General Survey, VS, and Pn

Question 1

Components of General Survey

(2)

Answer 1

1. General appearance
2. Height and weight

Question 2

Observation

(timing, aspects)

Answer 2

Timing - the entire duration of the appt, especially during the genearl survey

Aspects - does the pt appear to…

• seem anxious or upset?
• be in pain?
• have adequate dress and hygiene?

Question 3

Aspects of General Appearance

(8)

Answer 3

1. Apparent state of health **(acute or chronically ill, frail)
2. Level of consciousness **(awake, alert, responsive, lethargive, obtunded, comatose)
3. Signs of distress (cardiac or respiratory, pn, anxiety/depression)
4. Skin (color and obvious lesions)
5. Dress, grooming, personal hygiene (appropriate to weather and temp, clean, properly fastened)
6. Facial expression (eye contact, appropriate change inf acial expression)
7. Odors (body and breath**)
8. Posture, gait, motor activity

Question 4

Height and Weight aspects

(5 height, 2 weight, 1 calculation)

Answer 4

Height

• Quantitative value in stocking feet
• Relative value - short or tall
• Build - slender, lanky, muscular, stocky
• Body symmetry
• General proportions, any defomrities

Weight

• Quantitative value
• Description - emancipated, slender, plump, obese
  
  • If obese, note fat distribution - even or concentrated

Calculation - BMI

Question 5

BMI Calculation Methods

(4)

Answer 5

Question 6

BMI Classifications

(5)

Answer 6

Question 7

General Health Hx Questions

(3, c qualifiers and descriptions)

Answer 7

1. Weight change
   
   1. Rapid vs gradual
      
      1. rapid usually = fluid
      2. gradual usually = tissue
   2. ​​Weight gain
      
      1. nutritional
      2. medical
   3. Weight loss
      
      1. psychosocial
      2. medical
2. Strength concerns
   
   1. Categories
      
      1. ​Fatigue
         
         1. Sense of weariness of loss of energy
      2. Weakness
         
         1. Demonstratable loss of muscle power
   2. ​Causes
      
      1. Psychosocial
      2. Medical
3. ​Temperature Ctrl
   
   1. Categories
      
      1. Fevers
      2. Chills
      3. Night sweats
   2. Questions to ask
      
      1. Exposure to illness
      2. Recent travel
      3. Any medications

Question 8

Vital Signs

(list 6)

Answer 8

1. Blood pressure
2. Heart rate and rhythm
3. Respiratory rate and rhythm
4. Temperature
5. Pain
6. Oxygen Saturation

Question 9

Optimal BP Conditions

(7)

Answer 9

1. Pt should avoid smoking or drinking caffeinated beverages 30 minutes prior to measurement
2. Ensure that the room is quiet and comfortably warm
3. Patient should be seated quietly in a chair with feet on the floor for at least 5 minutes
4. Patient’s arm should be FREE of clothing
5. Palpate the brachial artery
6. Position the arm so that the brachial artery is at heart level
7. Rest the arm on a table a little above the patient’s waist, or support the patient’s arm with your own at his mid-chest level

Question 10

BP Cuff Size

(width and length)

Answer 10

1. Width: 40% of upper arm circumference
2. Length: 80% of upper arm circumference

Question 11

BP Procedure

(6 steps)

Answer 11

1. Center the inflatable cuff over the brachial artery with the lower border 2.5 cm above the antecubital crease
2. Secure the cuff snugly, not tightly, and position the patient’s arm so that it is slightly flexed at the elbow
3. With the fingers of your opposite hand, palpate the radial artery and inflate the cuff until the radial pulse disappears; add 30 mm Hg to this pressure
4. Deflate the cuff promptly and completely and wait 15-30 seconds
5. Place the bell of the stethoscope lightly over the brachial artery
6. Inflate the cuff to the sum pressure previously determined and deflate slowly
   
   • The point at which you hear the first two consecutive beats is the systolic pressure
   • The disappearance point is the diastolic pressure

Question 12

Auscultatory Gap

Answer 12

A silent interval that may be present between the systolic and diastolic blood pressures; i.e., the sound disappears for a while, then reappears

Question 13

Orthostatic BP

(definition, normal vs abnormal values)

Answer 13

Definition: Measure blood pressure and heart rate with the patient supine; wait 3 minutes, then have the patient stand up; now repeat the measurements

Results:

• Normal: systolic BP drops slightly or remains unchanged; diastolic BP rises slightly
• Orthostasis: systolic BP drops >20 mm Hg or diastolic BP drops >10 mm Hg

Question 14

BP Values

(normal, 2 procedural considerations c abnormal)

Answer 14

Normal (adults older than 18 years)

• Systolic: <120 mm Hg
• Diastolic: <80 mm Hg

If blood pressure is elevated:

• Repeat blood pressure and verify in the contralateral arm
• Consider “White Coat Hypertension”
  
  • Occurs in 10%–20% of all patients
  • Try to relax the patient and retake BP later in the visit

Question 15

Procedure, Heart Rate and Rhythm

(2 steps)

Answer 15

1. Use the pads of the index and middle fingers to press on the radial artery
2. If the rate seems normal (50–90 bpm) and the rhythm is regular, count the rate for 30 seconds and multiple by 2. If the rate is fast or slow and/or the rhythm is irregular, count for a full 60 seconds.

Question 16

Pulse Qualities

(3)

Answer 16

1. Quantity
2. Regularity
3. Volume

Question 17

Tachycardia causes

(7)

Answer 17

1. Fever
2. Hypoxia
3. Drug induced
4. Pneumothorax
5. Pulmonary emboli
6. Anxiety
7. Pain

Question 18

Bradycardia causes

(5)

Answer 18

1. }Normal
2. }Drug induced
3. }Hypothermia
4. }MI
5. }Carotid artery stimulation

Question 19

Factors that Affect Body Temp

(5)

Answer 19

1. Gender
2. Recent activity
3. Food/fluid consumption
4. Time of day
5. Stage of menstrual cycle

Question 20

Temperature Fever Thresholds

Answer 20

A fever is indicated when body temperature rises above 98.6° F orally or 99.8° F rectally.

Can be measured in Farenheit or Celcius

C = 38-38.5

F = 101-101.5

Note:

• Rectal tempeatures tend to be 0.5-0.7 ºF than oral temperatures
• Axillary temperatures tend to be 0.3-0.4º lower than oral temperatures

Question 21

Oral Temp Methods

Answer 21

1. Glass
2. Mercury
3. Digital

Question 22

Temperature by Ear

Answer 22

By ear (tympanic) a special thermometer can quickly measure the temperature of the ear drum, which reflects the body’s core temperature.

Question 23

Hypothermia

Answer 23

}Hypothermia is defined as a drop in body temperature below 95° F.

Question 24

Obervations of Respiratory Rate

(4)

Answer 24

• Normal rate: ~20 breaths/minute
  
  • Count for 60 seconds
• Observe rhythm: regular, irregular
• Observe depth: shallow, gasping
• Observe effort: normal, labored

Question 25

Tachypnea Causes

(7)

Answer 25

1. Fever
2. CHF
3. Anemia
4. Hyperthyroid
5. Pneumonia
6. COPD
7. Metabolic acidosis

Question 26

Bradypnea Causes

(3)

Answer 26

1. Uremia
2. Various drugs
3. Increased intracranial pressure

Question 27

Pain Assessment

(3 types)

Answer 27

1. Nociceptive or somatic – related to tissue damage
2. Neuropathic – resulting from direct trauma to the peripheral or central nervous system
   
   • Psychogenic – relates to factors that influence the patient’s report of pain
   • Psychiatric conditions
   • Personality and coping style
   • Cultural norms
   • Social support systems
3. Idiopathic – no identifiable etiology

Measured on scale of 0-10, with 10 being the worst

Question 28

Oxygen Saturation

(function,

Answer 28

“The 5th vital sign”

Function: qualify the degree of hypoxic impairment (cardio-pulmonary disorder)