1. Copyright 2002, Delmar, A division of Thomson Learning Chapter 9 General Survey and Vital Signs

2. Copyright 2002, Delmar, A division of Thomson Learning Competencies Describe initial assessment observations. Discuss factors affecting respiratory rate. Perform respiratory rate assessment. Describe the characteristics that are included in an assessment of pulse. Measure apical, radial, and brachial pulses. (continues)

3. Copyright 2002, Delmar, A division of Thomson Learning Competencies Discuss factors influencing body temperature. Compare oral, rectal, axillary, and tympanic methods for temperature measurement. (continues)

4. Copyright 2002, Delmar, A division of Thomson Learning Competencies Demonstrate body temperature assessment techniques utilizing glass, electronic, and tympanic thermometers. Describe factors influencing blood pressure and blood pressure measurement. Describe two methods to measure blood pressure.

5. Copyright 2002, Delmar, A division of Thomson Learning General Survey Physical presence Assess the patient’s  Stated age vs. Apparent age  General appearance  Body fat  Stature  Motor activity  Body and breath odors (continues)

6. Copyright 2002, Delmar, A division of Thomson Learning General Survey Psychological presence Observe the patient’s  Dress, grooming, personal hygiene  Mood and manner  Speech  Facial expressions (continues)

7. Copyright 2002, Delmar, A division of Thomson Learning General Survey Distress Assess for  Labored breathing, wheezing, cough, labored speech  Painful facial expressions, sweating, guarding  Serious or life-threatening complications  Emotional distress or anxiety

8. Copyright 2002, Delmar, A division of Thomson Learning Vital Signs Respiration  How to assess?  Count for 1 full minute  Normal findings  Adult rate 12–20 per minute  Abnormal findings  Tachypnea  Bradypnea  Apnea (continues)

9. Copyright 2002, Delmar, A division of Thomson Learning Vital Signs Pulse  How to assess?  Count for 1 full minute  Rate  Normal range for adults = 60–100 bpm  Rhythm  Regular vs. Irregular  Volume  Absent to bounding  Use 3- or 4-point scale for measuring

10. Copyright 2002, Delmar, A division of Thomson Learning Factors Affecting Heart Rate Age Gender Activity Emotional status Pain Environmental factors Stimulants Medications

11. Copyright 2002, Delmar, A division of Thomson Learning Peripheral Pulses Pedal  Dorsalis pedis  Posterior tibialis Popliteal Femoral Brachial Carotid Temporal

12. Copyright 2002, Delmar, A division of Thomson Learning Pulses Radial  Location?  How to find?  Count for 30 or 60 seconds Apical  Location?  How to find?  Count for 30 or 60 seconds (continues)

13. Copyright 2002, Delmar, A division of Thomson Learning Pulses Rate  Tachycardia  Bradycardia  Asystole Rhythm  Regular vs. Irregular  Dysrhythmias Volume  Weak vs. Strong

14. Copyright 2002, Delmar, A division of Thomson Learning Vital Signs Temperature Celsius  How to convert?  5/9 x (temp in °F – 32 degrees) Fahrenheit  How to convert?  (9/5 x temp in °C) + 32 degrees

15. Copyright 2002, Delmar, A division of Thomson Learning Routes Oral Average  37.0° C or 98.6° F Range  36–38° C or 96.8–100.4° F Advantages  Convenient, accessible Disadvantages  Safety, physical abilities, accuracy

16. Copyright 2002, Delmar, A division of Thomson Learning Rectal Average  0.7° C or 0.4° F higher than oral Range  36.7–38.5° C or 98.0–101.6° F Advantages  Most accurate Disadvantages  Safety, invasive, uncomfortable

17. Copyright 2002, Delmar, A division of Thomson Learning Axillary Average  0.6° C or 1° F lower than oral Range  35.4–37.4° C or 95.8–99.4° F Advantages  Safe, noninvasive Disadvantages  Accuracy? Length of time to obtain measurement

18. Copyright 2002, Delmar, A division of Thomson Learning Tympanic Average  Calibrated to oral or rectal scales Range  Same as oral and rectal Advantages  Convenient, fast, safe Disadvantages  Accuracy? Technique affects reading

19. Copyright 2002, Delmar, A division of Thomson Learning Variables Affecting Body Temperature Circadian rhythms Hormones Age Exercise Stress

20. Copyright 2002, Delmar, A division of Thomson Learning Temperature Variations Hyperthermia Hypothermia

21. Copyright 2002, Delmar, A division of Thomson Learning Blood Pressure Force exerted by the flow of blood pumped into the large arteries Korotkoff sounds  Phase I  Phase II  Phase III  Phase IV  Phase V

22. Copyright 2002, Delmar, A division of Thomson Learning Measuring Blood Pressure Systole Diastole Pulse pressure Equipment  Sphygmomanometer  Aneroid manometer  Mercury manometer (continues)

23. Copyright 2002, Delmar, A division of Thomson Learning Measuring Blood Pressure Sites  Brachial  Thigh  Avoid AV shunts or fistulas, affected arm of postmastectomy patient (continues)

24. Copyright 2002, Delmar, A division of Thomson Learning Measuring Blood Pressure Documentation  Position of patient  Location where taken Normal findings  100–140/60–90  Average = 120/80 Hypotension Hypertension

25. Copyright 2002, Delmar, A division of Thomson Learning Common Errors in Blood Pressure Measurements Incorrect cuff size Unrecognized auscultatory gap Incorrect cuff placement

26. Copyright 2002, Delmar, A division of Thomson Learning Factors Influencing Blood Pressure Stress White coat syndrome Medications Hypervolemia Hypovolemia