Bates’ Visual Guide to Physical Examination

Volume 4: 4.4 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 weight and height are especially important in the elderly and are needed for calculation of the body mass index.

Deepen your observations about the patient you have been gathering since the visit began with a careful general survey. What is the patient’s apparent state of health and degree of vitality? What is the person’s mood and affect? How does he walk and move on to the examining table? Is screening for cognitive changes needed? Note the patient’s hygiene. Significant shortening of a patient’s height is usually obvious by old age. Are there changes in his posture or involuntary movements?

Now measure vital signs beginning with blood pressure using recommended techniques. Check for increased systolic blood pressure and why didn’t pulse pressure, defined as systolic blood pressure minus diastolic blood pressure. Assessor orthostatic hypotension defined as a drop in systolic blood pressure of greater than or equal to 20 mmHg, a drop in diastolic pressure of greater than or equal to 10 mmHg or a gain in heart rate of 20 beats per minute within 3 minutes of standing. Measure blood pressure and heart rate in two positions; supine, after the patient rests for up to two minutes and then within 3 minutes as he stands.

Measure heart rate, respiratory rate and temperature. With older patients, the apical method may yield more information about arrhythmias. Obtain oxygen saturation using a pulse oximeter.