Chapter 28: Assisting with the Physical Examination

knee-chest position

(genupectoral position) The person kneels and rests the body on the knees and chest the head is turned to one side, the arms are above the head or flexed about 90 degrees at the hips.

dorsal recumbent position

(horizontal recumbent position) The supine position with the legs together.

percussion hammer

(reflex hammer) An instrument used to tap body parts to test reflexes.

The doctor or nurse tells the person:

- About the exam - Reasons for the exam - Who will do the exam - When the exam will be done - About the procedure

When is weight and height taken?

- Before physical exams - On admission to the center - Daily, weekly, or monthly

What you do depends on:

- Center policies and procedures - The examiner's preferences

What are some things in your role you may be asked to do to prepare for an exam?

- Collect needed linens - Collect equipment - prepare the room for the exam -Provide lighting - Transport the person to and from the exam room - Measure vital signs, weight, and height - Position and drape the person - Hand equipment and supplies to the examiner - Label specimen containers - Discard used supplies - Clean equipment - Help the person dress or move to a comfortable position after the exam - Follow center policy for soiled linens

What do you do after a patient leaves the exam room?

- Discard disposable items - Replace supplies so the tray is ready for the net exam - Clean reusable items according to center policy. Return them to the tray or storage area. This includes the otoscope and ophthalmoscope tips and stethoscope. - Send a reusable speculum to the supply area. It needs to be sterilized. - Cover the exam table with a clean draw sheet or paper - Label specimens. Take them to the designated area with a requisition slip. - Clean and straighten the person's unit or exam room - Follow center policy for soiled linens. - Make sure the exam room is clean and that supplies, and equipment are ready for the next exam.

If a person refuses or resists and exam:

- He or she is not restrained or forced to have it - The exam is tried another time. - Sometimes a family member can calm the person - The doctor may order drugs to help the person relax. - The person's rights are always respected.

You may be asked to:

- Prepare, position, and drape the person - Assist the doctor or RN during the exam.

Why are exams needed?

- Promote health - Determine fitness for work - Diagnose disease

Person with dementia during an exam may:

- Resist the examiner's efforts - Be agitated and aggressive because of confusion and fear

What are the different types of scales?

- Standing scale - Chair scale - Lift scale - Wheelchair scale

What are the different examination positions?

- The dorsal recumbent (horizontal recumbent) position - The lithotomy position - The knee-chest position - The Sim's position

How do you assist a patient after an exam?

- The person dresses or returns to bed. - The vaginal and anal areas are wiped or cleaned before the person dresses or returns to the room.

How is is the patients privacy protected?

- The person is screened and the room is closed - Usually a hospital gown is worn - The person is covered with a drape - Only the part being examined is exposed

When measuring weight and height, follow these guidelines:

- The person wears only a gown or pajamas. Clothes add weight. No footwear is worn. Footwear adds to the weight. and height measurements - The person voids before being weighed. A full bladder adds weight - Weigh the person at the same time of day. Before breakfast is the best time. Food and fluids add weight. - Use the same scale for daily, weekly, and monthly weights. Scales weigh differently. - Balance the sale at zero (0) before weighing the person. For balance scales, move the weight to zero. A digital scale should read at zero.

Under OBRA, the person has the right to know:

- Who will do the exam - Why it is done - What to expect

Before helping the person assume and maintain the position, explain the following:

- Why the position is needed - How to assume the position - How the body is draped for warmth and privacy - How long to expect to stay in the position

1 foot = ____

12 inches

1 pound = ____

16 ounces

1 kilogram = ____

2.2 pounds

1 inch = _____

2.54 centimeters

otoscope

A lighted instrument used to examine the external ear and the eardrum (tympanic membrane).

ophthalmoscope

A lighted instrument used to examine the internal eye structures.

An instrument used to tap body parts to test reflexes is A.) A percussion hammer B.) A tuning fork C.) An ophthalmoscope D.) A nasal speculum

A.) A percussion hammer

After an examination is complete, the nursing assistant should do all of the following except: A.) Discard all items and supplies used B.) Assist the resident to dress C.) Label any specimens collected D.) Place a clean cover on the examination table

A.) Discard all items and supplies used

The person is supine with the legs together. This is the A.) Dorsal recumbent position B.) Lithotomy position C.) Knee-chest position D.) Sims' position

A.) Dorsal recumbent position

The knee-chest position is also called: A.) Genupectoral position B.) Dorsal recumbent position C.) Lithotomy position D.) Horizontal recumbent position

A.) Genupectoral position

What should the nursing assistant do when weighing a resident? A.) Have the resident void B.) Remove all of the resident's clothes C.) Let the resident keep shoes on D.) Weigh before bed

A.) Have the resident void

A person is weighed daily. Which of the following does not need to be the same each day? A.) The same nursing assistant needs to do the weighing B.) The weight should be measured the same time each day C.) The same amount of clothing should be worn D.) The same scale should be used

A.) The same nursing assistant needs to do the weighing

nasal speculum

An instrument used to examine the inside of the nose.

laryngeal mirror

An instrument used to examine the mouth, teeth, and throat.

vaginal speculum

An instrument used to open the vagina to examine it and the cervix.

tuning fork

An instrument vibrated to test hearing.

Mrs. Janz's weight is 62 kilograms. She asks you to tell her the weight to pounds. Your answer to her would be? A.) Approximately 125 pounds B.) Approximately 137 pounds C.) Approximately 168 pounds D.) Approximately 168 pounds

B.) Approximately 137 pounds

Which is not a rule for assisting with the physical exam? A.) Practice hand hygiene before and after the exam. B.) Choose a comfortable position for the person and assist her or him into position. C.) Stay in the room when a female is examined (unless you are male). D.) Follow Standard Precautions and the Bloodborne Pathogen Standard.

B.) Choose a comfortable position for the person and assist her or him into position.

Which position is usually used to examine the vagina and cervix? A.) Side-lying B.) Lithotomy C.) Knee-chest D.) Dorsal recumbent

B.) Lithotomy

A person is supine. The hips are flexed and externally rotated. The feet are supported in stirrups. The person is in the? A.) Dorsal recumbent position B.) Lithotomy position C.) Knee-chest position D.) Sims position

B.) Lithotomy position

The woman lies on her back with her hips at the edge of the exam table; knees are flexed and hips are externally rotated; feet are in stirrups. This is the A.) Dorsal recumbent position B.) Lithotomy position C.) Knee-chest position D.) Sims' position

B.) Lithotomy position

You are preparing Mrs. Janz for the physical exam. Which is false? A.) She will wear only a gown B.) She will void after the exam C.) Her vital signs are measured before the exam D.) The doctor or nurse tells you what position to place Mrs. Janz

B.) She will void after the exam

The otoscope is used to examine? A.) Internal eye structures B.) The external ear and eardrum C.) Reflexes D.) The vagina

B.) The external ear and eardrum

Who should have access to the results of an examination? A.) All staff B.) The resident C.) Family members D.) None of the above

B.) The resident

A person is weighed on a wheelchair scale. Which is true? A.) The person can have a pillow or cushion in the wheelchair B.) The wheelchair weight must be subtracted from the total weight that the scale reads C.) The person does not need to void before being weighed D.) It makes no difference if the footrests are no or off

B.) The wheelchair weight must be subtracted from the total weight that the scale reads

Mrs. Janz's height is 5 feet and 2 inches. What is her height in centimeters? A.) 25 cm B.) 62 cm C.) 132.56 cm D.) 157.48 cm

C.) 132.56 cm

You will assist with Mrs. Janz's exam. Which is false? A.) Hand hygiene is practiced before and after the exam B.) Instruments are placed near the examiner C.) A male nursing team member stays in the room D.) Provide for privacy by screening, closing the door, and proper draping

C.) A male nursing team member stays in the room

Which is not a way to provide privacy during the exam? A.) Close doors and window coverings. B.) Screen and drape the person. C.) Allow the person to choose and wear his or her own clothing. D.) Expose only the body part being examined.

C.) Allow the person to choose and wear his or her own clothing.

A lighted instrument used to examine the internal eye structures is A.) A percussion hammer B.) A tuning fork C.) An ophthalmoscope D.) An otoscope

C.) An ophthalmoscope

Which position is best when used to examine the abdomen? A.) Sims' B.) Genupectoral C.) Dorsal recumbent D.) Lithotomy

C.) Dorsal recumbent

The person kneels and rests the body on the knees and chest. The head is turned to one side. The arms are above the head or flexed at the elbows. The back is straight. The body is flexed about 90 degrees at the hips. This is the A.) Dorsal recumbent position B.) Lithotomy position C.) Knee-chest position D.) Sims' position

C.) Knee-chest position

Which part of an exam can you do? A.) Test reflexes B.) Inspect the mouth, teeth, and throat C.) Measure weight, height, and vital signs D.) Observe the perineum and rectum

C.) Measure weight, height, and vital signs

What instrument would be used to examine the ear? A.) Ophthalmoscope B.) Speculum C.) Otoscope D.) Laryngeal mirror

C.) Otoscope

Which is not important in preparing the person for exam? A.) Protect privacy. B.) A patient gown is worn. C.) Provide something to drink or a snack for comfort. D.) The person voids before the exam.

C.) Provide something to drink or a snack for comfort.

When are height and weight not required to be measured? A.) Before a physical exam B.) Upon admission to the nursing center C.) When the nursing assistant thinks a person may be losing weight D.) Daily, weekly, or monthly as ordered by the physician, the nurse, or listed on the care plan

C.) When the nursing assistant thinks a person may be losing weight

cm

Centimeter

Which scales can be used to weigh a resident? A.) Bed scale B.) Chair scale C.) Wheelchair scale D.) All of the above

D.) All of the above

Why should a nursing assistant have a resident void before a physical examination? A.) A full bladder can change the normal position of organs B.) A full bladder can cause discomfort during abdominal examination C.) Able to collect a urine specimen if needed D.) All of the above

D.) All of the above

What instrument would be used to test reflexes? A.) Tuning fork B.) Speculum C.) Ophthalmoscope D.) Percussion hammer

D.) Percussion hammer

You are preparing a person for an exam. You should to the following except? A.) Ask the person to void B.) Ask the person to undress C.) Drape the person D.) Tell the nurse when the person is ready

D.) Tell the nurse when the person is ready

Which is not important when weighing a person? A.) Weigh the person at the same time every day. B.) Have the person void before being weighed. C.) Use the same scale. D.) Weighing the person with the same gown.

D.) Weighing the person with the same gown.

Who performs the physical exams?

Doctors and many RN's perform physical exams.

ID

Identification

How often in nursing centers does resident's have an exam?

Once a year.

oz

Ounce

Ib

Pound

RN

Registered nurse

Sims Position

Sometimes used to examine the rectum or vagina.

How is the patient prepared physically and mentally for an exam?

The nurse explain the exam's purpose and what to expect.

lithotomy position

The woman lies on her back with her hips at the edge of the exam table; her knees are flexed, her hips are externally rotated, and her feet are in stirrups.

The person must give informed consent for the exam? True or false?

True.

kg

kilogram

What instrument can be sometimes be changed into an ophthalmoscope?

otoscopes