, or an ineffective left ventricular contractile force

Question 13

What is systolic BP a measure of?

Answer 13

is a measure of left ventricular function

Question 14

What is sepsis?

Answer 14

• Sepsis is the clinical syndrome that results from a dysregulated inflammatory response to an infection that is non-resolving and deleterious, often leading to organ dysfunction.
• Sepsis is defined as the presence (probable or documented) of infection together with systemic manifestations of infection

Question 15

What are the diagnostic criteria for sepsis?

Answer 15

• Documented/suspected infection
• Temperature >38.3*C or <36*C
• HR > 90
• RR > 20
• SBP <90, MAP <79=0, or SBP decrease of >40
• AMS
• Edema or positive fluid balance
• Hyperglycemia BG >140 in the absence of DM
• WBC > 12k or <4k
• Acute Oliguria (U/O <0.5mL/kg/hr)
• Creatinine increase >0.5
• INR > 1.5 or aPTT > 60
• Lactic Acid >1.0

Question 16

What is septic shock?

Answer 16

• Septic shock is defined as sepsis-induced hypotension persisting despite adequate fluid resuscitation, which may be defined as infusion of 30 mL/kg of crystalloids (a portion of this may be albumin equivalent).
• Septic shock is a type of vasodilatory or distributive shock. In other words, it results from a marked reduction in systemic vascular resistance, often associated with an increase in cardiac output.