GENERAL SURVEY

Physical development and body build Gender/sexual development Apparent age Skin condition and color Dress and hygiene Posture and gait Level of consciousness Behaviors, body movements, and affect Facial expression Speech Vital signs

RESPIRATIONS Observe rise and fall of chest with each breath: Rate and Rhythm and Depth <12bradynpea >20tachypnea In older adults: normal 15-22, rate may increase with shallower inspiratory phase Rhythm: Regular or Irregular Depth: Normal: Equal, bilateral chest expansion Abnormal: unequal, shallow, extremely deep chest expansion, labored, or gasping

TEMPERATURE Normal: 96.0-99.9 orally In older adults: 95.0-97.5 These things affect temp: strenuous exercise, stress, ovulation Body temp is lowest in early morning (4am-6am) Body temp is highest late in evening (8pm-midnight)

BLOOD PRESSURE
Measure on dominant arm first. Take BP in both arms when recording for the first time. A pressure difference of 10 mm Hg between arms is normal A drop of < 20 mm Hg from recorded sitting is normal. Orthostatic hypotension: a drop of > 20 mm Hg or more from the recorded sitting BP may indicate orthostatic hypotension Assess pulse pressure: Normal 30-50 mm Hg; widening pulse pressure due to aging and less elastic peripheral arteries. If pulse pressure < 30 mm Hg or > 50 mm Hgcardiovascular disease. When taking BP, arm should be supported at heart level and bladder of cuff should encircle arm at least 80% of the arm circumference. DO NOT TALK

CHAPTER 7: ASSESSING GENERAL STATUS & VITAL SIGNS

ORDER TO TAKE VITAL SIGNS 1ST Temperature 2nd Pulse 3rd Respiration 4th Blood pressure

PULSE Definition: shock wave produced when the heart contracts and forcefully pumps blood out of the ventricles to the aorta. Characteristics to assess: Rate, Rhythm, Amplitude and Contour, and Elasticity. Amplitude can be quantified as follows: 1+ Thready or weak (easy to obliterate) 2+ Normal (obliterate with moderate pressure) 3+ Bounding (unable to obliterate or requires very firm pressure) Rhythm: Regular OR Irregular Rate: Bradycardia, Normal, Tachycardia Contour: Normal: Upstroke smooth, gradual downstroke Note: a delayed upstroke, bounding pulse or thready pulse is ABNORMAL If amplitude and contour are abnormal, follow-up by palpating carotid arteries. Elasticity: Normal (straight, resilient, springy. Abnormal (Rigid)