1. The Physical Examination
Chapter 5
The Physical Examination

2. Lesson 5.1
Preparation for the Physical Examination and Measuring Height and Weight
Identify the three components of a complete patient examination.
List the guidelines that should be followed in preparing the examining room.
Identify equipment and instruments used during the physical examination.

3. Lesson 5.1
Preparation for the Physical Examination and Measuring Height and Weight
Explain the purpose of measuring height and weight.
List the guidelines that should be followed when measuring height and weight.

4. Introduction to Physical Examination
Complete patient examination consists of
Health history
Physical examination (PE)
Laboratory and diagnostic tests
What are some reasons for performing a physical examination?
Why must a complete physical examination include all three of these components?
What role does each of these components play in diagnosing a patient’s condition?

5. Introduction to Physical Examination (Cont.)
Results used by physician to:
Determine the patient's state of health
Arrive at a diagnosis and prescribe treatment
Observe any change in the patient's illness after treatment has been instituted
What should the physician do if he or she arrives at a diagnosis and prescribes treatment but the patient’s condition does not improve?

6. Introduction to Physical Examination (Cont.)
Important and frequent responsibility of MA:
Assist physician with PE
Purpose of PE
To detect early signs of illness
Helps prevent serious health problems
Prerequisite for employment
Participation in sports
Attendance at summer camp
Admission to school
Why would a physical examination be an important prerequisite for employment, school admission, or sports participation?

7. Definition of Terms
Final diagnosis: Scientific method for determining and identifying a patient's condition through evaluation of the health history, PE, laboratory tests, and diagnostic procedures
Often simply called the diagnosis
Provides a logical basis for treatment and prognosis
Do laboratory tests and diagnostic procedures need to be performed to arrive at a final diagnosis for every condition?
What are some conditions for which laboratory tests or diagnostic procedures do not need to be performed? (Otitis media; chickenpox.)

8. Definition of Terms (Cont.)
Clinical diagnosis: Intermediate step in the determination of a final diagnosis
Obtained through evaluation of the health history and PE (without laboratory and diagnostic tests)
Laboratories and diagnostic imaging facilities provide space on laboratory request: to specify clinical diagnosis
Assists laboratory in correlating clinical data with the physician's needs
When physician has analyzed the test results: final diagnosis can often be established
What does PE stand for?
Give an example of a diagnostic test.
The clinical diagnosis is indicated on the laboratory request by its ICD code.
How does the clinical diagnosis assist the outside laboratory in determining the pathogenicity of the specimen?

9. Definition of Terms (Cont.)
Differential diagnosis: Two or more diseases may have similar symptoms
Determines which disease is causing the symptoms so that a final diagnosis can be made
Example: strep throat and pharyngitis have similar symptoms
Differential diagnosis is made by strep test
Prognosis: Probable course and outcome of a patient's condition and the patient's prospects for recovery
What is another example of a differential diagnosis?
Should the physician promise the patient that he or she will be cured? Why or why not?
What types of terms should be used when presenting the prognosis to the patient?

10. Definition of Terms (Cont.)
Risk factor: Physical or behavioral condition that increases the probability that an individual will develop a particular condition
Includes:
Genetic factors
Habits
Environmental conditions
Physiological conditions
What are examples of diseases or conditions associated with each of the risk factor categories?
What are some risk factors for coronary artery disease?
What are some risk factors for diabetes mellitus?
What are some risk factors for emphysema?

11. Definition of Terms (Cont.)
Risk factor: Physical or behavioral condition that increases the probability that an individual will develop a particular condition
Does not mean the disease will develop
Only that the chance of developing it is greater
Example: Smoking is a risk factor for lung cancer and heart disease
Acute illness: characterized by symptoms that have a rapid onset
Usually severe and intense
Subside after a short time
Example: colds, influenza, strep throat, pneumonia
What are some other examples of acute illnesses?
Describe the course of illness that influenza takes.

12. Definition of Terms (Cont.)
Chronic illness: Characterized by symptoms that persist for more than 3 months
Patient shows little change over a long time
Examples: diabetes, hypertension, emphysema
Therapeutic procedure: A procedure performed to treat patient's condition with the goal of eliminating it or promoting as much recovery as possible
Examples: administration of medications, ear irrigation
In some cases of acute illness, the acute episode progresses into a chronic illness.
What other acute illness may progress into chronic illness?
What are other forms of therapeutic procedures?

13. Definition of Terms (Cont.)
Laboratory testing: the analysis and study of specimens obtained from the patient to assist in diagnosis and treatment of disease
Examples: hemoglobin test, glucose test, strep test
If the physician suspects a patient has a UTI, what specimen would he or she have the MA obtain?
What laboratory tests are commonly performed in the medical office?

14. Definition of Terms (Cont.)
Diagnostic procedure: performed to assist in the diagnosis of a patient's condition
Examples: electrocardiography, colonoscopy, mammography
What are some examples of diagnostic procedures performed in the medical office?

15. Preparation of the Examining Room
Important to properly prepare the examining room
Provides a comfortable and healthy environment
Facilitates the PE
Why is it important to make the patient comfortable for the examination?

16. Preparation of the Examining Room (Cont.)
Guidelines:
Should be free from clutter and well lit
Check daily for ample supplies; restock as needed
Empty waste receptacles frequently
Replace biohazard containers as necessary
What procedures should be followed when replacing biohazard containers?

17. Preparation of the Examining Room (Cont.)
Guidelines:
Room should be well ventilated
Maintain room temperature
Should be comfortable for both clothed and disrobed patients
Clean and disinfect daily
Examining tables
Countertops
Faucets
What is the brand name of a disinfectant that could be used on an examination table?

18. Preparation of the Examining Room (Cont.)
Guidelines:
Remove dust and dirt from furniture and towel dispensers
Change examining table paper after each patient; restock gowns and drapes as needed
Patient's privacy should be ensured
Keep the examining room door closed during patient examination
HIPAA must be followed to ensure patient confidentiality.

19. Preparation of the Examining Room (Cont.)
Guidelines:
Clean and prepare items the physician will be using for examinations:
Equipment
Instruments
Supplies
What equipment and supplies are frequently used for the physical examination?
Which of these items should be checked for working condition before they are used by the physician?

20. Preparation of the Examining Room (Cont.)
Guidelines:
Check equipment and instruments frequently for proper working condition
Protects patient from harm caused by faulty equipment
Have equipment and supplies ready for examination
Arrange for easy access by physician
Type varies based on: type of examination; physician's preference
See Table 5-1 (p. 175) for a complete list of equipment and supplies needed for the physical examination.
Make sure the physician can reach all items easily.

21. Preparation of the Examining Room (Cont.)
Guidelines:
Know how to operate and care for equipment
Refer to the operating manual – read carefully; keep available for reference
Why is it important to know how to operate and care for each item?

22. Preparation of the Examining Room (Cont.)
Physical Examination Equipment and Supplies
List the function of each item on this PE tray.
Describe the care and maintenance for each of the reusable items shown in this illustration.

23. Preparation of the Patient
MA's responsibility: prepare the patient for PE
After greeting and escorting patient to the examining room
Identify the patient by name and DOB – ask patient to state this information
Compare information with demographic data in patient’s chart – to avoid mistaking one patient for another; could be held liable if you perform procedure on the wrong patient by mistake
Why is it important to escort the patient to the examination room?
Ask students to role-play different scenarios to obtain the patient’s name and date of birth.
How do you verify the identity of a patient when using an EMR?

24. Preparation of the Patient (Cont.)
MA's responsibility: prepare the patient for PE
Take vital signs
Measure height and weight
Explain the purpose of the examination and offer to answer questions
Apprehension can be reduced by:
Addressing patient by name of choice
Having a friendly and supportive attitude
Speaking clearly, distinctly, and slowly
What vital signs are typically measured on each patient?
What are some other ways to reduce patient apprehension?

25. Preparation of the Patient (Cont.)
MA's responsibility: prepare the patient for PE
Ask patient if he or she needs to void before the examination
Makes examination easier for physician to perform
Makes examination more comfortable for patient
If urine specimen is needed: patient is asked to void
If a urine specimen is needed, what directions would the MA relay to the patient?

26. Preparation of the Patient (Cont.)
MA's responsibility: prepare the patient for PE
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
Elderly and disabled patients may have difficulty disrobing; therefore, assistance should be offered.
Patients who do not speak English may need a visual demonstration of putting on a gown and drapes.

27. Preparation of the Patient (Cont.)
MA's responsibility: prepare the patient for PE
Disrobing facility should be comfortable and private
Helpful to have a place for patient to sit
Should have hooks and hangers for clothing
Describe the components of an “ideal” disrobing location.
Describe the components of a disrobing location that would be less than ideal.

28. Preparation of the Patient (Cont.)
MA's responsibility: prepare the patient for PE
MA should have patient's medical record available for review by the physician
Use designated location for medical record – Examples: shelf next to examining room door; chart holder on outside of door
Follow HIPAA privacy rule to protect patient's health information – patient-identifiable information should not be visible
Help patient on and off the examining table for safety
Colored flags are often used to inform the physician that the patient is ready to be seen.
What are some other methods that can be used to inform the physician that the patient is ready to be seen?

29. Assessment of the Patient
Extent of assessment during PE depends on:
Purpose of examination
Patient's condition
Complete PE includes: thorough assessment of all body systems
Physician uses an organized and systemic approach:
Starts with head and proceeds toward the feet
Facilitates the examination process
Requires fewest position changes by patient
What assessments are included in a complete physical examination?

30. Assessment of the Patient (Cont.)
Results of PE are documented by physician
PPR (paper-based patient record)
Physician notes result of PE – preprinted forms are available for this purpose
Physician later uses notes to dictate findings of PE – are transcribed into a PE report
What are the four assessment techniques?

31. Assessment of the Patient (Cont.)
Results of PE are documented by physician
EMR (electronic medical record)
Physician records findings on a computer – using free-text entry, drop-down lists, check boxes
EMR program uses this information to generate PE report
Physician does not need to dictate findings – alleviates need to transcribe dictation into a PE report
Patients who exhibit symptoms of illness
Do not require a complete PE
Physician examines body system associated with symptoms
What are the advantages and disadvantages of an EMR?
Why should an EMR be password protected?

32. Inspection
Inspection: The process of observing a patient to detect the signs of disease
Assessment technique most frequently used
Good lighting is required
Why is inspection most frequently used?

33. Inspection (Cont.)
Inspection: The process of observing a patient to detect the signs of disease
Observe patient for:
Color
Speech
Deformities
Skin condition (rashes, scars, warts)
Body contour and symmetry
Orientation to the surroundings
Body movements
Anxiety level
Why should the patient be observed for color?
What are some examples of instances in which the medical assistant uses inspection to perform procedures?

34. Palpation
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 the detection of abnormalities
What are some examples of facial expressions that could indicate a problem?

35. Palpation (Cont.)
Palpation: The process of feeling with the hands to detect the signs of disease
Used to determine:
Placement and size of organs
Presence of lumps
Pain
Swelling
Tenderness
What are some examples of instances in which the medical assistant uses palpation when performing procedures?

36. Palpation (Cont.)
Palpation: The process of feeling with the hands to detect the signs of disease
Examples of palpation
Breast examination
Measuring radial pulse
Types of palpation
Light: to determine areas of tenderness – fingertips are placed on the body part; gently depressed ½ inch
Give an example of an area in which light palpation may be used.

37. Palpation (Cont.)
Palpation: The process of feeling with the hands to detect the signs of disease
Types of palpation
Deep: to examine condition of organs – two hands are used: one to support the body from below, other to press over the area (example: bimanual pelvic examination)
What is the purpose of a bimanual pelvic examination?

38. Percussion
Percussion: The process of tapping the 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
Any condition that changes the density of an organ or tissue, such as fluid in the lungs, will change the quality of the sound in a percussion examination.

39. Percussion (Cont.)
Percussion: The process of tapping the body and listening to the sounds produced to detect the signs of disease
Technique
Fingertips are used to produce a sound vibration
Nondominant hand: placed over area with fingers slightly separated
Dominant hand: strike the joint of middle finger placed on patient to produce a sound vibration
See Fig (p. 206) for an illustration of percussion.

40. Percussion (Cont.)
Percussion: The process of tapping the body and listening to the sounds produced to detect the signs of disease
Technique
Dominant hand: strike the joint of middle finger placed on patient to produce a sound vibration
Dense structures: produce a dull sound (liver, spleen, heart)
Empty or air-filled structures: produce a hollow sound (lungs)
Any condition that changes density of organ or tissue (e.g., fluid in the lungs) changes quality of the sound
See Fig (p. 206) for an illustration of percussion.

41. Auscultation
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 BP
The physician may also listen for bowel sounds.

42. Auscultation (Cont.)
Auscultation: The process of listening with a stethoscope to the sounds produced within the body to detect the signs of disease
Guidelines
Minimize environmental noise – interferes with effective listening
Diaphragm chest piece: used for high-pitched sounds (lung and bowel)
Bell chest piece: used for low-pitched sounds (heart and vascular system)
Clean chest piece with an antiseptic and warm it before placing on the patient
Why should the chest piece be warmed?
What type of antiseptic is typically used to clean the chest piece?

43. Assisting the Physician
The MA is responsible for
Helping patient change positions
Handing physician instruments and supplies
Reassuring patient to reduce apprehension
Assisting patient off the examining table after the PE
Providing patient with additional information if needed
Scheduling a return visit
Patient education to promote wellness
Hand the instruments to the physician in working order.
Ask students to role-play examples of methods that are effective in helping to reassure the patient.
What other patient teaching might the MA need to relay to the patient?

44. Watch videos 19 to 22 Using your book, complete the online questions (go to the Dale MAA folder into Concepts for Practice and then online quizzes.