Chapter 24: Physical Examination

Examination Postions:

-Supine (horizontal recumbent) -Dorsal recumbent -Lithotomy -Fowler's -Proctologic -Prone -Sims' -Trendelenburg

Body Movements

-Voluntary body movements are those movements intended to be made by the patient. Involuntary body movements are movements not controlled by the patient. -Tremors are a form of involuntary movement that may be seen in the mouth, fingers, hands, arms, and legs of a patient. Tremors can indicate a neurologic health problem. Involuntary body movements usually are easily observed.

Suspine

Assumed when lying flat facing up. used: Examination of the anterior surface of the body from head to toe.

______________is the process of listening directly to body sounds, normally with a stethoscope.

Ausculatiion

Listening to the patient's chest as he or she breathes is called _____?

Auscultation

Breath Odors

Breath odors may be detected when speaking with the patient or when obtaining vital signs. A sweet fruity odor may indicate acidosis. This may result from diabetes mellitus, starvation, or renal disease. A musty odor may indicate liver disease, and an ammonia odor may indicate uremia. Poor oral hygiene results in gingivitis (gum disease), caries (cavities), tooth loss, and foul breath odors

The most comfortable position for patients with back or abdominal problems when laying on an exam table is ________?

Dorsal recumbent

Know what order physical examination goes in?

Head eyes ears nose mouth and throat neck chest breast abdomen gentials rectum relfexes

What are the six methods used in a physical examination?

Inspection, Palpation, percussion, auscultation,mensuration, manipulation

What are words used to describe skin color?

Jaundice, Cyanosis, Pallor , Flushing

Examination of the ears is an important aspect of a physical exam. What is not utilized when examining the ears?

Ophthalmoscope

What are the basic components of a physical examination?

Patient appearance Gait Stature Posture Speech Breath Weight skin and appendages.

Ataxia

Patient appearance, Gait, stature, breath odors, posture, body movements, speech, weight and skin

Basic Components of physical examination

Patient appearance, Gait, stature, breath odors, posture, body movements, speech, weight and skin

___________is the process of eliciting sounds from the body by tapping with either a percussion hammer or fingers.

Percussion

What types of things will you need for physical examintion?

Stethoscope Latex gloves Penlight Flexible tape measure Urine specimen container Tongue depressor Ophthalmoscope Otoscope Tuning fork Metal nasal speculum Percussion hammer Guaiac/occult blood slide Guaiac/occult blood slide developer Sphygmomanometer

Examination positions

Supine (horizontal recumbent) Dorsal recumbent Lithotomy Fowler's Proctologic Prone Sims' Trendelenburg

What are the 7 examination positions?

Supine, dorsal recumbent, lithotomy, fowler's, proctologic, prone, Sims' and trendelenburg.

There are two methods used to perform percussion:

The direct method: is performed by tapping directly on the surface of the skin. The indirect method: is performed by placing a finger or hand on the surface of the skin and tapping the hand

Trendelenburg

The head of the table should tilt downward toward the floor and the feet should point upward toward the ceiling. used: to aid a person who is in shock. By lowering the head and elevating the legs, blood flow from the major vessels in the lower extremities will, by gravity, flow upward toward the brain and major organs. This may help to increase blood pressure enough to sustain the patient until taken to the emergency department position is to elevate and incline the legs so that the abdomen and pelvic organs are pushed up toward the chest by gravity, making visibility and maneuverability easier for the provider doing either abdominal or pelvic surgery.

stature

The height of the patient is measured. The provider looks for height, trunk, and limb proportion. Stature is the natural height of a person in an upright position.

What is manipulation?

This is the method of checking the flexion and extension. For example, moving the patient's arm or leg up and down or out and back.

Ears:

Vertigo (dizziness) may indicate that the patient has an inner ear infection (labyrinthitis). Tinnitus (ringing in the ears) may indicate inner ear problems. Other symptoms of ear problems include pain, discharge, and deafness. The tuning fork is used in testing the sensations of hearing, including bone conduction and air conduction.

cyanosis

a bluish discoloration of the skin resulting from poor circulation or inadequate oxygenation of the blood.

fenestrated drape

a type of drape with an opening, usually round, that can be placed with the opening over a particular body area; used in surgery and for proctologic examinations

jaudince

a yellowish discoloration of the skin can indicate bile in the blood as a result of liver or gallbladder disease

Palpation:

an examination of the body using touch and is often used to help verify observations

Manipulation

checks the amount of flexion and extension of a joint by applying forceful passive movement on the joint. Range of motion of some joints may be checked using this method.

Manipulation:

checks the amount of flexion and extension of a joint by applying forceful passive movement on the joint. Range of motion of some joints may be checked using this method.

scleroderma

chronic progressive disease of the skin and internal organs with hardening and shrinking of connective tissue

symmentry

correspondence in shape, size, and position of body parts on opposite sides of the body

ataxia

defective muscular coordination, primarily seen when attempting voluntary muscular movements

pyorrhea

discharge of pus from the gums, around the teeth

Mensuration:

examination uses the process of measuring.

Head

face is checked for puffiness, especially around the eyes. Facial skin is checked for scleroderma, a tight and atrophied skin. The older adult patient may have fatty patches that appear raised and yellowish on the eyelids. The face, hair, and scalp are checked for scars, lumps, hair loss, or other lesions. The head and neck are palpated for painful areas, lumps, and swelling.:

________ this examination includes internal genitalia, external genitalia, and rectal exam.

female genital

Closer observation:

focuses on body symmetry (correspondence in shape and size of body parts located on opposite sides of the body) and contour.

Auscultation. palpation, and mensuration are utilized to examine what area of the body?

heart

dosal recumbent

in this position, the patient lays on his or her back (dorsal) face up, legs separated, knees flexed, with feet flat on the table

Skin and Apendages:

include abnormal skin color such as redness, pallor, cyanosis, jaundice, and vitiligo. . - Pallor is defined as lack of color or paleness often seen with anemia -cyanosis is a slightly blue or gray discoloration of the skin, often seen in patients with respiratory or cardiac problems - jaundice is a yellowing of the skin, often caused by obstructed bile ducts or liver disease -vitiligo is characterized by white patches on the skin, observed against normal pigmentation. Skin texture may be smooth, rough, and scaly and have loss of elasticity. -Infections, either local or systemic, may be observed in nails that are brittle, grooved, or lined. appearance of the fingertips can be indicators of disorders as seen in clubbing, which may indicate congenital heart disease, and spooning, which may be seen in severe iron-deficiency anemias. Abnormal hair distribution, as in facial hair on a female patient, may indicate hormonal changes.

labyrinthitis

inflammation of inner ear or labyrinth

Six methods of examination

inspection palpation percussion ausculation manipulation menusuration

Palpation

is an examination of the body using touch and is often used to help verify observations. A body part or organ is palpated for size and condition

Local inspection:

is the focus on a specific body area, for example, the skin. Deformities and skin rashes are observed. Skin color is noted

What is mensuration?

is the method of measuring, this is used every day in the examination room for height and weight.

Percussion

is the process of eliciting sounds from the body by tapping with either a percussion hammer or fingers. The vibrations and sounds from underlying organs and cavities can be felt and heard.

Auscultation

is the process of listening directly to body sounds, normally with a stethoscope. The provider listens for lung and heart sounds such as murmurs, rales, or bruits, which generally are abnormal sounds heard on auscultation of an organ or vessel such as a vein or an artery.

Observation or Exmination:

is the process of obtaining physical information by observing the patient.

Observation or inspection

is the process of obtaining physical information by observing the patient. Inspection is perhaps the most important tool of examination and is the thorough and unhurried visualization of the patient. Many diagnoses may be made from the data collected by a skilled practitioner simply using the sense of sight.

Proctologic

kneel on the knee board of the table. The patient then bends at the hips and rests the chest on the table. The head is supported by a head board. The table is then turned to elevate the buttocks. used: for proctologic examinations.

pallor

lack of color, paleness

Sims'

lie on the left side; the left arm and shoulder may be drawn back behind the body. The left knee is slightly flexed to support the body, and the right knee is flexed sharply. A small pillow is provided for placement under the patient's head. A pillow may also be placed between the patient's legs if it will not interfere with the examination being performed. The drape should be large enough to cover the patient from the shoulders to the knees used: For vaginal or rectal examination, for obtaining a rectal temperature, for a sigmoidoscopy, or for administering an enema.

Dorsal recumbent

lie on their back (dorsal) face up, legs separated, knees flexed with feet flat on the table. This is the most comfortable position for patients with back and abdominal problems. used: For rectal, genital, head, neck, and chest examinations, as well as abdominal palpation. It can also be used for urinary catheterization. Preteen and early teen girls requiring a pelvic examination may be placed in this position and will require careful instructions and procedure explanations

Lithotomy

lie on their back similar to the dorsal recumbent position except the buttocks should be as close to the bottom edge of the table as possible, and feet are placed in stirrups attached to the foot of the table. used: used for genital and pelvic examinations; it can also be used for urinary catheterization.

mensuration

method of examination uses the process of measuring. The measurements of height and weight, the length of a limb, and the amount of flexion and extension of an extremity are all forms of mensuration ex. measuring a baby's head

Equipment

must be in working order (e.g., bulbs for scopes, good room lighting) and the room properly stocked with gowns, drapes, and other supplies such as gloves, an antibacterial hand washing product, a biohazard container, and any other materials needed to comply with Standard Precautions, such as a sharps container. In addition, the medical assistant is responsible for patient preparation. Urine, blood samples, and an ECG may be performed (if requested by the provider). Vital signs and height and weight will be measured. Signed consent forms, if needed, should be in the patient's record. If the patient needs help undressing and putting on a gown, the medical assistant provides assistance. Patient data can be documented immediately using the computer to electronically record all of the information (vital signs, height and weight, known allergies, any medications the patient is taking) (Figure 24-7)

There are 6 methods used by the provider to examine the body they include

observation or inspection palpation percussion auscultation mensuration manipulation.

6 examination Procedures

observation or inspection, palpation, percussion, auscultation, mensuration, and manipulation.

What are the six methods used by the provider to examine the body?

observation or inspection, palpation, percussion, auscultation, mensuration, and manipulation.

______ consist of eliciting sounds from the body by tapping.

percussion

Gait:

pertains to the manner or style of walking. The patient may have a limp, walk with feet wide apart, appear to be dragging one leg, or have difficulty maintaining balance

Instructions that might be given to a patient during a breast exam is ____________.

place your hand behind your head.

The general health:

posture, body movements, skin, mannerisms, and care in grooming are noted.

Temperature, audiometry, pulse, electrocardiogram, blood pressure, urinalysis, height and weight, venipuncture and blood testing, and snellen test are what?

procedures and test the medical assistant might perform

Ausculatation:

process of listening directly to body sounds, normally with a stethoscope

Cyanosis is an indicator of diseases of which system?

respiratory and cardiovascular

tinnitus

ringing or buzzing sound in the ear

Fowler's

sit with the back of the examination table raised to either 45 degrees (semi-Fowler's) or 90 degrees used: patients having cardiovascular or respiratory problems to facilitate their breathing, and for examination of the upper body and head.

vitiligo

skin disorder characterized by smooth white spots on various areas of the body

bruitis

sound of venous or arterial origin heard on auscultation

A patient having an examination of the abdomen should be placed in which position?

suspine

proctologic

the branch of medicine dealing with diseases of the rectum and the anus

Percussion:

the process of eliciting sounds from the body by tapping with either a percussion hammer or fingers -The vibrations and sounds from underlying organs and cavities can be felt and heard. -this method can determine the presence of air or solid material in the organ or cavity being checked

vertigo

the sensation of dizziness

Prone

to lie face down on the table with head turned to side; arms may be placed above the head or along the side of the body. The drape must cover from the mid-chest area to the legs. used: When examining the posterior aspect of the body, including the back or spine and legs.