General Survey Measurement Vital Signs Chapter 9 Elsevier

General Survey, Measurement, Vital Signs Chapter 9 Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 9 -

Chapter 9: General Survey, Measurement, Vital Signs General Survey Physical appearance Body structure Ø Age Ø Stature Ø Sex Ø Nutrition Ø Level of consciousness Ø Symmetry Ø Posture Ø Position Ø Body build, contour Ø Skin color Ø Facial features Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. 2

Chapter 9: General Survey, Measurement, Vital Signs General Survey (cont. ) Mobility Behavior Ø Gait Ø Facial expression Ø Range of motion Ø Mood and affect Ø Speech Ø Dress Ø Personal hygiene Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. 3

Chapter 9: General Survey, Measurement, Vital Signs Measurement Weight Ø Balance scale Ø Recommended range for height Height Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. 4

Chapter 9: General Survey, Measurement, Vital Signs Temperature Hypothalamus as thermostat mechanism Ø Influences on temperature Ø • • Ø Diurnal cycle Menstrual cycle Exercise Age Routes of temperature measurement • • • Oral Electronic thermometer Axillary Rectal Tympanic membrane thermometer Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. 5

Chapter 9: General Survey, Measurement, Vital Signs (cont. ) Pulse Stroke volume Ø Technique of measurement Ø Rate • Normal rate for age group • Bradycardia • Tachycardia Ø Rhythm • Sinus arrhythmia Ø Force Ø Elasticity Ø Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. 6

Chapter 9: General Survey, Measurement, Vital Signs (cont. ) Respirations Ø Technique of measurement Ø Normal rate for age group Ø Ratio of pulse rate to respiratory rate should be approximately 4: 1 Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. 7

Chapter 9: General Survey, Measurement, Vital Signs (cont. ) Blood pressure Ø Systolic pressure Ø Diastolic pressure Ø Pulse pressure Ø Mean arterial pressure Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. 8

Chapter 9: General Survey, Measurement, Vital Signs Blood Pressure Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. 9

Chapter 9: General Survey, Measurement, Vital Signs (cont. ) Ø Influences on blood pressure • Age • Race • Weight • Emotions • Sex • Diurnal rhythm • Exercise • Stress Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. 10

Chapter 9: General Survey, Measurement, Vital Signs (cont. ) Ø Physiologic factors controlling blood pressure • Cardiac output • Peripheral vascular resistance • Volume of circulating blood • Viscosity • Elasticity of vessel walls Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. 11

Chapter 9: General Survey, Measurement, Vital Signs Factors Controlling Blood Pressure Illustration Pat Thomas, © 2006 Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. 12

Chapter 9: General Survey, Measurement, Vital Signs (cont. ) Blood pressure measurement Ø Sphygmomanometer Ø Cuff width and size Ø Blood pressure measurement in the arm • • Position of person Palpate brachial artery Proper inflation and deflation technique Korotkoff’s sounds I, systolic pressure IV, muffling of sounds V, diastolic pressure Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. 13

Chapter 9: General Survey, Measurement, Vital Signs Measuring Blood Pressure Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. 14

Chapter 9: General Survey, Measurement, Vital Signs (cont. ) Common errors in blood pressure measurement Ø Orthostatic (or postural) hypotension Ø Blood pressure measurement in the thigh • Thigh pressure higher than in the arm • Screen for coarctation of aorta Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. 15

Chapter 9: General Survey, Measurement, Vital Signs Sample Charting Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. 16

Chapter 9: General Survey, Measurement, Vital Signs Significant elevation in blood pressure measurements from one day to the next could be attributed to A. A decrease in cuff size B. An increase in cuff size C. New onset of pain or anxiety D. A and C Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. 17

Chapter 9: General Survey, Measurement, Vital Signs Which patient would be most likely to present with a pulse rate that is lower than normal? A. A 70 -year-old telephone salesman presenting with dehydration. B. A 20 -year-old runner who had surgery 4 days ago for a fractured leg. C. A 67 -year-old who presented with an exacerbation of his COPD Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. 18