Health and Physical Assessment In

Nursing 3rd Edition DAmico Solutions

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 D’Amico Chapter 7
Concepts for Lecture

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PEARSON NURSING STUDENT RESOURCES

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LEARNING OUTCOME 1
Describe the general survey as part of a comprehensive health assessment.

Concepts for Lecture

1. The general survey begins during the interview and provides clues to guide the nurse during
later assessment of body regions and systems.

2. The general survey is done during subjective data gathering and includes what is seen, heard,
or smelled during the initial phase of assessment.

©2012 by Pearson Education, Inc.

D’Amico/Barbarito, Instructor’s Resource Manual for Health & Physical Assessment In Nursing,
2nd Edition
PowerPoint Slides

1. General Survey (Figure 7.1)

2. Use of Senses During General Survey

• Vision
• Hearing
• Smell

Suggestions for Classroom Activities

• Ask students to provide examples of how the general survey can lead them to specific
physical assessments for clients.

LEARNING OUTCOME 2
Identify the components of the general survey.

Concepts for Lecture

1. The components of the general survey include four major categories of observation: physical
appearance, mental status, mobility, and behavior.

2. Physical appearance includes body shape and build and assessment of function and
symmetry.

3. The client’s mental status includes orientation, affect, and anxiety.

4. Mobility includes posture, gait, and range of motion.

5. Client behavior includes grooming, bodily odors, hygiene, facial expression, mood, and level
of anxiety.

6. Measurements of height and weight are taken to establish baseline data and help determine
health status.

7. The chronologic age and developmental stage must be considered when assessing the four
components of the general survey and may require variations in data collection techniques.

©2012 by Pearson Education, Inc.

D’Amico/Barbarito, Instructor’s Resource Manual for Health & Physical Assessment In Nursing,
2nd Edition
PowerPoint Slides

1. Components of the General Survey

• Physical appearance
• Mental status
• Mobility
• Behavior

2. Physical Appearance

• Body shape
• Build
• Assessment of function and symmetry

3. Mental Status

• Orientation
• Affect
• Anxiety

4. Mobility

• Posture
• Gait
• Range of motion

5. Behavior

• Grooming
• Bodily odors
• Hygiene
• Facial expression
• Mood
• Level of anxiety

6. Height and Weight Measurements

• Height (Figures 7.2 and 7.3)

• Weight (Figure 7.4 and Table 7.1)

©2012 by Pearson Education, Inc.

D’Amico/Barbarito, Instructor’s Resource Manual for Health & Physical Assessment In Nursing,
2nd Edition
7. Chronologic Age and Developmental Stage Considerations

• Length of infants (Figure 7.5)

• Weight of infants (Figure 7.6)

Suggestions for Classroom Activities

• Provide students with a list of objective assessments and have them appropriately place
them under one of the four major components of the general survey.

Suggestions for Clinical Activities

• Have students read the history and physicals on selected hospitalized clients and identify
which assessment data were gathered in the general survey.

LEARNING OUTCOME 3
Measure vital signs.

Concepts for Lecture

1. Vital signs include temperature, pulse, respiratory rate, blood pressure, pain, and oxygen
saturation, if applicable. Vital signs are used to obtain baseline data, to detect or monitor a
change in the client’s health status, and to monitor clients at risk for alterations in health.

2. Temperature may be measured using oral, rectal, axillary, tympanic, or temporal artery
routes. The safest method to measure temperature is the axillary route.

3. Pulse rate refers to the measure of heartbeats per minute. Pulse points include the apical and
peripheral sites. When assessing the pulse, consider rate, rhythm, and quality.

4. Respiratory rate refers to the number of breaths per minute. Assessing respiration refers to
counting each respiratory cycle (inspiration and expiration) as one breath.

5. Blood pressure is measured with a blood pressure cuff, a sphygmomanometer, and a

stethoscope. Blood pressure is recorded as systolic and diastolic measurements. Systolic
blood pressure is the pressure during left ventricular contraction. Diastolic pressure is the
pressure during the “resting” period of the heart.

6. Pain is considered the fifth vital sign. Pain is individual and subjective.

©2012 by Pearson Education, Inc.

D’Amico/Barbarito, Instructor’s Resource Manual for Health & Physical Assessment In Nursing,
2nd Edition
 7. Pain assessment includes a pain history and observations of behaviors and physiologic
changes. The pain history includes assessment of the location, intensity, quality, pattern,
precipitating factors, methods to relieve pain, impact on activities of daily living (ADLs),
coping strategies, and emotional responses.

8. Pain scales using numbers or faces and descriptive statements help “quantify” the pain
experience and guide intervention.

9. The site of the pain and the duration of the pain determine physiologic responses to pain.
Responses include sympathetic and parasympathetic nervous system responses.

10. Oxygen saturation is reported as a percentage and represents the light absorbed by
oxygenated and deoxygenated hemoglobin. A value of 95% to 100% is considered normal,
whereas a value of 70% is considered life threatening.

PowerPoint Slides

1. Vital Signs

• Temperature
• Pulse
• Respiratory rate
• Blood pressure
• Pain
• Oxygen saturation
• Use of Vital Signs

o Obtain baseline data

o Detect of monitor a change
o Monitor clients at risk

2. Temperature Routes

• Oral (Figure 7.8)

• Rectal
• Axillary
• Tympanic
• Temporal Artery

©2012 by Pearson Education, Inc.

D’Amico/Barbarito, Instructor’s Resource Manual for Health & Physical Assessment In Nursing,
2nd Edition
3. Pulse and Pulse Points (Figures 7.10 and 7.11)

• Apical (Figure 7.10)

• Peripheral (Figure 7.11)
• Pulse considerations

o Rate
o Rhythm
o Quality

4. Respirations

5. Blood Pressure (Figures 7.14, 7.15, and Box 7.1)

• Systolic—Pressure during left ventricular contraction

• Diastolic—Pressure during the “resting” period of the heart

6. Pain

7. Pain Assessment

• Pain history
• Observations of behaviors
• Physiologic changes
• Pain history
• Location
• Intensity (Figures 7.17 and 7.18)
• Quality
• Pattern
• Precipitating factors
• Methods to relieve pain
• Impact on ADLs
• Coping strategies
• Emotional responses

8. Pain Scales

©2012 by Pearson Education, Inc.

D’Amico/Barbarito, Instructor’s Resource Manual for Health & Physical Assessment In Nursing,
2nd Edition
 9. Physiologic Responses to Pain

• Sympathetic
• Parasympathetic

10. Oxygen Saturation

Suggestions for Classroom Activities

• Have students practice taking vital signs on each other.

Suggestions for Clinical Activities

• Have students practice taking vital signs on selected clients.

LEARNING OUTCOME 4
Discuss the factors that affect vital signs.

Concepts for Lecture

1. Temperature is influenced by age, diurnal rhythms, exercise, hormones, stress, illness, and
the ingestion of food and fluids.

2. Pulse rate can be affected by age, gender, exercise, stress, fever, hemorrhage, medications,
and position change.

3. Respiratory rate is affected by exercise, stress, increased temperature, increased altitude,

medications, and obesity.

4. Blood pressure is affected by cardiac output, blood volume, and peripheral vascular
resistance, the last of which is determined by blood viscosity and the elasticity of vessels.

5. Blood pressure is also affected by age, gender, race, obesity, physical activity, stress, diurnal
variations, and medications.

©2012 by Pearson Education, Inc.

D’Amico/Barbarito, Instructor’s Resource Manual for Health & Physical Assessment In Nursing,
2nd Edition
PowerPoint Slides

1. Temperature

• Age
• Diurnal rhythms
• Exercise
• Hormones
• Stress
• Illness
• Ingestion of food and fluids

2. Pulse

• Age
• Gender
• Exercise
• Stress
• Fever
• Hemorrhage
• Medications
• Position change

3. Respiratory Rate

• Exercise
• Stress
• Increased temperature
• Increased altitude
• Medications
• Obesity

4. Blood Pressure

• Cardiac output
• Blood volume
• Peripheral vascular resistance

o Blood viscosity
o Elasticity of vessels

©2012 by Pearson Education, Inc.

D’Amico/Barbarito, Instructor’s Resource Manual for Health & Physical Assessment In Nursing,
2nd Edition
5. Blood Pressure

• Age
• Gender
• Race
• Obesity
• Physical activity
• Stress
• Diurnal variations
• Medications

Suggestions for Classroom Activities

• Have students discuss the factors that can affect vital signs by outlining specific
variations that may occur for each of the vital signs. (See Table 7.2.)

Suggestions for Clinical Activities

• Have students analyze vital signs on selected clients.

LEARNING OUTCOME 5
Apply critical thinking during the initial nurse-client encounter.

Concepts for Lecture

1. The nurse uses critical thinking during the general survey to collect and analyze relevant data
in order to plan and implement care for clients.

PowerPoint Slides

1. Critical Thinking and the General Survey

Suggestions for Classroom Activities

• Have students use the chapter case study to collect data during a general survey.

Suggestions for Clinical Activities

• Have students perform a general survey on selected clients.

©2012 by Pearson Education, Inc.

D’Amico/Barbarito, Instructor’s Resource Manual for Health & Physical Assessment In Nursing,
2nd Edition