1. At first glance A general patient assessment

4. General appearance • Facial expression • Self-care • Unusual odors Fruity breath Halitosis Putrid breath or body odor Fishy vaginal odor Urine or ammonia like odor Fecal breath or body odor

5. Assessing vital signs • Temperature normal oral 36 to 37.5 normal rectal 36.3 to 37.9 normal tympanic (core) 36.2 to 37.8 Temperature starts low in the morning and gradually increases throughout the day.

6. Temperature continued • When is a patient febrile oral >99.5 rectal>100.5 tympanic>101.3 Hyperpyrexia, temperature >105 this is a medical emergency and the temp must be quickly brought down

7. How about hypothermia • Mild hypothermia-34 to 35 • Moderate hypothermia-30-34 • Severe hypothermia-<30

8. You need to get the beat-pulse • Radial artery is first choice • Thready or weak pulse, may check apical heart rate, carotid or femoral pulses. assessing pulse is the rate WNL (60-100) are radial and apical pulse the same is the pulse weak, thready, bounding

9. Pulse abnormalities • Pulsusalternans weak beats alternate with strong beats, regular rhythm. May indicate left ventricular failure. • Pulsusbigeminus two beats in rapid succession followed by a pause. irregular rhythm. early beats with a change in amplitude. may indicate cardiac arrhythmias

10. More pulse abnormalties • Pulsusparadoxus pulse amplitude that increases with expiration and decreases with inspiration. • Pulsustardus slow pulse rate, may indicate severe aortic stenosis.

11. Respirations • Normal findings Eupnea rate between 12-20 regular, quiet, effortless • Abnormal findings tachypnea > 20 bradypnea <12 apnea-none, bad sign

12. Respiratory abnormalities (cont.) hyperventilation-deep respirations, slightly fast rate Kussmaul’s- fast and deep, no pauses. Cheyne-stokes-cyclic pattern of apnea and varied breathing. Biots-fast and deep with periods of apnea

13. Blood pressure • Normal systolic 120-139 • Normal diastolic 60-80 • Normal pulse pressure 30-40 blood pressure typically peaks at midmorning and drops to its lowest at 3-4 am.

14. Blood pressure abnormalities • Orthostatic hypotension-a drop of 20mm hg or more in systolic pressure when patient rises from a lying to sitting then to standing, may also have increased pulse and near syncope or syncope. • Hypotension-systolic below 90, diastolic below 60, need to know patients baseling. • Hypertension-above 140/90, obtained on at least 3 occasions, what makes your B/P go up and it is not considered hypertension?

15. Height and weight and BMI • BMI=weight in kg./height in meters squared. • BMI>25.8 (women), 26.4 (men)are 20% over their ideal body weights and at risk for obesity