Assisting with General Physical Examination

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38

• Assisting 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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Learning Outcomes (cont.)

• 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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Learning Outcomes (cont.)

• 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 patients overall state of health or to
diagnose a medical problem.
Excellent!
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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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Apply Your Knowledge

• 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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Safety Precautions (cont.)

• 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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Safety Precautions (cont.)

• 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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Apply Your Knowledge
Impressive!
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.
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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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Apply Your Knowledge

• What can you do to elicit the patients
  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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Positioning and Draping (cont.)

• Supine/recumbent
• Dorsal recumbent

• Sitting
• Symmetry

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Positioning and Draping (cont.)

• Lithotomy

• Fowlers

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Positioning and Draping (cont.)

• Prone

• Sims

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Positioning and Draping (cont.)

• Knee-Elbow
• Fenestrated drape

• Proctologic

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Apply Your Knowledge
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.
Very Good!
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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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Apply Your Knowledge

• 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.

SUPER!
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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.)

• Manipulation
• Systemic moving of a patients body parts
• Check for abnormalities
• Determine range of motion of joints

• Mensuration process of measuring

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Apply Your Knowledge
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 Jimmys 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 patients comfort
• Protect the patients modesty

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Components of the General Physical Examination
(cont.)

• 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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Components of the General Physical Examination
(cont.)

• 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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Components of the General Physical Examination
(cont.)

• 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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Components of the General Physical Examination
(cont.)

• 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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Components of the General Physical Examination
(cont.)

• Heart
• Percussion size of heart
• Auscultation
• Heart sounds
• Rate, rhythm, intensity, and pitch

• Breasts
• Inspection
• Palpation
• Lymph nodes
• Breasts

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Components of the General Physical Examination
(cont.)

• Abdomen
• Inspection
• Auscultation
• Percussion
• Palpation

• Findings described using system of landmarks

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Components of the General Physical Examination
(cont.)

• Female genitalia
• Lithotomy position
• Assist to relax

• Male genitalia
• Inspection
• Penis and scrotum
• Groin
• Palpation
• Penis and scrotum
• Lymph nodes

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Components of the General Physical Examination
(cont.)

• Rectum
• Palpation using a digital exam
• Lesions or abnormalities
• Occult blood

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Components of the General Physical Examination
(cont.)

• Musculoskeletal system
• Posture scoliosis
• Gait
• Range of motion

• Muscle strength
• Body measurements
• Lesions, deformities, or circulatory problems

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Components of the General Physical Examination
(cont.)

• 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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Apply Your Knowledge
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.
Good Job!
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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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Apply Your Knowledge
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 patients 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,
  Fowlers, 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 patients 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