1. General Survey, Vital Signs, and Pain
Chapter 9
General Survey, Vital Signs, and Pain

2. Competencies Describe general assessment observations.
Discuss factors affecting respiratory rate and heart rate.
Describe the characteristics that are included in an assessment of pulse.
(continues)

3. Competencies Discuss factors influencing body temperature.
Describe factors influencing blood pressure and blood pressure measurement.
(continues)

4. Competencies Obtain a patient’s vital signs.
Conduct a pain assessment on a patient experiencing pain.

5. General Survey Physical presence Assess patient’s
stated age vs. apparent age
general appearance
body fat
stature
(continues)

6. General Survey Assess patient’s (cont’d) Psychological presence
motor activity
body and breath odors
Psychological presence
(continues)

7. General Survey Observe patient’s Distress
dress, grooming, personal hygiene
mood and manner
speech
facial expressions
Distress
(continues)

8. General Survey Assess for
Labored breathing, wheezing, cough, labored speech
Painful facial expressions, sweating, guarding
Serious or life-threatening occurrences
Emotional distress or anxiety

9. Vital Signs Respiration Position self and observe
Count for one full minute
Normal findings
Adult rate 12–20 per minute
(continues)

10. Vital Signs Respiration (cont’d) Abnormal findings Tachypnea Bradypnea
Apnea
(continues)

11. Vital Signs Pulse Rate Rhythm Volume
Normal range for adults is 60–100 bpm
Rhythm
Regular vs. irregular
Volume
Absent to bounding
Use 3-point or 4-point scale for measuring

12. Factors Affecting Heart Rate
Age
Gender
Activity
Emotional status
Pain
(continues)

13. Factors Affecting Heart Rate
Environmental factors
Stimulants
Medications
Disease

14. Peripheral Pulses Temporal Carotid Apical Brachial Radial Femoral
Popliteal
Posterior tibial
Dorsalis pedis

15. Pulses Radial Apical How to find
Count for 30 seconds if regular or 60 seconds if irregular
Apical
(continues)

16. Pulses Rate Rhythm Tachycardia Bradycardia Asystole
Regular vs. irregular
Dysrhythmias or arrhythmias
(continues)

17. Pulses
Volume
Weak or thready
Strong or bounding
Normal 2+

18. Vital Signs Temperature Celsius Fahrenheit
5/9 x (temp in Fahrenheit – 32 ) = Celsius
Fahrenheit
(9/5 x temp in C) + 32 = Fahrenheit

19. Variables Affecting Temperature
Circadian rhythm
Hormones
Age
Exercise
Stress
Environmental extremes
Health status

20. Oral Temperature Route
Average
37.0°C or 98.6°F
Range
36°–38°C or 96.8°–100.4°F
(continues)

21. Oral Temperature Route
Advantages
Convenient, accessible
Disadvantages
Safety, physical abilities, accuracy

22. Rectal Temperature Average Range 0.4°C or 0.7°F higher than oral
(continues)

23. Rectal Temperature Advantages Disadvantages Most accurate
Invasive, uncomfortable, and possibly embarrassing

24. Axillary Temperature Average Range 0.6°C or 1°F lower than oral
(continues)

25. Axillary Temperature Advantages Disadvantages Safe, noninvasive
Length of time; placement may affect result

26. Tympanic Temperature Average Range Calibrated to oral or rectal scales
Same as oral and rectal
(continues)

27. Tympanic Temperature Advantages Disadvantages Convenient, fast, safe
Research is inconclusive
Technique affects measurement

28. Temperature Variations
Hyperthermia
Hypothermia

29. Blood Pressure
Force exerted by the flow of blood pumped into the large arteries
(continues)

30. Blood Pressure Korotkoff sounds Phase I Phase II Phase III Phase IV
Phase V

31. Measuring Blood Pressure
Systole
Diastole
Pulse pressure
(continues)

32. Measuring Blood Pressure
Sites
Brachial
Posterior thigh
Avoid AV shunts or fistulas, affected arm of postmastectomy patients
(continues)

33. Measuring Blood Pressure
Equipment
Sphygmomanometer
Aneroid manometer
Mercury manometer
Ensure that patient has not had caffeine or tobacco in past 30 minutes
(continues)

34. Measuring Blood Pressure
Position patient
Normal adult findings: 120/80
Baroreceptors
Hypertension
Hypotension

35. Common Errors in Blood Pressure Measurements
Incorrect cuff size
Unrecognized auscultatory gap
Incorrect cuff placement

36. Pain
5th vital sign
Unpleasant sensory or emotional experience associated with actual or potential tissue damage
(continues)

37. Pain Nociceptive pain Neuropathic pain Somatic Visceral
Lesions in central or peripheral nervous system
(continues)

38. Pain Types of pain by duration Acute Chronic malignant
Chronic nonmalignant
(continues)

39. Pain Variables affecting pain Age Gender Previous experience with pain
Culture
(continues)

40. Pain Effects of pain on the body Physiological responses
Emotional and subjective responses
Can affect every system and take a toll on health
(continues)

41. Pain Assessing pain Location Radiation Quality Quantity
Associated manifestations
Aggravating factors
(continues)

42. Pain Assessing pain (cont’d) Alleviating factors Setting Timing
Meaning and impact

43. Assessing Pain Pain assessment tools Numeric rating scale
Visual analog scale
Brief pain inventory
Initial pain assessment tool
McGill Pain Questionnaire

44. Pain Management Management depends on type and etiology of pain
Common medications to treat pain
Common nonpharmacological treatments for pain

45. Pain History Goal is to assess the meaning and impact of pain
Ask questions to determine how pain is impacting the multiple aspects of the patient’s life