The Physical Examination Chapter 25 The Physical Examination

Methods of Examination Observation or inspection General health Posture Body movements Skin

Methods of Examination Observation or inspection Mannerisms Care in grooming Body symmetry and contour Skin rashes and color Deformities

Methods of Examination Palpation Examination of body using touch Abdominal masses Skin texture, moisture, temperature Use of fingertips, one or both hands, or palm of hand [FIGURE 25-2]

Methods of Examination Percussion Eliciting sounds from body by tapping Vibrations and sounds from underlying organs and cavities Presence of air or solid material Dull and hollow sounds Direct and indirect methods

Methods of Examination Auscultation Listening directly to body sounds Provider normally uses stethoscope Lung, heart, abdomen, bowel sounds Determines blood pressure reading [FIGURE 25-4]

Methods of Examination Mensuration Measuring process Height Weight Length of limb Amount of flexion and extension Chest and infant head circumference Use of tape measure

Methods of Examination Manipulation Checks degree of flexion and extension of joints Applying forceful passive movement on joint Range of motion of joints

Positioning and Draping Each position makes examination of area of body easier and more efficient Always provide for patient safety Proper draping Protect modesty Prevent embarrassment Provide comfort from chills

Examination Positions Supine (horizontal recumbent) Dorsal recumbent [FIGURE 25-6 and FIGURE 25-7]

Examination Positions Lithotomy Semi-Fowler’s (45-degree angle) [FIGURE 25-8 and FIGURE 25-9]

Examination Positions High-Fowler’s (90-degree angle) Prone [FIGURE 25-10 and FIGURE 25-12]

Examination Positions Knee-chest position Rarely used Used for proctologic examinations and sigmoidoscopy procedures Proctologic table has made position unnecessary Fenestrated drape covers patient from shoulders to knees (See FIGURE 25-11)

Examination Positions Sims’ (lateral) >> Trendelenberg Aid person who is in shock Elevate and incline legs [FIGURE 25-13]

Equipment and Supplies for the Physical Examination [FIGURE 25-14] (See Table 25-1: Some Common Instruments and Supplies Needed for a Physical Examination)

Equipment and Supplies for the Physical Examination Equipment and supplies needed vary with provider and type of examination Equipment in working order Room properly stocked MA responsible for patient preparation (See FIGURE 25-11)

Basic Components of a Physical Examination [FIGURE 25-16]

Basic Components of a Physical Examination Patient appearance Gait Stature Posture Body movements Speech Breath odors Nutrition Skin and appendages

Physical Examination Sequence Patient’s vital signs, height, weight, visual acuity, auditory ability Laboratory procedures Patient instructed about undressing Gown and drape provided MA remains in room when provider examining patient

Physical Examination Sequence MA places instruments for examination on counter or Mayo stand Starts at head and proceeds downward Head Eyes Ears Nose Mouth and throat (See Table 25-2: Components of the Physical Examination)

Physical Examination Sequence Starts at head and proceeds downward Neck Chest Breast Abdomen Genitals Rectum Reflexes (See Procedure 25-1: Assisting with a Complete Physical Examination)

After the Examination Patient instructed to dress Remain in room if patient requires assistance Instructions regarding testing procedures and treatment plans given by provider Once patient has left room, equipment and supplies sanitized, disinfected, sterilized