General Survey, Measurement,

Vital Signs
Chapter 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

General Survey

Physical appearance

Body structure

Age

Stature

Sex

Nutrition

Level of
consciousness

Symmetry

Posture

Skin color

Facial features

Position

Body build, contour

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

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Chapter 9: General Survey, Measurement, Vital Signs

General Survey
(cont.)

Mobility

Behavior

Gait

Facial expression

Range of motion

Mood and affect

Speech

Dress

Personal hygiene

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 9-3

Chapter 9: General Survey, Measurement, Vital Signs

Measurement

Weight

Balance scale

Recommended range for height

Height

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 9-4

Chapter 9: General Survey, Measurement, Vital Signs

Vital Signs

Temperature

Hypothalamus as thermostat mechanism

Influences on temperature
Diurnal cycle
Menstrual cycle
Exercise
Age
Routes of temperature measurement
Oral
Electronic thermometer
Axillary
Rectal
Tympanic membrane thermometer

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 9-5

Chapter 9: General Survey, Measurement, Vital Signs

Vital Signs
(cont.)

Pulse
Stroke volume
Technique of measurement
Rate
Normal rate for age group
Bradycardia
Tachycardia
Rhythm
Sinus arrhythmia
Force
Elasticity

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 9-6

Chapter 9: General Survey, Measurement, Vital Signs

Vital Signs
(cont.)

Respirations

Technique of measurement

Normal rate for age group

Ratio of pulse rate to respiratory rate should be

approximately 4:1

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 9-7

Chapter 9: General Survey, Measurement, Vital Signs

Vital Signs
(cont.)

Blood pressure

Systolic pressure

Diastolic pressure

Pulse pressure

Mean arterial pressure

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 9-8

Chapter 9: General Survey, Measurement, Vital Signs

Blood Pressure

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 9-9

Chapter 9: General Survey, Measurement, Vital Signs

Vital Signs
(cont.)

Influences on blood pressure

Age
Race
Weight
Emotions
Sex
Diurnal rhythm
Exercise
Stress
Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 9-10

Chapter 9: General Survey, Measurement, Vital Signs

Vital Signs
(cont.)

Physiologic factors controlling blood pressure

Cardiac output
Peripheral vascular resistance
Volume of circulating blood
Viscosity
Elasticity of vessel walls

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 9-11

Chapter 9: General Survey, Measurement, Vital Signs

Factors Controlling Blood Pressure

Illustration Pat Thomas, 2006

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 9-12

Chapter 9: General Survey, Measurement, Vital Signs

Vital Signs
(cont.)

Blood pressure measurement

Sphygmomanometer

Cuff width and size

Blood pressure measurement in the arm

Position of person
Palpate brachial artery
Proper inflation and deflation technique
Korotkoffs sounds

I, systolic pressure

IV, muffling of sounds

V, diastolic pressure

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 9-13

Chapter 9: General Survey, Measurement, Vital Signs

Measuring Blood Pressure

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 9-14

Chapter 9: General Survey, Measurement, Vital Signs

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

Screen for coarctation of aorta

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 9-15

Chapter 9: General Survey, Measurement, Vital Signs

Sample Charting

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 9-16

Chapter 9: General Survey, Measurement, Vital Signs

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

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 9-17

Chapter 9: General Survey, Measurement, Vital Signs

Which patient would be most likely

to present with a pulse rate that is
lower than normal?
A.

B.

C.

A 70-year-old telephone salesman

presenting with dehydration.
A 20-year-old runner who had surgery 4
days ago for a fractured leg.
A 67-year-old who presented with an
exacerbation of his COPD

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 9-18