1. Assisting with the Physical Examination
Chapter 35
Assisting with the Physical Examination
The main purpose of a physical examination is for the physician to assess the status of the patient’s health.
What are the responsibilities of a medical assistant when assisting with the physical examination?
What does the abbreviation CPX mean?
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2. Preparing the Patient for a Physical Examination
Gown
Should expose only the area being examined
Position of patient
Appropriate for the type of procedure to be done
Drape
Minimize the exposure of nonessential parts and provide warmth
Gowns can be either full length or half length.
Show an example of a full-length gown and a half-length gown.
Some positions can be uncomfortable to the patient.
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3. Gown Right type of gown for the procedure
Gown opening depends on physician preference and area to be examined
Be specific about what clothing is to be removed, and where to put it
Offer to assist patients as needed—never just start helping them disrobe
Always allow enough time for the patient to put on a gown.
Never enter an examination room without knocking and getting permission from the patient.
Gowns are thin and patients can get cold easily.
Have a blanket available for a patient who gets cold.
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4. Procedure: Assisting with the Physical Examination
Sanitize hands, obtain chart, and greet the patient
Measure height and weight, and document
Measure visual acuity, and document
Obtain urine sample
Take and record vital signs
Why is a urine sample obtained?
What should the medical assistant do if the patient is unable to give a urine sample?
Define void and visual acuity.
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5. Procedure: Assisting with the Physical Examination (cont.)
Assist physician with eye and ear exam
Hand tuning fork and nasal speculum to physician
Pass tongue depressor to physician
Hand physician percussion hammer
Position patient for body system exam
How would a medical assistant clean a tuning fork?
Many offices use disposable nasal speculums.
What happens when a nasal speculum instrument is squeezed?
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6. Common Instruments and Supplies Used in a Physical Examination
What items are disposable?
What items are cleaned and reused?
What items contain a battery to be recharged?
Discuss other equipment and supplies a physician may request.
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7. Consent Forms Needed for treatment beyond basic wellness examination
Must be signed, dated, and witnessed
Details must be explained to patient in terms that can be understood
Must be done before the treatment
Considered assault and battery without signed consent form
Define implied consent.
For what type of procedures can a medical assistant obtain implied consent?
What procedures require a consent form?
Do patients have the right to refuse treatment and procedures?
Can a patient withdraw her or his consent at any time?
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8. The Consent Form Give the student another example of a consent form.
Have the students compare and contrast the consent forms.
Define assault and battery.
What can happen if the medical assistant does not get a consent form signed by the patient and the physician performs the procedure?
Have the students practice completing consent forms for a stress test.
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9. Draping Draping the patient provides: Warmth Comfort Modesty
Show the students an example of a disposable paper drape and a reusable cotton drape.
Disposable paper drapes cost about 60 cents a piece.
Reusable cotton drapes cost about $15 a piece.
Some medical offices use a laundry service to clean the reusable cotton drapes.
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10. Criteria for Positioning
Patient’s chief complaint
Determines area to be exposed
Procedure to be performed
Important to be able to view area to be examined
Patient’s age
Older adults have difficulty maintaining some positions
Many types of positions are used for various procedures.
Always consider the patient’s comfort.
Minimize exposure of nonessential body parts.
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11. Examination Positions
Depend on procedure done or part examined
Sitting
Standing
Horizontal recumbent
Dorsal recumbent
Lithotomy
Sims’
Prone
Knee-chest
Fowler’s
The medical assistant needs to explain to the patient the resaon for the position.
Always provide the patient with clear instructions on assuming the position.
Patient safety must be the prime consideration.
Assist the patient in and out of the position, as the patient requires or requests.
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12. Procedure: Sitting and Standing Positions
Upright on the end of the table using a footstool or footrest
Shouldn’t allow feet to dangle for extended periods
Used to begin the physical
Standing
Why is it important not to allow the patient’s feet to dangle for an extended period of time?
The sitting position allows the upper extremities to be clearly accessible.
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13. Sitting Position
Review the procedures that would require a patient to be in the sitting position.
The sitting position is the most often used.
Have the students practice Procedure 35-2.
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14. Procedure: Recumbent Position
Horizontal recumbent (supine)
Patient lying flat on the back with arms to the sides and head elevated on pillow
Used to examine chest, abdomen, lower extremities
Dorsal recumbent
Supine but knees flexed and feet flat on the table
Used to examine perineal area
Drape placed in a diamond shape to cover pubic area
How would the medical assistant drape a patient in horizontal recumbent (supine) position?
How would the medical assistant drape a patient in a dorsal recumbent position?
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15. Horizontal Recumbent Position
Review the procedures that would require a patient to be in a horizontal recumbent position.
What is another name for this position?
Demonstrate placing a patient in this position.
Have the students practice Procedure 35-3.
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16. Dorsal Recumbent Position
Review the procedures that would require a patient to be in a dorsal recumbent position.
Demonstrate placing a patient in this position.
In this picture where should the feet be placed?
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17. Procedure: Lithotomy Position
Best for Pap smear and pelvic examination
Dorsal recumbent position assumed first
Buttocks moved to edge of table, feet in stirrups
Diamond-shaped drape used
Patient put in this position when physician ready for exam
Uncomfortable for patient so don’t want to maintain this position for very long
How would the medical assistant drape a patient in lithotomy position?
Show the students an example of a diamond-shaped drape.
Why is the dorsal recumbent position assumed first?
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18. Lithotomy Position
Review the procedures that would require a patient to be in a lithotomy position.
Demonstrate placing a patient in this position.
Have the students practice 35-4.
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19. Procedure: Sims’ Position
Also referred to as lateral
Patient turned onto left side
Left arm kept behind body; right arm is up, flexed, and forward
Right leg sharply bent to expose the anal area
Drape is positioned to cover back from under the arms to toes
Used for examination of anal area
Why is the patient placed on his or her left side and not the right side?
The Sims’ position is used for what other types of procedures?
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20. Sims’ Position What is another name for the Sims’ position?
Review the procedures that would require a patient to be in a Sims’ position.
Demonstrate placing a patient in this position.
Have the students practice Procedure 35-5.
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21. Procedure: Prone Position
Patient lying on abdomen with head turned slightly to the side
Arms above head or alongside body
Used to examine back and lower extremities
Drape starts just under arms to the feet
Adjusted as needed
If a patient has difficulty breathing, do not put him or her in a prone position until the physician is ready to examine him or her.
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22. Prone Position
Review the procedures that would require a patient to be in a prone position.
Demonstrate placing a patient in this position.
Have the students practice Procedure 35-6.
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23. Procedure: Knee-Chest Position
Begins with the patient in the prone position
Assist to a kneeling position
Buttocks elevated
Head and chest lowered on the table
Arms above head and bent at elbows
Patient put in position only when physician ready for exam
Used for sigmoidoscopy
Never leave patient unattended
Why is the patient in the prone position first?
Why should the medical assistant never leave a patient unattended in this position?
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24. Knee-Chest Position
Review the procedures that would require a patient to be in a knee-chest position.
Demonstrate placing a patient in this position.
Have the students practice Procedure 35-7.
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25. Procedure: Fowler’s and Semi-Fowler’s Positions
Patient lying in supine with back of table elevated at either a 45- or 90-degree angle
Legs slightly bent at knees
Used:
To help patient breathe easier
To examine upper extremities
How can this position help a patient breathe easier?
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26. Fowler’s Position
Review the procedure that would require a patient to be in a Fowler’s position.
Demonstrate placing a patient in a Fowler’s position.
Review the procedures that would require a patient to be in a semi-Fowler’s position.
Demonstrate placing a patient in a semi-Fowler’s position.
Have the students practice Procedure 35-8.
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27. Safety and Comfort in Patient Positioning
Responsibility of medical assistant to ensure safety and comfort
Keep patient free from harm
Never leave unsteady, older adult patient sitting alone on exam table
What safety measures should the medical assistant be aware of?
How can a medical assistant make a patient feel comfortable?
Why should a medical assistant never leave an unsteady or elderly patient alone on an examination table?
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28. Primary Methods of Examination Related to Sensory Organs
Inspection—vision
Visually examining
Palpation—touch
Using touch to detect abnormalities
Percussion—touch and tapping
Tapping body surfaces and listening for sounds
Auscultation—hearing
Using stethoscope to listen for body sounds
Define mensuration.
Why are different measurements important?
What type of measurements might be taken on a patient?
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29. Inspection During inspection, all body parts are viewed.
Always check the surface areas for symmetry.
Observe the condition and color of the skin.
Check the patient’s ROM.
Define body contours.
Demonstrate how inspection is performed.
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30. Palpation Palpation is used to locate organs and lymph nodes.
Detects tenderness in organs and lymph nodes.
When does the medical assistant use palpation?
Demonstrate how palpation is performed.
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31. Percussion Discuss the two methods used to perform percussion.
Percussion is used by the physician to detect the presence of air, fluid, or masses and can be used to locate the margins of internal organs.
Percussion over an air filled organ produces a high-pitched, hollow sound.
Percussion over a solid or fluid-filled structure sounds dull and flat.
Percussion is also accomplished by using a percussion hammer (reflex) to check reflexes.
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32. Auscultation
Auscultation is done in all four quadrants of the abdomen.
Auscultation of the lungs is done bilaterally – posterior, the sides, and then the anterior chest.
Auscultation of heart sounds and blood flow in the carotid artery.
Why is it important for a physician to listen to various heart sounds?
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33. Vision Testing Done in medical offices for various reasons:
Changes in visual acuity
Blurred vision
Loss of vision
May be part of general physical examination
Use ophthalmoscope to view condition of:
Retina
Optic nerve
Blood vessels of the eye
Discuss the various diseases or injuries that can cause blurred vision or loss of vision.
How are most vision changes corrected?
What happens to a patient’s eyes as he or she ages?
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34. Ophthalmoscope What is the purpose of the ophthalmoscope?
Part of everyday room maintenance is checking the ophthalmoscope to make certain it is in good working order.
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35. Snellen Eye Chart
Screening device to measure patient’s ability to view letter or images at a distance
Most commonly used visual acuity test in medical office
What equipment is needed to assess distance visual acuity using the Snellen Eye Chart?
At what distance will a patient be standing from the chart?
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36. Snellen Eye Chart (cont.)
Types of Snellen charts
Alphabet for English-speaking patients
Rotating E chart for non–English-speaking people and children
Object chart for preschoolers
Why are there three different types of Snellen Eye Charts?
Why is it important to have all three available?
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37. Snellen Visual Charts Who would us the “B” chart?
Who would use the “C” chart?
What does the bottom number of the fraction indicate about a person’s vision?
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38. Procedure: Assess Distance Visual Acuity—Snellen Chart
Sanitize hands, assemble equipment and supplies, greet and identify the patient
Position patient 20 feet from chart
Position Snellen chart at eye level
Why is the patient positioned 20 feet from the Snellen Eye Chart?
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39. Procedure: Assess Distance Visual Acuity—Snellen Chart (cont.)
Alternate covering eyes with occluder, having patient verbally identify letters in row of chart
Continue until maximum of two errors is made
Chart results
What is an occluder?
How would a medical assistant clean an occluder?
Demonstrate Procedure 35-9,
Have the students practice Procedure 35-9.
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40. Common Visual Defects How are these visual defects detected? 40
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41. Procedure: Ishihara Color Vision Plates
Sanitize hands, assemble equipment, greet and identify the patient
More accurate in a quiet area
Use natural daylight if possible
Patients have 3 seconds to verbally identify numbers or trace numbers with cotton tip
Why is it important to use natural daylight?
What can happen if artificial light is used?
Why is a cotton tip applicator used to trace the numbers?
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42. Procedure: Ishihara Color Vision Plates (cont.)
Test for color-blindness
Given to airplane pilots and cosmetologists prior to schooling
Chart results
What other occupations must be tested for color-blindness?
Demonstrate how to chart the results of the Ishihara Color Vision Test.
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43. Ishihara Color Vision Test Plates
What numbers are being shown?
Demonstrate how to conduct a color blind test.
Have the students practice the Procedure
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44. Procedure: Jaeger Reading Card
Tests a person’s ability to read at a prescribed distance: 14 to 16 inches from the eyes
Conducted with a card containing sentences or phrases
Read with each eye separately out loud down to the smallest that can be seen
Document the number at which the patient stopped reading
Demonstrate Procedure 35-11
Have the students practice Procedure
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45. The Jaeger Reading Card
How should the Jaeger Reading Card be cleaned between patient uses?
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46. Documenting Visual Testing Procedures
Demonstrate how to document visual testing procedures.
Have the students practice documenting visual testing procedures.
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47. Ear Examination Otoscope used to examine:
External ear canal
Tympanic membrane
Middle ear
Otoscope: battery-operated lighted instrument with disposable speculum on the end
Fits into the ear canal for viewing
What is the purpose of the otoscope?
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48. Otoscope Why does the physician use the otoscope?
How does the technique differ from child and adult when the physician is examining the patient’s ear?
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49. Conclusion
Care must be taken to treat each patient with respect and dignity during the physical examination
Patient care is enhanced when the medical assistant is organized
Patients will have more confidence in their treatment plan when the medical assistant demonstrates competency and care
Review Table 35-2.
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