Transcript Assisting with Examinations in the Basic Specialties

PowerPoint® to accompany
Medical Assisting
Chapter 40
Second Edition
Ramutkowski  Booth  Pugh  Thompson  Whicker
Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.
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Assisting with Examinations in the
Basic Specialties
Objectives:
40-1 Briefly describe the medical specialties of internal
medicine, pediatrics and obstetrics and gynecology.
40-2 Describe the types of examinations and diagnostic
tests performed in each of these specialties and the
medical assistant’s role in them.
40-3 List and describe some common diseases and
disorders seen in these medical specialties and typical
treatment for them.
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Assisting with Examinations in the
Basic Specialties
Objectives (cont.)
40-4 Explain the medical assistant’s duties in assessing for
chronic fatigue syndrome.
40-5 Identify common signs of domestic violence and child
abuse.
40-6 Describe the medical assistant’s responsibilities in
performing a scoliosis examination.
40-7 Describe the medical assistant’s role in assisting with a
cervical biopsy.
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Introduction
 Medical practice
act is a law that
defines the exact
 Medical assistants
are allowed to
perform clinical
duties physicians
and other health
care personnel
may perform.
procedures only
under the
supervision of the
physician.
Because state laws vary, you will need to know
the scope of practice for medical assistants in the
state where you work.
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Specialty Examinations
 Specialties are
physicians who have
taken additional
training beyond
medical school and
their residencies.
 They must pass
rigorous examinations
in their chosen
specialty.
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Internal Medicine
 Diagnosis and treats
disorders and
diseases of the
body’s internal
organs.
 They treat medical
problems with
medicine, and/or
modalities
(therapeutic agents.)
An internist can refer patients to a doctor in one of the
internal medicine subspecialties.
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Assisting with the Physical
Examination
 Usually the same as a general physical
examination.
 You may be expected to assess for chronic
fatigue syndrome.
 Patients must have four or more of the following:
• Impairment in short-term memory, sore throat, muscle
pain, tender lymph nodes, multi-joint pain without
swelling, unrefreshing sleep and post-exertional malaise
lasting more than 24 hours.
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Detecting Substance Abuse
Signs of abuse
 Alcohol - Depressed pulse
rate, respiration and blood
pressure.
 Cocaine – Excitation,
increase pulse rate and
blood pressure.
 Inhalants – Muscle
weakness, hearing loss,
changes in heart rate,
nausea and dizziness.
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Detecting Domestic Violence
 Report



Injuries that the patient tries to hide or excuse
Unusual bruising
Signs in a patient’s tone of voice or choice of
words
 Reporting suspected domestic violence is
mandatory in some states.
 Keep list of services available for patient
handy.
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Detecting Elder Abuse
 Occurs in all racial, socioeconomic and
religious groups
 Risk factors:
 History of alcoholism, drug abuse or violence
in the family.
 History of mental illness in the abuser.
 Isolation of the victim from family members.
 Recent stressful events affecting the abuser or
victim.
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Detecting Elder Abuse (cont.)
Signs of neglect:





Foul odor from the patient’s body
Poor skin color
Inappropriate clothing for the season
Soiled clothing
Extreme concern about money
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Diagnostic Testing
Measurement of arterial blood gases
Radiologic tests
 Chest x-ray
 Computed tomography (CT)
 Magnetic resonance imaging (MRI)
 Venography and venous ultrasonography
 Radionuclide imaging
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Diseases and Disorders
Diseases of Aging








Constipation-diarrhea cycle
Hyperlipidemia
Osteoporosis
Alzheimer’s diseases
Infectious diseases
Infectious mononucleosis
Lyme disease
Pneumonia
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Sexually Transmitted Diseases
 Diseases acquired through
sexual contact with an
infected person.






Candidiasis
Chlamydia
Genital herpes
Genital warts
Gonorrhea
Trichimoniasis
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Apply Your Knowledge
What are symptoms seen in patients
who are abusing inhalants?
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Apply Your Knowledge –Answer
What are symptoms seen in patients
who are abusing inhalants?
Inhalants users can have muscle
weakness, hearing loss, changes in
heart rate, nausea and dizziness.
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Pediatrics
 Specializes in the
health care of
children, monitoring
their development
and diagnosing and
treating their illness.
 To be a good pediatric
medical assistant, you
must first like
children of all ages.
 You role as liaison
between caregiver
and physician will be
an important one.
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Assisting with the Pediatric
Physical Examination
 Ask questions about eating
habits, sleep patterns, daily
activities, immunization
schedules and toilet training.
 Adolescents may be sensitive
toward rapid growth and
physical, sexual and social
development.
 Calmly explain procedures and
be cheerful and mindful of a
child’s feeling.
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Assisting with the Pediatric Physical
Examination (cont.)
 Examining the Well Child
 Infants need seven well-baby
examinations during their first year
at these intervals
•
•
•
•
2 weeks,
1 month
2 month
4 month
•6 month
•9 month
•1 year
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Assisting with the Pediatric Physical
Examination (cont.)
 Examining the Well Child
 Children in the second year of life should have
checkups at 15 and 18 months.
 From the age of 2, children should have
checkups every year.
 Follow Universal Precautions and prepare
for the physical examination the same way
you would for an adult except draping and
positioning.
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Examining for Scoliosis
 An abnormal lateral curving
of the spine into an S curve.
 Appears most often in
adolescent girls.
 Treatment may include
exercises, a Milwaukee brace,
surgical rod implantation.
 Untreated scoliosis can cause
debilitating symptoms as the
patient matures.
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Detecting Child Abuse or Neglect
 Notice signs of physical injury






Bruises or burns
Lesions on child’s genitalia
Dirty or neglected appearance
Hunger
Extreme sadness or fear
Inability to communicate
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Detecting Child Abuse or Neglect
(cont.)
 Physician will exam for:



Internal injuries, tenderness when palpated or
auscultated
Malnutrition, tooth discoloration, unhealthy
gums
Lack of cognitive ability, dulled neurological
responses
 You are legally responsible for reporting
suspected child abuse or neglect.
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Pediatric Diseases and Disorders
 AIDS
 Attention Deficit Hyperactivity Disorder and





Learning Disabilities (ADH)
Cerebral Palsy
Congenital Heart Disease
Down Syndrome
Hepatitis B
Respiratory Syncytial Virus
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Pediatric Diseases and Disorders
(cont).
 Sudden Infant
Death
Syndrome
 Spina Bifida
 Viral
Gastroenteritis
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Obstetrics and Gynecology
 Specializes in the female reproductive
system.
 Focus on caring for women during
pregnancy and childbirth (obstetricians.)
 Focus on conditions of the female
reproductive system
(gynecologists.)
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Assisting with the Gynecologic
Physical Examination
 Provides an overview of a women’s health
and opportunity for cancer-screening exams
and tests.
 Female assistant should be in the room
during the exam to assist a male doctor and
to provide legal protection.
 Your role is similar to that of the general
physical examination
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Pelvic Examination
 The doctors checks external
genitalia, cervix, vaginal wall,
internal reproductive organs, and
rectum.
 Doctor uses a speculum –
instrument that expands the
vaginal opening to permit viewing
of the vagina and cervix.
 Your role is to assist the patient into
position and provide assistance to
the doctor.
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Apply Your Knowledge
What is the correct position to have a
patient assume for a pelvic examination
and how should you assist the patient in
assuming this position?
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Apply Your Knowledge -Answer
What is the correct position to have a
patient assume for a pelvic examination
and how should you assist the patient in
assuming this position?
Lithotomy - Assist the patient into position, with her
feet in the stirrups of the examining table and her
buttocks at the end of the table.
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Diagnostic Tests and Procedures
 Pregnancy tests –

Human Chorionic
Gonadotropin
 Tests for STDs
 Radiologic Tests


Ultrasound
CT and MRI
 Hysterosalpingograph –
examination of the
fallopian tubes, and uterus.
 Mammogram – detects
cancer of the breast.
A patient should schedule mammography for the
week after her menstrual period, when the breasts
are most normal and least swollen.
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Therapeutic Procedures
 Amniocentesis –
performed when
genetic or metabolic
defect is suspected
 Biopsy – surgical
removal of tissue
that assists with
determining cancer.
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Therapeutic Procedures (cont.)
 Colposcopy –
examination of the
vagina and cervix with
a colposcope.
 Fine needle aspiration
– obtain sample of cyst,
lump or tumor of breast
 Hysterectomy –
removal of the uterus
 Laparoscopy – view
internal female organs
 Pap smear – determine
presence of abnormal
or precancerous cells
The physician may use needles or other instruments
to obtain tissues or amniotic fluid samples
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Pregnancy
 First trimester – conception to 12 weeks
 Second trimester – 12 weeks to sixth month
 Third trimester – sixth month until birth.
 Nagele’s rule – to estimate the delivery date
for a pregnant women.
 Subtract 3 months from first day of last period
and add 7 days plus one year.
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Prenatal Care
Assisting with prenatal
care
 Help teach and support
both the parents.
 Patient education is
important
 Assist with routine
prenatal patient visit
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Assisting with Prenatal Visits
 You may :






Ask the patient about any problems.
Ask the patient to empty her bladder and obtain a
urine specimen and perform reagent urine test.
Weigh the patient.
Assist the patient to the exam table.
Assist the physician as needed.
Assist the patient from the table.
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Apply Your Knowledge
A pregnant patient of 38 years may be
carrying twins. What diagnostic tests
may be performed and why?
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Apply Your Knowledge -Answer
A pregnant patient of 38 years may be
carrying twins. What diagnostic tests
may be performed and why?
Ultrasound – to determine fetal size and position
Amniocentesis – determine genetic or metabolic
disorder of the fetus.
Alpha fetoprotein – measured in the amniotic fluid
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Apply Your Knowledge
A patient has just found out she was
pregnant. Her last period started on
January 23rd. Using Nagele’s rule what
day would be her estimated date of
delivery?
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Apply Your Knowledge -Answer
A patient has just found out she was
pregnant. Her last period started on
January 23rd. Using Nagele’s rule what
day would be her estimated date of
delivery?
Nagele’s rule says count back three months [1December, 2-November, 3-October], then add
seven days, [23 + 7 = 30]. Her estimated date of
delivery would be October 30th.
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Summary
Medical Assistant
Medical assistants positions in the basic specialist
usually involve a wide range of responsibilities and
tasks.
You will find many opportunities to develop your
skills and interests if you work in one of these
medical specialties.
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End of Chapter
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