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CHAPTER 38 Assisting with General Physical Examination.

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Presentation on theme: "CHAPTER 38 Assisting with General Physical Examination."— Presentation transcript:


2 CHAPTER 38 Assisting with General Physical Examination

3 38-2 Learning Outcomes (cont.) 38.1 Identify the purpose of a general physical exam Describe the role of the medical assistant in a general physical exam Explain safety precautions used during a general physical exam.

4 38-3 Learning Outcomes (cont.) 38.4 Carry out the steps necessary to prepare the patient for an exam Carry out positioning and draping a patient in each of the nine common exam positions Apply techniques to assist patients from different cultures and patients with physical disabilities.

5 38-4 Learning Outcomes (cont.) 38.7 Identify the six examination methods used in a general physical exam List the components of a general physical exam Describe follow-up steps after a general physical exam.

6 38-5 Introduction Physical examination – 1st 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.

7 38-6 The Purpose of General Physical Exam To confirm an overall state of health and provide baseline values To diagnose a medical problem

8 38-7 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

9 38-8 Apply Your Knowledge Why does the physician perform a general physical examination? ANSWER: A physical examination is used to confirm the patients overall state of health or to diagnose a medical problem.

10 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

11 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

12 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!

13 38-12 Safety Precautions OSHA standards and guidelines –Protect employees –Make the workplace safe CDC guidelines – protect patients and health-care workers

14 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

15 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

16 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

17 38-16 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 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. Impressive!

18 38-17 Preparing the Patient for an Exam Emotional preparation –Explain exactly what will occur and what they will feel –Use simple direct language

19 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

20 38-19 Apply Your Knowledge What can you do to elicit the patients 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!

21 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

22 38-21 Supine/recumbent Dorsal recumbent Positioning and Draping (cont.) Sitting –Symmetry

23 38-22 Lithotomy Positioning and Draping (cont.) Fowlers

24 38-23 Positioning and Draping (cont.) ProneSims

25 38-24 Positioning and Draping (cont.) Knee-Elbow –Fenestrated drape Proctologic

26 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.

27 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

28 38-27 Special Patient Considerations Patients with disabilities – provide assistance as needed –Disrobing –Moving to exam table –Assuming exam position

29 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.

30 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

31 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

32 38-31 Examination Methods (cont.) Mensuration – process of measuring Manipulation –Systemic moving of a patients body parts –Check for abnormalities –Determine range of motion of joints

33 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 are any visual abnormalities of Jimmys 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!

34 38-33 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

35 38-34 Components of the General Physical Examination (cont.) Medical assistant –Be familiar with the components of the examination –Know equipment and supplies used –Ensure the patients comfort –Protect the patients modesty

36 38-35 Components of the General Physical Examination (cont.) General appearance –General state of heath –Distress or pain –Skin –Nails and nail beds –Hair Head –Abnormal condition of scalp or skin –Puffiness –Abnormal growths

37 38-36 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 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

39 38-38 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

40 38-39 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

41 38-40 Components of the General Physical Examination (cont.) Abdomen –Inspection –Auscultation –Percussion –Palpation –Findings described using system of landmarks

42 38-41 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

43 38-42 Components of the General Physical Examination (cont.) Rectum –Palpation using a digital exam Lesions or abnormalities Occult blood

44 38-43 Components of the General Physical Examination (cont.) Musculoskeletal system –Posture ~ scoliosis –Gait –Range of motion –Muscle strength –Body measurements –Lesions, deformities, or circulatory problems

45 38-44 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

46 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.

47 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

48 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.

49 38-48 Additional Tests and Procedures After dressing –Urine reagent strip tests –Pulmonary function tests –Eye or ear irrigation or medication administration

50 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

51 38-50 Follow-Up Scheduling appointments –Future office visits –Outside appointments Helping plan for home nursing care Helping the patient obtain assistance

52 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!

53 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 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.

54 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.

55 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 patients 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

56 38-55 In Summary (cont.) 38.5 The nine common exam positions include sitting, supine, dorsal recumbent, lithotomy, Fowlers, prone, Sims, knee-chest, and proctologic 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.

57 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 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.

58 38-57 In Summary (cont.) 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 patients condition.

59 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

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