Chapter 9- General Survey, Measurements & Vital Signs

The general survey is a study of whole person

• Covers general health state and any obvious physical characteristics
• An introduction for physical examination that will follow; should give an overall impression of person

Abnormal Findings:

In Body Height & Proportion

See pg. 154

Vital Signs

Achondroplastic Dwarfism

Hypopituatary Dwarfism

• genetic disorder converting cartilage to bone
• normal trunk size
• short arms, legs and stature
• relative large head
• lumbar lordosis and abdominal protrusion

Acromegaly

Temperature

• deficiency in growth hormone
• appears much younger than chronological age
• infantile facial features

• excessive secretion of growth hormone in adulthood
• overgrowth of bones in face, head, hands and feet
• no change in height
• internal organs enlarge also

Pulse

Normal temperature is influenced by: (cont.)

• Exercise: moderate to hard exercise increases body temperature
• Age: wider normal variations occur in infant and young child due to less effective heat control mechanisms; in older adults, temperature usually lower than in other age groups, with a mean of 36.2° C (97.2° F)
• Oral temperature accurate and convenient
• Oral sublingual site has rich blood supply from carotid arteries that quickly responds to changes in inner core temperature

Assess pulse, including

• Rate
• Rhythm
• Force
• Elasticity

Endongenous Obesity- Cushing Syndrome

Temperature

Gigantism

• either administration of adrenocorticotropin (ACTH) or excessive production of ACTH by pituitary gland
• weight gain & edema with central trunk & cervical obesity
• round face (moon face)
• excessive catabolism causes muscle wasting, weakness, thin arms and legs
• reduced height
• fragile skin, bruising and acne
• difference from exogenous obesity. body fat is evening distributed and mm. strength is intact

Anorexia Nervosa

Heart Rate cont....

Temperature (cont.)

• Normal oral temperature in a resting person is 37° C (98.6° F), with a range of 35.8° C to 37.3° C (96.4° F to 99.1° F)
• Rectal measures 0.4° C to 0.5° C (0.7° F to 1° F) higher
• Normal temperature is influenced by:
• Diurnal cycle of 1° F to 1.5° F, with trough occurring in early morning hours and peak occurring in late afternoon to early evening
• Menstruation cycle in women; progesterone secretion, occurring with ovulation at midcycle, causes a 0.5° F to 1.0° F rise in temperature that continues until menses

• Excessive secretion of growth hormone
• increased height
• increased weight

Respirations

Blood Pressure

• serious psychological disorder
• severe, life-threatening weight loss
• amenorrhea in women
• disorted body image

• Bradycardia
• Tachycardia

• Average BP in young adult is 120/80 mm Hg; varies normally with many factors, such as:
• Age: gradual rise through childhood and into adult years
• Gender: after puberty, females show a lower BP than males; after menopause, females higher than males
• Race: African American adult’s BP usually higher than white person’s of same age
• The incidence of hypertension is twice as high in African Americans as in whites; reasons for difference not understood fully but appear to be due to genetic heritage and environmental factors

• Count for 30 seconds, or full minute if you suspect an abnormality
• Avoid 15-second interval; the result can vary by a factor of + or - 4, which is significant with small number
• Normally, both pulse and respiratory rates rise as a response to exercise or anxiety

Blood Pressure

Pulse

• Stroke volume: amount of blood every heart beat pumps into aorta
• Palpating peripheral pulse gives rate and rhythm of heartbeat, as well as local data on condition of artery
• Radial pulse usually palpated while vital signs measured
• Using pads of the first three fingers, palpate radial pulse at flexor aspect of wrist laterally along radius bone
• Push until strongest pulsation is felt
• 15 vs. 30 sec

• Average BP in young adult is 120/80 mm Hg; varies normally with many factors, such as: (cont.)
• Diurnal rhythm: daily cycle climbs to high in late afternoon or early evening and declines to an early morning low
• Weight: higher in obese persons
• Emotions: momentarily rises with fear, anger, and pain as a result of stimulation of the sympathetic nervous system
• Stress: elevated in persons feeling continual tension because of lifestyle, occupational stress, or life problems

Heart Rate

Blood Pressure

• In resting adult, normal heart rate range is 60 to 100 beats per minute (bpm)
• Rate normally varies with age, and is more rapid in infancy and childhood and moderate during adult and older years
• Rate also varies with gender; after puberty, females have slightly faster rate than males
• In adult, a heart rate less than 60 bpm is bradycardia
• This occurs normally in well-trained athlete whose heart muscle develops along with skeletal muscles
• Why?

Blood Pressure

• Level of BP determined by five factors
• Cardiac output: if heart pumps more blood into blood vessels, pressure on container walls increases
• Peripheral vascular resistance: opposition to blood flow through arteries; when vessels becomes smaller or constricted pressure needed to push becomes greater
• Volume of circulating blood: refers to how tightly blood is packed into arteries; increasing contents in vessels increases pressure
• Viscosity: “thickness” of blood determined by its formed elements, blood cells; when contents thicker, pressure increases
• Elasticity of vessel walls

• Blood pressure (BP) is force of blood pushing against side of its container, vessel wall
• Strength of push changes with event in cardiac cycle
• Systolic pressure: maximum pressure felt on artery during left ventricular contraction, or systole
• Diastolic pressure: elastic recoil, or resting, pressure that blood exerts constantly between each contraction

General Survey

Objective Data

For Thursday.....

Objective Data

Physical appearance

• Age: person appears his or her stated age
• Sex: sexual development appropriate for gender and age
• Level of consciousness: person alert and oriented, attends to your questions and responds appropriately
• Skin color: color tone even, pigmentation varying with genetic background, skin intact with no obvious lesions

Launch a general survey at moment you first encounter person

Body structure

• Stature: height appears within normal range for age, genetic heritage
• Nutrition: weight appears within normal range for height and body build; body fat distribution even
• Symmetry: body parts look equal bilaterally and are in relative proportion
• Posture: person stands comfortably erect as appropriate for age
• Note normal “plumb line” through anterior ear, shoulder, hip, patella, ankle

Measurements

Objective Data

• Mobility, gait
• behavior , affect

Objective Data

Physical appearance (cont.)

Facial features:

• symmetric with movement
• No signs of acute distress present

Body structure (cont.)

• Body build, contour: proportions are correct
• Arm span (fingertip to fingertip) equals height
• Body length from crown to pubis roughly equal to length from pubis to sole
• Obvious physical deformities: note any congenital or acquired defects

Body structure (cont.)

Exceptions:

• Standing toddler who has a normally protuberant abdomen (toddler lordosis)
• Aging person who may be stooped with kyphosis
• Position: person sits comfortably in chair or on bed or examining table, arms relaxed at sides, head turned to examiner

• Height
• Weight
• BMI- p. 131
• Wait to hip ratio
• Assesses body fat distribution as indicator of health risk
• Obese persons with a greater proportion of fat in upper body, especially in abdomen, have android obesity
• Obese persons with most of fat in hips and thighs have gynoid obesity

Chapter 9- General Survey, Measurements & Vital Signs