Physical Examination PDF

PHYSICAL EXAMINATION Kevin Michael M. Jasani-NCM 118 1 GENERAL APPEARANCE Level of Consciousness and Mental Status May help determine inadequate perfusion to the brain Kevin Michael M. Jasani-NCM 118 2  Signs of Distr...

PHYSICAL EXAMINATION Kevin Michael M. Jasani-NCM 118 1 GENERAL APPEARANCE Level of Consciousness and Mental Status May help determine inadequate perfusion to the brain Kevin Michael M. Jasani-NCM 118 2  Signs of Distress GENERAL Discomfort APPEARANCE Shortness of breath Anxiety Anthropometric Measurements Weight Height Body Mass Index Kevin Michael M. Jasani-NCM 118 3  Major vessels in the legs and SKIN arms for catheter insertion AND Systemic anticoagulation with EXTREMITIES heparin is necessary Hematomas may occur as a complication Frequently check the catheter insertion sites until hemostasis is achieved Kevin Michael M. Jasani-NCM 118 4 SKIN AND Peripheral Edema EXTREMITIES Edema on sacral area on bed rest Pitting edema Kevin Michael M. Jasani-NCM 118 5 Kevin Michael M. Jasani-NCM 118 6 SKIN Capillary Refill Time AND Normal: less than 2 seconds EXTREMITIES Prolonged: inadequate arterial perfusion to the extremities Clubbing of fingers and toes Chronic hemoglobin desaturation Kevin Michael M. Jasani-NCM 118 7 Kevin Michael M. Jasani-NCM 118 8 SKIN Hair loss, brittle nails, dry or AND scaling skin, atrophy of the skin, EXTREMITIES skin color changes, and ulcerations: indicative of chronically reduced oxygen and nutrient supply to the skin Kevin Michael M. Jasani-NCM 118 9 BLOOD PRESSURE Systemic arterial BP is the pressure exerted on the walls of the arteries during ventricular systole and diastole. Kevin Michael M. Jasani-NCM 118 10 BLOOD Factors that affect blood PRESSURE pressure: cardiac output distention of the arteries volume, velocity, and viscosity of the blood Kevin Michael M. Jasani-NCM 118 11 BLOOD PRESSURE Normal: Systole: 100 Kevin Michael M. Jasani-NCM 118 15  CLASSIFICATION OF BLOOD PRESSURE (mmHg) SYSTOLE DIASTOLE NORMAL 100 HYPERTENSION Kevin Michael M. Jasani-NCM 118 16 PULSE The difference between the PRESSURE systolic and the diastolic pressures. A normal pulse pressure is 40 mm Hg. Kevin Michael M. Jasani-NCM 118 17  A narrow pulse pressure occurs when there is vasoconstriction PULSE that is compensating for a low stroke volume and ejection PRESSURE velocity (shock, HF, hypovolemia, mitral regurgitation) or obstruction to blood flow during systole (mitral or aortic stenosis). This compensation allows for adequate organ perfusion. Kevin Michael M. Jasani-NCM 118 18 PULSE A wide pulse pressure is associated with conditions that elevate the PRESSURE stroke volume (anxiety, exercise, bradycardia), or cause vasodilation (fever, septic shock). Abnormal pulse pressures require further cardiovascular assessment Kevin Michael M. Jasani-NCM 118 19  Normal postural responses that occur when a person moves ORTHOSTATIC from a lying to a standing (POSTURAL) position include: BP CHANGES (1) a heart rate increase of 5 to 20 bpm above the resting rate; (2) an unchanged systolic pressure, or a slight decrease of up to 10 mm Hg; (3) a slight increase of 5 mm Hg in diastolic pressure Kevin Michael M. Jasani-NCM 118 20  Orthostatic (postural) hypotension is a sustained decrease of at least 20 mm Hg in systolic BP or 10 mm Hg in ORTHOSTATIC diastolic BP within 3 minutes of HYPOTENSION moving from a lying or sitting to a standing position. It is usually accompanied by dizziness, lightheadedness, or syncope. The risk of orthostatic hypotension increases with age and is associated with fall risk. Kevin Michael M. Jasani-NCM 118 21  NV: 60 – 100 beats per minute PULSE Tachycardia: >100 RATE Bradycardia: