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When does the general survey begin?
1st moments of patient encounter
What vital signs should be documented during the general survey?
- Normal ranges for all
What is often associated as the 5th vital sign?
What are the common or concerning symptoms of the health hx for the gen survey?
- Wt change
- Fever, chills, night sweats
What are some good questions to start with when concerning changes in weight?
- How often do you check your wt?
- How is it compared to a yr ago?
- Why do you think it has changed?
- What would you like to weigh
Does rapid changes in wt over a few days indicated change in tissue or body fluids?
What can be associated with rapid weight loss?
- Not enough food supply
- GI absorption issues
- Increased metabolism
- Loss of nutrients-urine, feces, or skin
What does wt loss with a relatively high food intake suggest?
What is fatigue?
Nonspecific symptom w/many causes & refers to weariness or energy loss
What type of questioning do you want to ask when dealing w/concerns of fatigue?
Open-ended & have patient describe what they are exp
What is weakness?
Denotes a loss of muscle power
Fatigue is a common symptom of depression & anxiety states but it is important to also consider what?
- Endocrine disorders
- Heart failure
- Pulmonary disease
- Kidneys or liver
- Electrolyte imbalance
- Nutritional deficits & malignancies
If weakness is localized in a neuroanatomical pattern in may suggest what?
When is a good time to ask about fever?
Acute or chronic illness
What is the normal pattern of body temp throughout the day & how does a fever exaggerate this?
- Body temp is normally higher in the day & falls at night
- Fever changes this pattern & typically night sweats occur
What are some general symptoms that often accompany a fever?
- Muscle & joint pain
During menopause what are some common feelings?
Heat & sweating
Night sweats are also seen in patients that have what?
What is the most important thing to focus on when dealing with concerns of a fever?
- Timing of illness
- Associated symptoms
What is one of the most common symptoms prompting office care?
What are the important topics for health promotion & counseling during the gen survey?
- Optimal wt, nutrition, diet
Overweight is characterized by a BMI of what?
25.0 to 29.9
Obesity is characterized by a BMI of what?
30.0 to 34.9
Obesity II is charactrized by a BMI of what?
35.0 to 39.9
Extreme obesity is characterized by a BMI of what?
Greater than or equal to 40
The normal range for BMI is what?
18.5 to 24.9
Underweight is characterized by a BMI of what?
Less than 18.5
If a patient reduces their wt by 5% to 10% they can improve what?
- Glucose tolerance
- Reduce risk for DM & hypertension
What are some tips for promoting optimal wt & nutrition?
- BMI & waist circumference measurments
- Risk factors for HD & obesity related diseases
- Dietary intake
- Patient's motivation to change
What are the 9 key messages when promoting patient health?
- Variety of foods among basic food groups-staying w/in energy needs
- Control portion size to manage bw
- 30 min of daily exs
- Increase intake of fruits & veggies, whole grains, nonfat or lowfat dairy
- Choose fats wisely-sat,trans,cholesterol low
- Carbs-sugars, starches, fiber
- Little salt
- Alcohol in moderation
- Keep food safe to eat
What is important for the adolescent & childbearing female to increase their daily intake of what?
It is important for older adults to identify w/foods that are rich in what?
VB12 & Ca+
What is important to discuss w/patients in regards to blood pressure & diet?
Reg & freq exs, decreased Na intake & increased K intake along with healthy wt reduces risk for hypertension & lowers BP
What is the daily recommended intake of sodium per day?
2400mg or 1tsp
The general appearance of the general survey begins as soon as the clinician enters the room & making note of what?
- Apparent state of health
- Level of consciousness
- Signs of distress
- Skin color
- Dress, grooming, personal hygiene
- Facial expressions
- Odors of body & breath
- Posture, gait, motor activity
How do you select the proper blood pressure cuff size?
- Width-40% of upper arm circumference
- Length-80% UAC
What happens if the cuff is too small (narrow) when recording BP?
BP will read high
What happens if the cuff is too large (wide) when recording BP?
- BP will read low small arm
- BP will read high lrg arm
When recording an accurate BP how long should the patient refrain from drinking caffeinated beverages or smoking?
At least 30 min
How should the examining room be for the patient when getting ready to get a BP checked?
Quiet & comfortably warm
How long should the patient be seated b4 recording BP & where should their arm level be at?
Should the arm selected have clothing around it or be free of clothing?
Free of clothing
How should the arm be positioned for the most accurate BP?
Heart level-4th interspace
What will happen if the brachial artery is 7 to 8 cm below heart level during a BP recording?
BP will read about 6 cm higher
What will happen if the brachial artery is 6 to 7 cm higher than heart level during a BP recording?
BP will read 5 cm lower
What can most likely occur if the cuff is loose or bladder balloons outside the cuff?
False high reading
How should the cuff be placed on the arm for a BP?
Centered over Brachial a w/lower border about 2.5 cm above antecubital crease.
How do you determine how high to raise the cuff pressure?
1st-estimate systolic pr by palpation of radial a & inflate cuff until radial pulse disappears & note pressure then add 30 mm HG to this number.
Why is it important to estimate how high to inflate the cuff for a BP?
- Prevents unnecessarily high cuff pr
- Avoids ausculatory gap
What is the ausculatory gap?
Silent interval that may be present btwn sys & dia pr
How long should you wait after estimating how high to inflate the cuff?
15 to 30s
What can possibly happen with an unrecognized auscultatory gap?
Lead to serious underestimation of sys pr or overestimation of dia pr
Korotkoff sounds are relatively high or low pitch sounds & heard better w/bell or diaphragm?
An auscultatory gap is associated with what?
- Arterial stiffness
- Atherosclerotic disease
What is the normal range for BP?
- Sys-less than 120
- Dia-less than 80
Pre-hypertension is classified as what?
- Sys-120 to 139
- Dia-80 to 89
Hypertension stage 1 is classified as what?
- Sys- 140 to 159
- Dia- 90-99
Hypertension stage 2 is classified as what?
- Sys greater than 160
- Dia greater than 100
Hypertension also effects on end organs which include?
What is the normal HR?
How do you identify an irregular heart rhythm?
- Beats appear in basic rhythm
- Irregularity vary consistently w/respiration
- Totally irregular
What is the normal respiratory rate for an adult?
20 breaths pm
What do you want to observe when recording respiratory rate & rhythm?
- Effort of breathing
How do you measure respiratory rate & rhythm?
Count number respirations in 1 min
What is the typical avg temp?
Are rectal temperatures higher or lower than oral temps & what is the difference?
Higher-.4 to .5 C
Are axillary temp higher or lower than oral temps & what is the difference?
Lower-1 C but take about 5-10min to register
If a patient has a weak or inaudible korotkoff sound what can you have them do to try to increase the intensity of the sounds?
- Raise arm b4 & while you inflate cuff then lower arm to determine BP
- Inflate cuff & have them make fist several times
What is white coat hypertension?
BP higher in office than at home/relaxed setting
How do you term if the pain is considered chronic pain?
- Greater than 3-6mo's
- Greater than 1mo for acute illness/inj
- Pain recurring at intervals of mo's/yrs
When dealing with the pain patient how should you go about the patients history?
- Associated features
- Attempted tx, meds, related illnesses & impact on ADL's
- Health disparities
When is it appropriate to use the face pain scale in the clinical setting?
- Language barriers
- Cognitive impairment
What are the different types of pain?
- Nociceptive or somatic
What is the pain that is related to tissue damage?
What is the pain that is related to direct injury to the peripheral or CNS?
What is the pain that is associated with many factors that influence the patients report of pain to include: psychiatric, personality, coping style, cultural norms, & social support systems?
What is the pain that is associated without an identifiable etiology?
What are the four A's to monitor patient outcomes?
- Adverse effects
- Aberrant drug-related behaviors
What is the state of adaptation in which exposure to a drug induces changes that result in diminution of one or more of the drug's effects over time?
What is the state of adapatation that is manifested by a drug-class specific w/drawl syndrome?
What is the primary, chronic, neurobiological disease, with genetic, psychosocial, and environmental factors influencing its development & manifestations?
The normal resp rate range is btwn?
- Up to 44 infants
Slow breathing is termed?
Rapid shallow breathing is termed?
Rapid deep breathing is termed?
Hyperpnea or hyperventilation