Patient

• Vital Signs


  • Temperature
  • Blood Pressure
  • Pulse
  • Respiration

  
• Vital Signs


  • Objective data
  • Factual information
  • Direct interaction with patient
• 4 classes of Vital Signs

  • Temperature
  • Blood Pressure
  • Pulse
  • Respiration

  
• Other Vital Signs


  • Height
  • Weight
  • Pain level
  • Level of consciousness
• Pain


  • Type
  • Level (10-point scale, corresponding facial expressions, verbal description)
• Pain is an important clinical feature that should be quickly evaluated for location, intensity, onset, and what makes it better or worse
• Level of Consciousness


  • Cerebral oxygenation
  • Oriented x3 (time, place, person)
  • Glasgow Coma Scale
• Temperature


  • Balanced by hypothalamus
  • Peripheral vasodilation
  • Sweating
  • Measurement sites (ear, mouth, axilla, rectum)
  • Measurement methods (glass thermometer, electronic thermometer)
• Pulse


  • Rate
  • Rhythm
  • Strength
  • Causes of tachycardia and bradycardia
  • Measurement sites (radial, brachial, femoral, carotid arteries)

  
• Respiratory Rate and Pattern

  • Measurement
  • Oxygen saturation
  • Observation
  • Hand over abdomen
  • Assessed without patient aware
• Blood Pressure


  • Identification of BP, DBP, SBP, Pulse Pressure
  • Hypertension, Hypotension, Orthostatic Hypotension
  • Measurement by Sphygmomanometer
  • Cuff size
  • Potential errors (long stethoscope, poor hearing, calibration errors, inappropriate cuff, rapid deflation)

  
• Vital Signs: Temperature, Heart Rate (Pulse), Respiratory Rate, Blood Pressure, Pulse Oximetry

  
• Normal ranges: Temperature (36.5-37.5), Heart Rate (60-100), Respiratory Rate (12-20), Blood Pressure (120/80), Pulse Oximetry (95-100%)
• General physical examination should include observation of the patient's general appearance, vital signs, weight, body habitus, and posture
• Hydration


  Mild (2.5L deficit), Moderate (4L deficit), Severe (6L deficit)
• Facies


  • Specific diagnoses can be made by looking at the patient's face
  • Diagnostic facies (acromegaly, Cushing's, Down syndrome, Hippocratic, Marfanoid, myxedematous, thyrotoxic, Parkinsonism)
• Skin Findings


  Mottling, Ecchymosis, Turgor, Skin lesions
• Jaundice


  Yellowish discoloration of skin and sclera due to hyperbilirubinemia
• Cyanosis


  • Blue discoloration of skin and mucous membranes due to deoxygenated hemoglobin
  • Central vs. Peripheral
• Pallor


  Deficiency of hemoglobin causing pale skin, especially in mucous membranes and sclera
• Alopecia


  • Non-scarring (alopecia areata, scalp ringworm, traction alopecia)
  • Scarring (burns, radiation, lupoid erythema, sarcoidosis)
• Clubbing


  Increase in soft tissue of distal fingers/toes, causes (cardiovascular, respiratory, gastrointestinal, thyrotoxicosis, familial)
• Nail Changes


  Blue nails (cyanosis), Red nails (polycythemia, CO poisoning), Yellow nails (yellow nail syndrome), Splinter hemorrhages (infective endocarditis, vasculitis), Koilonychia (iron deficiency anemia, fungal infection, Raynaud's), Onycholysis (thyrotoxicosis, psoriasis), Leukonychia (hypoalbuminemia), Nail fold erythema (SLE), Terry's nails (chronic renal failure, cirrhosis)
• Proper sterile technique reduces infection by preventing contamination from disease-causing microorganisms
• Sterile Technique Components


  • Hand hygiene
  • Personal protective equipment (PPE)
  • Clean environment
  • Sterile instruments
  • Proper disposal
• General Appearance Examination


  • Greeting the patient
  • Facial expression
  • Body build and posture
• Physical Examination Techniques


  • Inspection (mental status)
  • Palpation
  • Percussion
  • Auscultation
• The physical examination should be performed in a quiet, well-lit, private setting to avoid exposing the patient to unnecessary discomfort
• Head Examination


  • Size, shape, swelling
  • Hair (quantity, distribution, texture)
  • Palpation
• Skin Inspection


  • Cyanosis
  • Flushed face
  • Pale lips
  • Diaphoresis
  • Pallor (conjunctival, tongue, fingernails)
  • Edema and swelling
• Eye Examination


  • Pupillary reactions (PERRLA)
  • Lens clarity
  • Abnormalities
• Pallor


  Pale color indicating anaemia due to reduction of oxyhaemoglobin
• Where to look for pallor

  • Conjunctival pallor (lining of the eyes)
  • Tongue color
  • Fingernails
  • Face (edema, swelling, cyanosis, flush)
• Examining the eyes with a light

  1. Look for normal pupillary reactions (PERRLA - pupils equal, round, reactive to light and accommodation)

  2. Observe for abnormal findings (unequal pupil size, non-reactive pupils, abnormal pupil shape/position, lens clarity, abnormalities)
• Abnormal eye findings can indicate neurological or ocular conditions, caused by head trauma, tumors, central nervous system disease, medications
• Brain death, catecholamines, and atropine can cause pupils to become dilated and fixed
• Examining the eyelids


  • Can check for discharge or pus, which may indicate cranial nerve disease
• Respiratory syncytial virus (RSV) in infants and children can cause eye redness and irritation
• Jaundice


  Yellowish discoloration formed by the liver, due to excessive yellow pigmented bilirubin (hyperbilirubinemia)
• Ptosis


  Drooping of the upper eyelid, may be an early sign of disease involving the third cranial nerve (oculomotor) or respiratory failure in neuromuscular diseases