Y khoa - Dược - Chapter 38: Assisting with general physical examination

38Assisting with General Physical ExaminationLearning 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. 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. 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.Introduction Physical examination – 1st step in the diagnosis or treatment processThe medical assistantMake the client comfortable Assist the physician 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 ExamTo confirm an overall state of health and provide baseline valuesTo diagnose a medical problemThe Purpose of General Physical Exam (cont.)Clinical diagnosisSign ~ objectiveSymptom ~ subjective Laboratory and diagnostic testsConfirm clinical diagnosisHelp determine the differential diagnosis and prognosisFormulation of treatment planApply Your KnowledgeWhy 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. Excellent!The Role of Medical AssistantTo assist the licensed practitioner and the patientBegins prior to the physical examInterviewWrite an accurate historyDetermine vital signs Measure weight and heightThe Role of Medical Assistant (cont.)Responsibilities Ensuring instruments and supplies are available Ensuring patient comfortHelping into positionKeeping them informedObserving them for distress or need for assistanceApply Your KnowledgeWhat 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.Hooray!Safety PrecautionsOSHA standards and guidelinesProtect employeesMake the workplace safeCDC guidelines – protect patients and health-care workersSafety 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 specimensSafety Precautions (cont.)Respiratory hygiene/cough etiquetteWear a mask to prevent exposure to an infectious disease transmitted by airborne dropletsIsolation precautions – personal protective equipmentSafety Precautions (cont.)Discard all disposable equipment and supplies appropriatelyClean and disinfect the exam room after each patientSanitize, disinfect, and sterilize equipment appropriatelyApply Your KnowledgeMrs. 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.Impressive!Preparing the Patient for an ExamEmotional preparationExplain exactly what will occur and what they will feelUse simple direct languagePreparing the Patient for an ExamPhysical Offer the bathroom Ask the patient to disrobe and put on an exam gown or cover with a drapeBe aware of modesty and comfortApply Your KnowledgeWhat 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.Way to go!Positioning and DrapingProper patient position facilitates the examinationAssist the patient to appropriate positionMake as comfortable as possibleCover with appropriate drapeKeep patient warmMaintain privacy/modestySupine/recumbentDorsal recumbentPositioning and Draping (cont.)SittingSymmetryLithotomyPositioning and Draping (cont.)Fowler’sPositioning and Draping (cont.)Prone Sims’ Positioning and Draping (cont.)Knee-ElbowFenestrated drape ProctologicApply Your KnowledgeAn 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!Special Patient ConsiderationsPatients from different cultures Avoid stereotyping and making judgmentsPatients May not know what to expectMay require more privacyMay refuse a specific examSpecial Patient ConsiderationsPatients with disabilities – provide assistance as neededDisrobingMoving to exam tableAssuming exam positionApply Your KnowledgeWhy 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.Examination MethodsInspection Visual examPosture, mannerisms, and hygieneSize, shape, color, position, symmetryPresence of abnormalitiesAuscultation Listening to body sounds using a stethoscopeExamination Methods (cont.)PalpationTouch Assess texture, temperature, shapePresence of vibration or movementsPercussion Tapping or striking the body to hear sounds or feel vibrationsUsed to determine location, size, or density of structure or organExamination Methods (cont.)Mensuration – process of measuringManipulation Systemic moving of a patient’s body partsCheck for abnormalities Determine range of motion of jointsApply Your KnowledgeJimmy 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.Ole! Components of the General Physical ExaminationExams – performed in a certain orderGeneral appearanceSpecific body sections Become familiar with the standard order for performing an exam Components of the General Physical Examination (cont.)Medical assistantBe familiar with the components of the examinationKnow equipment and supplies usedEnsure the patient’s comfort Protect the patient’s modestyComponents of the General Physical Examination (cont.)General appearanceGeneral state of heathDistress or pain SkinNails and nail bedsHairHead Abnormal condition of scalp or skinPuffiness Abnormal growthsComponents of the General Physical Examination (cont.)Neck Lymph nodes, thyroid glands, and major blood vesselsSymmetry and range of motionEyes The presence of disease or abnormalities Pupils for light responseMuscles Internal structures Components of the General Physical Examination (cont.)Ears Outer earSymmetry and sizeLesions, redness, or swellingInner ear structuresCanals Eardrums Nose and sinusesInfection or allergyNasal mucosaTenderness in sinusesComponents of the General Physical Examination (cont.)Mouth and throatMouth ~ overall health and hygieneThroat ~ swelling or rednessChest and lungs Hyperventilation Inspection Auscultation Palpation and percussionComponents of the General Physical Examination (cont.)Heart Percussion – size of heartAuscultationHeart soundsRate, rhythm, intensity, and pitchBreastsInspectionPalpationLymph nodesBreasts Components of the General Physical Examination (cont.)Abdomen Inspection AuscultationPercussionPalpation Findings described using system of landmarksComponents of the General Physical Examination (cont.)Female genitaliaLithotomy positionAssist to relaxMale genitalia Inspection Penis and scrotum Groin Palpation Penis and scrotumLymph nodesComponents of the General Physical Examination (cont.)Rectum Palpation using a digital exam Lesions or abnormalitiesOccult bloodComponents of the General Physical Examination (cont.)Musculoskeletal systemPosture ~ scoliosis Gait Range of motionMuscle strengthBody measurementsLesions, deformities, or circulatory problemsComponents of the General Physical Examination (cont.)Neurological systemReflexesMental and emotional statusSensory and motor functionsIntellectual assessment in childrenMental status and memory in elderlyApply Your KnowledgeIn 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.Good Job!After the ExaminationAssist patient to a sitting positionAllow the patient to perform any necessary self-hygiene measuresAllow patient to dressPerform additional tests or proceduresAdditional Tests and ProceduresPrior to dressingCold and heat therapyApplying bandagesCollecting specimensSome medications should be administered before the patient dresses while others can be given after he is dressed.Additional Tests and ProceduresAfter dressingUrine reagent strip testsPulmonary function testsEye or ear irrigation or medication administrationPatient EducationAssess needs Risk factors for diseaseMedication administrationSelf-help or diagnostic techniquesUse proper language levelEnsure understandingGive written instructionsFollow-UpScheduling appointmentsFuture office visitsOutside appointmentsHelping plan for home nursing careHelping the patient obtain assistanceApply Your KnowledgeWhat 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!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.38.2 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 patientsIn 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.)38. 9 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 38Health is the thing that makes you feel that now is the best time of the year. ~ Franklin P. Adams