Question

At Inner City Health Care, clinical medical assistant Wanda Slawson, CMA (AAMA), is helping Liz Corbin, a part-time administrative/clinical medical assistant, to learn to prepare the examination room and patients for the physical examination. In addition to alerting Liz to provider preferences, Wanda wants to be sure that Liz has a solid understanding of the methods of examination, positions and draping, and the components of the physical examination.

1. In reviewing with Liz the methods of examination used by the providers, what six primary methods would Wanda have Liz describe?

2. What patient positions would Liz need to know?

3. Wanda asks Liz to recall the various examination components and their significance. How should Liz respond?

Answer 1

# The Physical Examination

- The history and the physical exam provide much of the information known about the patient's health status.

- As a nurse, you may be called upon to assist the physician or other health care providers during a physical examination.

- You should know the basics of the examination in order to have the appropriate equipment and supplies on hand, and so that you may place the patient in the proper position and drape him correctly.

# The purposes for performing a physical examination are:

- To determine the patient's level of health or physiological function.

- To arrive at a tentative diagnosis when there is a health problem or disease.

- To confirm a diagnosis of disease or dysfunction.

- To evaluate the effectiveness of prescribed medical treatment and therapy.

# The physical examination can be performed by the following health care providers:

- a physician

- nurse practitioner

- physician assistant

# The health care provider makes specific and general observations as he examines the patient from head to toe. The exam should include:

- throat

- eyes

- ears

- nose

- mouth

- neck

- chest

- breasts

- abdomen

- extremities

A vaginal or rectal examination is performed if indicated.

# Purpose for Draping the Patient During the Physical Exam

- To prevent unnecessary exposure of the patient's body.

- To help the patient relax--a patient who is embarrassed will be tense and less cooperative.

- To prevent chilling -- the drapes will provide warmth.

# Types of Physical Exams

- Primary care health screening

Many students schedule a periodic physical exam to check on their health. Primary care health screenings are covered by the student health fee and have no charge.

- Third-party-requested physical exam

This is a physical examination required by a third party, usually a potential employer or a study abroad program. This type of physical is not covered by the student health fee and has an additional charge. If lab tests or immunizations are required to complete this physical, there is also a charge for those.

- Peace Corps physical exam

This is a specific type of third-party physical with an extensive physical exam. It is not covered by the student health fee and has an additional charge. There is also a charge for any immunizations required to complete the exam.

- Travel physical

This is a third-party-requested physical exam that is required for participation in program of study, travel, or employment abroad. The health care provider is required to complete accompanying paperwork about a student’s health status. This service is not covered under the student health fee, and there is a charge. There is also a charge for any lab tests or immunizations required to complete this physical. Please note that this is different from a travel consultation.

- Women’s physical exams

The Women’s Health Clinic provides physical exams for women with gynecological symptoms or concerns for no charge. Appointments may be made through MyUHS.

# Different positions used in physical all examination are :-

Anatomical position

Used for posture and movements

Dorsal recumbent position

Used for digital vaginal or rectal exams. Gown is opened in the front. both feet should be flat on the table, knees flexed

Horizontal recumbent/Supine position

Used to exams of breasts/abdominal organs/hemmoroids. Lying flat on the table, with legs together, hands at sides of body.

Sims' position

Examination/treatment of the rectal area & enemas. Turned on left side, right leg drawn up high & forward, left arm along back and chest forward. Gown open in back

Prone position

Examination of the spine/back. On the stomach, head to one side, hands underneath the head, gown open in back

Lithotomy position

Pap smears. On back, legs flexed on abdomen, ffet in stirups, thighs apart. Gown open in back.

High-Fowler's position

Used for respiratory or cardiovascular problems. On back, head raised 90 ⁹ angle, knees elevate

Semi-Fowler's position

Used with respiratory or cardiovascular problems. On back, head elevated to a 45⁹ angle

Knee-chest/Genupectoral position

Rectal exams, proctological exams and occasionally a sigmoidoscopy. Hands folded under head, chest down to the table, knees separated. gown open in the back

Modified Trendelenburg position

Used for syncope, and used with a manual table.

# Liz should respond in a knowledgeable way as she has been explained everything regarding physical examination by Wanda.