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8 Cards in this Set
- Front
- Back
What are the big picture components of the CP exam?
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General Assessment
Vital Signs Posterior Exam Anterior Exam supine- lungs Anterior Exam supine- heart Anterior Exam sitting |
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What are the components of the general assessment of the patient?
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*Assess general appearance, including signs of distress.
*Inspect skin, lips, nails for general appearance and color, texture, or lesions. *Could check cap refill and radial/dorsalis pedis pulses here. **LOWER PATIENT'S GOWN BELOW SHOULDERS; HAVE PT HOLD THE GOWN IN PLACE** |
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What are the components of the posterior exam?
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*LOOK:
1) Assess general respiratory effort. 2) Observe symmetry of chest expansion and shape of chest wall. *FEEL: 1) Palpate anterior, posterior, and lateral chest walls for tenderness. Do this at upper chest and lower chest levels. Do several levels on the back as well. **RAISE GOWN BACK UP, BUT DON'T TIE IT** 2) Assess respiratory expansion at the 10th rib. *LISTEN: 1) Percuss posterior lung fields at 4 levels and at mid axillary line. 2) Auscultate posterior lung fields at 4 levels and at mid axillary line. |
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What are the components of the anterior lung exam?
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**LOWER THE EXAM BED TO 30˚, LAY PATIENT DOWN AND DRAPE THE LEGS TO THE WAIST**
*LOOK: 1) Observe shape and movement of chest wall. *LISTEN: *RAISE PATIENT'S GOWN UP FROM BELOW*. 1) Percuss anterior lung field at 2 levels. 2) Auscultate the anterior lung fields at 2 levels. |
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Discuss the Tactile Fremitus test:
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*Use ulnar surface of your KNIFE-HANDS!
*Posteriorly: 1) Place hands at position 1, horizontally. 2) Place hands vertically, between 2 and 3. 3) Place hands horizontally again, below position 3. *Anteriorly: 1) Knife hands should be horizontal, at upper lung level (1) and lower level (below nipple or bra line). *Patient says "toy boat." If there's decreased transmission of voice sounds, the test is positive. |
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Discuss the Bronchophony test:
Discuss the Egophony test: Discuss the Whispered Pectoriloquy test: |
BRONCHOPHONY:
*Listen with stethoscope and have patient say "99." *Louder voice sounds are a positive test. EGOPHONY: *Listen with stethoscope and have patient say "eeee." *If what you hear is "A," that's a positive test. WHISPERED PECTORILOQUY: *Listen with stethoscope and have patient whisper "99." *If what you hear is loud and clear, that's a positive test. |
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What are the components of the anterior heart exam?
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*LOOK:
**PATIENT SHOULD ALREADY BE SUPINE AT 30˚** 1) Patient should turn head to left. 2) Look for JV pulsations and distention. *FEEL: 1) Test for HJ reflux. 2) Palpate the carotid pulses, one at a time. 3) Palpate for heaves using palm of your hand--do this over the sternum, and in tricuspid and mitral areas. 4) Palpate for thrills using the ball of your hand. Do this in the 4 heart areas. *LISTEN: 1) Auscultate all 4 heart areas using both bell and diaphragm. 2) Put patient in LLDP, and auscultate mitral and axillary areas using the bell. **PUT GOWN BACK DOWN, BACK UP OVER SHOULDERS, AND HELP PATIENT SIT UP.** 3) Auscultate aortic and pulmonic areas with diaphragm while patient leans forward. 4) Auscultate carotids while patient holds breath. |
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What is the NORMAL CP exam oral presentation?
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*ON CARDIOVASCULAR EXAM:
-NO JVD, or HJR. -PMI is well localized to the 5IC in the MCL. -No heaves or thrills. -Regular rhythm. -Crisp S1 and S2, with normal splitting of S2. -No murmurs, rubs, or gallops. -Carotid upstrokes are brisk, w/o bruits. -Radial, femoral, and dorsalis pedis pulses are 2+ and symmetric bilaterally. *ON PULMONARY EXAM: -Thorax is symmetric with no increase in AP diameter. -Good expansion on respiration. -No TTP of the chest wall. -Resonant to percussion with no areas of dullness. -LCAB, no crackles, wheezes, rhonchi, or rubs. *BONUS: -TF is symmetric. -No e to a ∆ on egophony. -No increase in loudness on bronchophony or Whispered Pectoriloquy. |