Health Promotion: Health Assessment
• Measure vital signs when the client is at rest
• Compare both sides of the body for symmetry
• Assess the systems related to the client’s major complaint first
• Offer rest periods if client becomes tired
• Culture and religious beliefs may play a role in observed differences
• Warm hands and equipment such as stethoscope before touching client
• Tell client what you are going to do before touching client
• Normal variations exist among clients and there is a range of normalcy for all physical findings
• Maintain the client’s privacy throughout the examination
• Control for environmental factors which may distort findings
• Check equipment prior to exam for functioning
• Consider growth and developmental needs when assessing specific age groups
• Integrate client teaching throughout the exam
Vasculature
• Compare blood pressure in arms left versus right
• Compare blood pressure with client lying, sitting and standing
Lungs - Airway
• Anemic patients may never become cyanotic
• Polycythemic patients may be cyanotic, even when oxygenation is normal
• Cough results from stimulation of irritant receptors, with implications of either acute or chronic etiology.
• Cyanosis indicates decreased available oxygen. Etiology can be either peripheral or central in origin.
• Wheezes indicates narrowing/inflammatory process of lower airways
• Stridor harsh sound produced near larynx by vibration of structures in upper airway. Classic “barky cough”
• Crackles or rales adventitious sounds, usually on inspiration and indicating inflammation