ems207 week2-chap7

NVCC EMS 207 - K Deal & E Stern

Health & Physical Assessment in Nursing

First Edition

Chapter 7

General Survey

Donita D’Amicoand

Colleen Barbarito


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


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?...


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


• 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


General Survey = The Size Up

Use of Senses During General Survey• Vision• Hearing• Smell• Taste(?)• Gut


General Survey = The Size Up

Class Exercise:

Partner up and size up the person next to you for:

15 secondsthen

90 seconds


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)”


The General Survey


Components of the General Survey

• Physical appearance

• Mental status

• Mobility

• Behavior



Physical Appearance• Body shape

• Build

• Assessment of function and symmetry


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?



Mobility• Posture

• Gait– Stumbling– Shuffling– Limping

• Range of motion



Behavior• Grooming

• Bodily odors

• Hygiene

• Facial expression

• Mood

• Level of anxiety


Age Related Considerations

• Developmental stage

• Regression from current stage

• Interaction with caretakers




Height and Weight

• Ask the patient?

• Proportionate?

• Estimated?


Figure 7.2 Measuring the client’s height with a platform scale.


Figure 7.4 Measuring the client’s weight with a standard platform scale.


Table 7.1 1999 Metropolitan Height and Weight Tables, Men and Women, Ages 25 to 59


• Length of infants

• Consider proportion

• “Length based measuring device”

• Actual Weight (when possible)


Chronological Age and Developmental Stage Considerations


Vitals


The Signs

• Temperature

• Pulse

• Respiratory rate

• Blood pressure

• Pain

• Oxygen saturation

• (newest) End tidal CO2


VitalsUse of Vital Signs

• Obtain baseline data

• Detect or monitor a change

• Monitor clients at risk


Going “Ye Ol’ Schoole”


Temperature

Temperature Routes

• Oral

• Rectal

• Tympanic

• Temporal Also works (if all else fails):•“Warm and Dry”•“Cold and Wet”


TemperatureFactors affecting Body Temperature• Age• Diurnal variation• Exercise• Hormones• Stress• Illness


Pulse and Pulse Points

Pulse rates is affected by:• Age• Gender• Exercise• Stress (stressors)• Fever• Hemorrhage• Medications• Positional changes



• What do we look for when palpating a pulse?

• Common locations?



• The value of auscultation of an Apical HR?


Respirations

• Rate

• Quality

• Effort

• Sounds


Blood Pressure

Mechanical vs Manual When?


Blood PressureFactors affecting BP:• Cardiac Output• Volume• Peripheral Vascular

resistance• Viscosity (Crit)• Vessel compliance• What else?...


Blood PressureOrthostatic BP• Clinical Indications• >20/10mmHG Change• >20 points HR Change• Pause in each stages

• Supine

• Sitting, feet dangle

• Standing


Box 7.1 Korotkoff’s Sounds


Box 7.1 (continued) Korotkoff’s Sounds


Pain – Yes it’s a Vital Sign

Pain Assessment• Pain history• Observations of behaviors• Physiological changes• Pain history• Location• Intensity



• How do you ask the pain question?• What is appropriate?• Cultural considerations


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.



Pain Assessment• Quality• Pattern• Precipitating factors• Methods to relieve pain• Impact on ADLs• Coping strategies• Emotional responses



Physiological Responses to Pain• Sympathetic

• Parasympathetic


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%


Oxygen Saturation

Factors affecting Noninvasive O2 saturation?

• Circulation

• Hemoconcentration

• Temperature

• Nail polish


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.


End Tidal CO2 Detection

Easy Cap II CO2 Detector• The normal values are 5% to

6% CO2

• Equivalent to 35-45 mmHg (pressure)


End Tidal CO2 Detection

Capnography Wave Form


Break

ems207 week2-chap7

Documents

buttock pain

chest pain

pain impact

pain question

general survey general

patient assessment

nd size

general survey donita