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Chapter 7 Body Systems Chapter 2 The Physical Examination and Its Basis in Physiology Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 1 Vital Signs Body temperature (T) Pulse (P) Respiration (R) Blood pressure (BP) Pulse oximetry (SpO2) Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 2 Table 2-1. Average Range for Vital Signs According to Age Group Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 3 Body Temperature Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 4 Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 5 Four Common Types of Fever Intermittent Remittent Relapsing Constant Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 6 Box 2-1 Clinical Signs of Hypothermia Below normal body temperature Decreased pulse and respiratory rate Severe shivering (initially) Patient indicating coldness or presence of chills Pale or bluish cool, waxy skin Hypotension Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 7 Box 2-1 Clinical Signs of Hypothermia (Cont’d) Decreased urinary output Lack of muscle coordination Disorientation Drowsiness or unresponsiveness Coma Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 8 Box 2-2 Common Therapeutic Interventions for Hypothermia Remove wet clothing Provide dry clothing Place patient in a warm environment (e.g., slowly increase the room temperature) Cover patient with a warm blanket or electric heating blanket Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 9 Box 2-2 Common Therapeutic Interventions for Hypothermia (Cont’d) Apply warming pads (increase temperature slowly) Cover patient’s head with a cap or towel Supply warm oral or intravenous fluids Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 10 Table 2-2 Factors Affecting Body Temperature (see text for full discussion) Age Environment Time of day Exercise Stress Hormones Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 11 Body Temperature Measurements The measurement of body temperature establishes an essential baseline for clinical comparison. To ensure reliability of a temperature reading: Select correct equipment Choose the most appropriate site Use the correct technique or procedure Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 12 Body Temperature Measurements (Cont’d) The four most commonly used sites are the: Mouth Rectum Ear (tympanic) Axilla Additional sites Esophagus Pulmonary artery Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 13 Core Temperature Sites Rectum Ear (tympanic) Esophagus Pulmonary artery Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 14 Table 2-3 Body Temperature Measurements: Summary of Body Temperature Sites, Advantages and Disadvantages, and Equipment Used Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 15 Pulse Rate Rhythm Strength Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 16 Table 2-1. Average Range for Vital Signs According to Age Group. Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 17 Figure 2-2. The nine common pulse sites. Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 18 Box 2-3 Scale to Rate Pulse Quality 0: Absent or no pulse 1+: Weak, thready, easily obliterated with pressure; difficult to feel 2+: Pulse difficult to palpate; may be obliterated by strong pressure 3+: Normal pulse 4+: Bounding, easily palpated, and difficult to obliterate Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 19 Respiration Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 20 Table 2-1. Average Range for Vital Signs According to Age Group. Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 21 Common Breathing Patterns Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 22 Volume Time (15 seconds) Eupnea. Normal range and rhythm; 12 to 20 breaths/min in regular rhythm and of moderate depth for an adult. Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 23 Volume Time (15 seconds) Bradypnea. Regular rhythm of fewer than 12 breaths/min. Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 24 Volume Time (15 seconds) Tachypnea. Regular rhythm of more than 20 breaths/min for an adult. Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 25 Volume Apnea Time (15 seconds) Apnea. Absence of breathing that leads to respiratory arrest and death. Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 26 Volume Time (15 seconds) Hypoventilation. Decreased rate and depth, decreasing alveolar ventilation and leading to an increased PaCO2. Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 27 Volume Time (15 seconds) Hyperventilation. Increased rate and depth, which increases alveolar ventilation and leads to a decreased PaCO2. Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 28 Apnea Volume Time (15 seconds) Cheyne-Stokes. Respirations become faster and deeper, then slower and shallower with a period of apnea. Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 29 Volume Time (15 seconds) Kussmaul’s. Increased rate and depth of breathing. Usually associated with diabetic ketoacidosis as a compensatory mechanism to eliminate excess carbon dioxide. Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 30 Apnea Volume Time (15 seconds) Biot’s. Fast, deep respirations with abrupt pauses. Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 31 Blood Pressure Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 32 Table 2-1. Average Range for Vital Signs According to Age Group. Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 33 Blood Pressure The arterial blood pressure is the force exerted by the circulating volume of blood on the walls of the arteries Systolic blood pressure Diastolic blood pressure Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 34 Blood Pressure (Cont’d) Function of: Blood flow generated by ventricular contraction Resistance. to blood flow by the vascular system • BP = V × R Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 35 Blood Flow Blood flow is equal to cardiac output Cardiac output (CO) is equal to: Volume of blood ejected from the ventricles during each heartbeat (stroke volume [SV]), multiplied by the heart .rate (HR) • CO = SV × HR Average CO is about 5 L/min Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 36 Blood Flow Abnormalities Hypertension Blood pressure is chronically above normal Hypotension Blood pressure falls below 90/60 mm Hg Orthostatic hypotension When blood pressure quickly drops as the individual rises to an upright position or stands Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 37 Pulsus Paradoxus ↓ Blood pressure during inspiration ↑ Blood pressure during expiration Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 38 Oxygen Saturation Often considered the fifth vital sign Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 39 Table 2-6. SpO2 and PaO2 Relationship for the Adult and Newborn Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 40 Table 2-7 Signs and Symptoms of Inadequate Oxygenation Central Nervous System Apprehension (early) Restlessness or irritability (early) Confusion or lethargy (early or late) Combativeness (late) Coma (late) Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 41 Table 2-7 Signs and Symptoms of Inadequate Oxygenation (Cont’d) Respiratory Tachypnea (early) Dyspnea on exertion (early) Dyspnea at rest (late) Use of accessory muscles (late) Intercostal retractions (late) Takes a breath between each word or sentence (late) Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 42 Table 2-7 Signs and Symptoms of Inadequate Oxygenation (Cont’d) Cardiovascular Tachycardia (early) Mild hypertension (early) Arrhythmias (early or late) Hypotension (late) Cyanosis (late) Skin is cool or clammy (late) Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 43 Table 2-7 Signs and Symptoms of Inadequate Oxygenation (Cont’d) Other Diaphoresis (early or late) Decreased urinary output (early or late) General fatigue (early or late) Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 44 Systematic Examination of the Chest and Lungs Inspection Palpation Percussion Auscultation Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 45 Lung and Chest Topography Thoracic cage landmarks Imaginary lines Lung borders and fissures Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 46 Thoracic Cage Landmarks Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
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