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Chapter 17 Assisting with the Physical Examination 351
Table 17-3
Test Purpose Medical Assistant’s Role
Complete Blood Count (CBC)
Blood Chemistry
Urinalysis A series of tests may be performed to
Chest x-ray Chest x-ray can be used to detect
Electrocardiogram (ECG) An electrocardiogram records the elec-
Common Tests Associated with Complete Physical Examination
Blood tests are the most commonly
performed medical tests. They provide
information about the patient’s general
health status and can be used to detect
various diseases, such as anemia and
heart disease.
examine the urine’s appearance and
acidity and the presence of proteins
and sugars. These tests are used to
detect infection and/or disease.
abnormalities of the lungs, heart, large
blood vessels, ribs, and thoracic spine.
trical activity of the heart. The report is
used to determine if there are defects or
disease of the heart.
Draw specimens for blood tests ordered
by the physician. If testing is not performed in the ofce, the medical assistant will process the specimen to be sent
to the laboratory.
Medical assistants need to instruct the
patient on various methods of urine
collection. Some basic urine tests are
performed in the ofce by the medical
assistant.
Only qualied x-ray technicians will
obtain a chest x-ray. Medical assistants
may need to provide directions to the
ofce where the x-ray will be taken.
The medical assistant may be trained
to perform an electrocardiogram.
Interpreting the ECG is the responsibility
of the physician.
Schedule a future appointment.
Schedule follow-up treatment, tests, or procedures.
See Table 17-3 for Common Tests Associated with
Complete Physical Examination.
C
O
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CLEANING THE
EXAMINATION ROOM
The examination room cannot be used for the next
patient until it has been cleaned and restocked with supplies. Disinfectant products are used to clean equipment
that cannot be sterilized such as the otoscope and ophthalmoscope handles. The examination table is wiped
clean with a disinfectant and table paper replaced. All
disposable supplies that were used must be discarded.
The waste receptacle in the room should be emptied.
C
O
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THE SEQUENCE OF THE
PHYSICAL EXAMINATION
The physician performs the physical examination in an
orderly sequence. The medical assistant needs to know
this sequence in order to best assist the physician during
the examination. It is important that you anticipate the
physician’s needs. The sequence of examination is:
Examination of specic areas of the body from head
r
to toe—head and neck; eyes, ears, nose, and sinuses;
mouth and throat; chest, breasts, abdomen, groin,
genitalia, and rectum; legs
Reex testing
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Observation of posture, gait, and coordination; tests
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of balance and strength
C
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G
EXAMINING THE BODY
Throughout the examination, the physician observes the
patient’s general appearance, behavior, speech, posture
(the position of the body and its limbs), nutritional status,
hair distribution, and skin. Now let’s take a detailed look
at the specic parts of the body the physician examines.
Head and Neck
The physician inspects the patient’s skull, face, scalp,
and hair. These structures also are palpated for size,
shape, and symmetry. This includes looking for nodules,
masses, and local trauma or injury. The patient may be
asked to move his head in all directions to assess the
range of motion. This allows the physician to check for
any limitations of movement. Structures of the neck are
also palpated.
Trachea—This main airway for the passage of air to
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the lungs is sometimes referred to as the “windpipe.”
Lymph nodes or lymph glands—These small bean-
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shaped structures help ght infections. There are
some lymph nodes located on the anterior neck.
352 Section IV Clinical Medical Assistant Skills
Thyroid—This gland is located in front of the neck
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below the larynx, the voice box. It produces substances that regulate metabolism and growth. The
thyroid is palpated for size and symmetry. The patient
may be asked to swallow to facilitate palpation.
Carotid arteries—These are large blood vessels
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located on both sides of the neck. They supply oxygenated blood to the brain. The carotid arteries may
be palpated and auscultated for abnormal sounds.
Eyes
The medical assistant often performs a visual acuity test
with the patient before the physician’s examination. A
Snellen chart is usually used for this examination. For
some patients, a color vision test may be performed. An
Ishihara chart is used for this examination. It consists of
a series of color plates or charts.
In addition to these vision tests, the physician will
examine these structures of the eye.
Sclera—The brous tissue that covers the eye. It is the
r
white part of the eye. It is examined to be sure the
color is normal.
Pupil—The black, round opening in the center of
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the eye that allows light to pass through. The pupil
will change size as more or less light is present. The
physician uses a penlight to check that the patient’s
pupils are equal in size. The pupils will be examined
to make sure they are round in shape and react normally to light. Normal pupil reaction is recorded
as
PERRLA, which means that the pupils are equal,
round, and reactive to light and accommodation.
Accommodation refers to the ability of the pupils to
adjust when focusing on objects at different distances.
Eye movement—The physician asks the patient to
r
watch movements of her ngers to assess eye movements. Normal eye movement is documented as EOM,
extraocular movement intact. Extraocular refers to
outside the eye. This abbreviation indicates that that
the eyes move appropriately to track moving objects.
Peripheral vision—The ability to see things off to the
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side while looking straight ahead is known as peripheral vision.
Retina—The light-sensitive area at the back of the
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eye. It may be viewed and assessed using the ophthalmoscope. The ophthalmoscope allows the physician
to look inside the eye and examine the condition of
the retina. The physician also looks at the blood vessels in the eye to check for any signs of disease.
lead to impaired hearing. The physician also examines
the tympanic membrane, or eardrum. The tympanic
membrane is evaluated for color and to ensure that it is
intact with no tears. Normally, it appears pearly gray and
concave. An infection of the ear may cause discoloration
of the tympanic membrane. Accumulation of uid behind
the ear drum can cause the ear drum to bulge outward.
Nose and Sinuses
The physician may examine both the exterior and the
interior of the patient’s nose. The exterior is palpated for
any abnormalities. The interior is inspected using a nasal
speculum and light.
Nasal septum—Checks the position of the nasal sep-
r
tum for deviation. The nasal septum is a thin wall
that separates the nasal cavities. Sometimes, it can be
displaced to the left or right as a result of injury. A
damaged nasal septum can block the nasal passage.
Nostrils—Check the color of the mucosa, the mem-
r
brane lining the cavity. The nostrils are also examined
for the presence of any discharge, lesions, obstruc-
tions, swelling, tenderness, or polyps. Polyps are soft
growths on membrane linings. They may be benign
(harmless) or malignant (cancerous).
The physician might test the patient’s sense of smell.
The patient closes his eyes and tries to identify a common substance such as alcohol, peppermint, lemon,
or strawberry by smell alone. The physician also may
inspect or palpate the paranasal sinuses. Sinuses are
air-lled cavities in the bones of the skull and face. The
paranasal sinuses are located near and are connected to
the nose.
Mouth and Throat
The physician inspects the mucous membranes of mouth,
gums, teeth, tongue, tonsils, and throat. Supplies and
instruments used to examine these structures include the
following:
Disposable gloves
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A light source
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A tongue blade
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A laryngeal mirror, if necessary
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The physician also assesses general dental hygiene
and the functioning of salivary glands. The goal is to
look for abnormalities in the oral cavity, such as abnormal color, ulcerations, or nodules.
Ears
The outer ear called the pinna or auricle is palpated for
size, shape, and symmetry. The physician inspects the ear
canal using an otoscope. Cerumen, ear wax, may be present in the ear canal. An accumulation of ear wax may
Chest
The patient’s gown is removed to the waist so the physician can examine the anterior chest. The general appearance and symmetry of the chest and breast area are
Chapter 17 Assisting with the Physical Examination 353
evaluated. The respiratory rate and pattern are noted, as
well as any obvious masses or swelling.
Examination of the chest includes palpation of the
axillary lymph nodes and the area over the heart. The
physician may use percussion to assess underlying structures. Using a stethoscope, the auscultation method of
examination is used to evaluate lungs for abnormal
breath sounds. During this examination, the patient may
be asked to take several deep breaths. The physician also
assesses heart sounds and the apical pulse.
The posterior chest is also inspected and palpated.
The physician examines the muscles of the back and
spine. Percussion of the back helps assess the lungs. With
a stethoscope, the physician listens to posterior lung
sounds. Again, the patient may be asked to take deep
breaths to facilitate the examination.
Breast Examination
Breasts may be palpated in both male and female patients.
The supine position is preferred for palpation. In this
position, the breast tissue attens out, making abnormalities easier to feel. The examination includes the:
Breast tissue and nipple
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Tissue extending up to the clavicle, the collarbone
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Axillary tissue, the underarm or armpit
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Tissue down to the bottom of the rib cage
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Patient Education
Teaching Breast Self-Examination for
Female Patients
Your goal is to help your patient learn how to
properly perform her own breast examination. Use a
breast model if one is available or an instruction sheet
containing illustrations. Teaching models should
be sanitized with each use. Participants should do
proper handwashing prior to touching the models.
1. Explain why the breasts should be examined
regularly. Tell the patient that she needs to
check for lumps, dimples, and thickened areas,
as these could be signs of malignancy. She
should be encouraged to examine her breasts at
the same time each month, about a week after
her menstrual period. Note that early detection
leads to early diagnosis and treatment.
2. Tell the patient that her breast tissue needs to
be examined in three different positions for the
most thorough examination.
Explain that she should disrobe and inspect
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her breasts in front of a mirror. She needs to
rst place her hands on her hips and then
Abdomen and Groin
After examining the breasts, the drape is lowered to
expose the body from the abdomen to the pubic area.
The patient’s chest is draped or gowned to just below
the breasts.
pulsations from the aorta—the main artery that carries
blood from the heart to the body. The aorta extends
from the heart down the center of the thoracic and
abdominal cavities.
raise her arms above her head. Tell the patient
that she needs to look for any changes in the
breast contour, or any swelling, dimpling of
the skin, or changes in the nipple. Regular
inspection will show her what is normal
forher.
In the shower, the patient should feel each
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breast with her hands using the at part of
her rst three ngers. Tell her to use her right
hand to lightly press over all areas of her left
breast. She should use her left hand to examine her right breast in the same way. Explain
that she needs to check for any lumps,
hard knots, or thickenings. Tell the patient
that doing this in the shower will be easier
because her hands will glide more smoothly
over wet skin.
After showering, the patient should lie down
r
and place a pillow or folded towel under
her right shoulder. This helps distribute the
breast tissue more evenly on the chest. Her
right hand is placed behind her head. She
should examine her right breast using the at
part of the ngers of her left hand. Describe
how to use small, circular motions, beginning at the outermost top of the breast and
moving clockwise around it. Remind the
patient to palpate every part of the breast tissue, moving her ngers in toward the nipple.
When she is nished, she will place the towel
or pillow under the left shoulder and repeat
the procedure, using her right hand to examine her left breast.
3. Tell the patient also to check for any abnormal discharge from her nipples. To do this, she
should gently squeeze each nipple using her
thumb and index nger. Tell her that she should
report any abnormal knots, lumps, thickening,
or discharge to the physician.
4. Provide the patient with a patient education
instruction sheet or pamphlet for use at home.
5. Document your teaching in the patient’s chart.
The abdomen is inspected for contour, symmetry, and
354 Section IV Clinical Medical Assistant Skills
The physician uses a stethoscope to listen to bowel
sounds. Percussion may be used to determine the outlines of the abdominal organs. Palpation is used to assess
organ enlargement, masses, pain, or tenderness.
The lower abdomen and groin are palpated to assess
enlargement of the inguinal lymph nodes. Inguinal
means related to the groin region. Palpation also is used
to determine the presence of a hernia. A hernia often
results from a weakness or tears in the muscle allowing
the underlying organ or structure to protrude through
the opening. The physician also may palpate the femoral
arteries, large arteries that pass through the right and
left groin area and extend into the thigh.
Genitalia and Rectum: Male Patients
The physician follows a routine series of steps in examining the male genitalia and rectum.
1. The physician puts on clean, disposable gloves to
examine the external male genitalia and the rectum.
The genitalia are inspected to check for symmetry,
lesions, swelling, masses, and hair distribution. The
scrotal contents may be visualized using the transillumination technique in a darkened room. The
scrotum is palpated for testicular size, contour, and
consistency.
2. The patient is then asked to bear down as if having
a bowel movement. The physician places a gloved
index nger upward along the side of the scrotum in
the inguinal ring to check for a hernia.
3. To check the anal region for lesions or hemorrhoids,
the physician will have the patient stand and bend
over the exam table or lie on the examination table
in Sims position. The physician inserts a lubricated
gloved nger into the anus and palpates the rectal
sphincter muscle and prostate gland for size, consistency, and any masses. The prostate gland is a gland
in men that produces the uid part of semen.
After the rectal exam, an occult blood test, a test for
hidden blood, may be performed on any stool obtained
from the gloved nger. After the examination of these
areas, provide the patient tissues to wipe off any excess
lubricant.
Patient Education
use. Participants should do proper hand washing
prior to touching the models.
1. Tell the patient to gently roll each testicle
between his ngers and thumb to check for
lumps and thickenings. Tell him to roll each testicle in a horizontal motion and then in a vertical one. Both hands should be used to check
each testicle to make sure all areas are palpated.
2. Explain that at the top of each testicle is a
cord-like structure called the epididymis, which
stores and transports sperm. The patient should
be able to identify this structure to avoid mistaking it for an abnormal growth or lump.
3. Instruct the patient to report any abnormal
lumps or thickenings to the physician.
4. Provide the patient with an instruction sheet to
use at home.
5. Document your teaching in the patient’s chart.
Genitalia and Rectum: Female Patients
The female genitalia and rectum usually are examined
with the patient in the lithotomy position. One corner of
the drape extends over the genitalia, and the other corner
covers her chest. A light source is used to direct light on the
vaginal area. There are several steps involved in this exam.
1. Wearing clean, disposable gloves, the physician
inspects the external genitalia for lesions, edema or
swelling, cysts, discharge, and hair distribution.
2. The physician inserts the vaginal speculum. This
allows the physician to easily inspect the vaginal
canal mucosa and cervix. A Pap smear from the cervix is obtained, and the speculum is removed.
3. The physician performs a bimanual examination to
palpate internal reproductive organs. During this
examination, the physician checks the organs for
size, contour, consistency, and any masses.
A rectovaginal examination is performed to examine the posterior uterus and vaginal wall. The physician
places a gloved index nger in vagina and a gloved and
lubricated middle nger in rectum at same time.
The rectum is inspected and palpated for lesions,
hemorrhoids, and sphincter tone. A stool specimen may
be obtained from the gloved nger and tested for occult
blood.
Teaching Testicular Self-Examination for
Male Patients
It will take about 10 minutes to teach a male
patient how to perform a testicular self-examination. Using a testicular model or pictures, explain
to the patient how to examine each testicle.
Teaching models should be sanitized with each
C
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There are several general guidelines for women, regarding gynecological and breast examinations.
r
GUIDELINES FOR WOMEN
Pap smear—The rst Pap smear is recommended at
ages 18 to 20. After the rst Pap smear, it’s recommended that women have a Pap smear every year.
Chapter 17 Assisting with the Physical Examination 355
Breast examination—The physician should examine
r
the breasts every 1 to 3 years for women ages 20 to 39
to detect lumps and thickenings that could be malignancies. For women age 40 and older, an annual breast
examination is recommended. Patients also should
perform regular breast self-examinations. They may
detect abnormalities that should be reported to their
physicians.
Mammogram—These x-rays of the breast are used to
r
detect abnormalities or disease. Annual mammograms
are recommended from the age of 40. If a patient is
at risk for developing breast cancer, a physician may
recommend mammograms earlier and more often.
Case Question
A
F
F
encourage Rebecca Martin to perform breast
self-examination on a regular basis?
Knowing that the patient is anxious
about the physical examination process,
what can the medical assistant say to
Legs
Visual inspection of the legs is performed to check for
the presence of varicose veins. These are abnormally
large, twisted blood vessels just below the skin that can
cause pain, swelling, or itching. Peripheral pulse sites are
palpated with the patient in the supine position. These
sites may be palpated again when the patient is standing.
Posture, Gait, and Reexes
With the patient standing, the physician will check the
patient’s general posture. The patient may be asked to
walk or perform other movements so the physician can
assess gait and coordination.
Gait refers to the style or way in which a person
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walks.
Coordination is the way the muscles and groups of
r
muscles work together during movement.
The physician may ask the patient to do a balance
test. The patient will stand with feet together and eyes
closed. Normally, the patient will be able to maintain
their balance. Other aspects of body movements that
may be tested are range of motion and the strength of
the arms and legs.
part. Atendon is a structure that attached a muscle to
bone. The tendons that are usually tested include the
following:
Biceps tendon—A tendon of the large muscle on the
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front of the upper arm.
Triceps tendon—The tendon of the muscle on the
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back of the upper arm that extends the elbow.
Patellar tendons—Sometimes known as the patellar
r
ligaments. Ligaments are similar to tendons. They are
tough bands of tissue that connect bone to bone or
cartilage. The patellar tendons connect the patella, or
kneecap, to the leg bone known as the tibia.
Achilles tendon—A large band of tissue connecting
r
the gastrocnemius muscle on the back of the leg to
the bone in the heel. This is the largest tendon in the
human body.
Plantar tendons—Several tendons on the sole (bot-
r
tom) of the foot.
C
O
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How often should patients have a complete physical
examination? Physicians may vary in their recommendations, but here are some general guidelines.
r
r
tion may have a physical examination more frequently.
At age 40, it is recommended that all patients have a
baseline electrocardiogram (ECG)—a test that records
the electrical activity of the heart.
GENERAL GUIDELINES
FOR PHYSICAL EXAMS
Ages 20 to 40, physical examinations may be performed every 1 to 3 years.
Over 40, a physical examination every year is
recommended.
Patients who are being treated for a medical condi-
Screening for Colon and Rectal Cancer
Beginning at age 50, patients should be tested for colon
and rectal cancer. There are several different approaches
recommended for colon and rectal cancer screening.
Annual rectal examination and fecal occult blood
r
test—Patients with increased risk for developing
colon or rectal cancer may begin screening earlier or
have screening more often.
Flexible sigmoidoscopy—The physician examines the
r
lining of the rectum and lower part of the colon with
a exible, lighted tube (Fig. 17-15).
Reexes
To test body reexes, the patient needs to be in a sitting position. The physician strikes the tendon with a
percussion hammer to observe the reaction of the body
This test is recommended every 5 years. It may be
used in conjunction with annual fecal occult blood tests.
Colonoscopy—The method of examining the colon—
r
a test in which a long, exible instrument with a light
and lens on the end is inserted into the rectum and
356 Section IV Clinical Medical Assistant Skills
General failure to thrive
r
Spontaneous bleeding or bleeding that does not
r
stop
Bumps, lumps, masses, or swelling anywhere on
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the body
Frequent stumbling for no apparent reason
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Figure 17-15 A exible sigmoidoscope. (Reprinted from
Kronenberger J, Ledbetter J. Lippincott Williams & Wilkins’
Comprehensive Medical Assisting. 5th ed. Philadelphia,
PA: Wolters Kluwer; 2016.)
colon. It allows physicians to examine the lining of
the colon and rectum for abnormalities. Some physicians recommend a colonoscopy at age 50. If the
results are normal, this test is recommended every
10years.
Patient Education
Teaching Warning Signs
You should take every opportunity to teach
patients about signs that might signal health problems. Important signals that should not be ignored
are frequent, severe headaches and persistent
abdominal pain. Patient education also includes
teaching patients to recognize the early warning
signs of cancer. One way to help patients remember the signs is the acronym CAUTION:
C Change in bowel or bladder habits
A A sore that does not heal
U Unusual bleeding or discharge
T Thickening, lumps, or changes in the shape of
breasts or testicles
I Indigestion or difculty swallowing
O Obvious change in a wart or mole
N Nagging cough or hoarseness of the voice
Parents and guardians should also know the
additional signs to watch for in children.
Continual crying for no obvious reason
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Unexplained nausea and vomiting
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C
O
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Immunizations are not just for children. Some immunizations are recommended for adults. The medical assistant should be familiar with the recommended schedule
of immunizations for adults. The patient’s immunization
record should be reviewed annually to ensure that all
immunizations are up to date.
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r
r
r
r
r
IMMUNIZATIONS FOR
ADULTS
A tetanus booster should be given every 10 years or
sooner if the patient has an open wound.
One injection of pneumonia vaccine is recommended for all adults over age 65 years and one or
two injections for younger adults with certain health
problems.
Adults born after 1957 should be vaccinated for
mumps, measles, and rubella unless they are already
immune to these diseases.
Inuenza vaccine for inuenza A and B should be
given annually after age 50 and after age 19 for persons with certain health problems.
A series of three hepatitis B injections is recommended
for adults who work in certain high-risk occupations
or engage in certain high-risk activities.
A series of two hepatitis A injections is recommended
for adults who work in certain high-risk occupations,
who engage in certain high-risk activities, or who
have certain blood disorders or liver disease.
Case Question
A
F
F
reason for the injection, what can the medical
assistant say to clearly explain why it is important that the patient receives this injection?
The medical assistant will need to
provide a tetanus booster for Rebecca
Martin. If the patient inquires about the
Chapter 17 Assisting with the Physical Examination 357
Procedure 17-1
Equipment: PPE, sharps container, gloves, paper towels,
disinfectant, and biohazard waste container.
1. Wash your hands and put on clean, disposable
gloves. If there’s a chance of contact with soiled
dressings, body uids, or other contaminated
items, put on personal protective equipment such
as a disposable gown, protective eyewear, and shoe
coverings.
2. Discard all disposable waste in the appropriate biohazard, sharps, or regular waste container.
Any broken glass requires special care. Use a
r
dustpan and brush, or forceps if necessary, to
pick up glass fragments and dispose of them
properly. They may be contaminated.
Remove soiled examination table paper and
r
linens.
Remove all soiled reusable instruments for disin-
r
fection or sterilization.
Cleaning and Preparing the
Examination Room
P
S
Y
6. Dispose of the paper towels in the biohazard waste
container. Remove the gloves and discard them into
the biohazard waste container. Wash your hands.
7. Check the supply of items that are kept in the
examination room, such as cotton applicators,
tongue blades, patient gowns, and instruments.
Restock supplies.
8. Set up equipment and supplies needed for the next
examination, including clean examination table
paper.
3. Remove the gloves and wash your hands. Put on
a new pair of gloves to continue tasks. Using disposable paper towels, remove any visible soil from
countertops, cabinets, or other surfaces in the
room.
4. Wipe all surfaces with an approved disinfectant.
Take care to clean every surface to prevent the
spread of microorganisms.
5. Check the protective coverings on equipment in
the ofce. If they are soiled, clean or replace them.
Disinfect ofce equipment and allow it to air-dry
before replacing any protective coverings.
(Reprinted from Kronenberger J, Ledbetter J.
Lippincott Williams & Wilkins’ Comprehensive
Medical Assisting. 5th ed. Philadelphia, PA: Wolters
Kluwer; 2016.)
9. Check equipment to ensure it is working properly,
such as the otoscope and ophthalmoscope.
10. Select the proper gown for the patient and place it
on the clean examination table. Set out any clean
drapes needed for the examination.
11. Return any unused supplies and items to their
proper places.
358 Section IV Clinical Medical Assistant Skills
Procedure 17-2
Equipment: Patient medical record, weight scale with
height bar, spygmomanometer, stethoscope, Snellen eye
chart, thermometer, and patient gown.
1. Wash your hands.
2. Greet the patient by name and escort him to the
prepared examining room. Identifying the patient
by name helps to prevent errors.
(Reprinted from Kronenberger J, Ledbetter J.
Lippincott Williams & Wilkins’ Comprehensive
Medical Assisting. 5th ed. Philadelphia, PA: Wolters
Kluwer; 2016.)
Preparing the Adult Patient for
the Physical Examination
P
S
Y
6. If the physician requires it, instruct the patient to
obtain a urine specimen. Even if a urine specimen
is not part of the physical examination, an empty
bladder makes abdominal and/or pelvic examinations more comfortable. Direct the patient to the
bathroom.
7. When the patient returns to the examination
room, provide instructions for disrobing and
explain how to put on the gown, open in the front
or the back.
The gown must open in the direction that pro-
r
vides the best accessibility for the examination.
Leave the room unless the patient needs help.
r
Elderly and disabled persons may need help dis-
r
robing and/or putting on the gown.
8. Assist the patient to sit on the end of the examining
table. The sitting position is often the rst position
used by the physician. Cover the patient’s legs with
a drape.
3. Explain the procedure. This may help the patient
feel less anxious.
4. Obtain and record the patient’s medical history and
chief complaint.
5. Measure and record the patient’s vital signs, height,
weight, and visual acuity. These measurements help
give the physician an overall picture of the patient’s
health.
(Reprinted from Kronenberger J, Ledbetter J.
Lippincott Williams & Wilkins’ Comprehensive
Medical Assisting. 5th ed. Philadelphia, PA: Wolters
Kluwer; 2016.)
(Reprinted from Kronenberger J, Ledbetter J.
Lippincott Williams & Wilkins’ Comprehensive
Medical Assisting.
5th ed. Philadelphia, PA: Wolters Kluwer; 2016.)
9. Enter all information into the patient’s electronic
record or if a paper chart is used, place it in a secure
area outside the examination room and notify the
physician that the patient is ready.
Chapter 17 Assisting with the Physical Examination 359
Procedure 17-3 Assisting with Patients in Wheelchairs
P
S
Y
Equipment: Wheelchair and exam table.
1. Wash your hands and greet the patient by name.
If you think you need help moving the patient, ask
another staff member to assist you. Don’t risk hurting yourself by trying to move the patient alone.
2. Bring the wheelchair as close as possible to the end
of the examination table. Locate the wheelchair at
a 90-degree angle to the table to minimize the distance for moving the patient.
3. Lock the wheels to stop the wheelchair from moving.
shoulders. Your knees should be in line with the
patient’s knees. Bending your knees slightly will
lower your body and make it easier for the patient
reach you. It also helps to avoid injury to your back
when you lift the patient.
8. Place your arms under the patient’s arms and
around the patient’s body. Prepare the patient by
explaining that you will count to three and then
lift. If possible, the patient can help by supporting
some of her body weight.
9. Count to three and lift the patient. Turn toward the
examination table. The back of the patient’s knees
should touch the table.
10. Lower the patient onto the examination table. If the
patient can’t sit without support, help the patient
into a supine position. Otherwise, keep the patient
in a sitting position.
11. If someone else is helping you move the patient,
decide which one of you will turn the patient toward
the examination table during the transfer. The stronger person should perform this maneuver.
12. You and your helper should both face the patient
with your knees slightly bent. Each of you should
have one knee in line with the patient’s knees.
The patient will put one hand on each person’s
shoulder.
4. Check to make sure the patient is wearing shoes or
slippers with nonskid soles. Lift the patient’s feet
off of the foot rests. Fold up the foot rests so the
patient does not trip over them.
5. Keep your own feet in front of the patient’s feet to
prevent the patient from slipping.
6. For some patients, you may need to place a footstool in front of the table to support their feet.
7. If you are moving the patient yourself, face the
patient and ask the patient to hold onto your
13. Place one of your arms around the patient. Your
helper should do the same. Lock your wrists
together to provide extra support. On the count of
three, lift the patient together.
14. One person turns the patient toward the examination table then both of you will gradually lower the
patient onto the table. You and the helper need to
work together to make the move as smooth as possible for the patient.
15. After the patient is comfortable and safely positioned on the examination table, unlock the wheels
on the wheelchair and move it back from the table
to an area where it will not get in the way.
16. Provide the patient with a gown and drape. If necessary, help the patient disrobe.
360 Section IV Clinical Medical Assistant Skills
Procedure 17-4 Assisting with Pregnant Patients
P
S
Y
Equipment: Spygmomanometer, stethoscope, weight scale
with height bar, specimen container for urine, patient
gown, and exam table.
1. Wash your hands.
2. Greet the patient by name, and escort her to the
prepared examining room. Identifying the patient
by name helps to prevent errors.
3. Prepare the patient for the examination as you
would for any other adult patient explaining the
examination procedure.
4. Measure and record vital signs, height, and weight.
5. Instruct the patient on collecting a urine sample.
The physician may require a urine test.
6. Ask the patient if she has any specic questions
regarding her pregnancy. Notify the physician of
these questions prior to her examination. Provide
the patient with education materials that may
address her concerns.
9. During the examination, take care when asking the
patient to move into different body positions. Some
body positions may not be suitable for pregnant
women.
10. Watch for signs that the patient is uncomfortable.
Be especially vigilant during changes in body position. When a pregnant patient has been lying on the
examination table for a length of time, blood may
collect in the pelvic regions. Sitting up suddenly
can cause dizziness or hyperventilation. Help the
patient to sit up slowly and give her time to adjust
to sitting before she stands up.
11. At the end of the examination, help the patient
down from the examination table. Leave the room
to give her privacy while she dresses. Ask her if she
needs assistance.
7. Provide instructions for disrobing and explain how
to put on the gown. Leave the room to give the
patient privacy while disrobing. Ask if she needs
any assistance.
8. Have the patient use a stool to step up to the examining table. Help her sit on the end of the table.
Cover her legs with a drape and provide additional
drapes as needed for privacy.