38-2
Learning Outcomes
38.1 Identify the purpose of a general physical
examination.
38.2 Describe the role of the medical assistant in
a general physical examination.
CHAPTER
38
38.3 Explain safety precautions used during a
general physical examination.
Assisting with a
General Physical
Examination
38.4 Carry out the steps necessary to prepare the
patient for an examination.
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38-3
Learning Outcomes (cont.)
38-4
Learning Outcomes (cont.)
38.5 Describe how to position and drape a patient in
each of the ten common examination positions.
38.9 Perform the procedures for vision
screenings.
38.6 Describe how to assist patients from different
cultures, patients with disabilities, and pediatric
patients during a physical examination.
38.10 Perform the procedures for hearing
screenings.
38.11 Explain the special needs of the elderly for
patient education.
38.7 Identify the six examination methods used in a
general physical examination.
38.12 Identify ways to help a patient follow up on a
doctor’s recommendations.
38.8 List the components of a general physical
examination.
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38-5
Introduction
38-6
Purpose of General Physical Examination
• You must make the • Physical
client comfortable
examination is the
and assist the
first step in the
physician during
process for the
the physical
physician.
examination
A skilled medical assistant can create an atmosphere
that results in a positive outcome for the patient
during the physical examination.
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• To confirm an overall
state of health
• To diagnose a
medical problem
– Focuses on an organ
system
– Based on patient’s
chief complaint
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1
38-7
Purpose of General Physical Examination
Role of Medical Assistant
(cont.)
• Clinical diagnosis
• Enable the doctor to
perform an effective
examination
– Based on signs and symptoms of a disease
• Sign – objective information that can be detected
• Symptom – subjective information from the patient
• Contribute to patient
confidence in care
– Laboratory and diagnostic tests
•
•
•
•
38-8
– Physical and
emotional comfort
Confirm clinical diagnosis
Aid in forming differential diagnosis
Aid in developing a prognosis
Formulate a treatment plan and/or drug therapy
• Tasks
– Interview
– Write an accurate
history
– Determine vital signs
and measure weight
and height
– Assist with
examination
Your responsibilities include ensuring that all instruments and
supplies are readily available to the doctor during the examination.
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38-9
Apply Your Knowledge
38-10
Safety Precautions
• Occupational Safety and Health
Administration (OSHA) standards and
guidelines
What are two purposes for a general physical examination?
Describe the role the medical assistant plays in this exam.
ANSWER: A physical examination is used to confirm the patient’s overall
state of health or to diagnose a medical problem. The medical assistant’s
role includes putting the patient at ease, performing the initial interview,
documenting the patient history, taking vital signs and body measurements,
assisting the physician in the exam, and making sure instruments and
supplies are available for the exam.
– Protect employee
– Make workplace safe
• Centers for Disease Control and
Prevention (CDC) guidelines
– Protect patients and health-care workers
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38-11
Safety Precautions (cont.)
38-12
Safety Precautions (cont.)
1. Hand washing
– Before and after each patient contact
– Before and after each procedure
3. Wear a mask if there is any possibility of
exposure to an infectious disease transmitted
by airborne droplets
4. Respiratory hygiene/cough
etiquette
2. Wear gloves if there is probability of
contact with
– Blood
– Body fluids


Nonintact skin
Moist surfaces
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5. Isolation precautions
– Personal protective equipment
– Keep patients with possible infections separated from
other patients
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2
38-13
Safety Precautions (cont.)
38-14
Impressive
!
Apply Your Knowledge
6. Discard all disposable equipment and
supplies appropriately
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?
7. Clean and disinfect the exam
room after each patient
ANSWER: Laura most likely has chickenpox. She and her mother
should be moved away from other patients in the waiting room to
a private area. Since chickenpox is 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.
8. Sanitize, disinfect, and sterilize
equipment appropriately
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38-15
38-16
Positioning and Draping
Preparing the Patient for an Examination
• Emotional – explain exactly what will occur
• Positions facilitate physician’s examination
– Assist the patient to appropriate position
• Physical – offer the bathroom and instruct
the patient on how to disrobe and don an
exam gown
– Make as comfortable as possible
– Cover with appropriate drape
• Keep patient warm
• Maintain privacy/modesty
• Positioning and draping – help patient
assume needed exam position and drape
to provide privacy
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38-17
Positioning and Draping (cont.)
•
Positions
– Sitting
– Supine
(recumbent)
– Dorsal recumbent
– Lithotomy
– Trendelenburg’s
– Fowler’s
– Prone
38-18
Positioning and Draping (cont.)
• Sitting
• Supine/recumbent
• Dorsal recumbent
– Sims’
– Knee-chest
– Proctologic
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3
38-19
Positioning and Draping (cont.)
38-20
Positioning and Draping (cont.)
• Lithotomy
• Fowler’s
• Sims’
• Trendelenburg’s
• Prone
• Knee-Chest
• Proctologic
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38-21
Special Considerations
38-22
Special Considerations (cont.)
• Patients from different cultures
•
Children
– Modify techniques based on age and ability
– Avoid stereotyping
– Avoid making judgments
– Emotional
• Involve child in the examination
• Approach infants and toddlers slowly, with a smile
and gentle voice
• Perform procedures quickly
• Patients with disabilities
– Provide extra assistance
as needed
– Ask for assistance with
patient transfers
– Physical
• Examination position based on age and ability
• Examine painful areas and genitalia of older
children last
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38-23
Apply Your Knowledge
38-24
Examination Methods
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.
• Inspection
– Visual examination
– Assesses posture,
mannerisms, and
hygiene
– Size, shape, color,
position, symmetry
• Palpation
– Touch texture,
temperature, shape
– Presence of vibration
or movements
– Superficial or with
additional pressure
– Presence of
abnormalities
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4
38-25
Examination Methods (cont.)
• Percussion
– Tapping and striking
the body to hear
sounds or feel
vibrations
– Determine location,
size, or density of
structure or organ
38-26
Examination Methods (cont.)
• Auscultation
• Manipulation
– Listening to body
sounds
– Systemic moving of a
patient’s body parts
– Range of motion of
joints
– Assess sounds from
heart, lungs, and
abdominal organs
• Mensuration
– Measuring
– Height and weight
– Length or diameter of
extremity
– Growth of uterus
during pregnancy
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38-27
38-28
Components of the General Physical
Examination
Apply Your Knowledge
Jimmy Jones is complaining of abdominal pain. What types
of examination methods will the physician most likely use to
assess this complaint?
• Overall appearance and the condition of
skin, nails, and hair
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 determine if there is fluid or air
in the abdomen, and auscultation to assess bowel sounds. The
medical assistant may be asked to measure the abdominal girth.
• The body
Bravo!
– Head, neck, eyes, ears, nose and sinuses,
mouth, and throat
– Chest and lungs, heart, breasts
– Abdomen, genitalia, and rectum
– Musculoskeletal and neurological systems
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38-29
Components of the General Physical
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
38-30
Components of the General Physical
Examination (cont.)
• General appearance
• Head
– Skin – a good indicator
of overall health
– Abnormal condition of
scalp or skin
– Nails and nail beds
– Puffiness
– Hair – pattern of
growth and texture
– Abnormal growths
Can you name these pieces
of examination equipment?
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5
38-31
Components of the General Physical
Examination (cont.)
• Neck
– Lymph nodes, thyroid
glands, and major
blood vessels
– Symmetry and range
of motion
38-32
Components of the General Physical
Examination (cont.)
• Eyes
• Ears
– The presence of
disease or
abnormalities
– Outer ear
• Symmetry and size
• Presence of lesions,
redness, or swelling
– Pupils for light
response
– Inner ear structures
• Canals
• Eardrums
– Muscles
• Nose and sinuses
– Nasal mucosa
– Structures of nose
– Palpation to check for
tenderness in sinuses
– Internal structures
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38-33
Components of the General Physical
Examination (cont.)
• Mouth and throat
– Mouth – impression of
overall health and
hygiene
– Throat
• Common site of
infection
• Tonsils – swelling or
redness
38-34
Components of the General Physical
Examination (cont.)
• Chest and lungs
• Heart and vascular
system
– Inspection
– Percussion – size of
heart
• Symmetry in expansion
• Shape
• Posture position
– Auscultation
• Heart sounds
• Rate, rhythm, intensity,
and pitch
– Palpation – fluid or
foreign mass in lungs
– Auscultation – listen
for abnormalities
– Pulses
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• Breasts
– Palpation for
abnormalities
• Abdomen
–
–
–
–
Inspection
Auscultation
Percussion
Palpation
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38-35
Components of the General Physical
Examination (cont.)
• Genitalia
– Female – lithotomy
position
– Male
• Supine position then
standing
• Infection, structural
abnormalities, lumps
• Rectum
– Usually performed
following exam of
genitalia
– Lesions or
abnormalities
– Occult blood
– An assistant of same
sex as patient must be
in the room during
examination
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38-36
Components of the General Physical
Examination (cont.)
• Musculoskeletal
system
–
–
–
–
–
–
Posture
Gait
Range of motion
Muscle strength
Body measurements
Development and
coordination in
children
• Neurological system
– Reflexes
– Mental and emotional
status
– Sensory and motor
functions
– Intellectual
assessment in children
– Mental status and
memory in elderly
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6
38-37
Apply Your Knowledge
38-38
Completing the Examination
What is the medical assistant’s role in a general
physical examination?
• Assist patient to a sitting
position
• Allow the patient to
perform any necessary
self-hygiene measures
ANSWER: The medical assistant should be familiar with
the components of the examination, know equipment and
supplies used, ensure the patient’s comfort, and protect
the patient’s modesty.
• Perform additional tests
or procedures
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38-39
Completing the Examination (cont.)
38-40
Completing the Examination (cont.)
• Screening for visual acuity
• Patient education
– Snellen chart – distance
– Jaegar chart – near vision
– Ishihara book – color vision
– Special considerations
– Assess needs
– Topics
• Risk factors for disease
• Medication administration
• Self-help or diagnostic techniques
• Children
• Patients with dementia or Alzheimer’s
disease
– Do not talk down to patient
– Ensure understanding
– Give written instructions
• Auditory acuity – audiometer
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38-41
Completing the Examination (cont.)
38-42
Completing the Examination (cont.)
• Follow-up
• Special problems of the elderly
– Greater need for patient education
– Common problems:
– Scheduling the patient for future visits
– Making outside appointments for diagnostic
tests
• Incontinence
• Depression
• Lack of information on preventive medicines
• Poor patient compliance when taking
medications
– Involve family members when possible
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– Helping the patient and patient’s family plan
for home nursing care
– Helping the patient obtain help from
community or social services
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7
38-43
Apply Your Knowledge
38-44
In Summary
What is important to remember when providing
patient education?
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.
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.
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.
Super!
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38-45
In Summary (cont.)
38-46
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.
38.5 The ten common exam positions include sitting,
supine, dorsal recumbent, lithotomy, Trendelenburg,
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.
38.4 The medical assistant should prepare the patient for
an exam emotionally, by using simple, direct
language; physically, by providing for the patient’s
comfort and privacy and by positioning him or her
according to the type of exam or procedure; and by
modifying techniques to meet the needs of special
patients.
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38-47
In Summary (cont.)
38-48
In Summary (cont.)
38.7 Assist patients with physical disabilities with transfers
and other tasks they cannot accomplish themselves.
38.8 Involve the child in the exam process and assist him
based upon his age and ability to cooperate.
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38.9
The six examination methods used in a general
physical exam include inspection, palpation,
percussion ,auscultation, mensuration, and
manipulation.
38.10 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.
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8
38-49
In Summary (cont.)
38-50
In Summary (cont.)
38.11 Vision screening procedures include using the
Snellen chart for distance visual acuity, the Jaegar
chart for screening for near vision, and the Ishihara
book for color vision screening.
38.12 An auditory acuity test is done before or after the
exam using some type of audiometer.
38.13 Patient education for the elderly requires ensuring
compliance when taking medications, providing
preventative medicine education tools, and
recognizing problems related to incontinence and
depression.
38.14 In order to assist the patient with follow-up after his
or her 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.
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38-51
End of Chapter 38
Health is the thing that
makes you feel that now is
the best time of the year.
~ Franklin P. Adams
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9