THE GENERAL SURVEY Definition: The general survey is a study of the whole person, covering the general health

state and any obvious physical characteristics. It is an introduction for the physical examination that will follow; it should give an overall impression, a gestalt, of the person. Objective parameters are used to form the general survey, but these apply to the whole person, not just to one body. Purpose: 1. Conduct a general survey of the clients health by gathering subjective and objective data. 2. Use collected data to help assess clients general health. 3. Differentiate expected versus unexpected findings in the physical assessment. Equipment: Provide a gown for the client if full examination is to occur.

Preparation: 1. Knowledge of norms or expected findings is essential in determining the meaning of the data as one proceeds. 2. Identify client and introduce self. 3. Provide for client privacy. 4. Perform hand hygiene and adhere to standard precautions. Considerations Cultural Considerations: During the physical exam portion of the assessment process, careful and sensitive questioning of the client or a translator may be needed to determine whether issues exist that may interfere with the exam: Removal of certain garments may be prohibited but can interfere with obtaining accurate weight, body measurements or assessment of clinical signs and symptoms. Examination or touching by a member of the opposite sex may be taboo. The nurse should engage in decision making with the client on how best to proceed when such issues are present. Infants and Young Children Approach: Observe the interaction between child and parent or adult. Evaluate how the adult holds and makes contact with the infant or child. A caring and nurturing interaction is expected.

Findings: Note any disturbances with the parent or adult interaction with the child. Any observations of a strained relationship or fear that the child demonstrates toward the adult should be explored. For infants or young children, watch the overall movement and tone of the body. The infant should hold their arms and legs and may respond with a startle if there is a loud or sudden movement or sound. Older children should demonstrate movement and development according to age parameters. Consult a growth and development textbook for a full discussion of expected childhood development. Pregnant Women Approach: The approach and techniques used in the general assessment of the pregnant woman is the same as for all other clients. As the woman enters the room, note any specific discomfort or difficulty with ambulation. Note shortness of breath and overall affect of body movement and comfort. Findings: Weight gain and changes in body posture and comfort with movement may be some of the obvious signs of pregnancy over time. Many of the specific signs of pregnancy-related changes are discussed in each of the detailed modules within this product. Older Adult Approach: The approach and techniques used in the general assessment of the older adult is the same as for all other clients. As the client ambulates, ensure safety by providing adequate space in the room and good lighting and a place for the client to sit. Findings: The posture of an older adult may look slightly stooped because of a generalized flexion, which also causes the older adult to appear shorter. A loss in height may also be due to thinning of the intervertebral discs. The gait of an older adult is often slower and the steps shorter. To maintain balance, the older adult may hold the arms away from the body or use a cane. The behavior of the older adult may be affected by various disorders common to this age group, such as vascular insufficiency and diabetes. In addition, medications may affect the clients behavior. Some medications may cause the client to feel anxious, and others may affect the clients alertness, orientation, or speech. You should also consider overmedication while assessing the behavior of the older adult; thus, be sure to record every medication the client is taking.

PROCEDURE 1. Physical Appearance Age the person appears his or her stated age

ABNORMAL FINDINGS

Appears older than stated age, as with chronic illness, chronic alcoholism.

Sex sexual development is appropriate for gender and age. Level of Consciousness the person is alert and oriented, attends to your questions appropriately Skin Color color tone is even, pigmentation varying with genetic background, skin is intact with no obvious lesions Facial Features facial features are symmetric with environment No signs of acute distress are present. and responds

Delayed or precocious puberty.

Confused, drowsy, lethargic

Pallor, cyanosis, jaundice, erythema, any lesions

Immobile, masklike, asymmetric, drooping

Respiratory signs wheezing

shortness of breath,

Pain, indicated by facial grimace, holding body part 2. Body Structure Stature the height appears within normal heritage Nutrition the weight appears within Cachectic, emaciated Simple obesity, with even fat distribution Centripetal extremities, (truncal) as in obesity Cushings fat concentrated in face, neck, trunk, with thin syndrome (hyperadrenalism) Symmetry body parts look equal bilaterally and are in relative proportion to each other PROCEDURE Unilateral atrophy or hypertrophy Asymmetric location of a body part ABNORMAL FINDINGS range for age, genetic Excessively short or tall

normal range for height and body fat distribution is even

Posture the person stand comfortably erect at appropriate for age

Rigid spine and neck; moves as one unit, e.g., arthritis Stiff and tense, ready to spring from chair, fidgety movements Shoulders depression slumped; looks deflated, e.g.,

Position the person sits comfortably in a chair or on the bed or examination table, arms relax at sides, head turned to examiner

Tripod leaning forward with arms braced on chair arms, occurs with chronic pulmonary disease Sitting straight up and resists lying down, e.g., congestive heart disease Curled up in fetal position, e.g., acute abdominal pain

Body build, contour proportions are 1. Arm span (fingertip to fingertip) equals height 2. Body sole Obvious physical deformities note any congenital or acquired defects 3. Mobility Gait normally, the base is as wide as the shoulder width; foot placement is accurate; the walk is smooth, even and well-balanced; and associated movements, such as symmetric arm swing, are present. Range of Motion note full mobility for each joint, and that movement is deliberate, accurate, smooth, and coordinated. No involuntary movement. Tic, tremors, seizures Limited joint range of motion Paralysis absent movement Movement jerky, uncoordinated Exceptionally stumbling Shuffling, dragging, nonfunctional leg. Limpinhg with injury Propulsion difficulty stopping wide base. Staggered, length from crown to pubis roughly equal to length form pubis to Elongated arm span, arm span greater than height, e.g. Marfans syndrome hypogonadism Missing extremities or digits; webbed digits; shortened limb

PROCEDURE 4. Behavior Facial Expression the person maintains eye contact (unless a cultural taboo exists), expressions are appropriate to the situation, e.g., thoughtful, serious or smiling (Note expressions both while the face is ate rest and while the person is talking) Mood and affect the person is comfortable and cooperative with the examiner and interacts pleasantly Speech articulation (the ability to form words) is clear and understandable The stream of talking is fluent, with an even pace. The person conveys ideas clearly. Word choice is appropriate to culture and education. The person communicates in prevailing language easily by himself or herself or with an interpreter.

ABNORMAL FINDINGS

Flat, depressed, angry, sad, anxious However, note that anxiety is common in ill people. Also, some people smile when they are anxious

Hostile, distrustful, suspicious, crying

Dysarthria ad dysphagia Speech defect, monotone, garbled speech Extremes of few words or of constant talking

5. Dress clothing is appropriate to the Trousers too large and held up by belt
climate, looks clean, and fits the body, and is appropriate to the persons culture and age group; for example, normally, Amish women wear clothing from the nineteenth century, Indian women labeled may as wear dress saris. should by Culturally not be Western determined standards. suggest weight loss, as does the addition of new holes in belt. If the belt is moved to a looser fit, it may indicate ascites or obesity. Consistent wear of certain clothing may provide clues; long sleeves may conceal needle marks of drug abuse; broad-brimmed hats may reveal sun intolerance; Velcro fasteners of buttons may indicate chronic motor dysfunction

bizarre

PROCEDURE 6. Personal hygiene appears clean for and his appropriately

the or

person groomed age,

ABNORMAL FINDINGS In a previously carefully groomed woman, unkempt hair and absent makeup may indicate malaise or illness

her

occupation, and socioeconomic group. (Note that a wide variation of dress and hygiene do is not normal. include Many use of cultures

deodorant or women shaving legs. Hair is groomed, brushed. Womens make-up is appropriate for age and culture. 7. Document any relevant findings.