Assisting With General Physical Examination

CHAPTER
38
Assisting with
General Physical
Examination
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38-2
Learning Outcomes (cont.)

38.1 Identify the purpose of a general
physical exam.
38.2 Describe the role of the medical

assistant in a general physical exam.
38.3 Explain safety precautions used during

a general physical exam.
38-3

38.4 Carry out the steps necessary to
prepare the patient for an exam.
38.5 Carry out positioning and draping a

patient in each of the nine common
exam positions.
38.6 Apply techniques to assist patients

from different cultures and patients with
physical disabilities.
38-4

38.7 Identify the six examination methods
used in a general physical exam.
38.8 List the components of a general

physical exam.
38.9 Describe follow-up steps after a

general physical exam.
38-5
Introduction
• Physical • The medical
examination – 1st assistant
step in the – Make the client
diagnosis or comfortable
treatment process – Assist the
physician
A skilled medical assistant can create an

atmosphere that results in a positive outcome
for the patient during the physical examination.
38-6
The Purpose of General Physical Exam

• To confirm an overall state of health and
provide baseline values
• To diagnose a
medical problem
38-7
The Purpose of General Physical Exam

(cont.)
• Clinical diagnosis
– Sign ~ objective
– Symptom ~ subjective
• Laboratory and diagnostic tests

– Confirm clinical diagnosis
– Help determine the differential diagnosis
and prognosis
– Formulation of treatment plan
38-8
Apply Your Knowledge

Why does the physician perform a general physical
examination?
ANSWER: A physical examination is used to confirm the

patient’s overall state of health or to diagnose a medical
problem.
38-9
The Role of Medical Assistant

• To assist the licensed practitioner and the
patient
• Begins prior to the physical exam
– Interview
– Write an accurate history
– Determine vital signs
– Measure weight and height
38-10
The Role of Medical Assistant (cont.)
• Responsibilities
– Ensuring instruments and
supplies are available
– Ensuring patient comfort
• Helping into position
• Keeping them informed
• Observing them for distress or need for assistance
38-11

What are your responsibilities when assisting with
a general physical exam?
ANSWER: Ensuring all supplies and instruments are

available for the physician and making sure the patient
is comfortable by
•Helping the patient into position
•Telling them what will happen
•Observing the patient for signs of distress or need for
assistance.
Hooray!
38-12
Safety Precautions
• OSHA standards and guidelines

– Protect employees
– Make the workplace safe
• CDC guidelines – protect patients and

health-care workers
38-13
Safety Precautions (cont.)

• Aseptic hand washing
– Before and after each
patient contact
– Before and after each
procedure
• Wear gloves if there may be contact with

– Blood – Nonintact skin
– Body fluids – Moist surfaces
– Also when handling specimens
38-14

• Respiratory hygiene/cough etiquette
• Wear a mask to prevent exposure to an

infectious disease transmitted by
airborne droplets
• Isolation precautions – personal protective

equipment
38-15

• Discard all disposable equipment and
supplies appropriately
• Clean and disinfect the exam

room after each patient
• Sanitize, disinfect, and sterilize

equipment appropriately
38-16
Impressive!
Mrs. Jefferson brings her daughter, Laura, to the office
because of what she describes as an upper respiratory
infection. Laura is coughing and the medical assistant
notices a blister-like rash on her arms. What actions
should the medical assistant take?
ANSWER: Laura and her mother should be moved away from

other patients in the waiting room to a private area. Since she is
coughing and could have an infection spread by droplet, the
medical assistant and physician should wear a mask and gloves
when in the room. In addition, the room should be cleaned and
sanitized following the appointment.
38-17
Preparing the Patient for an Exam
• Emotional preparation
– Explain exactly what will occur and what they
will feel
– Use simple direct language
38-18
Preparing the Patient for an Exam
• Physical
– Offer the bathroom
– Ask the patient to disrobe and put on an exam
gown or cover with a drape
– Be aware of
modesty and
comfort
38-19

What can you do to elicit the patient’s cooperation
during a physical exam?
ANSWER: Explain what she can expect to

happen during the examination and that her
cooperation will help the exam proceed
smoothly.
Way to go!
38-20
Positioning and Draping

• Proper patient position facilitates the
examination
– Assist the patient to appropriate position
– Make as comfortable as possible
– Cover with appropriate drape
• Keep patient warm
• Maintain privacy/modesty
38-21
Positioning and Draping (cont.)

• Sitting • Supine/recumbent
– Symmetry
• Dorsal recumbent
38-22

• Lithotomy • Fowler’s
38-23

• Prone • Sims’
38-24

• Knee-Elbow • Proctologic
– Fenestrated drape
38-25
An elderly female patient needs her lower abdomen and

genitalia examined by the physician. What would be the
best position to place her in and why?
ANSWER: The dorsal recumbent position is recommended over

the lithotomy position because an elderly patient may have
difficulty placing her legs in stirrups.
38-26
Special Patient Considerations
• Patients from different cultures

– Avoid stereotyping and making judgments
– Patients
• May not know what to expect
• May require more privacy
• May refuse a specific exam
38-27
Special Patient Considerations

• Patients with disabilities – provide
assistance as needed
– Disrobing
– Moving to exam table
– Assuming exam
position
38-28

Why is it important to avoid stereotyping when
caring for patients from other cultures?
ANSWER: This can lead to making incorrect

judgment that may influence the care you
provide the patient.
38-29
Examination Methods
• Inspection • Auscultation
– Visual exam – Listening to body
sounds using a
– Posture, stethoscope
mannerisms, and
hygiene
– Size, shape, color,
position, symmetry
– Presence of
abnormalities
38-30
Examination Methods (cont.)
• Palpation • Percussion
– Touch – Tapping or striking
the body to hear
– Assess texture,
sounds or feel
temperature, shape
vibrations
– Presence of
– Used to determine
vibration or
location, size, or
movements
density of structure
or organ
38-31
Examination Methods (cont.)

• Mensuration – • Manipulation
process of – Systemic moving of
measuring a patient’s body
parts
– Check for
abnormalities
– Determine range of
motion of joints
38-32

Jimmy Jones is complaining of abdominal pain. What types
of examination methods will the physician most likely use to
assess this complaint?
ANSWER: The physician will use inspection to

determine if there are any visual abnormalities of
Jimmy’s abdomen, palpation to feel for any
abnormalities, percussion to assess for vibrations, and
auscultation to assess bowel sounds. The medical
assistant may be asked to measure the abdominal girth.
Ole!
38-33
Components of the General Physical

Examination
• Exams – performed in a certain order

– General appearance
– Specific body sections
• Become familiar with the standard order

for performing an exam
38-34

Examination (cont.)
• Medical assistant
– Be familiar with the
components of the
examination
– Know equipment and supplies used
– Ensure the patient’s comfort
– Protect the patient’s modesty
38-35

Examination (cont.)
• General appearance • Head

– General state of – Abnormal
heath condition of scalp
or skin
– Distress or pain
– Puffiness
– Skin
– Abnormal growths
– Nails and nail beds
– Hair
38-36

Examination (cont.)
• Neck • Eyes
– Lymph nodes, – The presence of
thyroid glands, and disease or
major blood abnormalities
vessels
– Pupils for light
– Symmetry and response
range of motion
– Muscles
– Internal structures
38-37

Examination (cont.)
• Ears • Nose and sinuses

– Outer ear – Infection or allergy
• Symmetry and size
• Lesions, redness,
– Nasal mucosa
or swelling – Tenderness in
– Inner ear structures sinuses
• Canals
• Eardrums
38-38

Examination (cont.)
• Mouth and throat • Chest and lungs

– Mouth ~ overall – Hyperventilation
health and hygiene
– Inspection
– Throat ~ swelling
or redness – Auscultation
– Palpation and
percussion
38-39

Examination (cont.)
• Heart • Breasts
– Percussion – size – Inspection
of heart
– Palpation
– Auscultation • Lymph nodes
• Heart sounds
• Breasts
• Rate, rhythm,
intensity, and pitch
38-40

Examination (cont.)
• Abdomen
– Inspection – Findings described
using system of
– Auscultation landmarks
– Percussion
– Palpation
38-41

Examination (cont.)
• Female genitalia • Male genitalia

– Inspection
– Lithotomy position
• Penis and scrotum
• Groin
– Assist to relax
– Palpation
• Penis and scrotum
• Lymph nodes
38-42

Examination (cont.)
• Rectum
– Palpation using a digital exam
• Lesions or abnormalities
• Occult blood
38-43

Examination (cont.)
• Musculoskeletal system
– Muscle strength
– Posture ~ scoliosis
– Body
– Gait measurements
– Range of motion – Lesions,
deformities, or
circulatory
problems
38-44

Examination (cont.)
• Neurological system
– Reflexes – Intellectual
assessment in
– Mental and emotional children
status
– Mental status and
– Sensory and motor memory in elderly
functions
38-45

In what order should the physician perform an
abdominal examination and why?
ANSWER: The physician will inspect, auscultate,

percuss, and palpate the abdomen. Auscultation
should be done before percussion or palpation to
avoid altering the bowel sounds.
38-46
After the Examination
• Assist patient to a sitting position
• Allow the patient to perform any

necessary self-hygiene measures
• Allow patient to dress
• Perform additional tests or procedures
38-47
Additional Tests and Procedures
• Prior to dressing
– Cold and heat therapy
– Applying bandages
– Collecting specimens
Some medications should be administered

before the patient dresses while others can
be given after he is dressed.
38-48
Additional Tests and Procedures
• After dressing
– Urine reagent strip tests
– Pulmonary function tests
– Eye or ear irrigation or medication

administration
38-49
Patient Education
• Assess needs
– Risk factors for disease
– Medication administration
– Self-help or diagnostic techniques
• Use proper language level
• Ensure understanding
• Give written instructions
38-50
Follow-Up
• Scheduling appointments
– Future office visits
– Outside appointments
• Helping plan for home nursing care
• Helping the patient obtain assistance
38-51

What is important to remember when providing
patient education?
ANSWER: You should provide information in a way

the patient can understand it, but you should not talk
down to the patient. In addition, you need to verify
that the patient understands what you taught.
Super!
38-52
In Summary
38.1 A general physical exam is done either to
confirm an overall state of health or to
examine a patient to diagnose a medical
problem.
38.2 The medical assistant assists the patient and

physician during an exam. Making the
patient physically and emotionally comfortable, as
well as providing materials and assistance to the
physician are essential to a successful exam.
38-53
In Summary (cont.)
38.3 During an exam, the medical assistant
should perform hand hygiene, wear gloves and
other personal protective equipment, ensure
respiratory hygiene/cough etiquette, use
isolation precautions, dispose of biohazardous
waste, and clean and disinfect the exam room
as necessary to provide for safety.
38-54
In Summary (cont.)
38.4 The medical assistant should prepare the
patient for an exam emotionally, by using
simple direct language; and physically, by
providing for the patient’s comfort and
privacy when positioning him or her according
to the type of exam or procedure, and by
modifying techniques to meet the needs of
special patients
38-55
In Summary (cont.)
38.5 The nine common exam positions include
sitting, supine, dorsal recumbent, lithotomy,
Fowler’s, prone, Sims’, knee-chest, and
proctologic.
38.6 When assisting with the physical exam,
avoid judging and stereotyping patients from
different cultures and obtain a translator for
proper communication if necessary. Assist
patients who have physical disabilities with
transfers and other tasks they cannot
accomplish themselves.
38-56
In Summary (cont.)
38.7 The six examination methods used in a
general physical exam include inspection,
auscultation, palpation, percussion,
mensuration, and manipulation.
38.8 A general physical exam typically includes
an evaluation of the general appearance,
head, neck, eyes, ears, nose and sinuses,
mouth and throat, chest and lungs, heart,
breasts, abdomen, genitalia, rectum,
musculoskeletal system, and neurological
system.
38-57
In Summary (cont.)
38. 9 In order to assist the patient with follow-up
after the exam, you may schedule future
visits, schedule visits outside of the office,
help plan for home care, and, if within your
scope of practice, provide education related
to the patient’s condition.
38-58
End of Chapter 38
Health is the thing

that makes you feel
that now is the best
time of the year.
~ Franklin P. Adams

Assisting With General Physical Examination

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CHAPTER

Learning Outcomes (cont.)

38.2 Describe the role of the medical

38.3 Explain safety precautions used during

Learning Outcomes (cont.)

38.5 Carry out positioning and draping a

38.6 Apply techniques to assist patients

Learning Outcomes (cont.)

38.8 List the components of a general

38.9 Describe follow-up steps after a

A skilled medical assistant can create an

The Purpose of General Physical Exam

The Purpose of General Physical Exam

• Laboratory and diagnostic tests

Apply Your Knowledge

ANSWER: A physical examination is used to confirm the

The Role of Medical Assistant

– Write an accurate history

– Determine vital signs

– Measure weight and height

The Role of Medical Assistant (cont.)

• Keeping them informed

• Observing them for distress or need for assistance

Apply Your Knowledge

ANSWER: Ensuring all supplies and instruments are

• OSHA standards and guidelines

• CDC guidelines – protect patients and

Safety Precautions (cont.)

• Wear gloves if there may be contact with

Safety Precautions (cont.)

• Wear a mask to prevent exposure to an

• Isolation precautions – personal protective

Safety Precautions (cont.)

• Clean and disinfect the exam

• Sanitize, disinfect, and sterilize

ANSWER: Laura and her mother should be moved away from

Preparing the Patient for an Exam

Preparing the Patient for an Exam

Apply Your Knowledge

ANSWER: Explain what she can expect to

Positioning and Draping

Positioning and Draping (cont.)

Positioning and Draping (cont.)

Positioning and Draping (cont.)

Positioning and Draping (cont.)

Apply Your Knowledge

An elderly female patient needs her lower abdomen and

ANSWER: The dorsal recumbent position is recommended over

Special Patient Considerations

• Patients from different cultures

• May require more privacy

• May refuse a specific exam

Special Patient Considerations

– Moving to exam table

Apply Your Knowledge

ANSWER: This can lead to making incorrect

Examination Methods (cont.)

Examination Methods (cont.)

Apply Your Knowledge

ANSWER: The physician will use inspection to

Components of the General Physical

• Exams – performed in a certain order

– Specific body sections