Presentation on theme: "Assisting with General Physical Examination"— Presentation transcript:
1 Assisting with General Physical Examination 38Assisting with General Physical Examination
2 Learning Outcomes (cont.) 38.1 Identify the purpose of a general physical exam.38.2 Describe the role of the medical assistant in a general physical exam.38.3 Explain safety precautions used during a general physical exam.
3 Learning Outcomes (cont.) 38.4 Carry out the steps necessary to prepare the patient for an exam.38.5 Carry out positioning and draping a patient in each of the nine common exam positions.38.6 Apply techniques to assist patients from different cultures and patients with physical disabilities.
4 Learning Outcomes (cont.) 38.7 Identify the six examination methods used in a general physical exam.38.8 List the components of a general physical exam.38.9 Describe follow-up steps after a general physical exam.
5 IntroductionPhysical examination – 1st step in the diagnosis or treatment processThe medical assistantMake the client comfortableAssist the physicianLearning Outcomes: 38.1 Identify the purpose of a general physical exam.38.2 Describe the role of the medical assistant in a general physical examination.A skilled medical assistant can create an atmosphere that results in a positive outcome for the patient during the physical examination.
6 The Purpose of General Physical Exam To confirm an overall state of health and provide baseline valuesTo diagnose a medical problemLearning Outcomes: 38.1 Identify the purpose of a general physical exam.Physicians can determine much about a patient’s general condition of health from the exam.Physicians usually focus on a particular organ system to diagnose a problem but generally perform an overall physical exam even when a specific medical problem exists because of the interdependence of organ systems
7 The Purpose of General Physical Exam (cont.) Clinical diagnosisSign ~ objectiveSymptom ~ subjectiveLaboratory and diagnostic testsConfirm clinical diagnosisHelp determine the differential diagnosis and prognosisFormulation of treatment planLearning Outcomes: 38.1 Identify the purpose of a general physical exam.The exam is used to make a clinical diagnosis – one based on the signs and symptoms of a disease.Sign – objective information that can be detected by a someone other than the affected person.Symptom – subjective information supplied by the patient. Only the patient can perceive these sensations, which are typically part of the chief complaint.Laboratory or other diagnostic tests are ordered to confirm a clinical diagnosis or to rule out other possible disorders.Differential diagnosis – determining the correct diagnosis when two or more are possible.Prognosis – forecast of the probable course and outcome of the disorder and the prospects of recovery.Laboratory and diagnostic tests also help the physician formulate a treatment plan or appropriate drug therapy.
8 Apply Your Knowledge Excellent! Why does the physician perform a general physical examination?ANSWER: A physical examination is used to confirm the patient’s overall state of health or to diagnose a medical problem.Learning Outcomes: 38.1 Identify the purpose of a general physical exam.Excellent!
9 The Role of Medical Assistant To assist the licensed practitioner and the patientBegins prior to the physical examInterviewWrite an accurate historyDetermine vital signsMeasure weight and heightLearning Outcome: Describe the role of the medical assistant in a general physical exam.The medical assistant’s role starts before the actual exam when you interview the patient, write an accurate history, determine vital signs, and measure weight and height.
10 The Role of Medical Assistant (cont.) ResponsibilitiesEnsuring instruments and supplies are availableEnsuring patient comfortHelping into positionKeeping them informedObserving them for distress or need for assistanceLearning Outcome: Describe the role of the medical assistant in a general physical exam.Your assistance enables the licensed practitioner to perform the exam as efficiently and professionally as possible.Your responsibilities includeEnsuring all instruments and supplies are readily available.Ensure that patients are physically and emotionally comfortable during the examHelping them into positionKeeping them aware of what is going to happen.Observing them for signs that indicate distress or the need for assistance.
11 Hooray! 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 byHelping the patient into positionTelling them what will happenObserving the patient for signs of distress or need for assistance.Learning Outcome: Describe the role of the medical assistant in a general physical exam.Hooray!
12 Safety Precautions OSHA standards and guidelines Protect employeesMake the workplace safeCDC guidelines – protect patients and health-care workersLearning Outcome: Explain safety precautions used during a general physical exam.Safety measures are outlined by the Department of Labor’s Occupational Safetyand Health Administration (OSHA) and The Department of Health and Human Services’ Centers for Disease Control and Prevention (CDC).OSHA standards and guidelines are designed to protect employees and make the workplace safe.The CDC establishes the guidelines intended to protect both patients and healthcare professionals in the medical office and the hospital setting.Together, these safety measures help protect you, the physician, and the patient from disease transmission.
13 Safety Precautions (cont.) Aseptic hand washingBefore and after each patient contactBefore and after each procedureWear gloves if there may be contact withBlood – Nonintact skinBody fluids – Moist surfacesAlso when handling specimensLearning Outcome: Explain safety precautions used during a general physical exam.Hand washing – OSHA standards allow the use of an approved waterless, alcohol-based hand cleaner between patients if no gross contamination or visible soilage is on your hands.
14 Safety Precautions (cont.) Respiratory hygiene/cough etiquetteWear a mask to prevent exposure to an infectious disease transmitted by airborne dropletsIsolation precautions – personal protective equipmentLearning Outcome: Explain safety precautions used during a general physical exam.Respiratory hygiene/cough etiquetteCover mouth/nose when coughingUse tissues and dispose of them in a no-touch receptacleObserve hand hygieneWear a surgical mask or maintain a distance of greater than three feet if possibleWear a mask if there is any possibility of exposure to an infectious disease transmitted by airborne droplets.Patients with highly contagious infectious diseases, like diphtheria or chickenpox, must be examined under isolation precautions. Wear personal protective equipment during contact.Refer to Points on Practice: Selecting Personal Protective Equipment (PPE)
15 Safety Precautions (cont.) Discard all disposable equipment and supplies appropriatelyClean and disinfect the exam room after each patientSanitize, disinfect, and sterilize equipment appropriatelyLearning Outcome: Explain safety precautions used during a general physical exam.If disposable equipment and supplies come in contact with a patient’s blood or body fluids, discard in biohazardous waste container.
16 Apply Your KnowledgeImpressive!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.Learning Outcome: Explain safety precautions used during a general physical exam.
17 Preparing the Patient for an Exam Emotional preparationExplain exactly what will occur and what they will feelUse simple direct languageLearning Outcome: Carry out the steps necessary to prepare the patient for an examination.Emotional preparationDescribe what patients can expect to feel and how their cooperation can contribute to the procedure’s success.A female physician may ask a male medical assistant to remain in the room when she examines a male patient. Likewise, a male physician will ask a female medical assistant to remain in the room when he examines a female patient.
18 Preparing the Patient for an Exam PhysicalOffer the bathroomAsk the patient to disrobe and put on an exam gown or cover with a drapeBe aware of modesty and comfortLearning Outcome: Carry out the steps necessary to prepare the patient for an examination.Ensure the room temperature is comfortable.Give the patient an opportunity to empty his bladder and/or bowels in order to be more comfortable during the exam. Collect a urine specimen at this time, if needed.Physical preparationExtent of disrobing depends on type of exam and doctor’s preference.Choose appropriate gown size.Explain how to put on gown, including whether it should open in back or front, be tied or left open.Leave the exam room while patient disrobes, unless patient requests assistance.
19 Apply Your Knowledge Way to go! What can you do to elicit the patient’s 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.Learning Outcome: Carry out the steps necessary to prepare the patient for an examination.Way to go!
20 Positioning and Draping Proper patient position facilitates the examinationAssist the patient to appropriate positionMake as comfortable as possibleCover with appropriate drapeKeep patient warmMaintain privacy/modestyLearning Outcome: Carry out positioning and draping a patient in each of the nine common exam positions.Positioning and drapingUse good body mechanics to protect yourself from injuryHelp minimize the time a patient spends in any embarrassing or uncomfortable positionChoose a drape that will keep the patient warm and maintain privacyYou may be able to ease any discomfort by using a small pillow to support part of the body.You may have to help the patient maintain a position during the exam.When making changes in the patient’s position, do so gradually. Always tell the patient what movement to expect.
21 Positioning and Draping (cont.) SittingSymmetrySupine/recumbentDorsal recumbentLearning Outcome: Carry out positioning and draping a patient in each of the nine common exam positions.These are positions commonly used during a medical exam.Symmetry – the degree to which one side is the same as the other.SittingPatient sits at edge of exam table without back support.The physicianExamines the patient’s head, neck, chest, heart, back, and arms.Evaluates the patient’s ability to fully expand the lungs.Drape is placed across patient’s lap for men or across chest and lap for women.Supine/recumbentPatient lies flat on back; the most relaxed position for many patients.A physician can examine the head, neck, chest, heart, abdomen, arms, and legs when a patient is in this position.Drape is placed from neck or underarms down to the feet.Dorsal recumbentSame as supine except the knees are drawn up and feet flat on table.May be more comfortable for patient with arthritis or back pain.Drape is placed from neck or underarms down to feet.
22 Positioning and Draping (cont.) LithotomyFowler’sLearning Outcome: Carry out positioning and draping a patient in each of the nine common exam positions.LithotomyPatient lies on back with knees bent and feet in stirrups attached to end of exam table, with buttocks near the edge of the table.Used during examination of the female genitalia.Use large drape with one point or corner between legs.Fowler’sPatient lies back on exam table on which head is elevated, usually to 45 degrees.The physician may examine the head, neck, and chest areas while the patient is in this position.Best position for examining patients who are experiencing shortness of breath or individuals with a lower back injury.Drape positioned from neck or underarms to feet.
23 Positioning and Draping (cont.) ProneSims’Learning Outcome: Carry out positioning and draping a patient in each of the nine common exam positions.PronePatient lies flat on table, facedown.The physician can examine the back, feet, or musculoskeletal system.Drape positioned from upper back to feet.Sims’Patient lies on left side with left leg slightly bent and left arm placed behind the back so patient’s weight rests primarily on the chest; right knee is bent and raised toward chest, and right arm is bent toward head for support.Used for anal or rectal exams and as well as perineal and certain pelvic exams.
24 Positioning and Draping (cont.) Knee-ElbowFenestrated drapeProctologicLearning Outcome: Carry out positioning and draping a patient in each of the nine common exam positions.Knee-chestPatient lies facedown on the table, supporting body with knees and chest, with thighs at 90-degree angle to table and slightly separated; head is turned to one side and arms are to the side or above the head.Used during exams of the anal and perineal areas and during certain proctologic procedures.Knee-elbowAn alternative to knee-chest that puts less strain on the patient.Patient supports body weight with the knees and elbows rather than the knees and chest.Fenestrated drape – drape with special opening that provides access to the area to be examined.ProctologicPatient lies facedown, bent at hips at 90-degree angle.Used as an alternative to the Sims’ or knee-chest position.Fenestrated drape.
25 Apply Your Knowledge Very Good! 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.Learning Outcome: Carry out positioning and draping a patient in each of the nine common exam positions.Refer to CONNECT to see a video about Positioning the Patient for an ExamVery Good!
26 Special Patient Considerations Patients from different culturesAvoid stereotyping and making judgmentsPatientsMay not know what to expectMay require more privacyMay refuse a specific examLearning Outcome: Apply techniques to assist patients from different cultures and patients with physical disabilities.Culture – a pattern of assumptions, beliefs, and practices that shape the way people think and act.Avoid stereotyping an individual or group on the basis of a single patient’s behavior.Can lead to incorrect judgments, which may influence the care you provide to patients.Avoid making judgments about patients or cultural groups on the basis of your experience with other patients or with your own family and friends.Patients from different culturesMay not be familiar with the medical exam and may not know what to expect.May be more modest than other patients and may have a greater need for privacyMay not want the physician to examine certain areas of their bodiesRefer to Procedure 38-2 Communicating Effectively with Patients from Other Cultures and Meeting Their Needs for PrivacyRefer to Connect to see a video about Communicating Effectively with Patients from Other Cultures and Meeting Their Needs for Privacy
27 Special Patient Considerations Patients with disabilities – provide assistance as neededDisrobingMoving to exam tableAssuming exam positionLearning Outcome: Apply techniques to assist patients from different cultures and patients with physical disabilities.Patients with Physical DisabilitiesHave different strengths and weaknesses, and vary in their ability to ambulateMay require extra assistance in preparing for a general physical exam.DisrobingMoving from a mobility device to the examining tableAssuming certain positions on or off the examining tableAsk for assistance if you are not sure whether you can safely move or lift a patient on your own.Refer to Procedure 38-3 Transferring a Patient in a Wheelchair for an ExamRefer to Connect to see a video about Transferring a Patient in a Wheelchair and Preparing for an Exam
28 SUPER! 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.Learning Outcome: Apply techniques to assist patients from different cultures and patients with physical disabilities.SUPER!
29 Examination Methods Inspection Auscultation Visual exam Posture, mannerisms, and hygieneSize, shape, color, position, symmetryPresence of abnormalitiesAuscultationListening to body sounds using a stethoscopeLearning Outcome: Identify the six examination methods used in a general physical examination.InspectionThe visual exam of the patient’s entire body and overall appearance.Provide good lighting.Make sure patient’s body parts are properly exposed.Auscultation – used to detect the flow of blood through an artery, and perform auscultation extensively in the general exam to assess sounds from the heart, lungs, and abdominal organs.
30 Examination Methods (cont.) PalpationTouchAssess texture, temperature, shapePresence of vibration or movementsPercussionTapping or striking the body to hear sounds or feel vibrationsUsed to determine location, size, or density of structure or organLearning Outcome: Identify the six examination methods used in a general physical examination.PalpationThe physician may palpate superficially or with additional pressure to assess characteristics of underlying tissues and organs.Depending on the characteristic the physician is measuring, she may perform palpation using the fingertips, one hand, two hands, or the palm of the hand.PercussionThe physician may perform percussion by striking the body directly with one or two fingers.More commonly indirect percussion is performed by placing one finger of one hand on the area and striking it with a finger from the other hand.
31 Examination Methods (cont.) ManipulationSystemic moving of a patient’s body partsCheck for abnormalitiesDetermine range of motion of jointsMensuration – process of measuringLearning Outcome: Identify the six examination methods used in a general physical examination.MensurationWeight and heightMeasurements may be done to monitor the growth of the uterus during pregnancy or to note the length and diameter of an extremity or wound.Manipulation – physicians may palpate an area of the body while manipulating it to check for abnormalities that affect movement.
32 Ole! 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 assess for vibrations, and auscultation to assess bowel sounds. The medical assistant may be asked to measure the abdominal girth.Learning Outcome: Identify the six examination methods used in a general physical examination.Ole!
33 Components of the General Physical Examination Exams – performed in a certain orderGeneral appearanceSpecific body sectionsBecome familiar with the standard order for performing an examLearning Outcome: List the components of a general physical exam.Each physician performs the general physical exam in a certain order.Most physicians begin by assessing the patient’s overall appearance and the condition of the patient’s skin, nails, and hair.They usually then proceed with the exam in this following order.Head, neck, eyes, ears, nose and sinuses, mouth, and throatChest and lungs, heart, breastsAbdomen, genitalia, and rectumMusculoskeletal and neurological systems
34 Components of the General Physical Examination (cont.) Medical assistantBe familiar with the components of the examinationKnow equipment and supplies usedEnsure the patient’s comfortProtect the patient’s modestyLearning Outcome: List the components of a general physical exam.Refer to Table 38-2 Components and Materials for a General Physical Exam and Procedure 38-4 Assisting with a General Physical ExamBasic items needed for general physical examPenlight Otoscope/ophthalmoscopeVision chart Color vision chartAudiometer Nasal speculumGloves Tongue depressorStethoscope Vaginal speculumLubricant Tape measureRefer to CONNECT to see a video about Assisting with a General Physical Exam
35 Components of the General Physical Examination (cont.) General appearanceGeneral state of heathDistress or painSkinNails and nail bedsHairHeadAbnormal condition of scalp or skinPuffinessAbnormal growthsLearning Outcome: List the components of a general physical exam.General AppearanceIs the patient in good health and of an acceptable weight.Is the patient distressed or in pain.What is the patient’s the level of the patient’s alertness.SkinColor, texture, moisture level, temperature, elasticityIndicator of overall healthLesionsNails and nail beds – may indicate poor nutrition, disease, infectionHairPattern of hair growth and the texture of the hair on the scalp and body.Sudden hair loss or changes in hair growth may be indicators of an underlying disease.
36 Components of the General Physical Examination (cont.) NeckLymph nodes, thyroid glands, and major blood vesselsSymmetry and range of motionEyesThe presence of disease or abnormalitiesPupils for light responseMusclesInternal structuresLearning Outcome: List the components of a general physical exam.NeckPalpates the patient’s lymph nodes, thyroid gland, and major blood vessels.Enlarged lymph nodes may indicate infection or a blood cancer.EyesChecks eye muscles by observing the patient’s ability to follow movement.Uses an ophthalmoscope to examine the patient’s retinas and other internal structures of the eyes.Vision tests may be performed before or after general exam.
37 Components of the General Physical Examination (cont.) EarsOuter earSymmetry and sizeLesions, redness, or swellingInner ear structuresCanalsEardrumsNose and sinusesInfection or allergyNasal mucosaTenderness in sinusesLearning Outcome: List the components of a general physical exam.EarsThe physician examines the inner structures of the patient’s ears using an otoscope.Checks the patient’s ear canals for redness, drainage, lesions, foreign objects, or the presence of excessive cerumen.Checks the color, shape, and reflectiveness of the eardrums.Hearing tests may be performed before or after general exam.Nose and SinusesChecks for the presence of infection or allergy.Nasal mucosa – lining of the noseUses a penlight to view the color.Notes any discharge, lesions, obstructions, swelling, or inflammation.May use palpation to check for tenderness in a patient’s sinuses.
38 Components of the General Physical Examination (cont.) The physician inspects the patient’s chest from the back, side, and front.Components of the General Physical Examination (cont.)Mouth and throatMouth ~ overall health and hygieneThroat ~ swelling or rednessChest and lungsHyperventilationInspectionAuscultationPalpation and percussionLearning Outcome: List the components of a general physical exam.Mouth and ThroatCondition of the mouth provides a general impression of overall health and hygiene.Examines the lining of the cheeks, the underside of the tongue, and the floor of the mouth forChanges in color or lesions.The condition of the teeth and gums.Examines the patient’s throat and tonsils carefully.Chest and LungsHyperventilation – overly deep breathing that leads to loss of carbon dioxide in the blood.Inspects the chest for its shape, symmetry, and postural position and the presence of deformities.Listens to the lung sounds during both normal and deep breathing to assess for abnormal breathing.Palpates the chest and performs percussion to check for the presence of fluid or a foreign mass in the lungs.
39 Components of the General Physical Examination (cont.) HeartPercussion – size of heartAuscultationHeart soundsRate, rhythm, intensity, and pitchBreastsInspectionPalpationLymph nodesLearning Outcome: List the components of a general physical exam.HeartThe heart and vascular system is usually examined at the same time as, or immediately after, the lung exam.Palpates to locate the correct anatomical landmarks for placing the stethoscope.Percusses to check the heart’s size.Notes the heart’s rate, rhythm, intensity, and pitch.BreastsDuring a general physical exam, every woman should have a complete breast exam to check for signs of cancer.Inspects the breasts for symmetry, contour, masses, and retracted areas.Palpates the lymph nodes under her arms.Palpates each breast in a circular, systematic manner to check for lumps, examines the areolas and nipples.The breasts of men are also checked in the same manner
40 Components of the General Physical Examination (cont.) AbdomenInspectionAuscultationPercussionPalpationFindings described using system of landmarksLearning Outcome: List the components of a general physical exam.The abdominal muscles should be completely relaxed.The order of exam methods for the abdomen isInspectionSkin color and surfaceShape and symmetry.Auscultation – bowel and vascular soundsPercussion – size and position of the organs.PalpationMuscle tonePresence of any tenderness or masses.This allows the physician to listen to bowel sounds before palpating the abdominal organs. Palpation of the abdominal area can change bowel sounds causing a misdiagnosis.Observations are described based on a system of landmarks that map out the abdominal region. The abdomen is typically divided into four equal sections, or quadrants.
41 Components of the General Physical Examination (cont.) Female genitaliaLithotomy positionAssist to relaxMale genitaliaInspectionPenis and scrotumGroinPalpationLymph nodesLearning Outcome: List the components of a general physical exam.Female Genitalia – the procedure for a gynecologic exam is described in detail in Assisting in Reproductive and Urinary Specialties.Male GenitaliaWhile supineInspects the patient’s penis for signs of infection or structural abnormalities and palpates for any lesions.The scrotum is examined in the same mannerThe testicles are palpated for lumps.While standingChecks for any bulges in the groin that may indicate a herniaPalpates the local lymph nodes to check for any abnormality.
42 Components of the General Physical Examination (cont.) RectumPalpation using a digital examLesions or abnormalitiesOccult bloodLearning Outcome: List the components of a general physical exam.RectumUsually examined after the genitalia.A dorsal recumbent or Sims’ position.Digital exam – palpation of the rectum for lesions or irregularities.Physician wears glovesLubrication usedAny stool found on the glove may be tested for the presence of occult blood which can be an indication of cancer or gastrointestinal bleed.After the rectal exam, offer the patient the opportunity to clean the anal area before you adjust the drape.Dispose of waste appropriately.
43 Components of the General Physical Examination (cont.) Musculoskeletal systemPosture ~ scoliosisGaitRange of motionMuscle strengthBody measurementsLesions, deformities, or circulatory problemsLearning Outcome: List the components of a general physical exam.Musculoskeletal SystemThe physician checks for good posture from the back and side.He may ask the patient to walk to assess the gait.The physician will have a child to bend at the waist to check for scoliosis – a lateral curvature of the spine.Determine range of motion,To detect joint deformities.To determine if there are any limitations in movement caused by an injury or other conditions.To follow a patient’s progress during recovery from an injury or surgery.Determine the strength of various muscle groups, and body measurements.The physician also examines the arms, hands, legs, and feet for any lesions, deformities, or circulatory problems.
44 Components of the General Physical Examination (cont.) Neurological systemReflexesMental and emotional statusSensory and motor functionsIntellectual assessment in childrenMental status and memory in elderlyLearning Outcome: List the components of a general physical exam.Neurological SystemIncludes an evaluation ofReflexesMental and emotional status, including intelligence, speech, and behaviorSensory and motor functions.The neurologic assessment is often done with the musculoskeletal assessment because both systems are involved in movement and coordination.Testing how a patient’s pupils react to light is part of an eye exam, but because this test also examines the patient’s light reflexTo check reflexes, the physician uses a reflex hammer to tap tendons in different areas of the patient’s body.Most exams of children also include an intellectual assessment.Physicians may also test the mental status and memory of older adults.
45 Apply Your Knowledge Good Job! 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.Learning Outcome: List the components of a general physical exam.Good Job!
46 After the Examination Assist patient to a sitting position Allow the patient to perform any necessary self-hygiene measuresAllow patient to dressPerform additional tests or proceduresLearning Outcome: Describe follow-up steps after a general physical exam.Assist in making the patient comfortable.Allow patient to dress before or after additional tests as appropriate
47 Additional Tests and Procedures Prior to dressingCold and heat therapyApplying bandagesCollecting specimensLearning Outcome: Describe follow-up steps after a general physical exam.Post-exam procedures may include taking body fat measurements, blood samples, or preparing the patient for a diagnostic or therapeutic procedure.Procedures medical assistants may perform before the patient dresses includeCold or heat therapyApplying a bandageCollecting specimensAdministering certain medicationsSome medications should be administered before the patient dresses while others can be given after he is dressed.
48 Additional Tests and Procedures After dressingUrine reagent strip testsPulmonary function testsEye or ear irrigation or medication administrationLearning Outcome: Describe follow-up steps after a general physical exam.Tests and procedures that can be done after the patient has dressed includeUrine reagent strip testsPulmonary function testsAdministration of oral medicationsEye or ear irrigation or medication administration.
49 Patient Education Assess needs Use proper language level Risk factors for diseaseMedication administrationSelf-help or diagnostic techniquesUse proper language levelEnsure understandingGive written instructionsLearning Outcome: Describe follow-up steps after a general physical exam.Based on the findings of the patient’s interview, history, and exam, you may identify areas in which the patient will benefit from additional education.Topics include:Risk factors for diseaseHow to administer certain medicationsHow to perform self-help or diagnostic techniques.Teach the patient the correct way to perform a diagnostic test.If a specimen is incorrectly obtained, the test results will be inaccurate.Address patients at a language level they can understand without talking down to them.To ensure they understand fully, ask patients to repeat each instruction and to perform each demonstration.Give patients written instructions they can refer to at home.
50 Follow-Up Scheduling appointments Helping plan for home nursing care Future office visitsOutside appointmentsHelping plan for home nursing careHelping the patient obtain assistanceLearning Outcome: Describe follow-up steps after a general physical exam.Follow-up may includeScheduling the patient for future visits at the office.Making outside appointments for diagnostic tests or for therapeutic procedures.Helping the patient and the patient’s family plan for home nursing care after an illness or surgical procedure.Helping the patient obtain help from community or social service organizations, such as adult day care, counseling, or meal programs.Follow-up appointments can be scheduledTo review diagnostic testing or laboratory results and to discuss possible treatment methods for any abnormal test results.To monitor previous treatments for diagnosed conditions.Use your critical thinking skills and follow office procedures to prepare patients correctly for the various types of patient visits.
51 Super! 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.Learning Outcome: Describe follow-up steps after a general physical exam.Refer to OLC to complete the activity “Building An Office Visit (OV) Note”Super!
52 In Summary38.1 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.
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.
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 patient’s 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
55 In Summary (cont.)38.5 The nine common exam positions include sitting, supine, dorsal recumbent, lithotomy, 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. Assist patients who have physical disabilities with transfers and other tasks they cannot accomplish themselves.
56 In Summary (cont.)38.7 The six examination methods used in a general physical exam include inspection, auscultation, palpation, percussion, mensuration, and manipulation.38.8 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.
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 patient’s condition.
58 End of Chapter 38Health is the thing that makes you feel that now is the best time of the year.~ Franklin P. Adams