ch 10 general survery and vitals

What are the major components of the general survey?

Overall appearance, level of consciousness, skin color and obvious lesions, dress/grooming/hygiene, facial expression, body habitus, posture, gait, and motor activity.

When does the general survey begin?

The moment you first encounter the patient.

What should you assess when evaluating level of consciousness?

Whether the patient is awake, alert, responsive, and appropriately interacting with the environment.

What should be observed about posture and motor activity?

Preferred posture, involuntary movements, mobility, and the quality and ease of gait.

What is fatigue?

A subjective feeling of weariness or lack of energy.

What is weakness?

A demonstrable loss of muscle power.

What is the key difference between fatigue and weakness?

Fatigue is a lack of energy; weakness is an actual loss of muscle strength.

What should be assessed in a patient reporting fatigue?

Severity and pattern, associated symptoms, sleep, lifestyle, psychosocial factors, medical history, and medications or substances.

What should be assessed when a patient reports fever?

Onset, duration, pattern, associated symptoms, exposures, medications, and recurrent episodes.

What are important causes of fever and night sweats?

Infection, inflammatory or autoimmune disease, malignancy, medications, and other systemic disorders.

What is an important initial question when assessing weight change?

Determine whether the weight change was intentional or unintentional.

What can cause unintentional weight loss?

Malignancy, endocrine disease, GI disease, chronic infection, psychiatric disorders, medication effects, and other chronic illnesses.

What should rapid weight gain make you consider?

Fluid retention, especially from cardiac, renal, or hepatic disease.

What is the formula for BMI?

Weight in kilograms divided by height in meters squared: kg/m².

What BMI is considered underweight?

Less than 18.5 kg/m².

What BMI is considered normal?

18.5–24.9 kg/m².

What BMI is considered overweight?

25.0–29.9 kg/m².

What BMI is obesity class I?

30.0–34.9 kg/m².

What BMI is obesity class II?

35.0–39.9 kg/m².

What BMI is obesity class III?

40 kg/m² or greater.

What is systolic blood pressure?

The peak arterial pressure occurring during ventricular contraction.

What is diastolic blood pressure?

Arterial pressure occurring during ventricular relaxation.

What is normal blood pressure according to ACC/AHA categories?

Systolic less than 120 AND diastolic less than 80 mm Hg.

What is elevated blood pressure?

Systolic 120–129 AND diastolic less than 80 mm Hg.

What is stage 1 hypertension?

Systolic 130–139 OR diastolic 80–89 mm Hg.

What is stage 2 hypertension?

Systolic 140 or greater OR diastolic 90 or greater mm Hg.

If systolic and diastolic pressures fall into different BP categories, which category is used?

The higher blood pressure category.

How should a patient be positioned for an accurate blood pressure measurement?

Seated comfortably with the back supported, feet flat on the floor, legs uncrossed, and arm supported.

Where should the patient's arm be positioned during blood pressure measurement?

At heart level.

What happens to the BP reading if the arm is above heart level?

The blood pressure may be falsely low.

What happens to the BP reading if the arm is below heart level?

The blood pressure may be falsely high.

What happens if the blood pressure cuff is too small?

The blood pressure may be falsely high.

What happens if the blood pressure cuff is too large?

The blood pressure may be falsely low.

How wide should the BP cuff bladder be compared with arm circumference?

Approximately 40% of the arm circumference.

How long should the BP cuff bladder be compared with arm circumference?

Approximately 80% of the arm circumference.

Why should systolic BP be estimated by palpation before auscultation?

To determine the appropriate cuff inflation level and help avoid missing an auscultatory gap.

How high should the cuff be inflated above the estimated systolic pressure?

Approximately 20–30 mm Hg above the estimated systolic pressure.

What are Korotkoff sounds?

Sounds produced as blood begins flowing through a partially compressed artery while the BP cuff deflates.

What does Korotkoff Phase I indicate?

The first clear tapping sounds; this represents systolic blood pressure.

What occurs during Korotkoff Phase II?

The sounds become softer and may have a swishing quality.

What occurs during Korotkoff Phase III?

The sounds become sharper and crisper.

What occurs during Korotkoff Phase IV?

The sounds become muffled.

What does Korotkoff Phase V indicate in adults?

Complete disappearance of the sounds; this represents diastolic blood pressure.

What is an auscultatory gap?

A temporary disappearance of Korotkoff sounds during cuff deflation before the sounds return.

Why is an auscultatory gap clinically important?

It can cause an inaccurate blood pressure measurement if it is not recognized.

What blood pressure change indicates orthostatic hypotension?

A decrease of at least 20 mm Hg systolic OR at least 10 mm Hg diastolic within about 3 minutes of standing.

What symptoms can occur with orthostatic hypotension?

Dizziness, lightheadedness, weakness, blurred vision, or syncope.

What characteristics should be assessed when evaluating a pulse?

Rate, rhythm, and amplitude.

What is the usual resting adult pulse range?

Approximately 60–100 beats per minute.

How long should an irregular pulse generally be counted?

A full 60 seconds.

What characteristics should be assessed when evaluating respirations?

Rate, rhythm, depth, and effort.

What is the normal resting adult respiratory rate?

Approximately 12–20 breaths per minute.

What is tachypnea?

An abnormally rapid respiratory rate.

What is bradypnea?

An abnormally slow respiratory rate.

Why should respirations be counted without drawing the patient's attention to them?

The patient may consciously alter the breathing pattern if aware that respirations are being observed.

What is the approximate normal core body temperature?

Approximately 37°C or 98.6°F, with normal individual variation.

When is body temperature generally lowest?

Early morning.

When is body temperature generally highest?

Later in the day.

What is hyperthermia?

An abnormally elevated body temperature.

What is hypothermia?

An abnormally low body temperature.

What is acute pain?

Pain with an identifiable cause that generally has a predictable course and resolves as healing occurs.

What is chronic pain?

Pain that persists beyond the expected period of healing or continues for a prolonged period.

What is nociceptive pain?

Pain caused by actual or potential tissue damage that activates pain receptors.

What are the two major types of nociceptive pain?

Somatic pain and visceral pain.

How is somatic pain commonly described?

Aching or localized pain involving structures such as the skin, muscles, joints, or bones.

How is visceral pain commonly described?

Deeper, less localized pain arising from internal organs.

What is neuropathic pain?

Pain caused by a lesion or disease affecting the somatosensory nervous system.

What words commonly suggest neuropathic pain?

Burning, shooting, electric shock-like, tingling, or pins-and-needles.

What characteristics should be assessed when evaluating pain?

Location, quality, severity, timing, duration, onset, aggravating factors, relieving factors, and associated symptoms.

What is the Numeric Rating Scale (NRS)?

A pain scale from 0–10, where 0 means no pain and 10 represents the worst possible pain.

What is the Visual Analog Scale (VAS)?

A visual line representing a continuum from no pain to severe pain.

What is the Wong-Baker FACES Pain Rating Scale?

A series of facial expressions that helps patients communicate the severity of pain.

Who may benefit from the Wong-Baker FACES scale?

Children and patients who have difficulty communicating pain using numbers.

What is an easy way to remember cuff-size errors?

A small cuff gives a BIG or falsely high BP reading; a cuff that is too large may give a falsely low reading.

What is an easy way to remember arm-position BP errors?

Arm down causes BP to read up; arm up causes BP to read down.

What BP cuff dimensions should be memorized for the exam?

Bladder width about 40% and bladder length about 80% of arm circumference.

What Korotkoff phases should be memorized for the exam?

Phase I equals systolic BP; Phase V equals diastolic BP.

What numbers should be memorized for orthostatic hypotension?

A drop of at least 20 mm Hg systolic or 10 mm Hg diastolic.

What description of pain should immediately make you think of neuropathic pain?

Burning, shooting, electric, tingling, or pins-and-needles pain.

What BMI cutoff numbers should be memorized?

18.5, 25, 30, 35, and 40.