5Components of General Survey General Appearance/ImpressionHeight and Weight
6General Appearance - Description Apparent state of healthAcute or chronically ill, frailLevel of consciousnessAwake, alert, responsive or lethargic, obtunded, comatoseSigns of distressCardiac or respiratory; pain; anxiety/depressionSkin color and obvious lesionsDress, grooming, and personal hygieneAppropriate to weather and temperatureClean, properly buttoned/zippedFacial expressionEye contact, appropriate changes in facial expressionOdors of body and breathPosture, gait, and motor activity
7Mental Status and Behavior Terminology To appreciate the differences in mental status and behavior, you must learn the terminologyLevel of consciousness: how aware the person is of his environmentAttention: the ability to focus or concentrateAlert: the patient is awake and awareLethargic: you must speak to the patient in a loud forceful manner to get a responseObtunded: you must shake a patient to get a responseStuporous: the patient is unarousable except by painful stimuli (sternal rub)Coma: the patient is completely unarousable
8Height and Weight small – medium – large? Height Weight Short or tall Build: slender and lanky, muscular, or stockyBody symmetryNote general body proportions and any deformitiesWeightEmaciated, slender, plump, obeseIf obese, is fat distributed evenly or concentrated over trunk, upper torso, or around the hips?small – medium – large?
25What next Health form History Secondary Assessment: Ongoing exam Secondary Assessment:Detailed examFocused examOngoing exam
26Health History: subjective Changes in weightRapid or gradualRapid changes over a few days suggest changes in fluid, not tissueWeight gain: nutrition vs. medical causesWeight loss: medical vs. psychosocial causesFatigue and weaknessFatigue: a sense of weariness or loss of energyWeakness: a demonstrable loss of muscle powerMedical vs. psychosocial causesFever, chills, and night sweatsAsk about exposure to illness or any recent travelSome medications may cause elevated temperature
27QuestionA patient presents with a 6-day history of rapid weight gain, and increasing fatigue. The most likely explanation is:DysphagiaExcessive absorption of nutrientsDiabetes mellitusAccumulation of body fluids
28Answer Accumulation of body fluids Rapid changes over a few days suggest changes in fluid.
29Vital Signs Blood pressure Heart rate and rhythm Respiratory rate and rhythmTemperaturePainSaO2
30QuestionA patient’s vital signs are recorded as follows:T F, HR 74, R 18, BP 180/98What would be the MOST appropriate action related to this patient’s vital signs?The blood pressure should not be repeatedRepeat the blood pressure and verify in contralateral armCheck the heart rate again to see if it is regularListen to the patient’s lungs for adventitious sounds
31AnswerRepeat the blood pressure measurement and verify in the contralateral arm
33Pain Types of pain Nociceptive or somatic – related to tissue damage Neuropathic – resulting from direct trauma to the peripheral or central nervous systemPsychogenic – relates to factors that influence the patient’s report of painPsychiatric conditionsPersonality and coping styleCultural normsSocial support systemsIdiopathic – no identifiable etiology
34Examination Techniques InspectionPalpationPercussionAuscultationSystem with cc: function / physiologySystem above and below