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This skill will require you to obtain the temperature, respiratory rate, heart rate, and pulse rate of both canine and feline patients. You will also assess the hydration status of patients as well as auscultate the heart and lungs of these patients as well. Upon completion of this skill, you will be able to obtain a TPR and hydration status; then correlate your results with the normal values for canine and feline patients. In addition, you will also be able to discern normal from abnormal heart and lung sounds heard during auscultation and correctly describe what you heard during auscultation.
Tips for materials required for submission:
Copies of patient records from 5 cases in which you obtained the TPR, assessed the heart and lung sounds, and assessed the hydration status.
When noting heart rates/ sounds:
Do not write: heart sounds normal.
Instead write: heart was absent of murmurs or arrhythmia, OR heart has a murmur/ arrhythmia right side, left side or both.
Ask your site supervisor if you are unable to determine the grade murmur the patient has. For most of you,this may be the first time you are hearing an abnormal heart sound. It is ok to ask questions!
Know the normal rates for canine and feline heart rates. You will need to know the normal rate to know if the values you are obtaining are normal/ abnormal.
When noting respiration rate/ lung sounds:
Do not write: lungs sound normal.
Instead write: lung sounds were not present or clear on the left/ right, cranial/ caudal aspect of thorax.
If there is an abnormality note it using correct terminology! You should be listening for sounds like:
Stridor: respiratory sounds heard without a stethoscope.
Crackles: sounds like crumpling cellophane paper.
Rasps: sounds like a musical whistle.
Rubs: sounds like sandpaper rubbing together.
Again do not be afraid to ask your site supervisor if you are unsure of what you are hearing. This is a learning experience!
When noting pulse character/ rate:
Do not write: pulse felt normal
Instead write: pulse rate was in rhythm with the heart and upon palpation it was determined normal.
Abnormalities need to be noted using correct terminology! Types of abnormalities associated with the pulse are a:
Hyperdynamic pulse: a rapid pulse that lifts your finger off the artery when palpated.
Pulse deficit: when the heart rate and pulse are not in sync.
Paradoxical pulse: a change in pulse strength from strong to weak as the animal inspires and expires.
When noting hydration status:
Do not write: hydration was WNL.
Instead write: lack of clinical signs determines the patient is less than 5% dehydrated.
Watch your wording! When you say less than 5% dehydrated it is the opposite of saying less than 5% hydrated. A patient that is 5% hydrated would be 95% dehydrated and most likely not alive. It is vital that you understand how to properly note the hydration status of a patient. See table below.
Do not forget to note the rectal temperature!
We do understand that you may not have time to do a physical exam on a patient when you are busy. You can substitute your in-patients by taking time with post-op patients while they are in their cages. Do not forget pre-anesthetic and anesthetic drugs can cause a sinus arrhythmia in a patient, depending on the drug given.
Do not submit records of anesthetic monitoring, that is beyond the scope of this skill. You will have an entire skill devoted to that in Externship 2.
Video of you performing one physical examination on a patient. This patient should match one of the records you submit.
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