GENERAL SURVEY

Prepared by:
NELLY JR. C. FREYRA-OMBAO, RN, MD
 Overall Impression
 Skin color  Level of comfort

 Dress  Behavior

 Hygiene  Body movement

 Posture  Affect

 Gait  Facial expression

 Body build  Speech

 Level of consciousness  Mental acuities

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 SOME TEAMS
Symmetry Trunk
Face and body Is he lean, stocky, obese?

Old Extremities
Deformities, edema
Does he look his age?
Mental Acuity Appearance
Is he clean or appropriately
Is he alert, confused,
dressed?
agitated or inattentive?
Movement
Expression
Posture, gait, coordination
Does he appear ill, in
Speech
pain or anxious?
Clear, appropriate, stressed

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 Mental Status Exam
 Level of consciousness
 Posture and body movements
 Dress, grooming and hygiene
 Facial expression and speech
 Mood, feelings, expressions
 Thought processes and perceptions
 Cognitive abilities

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 Mental Status Exam
 May include the following in certain
situations:
o Mini Mental State exam
o History of mental illness
o Behavioral changes
o Memory loss
o Brain lesions or injuries

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 Level of Consciousness
 Lethargic – client opens eyes; answers
questions and falls back asleep
 Obtunded – client opens eyes to loud voice,
responds slowly with confusion, seems
unaware of environment
 Stupor – client awakens to vigorous shake
or painful stimuli but returns to unresponsive
sleep

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 Level of Consciousness and Positioning

 Coma – client remains unresponsive to all

stimuli; eyes stay closed.
 Decorticate – client draws hands up to the
chest (corticospinal tract lesions)
 Decerebrate – client extends arms and legs,
arches neck and rotates hands and arms
internally (midbrain, pons, diencephalon
lesions)

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 Glasgow Coma Scale
Eye Opening Response Spontaneous opening---------------- 4
To verbal command------------------ 3
To pain--------------------------------- 2
No response--------------------------- 1

Most appropriate verbal response Oriented-------------------------------- 5

Confused------------------------------ 4
Inappropriate words------------------ 3
Incoherent----------------------------- 2
No response--------------------------- 1

Most integral motor response (arm) Obeys verbal commands------------ 6

Localizes pain------------------------ 5
Withdraws from pain---------------- 4
Flexion (decorticate)----------------- 3
Extension (decerebrate)-------------- 2
No response--------------------------- 1

Score of ≤ 10 needs emergency attention; score of ≤7 is generally

considered to be in a coma.
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 Posture and Body Movements
 Normal
o Relaxed, with shoulders and back erect when
sitting or standing
 Abnormal:
o Slumped posture –
powerlessness/hopelessness
o Prolonged euphoric laughing – mania
o Bizarre body movements and behavior -
schizophrenia

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 Dress, Grooming, Hygiene
 Normal:
o Skin is clean
o Nails are neat and trim
o Facial hairs shaven or trimmed
o Clothes fit and are appropriate for the occasion and
weather
 Abnormal:
o Unusually meticulous grooming and finicky mannerism
– obsessive-compulsive disorder
o Poor hygiene and inappropriate dress – depression,
schizophrenia, dementia, Alzheimer's disease

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 Facial Expression
 Normal:
o Good eye contact
o Smiles and frowns appropriately
 Abnormal:
o Poor eye contact – depression
o Extreme facial expression – anxiety
o Masklike, expressionless face – Parkinson’s
disease

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 Speech
 Normal:
o Moderate tone, clear and with moderate
pace

 Abnormal:
o Slow, repetitive speech – depression,
Parkinson’s
o Loud, rapid speech – mania

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 Sources of Speech and Voice Problems
PROBLEM DESCRIPTION SOURCE
Dysphonia Voice volume disorder Laryngeal disorders or impairment
of vagus nerve

Cerebellar Irregular uncoordinated Multiple sclerosis

dysarthria speech

Dysarthria Defect in muscular Lesions of the nervous system,

control of speech Parkinson’s disease or cerebellar
(slurring) disease

Aphasia Difficulty producing or Motor lesions in the dominant

understanding language cerebral hemisphere

Wernicke’s Rapid speech that lacks Lesion in the posterior superior

aphasia meaning temporal lobe

Broca’s aphasia Slowed speech with Lesion in the posterior inferior

difficult articulation, but frontal lobe
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 Mood and Affect
 Mood – a person’s pervading feeling or state
of mind

 Affect – a person’s expression of his mood

o Labile affect – rapid, dramatic fluctuation in the
range of emotion
o Flat affect – unresponsive range of emotion
o Inappropriate affect – inconsistency between
expression and mood

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Moods, Feelings and Expressions
 Normal:
o Cooperative, friendly
o Expresses feelings appropriate to the situation
o Verbalizes positive feelings
o Expresses positive coping mechanisms

 Abnormal:
o Expression or prolonged negative, gloomy, despairing feelings –
depression
o Expression of elation, grandiosity and engagement in high-risk but
pleasurable activities – manic
o Excessive worry – anxiety, obsessive-compulsive disorders
o Eccentric moods - schizophrenia

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 Mini Mental State Test
 AKA Folstein test
 A brief 30-point questionnaire test that is
used to screen for cognitive impairment
 Any score greater than or equal to 25 points
(out of 30) is effectively normal (intact)
 Low scores can indicate severe (≤9 points),
moderate (10-20 points) or mild (21-24
points) cognitive impairment

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Vital signs
 Temperature
 Normal - (36.5°C to 37.7°C) 96.0°F to 99.9°F
 Lowest from 4-6am, highest 8pm-mn
 Hypothermia - <36.5°C or 96°F
o Prolonged cold exposure, hypoglycemia,
hypothyroidism, starvation
 Hyperthermia - >38°C or 100°F (>41°C)
o Viral or bacterial infection, malignancies, trauma,
blood, endocrine and immune disorders
 In geriatric clients, temperature may range
from 95-97.5°F (35-36.5°C)

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 Pulse
 Normal - 60-100 beats/minute
 Shockwave traveling along the fibers of the
arterial walls when the heart pumps blood out
of the ventricles into the aorta
 Rate, rhythm, amplitude
 Amplitude:
o 1+ thready and weak (easy to obliterate)
o 2+ normal (obliterate with moderate pressure)
o 3+ bounding (unable to obliterate or requires very
firm pressure)

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 Respiration
 Normal - 12-20 breaths/min
 Assess the rate, rhythm and depth

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 Breathing Patterns
 Eupnea
o Normal breathing
o Regular in depth and rhythm
o 12-18 breaths per minute
 Apnea
o Cessation of breathing
o Life-threatening if sustained
 Hyperpnea
o Increase in depth of respiration

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 Breathing Patterns
 Bradypnea
o Abnormally slow breathing
o Associated with increased intracranial
pressure, brain injury and drug overdose
 Tachypnea
o Abnormally rapid breathing
o Commonly seen in patients with pneumonia,
pulmonary edema, metabolic acidosis,
septicemia, severe pain and rib fracture

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 Breathing Patterns
 Dyspnea
o Labored or difficult breathing, possibly normal if
associated with exercise
 Orthopnea
o Discomfort or difficulty with breathing in any but an
upright sitting or standing position
o May be a sign of cardiovascular disease
 Kussmaul’s respiration
o Abnormal respiratory pattern characterized by irregular
periods of increased rate and depth of respiration
o Diabetic ketoacidosis

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 Breathing Patterns
 Biot’s respirations
o AKA cluster breathing
o Abnormal respiratory pattern characterized by
irregular periods of apnea alternating with short
periods of respiration of equal depth
 Cheyne-Stokes respiration
o Characterized by initially show, shallow respirations
that increase in rapidity and depth and then
gradually decrease until respiration stops for 10 to
20 seconds; pattern then repeats itself in the same
manner

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 Blood Pressure
 Normal - 100-130/60-80mmHg
 Reflects the pressure exerted on the walls of
the arteries
 Systolic pressure/diastolic pressure
 Factors affecting BP
o Blood volume and cardiac output
o Distensibility of the arteries
o Blood viscosity
o External influence
o Position of the arm/body

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Blood Pressure Classification in Adults
Category Systolic Diastolic
Normal <140 <90
Isolated Systolic
>140 <90
Hypertension
Mild Hypertension 140-159 90-99
Moderate
160-179 100-109
Hypertension
Severe
180-209 110-119
Hypertension
Crisis Hypertension >210 >120

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