Ch 8. Assess: General Status and Vital Signs

Temperature Measurement Temporal Artery

(normal range: 97.4°‐100.3°F) - Place thermometer over the forehead; press & hold the scan button across the forehead over the temporal artery to a point behind the ear - Multiple readings result in a calculated value - Can be affected by diaphoresis

Amplitude (intensity) & contour, elasticity

- 0: Absent - 1+: Weak, diminished (easy to obliterate) - 2+: Normal (obliterate with moderate pressure) - 3+: Bounding (unable to obliterate or requires firm pressure) • Palpate arterial elasticity (resilient and springy)

Childbearing Women: Objective (observed behavior)

- 1st trimester ambivalent; 2nd trimester introspective, energetic; 3rd trimester restless, preparing for the baby, possible labile moods

older adults blood pressure

- BP increases as elasticity decreases with wider pulse pressure - Rigid, arteriosclerotic arteries account for higher SBP - Take BP to detect actual or potential orthostatic hypotension and fall risk

Hypothermia <96.0°F

- Prolonged cold exposure - Hypoglycemia - Hypothyroidism - Starvation - Neuro dysfunction/shock

older adult pulse

- The older client's artery may feel more rigid, hard, and bent - Proximal pulses may be easier to palpate due to loss of supporting, surrounding tissue - Distal pulses may be more difficult to palpate or nonpalpable

older adult respirations

- The respiratory rate may range from 15 to 22. - RR may increase with a shallower inspiratory phase because vital capacity and inspiratory reserve volume decrease with aging.

A patient had ingested hot coffee immediately after having an oral temperature reading obtained of 101°F. The health care provider is asking for the temperature measurement to be repeated using a tympanic membrane thermometer. What temperature will the nurse most likely obtain using this different measurement route?

102.4°F The tympanic membrane thermometer measures core body temperature, which is higher than the normal oral temperature by approximately 1.4°F. The nurse will most likely obtain a body temperature of 102.4°F for the patient. The temperature 99.6°F is 1.4°F lower than the oral temperature. The temperature 98.6°F is considered a normal body temperature. The temperature 103.8°F is a difference of 2.8°F and not expected if using a tympanic membrane thermometer.

A nurse is assessing the respiratory rate of an elderly client. Which of the following findings in breaths per minute would indicate a normal respiratory rate in this client?

18 A respiratory rate of 18 breaths/min would be normal for this client. In older adults, the normal respiratory rate would range between 15 and 22 breaths/min. Respiratory rates of fewer than 15 breaths/min or more than 22 breaths/min would be an abnormal respiratory rate for this client.

A nurse has assessed the blood pressure of a recently admitted patient and obtained a reading of 128/78 mm Hg. What is this patient's pulse pressure?

50 mm Hg The pulse pressure is the difference between the SBP and the DBP and reflects the stroke volume. Normal pulse pressure is approximately 40 mm Hg. The mean arterial pressure is calculated by adding one third of the SBP and two thirds of the DBP. A mean pressure of 60 mm Hg is needed to perfuse the vital organs.

Cushing's Syndrome (Endogenous obesity):

: Centralized weight gain

A nurse is assessing the general status and vital signs of a client. Which of the following are subjective findings, which the nurse obtained from the client? Select all that apply

A list of all of the client's current medications Date and location of the clients last blood pressure check Onset and character of the clients chest pain Subjective findings, which are those the client must report to the nurse, include date and location of the clients last blood pressure check, the onset and character of the clients chest pain, and a list of all of the clients current medications. Objective findings, which are obtained by the nurses direct observation or assessment, include respiratory rate, core body temperature, and blood pressure.

Before assessing vital signs, the nurse knows that it is important to assess what?

Any medications the client is currently taking Prior to assessing vital signs, it is important to assess any medications the client is currently taking. It is not necessary to know the client's height and weight, mental status, or a complete family history before assessing vital signs.

Newborn and Infants Vitals

Apical pulse rate (count for 1 full minute) - Newborn to 1 mo. 120‐160 - 6 mos. - 1 yr. 110 bpm Respirations: Observe ABDOMEN - Neonate 30‐60/min - Unlabored - Infants are nose breathers - Clear lung sounds Temperature: - Rectal most accurate; no further than 2 cm. into rectum; lubricated - 99.4°F normal Blood pressure if necessary (use Doppler or Dinamapp); appropriate sized BP cuff; covering 2/3 of upper arm

The nurse is caring for a client who is having nothing by mouth (NPO) on the first postoperative day. The client's blood pressure was 120/80 mm Hg approximately 4 hours ago, but it is now 140/88 mm Hg. The nurse should ask the client which of the following questions?

Are you having pain from your surgery?" A client's blood pressure will normally vary throughout the day due to external influences. This includes pain.

Childbearing Woman: Subjective

Ask about pre‐pregnancy weight. How much weight gained since last menstrual period - Optimal weight gain during pregnancy depends on the client's height and weight - Low pregnant weight and inadequate weight gain during pregnancy contribute to intrauterine growth retardation and low birth weight

A patient has arrived to the clinic for a routine physical examination. Prior to assessing the patient's blood pressure, what should the nurse do?

Ask the patient to sit quietly in a chair for 5 minutes.

Childbearing Women: Objective (BP)

BP range: 90‐134/60‐89; BP decreases during 2nd trimester; returns to baseline by 32‐34 weeks • Elevated BP at 9‐11 weeks may be indicative of chronic hypertension, hydatidiform mole pregnancy or thyroid storm. After 20 weeks BP > 140/90 may be RT PIH

The nurse is beginning examination of the client. All the following areas are important to observe as part of the general survey except:

Blood pressure Blood pressure is a vital sign, not part of the general survey. Apparent age, signs of distress, and appearance are all parameters of the general survey.

Factors Contributing to BP Box

Cardiac output (volume of blood ejected each minute) ‐ increased with exercise • Peripheral vascular resistance happens in pts. with circulatory disorders will increase BP • Circulating blood volume (increase volume = increased BP; sudden drop in BP may indicate blood loss) • Blood viscosity (thickness) - thicker blood, as with polycythemia = BP • Elasticity of vessel walls; atherosclerosis BP

During the physical assessment of a client, a nurse observes that the client tends to lean forward and brace himself with his arms. The nurse recognizes this as a sign of what disease process?

Chronic pulmonary obstructive disease Chronic pulmonary obstructive disease could be the possible reason for the client tending to lean forward and brace himself with his arms. This is the "tripod position." Stiff, rigid movements are common in clients with arthritis or Parkinson's disease. Osteoporotic thinning is common in elderly clients.

Which technique demonstrates the proper positioning of the client's arm by a nurse when measuring a blood pressure?

Client sitting with arm slightly flexed and even with the heart Ideally, the blood pressure should be taken after the client has been in a comfortable position for 5 to 10 minutes. The blood pressure cuff should be placed against the clients skin with the bladder over the arterial pulsation. The clients arm should be slightly flexed and supported with the nurses arm. The arm should be at the level of the heart with the palm up.

General Impression/Survey observations

Compare client's stated age with apparent age and developmental stage. - Client appears stated age • Observe skin condition and color. - Light to dark beige‐pink, tan, dark brown, or olive • Observe posture and gait. - Posture is erect and comfortable for age; rhythmic gait, coordinated arm swing - Full range of motion (mobility)

The nurse should know that some disease processes affect facial expression. What are they? (Mark all that apply.)

Depression Parkinsonism Hyperthyroidism The stare of hyperthyroidism; the immobile face of parkinsonism; the flat or sad affect of depression. Decreased eye contact may be cultural, or may suggest anxiety, fear, or sadness. Asymmetry of the face could be a stroke, palsy, or injury to the cranial nerve.

The nurse is reviewing the chart of a newly admitted client and identifies the client has Marfan's syndrome. What assessment finding would the nurse expect to find?

Elongated fingers

(Exogenous)Obesity

Excessive body fat RT excessive caloric intake Intake - Fat distribution is evenly distributed

gigantism

Excessive growth hormone; if occurs before growth plates increased height

A nurse is teaching a class on hypertension in a community setting. What risk factor would the nurse be sure to address to the class?

Family history Clients should be educated about the risks of hypertension. Risk factors include obesity, cigarette smoking, heavy alcohol consumption, prolonged stress, high cholesterol and triglyceride levels, family history, and renal disease. Weight loss, low triglyceride level, and smoking cessation are not risk factors for hypertension.

Pain

Fifth vital sign • Observe comfort level • Ask the client if there is pain; if so, rate on a 0‐ 10 scale; use COLDSPA to further assess

HEENT (part of general survey)

Head - observe that facial features appear symmetric - No facial droop • Eyes - can the person see; eyes follow you • Ears - can the person hear and participate in conversation • Nose and throat - patent airway, ability to swallow

An older adult client with COPD has come to the clinic for a routine follow-up visit. The nurse escorts the client to an examination room and measures vital signs. The nurse would expect the patient's vital signs to be what?

Higher than normal

Temperature Measurement Axillary

Hold the thermometer under the axilla firmly by having the client hold the arm down and across the chest for 10 min. • Normal range is 95.6° to 98.5°F • Axillary temp is 1°F LOWER than oral temperature

The nurse explains to the client that smoking has what effect on the body? Select all that apply.

Hypertension Peripheral vascular disease Vasoconstriction

Errors in BP measurement

Incorrect cuff size - Cuff too narrow: falsely HIGH BP - Cuff too loose or uneven: falsely HIGH BP • Arm position - Arm above level of heart: falsely LOW BP - Arm below level of heart: falsely HIGH BP • Deflation rate - Deflating cuff too quickly‐false LOW SBP; or HIGH DBP - Deflating cuff too slowly - Falsely high DBP • Failing to wait 1‐2 minutes before repeating reading = falsely HIGH DBP

The client is exercising. The nurse understands that exercise has what effect on the body? Select all that apply.

Increased blood pressure Increased cardiac output Increased heart rate During exercise, the blood pressure, heart rate and cardiac output increase. Peripheral vascular resistance is related to circulatory disorders.

During general inspection, the examiner:

Integrates visual, auditory, and olfactory data The general inspection integrates sights, smells, and sounds to form a preliminary sense of the client's status. Pain assessment and work environment are not part of the scope, and it is not necessary to position the client in a lying position at this stage.

A nurse obtains a blood pressure on an elderly client of 160/70 mm Hg. The nurse knows that the term for this condition is what?

Isolated systolic hypertension The elderly are prone to isolated systolic hypertension (systolic greater than 140 but diastolic under 90) due to arteriosclerosis that makes blood vessels stiff and less compliant. Orthostatic hypotension is a blood pressure that drops when a client changes positions. Stage 1 hypertension is a blood pressure reading of 140 to 159/90 to 99 mm Hg. Hypertension is not normal for any client.

Older adult temp

May range from 95.0°F to 97.5°F. (consistently lower than younger people) - May not have an obviously elevated temperature with an infection or not be considered hypothermic below 96°F

A patient recovering from a stroke complains of pain. The nurse suspects this patient is most likely experiencing which type of pain?

Neuropathic Neuropathic pain can occur from central nervous system brain injury caused by a stroke. Nociceptive pain is caused by tissue damage. Somatic pain is another term used for nociceptive pain. Idiopathic pain does not have an identified cause.

The nurse aide reports to the nurse that an older adult client has abnormal vital signs. What is important to remember in this type of situation?

Normal readings vary according to age When encountering an abnormal value, the nurse should obtain the vital sign(s) again to assess accuracy. The nurse should also consider whether the client appears to be in distress, noting skin color, respiratory effort, and behavior. Normal readings vary according to age.

Measuring Respirations

Observe client's CHEST rise/fall w/each breath • Count rate for 30 seconds; multiply by 2 • Normal range is 12‐20 breaths/min for adults • Count when client is unaware - Place the client's arm across the chest while palpating the pulse to assist with counting respirations - Keep your fingers on the client's pulse after you finish - Watch chest movement after auscultating apical beat • Assess rhythm, depth and effort

General Impression/Survey

Observe physical development, body build, and fat distribution - Wide range of normal body types - Height within normal limits for age/heritage - Arm span is equal (fingertip to fingertip) - Fat distribution even; weight appears WNL for height & body build - Symmetry - left and right side of body appear proportiona

Acromegaly

Overgrowth of bones in face, head & hands

Assessment of the pulse amplitude is accomplished by which of the following?

Palpating the flow of blood through an artery

In interviewing a client about his heart rate, the nurse asks whether he has noticed any alteration to his heartbeat. The client responds that he sometimes feels his heart race even when he has not been exerting himself physically. This alteration is known as which of the following?

Palpitation An alteration in heartbeat felt by a client is called a palpitation and can be caused by various circumstances including thyroid dysfunction, medication reaction, or alteration in fluid volume. Dyspnea is difficulty breathing. Pulse pressure is the difference between systolic and diastolic blood pressures. Apical beats are simply the beats of the heart palpated directly over the apex of the heart, on the chest.

A student nurse studying hypertension would learn that the risk factors include what?

Prolonged stress, renal disease, heavy alcohol consumption Risk factors for hypertension include obesity, cigarette smoking, heavy alcohol consumption, prolonged stress, high cholesterol and triglyceride levels, family history, and renal disease. Hepatic disease and alcohol abstinence are not risk factors for hypertension.

Childbearing Women: Objective (pulse range)

Pulse range 60‐90 beats per minute; may increase 10‐15 bpm higher than pre‐pregnant levels • Irregularities in heart rhythm, chest pain, dyspnea, and edema may indicate cardiac disease - Temperature range: 97‐98.6° F. Elevated temp (above 100 ° F.) may indicate infection

Since the nurse is unable to obtain an average-sized cuff to assess an adult patient with a large arm, the nurse uses an oversized cuff. What blood pressure reading will the nurse most likely obtain for this patient?

Reading will be high If the blood pressure cuff used is too large and the patient's arm is large, the blood pressure reading will be high. If the blood pressure cuff is too large and the patient's arm is small, the reading will be low. The reading obtained with an inappropriately sized cuff will not be correct. The reading can be obtained; however, the reading will be incorrect.

Temperature Measurement Rectal

Rectal: Cover with a disposable sterile sheath, and lubricate the thermometer. • Wear gloves and insert 1 inch into rectum • Use this route ONLY if other routes not practical • Rectal route is 0.7° to 1°F HIGHER than normal oral temperature range

Blood Pressure

Reflects pressure exerted on artery walls • Stroke volume = amt. of blood pumped each beat. (Pulse pressure = SV; SBP‐DBP)

You are educating your patient on taking blood pressure at home. What would be important to include in your patient education?

Routine recalibration of the device

The nurse is caring for a newly admitted adult client. When performing the general survey of this client, the nurse knows that accurate measurements provide critical information about what?

State of health Anthropometric measurements are the various measurements of the human body, including height and weight. They provide critical information about the adult's state of health. Accurate measurements do not provide critical information about safety, past surgeries, or growth pattern in the adult client.

Marfan's Syndrome:

Tall, thin stature; elongated arms and fingers, arm span greater than height

A nurse is assessing the blood pressure of a team of healthy athletes at the heath care facility. Which of the following observations can be made by the nurse and athletes by measuring the blood pressure?

The ability of the arteries to stretch Measuring the blood pressure helps to assess the efficiency of the client's circulatory system. Blood pressure measurements reflect the ability of the arteries to stretch, the volume of circulating blood, and the amount of resistance the heart must overcome when it pumps blood. Measuring the blood pressure does not help in assessing the thickness of blood, oxygen level in the blood, or the volume of air entering the lungs.

An 86-year-old male patient with a diagnosis of vascular dementia and cardiomyopathy is exhibiting signs and symptoms of pneumonia. The nurse has attempted to assess his temperature using an oral thermometer but the patient is unable to follow directions to close his mouth and secure the thermometer sublingually. As well, he repeatedly withdraws his head when the nurse attempts to use a tympanic thermometer. How should the nurse proceed with assessment?

The axillary site is an accurate and acceptable alternative when other sites are impractical or contraindicated. Rectal temperatures are contraindicated in cardiac patients; mercury thermometers are not commonly used. It is unacceptable for the nurse to rely solely on subjective assessments to determine whether the patient is febrile.

A nurse assesses a female client's core body temperature and finds that she has a slightly elevated temperature. Which of the following factors could explain this finding? Select all that apply.

The client just finished exercising. The client is ovulating. The client is stressed. Several factors may cause normal variations in the core body temperature. Strenuous exercise, stress, and ovulation can raise temperature. Body temperature is lowest early in the morning (4:00 to 6:00AM) and highest late in the evening (8:00PM to midnight). Hypothermia (lower than 36.5˚C or 96.0˚F) may be seen in prolonged exposure to the cold, hypoglycemia, hypothyroidism, or starvation. Hyperthermia (higher than 38.0˚C or 100˚F) may be seen in viral or bacterial infections; malignancies; trauma; and various blood, endocrine, and immune disorders.

The nurse is assessing a new patient's blood pressure using a manual sphygmomanometer. Which of the following sounds constitutes the patient's systolic blood pressure?

The first appearance of faint but distinctive tapping sounds

During a general survey, the nurse asks if the patient is feeling cold. What did the nurse most likely observe in the patient?

The patient is wearing clothing that is inconsistent with warm weather. The question ;Are you feeling cold?; would be applicable for the patient who is wearing clothing that is inconsistent with warm weather. The question ;Are you feeling cold would not be appropriate for the patient who is bouncing both legs up and down while seated. This could indicate anxiety. An oral temperature of 37°C (98.6°F) is within normal limits while the bluish color of the lips is associated with cyanosis, a respiratory issue.

Additional Factors that Cause BP Variations

Time of day (lower in AM; higher afternoon, evening) • Affected by caffeine, alcohol, nicotine intake, exercise, emotions, muscle tension, bladder distention, pain, noise, temperature, arm position • Body position - higher with standing - In reclining person, BP is slightly lower because of decreased resistance - Arm position - should be at level of heart, palm up • Gender, race, age, weight

What is the importance of assessing vital signs? (Select all that apply.)

To establish a baseline To monitor risks for alterations in health To evaluate the client's responses to treatment Assessment of vital signs helps nurses to establish a baseline, monitor a client's condition, evaluate responses to treatment, identify problems, and monitor risks for alterations in health. Vital signs are not assessed to carry out orders from the healthcare provider or to plan how to improve a client's condition.

The nurse recognizes that assessment of core body temperature is quick, noninvasive, and safe using which method?

Tympanic The tympanic temperature is a good device for measuring core body temperature because it measures temperature quickly and safely. The tympanic membrane is supplied by a tributary of the artery (internal carotid) that supplies the hypothalamus (the body's thermoregulatory center). Oral is the most commonly used because it is the easiest to obtain. Axillary temperature is usually about 0.5°F to 1.0° F below the oral temperature. Rectal readings are often 0.4°F to 0.5°F higher than the oral temperature.

Temperature Measurement Oral

Use an electronic thermometer with a disposable cover; place under the client's tongue to the right or left of the frenulum, deep in the posterior sublingual pocket • Ask client to close lips around the probe; reading in about 2 minutes - Not for client with ET Tube or wired jaw • Normal range is 96.6°‐99.5°F

Measuring Pulse Rate ‐ Radial

Use pads of 2 middle fingers; lightly palpate the radial artery on the lateral aspect of the wrist - Count for 30 seconds if regular (multiply by 2) - Count for a full minute if irregular, then verify with apical pulse - Never count for 15 seconds—potential error - Normal range is 60‐100 bpm for adults

Hyperthermia > 100°F

Viral or bacterial infx - Malignancies - Trauma - Blood, endocrine, immune disorders

Thigh Pressure

When arm BP is excessive, esp. in adolescents, compare with thigh pressure to check for coarctation of the aorta • NORMALLY thigh pressure is higher (10‐40) • Wrap a large cuff around lower 1/3 of popliteal artery • With coarctation of the aorta, arm pressures are high

A female client is admitted to the health care facility due to reports of decreased appetite, loss of sleep, feelings of being unsafe in her own home, and inability to concentrate. She appears pale; her hair is disheveled, she is not wearing makeup, and she will not make eye contact. Based on this data, which nursing diagnosis can the nurse confirm?

anxiety The major defining characteristics of anxiety are present: loss of sleep, feeling unsafe, inability to concentrate, and poor eye contact. There are no major characteristics for the nursing diagnosis of imbalanced nutrition: less than body requirements, risk for self-directed violence, or impaired verbal communication.

A client is concerned that a blood pressure reading of 180/78 mm Hg is extremely high when the readings usually are around 130/60 mm Hg. What could have caused this elevation in blood pressure?

arm below the level of the heart

The nurse begins a client assessment by conducting a general survey that focuses on objective observations. What is the primary purpose for collecting this sort of information first?

assists the nurse in formulating appropriate subjective questioning

A client's blood pressure is affected by

cardiac output, distensibility of the arteries, blood volume, blood velocity and viscosity.

• Body temperature is lowest (trough) in?

early AM and highest (peak) late in the evening

Measure head and chest circumference (FOC/OFC) at? (infants)

every visit - Head circumference is greater than chest at birth by 2 cm. - Head reaches 90% of full adult size by age 6 - Chest circumference is measured only to compare with head size

A client is wearing a hospital gown and sitting on the examination table. What area should the nurse include when completing the general survey?

facial expression The general survey provides an overall impression of the client and includes facial expression. Pulse rate is palpated and would occur later in the examination. Breath sounds are auscultated and would occur later in the examination. Skin temperature is palpated and would occur later in the examination.

• Systolic blood pressure

is a measurement of the pressure of the blood in the arteries when the ventricles are contracted

Diastolic blood pressure

is a measurement of the pressure of the blood in the arteries when the ventricles are relaxed.

Osteoporotic thinning and collapse of the vertebrae secondary to bone loss in an elderly client may result in

kyphosis In older adults, osteoporotic thinning and collapse of the vertebrae secondary to bone loss may result in kyphosis.

- Osteoporotic thinning and collapse of the vertebrae secondary to bone loss may result in?

kyphosis shorter height

Temperature Measurement Tympanic

normal range is 98.0°‐100.9°F) - Place probe gently into opening of the ear canal - Reading displayed in 2‐3 seconds

The nurse is preparing to assess the respirations of an alert adult client. The nurse should

observe for equal bilateral chest expansion of 2.54 to 5.08 cm (1 to 2 in). When observing respiratory depth the nurse should assess for equal bilateral chest expansion of 1 to 2 inches.

If a client takes antihypertensive medications or has a history of fainting or dizziness, assess for ?

orthostatic HTN - Measure BP and pulse with the client in a standing or sitting position AFTER measuring BP with the client in a supine position - A drop of < 20 mmHg from recorded sitting position is normal

The nurse assesses the client's vital signs as follows: respirations 20 breaths/minute, tympanic temperature 100.9°F, pulse 88 beats/minute, and blood pressure 104/64 mm Hg. The nurse should

record the vital signs. Validate the assessment data you have collected. This is necessary to verify that the data are reliable and accurate. Document the assessment data following the health care facility or agency policy.

The nurse is having difficulty auscultating Korotkoff sounds. The nurse should (Select all that apply.)

reposition the stethoscope consider shock be certain there is full skin contact with the bell

A patient recovering from abdominal surgery is complaining of pain. The nurse realizes that the patient is most likely experiencing which type of pain?

somatic Somatic pain is caused by tissue damage, which would occur after abdominal surgery. Psychogenic pain relates to factors that influence the patient's report of pain such as anxiety and depression. Idiopathic pain does not have an identified cause. Neuropathic pain results from direct injury to the peripheral or central nervous system.

General survey begins with?

the first encounter with the patient - Use observational skills - Observations lead to clues about health status • Beginning with vital signs is non‐invasive & most clients are accustomed to this • Vital signs provide data reflecting the cardiovascular system, neurologic, peripheral vascular and respiratory systems.

Students are touring the hospital before starting their clinical rotations. The instructor points out that the type of thermometer used in this facility is noninvasive, safe, efficient, and quick. What type of thermometer is the instructor describing?

tympanic Tympanic thermometers use infrared sensors to detect the heat that the tympanic membrane produces. The tympanic membrane thermometer is noninvasive, safe, efficient, and quick. Because the reading is so quick (2 to 3 seconds), it is commonly used in emergency departments and hospitals.

Hands‐on physical examination begins with?

vital signs. • Order of vital signs (in adults) - Temperature - Pulse - Respirations - Blood pressure

Newborn & Infants: Subjective

• Ask about the infant's birth weight, length, and head circumference? -These components are monitored to assess for adequate nutrition and growth at regular intervals - Reassessment of these components should occur at regular intervals

Childbearing Women: Objective Weight

• Height and weight: Establish baseline. - The client with normal pre‐pregnant weight should gain 2‐4 lbs. in the 1st trimester and approximately 11‐12 pounds in both 2nd and 3rd trimester (total 25‐35) • A sudden gain > 5 lbs. in a week may be associated withpregnancy induced hypertension and fluid retention • Weight gain < 2 lbs. a month may indicate poor nutrition -

Preparation for Survey of General Health Status

• Observe the client's posture, movements, and overall appearance • Client should be in a comfortable position on bed, exam table, chair or home setting • Explain the procedure to the client