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General assesment and vital sign

DAP
General Assesment

 Is a quick assesment of the patient as a


whole, including patient physical
appearance, behaviour , mobility, certain
physical parameters (height, weight, age,
vital signs)
 Should be providing an overall impression of
the patient’s health status.
Physical appearance, behaviour, and
mobility (1)

 Age
 Skin color
 facial features
 level of consciousness
 sign of acute distress
 nutrition, body structure
 dress and grooming
 Behaviour
 mobility
(2)

 Age : could it be chronic illness?


 Skin :
1. Cyanotic (lips and oral cavity): sob, lung disease
2. Pallor and jaundice (nails bed,conjunctiva and nails)
3. Pigmentation (genetic)
 Facial features : symmetric movement,
matching expression with saying
Example : Paralizing one side face, Bell’s palsy, flat effect
(3)

 Level of consciousness
Allerted to time, place and person.Example :Disorientation, lethargy, stupor,coma
 Sign of acute stress
ARS : sob, wheezing, facial grimacing, holding a body part
 Nutrition
Patient weight. Example : Cushing syndrome, cachetic appearance
 Body structure
Symmetric body movement. Stand comfortably appropiate with age. Example :
tripod position, Kyphosis, lordosis are related with osteoporosis
 Dress and grooming
Patient’s clothing should correspond with climate, clean and fit appropiately.
Groomed appropiately with age, gender, occupation, cultural
(4)

 Behaviour
Cooperative and interact pleasently, speech should be clear, understable,
appropiate word choice with education, culture

 Mobility
Walk smooth, even, well balanced. Example : shuffling gait, ataxia
Physical Parameters (1)

 Height (genetic)
To asses bone density in osteoporosis.
Evaluation : stand erect, without shoes, against a flat and measuring surface. Place
the headpiece intersect the height scale.

 Weight
Reflect the nutritional status. Find BMI (kg/m2)
Under : < 18,5
Healthy : 18,5-24,9
Overweight : 25-29,9
Obesity class I : 30-34,9 class II 35-39,9 class III ≥ 40
Example : risk of overweight , unintended weight loss, decreased of patient
appetite, weight gain
(2)

 Vital signs
1. Temperature
NBT (36,4-37,2), affected by hormones,
exercises, drug, biological rhytmis. Diurnal
temperature, Progesterone excretion
Tools : oral route (37), rectal route (37,5),
axillary route (36,5), Tympanic route
2. Pulse
What is heart beat means?
Radial pulse, bradychardia (< 60 ppm),
tachicadia (>100 ppm), arrhytmia.
RP depends on age, (see table 5-1) ex : adult
60-100 ppm normally
3. Respiration Rate
Most people are unaware of their breathing
To measure RR : Count the number of
respiration in 30 sc, if irregular count it for 60
sc. Record as rpm
NRR depends on age (see table 5-2)
Bradypnea (< 12 rpm), Tachypnea (>20 rpm)
4. Blood pressure
Definition
Depends on : cardiac output and peripheral
vascular resistance
Systolic and diastolic pressure.
Korotkoff sounds : no sound, soft and clear
tapping, swooshing, tapping, muffling,no
sound
 Blood flow phase :
I : faint, clear tapping
II : swooshing
III : Tapping (systolic)
IV : Muffling (hyperkinetic)
V : Cessation ( diastolic)
Evaluation : ask about smoking within previous
30 mnt, seated in a chair, after 5 min of a rest
 Classification of BP (JNC VI and JNC VII)
 Common errors in measurement
 Factors affecting BP : age, race, diurnal
rhythm, weight, exercise, emotions,
medications
Special considerations

 Pediatric patients
Temperatures, pulse, rr, BP, routine growth measurements,
 Geriatric patients
Posture change, NBT, Hypertension
 Pregnant woman
Posture change, weight gain
BP unchanged ( 1 st sem), decrease (2 nd sem), returns or slightly
exceed ( 3 rd sem)
Gestational hypertension?
The End