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300 Midterm NotesI. General Survey 109 A. general appearance 1. Apparent state of Health: frail, fit, robust. 2. Level of Consciousness: awake, alert, responsive. 3. Signs of distress 4. Skin color and lesions 5. Dress, grooming, personal hygiene 6. Odor 7. Posture, gate, motor activity 8. height, weight 9. BMI a) If > 35, measure waist. b) Too much fat, if: > 35 in women, > 40 in men.I. Vital Signs A. Blood pressure 1. Size: a) Width of bladder --> 40% circumference (12-14 cm in a… b) Length of bladder --> 80% circumference. c) ** if too NARROW, reading will be too HI. d) ** if too WIDE, will be low on a small arm, hi on a large… e) encourage recallibration of home cuff. f) Re-check later in the appointment if initial reading is high… B. Technique for measuring 1. no drinking/smoking for 30 minutes. 2. quiet sitting comfortably on chair (not table). 3. Find brachail puls, put at heart level. 4. *** if brach art. 7-8cm below heart, BP will be 6 cm higher. 5. Loose high reading. 6. pump to 30 above radial, will avoid “Korotkoff sounds” (a… 7. release at 2-3 mmHg per second. 8. If muffling point and dissappearing point >10 mmHg then … 9. Repeat in >2 minutes. If >5mmHg off, repeat.
10. Take in both arms C. Normal vs AbnormalI. category I. Systolic I. Diastolicnormal <120 <80Prehypertensive 120-139 80-89Hypertensive stage 1 (stage 2) 140-159 (>160) 90-99 (>100) D. Heart and Rhythm 1. If heart rate is normal count 30 seonds, if abnormal, count … 2. Che how compares to past readings. E. Resp rate and rhythm 1. aprox 20 quiet per minute, occasional sigh is normal. F. Temp 1. norm 37 (98.6) a) lower in am b) Rectal is higher by .4-.5 (1) c) Axillary is lower by 1 2. Fever = pyrexia 3. Hyperpyrexia = 41.1 (106) 4. Hypothermea = 35 (95.4) 5. Tympanic a) measures core temp b) higher by .8 (1.4) G. Other 1. White coat hypertension >140/90 a) 10-25% patient b) re-measure later in apt. 2. Obese, use thigh cuff, thin, use peds cuff. 3. 4. H. II. Conclusion