M1 H&P: Vital Signs and Skin

Devin Nickol, M.D.

Vital Signs

I. Why even bother learning to assess vital signs?

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II. Technique

- Setup

- Patient position:
- The patient should not have exercised, consumed caffeine, nicotine or alcohol for ___ minutes prior to the measurement.
- The same technique should be used each time vital signs are measured.

- Equipment

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- Blood pressure measurement

- The patient's arm should be supported with the elbow ___________________

- Ensure proper cuff size using _____________________________

- Inflate the cuff until _________________________________, note the reading and deflate

- Place the stethoscope _________________ over the ______________ artery

- Reinflate cuff to _____________ mmHg above the previous reading

- Deflate the cuff slowly

- Note the systolic pressure when ________________________________

- Note the diastolic pressure when _______________________________

- Record as systolic over diastolic, for example: ________________

- If auscultation is impossible, measure _____________________________ instead

- Deflate cuff until ______________________________________

- Record using special format, for example: _______________

- Pulse measurement

- Palpate the radial artery with your ____________________ fingers

- Note whether pulse is regular or irregular

- Count the beats for ___ seconds then multiply by ___

- Record in _________ per ___________, include rhythm

- Respiration measurement

- Observe patient breathing and count respiratory cycles

- Measure for ___ seconds and multiply by ___

- Record in ___________ per ____________

- Don't tell the patient you are measuring their breathing, pretend to still be ____________________________________

- Temperature measurement

- Multiple methods of measurement exist
- Always document which you use
- Rectal: most accurate of the commonly used methods, normal = __________
- Tympanic: normal = __________________
- Oral: normal = ___________________
- Axillary: least accurate, normal = __________________

- Recording

Example: 140/78    84    16    37.5 tymp

                (BP)      (P)    (R)    (T)

What's wrong?     140/78   81   15   37.3 tymp

What's wrong?     120/80   80   16   37.0 oral

- Helpful tips

- Recheck "strange" results yourself, especially if you are going to act on them
- Beware of "abnormally normal" values
- Consider the effects of patient mood and emotions on readings

 

Skin

I. Description of lesions

- Size and shape
- Configuration
- Elevation or depression
- Palpable characteristics
- Color
- Location

II. Categories of lesions

- Flat (non-palpable)

- Macule
- Patch
- Petechiae
- Purpura
- Ecchymosis
- Spider angioma

- Raised and solid

- Papule
- Plaque
- Nodule
- Tumor
- Wheal
- Scale
- Crust

- Raised and cystic

- Vesicle
- Pustule
- Bulla
- Cyst

- Depressed

- Atrophy
- Erosion
- Ulcer
- Fissure

III. Turgor

- Pinch skin on the forearm or near the ________________
- Normal skin should return to shape quickly, abnormal skin "tents" for a prolonged period
- Skin turgor decreases naturally with ___________________

IV. Temperature

- Assess with dorsum of hand or fingers
- Elevated skin temperature can indicate increased blood flow, infection or metabolic disturbances
- Decreased skin temperature can indicate decreased blood flow, hypothermia or metabolic disturbances

V. Hair

- Assess color and distribution
- Assess texture/oiliness

VI. Nails

- Color
- Length
- Symmetry
- Shape
- Clubbing