Physical Examination

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1
Physical
Examination
Putu Indraswari Aryanti, S.Kep., Ns., M.Kep
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General Principles
• A complete or partial physical examination is conducted
following a careful comprehensive or problem -related
h i s t o r y.
• It is conducted in a quiet, well -lit room with consideration for
patient privacy and comfort
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• HAND HYGIENE!!
• Proper personal protective equipment (PPE) : gloves, mask,
face shield, eye protection
• Patient privacy
• Gown
• Linen for draping
• Patient palcement
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Approaching the Pt
Conduct the examination systematically from head
to foot so as not to miss observing any system or
body part.
Explain all procedures to the patient while the
examination is being conducted to avoid alarming
or worrying the patient and to encourage
cooperation.
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Click to edit PHYSICAL EXAMINATION
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• HAND HYGIENE!!
• Proper personal protective equipment (PPE) : gloves, mask,
face shield, eye protection
• Patient privacy
• Gown
• Linen for draping
• Patient palcement
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“
Inspection – The process of observation,
a visual examination of the patient’s
body parts to detect normal
characteristic or significant physical
signs
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“
Palpation – Involves the use of the sense
of touch. Giving gentle pressure or
deep pressure using your hand is the
main activity of palpation
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“
Percussion – Involves tapping the body
with fingertips to evaluate the size,
borders, and consistency of body organs
and discover fluids in body cavities
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Table
Title Title Title Title
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Chart
$300.000
$250.000
$200.000
$150.000
$100.000
$50.000
$0
20YY 20YY 20YY 20YY 20YY
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Auscultation – Listening to sounds
produced by the body
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- Author
2020
Thank You 1
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Mention whatMaster
activity
title
youstyle
do for each case listed below!
No. Activity Technique
1 Examining patient’s respiratory

2 Inspecting the mouth and throat
3 Asking patient to stand up to find whether there is
scoliosis or not
4 Pressing her middle finger of non dominant hand firmly
against the patient’s back.With palm and fingers
remaining off the skin, the tip of the middle finger of the
dominant hans strikes the other, using quick, sharp
stroke
5 Observing the color of the eyes
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Instructions and Feedback
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Useful
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Explaining what you are going to do immediately

• Now I am going to …
Press your … + (parts of the body) gently
• It’s time for me to … Examine your … + (parts of the body) gently
• Now I want to …
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Useful
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Instruction
• Would you… ? Remove your … (wig)
• Now I want you to …? Put off your … (hairpieces)
• Please + … (V1 + adverb)
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Listen
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Flex your neck with chin toward

Bend your neck with ear toward shoulder
Shrug your shoulder
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Laboratory
Findings
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Diagnostic
Click Decision
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• The current list of test offered by one major reference laboratory
includes nearly 3.000 analytes, which does not include the
additional array of more commonly ordered tests (eg. Complete
Blood Count <CBC>, electrolytes <sodium, potassium, chloride,
carbon dioxide>, Thyroid Stimulating Hormone <TSH>, glucose,
etc.)
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Medical
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• The recent emphasis on reducing health care costs and the

emergence of managed care organizations led to effort to reduce
the abuse (over-ordering) and misuse (eg. Ordering the right test for
the wrong purpose or vice versa) of the tests
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Medical
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• Consider:
• The importance selecting and ordering the most rational laboratory test(s) on
a specific patient is heightened in the current age of managed care, medical
necessity and outcome-oriented medicine
• Targeted approach based on an understanding of the test’s diagnostic
performance and the major ‘legitimate’ reasons for ordering a laboratory test
• As second and third party seek to provide quality medicine cost effectively,
reduction in the ordering of ‘unnecessary’ laboratory tests has become a
favorite target of these efforts
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Medical
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• Consider:
• The critical question facing becomes: What constitutes an unnecessary
laboratory test?
• In the current climate of business – oriented medicine, the answer should
not be: Any test for which reimbursement by a payer (eg. Medicare) is likely
to be denied
• The correct answer is : Any test for which the results are not likely to be
‘medically necessary’in the appropriate management of the patient’s medical
condition
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Labs to Know
Female
Hgb: 12 – 16 g/dl
• Complete Blood Count Hct : 37 – 47 %
• RBC : 4,5 – 5,5 mil
• WBC : 5.000 – 10.000
• Platelets : 150.000 – 400.000 Male
• Coagulation Hgb : 14-18 g/dl
• PT : 10 – 12 seconds Hct : 42 – 52 %
• INR : <1  Taking Warfarin INR 2-3
• aPTT : 30 – 40 seconds  Heparin 1,5 – 2,5 x’s (Therapeutic)
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METABOLIC PANEL
• Glucose : 70-100 mg/dl

• Calcium : 8,5 – 10,5 mg/L • Sodium : 135 – 145 mEq/L
• Chloride : 95 – 105 mEq/L
• Magnesium : 1,5 -2,5 mg/dl
• Phosphorus : 2,5 – 4,5 mg/dl
• Potassium : 3,5 – 5 mEq/L • BUN : 5 – 20
• Albumin : 3,4 – 5,4 g/dl • Creatinine : 0,6 – 1,2 mg/dl
• ALP : 40 – 120 u/L • Total Protein 6,2 – 8,2 g/dl
• ALT : 7 – 56 u/L • AST : 10 – 40 u/L
• Bilirubin : <1 mg/dl
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LIPID
Click to edit Master title style PANEL
• LDL : < 100 mg/dl
• HDL : > 60 mg/dl
• Total Cholesterol : < 200 mg/dl
• Triglycerides : < 150 mg/dl
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ABG’s Hemoglobin A1c

• pH : 7,35 – 7,45 • 4,6 % ( non-diabetic)
• pCO2 : 45 – 35 • < 7% (diabetic
• HCO3 : 22 – 26
• PO2 : 80 – 100%
• O2 Sat : 96 – 100%
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Assignment
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– Role
style Play
Answer these question based on the information in the cases listed below.
• What kind of lab. test is needed for each case?
• Case 1………………………..test Case 4……………test
• Case 2………………………..test Case 5……………test
• Case 3………………………..test
• Make a complete conversation according to the cases described below.
• Do this pairs.
• Each pair chooses only one case
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• Case 1:
A patient suffering from fever and persistent cough is suspected with
TB. The doctor asked her to have Mantoux skin test and sputum test.
• Case 2:
• A mother with absence of periods for two weeks wants to confirm
about her pregnancy. She has to undergo a set of urinal test.
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•Click
Caseto3: edit Master title style
A patient is suspected with coronary heat disease. A doctor advised
him to have a cholesterol test.
• Case 4:
• A patient suspected with TB needs a series of test to confirm the
diagnosis. Blood test, sputum, mantoux test.
• Case 5:
• A patient complains about having a pain in the center of the chest.
The pain spreads to the throat, the back and arms (mainly the left
one). The doctor orders laboratory test to check the level of his fat,
and the urinal test to determine whether he has diabetes or not.
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Physical Examination

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Physical Examination

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Title Title Title Title

1 Examining patient’s respiratory

Explaining what you are going to do immediately

• Please + … (V1 + adverb)

Flex your neck with chin toward

• The recent emphasis on reducing health care costs and the

• Glucose : 70-100 mg/dl

ABG’s Hemoglobin A1c

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