HEALTH ASSESSMENT

IN NURSING
METHODS OF ASSESSMENT:
IV. ASSESSING GENERAL HEALTH
STATUS AND VITAL SIGNS
TEMPERATURE:
 HEAT LOSS MECHANISMS:
• CONDUCTION : is defined as the transfer of heat from a warmer object to a
cooler object when the two objects are in direct contact with each other.
• RADIATION: heat loss from the human body occurs primarily due to infrared
emission. Radiative heat loss occurs primarily on cold, clear nights, and is
readily noticeable after sunset.
• CONVECTION: heat loss occurs in response to movement of a fluid or gas.
The biggest factor contributing to convective heat loss, of course, is wind. In
outdoor clothing systems, convective heat loss occurs when warm air next to
the body and in the clothing is displaced by cool air from the outside
environment.
• EVAPORATION Evaporation occurs when a liquid (such as sweat) changes
phase to a vapor (sweat vapor). This phase change requires heat.
Unfortunately, your body heat drives this phase change. Evaporative heat
loss may be most noticeable in context of the “flash-off” effect, which occurs
after a period of intense physical activity and sweating in cold conditions,
followed by rapid evaporation and chill after stopping to rest.
THERMOREGULATION:
PULSE:
 RELATED TERMS:

1. STROKE VOLUME: is the volume of

blood pumped from one ventricle of the
heart with each beat.
2. CARDIAC OUTPUT: is the volume of
blood being pumped by the heart, in
particular by a left or right ventricle in the
time interval of one minute.
POINT OF MAXIMUM IMPULSE
12 LEAD ECG MACHINE
RESPIRATION
OXYGEN DEVICES
Venturi Device: High Flow
System
ENDOTRACHEAL TUBE
TRACHEOSTOMY TUBE
PULSE OXIMETER
BLOOD PRESSURE: sometimes referred to as arterial
blood pressure, is the pressure exerted by circulating blood upon the
walls of blood vessels.

• FACTORS TO CONSIDER:

1.BLOOD
VOLUME
2.PERIPHERAL
RESISTANCE
3.VISCOSITY OF
THE BLOOD
 BRIEF HISTORY: BLOOD PRESSURE DEVICES
• Stephen Hale's Tube
– Credit for inventing the first blood pressure measurement device goes to British scientist Stephen
Hale, who inserted a brass pipe into the artery of a horse, connected it to a glass tube and
showed pressure forced blood up into the tube.
• The Kymograph
– In 1847, the first recording of human blood pressure was made by German physician Carl
Ludwig, who inserted a catheter into a patient's artery and hooked it to an invention called the
kymograph, which used a quill attached to an ivory float to sketch blood pressure readings on a
rotating drum.
• The Sphygmomanometer
– In 1881, Samuel Karl Ritter invented the sphygmomanometer, which used a water filled bag to
deaden the arterial pulse in order to record the blood's systolic (higher) pressure.
• The Inflatable Cuff
– In 1896, Italian physician Scipione Riva-Rocci introduced the mercury sphygmomanometer,
which used an inflatable cuff on the upper arm to nullify the arterial pulse and measure blood
pressure, a method that is still used today.
• Diastolic Pressure Debuts
– In 1905, Nikolai Korotkoff observed that the arteries made sounds when the inflatable cuff was
being tightened and loosened and developed a way to interpret the sounds. He developed the
auscultatory method to measure diastolic blood pressure and added the final refinement to
measuring blood pressure.
 STEPHEN
HALE’S TUBE
• He inserted a brass pipe
into an animal's blood
vessel and used the
flexible windpipe of a
goose to connect the
pipe to a long glass
tube. The height to
which the animal's
blood spurted up into
the tube gave a measure
of the pressure on the
blood.
KYMOGRAPH
SPHYGMOMANOMETER
ANEROID MANOMETER
BLOOD PRESSURE CATEGORIES:
Category systolic, mm Hg diastolic, mm Hg

Hypotension < 90 < 60

Desired 90–119 60–79

Prehypertension 120–139 80–89

Stage 1 hypertension 140–159 90–99

Stage 2 hypertension 160–179 100–109

Hypertensive emergency ≥ 180 ≥ 110

THE HUMAN HEART