The Physical Examination

LEARNING OBJECTIVES	PROCEDURES
Preparation for the Physical Examination
1. Identify the three components of a complete patient examination. 2. List the guidelines that should be followed in preparing the examining room. 3. Identify equipment and instruments used during the physical examination.	Prepare the examining room. Operate and care for equipment and instruments used during the physical examination, according to the manufacturers’ instructions. Prepare a patient for a physical examination.
Measuring Weight and Height
4. Explain the purpose of measuring weight and height. 5. List the guidelines that should be followed when measuring weight and height.	Measure weight and height.
Body Mechanics
6. Explain the importance of using proper body mechanics. 7. State the basic principles related to proper body mechanics that should be followed.	Demonstrate proper body mechanics when standing, sitting, and lifting an object.
Positioning and Draping
8. Explain the purposes of positioning and draping. 9. List one use of each patient position.	Position and drape a patient in each of the following positions: Sitting Supine Prone Dorsal recumbent Lithotomy Sims Knee-chest Fowler’s
Wheelchair Transfer
10. Explain the purpose of a wheelchair. 11. Describe the purpose of a transfer belt.	Transfer a patient from a wheelchair to the examining table and back again.
Assessment of the Patient
12. List and define the four techniques of examining the patient. 13. State an example of the use of each examination technique during the physical examination of a patient.
Assisting the Physician
14. Describe the responsibilities of the medical assistant during the physical examination.	Assist the physician during the physical examination of a patient.

Introduction to the Physical Examination

A complete patient examination consists of three parts: the health history, the physical examination of each body system, and laboratory and diagnostic tests. The physician uses the results to determine the patient’s general state of health, to arrive at a diagnosis and prescribe treatment, and to observe any change in a patient’s illness after treatment has been instituted.

An important and frequent responsibility of the medical assistant is to assist with a physical examination. Because health-promotion and disease-prevention activities have become an important focus of health care, individuals are becoming more aware of the need for a yearly physical examination to detect early signs of illness and to prevent serious health problems. Also, a physical examination may be a prerequisite for employment, participation in sports, attendance at summer camp, and admission to school. The physical examination is explained in detail in this chapter. Taking the health history, collecting specimens, and performing laboratory and diagnostic tests are discussed in other chapters.

Definitions of Terms

The medical assistant should know and understand the following terms related to the patient examination:

Final diagnosis. Often simply called the diagnosis, this term refers to the scientific method of determining and identifying a patient’s condition through evaluation of the health history, the physical examination, laboratory tests, and diagnostic procedures. A final diagnosis is crucial because it provides a logical basis for treatment and prognosis.

Clinical diagnosis. The clinical diagnosis is an intermediate step in the determination of a final diagnosis. The clinical diagnosis of a patient’s condition is obtained through evaluation of the health history and the physical examination without the benefit of laboratory or diagnostic tests. Laboratory and diagnostic imaging facilities provide a space to specify the clinical diagnosis on their request forms; this information assists the facility in correlating data from their test results with the physician’s needs. When the physician has analyzed the test results, a final diagnosis can often be established.

Differential diagnosis. Two or more diseases may have similar symptoms. The differential diagnosis involves determining which of these diseases is producing the patient’s symptoms so that a final diagnosis can be established. For example, streptococcal sore throat and pharyngitis have similar symptoms. A differential diagnosis is made by obtaining a throat specimen and performing a strep test.

Prognosis. The prognosis consists of the probable course and outcome of a patient’s condition and the patient’s prospects for recovery.

Risk factor. A risk factor is a physical or behavioral condition that increases the probability that an individual will develop a particular condition; examples are genetic factors, habits, environmental conditions, and physiologic conditions. The presence of a risk factor for a certain disease does not mean that the disease will develop; it means only that a person’s chances of developing that disease are greater than those of a person without the risk factor. For example, cigarette smoking is a risk factor for developing lung cancer and heart disease. A person who smokes has a higher risk of developing lung cancer than a person who does not or who has stopped smoking.

Acute illness. An acute illness is characterized by symptoms that have a rapid onset, are usually severe and intense, and subside after a relatively short time. In some cases, the acute episode progresses into a chronic illness. Examples of acute illness include colds, influenza, strep throat, and pneumonia.

Chronic illness. A chronic illness is characterized by symptoms that persist for longer than 3 months and show little change over a long time. Examples of chronic illness include diabetes mellitus, hypertension, and emphysema.

Therapeutic procedure. A therapeutic procedure is performed to treat a patient’s condition with the goal of eliminating it or promoting as much recovery as possible. Examples of therapeutic procedures include administration of medication, ear and eye irrigations, and application of heat and cold.

Laboratory testing. Laboratory testing involves the analysis and study of specimens obtained from patients to assist in diagnosing and treating disease. Examples of laboratory testing include the hemoglobin test, glucose test, urinalysis, and strep testing.

Diagnostic procedure. A diagnostic procedure is a procedure performed to assist in the diagnosis of a patient’s condition; examples include electrocardiography, colonoscopy, and mammography.

Highlight on Health Screening

The chance of developing certain diseases is greater at different ages. Periodic health screening is recommended for the detection and early treatment of disease.

Test or Procedure	Gender	Recommended Frequency (for Individuals of Average Risk)
Beginning at Age 20 Years
Blood pressure	M and F	Every year
Cholesterol levels	M and F	Every 5 years
Blood glucose level	M and F	Every 3-5 years
Breast self-examination	F	Every month
Beginning at the Age Specified
Clinical breast examination (by a physician)	F	Every 3 years between the ages of 20 and 39 and then every year beginning at age 40
Pap test and pelvic examination	F	Begin within 3 years of the onset of vaginal intercourse or at age 21, whichever comes first, then every 1 to 2 years
Testicular self-examination	M	Every month beginning at age 15
Fecal occult blood test	M and F	Every year starting at age 50
Colonoscopy	M and F	Every 10 years beginning at age 50
Prostate cancer screening	M	Should be offered by a health provider every year beginning at age 50 to men with a life expectancy of at least 10 years
Mammography	F	Every year beginning at age 40
Electrocardiogram	M and F	One baseline recording starting at age 40

Preparation of the Examining Room

Proper preparation of the examining room provides a comfortable and healthy environment for the patient and facilitates the physical examination. The following guidelines should be followed in preparing the examining room:

1. Ensure that the examining room is free of clutter and well lit.

2. Check the examining rooms daily to ensure there are ample supplies. Restock supplies that are getting low.

3. Empty waste receptacles frequently.

4. Replace biohazard containers as necessary. When removing biohazard containers from the examining room (see Chapter 17), follow the OSHA Bloodborne Pathogens Standard.

5. Make sure the room is well ventilated, and install an air freshener to eliminate odors.

6. Maintain room temperatures that are comfortable not only for a fully clothed individual, but also for an individual who has disrobed.

7. Clean and disinfect examining tables, countertops, and faucets daily.

8. Remove dust and dirt from furniture and towel dispensers.

9. Change the examining table paper after each patient by unrolling a fresh length. Check to ensure there is an ample supply of gowns and drapes ready for use.

10. Ensure that the examining room door is closed during the examination because patient privacy is paramount.

11. Properly clean and prepare equipment, instruments, and supplies that are used for patient examinations so that they are ready for use by the physician. Table 20-1 lists the equipment and supplies, along with their uses, that may be employed during a physical examination.

Table 20-1

Equipment and Supplies for the Physical Examination

Item	Description and Purpose
Patient examination gown	Gown made of disposable paper or cloth that provides patient modesty, comfort, and warmth.
Drape	A length of disposable paper or cloth to cover a patient or parts of a patient to provide comfort and warmth and reduce exposure.
Sphygmomanometer	Instrument used to measure blood pressure.
Stethoscope	Instrument used to auscultate body sounds, such as blood pressure and lung and bowel sounds.
Thermometer	Instrument used to measure body temperature.
Upright balance scale	Device used to measure weight and height.
Otoscope	Lighted instrument with lens, used to examine external ear canal and tympanic membrane.
Tuning fork	Small metal instrument consisting of stem and two prongs, used to test hearing acuity.
Ophthalmoscope	Lighted instrument with lens, used for examining interior of eye.
Tongue depressor	Flat wooden blade used to depress patient’s tongue during examination of mouth and pharynx.
Antiseptic wipe	Disposable pad saturated with antiseptic, such as alcohol, that is used to cleanse skin.
Tape measure	Flexible device calibrated in inches on one side and centimeters on the other side, used to measure patient (e.g., diameter of limb, head circumference).
Percussion hammer	Instrument with rubber head, used for testing neurologic reflexes.
Speculum	Instrument for opening body orifice or cavity for viewing (e.g., ear speculum, nasal speculum, vaginal speculum).
Disposable gloves	Gloves, usually latex, that are worn only once to provide protection from bloodborne pathogens and other potentially infectious materials.
Lubricant	Agent that is applied to physician’s gloved hand or to speculum that reduces friction between parts to make insertion easier.
Specimen container	Container in which body specimen is placed for transport to laboratory (after it has been labeled).
Tissues	Used for wiping body secretions.
Cotton-tipped applicator	Small piece of cotton wrapped around the end of a slender wooden stick, used for collection of specimen from the body.
Overhead examination light	Light mounted on flexible movable stand to focus light on area for good visibility.
Basin	Container in which used instruments are deposited.
Biohazard container	Specially made container used for receiving items that contain infectious waste.
Waste receptacle	Container for used disposable articles that do not contain infectious waste.

From Bonewit-West K: Clinical procedures for medical assistants, ed 8, St Louis, 2011, Saunders.

12. Check equipment and instruments regularly to verify that they are in proper working condition. This protects the patient from harm caused by faulty equipment.

13. Have equipment and supplies ready for the examination and arranged for easy access by the physician. Equipment and supplies needed for the physical examination vary according to the type of examination and the physician’s preference (Figure 20-1).

Figure 20-1 Common instruments and supplies used during the physical examination.

14. Know how to operate and care for each piece of equipment and each instrument. The manufacturer provides an operating manual, which should be read carefully and thoroughly and kept available for reference.

Preparation of the Patient

It is the medical assistant’s responsibility to prepare the patient for the physical examination. After greeting and escorting the patient to the examining room, the medical assistant should identify the patient by asking the patient to state his or her full name and date of birth. This information should be compared with the demographic data indicated in the patient’s chart. The patient should not be asked whether he or she is a certain patient. For example, the patient should not be asked: “Are you Mary Williams?” The patient may not hear the medical assistant correctly or may not be paying attention and may answer in the affirmative even if he or she is not that patient. Proper identification is essential to avoid mistaking one patient for another. If the medical assistant performs a procedure on the wrong patient by mistake, he or she could be held liable. The medical assistant then takes vital signs and measures the weight and height of the patient. The results of these procedures are charted in the patient’s medical record.

The medical assistant can reduce a patient’s apprehension and embarrassment by addressing the patient by his or her name of choice, by adopting a friendly and supportive attitude, and by speaking clearly, distinctly, and slowly. The medical assistant should explain the purpose of the examination and offer to answer any questions. This also facilitates the physical examination of the patient.

The patient should be asked whether he or she needs to void before the examination. An empty bladder makes the examination easier and is more comfortable for the patient. If a urine specimen is needed, the patient is asked to void.

Instructions on disrobing for the examination should be specific so that the patient understands what items of clothing to remove and where to place the clothing. The disrobing area should be comfortable and should provide privacy. It is helpful to have a place for the patient to sit to make it easier to remove clothing and shoes. The area also should be equipped with hooks for hanging clothing. Instructions for putting on the examination gown and for locating the gown opening reduce patient confusion. If the medical assistant senses that the patient will have trouble undressing, assistance should be offered. Elderly and disabled patients sometimes have difficulty removing clothing.

The medical assistant is responsible for making the patient’s medical record available for review by the physician. The medical office has a designated location where the record is placed, such as a small shelf mounted on the wall next to the outside of the examining room door or in a chart holder mounted on the outside of the examining room door. The medical assistant should ensure that the medical record is placed so that patient-identifiable information is not visible. This is required by the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule to protect a patient’s health information.

The physical examination is performed with the patient positioned on an examining table, which is specially constructed to facilitate the examination. For safety, it is advisable to help the patient onto and off of the examining table.

Highlight on Patient Teaching

The purpose of patient teaching is to help the patient develop habits, attitudes, and skills that enable the individual to maintain and improve his or her own health.

Fact: Patients who are active, informed participants in their health care are more apt to follow the physician’s instructions than patients who are passive recipients of medical services.

Action: Provide patients with information on health care. Every patient interaction is an opportunity for teaching.

Fact: Adult learners are goal oriented and performance centered. They need and want information that would assist them in managing and improving their health.

Action: Review the information that you provide to patients, and determine whether it is nice to know or necessary to know. Select subject matter that is practical and useful and relates directly to the patient’s needs.

Fact: The more information that is presented, the more the patient is likely to forget. Approximately one half of information presented to the patient is forgotten in the first 5 minutes after giving it.

Action: When teaching, use the following pointers to help patients learn and retain information:

• Keep it short and be specific.

• Speak in terms the patient can understand.

• Focus on “how,” rather than “why.”

• Repeat and reinforce important information.

• Give practical examples, and provide ample time for patient practice.

• Ask for feedback from the patient to determine whether he or she understands the information.

• Provide the patient with written information.

Fact: Each individual has a distinct style of learning and learns best when using his or her preferred learning style. The three main learning styles are reading, listening, and doing. People often use more than one style for learning.

Action: Use a variety of teaching strategies to engage the various learning styles of patients. Examples of teaching strategies include explanations, printed handouts, audiovisual aids, demonstrations, and discussions.

Fact: Only two thirds of patients comply with health care instructions prescribed by the physician. Factors that influence compliance include the patient’s adaptation to illness, motivation to change, physical capability, and support systems.

Action: The following help increase patient compliance with prescribed treatment:

• Address the patient by his or her name of choice. (Keep in mind that many patients object to being called by their first name by strangers.)

• Encourage the patient to take an active role in personal health care.

• Help the patient set goals and objectives for change.

• Encourage care and support from family members.

• Make the patient aware of outside resources.

• Give positive reinforcement when the patient makes healthy changes.

What Would You Do? What Would You Not Do?

Case Study 1

Abbey Auden, 35 years old, is at the medical office. Her husband got a backyard trampoline for their two school-age children, and she decided to try it out. Abbey landed wrong on the trampoline and hurt her back and neck. For the past 5 days, she has been having headaches and back pain. Abbey refuses to have her weight taken because she has gained weight over the past several years and does not want to know how much she’s gained. She does not understand why weight has to be taken at an office visit in the first place. Abbey says that many times when she should go to the doctor, she doesn’t, just to avoid being weighed. She says she would not even be here now except that her husband insisted that she come.

Putting It All into Practice

My Name is Hope Fauber, and I am a certified medical assistant. I work in a medical clinic with a family medicine department of 10 physicians and 10 residents and interns. My duties cover a broad spectrum, from pediatrics to geriatrics, and include prenatal care, allergy injections, minor office surgery, electrocardiograms, colposcopies, immunizations, and wound care.

At our clinic, many of the patients are elderly. I occasionally come across geriatric patients who are not very cooperative and are “set in their ways.” One 90-year-old woman, in particular, had a reputation in the office for being cantankerous and difficult to work with. One day, when the physician ordered laboratory work on her, I prepared to draw blood from her tiny, frail body, praying that everything would go smoothly. As I helped her up after a successful “stick,” she, of all people, reached to give me a hug and said to me, “I like you. That didn’t even hurt!” She continued to hold my hand and talk to me as I walked her out of the office. This turned out to be the last time I would see her because she moved out of town, but not out of my heart, leaving a lasting impression on my life.

Measuring Weight and Height

The medical assistant routinely measures the weight and height of many types of patients. The process of measuring the patient is mensuration. A change in weight may be significant in the diagnosis of a patient’s condition and in prescribing the course of treatment. Underweight and overweight patients who follow a diet therapy program should be weighed at regular intervals to determine their progress. Prenatal patients are weighed during each prenatal visit to assist in the assessment of fetal development and of the mother’s health. Procedure 20-1 describes how to measure height and weight.

Procedure 20-1 Measuring Weight and Height

Outcome

Measure weight and height.

Equipment/Supplies

• Upright balance scale

• Paper towel

Weight

1. Procedural Step. Sanitize your hands.

2. Procedural Step. Check the scale to ensure it is balanced as follows:

a. Make sure the upper and lower weights are on zero. When the weights are on zero, they are all the way to the left of the calibration bars.

b. Look at the indicator point. If the scale is balanced, the indicator point is resting in the center of the balance area.

c. If the indicator point rests below the center, adjust the screw on the balance knob by turning it clockwise (to the right) until the indicator point rests in the center of the balance area.

d. If the indicator point rests above the center, adjust the screw on the balance knob by turning it counterclockwise (to the left) until the indicator point rests in the center of the balance area.

Principle. If the scale is not balanced, the weight measurement will be inaccurate.

3. Procedural Step. Greet the patient and introduce yourself.

4. Procedural Step. Identify the patient and explain to the patient that you will be measuring his or her height and weight.

5. Procedural Step. Instruct the patient to remove shoes and outer clothing such as a jacket or sweater. A good medical aseptic practice is to place a paper towel on the platform of the scale to protect the patient’s feet.

Principle. Removing heavy clothing and shoes allows a more accurate measurement of the patient’s weight.

6. Procedural Step. Assist the patient onto the scale, and instruct the patient not to move.

Principle. It is not possible to balance the scale if the patient is moving.

7. Procedural Step. Balance the scale as follows:

a. Move the lower weight to the notched groove that does not cause the indicator point to drop to the bottom of the calibration area. Ensure that the lower weight is seated firmly in its groove.

b. Slide the upper weight slowly along its calibration bar by tapping it gently until the indicator point comes to rest at the center of the balance area.

Principle. Not seating the lower weight firmly in its groove results in an inaccurate reading.

8. Procedural Step. Read the results to the nearest quarter pound by adding the measurement on the lower scale to the measurement on the upper scale. Jot down this value or make a mental note of it.

9. Procedural Step. Ask the patient to step off of the scale platform. Provide assistance if needed.

Height

1. Procedural Step. Slide the movable calibration rod upward until the measuring bar is well above the patient’s apparent height. Open the measuring bar to its horizontal position.

2. Procedural Step. Instruct the patient to step onto the scale platform with his or her back to the scale. Provide assistance if needed. Instruct the patient to stand erect and to look straight ahead.

Principle. Looking straight ahead helps the patient to stand erect and balanced, which ensures an accurate measurement.

3. Procedural Step. Carefully lower the measuring bar (keeping it horizontal) until it rests gently on top of the patient’s head with the hair compressed. The measuring bar should form a 90-degree angle with the calibration rod.

Principle. The measuring bar must be at a 90-degree angle to ensure an accurate height measurement.

4. Procedural Step. Keeping the measuring bar in a horizontal position, instruct the patient to step down and put on his or her shoes. Hold the bar in a horizontal position until the patient has stepped off the scale.

5. Procedural Step. Read the height measurement from the top down to the nearest quarter-inch marking at the junction of the stationary calibration rod and the movable calibration rod. (NOTE: If the patient’s height is less than the top value of the stationary rod, read the measurement from the bottom up directly on the stationary calibration rod.) Jot down this value or make a mental note of it.

6. Procedural Step. Return the measuring bar to its vertical (resting) position, and slide the movable calibration rod to its lowest position. Return the weights to zero.

7. Procedural Step. Sanitize your hands, and chart the results. Include the date and time and the patient’s weight and height measurements. The weight should be charted in pounds to the nearest quarter pound, and the height should be charted in feet and inches to the nearest quarter inch.

What Would You Do? What Would You Not Do?

Case Study 2

Karen Steiner drops her 17-year-old daughter, Mikayla, off at the medical office for her sports physical examination. Mikayla is captain of the varsity cheerleading squad and is getting ready to start her senior year in high school. Mikayla’s vital signs are normal, and she measures 5 feet 6 inches tall and weighs 105 pounds. With some reluctance, Mikayla admits that she’s been having problems with heartburn, and she’s pretty sure she knows what’s causing it. She says that she has to keep her weight down for cheerleading, and after eating dinner with her family, she makes herself vomit to get rid of the food in her stomach. Mikayla is not too concerned about doing this because a lot of the popular girls at school are doing the same thing. She says it’s the easy way to stay slim, and she would like to lose another 10 pounds before football season starts. Mikayla wants some prescription drug samples to help with the heartburn because the over-the-counter pills that she’s been taking are not working anymore. She does not want her parents to know about any of this because she’s afraid that they would not understand and might make her drop out of cheerleading.

Highlight on Cultural Diversity

Culture consists of the values, beliefs, and practices of a particular group of people. Culture is deeply rooted and is passed on from one generation to the next through communication. It includes areas such as religion, dietary practices, family lines of authority, family life patterns, beliefs, and health practices.

As the demographics of the United States continue to change, the medical assistant is faced with the challenge of providing care to an increasing number of cultural groups. It is important for the medical assistant to learn as much as possible about the cultural values of patients coming to the medical office. This is known as cultural awareness and can be accomplished by carefully observing and listening to patients to acquire knowledge of their cultural values.

Cultural sensitivity is respect and appreciation for cultural diversity, whereas cultural competence is understanding and using the cultural background of a patient to assist with the resolution of a problem. Because health practices are part of a patient’s culture, changing them may have a negative impact on the patient. Whenever possible, the medical assistant should incorporate factors from a patient’s cultural background into his or her health care.

Guidelines for Achieving Cultural Competence

The following guidelines help the medical assistant in developing cultural awareness and sensitivity and in achieving cultural competence:

1. Respect the patient’s values, beliefs, and practices. Even if you do not agree with them, it is important to respect the patient’s right to hold these values and to not dismiss them as strange or odd. Cultural values play an important role in a patient’s lifestyle. Patients from some cultures believe that losing blood depletes the body’s strength and provides a route for the soul to leave the body. If a blood specimen is needed, these patients may become highly distressed or refuse to have their blood drawn. Members of some cultural groups believe that illness results when the body’s natural balance or harmony is disturbed. To restore the balance, alternative forms of medicine, such as herbal remedies and aromatherapy, are used.

2. Refrain from cultural stereotypes. Not all people of a cultural group have the same beliefs, practices, and values. Assuming that all members of a cultural group are alike is known as stereotyping and should be avoided. Just as one would never assume that all people in the United States like hamburgers and baseball, every individual must be approached according to his or her specific beliefs and practices.

3. Always address patients by their last names (and Mr., Mrs., Miss, Ms.) unless they give you permission to use other names. In many cultures, using a first name to address anyone other than family or friends is considered disrespectful. Most older people in the United States dislike being called by their first name and feel it shows a lack of respect.

4. Speak slowly and clearly. Communicating with a patient may be difficult if the patient has a limited knowledge of English. With these patients, you should speak slowly and clearly in a normal tone and volume of voice. Speaking loudly does not help the patient understand any better and may be offensive to the patient.

5. Show respect for cultural lines of authority. In many cultures, respect is given based on age and gender. In certain cultures, elders are considered the holders of the culture’s wisdom and are highly respected. In other cultures, youth is valued over age. In certain cultures, the male dominates, and women have very little status. Because of this, a female patient from this type of culture may not be permitted to give her own health history or to answer questions. In addition, a male patient from this culture may not accept instructions from a female medical assistant.

6. Use appropriate eye contact. In most cultures, direct eye contact is important and generally shows that the other is attentive and listening. It conveys self-confidence, openness, interest, and honesty, whereas the lack of eye contact may be interpreted as secretiveness, shyness, guilt, or lack of interest. Other cultures consider eye contact impolite or an invasion of privacy; these patients show respect by avoiding direct eye contact.

7. Be aware of cultural responses to illness. The conditions under which an individual assumes the role of a (sick) patient and the way he or she performs in that role vary with culture. Individuals of some cultures resist the sick role and blame sickness on external forces as a means of punishment. These individuals may deny their illness and fail to provide much information when the medical assistant takes their symptoms. In other cultures, individuals take an optimistic view of the outcome of health care and, because of this, are more likely to elicit information and to follow the physician’s instructions.

8. Learn to appreciate the richness of diversity as an asset, rather than a hindrance, to communication and effective interaction with patients.

Patient Teaching

Health Promotion and Disease Prevention

Teach patients the essentials of health promotion and disease prevention. Help patients become aware of the following patterns of behavior that promote and support health:

• Keeping up to date with immunizations

• Eating nutritiously from the food pyramid

• Exercising regularly

• Maintaining normal weight

• Managing stress

• Maintaining high self-esteem

• Avoiding tobacco and drugs

• Using alcohol wisely

• Understanding how the environment affects health and taking appropriate action to improve it

• Knowing the facts about cardiovascular disease, cancer, infections, sexually transmitted diseases, and accidents, and using this knowledge to protect against them

• Understanding the changes that occur through the natural processes of aging

• Developing a sense of responsibility for health by taking an active role in establishing and maintaining a healthy lifestyle

Guidelines for Measuring Weight and Height

When using an upright balance scale to measure weight and height, use the following guidelines.

Weight

1. Locate the scale to provide privacy for the patient. Place the scale on a hard, level surface in a private location. Many patients are self-conscious about having their weight measured and prefer that it be done in privacy. Do not make weight-sensitive comments during the procedure. This is especially important for patients with weight control problems such as obesity and eating disorders.

2. Balance the scale before measuring weight. If the scale is not balanced, the weight measurement will be inaccurate. The scale is balanced when the upper and lower weights are on zero and the indicator point comes to a rest at the center of the balance area.

3. Assist the patient. Assist the patient onto and off of the scale platform. The scale platform moves slightly and may cause the patient to become unsteady.

4. Obtain an accurate weight. Always ask the patient to remove his or her shoes. Measure weight with the patient in normal clothing. Ask the patient to remove heavy outer clothing, such as a sweater or a jacket.

5. Interpret the calibration markings accurately. The lower calibration bar is divided into 50-lb increments (Figure 20-3, A). The upper calibration bar is divided into pounds and quarter pounds. The longer calibration lines indicate pound increments, and the shorter calibration lines indicate quarter-pound and half-pound increments (Figure 20-3, B).