UNIVERSITY OF SANTO TOMAS

Faculty of Medicine & Surgery

Department of Medicine
Medicine 1 SY 2017-2018
General Survey, Vital Signs, Anthropometric Measurements Checklist

PREPARATION
Asks permission
Explains what exactly is to be done to the patient
Ensures privacy and patient’s comfort
Ensures adequate lighting and exposure.
GENERAL SURVEY
Makes an accurate general survey and report according to the following parameters:
A. General appearance. Describe the general state of health (well, acutely ill or chronically ill )
B. Skin color/Obvious skin lesions. Note for presence of jaundice, being sallow or pallor, cyanosis

C. Facies. Note for characteristic facies such moon facies of Cushing’s syndrome, stare of hyperthyroidism, etc.

D. Level of comfort. State whether patient is comfortable or in distress based on manner of speech (speaks in phrases);
position ( assumes tripod , 2-3 pillow orthopnea; squatting)

E. Level of consciousness. Report whether conscious, confused, lethargic, somnolent, obtunded, stuporous, or comatose;
Use also Glasgow coma scale:

MOTOR response
6- Obeys commands: follows simple commands
5- Localizes to pain: arms attempts to remove the supraorbital/chest pressure
4- Withdraws to pain: arms withdraws, shoulder abducts
3- Decorticate: arms flexes
2- Decerebrate: shoulders adducted, shoulder and forearm internally rotated
1- None: no response to any pain

VERBAL response
5- Oriented: converses and is oriented
4- Confused: converses but disoriented
3- Inappropriate words: Intelligible, no sustained sentences
2- Incomprehensible sounds: moans/groans
1- None: no verbalization of any type

EYE opening
4- Spontaneous: eyes open
3- To speech: non-specific response
2- To pain: pain from sternal, supraorbital pressure
1- None: no response to pain

F. Ambulatory status. Observe if patient is ambulatory, ambulate with assistance, wheelchair borne, stretcher-borne,
bedridden.
G. Posture, gait disturbances, and general motor activity. State if patient is relax, rigid, tense, restless, pacing, dragging one
foot, limping, shuffling gait, involuntary movements, immobile part
H. Body habitus. Classify patient whether hyposthenic (ectomorphic); sthenic (mesomorphic); hypersthenic (endomorphic)
I. Body Symmetry. Symmetrical, discrepancies in the size of parts, atrophy, hypertrophy. Abnormal distribution of normal
tissues (fat, muscles, subcutaneous tissue, bone)
J. Personal Hygiene and Grooming. Appropriate, well groomed, meticulous, unkempt
K. Odors of the body and breath. No characteristic odor, scent of alcohol, acetone breath in DKA, ammoniacal fish breath of
kidney failure
L. Mood and affect
- Attitude towards the examiner. Cooperative, guarded, suspicious, evasive, hostile, seductive
- Predominant mood. Neutral, anxious, fearful, elated, euphoric, angry, depressed, irritable
- Affect. Broad, restricted, labile. Intensity (blunted, flat, animated)
- Appropriateness
M. Psychomotor activity and speech
- Manner of Speech. Normal, slurred, appropriateness of words, hoarseness, pitch (high or low)
- Presence of abnormal movements. Grimacing, mannerism, stereotyping
N. Thought process and content. How the patient responds to questions; Stream of though is appropriate or inappropriate
(paranoia, delusions, obsessions, compulsions, phobias, illusions, hallucination, depersonalization, derealization)

GSVSAMSY 2017-2018
 UNIVERSITY OF SANTO TOMAS
Faculty of Medicine & Surgery
Department of Medicine
Medicine 1 SY 2017-2018
General Survey, Vital Signs, Anthropometric Measurements Checklist

O. Cognitive functions
- Orientation – as to time, place, person
- Memory – immediate, recent, remote

VITAL SIGNS
SYSTEMIC BLOOD PRESSURE
Prepare sphygmomanometer and stethoscope
Prepare paper and pen for immediate recording of blood pressure (BP)
Explain procedure in a reassuring manner
Ask permission
Ask for intake of the following 30-60 minutes prior to BP determination: caffeinated drinks, alcohol, illicit drugs,
antihypertensive meds, NSAIDs and steroids.
Ask for activities done 30-60 minutes prior to BP determination: smoking cigarettes, exercise or its equivalent
Ask and/or note for any condition the patient might be having prior to or during BP determination: anxiety, pain, bladder
distention, temperature change, noise
Instruct patient to rest for 5 minutes in a quiet and comfortably warm room
Instruct the patient to refrain from talking or doing anything from while blood pressure is taken
Avoid talking during the procedure

GSVSAMSY 2017-2018
 UNIVERSITY OF SANTO TOMAS
Faculty of Medicine & Surgery
Department of Medicine
Medicine 1 SY 2017-2018
General Survey, Vital Signs, Anthropometric Measurements Checklist

RIGHT UPPER EXTREMITY BP

Move to the right side of the patient
If seated, patient: A. should be comfortable
B. should not sit with legs crossed
C. should be positioned with the feet flat on the floor
D. should sit with the back supported against the chair
E. should have his/her bared arm resting on a standard table or other support such that the arm on the
table is a little above the patient’s waist
F. should maintain the midpoint of the upper arm(brachial artery level) always at the level of the
heart(approximately at the 4th intercostal space at its junction with the sternum)

If supine, patient: A. should be positioned at a 30-45 degree angle

B. should maintain the midpoint of the upper arm(brachial artery level) always at the level of the
heart(approximately at the 4th intercostal space at its junction with the sternum)
C. should be draped properly

If standing, patient: A. should be supported in such a way that the arm is at mid chest level
B. should maintain the midpoint of the upper arm(brachial artery level) always at the level of the
heart(approximately at the 4th intercostal space at its junction with the sternum)

Remove clothing around patient’s arm and avoid rolling up the sleeve in such a manner that it forms a tight tourniquet
around the upper arm
Estimate by inspection, or measure with a tape, the circumference of the bare upper arm at midpoint between acromium
and olecranon
Select and use an approximately sized cuff. The length of the inflatable bladder inside the cuff should encircle 80% of the
upper arm, almost long enough to encircle the arm proper and the width of the inflatable bladder should be about 40%
(12-14 cm) of the upper arm circumference
Record if the available cuff is too small or too large
Use index and middle fingers to palpate for the patient’s brachial and radial arteries
Apply the cuff 2.5 cm above the antecubital fossa where the head of the stethoscope is to be placed
Ensure that the center of the inflatable bladder of the BP cuff is over the brachial artery pulsation
Wrap and secure the cuff snugly around the patient’s bare arm(make sure you are able to insert only 1 finger underneath
the cuff)
Place the manometer at eye level where it is easily visible. In cases of aneroid sphygmomanometer, hook the manometer
to the clothe cover of the inflatable bladder
Ensure the tubing from the cuff is unobstructed
MEASURE PALPATORY BP
Use index and middle fingers to palpate the radial artery
With the other hand, rapidly inflate cuff 10 mmHg increments while palpating radial artery pulse and note when the
pulse disappears.
Countercheck by further increasing by 20-30 mmHg above the level the pulse disappears during cuff inflation, after
which deflate cuff by 2-3mmHg/sec and note at which level the radial pulse reappears during deflation.
Read BP on the manometer and states palpatory (systolic) BP.
Deflate the cuff thereafter
MEASURE AUSCULTATORY BP
Waist 15-30 seconds after getting the palpatory BP
Place the earpieces of the stethoscope into your ear canals, angled forward to fit snugly
Palpate for the brachial artery again using index and middle finger
Place the head of the stethoscope(the low frequency bell over the brachial artery pulsation), just above and medial to
the antecubital fossa but below the edge of the cuff, and hold it firmly (but not too tightly) in place, making sure to
make an air seal with its full rim by ensuring that the head makes contact with the skin around its entire
circumference
Inflate the BP cuff rapidly and steadily to a pressure 20-30 mm Hg above the palpatory (systolic) BP previously
recorded
Partially unscrew(open) the valve and slowly deflate BP cuff by 2-3 mm Hg/sec while listening for the appearance of the
the Korotkoff sounds
As the pressure in the bladder falls, note the level of pressure on the manometer when the first Korotkoff sound is
heard (Phase I). Record this as the auscultatory systolic BP rounded off upward to the nearest 0-5 mmHg
Continue to deflate slowly by 2-3 mm Hg/sec and note the level on the manometer when the Korotkoff sound
disappears (Phase V). State and record this as the diastolic BP rounded off upward to the nearest 0-5 mmHg

GSVSAMSY 2017-2018
 UNIVERSITY OF SANTO TOMAS
Faculty of Medicine & Surgery
Department of Medicine
Medicine 1 SY 2017-2018
General Survey, Vital Signs, Anthropometric Measurements Checklist

LEFT UPPER EXTREMITY BP

Stay on the left side of the patient.
Perform the above procedures correctly to the left upper extremity
State palpatory BP first
State auscultatory BP
Compare the BP on the left and the right upper extremities and state if the difference is within acceptable limits
RIGHT LOWER EXTREMITY BP (follow same procedure as BP taken in the upper extremities
with the following differences)
Position patient in prone or supine with leg slightly flex
Use a wide, long thigh cuff with a bladder size of 18 x 42 cm.
Apply the cuff to the mid-thigh
Center the bladder over the posterior surface
Wrap the cuff securely and snugly
Listen over the popliteal artery
State the BP on the right lower extremity
LOWER LEFT EXTREMITY BP
Perform the above procedures to the left lower extremity and state the BP on the left lower extremity
Compare the BP on the left and the right lower extremities and state if the difference is within acceptable limits
Compare the BP on the upper and the lower extremities and states if the difference is within acceptable limits
PULSE RATE
RADIAL PULSE
Position the patient’s arm in a relaxed position, palm downward or upward on top of the table, or the patient’s upper thigh, or
supported by your other
Locate radial artery using the pads of your index and middle fingers aligned longitudinally over the course of the artery by
applying gentle but firm pressure in the medial and ventral side of the patient’s wrist just below the base of his thumb. Do not
occlude the radial pulse
Counts the pulse rate for one full minute using a watch with a second hand
Simultaneously palpate radial pulses on both sides
Evaluate the pulse rhythm if regular or irregular
Compare the volume of pulsation on each artery and grade
0 – absent
1+ - weak or thread
2+ - normal
3+ - increased or strong
State and record
RESPIRATORY RATE
With the patient unaware, the respiratory rate is determined in a subtle way by pretending to continue counting pulse rate and
note the number of rise/fall (cycles) of the chest for 1 full minute and pattern if any
States respiratory rate
TEMPERATURE ( Choose one from the two methods BUT please note that there are other
methods to take the temperature such as temple, oral, rectal temperature determination)
With the use of a digital thermometer, takes the temperature
Tympanic membrane temperature
Do not attempt to take if patient has impacted cerumen, otitis media or interna or externa
Wash hands or use disinfectant and air dry
Ensures external auditory canal is free of cerumen
Prepare a new and undamaged probe cover
Turn on the thermometer
Straighten the external auditory canal by pulling the pinna upward then backward with one hand
Gently insert the probe to the external auditory canal and wait for the beep
Remove the probe
Read the temperature in the LED window and record
Immediately remove the probe cover and discard to a biohazard waste container
Clean digital thermometer with disinfectant
Return digital thermometer to the container
Wash hands or use disinfectant and air dry
Thank the patient
Axillary temperature
Do not attempt to take if patient has axillary abscess, shoulder limitation/fracture, open sores, abrasions, or if the
patient is uncooperative

GSVSAMSY 2017-2018
 UNIVERSITY OF SANTO TOMAS
Faculty of Medicine & Surgery
Department of Medicine
Medicine 1 SY 2017-2018
General Survey, Vital Signs, Anthropometric Measurements Checklist

Wash hands or use disinfectant and air dry

Explain the procedure to the patient and get consent
Remove the patient’s clothing or gown as needed to access the axillary region
Pat the patient’s axilla dry with tissue or gauze if needed. Do not rub the area
Turn on the thermometer
Place the thermometer in the center of the armpit pointing the stem to the upper chest, making sure that the
temperature is touching only the skin and not the clothing
Firmly appose the arm to the chest to keep the thermometer in place until the beep is heard
Remove the probe
Read the temperature in the LED window and record
Clean digital thermometer with disinfectant
Return digital thermometer to the container
Wash hands or use disinfectant and air dry
Thank the patient
ANTHROPROMETRIC MEASUREMENTS
Height : Measure the height of the patient in meters

STANDING
Ask the patient to remove shoes
Instruct patient to stand straight with feet together and place his back against the measuring tape against the wall
wherein the measuring tape is affixed, or
Instruct the patient to stand erect, feet together, with the head, shoulders, buttocks and heels touching the wall or the
measuring tape before measuring the height in centimeters
Measure the height in centimeters from the top of the head to the heels of the feet
Convert measurement to meters and record

SUPINE IN PATIENTS UNABLE TO STAND

Place patient in a supine position with the body fully extended
Measure the height in centimeters from the top of the head to the heels with a tape measure in centimeters
Convert measurement to meters and record
Weight: Measure the weight of the patient in kilograms
Instruct the patient to empty his/her bladder
Ask the patient to remove shoes
Prepare and use a calibrated weighing scale. Make sure the needle is at zero. Use a bed scale for patient who is bed
ridden
For serial weight measurements, obtain the time of the measurement at approximately the same time of the day and as
much as possible wearing the same amount of clothing.
Have the patient stand still at the middle of the platform of the weighing scale
Wait for the needle to stabilize, then read. Record the weight in kilograms.
Compute for the body mass index (BMI)
BMI = weight in kg/height in meter2

GSVSAMSY 2017-2018