General Survey, Measurement,
Vital Signs
Health Assessment Across the
Lifespan
NRS 102
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 9: General Survey, Measurement, Vital Signs
General Survey

Physical appearance

Body structure

Age

Stature

Sex

Nutrition

Level of
consciousness

Symmetry

Posture

Position

Body build, contour

Skin color

Facial features
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 9-2
Chapter 9: General Survey, Measurement, Vital Signs
General Survey
(cont.)

Mobility

Behavior

Gait

Facial expression

Range of motion

Mood and affect

Speech

Dress

Personal hygiene
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 9-3
Chapter 9: General Survey, Measurement, Vital Signs
Measurement


Weight

Balance scale

Recommended range for height
Height
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 9-4
Chapter 9: General Survey, Measurement, Vital Signs
Vital Signs

Temperature



Hypothalamus as thermostat mechanism
Influences on temperature
• Diurnal cycle
• Menstrual cycle
• Exercise
• Age
Routes of temperature measurement
• Oral
• Electronic thermometer
• Axillary
• Rectal
• Tympanic membrane thermometer
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 9-5
Chapter 9: General Survey, Measurement, Vital Signs
Abnormal Body Temp
Hypothermia

Heat loss during prolonged exposure to cold

Classified by core temp (mild-severe)

May be intentional (surgery)

Early signs- uncontrolled shivering, loss of
memory, poor judgment

Later signs- Cyanosis, decreased VS, cardiac
dysrhythmias, loss of consciousness

Frostbite- body exposure to subnormal temps
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 9: General Survey, Measurement, Vital Signs
Abnormal Body Temp
Hyperthermia

Elevated body temp related to body’s inability
to promote heat loss or reduce heat
production

Heatstroke- prolonged exposure to sun or
high environmental temp. Heat depresses
hypothalamus function

Heat Exhaustion- profuse diaphoresis result
in fluid & electrolyte loss
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 9: General Survey, Measurement, Vital Signs
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 9: General Survey, Measurement, Vital Signs
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 9: General Survey, Measurement, Vital Signs
Vital Signs

Pulse






Stroke volume
Technique of measurement
Rate
• Normal rate for age group
• Bradycardia
• Tachycardia
Rhythm
• Sinus arrhythmia
Force
Elasticity
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 9-10
Chapter 9: General Survey, Measurement, Vital Signs
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 9: General Survey, Measurement, Vital Signs
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 9: General Survey, Measurement, Vital Signs
Vital Signs

Respirations

Technique of measurement

Normal rate for age group

Ratio of pulse rate to respiratory rate should be
approximately 4:1
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 9-13
Chapter 9: General Survey, Measurement, Vital Signs
Assessing Respirations

Assessing rate- observe full inspiration &
expiration

Assess for full minute

Normal adult 12 –20 breaths/minute

Varies with age, rate declines throughout life

Apnea Monitor
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 9: General Survey, Measurement, Vital Signs
Normal & Abnormal Respirations

Eupnea- normal respirations

Bradypnea- abnormally slow < 12

Tachypnea- abnormally fast >20

Hyperpnea- labored, after exercise

Hyperventilation/Hypoventilation

Cheyne-Stokes

Kussmauls

Biot’s
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 9: General Survey, Measurement, Vital Signs
Vital Signs

Blood pressure

Systolic pressure

Diastolic pressure

Pulse pressure

Mean arterial pressure
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 9-16
Chapter 9: General Survey, Measurement, Vital Signs
Blood Pressure
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 9-17
Chapter 9: General Survey, Measurement, Vital Signs
Vital Signs

Influences on blood pressure
• Age
• Race
• Weight
• Emotions
• Sex
• Diurnal rhythm
• Exercise
• Stress
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 9-18
Chapter 9: General Survey, Measurement, Vital Signs
Vital Signs
(cont.)

Physiologic factors controlling blood pressure
• Cardiac output
• Peripheral vascular resistance
• Volume of circulating blood
• Viscosity
• Elasticity of vessel walls
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 9-19
Chapter 9: General Survey, Measurement, Vital Signs
Factors Controlling Blood Pressure
Illustration Pat Thomas, © 2006
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 9-20
Chapter 9: General Survey, Measurement, Vital Signs
Vital Signs

Blood pressure measurement

Sphygmomanometer

Cuff width and size

Blood pressure measurement in the arm
•
•
•
•
Position of person
Palpate brachial artery
Proper inflation and deflation technique
Korotkoff’s sounds

I, systolic pressure

IV, muffling of sounds

V, diastolic pressure
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 9-21
Chapter 9: General Survey, Measurement, Vital Signs
Measuring Blood Pressure
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 9-22
Chapter 9: General Survey, Measurement, Vital Signs
Vital Signs

Common errors in blood pressure
measurement

Orthostatic (or postural) hypotension

Blood pressure measurement in the thigh
• Thigh pressure higher than in the arm
• Screen for coarctation of aorta
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 9-23
Chapter 9: General Survey, Measurement, Vital Signs
Assessment of Diffusion &
Perfusion

Assessed by oxygen saturation of blood

Oxygen attaches to hemoglobin molecule in
RBC

% of hemoglobin that is bound with oxygen in
the arteries is the % of saturation of
hemoglobin (SaO2)

Usually 95-100%

Affected by factors that interfere with
ventilation, diffusion, & perfusion
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 9: General Survey, Measurement, Vital Signs
Measurement of Arterial Oxygen
Saturation

Pulse oximeter

Allows indirect measurement of oxygen
saturation

SpO2 is a reliable estimate of SaO2

Measurement is affected if extremity is cold,
edematous or if nail polish is present
(interference with light transmission)
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 9: General Survey, Measurement, Vital Signs
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 9: General Survey, Measurement, Vital Signs
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 9-27
Chapter 9: General Survey, Measurement, Vital Signs
Sample Charting
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 9-28
Chapter 9: General Survey, Measurement, Vital Signs
Significant elevation in blood pressure
measurements from one day to the next
could be attributed to
A. A decrease in cuff size
B. An increase in cuff size
C. New onset of pain or anxiety
D. A and C
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 9-29
Chapter 9: General Survey, Measurement, Vital Signs
Which patient would be most likely
to present with a pulse rate that is
lower than normal?
A. A 70-year-old telephone salesman
presenting with dehydration.
B. A 20-year-old runner who had surgery 4
days ago for a fractured leg.
C. A 67-year-old who presented with an
exacerbation of his COPD
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 9-30