This paper examines the fundamental components of a physical examination, including observation, vital signs, auscultation, percussion, and palpation, and explains how each contributes to clinical diagnosis. It then analyzes a patient case involving a blood pressure reading of 160/100 mmHg, explaining what systolic and diastolic values represent biologically and how they indicate hypertension. The paper also identifies laboratory tests ordered for the patient — including hematocrit, potassium, hemoglobin, and serum aldosterone — and discusses the clinical significance of hematocrit measurement in particular. Finally, it compares the patient's second-round lab results against established reference ranges to identify abnormal values.
Physical examination consists of five basic components, performed after obtaining a patient's description of the history of his or her symptoms. First, the provider observes the patient for physical signs of disease, evaluating factors such as mobility, posture, facial expression, alertness, responsiveness to stimuli, and changes in skin color (Jarvis, 2011, pp. 33, 127–129). Second, the provider takes the patient's vital signs — including blood pressure, heart rate, breathing rate, and temperature — and compares the results with established reference ranges (Jarvis, 2011, pp. 136–150).
Third, the provider performs auscultation, using a stethoscope to listen to the patient's lungs, heart, and bowel sounds (Jarvis, 2011, p. 118). Fourth, percussion is performed by tapping on the patient's chest and abdomen to listen for sounds that indicate normal conditions, the presence of fluid, excess air, and the size of the lungs or affected area (Jarvis, 2011, p. 116). Fifth, the provider performs palpation, using the fingers to apply pressure to body regions and organs in order to assess organ size, consistency, shape, tenderness, and the presence of any abnormal masses (Jarvis, 2011, p. 115). Together, the patient's symptom history and these five examination steps help the provider narrow the possible causes of a disorder and determine appropriate imaging tests and laboratory work.
Blood pressure is measured using a sphygmomanometer — an inflatable cuff with an attached pressure gauge that records pressure in millimeters of mercury (mmHg) — along with a stethoscope (WebMD, LLC, n.d.). The cuff is wrapped around the patient's upper arm, forearm, or wrist, depending on cuff size, and is inflated to a pressure known to exceed the patient's systolic pressure. As the cuff is deflated, the provider listens with the stethoscope for blood moving through the artery. The first sound heard — a "whooshing" noise — corresponds to the systolic blood pressure, which is read from the pressure gauge. After the whooshing noise ceases, the provider records the diastolic blood pressure (WebMD, LLC, n.d.).
The top number represents systolic blood pressure, which measures the pressure in the arteries caused by the heart beating and forcing blood through them to the rest of the body. A normal systolic reading is below 120 mmHg; a reading of 120–139 mmHg indicates prehypertension and an elevated risk of heart disease; and a reading of 140 mmHg or higher indicates hypertension, or high blood pressure (WebMD, LLC, n.d.). The bottom number represents diastolic blood pressure, which reflects the pressure in the arteries when the heart rests between beats. A normal diastolic reading is below 80 mmHg; a reading of 80–89 mmHg indicates prehypertension; and a reading of 90 mmHg or higher indicates hypertension (WebMD, LLC, n.d.).
The patient's blood pressure reading of 160/100 mmHg is abnormal on both measures. A systolic reading of 160 mmHg is well above the 140 mmHg threshold for hypertension, and a diastolic reading of 100 mmHg is well above the 90 mmHg threshold. Therefore, the patient's blood pressure indicates hypertension, or high blood pressure, on both values.
"Blood and urine tests including hematocrit analysis"
"Second-round lab results compared to normal ranges"
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