Bates’ Visual Guide to Physical Examination

Volume 1: 1.3 General Survey and Vital Signs Video Transcript

Narrator: With the patient’s health history in mind and after good hand hygiene, you are ready for the physical examination.

For a healthy patient, a complete head-to-toe assessment should take beginning students about 20-30 minutes. With the patient sitting, begin your assessment with a general survey, inspecting the patient closely literally from head to toe in order to form impressions for your later written assessment. Note characteristics such as apparent state of health, ease of breathing, height, build and sexual development. Obtain the patient’s weight. Note posture, motor activity and gate as well as dress, grooming, personal hygiene and any odors of the body or breath. Observe the patient’s facial expressions and listen to the patient’s manner of speaking as you note his or her state of awareness.

Now measure vital signs. When measuring blood pressure, select a cuff of the appropriate size and position the patient’s arm properly at heart level. This will help ensure an accurate reading. Record the patient’s heart rate by checking the radio, or in older adults the apical pulse.

Next, check respiration. Listen to the number of respirations per minute by subtly placing the stethoscope over the patient’s trachea. Next, check the patient’s temperature. Three methods are commonly used: oral, via the tympanic membrane, or at times rectal. Oral temperatures are the most common but should not be used for patients who are unconscious, restless or unable to close their mouths.