CH 9: General Survey and Measurement

General survey

Study of whole person:

• Covers general health state

• Provide overall impression

• Includes objective parameters of whole body

• Includes areas of physical appearance, body structure/symmetry, mobility, and behavior

Objective Data: Physical Appearance

• Age

• Sex

• Level of cognizance

• Skin color

• Facial features (symmetric with movement)

• Overall appearance (absence/presence of stress)

Objective Data: Body Structure

• Stature/height

• Nutrition; weight; body fat distribution

• Symmetry: body parts look equal bilaterally and are

  in relative proportion

• Posture

• Position: description of patient’s position during

  assessment

• Body, build, contour: proportions and note deformities

Objective Data: Mobility

• Gait: normally base is as wide as shoulder width

• Foot placement; walk is even and well-balanced and associated movements (e.g. arm swing)

• No involuntary movement

Objective Data: Behavior (Mood/Speech)

• Facial expression: patient maintains eye contact (if culturally appropriate); expression appropriate to situation. Note expression while talking and at rest

• Mood and affect: person is comfortable and cooperative/interacts pleasantly

• Speech: Articulation clear and understandable

  • Speech pattern (e.g. fluent, even)

  • Convey ideas clearly

  • Word choice apropos culture/education

  • Person communicates in prevailing language

Objective Data: Behavior (Dress/Hygiene)

• Dress: appropriate to climate, looks clean and fits

  body, and is appropriate to person’s culture and age group

• Personal hygiene: person appears clean and

  groomed appropriately for his or her age, occupation and socioeconomic group

Examples of cultural dress

• Amish women wear clothing from nineteenth century.

• Indian women may wear saris.

• Culturally determined dress should not be labeled as bizarre by Western standards or by adult expectations.

Objective Data: Weight Measurements

• Uses a standardized balance or electronic standing scale.

• Instruct person to remove his or her shoes and heavy outer clothing before standing on scale

• Record in Kg and Lb

• When sequence of repeated weights is necessary, aim for approximately same time of day and same type of clothing worn each time

• Show person how his or her weight matches up to

  recommended range for height.

• Compare person’s current weight with previous visit.

Body Mass Index (BMI)

Body mass index is practical marker of optimal weight for height and an indicator of obesity or protein-calorie malnutrition.

Objective Data: Waist circumference

• Assesses body fat distribution as indicator of health risk. Measure hip/waist

• Excess abdominal fat is an independent risk factor for disease, over and above that of body mass index (BMI).

• Note the measurement at end of normal expiration.

Where is waist circumference measured?

Measured in inches at smallest circumference below rib cage and above iliac crest

Where is hip circumference measured?

Measured in inches at largest circumference of buttocks

Hypopituitary dwarfism

Deficiency in growth hormone in childhood results in retardation of growth. Results in delayed puberty, hypothyroidism, and adrenal insufficiency

Achondroplastic dwarfism

A genetic disorder in converting cartilage to bone results in normal trunk size, short arms and legs, and short stature. It is characterized by a relatively large head with frontal bossing; midface hypoplasia (small); and often thoracic kyphosis, prominent lumbar lordosis, and abdominal protrusion.

Gigantism

Excessive secretion of growth hormone by the anterior pituitary results in overgrowth of the entire body. When this occurs during childhood before closure of bone epiphyses, it causes increased height, increased weight, and delayed sexual development.

Acromegaly (Hyperpituitarism)

Excessive secretion of growth hormone in adulthood after normal completion of body growth causes overgrowth of bone in face, head, hands, and feet but no change in height. Internal organs also enlarge (e.g., cardiomegaly), and metabolic disorders (e.g., diabetes mellitus) may be present.

Anorexia Nervos

Mental health disorder characterized by severe and life-threatening weight loss in an otherwise healthy person. Results in amenorrhea (absence of menstrual periods) in females

Bulimia Nervosa

Mental health disorder characterized by episodes of binge eating and then purging. The purging is often accomplished by self-induced vomiting or laxative use. Causes electrolyte imbalances and erosion of tooth enamel

Endogenous Bbesity — Cushing’s Syndrome

Either administration of adrenocorticotropin (ACTH) or excessive production of ACTH by the pituitary stimulates the adrenal cortex to secrete excess cortisol. Excessive catabolism causes muscle wasting; weakness; thin arms and legs; reduced height; and thin, fragile skin with purple abdominal striae, bruising, and acne. Obesity in face, neck and trunk (centripetal obesity)

Marfan Syndrome

This inherited connective tissue disorder is characterized by tall, thin stature; arm span greater than height. This inherited connective tissue disorder is characterized by tall, thin stature

Bulimia Nervosa Behaviors

Behaviors may include excessive eating, exercise, and/or fasting; peculiar eating habits or rituals; and preoccupation with food, eating, and body shape.

Anorexia Nervosa Behaviors

Behavior is characterized by fanatic concern about weight, aversion to food, distorted body image (perceives self as fat despite skeletal appearance), starvation diets, frenetic exercise patterns, intense fear of weight gain, and striving for perfection. Results in amenorrhea in females.

How is Cushing’s Syndrome different from exogenous obesity?

Exogenous obesity caused by excessive calorie intake; body fat is evenly distributed and muscle strength is intact