Transcript Medical Assistant Skills

Medical Assistant Skills
Medical Professions Education II
Diversified Health Occupations
Pages 567- 614
Medical Assistant Skills
OBJECTIVES
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Upon Completion of this unit, the student should be
able to:
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Measure and record height and weight of infants and adults
Patient positioning
Use a Snellen Chart to screen for vision problems
Prepare for and assist with ENT, GYN and general exams
Define, pronounce, and spell all of the key terms
Medical Assistant Skills
Measuring /Recording Height & Weight
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Are you concerned
with how much you
weigh?
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Why are people
interested with
their weight and
height?
Medical Assistant Skills
Height and Weight
Height and weight measurements are used to
determine if a person is overweight or
underweight
 Must be accurate~~ ALWAYS RECHECK
CALCUALTIONS (10% deviation is usually considered normal)
 When are the measurements taken?
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Admittance to hospital, LTCF, or other health care agency
General exam
At times during certain laboratory exams
For calculating dosage for certain medications
Medical Assistant Skills
Height and Weight
For calculating dosage for certain medications
 Height, weight, and head circumference is
checked frequently on infants and toddlers
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Infant growth is rapid
Usually checked every 2 months to detect changes that may
indicate problems with growth and development
Measurements recorded on a NCHS growth graph, which allows
MD to check the child’s growth and compare it to the average
percentiles of other children the same age
Abnormal growth patterns may indicate nutritional deficiencies
or genetic diseases
Medical Assistant Skills
Height and Weight
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Daily Weights
 Often
order for pts. with edema due to heart, kidney, or
other diseases
 Must use the same scale each day
 Make sure scale is balanced before weighing patient
 Weigh patient at same time each day
 Make sure patient is wearing same amount of clothing
Medical Assistant Skills
Height and Weight
SAFETY!!!
 WATCH
THE PATIENT CLOSELY AT ALL TIMES
 PREVENT
 AVOID
FALLS FROM THE SCALES
POSSIBLE INJURY FROM THE
PROTRUDING HEIGHT LEVER
Medical Assistant Skills
Height and Weight
 Most
pts. are very
WEIGHT conscious!
 Make
only
POSITIVE
statements while
weighing a patient!
Medical Assistant Skills
SCALES
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A wide variety of scales are used to obtain
measurements
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CLINICAL SCALES
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INFANT SCALES
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Contain balance beam for measuring weight
Have measuring rod for determining weight
Provide an area for placing infant in a lying down or flat position
SPECIAL SCALES
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Bed scale w/mechanical lift
Wheelchair scale
Medical Assistant Skills
RECORDING WEIGHT
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Recorded as lbs. and
ozs or as kg. (2.2lbs)
ADULT SCALE
Top weight scale on a
clinical scale
Usually goes from 1 to
50 lbs
Each small line
represents ¼ lbs
Scale is read ¼, ½,
¾, and 1
Each long line
represents 1 lb
For pts who weigh
more than 50 lbs, the
lower scale is used
first
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Most scales measure
lbs. in ¼-pound
increments
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Metric scales use kg
with 0.1-kg (1gram)
increments
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Medical Assistant Skills
Recording Weight
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Adult scale, cont.
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Bottom scale is usually in 50-lbs
increments
EXAMPLE:
A.
B.
C.
D.
Bottom scale is set at 100 lbs.
Top scale is set at 24 ½ pounds
100 + 24 ½ = 124 ½ pounds
PATIENT’S WEIGHT IS 124 ½ LBS.
Medical Assistant Skills
Recording Weight
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Infant Scales
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Vary…some have digital numbers that are easier to
read, others have weights in lbs. and ozs.
Remember there are 16 oz in 1 lb
Each short line represents 1 oz with lines for 4, 8, and
12 ozs slightly longer
Each long line represents 1 lb.
At times, ozs. are converted to fractions of a lbs
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To convert 8 ounces to a fraction of a pound, divide by 16 (16
ounces = 1 pound)
8/16 = ½ pounds
EXAMPLE
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Infant weighs 8lbs 4 oz…divide only the ozs. by 16.
 4/16 = ¼
 TOTAL WEIGHT = 8 ¼ POUNDS
Medical Assistant Skills
Recording Height
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Recorded as feet and inches or as
centimeters
Measuring bar measures inches and
fractions or ¼-inch increments
Metric bar uses one centimeter increments
1 inch equals 2.5 centimeters
Medical Assistant Skills
Recording Height
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Each small line represents ¼ inch
Each long line represents 1 inch
From the bottom of the scale up to the
break in the bar, readings are taken in an
upward direction
If a pt is taller than 50 inches, reading are
taken in a downward direction and read at
the break in the bar
Medical Assistant Skills
Recording Height
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Height for adults is recorded in feet and
inches
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Inches must be converted
Remember there are 12 inches in 1 foot
Divide 12 into the number of inches
obtained
EXAMPLE:
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Measurement recorded is 64 inches
12/ 64 ½ =
5 ft 4 ½ inches
Medical Assistant Skills
Recording Height
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TAPE MEASURE FOR INFANT HEIGHT
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Tape measure is read like a ruler
Each small line is 1/8 inch
Each longest line is 1 inch
Readings are 1/8, ¼, 3/8, ½, 5/8, ¾, 7/8, and
1 inch
Medical Assistant Skills
Height and Weight
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IMPORTANT PRINCIPLES FOR MEASURING
WEIGHT/HEIGHT ON A CLINICAL SCALE
ADULT
Balance the scale with the weight at zero
Ask pt to remove shoes, jacket, heavy
outerwear, etc.
Make sure pt stands unassisted with feet
slightly apart and centered on platform
Make sure pt stands erect for height
measurement
Medical Assistant Skills
Height and Weight
IMPORTANT PRINCIPLES FOR MEASURING
WEIGHT/HEIGHT ON AN INFANT SCALE
INFANT
Be ALERT with the infant AT ALL TIMES!
Place a sheet of paper on the scale and balance
scale at zero
Remove infant’s clothing, including diaper
To record height place infant on a flat surface and
mark the height accurately
Head circumference is frequently measured on an
infant
NEVER LEAVE AN INFANT UNATTENDED!!!
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Medical Assistant Skills
POSITIONING
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Pts must be positioned correctly for variety
of exams, test, and procedures
Wide variety of positions are used for
different procedures or exams
Pt may be in a bed or on an exam table,
surgical table, diagnostic or treatment table
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IMPORTANT to know how to operate the table!
DISINFECT the table before and after pt use.
Table paper is frequently used to cover the
table prior to exams and then removed and
replaced before next exam
Medical Assistant Skills
POSITIONING
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During any procedure or exam
reassure the pt
 Help
them understand what is being done
 Watch the pt carefully for signs of distress
 Observe all safety factors to prevent falls or
injuries
Medical Assistant Skills
POSITIONING
Use correct body mechanics at all times to
prevent injury to yourself
 Position used depends upon exam,
procedure, or test being performed
 Proper draping is essential for all positions
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 Care
must be taken to avoid unnecessary exposure
 Drape must be applied so MD or tech will have ready
access to the area being examined or treated
 Close door to room and draw curtains if they are
present
Medical Assistant Skills
POSITIONING
HORIZONTAL RECUMBENT
OR SUPINE POSITION
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Used to exam or treat the front
or anterior part of the body
Pt lies flat on back with legs
slightly apart
One small pillow is allowed
under the head
Arms are flat at the side of the
body
Drape pt with large sheet or
drape
Medical Assistant Skills
POSITIONING
PRONE POSITION
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Used for exams of back or spine
Pt lies on the abdomen with head turned
to either side
Small pillow is placed under the head
Arms may be flexed
at elbows and positioned
on either side of the head
Drape pt with large
sheet or drape
Medical Assistant Skills
POSITIONING
SIMS’ OR LEFT LATERAL POSITION
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Used for simple rectal or sigmoidoscopic exams, enemas,
rectal temps, and rectal treatments
Patient lies on left side
Head rests on small pillow and is turned to the side
L arm is extended behind the back
R arm is bent at elbow and placed in comfortable position
in front of the body
L leg is bent or flexed slightly
R leg is bent or flexed sharply and brought up to the
abdomen
Drape pt with one large sheet or drape or two small
sheets that meet at the rectal area
SIM’S OR LEFT LATERAL
Medical Assistant Skills
POSITIONING
KNEE-CHEST POSITION
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Used for rectal exams- usually a sigmoidoscopic exam
Pt lies on stomach, abdomen, or prone position
Pt raises buttocks and abdomen until weight is resting
on upper chest and knees
Head rest on small pillow and is turned to either side
Arms are flexed slightly at the elbows and extended
above the head
Knees are separated slightly
Thighs are at right angles to the table/bed
Draping can be done by
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1 large sheet can be used to cover the pt
1 large sheet with a hole at the rectal area
2 smaller sheets or drapes that meet at the rectal area
KNEE-CHEST
Medical Assistant Skills
POSITIONING
KNEE-CHEST POSITION, cont.
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Safety precautions!!!
 Remain with the pt at all times while in the kneechest position
 This is a difficult position to maintain and should
only be used when absolutely necessary
 After exam, place pt in a prone position and then
turn over to supine
 Watch closely for s/s dizziness or discomfort
Medical Assistant Skills
POSITIONING
FOWLER’S
Used to facilitate breathing, relieve distress,
encourage drainage, and examine the head, neck,
and chest
 Pt lies on back with head elevated at different
angles
 A small pillow may be place under the pt’s head
 Flex knees slightly and place small pillow under
knees
 Drape with a large sheet or drape
 Don’t tuck sheet! : )
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Fowler’s
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Low- Fowlers: head elevated at 25° angle
Mid-fowler’s or semi –Fowler’s- head
elevated at 45° angle
Fowler’s
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High Fowler’s- head elevated at 90° angle
Medical Assistant Skills
POSITIONING
LITHOTOMY POSITION
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Used for vaginal examinations, pap tests, urinary
catherization, cystoscopic examinations, and surgery
of the pelvic area
Medical Assistant Skills
POSITIONING
LITHOTOMY POSITION
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Pt lies on back with head on small pillow
Arms rest at sides of body
Pt slides buttocks down on table to where lower end
of table folds down or pulls out
Place sheet or drape over pt in diamond position
Flex and separate the knees
Place feet in stirrups on table
Drop the lower end of the table or push it in if this is
possible
Medical Assistant Skills
POSITIONING
LITHOTOMY POSITION
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To remove pt from position:
 Raise the end of the table or pull it out so it is
level
 Lift feet out of stirrups and place on table
 Ask pt to slide back up on table
Medical Assistant Skills
POSITIONING
DORSAL RECUMBENT POSITION
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Similar to lithotomy position and used for same
purposes
Medical Assistant Skills
POSITIONING
TRENDELENBURG POSITION
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Requires a special table or bed and assistance
Care must be taken so pt does not slide off table or
bed
Draping depends on procedure or treatment
performed
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Usually 1 large sheet is used to drape pt
For surgical procedures, use a large sheet with a hole to expose
the surgical area
2 smaller sheets can be used
Do not tuck!
Special safety precautions
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use straps to secure pt in this position
Remain with patient at all times
Medical Assistant Skills
POSITIONING
STANDARD TRENDELENBURG POSITION
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Used for circulatory shock because it increases
circulation of the blood to the brain and head
Pt lies flat on back with head on small pillow
Arms are flat at sides
Entire bed or table is elevated at the feet
Pt lies in horizontal recumbent with head lower than
the feet
Medical Assistant Skills
POSITIONING
SURGICAL
TRENDELENBURG
POSITION
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Used for surgery on pelvic
organs and pelvic treatments
Pt lies flat on back with head
on small pillow
Arms are flat at sides
Top of table is lowered at an
angle to lower the head
Bottom of table is lowered at
an angle to incline legs and
feet downward
Straps are used frequently to
hold the pt in position
Medical Assistant Skills
POSITIONING
JACKKNIFE POSITION
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Used for rectal surgery or exams, or back surgery and
treatments
Requires a special table that will break in the middle
Care must be taken so pt will not slide off or be
injured in any way
Pt lies in prone position
Secure the safety straps on the table around the pt
Lower the top of the table so the head and upper
body are inclined at a downward angle
Draping is done in a variety of ways
Special safety precautions
JACKKNIFE POSITION
Medical Assistant Skills
Basic Principles for Positioning
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Determine the exam, tx, or procedure to be performed
Determine which position will be required
Prepare pt correctly
Assist pt onto table
Position pt in correct position
Drape pt correctly for position
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To change positions:
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Observe all safety precautions
Watch pt at all times for s/s of dizziness, pain, or discomfort
When exam/tx is complete, assist pt to a sitting
position…SLOWLY
Assist pt off of table
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VISUAL SCREENINGS
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Vision screening test
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Often given as a part of a physical examination
Given to detect eye disease
VISUAL SCREENINGS
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SNELLEN CHARTS are frequently used to
test vision
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Some contain pictures for use with small children
Some contain the letter E in a variety of positions
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“TUMBLING E”
Common type contains letters of the alphabet
VISUAL SCREENINGS
INTERPRETATION OF READINGS ON SNELLEN CHART
 Characters have specific heights
 Range from smallest on the bottom to largest on the
top
 Person with normal vision
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Should see figures that are 20 mm high while standing at
a distance of 20 feet from the chart
Person would have 20/20 vision
VISUAL SCREENINGS
INTERPRETATION OF READINGS ON SNELLEN CHART
 Top number represents the distance the patient is
standing from the chart
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For the Snellen test, the pt is positioned 20 feet from the
chart
Special calibrated charts can be used where pt can stand
closer but letters are smaller to accommodate closer
distance
Lower or bottom number refers to the height of the
characters that the patient can read
VISUAL SCREENINGS
BASIC PRINCIPALS FOR SCREENING VISION WITH A
SNELLEN CHART
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Attach chart to wall or place in a lightened stand
Measure distance of 20 feet directly away from the front of the chart and place a
piece of tape on the floor
Explain the procedure to pt and check to make sure pt knows letters/characters
on chart
Position pt with heels on taped line 20 feet from chart
Point to various letters/figures on the chart and ask pt to identify them
Note the line on which the pt can read all characters correctly and record the
reading on this line
Ask pt to cover one eye with an eye shield or card and test the uncovered eye
following the same procedure as above, then repeat with opposite eye.
If pt wears corrective lenses check the vision with corrective lenses first
Record all information correctly
VISUAL SCREENINGS
INTERPRETATION OF READINGS ON SNELLEN CHART
 A person has 20/30 vision
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WHILE STANDING 20 Ft FROM CHART, Pt. CAN SEE FIGURES
30mm HIGH
Can also be interpreted that the pt standing 20 feet away can see
what a pt with normal vision can see standing 30 feet from the
chart
A person has 20/100 vision
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WHILE STANDING 20 Ft FROM CHART, Pt CAN ONLY SEE FIGURES
THAT ARE 100mm HIGH
Also means that pt, standing 20 feet from chart, can see what
person with normal vision could see standing 100 feet from the
chart
VISUAL SCREENINGS
Test for color blindness
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Usually tested by the Ishihara method
Ishihara book contains a series of number printed in
colored dots against a background of dots in contrasting
colors
Pts with normal color vision are able to readily identify
the number
Pts with color blindness will not be able to see a number
or they will identify an incorrect number
Test most accurate if conducted in a room illuminated by
natural daylight with no bright sunlight
VISUAL SCREENINGS
IMPORTANT TERMS OR ABBREVIATIONS
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OD: oculus dexter or RIGHT EYE
OS: oculus sinister or LEFT EYE
OU: oculus uterque, each eye or BOFOFUM
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Myopia: nearsightedness; defect in distant vision
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Hyperopia: farsightedness; defect in close vision
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Ophthalmoscope: instrument for examining the eye
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Tonometer: instrument to measure intraocuolar tension
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or pressure; increased pressure often indicated glaucoma
Assisting with
Physical Exams
3 Major kinds of examinations
1.
EENT (eye, ear, nose, and throat exams
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Examines only these parts of the body
Uses special equipment to examine these areas
GYN (gynecological exams)
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Exams the female reproductive organs
MD usually exams the breasts, vagina, cervix, and other pelvic
organs
A Pap or Papanicolaou test is frequently done to detect CA of the
cervix or reproductive organs
Assisting with
Physical Exams
3 Major kinds of examinations, cont.
3. CHECK-UP (general or complete physical exams)
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4.
5.
All areas of the body are examined
Blood and urine tests are done frequently
Xrays and electrocardiogram (ECG or EKG) may be included
EENT and GYN examination may be performed
Necessary equipment and tests to be done are determined by the
physician doing the examination
Assisting with
Physical Exams
TECHNIQUES USED DURING THE EXAMINATION
Observation or inspection
Palpation
Percussion
Auscultation
Assisting with
Physical Exams
EQUIPMENT USED FOR EXAMS
1.
2.
Equipment used will vary depending on body areas to be
examined
Important to anticipate what MD will need and assemble
the items for convenient use
AYER BLADE
LARYNGEAL MIRROR
OPHTHALMOSCOPE
OTOSCOPE PERCUSSION HAMMER
SIGMOIDSCOPE
SPECULUM
SPHYGMOMANOMETER
STETHOSCOPE
TONGUE BLADE/DEPRESSOR
TONOMETER
TUNING FORK
Assisting with
Physical Exams
Preparing the Patient
1.
2.
3.
4.
5.
Carefully explain the procedure to help alleviate
fear
Pts are often apprehensive and need reassurance
Usually pt must remove all clothing and put on
exam gown
Pt should void before exams so the bladder is
empty and internal organs in area of bladder can
be palpated.
Correct positioning and draping is essential
Preparing the Patient
1.
2.
3.
4.
TESTS DONE PRIOR TO EXAM
Height and weight
Vital signs
Vision screening
Audiometric screening
Assisting with Medical
Exams
Be prepared to assist as needed during
examinations
1. Hand equipment to MD as needed
2. Position pt correctly for each part of exam
3. Pay attention so you are ready to help with
each procedure
Assisting with Medical
Exams
Observe standard precautions at all times
1. Wash hands frequently
2. Wear gloves if contact with blood or body
fluids is likely
3. Wear other PPE accordingly
4. Clean and disinfect or sterilize any
instruments or equipment contaminated with
blood or body fluids
5. Be aware of and take steps to prevent the
spread of infection
Assisting with Medical
Exams
The Doctor is IN!
(refer to handout)