CHAPTER 38 Assisting with General Physical Examination.

CHAPTER

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38Assisting with

General Physical Examination

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Learning Outcomes (cont.)

38.1 Identify the purpose of a general physical exam.

38.2 Describe the role of the medical assistant in a general physical exam.

38.3 Explain safety precautions used during a general physical exam.

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38.4 Carry out the steps necessary to prepare the patient for an exam.

38.5 Carry out positioning and draping a patient in each of the nine common exam positions.

38.6 Apply techniques to assist patients from different cultures and patients with physical disabilities.

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38.7 Identify the six examination methods used in a general physical exam.

38.8 List the components of a general physical exam.

38.9 Describe follow-up steps after a general physical exam.

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Introduction

• Physical examination – 1st step in the diagnosis or treatment process

• The medical assistant– Make the client

comfortable – Assist the

physician

A skilled medical assistant can create an atmosphere that results in a positive outcome

for the patient during the physical examination.

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The Purpose of General Physical Exam

• To confirm an overall state of health and provide baseline values

• To diagnose a medical problem

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The Purpose of General Physical Exam (cont.)

• Clinical diagnosis– Sign ~ objective

– Symptom ~ subjective

• Laboratory and diagnostic tests– Confirm clinical diagnosis

– Help determine the differential diagnosis and prognosis

– Formulation of treatment plan

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Apply Your Knowledge

Why does the physician perform a general physical examination?

ANSWER: A physical examination is used to confirm the patient’s overall state of health or to diagnose a medical problem.

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The Role of Medical Assistant

• To assist the licensed practitioner and the patient

• Begins prior to the physical exam– Interview

– Write an accurate history

– Determine vital signs

– Measure weight and height

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The Role of Medical Assistant (cont.)

• Responsibilities – Ensuring instruments and

supplies are available

– Ensuring patient comfort• Helping into position

• Keeping them informed

• Observing them for distress or need for assistance

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What are your responsibilities when assisting with a general physical exam?

ANSWER: Ensuring all supplies and instruments are available for the physician and making sure the patient is comfortable by•Helping the patient into position•Telling them what will happen•Observing the patient for signs of distress or need for assistance.

Hooray!

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Safety Precautions

• OSHA standards and guidelines– Protect employees– Make the workplace safe

• CDC guidelines – protect patients and health-care workers

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Safety Precautions (cont.)

• Aseptic hand washing– Before and after each

patient contact– Before and after each

procedure

• Wear gloves if there may be contact with– Blood – Nonintact skin– Body fluids – Moist surfaces– Also when handling specimens

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• Respiratory hygiene/cough etiquette

• Wear a mask to prevent exposure to an infectious disease transmitted by airborne droplets

• Isolation precautions – personal protective equipment

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• Discard all disposable equipment and supplies appropriately

• Clean and disinfect the exam room after each patient

• Sanitize, disinfect, and sterilize equipment appropriately

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Mrs. Jefferson brings her daughter, Laura, to the office because of what she describes as an upper respiratory infection. Laura is coughing and the medical assistant notices a blister-like rash on her arms. What actions should the medical assistant take?

ANSWER: Laura and her mother should be moved away from other patients in the waiting room to a private area. Since she is coughing and could have an infection spread by droplet, the medical assistant and physician should wear a mask and gloves when in the room. In addition, the room should be cleaned and sanitized following the appointment.

Impressive!

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Preparing the Patient for an Exam

• Emotional preparation– Explain exactly what will occur and what they

will feel

– Use simple direct language

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Preparing the Patient for an Exam

• Physical – Offer the bathroom

– Ask the patient to disrobe and put on an exam gown or cover with a drape

– Be aware of modesty and comfort

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What can you do to elicit the patient’s cooperation during a physical exam?

ANSWER: Explain what she can expect to happen during the examination and that her cooperation will help the exam proceed smoothly.

Way to go!

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Positioning and Draping

• Proper patient position facilitates the examination

– Assist the patient to appropriate position

– Make as comfortable as possible

– Cover with appropriate drape

• Keep patient warm

• Maintain privacy/modesty

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• Supine/recumbent

• Dorsal recumbent

Positioning and Draping (cont.)

• Sitting– Symmetry

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• Lithotomy


• Fowler’s

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• Prone • Sims’

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• Knee-Elbow– Fenestrated drape

• Proctologic

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An elderly female patient needs her lower abdomen and genitalia examined by the physician. What would be the best position to place her in and why?

ANSWER: The dorsal recumbent position is recommended over the lithotomy position because an elderly patient may have difficulty placing her legs in stirrups.

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Special Patient Considerations

• Patients from different cultures – Avoid stereotyping and making judgments

– Patients • May not know what to expect

• May require more privacy

• May refuse a specific exam

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Special Patient Considerations

• Patients with disabilities – provide assistance as needed– Disrobing

– Moving to exam table

– Assuming exam position

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Why is it important to avoid stereotyping when caring for patients from other cultures?

ANSWER: This can lead to making incorrect judgment that may influence the care you provide the patient.

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Examination Methods

• Inspection

– Visual exam

– Posture, mannerisms, and hygiene

– Size, shape, color, position, symmetry

– Presence of abnormalities

• Auscultation – Listening to body

sounds using a stethoscope

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Examination Methods (cont.)

• Palpation– Touch

– Assess texture, temperature, shape

– Presence of vibration or movements

• Percussion – Tapping or striking

the body to hear sounds or feel vibrations

– Used to determine location, size, or density of structure or organ

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Examination Methods (cont.)

• Mensuration – process of measuring

• Manipulation – Systemic moving of

a patient’s body parts

– Check for abnormalities

– Determine range of motion of joints

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Jimmy Jones is complaining of abdominal pain. What types of examination methods will the physician most likely use to assess this complaint?

ANSWER: The physician will use inspection to determine if there are any visual abnormalities of Jimmy’s abdomen, palpation to feel for any abnormalities, percussion to assess for vibrations, and auscultation to assess bowel sounds. The medical assistant may be asked to measure the abdominal girth.

Ole!

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Components of the General Physical Examination

• Exams – performed in a certain order– General appearance

– Specific body sections

• Become familiar with the standard order for performing an exam

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Components of the General Physical Examination (cont.)

• Medical assistant– Be familiar with the

components of the examination

– Know equipment and supplies used

– Ensure the patient’s comfort

– Protect the patient’s modesty

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• General appearance– General state of

heath

– Distress or pain

– Skin

– Nails and nail beds

– Hair

• Head – Abnormal

condition of scalp or skin

– Puffiness

– Abnormal growths

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• Neck – Lymph nodes,

thyroid glands, and major blood vessels

– Symmetry and range of motion

• Eyes – The presence of

disease or abnormalities

– Pupils for light response

– Muscles

– Internal structures

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• Ears – Outer ear

• Symmetry and size• Lesions, redness,

or swelling

– Inner ear structures• Canals • Eardrums

• Nose and sinuses– Infection or allergy

– Nasal mucosa

– Tenderness in sinuses

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• Mouth and throat– Mouth ~ overall

health and hygiene

– Throat ~ swelling or redness

• Chest and lungs – Hyperventilation

– Inspection

– Auscultation

– Palpation and percussion

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• Heart – Percussion – size

of heart

– Auscultation• Heart sounds• Rate, rhythm,

intensity, and pitch

• Breasts– Inspection

– Palpation• Lymph nodes

• Breasts

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• Abdomen – Inspection

– Auscultation

– Percussion

– Palpation

– Findings described using system of landmarks

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• Female genitalia

– Lithotomy position

– Assist to relax

• Male genitalia – Inspection

• Penis and scrotum • Groin

– Palpation • Penis and scrotum• Lymph nodes

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• Rectum

– Palpation using a digital exam

• Lesions or abnormalities

• Occult blood

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• Musculoskeletal system– Posture ~ scoliosis

– Gait

– Range of motion

– Muscle strength

– Body measurements

– Lesions, deformities, or circulatory problems

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• Neurological system– Reflexes

– Mental and emotional status

– Sensory and motor functions

– Intellectual assessment in children

– Mental status and memory in elderly

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In what order should the physician perform an abdominal examination and why?

ANSWER: The physician will inspect, auscultate, percuss, and palpate the abdomen. Auscultation should be done before percussion or palpation to avoid altering the bowel sounds.

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After the Examination

• Assist patient to a sitting position

• Allow the patient to perform any necessary self-hygiene measures

• Allow patient to dress

• Perform additional tests or procedures

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Additional Tests and Procedures

• Prior to dressing– Cold and heat therapy

– Applying bandages

– Collecting specimens

Some medications should be administered before the patient dresses while others can

be given after he is dressed.

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Additional Tests and Procedures

• After dressing– Urine reagent strip tests

– Pulmonary function tests

– Eye or ear irrigation or medication administration

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Patient Education

• Assess needs – Risk factors for disease– Medication administration– Self-help or diagnostic techniques

• Use proper language level

• Ensure understanding

• Give written instructions

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Follow-Up

• Scheduling appointments– Future office visits– Outside appointments

• Helping plan for home nursing care

• Helping the patient obtain assistance

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What is important to remember when providing patient education?

ANSWER: You should provide information in a way the patient can understand it, but you should not talk down to the patient. In addition, you need to verify that the patient understands what you taught.

Super!

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In Summary

38.1 A general physical exam is done either to confirm an overall state of health or to

examine a patient to diagnose a medical problem.

38.2 The medical assistant assists the patient and physician during an exam. Making the

patient physically and emotionally comfortable, as well as providing materials and assistance to the physician are essential to a successful exam.

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In Summary (cont.)

38.3 During an exam, the medical assistant should perform hand hygiene, wear gloves and other personal protective equipment, ensure respiratory hygiene/cough etiquette, use isolation precautions, dispose of biohazardous waste, and clean and disinfect the exam room as necessary to provide for safety.

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In Summary (cont.)

38.4 The medical assistant should prepare the patient for an exam emotionally, by using simple direct language; and physically, by providing for the patient’s comfort and

privacy when positioning him or her according to the type of exam or procedure, and by modifying techniques to meet the needs of special patients

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In Summary (cont.)

38.5 The nine common exam positions include sitting, supine, dorsal recumbent, lithotomy, Fowler’s, prone, Sims’, knee-chest, and

proctologic.

38.6 When assisting with the physical exam, avoid judging and stereotyping patients from different cultures and obtain a translator for proper communication if necessary. Assist patients who have physical disabilities with transfers and other tasks they cannot accomplish themselves.

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In Summary (cont.)

38.7 The six examination methods used in a general physical exam include inspection, auscultation, palpation, percussion, mensuration, and manipulation.

38.8 A general physical exam typically includes an evaluation of the general appearance, head, neck, eyes, ears, nose and sinuses, mouth and throat, chest and lungs, heart, breasts, abdomen, genitalia, rectum,

musculoskeletal system, and neurological system.

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In Summary (cont.)

38. 9 In order to assist the patient with follow-up after the exam, you may schedule future visits, schedule visits outside of the office, help plan for home care, and, if within your scope of practice, provide education related to the patient’s condition.

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End of Chapter 38

Health is the thing that

makes you feel that now

is the best time of the

year.

~ Franklin P. Adams

CHAPTER 38 Assisting with General Physical Examination.

Documents

exam physical

comfort slide

assistance slide

privacymodesty slide

height slide

symmetry slide

pronesims slide

physical exam interview