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CPD Lab 1 Final > Week 10 - General Survey & Vital Signs > Flashcards

Week 10 - General Survey & Vital Signs Flashcards

1
Q

When should you record height and weight?

A

Children, elderly, immunocompromised, later stages of chronic disease, pregnant woman (OB), someone wanting to alter weight, sports physical

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2
Q

What is body habitus?

A

Anthropometric measurements include height and weight

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3
Q

What is the body mass index and how does it help us?

A

a more reliable estimate of body fat than weight alone - correlates well with precise measures of total body fat.

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4
Q

Calculation for BMI:

A

Weight (lbs) * 700/Height (in)]/Height (in)

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5
Q

What does a BMI of < 18.5 indicate?

A

Underweight

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6
Q

What does a BMI of > 25 indicate? What is the prevalence in the US?

A

Overweight

Prevalence: 50% of US adults

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7
Q

What does a BMI of > 30 indicate? What is the prevalence in the US?

A

Obese

Prevalence: 25% of US adults

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8
Q

What diseases and health conditions are overweight and obese individuals at increased risk for?

A
  • Hypertension
  • Dyslipidemia (high LDL cholesterol, low HDL cholesterol, or high levels of triglycerides)
  • Type 2 diabetes
  • Coronary heart disease
  • Stroke
  • Gallbladder disease
  • Osteoarthritis
  • Sleep apnea and respiratory problems
  • Some cancers (ovary, kidney, esophagus, endometrial, breast, pancreas and colon)
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9
Q

Which BMI ranges have higher mortality rates compared to normal BMI?
What do overweight individuals have a decreased risk of death from?

A

Higher Mortality rates: Overweight and Obese BMIs

Overweight individuals have a decreased risk of death from non-CVD related causes

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10
Q

Where is central subcutaneous fat found?

A

Central = Neck, shoulder, chest, upper abdomen

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11
Q

What does “peripheral” imply for subcutaneous fat?

A

Peripheral = Lower abdomen, pelvic girdle, buttocks, thighs

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12
Q

How do you measure Waist-to Hip (WHR) Ratio? What does a high WHR indicate?

A

WHR is the circumference of the waist divided by that of the hips.
Measure the waist at the mid-point between the lower costal margin and iliac crest.
Measure the hips at the widest part of the gluteal region, usually the ischial tuberosity.

A high WHR indicates central obesity.

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13
Q

What is the significance of WHR measurements?

A

Adverse health outcomes (hypertension, diabetes, atherosclerotic cardiovascular disease) are strongly associated with WHR > 1.0 in men and WHR > 0.85 in women .

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14
Q

What does Body proportion potentially indicate?

A

a metabolic/genetic abnormality (e.g., Turner’s syndrome or Marfan’s syndrome).

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15
Q

Describe the appearance of Turner’s Syndrome

What sex is it more prominent in?

A 
short stature
short neck (webbed appearance) 
widely space aereola
low set ears
amenorrhea/infertility
Females (1:2,500)
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16
Q

Describe the appearance of Marfan’s syndrome

A

reduced upper-to-lower body segment ratio (0.85 vs 0.93) or arm span-to-height ratio greater than 1.05.
Arms and legs may be unusually long in proportion to the torso.

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17
Q

Describe appearance of Arachnodactyly.

A 
long fingers
pectus excavatum (chest) and carinatum
lens dislocation (dt weakened CT) may be present. 
Worst case: weakened abdominal aorta. 
THINK: WEAKENED CT
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18
Q

State of Health/Degree of Illness

How does the patient look?

A

No apparent distress?
Acutely or chronically ill?
Frail?
Cachexia (general physical wasting and malnutrition usually associated with chronic disease) or Marasmus (protein-calorie malnutrition)?

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19
Q

Signs of Distress

A

Signs of Distress
• Respiratory
• Cardiac
• Toxic

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20
Q

Respiratory Signs of Distress:

A

tachypnea, use of accessory muscles

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21
Q

Cardiac Signs of Distress:

A

Levine’s sign (clutching chest) has 80 % sensitivity for MI

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22
Q

Toxic Signs of Distress:

DDX?

A

anxious, flushed, sweaty and febrile with tachycardia and tachypnea.
o DDx: sepsis, poisoning, thyroid storm, heat stroke.

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23
Q

Apparent Age: Why might a patient appear older or younger than their actual age?

A

older: due to cigarette smoking, chronic sunlight exposure.

appear younger: due to hypogonadism, anorexia.

24
Q

Where is the pulse typically measured? What should be noted during measurement?

A

Measured at the radial artery

note the rate, rhythm, amplitude (normal, bounding, barely perceptible), and contour (pulsus alternans – every other beat full amplitude/small amp → Left CHF) or pulsus paradoxus – insp./ HR slows/amp decreases – presses down on cardiac vasculature).

25
Q

What is pulsus alternans?

A

every other beat full amplitude/small amp →

indicative of left ventricular systolic impairment

26
Q

What is pulsus paradoxus?

Common Causes?

A

insp./ HR slows/amp decreases – presses down on cardiac vasculature).
Drop in pulse ampltude (or systolic BP) with inspiration. Common causes include pericardial tamponade or status asthmaticus.

27
Q

Normal Range for heart rate for an adult?

A

60-100 beats per minute

28
Q

What type of irregularities might you see in rhythm (pulse)?

A

Can be regularly irregular (faster inspiration. Slows with expiration), or irregularly irregular

29
Q

What does Contour describe?

A

changes in pulse amplitude

30
Q

How would you describe differences in amplitude of the pulse?

A

The pulse can be barely perceptible, normal, strong, or bounding.

31
Q

Blood Pressure - which sound is systolic and which is diastolic when listening with a blood pressure cuff?

A

Systolic pressure is read at the first sound that you hear while deflating the cuff. Listen for muffling then disappearance. The pressure at which sound disappears is the diastolic pressure.

32
Q

What is pulse pressure? What is a normal measurement?

A

the difference between systolic and diastolic blood pressure.
A normal pulse pressure is > 25% and < 50% of systolic BP.

33
Q

What percentage indicates abnormally wide pulse pressure?

What is its normal cause?

A

(> 50% systolic)
usually caused by hyperkinetic heart syndrome, a hemodynamic state characterized by high stroke volume and low peripheral reisistance, e.g., aortic regurgitation, patent ductus arteriosis, exercise, fever, anemia, Beriberi (severe niacin deficiency), Paget’s disease, cirrhosis, pregnancy, thyrotoxicosis.

34
Q

What percentage indicates an abnormally narrow pulse pressure?
What is it associated with?

A

(< 25% systolic)

associated with decreased left ventricular stroke volume, e.g., cardiac tamponade, pericarditis.

35
Q

What signs helps you recognize hemodynamic instability/

A
  • skin color
  • skin turgor
  • skin temperature
  • supine, serial and orthostatic vital signs
  • neck vein signs
36
Q

What are serial vital sign measurements used for?
Do they detect large or small volumes?
What measurement is a sensitive indicator of depletion?

A

assessing blood loss
They do not reliably detect small degrees of blood loss.
Up to 15 percent of the total blood loss volume can occur with minimal hemodynamic changes or any alteration of the supine vital signs.
Orthostatic tilt testing is a sensitive indicator of blood volume depletion; it is capable of detecting blood loss of 1000 ml with 95% sensitivity.

37
Q

What is noted when assessing Respiratory Rate? What is the normal rate?

A

Note rate, depth and rhythm of breathing.

The normal adult rate is 14-20 breaths/minute.

38
Q

Define Tachypnea:

A

respiration > 20 breaths/minute. Present in many heart and lung diseases and in 92% of patients with pulmonary emboli.

39
Q

Define Hyperpnea

A

Hyperpnea: Kussmaul’s respirations. Rapid deep respirations, seen with diabetic ketoacidosis.

40
Q

Define Hypopnea

A

Hypopnea: Shallow respirations, associated with obesity hypoventilation (Pickwickian syndrome)

41
Q

Define Apnea

A

Apnea: absence of respirations for 20 seconds, associated with airway obstruction during sleep. In Central Sleep Apnea, the brain’s control centers “forget” to breathe during sleep.

42
Q

What measurements indicate fever in rectal, oral and axillary temperatures?

A

Rectal Temperature is ≥ 38 degrees Celsius (100.4 degrees Fahrenheit).
Oral temperature is ≥ 37.5 degrees Celsius (99.5 degrees Fahrenheit).
Axillary temperature is ≥ 37.2 degrees Celsius (99 degrees Fahrenheit).

43
Q

How is pyrexia classified?

A
  • Low-grade: 38 - 39 °C (100.4 - 102.2 °F)
  • Moderate: 39 - 40 °C (102.2 - 104 °F)
  • High-grade: > 40 °C (> 104 °F)
  • Hyperpyrexia: > 42 °C (> 107.6 °F)
44
Q

What does the presence of a fever potentially indicate?

A

often indicates the presence of infection, but may be present in inflammatory diseases (e.g., autoimmune disease), malignancy, hyperthyroidism, heat stroke. Fever patterns may give clues to the cause.

45
Q

What is the ratio of temperature and HR increase?

What DDX does an abnormality include?

A

Normally, each degree of increase in temperature is accompanied by a 10 bpm increase in heart rate.

When the pulse does not increase as expected, the differential diagnosis includes salmonella, typhoid, brucellosis, legionella, mycoplasma peumonia, and iatrogenic causes (beta blockers, digitalis).

46
Q

Pulse Oximetry

A

Pulse oximetry allows noninvasive measurement of arterial hemoglobin saturation without the risk associated with arterial puncture. Pulse oximetry uses the differential absorbency of light by oxyhemoglobin and deoxyhemoglobin to estimate the oxygen saturation

Pulse oximetry is regarded as a fifth vital sign, it is important in primary care as well as inpatient settings where assessment of a patient’s oxygen status is needed.

47
Q

Pulse oximetry advantages over physical examination alone

A

Frank cyanosis does not develop until the level of deoxyhemoglobin reaches 5 g/dL, which corresponds to an arterial oxygen saturation of around 67%.

48
Q

Limitations of pulse oximetry

A

accurate plus or minus 2%. While oximetry is far more convenient than arterial blood gases, it does not assess ventilation (respiratory rate and tidal volumn). A large acute decrease in PaO2 will not be detected quickly by pulse oximetry because of the oxygen and hemoglobin dissociation curve. Nor can hypercapnea (high C O2) be measured. Therefore, in acute settings, pulse oximetry must be supplemented with arterial PaO2, PaC O2.

49
Q

What conditions can cause inaccuracy with pulse oximetry?

A

Motion from shivering, seizures, or transport of the patient can affect readings. Ambient light–such as intense daylight, fluorescent can cause spurious pulse oximetry readings. Electromagnetic radiation from MRIs and even cell phones can affect readings.

50
Q

Pulse oximetry readings may be inaccurate in certain patient situations.

A

The results of pulse oximetry should be interpreted with caution with abnormal hemoglobins (i.e.sickle cell disease in children), nail polish, fake nails, deeply pigmented skin (photo type 5 and 6), poor perfusion (Reynaud’s phenomenon, low blood pressure). In adults the accuracy of pulse oximeters decreases dramatically when systolic blood pressure falls below 80 mmHg, generally resulting in an underestimation of the actual arterial oxygen saturation. Hypothermia can cause peripheral vasoconstriction; warming the extremity can help. Anemia, when severe can alter readings. Carbon monoxide poisoning creates problems because carbon monoxide binds to hemoglobin, resulting in inadequate oxygen transport despite normal pulse oximeter readings. Pulse oximeters were validated on healthy volunteers who were subjected to low oxygen environments, any readings below 75% saturation are estimates based on interpolation, and may be less accurate.

51
Q

Clinical uses of pulse oximetry in primary care - COPD:

A

establishes a baseline value in monitor patient’s with exercise-related dyspnea, screening to identify who should be referred for oxygen therapy. Titrating oxygen flow to maintain oxygen saturation greater than 90%.

52
Q

Clinical uses of pulse ox: Asthma

A

evaluation and assessment of severity, complementing peak flow meter data. Monitoring patients at the initiation of oxygen therapy or response to other therapy. Particularly important in children with severe acute wheezing. Follow-up for patient’s after severe or complicated exacerbations.

53
Q

Clinical uses of pulse ox: Acute respiratory infxn

A

(community-acquired pneumonia, influenza, and acute respiratory distress) assessing the severity of a lower respiratory tract infection (pulse oximetry may be used instead of arterial blood gases in the pneumonia severity index (PSI)

54
Q

How is pulse ox used in exercise testing?

A

Pulse oximetry can be used in conjunction with a 6-minute walk test:
patient walks a 100-foot path for 6 minutes.
Pulse oximetry is recorded before and after.
Post-walk desaturations greater than or equal to 5% or less than 92% are considered abnormal.

55
Q

Normal, Hypoxic and Exercise Desaturation Pulse Ox levels at sea level

A

There are multiple factors that impact tissue hypoxia; as a result there is no consensus on what constitutes normal and abnormal oximetry.
Here’s our best advice for patients at sea level:
SpO2 > 95 = normal
Sp O2 < 92-95%= hypoxia
Sp O2 exercise desaturation > 5% = abnormal

CPD Lab 1 Final (3 decks)

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