FNP Clinical Question.. What do you actually do during a physical exam?

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Hi all,

So i'm a new FNP. I've been working for about 6 months now.. As many of you all know, it's very difficult, if not impossible, to do a comprehensive physical exam in 15 minutes. I'm curious to know what the others out there do as far as physical exams. I know many of them are focused, depending on each patient, but let's hypothetically say you have a healthy patient coming in for a physical. I would love to see a sample of what exam items you include/exclude. For an example, does everyone do reflexes? If so, which ones? Cranial nerves? Do you check ears on everyone? Pulses? I'd love to know what everyone's REALISTIC physical exams are like. Also, how does this change for your peds patients (school age, not infants of course).

Thank you in advance!

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I am a Psych NP, not an FNP, but I just had my yearly employment physical with my FNP and there were no cranials nerves or any of that nonsense.

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Specializes in Adult Primary Care.

I have the luxury of scheduling all annual H&Ps for one hour and I do pretty much everything!!!

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A full physical should be scheduled in a block that's longer than 15 minutes... It should be a full ROS and true head-to-toe PE - cranial nerves, reflexes, strength, pulses, the whole kit and caboodle. Especially for school age children, I would say, as you are assessing development.

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My advice is to know why you're doing what you're doing. For example, the history should guide you to what you need to spend more time on with your physical. If the patient can't finish a sentence d/t having to catch their breath, then I'd be inclined to spend a lot of time doing all that we are taught about assessing heart/lungs. The MSC exam, on the other hand, I might keep to my basics and not so much time.

It's like learning to write, as in, you spend forever learning to write a complete sentence, and then it comes to you and you get to paragraphs and now novels, etc. But, step one, learn the sentence. So for now, it might take a while to do a good H&P, but that's okay because it will all come together if you put in the time and effort now.

All said, 15 minute blocks for a full physical is not adequate.

Good luck!

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Specializes in Cardiology, Research, Family Practice.
A full physical should be scheduled in a block that's longer than 15 minutes... It should be a full ROS and true head-to-toe PE - cranial nerves, reflexes, strength, pulses, the whole kit and caboodle. Especially for school age children, I would say, as you are assessing development.

Yes.

If you're billing a preventive care visit Z00.00 or Z00.01, it is to include a full head to toe, including cranial nerves, pulses, thyroid, reflexes, etc.

In my experience, the PE is least time consuming part of a wellness visit. It is much more time consuming to HPI their multitude of problems since patients rarely present for a PE without a reason, e.g. "I've been having chest pain and while I'm here I think I have a sinus infection, and I passed out in the parking lot, and I have toenail fungus and I've been having rectal bleeding, so I figured I'd come in since I haven't had a physical in 30 yrs, and (my favorite) I can't lose weight no matter what I do".

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