Table of Contents Factors Affecting the Pulse Rate...................................

6
Lesson 4: Health Management & Physical Examination . 2
Pulse Sites ................................................................... 6
Health Assessment vs Physical Examination .............. 2
Assessment of the Pulse .............................................. 6
Health Assessment ...................................................... 2
Rate ......................................................................... 6
Physical Examination ................................................... 2
Rhythm ..................................................................... 6
Modes of Examination .............................................. 2
Volume (Amplitude) .................................................. 6
Positions in Physical Examination ............................. 2
Arterial Wall Elasticity ............................................... 6
Assessing the General Appearance and Behavior of an
Presence/Absence of Bilateral Equality ..................... 6
Individual.................................................................. 2
Respiration..................................................................... 7
Laboratory and Diagnosis Examinations ................... 2
Three Processes .......................................................... 7
Framework for Health Assessment .............................. 3
Two Types of Breathing................................................ 7
Functional Health Framework....................................... 3
Costal ....................................................................... 7
Data Collection in terms of Gordon ........................... 3
Diaphragmatic .......................................................... 7
11 Functional Patterns .......................................... 3
Respiratory Centers ..................................................... 7
Head-to-Toe Framework .............................................. 3
Medulla oblongata .................................................... 7
Body System Framework ............................................. 3
Pons ......................................................................... 7
Assessing Vital Signs ................................................... 3
Pneumotaxic Center .............................................. 7
Body Temperature......................................................... 4
Apneustic Center................................................... 7
Types of Body Temperature ......................................... 4
Carotid and Aortic Bodies ......................................... 7
Core Temperature .................................................... 4
Assessing Respiration .................................................. 7
Surface Temperature................................................ 4
Rate ......................................................................... 7
Factors Affecting the Body’s Heat Production ............... 4
Depth ....................................................................... 7
Basal Metabolic Rate (BMR)..................................... 4
Rhythm ..................................................................... 7
Muscle Activity ......................................................... 4
Quality or Character .................................................. 7
Thyroxin Output ........................................................ 4
Major Factors Affecting Respiratory Rate...................... 7
Epinephrine, Norepinephrine, and Sympathetic
Stimulation ............................................................... 4 Must Know (Terms) ...................................................... 7

Increase Temperature of the Body Cells ................... 4 Blood Pressure .............................................................. 8

Processes Involved in Heat Loss.................................. 4 Determinants of Blood Pressure ................................... 8

Radiation.................................................................. 4 Blood Volume ........................................................... 8

Conduction ............................................................... 4 Cardiac Output ......................................................... 8

Convection ............................................................... 4 Elasticity or Compliance of Blood Vessels ................. 8

Evaporation .............................................................. 4 Peripheral Resistance ............................................... 8

Factors Affecting Temperature ..................................... 4 Blood Viscosity ......................................................... 8

Alterations in Body Temperature .................................. 5 Sex/Gender .............................................................. 8

Pyrexia ..................................................................... 5 Medications .............................................................. 8

Hyperpyrexia ............................................................ 5 Diurnal Variations ..................................................... 8

Hypothermia............................................................. 5 Diseases Process ..................................................... 8

Types of Fever............................................................. 5 Factors Affecting Blood Pressure.................................. 8

Intermittent Fever ..................................................... 5

Remittent Fever ........................................................ 5
Relapsing Fever ....................................................... 5
Constant Fever......................................................... 5
Decline of Fever........................................................... 5
Crisis of Flush or Defervescence Stage .................... 5
Lysis ........................................................................ 5
Clinical Signs of Fever ................................................. 5
Onset of Fever ......................................................... 5
Course of Fever ....................................................... 5
Defervescence ......................................................... 5
Interventions in Clients with Fever ................................ 5
Pulse .............................................................................. 6

1
LESSON 4: HEALTH MANAGEMENT & PHYSICAL Positions in Physical Examination
EXAMINATION
➢ Dorsal Recumbent
→ back lying position with knees flexed and hips
Health Assessment vs Physical Examination
externally rotated
Health Assessment
➢ Dorsal/Supine
→ is a collection of data about an individual’s health → back lying position with or without a pillow

→ Purpose of Health Assessment ➢ Sitting or Seated Position

▪ to make a clinical judgment or diagnosis about the → back unsupported and legs hanging freely
individual’s health state or condition
➢ Fowler’s position
▪ to obtain baseline data about the client’s functional → Semi-Fowler’s
abilities ▪ head of the bed is elevated 15-45
degrees angle
→ a comprehensive health assessment encompasses the
dimensions of a person: → High Fowler’s
▪ Physical ▪ head of the bed raised at 80-90 degrees
▪ Psychological angle
▪ Social
▪ Spiritual ➢ Lithotomy
→ back-lying position with feet supported in stirrups

Physical Examination
➢ Genupectoral/Knee-Chest Kneeling position
→ is a head-to-toe review of each body system that offers → with torso at 90 degrees angle to hips
objective information about the client
▪ and allows the healthcare provider to make clinical ➢ Lateral/Side-lying Position
judgments
➢ Sim’s Position/Semi-Prone Position
→ Purpose of Physical Examination
▪ for routine screening to determine the client’s ➢ Prone/Face-lying position
eligibility for health insurance → with the head turned to the side; aka abdominal-
lying position
▪ for acquiring a new job

▪ for the client’s admission to the hospital Assessing the General Appearance and Behavior of an
Individual

age, sex, race body built, height, and weight

Modes of Examination
hygiene and grooming in relation to the client’s age,
➢ Inspection lifestyle, and health
signs of distress
→ assessing using the sense of sight
attitude
➢ Palpation speech
→ examining the body using the sense of touch posture and gait
→ use the fat pads of the fingers body and breath odor
obvious sign
➢ Percussion
→ tapping body parts to produce sounds affect and mood
thought process
➢ Auscultation
→ listening to body sounds with the use of a
stethoscope Laboratory and Diagnosis Examinations

→ specimen used:
▪ urine
▪ stool
▪ blood
▪ other body secretions

2
 Framework for Health Assessment Body System Framework

→ this may be used during the assessment

Functional Health Framework
▪ especially among acutely and critically ill
→ evaluates the effects of the mind, body, and environment clients/patient
▪ in relation to a person’s ability to perform the task
of daily living → systems involved:
▪ Respiratory
▪ Cardiovascular
Data Collection in terms of Gordon ▪ Musculoskeletal
▪ Gastrointestinal
11 Functional Patterns ▪ Integumentary
→ Health Perception and Health Management ▪ Endocrine
→ Activity and Exercise ▪ Reproductive
→ Nutrition and Metabolisms ▪ Psychosocial
→ Elimination ▪ Neurologic
→ Sleep and Rest ▪ Sensory
→ Cognition and Perception
→ Self-Perception and Self -Concept Assessing Vital Signs
→ Roles and Relationships
→ Coping and Stress Tolerance → the vital signs or cardinal signs are:
▪ body temperature
→ Sexuality and Reproduction
▪ pulse
→ Values and Belief
▪ respiration and
▪ blood pressure
Head-to-Toe Framework

→ collecting data from head and systematically to toe

▪ Cephalo-Caudal Manner

→ General health state

▪ vital sign
▪ weight
▪ nutritional status

→ Head
▪ hair
▪ scalp
▪ eyes
▪ ears
▪ oral cavity
▪ cranial nerves

→ Neck

→ Chest

→ Abdomen

→ Extremities

→ Genitals

→ Rectum

3
 Body Temperature Processes Involved in Heat Loss

Types of Body Temperature Radiation

→ the transfer of heat from the surface of one object to the

Core Temperature
surface of another
→ the temperature of the deep tissue of the body ▪ without contact between two objects
→ measured by taking an oral and rectal temperature
→ ex. it feels warm in a crowded room

Surface Temperature
Conduction
→ the temperature of the:
▪ skin → the transfer of heat from one surface to another
▪ subcutaneous tissue
▪ and fat → it requires a temperature difference between the two
surfaces
→ measured by taking axillary temperature
→ ex. application of moist wash-cloth over the skin
→ body heat is primarily produced by metabolisms

→ the heat-regulating center is found in the hypothalamus Convection

→ the dissipation of heat by air currents

→ ex. exposure of the skin towards the electric fan
Factors Affecting the Body’s Heat Production

Basal Metabolic Rate (BMR) Evaporation

→ the younger the person, the higher the BMR → the continuous vaporization of moisture from the:
▪ skin
→ the older the person, the lower the BMR ▪ oral mucus
▪ respiratory tract
→ therefore, older persons have lower BT than the young  also insensible heat loss
person
→ ex. Tepid Sponge bath
▪ increases peripheral circulation, thereby
Muscle Activity
increasing heat loss by evaporation
→ exercise, swimming
→ increases cellular metabolic rate
Factors Affecting Temperature
→ therefore, exercise increases body heat temperature
→ Age
▪ the infant’s body temperature is generally affected
Thyroxin Output
by the temperature of the environment
→ increase cellular metabolic rate (chemical
thermogenesis) ▪ elder people are at risk of hypothermia due to:
 decreased thermoregulatory controls
→ Hyperthyroidisms  decreased subcutaneous fat
▪ is characterized by an increase in body  inadequate diet
temperature  sedentary activity

→ Diurnal Variations
Epinephrine, Norepinephrine, and Sympathetic Stimulation
▪ the highest temperature is usually reached
→ increase the cellular metabolisms between 8:00 a.m. to 12:00 noon
→ these in turn increase body temperature
▪ and the lowest temperature is reached between
4:00-6:00 a.m.
Increase Temperature of the Body Cells

→ fever → Exercise
▪ increases the rate of cellular metabolisms
→ Hormones
▪ Ex.
 progesterone
 thyroxine
 norepinephrine
 and epinephrine
 increase body temperature

 estrogen decreases body temperature

→ Stress

4
Alterations in Body Temperature Clinical Signs of Fever

Pyrexia Onset of Fever

→ body temperature above the normal range → cold or chill stage of fever
▪ Hyperthermia, or fever → increased heart rate
→ increased respiratory rate and depth
→ shivering
Hyperpyrexia
→ pale, cold skin
→ very high fever, 41°C (105.8 F) and above → cyanotic nail bed
→ complaints of feeling cold
→ “Goose flesh” appearance of the skin
Hypothermia
→ cessation of sweating
→ subnormal core body temperature → rise in body temperature

→ this may be caused by:

Course of Fever
▪ excessive heat loss
▪ inadequate heat production → absence of chills
▪ or impaired hypothalamic function
→ skin that feels warm
Types of Fever
→ the feeling of being neither hot nor cold
Intermittent Fever
→ increased pulse and respiratory rates
→ the temperature fluctuates between periods of fever and
periods of normal/subnormal temperature → increased thirst
▪ mild to severe dehydration

Remittent Fever
→ drowsiness, restlessness, delirium, and convulsions
→ the temperature fluctuates within a wide range over the 24-
hour period → herpetic lesions of the mouth
▪ but remains above the normal range ▪ fever blisters

→ loss of appetite
Relapsing Fever

→ the temperature is elevated for a few days, alternated with → malaise, weakness, and aching muscles
a 1- or 2-days normal temperature

Defervescence
Constant Fever
→ fever abatement
→ body temperature is consistently high → skin that appears flushed and feels warm
→ very high fever temperatures (41-42°C) → sweating
→ decreased shivering
→ possible dehydration
Decline of Fever

Crisis of Flush or Defervescence Stage Interventions in Clients with Fever

→ the sudden decline in fever → provide TSB
→ indicates impairment of the function of the hypothalamus → administer antipyretics (38°C and above)

Lysis

→ the gradual decline of fever

→ indicates that the body can maintain homeostasis
→ the desired decline of fever

5
 Pulse Assessment of the Pulse

→ it is a wave of blood created by contraction of the left

Rate
ventricle of the heart
→ the normal rates per minute:
→ the pulse rate is regulated by the autonomic nervous
system (ANS) NB to 1 month 80-180 beats /min
1 year 80-140 beats /min
2 years 75-120 beats/min
Factors Affecting the Pulse Rate 6 years 75-120 beats/min
10 years 60-90 beats/min
→ Age
▪ younger persons have higher pulse rates than Adult 60-100 beats/min
older persons
→ Tachycardia
→ Sex/Gender ▪ PR above 100 beats/min. (Adult)
▪ puberty females have higher pulse rates than the
males → Bradycardia
▪ PR below 60 beats/min. (adult)
→ Exercise
Rhythm
→ Fever
→ the pattern and intervals of beat
→ Medications
▪ digitalis, beta blocker decreases pulse rate → Dysrhythmia
▪ irregular rhythm
▪ epinephrine and atropine sulfate increase pulse
rate
Volume (Amplitude)
→ Hemorrhage → a normal pulse can be felt with moderate pressure
▪ increase pulse rate as a compensatory
mechanism for the blood loss → a full or bounding pulse
▪ it can be obliterated only by great pressure
→ Stress
▪ Sympathetic Nervous Stimulation increases the → thready pulse
activity of the heart ▪ it can easily be obliterated (also weak, feeble)

→ Position Changes
▪ in sitting or standing position there is a decreased Arterial Wall Elasticity
venous return to the heart → the artery feels straight, smooth, soft, and pliable
 decreases BP
 increases in the heart rate
Presence/Absence of Bilateral Equality

Pulse Sites → absence of bilateral equality indicates cardiovascular

disorder
→ Temporal
→ Carotid
→ Apical
→ Brachial
→ Radial
→ Femoral
→ Posterior Tibia
→ Popliteal
→ Pedal (Dorsalis pedis)

6
 Respiration Assessing Respiration

→ the act of breathing

Rate

→ normal: 12-20/minute in an adult

Three Processes

→ Ventilation
▪ the movement of gases in and out of the lungs
▪ Inhalation (Inspiration)
▪ Exhalation (Expiration)
Depth
→ observe the movement of the chest
→ it may be normal, deep, and shallow

→ Diffusion
▪ the exchange of gases from an area of higher Rhythm
pressure to an area of lower pressure → observe for regularity of exhalations and inhalations

▪ it occurs at the alveoli-capillary membrane

Quality or Character
→ Perfusion
→ refers to respiratory effort and the sound of breathing
▪ the availability and movement of blood for
transport of:
 gases Major Factors Affecting Respiratory Rate
 nutrients
→ Exercise
 and metabolic waste products

→ Stress
Two Types of Breathing
→ Environment
Costal ▪ high temp = decrease RR
▪ low temp = increase RR
→ thoracic
→ involves movement of the chest → Medications
▪ e,g narcotics decrease RR
Diaphragmatic

→ abdominal Must Know (Terms)

→ involves movement of the abdomen → Eupnea
▪ normal respiration
Respiratory Centers
→ Tachypnea
Medulla oblongata ▪ rapid respiration

→ is the primary respiratory center ▪ above 20 breaths per minute in an adult

→ Bradypnea
Pons
▪ slow breathing
→ contains the following:
▪ less than 12 breaths/minute in an adult

Pneumotaxic Center → Dyspnea

→ responsible for the rhythmic quality of breathing ▪ difficult and labored breathing

→ Orthopnea
Apneustic Center ▪ ability to breathe only in the upright position
→ responsible for the deep, prolonged inspiration
→ Apnea
▪ absence of respirations
Carotid and Aortic Bodies
→ Platypnea
→ contain peripheral chemoreceptors
▪ the difficulty of breathing in an upright position

→ these take up the work of breathing

→ Hyperventilation
▪ when central chemoreceptors in the medulla
▪ deep rapid respiration
oblongata are damaged
▪ CO2 excessively exhaled
→ respond to the low oxygen concentration in the blood
 respiratory alkalosis

→ responds to the pressures

→ Hypoventilation
▪ slow, shallow respiration

▪ CO2 excessively retained

 respiratory acidosis

7
 Blood Pressure Determinants of Blood Pressure

→ is the measure of the pressure exerted by blood as it

Blood Volume
pulsates through the arteries
→ Hypervolemia raises BP
→ Systolic Pressure → Hypovolemia lowers BP
▪ is the pressure of blood as a result of contraction
of the ventricles
Cardiac Output
▪ 100-140 mmHg → when the pumping action of the heart is weak (decreased
CO),
→ Diastolic Pressure ▪ BP decreases
▪ is the pressure when the ventricles are at rest

▪ 60-90 mmHg Elasticity or Compliance of Blood Vessels

→ in older people, the elasticity of blood vessels decreases

→ Pulse pressure is the difference between the systolic and ▪ thereby increasing BP
diastolic pressures
▪ 30-40 mmHg
Peripheral Resistance

Factors Affecting Blood Pressure → Vasoconstriction elevates BP

→ Vasodilation lowers BP
→ Age
▪ oder people have higher BP due to decreased
elasticity of blood vessels Blood Viscosity

→ viscosity increases markedly

→ Exercise
▪ when the Hct is more than 60-65%
▪ increase cardiac output, hence increasing BP

→ increased blood viscosity raises BP

→ Stress
▪ sympathetic nervous system stimulation causes
increased BP Sex/Gender

→ Race → after puberty and before age 65 years, males have higher
BP
→ Obesity
→ after the age of 65 years, females have higher BP due to
hormonal variations in menopause

Medications

Diurnal Variations

→ BP is lowest in the morning

▪ and highest in the late afternoon or early evening

Diseases Process

→ Diabetes Mellitus
→ Renal Failure
→ Hyperthyroidism
→ Cushing’s Diseases
▪ cause increase BP