1. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Chapter 25 The Physical Examination

2. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Methods of Examination Observation or inspection –General health –Posture –Body movements –Skin

3. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Methods of Examination Observation or inspection –Mannerisms –Care in grooming –Body symmetry and contour –Skin rashes and color –Deformities

4. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Methods of Examination Palpation –Examination of body using touch –Abdominal masses –Skin texture, moisture, temperature –Use of fingertips, one or both hands, or palm of hand

5. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Methods of Examination Percussion –Eliciting sounds from body by tapping –Vibrations and sounds from underlying organs and cavities –Presence of air or solid material –Dull and hollow sounds –Direct and indirect methods

6. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Methods of Examination Auscultation –Listening directly to body sounds –Provider normally uses stethoscope –Lung, heart, abdomen, bowel sounds –Determines blood pressure reading

7. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Methods of Examination Mensuration –Measuring process Height Weight Length of limb Amount of flexion and extension Chest and infant head circumference –Use of tape measure

8. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Methods of Examination Manipulation –Checks degree of flexion and extension of joints –Applying forceful passive movement on joint –Range of motion of joints

9. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Positioning and Draping Each position makes examination of area of body easier and more efficient Always provide for patient safety Proper draping –Protect modesty –Prevent embarrassment –Provide comfort from chills

10. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Examination Positions Supine (horizontal recumbent) Dorsal recumbent

11. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Examination Positions Lithotomy Semi-Fowler’s (45- degree angle)

12. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Examination Positions High-Fowler’s (90- degree angle) Prone

13. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Examination Positions Knee-chest position –Rarely used –Used for proctologic examinations and sigmoidoscopy procedures –Proctologic table has made position unnecessary –Fenestrated drape covers patient from shoulders to knees

14. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Examination Positions Sims’ (lateral) >> Trendelenberg –Aid person who is in shock –Elevate and incline legs

15. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Equipment and Supplies for the Physical Examination

16. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Equipment and Supplies for the Physical Examination Equipment and supplies needed vary with provider and type of examination Equipment in working order Room properly stocked MA responsible for patient preparation

17. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Basic Components of a Physical Examination

18. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Basic Components of a Physical Examination Patient appearance Gait Stature Posture Body movements Speech Breath odors Nutrition Skin and appendages

19. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Physical Examination Sequence Patient’s vital signs, height, weight, visual acuity, auditory ability Laboratory procedures Patient instructed about undressing Gown and drape provided MA remains in room when provider examining patient

20. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Physical Examination Sequence MA places instruments for examination on counter or Mayo stand Starts at head and proceeds downward –Head –Eyes –Ears –Nose –Mouth and throat

21. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Physical Examination Sequence Starts at head and proceeds downward –Neck –Chest –Breast –Abdomen –Genitals –Rectum –Reflexes

22. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. After the Examination Patient instructed to dress Remain in room if patient requires assistance Instructions regarding testing procedures and treatment plans given by provider Once patient has left room, equipment and supplies sanitized, disinfected, sterilized