1. Assisting with the Primary Physical Examination
Chapter 31

2. Anatomy and Physiology
Anatomy is the study of how the body is shaped and structured.
structural development
levels of organization
relationships among microscopic parts
the interrelationship of structure and function
Physiology is the study of body functions.

3. Structural Development
Cells
Tissues
Epithelial
Connective
Muscle
Nervous
Organs
Composed of two or more types of tissue bound together into a more complex structure with a common purpose or function
May have one or many functions and may be considered a unit in one or several systems

4. Systems
A body system is composed of several organs and their associated structures, which work together to perform a specific function.
Of 11 systems in the human body, each system has specific units, and each performs specific functions.

5. Primary Care Physician
PCP treats patients of all ages for a broad range of diseases and complaints.
A PCP is qualified to provide continuing healthcare for the entire family, from birth to old age.
The PCP evaluates a patient’s total healthcare needs, provides personal medical care within one or more fields of medicine, and refers the patient to a specialist when an advanced or serious condition warrants additional expertise.

6. Physical Examination
The purpose of a physical examination is to determine the overall state of well-being of the patient.
Frequently, laboratory and other diagnostic tests are ordered to supplement the physician’s initial diagnosis.

7. Preparing for the Physical Examination
The medical assistant’s duties include:
preparing and maintaining the examination room and equipment
preparing the patient
assisting the physician during the physical examination

8. Preparing for the Physical Examination (cont’d)

9. Supplies and Instruments Needed for the Physical Examination
Instruments typically are used during the physical examination to see, feel, and listen to parts of the body.
All equipment must be in good working order, properly disinfected, and readily available.

10. Supplies and Instruments Needed for the Physical Examination (cont’d)

11. Ophthalmoscope
Ophthalmoscope: Instrument used to inspect the inner structures of the eye.
The stainless-steel handle contains batteries, onto which a head is attached, equipped with a light and magnifying lenses and an opening through which the eye is viewed.

12. Instruments
Tongue depressor: Flat, wooden blade used to hold down the tongue when examining the throat.
Reflex hammer: Sometimes referred to as a percussion hammer, this has a hard rubber head used to test neurologic reflexes of the knee and elbow by striking the tendons.

13. Instruments (cont’d)

14. Otoscope
Otoscope: Instrument used to examine the external auditory canal and tympanic membrane.
The stainless steel handle containing batteries, onto which a head is fastened.
The head contains a light focused through a magnifying lens and a disposable ear speculum.

15. Nasal Speculum
Nasal speculum: Stainless-steel instrument used to inspect the lining of the nose, nasal membranes, and internal septum.
Spreads apart to dilate the nostrils.

16. Nasal Speculum (cont’d)

17. Tuning Fork
The tuning fork is used to check a patient's auditory acuity and to test bone vibration.
Consists of a handle and two prongs that produce a humming sound when the physician strikes the prongs.

18. Tuning Fork (cont’d)

19. Tape Measure
Tape measure: Flexible ribbon ruler usually printed in inches and feet on one side and in centimeters and meters on the opposite side.
Used to assess infant length and head circumference, patient wound size, and so on.

20. Stethoscope
Stethoscope: Listening device used to auscultate certain areas of the body, particularly the heart and lungs.
Two earpieces are connected to flexible rubber or vinyl tubing. At the distal end of the tubing is a diaphragm or bell (many have both) that enables the physician to hear internal body sounds.

21. Stethoscope (cont’d)

22. Gloves
Gloves: Disposable latex gloves protect the physician and the patient from microorganisms.
Under Standard Precautions, gloves are to be worn whenever there is a possibility of contact with body fluids, broken skin or wounds, or contaminated items.

23. Methods of Examination
Inspection is use of observation to detect significant physical features or objective data. Focus on the patient's general appearance (the general state of health, including posture, mannerisms, grooming) then on more detailed observations, including body contour, gait, symmetry, visible injuries and deformities, tremors, rashes, and color changes.

24. Palpation
Palpation is the use of touch to determine the body’s condition or that of an underlying organ. Palpation may include touching the skin or the more firm feeling of the abdomen for underlying masses and involves a wide range of perceptions: temperature, vibrations, consistency, form, size, rigidity, elasticity, moisture, texture, position, and contour.

25. Palpation (cont’d)

26. Percussion
Percussion involves tapping or striking the body, usually with the fingers or a small hammer, to elicit sounds or vibratory sensations, to determine the position, size, and density of an underlying organ or cavity.

27. Percussion (cont’d)

28. Auscultation
Auscultation uses a stethoscope to listen to sounds arising from the body and distinguish between normal and abnormal sounds.

29. Auscultation (cont’d)

30. Measurements Mensuration is the process of measuring.
Measurements are recorded of the patient’s height and weight, the length and diameter of an extremity, the extent of flexion or extension of an extremity, the uterus during pregnancy, the size and depth of a wound, or the pressure of a grip.

31. Manipulation
Manipulation is the forceful, passive movement of a joint to determine its range of extension or flexion.

32. Positioning and Draping for Physical Examinations
The medical assistant instructs the patient about, and assists the patient into, these positions with as much ease and modesty as possible and helps the patient to maintain the position during the examination with as little discomfort as possible.
Draping with an examination sheet protects the patient from embarrassment and keeps the patient warm.

33. Fowler’s Position

34. Semi-Fowler’s Position

35. Supine Position

36. Dorsal Recumbent Position

37. Lithotomy Position

38. Sims’ Position

39. Prone Position

40. Knee-Chest Position

41. Trendelenburg Position

42. Principles of Body Mechanics
Maintain good posture whether sitting or standing.
Avoid twisting or turning; move feet to face the object.
Do not cross legs.
Keep back of knees away from chair edge when sitting.
Do not reach for heavy items.
To lift, bend knees, keep back straight, and bring item as close as possible to body while lifting. Reverse these steps when lowering a heavy item.
Push rather than pull heavy items.

43. Principles of Body Mechanics

44. Transferring a Patient

45. Examination Sequence Presenting appearance Nutrition and stature
Speech
Breath odors
Skin
Head
Eyes, ears, nose, and mouth

46. Examination Sequence Neck Reflexes Chest Abdomen
Breast and testicular examinations
Rectum

47. Patient Education
The physical examination process is an excellent time for the medical assistant to assess the need for patient education. The MA should consider:
The information that the patient needs to know
How to convey the information so that the patient will understand
How the patient will use the information once he or she has it