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Bates' Physical Exam: Chapter 4
Beginning the Physical Examination: General Survey, Vital Signs, and Pain
Terms in this set (25)
What does a rapid change in weight suggest?
Changes in body fluids, not changes in tissues. p.102
If weight gain or loss appears to be a problem, what should you ask about?
The amount of change, its timing, the setting in which it occurred, and any associated symptoms. p.102
What are some symptoms of malnutrition?
Weakness, easy fatigability, cold intolerance, flaky dermatitis, ankle swelling. p.103
What does weakness often suggest, especially if localized in a neuroanatomical pattern?
Possible neuropathy or myopathy p.103
When fever exaggerates the swing between a temperature's daily rise and fall. p.103
How many U.S. adults maintain a healthy weight?
Fewer than half of U.S. adults maintain a healthy weight, with a Body Mass Index (BMI) between 18.5 and 24.9. p. 108
Four steps to promote optimal weight and nutrition
1) Measure BMI and waist circumference; identify risk of overweight and obesity and establish additional risk factors for heart disease and obesity-related diseases.
2) Assess dietary intake
3) Assess the patient's motivation to change
4) Provide counseling about nutrition and exercise. p. 109
What are the classifications of overweight and obesity by BMI?
Obesity Class BMI
Obesity I 30.0-34.9
III > 40
Strategies to Promote Weight Loss
1) The most effective diets combine realistic diets combine weight loss goals with exercise and behavioral reinforcements.
2) Encourage patients to walk 30 to 60 minutes 5 or more days a week, or a total of at least 150 minutes a week. Pedometers help match distance in steps with calories burned.
3) The total calorie goal, usually 800 to 1,200 calories per a day, is more important than type of diet.
4) Encourage behavioral habits that have been shown to assist weight loss such as portion-controlled meals, meal planning, food diaries, and activity records.
5) Follow professional guidelines for pharmacologic therapies in patients at high weights and morbidities who do not respond to conventional treatment. p.111
What foods emphasize a nutrient-dense diet?
Vegetables, fruits, whole grains, fat-free or low-fat milk and milk products, seafood, lean meats and poultry, eggs, beans and peas, and nuts and seeds. Water and unsweetened beverages should be consumed instead of soda, energy drinks with sweeteners, or sports drinks. p.112
What is the Healthcare Provider looking for in the General Survey?
Patient's appearance, level of consciousness, signs of distress, skin color and obvious lesions, dress, grooming and personal hygiene, facial expression, odors, posture, gait, motor activity, height, and weight.
Bickley, Lynn S. (2012-03-28). Bates' Guide to Physical Examination and History Taking (Kindle Location 3988). Lippincot (Wolters Kluwer Health). Kindle Edition.
What are 3 factors that contributes to the body's habitus?
Socioeconomic status, nutrition, genetic makeup, degree of fitness, mood state, early illnesses, gender, geographic location, and age cohort.
Bickley, Lynn S. (2012-03-28). Bates' Guide to Physical Examination and History Taking (Kindle Locations 3993-3994). Lippincot (Wolters Kluwer Health). Kindle Edition.
How would you describe a patient's apparent state of health?
Acutely or chronically ill, frail, or fit and robust.
Bickley, Lynn S. (2012-03-28). Bates' Guide to Physical Examination and History Taking (Kindle Locations 4007-4008). Lippincot (Wolters Kluwer Health). Kindle Edition.
Describe a patient's level of consciousness.
Is the patient awake, alert, and responsive to you and others in the environment? If not, promptly assess the level of consciousness.
Bickley, Lynn S. (2012-03-28). Bates' Guide to Physical Examination and History Taking (Kindle Locations 4009-4012). Lippincot (Wolters Kluwer Health). Kindle Edition.
True or false:Currently there is no consensus on the setting, timing, or total number of blood pressure measurements needed for classifying patients or guiding treatment.
What is white coat hypertension?
Constituting roughly 15-20% of Stage 1 hypertensives, and is when the office blood pressure is high but ambulatory
pressures are normal, so cardiovascular risk is low.
What happens if the cuff size is too small or too big?
If the cuff size is too small (narrow), the blood pressure cuff will read high; if the cuff is too large (wide) the blood pressure will read low on a small arm and high on a large arm.
According to JNCVll blood pressure classification for adults- what would a blood pressure of 170/92 be classified?
A BP of 170/92 is classified as Stage 2 hypertension because the systolic is > 160.
What is orthostatic hypotension?
Orthostatic hypertension is a drop in systolic blood pressure of 20 mm Hg or greater or in diastolic blood pressure of 10 mm Hg or greater within 3 minutes of standing.
What are the causes of orthostatic
Drugs, moderate or severe blood loss, prolonged bed rest, and diseases of the autonomic nervous system. (P.118.)
What is auscultatory gap and what is associated
Auscultatroy gap is a silent interval that may be present between the systolic and the diastolic pressures. It is
associated with Arterial stiffness and atherosclerotic disease. (P. 116)
Name 3 steps to ensure accurate blood pressure
Avoid smoking or drinking caffeinated beverages for 30 minutes before measurement. Check to make sure the
examining room is quiet and comfortably warm. Patient to sit quietly for 5 minutes in a chair with feet on the floor, arm should be supported at heart level. (P.115)
Blood Pressure of <130/80 is goal for which
Hypertension, Diabetes or Renal disease patients. (P.118)
According to JNCVII what are the ranges for;
Prehypertension BP, Hypertension Stage 1 and Hypertension Stage 2?
Pre hypertension is Systolic 120 -139 and diastolic 80-89
Hypertension stage 1 is Systolic BP 140-159 and Diastolic BP of 90-99.
Hypertension Stage 2 Systolic BP ≥160 and Diastolic ≥100. (p. 118)
Does a patient's grooming , dress and personal hygiene play an important part of the general survey?
Yes. Excess clothing may reflect the cold intolerance of hypothyroidism, hide skin rash or needle marks, or signal personal lifestyle preferences.
Bickley, Lynn S. (2012-03-28). Bates' Guide to Physical Examination and History Taking (Kindle Locations 4030-4031). Lippincot (Wolters Kluwer Health). Kindle Edition.
Cut-out holes or slippers may indicate gout, bunions, or other painful foot conditions. Untied laces or slippers also suggest edema.
Bickley, Lynn S. (2012-03-28). Bates' Guide to Physical Examination and History Taking (Kindle Locations 4034-4035). Lippincot (Wolters Kluwer Health). Kindle Edition.
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