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Flashcards in General Survey, VS, and Pn Deck (28):
1

Components of General Survey

(2)

  1. General appearance
  2. Height and weight

2

Observation

(timing, aspects)

Timing - the entire duration of the appt, especially during the genearl survey

Aspects - does the pt appear to...

  • seem anxious or upset?
  • be in pain?
  • have adequate dress and hygiene?

3

Aspects of General Appearance 

(8)

  1. Apparent state of health (acute or chronically ill, frail)
  2. Level of consciousness (awake, alert, responsive, lethargive, obtunded, comatose)
  3. Signs of distress (cardiac or respiratory, pn, anxiety/depression)
  4. Skin (color and obvious lesions)
  5. Dress, grooming, personal hygiene (appropriate to weather and temp, clean, properly fastened)
  6. Facial expression (eye contact, appropriate change inf acial expression)
  7. Odors (body and breath)
  8. Posture, gait, motor activity

4

Height and Weight aspects

(5 height, 2 weight, 1 calculation)

Height

  • Quantitative value in stocking feet
  • Relative value - short or tall
  • Build - slender, lanky, muscular, stocky
  • Body symmetry
  • General proportions, any defomrities

 Weight

  • Quantitative value
  • Description - emancipated, slender, plump, obese
    • If obese, note fat distribution - even or concentrated

Calculation - BMI 

5

BMI Calculation Methods

(4)

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6

BMI Classifications

(5)

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7

General Health Hx Questions

(3, c qualifiers and descriptions)

  1. Weight change
    1. Rapid vs gradual
      1. rapid usually = fluid
      2. gradual usually = tissue
    2. ​​Weight gain
      1. nutritional
      2. medical
    3. Weight loss
      1. psychosocial
      2. medical
  2. Strength concerns
    1. Categories
      1. ​Fatigue
        1. Sense of weariness of loss of energy
      2. Weakness
        1. Demonstratable loss of muscle power
    2. ​Causes
      1. Psychosocial
      2. Medical
  3. ​Temperature Ctrl
    1. Categories
      1. Fevers
      2. Chills
      3. Night sweats
    2. Questions to ask
      1. Exposure to illness
      2. Recent travel
      3. Any medications 
         

8

Vital Signs

(list 6)

  1. Blood pressure
  2. Heart rate and rhythm
  3. Respiratory rate and rhythm
  4. Temperature
  5. Pain
  6. Oxygen Saturation

9

Optimal BP Conditions

(7)

  1. Pt should avoid smoking or drinking caffeinated beverages 30 minutes prior to measurement
  2. Ensure that the room is quiet and comfortably warm
  3. Patient should be seated quietly in a chair with feet on the floor for at least 5 minutes
  4. Patient’s arm should be FREE of clothing
  5. Palpate the brachial artery
  6. Position the arm so that the brachial artery is at heart level
  7. 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

10

BP Cuff Size

(width and length)

  1. Width: 40% of upper arm circumference
  2. Length: 80% of upper arm circumference

11

BP Procedure

(6 steps)

  1. Center the inflatable cuff over the brachial artery with the lower border 2.5 cm above the antecubital crease
  2. Secure the cuff snugly, not tightly, and position the patient’s arm so that it is slightly flexed at the elbow
  3. 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
  4. Deflate the cuff promptly and completely and wait 15-30 seconds
  5. Place the bell of the stethoscope lightly over the brachial artery
  6. Inflate the cuff to the sum pressure previously determined and deflate slowly
    • The point at which you hear the first two consecutive beats is the systolic pressure
    • The disappearance point is the diastolic pressure

12

Auscultatory Gap


A silent interval that may be present between the systolic and diastolic blood pressures; i.e., the sound disappears for a while, then reappears
 

13

Orthostatic BP

(definition, normal vs abnormal values)

Definition: Measure blood pressure and heart rate with the patient supine; wait 3 minutes, then have the patient stand up; now repeat the measurements

Results:

  • Normal: systolic BP drops slightly or remains unchanged; diastolic BP rises slightly
  • Orthostasis: systolic BP drops >20 mm Hg or diastolic BP drops >10 mm Hg

14

BP Values

(normal, 2 procedural considerations c abnormal)


Normal (adults older than 18 years)

  • Systolic: <120 mm Hg
  • Diastolic: <80 mm Hg

If blood pressure is elevated:

  • Repeat blood pressure and verify in the contralateral arm
  • Consider “White Coat Hypertension”
    • Occurs in 10%–20% of all patients
    • Try to relax the patient and retake BP later in the visit

15

Procedure, Heart Rate and Rhythm

(2 steps)

  1. Use the pads of the index and middle fingers to press on the radial artery
  2. If the rate seems normal (50–90 bpm) and the rhythm is regular, count the rate for 30 seconds and multiple by 2. If the rate is fast or slow and/or the rhythm is irregular, count for a full 60 seconds. 

16

Pulse Qualities

(3)

  1. Quantity
  2. Regularity
  3. Volume

17

Tachycardia causes

(7)

  1. Fever
  2. Hypoxia
  3. Drug induced
  4. Pneumothorax
  5. Pulmonary emboli
  6. Anxiety
  7. Pain

18

Bradycardia causes

(5)

 

  1. }Normal
  2. }Drug induced
  3. }Hypothermia
  4. }MI
  5. }Carotid artery stimulation
     

19

Factors that Affect Body Temp

(5)

  1. Gender
  2. Recent activity
  3. Food/fluid consumption
  4. Time of day
  5. Stage of menstrual cycle

20

Temperature Fever Thresholds

 

 

A fever is indicated when body temperature rises above 98.6° F orally or 99.8° F rectally.

Can be measured in Farenheit or Celcius

C = 38-38.5

F = 101-101.5

 

Note:

  • Rectal tempeatures tend to be 0.5-0.7 ºF than oral temperatures
  • Axillary temperatures tend to be 0.3-0.4º lower than oral temperatures

21

Oral Temp Methods

  1. Glass
  2. Mercury 
  3. Digital 

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22

Temperature by Ear

By ear (tympanic) a special thermometer can quickly measure the temperature of the ear drum, which reflects the body's core temperature.

23

Hypothermia


}Hypothermia is defined as a drop in body temperature below 95° F.
 

24

Obervations of Respiratory Rate

(4)

  • Normal rate: ~20 breaths/minute
    • Count for 60 seconds
  • Observe rhythm: regular, irregular
  • Observe depth: shallow, gasping
  • Observe effort: normal, labored

25

Tachypnea Causes

(7)

  1. Fever
  2. CHF
  3. Anemia
  4. Hyperthyroid
  5. Pneumonia
  6. COPD
  7. Metabolic acidosis

26

Bradypnea Causes

(3)

  1. Uremia
  2. Various drugs
  3. Increased intracranial pressure

27

Pain Assessment 

(3 types)

  1. Nociceptive or somatic – related to tissue damage
  2. Neuropathic – resulting from direct trauma to the peripheral or central nervous system
    • Psychogenic – relates to factors that influence the patient’s report of pain
    • Psychiatric conditions
    • Personality and coping style
    • Cultural norms
    • Social support systems
  3. Idiopathic – no identifiable etiology

Measured on scale of 0-10, with 10 being the worst

28

Oxygen Saturation

(function, 

"The 5th vital sign"

Function: qualify the degree of hypoxic impairment (cardio-pulmonary disorder)