Diagnostic Tests for Hypotension
Hypotension Tests: Book Excerpts
- DIAGNOSTIC WORKUP - HYPOTENSION, CHRONIC
- History and physical examination - Pulse pressure, narrowed
- History and physical examination - Pulse, absent or weak
- History and physical examination - Pulsus paradoxus
- History and physical examination - Orthostatic hypotension [Postural hypotension]
- History and physical examination - Blood pressure decrease [Hypotension]
- History and physical examination - Low birth weight
- History and physical examination - Pulse pressure, narrowed
- History and physical examination - Pulse, absent or weak
- History and physical examination - Pulsus paradoxus
- History and physical examination - Orthostatic hypotension [Postural hypotension]
- History and physical examination - Blood pressure decrease [Hypotension]
- History and physical examination - Low birth weight
- Physical examination - Low Back Pain
- Diagnostic Approach - Orthostatic Hypotension
- Diagnostic Approach - Low Back Pain
- Physical assessment - Pulse pressure, narrowed
- Physical assessment - Pulse pressure, widened
- Physical assessment - Pulse, absent or weak
- Physical assessment - Pulsus paradoxus
- Physical assessment - Orthostatic hypotension
- History and physical examination - Pulse pressure, narrowed
- History and physical examination - Pulse, absent or weak
- History and physical examination - Pulsus paradoxus
- History and physical examination - Orthostatic hypotension [Postural hypotension]
- History and physical examination - Blood pressure, decreased [Hypotension]
- History and physical examination - Low birth weight
Home Diagnostic Testing
These home medical tests may be relevant to Hypotension:
Hypotension Diagnosis: Book Excerpts
- Ask the Following Questions - HYPOTENSION, CHRONIC
- Differential Diagnosis - Hypotension
- Differential Diagnosis - Low Back Pain/Swelling
- Approach to the Diagnosis - HYPOTENSION AND SHOCK
- Approach to the Diagnosis - LOW BACK PAIN
- History and physical examination - Pulse pressure, narrowed
- History and physical examination - Pulse, absent or weak
- History and physical examination - Pulsus paradoxus
- History and physical examination - Orthostatic hypotension [Postural hypotension]
- History and physical examination - Blood pressure decrease [Hypotension]
- History and physical examination - Low birth weight
- History and physical examination - Pulse pressure, narrowed
- History and physical examination - Pulse, absent or weak
- History and physical examination - Pulsus paradoxus
- History and physical examination - Orthostatic hypotension [Postural hypotension]
- History and physical examination - Blood pressure decrease [Hypotension]
- History and physical examination - Low birth weight
- History - Low Back Pain
- Differential Overview - Orthostatic Hypotension
- Differential Overview - Low Back Pain
- History - Pulse pressure, widened
- History - Hypotension, orthostatic
- History - Pulsus paradoxus [Paradoxical pulse]
- History - Pulse pressure, narrowed
- History - Pulse pressure, widened
- History - Pulse, absent or weak
- History - Pulsus paradoxus
- History - Orthostatic hypotension
- History and physical examination - Pulse pressure, narrowed
- History and physical examination - Pulse, absent or weak
- History and physical examination - Pulsus paradoxus
- History and physical examination - Orthostatic hypotension [Postural hypotension]
- History and physical examination - Blood pressure, decreased [Hypotension]
- History and physical examination - Low birth weight
- Approach to the Diagnosis - LOW BACK PAIN
- Approach to the Diagnosis - HYPOTENSION AND SHOCK
Diagnosis of Hypotension: medical news summaries:
The following medical news items
are relevant to diagnosis of Hypotension:
Diagnostic Tests for Hypotension: Online Medical Books
16 MEDICAL BOOKS ONLINE!
Review excerpts from medical books online, free, without registration,
for more information about the diagnostic tests for Hypotension.
HYPOTENSION, CHRONIC:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
Routine studies include a CBC, sedimentation rate, chemistry panel, urinalysis, thyroid panel, EKG, and chest x-ray. Blood volume and arterial blood gas studies may be useful. If there is cardiomegaly or a murmur, echocardiography and venous pressure and circulation time should be done. A cardiologist should also be consulted.
If there is hyperpigmentation, a serum cortisol and ACTH stimulation test should be done. A skull x-ray can be done to rule out pituitary tumors. A visual field examination by a qualified ophthalmologist may be helpful in this regard also. Twenty-four-hr blood pressure monitoring may be useful in the workup also.
» READ BOOK EXCERPT ONLINE »
Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
Pulse pressure, narrowed:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
After you detect a narrowed pulse pressure, check for other signs of heart failure, such as hypotension, tachycardia, dyspnea, jugular vein distention, pulmonary crackles, and decreased urine output. Also check for changes in skin temperature or color, the strength of peripheral pulses, and the patient’s level of consciousness (LOC). Auscultate the heart for murmurs. Ask about a history of chest pain, dizziness, or syncope.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Pulse, absent or weak:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
If you detect an absent or a weak pulse, quickly palpate the remaining arterial
pulses to distinguish between localized or generalized loss or weakness. Then quickly check the patient’s other vital signs, evaluate his cardiopulmonary status, and obtain a brief history. Based on your findings, proceed with emergency interventions. (See Managing an absent or a weak pulse, pages 506 and 507.)
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Pulsus paradoxus:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
If the patient doesn’t have cardiac tamponade, find out if he has a history of chronic cardiac or pulmonary disease. Ask about the development of associated signs and symptoms, such as a cough or chest pain. Then auscultate for abnormal breath sounds.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Orthostatic hypotension [Postural hypotension]:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
If the patient is in no danger, obtain a history. Ask the patient if he frequently experiences dizziness, weakness, or fainting when he stands. Also ask about associated symptoms, particularly fatigue, orthopnea, impotence, nausea, headaches, abdominal or chest discomfort, and GI bleeding. Then obtain a complete drug history.
Begin the physical examination by checking the patient’s skin turgor. Palpate peripheral pulses and auscultate the heart and lungs. Finally, test muscle strength and observe the patient’s gait for unsteadiness.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Blood pressure decrease [Hypotension]:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
If the patient is conscious, ask him about associated symptoms. For example, does he feel unusually weak or fatigued? Has he had nausea, vomiting, or dark or bloody stools? Is his vision blurred? Is his gait unsteady? Does he have palpitations? Does he have chest or abdominal pain or difficulty breathing? Has he had episodes of dizziness or fainting? Do these episodes occur when he stands up suddenly? If so, take the patient's blood pressure while he's lying down, sitting, and then standing; compare readings. (See Ensuring accurate blood pressure measurement.) A drop in systolic or diastolic pressure of 10 to 20 mm Hg or more and an increase in heart rate of more than 15 beats/minute between position changes suggest orthostatic hypotension.
Next, continue with a physical examination. Inspect the skin for pallor, sweating, and clamminess. Palpate peripheral pulses. Note paradoxical pulse — an accentuated fall in systolic pressure during inspiration — which suggests pericardial tamponade. Then auscultate for abnormal heart sounds (gallops, murmurs), rate (bradycardia, tachycardia), or rhythm. Auscultate the lungs for abnormal breath sounds (diminished sounds, crackles, wheezing), rate (bradypnea, tachypnea), or rhythm (agonal or Cheyne-Stokes respirations). Look for signs of hemorrhage, including visible bleeding and palpable masses, bruising, and tenderness. Assess the patient for abdominal rigidity and rebound tenderness; auscultate for abnormal bowel sounds. Also, carefully assess the patient for possible sources of infection such as open wounds.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Low birth weight:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
As soon as possible, evaluate the neonate’s neuromuscular and physical maturity to determine gestational age. (See Ballard Scale for calculating gestational age, pages 382 and 383.) Follow with a routine neonatal examination.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Pulse pressure, narrowed:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
After you detect a narrowed pulse pressure, check for other signs of heart failure, such as hypotension, tachycardia, dyspnea, jugular vein distention, pulmonary crackles, and decreased urine output. Check for changes in skin temperature or color, strength of peripheral pulses, and level of consciousness (LOC). Auscultate the heart for murmurs. Ask about a history of chest pain, dizziness, or syncope.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Pulse, absent or weak:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
If you detect an absent or weak pulse, quickly palpate the remaining arterial pulses to distinguish between localized or generalized loss or weakness. Then quickly check other vital signs, evaluate cardiopulmonary status, and obtain a brief history. Based on your findings, proceed with emergency interventions. (See Managing an absent or weak pulse, pages 638 and 639.)
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Pulsus paradoxus:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
If the patient doesn’t have cardiac tamponade, find out if he has a history of chronic cardiac or pulmonary disease. Ask about the development of associated signs and symptoms, such as a cough or chest pain. Auscultate for abnormal breath sounds.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Orthostatic hypotension [Postural hypotension]:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
If the patient is in no danger, obtain a history. Ask the patient if he frequently experiences dizziness, weakness, or fainting when he stands. Also ask about associated symptoms, particularly fatigue, orthopnea, impotence, nausea, headache, abdominal or chest discomfort, and GI bleeding. Then obtain a complete drug history.
Begin the physical examination by checking the patient’s skin turgor. Palpate peripheral pulses and auscultate the heart and lungs. Finally, test muscle strength and observe the patient’s gait for unsteadiness.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Blood pressure decrease [Hypotension]:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
If the patient is conscious, ask him about associated symptoms. For example, does he feel unusually weak or fatigued? Has he had nausea, vomiting, or dark or bloody stools? Is his vision blurred? Gait unsteady? Does he have palpitations, chest or abdominal pain, or difficulty breathing? Has he had episodes of dizziness or fainting? Do these episodes occur when he stands up suddenly? If so, take the patient’s blood pressure while he’s lying down, sitting, and then standing and compare readings. A drop in systolic or diastolic pressure of 10 mm Hg or more and an increase in heart rate of more than 15 beats/minute between position changes suggest orthostatic hypotension. (See Ensuring accurate blood pressure measurement, page 104.)
Next, continue with a physical examination. Inspect the skin for pallor, sweating, and clamminess. Palpate peripheral pulses. Note a paradoxical pulse—an accentuated fall in systolic pressure during inspiration—which suggests pericardial tamponade. Then auscultate for abnormal heart sounds (gallops, murmurs), rate (bradycardia, tachycardia), or rhythm. Auscultate the lungs for abnormal breath sounds (diminished sounds, crackles, wheezing), rate (bradypnea, tachypnea), or rhythm (agonal or Cheyne-Stokes respirations). Look for signs of hemorrhage, including visible bleeding, palpable masses, bruising, and tenderness. Assess the patient for abdominal rigidity and rebound tenderness; auscultate for abnormal bowel sounds. Also, carefully assess the patient for possible sources of infection such as open wounds.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Low birth weight:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
As soon as possible, evaluate the neonate’s neuromuscular and physical maturity to determine gestational age. (See Ballard Scale for calculating gestational age, pages 488 and 489.) Follow with a routine neonatal examination.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Low Back Pain:
Physical examination
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
Evaluation should be both general and specific. It is prudent to leave the potentially most painful parts of the examination to the end.
A. General. Examination includes auscultation of the heart and assessment of peripheral pulses and blood pressure. Abdominal examination should focus on possible causes of back pain (Table 12.5). Assess gait.
B. Neurologic. The lower extremity examination includes motor strength, deep tendon reflexes, sensation, proprioception, and certain functional maneuvers (Table 12.6). Romberg and Babinski reflexes should also be assessed. Rectal examination should assess sphincter tone, which can be compromised in sacral root dysfunction. In the primary care setting, most clinically significant disc herniations will be detected by the following limited examination: dorsiflexion of the great toe and ankle, Achilles reflex, light touch sensation of the medial (L 4), dorsal (L5), and lateral (S1) aspect of the foot, and the straight leg raise (SLR) test (1).
C. Musculoskeletal. Assess range of motion of the spine and lower extremities. Perform the SLR test passively with the patient supine. Note the angle of leg elevation precipitating pain. A positive test for sciatica is buttock pain radiating to the posterior thigh, and perhaps to the lower leg and foot. Sciatica, with pain and resistance on internal rotation of the hip, can indicate piriformis muscle spasm or strain. The SLR test is usually negative in spinal stenosis (2). Percussion of the spine and upper pelvis helps to identify areas of localized tenderness, as in fracture, metastatic disease, and some rheumatologic conditions. Palpate standard trigger points looking for fibromyalgia. Check for paraspinal muscle spasm. Measure thigh and calf circumferences to look for muscular atrophy.
Testing
A. Clinical laboratory tests. Testing will be guided by the differential diagnosis as determined by the history and physical examination. If the back pain is felt to be of musculoskeletal origin, no test may be indicated. A urinalysis can help rule out hematuria or infection, if the pain is thought to be urologic or as a result of trauma. If the history suggests a medical problem, the considered diagnoses will determine the laboratory work. Extensive medical workup may be needed for a primary or metastatic malignancy. A calcium level should always be measured to identify a potentially lethal hypercalcemia. Rheumatologic studies may be indicated if a connective tissue disease (e.g., ankylosing spondylitis or rheumatoid arthritis) is suspected. If the pain is thought to be secondary to an urgent or life-threatening condition, have pertinent tests done expeditiously.
B. Diagnostic imaging. In the absence of “red flags,” lumbar spine films are not indicated for musculoskeletal sounding low back pain of less than 1 month duration (1). Neurologic emergencies (e.g., major spine trauma, cauda equina syndrome) require magnetic resonance imaging (MRI) studies. It is usually unproductive to order an MRI for straightforward lumbar muscular strain or for initial evaluation of simple disc herniation, as the prevalence rate of nonsignificant abnormal findings is high. A bone scan may be helpful when tumor, infection, or occult fracture is suspected. Electromyography may be useful to assess for nerve root dysfunction when symptoms are questionable.
Diagnostic assessment
The most common cause of low back pain in the outpatient setting is musculoskeletal strain. Although temporarily very debilitating, muscle strain can be conservatively treated and usually has few long-term complications. Variations from this basic presentation must be recognized to identify more structurally significant or medically threatening problems. Clues to these other diagnoses, which are found in the history, are reinforced by abnormalities in the physical examination; they are found less often by diagnostic testing.
The following “red flags” suggest possible urgent diagnoses. A history of recent trauma or motor vehicle accident can signify a vertebral fracture or subluxation. Fever can indicate an infection of the spine or pyelonephritis (Chapter 2.6). Recent genitourinary instrumentation or other invasive procedure can precede this presentation. Weight loss, other constitutional symptoms, or pain at rest (or at night) may suggest cancer (Chapter 2.13). Neurologic abnormalities can signify nerve dysfunction or cord compression. Urinary or fecal incontinence or retention, saddle area perineal numbness, or anal sphincter incompetence suggests cauda equina syndrome. A sudden tearing sensation in the back with associated hypotension can be caused by a rupturing abdominal aortic aneurysm.
References
1. Bigos SJ. Acute low back problems in adults. Clinical Practice Guideline. No. 14. AHCPR Publication No. 95-0642. Rockville, MD: Agency for Health Care Policy and Research, Public Health Service, US Department of Health and Human Services; December 1994.
2. Alvarez JA, Hardy Jr. RH. Lumbar spine stenosis: a common cause of back and leg pain. Am Fam Physician 1998;57:1825–1834.
» READ BOOK EXCERPT ONLINE »
Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Orthostatic Hypotension:
Diagnostic Approach
(Field Guide to Bedside Diagnosis)
Dysautonomia is characterized by orthostatic hypotension (postural lightheadedness, fainting, dim vision, weakness, unsteady gait), urinary dysfunction (frequency, urgency, stress incontinence), sexual dysfunction (impotence, retrograde ejaculation), bowel dysfunction (nocturnal diarrhea, incontinence), and/or decreased sweating. It is most easily recognized by the presence of orthostatic hypotension without reflex tachycardia. Within 2 to 5 minutes of quiet standing there will be a 20 mm Hg drop in systolic pressue, a 10 mm Hg drop in diastolic pressure, or symptoms of cerebral hypoperfusion.
With gastrointestinal hemorrhage, an orthostatic blood pressure change of 10 mm Hg suggests a loss of at least 20% of intravascular volume.
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Low Back Pain:
Diagnostic Approach
(Field Guide to Bedside Diagnosis)
Radicular pain has such a high sensitivity for nerve root compression that its absence makes important disc herniation unlikely. Not all radicular pain is due to a herniated disc however. Other causes include spinal stenosis, ligamentous hypertrophy, deep lumbar muscle spasm, and deep trochanteric bursitis.
Back pain at rest or unassociated with posture/movement should increase the suspicion of tumor, fracture, infection, or referred visceral pain. Spinal tenderness is a sensitive but not specific indicator. Clues to metastatic cancer include a history of cancer, unexplained weight loss, and signs of cord compression, such as motor weakness of the legs, urinary or fecal incontinence, and absent anal reflex. Recent bacterial infection, injection drug use, or immune suppression (from steroids, chemotherapy, or HIV) should raise suspicion for infection. Fever occurs in osteomyelitis (50%), epidural abscess (83%), and tuberculosis (27%).
A red flag for fracture in a young adult is major trauma, such as a fall from a height or a motor vehicle accident. In older adults, minor trauma or strenuous lifting can cause a compression fracture.
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Pulse pressure, narrowed:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
After you detect a narrowed pulse pressure, check for other signs of heart failure, such as hypotension, tachycardia, dyspnea, jugular vein distention, pulmonary crackles, and decreased urine output. Also check for changes in skin temperature or color, strength of peripheral pulses, and level of consciousness (LOC). Auscultate the heart for murmurs.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Pulse pressure, widened:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
After you detect a widened pulse pressure, assess for signs and symptoms of heart failure, such as crackles, dyspnea, and jugular vein distention. Also check for changes in skin temperature and color, strength of peripheral pulses, and LOC. Auscultate the heart for murmurs. Check for peripheral edema.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Pulse, absent or weak:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
If you detect an absent or weak pulse, palpate the remaining arterial pulses to distinguish between localized or generalized loss or weakness. (See Managing an absent or weak pulse, pages 532 and 533.) Then check other vital signs and evaluate cardiopulmonary status.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Pulsus paradoxus:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Auscultate for abnormal breath sounds. Next, complete your cardiac and pulmonary assessments.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Orthostatic hypotension:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Begin the physical assessment by checking the patient’s skin turgor. Palpate peripheral pulses, and auscultate the heart and lungs. Finally, test muscle strength and observe the patient’s gait for unsteadiness.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Pulse pressure, narrowed:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
After you detect a narrowed pulse pressure, check for other signs of heart failure, such as hypotension, tachycardia, dyspnea, jugular vein distention, pulmonary crackles, and decreased urine output. Also check for changes in skin temperature or color, the strength of peripheral pulses, and the patient's level of consciousness (LOC). Auscultate the heart for murmurs. Ask about a history of chest pain, dizziness, or syncope. Obtain a complete drug history.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Pulse, absent or weak:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
If you detect an absent or a weak pulse, quickly palpate the remaining arterial pulses to distinguish between localized or generalized loss or weakness. If localized, ask whether the patient has experienced or is presently experiencing pain in that area. Assess the limb for color and temperature. Then quickly check the patient's other vital signs, evaluate his cardiopulmonary status, and obtain a brief history. Based on your findings, proceed with emergency interventions. (See Managing an absent or a weak pulse, pages 498 and 499.)
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Pulsus paradoxus:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
If the patient doesn't have signs of cardiac tamponade, find out if he has a history of chronic cardiac or pulmonary disease. Ask about the development of associated signs and symptoms, such as a cough or chest pain. Then auscultate for abnormal breath sounds.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Orthostatic hypotension [Postural hypotension]:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
If the patient is in no danger, obtain a history. Ask the patient if he frequently experiences dizziness, weakness, or fainting when he stands. Also ask about associated symptoms, particularly fatigue, orthopnea, impotence, nausea, headaches, abdominal or chest discomfort, and GI bleeding. Then obtain a complete drug history.
Begin the physical examination by checking the patient's skin turgor. Palpate peripheral pulses and auscultate the heart and lungs. Finally, test muscle strength and observe the patient's gait for unsteadiness.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Blood pressure, decreased [Hypotension]:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
If the patient is conscious, ask him about associated symptoms. For example, does he feel unusually weak or fatigued? Has he had nausea, vomiting, or dark or bloody stools? Is his vision blurred? Is his gait unsteady? Does he have palpitations? Does he have chest or abdominal pain or difficulty breathing? Has he had episodes of dizziness or fainting? Do these episodes occur when he stands up suddenly? If so, take the patient's blood pressure while he's lying down, sitting, and then standing; compare readings. (See Ensuring accurate blood pressure measurement.)
A drop in systolic or diastolic pressure of 10 to 20 mm Hg or more and an increase in heart rate of more than 15 beats/minute between position changes suggest orthostatic hypotension.
Next, continue with a physical examination. Inspect the skin for pallor, sweating, and clamminess. Palpate peripheral pulses. Note paradoxical pulse—an accentuated fall in systolic pressure during inspiration—which suggests pericardial tamponade. Then auscultate for abnormal heart sounds (gallops, murmurs), rate (bradycardia, tachycardia), or rhythm. Auscultate the lungs for abnormal breath sounds (diminished sounds, crackles, wheezing), rate (bradypnea, tachypnea), or rhythm (agonal or Cheyne-Stokes respirations). Look for signs of hemorrhage, including visible bleeding and palpable masses, bruising, and tenderness. Assess the patient for abdominal rigidity and rebound tenderness; auscultate for abnormal bowel sounds. Carefully assess the patient for possible sources of infection such as open wounds.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Low birth weight:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
As soon as possible, evaluate the neonate's neuromuscular and physical maturity to determine gestational age. (See Ballard Scale for calculating gestational age.) Follow with a routine neonatal examination.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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