Physical exam Flashcards
Preparing for the Physical Examination
*Review the chart
*Reflect on your approach to the patient
*Check your equipment
*Observe standard and universal precautions
*Adjust the lighting and the environment
*Make the patient comfortable
*Choose the sequence of examination: Avoid unnecessary changes in position
Review and Reflect
Review Chart:
-Current complaint
- Past encounters
- Diagnostic results
- Preventative care
Reflect:
- As a beginner, avoid interpreting your findings
- identify yourself as a student
“The skillful clinician is thorough without wasting time, systematic but flexible and gentle, yet not afraid to cause discomfort should this be required” - bates
Preparing the Setting
Environment:
- Noise level
- Visibility
- Temperature
Safety:
Comfort:
- Physical
- Psychological /emotional
Privacy
Chaperones
In gynecology and genitourinary
medicine, a chaperone is usually used
when the clinician and client are of
different sexes.”
- Important for patient and clinician
- Explain process
- Procedure
- Safety net
Draping
- Exposing the patient appropriately
-Privacy
-Adequate exposure
-Draping according to gender - Lay drape over patient adequately
- Male draping: Inguinal area
- Female draping: Axillary and Breast exam
- One sleeve removed at a time
- Pelvic area
Positioning the Patient + draping
Yourself: give yourself a clear access to exit
Give clear instructions at each step
Keep patient informed especially before awkward segments
Abdominal exam: only the abdomen should be exposed
Choose sequence in a way that avoids unnecessary changes in positioning
Concluding exam: lower the bed to avoid risk of falls and raise the bedrails
Examination in Special Patient Conditions
*Patient on bedrest
*Patient using a wheelchair
*Patient post procedure
*Patient with obesity
*Patient who is in pain
*Patient on special precautions
Cardinal Techniques of Examination
Inspection
Palpation
Auscultate: use of diaphragm and bell - location, timing, duration, pitch, and intensity
Percussion: strike to generate sound wave like resonance or dullness from underlying organs, tactile vibration
Exceptions to the sequence
Recording Your Findings
- Knowing what to include and
what to leave out - Dependent on experience
and understanding of illness
and pathophysiology - Will become more focused
with time - As a beginner, avoid
interpreting your findings to
the patient.
Cardinal Techniques of Examination: what are the goals and recommendations
Recommendations/Goals:
Maximize pt comfort
Minimize changes in position
Bates recommendation:
- Examine the pt from the patients RIGHT SIDE and and move to the opposite side/foot of bed as necessary
- In general: move from head to toe
Enhance clinical efficiency
When should you use an alcohol-based hand sanitizer?
-Immediately before touching a patient
-Before performing an aseptic task or handling invasive medical devices
-Before moving from work on a soiled body site to a clean body site on the same patient
-After touching a patient or patient’s immediate environment
-After contact with blood, body fluid or contaminated surfaces
-Immediately after glove removal
What PPE should be worn when taking droplet + airborne + reverse isolation precautions?
Gloves
Gown
Respiratory mask
When should you stand behind the patient?
Feel the thyroid gland
Examine the back, posterior thorax, lungs
When should you wash with soap and water?
-When hands are visibly soiled
-After caring for a person with known or suspected infectious diarrhea
-After known or suspected exposure to spores
What PPE should be worn when taking contact precautions?
Gloves
Gown
How should the patient be seated when taking vital signs?
On the edge of the bed or exam table
When should the patient be seated?
Breast
Axillae
Epitrochlear nodes
How should the patient be positioned for the cardiovascular exam?
Lying down with head of exam table ~30 degrees
How should the patient lay when listening at the apex for an S3 mitral stenosis?
Left side
When should the patient be supine?
Peripheral vascular
Musculoskeletal
Nervous system
abdomen
examining the lower extremities
When should the patient lay on their left side?
Rectal exam in men
