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Health Assessment Ch. 9 Normal Range of Findings

General Survey, Measurement, Vital Signs
STUDY
PLAY
PHYSICAL APPEARANCE
age, sex, level of consciousness, skin color, facial features
Age
The person appears his or her stated age
Sex
Sexual development is appropriate for gender and age
Level of consciousness
the person is alert and oriented, attends to your questions and responds 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 movement
BODY STRUCTURE
stature, nutrition, symmetry, posture, position, body build contour
Stature
the height appears within normal range for age, genetic heritage
Nutrition
the weight appears within normal range for height and body build; body fat distribution is even
Symmetry
body parts look equal bilaterally and are in relative proportion to each other
Posture
the person stands comfortably erect as appropriate for age. note the normal "plumb line" though anterior ear, shoulder, hip, patella, ankle. expectations are the standing toddler who has a normally protuberant abdomen and the aging person who may be stopped with kyphosis.
Position
the person sits comfortably in a chair or on the bed or examination table, arms relaxed at sides, head turned to examiner
Body, Build, Contour
1. arm span (fingertip to fingertip) = height
2. body length from crown to pubis roughly equal to length from pubis to sole
MOBILITY
Gait, range of motion
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 are swing, are present
Range of motion
note full mobility for each joint and that movement is deliberate, accurate, smooth, and coordinated
no involuntary movement
BEHAVIOR
facial expression, mood and affect, speech, dress, personal hygiene
Facial expression
the person maintains eye contact, expressions are appropriate to the situation
Mood and Affect
the person is comfortable and cooperative with the examiner and interacts pleasantly
Speech
articulation is clear and understandable
the stream of talking is fluent, with an even pace
the person conveys ideas clearly
word choice is appropriate to cultrue and education
the person communicates in prevailing language easily by himself or herself or with and interpreter
Dress
clothing is appropriate to the climate, looks clean and fits the body, and is appropriate to the person's culture and age-group
personal hygiene
the person appears clean and groomed appropriately for his or her age, occupation, and socioeconomic group.
hair is groomed, brushed, women's makeup is appropriate for age and culture
MEASUREMENT
Weight, height, body mass index, waist circumference
Weight
use balance or electronic standing scale. remove shoes and heavy clothing. record in kilograms and in pounds
Height
use wall mounted device or measuring pole on the balance scale. align with top of head, shoeless,l standing straight, looking straight, feet, head and shoulders should touch hard surface
Body mass index
practical marker of optimal healthy weight for height and and indicatior of obesity or malnutrition.
healthy is level of 19 or greater to less than 25

Note: BMI overestimates body fat in persons who are very muscular, and it underestimates body fat in older adults who have lost muscle mass
What is the BMI formula?
weight (in pounds)/height (in inches)^2 X 703

Weight (in kg)/height (in meters)^2
Waist circumference
with person standing, locate the hip bone and the top of its right iliac crest. place measuring tape around the waist, parallel to the floor, at the level of the iliac crest.
VITAL SIGNS
Temperature, pulse, respirations, blood pressure
What is normal oral temperature of resting person? How much higher does rectal temp measure?
37 C (98.6 F), with a range of 35.8 to 37.3 C (96.4 to 99.1 F)
rectal = .4 to .5 C higher (.7 to 1 F)
What core temperature does cellular metabolism require?
37.2 C (99 F)
What is unique about the oral sublingual site for taking temperature?
it has a rich blood supply from the carotid arteries taht quickly responds to changes in inner core temp
When is the tempanic membrane thermometer used?
unconscioius patients or with those in emergency departments, recover areas, labor and delivery units
stroke volume
the amount of blood pumped with every heartbeat
What is the average stroke volume in an adult?
70mL
What is the normal heart rate range?
50-90 bpm
After puberty who has a faster heart rate?
females
what is bradycardia?
heart rate <50 bpm
What is tachycardia?
heart rate >90 bpm
Sinus arrythmia
normally occurs in children and young adults; the heart rate varies with the respiratory cycle, speeding up at the peak of inspiration and slowing to normal with expiration
What is the normal respiration rate for adults?
10-20 breaths per minute
systolic pressure
the maximum pressure felt on the artery during left ventricular contraction, or systole
diastolic pressure
the resting pressure that the blood exerts constantly between each contraction
pulse pressure
the difference between the systolic and diastolic pressures and reflects the stroke volume
mean arterial pressure (MAP)
the pressure forcing blood into the tissues, averaged over the cardiac cycle