GENERAL SURVEY

GENERAL SURVEYKeys to a thorough and accurate PE- develop a systematic sequence of examination- minimize the number of times you ask the patient to change positionThe Skillful Clinician- thorough without wasting time- systemic without being rigid- gentle yet not afraid to cause discomfortBeginning the examination: Setting the stage- reflect on your approach to the patient- adjust the lighting and the environment- determine the scope of the examination- choose the sequences of the examination- make the patient comfortableSequenceSittingSupine

- General Survey- Vital Signs- Skin- HEENT- Neck- Back- Posterior thorax and lungs- Breasts, axillae- Anterior thorax and lungs- Cardiovascular system- Abdomen- Lower extremities (standing)- Nervous System (sitting)- Rectal/Genital

General Survey- patients general state of health, height, build, and sexual development- obtain patients weight- 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 manner, affect and reactions to persons and things in the environment- listen to the patients manner of speaking and note the state of awareness or level of consciousnessApparent State of Health- acutely ill- chronically ill- frail- feebleLevel of Consciousness- awake- alert- response to you or to others in the roomSigns of Distress- cardiac or respiratory distress- pain- anxiety or depressionHeight or build- is the patient unusually short or tall?- is the build slender, lanky, muscular or stocky?Weight- is the patient emancipated, slender, plump or obese?- is the fat distributed evenly or concentrated over the trunk?Skin color and obvious lesions- pallor- cyanosis- jaundice- rashes- bruises

Dress, grooming and personal hygiene- how is the patient dressed?- is the clothing appropriate to the temperature and weather?- is it clean, properly buttoned and zipped?- how does it compare with clothing worn by people of his age and social group?Facial expression- observe facial expression at rest, during conversation about specific topics, etc- watch for eye contactOdors of the body and breath- fruity odor of diabetes- scent of alcohol- liver failurePosture, gait and motor activity- what is the patients preferred posture?- is the patient restless or quiet?- is there any apparent involuntary motor activity?Vital Signs- measure height and weight- measure blood pressure- count the pulse- count the respiratory rate- measure the body temperatureBlood Pressure- selecting the correct BP cuff- 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 80% of upper arm circumference

CategorySystoleDiastole

Hypertension- Stage 3- Stage 2- Stage 1> 180160-179140-159>110100-10990-99

High Normal130-13985-89

Normal