At first glance

A general patient assessment

General appearance

• Facial expression• Self-care• Unusual odors

Fruity breathHalitosisPutrid breath or body odorFishy vaginal odorUrine or ammonia like odorFecal breath or body odor

Assessing vital signs

• Temperaturenormal oral 36 to 37.5normal rectal 36.3 to 37.9normal tympanic (core) 36.2 to 37.8

Temperature starts low in the morning and gradually increases throughout the day.

Temperature continued

• When is a patient febrileoral >99.5rectal>100.5tympanic>101.3

Hyperpyrexia, temperature >105this is a medical emergency and the temp must be quickly brought down

How about hypothermia

• Mild hypothermia-34 to 35• Moderate hypothermia-30-34• Severe hypothermia-<30

You need to get the beat-pulse

• Radial artery is first choice• Thready or weak pulse, may check apical heart

rate, carotid or femoral pulses.assessing pulse

is the rate WNL (60-100)are radial and apical pulse the

sameis the pulse weak, thready,

bounding

Pulse abnormalities

• Pulsus alternans weak beats alternate with strong beats, regular rhythm. May indicate left ventricular failure.

• Pulsus bigeminus two beats in rapid succession followed by a pause.irregular rhythm.early beats with a change in amplitude.may indicate cardiac arrhythmias

More pulse abnormalties

• Pulsus paradoxuspulse amplitude that increases with

expiration and decreases with inspiration.• Pulsus tardus

slow pulse rate, may indicate severe aortic stenosis.

Respirations

• Normal findings Eupnearate between 12-20regular, quiet, effortless

• Abnormal findingstachypnea > 20bradypnea <12apnea-none, bad sign

Respiratory abnormalities (cont.)

hyperventilation-deep respirations, slightly fast rate

Kussmaul’s- fast and deep, no pauses.Cheyne-stokes-cyclic pattern of apnea

and varied breathing.Biots-fast and deep with periods of

apnea

Blood pressure

• Normal systolic 120-139• Normal diastolic 60-80• Normal pulse pressure 30-40

blood pressure typically peaks at midmorning and drops to its lowest at 3-4 am.

Blood pressure abnormalities

• Orthostatic hypotension-a drop of 20mm hg or more in systolic pressure when patient rises from a lying to sitting then to standing, may also have increased pulse and near syncope or syncope.

• Hypotension-systolic below 90, diastolic below 60, need to know patients baseling.

• Hypertension-above 140/90, obtained on at least 3 occasions, what makes your B/P go up and it is not considered hypertension?

Height and weight and BMI

• BMI=weight in kg./height in meters squared.• BMI>25.8 (women), 26.4 (men)are 20% over

their ideal body weights and at risk for obesity