1. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. General Survey, Measurement, Vital Signs Health Assessment Across the Lifespan NRS 102

2. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 9: General Survey, Measurement, Vital Signs Slide 9-2 General Survey  Physical appearance  Age  Sex  Level of consciousness  Skin color  Facial features  Body structure  Stature  Nutrition  Symmetry  Posture  Position  Body build, contour

3. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 9: General Survey, Measurement, Vital Signs Slide 9-3 General Survey (cont.)  Mobility  Gait  Range of motion  Behavior  Facial expression  Mood and affect  Speech  Dress  Personal hygiene

4. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 9: General Survey, Measurement, Vital Signs Slide 9-4 Measurement  Weight  Balance scale  Recommended range for height  Height

5. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 9: General Survey, Measurement, Vital Signs Slide 9-5 Vital Signs  Temperature  Hypothalamus as thermostat mechanism  Influences on temperature Diurnal cycle Diurnal cycle Menstrual cycle Menstrual cycle Exercise Exercise Age Age  Routes of temperature measurement Oral Oral Electronic thermometer Electronic thermometer Axillary Axillary Rectal Rectal Tympanic membrane thermometer Tympanic membrane thermometer

6. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 9: General Survey, Measurement, Vital Signs Abnormal Body Temp Hypothermia  Heat loss during prolonged exposure to cold  Classified by core temp (mild-severe)  May be intentional (surgery)  Early signs- uncontrolled shivering, loss of memory, poor judgment  Later signs- Cyanosis, decreased VS, cardiac dysrhythmias, loss of consciousness  Frostbite- body exposure to subnormal temps

7. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 9: General Survey, Measurement, Vital Signs Abnormal Body Temp Hyperthermia  Elevated body temp related to body’s inability to promote heat loss or reduce heat production  Heatstroke- prolonged exposure to sun or high environmental temp. Heat depresses hypothalamus function  Heat Exhaustion- profuse diaphoresis result in fluid & electrolyte loss

8. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 9: General Survey, Measurement, Vital Signs

9. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 9: General Survey, Measurement, Vital Signs

10. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 9: General Survey, Measurement, Vital Signs Slide 9-10  Pulse  Stroke volume  Technique of measurement  Rate Normal rate for age group Normal rate for age group Bradycardia Bradycardia Tachycardia Tachycardia  Rhythm Sinus arrhythmia Sinus arrhythmia  Force  Elasticity Vital Signs

11. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 9: General Survey, Measurement, Vital Signs

12. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 9: General Survey, Measurement, Vital Signs

13. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 9: General Survey, Measurement, Vital Signs Slide 9-13  Respirations  Technique of measurement  Normal rate for age group  Ratio of pulse rate to respiratory rate should be approximately 4:1 Vital Signs

14. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 9: General Survey, Measurement, Vital Signs Assessing Respirations  Assessing rate- observe full inspiration & expiration  Assess for full minute  Normal adult 12 –20 breaths/minute  Varies with age, rate declines throughout life  Apnea Monitor

15. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 9: General Survey, Measurement, Vital Signs Normal & Abnormal Respirations  Eupnea- normal respirations  Bradypnea- abnormally slow < 12  Tachypnea- abnormally fast >20  Hyperpnea- labored, after exercise  Hyperventilation/Hypoventilation  Cheyne-Stokes  Kussmauls  Biot’s

16. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 9: General Survey, Measurement, Vital Signs Slide 9-16  Blood pressure  Systolic pressure  Diastolic pressure  Pulse pressure  Mean arterial pressure Vital Signs

17. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 9: General Survey, Measurement, Vital Signs Slide 9-17 Blood Pressure

18. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 9: General Survey, Measurement, Vital Signs Slide 9-18  Influences on blood pressure Age Age Race Race Weight Weight Emotions Emotions Sex Sex Diurnal rhythm Diurnal rhythm Exercise Exercise Stress Stress Vital Signs

19. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 9: General Survey, Measurement, Vital Signs Slide 9-19  Physiologic factors controlling blood pressure Cardiac output Cardiac output Peripheral vascular resistance Peripheral vascular resistance Volume of circulating blood Volume of circulating blood Viscosity Viscosity Elasticity of vessel walls Elasticity of vessel walls Vital Signs (cont.)

20. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 9: General Survey, Measurement, Vital Signs Slide 9-20 Factors Controlling Blood Pressure Illustration Pat Thomas, © 2006

21. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 9: General Survey, Measurement, Vital Signs Slide 9-21 Vital Signs  Blood pressure measurement  Sphygmomanometer  Cuff width and size  Blood pressure measurement in the arm Position of person Position of person Palpate brachial artery Palpate brachial artery Proper inflation and deflation technique Proper inflation and deflation technique Korotkoff’s sounds Korotkoff’s sounds  I, systolic pressure  IV, muffling of sounds  V, diastolic pressure

22. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 9: General Survey, Measurement, Vital Signs Slide 9-22 Measuring Blood Pressure

23. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 9: General Survey, Measurement, Vital Signs Slide 9-23 Vital Signs  Common errors in blood pressure measurement  Orthostatic (or postural) hypotension  Blood pressure measurement in the thigh Thigh pressure higher than in the arm Thigh pressure higher than in the arm Screen for coarctation of aorta Screen for coarctation of aorta

24. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 9: General Survey, Measurement, Vital Signs Assessment of Diffusion & Perfusion  Assessed by oxygen saturation of blood  Oxygen attaches to hemoglobin molecule in RBC  % of hemoglobin that is bound with oxygen in the arteries is the % of saturation of hemoglobin (SaO2)  Usually 95-100%  Affected by factors that interfere with ventilation, diffusion, & perfusion

25. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 9: General Survey, Measurement, Vital Signs Measurement of Arterial Oxygen Saturation  Pulse oximeter  Allows indirect measurement of oxygen saturation  SpO2 is a reliable estimate of SaO2  Measurement is affected if extremity is cold, edematous or if nail polish is present (interference with light transmission)

26. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 9: General Survey, Measurement, Vital Signs

27. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 9: General Survey, Measurement, Vital Signs Slide 9-27

28. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 9: General Survey, Measurement, Vital Signs Slide 9-28 Sample Charting

29. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 9: General Survey, Measurement, Vital Signs Slide 9-29 Significant elevation in blood pressure measurements from one day to the next could be attributed to A.A decrease in cuff size B.An increase in cuff size C.New onset of pain or anxiety D.A and C

30. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 9: General Survey, Measurement, Vital Signs Slide 9-30 Which patient would be most likely to present with a pulse rate that is lower than normal? A.A 70-year-old telephone salesman presenting with dehydration. B.A 20-year-old runner who had surgery 4 days ago for a fractured leg. C.A 67-year-old who presented with an exacerbation of his COPD