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Draping patients for CS or PE exam

Discussion in 'Step II' started by Piers, Dec 7, 2008.

  1. Piers

    Piers Junior Member
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    Do all the patients wear gowns? If so, do we still need to drape the patient? In what kind of cases? For gowned patients, should we untie and tie the gowns or ask the patients to tie and untie?

    Any guidelines would be appreciated.
     
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  3. smq123

    smq123 John William Waterhouse
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    - All the patients wear gowns.

    - Yes, you still need to drape the patient.

    - I draped them for all cases, just to be safe.

    - Ask the patient if they mind if you untie their gown, or if they would like to do it.
     
  4. usmlepaul

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    When the patient sit up, how can we examine the anterior chest without exposing the patient's back?? it seems impossible to do so by draping...
    any suggestion?? thx in advance..
     
  5. smq123

    smq123 John William Waterhouse
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    If I remember correctly, the patient gowns tie in the FRONT. So, to listen to the anterior chest, the patient just unties the gown and gently reveals enough skin for you to listen. You can also gently pull down the back of the gown to listen to the posterior chest, without necessarily revealing too much of the patient.

    If anyone who took the test more recently than I did can comment, that'd be great. But that's what I remember.
     
  6. FutureInternist

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    I took the PE & the patients' gown tied in the back, but you will be listening to heart & lungs anyway so just untie, listen to the back, pull it up a bit while you put your hand under the gown & once finished, tie it back up.
     
  7. Medicinewarrior

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    i was told by nbome staff that you should only drape if you need to do a part of the physical that involves drapping (abd exam/LE exam)

    With that said, I forgot to drape about 4 of my patients completely and still passed.

    I did ask every patient for permission to untie their gown
     
  8. docmike1983

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    Is it ok to expose both the anterior and posterior chest when examing the anterior chest? How does one use the gown to cover the posterior while examing the anterior if the gown ties from the back? I cant afford failing on stupid details like this.
     
  9. smq123

    smq123 John William Waterhouse
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    Doesn't First Aid for Step 2 CS cover topics like these?

    That book really does do a great job of preparing you for this exam.
     
  10. docmike1983

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    No it does not. I have not been able to find a good source that instructs you in how to drape the patient for each physical exam maneuver. I need to know precisely how the patient is draped for each exam. For example, how the heck do you drape the patient while examining the back range of motions or gait? The drape will fall off! And the issue of how to drape while doing an anterior chest exam remains unsolved. I am taking the exam this tuesday and I cant afford to fail. I want to start my pathology residency this july and never see a patient (fake or real) ever again!
     
  11. smq123

    smq123 John William Waterhouse
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    <sigh>

    Step 2 CS is NOT that intimidating as you seem to think it is. It really wasn't that bad. If you are a native English speaker, the odds are overwhelmingly in your favor.

    When I did Step 2 CS, I did NOT examine gait or range of motion of the back. I can't imagine any scenario that they would test where that would be necessary. The main reason why you would test gait or back range of motion is if you are suspecting a stroke or a traumatic injury. Neither of those scenarios come up often.

    Again, just to calm you down, WHILE TAKING STEP 2 CS, I NEVER ASKED THE PATIENT TO STEP DOWN FROM THE EXAMINING TABLE. Not even once.

    If you REALLY feel like a gait exam might be necessary, but don't want to do it, include it in your write up at the end.

    For the anterior chest exam, I had the patient untie the gown in the back, and carefully lower the front of the gown a few inches - just enough to listen to heart and lungs. I had the PATIENT hold the top of the gown against her chest, and then pull it back up once I was done. That's all you need.

    You're overthinking this. Really, just read First Aid for Step 2 CS. THOSE are the types of cases you will see, and it has all the info that you need. Don't forget to wash your hands, too!
     
  12. docmike1983

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    Thank you for your response. However, you are referring to the USMLE CS. I am going to DO school and need to take the COMLEX PE. COMLEX exams are poorly organized exams. If I were taking the CS this tuesday I would feel at ease. However I am taking the PE and scared to death.
     
  13. smq123

    smq123 John William Waterhouse
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    Ooooh....eep. I see. Good luck. :luck:

    I think the approach to the anterior chest that I mentioned would probably still help when taking COMLEX PE.
     
  14. LadyGrey

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    You are seriously over-thinking this. Even for the PE, it's not that complicated.

    Draping 101:

    Put the sheet over the patient's lap. If you're examining the abdomen, the patient is lying down, and the drape is covering his/her underwear and legs. That way you can pull up the gown a bit to expose the belly (leaving the chest still covered) and the legs and groin area are not exposed.

    There is no need to drape the back when doing an anterior chest exam. The back is not a sensitive area that people don't want exposed. There is no need to fully expose the chest, either. You want your steth to be on skin, but you can do that by sliding under the gown. Whatever you do, just ask/tell the patient you're going to do it first.

    Basically if the patient is lying on her back, put a sheet over her groin/legs. I don't think I put anyone prone for any of my OMT, but if I did, I'd probably put the sheet over the butt/legs just for added patient modesty and comfort. You have complete freedom in what OMT you choose, so just don't pick anything where draping would be an issue. I wasn't about to do techniques where the patient's leg is over my shoulder or anything.
     
  15. DQMW

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    I have a question....I pulled up the gown and verbalized to help them "get covered back up" after each heart and lung PE, but did not actually tie every patients' gown. How bad is that?? Do I miss points for not doing the tying? For whatever reason, I just thought that was sufficient.
     
  16. NeuroCritDoc

    NeuroCritDoc Neuro!
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    You should tie their gowns back up. But I highly doubt it'll cause you to fail. Maybe a few points off.
     

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