PHYSICAL EXAM OVERVIEW GENERAL SURVEY VITAL SIGNS Ian

PHYSICAL EXAM OVERVIEW GENERAL SURVEY VITAL SIGNS Ian V. Sumagaysay, RN, MAN Clinical Instructor

Lecture Outline • OVERVIEW – comfort – sequence – maneuvers • GENERAL SURVEY • VITAL SIGNS and MEASUREMENTS

Physical Examination OVERVIEW • COMFORT – Your comfort – Patient’s comfort

Physical Examination OVERVIEW • SEQUENCE – perform regional sequence • maximize effeciency • minimize patient movement

Physical Examination OVERVIEW • Examination maneuvers – – inspection palpation percussion auscultation

Lecture Outline • OVERVIEW • GENERAL SURVEY – – definition anatomy and physiology history considerations techniques of examination • VITAL SIGNS and MEASUREMENTS

GENERAL SURVEY AN OVERVIEW OF THE PERSON AS A WHOLE Documented as a narrative at the beginning of the physical exam.

GENERAL SURVEY Historical Considerations • • WEIGHT FATIGUE WEAKNESS FEVER

General Survey Items • OBSERVATION OF • • Overall appearance General state of health Nutrition and hydration Mobility Height-weight-build Sexual development Extracorporeal

General Survey Items • Overall appearance Things that you notice right away and things that you notice later (Gone With the Wind) – – – apparent age dress, grooming, hygiene obvious skin abnormalities asymmetries other obvious problems

General Survey Items • General State of Health – apparent state of overall health frail, robust, ill – signs of distress breathing, pain, anxiety

General Survey Items • Nutrition and Hydration – – Cachexic Muscle wasting Obese Dehydrated

General Survey Items • MOBILITY – – lying in bed sitting comfortably in the chair unable to remain still gait - ambulates with assistive device. limps – Posture

General Survey Items • Height-Weight-Build – – short vs tall lanky, symmetrical slender, plump fat distribution

Height-Weight-Build • dependant on • • • genetics nutrition early illnesses gender geography age

Height-Weight-Build Age Dependant Proportions

Height-Weight-Build Age Dependant Proportions

Height-Weight-Build Fat Distribution

General Survey Items • Sexual development – – Tanner Staging voice facial hair breast size

General Survey Items • Extracorproreal – – – – other things around the room/person bedside books nicotine stains lots of flowers rosary beads empty walls and table odors - alcohol, urine

Example Write-up • The patient is a moderately obese, young adult caucasian male who appears his stated age of 33 and is in no acute distress. Patient ambulates without difficulty and moves freely. He appears well-groomed, clean, and is dressed in an examination gown. Patient talks freely but appears to be somewhat anxious.

Lecture Outline • OVERVIEW • GENERAL SURVEY • VITAL SIGNS and MEASUREMENTS – – – Temperature Pulse Respirations Blood Pressure Height Weight

Temperature • PHYSIOLOGY – thermoregulatory mechanisms – fever – hypothermia • METHODS • FALSE READINGS • “AFEBRILE”

Pulse • PHYSIOLOGY • METHODS – peripheral – apical • CHARACTER – rate – rhythm – force

Respirations • PHYSIOLOGY • METHOD • CHARACTERISTICS – Rate – Rhythm – Effort

Blood Pressure • PHYSIOLOGY • METHOD – environment – positioning – technique • CHARACTERISTICS • RECORDING