GENERAL SURVEY,

MEASUREMENT AND VITAL

SIGNS
The general survey is the study of the
whole person, covering the general
health state and any obvious physical
characteristics. It is done during
initial encounter with the patient.
Measurement and vital signs are also
obtained as part of the comprehensive
assessment of the general health status
of the person.
GENERAL SURVEY
FOUR AREAS CONSIDERED/COMPONENTS DURING GENERAL SURVEY:
 1. PHYSICAL APPEARANCE
o AGE
 Normal: the patient appears his/her stated age
 Abnormal: appears older than stated age as with chronic
illness, chronic alcoholism
o SEX
 Normal: developmentally appropriate for age and gender
 Abnormal: delayed puberty
o LEVEL OF CONSCIOUSNESS
 Normal: alert, oriented, attends to questions and responds
appropriately
 abnormal: confused, drowsy, lethargic
o SKIN COLOR
 Normal: tone is even and intact
 Abnormal: pallor, cyanosis, jaundice, erythema
o FACIAL FEATURES:
 Normal: symmetry and movement
 Abnormal: immobile, mask-like
o OVER-ALL APPEARANCE:
 Normal: no signs of acute distress
 Abnormal: Respiratory signs: shortness of breath,
wheezing
 Pain: indicated by facial grimace,
holding/guarding body par, knees
drawn up over the abdomen
2. BODY STRUCTURE
o STRUCTURE:
• Normal: Height is within normal range for age, genetic heritage
• Abnormal: excessively short or tall
  
o NUTRITION:
• Normal: Weight is within N range for height and body built; body fat
distribution is even
• Abnormal: emaciated, obese
o SYMMETRY:
• Normal: body parts look equal bilaterally and relative in proportion to
each other
• Abnormal: loss of muscle volume; asymmetric appearance
o POSTURE:
• Normal: stands comfortably erect
• Abnormal: stiff and tense, fidgety movements
o POSITION:
• Normal: assumes comfortable and relaxed position, arms at the sides,
head turned to the examiner
• Abnormal: curled up in fetal position; sitting up and resists lying
down
3. MOBILITY
o GAIT (manner of walking):
 Normal: the base is as wide as the shoulder width;
foot placement is accurate; the walk is smooth,
even and well-balanced;
 Abnormal: stumbling; limping with injury
o RANGE OF MOTION
 Normal: Full mobility of each joint, movement
is deliberate, accurate, smooth and
coordinated.
 Abnormal: limited joint range of motion,
movement is jerky, uncoordinated.
 4. BEHAVIOR
o FACIAL EXPRESSION
 Normal: maintains eye contact, expressions are
appropriate to the situation.
 Abnormal: flat, depressed, angry, sad, anxious
o MOOD AND AFFECT
 Normal: comfortable, cooperative with the
examiner and interacts pleasantly.
 Abnormal: hostile, distrustful, suspicious,
crying
 
o SPEECH
 Normal: speaks clearly; stream of talking is fluent,
with an even pace
 Abnormal: difficulty in talking; abnormal pitch and
volume, voice is hoarse or whispered, constant talking
o DRESS
 Normal: clothing is appropriate to the climate, looks
clean and fits the body and is appropriate to age group
 Abnormal: looks unclean, inappropriate to the climate
o PERSONAL HYGIENE
 Normal: appears clean and groomed appropriately for
his/her age; hair is groomed, brushed
 Abnormal: unkempt hair
MEASUREMENT
1. WEIGHT (the best indicator of a patient’s
nutritional status; unexplained weight loss may be a
sign of an illness. Obesity affects a person’s
health and may increase risk for certain chronic
illness such as heart disorders, hypertension,
diabetes mellitus)
 Use standardized weighing scale.
 Instruct patient to remove his/her shoes and heavy
outer clothing before standing on the scale.
 Use the same weighing scale for repeated morning
of weights.
 Weigh the patient approximately the same time of
the day.
2,HEIGHT
a.Use a well-mounted device or the measuring
pole on the balance scale
b.Align the extended headpiece with the top of
the head.
c.The patient should be shoeless, standing
straight and looking straight ahead. Place
back of the head toward balancing bar.
d.Feet, shoulders and buttocks should be in
contact with the hard surface.
3. BODY MASS INDEX
 It is a practical marker of optimal weight for
height and an indicator of obesity or protein-
calorie malnutrition. It is calculated by;

 Body Mass index (BMI) = Weight in kilograms

 Height (in meters)2
 
 = Weight in Pounds X 703
 Height (in inches)2
 BMI Interpretation for
Adults
Below 18.5 Underweight

18.5 -24.9 Normal Weight

25.0 -29.9 Overweight

30.0 -39.9 Obesity

40.0 and above Extreme Obesity

 2 to 20 years:
85th to 95th percentile = Risk for Overweight
 
  
VITAL SIGNS
 The vital signs or cardinal signs
are the clearest indicators of
overall health status:
o BODY TEMPERATURE
o PULSE
o RESPIRATION
o BLOOD PRESSURE
  BODY TEMPERATURE: the balance between the heat
produced by the body and the heat lost from the
body.
 BODY HEAT is primarily produced by metabolism.
 The heat regulating is found in the HYPOTHALAMUS.
o TYPES OF BODY TEMPERATURE:
1. CORE TEMPERATURE: the temperature of the deep
tissues of the body; measured by taking oral and
rectal temperature.
2. SURFACE TEMPERATURE: the temperature of the skin,
subcutaneous tissue and fat; measured by taking
axillary temperature
 FACTORS AFFECTING THE BODY’S HEAT PRODUCTION:
 BASAL METABOLIC RATE (BMR)
 The younger the person, the higher the BMR; the older the
person, the lower the BMR. Therefore, the older persons have
lower body temperature than the younger persons.
 MUSCLE ACTIVITY (EXERCISE, SWIMMING)
 Increases cellular metabolic rate; therefore, exercise
increase body heat production.
 THYROXINE OUTPUT
 Increases cellular metabolic rate; hyperthyroidism is
characterized by increased body temperature
 EPINEPHRINE, NOREPINEPHRINE AND SYMPATHETIC STIMULATION
 Increase the rate of cellular metabolism; these in turn
increase body temperature.
 INCREASE TEMPERATURE OF BODY CELLS(FEVER)
 Increases the rate of cellular metabolism
  PROCESSES INVOLVED IN HEAT LOSS
1. Radiation
 the transfer of heat from the surface of one object to the
surface of another without contact between two objects
 Example: It feels warm in a crowded room.
1. Conduction
 the transfer of heat from one surface to another; it requires
temperature difference between the two surfaces
 Example: Application of moist wash-cloth over the skin.
1. Convection
 The dissipation of heat by air currents
 Example: Exposure of the skin towards electric fan
1. Evaporation
 The continuous vaporization of moisture from the skin, oral
mucosa, respiratory tract
 Example: tepid sponge bath increases peripheral circulation
thereby increasing heat loss by evaporation.
  FACTORS AFFECTING TEMPERATURE
AGE
 The infant’s body temperature is greatly affected by the
temperature of the environment. Elder people are at risk of
hypothermia due to decreased thermoregulatory controls, decreased
subcutaneous fat, inadequate diet and sedentary activity.
DIURNAL VARIATIONS
 Highest temperature is usually reached between 8PM to 12MN and
the lowest temperature is reached between 4AM-6AM
EXERCISE
 Strenuous exercise increases metabolic rate thus the body
temperature.
HORMONES
 Progesterone, thyroxin, norepinephrine and epinephrine increase
body temperature
STRESS
 Sympathetic nervous system stimulation increases the production
of epinephrine and norepinephrine thereby increasing the
metabolic rate and heat production.
  ALTERATIONS IN BODY TEMPERATURE
 PYREXIA/HYPERTHERMIA/FEVER: body
temperature above normal range
 HYPERPYREXIA: very high fever, 41°C and
above.
 HYPOTHERMIA: subnormal core body
temperature; this may be caused by
excessive heat loss, inadequate heat
production of impaired hypothalamic
function
  TYPES OF FEVER
1. Intermittent Fever: the temperature fluctuates
between periods of fever and periods of
normal/subnormal temperature.
2. Remittent Fever: the temperature fluctuates within a
wide range over the 24-hour period but remains above
normal range.
3. Relapsing fever: the temperature is elevated for a
few days alternated with 1 or 2 days of normal
temperature.
4. Constant Fever: body temperature is consistently
high.
  PULSE
 It is wave of blood created by
contraction of the left
ventricle of the heart. The
pulse rate is regulated by the
autonomic nervous system.
  FACTORS AFFECTING THE PULSE RATE
o AGE: younger persons have higher pulse rate than older persons
o SEX/GENDER: After puberty, females have higher pulse rate than the
males
o EXERCISE: Increase metabolic rate thereby increasing the pulse
rate.
o FEVER: Increases metabolic rate therefore the pulse rate
increases.
o MEDICATIONS: Digitalis, beta blockers decrease pulse rate;
epinephrine, atropine sulphate increase pulse rate.
o POSITION CHANGES: in sitting or standing position there is
decreased venous return to the heart, decrease BP, therefore
increase in the heart rate.
o HEMORRHAGE: Increases pulse rate as compensatory mechanism for
blood loss.
o STRESS: Sympathetic nervous stimulation increases the activity of
the heart.
 PULSE SITES:
• RADIAL: base of thumb
• TEMPORAL: side of forehead
• CAROTID: side of neck
• BRACHIAL: inner aspect of elbow
• FEMORAL: inner aspect of upper thigh
• POPLITEAL: behind knee
• DORSALIS PEDIS: top of foot
• APICAL: over apex of heart; taken with stethoscope;
left side of chest
ASSESSMENT OF THE PULSE RATE:
 NORMAL PULSE RANGE
• Adult: 60 - 100 bpm
• Newborn: 120 bpm
• 4 year-old: 100 bpm
• 8 year-old: 90 bpm
• 14year-old: 85 bpm
TACHYCARDIA: pulse rate above 100 beats/min
(adult)
 BRADYCARDIA: pulse rate below
60beats/min(adult)
1. RHYTHM: The pattern and intervals of beats; dysrhythmia is
irregular rhythm.
2. VOLUME(Amplitude): the strength of the pulse
 A normal pulse can be felt with moderate pressure.
 Full or bounding pulse: It can be obliterated only by great
pressure.
 Thready pulse: It can easily be obliterated only by great
pressure.
 The pulse volume is recorded in using a three-point scale:
 3+ full, bounding
 2+ normal
 1+ weak, thready
0 absent
1. ARTERIAL WALL ELASTICITY: The artery feels straight, smooth,
soft and pliable
2. PRESENCE/ABSENCE OF BILATERAL EQUALITY: Absence of bilateral
equality indicates cardiovascular disorder
RESPIRATION
 The act of breathing
 Three processes:
o Ventilation: the movement of gases in and out of
the lungs
o Inhalation (inspiration)
o Exhalation (expiration)
o Diffusion: the exchange of gases from an area of
higher pressure to an area of lower pressure;
occurs at the alveolo-capillary membrane
o Perfusion: the availability and movement of blood
for transport of gases. Nutrients and metabolic
waste products
 
 
TWO TYPES OF BREATHING:
oCostal (thoracic): involves
movement of the chest
oDiaphragmatic (abdominal):
involves movement of the
abdomen
RESPIRATORY CENTERS
Medulla Oblangata: primary respiratory center
Pons contains the following:
 Pneumotaxic center: responsible for the rhythmic
quality of breathing
 Apneustic center: responsible for the deep,
prolonged inspiration
Carotid and aortic bodies
Muscle and joints contain proprioreceptors
 Proprioreceptors: exercise increases respiratory
rate
 
MAJOR FACTORS AFFECTING RESPIRATORY RATE
 Exercise: increases RR
 Stress: Increases RR
 Environment: increased temperature of the
environment decreases RR; decreased temperature,
increases RR
 Increased altitude: increases RR
 Medications (e.g. narcotics decrease RR)
o EUPNEA: Normal respiration that is quiet, rhythmic and
effortless
o TACHYPNEA: rapid respiration, above 20breaths/minute in
adult
o BRADYPNEA: slow breathing, less than 12 breaths/minute
in adult
o HYPERVENTILATION: deep rapid respiration; carbon
dioxide is excessively exhales (respiratory alkalosis)
o HYPOVENTILATION: slow, shallow respiration; carbon
dioxide is excessively retained( respiratory acidosis)
o DYSPNEA: difficult and labored breathing
o ORTHOPNEA: ability to breath only in upright position
o APNEA: absence of respirations
 BLOOD PRESSURE

 the measure of the pressure exerted by

the blood as it pulsates through the
arteries
 BP= Cardiac Output X Total peripheral
resistance or CO x TPR
 Systolic Pressure: the pressure of blood as a result of
contraction of the ventricles
 Diastolic pressure: the pressure when the ventricles are at
rest
 Pulse pressure: the difference between the systolic and
diastolic pressure
 (S – D = PP); normal is 30-40mmHg
 HYPERTENSION: abnormally high blood pressure over 140mmHg
systolic and or above 90mmHg diastolic for at least two
consecutive readings.
 HYPOTENSION: abnormally low blood pressure, systolic
pressure below 100/60mmHg
 ORTHOSTATIC HYPOTENSION: a drop in systolic pressure more
than 20mmHg; occurs with a quick change to a standing
position. This is due to abrupt peripheral vasodilation
without compensatory increase in cardiac output; it may also
prolonged bed rest.
DETERMINANTS OF BLOOD PRESSURE
1. Blood volume: hypervolemia raises BP; hypovolemia lowers
BP
2. Peripheral Resistance: vasoconstriction elevates BP;
vasodilatation lowers BP
3. Cardiac Output: when the pumping action of the heart is
weak (decreased CO)BP decreases
4. Elasticity or compliance of blood vessels: in older
people, elasticityof blood vessels decreases thereby
increasing BP
5. Blood Viscosity (viscosity increases markedly when the
hematocrit is more than 60-65%;increased blood viscosity
raises the BP
 
FACTORS AFFECTING BLOOD PRESSURE
1. AGE: older people have higher BP due to decreased elasticity of
blood vessels
2. EXERCISE: increases cardiac output, hence the bp
3. STRESS: sympathetic nervous system stimulation causes increased BP
4. RACE: hypertension is one of the 10 leading causes of death among
Filipinos
5. OBESITY: BP generally is elevated among overweight and obese
people.
6. SEX/GENDER: After puberty and before age 65 years, males have
higher BP; After 65 years, females have higher BP due to hormonal
variations in menopause
7. MEDICATIONS: Some medications may increase or decrease BP
8. DIURNAL VARIATIONS: BP is lowest in the morning and highest in the
late afternoon or early evening.
9. DISEASE PROCESS: Diabetes Mellitus, Renal Failure,
Hyperthyroidism, Cushing’s Disease cause increase in BP