Respiratory and cardiovascular physical exam

I only need the objective section for a soap note write-up for a respiratory and cardiovascular exam. This paper must answer all of the points listed below with normal findings using citations from the resources I provide in the document uploads. Also, include one peer-reviewed article written in the three years. Lastly, I have uploaded a sample of a soap note so that you can see how a soap note should be formatted. 

 

Thorax (13 points)—patient sitting upright

__/1 point: Observe the rate, rhythm, depth, and effort of breathing noting color and any cyanosis

__/1 point: Inspect for accessory muscle use noting retraction of interspaces during inspiration

__/2 points: Inspect shape of the chest (AP diameter to lateral chest diameter) noting symmetry and deformities

__/1 point: Palpate the chest wall noting tenderness and fremitus

__/1 point: Palpate the chest for lung expansion/excursion

__/2 points: Percuss the chest noting any abnormalities, note diaphragmatic excursion of the posterior chest

__/5 points: Auscultate the lungs noting pitch, intensity, and duration of inspiratory and expiratory sounds; identify any adventitious sounds

Special Techniques (3 points)

__/1 point: Assess voice transmission with egophony (change from “ee” to “ay”)

__/1 point: Assess voice transmission with bronchophony (change with stated word such as “baseball” or “Scooby Doo”)

__/1 point: Assess for voice transmission with whispered pectoriloquy (clearer whispered voice)

Cardiac (15 points)—patient is supine with 30-degree elevation of the head unless otherwise stated

__/1 point: Inspect for jugular venous pressure and carotid pulsations

__/0.5 points: Auscultate the carotid pulse for presence of bruits

__/0.5 points: Palpate the carotid pulse noting amplitude and presence of any thrills

__/1 point: Palpate anterior chest noting heaves, lifts, thrills, crepitus, and tenderness

__/1 point: Palpate the PMI noting location, amplitude and duration

__/10 points: Auscultate the anterior chest with both diaphragm and bell of the stethoscope in aortic, pulmonic tricuspid, Erb’s Point, and mitral areas noting location, timing, intensity, pitch, rhythm, extra sounds, and quality of murmurs if present

__/1 point: Note systole and diastole (S2>S1 at base and S1>S2 at apex)

Special Techniques (2 points)

__/1 point: Auscultate for mitral stenosis with the patient in the left lateral decubitus position

__/1 point: Auscultate for aortic regurgitation with the patient sitting up, leaning forward, exhaling completely, and briefly holding their breath after expiration (listening at LSB at the apex)

Peripheral Vascular System (15 points)

__/2 points: Palpate radial and brachial pulses

__/1 point: Palpate one or more epitrochlear nodes

__/1 point: Palpate axillary lymph nodes

__/1 point: Palpate and estimate the width of the abdominal aorta noting presence of a pulsatile mass

__/1 point: Palpate superficial inguinal lymph nodes

__/1 point: Inspect lower extremities noting size, symmetry, edema, venous pattern, pigmentation, color, hair distribution, and varicosities or ulcers

__/4 points: Palpate the femoral, popliteal, dorsalis pedis, and posterior tibial pulses

__/1 point: Assess temperature of the feet and legs; compare for symmetry

__/2 points: Palpate for peripheral edema and venous tenderness

Special Techniques (2 points)

__/2 points: Assess arterial perfusion of the hands by performing the Allen test