Physical Assessment & CPE Quick Review

CPE Overview

  • Skills timed: 2020 min Vital Signs, 2020 min Head-to-Toe
  • Arrive prepared with scripted intro:
    • Greet, state purpose & duration (≈1414 min)
    • Verify Name, DOB, allergies, special considerations
  • Four assessment systems tested: Integumentary, Respiratory, Cardiovascular, Peripheral Vascular

Documentation (Nurse’s Note)

  • Must include: Date, Time, Patient Name, Your Credential/Title
  • Write head-to-toe; expect ≈\approx 2 pages on first attempt

Key Anatomy Landmarks to Verbalize

  • Brachial (AC = Antecubital), Metatarsals/Tarsals, Digits
  • Scapula (posterior), Clavicle (collarbone), Acromion

Integumentary System

  • Largest organ: skin, hair, nails
  • Functions: protection, sensation, temperature regulation (diaphoresis = sweating)
  • Normal charting phrase: “Skin clean, dry, intact; no edema or lesions”

Respiratory Assessment

  • Lung auscultation points: 55 anterior, 99 posterior
    • Start at apex; zig-zag top→bottom, staying between spine & scapula posteriorly
  • Breath sounds
    • Tracheal (loud), Bronchial, Bronchovesicular (medium), Vesicular (soft, rustling)
  • Gravity-dependent bases prone to infection—encourage ambulation

Cardiovascular Assessment

  • Only valve required for CPE: Mitral/Apical
    • Location: Left mid-clavicular line, 5th5^{th} intercostal space
    • Statement: “Auscultating PMI; regular rate & rhythm noted”
  • Heart sounds
    • S<em>1S<em>1 (lub): AV valves close — start of systole • S</em>2S</em>2 (dub): Aortic/Pulmonic valves close — start of diastole

Peripheral Vascular Assessment

  • Pulses (palpate bilaterally except carotids):
    • Carotid (one side at a time)
    • Brachial, Femoral, Posterior Tibial, Dorsalis Pedis
  • Capillary refill: "<3 sec bilateral upper & lower extremities"
  • Edema: chart “No edema noted bilaterally” (grading not required)

Technique Reminders

  • Auscultation = listening; Palpation = touch; Percussion reserved for advanced practice
  • Avoid simultaneous pressure on both carotids (risk of syncope)
  • Maintain patient modesty; use gentle under-hand breast displacement on females

Practice Tips

  • Rehearse script + landmark pointing on mannequins/teddy bear
  • Use flashcards for conversions & landmark names
  • Open lab from 0707:0000 — mannequins and whiteboard available before class