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
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