General Survey and Vital Signs Flashcards
(60 cards)
1
Q
Order of Basic Exam Technique (unless otherwise specified)
A
- Inspection (synonymous with Assessment)
- Palpation
- Percussion
- Auscultation
2
Q
Basic Exam Techniques
A
Perform a thorough, accurate exam
- Develop a routine sequence, usually head to toe order
- Examine from right-hand side
- Speak to pt during the PE - let them know what you are doing & why
3
Q
General Survey
A
-Overall impression of the patient based on clinical observation = objective findings
4
Q
Components of General Survey
A
- Apparent state of health
- Level of consciousness
- Signs of distress
- Dress, grooming & personal hygiene
- Facial expression
- Breath & body odors
- Posture, gait & motor activity
- Body habitus
5
Q
Apparent State of Health
A
Fit, frail, healthy, appearing, WD/WN, robust
6
Q
Level of Consciousness
A
Alert, oriented, confused, drowsy, sleepy, responsive
7
Q
Signs of Distress
A
Labored breathing, seems anxious, positio (exam table, chair), pallor, sitting comfortably, tripoding, curled up on table
8
Q
Grooming and Hygiene
A
Condition of clothes/shoes, personal cleanliness
9
Q
Facial Expression
A
Appropriate to conversation, eye contact, flat affect
10
Q
Breathe/Body Odors
A
Alcohol, fruity/sweet, tobacco, halitosis
11
Q
Posture, Gait, and Motor Activity
A
Invountary Movements, tremors, fidgets, non-movement, limps, uneven gait, gait intact
12
Q
Body Habitus
A
Morbidly obese, overweight, emaciated, muscular
13
Q
General Survey
A
- Objective
- Clinical observation
- Physical signs= PE
- Clinician’s impression of patient
14
Q
General ROS
A
- Subjective
- Patient based history
- Symptom based information obtained through question/answers
- weight change
- fatigue
- Weakness
- Fever/Chills, night sweats
15
Q
Weight Gain Causes
A
- tissue vs. body fluids
- tissue–> fat; takes months
- body fluids –> edema, hours/days
16
Q
Weight Loss Causes
A
- Decreased intake of food (anorexia, dysphagia, vomiting, insufficient food supply, eating disorder, need dental work)
- increased caloric intake (hyperthyroid, malignancy, eating disorders, malabsorption)
17
Q
Fatigue
A
- relatively non-specific complaint
- a sense of weariness of loss of energy
- consider context of symptom (response to hard work/stress/grief or unrelated to specific factor)
18
Q
Weakness
A
- not synonymous with fatigue
- denotes a demonstrated loss of muscle strength
- localized to a neuro-anatomic pattern (suggests a disorder of nervous system or muscles)
- Need MSS, CNS & Psych ROS
19
Q
Fever/Chills, Night Sweats
A
- Ask pt to clarify what they mean by having a fever (subjective vs. pt used thermometer)
- Has the pt. noted excessive sweating or felt chilly & cold? (+ response: is it night time or throughout day)
- Distinguish between subjective chilliness verses a shaking chill
20
Q
Vital Signs
A
BP, Pulse, Respiration, Temperature, Height, Weight
21
Q
BP
A
- Patients should avoid exercise, smoking, caffeine before BP reading
- Width of inflatable cuff = 40% of upper arm circumference
- Length = 80% of upper arm circumference
- Support pt’s arm so brachial artery at heart level
- pt should be sitting, legs uncrossed
22
Q
How long do you wait if you need to repeat BP?
A
Wait 2 minutes for same arm or use other arm
23
Q
Normal Blood Pressure
A
Systolic: 90-119
Diastolic: 60-79
24
Q
Pre-Hypertension
A
Systolic: 120-139
Diastolic: 80-90
25
Hypertension Stage 1
Systolic: 140-159
Diastolic: 90-99
26
Hypertension Stage 2
Systolic: 160+
Diastolic: 100+
27
White Coat Hypertension
- Systolic BP may go up because of anxiety/nervousness
| - may want to recheck at the end of visit
28
Masked Hypertension
- Ambulatory is elevated
| - Fine clinically
29
Hypertensive Urgency/Emergency
diastolic BP above 150
30
Coarctation of the Aorta
- narrowing of the aorta
| - need to check for this when someone is diagnosed with hypertension
31
Orthostatic (Postural) Hypotension
- Measure BP in 3 positions for pt on HTN medication or with a history of fainting, postural dizziness, possible depletion of BV
- Wait 1-5 minutes between sitting and standing
- Fall in Systolic Pressure is 20mm Hg or more from supine or sitting to standing
32
Positive Response for Orthostatic Hypotension
- Fall in Systolic Pressure is 20mm Hg or more from supine or sitting to standing
- Fall in Diastolic pressure is 10mm Hg or more
33
Special Considerations for BP
- Coarctation of the aorta
- Orthostatic (Postural) Hypotension
- Very obese, very thin, weak Korotkoff sounds
34
Pulse
- rate (bpm), rhythm (pattern), amplitude (strength, bounding), and contour (speed of upstroke)
- Sites: Radial, carotid, brachial (infants)
35
Pulse Rate
Fast (>100, tachycardia), Normal (60-100), slow (<60, bradycardia)
36
Rhythm of Pulse
- Regular
| - Regularly irregular or irregularly irregular (evaluate by auscultation)
37
Respiration
-Observe signs of respiratory alteration
-Count while patient is distracted and not talking
-Observe one complete respiratory cycle
-Regular- count for 30 sec x 2
Irregular- count for full minute
38
Patterns of Respiration
Bradypnea, Tachypnea, hyperventilation, obstructive breathing, Cheyne-Stokes, Ataxac (Biot's) breating
39
Bradypnea
abnormally slow breathing rate
40
Tachypnea
rapid and shallow breathing
41
Hyperventilation (hyperpnea)
rapid and deep breathing
42
Obstructive breathing
prolonged expiration (such as COPD, Asthma attack)
43
Cheyne-Stokes
deep alternating breathing with apneic
| -take slow or rapid deep breaths and then stop
44
Ataxic (Biot's) breathing
- unpredictable and irregular
| - no real pattern
45
Normal Oral Temperature
- 37 C or 98.6 F
| - lower in arm and higher in PM
46
Normal Rectal Temperature
higher by 0.4-0.5C (0.7.-0.9F)
47
Normal Axillary Temperature
lower than oral by 1 degree, less accurate
48
Normal Tympanic Temperature
higher by 0.8°C (1.4°F)
49
refers to extreme elevations in temperature, above 41.1° C (106°F)
Hyperpyrexia
50
refers to an abnormally low temperature, below 35°C (95°F) rectally
Hypothermia
51
What are two terms that mean elevated temperature?
Hyperpyrexia and Hypothermia
52
Pulse Oximetry
- Indirect measurement of oxygen saturation
- % of hemoglobin in the oxyhemoglobin configuration
- Normal range = 95 to 100%
- Does not determine: metabolism of oxygen or amount of oxygen used
53
Pulse Oximetry Normal
95-100%
54
Healthy Lifestyles Motivational Interview
Optimal weight & nutrition (Obesity in the population; Variables to promote and/or evaluate)
Nicotine cessation
Dealing w/pain
55
Assess Healthy Lifestyle (5 R's)
```
Relevance change or cessation
Risks
Rewards
Roadblocks
Repetition
```
56
Assessing readiness to change to Healthy Lifestyle
- Ask about use, exercise, foods
- Advise (Be clear about why a change is in pt best interests)
- Assess (w/readiness for change)
- Assist (Develop realistic & attainable plan)
- Arrange (Follow up visit to review pt success or reassess readiness cessation/change)
57
5 A's
Ask, Advise, Assess, Assist, Arrange
58
Types of Pain
Nociceptive (somatic)
Neuropathic
Central sensitization
Psychogenic & idiopathic
59
Normal Pulse for Adults
60-100 bpm
60
Normal Respiratory Rate
14-20 breathes per minute
