THE PHYSICAL EXAM

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THE PHYSICAL EXAM

• DECRIPTION OF THE PATIENT
• VITAL SIGNS - BP-T-P-R---02
• HEENT
• NECK
• CHEST
• CARDIAC
• ABDOMEN
• MUSCULOSKELETAL
• EXTREMITIES
• SKIN
• NEUROLOGICAL
• LAB
• PROBLEM LIST
• ASSESSMENT/PLAN

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THE PHYSICAL EXAM

• ALWAYS DESCRIBE IN DETAIL WHAT YOU FIND ON THE
  EXAMINATION OF YOUR PATIENT
• THE PATIENT HAS A LUMP ON HER LEFT BREAST
• THE PATIENT HAS A 2X2 CM MASS WHICH IS
  NON-TENDER, NON-MOBILE, LOCATED IN THE UPPER
  OUTTER QUADRANT OF HER LEFT BREAST WITH NO SKIN
  CHANGES

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THE PHYSICAL EXAMTHE BASICS

• INSPECTION - LOOKING
• PALPATION - FEELING
• PERCUSSION - TAPPING
• AUSCULTATION - LISTENING

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THE PHYSICAL EXAMINSPECTION

• GENERAL APPEARANCE
• NUTRITIONAL STATUS
• BODY HABITUS
• SYMMETRY
• POSTURE AND GAIT
• SPEECH

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PALPATION

• FEEL WITH THE HAND FINGERTIPS
• TEXTURES
• DIMENSIONS
• CONSISTENCY
• TEMPERATURE
• EVENTS

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PALPATION DESCRIBE THE
FEATURES OF A PARTICULAR PHYSICAL FINDING

• HARD OR SOFT
• MOVEABLE OR STATIONARY
• PAINFUL
• PULSATILE
• FLUCTUANT
• LARGE OR SMALL - SIZE

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PERCUSSIONTYPES OF SOUNDS

• TYMPANY OVER THE ABDOMEN
• RESONANCE HEARD OVER THE LUNG
• DULLNESS HEARD OVER THE LIVER OR THIGH

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AUSCULTATIONDESCRIBE WHAT YOU HEAR

• QUIET
• TINKLES
• CRACKLES
• WHEEZES
• S3
• NORMAL

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THE PHYSICAL EXAMPREPARATION

• BE PREPARED
• THE EQUIPMENT REQUIRED IS LOCATED ON PAGE 117
  TABLE 6-1 IN SWARTZ
• WASH YOUR HANDS
• LAY EQUIPMENT OUT
• GOWN
• CHAPERONE
• SPEAK TO THE PATIENT
• POSITIONS
• PRECAUTIONS

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LABORATORY DATA

• WBC-HGB-HCT-PLATELETS
• NA-K-CL-HCO3-BUN-CREATNINE
• CHEST X-RAY
• URINALYSIS
• EKG

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PROBLEM LIST

• THE PURPOSE OF THIS SECTION IS TO HELP YOU.
• ORGANIZING THE PATIENTS PROBLEMS IN ORDER OF
  THEIR IMPORTANCE ALLOWS YOU TO LOOK AT THE BIG
  PICTURE. HOW DO THE PIECES FIT TOGETHER ?
• HOW DO I PLAN TO EVALUATE THE PROBLEMS.

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PROBLEM LIST MOST ACTIVE TO LEAST
ACTIVE 1.CONGESTIVE HEART FAILURE 2.COPD 3.DIABET
ES 4.PEPTIC ULCER DISEASE 5.HISTORY OF COLON
CANCER
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ASSESSMENT AND PLAN

• THIS IS WHERE YOU DISCUSS YOUR DIFFERENTIAL
  DIAGNOSIS AND MANAGEMENT PLAN.
• IT IS IMPORTANT TO BE THOROUGH AND CLEAR.