General Survey and Vital Signs Flashcards by Jen Esquinance

3 types of cardiac rhythms

Regular
Irregular
Irregularly irregular

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Irregularly irregular is an example of what disease?

A. Fib

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Amplitude of 0 in pulse is __

absent

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Amplitude of +1 in pulse is __

diminshed

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Amplitude of +2 in pulse is __

normal

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Amplitude of +3 in pulse is __

increased

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Amplitude of +4 in pulse is __

bounding

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Small weak pulses maybe a sign of 
-
-
-
-

Hypovolemia
Aortic Stenosis
Cold
CHF

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Large, bounding pulses maybe a sign of
-
-
-
-
-
-

Fever
Anemia
Hyperthyroidism
PDA
Heart Block
Atherosclerosis

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Varies in amplitude from beat to beat (Big pulse, little pulse) In patients with LV failure, usually associated with S3

Pulses Alternans

It ALTERNATES!!!

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Normal/Premature/Normal/Premature Pulse

Bigeminal Pulse

It likes it both ways - BI

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Decreases with inspiration, pericardial tamponade, obstructive lung disease (COPD), constrictive pericarditis

Paradoxical Pulse

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Kentucky is associated with what heart sound?

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Tennessee is associated with what heart sound?

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pulse that is found in the groin, just medial to quadriceps

Femoral

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pulse that is found in the middle of the popliteal fossa, it is palpated better when the knee is flexed 30 degrees

Popliteal

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pulse that is posterior to medial malleolus, in the ankle

Posterior Tibial

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pulse that is on the dorsal food, lateral to extensor hallucis longus

Dorsalis pedis

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pulse that is found in the nexk, medial to and below the angle of jaw

carotid

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pulse that is ventral wrist, proximal to the base of the thumb

radial

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pulse that is antecubital fossa, medial to the biceps tendon

brachial

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in what disease will there be an absent or diminished dorsalis pedis and posterior tibial pulse?

Peripheral vascular disease

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What are the reasons you need to be able to find a pulse?

obtaining arterial blood for blood gas measurement

- finding femoral vein for emergency access

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Normal pulse for Adults

60 to 100

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Normal pulse of newborns

120-170

Normal pulse for 1 year olds

80-160

Normal pulse for 3 year olds

80-120

Normal pulse for 6 year olds

75-115

Normal pulse for 10 year olds

70-110

What characterictics do you use when assessing the respirations?

- Depth - Effort of breathing - ratE - Rhythm DEER

how long do you want to count the respirations for infants?

60 Do this BEFORE you take a rectal temp on an infant, they ALL scream when you take a rectal temp and then they will really be huffing and puffing. Its easiest to count the respirations while the baby is sleeping and you haven't touched them yet! Just watch their chest go up and down!!!

How long do you want to count the respirations for adults?

15 or 30 seconds 15 x 4 to get your 60 seconds or 30 x 2

Normal respiration rate for Adults

12-20 Every normal breathing ER patient I took care of had 18 has their rate!! Bahahaha

Normal respiration rate for newborns

30-80

Normal respiration rate for 1 year olds

20-40

Normal respiration rate for 3 year olds

20-30

Normal respiration rate for 6 year olds

16-22

respiration rate under 12

bradynpea

Possible causes of bradynpea

- Coma - Medications - Deep Sleep

Possible causes of tachynpea

- Anxiety - Heart/Lung Disease - Pain

respiration rate over 20

tachynpea

respiration rate over 20 AND DEEP

hyperpnea

Possible causes of hypernea

- Exercise - Anxiety - Metabolic

What are the 4 respiration patterns we talked about?

- Sighing - Cheyne- Stokes - Kussmaul - Stridor

What respiration pattern is normal if occasionally, anxiety if frequent?

sighing

What respiration pattern is caused by drugs or CNS damage?

Cheyne-Stokes

What respiration pattern is rapid, deep, labored (metabolic acidosis)?

Kussmaul These are BAD! Pt is circling the drain fast ..

What respiration rate is harsh, high pitched inspiration, airway obstruction?

Stridor Only heard during INSPIRATION

Normal oral temperature

37 Degrees C / 98.6 Degrees F

Normal early AM Oral temperature

35.8/96.4

Normal late PM Oral temperature

37.3/99.1

Equation to convert F to C

Tc = (5/9) x (Tf - 32) Tc- Temp in C Tf- Temp in F

Equation to convert C to F

Tf= ((9/5) x Tc) + 32 Um yea, they have an App for that..

Preferred temperature taking method

Oral

What method of taking a temperature is not recommended if the patient is unconscious, restless, or unable to close mouth?

Oral Unconscious patients - ALWAYS take rectal

Technique of taking a temperature

Oral Rectal Tympanic Membrane Temporal Scanner

lie on side with hip flexed, use lube and insert 3-4 cm towards umbilicus

Rectal technique

position so beam aims at TM, wait 2-3 seconds

Tympanic membrane technique

Thermometer under tongue, with probe cover, wait 3 minutes if mercury, 10 seconds if electronic, wait 10 minutes after hot or cold liquids

I have no idea how to ask that on a flash card so just read that again!

what technique to taking a temperature reads 0.4 - 0.5 Degrees C/0.7 - 0.8 Degrees F HIGHER than oral

Rectal Because this method is closer to core temp and isn't really exposed to the air like your mouth is. Fun Fact!

What technique to taking a temperature is poor correlation with rectal temperature, lower than oral temperatures by 1 degree, considered less accurate than others

Axillary

What technique of taking a temperature is quick, safe, reliable if performed properly, no cerumen in canal, measures core body temperature ( Higher than oral by approx. 0.8 degrees C/1.4 degrees F

Tympanic

what is the most accurate way to take a temperature?

tympanic

What is considered an elevated body temperature (fever)?

greater than 100.5 Holly and I learned it as 100.4 in the ER but he says .5

Excessive heat exposure and/or poor heat dissipation (heat stroke) and elevation of the hypothalamic thermoregulatory set points are possible causes of

pyrexia (fever) Pyro- means fire A pyromaniac loves to set fires.

I'm not listing the million causes of a differential disgnosis of a fever

AINT NOONE GOT TIME FOR THAT!

The 5 W's Philpot came up with for causes of a Fever

``` When? Water (urine) Wound Wonder drugs Weird disease ```

extreme elevation of temp greater than 41.1 C or 106 F

hyperpyrexia

abnormally low temp less than 35 C or 95 F rectally

Hypothermia

To assess ___ properly, press down firmly on the patients finger or toe nail so its blanches and then release the pressure and observe how long it takes the nail bed to "pink" up

capillary refill

What is an abnormal capillary refill time?

greater than 3 seconds

``` Abnormal capillary refill time is possibiliy caused by: - - - - - ```

``` Peripheral vascular disease Arterial blockage Heart Failure Hypoperfusion Shock ```

Noninvasive measurement of gas exchange and red blood cell oxygen carrying capacity imperfect and has limitations

oxygen saturation

what vital sign provides important information about cardiopulmonary dysfunction and helps quantify the degree of impairment?

oxygen saturation

detects hypoxia before the patient becomes clinically cyanotic (IE DEAD)

oxygen saturation

t/f oxygen saturation can have a value greater than 100.

FALSE!! It's a percentage so 100 % is the best

Which part of the general survey would the question "is the patient acutely or chronically ill, frail, or fit and robust?" fall under?

Apparent State of Health

Which part of the general survey would the question "is the patient awake, alert, and responsive to you and others in the environment?" fall under?

Level of Consciousness

what are the signs of distress for cardiac or respiratory distress?

is there clutching of the chest, pallor, diaphoresis, or labored breathing, wheezing, and coughing?

what are the sins of distress for pain?

is there wincing, sweating, protectiveness of a painful area, facial grimacing, or an unusual posture favoring one limb or body area?

what are the signs of distress for anxiety or depression?

are there anxious facial expressions, fidgety movements, cold and moist palms, inexpressive or flat affect, poor eye contact, or psychomotor slowing?

T/F Sweating is a sign of distress for depression or anxiety.

FALSE! sweating = pain cold and moist palms = anxiety or depression

what do you measure a patients height in?

stocking feet

Is the patient short or tall? Is the build slender, muscular, or stocky? Is the body symmetric? General Body Proportions? Any Deformities? Are ALL associated with which part of the general survey?

height & weight

calculate: | 5ft 5in = ______ cm

165.1 cm | 1 inch = 2.54 cm

calculate: | 165.1 cm = _____ m

1.65 meters | 100 cm = 1 meter

T/F You should always weigh the patent with their shoes on so they look taller.

NO NO NO DUHHHHH | ALWAYS WEIGH WITH SHOES OFF!!!!!!!

T/F Weighing a patient is the only index of caloric intake in that patient.

FALSE! - weighing the patient is ONLY ONE index of caloric intake ; there are many others

T/F The most valuable data about a patients weight loss is to take it once and trust the patient when they say promise they weigh that weight all year round.

FALSE!!!! Changes OVER TIME show valuable data!!!!!

Changes in weight can be due to what two changes in the body?

1. changes in body fluid status | 2. changes in fat or muscle mass

the loss of body mass that cannot be reversed nutritionally is _______. This should also be noted in the heigh & weight portion of your general survey if present

cachexia

calculate: | 105 lb = ______ kg

47. 73 | 2. 2 lbs = 1 kg

calculate: | 50 kg = _______ pounds

110 lbs | 2.2lbs = 1 kg

what is the more accurate measurement of body fat?

BMI

how do you calculate body mass index

weight (kg) / Height^2 (m^2)

in a healthy adult, their BMI will be between _____ - ______.

18.5 - 24.9

If BMI is above 25 : assess ______ , ______.

nutrition, screen

If BMI is below 18.5 : ______.

concern

BMI is significant because it is vital for ______ ______.

promoting health

What fraction of the US adults are overweight? What is their BMI?

2/3 … BMI > 25

What fraction of the US are obese? What is their BMI?

1/3 … BMI > 30

What percentage of the US are morbidly obese? What is their BMI?

5% … BMI > 40

What are the risk factors for being obese?

DM, Heart disease, stroke, HTN, Osteoarthritis, & some forms of Ca.

Measuring the patients waist circumference- the patient may have excess body fat if the waist measures greater than or equal to _____ inches in women & ____ inches in men.

35 inches in women | 40 inches in men

Who has a higher risk of under nutrition than younger adults?

elderly

What are the two examples of medical conditions associated with weight loss that were given in our notes?

Anorexia, bulimia

T/F Diet, physical activity, waist circumference, blood pressure, blood sugar level, cholesterol level, family history of diseases, smoking, and BMI are all indicators of health risks associated with obesity.

True

When looking at skin color & obvious lesions during the general survey what should u look for? What should u observe?

look for pallor, cyanosis, jaundice, rashes, bruising | observe diaphoresis

How are they dressed? Appropriate? Clean, buttoned, zipped? Properly? Shoes? Jewelry? Piercings? Cleanliness? Grooming? - are all questions associated with which part of the general survey?

dress, grooming & hygiene

T/F you should always assume that alcohol on a patients breath explains changes in mental status or neurologic findings.

FALSE. NEVER DO THIS

what are the two things that are used as diagnostic clues for a patients odors?

body & breath odors

What are the questions you should ask during the posture, gait, motor activity of the general survey?

preferred posture? resless? change of position? fast/slow?

What are you observing about the patient when observing their facial expression?

``` eye contact, affect, expression, involuntary movements, immobility, gait, blanche movement disorders? ```

What are the 5 vital signs?

1. Blood Pressure 2. Heart Rate 3. Respiratory Rate 4. Temperature 5. Pulse Ox

force of the blood pushing against the walls of the arteries

arterial blood pressure

Systolic or Diastolic is highest when the heart beats?

Systolic

Systolic or Diastolic is lowest when the heart beats?

Diastolic

How is arterial blood pressure written?

Systolic / Diastolic

T/F Blood pressure is static.

false - it varies with position circadian rhythm, stress, nutritional status, drugs, & disease

How do you calculate pulse pressure?

Systolic BP - Diastolic BP

What is a normal pulse pressure?

40 | 120 - 80 = 40

Isolated systolic hypertension = widened or narrow pulse pressure

widened - >40

Tachycardia = widened or narrowed pulse pressure?

narrowed - <30

Aortic regurgitation = widened or narrowed pulse pressure?

widened - >40

Thyrotoxicosis = widened or narrowed pulse pressure?

widened - > 40

Patent Ductus Arteriosus = widened or narrowed pulse pressure?

widened - >40

Arteriorvenous fistula = widened or narrowed pulse pressure?

widened - >40

Beiberi heart - widened or narrowed pulse pressure?

widened - >40

Severe Aortic Stenosis = widened or narrowed pulse pressure?

narrowed - < 30

Constrictive pericarditis = widened or narrowed pulse pressure?

narrowed - <30

Aortic Coarctation = widened or narrowed pulse pressure?

widened - >40

Anemia = widened or narrowed pulse pressure?

widened - >40

Pericardial effusion - widened or narrowed pulse pressure?

narrowed - < 30

Anemia - widened or narrowed pulse pressure?

widened - >40

Emotional State - widened or narrowed pulse pressure

widened - >40

Ascites = widened or narrowed pulse pressure?

narrowed - <30

What is normal BP classification?

SBP <80 mmHg

What is the BP classification for prehypertension?

SBP 120-139 mmHg or DBP 80-89 mmHg

What is the BP classification of stage 1 HTN?

SBP = 140-159 mmHg or DBP = 90-99 mmHg

What is the BP classification of Stage 2 HTN?

SBP = >160 mmHg or DBP >100 mmHg

What is the HTN prevalence in the US?

~50 million ppl

T/F: The BP relationship to risk of CVD is continuous, consistent, and independent of other risk factors.

TRUE

T/F: Each increment of 10/5 mmHg doubles the risk of CVD across the entire BP range starting from 115/75 mmHg.

FALSE: (each increment of 20/10 doubles the risk)

What signals the need for increased education to reduce BP in order to prevent HTN?

prehypertension

HTN is the most important modifiable risk factor for which diseases?

1. Coronary Heart dz 2. Stroke 3. CHF 4. End-stage renal dz 5. Peripheral vascular dz

What complications can occur to the CNS due to HTN?

1. intracerebral hemorrhage 2. lacunar infarcts 3. encephalopathy 4. thrombotic stroke 5. transient ischemic attack

What ophthalmologic complications arise due to HTN?

1. fundal hemorrhages 2. exudates 3. papilledema

What cardiac complications arise due to HTN?

1. LVH 2. CHF 3. angina pectoris 4. MI

What vascular complications arise due to HTN?

1. aortic dissection | 2. diffuse athrosclerosis

What renal complications arise due to HTN?

1. nephrosclerosis | 2. renal artery stenosis

What should the width of the sphygmomanometer cuff be?

~40% upper arm circumference

What should the length of the sphygmomanometer cuff be?

~80% upper arm circumference

What happens if the sphygmomanometer cuff is too short or narrow?

will receive a falsely high reading

What are the 3 types of sphygmomanometer?

1. aneroid 2. mercury 3. electronic

T/F: It's ok if the pt. drinks coffee right before getting ready to measure their BP.

FALSE: (NO smoking /drinking caffeine for 30 MIN BEFORE

T/F: While getting ready to measure the pts BP, you should allow them to rest for 5 min and wait quietly, in a comfortably cold room.

FALSE: (rest for 5 min, & wait in a WARM room)

When getting ready to measure BP, what should you check the arm for?

1. to make sure it is free of clothing 2. no AV fistulas present 3. no scarring, or lymphedema

After you have checked the arm, what is the next step in measuring BP?

palpate the brachial artery, position the arm with the antecubital crease close to the heart, & rest or support the arm

Once the are is rested in antecubital crease: heart position, what is the next step in measuring BP?

center the bladder to and make the cuff lower border be ~2.5 cm above the antecubital crease, secure snugly, and flex elbow slightly.

After the cuff has been secured in the proper position, what is the next step in measuring BP?

estimate the systolic BP by radial palpation

Why is there a need to palpate the radial artery before using the sphygmomanometer?

in order to know how high to pump the cuff for an accurate reading

after palpating the radial artery what is the next step in measuring BP?

- place the bell over the brachial artery - inflate cuff rapidly to level determined (radial pulse + 30mmHg) - deflate slowly (~2-3 mmHg/sec) - listen for Korotkoff sounds

silent interval present between the systolic & diastolic pressures

auscultatory gap

What may auscultatory gap be related to?

carotid atherosclerosis and to increased arterial stiffness in hypertensive pts, independent of age

T/F: Auscultatory gaps may have prognostic relevance.

TRUE

Which pressure is present during Korotkoff phase 1?

systolic pressure

Which pressure is korotkoff phase 5?

diastolic pressure

Which pressure is determined by the onset of consecutive sounds during BP reading?

systolic pressure

which pressure is marked by the disappearance of sounds during a BP reading?

diastolic pressure

T/F: anxiety can cause a false high BP reading

TRUE

T/F: Improper cuff size (too small), can cause a false high BP reading.

TRUE

T/F: The arm being placed too high can cause a false high BP reading.

FALSE (too low)

T/F: Muscle relaxation can cause a false high BP reading.

FALSE (muscle contraction)

What can cause a false low BP reading?

1. arm too high 2. improper cuff size (too large) 3. bell pressed too firmly, or touching cuff 4. failure to recognize an auscultatory gap

What can cause weak or inaudible sounds during a BP reading?

1. technical problem 2. SHOCK!!! 3. arrhythmias 4. ambient noise

Which position works best for measuring leg pressures?

having the patient PRONE, leg flexed slightly, heel resting on bed

Where do you apply the BP cuff to measure a leg pressure?

midthigh (center over posterior, wrap securely)

Which artery do you listen over to measure a leg pressure?

popliteal artery

a narrowing of the aorta, typically found just after the vessels are given off to the left arm.

coarctation of the aorta

What does coarctation of the aorta lead to?

leads to HTN due to kidneys detecting low BP and initiating RAAS

What is the key finding of coarctation of the aorta?

elevated BP in the arms, with low BP in the legs

T/F: You should wait til the end of the exam to record the BP readings.

FALSE (record IMMEDIATELY after reading!!)

T/F: the arm in which the pressure is being recorded and the position of the subject should be noted

TRUE

T/F: pressures should be recorded in both arm on the first visit.

TRUE

T/F: In obese pts the bladder size should be indicated.

TRUE

T/F: If the pt. is anxious, restless or distressed, a note should be made with the BP.

TRUE

T/F: The presence of an auscultatory gap should sometimes be indicated.

FALSE (ALWAYS)

Number of heart beats per minute

heart rate

How do you measure pulse?

- apply gentle pressure to radial artery - use pads of index & long fingers - count beats for 15 sec & multiply by 4

normal blood pressure =

< 80

prehypertension

120-139 & 80-89

stage 1 hypertension

140-159 & 90-99

Stage 2 hypertension

greater than or equal to | 160 & 100

What is HTN prevalence for CVD risk?

50 million people in the USA

The _____ relationship to risk of CVD is continuous, consistent, and independent of other risk factors.

blood pressure

Each increment of _____ mmHg doubles the risk of CVD across the entire BP range starting from _____.

20/10 | 115/75

______ signals the need for increased education to reduce BP in order to prevent hypertension

Prehypertension

What is the most modifiable risk factor 1. coronary heart disease 2. stroke 3. congestive heart failure 4. end stage renal disease 5. peripheral vascular disesase

Hypertension

the leading cause of death in north america

coronary heart disease

the third leading cause of death

stroke

what are the 5 systemic complications associated with hypertension?

1. central nervous system 2. opthalmologic 3. cardiac 4. vascular 5. renal

Intracerebral hemorrhage, lacunar infarcts, encephaolophathy, thrombotic stroke, transient ischemic attack are associated with what "general" complication of hypertension?

central nervous system

fundal hemorrhages, exudates, papilledema are associated with what "general" complication of hypertension

opthalmologic

LVH, congestive heart failure, angina pectorals, myocardial infarction are associated with what general complication of hypertension

cardiac

aortic dissection, diffuse arteriosclerosis are associated with what "general" complication of hypertension?

vascular

nephrosclerosis & renal artery stenosis are associated with what general complication of hypertension?

renal

the beating of the heart or the pulse

sphygmost

a device for measuring pressure or tension

manometer

General Survey and Vital Signs Flashcards

(208 cards)