The general survey is the first part of the physical examination that begins the moment the nurse meets the client to obtain an overall impression about the client’s general health status. The general survey includes observation of the client’s physical development, body build, gender, apparent age as compared with reported age, skin condition and color, dress and hygiene, posture and gait, level of consciousness, behaviors, body movements, affect, facial expressions, speech patterns and clarity, and vital signs.

The client’s vital signs, indicators of one’s health, include temperature, pulse, respirations, and blood pressure. Pain for a time was considered to be the "fifth vital sign" but this designation was dropped because of the opioid crisis. For the body to function on a cellular level, a core body temperature between 35.5°C and 37.7°C (96°F and 99.9°F orally) must be maintained. Arterial or peripheral pulses are shock waves produced when the heart contracts and forcefully pumps blood out of the ventricles into the aorta. The body has many arterial pulse sites. One of them-the radial pulse-gives a good overall picture of the client’s health status. The respiratory rate and character are additional clues to the client’s overall health status. Blood pressure reflects the pressure exerted on the walls of the arteries. This pressure varies with the cardiac cycle, reaching a high point with systole and a low point with diastole. Therefore, blood pressure is a measurement of the pressure of the blood in the arteries when the ventricles are contracted ( systolic blood pressure) and when the ventricles are relaxed (diastolic blood pressure). Blood pressure is expressed as the ratio of the systolic pressure over the diastolic pressure. Cardiac output, distensibility of the arteries, blood volume, blood velocity, and blood viscosity (thickness) all affect a client’s blood pressure. The difference between systolic and diastolic pressure is termed the pulse pressure. Determine the pulse pressure after measuring the blood pressure because it reflects the stroke volume-the volume of blood ejected with each heartbeat. Finally, pain screening is essential for an overall impression of the client. See Chapter 7 for an in-depth Pain Assessment.