1. Physical examination General Survey, vital Signs &Pain Present by : Assist.Prof.Dr/Amira Yahia

2. Introduction General survey : begins with the first moments of the patient encounter(facial expression,grooming,posture and gait) Height, weight should be record before enter patient to examining room. Vital signs : Include blood pressure, heart rate,respiratory rate,and temperature and range of normal

3. Pain : The fifth vital sign Changing weight: This result from changes in the body tissues or body fluid. Weight gain: Occurs when caloric intake exceeds caloric expenditures over time and typically appears as increased body fat. Weight loss: Is an important symptoms of many cause. Mechanisms include one or more of the following:

4. Decrease intake of food (anorexia, dysphagia, and vomiting) Insufficient supplies of food (detective absorption through GIT) Increased metabolic requirement Loss of nutrients through the urine,feces or injured skin

5. Fatigue and weakness: Fatigue refer to sense of weariness or loss of energy (common symptom of depression,and anxiety) Fever,chills,and night sweats: Fever refer to an abnormal elevation in body temperature When patient is felt fever or unusually hot,excessive sweating occur Try to distinguish between subjective chilliness and shaking chill With shivering through out the body and chattering of teeth

6. Feeling cold, Goosebumps and shivering accompany arising temperature,feeling of hot and sweating accompany falling in temperature. Normally body temperature rises during the day and falls during the night when this occur night sweats happen and other symptom occur (malaise, headache, and pain in the muscle and joints

7. Pain : Is one of the most common symptom that prompting the office care It classified into acute and chronic

8. Classification of overweight and obesity by BMI typeObesity classBMI(Kg/M2) underweight<18.5 Normal18.5-24.9 overweight25-29.9 ObesityI30-34.9 ObesityII35-39.9 Exterme ObesityIII≥40

9. Promoting patient health 1.Consume a variety of foods with in and among the basic food groups 2.Control caloric intake and portion size to manage body weight 3.Maintain moderate physical activity for at least 30 minutes each day 4.Increase daily intake of fluid and vegetables and non fat, low fat –milk and milk product 5.Choose fat keeping intake of saturated fat 6.Choose carbohydrates,sugar starches and fibers 7.Choose and prepare food with little salt 8.Keep food safe to eat

10. Vital signs Blood pressure Classification CategorySystolic(mmHg)Diastolic(mmHg) normal<120<80 prehypertension120-13980-90 Hypertension : Stage 1140-15990-99 Stage 2≥160≥100

11. Heart rate &rhythm: Count for one minute Normal range 50-90 beats/minute Rhythm : Regular or irregular

12. Respiratory rate : Check rate,rhythm,depth and effort of breathing Normal for adults 20 breath /minute Temperature : Normal 37ċ (98.6F) Method of taking: Oral Rectal Tympanic

13. Acute and chronic pain Definition of pain: Is an unpleasant sensory and emotional experience associated with tissue damage Chronic pain : is pain not associated with cancer or other medical conditions that persist for more than 3-6 months. Pain last 1month called acute Assessment: Location Severity Associated features

14. Types of pain: 1. nociceptive or somatic pain: Pain related to tissue damage 2. Neuropathic pain: Pain resulting from direct injury to peripheral or central nervous system 3. Psychogenic and idiopathic pain : Pain related to the many factors that influence the patient report of pain