General Survey & Cultural Assessment Fa24

General Survey

  • A general survey involves assessing the whole person, covering:

    • General health state

    • Obvious physical characteristics

  • Begins at the moment of first encounter:

    • Observe body language, appearance, and verbal responses.

    • Note what the patient is doing upon entering the room.

    • Collect data while introducing yourself and shaking hands.

Aspects of General Survey

  • During health history, assessment, and vital signs, observe:

    1. Physical appearance

    2. Body structure

    3. Mobility

    4. Behavior

Physical Appearance

  • Age: Person appears their stated age.

  • Sex: Sexual development appropriate for gender and age.

  • Level of Consciousness: Person is alert, oriented, and responsive to questions.

  • Skin Color: Even tone, varying pigmentation, intact skin, no lesions.

  • Facial Features: Symmetric and capable of movement.

  • Distress: No signs of acute distress present.

Body Structure

  • Stature: Height within normal range for age and heritage.

  • Nutrition: Weight normal for height and body build; even body fat distribution.

  • Symmetry: Body parts are bilateral and proportionate.

  • Posture: Stands erect, with a normal plumb line.

Additional Body Structure Details

  • Position: Relaxed posture in chair, bed, or table.

  • Body Build: Proportions correct; arm span equals height.

  • Deformities: Note any congenital or acquired defects.

Mobility

  • Gait: Normal gait with a base as wide as the shoulders.

  • Foot Placement: Accurate, smooth, even, well-balanced with symmetric arm swing.

  • Range of Motion: Full mobility; deliberate, smooth, and coordinated movements.

  • Involuntary Movement: None present.

Behavior

  • Facial Expression: Maintains eye contact (cultural variations acknowledged);

    • Expressions appropriate for the situation.

  • Mood/Affect: Cooperative, pleasant interaction with the examiner.

  • Speech: Clear articulation, fluent, maintains an even pace.

    • Word choice is appropriate to culture and education.

  • Communication: Able to convey ideas clearly, possibly with an interpreter.

Continued Behavior Assessment

  • Dress: Culturally appropriate, clean, well-fitting, not deemed bizarre by standards.

  • Personal Hygiene: Appears clean and well-groomed according to age, occupation, and socio-economic group.

Aging Adult Considerations

  • Physical Appearance: By the 8th and 9th decades, more angular body contours; proportions may shift.

  • Posture: General flexion commonly observed.

  • Gait: Older adults adopt a wider base due to balance issues; arms often extended.

Measurements in Aging Adults

  • Weight: Appears sharper in contour; 80s and 90s may see weight loss, especially in men.

  • Fat Distribution: Subcutaneous fat loss from face/extremities; gain around abdomen.

  • Height: Many become shorter due to spinal shortening and posture changes.

Sample Patient Charting

  • Date/Time: 8/22/2023, 0830

  • Patient Profile: 47-year-old Hispanic male, high school principal.

  • Observation: Well-nourished, alert, cooperative, resting in bed.

  • Measurements:

    • Height: 163 cm (5’4”)

    • Weight: 77.1 kg (170 lbs)

    • Temperature: 37°C oral (98.6°F)

    • BP: 146/84 sitting

    • Heart Rate: 80

    • Respiratory Rate: 18

    • SpO2: 99% on room air.

  • Patient Status: Denies pain; has call light in hand.

Cultural Assessment

  • Importance of Cultural Awareness:

    • Understanding cultural diversity; being self-aware of one’s own culture is crucial.

    • Cultural self-assessment aids in becoming culturally competent.

Culturally Competent Care

  • Understanding own heritage-based cultural values is essential before addressing other cultures.

    • Recognizing biases is the first step to providing culturally sensitive care.

Cultural Concepts

  • Culture:

    • Learned through language and socialization.

    • Shared by group members and adapted to environmental conditions.

    • Dynamic and ever-changing.

Culture-Related Terminology

  • Ethnicity: Social group with shared traits.

    • Ethnic Identity: Self-identification with an ethnic group.

    • Acculturation: Adopting majority culture’s behaviors.

Religion vs. Spirituality

  • Spirituality: Broader belief encompassing something larger than oneself.

  • Religion: Organized system of beliefs that can fulfill spiritual needs; can exist separately from spirituality.

    • Use open-ended questions to understand patient’s preferences.

Disease Causation Theories

  • Biomedical: Cause and effect related to physical and psychological illnesses.

  • Naturalistic/Holistic: Beliefs in nature’s forces balancing the universe.

  • Magicoreligious: Supernatural forces influencing health and illness.

Traditional Treatments and Cultural Healers

  • Various cultures have their own healers:

    • Hispanic: Curandero, espiritualista.

    • Black: Hougan, spiritualist.

    • American Indian: Shaman.

    • Asian: Herbalists, acupuncturists.

Transcultural Expression of Pain

  • Pain management is influenced by cultural context.

  • Highly personal experience and can involve silent suffering.

Culturally Competent Nursing

  • Culturally Sensitive: Basic understanding of diverse cultures.

  • Culturally Appropriate: Application of cultural knowledge for health improvement.

  • Culturally Competent: Universal understanding applied within care context.

Developing Cultural Sensibility

  • Explore personal history and culture to understand how it affects care provision.

  • Recognizing one’s own values and beliefs enables better service to others.

Cultural Assessment Inquiry Suggestions

  • Assess family roles, traditions, community involvement, and communication of tough topics.