Ch. 35 Physical Examination

Preparing exam rooms

• Arranging drapes, gowns, and other patient supplies before the patient enters the room

• Cleaning, disinfecting, and arranging the equipment and instruments for easy access to the provider

• Checking expiration dates on all packages and supplies regularly and discarding all expired supplies

• Obtaining specimens after they are ordered by the provider

• Replacing the sharps container when it is two-thirds full

Ophthalmoscope

an instrument used to inspect the inner structures of the eye

Otoscope

a stainless steel handle containing batteries used to inspect the external auditory canal and tympanic membrane.

Reflex hammer

A reflex or percussion hammer is a stainless-steel instrument used to test neurologic reflexes.

Stethoscope

a listening device used to auscultate the heart and lungs.

Assisting the patient for examination

• Ensuring that the health record is complete and the needed consent forms have been signed

• Introducing self, verifying the patient’s identity, addressing the patient by his or her preferred name

• Measuring and recording vital signs, height, weight, and BMI

• Conducting an initial investigation for the reason of visit and explaining the procedure of the examination

• Asking if the patient needs to empty the bladder before the examination as a full bladder affects reports

• Providing a drape to ensure the patient’s privacy after the removal of the patient’s clothes

• Assisting the patient in and out of various examination positions

• Assisting the patient in dressing after the examination

Assisting the provider during exam

• Drape and position the patient during examination phases.

• Assist in collecting and labeling the specimen properly such as urine, throat cultures, and Pap test specimens.

• Conduct the diagnostic tests such as hearing and visual screenings ordered by the healthcare provider.

• Hand instruments or equipment to the healthcare provider during the procedure.

• Conduct follow-up diagnostic procedures as ordered by the healthcare provider.

• Complete all the required patient forms.

General appearance

Gait, posture

Breath odor

Breath odors may be associated with poor oral hygiene or a symptom of an underlying pathological condition such as diabetes mellitus, renal disease, starvation, liver disease, or uremia.

Aphonia

The inability to speak due to loss of voice that occurs with overuse or laryngitis.

Motor aphasia

Slurred or incoherent speech after a cerebrovascular accident (CVA).

Aphasia

The loss of expression by speech or writing due to a brain disease or injury.

Dysphasia

Lack of coordination and arrangement of words due to a brain lesion.

Sensory aphasia

Pronunciation of words is correct but words are used inappropriately.

Skin

The skin reflects the condition of the patient's nutritional status and hydration level. Presence of disease involves dryness, scaling, extended wound healing, and frequent breaks in the skin. Fingernails and toenails are included in the skin assessment.

Head

The face is the reflection of the patient’s state and provides a great deal of information on how patient handles stress.

Eyes and ears

An ophthalmoscope is used to assess the patient’s eyes while an otoscope with a disposable speculum is used to examine the patient’s ears.

Nose and sinuses

The color and texture of the nasal mucosa are examined.

Mouth and throat

The MA should have a tongue depressor and gauze available for the provider during this assessment.

Neck

The patient may be asked to move the head in various directions for neck examination; therefore, the MA should be prepared to assist. The thyroid gland is examined for symmetry, size, and texture.

Chest

The MA should have a tape measure available for the provider to measure variations between upper and lower chest expansion. A barrel-shaped chest indicates emphysema. A stethoscope should also be available for the provider during this assessment

Abdomen

The patient’s gown and drape often require repositioning during this assessment.

Reflexes

A reflex hammer is often used for this assessment. The patient may require repositioning during the assessment.

Breast, testic*es, and rect*m

The patient’s gown and drape often require repositioning during this assessment.

Inspection

involves observation to detect significant physical features or objective data. The examiner observes the patient's general appearance, body contour, gait, symmetry, visible injuries and deformities, tremors, rashes, and color changes.

Palpation

involves touching the skin or performing a firmer exploration for underlying masses, often involving the abdomen.

Percussion

an examination technique that determines the position of, size of, density of, and amount of air in an underlying organ or cavity. It is performed by tapping or striking the body with the fingers or a small hammer to elicit sounds or vibratory sensations.

Auscultation

requires a stethoscope to listen to sounds arising from the body. Auscultation is useful for evaluating sounds originating in the lungs, heart (murmur or bruit), and abdomen (bowel sounds).

Mensuration

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

Manipulation

the passive movement of a joint that is used to determine the range of extension or flexion of the body part.

Dorsal recumbent position

In the dorsal recumbent position, the patient lies facing upward, with the weight primarily distributed to the surface of the back. This is accomplished by flexing the knees so that the feet are flat on the table.

Sims’ position

Side lying with the top leg bent over the bottom leg

Knee-chest position

requires the patient to rest on the knees and the chest with the head turned to one side. The thighs are perpendicular to the table, slightly separated, and the buttocks extended up into the air keeping the back straight.