Y khoa, dược - Assisting with a general physical examination

Screening for visual acuity Snellen chart – distance Jaegar chart – near vision Ishihara book – color vision Special considerations Children Patients with dementia or Alzheimer’s disease Auditory acuity – audiometer

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38Assisting with a General Physical Examination38-2Learning Outcomes38.1 Identify the purpose of a general physical examination. 38.2 Describe the role of the medical assistant in a general physical examination. 38.3 Explain safety precautions used during a general physical examination. 38.4 Carry out the steps necessary to prepare the patient for an examination.38-3Learning Outcomes (cont.)38.5 Describe how to position and drape a patient in each of the ten common examination positions.38.6 Describe how to assist patients from different cultures, patients with disabilities, and pediatric patients during a physical examination.38.7 Identify the six examination methods used in a general physical examination.38.8 List the components of a general physical examination. 38-4Learning Outcomes (cont.)38.9 Perform the procedures for vision screenings.38.10 Perform the procedures for hearing screenings.38.11 Explain the special needs of the elderly for patient education.38.12 Identify ways to help a patient follow up on a doctor’s recommendations.38-5Introduction You must make the client comfortable and assist the physician during the physical examinationPhysical examination is the first step in the process for the physician. A skilled medical assistant can create an atmosphere that results in a positive outcome for the patient during the physical examination.38-6Purpose of General Physical ExaminationTo confirm an overall state of healthTo diagnose a medical problemFocuses on an organ system Based on patient’s chief complaint38-7Purpose of General Physical Examination (cont.)Clinical diagnosisBased on signs and symptoms of a diseaseSign – objective information that can be detectedSymptom – subjective information from the patientLaboratory and diagnostic testsConfirm clinical diagnosisAid in forming differential diagnosisAid in developing a prognosisFormulate a treatment plan and/or drug therapy38-8Role of Medical AssistantEnable the doctor to perform an effective examination Contribute to patient confidence in carePhysical and emotional comfortTasks InterviewWrite an accurate historyDetermine vital signs and measure weight and heightAssist with examination Your responsibilities include ensuring that all instruments and supplies are readily available to the doctor during the examination.38-9Apply Your KnowledgeWhat 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.Excellent!38-10Safety PrecautionsOccupational Safety and Health Administration (OSHA) standards and guidelinesProtect employeeMake workplace safeCenters for Disease Control and Prevention (CDC) guidelinesProtect patients and health-care workers38-11Safety Precautions (cont.)Hand washingBefore and after each patient contactBefore and after each procedureWear gloves if there is probability of contact withBlood  Nonintact skinBody fluids  Moist surfaces38-12Safety Precautions (cont.)Wear a mask if there is any possibility of exposure to an infectious disease transmitted by airborne droplets Respiratory hygiene/cough etiquetteIsolation precautions Personal protective equipmentKeep patients with possible infections separated from other patients38-13Safety Precautions (cont.)Discard all disposable equipment and supplies appropriatelyClean and disinfect the exam room after each patientSanitize, disinfect, and sterilize equipment appropriately38-14Apply Your KnowledgeMrs. 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 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.Impressive!38-15Preparing the Patient for an ExaminationEmotional – explain exactly what will occurPhysical – offer the bathroom and instruct the patient on how to disrobe and don an exam gownPositioning and draping – help patient assume needed exam position and drape to provide privacy38-16Positioning and DrapingPositions facilitate physician’s examinationAssist the patient to appropriate positionMake as comfortable as possibleCover with appropriate drapeKeep patient warmMaintain privacy/modesty38-17Positioning and Draping (cont.)PositionsSittingSupine (recumbent)Dorsal recumbentLithotomy Trendelenburg’sFowler’sProne Sims’ Knee-chestProctologic38-18Positioning and Draping (cont.)SittingSupine/recumbentDorsal recumbent38-19Positioning and Draping (cont.)LithotomyTrendelenburg’sFowler’sProne 38-20Positioning and Draping (cont.)Sims’ Knee-ChestProctologic38-21Special ConsiderationsPatients from different cultures Avoid stereotyping Avoid making judgmentsPatients with disabilitiesProvide extra assistance as neededAsk for assistance with patient transfers38-22Special Considerations (cont.)ChildrenModify techniques based on age and abilityEmotional Involve child in the examinationApproach infants and toddlers slowly, with a smile and gentle voicePerform procedures quickly Physical Examination position based on age and abilityExamine painful areas and genitalia of older children last 38-23Apply Your KnowledgeAn 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.Very Good!38-24Examination MethodsInspectionVisual examination Assesses posture, mannerisms, and hygieneSize, shape, color, position, symmetryPresence of abnormalitiesPalpationTouch texture, temperature, shapePresence of vibration or movementsSuperficial or with additional pressure38-25Examination Methods (cont.)Percussion Tapping and striking the body to hear sounds or feel vibrationsDetermine location, size, or density of structure or organAuscultation Listening to body soundsAssess sounds from heart, lungs, and abdominal organs38-26Examination Methods (cont.)Manipulation Systemic moving of a patient’s body partsRange of motion of jointsMensuration MeasuringHeight and weightLength or diameter of extremityGrowth of uterus during pregnancy38-27Apply Your KnowledgeJimmy 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 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.Bravo!38-28Components of the General Physical ExaminationOverall appearance and the condition of skin, nails, and hairThe body Head, neck, eyes, ears, nose and sinuses, mouth, and throatChest and lungs, heart, breastsAbdomen, genitalia, and rectumMusculoskeletal and neurological systems38-29Components of the General Physical Examination (cont.)Medical assistantBe familiar with the components of the examinationKnow equipment and supplies usedEnsure the patient’s comfort Protect the patient’s modestyCan you name these pieces of examination equipment?38-30Components of the General Physical Examination (cont.)General appearanceSkin – a good indicator of overall healthNails and nail bedsHair – pattern of growth and textureHead Abnormal condition of scalp or skinPuffiness Abnormal growths38-31Components of the General Physical Examination (cont.)Neck Lymph nodes, thyroid glands, and major blood vesselsSymmetry and range of motionEyes The presence of disease or abnormalities Pupils for light responseMuscles Internal structures 38-32Components of the General Physical Examination (cont.)Ears Outer earSymmetry and sizePresence of lesions, redness, or swellingInner ear structuresCanals Eardrums Nose and sinusesNasal mucosaStructures of nosePalpation to check for tenderness in sinuses38-33Components of the General Physical Examination (cont.)Mouth and throatMouth – impression of overall health and hygieneThroat Common site of infectionTonsils – swelling or rednessChest and lungs Inspection Symmetry in expansionShapePosture position Palpation – fluid or foreign mass in lungsAuscultation – listen for abnormalities38-34Components of the General Physical Examination (cont.)Heart and vascular systemPercussion – size of heartAuscultationHeart soundsRate, rhythm, intensity, and pitchPulses BreastsPalpation for abnormalitiesAbdomen Inspection AuscultationPercussionPalpation 38-35Components of the General Physical Examination (cont.)GenitaliaFemale – lithotomy positionMale Supine position then standingInfection, structural abnormalities, lumpsAn assistant of same sex as patient must be in the room during examinationRectum Usually performed following exam of genitaliaLesions or abnormalitiesOccult blood38-36Components of the General Physical Examination (cont.)Musculoskeletal systemPostureGait Range of motionMuscle strengthBody measurementsDevelopment and coordination in childrenNeurological systemReflexesMental and emotional statusSensory and motor functionsIntellectual assessment in childrenMental status and memory in elderly38-37Apply Your KnowledgeWhat is the medical assistant’s role in a general physical examination?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.Good Job!38-38Completing the ExaminationAssist patient to a sitting positionAllow the patient to perform any necessary self-hygiene measuresPerform additional tests or procedures38-39Completing the Examination (cont.)Screening for visual acuity Snellen chart – distance Jaegar chart – near visionIshihara book – color visionSpecial considerationsChildren Patients with dementia or Alzheimer’s diseaseAuditory acuity – audiometer38-40Completing the Examination (cont.)Patient educationAssess needsTopics Risk factors for diseaseMedication administrationSelf-help or diagnostic techniquesDo not talk down to patientEnsure understandingGive written instructions38-41Completing the Examination (cont.)Special problems of the elderlyGreater need for patient educationCommon problems:IncontinenceDepressionLack of information on preventive medicinesPoor patient compliance when taking medicationsInvolve family members when possible 38-42Completing the Examination (cont.)Follow-upScheduling the patient for future visitsMaking outside appointments for diagnostic testsHelping the patient and patient’s family plan for home nursing careHelping the patient obtain help from community or social services38-43Apply Your KnowledgeWhat 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!38-44In Summary38.1 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.38-45In 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. 38.4 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.38-46In Summary (cont.)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.38-47In 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.38-48In Summary (cont.)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. 38-49In 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.38-50In Summary (cont.)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.38-51End of Chapter 38Health is the thing that makes you feel that now is the best time of the year. ~ Franklin P. Adams

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