Vital Signs And General Physical Assessment Flashcards
What are common and concerning symptoms of a general physical assessment?
-Constitutional symptoms (ROS)
Fatigue
Weakness
fever,chills, and night sweats
weight change
pain
What could some of the differential diagnosis of fatigue be?
-Depression
-Anxiety
-Infection
-Endocrine disorders
-Heart failure
-Anemia
-Malignancies
-Medications
What are the four ways to determine the areas of involvement?
-Proximal
-Distal
-Symmetric
-Asymmetric
1.Focal: Portion of face or extremity
2. Monoparesis: in an extremity
3. Paraparesis: in both extremities
4. Hemiparesis: in one side of the body
What is Progressive fatigue?
Subacute onset of distal lower extremities
*Guillain Barre syndrome
What is chronic weakness?
gradual onset of weakness in lower extremities
*Can be seen in metastatic cord lesions and lumbar disc disease
What are the two different types of Focal asymmetric weakness?
1.Central
-Ischemic
-Thrombotic
-mass lesions
2. Peripheral
-nerve injury
-Neuromuscular junction disorders
- Myopathies
How to identify proximal weakness in the upper and lower extremities?
Upper extremities:
-combing hair
-Reaching up to a shelf
Lower extremities
-Getting up out of a chair
-Climbing a high step
What is the bilateral distal weakness?
Polyneuropathy
*caused by DM
What should you inquire when someone has fever, chills, and night sweats?
-Travel
-Contact with sick people
-Medications
-Illness
-cycle history
How can weight changes happen in the body?
-Rapid changes suggest body fluids
*CHF, nephrotic syndrome, liver failure
What are the aspects of weight gain?
-Caloric intake exceeds caloric expenditure
-Abnormal accumulation of body fluids
What are the aspects of weight loss?
-5% or more loss over 6 month period
-multiple causes
What is the “healthy” BMI
18.5 and 24.9
What should be investigated if there is a BMI less than 18.5?
-anorexia
-bulimia
What is the four step approach about weight and nutrition
- Measure BMI and waist circumference
- Assess dietary intake
- Assess the patient’s motivation
- Provide counseling about nutrition and exercise
What are the additional risk factors of weight gain?
HTN
High LDL cholesterol
Low HDL cholesterol
High triglycerides
High blood sugar
FH (family history) of premature heart disease
Physical inactivity
Cigarette smoking
What is the recommended sodium intake?
USDS recommends 2.3g/day
AHA recommends 1.5g/day
What are reasonable goals for weight loss?
-5 to 10% reduces risk of diabetes and other obesity associated health problems
-Actvity 30-60 min per day
-Portion control
-1/2 pound to 2 pound per week
-Monitor calories
-Accountability
At what moment does the general assessment begin?
The moment you step into the room
What is being perceived during the general assessment?
-State of health
-Deamenor
-Facial affect
-Posture
-Gait
What are the three components of the general assessment?
- Patient’s general appearance
- Height
- Weight
What are the observed areas in the GA?
-Apparent state of health
-Level of consciousness
-Signs of distress
-Skin color and obvious lesion
-Dress, grooming, and personal hygiene
-Facial expression
-Odors of the body and breath
-Posture, gait, and motor activity
-symmetry
- Height
-Weight
What are the different type of factors that contribute to body habitus (body stature)
-socioeconomic status
-nutrition
-genetic make-up
-degree of fitness
- mood state
-early illnesses
-gender
-geographic location
-age cohort
What are the components of mental status?
-Speech
-Awareness/consciousness
-Manner
-mood
Orientation
What are the different levels of consciousness?
Alert
Lethargic
Obtunded
Stupor
Coma
Describe alertness
Patient opens the eyes, looks at you, and responds fully and appropriately to stimuli
Describe lethargic
Sleepy,drowsy, or mental sluggishness
*patient requires you to speak with a loud voice, appears drowsy but opens the eyes and looks
Describe obtunded?
A result of intoxication, metabolic illness, infection, or neurological catastrophe
*have to shake the patient gently as if awakening a sleeper
Describe stuporous?
A state of altered mental status and decreased responsiveness to one’s environment
*needs to be awoken by a sternum rub
Describe a coma
A state of unconsciousness from which one cannot be aroused
Signs of distress need to be addressed immediately true or false?
True
What is the preferred position (posture) of a person with CHF and COPD respectively?
Upright with CHF
Leaning forward with arms braced in COPD
What is Gait?
The manner of walking, how a patient walks
What are the five vital signs?
Temperature
Pulse
Respiration
Blood pressure
Pain
What do vital signs do?
Helpful in the diagnosis
Provides critical initial information
What are the methods of taking temperature?
Oral
Rectal
Axillary
Tympanic
Temporal artery
What is the device to take oral temperature?
Electronic thermometer
What can cause inaccurate readings of oral temperature?
-hot or cold liquids
-smoking
-rapid respirations
*wait 10-15 minutes before measuring temperature
What is the least accurate temperature method?
Axillary
*Used for infants and children
What is the most commonly used temperature method?
Tympanic membrane
*measure core body temperature
Definition of fever/pyrexia?
Elevated body temperature
*associated with infection and inflammation
Definition of hyperpyrexia?
Extreme elevation
*106 F
Describe hyperthermia?
-elevation of body temperature not caused by fever
-inability of body to dissipate heat
- related to medication, drugs, and heat stroke
Describe hypothermia
-abnormally low temperature
*below 35 F (95 F)
Bradycardia bpm
<60 bpm
Tachycardia bpm
> 100bpm
Normal bpm
60-100bpm
What are the causes of bradycardia?
-athletic conditioning
-sick sinus syndrome
-increased intracranial pressure
-hypothyroidism
-hypothermia
What are the causes of tachycardia?
-fever
-hyperthyroidism
-anxiety
-anemia
-exertion
-pulmonary embolism
-fear
-acute coronary syndrome
-drugs
List and describe the pulse character
0=absent; no palpable
1= weak; diminished amplitude, may have difficulty locating
2=normal; readily palpable
3= strong; increased amplitude, quickly palpable
4=Bounding
*estimation of the amount of blood ejected into the arterial system through left ventricular contraction minus any obstruction of arterial flow
What is the term of normal pulse 2?
Hemodynamically stable
How do you watch for respirations
complete while patient is unaware
What is the normal respiratory rate?
12-20bpm
*Eupena
What is Bradypnea?
Slow breathing
<12 bpm
*count for full 60 seconds
What is Tachypnea?
Rapid breathing
*>20 bpm
*Count for full 60 seconds
What are causes of abnormal respirations?
-apneustic
-obstructive
-restrictive
-hyperpnea
-sighing
-Cheyenne-stokes
-ataxic
Describe apneustic
Inspiration phase longer than expiratory phase
Describe obstructive pattern
Expiratory phase longer than inspiratory phase
Describe restrictive pattern
Shallow inspirations that become rapid with exertion
Describe hyperpnea
Rapid, deep inspirations
Describe sighing
Deep inspirations with the breathing pattern
Describe Cheyene-stokes
Increasing and decreasing amplitude of respirs and periods of apnea
Describe ataxic (Biot’s breathing)
-irregular, unpredictable pattern with periods of apnea
What is blood pressure?
Arterial blood pressure is an estimation of the force of blood on the wall of the artery
What is systolic blood pressure
Pressure of the blood on the arterial wall at the peak of left ventricular contraction
What is diastolic blood pressure
The resting pressure on the arterial wall
What are some office errors leading to inaccurate results of blood pressure?
-Observer and measurement error
-Natural physiology fluctuations in blood pressure
-Anxiety
-Presence of “white coat”
What is masked hypertension?
-Office blood pressure is normal but the ambulatory readings are high
What are contraindications of blood pressure?
-Physical defects
*injuries to arms
*Fistulas
*Mastectomy
-Therapeutic interventions
What is the Palpation systolic pressure?
Used to determine how high to raise the cuff pressure
What is the auscultation gap
Period between systolic and diastolic where the pulse is not audible but returns with continued deflation
What is the diagnostic criteria for hypertension
Must have 2 or more properly measured elevated readings, with patient seated, on 2 more separate occasions
What is the definition of orthostatic hypotension?
-Drop in systolic BP of 20mmHg or diastolic BP drops >10mm Hg
-Increase in pulse by 20 bpm from supine to standing
What is pulse pressure?
Systolic-diastolic=pulse pressure
*low/narrow (less than 25mmHg) *high/wide (>100mmHg)
What are the different types of pain?
Somatic
*related to tissue damage, M/S or visceral
Neuropathic pain
*pain resulting from direct injury to somatosensory system
Central sensitization pain
*Alteration of CNS sensation, low pain threshold
Psychogenic pain
*factors that influence the patient’s report of pain
Idiopathic pain
*no identifiable etiology
What are the four A’s to monitoring pain outcome?
- Analgesia
- Activities of daily living
- Adverse effects
- Aberrant drug-related behaviors
What are the 7 attributes of symptoms?
- Location
- quality
- Quantity or severity
- Timing
- Setting in which it occurs
- Remitting or exacerbating factors
- Associated manifestations
