physical exam overview general survey vital signs
TRANSCRIPT
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PHYSICAL EXAMPHYSICAL EXAM
OVERVIEW
GENERAL SURVEY
VITAL SIGNS
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• OVERVIEW– comfort
– sequence
– maneuvers
• GENERAL SURVEY
• VITAL SIGNS and MEASUREMENTS
Lecture OutlineLecture Outline
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Physical Examination Physical Examination OVERVIEWOVERVIEW
• COMFORT– Your comfort– Patient’s comfort
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Physical Examination Physical Examination OVERVIEWOVERVIEW
• SEQUENCE– perform regional sequence
• maximize effeciency• minimize patient movement
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Physical Examination Physical Examination OVERVIEWOVERVIEW
• Examination maneuvers– inspection– palpation– percussion– auscultation
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• OVERVIEW• GENERAL SURVEY
– definition
– anatomy and physiology
– history considerations
– techniques of examination
• VITAL SIGNS and MEASUREMENTS
Lecture OutlineLecture Outline
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GENERAL SURVEYGENERAL SURVEY
AN OVERVIEW OF THE PERSON
AS A WHOLE
Documented as a narrative at the beginning of the physical exam.
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GENERAL SURVEYGENERAL SURVEYHistorical Historical
ConsiderationsConsiderations• WEIGHT
• FATIGUE
• WEAKNESS
• FEVER
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The General SurveyThe General Survey
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General Survey ItemsGeneral Survey Items
• OBSERVATION OF• Overall appearance• General state of health• Nutrition and hydration• Mobility• Height-weight-build • Sexual development• Extracorporeal
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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
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General Survey ItemsGeneral Survey Items
• General State of Health– apparent state of overall health
frail, robust, ill – signs of distress
breathing, pain, anxiety
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General Survey ItemsGeneral Survey Items
• Nutrition and Hydration– Cachexic– Muscle wasting– Obese– Dehydrated
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General Survey ItemsGeneral Survey Items
• MOBILITY - – lying in bed– sitting comfortably in the chair– unable to remain still– gait - ambulates with assistive device. limps– Posture
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General Survey ItemsGeneral Survey Items
• Height-Weight-Build– short vs tall– lanky, symmetrical– slender, plump– fat distribution
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Height-Weight-BuildHeight-Weight-Build
• dependant on• genetics• nutrition• early illnesses• gender• geography• age
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Height-Weight-BuildHeight-Weight-Build
Age Dependant Proportions
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Height-Weight-BuildHeight-Weight-Build
Age Dependant Proportions
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Height-Weight-BuildHeight-Weight-Build
Age Dependant Proportions
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Height-Weight-BuildHeight-Weight-Build
Fat Distribution
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Height-Weight-BuildHeight-Weight-Build
Changes related to Endocrine Disease
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General Survey ItemsGeneral Survey Items
• Sexual development– Tanner Staging– voice– facial hair – breast size
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General Survey ItemsGeneral Survey Items
• Extracorproreal– other things around the room/person– bedside books– nicotine stains– lots of flowers– rosary beads– empty walls and table– odors - alcohol, urine
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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.
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• OVERVIEW• GENERAL SURVEY• VITAL SIGNS and MEASUREMENTS
– Temperature
– Pulse
– Respirations
– Blood Pressure
– Height
– Weight
Lecture OutlineLecture Outline
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TemperatureTemperature
• PHYSIOLOGY– thermoregulatory mechanisms– fever– hypothermia
• METHODS
• FALSE READINGS
• “AFEBRILE”
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PulsePulse
• PHYSIOLOGY
• METHODS– peripheral– apical
• CHARACTER– rate– rhythm– force
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RespirationsRespirations
• PHYSIOLOGY
• METHOD
• CHARACTERISTICS– Rate– Rhythm– Effort
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Blood PressureBlood Pressure
• PHYSIOLOGY
• METHOD– environment– positioning– technique
• CHARACTERISTICS
• RECORDING
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KOROTKOFF SOUNDSKOROTKOFF SOUNDS
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