Transcript CH. 20 PPT File - Northwest ISD Moodle

Chapter 20:Chapter XX:
Chapter Title
Assisting with the Physical
Examination
Learning Outcomes
 Cognitive Domain
Note: AAMA/CAAHEP 2015 Standards are italicized.
 1. Spell and define the key terms
 2. Identify and state the use of the basic and specialized
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instruments and supplies used in the physical examination
3. Describe the four methods used to examine the patient
4. State your responsibilities before, during, and after the physical
examination
5. List the basic sequence of the physical examination
6. Describe the normal function of each body system
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Learning Outcomes (cont'd.)
 Psychomotor Domain
Note: AAMA/CAAHEP 2015 Standards are italicized.
 1. Assist with the adult physical examination (Procedure 20-1)
 2. Assist provider with a patient exam
 3. Coach patients appropriately considering cultural diversity,
developmental life stages, and communication barriers
 4. Document accurately in the patient record
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Learning Outcomes (cont'd.)
 Affective Domain
Note: AAMA/CAAHEP 2015 Standards are italicized.
 1. Incorporate critical thinking skills in performing patient
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assessment
2. Show awareness of a patient’s concerns related to
procedure being performed
3. Explain to a patient the rationale for performance of a
procedure
4. Demonstrate empathy, active listening, and nonverbal
communication
5. Demonstrate respect for individual diversity, incorporating
awareness of one’s own biases in areas including gender,
race, religion, age, and economic status
6. Protect the integrity of the medical record
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Learning Outcomes (cont'd.)
 ABHES Competencies
 1. Prepare and maintain examination and treatment area
 2. Prepare patient for examinations and treatments
 3. Assist physician with routine and specialty examinations
and treatments
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Introduction
New patients usually receive a complete physical
examination, which gives the physician baseline
information about the patient. This baseline
information is valuable for future comparison and can
aid the physician in diagnosis. Routine examinations
are performed thereafter at regular intervals to help
maintain the patient’s health and prevent disease.
The purpose of the complete physical examination is to assess the patient’s
general state of health and detect signs and symptoms of disease.
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Introduction (cont’d.)
diagnosis: identification of a disease or condition by evaluating
physical signs and symptoms, health history, and laboratory tests; a
disease or condition identified in a person
clinical diagnosis: record containing a diagnosis based only on the
patient’s clinical symptoms
differential diagnosis: a diagnosis made by comparing the
patient’s symptoms to two or more diseases that have similar
symptoms
As a medical assistant, you are responsible for assisting with taking the medical
history, preparing the patient for the examination, and assisting the physician during the
examination so that a clinical or differential diagnosis can be made as accurately as
possible.
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Basic Instruments and Supplies
 Physician uses instruments and
supplies, but medical assistant
must be familiar
 Basic:
o Gloves
o Applicators
o Tongue depressors
o Tape measure
Common supplies used in the adult
physical examination: tape measure,
gloves, tongue depressor, and cottontipped applicator.
Instruments used during the physical examination enable the examiner to see,
hear, or feel areas of the body being assessed.
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Checkpoint Question
Jackie works in a general surgery physician
office. Instruments and supplies in her office
may be different from those found in a pediatric
office. Why is there variation in the types of
instruments and supplies used in each medical
office?
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Checkpoint Answer
Although there are some basic instruments and
supplies found in most medical offices, the
exact equipment used from one office to the
next may vary according to the preference and
specialty of the physician.
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Basic Instruments and Supplies (cont’d.)
 Percussion Hammer


A reflex hammer.
Test neurologic reflexes at
tendons (ankle, knee, wrist,
elbow
Babinski reflex — sole of
foot
Babinski reflex: reflex
(dorsiflexion of the great toe
and extension and fanning of
the other toes upon stroking
the sole of the foot) exhibited
normally by infants. This reflex
is abnormal in children and
adults
The percussion hammer is used to test neurologic reflexes.
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Basic Instruments and Supplies (cont’d.)
 Tuning Fork
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Test hearing
Strike prongs against hand,
place end against bony part
of skull next to ear
A tuning fork.
The tuning fork is used to test hearing.
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Basic Instruments and Supplies (cont’d.)
 Nasal Speculum

A nasal speculum.
View inside of nose,
membranes, septum
speculum: instrument that
enlarges and separates the
opening of a cavity to expose
its interior for examination
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Basic Instruments and Supplies (cont’d.)
 Otoscope and Audioscope
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Otoscope — examine ear
canal, tympanic membrane
Audioscope — test hearing
tympanic membrane: thin,
semitransparent membrane in
the middle ear that transmits
sound vibrations; the eardrum
The otoscope permits visualization of the ear canal and tympanic membrane.
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Basic Instruments and Supplies (cont’d.)
(A) A portable otoscope. (B) Wall-mounted examination instruments.
From left: sphygmomanometer with cuff, ophthalmoscope, otoscope, and
dispenser for disposable otoscope speculum covers.
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Basic Instruments and Supplies (cont’d.)
An audioscope.
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Basic Instruments and Supplies (cont’d.)
 Ophthalmoscope

Examine interior of eye
A portable ophthalmoscope.
The ophthalmoscope is used to examine the interior structures of the eyes.
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Basic Instruments and Supplies (cont’d.)
 Examination Light and
Gooseneck Lamp
 Improve visualization of body
parts being examined
 Gooseneck — flexible
An examination light.
You have the responsibility to make sure all examination lights are in proper
working order and to direct the light toward the area of the body as indicated by the
physician.
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Basic Instruments and Supplies (cont’d.)
 Stethoscope


Hear body sounds: heart,
lungs, intestines
Measure blood pressure
A stethoscope.
The stethoscope is used for listening to body sounds.
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Basic Instruments and Supplies (cont’d.)
 Penlight or Flashlight
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
Better visualization of
specific area
Eyes, nose, throat
A penlight.
A common flashlight may be used if a penlight is not available.
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Checkpoint Question
Dr. Rowe would like to check the hearing of a
preoperative patient. Which instruments should
Jackie make available for Dr. Rowe to test the
ears and hearing?
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Checkpoint Answer
The tuning fork and audioscope are used to
test hearing. The otoscope is used to assess
the internal structures of the ear.
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Instruments and Supplies Used in Specialized Examinations
 Head Light or Mirror
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Light attached to
mirror and placed on
head
Ear, nose, and throat
physician
A head light.
An ear, nose, and throat specialist (otorhinolaryngologist) may wear a headlight
or head mirror during the examination of these structures.
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Instruments and Supplies Used in Specialized Examinations (cont’d.)
 Laryngeal Mirror and
Laryngoscope
 Mirror — on long
handle, allows view of
threat and larynx
 Laryngoscope —
blade and small light
allows view deeper
into throat
A laryngoscope handle and blades
(straight and curved).
The laryngeal mirror is a stainless steel instrument with a long, slender handle
and a small, round mirror.
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Instruments and Supplies Used in Specialized Examinations (cont’d.)
 Vaginal Speculum
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Stainless steel or plastic
Allows examination of vagina
and cervix
Allows sampling of cervical
cells with Ayre spatula/cervical
scraper for Pap smear
Allows sampling of cells with
histobrush for Papanicolau
(Pap) smear
Papanicolaou (Pap)
test or smear: smear

of tissue cells examined
for abnormalities
including cancer,
especially of the

cervix; named for
George N.
Papanicolaou, a
physician, anatomist,
and cytologist
To obtain the cells for a Pap smear, or to visually examine internal female
reproductive structures, the vaginal speculum is inserted into the vagina to expand
the opening.
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Instruments and Supplies Used in Specialized Examinations (cont’d.)
Vaginal specula.
Cotton-tipped applicator (left), Ayre
spatula (center), and histobrush (right).
Cotton-tipped applicators of this size are
frequently used to remove excess
vaginal secretions or to apply
medications during the gynecologic
examination.
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Instruments and Supplies Used in Specialized Examinations (cont’d.)
 Lubricant
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
Facilitates bimanual exam
— insertion of gloved,
lubricated fingers of one
hand into vagina, other hand
on abdomen
Rectal exam
lubricant: agent that
reduces friction
bimanual: pertaining to the
use of both hands; an
examination performed
with both hands
Lubricant is a water-soluble gel used to reduce friction and provide easy
insertion of an instrument in the physical examination.
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Instruments and Supplies Used in Specialized Examinations (cont’d.)
 Anoscope, Proctoscope, and
Sigmoidoscope
 All come with obturator —
tip that allows instrument to
be easily inserted
 Anoscope — short stainless
steel instrument to visualize
anal canal
 Proctoscope — longer,
visualizes anus and rectum
The anoscope with the obturator.
obturator: smooth,
rounded, removable inner
portion of a hollow tube,
such as an anoscope, that
allows for easier insertion
The anoscope is a short stainless steel or plastic speculum that is inserted into
the rectum to inspect the anal canal.
The proctoscope is another type of speculum that is used to visualize the
rectum and the anus.
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Instruments and Supplies Used in Specialized Examinations (cont’d.)
 Sigmoidoscope — long,
flexible, visualizes rectum and
sigmoid colon
A flexible sigmoidoscope.
A longer instrument used to visualize the rectum and the sigmoid colon is the
sigmoidoscope.
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Checkpoint Question
What are the uses of the anoscope,
proctoscope, and sigmoidoscope? How would
Jackie explain the function of an obturator?
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Checkpoint Answer
The anoscope is the shortest and is used to
inspect the anal canal. The proctoscope is
longer than the anoscope and is used to
visualize the rectum and the anus. The
sigmoidoscope is the longest of the three and
is used to inspect the rectum and sigmoid
colon. The obturator is a smooth, rounded,
removable inner portion of a hollow tube that
allows for easier insertion
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Examination Techniques
inspection: visual examination
palpation: technique in which the examiner feels the texture,
size, consistency, and location of parts of the body with the hands
percussion: striking with the hands to evaluate the size, borders,
consistency, and presence of fluid or air
auscultation: act of listening for sounds within the body, usually
with a stethoscope, such as to evaluate the heart, lungs, intestines, or
fetal heart tones
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Examination Techniques (cont’d.)
 Inspection

Visual examination of the body:
o General appearance
o Movement
o Skin/membranes
o Symmetry and asymmetry
o Smells
symmetry: equality
in size or shape or
position of parts on
opposite sides of the
body
asymmetry: lack or
absence of symmetry;
inequality of size
or shape on opposite
sides of the body
Inspection is looking at areas of the body to observe physical features.
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Examination Techniques (cont’d.)
 Palpation
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Touching body parts with hands or fingers:
o Pulse
o Growths/swellings
o Organ shape/size
o Tenderness/pain
o Temperature, moisture, texture,
elasticity of skin
Bimanual — both hands
Digital — fingers
Manipulation — moving body parts to test
range of motion (ROM)
manipulation: skillful
use of the hands in
diagnostic procedures
range of motion
(ROM): range in
degrees of angle
through which a joint
can be extended and
flexed
Palpation is touching or moving body areas with the fingers or hands.
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Examination Techniques (cont’d.)
 Percussion

Tapping of body with hand or instrument to
produce sound:
o Direct — tapping body with a finger
o Indirect — place finger on body, then tap
with finger of other hand to determine
presence of air inside body
Percussion is tapping or striking the body with the hand or an instrument to
produce sounds.
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Examination Techniques (cont’d.)
 Auscultation


Listening to sounds of body
Stethoscope or direct with ear:
o Heart
o Lungs
o Abdomen
o Blood vessels
Auscultation is listening to the sounds of the body.
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Checkpoint Question
Jackie is assisting Dr. Rowe with physical
examinations today. Which of the examination
techniques used by Dr. Rowe require the use of
the hands and fingers to feel organs or
structures?
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Checkpoint Answer
The examination technique that requires the
use of the hands or fingers is palpation.
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Responsibilities of the Medical Assistant
 Room Preparation
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Clean
Comfortable temperature
Adequate light and ventilation
Exam table disinfected and covered with fresh
paper
Supplies stocked
Equipment working
Medical assistants are usually responsible for preparing the examination rooms,
equipment, and supplies in the clinical area.
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Responsibilities of the Medical Assistant (cont’d.)
 Patient Preparation
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Call patient in
Escort to room
Be supportive and caring — develop rapport
Treat as individual
Speak clearly and confidently
Obtain history if appropriate
Instruct for undressing and putting on gown, drape legs
Leave room unless helping
Obtain urine specimen if needed
Place chart outside room
Notify physician
Before the physician sees the patient, it may be your responsibility to obtain and
record the patient’s history, chief complaint, and vital signs.
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Checkpoint Question
Each morning, Jackie prepares the examination
rooms by making sure there are adequate
supplies and equipment is ready to use. What
would be the advantage of checking the
working condition of equipment at the
beginning of each work day?
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Checkpoint Answer
The working condition of equipment that may
be used during patient examinations should be
checked at the beginning of each work day to
increase efficiency and improve patient care.
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Responsibilities of the Medical Assistant (cont’d.)
 Assisting the Physician
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Hand physician instruments, supplies
Direct light
Remain in room if male physician with female patient or
female physician with male patient
Help patient into positions if necessary
Support and reassure
Always assess the patient’s facial expression and level of anxiety by noting
verbal and nonverbal behavior during the examination.
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Responsibilities of the Medical Assistant (cont’d.)
The Erect or Standing Position: The patient
stands erect facing forward with the arms at the
sides.
Body Part
Instrument Used
Male genitalia and
hernia
Gloves
Legs
Percussion hammer
Spine, posture, gait,
coordination, balance,
strength, flexibility
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Responsibilities of the Medical Assistant (cont’d.)
Body
. Part
Instrument Used
General appearance
Sitting Position: The
patient sits erect at the
end of the examination
table with the feet
supported on a footrest
or stool.
Head, neck
Stethoscope
Eyes
Ophthalmoscope, penlight
Ears
Otoscope, tuning fork
Nose
Nasal speculum, penlight, odors
Sinuses
Penlight
Mouth
Glove, tongue blade, penlight
Throat
Glove, tongue blade, penlight,
laryngeal mirror, laryngoscope
Axilla, arms
Chest
Stethoscope
Breasts
Upper back
Stethoscope
Reflexes
Percussion hammer
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Responsibilities of the Medical Assistant (cont’d.)
The Supine Position:
The patient lies on the
back with arms at the
sides. A pillow may be
placed under the head
for comfort.
Body Parts
Instruments Needed
Chest
Stethoscope
Abdomen
Stethoscope
Breasts
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Responsibilities of the Medical Assistant (cont’d.)
The dorsal recumbent
position. The patient is
supine with the legs
separated, knees bent,
and feet flat on the
table.
Body Parts
Instruments Needed
Female genitalia and
internal organs
Gloves, vaginal
speculum, Ayre
spatula, histobrush,
lubricant
Male genitalia and
hernia
Gloves
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Responsibilities of the Medical Assistant (cont’d.)
The lithotomy position is similar to
the dorsal recumbent position but
with the patient’s feet in stirrups
rather than flat on the table. The
stirrups should be level with each
other and about 1 foot out from the
edge of the table. The patient’s feet
are moved into or out of the stirrups
at the same time to prevent back
strain.
Body Parts
Instruments Needed
Female genitalia and Gloves, vaginal
internal organs
speculum, Ayre
spatula, histobrush,
lubricant
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Responsibilities of the Medical Assistant (cont’d.)
The Sims position. The
patient lies on the left side
with the left arm and shoulder
behind the body, right leg and
arm sharply flexed on the
table, and left knee slightly
flexed.
Body Parts
Instruments Needed
Female genitalia and
internal organs
Gloves, vaginal
speculum, Ayre spatula,
histobrush, lubricant
Male rectum
Gloves, lubricant, fecal
occult blood test
Prostate
Gloves, lubricant
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Responsibilities of the Medical Assistant (cont’d.)
The prone position. The
patient lies on the abdomen
with the head supported and
turned to one side. The arms
may be under the head or by
the sides, whichever is more
comfortable.
Body Parts
Instruments Needed
Back, spine, legs
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Responsibilities of the Medical Assistant (cont’d.)
Body Parts
Instruments Needed
Rectum
Glove, lubricant,
anoscope, proctoscope,
or sigmoidoscope, fecal
occult blood test
Female genitalia
Glove, lubricant, vagial
speculu, Ayre spatula,
histobrush
Prostate
Glove, lubricant
Knee-chest position. The
patient kneels on the table
with the arms and chest on
the table, hips in the air, and
back straight.
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Responsibilities of the Medical Assistant (cont’d.)
Body Parts
Instruments Needed
Head, neck, chest
Stethoscope
Fowler position. The patient
is half-sitting with the head of
the examination table
elevated 80 degrees to 90
degrees.
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Responsibilities of the Medical Assistant (cont’d.)
Body Parts
Instruments Needed
Head, neck, chest
Stethoscope
Semi-Fowler position. The
patient is in a half-sitting
position with the head of the
table elevated 30 degrees to
45 degrees and the knees
slightly bent.
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Responsibilities of the Medical Assistant (cont’d.)
Trendelenburg position. The patient lies on the back with arms
straight at either side, and the head of the bed is lowered with the
head lower than the hips; the legs are elevated at approximately
45 degrees.
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Responsibilities of the Medical Assistant (cont’d.)
 Postexamination Duties
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Assist patient in sitting and dressing if necessary
Instruct patient on what to do after
Reinforce physician instructions
Educate patient
Escort patient to front desk, assist with appointments or
other processes as needed
Clean room, disinfect and re-paper table, restock
supplies
Ensure room is ready for next patient
After the physical examination, you should perform any follow-up treatments and
procedures as necessary or as ordered by the physician.
Check the medical record to be sure that all data have been accurately
documented before releasing the record to the billing department.
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Checkpoint Question
When assisting Dr. Rowe with performing
physical examinations, what are her four basic
responsibilities?
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Checkpoint Answer
The clinical medical assistant is responsible
for:
1. Preparing the examination room
2. Preparing the patient
3. Assisting the physician
4. Cleaning the examination room and
equipment after the examination
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Physical Examination Format
 To begin:
o
o
Seat and drape patient
Observations throughout exam —
appearance, behavior, speech, posture,
hair distribution, nutritional status, skin
The physician usually progresses through the examination in an orderly,
methodical sequence.
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Physical Examination Format (cont’d.)
 Head and Neck




Examine skull, scalp, hair, face
Look for nodules, masses, injuries, lesions
Examine lymph nodes, thyroid, trachea for
size and symmetry
Carotid artery — bruit
bruit: abnormal
sound or murmur
in the blood
vessels during
auscultation
The patient’s skull, scalp, hair, and face are inspected and palpated for size,
shape, and symmetry.
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Physical Examination Format (cont’d.)
 Eyes and Ears
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Visual acuity before physical exam
Sclera — color
Pupils — PERRLA
Extraocular eye movement — EOM
Peripheral vision
Ophthalmoscope:
o Interior of eye
o Retina
o Vasculature
Using the ophthalmoscope, the physician visualizes the interior of the
eye and evaluates the condition of the retina and any pathology of the interlobular
blood vessels.
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Physical Examination Format (cont’d.)
PERRLA: abbreviation used in documentation to denote pupils equal,
round, reactive to light, and accommodation if all findings are normal;
refers to the size and shape of the pupils, their reaction to light, and their
ability to adjust to distance
extraocular: outside the eye, as in extraocular eye movement
peripheral vision: side vision while looking straight ahead
sclera: white fibrous tissue that covers the eye
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Physical Examination Format (cont’d.)
 Palpate ears — size,
symmetry, lesions, nodules
 Otoscope:
o Ear canal
o Cerumen — ear wax
o Tympanic membrane —
normal is pearl gray and
concave, infected is
discolored and bulging
 Tuning fork — auditory test
Cerumen: yellowish or brownish
waxlike secretion in the external
ear canal; earwax
A normal tympanic membrane.
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Physical Examination Format (cont’d.)
 Nose and Sinuses
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
External — abnormalities
Internal — color, discharge, lesions,
polyps, obstructions, tenderness,
swelling, position of nasal septum
Sense of smell
Transilluminate for view of sinuses —
penlight in darkened room
nasal septum: wall
or partition dividing
the nostrils
transillumination:
passage of light
through body tissues
for the purpose of
examination
The external nose is palpated for abnormalities and inspected using a nasal
speculum and light.
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Physical Examination Format (cont’d.)
 Mouth and Throat
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
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

Mucous membranes
Teeth, gums, dental hygiene
Tongue
Throat, tonsils
Salivary gland function
The physician inspects the mucous membranes of the mouth, gums, teeth,
tongue, tonsils, and throat using clean gloves, a light source, and a tongue blade.
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Checkpoint Question
What is the tympanic membrane, and how does
infection affect its appearance?
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Checkpoint Answer
The tympanic membrane, also called the
eardrum, is a thin membrane between the outer
and middle ear that transmits sound waves to
the inner ear. Normally, it is a pearly gray and
concave. However, in the presence of an
infection and fluid behind it, it may be
discolored and bulge outward.
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Physical Examination Format (cont’d.)
 Chest, Breasts, and Abdomen
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General appearance
Respiratory rate and rhythm
Masses or swelling
Palpate chest and axillary lymph nodes
Auscultate lungs:
o Lung and heart sounds, apical pulse
The physician observes the general appearance and symmetry of the chest and
breast area, the respiratory rate and pattern, and any obvious masses or swelling.
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Physical Examination Format (cont’d.)
 Back and spine
 Auscultate posterior lung sounds
 Palpate breasts, nipples, tissue to clavicle, axilla,
bottom of rib cage:
 Women — supine
The supine position is preferred for palpation of the breasts because the breast
tissue flattens out, making any abnormalities easier to feel.
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Physical Examination Format (cont’d.)
 Inspect, palpate, and percuss abdomen
 Auscultate bowel sounds
 Palpate inguinal lymph nodes
 Check for hernia
inguinal: pertaining
to the regions of the
groin
hernia: protrusion of
an organ through the
muscle wall of the
cavity that normally
surrounds it
The abdomen is inspected for contour, symmetry, and pulsations
from the aorta, a large artery that extends from the heart down the center of the
thoracic and abdominal cavities.
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Checkpoint Question
Jackie assists a patient into position for
a breast examination. Why is the patient
supine for palpation of the breasts?
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Checkpoint Answer
When the patient is supine, the breast tissue
flattens out, making it easier for the examiner
to feel any abnormalities.
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Physical Examination Format (cont’d.)
 Genitalia and Rectum

Men:
o Scrotum — size, contour,
consistency
o Transilluminate contents
o Inguinal area — hernia exam
o Anus — lesions, hemorrhoids
o Rectum — sphincter tone, prostate
size, consistency, masses
o Stool specimen for occult blood
test
occult blood: blood
hidden or concealed
from observation
The male genitalia are inspected to note symmetry, lesions, swelling, masses,
and hair distribution.
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Physical Examination Format (cont’d.)
 Women:
o
o
o
o
o
External genitalia —lesions, edema, cysts,
hair distribution
Internal — vagina, cervix
Pap smear
Bimanual exam — two fingers of dominant
hand in vagina, nondominant hand on
abdomen, palpate internal reproductive
organs
Rectovaginal exam — index finger in vagina,
middle finger in rectum to palpate for lesions,
hemorrhoids, sphincter tone, stool specimen
rectovaginal:
pertaining to
the rectum
and vagina
The female genitalia and rectum are usually examined with the patient in the
lithotomy position and with one corner of the drape extending over the genitalia and
the other corner covering the patient’s chest.
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Physical Examination Format (cont’d.)
 Legs
Inspect
 Palpate peripheral pulse — supine
and standing
 Reflexes
 Percussion hammer — biceps, triceps,
patella, Achilles and plantar tendons
 Patient usually sitting

The legs are inspected and the peripheral pulse sites palpated with the patient
supine.
The examiner uses the percussion hammer to test the patient’s reflexes by
striking the biceps, triceps, patellar, Achilles, and plantar tendons.
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Physical Examination Format (cont’d.)
 Posture, Gait, Coordination, Balance, and
Strength
 Inspect posture, spine — standing
 Inspect gait, coordination — walking
 Inspect balance — stand, feet together, eyes
closed
 Arm range of motion, strength
Gait:
manner or
style of
walking
The general posture of the patient and the spine may be inspected with the
patient standing.
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Checkpoint Question
Why would Dr. Rowe perform
rectovaginal and bimanual pelvic
examinations?
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Checkpoint Answer
The rectovaginal examination is done to
palpate the posterior uterus and vaginal wall.
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General Health Guidelines and Checkups
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Patient education step
Ages 20 to 24 years, physical exam every 1 to 3
years
 Over age 40 years, every year
1st Pap no later than 21 years, the every 2 years
Breast exam every 3 years at 20 to 40 years old
Baseline mammogram at 35 years old, yearly after
age 40
For patients aged 20 to 40 years, physical examinations are scheduled about
every 1 to 3 years.
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General Health Guidelines and Checkups (cont’d.)
 Baseline ECG at age 40 years
 Rectal exam and fecal occult blood at age 40 years
 Colonoscopy at age 50 years:
 Every 3–5 years
 Men PSA and DRE at age 50 years
All patients should have a baseline electrocardiogram (ECG) at age 40 and
follow-up ECGs as necessary.
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General Health Guidelines and Checkups (cont’d.)
 CDC-recommended immunizations:
o
o
o
o
o
o
o
Tdap once
Tetanus every 10 years, sooner if have open wound
MMR: one or two doses between ages of 19 and 49
years
Varicella (chicken pox) two doses between ages 19 and
49 years
Seasonal flu each year for everyone over 6 months of
age
Pneumococcal at age 65 years
Hepatitis B series for adults
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Checkpoint Question
Dr. Rowe asks Jackie to explain the procedure
to perform a self-breast examination to a young
female patient. Why are monthly breast selfexaminations important for women aged 20 to
40 years?
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Checkpoint Answer
Monthly breast self-examinations are important
in women ages 20 to 40 years to detect
abnormal lumps or thickenings that may be
malignancies. Cancers are most likely to be
cured if detected and treated early.
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