physical examination methods/Patient Positioning/chapter 36

inspection

this is a visual exam by examining the exterior surface of the body. at the same time the physician is examining the patients general state of health, overall demeanor, grooming, and social interactions. some interior portions of the body include the throat, eyes, ears, vaginal wall, cervix, and rectum may be inspected using special instruments. physician will make a note that is unusual in color, size, shape, position, or symmetry of the areas being inspected

Sims' Position

this position is a lateral recumbent position. patient is place on the left side with the right leg sharply bent upward and the left leg slightly bent. the right arm is flexed next to the head for support. this position is used for rectal exams, rectal temperatures, enemas and perineal and pelvic exams

Proctologic Position

this position is also called jackknife position. it is used to proctologic examinations with a sigmoidoscope. this position is similar to the knee chest position but with a greater bend at the hips. patients will lie face down with hips at the hinge of the table. a special examination table may then be tipped downward.

Supine Position

this position is also known as the horizontal recumbent position. patients lie flat on their back with hands at the sides. patients feet are supported by extending the examination table. this position is used to examine anything on the anterior (front) or ventral surface of the body. (head chest stomach) and for certain types of x-rays. this position may not be good for patients who are short of breath (sob) or who have lower back problems. using a pillow under the head and under the knees may help alleviate pain and be more comfortable.

Trendelenburg Position

this position is not normally used in a physicians office except in cases of shock or low blood pressure. for this position the patient is placed in the supine position and the end of the table is raised to about a 30-degree angle. patients legs are then elevated above the patients head

Sitting Position

this position is used to examine the head and chest (anterior and posterior) the patient sits upright with legs over the side of the examination table

Knee Chest Position

patient is placed in the in this position and then asked to pull the knees up to a kneeling position with thighs at a 90 degree angle to the table with buttocks in the air. head is turned to one side and the arms may b placed under the head or on either side of the head for comfort and support. some may need assistance for this position and never be left unattended. this position is used for proctologic exams, sigmoidoscopy procedures, and rectal and vaginal exams.

Fowler's Position

patient sits on the examination table with the head of the table raised to a 90-degree angle. if the patient is able he or she may be seated on the edge of the table with feet over the edge in an upright position this position is useful for examinations of the head, neck and upper body. patients that difficulty breathing in the supine position may find this position more comfortable.

percussion

a process of using the fingertips to tap the body lightly but sharply to gain information about the position and size of the underlying body parts. you use two fingers of one hand are placed on the patients skin and then struck with the index and middle finger of the other hand and gently thumping or tapping the chest wall and abdomen which produces standard sound or vibrations. this is determined of the presence of fluid or pus in the cavity.

palpation

a process of using the hands to feel the skin, accessible underlying organs, and other tissues. other areas examined can include the axillae (armpits), neck, and chest. this is used to determine an unusual tenderness, size, shape, and texture. oftentimes, abnormalities and masses in the breasts and abdomen can be discovered.

manipulation

is the process of passively assessing the range of motion (rom) of a joint. this process may also be used to palpate for abnormalities and warmth.

Dorsal Recumbent Position

patient is lying flat on the back with knees bent and feet flat on table. this position relieves strain on the lower back and relaxes abdominal muscles. this position is used to inspect the head, neck chest, and vaginal, rectal, or perineal areas

mensuration

this is a tool to measure the body or specific body parts. these special tools include a scale, tape measure, and calipers. scales are used to measure both adult and pediatric weight, tape measures can be used to measure the length and width of a wound of the circumference of infants head or chest. calipers is used to determine the amount of the body fat.

Lithotomy Position

this position is similar to the dorsal recumbent position except the patients feet are placed in stirrups that are attached to the end and sides of the table. stirrups must be locked in place to ensure patient safety. patient may need assistance to put feet in stirrups. after the feet are in the stirrups the patient is instructed to slide down until the buttocks is positioned at the edge of the table. this position is used for vaginal examinations requiring the use of a vaginal speculum used to hold open the walls of the vagina and for obtaining cell samples of the cervix. patients with severe arthritis or those who are severely obese or at the end of pregnancy may find this position impossible. patient can use the dorsal recumbent position with permission from the physician.

Semi-Fowler's Position

this position is similar to the fowler position but the of the table is at a 45-degree angle instead of a 90. this position is used for post surgical exams, patients with breathing difficulties or lower back injuries, or those suffering from general malaise

Prone Position

this position requires the patient to lie face down flat on the stomach with the head turned to the side and arms either alongside of the body or crossed under the head. this position is the opposite of the supine position. this position is used for back exams and certain types of surgery. patients that have trouble breathing, women in late term pregnancies, or the elderly should use the sims position.

auscultation

this process is listening to sounds within the body. sounds made by the heart, lungs, stomach, and bowel are assessed for strength and rhythm. the presence and absence of sounds is also important for notation. the physician will differentiate abnormal body sounds from normal ones. these sounds can be heard by using the auscultation method of examination. a stethoscope is usually used to amplify body sounds. however this can also be done by placing the ear directly over the body surface