1. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 32 Assisting With the Physical Examination

2. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.  Exams are done to:  Promote health  Determine fitness for work  Diagnose disease  In nursing centers, residents have an exam at least once a year. Slide 2

3. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Your Role and Equipment  What you do depends on:  Center policies and procedures  The examiner’s preferences  You need to know the following instruments:  Laryngeal mirror: used to examine the mouth, teeth, and throat  Nasal speculum: used to examine the inside of the nose  Ophthalmoscope: used to examine the internal eye structures Slide 3

4. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.  Otoscope: used to examine the external ear and the eardrum (tympanic membrane)  Percussion hammer (reflex hammer): used to tap body parts to test reflexes  Tuning fork: used to test hearing  Vaginal speculum: used to open the vagina to examine it and the cervix. Slide 4

5. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Preparing the Person  You must be sensitive to the person’s feelings and concerns.  The person is prepared physically and mentally for the exam.  Under OBRA, the person has the right to know:  Who will do the exam  Why it is done  What to expect  The resident has the right to personal choice.  The exam is done only with the person’s consent. Slide 5

6. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.  The doctor or nurse tells the person:  About the exam  Reasons for the exam  Who will do the exam  When the exam will be done  About the procedure  Privacy is protected.  The person is screened and the room door is closed.  Usually a hospital gown is worn.  The person is covered with a drape.  Only the part being examined is exposed. Slide 6

7. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.  The person voids before the exam.  An empty bladder: Lets the examiner feel the abdominal organs Lets the examiner feel the abdominal organs Promotes comfort, especially when the abdominal organs are felt Promotes comfort, especially when the abdominal organs are felt  If a urine specimen is needed, obtain it at this time.  Measure weight, height, and vital signs before the exam starts.  Drape and position the person for the exam. Slide 7

8. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Positioning and Draping  Before helping the person assume and maintain the position, explain the following:  Why the position is needed  How to assume the position  How the body is draped for warmth and privacy  How long to expect to stay in the position  These positions are common:  The dorsal recumbent (horizontal recumbent) position  The lithotomy position  The knee-chest position  The Sims’ position Slide 8

9. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Assisting with the Exam  You may be asked to:  Prepare, position, and drape the person.  Assist the doctor or RN during the exam.  Persons with dementia may:  Resist the examiner’s efforts  Be agitated and aggressive because of confusion and fear Slide 9

10. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.  If a person refuses or resists an exam:  He or she is not restrained or forced to have it.  The exam is tried another time.  Sometimes a family member can calm the person.  The doctor may order drugs to help the person relax. The person’s rights are always respected. The person’s rights are always respected. Slide 10

11. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. After the Exam  The person dresses or returns to bed.  The vaginal and anal areas are wiped or cleaned before the person dresses or returns to the room. Slide 11

12. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.  You also need to:  Discard disposable items.  Replace supplies so the tray is ready for the next exam.  Clean reusable items according to center policy.  Send the speculum to the supply area for sterilization.  Cover the exam table with a clean drawsheet or paper.  Label specimens.  Take them to the designated area with a requisition slip.  Clean and straighten the person’s unit or exam room.  Follow center policy for soiled linens. Slide 12

13. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Quality of Life  Resident care is given in a way that promotes dignity, self-esteem, and physical, mental, and social well-being.  The person should know the reasons for the exam and how it will be done.  Only staff involved in the person’s care need to know the reason for the exam and its results.  If the person consents, the doctor tells the family.  The person can share the information with others if he or she wants to. Slide 13