CHAPTER 32

Assisting with the physical examination

Objectives

• Define the key terms listed in this chapter.

• Explain what to do before, during, and after an examination (exam).

• Identify the equipment used for an exam.

• Describe how to prepare and drape a person for an exam.

• Explain the rules for assisting with an exam.

• Perform the procedure described in this chapter.

• Explain how to promote quality of life.

Key terms

dorsal recumbent position  The supine position with the legs together; horizontal recumbent position

genupectoral position  See “knee-chest” position

horizontal recumbent position  See “dorsal recumbent position”

knee-chest position  The person kneels and rests the body on the knees and chest; the head is turned to one side, the arms are above the head or flexed at the elbows, the back is straight, and the body is flexed about 90 degrees at the hips; genupectoral position

laryngeal mirror  An instrument used to examine the mouth, teeth, and throat

lithotomy position  The woman lies on her back with her hips at the edge of the exam table, her knees are flexed, her hips are externally rotated, and her feet are in stirrups

nasal speculum  An instrument used to examine the inside of the nose

ophthalmoscope  A lighted instrument used to examine the internal eye structures

otoscope  A lighted instrument used to examine the external ear and the eardrum (tympanic membrane)

percussion hammer  An instrument used to tap body parts to test reflexes; reflex hammer

tuning fork  An instrument vibrated to test hearing

vaginal speculum  An instrument used to open the vagina for examining it and the cervix

Doctors and many RNs perform physical exams. Exams are done to:

• Promote health

• Determine fitness for work

• Diagnose disease

Your role

Your role depends on center policies and procedures. It also depends on what the examiner prefers. You may do some or all of the following:

• Collect needed linens.

• Collect equipment and supplies.

• Prepare the room for the exam.

• Provide lighting.

• Transport the person to and from the exam room.

• Measure vital signs, weight, and height.

• Position and drape the person.

• Hand equipment and supplies to the examiner.

• Label specimen containers.

• Discard used supplies.

• Clean equipment.

• Help the person dress or to a comfortable position after the exam.

• Follow center policy for soiled linens.

Equipment

The instruments in Figure 32-1 are used in the exam:

• Laryngeal mirror—used to examine the mouth, teeth, and throat.

• Nasal speculum—used to examine the inside of the nose.

• Ophthalmoscope—a lighted instrument used to examine the internal eye structures.

• Otoscope—a lighted instrument used to examine the external ear and the eardrum (tympanic membrane). Some scopes can be changed into an ophthalmoscope.

• Percussion hammer (reflex hammer)—used to tap body parts to test reflexes.

• Tuning fork—vibrated to test hearing.

• Vaginal speculum—used to open the vagina to examine it and the cervix.

Some centers have exam trays in the supply department. If not, collect the items listed in the procedure: Preparing the Person for an Examination, p. 498. Arrange them on a tray or table.

PREPARING THE PERSON FOR AN EXAMINATION

Quality of life

Remember to:

• Knock before entering the person’s room.

• Address the person by name.

• Introduce yourself by name and title.

• Explain the procedure to the person before beginning and during the procedure.

• Protect the person’s rights during the procedure.

• Handle the person gently during the procedure.

Pre-procedure

1 Follow Delegation Guidelines: Preparing the Person. See Promoting Safety and Comfort: Preparing the Person.

2 Practice hand hygiene.

3 Collect the following:

• Flashlight

• Sphygmomanometer

• Stethoscope

• Thermometer

• Tongue depressors (blades)

• Laryngeal mirror

• Ophthalmoscope

• Otoscope

• Nasal speculum

• Percussion (reflex) hammer

• Tuning fork

• Tape measure

• Gloves

• Water-soluble lubricant

• Vaginal speculum

• Cotton-tipped applicators

• Specimen containers and labels

• Disposable bag

• Kidney basin

• Towel

• Bath blanket

• Tissues

• Drape (sheet, bath blanket, drawsheet, or paper drape)

• Paper towels

• Cotton balls

• Waterproof pad

• Eye chart (Snellen chart)

• Slides

• Gown

• Alcohol wipes

• Wastebasket

• Container for soiled instruments

• Marking pencils or pens

4 Decontaminate your hands.

5 Identify the person. Check the ID (identification) bracelet against the assignment sheet. Also call the person by name.

6 Provide for privacy.

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