Medical Assisting Chapter 38 PowerPoint® to accompany Medical Assisting Chapter 38 Second Edition Ramutkowski  Booth  Pugh  Thompson  Whicker Chapter 38 Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Assisting with a General Physical Examination Objectives: 38-1 State 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 Outline the steps necessary to prepare the patient for an examination.

Assisting with a General Physical Examination Objectives (cont.) 38-5 Explain ways to assist patients from different cultures, patients with disabilities, children, and pregnant women. 38-6 Identify and describe the six examination methods used in general physical examination. 38-7 List the components of a general physical examination.

Assisting with a General Physical Examination Objectives (cont.): 38-9 Explain the special needs of the elderly for patient education. 38-10 Identify ways to help a patient follow up on a doctor’s recommendations.

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. A skilled medical assistant can create an atmosphere that results in a positive outcome for the patient during the physical examination.

Purpose of General Physical Examination Examine a healthy person to confirm an overall state of health and provide baseline values for vital signs. Examine a patient to diagnose a medical problem.

Role of Medical Assistant Assist both the doctor and the patient Your presence enables the doctor to perform his examination as effectively as possible You do the interview, write an accurate history, determine vital signs, and measure weight and height. Your responsibilities include ensuring that all instruments and supplies are readily available to the doctor during the examination.

Safety Precautions Perform a thorough hand washing. Wear gloves whenever it is possible to have contact with blood, body fluids, nonintact skin, or moist surfaces. Wear a mask if the patient is suspected of having a infectious disease that can be transmitted by airborne droplets

Safety Precautions (cont.) Wear personal protective equipment if patient is highly contagious. Discard all disposable equipment and supplies in biohazardous waste containers Clean and disinfect the exam room after each patient.

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 a exam gown Positioning and draping – help patient assume needed exam position and drape to provide privacy

Examination Positions Sitting Supine or prone Dorsal recumbent Lithotomy or proctologic Trendelenburg's Fowler’s Sims’ or knee-chest

Special Considerations: Culture Avoid stereotyping an individual or group on the basis of a single patient’s behavior. Avoid making judgment about patients based on your experience with other patients Patients from different cultures may never have had a medical examination and may not know what to expect

Special Considerations: Disabilities Patients may require extra assistance in preparing for a general physical examination. You may need to help them disrobe, move from the mobility device to the exam table and assume certain positions on or off the exam table.

Special Considerations: Children Older infants and toddler may be examined on the parent’s lap. Preschool children can be placed on the exam table with parent nearby. Doctors will perform percussion and auscultation first and painful areas last. Doctors may examine older children’s genitalia last because it may be embarrassing for the child.

Special Considerations: Pregnant Women Prone and lithotomy positions are not recommended. Other positions may be difficult or impossible to achieve.

Apply Your Knowledge A elderly female patient will needs her lower abdomen and genitalia examined by the physician. What would be the best position to place her in and why?

Apply Your Knowledge -Answer A elderly female patient will needs her lower abdomen and genitalia examined by the physician. What would be the best position to place her in and why? Dorsal recumbent position - This position may be recommended over lithotomy since an elderly patient may have difficult placing her legs in stirrups.

Examination Methods Inspection –visual examination Palpation- uses touch extensively to assess characteristics of the body. Percussion – involves tapping and striking the body to hear sounds or feel vibrations. Auscultation – process of listening to body sounds. Mensuration – process of measuring Manipulation –systemic moving of a patient’s body parts.

Components of the General Physical Examination Overall appearance and the condition of the patient’s skin, nails and hair. Doctor examines the body in the following order: Head, neck, eyes, ears, nose and sinuses, mouth and throat Chest and lungs, heart, breasts Abdomen, genitalia, and rectum Musculoskeletal and neurological system

Components of the General Physical Examination (cont.) Be familiar with the components and the equipment used for a general physical examination. Ensure the patient is comfortable and his/her modesty is protected. Can you name these pieces of examination equipment?

General Physical Examination -Head, Neck, Eyes, Ears Head - any abnormal conditions of scalp, skin, or growths Neck – checks for symmetry and range of motion Eyes – check for the presence of disease or abnormalities Ears – checks for symmetry, presence of lesions, redness, or swelling

General Physical Examination -Nose, Sinuses, Mouth and Throat Nose- checks for presence of infection or allergy Sinuses – checks for any discharge, lesions, obstructions, swelling or inflammation Mouth – check general impression, condition of gums and teeth Throat – checks for redness or swelling

General Physical Examination -Chest and Lungs, Heart, Breasts Chest – checks shape, symmetry and postural position and any deformity Lungs – listens to lung sounds to check for any abnormal breathing Heart – check the size by percussion and listens for abnormal heart sounds Breasts – checks for symmetry, contour, masses, or retracted areas

General Physical Examination -Abdomen, and Genitalia Abdomen –listens for bowel sounds, palpates all four quadrants and inspects for color, shape and symmetry Genitalia – if patient male and doctor is female have another male present, if patient is female and doctor is male have another female present

General Physical Examination - Rectum Have patient in dorsal recumbent or Sims’ position Digital examination to palpate the rectum for lesions or irregularities Test for blood in the stool by doing Hemoccult or Seracult test Assist patient in personal hygiene as needed

General Physical Examination- Musculoskeletal & Neurological Musculoskeletal – checks for good posture and ask the patient to walk to assess gait Determines range of motion, strength of various muscle groups and body measurements Neurological – evaluates reflexes, mental and emotional status and sensory and motor functions

Completing the Examination Help the patient into a sitting position. Allow the patient to perform any necessary self-hygiene measures. Check with doctor about other tests or procedures.

Patient Education Pay special attention to educating patient about risk factors for disease. Be sure that you address the patient at a language level they can understand without talking down to them. Be sure they understand fully.

Special Problems - Elderly Common problems: Incontinence Depression Lack of information on preventive medicines Lack of compliance when taking medications

Follow-up Follow-up may include: 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.

Apply Your Knowledge The physician will be performing a rectal examination on a patient. What position should you place the patient in and what equipment should you have available for the physician?

Apply Your Knowledge -Answer The physician will be performing a rectal examination on a patient. What position should you place the patient in and what equipment should you have available for the physician? Rectal examinations are usually performed in the Sim’s position, but protologic can be used. Equipment needed: drape, gloves, lubricant, tissues, and Hemoccult or Seracult test equipment

The general physical examination is the cornerstone of medical care. Summary Medical Assistant The general physical examination is the cornerstone of medical care. You must address the comfort, privacy and education needs of the patient and anticipate the needs of the physician during the examination.

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