Assisting with General Physical Examination

Assisting with General Physical Examination
38 Assisting with General Physical Examination

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.

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.

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.

Introduction Physical examination – 1st step in the diagnosis or treatment process The medical assistant Make the client comfortable Assist the physician Learning 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.

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

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 Learning 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.

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!

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 Learning 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.

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 Learning 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 include Ensuring all instruments and supplies are readily available. Ensure that patients are physically and emotionally comfortable during the exam Helping them into position Keeping them aware of what is going to happen. Observing them for signs that indicate distress or the need for assistance.

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 by Helping the patient into position Telling them what will happen Observing 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!

Safety Precautions OSHA standards and guidelines
Protect employees Make the workplace safe CDC guidelines – protect patients and health-care workers Learning Outcome: Explain safety precautions used during a general physical exam. Safety measures are outlined by the Department of Labor’s Occupational Safety and 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.

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 Learning 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.

Respiratory hygiene/cough etiquette Wear a mask to prevent exposure to an infectious disease transmitted by airborne droplets Isolation precautions – personal protective equipment Learning Outcome: Explain safety precautions used during a general physical exam. 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 Wear 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)

Discard all disposable equipment and supplies appropriately Clean and disinfect the exam room after each patient Sanitize, disinfect, and sterilize equipment appropriately Learning 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.

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 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.

Preparing the Patient for an Exam
Emotional preparation Explain exactly what will occur and what they will feel Use simple direct language Learning Outcome: Carry out the steps necessary to prepare the patient for an examination. Emotional preparation Describe 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.

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 Learning 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 preparation Extent 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.

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!

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 Learning Outcome: Carry out positioning and draping a patient in each of the nine common exam 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 You 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.

Positioning and Draping (cont.)
Sitting Symmetry Supine/recumbent Dorsal recumbent Learning 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. Sitting Patient sits at edge of exam table without back support. The physician Examines 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/recumbent Patient 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 recumbent Same 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.

Lithotomy Fowler’s Learning Outcome: Carry out positioning and draping a patient in each of the nine common exam 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. Used during examination of the female genitalia. Use large drape with one point or corner between legs. Fowler’s Patient 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.

Prone Sims’ Learning Outcome: Carry out positioning and draping a patient in each of the nine common exam positions. Prone Patient 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.

Knee-Elbow Fenestrated drape Proctologic Learning Outcome: Carry out positioning and draping a patient in each of the nine common exam positions. 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. Used during exams of the anal and perineal areas and during certain proctologic procedures. Knee-elbow An 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. Proctologic Patient lies facedown, bent at hips at 90-degree angle. Used as an alternative to the Sims’ or knee-chest position. Fenestrated drape.

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 Exam Very Good!

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 Learning 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 cultures May 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 privacy May not want the physician to examine certain areas of their bodies Refer to Procedure 38-2 Communicating Effectively with Patients from Other Cultures and Meeting Their Needs for Privacy Refer to Connect to see a video about Communicating Effectively with Patients from Other Cultures and Meeting Their Needs for Privacy

Special Patient Considerations
Patients with disabilities – provide assistance as needed Disrobing Moving to exam table Assuming exam position Learning Outcome: Apply techniques to assist patients from different cultures and patients with physical disabilities. Patients with Physical Disabilities Have different strengths and weaknesses, and vary in their ability to ambulate May require extra assistance in preparing for a general physical exam. Disrobing Moving from a mobility device to the examining table Assuming certain positions on or off the examining table Ask 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 Exam Refer to Connect to see a video about Transferring a Patient in a Wheelchair and Preparing for an Exam

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!

Examination Methods Inspection Auscultation Visual exam
Posture, mannerisms, and hygiene Size, shape, color, position, symmetry Presence of abnormalities Auscultation Listening to body sounds using a stethoscope Learning Outcome: Identify the six examination methods used in a general physical examination. Inspection The 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.

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 Learning Outcome: Identify the six examination methods used in a general physical examination. Palpation The 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. Percussion The 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.

Examination Methods (cont.)
Manipulation Systemic moving of a patient’s body parts Check for abnormalities Determine range of motion of joints Mensuration – process of measuring Learning Outcome: Identify the six examination methods used in a general physical examination. Mensuration Weight and height Measurements 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.

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!

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 Learning 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 throat Chest and lungs, heart, breasts Abdomen, genitalia, and rectum Musculoskeletal and neurological systems

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 Learning 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 Exam 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 Refer to CONNECT to see a video about Assisting with a General Physical Exam

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 Learning Outcome: List the components of a general physical exam. General Appearance Is 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. Skin Color, texture, moisture level, temperature, elasticity Indicator of overall health Lesions Nails and nail beds – may indicate poor nutrition, disease, infection Hair Pattern 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.

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: List the components of a general physical exam. Neck Palpates the patient’s lymph nodes, thyroid gland, and major blood vessels. Enlarged lymph nodes may indicate infection or a blood cancer. Eyes Checks 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.

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 Learning Outcome: List the components of a general physical exam. Ears The 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 Sinuses Checks for the presence of infection or allergy. Nasal mucosa – lining of the nose Uses 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.

The physician inspects the patient’s chest from the back, side, and front. 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 Learning Outcome: List the components of a general physical exam. Mouth and Throat Condition 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 for Changes in color or lesions. The condition of the teeth and gums. Examines the patient’s throat and tonsils carefully. Chest and Lungs Hyperventilation – 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.

Heart Percussion – size of heart Auscultation Heart sounds Rate, rhythm, intensity, and pitch Breasts Inspection Palpation Lymph nodes Learning Outcome: List the components of a general physical exam. Heart The 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. Breasts During 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

Abdomen Inspection Auscultation Percussion Palpation Findings described using system of landmarks Learning Outcome: List the components of a general physical exam. The abdominal muscles should be completely relaxed. The order of exam methods for the abdomen is Inspection Skin color and surface Shape and symmetry. Auscultation – bowel and vascular sounds Percussion – size and position of the organs. Palpation Muscle tone Presence 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.

Female genitalia Lithotomy position Assist to relax Male genitalia Inspection Penis and scrotum Groin Palpation Lymph nodes Learning 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 Genitalia While supine Inspects the patient’s penis for signs of infection or structural abnormalities and palpates for any lesions. The scrotum is examined in the same manner The testicles are palpated for lumps. While standing Checks for any bulges in the groin that may indicate a hernia Palpates the local lymph nodes to check for any abnormality.

Rectum Palpation using a digital exam Lesions or abnormalities Occult blood Learning Outcome: List the components of a general physical exam. Rectum Usually examined after the genitalia. A dorsal recumbent or Sims’ position. Digital exam – palpation of the rectum for lesions or irregularities. Physician wears gloves Lubrication used Any 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.

Musculoskeletal system Posture ~ scoliosis Gait Range of motion Muscle strength Body measurements Lesions, deformities, or circulatory problems Learning Outcome: List the components of a general physical exam. Musculoskeletal System The 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.

Neurological system Reflexes Mental and emotional status Sensory and motor functions Intellectual assessment in children Mental status and memory in elderly Learning Outcome: List the components of a general physical exam. Neurological System Includes an evaluation of Reflexes Mental and emotional status, including intelligence, speech, and behavior Sensory 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 reflex To 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.

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!

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 Learning 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

Additional Tests and Procedures
Prior to dressing Cold and heat therapy Applying bandages Collecting specimens Learning 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 include Cold or heat therapy Applying a bandage Collecting specimens Administering certain medications Some medications should be administered before the patient dresses while others can be given after he is dressed.

Additional Tests and Procedures
After dressing Urine reagent strip tests Pulmonary function tests Eye or ear irrigation or medication administration Learning Outcome: Describe follow-up steps after a general physical exam. Tests and procedures that can be done after the patient has dressed include Urine reagent strip tests Pulmonary function tests Administration of oral medications Eye or ear irrigation or medication administration.

Patient Education Assess needs Use proper language level
Risk factors for disease Medication administration Self-help or diagnostic techniques Use proper language level Ensure understanding Give written instructions Learning 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 disease How to administer certain medications How 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.

Follow-Up Scheduling appointments Helping plan for home nursing care
Future office visits Outside appointments Helping plan for home nursing care Helping the patient obtain assistance Learning Outcome: Describe follow-up steps after a general physical exam. Follow-up may include Scheduling 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 scheduled To 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.

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!

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.

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.

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

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.

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.

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.

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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