oldkidontheblock
Forum Guru
Topics: 57
Posts: 912
|
- Is it ok that after taking a history and before starting the PE if I ask the SP : Is there anything else you would like to tell me which I may have not asked you? I read it somewhere that they are very keen to answer and tell you too, unless the SP has been told to act weird.
- If during PE I remember suddenly something which I forgot to ask, Can I ask it then?
- In PE if I have to do both chest and abdominal examination, how would i drape the patient? I think i should do: First after consent for lung and heart examination, I untie his/her gown make him/her lie down and bring the gown down to the level of abdomen and expose the chest, finish my examination from front then make her/him sit up tie the gown and from the exposed posterior part do the chest examination if needed or omit it. Then again make her/him lie down and expose the abdomen by moving the gown up from down and draping accordingly. This method will expose as little part as possible to examine but it would be difficult for the patient first lying down then sitting up and then lying down again. Can anyone guide me on this?
- In PN if I forget to write something or I feel that the order of my DDs need to be recorrected shall I cancel and rewrite or leave it due to the mess it would show on the sheet?
Edited by oldkidontheblock on 04/14/08 - 02:58 AM
___________________
Malcolm Forbes: Victory is sweetest when you've known defeat
|
| supra
Forum Elite
Topics: 16
Posts: 343
|
hey oldkidontheblock,LEMME TRY 2 ANSWER UR QUERIES.
1)its a good practice to ask the SP,DO U HAVE ANYTHING ELSE 2 TELL ME.,at the end of history.
2)i guess it is better 2 ask questions atleast during the PE rather than completely omitting it coz teh question might be important for the diagnosis,i feel the SP will just have a checklist of questions whether asked or not but not when dis was asked.
3)for the drapin part,make the patient sit,first examine eyes n mouth and neck ,whichever relevant,then ask the SP'S PERMISSION 2 UNTIE HIS gown,then listen 2 his lungs from behind,check 4 CVA tenderness,then any spine tenderness if relevant,then come 2 the front ,ask SP's permisssion 2 lower his gown to listen 2 his/her heart.after heart,tie the gown,thank the SP,AND TELL HIM/HER DAT U R GONNU EXAMINE THE BELLY,FOR WHICH U ASK HIM 2 LIE DOWN,JUST LOWER THE DRAPE,ASK THE PATIENT 2 BEND THE KNEES,ask him 2 relax n finish the I,A,P,P,THEN CHECK THE EXTREMETIES 4 swellings, pulses.put the drape back in place ,thank the SP AND ASK HIM 2 SIT UP 4 COUNSELLING/CLOSURE.
4)I think it is better to keep the patient note as neat as possible n try not 2 mess it up,,so write ur diagnosis only after thinking well abt it.
HOPE DIS HELPS.
|
| arlete
Intern in 2009!!!!!
Topics: 36
Posts: 2,561
|
1 - Agree with supra: yes. The reaction will be different from SP to SP.
2 - I did that a lot, although I tried not to.
3 - You only examine the heart with patient lying down if it is a complete heart examination, with PMI, JVD and lateral auscultation of the mitral region. In this case, don't make the patient sit up to tie the gown. Cover the chest with the gown, then explain to the patient you are going to expose the belly, move the gown and the drape up. After the abdominal exam, when the patient sits up, you tie the gown. it's better not to make the SP feel he's at the gym. 
4 - I agree, neat is better. If it's something really important, trace over it and write whatever you think it's better besides or under it. Remember, when you write the PN, start with DD and work up. Those are the only items you didn't prove you know yet. You've got points for the history and PE already.
___________________
When men make the rules, God decides the exceptions.
|
| oldkidontheblock
Forum Guru
Topics: 57
Posts: 912
|
Arlete, I agree with points1, 2 and 4. Because this normally happens in clinic. But I was thinking that may be the SP won't like his/her gown untied from the behind while I examine the belly, though it seems more convenient for both me and the SP.
Supra, I think I will not tell the SP to sit up and listen to my counselling because firstly SPs I guess are trained and they know that the examination is over, secondly if its a real patient he will not like a doc telling him to sit up and listen to his counselling, I won't to my doc .
___________________
Malcolm Forbes: Victory is sweetest when you've known defeat
|
| arlete
Intern in 2009!!!!!
Topics: 36
Posts: 2,561
|
As long as the whole chest and shoulders are covered and the patient is comfortable, I think the knot being tied or not before belly examination doesn't make a big difference. But I think it's not a big deal and it probably doesn't count for your evaluation exactly when you do it. So, go with your guts. Just don't forget to do it!
___________________
When men make the rules, God decides the exceptions.
|
| supra
Forum Elite
Topics: 16
Posts: 343
|
if the patient is in no acute distress,i wud prefer the SP to sit up 2 discuss his/her diagnosis as he wud pay more attention and we can counsel him effectively if he is attentive.If THE SP is in severe pain,there is no option but to counsel him in the position THE SP prefers,mostly lying down.that is my personal opinion,lets seniors answer
|
|
| |
| | | | | | |
