PHYSICAL EXAM OVERVIEW GENERAL SURVEY VITAL SIGNS.

PHYSICAL EXAMPHYSICAL EXAM

OVERVIEW

GENERAL SURVEY

VITAL SIGNS

• OVERVIEW– comfort

– sequence

– maneuvers

• GENERAL SURVEY

• VITAL SIGNS and MEASUREMENTS

Lecture OutlineLecture Outline

Physical Examination Physical Examination OVERVIEWOVERVIEW

• COMFORT– Your comfort– Patient’s comfort


• SEQUENCE– perform regional sequence

• maximize effeciency• minimize patient movement


• Examination maneuvers– inspection– palpation– percussion– auscultation

• OVERVIEW• GENERAL SURVEY

– definition

– anatomy and physiology

– history considerations

– techniques of examination

• VITAL SIGNS and MEASUREMENTS


GENERAL SURVEYGENERAL SURVEY

AN OVERVIEW OF THE PERSON

AS A WHOLE

Documented as a narrative at the beginning of the physical exam.

GENERAL SURVEYGENERAL SURVEYHistorical Historical

ConsiderationsConsiderations• WEIGHT

• FATIGUE

• WEAKNESS

• FEVER

The General SurveyThe General Survey

General Survey ItemsGeneral Survey Items

• OBSERVATION OF• Overall appearance• General state of health• Nutrition and hydration• Mobility• Height-weight-build • Sexual development• Extracorporeal

General Survey ItemsGeneral Survey Items• Overall appearance

Things that you notice right away and things that you notice later

(Gone With the Wind)

– apparent age – dress, grooming, hygiene– obvious skin abnormalities– asymmetries– other obvious problems


• General State of Health– apparent state of overall health

frail, robust, ill – signs of distress

breathing, pain, anxiety


• Nutrition and Hydration– Cachexic– Muscle wasting– Obese– Dehydrated


• MOBILITY - – lying in bed– sitting comfortably in the chair– unable to remain still– gait - ambulates with assistive device. limps– Posture


• Height-Weight-Build– short vs tall– lanky, symmetrical– slender, plump– fat distribution

Height-Weight-BuildHeight-Weight-Build

• dependant on• genetics• nutrition• early illnesses• gender• geography• age


Age Dependant Proportions


Fat Distribution


Changes related to Endocrine Disease


• Sexual development– Tanner Staging– voice– facial hair – breast size


• Extracorproreal– other things around the room/person– bedside books– nicotine stains– lots of flowers– rosary beads– empty walls and table– odors - alcohol, urine

Example Write-upExample Write-up

• The patient is a moderately obese, young adult caucasian male who appears his stated age of 33 and is in no acute distress. Patient ambulates without difficulty and moves freely. He appears well-groomed, clean, and is dressed in an examination gown. Patient talks freely but appears to be somewhat anxious.

• OVERVIEW• GENERAL SURVEY• VITAL SIGNS and MEASUREMENTS

– Temperature

– Pulse

– Respirations

– Blood Pressure

– Height

– Weight


TemperatureTemperature

• PHYSIOLOGY– thermoregulatory mechanisms– fever– hypothermia

• METHODS

• FALSE READINGS

• “AFEBRILE”

PulsePulse

• PHYSIOLOGY

• METHODS– peripheral– apical

• CHARACTER– rate– rhythm– force

RespirationsRespirations

• PHYSIOLOGY

• METHOD

• CHARACTERISTICS– Rate– Rhythm– Effort

Blood PressureBlood Pressure

• PHYSIOLOGY

• METHOD– environment– positioning– technique

• CHARACTERISTICS

• RECORDING

KOROTKOFF SOUNDSKOROTKOFF SOUNDS

PHYSICAL EXAM OVERVIEW GENERAL SURVEY VITAL SIGNS.

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