Transcript Lesson 1

Pearson's Comprehensive
Medical Assisting
Administrative and Clinical Competencies
THIRD EDITION
CHAPTER
37
Assisting with
Medical Specialties
Lesson 1:
Diagnosing and Treating Allergies
and Skin Disorders
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Lesson Objectives
Upon completion of this lesson, students
should be able to:
1. Define and spell the terms to learn for
this chapter.
2. Identify the medical assistant's role,
including job duties, in various medical
specialties.
3. Prepare patients for examinations and
diagnostic procedures.
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Lesson Objectives
Upon completion of this lesson, students
should be able to:
4. Discuss the importance of proper
patient preparation in regards to
procedures such as sigmoidoscopy and
colonoscopy.
5. Explain how the medical assistant will
assist the physician in specialized
examinations, such as the neurological
exam.
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Lesson Objectives
Upon completion of this lesson, students
should be able to:
6. Identify ways to promote open-ended
communication and proper
documentation within the patient's
medical record.
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The Role of the Medical Assistant
• Role of the MA is to assist the
physician during special examinations
and to instruct the patient before,
during, and after many of these
procedures
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The Role of the Medical Assistant
• Primary care physicians and internal
medicine physicians may perform some
procedures that are found in medical
specialist offices (for example,
electrocardiograms).
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The Role of the Medical Assistant
• The MA will come into contact with a
variety of conditions and diseases,
regardless of the type of office he or
she is working in.
• MAs will encounter patients who exhibit
a wide range of emotions to specialized
testing and procedures.
 MAs must provide support and empathy
in all circumstances.
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Assisting with Allergy and
Immunology
• Allergist or immunologist is a physician
specially trained in diagnosing,
treating, and managing allergies,
asthma, and immune disorders
• Clinical MA working with
allergist/immunologist will likely
perform the following tasks:
 Room patients and obtain vital signs
and measurements
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Assisting with Allergy and
Immunology
• Clinical MA Tasks
 Review specialized questionnaires
pertaining to the patient's allergy or
immunology history
 Prepare the exam room for specialty
procedures (e.g., those associated with
allergy testing)
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Assisting with Allergy and
Immunology
• Clinical MA Tasks
 Administer desensitizing injections
 Provide patient education and support
based on treatment protocol established
by physician
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Assisting with Allergy and
Immunology
• MA working in this field should have
working knowledge of some common
types of allergies





Allergic Rhinitis
Asthma
Contact Dermatitis
Eczema
Urticaria (hives)
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Assisting with Allergy and
Immunology
• Allergic rhinitis
 Inflammation of the nasal mucosa that
results in nasal congestion, rhinorrhea
(runny nose), sneezing, and itching of
the nose
 Seasonal allergic rhinitis, such as hay
fever, occurs only during certain
seasons of the year
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Assisting with Allergy and
Immunology
• Allergic rhinitis
 Children suffering from this type of
allergy may rub their nose in an upward
movement, called the "allergic salute."
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Assisting with Allergy and
Immunology
• Asthma
 Condition seen most frequently in
childhood in which wheezing, coughing,
and dyspnea are major symptoms
 Asthmatic attacks may be caused by
allergens inhaled from air, food, and
drugs.
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Assisting with Allergy and
Immunology
• Asthma
 Patient's airway is affected by
constriction of the bronchial passages
 Treatment includes medication and
reducing exposure to causative factors.
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Assisting with Allergy and
Immunology
• Contact dermatitis
 Inflammation and irritation of the skin
due to contact with an irritating
substance, such as soap, perfume,
cosmetics, plastics, dyes, and plants,
such as poison ivy
 Treatment consists of topical and
systemic medications and removal of
the causative item.
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Assisting with Allergy and
Immunology
• Eczema
 Superficial dermatitis accompanied by
papules, vesicles, and crusting
 Condition can be acute or chronic
• Urticaria (hives)
 Skin eruption of pale reddish wheals
with severe itching
 Usually associated with a food allergy,
stress, or drug reactions
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Assisting with Allergy and
Immunology
• Allergy testing is ordered by the
physician to determine a patient's
sensitivities to allergens.
• Allergy testing methods include:




Scratch or skin testing
Intradermal tests
Patch tests
Radioallergosorbent test (RAST)
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Assisting with Allergy and
Immunology
• Scratch Test
 Usually performed on patient's arm or
back
 Skin divided into small squares,
approximately 1 inch apart, and labeled
with ballpoint pen to indicate allergen
being used
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Assisting with Allergy and
Immunology
• Scratch Test
 Drop of allergen is placed on skin at
appropriately labeled site
 Skin is scratched with needle or lancet;
a new needle is used for each allergen
tested
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Assisting with Allergy and
Immunology
• Scratch Test
 Many tests using different allergens can
be performed at the same time.
 If a wheal forms within 15 minutes after
placing an allergen on the skin, an
allergy is indicated.
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Assisting with Allergy and
Immunology
• Scratch Test
 Advise patient to remain in the
physician's office for at least 30 minutes
after testing in the event there is a
delayed reaction
 Will likely be performed in a specialist's
office
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FIGURE 37-1
Wheals are formed in reaction to scratch testing and intradermal testing of allergens.
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Assisting with Allergy and
Immunology
• Intradermal Test
 Performed by injecting 0.01 to 0.02 mL
of an allergen extract into the anterior
surface of the forearm
 Several tests (10 to 18) can be
performed on each arm.
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Assisting with Allergy and
Immunology
• Intradermal Test
 A red wheal is a positive sign of an
allergy to a specific allergen.
 Test considered more accurate than a
scratch test; commonly performed in
specialist's office
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FIGURE 37-2 The patient’s forearm shows a number of wheals formed after injection with an allergen. The size
of the wheal corresponds to the severity of the allergy to the allergen.
So. Illinois Univ/Science Source
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Assisting with Allergy and
Immunology
• Patch Test
 Consists of placing a small amount of
the allergen onto the anterior forearm
or upper back, and then covering this
with a protective wrap (plastic or
specialty paper)
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Assisting with Allergy and
Immunology
• Patch Test
 Several tests can be performed at the
same time and these are read after the
patches have remained in place for 24
to 48 hours
 Test used to detect the causative agents
in contact dermatitis
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FIGURE 37-3 A medical assistant labels the allergens for a patch test.
Science Photo Library/Getty Images
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Assisting with Allergy and
Immunology
• Radioallergosorbent Test (RAST)
 Measures blood levels of antibodies to
particular antigens
 Venipuncture performed on the patient;
blood sample sent to laboratory where it
is exposed to a variety of suspected
allergens and levels of antibodies are
measured
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Assisting with Allergy and
Immunology
• Radioallergosorbent Test (RAST)
 Expensive, but more sensitive and
useful for patients with dermatological
problems or who cannot stop taking
allergy medication safely in order to
have one of the other tests performed
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Assisting with Dermatology
• Dermatologist is a physician who is
specially trained in the diagnosis and
treatment of disorders of the skin or
integumentary system
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Assisting with Dermatology
• Clinical MA working for a dermatologist
may perform some of the following
duties:
 Room patients and obtain vital signs
and measurements
 Review patient's medical history and
complete dermatology-related
questionnaires
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Assisting with Dermatology
• Clinical MA Tasks
 Prepare the exam room for specialty
procedures, such as those associated
with performing minor skin surgeries
and obtaining skin biopsies
 Prepare the patient and assist the
physician with procedures related to
medical and cosmetic dermatology,
including laser surgery and chemical
peels
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Assisting with Dermatology
• Clinical MA Tasks
 Assist in the debridement of wounds
and obtain wound cultures
 Provide patient education and support
based on the treatment protocol
established by the physician
• MA may receive special training to work
as Mohs technician:
 Helps the physician during Mohs surgery
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Assisting with Dermatology
• Mohs Technician
 Mohs surgery is performed to remove
cancerous skin lesions and surrounding
layers of skin
 Important and crucial role in a
dermatology practice that treats skin
cancer
• Skin cancer is the most common form of
cancer within the United States.
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Diagnostic Tests and Procedures to Treat
Integumentary System Disorders
• Adipectomy
 Surgical removal of fat
• Biopsy
 Removal of a piece of tissue by syringe
and needle, knife, punch, or brush to
examine under a microscope as an aid
in diagnosis
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Diagnostic Tests and Procedures to Treat
Integumentary System Disorders
• Cauterization
 Destruction of tissue with a caustic
chemical, electrical current, freezing, or
hot iron
• Chemobrasion
 Abrasion of skin using chemicals; also
called chemical peel
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Diagnostic Tests and Procedures to Treat
Integumentary System Disorders
• Cryosurgery
 Use of extreme cold to freeze and
destroy tissue
• Curettage
 Removal of superficial skin lesions with
a curette or scraper
• Debridement
 Removal of foreign material or dead
tissue from a wound
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Diagnostic Tests and Procedures to Treat
Integumentary System Disorders
• Dermabrasion
 Abrasion or rubbing, using wire brushes
or sandpaper
• Dermatoplasty
 Transplantation of skin or skin grafting;
may be used to treat large birthmarks
(hemangiomas) and burns
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Diagnostic Tests and Procedures to Treat
Integumentary System Disorders
• Electrocautery
 To destroy tissue with an electrical
current
• Exfoliative cytology
 Scraping cells from tissue and then
examining them under a microscope
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Diagnostic Tests and Procedures to Treat
Integumentary System Disorders
• Frozen section
 Taking a thin piece of tissue from a
frozen specimen for rapid examination
under a microscope; often performed
during a surgical procedure to detect
cancer
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Diagnostic Tests and Procedures to Treat
Integumentary System Disorders
• Fungal scrapings (FS)
 Scrapings taken with a curette from
lesions, placed on a growth medium and
examined under the microscope to
identify fungal growth
• Incision and drainage (I&D)
 Making an incision to create an opening
for the drainage of material, such as
pus
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Diagnostic Tests and Procedures to Treat
Integumentary System Disorders
• Laser therapy
 Removal of skin lesions and birthmarks
using a laser that emits intense heat
and power at close range; the laser
converts frequencies of light into one
small beam
• Lipectomy
 Surgical removal of fat
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Diagnostic Tests and Procedures to Treat
Integumentary System Disorders
• Marsupialization
 Creating a pouch to promote drainage
by surgically opening a closed area,
such as a cyst
• Needle biopsy
 Using a sterile needle to remove tissue
for examination under a microscope
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Diagnostic Tests and Procedures to Treat
Integumentary System Disorders
• Rhytidectomy
 Surgical removal of excess skin to
eliminate wrinkles; commonly referred
to as a facelift
• Skin grafts
 Transfer of skin from a normal area to
cover another site; used to treat burn
victims and after some surgical
procedures
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Diagnostic Tests and Procedures to Treat
Integumentary System Disorders
• Sweat test
 Test performed on sweat to see the
level of chloride; there is an increase in
skin chloride in some diseases such as
cystic fibrosis.
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Diagnostic Tests and Procedures to Treat
Integumentary System Disorders
• Tzanck test
 A microscopic examination of a small
piece of tissue that has been surgically
scraped from a pustule; the specimen is
placed on a slide and stained, then the
type of viral infection can be identified
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Taking a Wound Culture
1. Warmly greet and identify the patient.
Explain the procedure and answer any
patient questions as necessary.
2. Assemble equipment and label the
culture tube with the patient's name,
date of birth, your initials, and today's
date.
3. Perform hand hygiene and don a pair
of gloves.
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Taking a Wound Culture
4. Remove the patient's wound dressing.
Take note of the amount and type of
exudate. Dispose of used dressing
materials in a biohazard waste
container.
5. Observe the wound for redness,
crusting, swelling, and odor.
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Taking a Wound Culture
6. Remove the sterile swab from the
culture tube and place it in the wound.
Rotate the swab back and forth to
obtain a good sample. Place the swab
in the sterile culture tube. Crush the
ampule of preservative that is found at
the bottom of the culture tube and
seal the tube.
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Taking a Wound Culture
7. Remove gloves, perform hand
hygiene, and apply sterile gloves.
8. Clean the wound using sterile water
and 4 x 4 gauze squares.
9. Apply sterile dressing over the wound.
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Taking a Wound Culture
10.Dispose of used gauze squares in the
biohazard waste container.
11.Remove gloves and dispose of them
properly in hazardous waste
container.
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Taking a Wound Culture
12.Instruct patient regarding proper
wound care. Provide both verbal and
written instructions.
13.Chart the procedure in the patient's
medical record, taking time to make
detailed notes regarding the
appearance of the wound and any
outstanding observations.
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Assisting with Dermatology
• Common Skin Disorders
 Most skin disorders are diagnosed, in
part, by observing the lesion.
 Skin lesions can occur whenever the
normal surface of the skin is invaded or
changed.
 Necessary to make descriptive notes in
patient's medical record indicating size
and appearance of any skin lesions, and
coloration and texture of skin
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Assisting with Dermatology
• Common Skin Disorders
 Skin lesions, also termed neoplasms or
tumors may be malignant (cancerous)
or benign (noncancerous)
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Assisting with Dermatology
• Common Skin Disorders
 Dermatological neoplasms
• Dermatofibroma
• Fibrous tumor of the skin; painless, round,
firm, red, and generally found on
extremities
• Hemangioma
• Benign tumor of dilated vessels
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Assisting with Dermatology
• Common Skin Disorders
 Dermatological neoplasms
• Keloid
• Formation of a scar after an injury or
surgery that results in a raised, thickened,
red area
• Keratosis
• Overgrowth or thickening of cells in the
epithelium located in the epidermis of the
skin
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Assisting with Dermatology
• Common Skin Disorders
 Dermatological neoplasms
• Leukoplakia
• Change in the mucous membrane that
results in thick, white patches on the
mucous membrane of the tongue and
cheek; considered precancerous and is
associated with smoking
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Assisting with Dermatology
• Common Skin Disorders
 Dermatological neoplasms
• Lipoma
• Fatty tumor that generally does not
metastasize (spread)
• Nevus
• Pigmented (colored) congenital skin
blemish that is usually benign but may
become cancerous; also called a birthmark
or mole
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Common Skin Disorders
• Common Skin Disorders
 Malignant (cancerous) neoplasms
• Basal cell carcinoma
• Epithelial tumor of the basal cell layer of
the epidermis; a frequent type of skin
cancer that rarely metastasizes
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Common Skin Disorders
• Common Skin Disorders
 Malignant (cancerous) neoplasms
• Karposi's Sarcoma
• Form of skin cancer frequently seen in
acquired immune deficiency syndrome
(AIDS) patients; consists of brownishpurple papules that spread from the skin
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Common Skin Disorders
• Common Skin Disorders
 Malignant (cancerous) neoplasms
• Malignant melanoma
• Dangerous form of skin cancer caused by
an overgrowth of melanin in the skin; may
metastasize
• Squamous cell carcinoma
• Epidermal cancer that may go into deeper
tissue but does not generally metastasize
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Common Skin Disorders
• Bacteria, viruses, and parasites can
invade the skin if protective barrier
broken
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Common Skin Disorders
• Inflammatory Skin Disorders
 Result in swelling, redness, and often
itching over infected site
•
•
•
•
•
Cellulitis
Decubitus ulcers
Psoriasis
Acne vulgaris
Scleroderma
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Common Skin Disorders
• Cellulitis, or erysipelas
 Inflammation of the cellular or
connective tissue caused by either
Staphylococcus or Streptococcus
infection of a cut or lesion
 Treatment consists of antibiotics and
application of warm compress
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Common Skin Disorders
• Decubitis Ulcers
 Open sores caused by pressure over
bony prominences on the body because
of a decrease or lack of blood flow
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Common Skin Disorders
• Decubitis Ulcers
 Can appear in bedridden patients who
lie in one position too long
 Treatment consists of relieving the
pressure through frequent turning and
exercise of the patient, thorough
cleansing of the wound, and topical
antibiotics.
 Deep ulcers may require surgical
debridement (removal of dead tissue).
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Common Skin Disorders
• Psoriasis
 Chronic inflammatory condition
consisting of distinct red or pink lesions
covered with silver scaling
 Not contagious and thought to be an
autoimmune disease
 Treatment consists of topical ointments
and, in some severe cases, ultraviolet
light therapy.
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FIGURE 37-4 Bilateral psoriasis on a patient’s knees.
Jody Jacobson/Getty Images
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Common Skin Disorders
• Acne vulgaris
 Inflammatory disease of the sebaceous
glands and hair follicles that results in
papules and pustules
 Treatment consists of thorough
cleansing and systemic and topical
antibiotics.
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Common Skin Disorders
• Scleroderma
 Chronic, progressive autoimmune
disease that affects the blood vessels
and connective tissue of the skin and
other organs
 Integumentary symptoms include
hardening of the skin, pallor, edema,
and fixating of skin to subcutaneous
tissues.
 No known cause and no cure
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Questions?
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