38 1 Purpose of General Physical Examination o

38 -1 Purpose of General Physical Examination o To confirm an overall state of health n o Baseline values for vital signs To diagnose a medical problem n Usually focuses on organ system based on patient’s chief complaint © 2009 The Mc. Graw-Hill Companies, Inc. All rights reserved

38 -2 Purpose of General Physical Examination (cont. ) o Clinical diagnosis n Based on signs and symptoms of a disease o o n Sign – objective information that can be detected Symptom – subjective information from the patient Laboratory and diagnostic tests o o Confirm clinical diagnosis Aid in forming differential diagnosis Aid in developing a prognosis Formulate a treatment plan and/or drug therapy © 2009 The Mc. Graw-Hill Companies, Inc. All rights reserved

38 -3 Preparing the Patient for an Examination o Emotional – explain exactly what will occur o Physical – offer the bathroom and instruct the patient on how to disrobe and don a exam gown o Positioning and draping – help patient assume needed exam position and drape to provide privacy © 2009 The Mc. Graw-Hill Companies, Inc. All rights reserved

38 -4 Preparing the Patient for an Examination: Positioning and Draping o Positions facilitate physician’s examination n Assist the patient to appropriate position n Make as comfortable as possible n Cover with appropriate drape o Keep patient warm o Maintain privacy / modesty © 2009 The Mc. Graw-Hill Companies, Inc. All rights reserved

38 -5 Preparing the Patient for an Examination: Positioning and Draping (cont. ) o Positions n n n n Sitting Supine / recumbent Dorsal recumbent Lithotomy Trendelenburg’s Fowler’s Prone n n n Sims’ Knee-chest Proctologic © 2009 The Mc. Graw-Hill Companies, Inc. All rights reserved

38 -6 Preparing the Patient for an Examination: Positioning and Draping (cont. ) o Sitting o Supine / Recumbent o Dorsal recumbent © 2009 The Mc. Graw-Hill Companies, Inc. All rights reserved

38 -7 Preparing the Patient for an Examination: Positioning and Draping (cont. ) o Lithotomy o Fowler’s o Trendelenburg’s o Prone © 2009 The Mc. Graw-Hill Companies, Inc. All rights reserved

38 -8 Preparing the Patient for an Examination: Positioning and Draping (cont. ) o Sims’ o Knee-Chest o Proctologic © 2009 The Mc. Graw-Hill Companies, Inc. All rights reserved

38 -9 Examination Methods o Inspection o Palpation n Visual examination n n Assesses posture, mannerisms, and hygiene Touch texture, temperature, shape n Size, shape, color, position, symmetry Presence of vibration or movements n Superficial or with additional pressure n n Presence of abnormalities © 2009 The Mc. Graw-Hill Companies, Inc. All rights reserved

38 -10 Examination Methods (cont. ) o Percussion n n Tapping and striking the body to hear sounds or feel vibrations Determine location, size, or density of structure or organ o Auscultation n Listening to body sounds n Assess sounds from heart, lungs, and abdominal organs © 2009 The Mc. Graw-Hill Companies, Inc. All rights reserved

38 -11 Examination Methods (cont. ) o Mensuration n Measuring n Height and weight n Length or diameter of extremity n Growth of uterus during pregnancy o Manipulation n Systemic moving of a patient’s body parts n Range of motion of joints © 2009 The Mc. Graw-Hill Companies, Inc. All rights reserved

38 -12 Components of the General Physical Examination o Overall appearance and the condition of skin, nails, and hair o The body n n Head, neck, eyes, ears, nose and sinuses, mouth, and throat Chest and lungs, heart, breasts Abdomen, genitalia, and rectum Musculoskeletal and neurological systems © 2009 The Mc. Graw-Hill Companies, Inc. All rights reserved

38 -13 Components of the General Physical Examination (cont. ) o General appearance o Head n Skin – a good indicator of overall health n Abnormal condition of scalp or skin n Nails and nail beds n Puffiness n Hair – pattern of growth and texture n Abnormal growths © 2009 The Mc. Graw-Hill Companies, Inc. All rights reserved

38 -14 Components of the General Physical Examination (cont. ) o Neck n n Lymph nodes, thyroid glands, and major blood vessels Symmetry and range of motion o Eyes n The presence of disease or abnormalities n Pupils for light response n Muscles n Internal structures © 2009 The Mc. Graw-Hill Companies, Inc. All rights reserved

38 -15 Components of the General Physical Examination (cont. ) o Ears n Outer ear o o n o Symmetry and size Presence of lesions, redness, or swelling Inner ear structures o o Canals Eardrums Nose and sinuses n Nasal mucosa n Structures of nose n Palpation to check for tenderness in sinuses © 2009 The Mc. Graw-Hill Companies, Inc. All rights reserved

38 -16 Components of the General Physical Examination (cont. ) o Mouth and throat n Mouth – impression of overall health and hygiene o Chest and lungs n Inspection o o o n Throat o o Common site of infection Tonsils – swelling or redness Symmetry in expansion Shape Posture position n Palpation – fluid or foreign mass in lungs n Auscultation – listen for abnormalities © 2009 The Mc. Graw-Hill Companies, Inc. All rights reserved

38 -17 Components of the General Physical Examination (cont. ) o Heart and vascular system n n Percussion – size of heart Auscultation o o n Heart sounds Rate, rhythm, intensity and pitch Pulses o Breasts n o Palpation for abnormalities Abdomen n n Inspection Auscultation Percussion Palpation © 2009 The Mc. Graw-Hill Companies, Inc. All rights reserved

38 -18 Components of the General Physical Examination (cont. ) o Musculoskeletal system n n n Posture Gait Range of motion Muscle strength Body measurements Development and coordination in children o Neurological system n n n Reflexes Mental and emotional status Sensory and motor functions Intellectual assessment in children Mental status and memory in elderly © 2009 The Mc. Graw-Hill Companies, Inc. All rights reserved

38 -19 Completing the Examination o Assist patient to a sitting position o Allow the patient to perform any necessary self-hygiene measures o Additional tests or procedures © 2009 The Mc. Graw-Hill Companies, Inc. All rights reserved

38 -20 Completing the Examination (cont. ) o Patient education n n Assess needs Topics o o o n n n Risk factors for disease Medication administration Self-help or diagnostic techniques Do not talk down to patient Ensure understanding Give written instructions © 2009 The Mc. Graw-Hill Companies, Inc. All rights reserved

38 -21 Completing the Examination (cont. ) o Special problems of the elderly n Greater need for patient education n Common problems: n o Incontinence o Depression o Lack of information on preventive medicines o Lack of compliance when taking medications Involve family members when possible © 2009 The Mc. Graw-Hill Companies, Inc. All rights reserved

38 -22 In Summary o General physical examination n n o Provides information about patient’s overall health status Assists the physician in making a diagnosis, prognosis, and treatment plan Medical assistant n n Addresses the comfort, privacy, and education needs of the patient Anticipates the needs of the physician during the examination © 2009 The Mc. Graw-Hill Companies, Inc. All rights reserved