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General Health and Susceptibility to Infection

  • General ill health and malnutrition increase susceptibility to infection.

Observation of Patient Symptoms and Signs

  • Diaphoresis: Profuse sweating indicating:

    • Fever

    • Pain

    • Severe stress

    • Increased metabolism

    • Acute anxiety

  • Facial Expressions: Communicate the patient's internal state particularly regarding stress response.

    • Specific patterns observed can precede clinical deterioration.

    • By observing facial expressions, healthcare providers may intuit pain, anxiety, alertness, and mood.

  • Body Positioning: Useful for assessing severity of pulmonary problems.

    • Tripod Sign: Patients with severe pulmonary hyperinflation often sit upright bracing their elbows on a table to give mechanical advantage to accessory breathing muscles.

Level of Consciousness

  • Sensorium: Term used to evaluate cognitive functioning and level of consciousness.

    • Evaluated by asking if patients are aware of:

    • Current circumstances (time, place, person, situation).

    • Normal sensorium is indicated by the ability to correctly identify:

    • Name

    • Current date

    • Location

    • Situation (e.g., "I'm in the hospital because I fell and broke my hip")

    • Documented as "oriented × 4."

  • Depressed Consciousness: May occur from:

    • Impaired cerebral blood flow (e.g., hypotension, neurovascular lesions).

    • May exhibit restlessness, confusion, disorientation leading to loss of consciousness under hypoxemia.

  • Glasgow Coma Scale (GCS):

    • Assesses consciousness and neurologic function using:

    • Eye opening

    • Verbal response

    • Motor response

    • Scores range from 3 (deep coma) to 15 (normal sensorium).

Vital Signs

  • Definition: Vital signs include body temperature, pulse rate, respiratory rate, blood pressure, and pulse oximetry, which are crucial for patient monitoring.

    • Abnormal vital signs often indicate adverse reactions to treatment; improvement suggests effective treatment.

Body Temperature

  • Normal Adult Temperature: Approximately 37°C (98.6°F) with usual fluctuations of ±0.5°C (1°F).

  • Regulation of body temperature occurs via:

    • Hypothalamus controlling skin perfusion and heat conservation.

    • Controlled largely through sweating (diaphoresis).

  • Hyperthermia: Elevated body temperature > 38.3°C (101°F) can result from:

    • Disease or normal activity.

    • Fever increases metabolism, affecting O₂ consumption and CO₂ production, thus increasing demand on heart and lungs.

  • Common Sources of Fever:

    • Bacterial, viral, fungal infections.

    • Noninfectious causes such as malignancies, head trauma, burns, and inflammatory diseases.

    • Fever of Unknown Origin (FUO): Sustained unexplained fever, common in patients with HIV.

  • Temperature Elevation Implications:

    • Low-grade fever often accompanies upper respiratory infections.

    • High fevers may signal influenza, pneumonia (especially when accompanied by cough or purulent sputum).

Hypothermia

  • Definition: Body temperature below normal due to prolonged cold exposure.

  • Hypothalamus response includes shivering and vasoconstriction to conserve heat.

  • Pathological causes of hypothermia:

    • Trauma to the hypothalamus, thyroid issues, or sepsis.

  • Symptoms of Hypothermia: Slow, shallow respiratory rate and decreased pulse rate due to reduced O₂ consumption and CO₂ production.

  • Temperature Measurement Sites:

    • Mouth, axilla, ear (tympanic), rectum.

    • Oral site unsuitable for infants or patients with certain conditions; axillary temperature often underestimates core temperature.

Pulse Rate

  • Evaluation includes rate, rhythm, and strength.

  • Normal Rate: 60 to 100 beats/min.

    • Tachycardia: >100 beats/min due to:

    • Exercise, fear, anxiety, low blood pressure, anemia, fever, hypoxemia, hypercapnia, certain medications.

    • Bradycardia: <60 beats/min due to:

    • Hypothermia, traumatic brain or cervical spinal injuries, arrhythmias, some medications.

  • Common Site for Pulse Evaluation: Radial artery; counted ideally for 1 minute, especially if irregular.

  • Pulse Characteristics:

    • Influenced by spontaneous ventilation; pulse strength slightly decreases during inspiration due to a reduction in stroke volume.

    • Pulsus Paradoxus: Significant decrease in pulse strength (>10 mm Hg) during inspiration; associated with:

    • Acute obstructive pulmonary disease, asthma, cardiac tamponade.

    • Pulsus Alternans: Alternating strong and weak pulses signaling left-sided heart failure rather than pulmonary disease.