Physical Assessment: General Survey

Question 2

Weight: Changes

Answer 2

2.2 lbs = 1 kgShoes offNote changes: may be due to fluid retention, muscle, or fat gain/loss.

Question 3

Weight: Calculation

Answer 3

2.2 lbs = 1 kg

Question 4

Weight: BMI, calculation and significant ranges

Answer 4

Weight (kg) / Height (m)^2Above 25: assess nutrition, screen-excess body fat or muscle toneBelow 18.5: Concern, suspect-Anorexia, Bulimia, malnutrition

Question 5

Height: Observations and screening

Answer 5

Short / tallSlender / lankyMuscular / stockyGeneral body proportionsDeformities

Question 6

Temperature: 4 types

Answer 6

OralRectal: coreAxillaryTympanic: core

Question 7

Temperature: Normal Limits (F and C)

Answer 7

97-99 F, 36.1-37.7 C

Question 8

Blood Pressure: 2 parts

Answer 8

Systolic (ventricles contractDiastolic (ventricles at rest)

Question 9

Blood pressure: Not Static, varies with

Answer 9

positionCircadian rhythmStressNutritional statusdrugsDisease

Question 10

Pulse Pressure

Answer 10

Systolic-DiastolicNormal is 30-40

Question 11

Widened Pulse Pressure Disease States (8)AAA - ABE - PT

Answer 11

Aortic CoarctationAortic RegurgitationAtreiovenus FistulaAnemiaBeriberi HeartEmotional StatePatent Ductus ArteriosusThryrotoxicosis

Question 12

Narrow Pulse Disease States

Answer 12

Ascites (fluid in abdomen)Pericardial Effusion (fluid around heart)Constrictive Pericarditis (thick shell around heart)Severe Aortic Stenosis (AV narrowed)Tachycardia

Question 13

JNC - 7: Normotensive, Pre-hypertension, Stage 1 hypertension, Stage 2 Hypertension

Answer 13

Normal: < 120 / < 80Pre: 120 - 139 / 80 - 89S1: 140 - 159 / 90 - 99S2: > 160 / > 100

Question 14

HTN Risk: Diseases

Answer 14

Coronary heart diseaseStrokeCHFEnd-stage renal diseasePVD

Question 15

HTN: Complications (in General Systems)

Answer 15

CNSOpthalmologicCardiacVascularRenal

Question 16

Korotkoff Sounds

Answer 16

Phase 1: THUDPhase 2: Sound of turbulent flowPhase 3: Softer thudPhase 4: Softer blowing sound that disappearsPhase 5: Silence

Question 17

Capillary Refill

Answer 17

Press down on nail bed and release. White spot should disappear in under 3 seconds

Question 18

Pulse: Location (6)

Answer 18

carotidradialbrachialfemoralposterior tibialdorsalis pedis

Question 19

Pulse: Normal limits AdultNewborn1yr3yr6yr10yr

Answer 19

Adult:60-100Newborn: 120-1701yr: 80-1603yr: 80-1206yr: 75-11510yr: 70-110

Question 20

Pressure: SphygmomanometerFalse HighFalse Low

Answer 20

High: Cuff too short or narrow-Anxiety, arm too low, muscle contraction, smokingLow: Cuff too wide or long-Arm too high, bell pressed too firmly/touching cuff, failure to recognize an auscultatory gap.

Question 21

Pulse Abnormalities: Small Weak

Answer 21

Hypovolemia, aortic stenosis, cold, CHF

Question 22

Pulse Abnormalities: Large Bounding (6)

Answer 22

Fever, anemia, hyperthyroidism,Patent Ductus Arteriosus (PDA), heart block, atherosclerosis

Question 23

Pulse Abnormalities: Pulsus Alternans

Answer 23

Varies in amplitude, beat to beatLV failure, S3

Question 24

Pulse Abnormalities: Paradoxical Pulse

Answer 24

Decreases with inspirationPericardial tamponade (acute type of pericardial effusion) Obstructive Lung disease, constrictive pericarditis.

Question 25

Breathing Rhythm: Patterns (7)

Answer 25

Bradypnea: under 12; coma, meds, deep sleepTachypnea: above 20; anxiety, heart/lung disease, FEVERHyperpnea: over 20 and deep, exercise, metabolicSighing: normal/anxietyCheyne-Stokes: dysrhythmic breathing due to CNS, drugsKussmal: Rapid deep, DKA, metabolic acidosisStridor: Harsh, high pitched inspiration

Question 26

Normal Breathing RatesAdultNewborn1 yr3 yr6 yr

Answer 26

Adult: 12-20Newborn: 30-801 yr: 20-403 yr: 20-306 yr: 16-22

Question 27

Cachexia

Answer 27

Decreased fat and muscle mass

Question 28

Pallor

Answer 28

Pale/White appearance: Due to anemia, hypoxiaAlso, Normal coloring

Question 29

Jaundice

Answer 29

Yellow coloration found in the palms, sclera, oral mucosaDue to Liver DiseaseNormal in newborn

Question 30

Systole

Answer 30

The pressure exerted against the arteries during ventricular contraction

Question 31

Diastole

Answer 31

The resting pressure when the ventricles are at rest

Question 32

Auscultatory gap

Answer 32

Silent interval present b/t the systolic and diastolic pressures

Question 33

Cyanosis

Answer 33

blue color of oral mucosa and nail beds. Associated with anemia and/or hypoxia

Question 34

Hyperpyrexia

Answer 34

Fever, > 38 C, 100.5 F

Question 35

Hypothermia

Answer 35

Low Temp < 35 C, 95 F (core)