Make sure to use soap and warm water and wash for 20 seconds. Then rinse your hands thoroughly and dry them with a clean paper towel.
If the patient is someone you have seen before, then you may simply say hello and ask how they are doing.
Keep in mind that having your patient change into a gown won’t always be necessary. Some patients may come in with complaints that can be checked with them in their street clothes, such as a cough or cold. Make sure there’s enough light in the room to see the patient well. Check to see if the room is quiet enough that you can hear the sound of the patient’s breath. Eliminate any hazards, such as wires or other items near the examination table that might prevent you from moving freely around it.
For example, if the patient has a bad cold and cough that has lingered for more than a couple of weeks, then you would focus your attention on their respiratory system.
For example, if the patient has come in complaining of severe period cramps, then you might ask if they have ever been diagnosed with PCOS or endometriosis. You can also ask general questions to gain a better understanding of the patient’s situation, such as “Have you ever had any surgeries?” and “Do you take any medications?”
You can also count the beats for 15 seconds and then multiply the result by 4 for an approximate heart rate. For example, if you count 20 beats in 15 seconds, then their heart rate is approximately 80 beats per minute.
With practice, you should be able to count respirations while taking a patient’s pulse.
Muscle pattern, such as a noticeable lack of muscle in the arms or legs Hair distribution, such as thinning hair on their head Odors, such as a foul odor indicating poor hygiene Movement and coordination, such as being unable to follow a pen with their eyes
Have your patient read the letters on a Snellen chart to check their visual acuity and asses the function of their second cranial nerve. [8] X Research source Ask the patient to cover up 1 eye and read the chart with the uncovered eye and then repeat for the other eye. [9] X Research source You may also ask the patient if they are having any issues with their vision. You may also want to check for symptoms of common eye issues. For example, you could check for conjunctivitis by looking for signs of swelling, discharge, and redness around the eyelids. [10] X Trustworthy Source American Optometric Association Professional medical organization dedicated to supporting optometrists and improving public eye and vision health Go to source
You may also ask the patient if they have noticed any hearing loss. If the patient has asked you to repeat yourself multiple times or if they are turning their head or leaning in to hear you better, then this may indicate hearing problems.
If the patient has normal hearing, they should report that they hear the sound equally in both ears. If they have hearing loss in 1 ear, they will report not hearing it as loudly in the affected ear.
If the patient has hearing loss in that ear, they will report no longer hearing the tuning fork after you take it away from their mastoid bone. Repeat the test on the other ear after you finish checking the first ear.
Ask the patient to follow a pen with their eyes to check for any issues with cranial nerves III, IV, and VI. [14] X Research source
You might also ask the patient if they have any issues with their sense of smell, which may indicate a problem with cranial nerve I. [16] X Research source You may also ask the patient if they suffer from allergies or other related problems as you inspect their nasal passages.
You might also ask the patient if they see a dentist regularly.
You may also touch the patient’s face lightly around their temples, middle of their face, and jaw to check for symmetry and to assess the function of cranial nerve V.
Signs of problems with the salivary glands or lymph nodes may include pain when you palpate them, hard spots on the glands, or swelling. [20] X Trustworthy Source Harvard Medical School Harvard Medical School’s Educational Site for the Public Go to source Also, check for an enlarged lymph node above the left mid cervical bone. This is a potential sign of gastric cancer and it requires further evaluation.
For example, if the patient’s thyroid gland is oversized or has a palpable nodule on it, then this would require further investigation.
Swelling and lack of tenderness in the axillary nodes may also indicate an infection, cancer of the lymph nodes, or a systemic inflammatory disorder, such as sarcoidosis.
You may also check for bruits, which are blocked blood vessels, at this time if you suspect a problem. Place the stethoscope over the patient’s carotid arteries 1 at a time and listen for a turbulent whooshing sound to detect a bruit. [23] X Trustworthy Source PubMed Central Journal archive from the U. S. National Institutes of Health Go to source
While you are listening to the patient’s lungs, observe them for signs of straining. For example, if you notice the person is using their whole chest to help them breathe, then this may indicate a respiratory issue.
If the patient cannot squeeze your hands tightly or if they seem to be much stronger on one side than the other, then there may be an issue that requires further investigation.
Proximal strength may decrease as a person ages, but if a young, relatively healthy patient has poor proximal strength then this may be a cause for concern.
A bruit makes a turbulent whooshing sound, so it should be easy to detect.
If the liver or spleen feels enlarged, this will require further investigation.
If you are a male provider, make sure to have a female chaperone in the room for any pelvic, breast, or rectal exams. Instruct the patient to put her feet into the stirrups for this part of the exam and drape a sheet over her to ensure her comfort. Gather what you will need before starting the exam, such as a speculum and items for collecting a sample from the patient’s cervix.
Ask the patient if they perform regular breast self-exams to check for issues. If not, instruct them on the benefit of doing these checks.
Perform the rectal exam with the patient lying on their side.
