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What are eight considerations for the general survey?
- 1) Measure height, weight, BP and TPR
- 2) Provides an exam gown; ask pt if he/she needs assistance, otherwise repect pt privacy
- 3) Wash hands before having contact with the pt
- 4) Explain each step
- 5) Give encouragement as you proceed
- 6) Organize the exam for optimal efficiency and patient comfort
- 7) Use a systematic approach so as not to forget anything
- 8) Give a summary of findings and give an opportunity for questions
What are the components for general survey?
- 1) Physical Appearance
- - age
- - sex
- - skin
- - facial features
- - signs of acute distress
- - personal hygiene
- 2) Body Structure
- - stature
- - nutrition
- - symmetry
- - posture
- - position
- - body build and contour
- - physical deformities
4) Metal Status and Behavior
Clinical Measurements analyzed in relation to:
- 1) normal ranges (e.g. B/P, P, R)
- 2) client's recent values and serial reading (e.g. daily weights for fluid monitoring in heart failure)
- 3) diagnosis (e.g. with cancer, you may expect the pt to be underweight)
When taking pt's weight you should...
- 1) remove shoes and heavy clothing
- 2) take serial weights
What are 5 factors of weight gain?
- 1) overeating or decreased activity
- 2) fluid volume excess
- - 2.2 pound weight gain
- - more than 2-3 lbs/wk is significant (may be related to heart failure)
- 3) hypothyroidism (slows metabolism)
- 4) Drug therapy
- 5) diabetes
What are 5 factors of weight loss?
- 1) Anorexia or decreased intake
- 2) dehydration
- 3) increased metabolic rate
- 4) diabetes (new onset or poor control)
- 5) malignancy, etc.
What are 6 factors temperature is affected by?
- 1) diurnal cycle (1-1.5 F change)
- - peak: late afternoon (4 pm)
- - trough: early am (4 am)
- 2) menstrual cycle (temp increase 0.5- 1.0 starting at midcycle ovulation through menses due to progesterone secretion
- 3) moderate/heavy exercise
- 4) age
- - children under 8 yo have high fevers with minor illness (e.g. 103-105 F)
- - older adults (increased risk for hypothermia)
- 5) illness
- 6) prolonged exposure to cold
What are the norms for oral, rectal, tympanic, and axillary temperature?
- Oral: 98.6 F (range- 96.4-99.1)
- 37 C ( range- 35.8-37.3)
- rectal: 1 F or 0.5 C higher than oral
- tympanic: 1 F or 0.5 C higher than oral
- axillary: 1 F or 0.5 C lower than oral
What is fever defined as?
101-101.5 F or 38-38.5 C
What is the technique for taking oral, rectal, axillary, and tympanic temperature.
- 1) Oral temp(use blue tip probe)
- - insert at base of tongue (sublingual pocket)
- - wait 15 minutes after hot/cold fluids, 2 min after smoking
- 2) Rectal (use red tip probe)
- - insert 1 in (use lubricant)
- 3) tympanic (use tympanic ear tip) - unreliable with ear infection or local inflammation (tooth)
- 4) axillary (use red tip probe)
What is sinus arrhythmia?
pulse increases with inspiration and decreases with expiration (common in children and young adults)
How do you take a child's pulse until 2 yo?
apical pulse, then radial count x 1 min
What is bradycardia and tachycardia?
- bradycardia <60 bpm
- tachycardia >60 bpm
What are 8 factors that affect pulse rate?
- 1) age (higher in children)
- 2) female
- 3) exercise
- 4) anxiety
- 5) pain
- 6) fever
- 7) dehydration
- 8) anemia
What is the pulse deficit and what are the normal and abnormal factors?
- pulse deficit: difference between apical and radial pulse
- - a healthy heart the apical rate should be the same as the radial rate.
- - if the apical rate is higher than the radial rate, then this indicates a cardiac arrhythmia
What is the pulse strength and what is the scale?
: force created in the artery by the stroke volume
- 4+ bounding
- 3+ full (norm during exercise)
- 2+ normal
- 1+ weak, thready
- 0 absent
What are the 5 factors to assess for respirations?
- 1) assess rhythm
- - if rhythm is regular: count for 30 sec and multiply by 2
- - if the rhythm is irregular: count for 60 seconds
- - children: count for 60 seconds
- 2) rate (varies with age and fitness)
- - children: age specific variations
- - adult norms: 10-20/min
- 3) depth
- - shallow, moderate, or deep.
- 4) Character
- - thoracic (women)
- - abdominal (men and infants)
- 5) abnormal patterns (hyperventilation, hypoventilation, apnea, dyspnea, etc.)
Define blood pressure, systolic pressure, pulse pressure, mean arterial pressure
- blood pressure: force exerted against walls of peripheral vessels during cardiac cycle
- systolic pressure: maximum pressure exerted on arterial walls during ventricular contraction
- pulse pressure: difference between systolic and diastolic B/P
- mean arterial pressure: (pressure forcing blood into the tissues averaged over the cardiac cycle)
- - MAP= DPB + 1/3 pulse pressure
What are the factors determining B/P?
- 1) Cardiac Output
- 2) Volume of Circulating Blood
- 3) Blood viscosity (increased pressure with thicker blood)
- 4) Peripheral Vascular Resistance (PVR)- increased pressure is generated to pump against constricted blood vessels.
- 5) sympathetic nervous system stimulation (stress--->stimulates SNS---> vasoconstriction--> increased blood pressure)
- 6) elasticity of vessels walls (increased pressure with stiffer vessels; occurs with arteriosclerosis)
What is the range for prehypertension and hypertension?
- prehypertension: SBP 120-139; DBP: 80-89
- hypertension: SBP more than or equal to 140; DBP more than or equal to 90
What is the goal blood pressure for patient with diabetes?
less than 130/80
What are some assessments in regard to HTN as a medical diagnoses?
- - document B/P until the diagnoses is mad; requires serial B/Ps to establish the diagnosis of HTN
- - check B/P in both arms (use the highest reading)
What are 11 factors that affect blood pressure?
- 1. Age
- 2. Male gender
- 3. Race (e.g. African Americans)
- 4. Diurnal Rhythm: highest in late afternoon and lowest in early am
- 5. Obesity
- 6. Exercise
- 7. Emotions, stress and pain (stimulation of SNS)
- 8. Smoking (wait 30 min before taking B/P)
- 9. ETOH
- 10. Meds (NSAIDS, pseudoephedrine [decongestants]
- 11. white coat syndrome
If B/P differs between arms, what reading would you use?
use the highest B/P reading
What is the Auscultatory Gap?
If present, there can be an unusually long silence (ranging from 10-40 mm) between the 1st and 2nd heart sound.
What is paradoxical pulse mean? What can it implicate?
- Normally the difference in SBP between inspiration and expiration = 5 mm Hg
- paradoxical pulse: If the difference is > then 10 mm Hg
- -this could mean cardiac tamponade, constrictive pericarditis or great respiratory effort (emphysema)
What is orthostatic hypotension?
- a significant drop in blood pressure that occurs when changing positions (from standing to sitting to standing)
- - results from peripheral vasodilation w/o compensatory increase in CO
- - check B/P and pulse when lying, then reassess B/P and pulse in sitting and
- standing positions..
- - wait 5 minutes between position changes before rechecking B/P and pulse
What is orthostasis?
a drop in SBP >20 mm Hg or pulse increase of >20 bpm between lying, sitting and or standing positions
What are three causes orthostatic hypotension?
- 1) hypovolemia (dehydration)
- 2) bedrest
- 3) medications (vasodilators)