GENERAL SURVEY
manner, affect and reactions to persons and things in
Keys to a thorough and accurate PE
the environment
- develop a systematic sequence of examination
- listen to the patients manner of speaking and note
- minimize the number of times you ask the patient to
the state of awareness or level of consciousness
change position
Apparent State of Health
The Skillful Clinician
- acutely ill
- thorough without wasting time
- chronically ill
- systemic without being rigid
- frail
- gentle yet not afraid to cause discomfort
- feeble
Beginning the examination: Setting the stage
Level of Consciousness
- reflect on your approach to the patient
- awake
- adjust the lighting and the environment
- alert
- determine the scope of the examination
- response to you or to others in the room
- choose the sequences of the examination
Signs of Distress
- make the patient comfortable
- cardiac or respiratory distress
Sequence
- pain
Sitting
- General Survey
Supine
- Anterior thorax and
- anxiety or depression
- Vital Signs
lungs
- is the patient unusually short or tall?
- Skin
- Cardiovascular system
- is the build slender, lanky, muscular or stocky?
- HEENT
- Abdomen
Weight
- Neck
- Lower extremities
- is the patient emancipated, slender, plump or obese?
- Back
(standing)
- is the fat distributed evenly or concentrated over the
- Posterior thorax and
- Nervous System
trunk?
lungs
(sitting)
Skin color and obvious lesions
- Breasts, axillae
- Rectal/Genital
- pallor
General Survey
- patients general state of health, height, build, and
sexual development
- obtain patients weight
Height or build
- cyanosis
- jaundice
- rashes
- bruises
- note posture, motor activity, and gait: dress,
grooming, and personal hygiene and any odors of the
body or breath
- watch the patients facial expressions and note
Dress, grooming and personal hygiene
- how is the patient dressed?
- Stage 3
> 180
>110
- is the clothing appropriate to the temperature and
- Stage 2
160-179
100-109
weather?
- Stage 1
High Normal
Normal
Optimal
140-159
130-139
<130
<120
90-99
85-89
<85
<80
- is it clean, properly buttoned and zipped?
- how does it compare with clothing worn by people
of his age and social group?
Facial expression
Heart Rate and Rhythm
- observe facial expression at rest, during
- radial pulse
conversation about specific topics, etc
- index and middle finger
- watch for eye contact
- regular rhythm: count the rate for 15 sec x 4
Odors of the body and breath
- brady/tachycardic: count for 60 sec
- fruity odor of diabetes
- irregular rhythm: cardiac auscultation
- scent of alcohol
- 60-100 BPM
- liver failure
Respiratory Rate and Rhythm
Posture, gait and motor activity
- visual inspection or subtle listening over the
- what is the patients preferred posture?
patients trachea
- is the patient restless or quiet?
- 14-20 breaths/min
- is there any apparent involuntary motor activity?
Temperature
Vital Signs
- average: 37 C
- measure height and weight
- febrile: >37.5 C
- measure blood pressure
- hypothermia: <36.5 C
- count the pulse
Anatomy and Physiology
- count the respiratory rate
- survey the patients general appearance and
- measure the body temperature
determine the height and weight: assess nutritional
Blood Pressure
status
- selecting the correct BP cuff
- triceps skinfold thickness (TSF) and mid-arm
- width of the inflatable cuff should be about
40% of the upper arm circumference (12-14 cm)
- length of the inflatable bladder should be about
muscle circumference (MAMC), estimate fat and
lean tissue mass, respectively
- waist circumference
80% of upper arm circumference
Body Mass Index
- body mass index (BMI) is a number calculated from
Category
Hypertension
Systole
Diastole
a persons height and weight
- provides reliable indicator of body fatness for most
people and is used to screen for weight categories
abdominal fat is a predictor of risk for obesity-related
that may lead to health problems
diseases)
BMI
Below 18.5
18.5 - 24.9
25 - 29.9
30 +
Weight Status
Underweight
Normal
Overweight
Obese
How reliable is BMI as an indicator of body fatness?
- the correlation between the BMI number and body
fatness is fairly strong, however the correlation caries
by sex, age, and race
- at the same BMI, women tend to have more
body fat than men
- at the same BMI, older people, on average, tend
to have more body fat than younger adults
Remember: BMI is only one factor related to risk for
disease!
- for assessing someones likelihood of developing
overweight or obesity-related diseases, the National
Heart, Lung and Blood Institute guidelines
recommend looking at two other predictors:
- Individuals waist circumference (because
- Other risk factors the individual has for
diseases and conditions associated with obesity (for
ex: high blood pressure or physical inactivity)
Clinical Implication
- Overweight and obese people are increased risk for
many diseases and health conditions:
- hypertension
- dyslipidemia (ex: high LDL, low HDL, high
triglycerides)
- Type II Diabetes
- coronary heart disease
- stroke
- gallbladder disease
- osteoarthritis
- sleep apnea and respiratory problems
- some cancers (endometrial, breast and colon)
