CHAPTER 38 Assisting with General Physical Examination 38

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CHAPTER 38 Assisting with General Physical Examination

CHAPTER 38 Assisting with General Physical Examination

38 -2 Learning Outcomes (cont. ) 38. 1 Identify the purpose of a general

38 -2 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.

38 -3 Learning Outcomes (cont. ) 38. 4 Carry out the steps necessary to

38 -3 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.

38 -4 Learning Outcomes (cont. ) 38. 7 Identify the six examination methods used

38 -4 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.

38 -5 Introduction • Physical examination – 1 st step in the diagnosis or

38 -5 Introduction • Physical examination – 1 st 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.

38 -6 The Purpose of General Physical Exam • To confirm an overall state

38 -6 The Purpose of General Physical Exam • To confirm an overall state of health and provide baseline values • To diagnose a medical problem

The Purpose of General Physical Exam (cont. ) • Clinical diagnosis – Sign ~

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 38 -7

38 -8 Apply Your Knowledge Why does the physician perform a general physical examination?

38 -8 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.

38 -9 The Role of Medical Assistant • To assist the licensed practitioner and

38 -9 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

38 -10 The Role of Medical Assistant (cont. ) • Responsibilities – Ensuring instruments

38 -10 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

38 -11 Apply Your Knowledge What are your responsibilities when assisting with a general

38 -11 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!

38 -12 Safety Precautions • OSHA standards and guidelines – Protect employees – Make

38 -12 Safety Precautions • OSHA standards and guidelines – Protect employees – Make the workplace safe • CDC guidelines – protect patients and health-care workers

38 -13 Safety Precautions (cont. ) • Aseptic hand washing – Before and after

38 -13 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

38 -14 Safety Precautions (cont. ) • Respiratory hygiene/cough etiquette • Wear a mask

38 -14 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

38 -15 Safety Precautions (cont. ) • Discard all disposable equipment and supplies appropriately

38 -15 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

38 -16 Apply Your Knowledge Impressive! Mrs. Jefferson brings her daughter, Laura, to the

38 -16 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.

38 -17 Preparing the Patient for an Exam • Emotional preparation – Explain exactly

38 -17 Preparing the Patient for an Exam • Emotional preparation – Explain exactly what will occur and what they will feel – Use simple direct language

38 -18 Preparing the Patient for an Exam • Physical – Offer the bathroom

38 -18 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

38 -19 Apply Your Knowledge What can you do to elicit the patient’s cooperation

38 -19 Apply Your Knowledge 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!

38 -20 Positioning and Draping • Proper patient position facilitates the examination – Assist

38 -20 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

38 -21 Positioning and Draping (cont. ) • Sitting • Supine/recumbent – Symmetry •

38 -21 Positioning and Draping (cont. ) • Sitting • Supine/recumbent – Symmetry • Dorsal recumbent

38 -22 Positioning and Draping (cont. ) • Lithotomy • Fowler’s

38 -22 Positioning and Draping (cont. ) • Lithotomy • Fowler’s

38 -23 Positioning and Draping (cont. ) • Prone • Sims’

38 -23 Positioning and Draping (cont. ) • Prone • Sims’

38 -24 Positioning and Draping (cont. ) • Knee-Elbow – Fenestrated drape • Proctologic

38 -24 Positioning and Draping (cont. ) • Knee-Elbow – Fenestrated drape • Proctologic

38 -25 Apply Your Knowledge An elderly female patient needs her lower abdomen and

38 -25 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.

38 -26 Special Patient Considerations • Patients from different cultures – Avoid stereotyping and

38 -26 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

38 -27 Special Patient Considerations • Patients with disabilities – provide assistance as needed

38 -27 Special Patient Considerations • Patients with disabilities – provide assistance as needed – Disrobing – Moving to exam table – Assuming exam position

38 -28 Apply Your Knowledge Why is it important to avoid stereotyping when caring

38 -28 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!

38 -29 Examination Methods • Inspection – Visual exam – Posture, mannerisms, and hygiene

38 -29 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

38 -30 Examination Methods (cont. ) • Palpation – Touch – Assess texture, temperature,

38 -30 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

38 -31 Examination Methods (cont. ) • Mensuration – process of measuring • Manipulation

38 -31 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

38 -32 Apply Your Knowledge Jimmy Jones is complaining of abdominal pain. What types

38 -32 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 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!

Components of the General Physical Examination • Exams – performed in a certain order

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 38 -33

Components of the General Physical Examination (cont. ) • Medical assistant – Be familiar

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 38 -34

Components of the General Physical Examination (cont. ) • General appearance • Head –

Components of the General Physical Examination (cont. ) • General appearance • Head – General state of heath – Distress or pain – Skin – Nails and nail beds – Hair – Abnormal condition of scalp or skin – Puffiness – Abnormal growths 38 -35

Components of the General Physical Examination (cont. ) • Neck – Lymph nodes, thyroid

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 38 -36

38 -37 Components of the General Physical Examination (cont. ) • Ears – Outer

38 -37 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

Components of the General Physical Examination (cont. ) • Mouth and throat – Mouth

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 38 -38

Components of the General Physical Examination (cont. ) • Heart – Percussion – size

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 38 -39

Components of the General Physical Examination (cont. ) • Abdomen – Inspection – Auscultation

Components of the General Physical Examination (cont. ) • Abdomen – Inspection – Auscultation – Percussion – Palpation – Findings described using system of landmarks 38 -40

Components of the General Physical Examination (cont. ) • Female genitalia – Lithotomy position

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 38 -41

Components of the General Physical Examination (cont. ) • Rectum – Palpation using a

Components of the General Physical Examination (cont. ) • Rectum – Palpation using a digital exam • Lesions or abnormalities • Occult blood 38 -42

Components of the General Physical Examination (cont. ) • Musculoskeletal system – Posture ~

Components of the General Physical Examination (cont. ) • Musculoskeletal system – Posture ~ scoliosis – Muscle strength – Gait – Body measurements – Range of motion – Lesions, deformities, or circulatory problems 38 -43

Components of the General Physical Examination (cont. ) • Neurological system – Reflexes –

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 38 -44

38 -45 Apply Your Knowledge In what order should the physician perform an abdominal

38 -45 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.

38 -46 After the Examination • Assist patient to a sitting position • Allow

38 -46 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

38 -47 Additional Tests and Procedures • Prior to dressing – Cold and heat

38 -47 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.

38 -48 Additional Tests and Procedures • After dressing – Urine reagent strip tests

38 -48 Additional Tests and Procedures • After dressing – Urine reagent strip tests – Pulmonary function tests – Eye or ear irrigation or medication administration

38 -49 Patient Education • Assess needs – Risk factors for disease – Medication

38 -49 Patient Education • Assess needs – Risk factors for disease – Medication administration – Self-help or diagnostic techniques • Use proper language level • Ensure understanding • Give written instructions

38 -50 Follow-Up • Scheduling appointments – Future office visits – Outside appointments •

38 -50 Follow-Up • Scheduling appointments – Future office visits – Outside appointments • Helping plan for home nursing care • Helping the patient obtain assistance

38 -51 Apply Your Knowledge What is important to remember when providing patient education?

38 -51 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!

38 -52 In Summary 38. 1 A general physical exam is done either to

38 -52 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.

38 -53 In Summary (cont. ) 38. 3 During an exam, the medical assistant

38 -53 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.

38 -54 In Summary (cont. ) 38. 4 The medical assistant should prepare the

38 -54 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

38 -55 In Summary (cont. ) 38. 5 The nine common exam positions include

38 -55 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.

38 -56 In Summary (cont. ) 38. 7 The six examination methods used in

38 -56 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.

38 -57 In Summary (cont. ) 38. 9 In order to assist the patient

38 -57 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.

38 -58 End of Chapter 38 Health is the thing that makes you feel

38 -58 End of Chapter 38 Health is the thing that makes you feel that now is the best time of the year. ~ Franklin P. Adams