1 chapter 20 the physical examination elsevier items and derived items © 2009 by saunders, an...

1

Chapter 20Chapter 20The Physical Examination

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.

22

PretestPretest

True or False1. A complete patient examination consists of

a physical examination and laboratory tests.

2. Arthritis is an example of a chronic illness.

3. An otoscope is used to examine the eyes.

4. A patient should be identified by name and date of birth.

5. The reason for weighing a prenatal patient is to determine the baby's due date.


33

6. The height of an adult is measured during every office visit.

7. The lithotomy position is used to examine the vagina.

8. Inspection involves the observation of the patient for any signs of disease.

9. Measuring blood pressure is an example of auscultation.

10. The supine position is used to examine the back.

Pretest, cont.Pretest, cont.

True or False


44

Content OutlineContent Outline

1. Complete patient examination consists of:a. Health historyb. Physical examination (PE)c. Laboratory and diagnostic tests

Introduction to the Physical Examination


55

Introduction to the Physical Examination, cont.


2. Results used by physician to:a. Determine patient's state of healthb. Arrive at a diagnosis and prescribe treatmentc. Observe any change in patient's illness after

treatment has been instituted


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3. Medical assistant has an important role in assisting the physician with a PE

4. Purpose of PEa. To detect early signs of illness

• Helps prevent serious health problems

b. Prerequisite for employmentc. Participation in sportsd. Attendance at summer campe. Admission to school


77

Definition of TermsDefinition of Terms

1. Final diagnosis: scientific method of determining and identifying a patient's condition through evaluation of the health history, PE, laboratory tests, and diagnostic procedures

a. Often simply called the diagnosis (dx)b. Provides a logical basis for treatment and

prognosis


88

Definition of Terms, cont. Definition of Terms, cont.

2. Clinical diagnosis: intermediate step in the determination of a final diagnosis

a. Obtained through evaluation of health history and PE (without laboratory and diagnostic tests)

b. Outside laboratories provide space on laboratory request: to specify clinical diagnosis• Assists laboratory in correlating clinical data with the

physician's needs

c. Once physician has analyzed test results: final diagnosis can usually be established


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3. Differential diagnosis: two or more diseases may have similar symptoms

a. Determines which disease is causing the symptoms so that a final diagnosis can be made

b. Example: “strep” throat and pharyngitis have similar symptoms• Differential diagnosis is made by strep test

4. Prognosis: probable course and outcome of a patient's condition and the patient's prospects for recovery


1010


5. Risk factor: physical or behavioral condition that increases the probability that an individual will develop a particular condition

a. Includes:• Genetic factors• Habits• Environmental conditions


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Definition of Terms, cont.Definition of Terms, cont.

b. Does not mean the disease will develop• Only that chance is greater of developing it• Example: Smoking is a risk factor for lung cancer

and heart disease

6. Acute illness: characterized by symptoms that have a rapid onseta. Usually severe and intenseb. Subside after a short time

• Example: influenza


1212


7. Chronic illness: characterized by symptoms that persist for more than 3 monthsa. Patient shows little change over a long time

• Examples: diabetes, hypertension, emphysema

8. Therapeutic procedure: a procedure performed to treat patient's condition with the goal of eliminating it or promoting as much recovery as possiblea. Example: administration of medications


1313

Definition of Terms, cont.Definition of Terms, cont.

9. Diagnostic procedure: performed to assist in the diagnosis of a patient's conditiona. Examples: electrocardiography, x-ray

examination

10. Laboratory testing: the analysis and study of specimens obtained from patient to assist in diagnosis and treatment of disease


1414

Preparation of the ExaminingRoom

Preparation of the ExaminingRoom

1. Important to properly prepare examining room

a. Provides comfortable and healthy environmentb. Facilitates the PE


1515

Preparation of the ExaminingRoom, cont.


2. Guidelinesa. Ensure room is free from clutter and well litb. Check daily for ample supplies; restock as

neededc. Empty waste receptacles frequentlyd. Replace biohazard containers as needed


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e. Ensure room is well ventilatedf. Maintain room temperature

• Should be comfortable for both clothed and unclothed patients

g. Clean and disinfect daily:• Examining tables• Countertops• Faucets


1717



h. Remove dust and dirt from furniture and towel dispensers

i. Change examining table paper after each patient; restock gowns and drapes as needed

j. Patient's privacy should be ensured• Keep examining room door closed during patient

examination


1818



k. Clean and prepare items the physician will be using for examinations:• Equipment• Instruments• Supplies


1919

Physical Examination Equipment and SuppliesPhysical Examination

Equipment and Supplies


2020

l. Check equipment and instruments frequently for proper working condition• Protects patient from harm caused by faulty

equipment

m. Have equipment and supplies ready for examination• Arrange for easy access by physician• Type varies on the basis of:

– Type of examination

– Physician's preference

Physical ExaminationEquipment and Supplies, cont.



2121

n. Know how to operate and care for equipment• Refer to the operating manual

– Read carefully

– Keep available for reference




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2323

Preparation of the PatientPreparation of the Patient

1. MA's responsibility: prepare the patient for PE:a. After escorting patient to examining room

• Identify the patient by name and date of birth– Purpose:

1) To avoid mistaking one patient for another

a) Could be held liable if perform procedure on wrong patient by

mistake


2424

Identify the PatientIdentify the Patient


2525

Preparation of the Patient, cont.Preparation of the Patient, cont.

b. Take vital signsc. Measure height and weightd. Explain purpose of examination and offer to

answer questionse. Apprehension can be reduced by:

• Addressing patient by name of choice• Having a friendly and supportive attitude• Speaking clearly, distinctly, and slowly


2626


f. Ask patient if he or she needs to empty the bladder before examination• Makes examination easier for physician to perform

– Makes examination more comfortable for patient • If urine specimen is necessary, patient is asked to void


2727

Preparation of the Patient, cont. Preparation of the Patient, cont.

g. Instructions for disrobing should be specific• Clothing that should be removed• Where to place clothing

– Instructions for putting on gown and location of gown opening

– MA should offer assistance if needed


2828

Identify the PatientIdentify the Patient


2929


h. Disrobing facility should be comfortable and private• Helpful to have a place for patient to sit• Should have hooks and hangers for clothing


3030


i. MA should have patient's medical record available for review by the physician

• Use designated location for medical record a. Shelf next to examining room door b. Chart holder on outside of door• Follow HIPAA privacy rule to protect patient's health

info– Patient-identifiable info should not be visible

j. Help patient on and off the examining table for safety


3131

Measuring Weight and HeightMeasuring Weight and Height

1. Mensuration: process of measuring the patient

2. Change in weight may be significant in:a. Diagnosis of patient's conditionb. Prescribing treatment


3232

Measuring Weight and Height, cont. Measuring Weight and Height, cont.

3. Underweight and overweight patients on diet therapy programa. Should have weight taken regularly to

determine progress

4. Prenatal patients weighed at each prenatal visit to:a. Assess fetal developmentb. Assess mother's health


3333


5. Adult weight is measured at each office visit6. Adult height usually only measured:

a. First office visit b. Complete PE


3434


7. Children weighed and measured at each office visit to:a. Observe pattern of growthb. Calculate and determine medication dosage

8. Height and weight are compared against a standardized charta. Determines if patient falls within normal limits


3535

From Report of the Dietary Guidelines Advisory Committee on the dietary guidelines for Americans, Washington, DC, 1995, U.S. Department of Health and Human Services

Height and WeightHeight and Weight


3636

What Would You Do?What Would You Not Do?



3737




3838


9. Guidelines for measuring weight and heighta. Weight: using an upright balance scale

• Locate scale to provide privacy for patient – Many patients are self-conscious about having

weight measured – Be careful not to make weight-sensitive comments

during procedure1) Especially important for patients with weight

control problems (obesity, eating disorders)


3939


• Balance scale – If scale not balanced, measurement will be inaccurate

– Scale is balanced:

1) When upper and lower weights are on zero

2) Indicator point comes to a rest at center of balance area


4040

Balance the Scale

Balance the ScaleBalance the Scale


4141


• Assist the patient– Assist patient on and off the scale platform

– Platform moves slightly: may cause patient to become unsteady


4242


• Obtain an accurate weight– Ask patient to remove shoes

– Measure weight with patient in normal clothing

– Ask patient to remove heavy outer clothing:

1) Sweater

2) Jacket


4343

Measuring WeightMeasuring Weight


4444


• Interpret calibration markings accurately– Lower calibration bar: divided into 50-lb increments


4545


– Upper calibration bar is divided into pounds and quarter pounds

1) Longer calibration lines: indicate pound increments

2) Shorter calibration lines indicate quarter-pound and half-pound increments


4646

Measuring Weight, cont.Measuring Weight, cont.


4747


• Determine patient's weight correctly– Add the measurement on lower scale to

measurement on upper scale– Round results to nearest quarter pound– Occasionally weight may need to be

converted to kilograms (kg) (metric unit) 1) May be required to determine medication

dosage2) 1 kg = 2.2 lb3) To convert pounds to kg: divide the

number of pounds by 2.2


4848


b. Height: using an upright balance scale • Provide for patient's safety

– Do not place patient on scale in a forward position

1) Measuring bar could fall into patient's face when patient steps off scale: could cause a facial injury


4949

Measuring HeightMeasuring Height


5050


• Determine the calibration markings accurately– Calibration markings are divided into either:

1) Inches

2) Feet and inches

– Calibration rod is also calibrated into centimeters (metric unit)


5151

Measuring Height, cont.Measuring Height, cont.


5252


• Read the measurement correctly– Read the measurement at the junction of the stationary

calibration rod and the movable calibration rod


5353


– If patient's height is less than the top value of the stationary calibration rod:

1) Read the measurement directly on the stationary rod

a) On most scales: highest calibration on stationary rod is 50 inches

b) Patients with a height of 50 inches or less will have their height read directly on stationary rod


5454

Measuring Height, cont.Measuring Height, cont.


5555


• Record the height measurement correctly. – Record height measurement in feet and inches.

– If the scale is calibrated in inches:

1) Convert the reading to feet and inches: divide the number of inches by 12

2) Example: Height measurement of 60 inches is recorded as 5 feet (60 inches divided by 12 equals 5)


5656




5757




5858

Positioning and DrapingPositioning and Draping

1. Correct positioning of the patient facilitates the examinationa. Permits better access to part being examined

2. Basic positions and use of eacha. Sitting: examination of the head, neck, chest,

upper extremities; measure vital signs


5959

SittingSitting


6060

SupineSupine

b. Supine: examination of head, chest, abdomen, extremities

• Not a comfortable position for patients with:– Respiratory problems

– Back injury

– Low back pain


6161

Supine, cont.Supine, cont.


6262

ProneProne

c. Prone: examination of back; assess extension of hip joint


6363

Dorsal Recumbent Dorsal Recumbent

d. Dorsal recumbent: vaginal and rectal examinations, insertion of urinary catheter, examine the head, neck, chest, and extremities of patients who have difficulty maintaining supine position

• Bending of legs is more comfortable for some patients


6464

Dorsal Recumbent, cont.Dorsal Recumbent, cont.


6565

LithotomyLithotomy

e. Lithotomy: vaginal, pelvic, and rectal examinations


6666

Sims Sims

f. Sims: used to examine the vagina and rectum, to measure rectal temperature, to perform a flexible sigmoidoscopy, and to administer an enema


6767

Knee-Chest Knee-Chest

g. Knee-chest: examine the rectum, perform a proctoscopic examination


6868

Fowler’s Fowler’s

h. Fowler's• Examine upper body of patients with cardiovascular

and respiratory problems (congestive heart failure, emphysema, asthma)

– Easier for these patients to breathe in this position• Draw blood from patients likely to faint


6969

Fowler’s, cont.Fowler’s, cont.


7070

Positioning and Draping, cont. Positioning and Draping, cont.

3. Position used depends on type of examination being performeda. More than one position may be used to

examine the same body partb. Explain position to patient and assist him or her

into itc. Take patient's endurance and degree of

wellness into consideration• Weak or ill patient may not be able to assume a

position• May require special assistance in attaining it


7171

Positioning and Draping, cont.Positioning and Draping, cont.

d. Do not keep patient in uncomfortable positions longer than necessary

e. Let the patient rest before getting off the examining table• Some positions cause patient to become dizzy

f. Assist patient off table to prevent falls


7272

Positioning and Draping, cont. Positioning and Draping, cont.

4. Draping provides modesty, comfort, and warmtha. Only part being examined should be exposed

5. Gowns and drapes are made of paper or cloth


7373

Assessment of the PatientAssessment of the Patient

1. Extent of assessment during PE depends on:

a. Purpose of examinationb. Patient's condition

2. Complete PE: thorough assessment of all body systems

a. Physician uses an organized and systemic approach• Starts with head and proceeds toward feet• Facilitates the examination process• Requires fewest position changes


7474

Assessment of the Patient, cont. Assessment of the Patient, cont.

3. Results are charted by physician in patient's medical record

4. Patients who exhibit symptoms of illness:a. Do not require a complete PEb. Physician examines body system associated

with symptom


7575

Inspection Inspection

5. Assessment techniquesa. Inspection: the process of observing a patient

to detect signs of disease• Assessment technique most frequently used• Good lighting is required


7676

Inspection, cont.Inspection, cont.

• Observe patient for:– Color

– Speech

– Deformities

– Skin condition

– Body contour and symmetry

– Orientation to the surroundings

– Body movements

– Anxiety level


7777

Palpation Palpation

b. Palpation: the process of feeling with the hands to detect the signs of disease • Helps verify data obtained from inspection• Patient's verbal and facial expressions are observed

– Assists in detection of abnormalities


7878

Palpation, cont.Palpation, cont.

• Used to determine:– Placement and size of organs

– Presence of lumps

– Pain

– Swelling

– Tenderness


7979


• Examples of palpation– Breast examination

– Measuring radial pulse• Types of palpation

– Light: to determine areas of tenderness

1) Fingertips are placed on the body part

2) Gently depressed ½ inch


8080

Palpation, cont. Palpation, cont.

– Deep: to examine condition of organs

1) Two hands are used:

– Example: bimanual pelvic examination

a) One to support the body from below

b) Other to press over the area


8181



8282

Percussion Percussion

c. Percussion: the process of tapping body and listening to the sounds produced to detect the signs of disease• Used to determine:

– Size of organs

– Density of organs

– Location of organs• Example: examination of lungs and abdomen


8383

Percussion, cont.Percussion, cont.

• Technique– Fingertips used to produce sound

– Nondominant hand: placed over area with fingers slightly separated

– Dominant hand: strike the joint of middle finger placed on patient to produce a sound

1) Dense structures: produce a dull sound (liver)

2) Empty or air-filled structures: produce a hollow sound (lungs)


8484

Percussion, cont.Percussion, cont.


8585

Auscultation Auscultation

d. Auscultation: the process of listening with a stethoscope to the sounds produced within the body to detect the signs of disease• Used to:

– Listen to heart and lungs

– Measure blood pressure


8686

Auscultation, cont.Auscultation, cont.

• Guidelines– Minimize environmental noise

1) Interferes with effective listening

– Diaphragm chestpiece: used for high-pitched sounds (lung and bowel)

– Bell chestpiece: used for low-pitched sounds (heart and vascular system)

– Clean chestpiece with an antiseptic and warm it before placing on the patient


8787

Assisting the PhysicianAssisting the Physician

1. The MA is responsible for:a. Helping patient change positionsb. Handing physician instruments and suppliesc. Reassuring patientd. Assisting patient off the examining table after

the PEe. Providing patient with additional information if

needed• Scheduling a return visit• Patient education


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8989




9090

PosttestPosttest

True or False1. The prognosis is what is wrong with the

patient.2. A risk factor means that a patient will

develop a certain disease.3. A CT scan is an example of a therapeutic

procedure.4. The function of a speculum is to open a

body orifice for viewing.5. The process of measuring the patient is

called mensuration.Elsevier items and derived items © 2009 by Saunders, an

imprint of Elsevier Inc.

9191

6. A reason for weighing a child is to determine drug dosage.

7. The purpose of draping a patient is to make it easier for the physician to examine the patient.

8. Sims position is used for flexible sigmoidoscopy.

9. Measuring pulse is an example of percussion.

10. BMI is the abbreviation for body mass index.

Posttest, cont.Posttest, cont.

True or False


1 chapter 20 the physical examination elsevier items and derived items © 2009 by saunders, an...

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