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

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 Slide 9-6  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 (cont.)

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 Slide 9-7  Respirations  Technique of measurement  Normal rate for age group  Ratio of pulse rate to respiratory rate should be approximately 4:1 Vital Signs (cont.)

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 Slide 9-8  Blood pressure  Systolic pressure  Diastolic pressure  Pulse pressure  Mean arterial pressure Vital Signs (cont.)

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 Slide 9-9 Blood Pressure

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  Influences on blood pressure Age Age Race Race Weight Weight Emotions Emotions Sex Sex Diurnal rhythm Diurnal rhythm Exercise Exercise Stress Stress Vital Signs (cont.)

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 Slide 9-11  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.)

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 Slide 9-12 Factors Controlling Blood Pressure Illustration Pat Thomas, © 2006

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 Vital Signs (cont.)  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

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 Slide 9-14 Measuring Blood Pressure

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 Slide 9-15 Vital Signs (cont.)  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

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 Sample Charting

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 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

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 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