At first glance A general patient assessment

General appearance Facial expression Self-care Unusual odors Fruity breath Halitosis Putrid breath or body odor Fishy vaginal odor Urine or ammonia like odor Fecal breath or body odor

Assessing vital signs Temperature normal oral 36 to 37.5 normal rectal 36.3 to 37.9 normal tympanic (core) 36.2 to 37.8 Temperature starts low in the morning and gradually increases throughout the day.

Temperature continued When is a patient febrile oral >99.5 rectal>100.5 tympanic>101.3 Hyperpyrexia, temperature >105 this is a medical emergency and the temp must be quickly brought down

How about hypothermia Mild hypothermia-34 to 35 Moderate hypothermia Severe hypothermia-<30

You need to get the beat-pulse Radial artery is first choice Thready or weak pulse, may check apical heart rate, carotid or femoral pulses. assessing pulse is the rate WNL (60-100) are radial and apical pulse the same is the pulse weak, thready, bounding

Pulse abnormalities Pulsus alternans weak beats alternate with strong beats, regular rhythm. May indicate left ventricular failure. Pulsus bigeminus two beats in rapid succession followed by a pause. irregular rhythm. early beats with a change in amplitude. may indicate cardiac arrhythmias

More pulse abnormalties Pulsus paradoxus pulse amplitude that increases with expiration and decreases with inspiration. Pulsus tardus slow pulse rate, may indicate severe aortic stenosis.

Respirations Normal findings Eupnea rate between regular, quiet, effortless Abnormal findings tachypnea > 20 bradypnea <12 apnea-none, bad sign

Respiratory abnormalities (cont.) hyperventilation-deep respirations, slightly fast rate Kussmaul’s- fast and deep, no pauses. Cheyne-stokes-cyclic pattern of apnea and varied breathing. Biots-fast and deep with periods of apnea

Blood pressure Normal systolic Normal diastolic Normal pulse pressure blood pressure typically peaks at midmorning and drops to its lowest at 3-4 am.

Blood pressure abnormalities Orthostatic hypotension-a drop of 20mm hg or more in systolic pressure when patient rises from a lying to sitting then to standing, may also have increased pulse and near syncope or syncope. Hypotension-systolic below 90, diastolic below 60, need to know patients baseling. Hypertension-above 140/90, obtained on at least 3 occasions, what makes your B/P go up and it is not considered hypertension?

Height and weight and BMI BMI=weight in kg./height in meters squared. BMI>25.8 (women), 26.4 (men)are 20% over their ideal body weights and at risk for obesity