1-5. BODY SYSTEMS USUALLY EXAMINED BY THE PHYSICIAN

a. Musculoskeletal System. The patient should be examined for symmetry of parts, for mobility, and for coordination.

b. Integumentary System. The patient's skin should be observed for intactness, color, the presence of scars or rashes, and the skin should be felt for warmth and unusual texture.

c. Eyes, Ears, Nose, and Throat. The patient should be examined for patency of passages and cavities, state of balance (equilibrium), and the receptiveness of the sense organs.

d. Cardiovascular System. The heart is listened to with a stethoscope to measure the rate, character, and regularity of the heartbeat, as well as to detect any abnormal sounds. Status of the heart and blood vessels is determined by indirectly measuring blood pressure and by directly measuring central venous or arterial pressure. Circulation and pulses in various parts of the body, especially the extremities, may be checked. By looking at blood vessels in the retina with an ophthalmoscope, the physician can infer the condition of the blood vessels in the rest of the body.

e. Respiratory System. The respiratory system is evaluated for respiratory rate, adequacy of ventilation and gas exchange membranes, clear lung fields, and symmetry of the chest. The physician can learn a lot about the chest and estimate the size and location of the heart and lungs by auscultation (listening) and by percussion (tapping and thumping). Arterial blood may be drawn to be analyzed for blood gases.

f. Gastrointestinal (GI) System. The GI tract is examined for intactness of mucosal membranes, adequacy of digestive process, and regular elimination of solids. Because portions of the digestive tract cannot be seen directly, X-ray procedures, such as a GI series, or gallbladder series are often ordered. Feces may also be examined for the presence of blood or pathogens. The physician may explore the rectum with a gloved finger. The patient is often in the Sims' position for this examination.

g. Neurologic System. The neurologic examination evaluates normal reflexes, adequate motor and sensory innervation, development of intellectual and psychological processes. It may consist of assessing the patient's orientation to time and place, assessing sensation by stimulating various parts of the body, and assessing the patient's sense of balance or ability to control body movements. A percussion hammer is used to test reflexes in various parts of the body. In addition, the pupils are checked with a flashlight for reflex. The pupils should quickly contract when a bright light is shined into the eye. The pupils should be round, regular, and of equal size. This is reported as PERRLA (pupils equal, round and reactive to light and accommodation). Accommodation is adjustment, especially of the eye, to variation in distance.

h. Genitourinary System. Genitourinary evaluation is to determine adequacy of urinary control and elimination, patency of membranes and passages, and appropriate development of reproductive organs. A vaginal or pelvic examination is done to discover any signs of irritation, growths, displacement, or other abnormal conditions in the pelvic organs or external genitalia. A rectal examination is usually included in the physical examination of a man over 35 years old. This exam aids in discovering cancer of the rectum or prostate gland while it is still in an early stage.

i. Endocrine System. The physician may palpate (use hands and fingers to examine) the sex glands and the thyroid gland to determine size and detect any growths. The adequacy of hormonal activity is assessed by observing certain characteristics of body function, growth, and development.

1-6. ASSISTING WITH AN INFANT OR CHILD

a. Make every effort to get the child's cooperation during the examination. If the child is too young or too ill to cooperate, use restraint when necessary. Position the child's arms along side the body and wrap the child in a sheet or blanket. Stand on the opposite side of the table from the examiner during the chest and abdominal examination. Hold the child's arms above his head with one of your hands and his feet at the ankles with your other hand.

b. The equipment used to examine an infant or child is the same as for adult except some items are smaller.

1-7. PHYSIOLOGICAL MEASUREMENTS ROUTINELY MADE

a. The patient's vital signs (temperature, pulse, respirations), blood pressure, height, and weight should be taken before the examination but 10 to 15 minutes after the patient has rested.

b. Routine examinations such as complete blood count (CBC) with differential, urinalysis, electrolytes, and chest x-ray are usually ordered. Complete the lab and x-ray request slips with the patient's name, rank, social security number, date, and all other required information.

c. Have the results from all lab tests available so that the health care provider can observe/assess and be aware of any abnormal lab values.

1-8. PURPOSES FOR DRAPING THE PATIENT DURING THE PHYSICAL EXAM

The patient should be drapped:

a. To prevent unnecessary exposure of the patient's body.

b. To help the patient relax—a patient who is embarrassed will be tense and less cooperative.

c. To prevent chilling — the drapes will provide warmth.

1-9. EVALUATION OF A PATIENT'S CONDITION AND NEED FOR ASSISTANCE

Your presence will be comforting for most patients. Some parts of the examination may be uncomfortable or painful. Evaluate the patient's condition and his need for assistance prior to the physical examination. Some factors to consider are:

a. Age. Elderly patients will probably need help getting to the examination room, getting on the examination table and assuming certain positions. Infants and children will not be cooperative and may need restraining.

b. Level of Understanding. Patients who are confused, unable to understand English, or very young may need nonverbal communication such as a smile or soft pat to assure them. Most patients will not understand medical terms. Assist them by explaining the examination and answering their questions in common language.

c. Ability to Move. Disabled patients who move poorly or not at all may need assistance.

d. State of Health. Some patients may be just too sick to tolerate a lengthy physical examination. Do not leave very ill or debilitated patients alone; assist them to move and remain in the various positions and observe them for fatigue.

1-10. CLOSING

The practical nurse that is assigned to assist in the physical examination plays an important role in supporting both the patient and the physician or other health care providers. Upon completion, chart that the examination was done, by whom, the patient's reaction, and any specimens sent to the lab or special procedures to be followed.

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