Transcript Chapter One

CHAPTER 5
THE PHYSICAL EXAMINATION
Introduction to the Physical
Examination
1. Complete patient examination consists of:
a. Health history
b. Physical examination (PE)
c. Laboratory and diagnostic tests
2. Results used by physician to:
a. Determine patient's state of health
b. Arrive at a diagnosis and prescribe treatment
c. Observe any change in patient's illness after
treatment has been instituted
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Introduction to the Physical
Examination, cont.
3. Purpose of PE
a. To detect early signs of illness
•
Helps prevent serious health problems
b. Prerequisite for employment
c. Participation in sports
d. Attendance at summer camp
e. Admission to school
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Definition of Terms
1. Final diagnosis: scientific method of
determining and identifying a patient's
condition through evaluation of the health
history, PE, laboratory tests, and diagnostic
procedures
a. Often simply called the diagnosis (dx)
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Definition of Terms, cont.
2. Clinical diagnosis: intermediate step in the
determination of a final diagnosis
a. Obtained through evaluation of health history and
PE (without laboratory and diagnostic tests)
b. Outside laboratories provide space on laboratory
request: to specify clinical diagnosis
c. Once physician has analyzed test results: final
diagnosis can usually be established
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Definition of Terms, cont.
3. Differential diagnosis: two or more diseases may
have similar symptoms
a. Determines which disease is causing the symptoms
so that a final diagnosis can be made
b. Example: “Strep” throat and pharyngitis have
similar symptoms
•
Differential diagnosis is made by strep test
4. Prognosis: probable course and outcome of a
patient's condition and the patient's prospects for
recovery
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Definition of Terms, cont.
5. Risk factor: physical or behavioral condition that
increases the probability that an individual will
develop a particular condition
a. Includes:
•
Genetic factors
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Habits
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Environmental conditions
b. Does not mean the disease will develop
•
Only that chance is greater of developing it
•
Example: Smoking is a risk factor for lung cancer and
heart disease
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Definition of Terms, cont.
6. Acute illness: characterized by symptoms that
have a rapid onset
a. Usually severe and intense
b. Subside after a short time
•
Example: influenza
7. Chronic illness: characterized by symptoms that
persist for more than 3 months
a. Patient shows little change over a long time
•
Examples: diabetes, hypertension, emphysema
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Definition of Terms, cont.
8. Therapeutic procedure: a procedure performed to
treat patient's condition with the goal of eliminating it or
promoting as much recovery as possible
a. Example: administration of medications
9. Diagnostic procedure: performed to assist in the
diagnosis of a patient's condition
a. Examples: electrocardiography, x-ray examination
10.Laboratory testing: the analysis and study of
specimens obtained from patient to assist in diagnosis
and treatment of disease
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Preparation of the Examining Room
Guidelines:
a.
b.
c.
d.
e.
f.
g.
Should be free from clutter and well lit
Check daily for ample supplies; restock as needed
Empty waste receptacles frequently
Replace biohazard containers as necessary
Room should be well ventilated
Maintain room temperature
Clean and disinfect daily:
•
Examining tables
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Countertops
•
Faucets
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Preparation of the Examining Room,
cont.
h. Remove dust/dirt from furniture & towel dispensers
i.
Change examining table paper after each patient
j.
Patient's privacy should be ensured
•
Keep door closed during patient examination
k. Clean and prepare items the physician will be using for
examinations (equipment, instruments, supplies)
l.
Check equipment and instruments frequently for proper
working condition
m. Have equipment and supplies ready for examination
n. Know how to operate and care for equipment
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Physical Exam Equipment and
Supplies
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Physical Exam Equipment and
Supplies, cont.
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Preparation of the Patient
1. MA's responsibility: prepare the patient for PE
a. After escorting patient to examining room
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Identify the patient by name and date of birth
b. Take vital signs
c. Measure height and weight
d. Explain purpose of examination and answer
questions
e. Apprehension can be reduced by:
•
•
•
Address patient by name of choice
Have a friendly and supportive attitude
Speak clearly, distinctly, and slowly
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Preparation of the Patient, cont.
f. Ask patient if he needs to empty the bladder before
examination
•
Makes examination easier for physician to perform and
more comfortable for patient
•
If urine specimen is needed: patient is asked to void
g. Instructions for disrobing should be specific
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Clothing that should be removed
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Where to place clothing
– Instructions for putting on gown and location of gown
opening
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Preparation of the Patient, cont.
h. Disrobing facility should be comfortable and private
i. MA should have patient's medical record available
for review by the physician
•
Use designated location for medical record
a. Shelf next to examining room door or chart holder
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Follow HIPAA privacy rule to protect patient's health info
j. Help patient on/off the examining table for safety
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Measuring Weight and Height
1. Mensuration: process of measuring
2. Change in weight may be significant in:
a. Diagnosis of patient's condition
b. Prescribing treatment
3. Underweight/overweight patients on diet
therapy program:
a. Should have weight taken regularly to determine
progress
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Measuring Weight and Height, cont.
4. Prenatal patients weighed at each prenatal
visit to:
a. Assess fetal development & mother's health
5. Adult weight is measured at each office visit
6. Adult height usually only measured:
a. First office visit
b. Complete PE
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Measuring Weight and Height, cont.
7. Children weighed and measured at each
office visit to:
a. Observe pattern of growth
b. Calculate and determine medication
dosage
8. Height and weight are compared against
a standardized chart:
a. Determines if patient falls within normal
limits
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Measuring Weight and Height, cont.
9. Guidelines for Measuring Ht/Wt:
a. Weight: Using an upright balance scale
•
Provide privacy for patient
– Many patients are self-conscious about having
weight measured
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Balance scale
– If scale not balanced: measurement will be
inaccurate
– Scale is balanced when upper and lower weights are
on zero and indicator point comes to a rest at center
of balance area
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Balance the Scale
Balance the Scale
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Measuring Weight and Height, cont.
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Assist the patient
– Assist patient on and off the scale platform
– Platform moves slightly: may cause patient to
become unsteady
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Obtain an accurate weight
– Ask patient to remove shoes
– Measure weight with patient in normal clothing
– Ask patient to remove heavy outer clothing
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Measuring Weight and Height, cont.
•
Interpret calibration markings accurately
– Lower calibration bar: divided into 50-pound
increments
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Measuring Weight and Height, cont.
– Upper calibration bar is divided into pounds
and quarter pounds
1) Longer calibration lines: indicate pound
increments
2) Shorter calibration lines indicate
quarter-pound and half-pound
increments
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Measuring Weight
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Measuring Weight and Height, cont.
•
Determine patient's weight correctly
– Add the measurement on lower scale
to measurement on upper scale
– Round results to nearest quarter
pound
– Occasionally weight may need to be
converted to kilograms (metric unit)
1) May be required to determine
medication dosage
2) 1 kg = 2.2 pounds
3) To convert pounds to kg: Divide
the number of pounds by 2.2
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Measuring Weight and Height, cont.
Height: Using an upright
balance scale
•
Do not place patient on
scale in a forward position
–
•
Measuring bar could fall
into patient's face when
patient steps off scale
Determine the calibration
markings accurately
–
Calibration markings are
divided into either:
1) Inches
2) Feet and inches
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Measuring Height
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Measuring Weight and Height, cont.
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Read the measurement correctly
– Read the measurement at the junction of the
stationary calibration rod and the movable
calibration rod
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Measuring Weight and Height, cont.
– If patient's height is less than the top value of the
stationary calibration rod
1) Read the measurement directly on the
stationary rod
a) On most scales: highest calibration
on stationary rod is 50 inches
b) Patients with a height of 50 inches
or less will have their height read
directly on stationary rod
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Measuring Height
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Measuring Weight and Height, cont.
•
Record the height measurement correctly.
– Record height measurement in feet and inches.
– If the scale is calibrated in inches:
1) Convert the reading to feet and inches:
divide the number of inches by 12
2) Example: Height measurement of 60
inches is recorded as 5 feet (60 inches
divided by 12 equals 5)
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Positioning and Draping
1. Correct positioning of the patient
facilitates the examination
a. Permits better access to part being examined
b. Sitting: Examination of the head, neck, chest,
upper extremities; measure vital signs
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Sitting Position
1. Examination of
the head, neck,
chest, upper
extremities;
measure vital
signs
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Supine Position
Supine: Examination
of head, chest,
abdomen,
extremities
•
Not a
comfortable
position for
patients with:
–
Respiratory
problems
–
Back injury
–
Low back
pain
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Prone Position
Prone: Examination of back; assess extension of hip
joint
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Dorsal Recumbent Position
Dorsal recumbent:
Vaginal and rectal
examinations, insertion
of urinary catheter,
examine the head,
neck, chest and
extremities of patients
who have difficulty
maintaining supine
position
•
Bending of legs is
more comfortable
for some patients
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Lithotomy Position
Lithotomy: Vaginal, pelvic and rectal examinations
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Sims Position
Sims: Used to
examine the
vagina and
rectum, to
measure rectal
temperature, to
perform a flexible
sigmoidoscopy,
an to administer
an enema
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Knee-Chest Position
Knee-chest: Examine the rectum, perform a
proctoscopic examination
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Fowler’s Position
Fowler's:
•
Examine upper
body of patients
with cardiovascular
and respiratory
problems
–
•
Easier for these
patients to
breathe in this
position
Draw blood from
patients likely to
faint
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Positioning and Draping, cont.
Position used depends on type of examination
being performed
a. More than one position may be used
b. Explain position to patient and assist them into it
c. Take patient's endurance and degree of wellness into
consideration
•
Weak or ill patient may not be able to assume a position
d. Do not keep patient in uncomfortable positions longer
than necessary
e. Let the patient rest before getting off the examining table
f. Assist patient off table to prevent falls
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Positioning and Draping, cont.
4. Draping provides modesty, comfort, and
warmth
a. Only part being examined should be
exposed
5. Gowns and drapes are made of paper or
cloth
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Inspection
Inspection: The process of observing a patient to detect the
signs of disease
•
Observe patient for:
– Color
– Speech
– Deformities
– Skin condition
– Body contour and symmetry
– Orientation to the surroundings
– Body movements
– Anxiety level
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Palpation
b. Palpation: The process of feeling with the hands to detect
the signs of disease
•
Helps verify data obtained from inspection
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Patient's verbal and facial expressions are observed
•
Used to determine:
– Placement and size of organs
– Presence of lumps
– Pain
– Swelling
– Tenderness
•
Examples of palpation
– Breast examination, measuring radial pulse
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Percussion
c. Percussion: The process of tapping body and listening to
the sounds produced to detect the signs of disease
•
Used to determine:
– Size, density, location of organs
•
Example: examination of lungs and abdomen
1) Dense structures: produce a dull sound (liver)
2) Empty or air-filled structures: produce a hollow
sound (lungs)
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Percussion, cont.
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Ausculatation
d. Auscultation: The process of listening with a
stethoscope to the sounds produced within the body
to detect the signs of disease
•
Used to:
– Listen to heart and lungs
– Measure blood pressure
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