General Survey, Vitals, and Pain Assessment Flashcards
- What are the four cardinal techniques of physical examination?
a. Inspection, auscultation,percussion, palpation
- What are some common or concerning constitutional symptoms?
. symptoms that are non-specific: {headache, visual disturbances, vertigo, ringing (tinnitus) in the ears, constant drainage from nose, recurring nosebleeds (epistaxis), bleeding gums, swollen glands,} - from lecture slides. Nausea, vomiting, fever, chills, weight loss, fatigue.
- How does the general survey augment the information obtained from the rest of the physical exam?
. The general survey, which starts from the moment you walk into the exam or hospital room, will give the doctor insight that can help clarify and lead you to a more defined, detailed story of the patient’s overall state of health. It aids the physician when they begin to systematically review each system during the physical exam.
- At what point in the patient encounter does the physician begin to gather data pertaining to the general survey?
. At the very start, upon first seeing the patient
- What types of data are collected during the general survey?
. patient’s general state of health, height, build, sexual development, weight, posture, dress, gait, grooming, personal hygiene and any odors of the body or breath
a. also note the patient’s facial expressions, manner, affect, reactions to people and things in the environment and their manner of speaking and state of awareness (level of consciousness-are they oriented to time and place?)
- What BMI range characterizes underweight, normal, overweight, obesity, and extreme obesity?
. BMI = calculation based on height and weight = weight (kg)/(height (m)^2) OR ( ((weight in lbs. x 700)/Height in inches^2)) -pg117
a. 40 = extremely obese/morbidly obese
- What is the purpose of “ambulatory” blood pressure monitoring? Measure BP at regulatory intervals, lowers white coat hypertension
Home and ambulatory blood pressure measurements are more accurate and predictive of cardiovascular disease and end-organ damage than conventional office measurements. Ambulatory blood pressure monitoring is fully automated and allows recording over an extended period of time based on empirical algorithms. This eliminates observer error (without inaccurate rounding), eliminates white coat hypertension, and increases the number of blood pressure readings so that an ambulatory blood pressure compares closely with mean ambulatory blood pressure.
What is white coat hypertension?
Raised blood pressure due to nervousness of doctor visit. In white coat hypertension, constituting roughly 15% to 20% of Stage 1 hypertensives, the office blood pressure is high but ambulatory pressures are normal. Thus, cardiovascular risk is low.
- What procedural steps are used to ensure an accurate blood pressure reading?
No smoke/caffeine 30min prior, no clothing on cuff, quiet/warm room, patient positioned properly with proper-sized cuff at 2.5cm above antecubital crease, seated quietly with feet on the floor for at least 5 mins before, palpate brachial prior to, arm muscles relaxed, arm positioned so that brachial artery is at heart level. Add 30mmHg to when the radial pulse disappears to appropriately estimate the systolic bp. Use the BELL of the stethoscope because Korotkoff sounds are relatively LOW PITCH.
- What factors contribute to inaccurate blood pressure readings?
The patient’s feet need to be flat on the floor for at least five minutes. The patient’s arm needs to be free of clothing, and the patient should have avoided smoking or drinking caffeinated beverages for at least 30 minutes prior to measurement. The patient’s arm needs to be positioned so that the brachial artery is at heart level. Having the arm too high will cause a false low blood pressure reading and having the arm too low will cause a falsely increased blood pressure reading. See question #12 regarding cuff size.
- What is the clinical significance of an auscultatory gap?
An auscultatory gap- a silent interval that may be present between the systolic and the diastolic pressures (i.e. the sound disappears and then reappears) - an incorrectly low systolic pressure reading will be obtained if the auscultatory gap is interpreted as being the beginning of the Korotkoff beats(first two consecutive beats), and an artificially high diastolic pressure will be obtained if the gap is interpreted as the end of the Korotkoff beats. If a real auscultatory gap is heard, this may be indicative of arterial stiffness and atherosclerotic disease.
- What is the effect of “cuff size” on the accuracy of blood pressure readings?
Proper cuff should be: width of the bladder 40% of upper arm circumference, with a bladder length 80% of upper arm circumference (almost long enough to encircle the arm). A loose cuff or a bladder that balloons outside the cuff leads to falsely high readings. If the cuff is too small (narrow), the blood pressure will read high; if the cuff is too large (wide), the blood pressure will read low on a small arm and high on a large arm.
- What systolic and diastolic values define normal, abnormal, prehypertension, and hypertension?
hypertension? Normal - 139/80–>89 , hypertension = >160/>100 in Stage 2
- What is orthostatic hypotension and how is it assessed?
Commonly seen in older adults you measure blood pressure and heart rate in two positions—supine after the patient is resting from 3 to 10 minutes, then within 3 minutes after the patient stands up. Normally, as the patient rises from the horizontal to the standing position, systolic pressure drops slightly or remains unchanged, while diastolic pressure rises slightly. Orthostatic hypotension is a drop in systolic blood pressure of 20 mm Hg or greater or drop in diastolic blood pressure of 10 mm JKHg or greater within 3 minutes of standing.
- What is considered a “normal” heart rate and rhythm in a healthy adult?
The range of normal is 50–90 beats per minute. beats appear in a basically regular rhythm? (2) Does the irregularity vary consistently with respiration? (3) Is the rhythm totally irregular?
