Assisting with Examinations

Purpose of a General Physical Exam

  1. Examine healthy patient to confirm overall status of health and determine baseline values for VS and measurements
  2. Examine a patient to diagnose a medical problem

Routine exams, usually annually, may be required as a sports physical, beginning a job or starting an exercise program

When diagnosing medical problems, focusing on the particular organ system

During a general exam, physicians check all major organs and body systems

Diagnoses

  • Initial (clinical) diagnosis-based on signs/symptoms of a disease
    • Sign- objective-detected by other persons
    • Symptom- subjective- what the patient reports
  • Differential Diagnosis-determining the correct diagnosis when two + diagnoses are possible
  • Prognosis-forecast of the patient outcome/ course of disease

Role of the MA

  • Assist both the provider and the patient
  • First, you interview the patient, document accurate history, take VS and measure height and weight
  • During the exam, you will be responsible for ensuring that:
    • All instruments and supplies are readily available
    • Patients are emotionally and physically comfortable by helping them into position and keeping them aware of what is going to happen
    • Observe for signs of distress or need for assistance
    • Provide comfort and safety to the patient and competent assistance to the provider

Preparing the Patient for an Exam

Emotional Preparation
  • Explain what will occur during exam
  • Use simple, direct language that patients can understand
  • Describe what the patient may expect to feel and importance of cooperation
  • May be asked to stay in room to examine patient of same gender as you are- protects both the patient and the provider
Physical Preparation
  • Offer patient to use the restroom prior to exam-collect urine sample if needed at this time
  • Room temperature-patient may have to disrobe, the extent depends on type of exam; specific instructions for patients who must undress; leave exam room at this time to provide patient privacy
  • Use appropriate size gown, draping techniques to maintain patient dignity and comfort

Positioning and Draping

Position depends on type of exam occurring and patient’s ability to move

Some are embarrassing or physically uncomfortable – explain the need and assist patient, minimize time required in these positions

Use pillows for support/comfort or physically assist patient to maintain position for examination

Make changes in position gradually

Cover patient with a drape, appropriately sized and keep patient warm and covered.

  • A fenestrated drape has a window cut into it so only the part that is being treated is uncovered
Special Patient Considerations

Avoid stereotyping- leads to incorrect judgments

Some cultures may be more modest and have a greater need for privacy, may be unfamiliar with exam process, and may decline examination of specific body areas

Physical disabilities-adaptive equipment, different mobility

May need to help disabled patients to disrobe, move to the exam table and assume certain positions

Exam Methods

Inspection-visual exam of the patient’s entire body and overall appearance

Auscultation-listening to body sounds (heart, lungs, abdomen) via stethoscope

Palpation-touch to feel for masses, pain, texture, temperature, vibrations, shape

Percussion-tapping the body to hear sounds or feel vibrations- can determine density, size and location of organs

Mensuration-process of measuring

Manipulation-systematic moving of patients body parts to check for abnormalities/ affected movement

Components of the General Physical Exam

Begin assessing patient’s appearance and condition of their skin, nails and hair, then:

  • Head-abnormalities of the scalp, skin, eyes, lips, abnormal growths
  • Neck-symmetry and range of motion, lymph nodes, thyroid gland, carotid arteries
  • Eyes-eyelids and conjunctiva for disease, eye muscles and pupil response
  • Ears-outer ears for size and symmetry, lesions. Internal structures for infection
  • Nose and Sinuses-infection/allergy, discharge, swelling, obstructions
  • Mouth and Throat-cheeks, tongue, floor of mouth, gums, throat for redness or swelling
  • Chest and lungs-shape, symmetry, postural deformity, lung sounds,
  • Heart sounds-rate, rhythm, intensity and pitch
  • Breasts-clinical breast exam for symmetry, masses, retracted areas, axillary lymph nodes
  • Abdomen-bowel sounds, shape, symmetry, organ enlargement, percussion sounds, masses
  • Genitalia-masses, lumps, hernias, inguinal lymph nodes
  • Rectum-lesions, irregularities
  • Musculoskeletal system-posture, range of motion, strength, circulation
  • Neurological System-reflexes, mental status, sensory and motor functions
Basic Items needed for a General Exam
  • Penlight
  • Otoscope/Ophthalmoscope
  • Vision Chart
  • Color Vision Chart
  • Audiometer
  • Nasal Speculum
  • Gloves
  • Tongue Depressor
  • Stethoscope
  • Vaginal Speculum
  • Lubricant
  • Tape Measure