Chapter 9: General Survey, Measurement, Vital Signs

Question 1

Physical appearance consist of?

Answer 1

Age, Sex, level of consciousness, skin color, facial features, overall appearance.

Question 2

Age findings?

Answer 2

The person appears his or her stated age. Appearance older than stated age, as with chronic illness or chronic alcoholism.

Question 3

Sex findings?

Answer 3

Sexual development should be appropriate for sex and age. If the individual is transgender note the stage of transformation. Note delayed or precocious puberty.

Question 4

Level of consciousness findings?

Answer 4

The person should be alert and oriented to person place time and situation. Attends to and responds appropriately to questions. No confuse drowsy lethargic.

Question 5

Skin color findings?

Answer 5

Skin color tone is even, pigmentation varying with genetic background; skin is intact with no obvious lesions. Make note of tattoos and piercings and a stage of healing. Note pallor, cyanosis, jaundice, erythema, And any lesions.

Question 6

Facial features findings?

Answer 6

Facial features are symmetric with movement. Note if immobile, Mask like, asymmetric, or drooping.

Question 7

Overall appearance findings?

Answer 7

No signs of acute distress are present. Cardiac or respiratory signs include diaphoresis, clutching the chest, shortness of breath, wheezing. Pain indicated by facial grimace or holding body part.

Question 8

Body structure includes what?

Answer 8

Stature, nutrition, symmetry, posture, position , Body build and contour, obvious physical deformities.

Question 9

Stature findings?

Answer 9

The height appears within normal range for age, genetic heritage. Note if excessively short or tall.

Question 10

Nutrition findings?

Answer 10

The weight appears within normal range for height and body build; body fat distribution is even. Note if cachectic, emaciated. No simple obesity, with even fat distribution. note centripetal obesity, truncal, fat concentrated in face, neck, Trunk, with extremities, as in Cushing syndrome.

Question 11

Symmetry findings?

Answer 11

Body parts look equal bilaterally and are in relative proportion to each other. Note unilateral atrophy or hypertrophy. Note asymmetrical location of a body part.

Question 12

Posture findings?

Answer 12

The person stands comfortably erect as appropriate for age. Note video of the normal “plumb line” through anterior ear, hip, shoulder, patella, ankle. Exceptions are the standing Toddler, who has a normally protuberant abdomen, toddler lordosis, and the aging person, who may be stooped with kyphosis.

Question 13

Position findings?

Answer 13

The person sits comfortably with arms relaxed at sides and head turned to examiner. Note if tripod - leaning forward with arms braced on chair arms; occurs with chronic pulmonary disease. Note if sit straight up and resists lying down example heart failure. Note if curled up in fetal position, example acute abdominal pain.

Question 14

Body build, contour findings?

Answer 14

Proportions are:
1. Arm span (fingertip to fingertip) equals height.
2. Body length from Crown to pubis equal to length from pubis to sole.
Note elongated arm span for example Marfan syndrome, hypogonadism.

Question 15

Obvious physical deformities findings?

Answer 15

Note any congenital or acquired defects. For example, missing extremities or digits; webbed digits; shortened limb.

Question 16

Mobility consists of what?

Answer 16

Gait and range of motion.

Question 17

Gait findings?

Answer 17

Feet approximately shoulder width apart; foot placement is accurate; walk is smooth and even, and person can maintain balance without assistance. Associated movements such as symmetric arm swing are present. No exceptionally wide base, staggering and stumbling. Note shuffling, dragging, nonfunctional leg. Note limping with injury. Note propulsion, Difficulty stopping.

Question 18

Range of motion findings?

Answer 18

Note full mobility for each joint and that movement is deliberate, accurate, smooth, and coordinated. Note involuntary movement. Note limited joint range of motion. Note paralysis, absence of movement. No jerky, uncoordinated movement. Note tics, tremors, seizures.

Question 19

Behavior consists of what?

Answer 19

Facial expression, mood and affect, speech, speech pattern, dress, and personal hygiene.

Question 20

Facial expression findings?

Answer 20

The person maintains eye contact (If culturally appropriate); expressions are appropriate to the situation.

Question 21

Mood and affect findings?

Answer 21

The person is comfortable in cooperative with the examiner and interacts pleasant.

Question 22

Speech findings?

Answer 22

Articulation is clear and understandable. Note Dysarthria and dysphasia, Speech defect, monotone, garbled speech.

Question 23

Speech pattern findings?

Answer 23

The stream of the talking is fluent, with an even pace. The person conveys ideas clearly.Word choice is appropriate for culture and education. Communicates in prevailing language easily by himself or herself or with an interpreter

Question 24

Dress findings?

Answer 24

Clothing is appropriate to the climate, looks clean and fits the body, And is appropriate to the culture and age group of the person. Culturally determined dress should not be labeled as inappropriate by Western standards or adult expectation.

Question 25

Personal hygiene findings?

Answer 25

The person appears clean and groomed appropriately for his or her age, Occupation, socioeconomic group. hair is groomed and brushed. Make up is appropriate for age and Culture.

Question 26

What measurements should you include in the general survey?

Answer 26

Weight, height, body mass index, and waist circumference.

Question 27

What is a BMI?

Answer 27

It is a practical marker of optimal healthy weight for height and an indicator of obesity or malnutrition. It provides a more accurate measurement of total body fat compared with the measure of a body weight alone. Healthy BMI is a level of 19 or greater to less then 25.

Question 28

Vital signs consist of what?

Answer 28

Temperature, pulse, blood pressure, respirations, and pain.

Question 29

How does the body maintain a steady temperature?

Answer 29

Through a thermostat, or feedback mechanism, regulated in the hypothalamus of the brain. The thermostat balances heat production with heat loss.

Question 30

What is the average normal oral temperature in a resting person? And what is the range of a normal oral temperature?

Answer 30

Normal oral temperature in the resting person is 37°C or 98.6°F. The normal range of oral temperature is 35.8° to 37.3°C or 96.4° to 99.1°F.

Question 31

What is the normal rectal temperature measures?

Answer 31

0.4° to 0.5°C or 0.7° to 1°F.

Question 32

Normal temperatures influenced by what?

Answer 32

A diurnal cycle of 1° to 1.5°F, with the trough occurring in the early morning hours and the peak occurring in late afternoon to early evening. The menstruation cycle in women. Progesterone secretion, Occurring with ovulation at midcycle, causes a 0.5° to 1°F rise in temperature that continues until menses. Exercise. Moderate to hard exercise increases body temperature. Age. Wider normal variations occur in the infant and young child because of less effective heat control mechanisms. In older adults temperature is usually lower than the other age groups, with a mean of 36.2°C or 97.2°F via the oral route.rectal temperatures remain 0.5°C higher than oral temperatures in older adults.

Question 33

What is the most convenient and accurate site temperature?

Answer 33

The oral temperature. In the sublingual pocket there is a rich blood supply from the carotid arteries that quickly responds to changes in the inner core temperature.

Question 34

Where should you place a glass or electronic thermometer while taking an oral temperature?

Answer 34

Place it at the base of the tongue in either of the posterior sublingual pockets. Do not placed in front of the tongue.

Question 35

How long should you leave a glass thermometer in the person's mouth?

Answer 35

3 to 4 minutes if the person is afebrile and up to eight minutes if febrile.

Question 36

How long should you wait to take an oral temperature if a person has just drank or smoked?

Answer 36

Wait 15 minutes if the person has just taken a hot or iced liquid and 2 minutes if he or she has just smoked.

Question 37

What is the most accurate temperature route?

Answer 37

A rectal temperature is the most accurate route, and the result is as close to core temperature as possible without using more invasive measures.

Question 38

How do you take a rectal temperature?

Answer 38

Wear gloves and insert a lubricated rectal probe on the electronic thermometer only 2 to 3 cm or 1 inch into the adult rectum, directed toward the umbilicus.

Question 39

What is hyperthermia?

Answer 39

The fever, caused by pyrogen secreted by toxic bacteria during infections or from tissue breakdown such as that following myocardial infarction, trauma,surgery, or malignancy. Neurologic disorders can also reset the thermostat of the brain at a higher level, resulting in heat production and conservation.

Question 40

What is hypothermia?

Answer 40

It is usually caused by accidental, prolonged exposure to cold. It also may be purposefully induced to lower the body's oxygen requirements during heat or peripheral vascular surgery or neurosurgery, amputation, postcardiac arrest, or gastrointestinal hemorrhage.

Question 41

What is the tympanic membrane temperature?

Answer 41

A TMT senses infrared emissions of the tympanic membrane (eardrum). The tympanic membrane shares the same vascular supply that perfuses the hypothalamus.

Question 42

How do you describe a pulse?

Answer 42

By noting it's rate, rhythm, and force.

Question 43

What is a stroke volume?

Answer 43

When the heart pumps blood into the aorta. About 70 mL in the adult.

Question 44

What creates the pulse?

Answer 44

After the stroke volume the force flares the arterial walls and generates a pressure wave, which is felt in the periphery as the pulse.

Question 45

What is traditional resting heart rate limits?

Answer 45

60 to 100 bpm.

Question 46

Normal rate variation across ages? Gender?

Answer 46

More rapid during childhood and infancy and more moderate during adult and older years. After puberty females have a slightly faster rate than males.

Question 47

What is bradycardia?

Answer 47

If an adult has a resting heart rate less than 60 bpm.

Question 48

What is tachycardia? Tachycardia occurs with what?

Answer 48

A more rapid heart rate, defined as over 100 bpm. Fever and also with sepsis, pneumonia, myocardial infarction, and pancreatitis.

Question 49

What is normal pulse rhythm?

Answer 49

Post normally has regular, even tempo.

Question 50

What is a sinus arrhythmia?

Answer 50

The heart rate varies with respiratory cycle, speeding up at the peak of inspiration and slowing down to normal with expiration. Inspiration momentarily causes a decreased stroke volume from the left side of the heart; to compensate the heart rate increases.

Question 51

What does the force of the pulse show?

Answer 51

It shows strength of the heart's stroke volume. A "full, bounding" pulse denotes an increased stroke volume.

Question 52

What is the pulse force scale?

Answer 52

3+ is full, bounding 2+ is normal 1+ is weak, thready 0 is absent

Question 53

A weak, thready pulse reflects?

Answer 53

A weak, thready pulse reflects a decreased stroke volume.

Question 54

Normal breathing is described as?

Answer 54

Relaxed, regular, automatic, and silent.

Question 55

Normal breaths per minute in a neonatal? Normal breaths per minute in a one-year-old? Two-year-old? 8 to 10-year-old? 12 to 14-year-old? 16-year-old? Adult?

Answer 55

30 to 40. 20 to 40. 25 to 32. 20 to 26. 18 to 22. 12 to 20. 10 to 20.

Question 56

What is blood pressure?

Answer 56

The force of the blood pushing against the side of its container, the vessel wall.

Question 57

What is systolic pressure?

Answer 57

It is the maximum pressure felt on the artery during the left ventricular contraction or systole.

Question 58

What is diastolic pressure?

Answer 58

It is the elastic recoil, or resting, pressure that the blood exerts constantly between each contraction.

Question 59

What is the pulse pressure?

Answer 59

It is the difference between the systolic and diastolic pressures and reflects the stroke volume.

Question 60

What is the mean arterial pressure?

Answer 60

The MAP is the pressure forcing blood into the tissues averaged over the cardiac cycle.

Question 61

The average blood pressure and young adults varies with factors such as what?

Answer 61

Age, sex, race, diurnal rhythm, weight, exercise, emotions, stress.

Question 62

How does blood pressure differ with age?

Answer 62

Normally a gradual rise occurs throughout childhood and into the adult years.

Question 63

How does blood pressure different with sex?

Answer 63

Before puberty no difference exists between males and females. After puberty females usually show a lower blood pressure reading than do male counterparts. After menopause blood pressure in females is higher than males.

Question 64

How does blood pressure differ with race?

Answer 64

In the United States and African-Americans adults blood pressure is often higher than that of a white person of the same age. The incidence of hypertension is twice as high and African-Americans as in whites.

Question 65

How does blood pressure differ with diurnal rhythm?

Answer 65

A daily cycle of a peak and a trough occurs: The blood-pressure clients to a high and late afternoon or early evening and then declines to an early morning low.

Question 66

How does blood pressure differ with weight?

Answer 66

Blood pressure is higher in obese people than in people of normal weight of the same age.

Question 67

How does blood pressure differ with exercise?

Answer 67

Increasing activity yields a proportionate increase in blood pressure. Within five minutes of terminating exercise, the blood pressure normally returns to baseline.

Question 68

How does blood pressure differ with emotions?

Answer 68

The blood-pressure momentarily rises with fear, pain, & anger as a result of stimulation of the sympathetic nervous system.

Question 69

How does blood pressure differ with stress?

Answer 69

The blood pressure is elevated and people feeling continual tension because of lifestyle, occupational stress, or life problems.

Question 70

The level of blood pressure is determined by what five factors?

Answer 70

Cardiac output, peripheral vascular resistance, volume of circulating blood, viscosity, elasticity of vessel walls.

Question 71

How does cardiac output affect blood pressure?

Answer 71

If the heart pumps more blood into the container, the pressure on the container walls increases.

Question 72

How does peripheral vascular resistance affect blood pressure?

Answer 72

Peripheral vascular resistance is the opposition to blood flow through the arteries. When the container become smaller, the pressure needed to push the contents becomes greater. Conversely, if the container becomes larger, less pressure is needed.

Question 73

How does volume of circulating blood affect blood pressure?

Answer 73

Volume of circulating blood refers to how tightly the blood is packed into the arteries. Increasing the contents in the container increases the pressure.

Question 74

How does blood viscosity affect blood pressure?

Answer 74

The sickness of blood is determined by its formed elements, the blood cells. When the contents are thicker, the pressure increases.

Question 75

How does the elasticity of the vessel walls affect blood pressure?

Answer 75

When the container walls are stiff and rigid, the pressure needed to push the contents increases.

Question 76

What is used to measure blood pressure?

Answer 76

Blood pressure is measured with a stethoscope and an aneroid sphygmomanometer.

Question 77

How do you determine the size of the cuff?

Answer 77

The cut consists of an inflatable rubber bladder inside a cloth cover. The width of the rubber bladder should equal 40% of the circumference of the person's arm. The length of the bladder should equal 80% of this circumference.

Question 78

How do you palpate the brachial artery?

Answer 78

Palpate the brachial artery just above the antecubital fossa, medial to the biceps tendon.

Question 79

How do you avoid missing an auscultatory gap?

Answer 79

Inflate the cuff until the brachial artery pulsation is obliterated and then 20 to 30 mmHg beyond.

Question 80

A difference of more than 10 to 15 mmHg between arms may indicate what?

Answer 80

Arterial obstruction on the side with the lower reading. This warrants referral.

Question 81

Describe the phases of Korotkoff sounds.

Answer 81

Phase 1 – soft clear tapping; indicate systolic pressure. Phase 2 – a swooshing soft murmur. Phase 3 – A knocking high-pitched sound. Phase 4 – an abrupt muffling. Phase 5 – silence, indicates diastolic pressure.

Question 82

Normal blood pressure classification?

Answer 82

Systolic less than 20, diastolic less than 80

Question 83

Pre-hypertension classification?

Answer 83

Diastolic 120 to 139, systolic 80 to 89.

Question 84

Stage one hypertension classification?

Answer 84

Systolic 140 to 159, diastolic 90 to 99. Initial drug therapy.

Question 85

Stage two hypertension classification?

Answer 85

Systolic greater than 160, diastolic greater than 100. Initial drug therapy.

Question 86

Taking a blood pressure reading when a person is anxious or angry or has just been active will result in what type of blood pressure?

Answer 86

I falsely high blood pressure due to sympathetic nervous system stimulation.

Question 87

Arm position above the level of the heart will result in what type of blood pressure?

Answer 87

I falsely low blood pressure because it eliminates the effect of hydrostatic pressure.

Question 88

Arm position below the level of the heart will result in what type of blood pressure?

Answer 88

I falsely high blood pressure because additional force of gravity added to the brachial artery pressure.

Question 89

When the person supports his own arm during a blood pressure reading this will result in what type a blood pressure?

Answer 89

I falsely high diastolic because of sustained isometric muscular contraction.

Question 90

Faulty leg position for example if a person's legs are crossed this will lead to what type of blood pressure reading?

Answer 90

This will lead to a falsely high systolic and diastolic blood pressure reading because of translocation of blood volume from dependent legs to thoracic area.

Question 91

If a blood pressure cuff is too narrow for extremity this will lead to what type of blood pressure reading?

Answer 91

This will lead to a falsely high blood pressure reading because of the excessive pressure needed to occlude the brachial artery.

Question 92

If the cuff wrap is too loose or uneven, or bladder balloons out of wrap this will result in what type of blood pressure reading?

Answer 92

This will result in a falsely high blood pressure reading because of the needed excessive pressure to occlude the Brachial artery.

Question 93

Inflating the cuff not high enough will result in what type of blood pressure reading?

Answer 93

I falsely low systolic reading due to missed initial systolic tapping or may tune in during an auscultatory gap.

Question 94

Inflating the cuff to high will result in what?

Answer 94

Pain

Question 95

Pushing the stethoscope too hard on the brachial artery will Result in what type of blood pressure reading?

Answer 95

I falsely low diastolic reading because of excessive pressure that distorts artery, And sounds continue.

Question 96

Deflating the cuff to quickly will result in what type of blood pressure reading?

Answer 96

I falsely low systolic or a falsely high diastolic blood pressure reading because of insufficient time to hear the tapping.

Question 97

Deflating the cuff to slowly Will result in what type of blood pressure reading?

Answer 97

I falsely high diastolic reading because of venous congestion in the forearm makes sounds less audible.

Question 98

Halting during descent and reinflating the cuff to recheck systolic pressure will result in what type of blood pressure reading?

Answer 98

I falsely high diastolic blood pressure reading due to venous congestion in the forearm.

Question 99

Failure to wait 1 to 2 minutes before repeating the entire blood pressure reading will result in what?

Answer 99

A falsely high diastolic blood pressure readings due to venous congestion in the forearm.

Question 100

What is orthostatic hypotension?

Answer 100

It is a drop in systolic pressure of greater than or equal to 20 mmHg or increase in pulse of greater than or equal to 20 bpm occurs with a quick change to a standing position. These changes are caused by abrupt peripheral vasodilation without a compensatory increase in cardiac output. Orthostatic changes occur with prolonged bed rest, older age, hypovolemia, and some medications.

Question 101

What is coarctation of the aorta?

Answer 101

A congenital form of narrowing. With coarctation of the aorta, arm pressures are high. Thigh pressure is lower because the blood supply to the thigh is below the constriction.

Question 102

What is kyphosis?

Answer 102

It is the humpback appearance common in the very old and with osteoporosis.

Question 103

What does a pulse oximeter measure?

Answer 103

It is a noninvasive method to assess arterial oxygen saturation. A sensor is attached to the person's finger or earlobe has a diode that emits light and a detector that measures the relative amount of light absorbed by oxyhemoglobin and unoxygenated hemoglobin.

Question 104

What is hypopituitary dwarfism?

Answer 104

A deficiency in growth hormone in childhood results in retardation of growth below the 3rd percentile, delayed puberty, hypothyroidism, and adrenal insufficiency.

Question 105

What is gigantism?

Answer 105

Excessive secretion of growth hormone by the anterior pituitary results in overgrowth of the entire body. When this occurs during childhood before closure of bone epiphyses in puberty, it causes increased height and weight and delayed sexual development.

Question 106

What is acromegaly?

Answer 106

Hyperpituitarism. Excessive secretion of growth hormone in adulthood after normal completion of body growth causes overgrowth of bone in face, head, hands, and feet but no change in height. Internal organs also enlarge, and metabolic disorders may be present.

Question 107

What is achondroplastic dwarfism?

Answer 107

It is a genetic disorder in converting cartilage to bone results in normal trunks size, short arms and legs, and short stature. It is characterized by a relatively large head with frontal bossing; midplace hypoplasia; and often thoracic kyphosis, prominent lumbar lordosis, and abdominal protrusion. The mean adult height Inman is about 131.5 cm or 4'4" and in women about 125 cm or 4'1".

Question 108

What is anorexia nervosa?

Answer 108

It is a serious mental health disorder characterized by severe and life-threatening weight loss in an otherwise healthy person. Behavior is characterized by fanatic concern about weight, aversion to food, distorted body image (perceive self as fat despite skeletal appearance), starvation diet, frenetic exercise patterns, and striving for perfection. Results in amenorrhea in females.

Question 109

What is Cushing's syndrome?

Answer 109

A type of endogenous obesity. Either administration of adrenocorticotropin where excessive production of ACTH by the pituitary stimulates the adrenal cortex to secrete excess cortisol. This causes Cushing's syndrome, characterized by weight gain and edema within the central trunk and cervical obesity and round, Moon face. Excessive catabolism causes muscle wasting; Weakness; thin arms and legs; reduced height; And thin, fragile skin with purple abdominal striae, Bruising, and acne.note that it is different than exogenous obesity because it is not caused by excessive caloric intake, Where fat is evenly distributed.

Question 110

What is Marfan syndrome?

Answer 110

It is a inherited connective tissue disorder characterized by tall, thin stature, Arachnodactyly, hyperextensible joints, Arm span greater than height, pubis to sole measurement exceeding crown to pubis measurement, sternal deformity, high arched narrow palate, narrow face, And pes planus (Flat feet). Early morbidity and mortality to occur as a result of cardiovascular complications such as mitral regurgitation and aortic dissection.

Question 111

Hypotension occurs with what?

Answer 111

Acute myocardial infarction because of decreased cardiac output. Shock because of decreased cardiac output. Hemorrhage because of decrease in total blood volume. Vasodilation because of decreasing peripheral vascular resistance. Addison disease (hypofunction of adrenal glands) because of decrease in circulating aldosterone.

Question 112

Associated symptoms and signs of hypotension?

Answer 112

Low BP is accompanied by an increased pulse, dizziness, diaphoresis, confusion, blurred vision. The skin feels cool and clammy because of the superficial blood vessels constrict to shunt blood to the vital organs. An individual having an acute myocardial infarction may also complain of crushing substernal chest pain, high epigastric pain, and shoulder or jaw pain.

Question 113

General survey consists of what four areas?

Answer 113

Physical appearance, body structure, mobility, and behavior.