Medical assisting Administrative and clinical procedures (5e) Chapter 38 Assisting with general physical examination

After completing chapter 38, you will be able to: Identify the purpose of a general physical exam, describe the role of the medical assistant in a general physical exam, explain safety precautions used during a general physical exam, carry out the steps necessary to prepare the patient for an exam,...

Assisting with General Physical

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

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

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.

– Make 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 Exam

• To confirm an overall state of health and

provide baseline values

• To diagnose a

medical problem

• Clinical diagnosis

– Symptom ~ subjective

• Laboratory and diagnostic tests

– Confirm clinical diagnosis

and prognosis

Apply Your Knowledge

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

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

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

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.

Safety Precautions

• OSHA standards and guidelines

– Protect employees

– Make the workplace safe

• CDC guidelines – protect patients and

health-care workers

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

Safety Precautions (cont.)

• Respiratory hygiene/cough etiquette

• Wear a mask to prevent exposure to an

infectious disease transmitted by

airborne droplets

• Isolation precautions – personal protective

equipment

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

Apply Your Knowledge

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.

Impressive!

Preparing the Patient for an Exam

• Emotional preparation

– Explain exactly what will occur and what they

will feel – Use simple direct language

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

Apply Your Knowledge

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.

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

• Lithotomy

Positioning and Draping (cont.)

• Fowler’s

Positioning and Draping (cont.)

Positioning and Draping (cont.)

• Knee-Elbow

– Fenestrated drape

• Proctologic

Apply Your Knowledge

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.

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

Special Patient Considerations

• Patients with disabilities – provide

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.

– Size, shape, color,

position, symmetry – Presence of

• Auscultation

– Listening to body sounds using a stethoscope

Examination Methods (cont.)

• Percussion

– Tapping or striking the body to hear sounds or feel vibrations

– Used to determine location, size, or density of structure

or organ

Examination Methods (cont.)

– Check for abnormalities – Determine range of motion of joints

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.

Ole

• Exams – performed in a certain order

– General appearance

– Specific body sections

• Become familiar with the standard order

for performing an exam

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

Examination (cont.)

• General appearance

– General state of

heath – Distress or pain

or skin – Puffiness – Abnormal growths

Components of the General Physical

abnormalities

– Pupils for light response

– Muscles – Internal structures

– Tenderness in sinuses

Components of the General Physical

– Auscultation – Palpation and percussion

Examination (cont.)

• Heart

– Percussion – size

of heart – Auscultation

• Heart sounds

• Rate, rhythm, intensity, and pitch

Components of the General Physical

landmarks

Components of the General Physical

– Lesions, deformities, or circulatory

problems

Components of the General Physical

– Mental status and memory in elderly

Apply Your Knowledge

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.

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

Additional Tests and Procedures

Additional Tests and Procedures

• After dressing

– Urine reagent strip tests

– Pulmonary function tests

– Eye or ear irrigation or medication

administration

Patient Education

• Assess needs

– Risk factors for disease

– Medication administration

– Self-help or diagnostic techniques

• Use proper language level

• Ensure understanding

• Give written instructions

• Scheduling appointments

– Future office visits

– Outside appointments

• Helping plan for home nursing care

• Helping the patient obtain assistance

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

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.

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

In Summary (cont.)

38.3 During an exam, the medical assistant

isolation precautions, dispose of biohazardous

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

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

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

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 38

Health is the

thing that makes you feel that now

is the best time of the

year.

~ Franklin P Adams