General Survey and Physical Appearance

• Traditional vital signs include body temperature, pulse, respirations, and blood pressure.
• A general survey includes physical appearance, mental status, mobility, and patient behavior.
• During a general survey, objective behaviors are assessed within the range of the patient's sex, age, race, ethnic background, and culture.

Physical Appearance

• Provides immediate and important cues to the patient's level of wellness.
• The patient’s lifestyle, socioeconomic level, and environment are considered when assessing appearance.

Mental Status

• Affect, mood, level of anxiety, orientation, and speech are assessed during the health history.
• Orientation to person, place, and time is assessed.

Mobility

• Gait, posture, and range of motion are observed.
• Deviations from the normal include weakness, stiffness, involuntary motor activity, or limitations in movement related to trauma, deformity, or those associated with obesity.

Patient Behavior

• Assessed through objective data about dress, grooming, body odors, facial expression, mood, affect, ability to make eye contact, and level of anxiety.
• Emotional state is assessed by noting what the patient says, as well as their body language, facial expression, and appropriateness of behavior in relation to the situation and circumstances.
• Patients are assessed for apprehension, fear, and nervousness
• The patient's speech is assessed for quantity, volume, content, articulation, and rhythm.

Lifespan Considerations

• The developmental stages based on age are used for pediatric patients, instead of assessing mental status.
• Infancy is characterized by dramatic changes in height and weight and the development of gross physical and social skills.
• Toddlerhood is marked by slower, steadier growth, fine motor skill improvement, and language development.
• The preschool years are characterized by motor and language skill refinement and beginning social skill development.
• The major developmental tasks of school-age children involve cognitive and social growth.
• Adolescence is characterized by periods of rapid growth, sexual maturation, and cognitive refinement.
• General appearance can provide very useful assessment data and information across the lifespan.
• Appearance of a younger child reveals a great deal of information about the child's parents or caretakers.
• Appearance of an older child provides clues about self-care or knowledge about proper hygiene.
• The nurse should note the child's interaction with the parents or caretakers.
• Appearance offers insight into the older adult's overall health status.
• Dress, grooming, and personal hygiene of an older adult may be affected by limitations in mobility, chronic disease, or lack of funds.
• Gait is often slower and the steps shorter in older adults.
• The posture of an older adult may look slightly stooped because of generalized flexion, which also causes the older adult to appear shorter.
• A loss in height may also occur due to the thinning or compression of the intervertebral disks.
• Behavior of the older adult may be affected by various disorders that are common to this age group, such as vascular insufficiency and diabetes.
• Medications may affect the patient's behavior.

Measuring Height and Weight

• Height and weight are obtained to establish baseline data and to help determine health status.
• The patient should be asked about height and weight before any measurements are taken.
• Large discrepancies between the stated height and weight and the actual measurements may provide clues to the patient's self-image.
• A disposable measuring tape should be used to determine the height of a bedridden patient while in a lying position, measuring from the top of the head to the bottom of the heel.
• Discrepancies in weight may indicate a patient's lack of awareness of a sudden loss or gain in weight that may be caused by illness.
• The patient is measured using a stick attached to a platform scale or to a wall.
• Patients should look straight ahead while standing as straight as possible with heels together and shoulders back.
• The standard platform scale or digital scale is used to measure the weight of older children and adults.
• Use the same scale at each visit.
• Weigh the patient at the same time of day.
• Weigh the patient in the same clothing.
• Weight the patient without shoes.
• The average height and weight for adult men and women are available in charts prepared by governmental agencies and insurers.
• The body mass index is considered a more reliable indicator of healthy weight.
• Children who can stand on their own at full height should be measured for height in a standing position rather than length in a lying position.
• Length should be used to measure infants who are unable to stand independently.
• Head circumference is a common length measurement for children under 3 years old
• Infant's or toddler's head circumference should be measured at the widest point, usually around the most prominent part of the occiput and above the eyebrows.
• Normal head circumference ranges from 34 to 37 centimeters in newborns up to 47 to 51 centimeters at 3 years of age (2001).
• Infants are weighed on a modified platform scale with curved sides to prevent injury.
• Infant weight is obtained in grams and ounces.

Measuring Vital Signs

• Vital signs are obtained for baseline data, to detect or monitor a change in the patient's health status, and to monitor patients at risk for alterations in health.
• Vital signs include body temperature, pulse, respiratory rate, blood pressure, pain, and oxygen saturation.
• Measurement of oxygen saturation and pain assessment may be included when taking vital signs.

Body Temperature

• Core temperature refers to deep tissues of the body and remains relatively constant
• Surface temperature involves Skin, subcutaneous tissue, fat and responds to environment.
• Heat balance, Basal metabolic rate, Exercise/Shivering, Secretion of thyroxine, epinephrine, and norepinephrine, Inflammation/Fever = Radiation, Conduction, Convection, and Evaporation
• The body temperature is affected by age, diurnal variations, exercise, hormones, stress, and the environment.
• Normal body temperature ranges from 96.8°F to 99.5°F (36°C and 37.5°C).

Pyrexia

• It is a body temperature above the normal range.
• Hyperthermia, fever
• Hyperpyrexia
• Very high fever
• Client described as febrile if fever, afebrile if no fever
• Common types are Intermittent, Remittent and Relapsing.
• Constant alterations in body temperature include Fever spike, Heat Exhaustion and Heat Stroke.
• Accurate assessment of body temperature can be done orally or rectally.
• Axillary measurements are preferred for newborns
• Other ways to measure are Tympanic membrane and Skin/temporal artery
• The goal of thermometers are to eliminate mercury from healthcare environments.
• Other types are Electronic, Chemical disposable, Temperature-sensitive tape, Infrared, Temporal artery and Noncontact
• C=(Fahrenheit temperature - 32) x 5/9
• F= (Celsius temperature x 9/5) + 32

Vital signs, encompassing body temperature, pulse, respirations, and blood pressure, are fundamental. A general survey assesses physical appearance, mental status, mobility, and behavior. Objective behaviors are evaluated considering the patient's demographics.