38 Assisting with a General Physical Examination

(1)

CHAPTER

38

Assisting with a

General Physical

Examination

38-2

Learning Outcomes

38.1 Identify the purpose of a general physical

examination.

38.2 Describe the role of the medical assistant in

a general physical examination.

38.3 Explain safety precautions used during a

general physical examination.

38.4 Carry out the steps necessary to prepare the

patient for an examination.

38-3

Learning Outcomes

(cont.)

38.5 Describe how to position and drape a patient in

each of the ten common examination positions.

38.6 Describe how to assist patients from different

cultures, patients with disabilities, and pediatric

patients during a physical examination.

38.7 Identify the six examination methods used in a

general physical examination.

38.8 List the components of a general physical

examination.

38-4

Learning Outcomes

(cont.)

38.9 Perform the procedures for vision

screenings.

38.10 Perform the procedures for hearing

screenings.

38.11 Explain the special needs of the elderly for

patient education.

38.12 Identify ways to help a patient follow up on a

doctor’s recommendations.

38-5

Introduction

• You must make the

client comfortable

and assist the

physician during

the physical

examination

• Physical

examination is the

first step in the

process for 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

Purpose of General Physical Examination

• To confirm an overall

state of health

• To diagnose a

medical problem

– Focuses on an organ system – Based on patient’s chief complaint

(2)

38-7

Purpose of General Physical Examination

(cont.)

• Clinical diagnosis

– Based on signs and symptoms of a disease

• Sign – objective information that can be detected • Symptom – subjective information from the patient

– Laboratory and diagnostic tests

• Confirm clinical diagnosis

• Aid in forming differential diagnosis

• Aid in developing a prognosis

• Formulate a treatment plan and/or drug therapy

38-8

Role of Medical Assistant

• Enable the doctor to

perform an effective

examination

• Contribute to patient

confidence in care

– Physical and emotional comfort

• Tasks

– Interview – Write an accurate history

– Determine vital signs and measure weight and height – Assist with examination

Your responsibilities include ensuring that all instruments and supplies are readily available to the doctor during the examination.

38-9

Apply Your Knowledge

What are two purposes for a general physical examination? Describe the role the medical assistant plays in this exam.

ANSWER: A physical examination is used to confirm the patient’s overall state of health or to diagnose a medical problem. The medical assistant’s role includes putting the patient at ease, performing the initial interview, documenting the patient history, taking vital signs and body measurements, assisting the physician in the exam, and making sure instruments and supplies are available for the exam.

38-10

Safety Precautions

• Occupational Safety and Health

Administration (OSHA) standards and

guidelines

– Protect employee

– Make workplace safe

• Centers for Disease Control and

Prevention (CDC) guidelines

– Protect patients and health-care workers

38-11

Safety Precautions

(cont.)

1. Hand washing

– Before and after each patient contact

– Before and after each procedure

2. Wear gloves if there is probability of

contact with

– Blood



Nonintact skin

– Body fluids



Moist surfaces

38-12

Safety Precautions

(cont.)

3. Wear a mask if there is any possibility of

exposure to an infectious disease transmitted

by airborne droplets

4. Respiratory hygiene/cough

etiquette

5. Isolation precautions

– Personal protective equipment

– Keep patients with possible infections separated from other patients

(3)

38-13

Safety Precautions

(cont.)

6. Discard all disposable equipment and

supplies appropriately

7. Clean and disinfect the exam

room after each patient

8. Sanitize, disinfect, and sterilize

equipment appropriately

38-14

Apply Your Knowledge

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 most likely has chickenpox. She and her mother should be moved away from other patients in the waiting room to a private area. Since chickenpox is 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 !

38-15

Preparing the Patient for an Examination

• Emotional – explain exactly what will occur

• Physical – offer the bathroom and instruct

the patient on how to disrobe and don an

exam gown

• Positioning and draping – help patient

assume needed exam position and drape

to provide privacy

38-16

Positioning and Draping

• Positions facilitate physician’s examination

– Assist the patient to appropriate position

– Make as comfortable as possible

– Cover with appropriate drape

• Keep patient warm • Maintain privacy/modesty

38-17

Positioning and Draping

(cont.)

•

Positions

– Sitting

– Supine

(recumbent)

– Dorsal recumbent

– Lithotomy

– Trendelenburg’s

– Fowler’s

– Prone

– Sims’

– Knee-chest

– Proctologic

38-18

Positioning and Draping

(cont.)

• Sitting

• Supine/recumbent

(4)

38-19

Positioning and Draping

(cont.)

• Lithotomy

• Trendelenburg’s

• Fowler’s

• Prone

38-20

Positioning and Draping

(cont.)

• Sims’

• Knee-Chest

• Proctologic

38-21

Special Considerations

• Patients from different

cultures

– Avoid stereotyping

– Avoid making judgments

• Patients with disabilities

– Provide extra assistance

as needed

– Ask for assistance with

patient transfers

38-22

Special Considerations

(cont.)

•

Children

– Modify techniques based on age and ability – Emotional

• Involve child in the examination

• Approach infants and toddlers slowly, with a smile and gentle voice

• Perform procedures quickly

– Physical

• Examination position based on age and ability • Examine painful areas and genitalia of older

children last

38-23

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.

38-24

Examination Methods

• Inspection

– Visual examination – Assesses posture, mannerisms, and hygiene – Size, shape, color,

position, symmetry – Presence of abnormalities

• Palpation

– Touch texture, temperature, shape – Presence of vibration or movements – Superficial or with additional pressure

(5)

38-25

Examination Methods

(cont.)

• Percussion

– Tapping and striking

the body to hear sounds or feel vibrations – Determine location, size, or density of structure or organ

• Auscultation

– Listening to body sounds

– Assess sounds from heart, lungs, and abdominal organs

38-26

Examination Methods

(cont.)

• Manipulation

– Systemic moving of a

patient’s body parts – Range of motion of

joints

• Mensuration

– Measuring – Height and weight – Length or diameter of

extremity – Growth of uterus

during pregnancy

38-27

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 Jimmy’s abdomen, palpation to feel for any abnormalities, percussion to determine if there is fluid or air in the abdomen, and auscultation to assess bowel sounds. The medical assistant may be asked to measure the abdominal girth.

Bravo!

38-28

Components of the General Physical

Examination

• Overall appearance and the condition of

skin, nails, and hair

• The body

– Head, neck, eyes, ears, nose and sinuses,

mouth, and throat

– Chest and lungs, heart, breasts

– Abdomen, genitalia, and rectum

– Musculoskeletal and neurological systems

38-29

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

Can you name these pieces of examination equipment?

38-30

Components of the General Physical

Examination

(cont.)

• General appearance

– Skin – a good indicator

of overall health – Nails and nail beds – Hair – pattern of

growth and texture

• Head

– Abnormal condition of scalp or skin – Puffiness – Abnormal growths

(6)

38-31

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

38-32

Components of the General Physical

Examination

(cont.)

• Ears

– Outer ear

• Symmetry and size • Presence of lesions,

redness, or swelling

– Inner ear structures

• Canals • Eardrums

• Nose and sinuses

– Nasal mucosa

– Structures of nose – Palpation to check for

tenderness in sinuses

38-33

Components of the General Physical

Examination

(cont.)

• Mouth and throat

– Mouth – impression of

overall health and hygiene – Throat • Common site of infection • Tonsils – swelling or redness

• Chest and lungs

– Inspection

• Symmetry in expansion • Shape

• Posture position

– Palpation – fluid or foreign mass in lungs – Auscultation – listen

for abnormalities

38-34

Components of the General Physical

Examination

(cont.)

• Heart and vascular

system

– Percussion – size of heart

– Auscultation

• Heart sounds • Rate, rhythm, intensity,

and pitch – Pulses

• Breasts

– Palpation for abnormalities

• Abdomen

– Inspection – Auscultation – Percussion – Palpation 38-35

Components of the General Physical

Examination

(cont.)

• Genitalia

– Female – lithotomy position

– Male

• Supine position then standing • Infection, structural

abnormalities, lumps

– An assistant of same sex as patient must be in the room during

• Rectum

– Usually performed following exam of genitalia – Lesions or abnormalities – Occult blood 38-36

Components of the General Physical

Examination

(cont.)

• Musculoskeletal

system

– Posture – Gait – Range of motion – Muscle strength – Body measurements – Development and coordination in children

• Neurological system

– Reflexes

– Mental and emotional status

– Sensory and motor functions – Intellectual

assessment in children – Mental status and

(7)

38-37

Apply Your Knowledge

What is the medical assistant’s role in a general

physical examination?

ANSWER: The medical assistant should be familiar with the components of the examination, know equipment and supplies used, ensure the patient’s comfort, and protect the patient’s modesty.

38-38

Completing the Examination

• Assist patient to a sitting

position

• Allow the patient to

perform any necessary

self-hygiene measures

• Perform additional tests

or procedures

38-39

Completing the Examination

(cont.)

• Screening for visual acuity

– Snellen chart – distance

– Jaegar chart – near vision

– Ishihara book – color vision

– Special considerations

• Children

• Patients with dementia or Alzheimer’s

disease

• Auditory acuity – audiometer

38-40

Completing the Examination

(cont.)

• Patient education

– Assess needs

– Topics

• Risk factors for disease

• Medication administration

• Self-help or diagnostic techniques

– Do not talk down to patient

– Ensure understanding

– Give written instructions

38-41

Completing the Examination

(cont.)

• Special problems of the elderly

– Greater need for patient education

– Common problems:

• Incontinence • Depression

• Lack of information on preventive medicines • Poor patient compliance when taking

medications

– Involve family members when possible

38-42

Completing the Examination

(cont.)

• Follow-up

– Scheduling the patient for future visits

– Making outside appointments for diagnostic

tests

– Helping the patient and patient’s family plan

for home nursing care

– Helping the patient obtain help from

community or social services

(8)

38-43

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!

38-44

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.

38-45

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.

38.4 The medical assistant should prepare the patient for an exam emotionally, by using simple, direct language; physically, by providing for the patient’s comfort and privacy and by positioning him or her according to the type of exam or procedure; and by modifying techniques to meet the needs of special patients.

38-46

In Summary

(cont.)

38.5 The ten common exam positions include sitting, supine, dorsal recumbent, lithotomy, Trendelenburg, 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.

38-47

In Summary

(cont.)

38.7 Assist patients with physical disabilities with transfers and other tasks they cannot accomplish themselves. 38.8 Involve the child in the exam process and assist him

based upon his age and ability to cooperate.

38-48

In Summary

(cont.)

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

38.10 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.

(9)

38-49

In Summary

(cont.)

38.11 Vision screening procedures include using the Snellen chart for distance visual acuity, the Jaegar chart for screening for near vision, and the Ishihara book for color vision screening.

38.12 An auditory acuity test is done before or after the exam using some type of audiometer.

38-50

In Summary

(cont.)

38.13 Patient education for the elderly requires ensuring compliance when taking medications, providing preventative medicine education tools, and recognizing problems related to incontinence and depression.

38.14 In order to assist the patient with follow-up after his or her 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.