(Aortic valve-2 nd intercostal space on the right sternal border) (Pulmonic valve-2 nd intercostal space on the left sternal border) (Erb’s point-3 rd intercostal space on the left sternal border) (Tricuspid-4 th intercostal space on the left sternal border) (Mitral valve-5 th intercostal space on the midclavicular line) 42. Inspect anterior chest for any obvious deformities in symmetry 43. Auscultate lung sounds in the anterior lung fields: Have her take normal breath sounds (Begin at the intercostal spaces) [Instructor hit six locations] 44. Auscultate lung sounds in the posterior lung fields: Have the pt turn around. Have her take normal breath sounds [Auscultate eight areas] Beginning above the scapulas. SEE VIDEO 45. Check upper extremities: Inspect joints of hands (Extend out your hands) Note any redness, swelling, or deformities of her finger joints 46. Palpate for capillary refill (should return to pink in less than 3 seconds) 47. Check radial pulses bilaterally: Have pt face palms inward. Palpate radial pulses (Are they equal, about 2+?, bilaterally) 48. Assess hand grips: Have pt grip “my” hands together as tightly as you can. (How strong o-5 and are they bilaterally equal)
49. Assess ROM should be performed bilaterally BUT for Immersion evaluation, it is only necessary to perform a ROM unilaterally (Same with deep tendon reflexes) 50. Assess passive ROM of the elbow: Flexion and extension on one side and then the other 51. Check strength of biceps and triceps: Have pt flex their elbows and push against your hands. Then, have the pt pull back towards themselves while you supply resisting force. (Rate bicep and triceps strength 0-5) 52. Assess passive ROM of the shoulder: (Flexion, extension, internal rotation, external rotation, then abduction and adduction) 53. Assess cerebellar coordination with rapid alternating movements. (Tell pt to take her thumb and touch her index finger, middle finger, fourth finger, and fifth finger) Tell her to repeat that (Did the pt do well and is the pt coordinated) 54. Tell pt to put her palms down on her thighs, and then palm up, and then down, and increase speed. (Was the task performed well, nice, normal, and coordinated) 55. Assess deep tendon reflexes: Bicep tendon (Support the pt arm on your arm, then place the thumb on the medial aspect of the antecubital fossa, and strike my thumbnail with the pointy end of the hammer) (Was there a contraction) 56. Check patellar reflex with the flat end of the hammer: (Did she have a good response) 57. Check Achilles reflex: Ask her to relax her foot, then dorsiflex the foot a little bit, and tap with the flat end. (Did you notice pronation) 58. Abdomen Examination: Have the pt lie down, expose her abdomen. (Observe the abdomen for its contours and symmetry, are there any distortions) Then (Auscultate the bowel sounds in all four quadrants)-(Are bowel sounds present in all four quadrants) Then (Auscultate for any bruits) Begin with Aortic area, right below the xiphoid process, midline (Then) Left Renal, above and lateral to the left of the umbilicus (Then) Right Renal, above and lateral to the right of the
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- Summer '17
- Left-handedness, pulse