Chapter 8

Assessing General Health Status

and Vital Signs
Preparation for Survey of General Health
Status

 Perform systematic examination and recording general

characteristics and impressions of the client.
 Observe any significant abnormalities.

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Observe Significant Abnormalities

 Skin color
 Dress
 Hygiene
 Posture and gait
 Physical development
 Body build
 Apparent age
 Gender

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General Survey #1
 Physical development and body build
 Gender and sexual development
 Apparent age as compared to reported age
 Skin condition and color
 Dress and hygiene
 Posture and gait

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General Survey #2
 Level of consciousness
 Behaviors, body movements, and affect
 Facial expression
 Speech
 Vital signs

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Interview
 General survey questions
 History of present health concern
 Personal history
 Family history
 Lifestyle and health practices

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Accurate General Survey #1

 Preparing the client

 Equipment
o Thermometer
o Protective, disposable covers for type of thermometer
o Aneroid or mercury sphygmomanometer or electronic
blood pressure measuring equipment
o Stethoscope
o Watch with second hand

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Accurate General Survey #2
 General impression
o Observe physical development, body build, and fat
distribution.
o Compare client’s stated age with apparent age and
developmental stage.
o Observe skin condition and color.
o Observe posture and gait.

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Vital Signs
 Hands-on physical examination begins with vital signs
 Provide data that reflect body systems status
o Cardiovascular
o Neurologic
o Peripheral vascular
o Respiratory

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Order of Vital Signs

 Temperature
 Pulse
 Respirations
 Blood pressure

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Pulse Amplitude
 0: Absent
 1+: Weak, diminished (easy to obliterate)
 2+: Normal (obliterate with moderate pressure)
 3+: Bounding (unable to obliterate or requires firm
pressure)

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Blood Pressure
 Systolic blood pressure is a measurement of the pressure
of the blood in the arteries when the ventricles are
contracted.
 Diastolic blood pressure is a measurement of the
pressure of the blood in the arteries when the ventricles
are relaxed.

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Pain
 Fifth vital sign
 Observe comfort level

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Older Client Considerations #1
 Temperature may range from 95.0°F to 97.5°F.
Therefore, the older client may not have an obviously
elevated temperature with an infection or be considered
hypothermic below 96°F.
 Osteoporotic thinning and collapse of the vertebrae
secondary to bone loss may result in kyphosis.
 In older men, gait may be wider based, with arms held
outward. Older women tend to have a narrow base and
may waddle to compensate for a decreased sense of
balance. Steps shorten, with decreased speed and arm
swing. Mobility may be decreased, and gait may be rigid.

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Older Client Considerations #2

 The older client’s artery may feel more rigid, hard, and
bent.
 In the older adult, the respiratory rate may range from
15 to 22. The rate may increase with a shallower
inspiratory phase because vital capacity and inspiratory
reserve volume decrease with aging.
 More rigid, arteriosclerotic arteries account for higher
systolic blood pressure in older adults. Systolic pressure
over 140 with diastolic pressure under 90 is called
isolated systolic hypertension.
 Widening of the pulse pressure is seen with aging due to
less elastic peripheral arteries.

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Rise in Temperature

 Strenuous exercise
 Stress
 Ovulation
 Hyperthermia
o Viral or bacterial infections
o Malignancies
o Trauma
o Various blood, endocrine, immune disorders

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Question #1
Is the following statement true or false?
The rectal temperature is lower than the normal oral
temperature.

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Answer to Question #1
False.
The rectal temperature is between 0.4°C and 0.5°C (0.7°F
and 1°F) higher than the normal oral temperature.

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Factors Affecting Blood Pressure
 Cardiac output
 Elasticity of arteries
 Blood volume
 Blood velocity (heart rate)
 Blood viscosity (thickness)

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Characteristics of Radial Pulse
 Rate
 Rhythm
 Amplitude and contour
 Elasticity

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Question #2
Is the following statement true or false?
Normally, pulsation is slightly stronger in the left wrist.

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Answer to Question #2
False.
Normally, pulsation is equally strong in both wrists.

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Normal and Abnormal Findings

 Share outcomes of assessment with peers.

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Validating and Documenting Findings

 Health promotion diagnoses

 Risk diagnoses
 Actual diagnoses
 Collaborative problems
 Medical problems

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