Introducation to the Physical Exam Flashcards
Why perform a PE
Exam is a way to collect Objective data; part of triad of Hx, PE, Labs/diagnostics - adds to you medication decision making
Improves, Pt/Provider relationship, establishes trust
Makes you focus on the Pt not the PC
Therapeutic benefits to touch and being physically close to the Pt
Finding from exam can help to better focus your DDx and plan
Prep for the Exam
Intro self
Confirm Pt ID
See how they would like to be addressed
Addressed physical barriers
Universal precautions with every Pt
Gather equipment
Consider the Pt
Enure Privacy and Safety - Close door and curtain, use appropriate draping, chaperones for sensitive exams, rails up and bed down when finished
Ensure Pt comfort - minimize position changes during exam; adjust room temperature, lighting, table height
Ask permission to begin the exam
Examiner positioning
Examine Pt from the Right side
Exam tables should allow right sided access
adjust table height
Use a larger wheelchair accessible room, if needed
General Order of the comprehensive PE
Vitals
General
Skin
Head and Neck
Lungs and Thorax
Breasts
Cardiac
Abd
Peripheral Vascular
Neuro
Musculoskeletal
Genital/pelvic
rectal/prostate
Psychiatric/MS
Some Pt positions
Fowler’s, Supine (dorsal recumbent), Prone, Lithotomy, Sim’s, Lateral (good for murmurs), Orthopneic (For breathing when fluid is in the lungs)
Focused PE
Select components that relate to the Pt’s CC
based on Age, risk, and knowledge of Dz patterns
Pt w/ physical and sensory Disabilities
Assume competency - that they can handle their own medical care; speak to them directly
Use Pt centered terms - “a pt who is blind or deaf”
Ask the Pt - don’t make assumptions about the what assistance they need.
Accommodate - make eye contact, with those that have hearing lose so that they can pip read; Provide alternative methods for communication; Do not separate from their wheelchair, provide a clear path to the exam room or table and provide assistance advice.
Caring for Pts across their life time
Infants - will have physiological differences in exam
Children - May need to alter the exam seq (do heart and lungs first)
Teens - may respond better to electronic Hx taking
Adults - postop/pain, times of emotional stress, obese pt, transgender, Pt on special precautions
Elderly - Mobility issues, hearing/vision loss, multisys chronic Dz, malnutrition
Cultural Differences
HC is diverse and Many different Pts
Make sure to examine your own culture and potential for Bias
Culture will influence Pt response to illness and Tx
Different customs can be confusing and misunderstanding can erode trust
Inability to trust the medical staff can adversely affect adherence
4 cardinal components
Inspection - close observation
Palpitation - with surface of palm and pad of finger to apply tactile pressure; assess fror tenderness, masses, rigidity
PErcussion - taping for sounds
Auscultation - sounds
Inspection
Visual eval of a given area
adequate lighting to enhance visualization of the area
sometimes indirect or cross lighting works best
look for abnormalities
Palpitation
Manual manipulation of an area using the hands to evaluate a body part.
superficial and deep
Used to assess size, presence of a hard or soft mass, or other abnormality
and to assess presence of tenderness
Percussion
Resonant over Areas that are hollow
Dull over areas that are solid such as bone, masses or solid viscera
Auscultation
Stethoscope is used to listed for normal v abn sounds
mostly for the heart, lungs and abd
Heart: S1, S2, MRG
Lungs: adventitious sounds - rales/crackles, rhonchi, wheezing
Can also be used for buits in the vasculature
