Download Measuring Weight and Height, cont.

Chapter 20
The Physical Examination
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Pretest
True or False
1. A complete patient examination consists of
a physical examination and laboratory
tests.
2. Arthritis is an example of a chronic illness.
3. An otoscope is used to examine the eyes.
4. A patient should be identified by name and
date of birth.
5. The reason for weighing a prenatal patient
is to determine the baby's due date.
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Pretest, cont.
True or False
6. The height of an adult is measured during
every office visit.
7. The lithotomy position is used to examine
the vagina.
8. Inspection involves the observation of the
patient for any signs of disease.
9. Measuring blood pressure is an example of
auscultation.
10. The supine position is used to examine the
back.
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Content Outline
Introduction to the Physical Examination
1. Complete patient examination consists of:
a. Health history
b. Physical examination (PE)
c. Laboratory and diagnostic tests
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Introduction to the Physical
Examination, cont.
2. Results used by physician to:
a. Determine patient's state of health
b. Arrive at a diagnosis and prescribe treatment
c. Observe any change in patient's illness after
treatment has been instituted
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Introduction to the Physical
Examination, cont.
3. Medical assistant has an important role in
assisting the physician with a PE
4. Purpose of PE
a. To detect early signs of illness
• Helps prevent serious health problems
b.
c.
d.
e.
Prerequisite for employment
Participation in sports
Attendance at summer camp
Admission to school
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Definition of Terms
1. Final diagnosis: scientific method of
determining and identifying a patient's
condition through evaluation of the health
history, PE, laboratory tests, and diagnostic
procedures
a. Often simply called the diagnosis (dx)
b. Provides a logical basis for treatment and
prognosis
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Definition of Terms, cont.
2. Clinical diagnosis: intermediate step in the
determination of a final diagnosis
a. Obtained through evaluation of health history
and PE (without laboratory and diagnostic
tests)
b. Outside laboratories provide space on
laboratory request: to specify clinical diagnosis
• Assists laboratory in correlating clinical data with the
physician's needs
c. Once physician has analyzed test results: final
diagnosis can usually be established
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Definition of Terms, cont.
3. Differential diagnosis: two or more
diseases may have similar symptoms
a. Determines which disease is causing the
symptoms so that a final diagnosis can be
made
b. Example: “strep” throat and pharyngitis have
similar symptoms
• Differential diagnosis is made by strep test
4. Prognosis: probable course and outcome of
a patient's condition and the patient's
prospects for recovery
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Definition of Terms, cont.
5. Risk factor: physical or behavioral condition
that increases the probability that an
individual will develop a particular condition
a. Includes:
• Genetic factors
• Habits
• Environmental conditions
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Definition of Terms, cont.
b. Does not mean the disease will develop
•
•
Only that chance is greater of developing it
Example: Smoking is a risk factor for lung cancer and
heart disease
6. Acute illness: characterized by symptoms
that have a rapid onset
a. Usually severe and intense
b. Subside after a short time
•
Example: influenza
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Definition of Terms, cont.
7. Chronic illness: characterized by symptoms
that persist for more than 3 months
a. Patient shows little change over a long time
• Examples: diabetes, hypertension, emphysema
8. Therapeutic procedure: a procedure
performed to treat patient's condition with the
goal of eliminating it or promoting as much
recovery as possible
a. Example: administration of medications
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Definition of Terms, cont.
9. Diagnostic procedure: performed to assist
in the diagnosis of a patient's condition
a. Examples: electrocardiography, x-ray
examination
10. Laboratory testing: the analysis and study
of specimens obtained from patient to assist
in diagnosis and treatment of disease
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Preparation of the Examining
Room
1. Important to properly prepare examining
room
a. Provides comfortable and healthy environment
b. Facilitates the PE
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Preparation of the Examining
Room, cont.
2. Guidelines
a. Ensure room is free from clutter and well lit
b. Check daily for ample supplies; restock as
needed
c. Empty waste receptacles frequently
d. Replace biohazard containers as needed
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Preparation of the Examining
Room, cont.
e. Ensure room is well ventilated
f. Maintain room temperature
• Should be comfortable for both clothed and unclothed
patients
g. Clean and disinfect daily:
• Examining tables
• Countertops
• Faucets
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Preparation of the Examining
Room, cont.
h. Remove dust and dirt from furniture and towel
dispensers
i. Change examining table paper after each
patient; restock gowns and drapes as needed
j. Patient's privacy should be ensured
• Keep examining room door closed during patient
examination
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Preparation of the Examining
Room, cont.
k. Clean and prepare items the physician will be
using for examinations:
• Equipment
• Instruments
• Supplies
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Physical Examination
Equipment and Supplies
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Physical Examination
Equipment and Supplies, cont.
l.
Check equipment and instruments frequently for
proper working condition
• Protects patient from harm caused by faulty
equipment
m. Have equipment and supplies ready for
examination
• Arrange for easy access by physician
• Type varies on the basis of:
– Type of examination
– Physician's preference
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Physical Examination
Equipment and Supplies, cont.
n. Know how to operate and care for equipment
• Refer to the operating manual
– Read carefully
– Keep available for reference
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Physical Examination
Equipment and Supplies, cont.
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Preparation of the Patient
1. MA's responsibility: prepare the patient for
PE:
a. After escorting patient to examining room
•
Identify the patient by name and date of birth
– Purpose:
1) To avoid mistaking one patient for another
a) Could be held liable if perform procedure on
wrong patient by mistake
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Identify the Patient
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Preparation of the Patient, cont.
b. Take vital signs
c. Measure height and weight
d. Explain purpose of examination and offer to
answer questions
e. Apprehension can be reduced by:
• Addressing patient by name of choice
• Having a friendly and supportive attitude
• Speaking clearly, distinctly, and slowly
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Preparation of the Patient, cont.
f. Ask patient if he or she needs to empty the
bladder before examination
• Makes examination easier for physician to perform
– Makes examination more comfortable for patient
• If urine specimen is necessary, patient is asked to void
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Preparation of the Patient, cont.
g. Instructions for disrobing should be specific
• Clothing that should be removed
• Where to place clothing
– Instructions for putting on gown and location of gown
opening
– MA should offer assistance if needed
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Identify the Patient
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Preparation of the Patient, cont.
h. Disrobing facility should be comfortable and
private
• Helpful to have a place for patient to sit
• Should have hooks and hangers for clothing
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Preparation of the Patient, cont.
i.
MA should have patient's medical record
available for review by the physician
• Use designated location for medical record
a. Shelf next to examining room door
b. Chart holder on outside of door
• Follow HIPAA privacy rule to protect patient's health
info
– Patient-identifiable info should not be visible
j. Help patient on and off the examining table for
safety
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Measuring Weight and Height
1. Mensuration: process of measuring
the patient
2. Change in weight may be significant in:
a. Diagnosis of patient's condition
b. Prescribing treatment
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Measuring Weight and Height, cont.
3. Underweight and overweight patients on diet
therapy program
a. Should have weight taken regularly to
determine progress
4. Prenatal patients weighed at each prenatal
visit to:
a. Assess fetal development
b. Assess mother's health
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Measuring Weight and Height, cont.
5. Adult weight is measured at each office visit
6. Adult height usually only measured:
a. First office visit
b. Complete PE
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Measuring Weight and Height, cont.
7. Children weighed and measured at each
office visit to:
a. Observe pattern of growth
b. Calculate and determine medication dosage
8. Height and weight are compared against a
standardized chart
a. Determines if patient falls within normal limits
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Height and Weight
From Report of the Dietary Guidelines Advisory Committee on the dietary guidelines for Americans, Washington, DC, 1995,
U.S. Department of Health and Human Services
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What Would You Do?
What Would You Not Do?
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What Would You Do?
What Would You Not Do?
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Measuring Weight and Height, cont.
9. Guidelines for measuring weight
and height
a. Weight: using an upright balance scale
•
Locate scale to provide privacy for patient
– Many patients are self-conscious about having
weight measured
– Be careful not to make weight-sensitive comments
during procedure
1) Especially important for patients with weight
control problems (obesity, eating disorders)
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Measuring Weight and Height, cont.
•
Balance scale
– If scale not balanced, measurement will be inaccurate
– Scale is balanced:
1) When upper and lower weights are on zero
2) Indicator point comes to a rest at center of
balance area
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Balance the Scale
Balance the Scale
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Measuring Weight and Height, cont.
• Assist the patient
– Assist patient on and off the scale platform
– Platform moves slightly: may cause patient to become
unsteady
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Measuring Weight and Height, cont.
•
Obtain an accurate weight
– Ask patient to remove shoes
– Measure weight with patient in normal clothing
– Ask patient to remove heavy outer clothing:
1) Sweater
2) Jacket
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Measuring Weight
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Measuring Weight and Height, cont.
• Interpret calibration markings accurately
– Lower calibration bar: divided into 50-lb increments
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Measuring Weight and Height, cont.
– Upper calibration bar is divided into pounds and
quarter pounds
1) Longer calibration lines: indicate pound
increments
2) Shorter calibration lines indicate quarter-pound
and half-pound increments
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Measuring Weight, cont.
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Measuring Weight and Height, cont.
•
Determine patient's weight correctly
– Add the measurement on lower scale to
measurement on upper scale
– Round results to nearest quarter pound
– Occasionally weight may need to be
converted to kilograms (kg) (metric unit)
1) May be required to determine medication
dosage
2) 1 kg = 2.2 lb
3) To convert pounds to kg: divide the
number of pounds by 2.2
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Measuring Weight and Height, cont.
b. Height: using an upright balance scale
•
Provide for patient's safety
– Do not place patient on scale in a forward position
1) Measuring bar could fall into patient's face when
patient steps off scale: could cause a facial injury
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Measuring Height
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Measuring Weight and Height, cont.
•
Determine the calibration markings accurately
– Calibration markings are divided into either:
1) Inches
2) Feet and inches
– Calibration rod is also calibrated into centimeters
(metric unit)
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Measuring Height, cont.
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Measuring Weight and Height, cont.
•
Read the measurement correctly
– Read the measurement at the junction of the stationary
calibration rod and the movable calibration rod
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Measuring Weight and Height, cont.
– If patient's height is less than the top value of the
stationary calibration rod:
1) Read the measurement directly on the stationary
rod
a) On most scales: highest calibration on
stationary rod is 50 inches
b)
Patients with a height of 50 inches or
less will have their height read directly
on stationary rod
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Measuring Height, cont.
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Measuring Weight and Height, cont.
•
Record the height measurement correctly.
– Record height measurement in feet and inches.
– If the scale is calibrated in inches:
1) Convert the reading to feet and inches: divide the
number of inches by 12
2) Example: Height measurement of 60 inches is
recorded as 5 feet (60 inches divided by 12
equals 5)
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What Would You Do?
What Would You Not Do?
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What Would You Do?
What Would You Not Do?
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Positioning and Draping
1. Correct positioning of the patient facilitates
the examination
a. Permits better access to part being examined
2. Basic positions and use of each
a. Sitting: examination of the head, neck, chest,
upper extremities; measure vital signs
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Sitting
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Supine
b. Supine: examination of head, chest, abdomen,
extremities
• Not a comfortable position for patients with:
– Respiratory problems
– Back injury
– Low back pain
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Supine, cont.
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Prone
c. Prone: examination of back; assess extension
of hip joint
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Dorsal Recumbent
d. Dorsal recumbent: vaginal and rectal
examinations, insertion of urinary catheter,
examine the head, neck, chest, and extremities
of patients who have difficulty maintaining
supine position
• Bending of legs is more comfortable for some
patients
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Dorsal Recumbent, cont.
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Lithotomy
e. Lithotomy: vaginal, pelvic, and rectal
examinations
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Sims
f. Sims: used to examine the
vagina and rectum, to
measure rectal
temperature, to perform a
flexible sigmoidoscopy, and
to administer an enema
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Knee-Chest
g. Knee-chest: examine the rectum, perform a
proctoscopic examination
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Fowler’s
h. Fowler's
• Examine upper body of patients with cardiovascular
and respiratory problems (congestive heart failure,
emphysema, asthma)
– Easier for these patients to breathe in this position
• Draw blood from patients likely to faint
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Fowler’s, cont.
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Positioning and Draping, cont.
3. Position used depends on type of
examination being performed
a. More than one position may be used to
examine the same body part
b. Explain position to patient and assist him or her
into it
c. Take patient's endurance and degree of
wellness into consideration
• Weak or ill patient may not be able to assume a
position
• May require special assistance in attaining it
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Positioning and Draping, cont.
d. Do not keep patient in uncomfortable positions
longer than necessary
e. Let the patient rest before getting off the
examining table
• Some positions cause patient to become dizzy
f. Assist patient off table to prevent falls
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Positioning and Draping, cont.
4. Draping provides modesty, comfort, and
warmth
a. Only part being examined should be exposed
5. Gowns and drapes are made of paper or
cloth
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Assessment of the Patient
1. Extent of assessment during PE depends
on:
a. Purpose of examination
b. Patient's condition
2. Complete PE: thorough assessment of all
body systems
a. Physician uses an organized and systemic
approach
• Starts with head and proceeds toward feet
• Facilitates the examination process
• Requires fewest position changes
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Assessment of the Patient, cont.
3. Results are charted by physician in patient's
medical record
4. Patients who exhibit symptoms of illness:
a. Do not require a complete PE
b. Physician examines body system associated
with symptom
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Inspection
5. Assessment techniques
a. Inspection: the process of observing a patient
to detect signs of disease
• Assessment technique most frequently used
• Good lighting is required
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Inspection, cont.
• Observe patient for:
– Color
– Speech
– Deformities
– Skin condition
– Body contour and symmetry
– Orientation to the surroundings
– Body movements
– Anxiety level
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Palpation
b. Palpation: the process of feeling with the hands
to detect the signs of disease
•
•
Helps verify data obtained from inspection
Patient's verbal and facial expressions are observed
– Assists in detection of abnormalities
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Palpation, cont.
• Used to determine:
– Placement and size of organs
– Presence of lumps
– Pain
– Swelling
– Tenderness
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Palpation, cont.
•
Examples of palpation
– Breast examination
– Measuring radial pulse
•
Types of palpation
– Light: to determine areas of tenderness
1) Fingertips are placed on the body part
2) Gently depressed ½ inch
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Palpation, cont.
– Deep: to examine condition of organs
1) Two hands are used:
a)
One to support the body from below
b)
Other to press over the area
– Example: bimanual pelvic examination
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Palpation, cont.
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Percussion
c. Percussion: the process of tapping body and
listening to the sounds produced to detect the
signs of disease
• Used to determine:
– Size of organs
– Density of organs
– Location of organs
• Example: examination of lungs and abdomen
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Percussion, cont.
•
Technique
– Fingertips used to produce sound
– Nondominant hand: placed over area with fingers
slightly separated
– Dominant hand: strike the joint of middle finger placed
on patient to produce a sound
1) Dense structures: produce a dull sound (liver)
2) Empty or air-filled structures: produce a hollow
sound (lungs)
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Percussion, cont.
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Auscultation
d. Auscultation: the process of listening with a
stethoscope to the sounds produced within the
body to detect the signs of disease
• Used to:
– Listen to heart and lungs
– Measure blood pressure
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Auscultation, cont.
•
Guidelines
– Minimize environmental noise
1) Interferes with effective listening
– Diaphragm chestpiece: used for high-pitched sounds
(lung and bowel)
– Bell chestpiece: used for low-pitched sounds (heart
and vascular system)
– Clean chestpiece with an antiseptic and warm it before
placing on the patient
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Assisting the Physician
1. The MA is responsible for:
a.
b.
c.
d.
Helping patient change positions
Handing physician instruments and supplies
Reassuring patient
Assisting patient off the examining table after
the PE
e. Providing patient with additional information if
needed
• Scheduling a return visit
• Patient education
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What Would You Do?
What Would You Not Do?
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What Would You Do?
What Would You Not Do?
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Posttest
True or False
1. The prognosis is what is wrong with the
patient.
2. A risk factor means that a patient will
develop a certain disease.
3. A CT scan is an example of a therapeutic
procedure.
4. The function of a speculum is to open a
body orifice for viewing.
5. The process of measuring the patient is
called mensuration.
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Posttest, cont.
True or False
6. A reason for weighing a child is to
determine drug dosage.
7. The purpose of draping a patient is to
make it easier for the physician to
examine the patient.
8. Sims position is used for flexible
sigmoidoscopy.
9. Measuring pulse is an example of
percussion.
10. BMI is the abbreviation for body mass
index.
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