Exam 1 - Starting the Physical Examination: General Survey and Vital Signs Flashcards
Components of the general survey
Apparent state of health
>Acute or chronically ill, frail
Level of consciousness
>Awake, alert, responsive or lethargic, obtunded, comatose
Signs of distress
>Cardiac or respiratory; pain; anxiety/depression
Skin color and obvious lesions
You walk into a patient’s exam room and what do you see?
Mental notes of the patient’s affect, body habitus, development, weight, height, overall hygiene, alertness and orientation
Document what you discover
How do you document personal hygiene and orientation?
Dress, grooming, and personal hygiene Appropriate to weather and temperature Clean, properly buttoned/zipped Odors of body and breath Posture, gait, and motor activity
How do you document facial expression?
Facial expression
Eye contact, appropriate changes in facial expression
How do you describe height?
Measure in stocking feet
Short or tall
Build: slender and lanky, muscular, or stocky
Body symmetry
Note general body proportions and any deformities
How do you describe weight?
Weight
Emaciated, slender, plump, obese
If obese, is fat distributed evenly or concentrated over trunk, upper torso, or around the hips?
Can calculate BMI from this.
Body Mass Index
BMI = (Weight * 700) / (height in inches squared)
When a BMI is greater than 35, why do you measure the hips of the patient?
If > 35 inches for women or if > 40 inches for men, they’re at an INCREASED risk for–
DM
HTN
Cardiovascular disease
**BMI skewed if very muscular or if muscle wasting
EXAMPLES of General Survey
Normal:
The patient is a well-developed, well-nourished middle aged male, appropriately dressed for the weather.
Patient is AAO x 3, well-developed, well-nourished, in no acute distress.
AAO x 3 = alert and oriented to person, place, time
Psych pt:
Patient with labile affect, oriented only to self, exhibiting poor hygiene and inappropriate behavior.
Vital signs
Blood pressure
Heart rate and rhythm
Respiratory rate and rhythm
Temperature
Important part of assessment & reassessment
Points you in a direction for the visit
If abnormal, you recheck them
“True blood pressure”
Average over many days/weeks
It is the patient’s real reading
During encounter “office measurement”
Room for error
Anxiety, stress, “white coat syndrome”
Measurement error
Physiologic fluctuations
White coat HTN
White coat HTN
Low regular readings at home but elevated in the office
Low risk of cardiovascular disease
Masked HTN
Masked HTN
Elevated readings at home but low in the office
High risk of cardiovascular disease
Hypertension
JNC 8 classifies HTN as anything >150/90
Optimal conditions to take BP
Patient to avoid smoking or drinking caffeinated beverages 30 minutes prior to measurement
Ensure that the room is quiet and comfortably warm
Patient should be seated quietly in a chair with feet on the floor for at least 5 minutes
Patient’s arm should be FREE of clothing
Palpate the brachial artery
Position the arm so that the brachial artery is at heart level
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
Cuff size and width
Width of the bladder: 40% of upper arm circumference
Length of the bladder: 80% of upper arm circumference
How do you determine what pressure to pump cuff to?
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
Korotkoff Sounds
The point at which you hear the first two consecutive beats is the systolic pressure = Korotkoff sounds
