Awhile ago, we just had a simulated/ mock physical examination. Before today’s session, we were tasked to research the physical examination findings of the 10 diseases we were given. Most of them are of respiratory system and the rests are cardiovascular and GI related.
Good thing I kept on asking my dear friend who is a nurse. She helped me a lot because she readily shares her experiences as a nurse and how they do physical exams. So awhile ago we were given a history of a patient with a chief complaint of chest discomfort. From there, I asked my friend who is a nurse what focused p.e routines to do. She said that its important to check the conjunctiva, the mouth, the jugular vein distentions on the neck, thorax & lung p.e., cardio p.e. and some palpations on the extremities. What I did was I did the routine introduction to establish rapport with my patient (since its a mock p.e., it was my female classmate). Then I checked her conjuctiva, her tongue and mouth. I didn’t use a tongue depressor because mine was not sterile. I inspected her neck. I proceeded with the auscultation of the anterior thorax and lungs. Then tactile fremitus, percussion and auscultation of the posterior thorax and lungs. And then I proceeded with the auscultation of the heart. I didn’t palpate anymore for the intercostal spaces of the ribs but I think it’s necessary. (I’m really inexperienced.) Also, I don’t know what I’m really doing with percussion with the posterior lungs. I find it difficult to percuss. I hope someday I’ll be better in doing it. Then after the cardio p.e., I checked her arm and capillary fill of her nails. My friend nurse checked the legs for edema. Again, all these are just for simulations for real life practice. We were given a case history and we were tasked to know what we’ll find in a p.e. and give out diagnoses.
For my group, our chief complaint was chest discomfort. After the mock p.e., our professor gave us the comprehensive p.e. findings for the disease we need to identify. And because of my friend who is a nurse, we were able to give the initial impression ACS.
Lesson learned. I need to be more familiar with the human anatomy. Also I need to perfect palpation,percussion and auscultation which at the present time, I’m still not an expert. And these things are the basic things doctors should be good at.