General Assesment and Vital Sign

8/8/2019 General Assesment and Vital Sign

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General assesment and vital sign

DAP


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General Assesment

Is a quick assesment of the patient as awhole, including patient physical

appearance, behaviour , mobility, certainphysical parameters (height, weight, age,vital signs)

Should be providing an overall impression ofthe patients health status.


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Physical appearance, behaviour, andmobility (1)

AgeSkin colorfacial featureslevel of consciousnesssign of acute distressnutrition, body structure

dress and groomingBehaviourmobility


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(2)

Age : could it be chronic illness?Skin :

1. Cyanotic (lips and oral cavity): sob, lung disease2. Pallor and jaundice (nails bed,conjunctiva and nails)3. Pigmentation (genetic)

Facial features : symmetric movement,matching expression with saying

Example : Paralizing one side face, Bells palsy, flat effect


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(3)

Level of consciousnessAllerted to time, place and person.Example :Disorientation, lethargy, stupor,coma

Sign of acute stressARS : sob, wheezing, facial grimacing, holding a body part

NutritionPatient weight. Example : Cushing syndrome, cachetic appearance

Body structureSymmetric body movement. Stand comfortably appropiate with age. Example :

tripod position, Kyphosis, lordosis are related with osteoporosis

Dress and groomingPatients clothing should correspond with climate, clean and fit appropiately.

Groomed appropiately with age, gender, occupation, cultural


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(4)

BehaviourCooperative and interact pleasently, speech should be clear, understable,

appropiate word choice with education, culture

MobilityWalk smooth, even, well balanced. Example : shuffling gait, ataxia


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Physical Parameters (1)

Height (genetic)To asses bone density in osteoporosis.Evaluation : stand erect, without shoes, against a flat and measuring surface. Place

the headpiece intersect the height scale.

WeightReflect the nutritional status. Find BMI (kg/m 2)Under : < 18,5Healthy : 18,5-24,9

Overweight : 25-29,9Obesity class I : 30-34,9 class II 35-39,9 class III 40Example : risk of overweight , unintended weight loss, decreased of patient

appetite, weight gain


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(2)

Vital signs1. Temperature

NBT (36,4-37,2), affected by hormones,exercises, drug, biological rhytmis. Diurnaltemperature, Progesterone excretion

Tools : oral route (37), rectal route (37,5),axillary route (36,5), Tympanic route


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2. PulseWhat is heart beat means?

Radial pulse, bradychardia (< 60 ppm),tachicadia (>100 ppm), arrhytmia.

RP depends on age, (see table 5-1) ex : adult

60-100 ppm normally


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3. Respiration RateMost people are unaware of their breathing

To measure RR : Count the number ofrespiration in 30 sc, if irregular count it for 60sc. Record as rpm

NRR depends on age (see table 5-2)Bradypnea (< 12 rpm), Tachypnea (>20 rpm)


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4. Blood pressureDefinition

Depends on : cardiac output and peripheralvascular resistanceSystolic and diastolic pressure.

Korotkoff sounds : no sound, soft and cleartapping, swooshing, tapping, muffling,nosound


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Blood flow phase :I : faint, clear tapping

II : swooshingIII : Tapping (systolic)IV : Muffling (hyperkinetic)

V : Cessation ( diastolic)Evaluation : ask about smoking within previous

30 mnt, seated in a chair, after 5 min of a rest


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Classification of BP (JNC VI and JNC VII)Common errors in measurement

Factors affecting BP : age, race, diurnalrhythm, weight, exercise, emotions,medications


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Special considerations

Pediatric patientsTemperatures, pulse, rr, BP, routine growth measurements,

Geriatric patientsPosture change, NBT, Hypertension

Pregnant womanPosture change, weight gain

BP unchanged ( 1 st sem), decrease (2 nd sem), returns or slightlyexceed ( 3 rd sem)

Gestational hypertension?


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The End

General Assesment and Vital Sign

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