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PA 2008 Ch 4 General survey & vitals


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What is BMI?
Body Mass Index
What BMI is considered overweight?
BMI >25
What BMI is considered obese?
BMI > 30
A Higher than normal BMI is considered a risk factor for what conditions/diseases
diabetes, heart disease, stroke,hypertension,osteoarthritis, sleep apnea syndrome, some cancers
If BMI is higher than normal what should be done and what are the limits
Measure the pts waist,pt may have increased body fat if measurement equal or exceed 35in women, 40in men
Classification of Overweight and obesity by BMI
Underweight < 18.5
Normal 18.5-24.9
Overweight 25.0-29.9
Obesity I 30.0-34.9 II 35.0-39.0 III = or > 40
what are the Clinical Guidelines on the identification ,evaluation & treatment of overweight & obese adults
10% reduction over6 months or 300-500 calorie decrease for BMI 27-35, 1/2 to 1 lb per week more does not lead to better results.
What should be a concern if BMI falls below 18.5
anorexia nervosa bulimia or other conditions (review table pg. 116 for differences)
Rapid changes in weight over a few days may suggest?
changes in body fluids, not tissue, several pounds of fluid may appear as edema.
Causes of weight loss can include?
GI diseases,endcrine disorders,chronic infections
malignancy,chronic cardiac,pulmonary,renal failure,depression,anorexia,bulimia
Weight loss with relatively high food intake may suggest?
diabetes mellitus, hyperthyroidism,or malabsorption,also consider binge eating and clandetine vomiting
malnutrition can be associated with psychosocial issues such as:
Poverty,old age, social isolation, physical diability,mental or emotional impairment,no teeth,ill fitting dentures,alcohol or drug abuse
Fatigue is a common symptom of anxiety states or depression but else should be considered?
Endocrine disorders, heart failure,chronic lung liver kidney,nutrition deficits,electrolyte imbalance,anemia,cancers,meds
Weakness denotes demonstrable loss of muscle if localized in a neuruanatomic pattern may suggest:
possible neuropathy or myopathy
Feeling cold, goosebumps and shivering accompany what type of change in body temp?
A rise in body Temp
Feeling hot and sweating accompany what type of change in body Temp?
A falling body temp.
Why should you inquire about meds when evaluating fever?
Some may cause fever and others aspirin NSADs ,acetaminophen, corticosteriods may mask
What 3 are important topics for Health promotion and counseling
optimal weight & nutrition
BP and diet
Adolescent females and women of child bearing age should increase intake of which nutrients?
Iron and folic acid
Adults over 50 should choose foods rich in which nutrients?
Vitamin B12 and calcium.
What are Vital signs?
Blood pressure, temperature, heart rate,respiratory rate
What is considered normal BP in adults >18?
< 120mm Hg systolic and <80mmHg Diastolic
What is considered Prehypertension in adults >18?
120-139 mmHg systolic and 80-89mmHg diastolic
What are the criteria for hypertension Stage I and II?
Stage I 140-159mmHg systolic &90-99mmHg diastolic
Stage II =or>160systolic & = or > 100 diastolic
When systolic and diastolic pressures fall in different categories how do you categorize?
Use the higher category
What can a pressure difference of 10-15mmHg from one arm to another indicate?
arterial compression or obstruction on the side with the lower pressure
For a diagnosis of Hypertension what evaluation criteria should be met before diagnosis?
The mean of 2 or more properly measured seated BP readings on 2 or more office visits, verified on contralateral arm.
Normally there may be a difference of how many mmHg from arm to arm and which should be used
5mmHg and sometimes up to 10mmHg the higher arm should be used.
What is orthostatic or postural blood pressure?
drop in systolic BP of > or equal to 20mmHg systolic or in diastolic > or equal to 10mmHg within 3 min of standing
What is the name of the sounds heard when taking BP?
Korotkoff sounds
What can be causes of orthostatic or postural hypotension?
drugs, loss of blood, prolonged bed rest,diseases of autonomic nervous system
What is white coat hypertension?
Anxiety related to office visits last for several visits, occurs in 12% to 25% of patients
In obese patients a BP cuff that is too small can lead to:
Overestimation of systolic BP
Coarctation of the aorta and occlusive aortic disease are distinguished by:
hypertension in upper extremeties,low BP in legs and diminished or delayed femoral pulses
When you cannot hear Korotoff sounds you may be able to estimate systolic pressure this way.
When evaluating pulse Irregular rhythms may indicate
atrial or ventricular premature contractions or atrial fibrillation
Irregularly Irregular rhythms on pulse indicate
Atrial fibrillation
What is the normal respiratory rate for adults?
14 to 20 breaths per minute.
Prolonged expirations may indicate what?
Narrowing of bronchioles.
Slow breathing (bradypnea) may be secondary to:
diabetic coma, drug induced respiratory depression,and increased intracrainial pressure
Rapid shallow breathing (tachypnea)can be caused by:
restrictive lung disease,pleuritic chest pain,and elevated diaphram
Rapid deep breathing(Hyperpnea or hyperventilation) can be caused by
exercise, anxiety and metabolic acidosis,
Hyperpnea or hyperventilation in the comatose pt. may indicate:
infarctin,hypoxia,or hypoglycemia affecting the midbrain or pons.
What is Kussmaul breathing?
deep breathing due to metabolic acidosis. It may be fast normal in rate or slow.
What is cheyne-Stokes Breathing and hat can it indicate?
periods of deep breathing W/ periods of apnea,normal in kids and aging, other causes heart failure,uremia,drug induced res. depression,brain damage
What is Ataxic or Biots breathing, what can it indicate?
unpredictable irregularity,breaths an be shallow or deep & stop shortly,may be brain damage,(medullary level)respiratory depression.
What is sighing respiration and what can it indicate?
breating w/ frequent sighs,
may be hyperventiatin syndrome(common cause of dizziness)occasional sighs normal
In obstructive lung disease why is expiration prolonged?
Narrowed airways increase resistance to air flow.causes include asthma,chronic bronchitis& COPD
Elevated body temperature is called fever or:
Abnormally high temperature is refered to as:
Hyperpyrexia over 41.1 C (106F)
What are causes for fever?
infection,trauma such as surgery or crush injuries,Ca,blood disorders, collegen vascular disease,drug reactions.
What is the chief cause of of hypothermia? name other causes
#1exposure to cold,sepsis
excess alcohol,hypoglycemia
elderly especially susceptable
What is normal oral temp?
Which is normally higher oral, rectal or axillary? which is least accurate? method
37C or 98.6
rectal higher
axillary least accurate.

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