Assisting with the Physical Examination Chapter 30 Assisting with the Physical Examination Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Physical Exams Doctors and many RNs perform physical exams. You may need to assist. Exams are done to: Promote health. Determine fitness for work. Diagnose disease. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Your Role Your role depends on: Agency policies and procedures What the examiner prefers P. 534 in the Textbook lists some of the tasks you might perform. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Equipment Instruments used in the exam Laryngeal mirror—used to examine mouth, teeth, and throat Nasal speculum—used to examine inside of the nose Ophthalmoscope—lighted instrument used to examine the internal eye structures Otoscope—lighted instrument used to examine the external ear and eardrum Percussion hammer (reflex hammer)—used to tap body parts to test reflexes Tuning fork—vibrated to test hearing Vaginal speculum—opens the vagina to examine it and the cervix Refer to Figure 30-1 on p. 535 in the Textbook. Some agencies have exam trays in the supply department. If not, collect the items listed in the procedure: Preparing the Person for an Examination, p. 536 in the Textbook. Arrange them on a tray or table. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Preparing the Person You must respect the person’s feelings and concerns. The person is prepared physically and mentally for the exam. The nurse explains the exam’s purpose and what to expect. The person must give informed consent for the exam. The physical exam concerns many people. Discomfort, embarrassment, exposure, and not knowing the procedure cause anxiety. Review the Focus on Communication: Preparing the Person Box on p. 535 in the Textbook. Review the Focus on Children and Older Persons: Preparing the Person Box on p. 535 in the Textbook. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Preparing the Person (cont’d) You can assist the nurse by: Providing for privacy Screen the person and close the room door. Help the person put on a patient gown. Explain that only the part being examined is exposed. Having the person void to empty the bladder Allows the examiner to feel the abdominal organs Obtaining a urine specimen (if needed) Explain how to collect the specimen. Label the container. The person removes all clothes for the exam. The gown reduces the naked feeling and the fear of exposure. A full bladder can change the normal position and shape of organs. It also causes discomfort, especially when feeling the abdominal organs. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Preparing the Person (cont’d) Measuring weight, height, and vital signs Record the measurements on the exam form. Draping the person Use a paper drape, bath blanket, sheet, or drawsheet. Positioning the person for the exam Review the Delegation Guidelines: Preparing the Person Box on p. 536 in the Textbook. Review the Promoting Safety and Comfort: Preparing the Person Box on p. 536 in the Textbook. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Positioning and Draping The examiner tells you how to position the person. Before helping the person assume and maintain the position, explain: Why the position is needed How to assume the position How the body is draped for warmth and privacy How long to expect to stay in the position Some positions are uncomfortable and embarrassing. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Positioning and Draping (cont’d) Dorsal recumbent (horizontal recumbent) position Used to examine the abdomen, chest, and breasts The person is supine with legs together. To examine the perineal area, knees are flexed and hips externally rotated. Drape the person. Lithotomy position Used to examine the vagina and cervix Hips are at the edge of the exam table; knees are flexed and hips externally rotated; feet are in stirrups. Drape as for perineal care. Refer to Figure 30-2, A, on p. 537 in the Textbook, for how to position and drape the person for the dorsal recumbent position. Some women cannot assume the lithotomy position. If so, the examiner tells you how to position the woman. Refer to Figure 30-2, B, on p. 537 in the Textbook, for how to position and drape the person for the lithotomy position. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Positioning and Draping (cont’d) Knee-chest position (genupectoral position) Used to examine the rectum The person kneels and rests the body on the knees and chest; head is turned to one side; arms are above the head or flexed at the elbows; back is straight; body is flexed about 90 degrees at the hips. Apply drape in a diamond shape to cover the back, buttocks, and thighs. Sims’ position Sometimes used to examine the rectum or vagina Drape in a diamond shape. Examiner folds back the near corner to expose the area being examined. Refer to Figure 30-2, C, on p. 537 in the Textbook, for how to position and drape the person for the knee-chest position. Refer to Figure30-2, D, on p. 537 in the Textbook, for how to position and drape the person for Sims’ position. Review the Focus on Children and Older Persons: Positioning and Draping Box on p. 537 in the Textbook. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Assisting with the Exam You may be asked to: Prepare, position, and drape the person. Assist the doctor or nurse during the exam. After the exam: Assist the person to dress or return to bed. Discard disposable items. Replace supplies. Clean re-usable items. Follow agency policy. Return items to the tray or storage area. To assist with the exam, follow the rules in Box 30-1 on p. 537 in the Textbook. Review the Focus on Communication: Assisting With the Exam Box on p. 538 in the Textbook. Review the Focus on Children and Older Persons: Assisting With the Exam Box on p. 538 in the Textbook. Before the person dresses or returns to the room, assist the person to wipe or clean any lubricant used in the exam. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Assisting with the Exam (cont’d) Send a re-usable speculum to the supply department for sterilization. Cover the exam table with a clean drawsheet or paper. Label specimens. Take them to the designated area with a requisition slip. Clean and straighten the person’s unit or exam room. Follow agency policy for soiled linens. Review the Teamwork and Time Management: After the Exam Box on p. 538 in the Textbook. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.