Vital Signs & Derm Terms - Medicine Study Set

why do we do general survey

gives us an overall impression of our patients well being

level of conscious questions

are they alert and orientated?

are they responding to physical and verbal stimuli?

common causes of unresponsivenesses

focal lesions of the brain

diffuse brain disease

psychogenic unresponsiveness

example of focal lesions of the brain

hemorrhage

hematoma

infarct

tumor

abscess

trauma

example of diffuse brain diseases

-drug intoxication's

-disturbances in glucose, sodium or calcium metabolism, renal failure, myxedema, pulmonary insufficiency

-hypothermia, hyperthermia

-hypoxia or anoxic event

-encephalitis, meningitis, seizures

example of psychogenic unresponsiveness

dementia

how to asses apparent state of health

make general judgment based on observations throughout the encounter

questions to ask during apparent state of health

-is the patient acutely or chronically ill?

-frail or fit? obese or cachectic?

-does the patient look "sick"?

-is there muscle wasting?

-are they diaphoretic?

signs of physical distress

pale, excessive sweating, trouble breathing, muscle twitching or spasms, intense pain, extreme fatigue, falling asleep

signs of emotional or psychological distress

crying, sighing frequently, confused, anxious, irritable, agitated, angry outburst, non-attendance, not concentrated, no motivation

signs of behavioral distress

withdrawing socially or verbally, poor self care, impulsive behavior, talk of suicide, excessively demanding

indicators of dress grooming personal hygiene

-socioeconomic status, homelessness, access to resources

-are they dressed in more layers than expected? (fever, anemia, hypothyroidism, vascular disease, psych, emaciated)

-are they dressed in too few layers (meds, hyperthyroidism, menopausal, psych)

-grooming- hair brushed, clean, discheveled, dirty nails

pallor could mean

anemia, cardiovascular or pulmonary dysfunction, reduced blood flow in artery, shock

cyanosis could mean

hypoxia to affected tissues, anaphylactic rxn, pulmonary or heart dx, anemia, poison/meds

jaundice could mean

liver disease

cholestasis

cirrhosis

uniform could mean

are there areas that are different?

inflammatory process, birth mark, systemic diseases

dry or oily could mean

metabolic disease

types of lesions

primary, secondary

facial expressions could indicate

pain

mood

neurological and cranial nerve issues

disease states

medications

clues to disease from facies and expressions: endocrine

-protruding jaw of acromegaly

-moon facies of Cushing syndrome

-prominent stare of hypothyroidism

-vitiligo/increased freckling in Addison dx

clues to disease from facies and expressions: CNS

-masklike facies of Parkinsonism

-drooping eye, sleepy appearance of myasthenia gravis

clues to disease from facies and expressions: cardiovascular

prominent earlobe crease associated with coronary heart disease

clues to disease from facies and expressions: infectious

-leonine facies of leprosy

-slapped-cheek appearance of fifth disease

clues to disease from facies and expressions: renal

-periorbital edema in acute nephritis

-earlobe abnormalities in some congenital renal diseases

clues to disease from facies and expressions: misc

-taut, stretched facies of scleroderma

-butterfly rash in LE

-hirsutism from drug therapy (ex minoxidil)

lack of eye contact could mean

depression, neurologic conditions, contempt, nervous/scared

Excessively energetic movements or constantly watchful eyes suggest

tension, mania, anxiety, drugs (meth, cocaine)

body odor could mean

exercise, poor hygiene, food medications, metabolic conditions, diabetes, kidney disease, infections

acetone breath could mean

diabetic ketoacidosis

ammonia breath could mean

uti or kidney disease

cinnamon breath could mean

TB

bitter almonds could mean

cyanide poisoning

fresh baked bread could mean

typhoid fever

foul breath could mean

infection

manner means

patient outward behavior towards others

mood means

behavior suggestive of feeling or state of mind

underweight BMI

<18.5

normal BMI range

18.5-24.9

overweight BMI range

25-29.9

obese BMI range

30-34.9

extremely obese BMI

>35

normal body temp is approx

37C or 98.6 F

fever or pyrexia is a temperature

>37C but <41.1 C

>98.6 F but < 106 F

hyperpyrexia

is extreme elevation >41.1 C (106 F)

hypothermia is below

35 C (95F)

oral temps are LOWER than

rectal and tympanic

oral temps are HIGHER than

axillary and temporal

fever causes

infection, exercise, hot weather, reaction to immunization, connective tissue disease, malignancy, drugs

hypothermia causes

environmental exposures, hypothyroidism, sepsis, malnutrition, thiamine deficiency, hypoglycemia, ethanol abuse, medications

why do we take radial pulse

-to assess HR, rhythm and strength

-can contribute to dx of underlying cardiovascular diseases

-clues about nutritional and health status/fitness

always compare radial pulse _____

bilaterally!

normal radial pulse

60-100 bpm

average resting pulse rate for adults

70 beats per minute

athletes resting pulse rate

50-60bpm

tachycardia

>100bpm

tachycardia causes

medications

drugs and alcohol

hyperthyroidism

pneumonia

arrhythmias

congential

bradycardia

<60 bpm

bradycardia causes

anorexia nervosa

bulimia nervosa

CHF

hypothyroidism

aging

arrhythmia

asymmetric radial pulses causes

-aortic dissection

-subclavian steal syndrome

-coarctation of the aorta

cause of bounding pulse

hypertension

expected respiratory rate in adults

12-20 breaths per minuge

bradypnea

less than 12 breaths per minute

tachypnea

more than 20 breaths per min

factors affecting breath rate

age, obesity, lung diseases (asthma, COPD, infections, CF), exposure, muscle weakness, smoking, lack of O2 in environment, anxiety, pain, CNS, poisoning, drugs/medications

why do we take palpable blood pressure

to avoid being misled by an auscultatory gap when using the stethoscope

make sure to use the _____ to hear the low-pitch sounds produced by the _______ in the artery

bell

turbulence of blood flow in artery

what does audible BP measure

pressure of blood going through arteries

systolic bp

the force exerted when the ventricles contract and largely the result of cardiac output, blood volume, compliance of arteries

diastolic bp

force exerted by peripheral vascular resistance when heart is in the filling or relaxed state

audible bp readings can be skewed with factors such as

smoking, caffeine, emotional distress, physical activity, incorrect cuff size

taking bp in both arms decreases the risk of missing an

elevated bp

when you have difference of bp in arms, you should use the ___ bp reading overall

higher

studies have shown if the SBP is > 10mmHg difference in arms, the patient is at higher risk of a

cardiovascular event or stroke

normal bp level

Systolic <120 and

Diastolic <80

elevated bp level

Systolic: 120-129 and

Diastolic: <80

high blood pressure (hypertension) stage 1 level

systolic 130-139 or diastolic 80-89

high blood pressure (hypertension) stage 2 level

systolic 140 or higher or diastolic 90 or higher

hypertensive crisis level

(emergency)

systolic higher than 180 and/or diastolic higher than 120

complications of HTN

-CAD

-Stroke

-MI

-kidney disease/failure

-complications of pregnancy

-eye damage

-vascular disease

hypotension causes: arrhythmias

bradycardia

tachycardia

fibrillation

hypotension causes: structural disease

valve disease, ischemic heart disease, pericardial disease, cardiac tamponade, congenital, obstructive cardiomyopathy, dilated cardiomyopathy, dilated cardiomyopathy, primary pulmonary hypertension

hypotension causes: hypovolemia

hemorrhage, diarrhea, dehydration, orthostatic volume shifts, drugs (diuretics0

hypotension causes: systemic vasodilation

sepsis, anaphylaxis, neurogenic, autonomic dysfunction, drugs

hypotension causes: obstructive

pulmonary embolism

orthostatic hypotension defined as

sustained reduction of SBP of at least 20mmHg or in DBP of at least 10mmHg

orthostatic hypotension historical features and possible etiology

skin inspection: inspecting the skin for any lesions noting:

color

morphology

configuration

size

location

distribution

brown color of lesion/skin could indicate

darkening of melanin( hormonal, cancer)

white color of lesion/skin could indicate

absence of melanin (vitiligo, albinism)

red (ERYTHEMA) color of lesion/skin could indicate

increased cutaneous blood flow (infection, polycythemia)

yellow color of lesion/skin could indicate

increased bile/carotene pigmentation (liver disease, diet, impetigo)

blue color of lesion/skin could indicate

increased unsaturated hemoglobin (lung disease, hypoxia, ingestion of silver)

skin inspection: localized distribution means

lesions appear in one area (impetigo, herpes simplex, cellulitis, contact dermatitis)

skin inspection: regional distribution means

legions involve a specific part of the body (acne, psoriasis, pityriasis rosea)

skin inspection: generalized distribution means

lesions appear widely distributed (urticaria, drug rxn)

skin inspection: morphology: discrete means

well demarcated and defined (psoriasis)

skin inspection: morphology: indistinct means

poorly defined, have borders merging into normal skin (nummular eczema)

skin inspection: morphology: active means

margin of lesion shows greater activity than center (tinea eruptions)

skin inspection: morphology: irregular means

non smooth or notched margins (malignant melanoma)

skin inspection: morphology: border raised above means

center of lesion depressed compared to edge (basal cell carcinoma)