Transcript Assisting with a General Physical Examination

PowerPoint® to accompany
Medical Assisting
Chapter 38
Second Edition
Ramutkowski  Booth  Pugh  Thompson  Whicker
Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.
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Assisting with a General Physical
Examination
Objectives:
38-1 State 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 Outline the steps necessary to prepare the patient
for an examination.
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Assisting with a General Physical
Examination
Objectives (cont.)
38-5 Explain ways to assist patients from different
cultures, patients with disabilities, children, and
pregnant women.
38-6 Identify and describe the six examination methods
used in general physical examination.
38-7 List the components of a general physical
examination.
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Assisting with a General Physical
Examination
Objectives (cont.):
38-9 Explain the special needs of the elderly for patient
education.
38-10 Identify ways to help a patient follow up on a
doctor’s recommendations.
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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.
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Purpose of General Physical
Examination


Examine a healthy
person to confirm an
overall state of
health and provide
baseline values for
vital signs.
Examine a patient to
diagnose a medical
problem.
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Role of Medical Assistant
 Assist both the doctor
and the patient
 Your presence enables
the doctor to perform
his examination as
effectively as possible
 You do the interview,
write an accurate
history, determine vital
signs, and measure
weight and height.
Your responsibilities include ensuring that all
instruments and supplies are readily available to
the doctor during the examination.
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Safety Precautions



Perform a thorough hand washing.
Wear gloves whenever it is possible to have
contact with blood, body fluids, nonintact
skin, or moist surfaces.
Wear a mask if the patient is suspected of
having a infectious disease that can be
transmitted by airborne droplets
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Safety Precautions (cont.)



Wear personal protective
equipment if patient is
highly contagious.
Discard all disposable
equipment and supplies in
biohazardous waste
containers
Clean and disinfect the
exam room after each
patient.
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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 a exam
gown
 Positioning and draping – help patient
assume needed exam position and drape to
provide privacy
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Examination Positions




Sitting
Supine or prone
Dorsal recumbent
Lithotomy or
proctologic
 Trendelenburg's
 Fowler’s
 Sims’ or knee-chest
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Special Considerations:
Culture
 Avoid stereotyping an individual or group
on the basis of a single patient’s behavior.
 Avoid making judgment about patients
based on your experience with other
patients
 Patients from different cultures may never
have had a medical examination and may
not know what to expect
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Special Considerations:
Disabilities
 Patients may require extra
assistance in preparing for
a general physical
examination.
 You may need to help
them disrobe, move from
the mobility device to the
exam table and assume
certain positions on or off
the exam table.
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Special Considerations:
Children
 Older infants and toddler may be examined on
the parent’s lap.
 Preschool children can be placed on the exam
table with parent nearby.
 Doctors will perform percussion and
auscultation first and painful areas last.
 Doctors may examine older children’s genitalia
last because it may be embarrassing for the
child.
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Special Considerations:
Pregnant Women
 Prone and lithotomy
positions are not
recommended.
 Other positions may be
difficult or impossible
to achieve.
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Apply Your Knowledge
A elderly female patient will needs her lower
abdomen and genitalia examined by the
physician. What would be the best position
to place her in and why?
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Apply Your Knowledge -Answer
A elderly female patient will needs her lower
abdomen and genitalia examined by the
physician. What would be the best position
to place her in and why?
Dorsal recumbent position - This position may be
recommended over lithotomy since an elderly
patient may have difficult placing her legs in
stirrups.
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Examination Methods



Inspection –visual
examination
Palpation- uses touch
extensively to assess
characteristics of the
body.
Percussion – involves
tapping and striking the
body to hear sounds or
feel vibrations.



Auscultation – process
of listening to body
sounds.
Mensuration – process
of measuring
Manipulation –
systemic moving of a
patient’s body parts.
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Components of the General
Physical Examination


Overall appearance and the condition of the
patient’s skin, nails and hair.
Doctor examines the body in the following
order:




Head, neck, eyes, ears, nose and sinuses, mouth
and throat
Chest and lungs, heart, breasts
Abdomen, genitalia, and rectum
Musculoskeletal and neurological system
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Components of the General
Physical Examination (cont.)


Be familiar with the
components and the
equipment used for a
general physical
examination.
Ensure the patient is
comfortable and
his/her modesty is
protected.
Can you name these pieces of
examination equipment?
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General Physical Examination Head, Neck, Eyes, Ears




Head - any abnormal conditions of scalp,
skin, or growths
Neck – checks for symmetry and range of
motion
Eyes – check for the presence of disease or
abnormalities
Ears – checks for symmetry, presence of
lesions, redness, or swelling
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General Physical Examination Nose, Sinuses, Mouth and Throat




Nose- checks for presence of infection or
allergy
Sinuses – checks for any discharge, lesions,
obstructions, swelling or inflammation
Mouth – check general impression, condition
of gums and teeth
Throat – checks for redness or swelling
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General Physical Examination Chest and Lungs, Heart, Breasts




Chest – checks shape, symmetry and postural
position and any deformity
Lungs – listens to lung sounds to check for
any abnormal breathing
Heart – check the size by percussion and
listens for abnormal heart sounds
Breasts – checks for symmetry, contour,
masses, or retracted areas
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General Physical Examination Abdomen, and Genitalia


Abdomen –listens for bowel sounds, palpates
all four quadrants and inspects for color,
shape and symmetry
Genitalia – if patient male and doctor is
female have another male present, if patient is
female and doctor is male have another
female present
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General Physical Examination Rectum




Have patient in dorsal recumbent or Sims’
position
Digital examination to palpate the rectum for
lesions or irregularities
Test for blood in the stool by doing Hemoccult
or Seracult test
Assist patient in personal hygiene as needed
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General Physical ExaminationMusculoskeletal & Neurological

Musculoskeletal – checks for good posture
and ask the patient to walk to assess gait


Determines range of motion, strength of various
muscle groups and body measurements
Neurological – evaluates reflexes, mental and
emotional status and sensory and motor
functions
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Completing the Examination



Help the patient into a
sitting position.
Allow the patient to
perform any necessary
self-hygiene measures.
Check with doctor
about other tests or
procedures.
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Patient Education



Pay special attention to educating patient
about risk factors for disease.
Be sure that you address the patient at a
language level they can understand without
talking down to them.
Be sure they understand
fully.
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Special Problems - Elderly
Common problems:




Incontinence
Depression
Lack of information on preventive
medicines
Lack of compliance when taking
medications
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Follow-up
Follow-up may include:
 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.
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Apply Your Knowledge
The physician will be performing a rectal
examination on a patient. What
position should you place the patient
in and what equipment should you
have available for the physician?
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Apply Your Knowledge -Answer
The physician will be performing a rectal
examination on a patient. What
position should you place the patient
in and what equipment should you
have available for the physician?
Rectal examinations are usually performed in the Sim’s
position, but protologic can be used. Equipment
needed: drape, gloves, lubricant, tissues, and
Hemoccult or Seracult test equipment
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Summary
Medical Assistant
The general physical examination is the cornerstone
of medical care.
You must address the comfort, privacy and
education needs of the patient and anticipate the
needs of the physician during the examination.
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End of Chapter
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