toenails bilaterally no visible abnormal findings noted inspected legs

Toenails bilaterally no visible abnormal findings

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toenails bilaterally no visible abnormal findings noted inspected legs bilaterally for edema no edema noted. Capillary refill tested in all 10 fingers and all ten toes refill time Less Than 3 seconds. Right carotid artery auscultated Bruit present. no bruit to left auscultation of carotid artery Auscultated heart sounds noted as 1 2 and 3 especially in the mitral valve area Auscultated breath sounds all sounds present noted adventitious sounds to the lower posterior right and left Noting fine crackles and rales. Auscultating abdominal aorta no bruit found. Upon examination of all abdominal arteries no bruit found. Upon auscultation of bowel sounds in all four quadrants present. Upon auscultation of liver and spleen no friction rubs noted. When palpating the right carotid artery noted thrill + 3, left carotid palpation no thrill, +2. Palpated PMI: displaced laterally brisk and tapping and less than 3 cm. Palpated bilateral brachial arteries no thrill 2+. Palpation of the left and right radial pulse no thrill, 2+. Palpated left and right femoral pulse no thrill +2. Upon palpation of bilateral tibial, dorsalis pedis pulse and popliteal pulse no thrill, 1+ dimished bilateral. Upon light palpation of all four abdominal quadrants like pressure no tenderness reported no masses guarding or distention. Upon deep palpation of all four abdominal quadrants no masses are abnormal findings noted. Location of the liver a palpable 1 cm below the right costal margin noted. Palpated spleen not palpable. Palpated right and left kidneys not palpable Skin turgor warm dry no tenting noted. Because all four quadrants of the abdomen no areas of dullness noted. On percussion of the spleen no abnormalities noted. Upon percussion of liver span 7cm in the midclavicular line. EKG performed regular sinus rhythm noted no st-elevation or changes. • General Survey: 58 year old male is alert and oriented, with clear speech and in no acute distress • Cardiac: S1, S2, without murmurs or rubs. PMI displaced laterally. S3 noted at mitral area. • Peripheral Vascular: Right side carotid bruit. JVP 3cm above sternal angle. Right carotid pulse with thrill, 3+. Left carotid pulse without thrill, 2+. Brachial, radial, femoral pulses without thrill, 2+. Popliteal, tibial, and dorsalis pedis pulses without thrill, 1+. Cap refill less than 3 seconds - 4 extremities. • Respiratory: Breathing is quiet and unlabored. Breath sounds are clear to auscultation in upper lobes and RML. Fine crackles/rales in posterior bases of L/R lungs. • Gastrointestinal: Round, soft, non-tender with normoactive bowel sounds in 4 quadrants; no abdominal bruits. No tenderness to light or deep palpation. Tympanic throughout. Liver is 7 cm at the MCL and 1 cm below the right costal margin.
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