General survey and vital signs 🩺

what are standard and *universal precautions*?

CDC guidelines to protect pts and examiners from spread of infectious disease

the idea that all blood, body fluid, secretions, non intact skin and mucous secretions may contain transmissible infectious agents

who do universal precautions apply to?

all patients in any settings

how do we apply use of standard and universal precautions?

- *Hand hygiene (before and after seeing patients)*

- Use of personal protective equipment (PPE)

- Cleaning of white coats, scrubs, stethoscope

- Cough etiquette

- Patient isolation

how should the pt be positioned during general survey, VS, and pain exam?

sitting

where should you be positioned during general survey, VS, and pain exam?

stand on the right side of the pt to start the examination

how do you observe *apparent state of health*?

acutely ill, frail, fit, well

what are the levels of consciousness?

****

alert

lethargy

obtundation

stupor

coma

what is lethargy?

eyes open when spoken to

what is obtundation?

opens eyes with tactile stimuli

what is stupor?

opens with painful stimuli

what is coma?

unarousable

how do we asses apparent state of discomfort or distress?

distress

pain

anxiety or depression

**

"clutching of the chest"

"labored breathing"

"diaphoresis"

what do we survey the skin for?

color and obvious lesions

*pallor, cyanosis, jaundice, rashes, mottled*

what do we asses body odor and breath for?

*fruity breath can mean DKA,* alcohol

what posture may be suggestive of discomfort?

leaning forward with arms braces (tripod position)

what do we measure for in general survey?

height, weight, BMI

what may short height be suggestive of?

Turner syndrome, dwarfism

what may being tall, thin, and having long limb be suggestive of?

marfan syndrome

what may height loss be suggestive of?

osteoporosis, vertebral compression fracture

what may weight loss be suggestive of?

malignancy, DM, hyperthyroidism, depression

what do we measure height with and how should patient be positioned?

stand on stadiometer facing forward, feet flat and slightly apart

what is a key step before measuring weight?

remove shoes

how is BMI measured?

BMI = wight (Kg) / height (m)

who may have elevated BMI?

muscular individuals

what BMI is considered underweight?

what BMI is considered extremely obese?

>40

how should pt be positioned when measuring blood pressure?

seated, comfortable, back supported, legs uncrossed, feet on the floor, arm should be free of clothing, supported, at heart level

where should blood pressure cuff be placed?

2.5 cm above the antecubital crease

what is used to avoid auscultory gap and estimate systolic blood pressure?

palpated radial pulse obliteration

what are normal blood pressure levels?

systolic

what are elevated blood pressure levels?

systolic 120-129

and

diastolic

what are the values of HTN stage 1?

systolic 130-139

or

diastolic 80-89

what are values of HTN stage 2?

systolic ≥140

or

diastolic ≥90

what are the values in a hypertensive crisis?

systolic >180

and/or

diastolic >120

what is orthostatic BP?

a drop in BP that occurs when a person stands up from a sitting or lying down position

how do we measure orthostatic BP?

measure BP in 2 positions

have pt rest for 3-10 min in supine position measure BP, *then wait 3 min,* have patient standing and measure BP

what will *confirm* orthostatic hypertension?

*drop in SBP 20 mmHg or 10 mmHg in DBP*

what are the causes of orthostatic hypertension?

*medications, hypovolemia, blood loss, prolonged rest, autonomic dysfunction*

how do we measure pulse rate and rhythm?

using index and middle finger, compress radial artery until pulse is detected

*if rate is regular, count for 30 seconds and multiply by 2*

if rate is fast or slow, count for 60 seconds

if the rhythm is irregular, count for 60 seconds

how do we measure respiratory rate and rhythm?

observe the *rate, rhythm, depth and effort*

count for *1 min by visual inspection* or listening to the breath over the trachea w stethoscope

how many breaths per min are normal, where do we often see prolonged breath

12-20 breath/min is normal

*prolonged breath is common in COPD*

what is normal temperature?

37ºC (98.6ºF)

what temperatures can we take?

core body temperature, tympanic, oral, rectal, axillary

how far can temperature vary? when does it become unsafe?

can range 1 degree over the course of the day

hypothermia = 35ºC (95ºF)

pyrexia = *38ºC (100.4ºF)

what are the two types of pain?

acute: associated with surgery, trauma, and acute illness, last hours, days to week

chronic: pain lasting longer than one month

what is nociceptive pain?

tissue damage to musculoskeletal system, viscera, or skin but the sensory system is intact

what are examples of nociceptive pain?

dull, pressing, pulling, throbbing, boring, spasmodic, colicky

what is neuropathic pain?

a direct consequence of a lesion or disease affecting the somatosensory system

what are examples of neuropathic pain?

electric shock, stabbing, burning, pins and needles

how can we use a consistent method to asses pain severity?

1. visual analog scale

2. numeric rating scale

3. wrong baker face scale

what are korotkoff sounds?

sounds heard when taking blood pressure