1. OVERVIEW GENERAL SURVEY VITAL SIGNS
PHYSICAL EXAM
OVERVIEW
GENERAL SURVEY
VITAL SIGNS

2. Lecture Outline OVERVIEW GENERAL SURVEY VITAL SIGNS and MEASUREMENTS
comfort
sequence
maneuvers
GENERAL SURVEY
VITAL SIGNS and MEASUREMENTS

3. Physical Examination OVERVIEW
COMFORT
Your comfort
Patient’s comfort

4. Physical Examination OVERVIEW
SEQUENCE
perform regional sequence
maximize effeciency
minimize patient movement

5. Physical Examination OVERVIEW
Examination maneuvers
inspection
palpation
percussion
auscultation

6. Lecture Outline OVERVIEW GENERAL SURVEY VITAL SIGNS and MEASUREMENTS
definition
anatomy and physiology
history considerations
techniques of examination
VITAL SIGNS and MEASUREMENTS

7. GENERAL SURVEY AN OVERVIEW OF THE PERSON AS A WHOLE
Documented as a narrative at the beginning of the physical exam.

8. GENERAL SURVEY Historical Considerations
WEIGHT
FATIGUE
WEAKNESS
FEVER

9. The General Survey

10. General Survey Items OBSERVATION OF Overall appearance
General state of health
Nutrition and hydration
Mobility
Height-weight-build
Sexual development
Extracorporeal

11. Things that you notice right away and things that you notice later
General Survey Items
Overall appearance
Things that you notice right away and things that you notice later
(Gone With the Wind)
apparent age
dress, grooming, hygiene
obvious skin abnormalities
asymmetries
other obvious problems

12. General Survey Items General State of Health
apparent state of overall health
frail, robust, ill
signs of distress
breathing, pain, anxiety

13. General Survey Items Nutrition and Hydration Cachexic Muscle wasting
Obese
Dehydrated
NUTRITION AND HYDRATION - Cachexic

14. General Survey Items MOBILITY - lying in bed
sitting comfortably in the chair
unable to remain still
gait - ambulates with assistive device. limps
Posture

15. General Survey Items Height-Weight-Build short vs tall
lanky, symmetrical
slender, plump
fat distribution

16. Height-Weight-Build dependant on genetics nutrition early illnesses
gender
geography
age

17. Height-Weight-Build
Age Dependant Proportions

18. Height-Weight-Build
Age Dependant Proportions

19. Height-Weight-Build
Age Dependant Proportions

20. Height-Weight-Build
Fat Distribution

21. Height-Weight-Build
Changes related to Endocrine Disease

22. General Survey Items Sexual development Tanner Staging voice
facial hair
breast size

23. General Survey Items Extracorproreal
other things around the room/person
bedside books
nicotine stains
lots of flowers
rosary beads
empty walls and table
odors - alcohol, urine

24. Example Write-up
The patient is a moderately obese, young adult caucasian male who appears his stated age of 33 and is in no acute distress. Patient ambulates without difficulty and moves freely. He appears well-groomed, clean, and is dressed in an examination gown. Patient talks freely but appears to be somewhat anxious.

25. Lecture Outline OVERVIEW GENERAL SURVEY VITAL SIGNS and MEASUREMENTS
Temperature
Pulse
Respirations
Blood Pressure
Height
Weight

26. Temperature PHYSIOLOGY METHODS FALSE READINGS “AFEBRILE”
thermoregulatory mechanisms
fever
hypothermia
METHODS
FALSE READINGS
“AFEBRILE”

27. Pulse
PHYSIOLOGY
METHODS
peripheral
apical
CHARACTER
rate
rhythm
force

28. Respirations
PHYSIOLOGY
METHOD
CHARACTERISTICS
Rate
Rhythm
Effort

29. Blood Pressure PHYSIOLOGY METHOD CHARACTERISTICS RECORDING environment
positioning
technique
CHARACTERISTICS
RECORDING

30. KOROTKOFF SOUNDS