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NVCC EMS 207 - K Deal & E Stern
Health & Physical Assessment in Nursing
First Edition
Chapter 7
General Survey
Donita D’Amicoand
Colleen Barbarito
NVCC EMS 207 - K Deal & E Stern
The General Survey
General Survey
a.k.a. The Size Up
NVCC EMS 207 - K Deal & E Stern Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Ed’s S3
Sixth Sense of Sickness
Sick or Not Sick?
a.k.a = BS factor
NVCC EMS 207 - K Deal & E Stern Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Size It UpDispatch: See the Woman,
Chest Pain, corner of Williams and 42nd
Size up the Scene and the patient.. Looking for?
Your “Initial Impression is?...
NVCC EMS 207 - K Deal & E Stern Bledsoe et al., Paramedic Care Principles & Practice Volume 2: Patient Assessment© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Case Study
8y/o male fell down a flight of stairs
• c/o buttock pain, right forearm deformity, headache with possible short +LOC.
• Pt is very calm, constantly asking if his Mom is there, GCS 15
• Vitals WNL, C-collar, LBB, right arm splinted +PMS
NVCC EMS 207 - K Deal & E Stern
• Airway clear – Name is Oliver• Multiple head contusions• Right forearm deformity• Circumferential contusion (some
old some new) both wrists• Bilateral knee abrasions with full
ROM• Contusions to anterior/superior
chest wall, spaced at either side of sternum
• Multi layer contusions to the buttock
The Size Up
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http://www.fordarlieroutier.org
http://www.fordarlieroutier.org
NVCC EMS 207 - K Deal & E Stern
General Survey = The Size Up
Use of Senses During General Survey• Vision• Hearing• Smell• Taste(?)• Gut
NVCC EMS 207 - K Deal & E Stern
General Survey = The Size Up
Class Exercise:
Partner up and size up the person next to you for:
15 secondsthen
90 seconds
NVCC EMS 207 - K Deal & E Stern
General Survey = The Size UpWhat did you learn?
<0:90 Size Up
The Purpose of the general survey is to obtain information to guide your physical assessment & examination.
Getting you to your version of the“Differential Diagnosis (DDx)”
NVCC EMS 207 - K Deal & E Stern
The General Survey
NVCC EMS 207 - K Deal & E Stern
Components of the General Survey
• Physical appearance
• Mental status
• Mobility
• Behavior
NVCC EMS 207 - K Deal & E Stern
Components of the General Survey
Physical Appearance• Body shape
• Build
• Assessment of function and symmetry
NVCC EMS 207 - K Deal & E Stern
Components of the General SurveyMental Status
• Orientation
• Affect
• Mood
• Anxiety
• Speech
• Self awareness– Own presence, medical hx, etc..
Other than visual observation how do you assess mental
status?
NVCC EMS 207 - K Deal & E Stern
Components of the General Survey
Mobility• Posture
• Gait– Stumbling– Shuffling– Limping
• Range of motion
NVCC EMS 207 - K Deal & E Stern
Components of the General Survey
Behavior• Grooming
• Bodily odors
• Hygiene
• Facial expression
• Mood
• Level of anxiety
NVCC EMS 207 - K Deal & E Stern
Age Related Considerations
• Developmental stage
• Regression from current stage
• Interaction with caretakers
Components of the General Survey
NVCC EMS 207 - K Deal & E Stern
Components of the General Survey
Height and Weight
• Ask the patient?
• Proportionate?
• Estimated?
NVCC EMS 207 - K Deal & E Stern
Figure 7.2 Measuring the client’s height with a platform scale.
NVCC EMS 207 - K Deal & E Stern
Figure 7.4 Measuring the client’s weight with a standard platform scale.
NVCC EMS 207 - K Deal & E Stern
Table 7.1 1999 Metropolitan Height and Weight Tables, Men and Women, Ages 25 to 59
NVCC EMS 207 - K Deal & E Stern
• Length of infants
• Consider proportion
• “Length based measuring device”
• Actual Weight (when possible)
Components of the General Survey
Chronological Age and Developmental Stage Considerations
NVCC EMS 207 - K Deal & E Stern
Vitals
NVCC EMS 207 - K Deal & E Stern
The Signs
• Temperature
• Pulse
• Respiratory rate
• Blood pressure
• Pain
• Oxygen saturation
• (newest) End tidal CO2
NVCC EMS 207 - K Deal & E Stern
VitalsUse of Vital Signs
• Obtain baseline data
• Detect or monitor a change
• Monitor clients at risk
NVCC EMS 207 - K Deal & E Stern
Going “Ye Ol’ Schoole”
NVCC EMS 207 - K Deal & E Stern
Temperature
Temperature Routes
• Oral
• Rectal
• Tympanic
• Temporal Also works (if all else fails):•“Warm and Dry”•“Cold and Wet”
NVCC EMS 207 - K Deal & E Stern
TemperatureFactors affecting Body Temperature• Age• Diurnal variation• Exercise• Hormones• Stress• Illness
NVCC EMS 207 - K Deal & E Stern
Pulse and Pulse Points
Pulse rates is affected by:• Age• Gender• Exercise• Stress (stressors)• Fever• Hemorrhage• Medications• Positional changes
NVCC EMS 207 - K Deal & E Stern
Pulse and Pulse Points
• What do we look for when palpating a pulse?
• Common locations?
NVCC EMS 207 - K Deal & E Stern
Pulse and Pulse Points
• The value of auscultation of an Apical HR?
NVCC EMS 207 - K Deal & E Stern
Respirations
• Rate
• Quality
• Effort
• Sounds
NVCC EMS 207 - K Deal & E Stern
Blood Pressure
Mechanical vs Manual When?
NVCC EMS 207 - K Deal & E Stern
Blood PressureFactors affecting BP:• Cardiac Output• Volume• Peripheral Vascular
resistance• Viscosity (Crit)• Vessel compliance• What else?...
NVCC EMS 207 - K Deal & E Stern
Blood PressureOrthostatic BP• Clinical Indications• >20/10mmHG Change• >20 points HR Change• Pause in each stages
• Supine
• Sitting, feet dangle
• Standing
NVCC EMS 207 - K Deal & E Stern
Box 7.1 Korotkoff’s Sounds
NVCC EMS 207 - K Deal & E Stern
Box 7.1 (continued) Korotkoff’s Sounds
NVCC EMS 207 - K Deal & E Stern
Pain – Yes it’s a Vital Sign
Pain Assessment• Pain history• Observations of behaviors• Physiological changes• Pain history• Location• Intensity
NVCC EMS 207 - K Deal & E Stern
Pain – Yes it’s a Vital Sign
• How do you ask the pain question?• What is appropriate?• Cultural considerations
NVCC EMS 207 - K Deal & E Stern
Figure 7.15 The Wong-Baker “Faces” pain rating scale. Source: From Hockenberry, MJ, Wilson D., Winkelstein ML:Wong’s Essentials of Pediatric Nursing, ed.7, St.Louis, 2005, p.1259. Used with permission. Copyright Mosby.
NVCC EMS 207 - K Deal & E Stern
Pain – Yes it’s a Vital Sign
Pain Assessment• Quality• Pattern• Precipitating factors• Methods to relieve pain• Impact on ADLs• Coping strategies• Emotional responses
NVCC EMS 207 - K Deal & E Stern
Pain – Yes it’s a Vital Sign
Physiological Responses to Pain• Sympathetic
• Parasympathetic
NVCC EMS 207 - K Deal & E Stern
Oxygen Saturation
The noninvasive pulse oximeter uses light pulses to measure percent of oxygenated hemoglobin based on calculations associated with the oxyhemoglobin dissociation curve (simplified)
95-100%
NVCC EMS 207 - K Deal & E Stern
Oxygen Saturation
Factors affecting Noninvasive O2 saturation?
• Circulation
• Hemoconcentration
• Temperature
• Nail polish
NVCC EMS 207 - K Deal & E Stern
End Tidal CO2 Detection• The concentration (measured as partial pressure) of carbon
dioxide (CO2) at the end of an exhaled breath• Expressed as a percentage of CO2 or mmHg.• The normal values are 5% to 6% CO2
• Equivalent to 35-45 mmHg (pressure)• CO2 reflects cardiac output and pulmonary blood flow as it is
transported by the venous system to the right side of the heart and then pumped to the lungs by the right ventricles.
• When CO2 diffuses out of the lungs into the exhaled air, we measure it through a capnometer• A Capnometer measures the partial pressure or maximal
concentration of CO2 at the end of exhalation.• Tip:
• During CPR, the amount of CO2 excreted by the lungs is proportional to the amount of pulmonary blood flow.
NVCC EMS 207 - K Deal & E Stern
End Tidal CO2 Detection
Easy Cap II CO2 Detector• The normal values are 5% to
6% CO2
• Equivalent to 35-45 mmHg (pressure)
NVCC EMS 207 - K Deal & E Stern
End Tidal CO2 Detection
Capnography Wave Form
NVCC EMS 207 - K Deal & E Stern
Break
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