Flashcards in Chapter 9: General Survey Measurements and Vital Signs Deck (41)
What is a general survey?
a study of the whole person
it covers general health state and any obvious physical characteristics
Describe a general survey encounter:
What leaves an immediate impression? Does person stand promptly as his or her name is called and walk easily to meet you?
Or does person look sick, rising slowly or with effort, with shoulders slumped and eyes without luster or downcast?
Is hospitalized patient conversing with visitors, involved in reading or television, or lying perfectly still?
Even as you introduce yourself and shake hands, you collect data
Does person fully extend the arm, shake your hand firmly, make eye contact, or smile? Are palms dry or wet and clammy?
As you proceed through health history, measurements, and vital signs, note following points that will add up to general survey.
Consider these four areas: physical appearance, body structure, mobility, and behavior
What objective data is taken on the physical appearance?
Age: person appears his or her stated age
Sex: sexual development appropriate for gender and age
Level of consciousness: person alert and oriented, attends to your questions and responds appropriately
Skin color: color tone even, pigmentation varying with genetic background, skin intact with no obvious lesion
Facial features: symmetric with movement
No signs of acute distress present
What objective data is taken on body structure?
Stature: height appears within normal range for age, genetic heritage
Nutrition: weight appears within normal range for height and body build; body fat distribution even
Symmetry: body parts look equal bilaterally and are in relative proportion
Posture: person stands comfortably erect as appropriate for age
Standing toddler who has a normally protuberant abdomen (toddler lordosis)
Aging person who may be stooped with kyphosis
Position: person sits comfortably in chair or on bed or examining table, arms relaxed at sides, head turned to examiner
Body build, contour: proportions are correct
Arm span (fingertip to fingertip) equals height
Body length from crown to pubis roughly equal to length from pubis to sole
Obvious physical deformities: note any congenital or acquired defects
What objective data is taken for mobility?
Gait: normally, base is as wide as shoulder width
Foot placement: accurate; walk smooth, even, and well-balanced; and associated movements, such as symmetric arm swing, are present
Range of motion: note full mobility for each joint, and that movement is deliberate, accurate, smooth, and coordinated
No involuntary movement
What objective data is taken on the behavior?
Facial expression: person maintains eye contact (unless a cultural taboo exists), expressions appropriate to situation (e.g., thoughtful, serious, or smiling)
Note expressions both while face is at rest and while person is talking
Mood and affect: person comfortable and cooperative with examiner and interacts pleasantly
Speech: articulation (ability to form words) clear and understandable
Stream of talking is fluent, with an even pace
Conveys ideas clearly
Word choice appropriate to culture and education
Person communicates in prevailing language easily by himself or herself or with interpreter
Dress: appropriate to climate, looks clean and fits body, and is appropriate to person’s culture and age group; for example, normally:
Amish women wear clothing from nineteenth century
Indian women may wear saris
Culturally determined dress should not be labeled as bizarre by Western standards or by adult expectations
Personal hygiene: person appears clean and groomed appropriately for his or her age, occupation, and socioeconomic group
What objective data is taken on measurements and weight?
Use a standardized balance or electronic standing scale
Inapproximately same time of day and same type of clothing worn each time
Record weight in kilograms and pounds
Show person how his or her weight matches up to recommended range for height
Compare person’s current weight with previous visit
Recent weight loss may be explained by successful dieting
Weight gain usually reflects overabundant caloric intake, unhealthy eating habits, and sedentary lifestyle
Instruct person to remove his or her shoes and heavy outer clothing before standing on scale
When sequence of repeated weights is necessary, aim for
Use wall-mounted device or measuring pole on scale
Align extended headpiece with top of head
Person should be shoeless, standing straight, looking straight ahead, with feet and shoulders on hard surface
Body mass index
Body mass index is practical marker of optimal weight for height and an indicator of obesity or protein-calorie malnutrition
What objective data is taken on waist circumference?
Assesses body fat distribution as indicator of health risk
Excess abdominal fat is an independent risk factor for disease, over and above that of body mass index (BMI)
Waist circumference measured in inches at smallest circumference below rib cage and above iliac crest
Hip circumference measured in inches at largest circumference of buttocks
Note the measurement at end of normal expiration
What is normal temperature influenced by?
Diurnal cycle of 1° F to 1.5° F, with trough occurring in early morning hours and peak occurring in late afternoon to early evening
Menstruation cycle in women: progesterone secretion, occurring with ovulation at midcycle, causes a 0.5° F to 1.0° F rise in temperature that continues until menses
Exercise: moderate to hard exercise increases body temperature
Age: wider normal variations occur in infant and young child due to less effective heat control mechanisms; in older adults, temperature usually lower than in other age groups, with a mean of 36.2° C (97.2° F)
What are the differences among the temperature sites?
Oral temperature accurate and convenient
Oral sublingual site has rich blood supply from carotid arteries that quickly responds to changes in inner core temperature
Normal oral temperature in a resting person is 37° C (98.6° F), with a range of 35.8° C to 37.3° C (96.4° F to 99.1° F)
Rectal measures 0.4° C to 0.5° C (0.7° F to 1° F) higher
What is stroke volume?
amount of blood every heart beat pumps into aorta (about 70ml in adult)
What part of the hand is used to palpate radial pulse?
pads of the first three fingers
What traits are assessed with pulse?
What are the variances in pulse?
Rate normally varies with age and is more rapid in infancy and childhood and moderate during adult and older years
Rate also varies with gender; after puberty, females have slightly faster rate than males
In adult, a heart rate less than 60 bpm is bradycardia
This occurs normally in well-trained athletes whose heart muscle develops along with skeletal muscles
Stronger, more efficient heart muscle pushes out a larger stroke volume with each beat, thus requiring fewer beats per minute to maintain a stable cardiac output
A more rapid heart rate, over 100 bpm, is tachycardia
Occurs normally with anxiety or with increased exercise to match body’s demand for increased metabolism
What is sinus arrhythmia?
one irregularity commonly found in children and young adults
Here heart rate varies with respiratory cycle, speeding up at peak of inspiration and slowing to normal with expiration
Inspiration momentarily causes a decreased stroke volume from left side of heart
To compensate, heart rate increases
If any other irregularities are felt, auscultate heart sounds for a more complete assessment
How is the strength of pulse rated?
Force of pulse is strength of heart’s stroke volume
Weak, thready pulse reflects a decreased stroke volume (e.g., as occurs with hemorrhagic shock)
Full, bounding pulse denotes increased stroke volume, as with anxiety, exercise, and some abnormal conditions
Pulse force recorded using three-point scale
3+ Full, bounding
1+ Weak, thready
How do you take respirations accurately?
Because most people are unaware of their breathing, do not mention that you will be counting respirations, because sudden awareness may alter normal pattern
Instead, maintain your position of counting radial pulse and unobtrusively count respirations
Count for 30 seconds or a full minute if you suspect an abnormality
Avoid 15-second interval; the result can vary by a factor of + or −4, which is significant with small number
Also, a fairly constant ratio of pulse rate to respiratory rate exists, which is about 4:1
Normally, both pulse and respiratory rates rise as a response to exercise or anxiety
What is blood pressure?
force of blood pushing against side of its container/vessel wall
What is systolic pressure?
maximum pressure felt on artery during left ventricular contraction or systole
What is diastolic pressure?
elastic recoil/resting pressure that blood exerts constantly between each contraction
What is pulse pressure?
difference between systolic and diastolic: reflects stroke volume
What is mean arterial pressure (MAP)?
pressure forcing blood into tissues, averaged over cardiac cycle
What are the differences seen in blood pressure?
Average BP in young adult is 120/80 mm Hg; varies normally with many factors:
Age: gradual rise through childhood and into adult years
Gender: after puberty, females show a lower BP than males; after menopause, females higher than males
Race: African American adult’s BP usually higher than White person’s of same age
The incidence of hypertension is twice as high in African Americans as in Whites; reasons for difference not understood fully but appear to be due to genetic heritage and environmental factors
What are the 5 factors that blood pressure is determined by?
1.) cardiac output
2.) peripheral vascular resistance
3.)Volume of circulating blood
5.) elasticity of vessel walls
How does cardiac output contribute to determining BP?
if heart pumps more blood into blood vessels, pressure on container walls increases
How does peripheral vascular resistance contribute to determining blood pressure?
opposition to blood flow through arteries, when vessels become smaller or constricted pressure needed to push becomes greater
How does the volume of circulating blood contribute to determining blood pressure?
refers to how tightly blood is packed into arteries; increasing contents in vessels increases pressure
How does viscosity contribute to determining blood pressure?
"thickness of blood determined by its formed elements, blood cells; when contents thicker, pressure increases
How does the elasticity of vessel walls contribute to determining blood pressure?
when vessels are stiff and rigid pressure needed to push increases