Physical examination
General Survey , vital Signs &Pain
Present by :
Assist .Prof .Dr/Amira Yahia
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
• 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:
• 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
• 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
• 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
• Pain :
• Is one of the most common symptom that prompting the
office care
• It classified into acute and chronic
Classification of overweight and obesity by BMI
type
Obesity class
BMI(Kg/M2)
underweight
<18.5
Normal
18.5-24.9
overweight
25-29.9
Obesity
I
30-34.9
Obesity
II
35-39.9
Exterme Obesity
III
≥40
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
Vital signs
• Blood pressure
• Classification
Category
Systolic(mmHg)
Diastolic(mmHg)
normal
<120
<80
prehypertension
120-139
80-90
Stage 1
140-159
90-99
Stage 2
≥160
≥100
Hypertension :
•
•
•
•
Heart rate &rhythm:
Count for one minute
Normal range 50-90 beats/minute
Rhythm :
Regular or irregular
• 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
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
• 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