Problem: Write an article based on this summary: Feel the patient's heart. Listen in the other 3 auscultation spots. Repeat steps 2 and 3, this time using the bell of your stethoscope. Ask the patient to lie on his/her left side and ensure proper draping. Leave the examination room and allow the patient to get dressed.

Answer: Also known as palpation, place your right hand over the patient's left pectoral. The heel of your hand should be against the sternal border and your fingers should lie just below the nipple. You hand should lay flat against the chest, fingers extended. Make sure you tell the patient what you are going to do before you begin, and explain the purpose. While palpating, be aware of the following: Can you feel a point of maximum impulse (PMI), which indicates the location of the left ventricle? Try to pinpoint its exact location, which is usually near the mid-clavicular line. If the ventricle is normal-sized and functioning, it should be about the size of a penny. If it is enlarged, it may be located closer to the armpit. What is the duration of the impulse? If the patient suffers from hypertension, the impulse will last longer. This is subtle and largely a subjective assessment, however. How strong is the impulse? Do you feel a vibration (or thrill)? If a valve is partially obstructed, you may detect this. If you notice a murmur during auscultation, then check again for a thrill. After auscultating the apex, it is important to listen to the following areas with your stethoscope: The left side of the patient's sternum, at the bottom (in the 5th intercostal space). This is the best place to auscultate the tricuspid valve. The left side of the patient's sternum, near the top (in the 2nd intercostal space). This is the best place to auscultate the pulmonic valve. The right side of the patient's sternum, near the top (in the 2nd intercostal space). This is the best place to auscultate the aortic valve. Note that listening to the heart's apex is the best spot to assess the mitral valve. The bell is the auscultatory part of the stethoscope with the smaller circumference and concave surface. It is sensitive to abnormal heart sounds called murmurs. The bell should be applied lightly over the skin to increase sensitivity to murmurs. Pinch the sides of the bell with your thumb and index finger. Rest the heel of your hand against the patient's chest to ensure that the bell is placed lightly. The bell should create an air-tight seal with the skin to easily hear abnormal heart sounds. This position amplifies the apex's heart sounds. Place the bell lightly on the apex and listen for murmurs. Ask the patient to sit up, lean forward, exhale completely and suspend breathing. This maneuver accentuates murmurs. Both of these maneuvers are "specialty techniques" used to better assess for any heart pathology or murmurs. Do not discuss your physical examination findings with the patient still undressed.

Problem: Write an article based on this summary: Recline in different positions for postural drainage. Breathe deeply from your stomach while draining your lungs. Tap on your chest and back to loosen up phlegm. Practice controlled coughing.

Answer: Lying in a variety of poses will help loosen phlegm and allow you to cough up mucous. First, lie on your back and prop pillows under you to elevate your hips. Then, lay on your right side with 2 pillows under your right hip. Rotate, and lay on your left side with 2 pillows under your left hip. Finally, lay on your stomach with 2 pillows under your hips. Stay in each position for 510 minutes. The medical term "postural drainage" simply means adjusting the position of your body so that phlegm can drain from your lungs. While reclining in each position for postural drainage, breathe by expanding your stomach. Rather than focusing on breathing high in your chest (which may cause a coughing fit), focus on breathing low in your stomach. This will help the phlegm drain from your lungs. Press out your stomach as far as it will go, and then imagine that you're trying to fill that entire space with air when you inhale. The medical term for this type of breathing is "belly breathing" or "diaphragmatic breathing." If the postural draining doesn't loosen up your phlegm, you may need to physically loosen up the congestion. Cup one of your hands and tap your chest and back with about as much force as you'd use to crack an egg. Avoid tapping directly on your sternum or on your spine. You may need to ask a friend or family member to help you tap hard-to-reach parts of your chest and back. As you tap your chest and recline for postural drainage, phlegm and mucous will begin to loosen in your lungs. To cough up phlegm, sit down and lean slightly forward in a chair. Fold your arms over your stomach, and lean forward. As you press down on your stomach, cough 2 or 3 times. Pause for a few seconds, and then repeat. As the phlegm comes up from your lungs, spit it out into a tissue, trash can, or other nearby receptacle. Practice controlled coughing to avoid coughing fits, which often cause your trachea and other airways to constrict.

Problem: Write an article based on this summary: Arrange your pancakes on a plate. Give Santa some eyes. Add a nose. Go the extra mile with detail.

Answer:
If you're using only one pancake per plate in order to make Santa's head, set your pancake closer to one edge. Leave yourself plenty of room up top to create a large hat to fill your plate. If using two pancakes for a head and body respectively, do the same and place Santa's feet as close to one edge as possible. For each pancake, set two chocolate chips where his eyes would be. Or, to make them stand out even more (and to add more flavor and vitamins to your meal), slice up a banana. Lay out a slice for each eye first, then top each with a chip. If you trimmed a second pancake down to make Santa's body, you could also cut two circles out of that and set the chips on top of those instead of bananas. Use your favorite red fruit to add some color to his face. Trim a strawberry into a nose shape and set in between his eyes. Center a fresh raspberry or cherry in his face. Or, instead of fresh fruit, scoop out whole chunks from pie filling and use those. Again, if you have excess left from cutting an outline of Santa's body, you could also use these to shape a nose if fruit isn't your thing. Use more banana slices or scrap pieces of pancake to shape ears on either side of his head. Load a liquid dropper with compote or red food coloring and give each cheek a drop of red to give Santa a blush from the wintry cold. Melt some extra chocolate chips and then draw a mouth, eyebrows, wrinkles, dimples, and/or laugh-lines with a toothpick. If you created a body, too, use a food brush to paint his boots, belt, and/or gloves with the chocolate while it's still melted.