1. Assisting with a General Physical Examination38
Assisting with a General Physical Examination

2. Learning Outcomes
38.1 Identify the purpose of a general physical examination.
38.2 Describe the role of the medical assistant in a general physical examination.
38.3 Explain safety precautions used during a general physical examination.
38.4 Carry out the steps necessary to prepare the patient for an examination.

3. Learning Outcomes (cont.)
38.5 Describe how to position and drape a patient in each of the ten common examination positions.
38.6 Describe how to assist patients from different cultures, patients with disabilities, and pediatric patients during a physical examination.
38.7 Identify the six examination methods used in a general physical examination.
38.8 List the components of a general physical examination.

4. Learning Outcomes (cont.)
38.9 Perform the procedures for vision screenings.
38.10 Perform the procedures for hearing screenings.
38.11 Explain the special needs of the elderly for patient education.
38.12 Identify ways to help a patient follow up on a doctor’s recommendations.

5. Introduction
You must make the client comfortable and assist the physician during the physical examination
Physical examination is the first step in the process for the physician.
Learning Outcomes:
38.1 Identify the purpose of a general physical examination.
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. Purpose of General Physical Examination
To confirm an overall state of health
To diagnose a medical problem
Focuses on an organ system
Based on patient’s chief complaint
Learning Outcome:
38.1 Identify the purpose of a general physical examination.
Exam to diagnose a medical problem
Organ systems are interdependent.
Even though exam is focused on one organ system, physician generally performs an overall physical exam.

7. Purpose of General Physical Examination (cont.)
Clinical diagnosis
Based on signs and symptoms of a disease
Sign – objective information that can be detected
Symptom – subjective information from the patient
Laboratory and diagnostic tests
Confirm clinical diagnosis
Aid in forming differential diagnosis
Aid in developing a prognosis
Formulate a treatment plan and/or drug therapy
Learning Outcome:
38.1 Identify the purpose of a general physical examination.
Differential diagnosis: Determining the correct diagnosis when two or more diagnoses 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. Role of Medical Assistant
Enable the doctor to perform an effective examination
Contribute to patient confidence in care
Physical and emotional comfort
Tasks
Interview
Write an accurate history
Determine vital signs and measure weight and height
Assist with examination
Learning Outcome:
38.2 Describe the role of the medical assistant in a general physical examination.
Your responsibilities include ensuring that all instruments and supplies are readily available to the doctor during the examination.

9. Apply Your Knowledge Excellent!
What are two purposes for a general physical examination? Describe the role the medical assistant plays in this exam.
ANSWER: A physical examination is used to confirm the patient’s overall state of health or to diagnose a medical problem. The medical assistant’s role includes putting the patient at ease, performing the initial interview, documenting the patient history, taking vital signs and body measurements, assisting the physician in the exam, and making sure instruments and supplies are available for the exam.
Excellent!

10. Safety Precautions
Occupational Safety and Health Administration (OSHA) standards and guidelines
Protect employee
Make workplace safe
Centers for Disease Control and Prevention (CDC) guidelines
Protect patients and health-care workers
Learning Outcome:
38.3 Explain safety precautions used during a general physical examination.

11. Safety Precautions (cont.)
Hand washing
Before and after each patient contact
Before and after each procedure
Wear gloves if there is probability of contact with
Blood  Nonintact skin
Body fluids  Moist surfaces
Learning Outcome:
38.3 Explain safety precautions used during a general physical examination.
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.

12. Safety Precautions (cont.)
Wear a mask if there is any possibility of exposure to an infectious disease transmitted by airborne droplets
Respiratory hygiene/cough etiquette
Isolation precautions
Personal protective equipment
Keep patients with possible infections separated from other patients
Learning Outcome:
38.3 Explain safety precautions used during a general physical examination.
Respiratory hygiene/cough etiquette
Cover mouth/nose when coughing
Use tissues and dispose of them in a no-touch receptacle
Observe hand hygiene
Wear a surgical mask or maintain a distance of greater than three feet if possible

13. 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
Learning Outcome:
38.3 Explain safety precautions used during a general physical examination.
Discarding disposable equipment and supplies appropriately: If they come in contact with a patient’s blood or body fluids, discard in biohazardous waste container.

14. Apply Your Knowledge
Impressive!
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 most likely has chickenpox. She and her mother should be moved away from other patients in the waiting room to a private area. Since chickenpox is 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.

15. Preparing the Patient for an Examination
Emotional – explain exactly what will occur
Physical – offer the bathroom and instruct the patient on how to disrobe and don an exam gown
Positioning and draping – help patient assume needed exam position and drape to provide privacy
Learning Outcome:
38.4 Carry out the steps necessary to prepare the patient for an examination.
Emotional preparation
Use simple, clear language
Involve children to inspect blunt instruments
Speak calmly to children and praise them when they cooperate
Approach infants slowly and gently
Physical preparation
Extent of disrobing depends on type of exam and doctor’s preference
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

16. Positioning and Draping
Positions facilitate physician’s examination
Assist the patient to appropriate position
Make as comfortable as possible
Cover with appropriate drape
Keep patient warm
Maintain privacy/modesty
Learning Outcome:
38.5 Describe how to position and drape a patient in each of the ten common examination positions.
Positioning and draping
Use good body mechanics to protect yourself from injury
Help minimize the time a patient spends in any embarrassing or uncomfortable position
Choose a drape that will keep the patient warm and maintain privacy

17. Positioning and Draping (cont.)
Sims’
Knee-chest
Proctologic
Positions
Sitting
Supine (recumbent)
Dorsal recumbent
Lithotomy
Trendelenburg’s
Fowler’s
Prone
Learning Outcome:
38.5 Describe how to position and drape a patient in each of the ten common examination positions.

18. Positioning and Draping (cont.)
Sitting
Supine/recumbent
Dorsal recumbent
Learning Outcome:
38.5 Describe how to position and drape a patient in each of the ten common examination positions.
Symmetry: The degree to which one side is the same as the other.
Sitting
Patient sits at edge of exam table without back support
Drape is placed across patient’s lap for men or across chest and lap for women
Supine/recumbent
Patient lies flat on back
Drape is placed from neck or underarms down to the feet
Dorsal recumbent
Patient lies faceup, with back supporting weight, knees drawn up and feet flat on table
Drape is placed from neck or underarms down to feet

19. Positioning and Draping (cont.)
Lithotomy
Trendelenburg’s
Fowler’s
Prone
Learning Outcome:
38.5 Describe how to position and drape a patient in each of the ten common examination positions.
Lithotomy
Patient lies on back with knees bent and feet in stirrups attached to end of exam table, with buttocks near the edge of the table
Use large drape with one point or corner between legs
Trendelenburg’s
Patient is supine on tilted table with head lower than legs
Drape positioned from neck or underarms to knees
Fowler’s
Patient lies back on exam table on which head is elevated, usually to 45 degrees
Drape positioned from neck or underarms to feet
Prone
Patient lies flat on table, facedown
Drape positioned from upper back to feet

20. Positioning and Draping (cont.)
Sims’
Knee-Chest
Proctologic
Learning Outcome:
38.5 Describe how to position and drape a patient in each of the ten common examination positions.
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
Drape positioned from upper back to feet
Knee-chest
Patient 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
Fenestrated drape: Drape with special opening that provides access to the area to be examined
Knee-elbow position may be used instead for pregnant, obese, and elderly patients
Proctologic
Patient lies facedown, bent at hips at 90-degree angle
Fenestrated drape

21. Special Considerations
Patients from different cultures
Avoid stereotyping
Avoid making judgments
Patients with disabilities
Provide extra assistance as needed
Ask for assistance with patient transfers
Learning Outcome:
38.6 Describe how to assist patients from different cultures, patients with disabilities, and pediatric patients during a physical examination.
Culture: Pattern of assumptions, beliefs, and practices that shape the way people think and act.

22. Special Considerations (cont.)
Children
Modify techniques based on age and ability
Emotional
Involve child in the examination
Approach infants and toddlers slowly, with a smile and gentle voice
Perform procedures quickly
Physical
Examination position based on age and ability
Examine painful areas and genitalia of older children last
Learning Outcome:
38.6 Describe how to assist patients from different cultures, patients with disabilities, and pediatric patients during a physical examination.

23. 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.
Very Good!

24. Examination Methods Inspection Palpation Visual examination
Assesses posture, mannerisms, and hygiene
Size, shape, color, position, symmetry
Presence of abnormalities
Palpation
Touch texture, temperature, shape
Presence of vibration or movements
Superficial or with additional pressure
Learning Outcome:
38.7 Identify the six examination methods used in a general physical examination.
Inspection
Provide good lighting
Make sure patient’s body parts are properly exposed

25. Examination Methods (cont.)
Percussion
Tapping and striking the body to hear sounds or feel vibrations
Determine location, size, or density of structure or organ
Auscultation
Listening to body sounds
Assess sounds from heart, lungs, and abdominal organs
Learning Outcome:
38.7 Identify the six examination methods used in a general physical examination.

26. Examination Methods (cont.)
Manipulation
Systemic moving of a patient’s body parts
Range of motion of joints
Mensuration
Measuring
Height and weight
Length or diameter of extremity
Growth of uterus during pregnancy
Learning Outcome:
38.7 Identify the six examination methods used in a general physical examination.

27. Bravo! 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 determine if there is fluid or air in the abdomen, and auscultation to assess bowel sounds. The medical assistant may be asked to measure the abdominal girth.
Bravo!

28. Components of the General Physical Examination
Overall appearance and the condition of skin, nails, and hair
The body
Head, neck, eyes, ears, nose and sinuses, mouth, and throat
Chest and lungs, heart, breasts
Abdomen, genitalia, and rectum
Musculoskeletal and neurological systems
Learning Outcome:
38.8 List the components of a general physical examination.

29. Components of the General Physical Examination (cont.)
Medical assistant
Be familiar with the components of the examination
Know equipment and supplies used
Ensure the patient’s comfort
Protect the patient’s modesty
Can you name these pieces of examination equipment?
Learning Outcomes:
38.2 Describe the role of the medical assistant in a general physical examination.
38.8 List the components of a general physical examination.
Basic items needed for general physical exam
Penlight
Otoscope/ophthalmoscope
Vision chart
Color vision chart
Audiometer
Nasal speculum
Gloves
Tongue depressor
Stethoscope
Vaginal speculum
Lubricant
Tape measure

30. Components of the General Physical Examination (cont.)
General appearance
Skin – a good indicator of overall health
Nails and nail beds
Hair – pattern of growth and texture
Head
Abnormal condition of scalp or skin
Puffiness
Abnormal growths
Learning Outcome:
38.8 List the components of a general physical examination.
Skin: Color, texture, moisture level, temperature, elasticity
Nail condition: May indicate poor nutrition, disease, infection

31. 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
Learning Outcome:
38.8 List the components of a general physical examination.
Enlarged lymph nodes may indicate infection or a blood cancer.
Enlarged thyroid gland may indicate thyroid disease.
Vision tests may be performed before or after general exam.

32. Components of the General Physical Examination (cont.)
Ears
Outer ear
Symmetry and size
Presence of lesions, redness, or swelling
Inner ear structures
Canals
Eardrums
Nose and sinuses
Nasal mucosa
Structures of nose
Palpation to check for tenderness in sinuses
Learning Outcome:
38.8 List the components of a general physical examination.
Cerumen: Waxy secretion from the ear, also known as earwax.
Hearing tests may be performed before or after general exam.
Nasal mucosa: Lining of the nose.

33. Components of the General Physical Examination (cont.)
Mouth and throat
Mouth – impression of overall health and hygiene
Throat
Common site of infection
Tonsils – swelling or redness
Chest and lungs
Inspection
Symmetry in expansion
Shape
Posture position
Palpation – fluid or foreign mass in lungs
Auscultation – listen for abnormalities
Learning Outcome:
38.8 List the components of a general physical examination.
Hyperventilation: Overly deep breathing that leads to loss of carbon dioxide in the blood.

34. Components of the General Physical Examination (cont.)
Heart and vascular system
Percussion – size of heart
Auscultation
Heart sounds
Rate, rhythm, intensity, and pitch
Pulses
Breasts
Palpation for abnormalities
Abdomen
Inspection
Auscultation
Percussion
Palpation
Learning Outcome:
38.8 List the components of a general physical examination.
Abdominal quadrants
Right upper quadrant
Right lower quadrant
Left upper quadrant
Left lower quadrant
Abdominal regions
Right hypochondriac region
Epigastric region
Left hypochondriac region
Right lumbar region
Umbilical region
Left lumbar region
Right iliac region
Hypogastric region
Left iliac region

35. Components of the General Physical Examination (cont.)
Genitalia
Female – lithotomy position
Male
Supine position then standing
Infection, structural abnormalities, lumps
An assistant of same sex as patient must be in the room during examination
Rectum
Usually performed following exam of genitalia
Lesions or abnormalities
Occult blood
Learning Outcome:
38.8 List the components of a general physical examination.
Digital exam: Palpation of the rectum for lesions or irregularities.

36. Components of the General Physical Examination (cont.)
Musculoskeletal system
Posture
Gait
Range of motion
Muscle strength
Body measurements
Development and coordination in children
Neurological system
Reflexes
Mental and emotional status
Sensory and motor functions
Intellectual assessment in children
Mental status and memory in elderly
Learning Outcome:
38.8 List the components of a general physical examination.

37. Apply Your Knowledge Good Job!
What is the medical assistant’s role in a general physical examination?
ANSWER: The medical assistant should be familiar with the components of the examination, know equipment and supplies used, ensure the patient’s comfort, and protect the patient’s modesty.
Good Job!

38. Completing the Examination
Assist patient to a sitting position
Allow the patient to perform any necessary self-hygiene measures
Perform additional tests or procedures
Learning Outcome:
38.8 List the components of a general physical examination.
Tests and procedures performed before patient dresses
Cold or heat therapy
Applying a bandage
Collecting culture specimens
Administering an injection
Applying a topical medication
Tests and procedures that can be performed after patient dresses
CLIA-waived laboratory tests
Otic or ophthalmic irrigation
Administration of certain medications
Pulmonary function tests

39. Completing the Examination (cont.)
Screening for visual acuity
Snellen chart – distance
Jaegar chart – near vision
Ishihara book – color vision
Special considerations
Children
Patients with dementia or Alzheimer’s disease
Auditory acuity – audiometer
Learning Outcomes:
38.9 Perform the procedures for vision screenings.
38.10 Perform the procedures for hearing screenings.

40. Completing the Examination (cont.)
Patient education
Assess needs
Topics
Risk factors for disease
Medication administration
Self-help or diagnostic techniques
Do not talk down to patient
Ensure understanding
Give written instructions
Learning Outcome:
38-11 Explain the special needs of the elderly for patient education.

41. Completing the Examination (cont.)
Special problems of the elderly
Greater need for patient education
Common problems:
Incontinence
Depression
Lack of information on preventive medicines
Poor patient compliance when taking medications
Involve family members when possible
Learning Outcome:
38-11 Explain the special needs of the elderly for patient education.
Patient compliance: Obedience in following the physician’s orders.

42. Completing the Examination (cont.)
Follow-up
Scheduling the patient for future visits
Making outside appointments for diagnostic tests
Helping the patient and patient’s family plan for home nursing care
Helping the patient obtain help from community or social services
Learning Outcome:
38.12 Identify ways to help a patient follow up on a doctor’s recommendations.

43. 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.
Super!

44. 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.

45. 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.
38.4 The medical assistant should prepare the patient for an exam emotionally, by using simple, direct language; physically, by providing for the patient’s comfort and privacy and by positioning him or her according to the type of exam or procedure; and by modifying techniques to meet the needs of special patients.

46. In Summary (cont.)
38.5 The ten common exam positions include sitting, supine, dorsal recumbent, lithotomy, Trendelenburg, Fowler’s, 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.

47. In Summary (cont.)
38.7 Assist patients with physical disabilities with transfers and other tasks they cannot accomplish themselves.
38.8 Involve the child in the exam process and assist him based upon his age and ability to cooperate.

48. In Summary (cont.)
38.9 The six examination methods used in a general physical exam include inspection, palpation, percussion ,auscultation, mensuration, and manipulation.
38.10 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.

49. In Summary (cont.)
38.11 Vision screening procedures include using the Snellen chart for distance visual acuity, the Jaegar chart for screening for near vision, and the Ishihara book for color vision screening.
38.12 An auditory acuity test is done before or after the exam using some type of audiometer.

50. In Summary (cont.)
38.13 Patient education for the elderly requires ensuring compliance when taking medications, providing preventative medicine education tools, and recognizing problems related to incontinence and depression.
38.14 In order to assist the patient with follow-up after his or her 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.

51. End of Chapter 38
Health is the thing that makes you feel that now is the best time of the year.
~ Franklin P. Adams