Chapter 40. The Physical Exam, Specialty Exams, and Procedures. Copyright 2012 Delmar, Cengage Learning. All rights reserved.

Transcription

1 Chapter 40 The Physical Exam, Specialty Exams, and Procedures

2 Physical Examination Determines the general state of health and well-being of the patient Covers all major body systems Performed by the provider Provider will judge a patient s speech by asking questions

3 Physical Examination MA Role Prepare the room, equipment, and patient MA may scribe MA should have basic knowledge of all H&P procedures

4 Exam Techniques Inspection- evaluation by sight Palpation- touching Percussion- producing sounds by tapping on body parts Auscultation- listening to sounds made by body Mensuration Manipulation- passive movement of a joint to determine range of extension and flexion

5 Physical Exam Format General appearance >> Skin >> Neck >> HEENT >> Chest >> Heart >> Inspection Inspection, palpation Inspection, palpation, manipulation Inspection, palpation Inspection, palpation Auscultation

6 Physical Exam Format Lungs >> Breasts >> Abdomen >> Back >> Auscultation, percussion Inspection, palpation Auscultation done before inspection, palpation, percussion Inspection, palpation, manipulation

7 Physical Exam Format Genitourinary >> and rectal (male and female) Extremities >> Mensuration,manipulation Muscle strength >> Movement with resistance Reflexes >> Inspection, palpation Men should begin routine testicular exams at age 15 (monthly) Percussion (physician doesn t check glabellar reflex commonly)

8 Physical Exam Format Other evaluations Romberg balance test- to performed to detect any muscle abnormality Coordination tests

9 Assisting Provider with Exams MA role may include: Hand instruments to provider in order of use Clean and maintain instruments and supplies Provide patient education and reassurance Record procedure performed and results on patient s chart

10 Provider Assessment and Plan Documentation of exam Provider decisions based on: Health history Exam findings Other procedures and lab tests Provider plan may include diet, exercise, physical therapy, medication, surgery

11 Provider Assessment and Plan MA role to check patient s chart for: Orders to perform any additional procedures Orders for appointments with specialists

12 Ear Exams Ear irrigation (lavage) may be required prior to performing procedures Due to cerumen (earwax) in the ear Audiometry- audiometer is the instrument used to measure one s hearing. (tones of frequencies) Otoscope-Instrument used when examining the ears Tympanometry- Procedure used to determine the ability of the middle ear to transmit sound waves - probe ear canal to measure ear pressure

13 Ear Exam Tuning fork exams Rinne Test- using a tuning fork and holding the shank against a patient s mastoid bone until the patient no longer hears the sound Weber Test- vibrating tuning fork is held against the vertex or the midline of the skull or forehead An indication of hearing loss is when a patient doesn t respond when spoken to by someone who is out of sight

14 Eye Exams Provider uses an ophthalmoscope to examine the internal structures of the eye Eye exams check vision acuity or color vision Eye irrigation procedures Soothes tissue Relieves inflammation Aids eye in draining Patient lies on affected side and head is turned that way

15 Eye Exams Visual acuity Perform in well-lighted room Test patient with and without corrective lenses Patient is considered legally blind if acuity is 20/200 or less Occluder is used to cover one of the patient s eyes during a vision test Snellen chart for distance acuity- most common screening for distance vision Jaeger system for near-vision acuity- most common method of screening for near vision acuity

16 Eye Exams Color vision acuity with Ishihara plates Patients with thyroid conditions should be screened routinely for color vision acuity Contrast sensitivity screening CSV-1000

17 Color Blindness Rarest form of color blindness is tritanopia which means the patient can t distinguish the color blue. Achromatic vision is total color blindness

18 Vital capacity tests Respiratory Exams Tests the greatest volume of air that can be expelled upon expiration after a maximum inspiration Spirometry- used to measure capacity Peak flow testing-measures patients ability to exhale Pulse oximetry- measures O2 Saturation (SAT) and pulse rate Advise patients to refrain from routine treatments

19 Proctological Exams Purpose is to examine the anus and interior of rectum with a proctoscope. Used when hemorrhoids, fissure, and ulcerations are suspected Prepare patients with instructions Sigmoidoscopy- examination of interior of sigmoid colon to daignose polyps, ulcerations, tumors, bleeding, cancer, and lower intestinal disorders Annual fecal occult blood tests typically begin around age 50, patients over the age of 40 should test their stool for blood every 2 years

20 Other Important Info Biopsy forceps are used to remove a tissue sample for examination Pulmonary function test is only performed on high-risk patients Pap test and pelvic exams should begin by age 21 Obturator is a tool with a solid, rounded end. What is this used for?