Transcript Assisting with Highly Specialized Examinations

CHAPTER
9
Assisting with Highly
Specialized
Examinations
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
9-2
Learning Outcomes
9.1
Discuss the medical specialties of allergy, cardiology,
dermatology, endocrinology, gastroenterology,
neurology, oncology, ophthalmology, orthopedics,
otology, surgery, and urology.
9.2
Describe the types of examinations and diagnostic
tests performed in each of these specialties and the
medical assistant’s role in these examinations and
tests.
9.3
Identify the most common diseases and disorders
seen in these medical specialties and typical
treatments for them.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
9-3
Learning Outcomes (cont.)
9.4
Carry out the procedure for assisting the physician in
performing a scratch test.
9.5
Carry out the procedure for assisting with a
sigmoidoscopy.
9.6
Prepare the ophthalmoscope for use.
9.7
Carry out the procedure for assisting with a needle
biopsy.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
9-4
Introduction
• Many physicians choose to specialize
• The medical assistant working for a
specialist will
– Assist with the examinations
– Assist with diagnostic testing and processing
specimens
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
The Medical Assistant’s Role in Specialized
Examinations
9-5
• Physicians that specialize focus on one
body system, a single type of disease, or
medical intervention
• Medical assistant role
– General administrative and
clinical tasks
– Assist with examinations
and procedures
– Communicate with and
educate patients
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
9-6
Allergy
• Allergist – diagnoses and treats allergies
• Allergies – inappropriate immune system
responses to normally harmless substances
• Allergen – substance that causes an allergic
reaction
• Allergic reactions may be localized or systemic
• Anaphylaxis – life-threatening allergic reaction
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
9-7
Allergy Examinations
• Involves a medical history and diagnostic
testing
• You must understand the function of the
immune system and how allergies are
treated
– Allergen avoidance
– Medications
– Desensitization to a substance
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
9-8
Allergy Testing
• Scratch test
– Used to test for
specific allergies
– May cause discomfort
and itching
• Intradermal test
– A dilute solution of
allergen into the skin
– More sensitive than
the scratch test
• Patch test
– A linen or paper patch
is soaked with an
allergen
– Contact dermatitis
• RAST
– Measures blood levels
of antibodies to
specific allergens
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
9-9
Apply Your Knowledge
1. How does the medical assistant participate in specialty
examinations?
ANSWER: The medical assistant performs general administrative and
clinical tasks, assists with examinations and procedures, and
communicates with and educates patients.
2. Match the following:
ANSWER:
C May be localized or systemic response A.
___
Allergen
___
A Substances causing an allergic reaction B.
Anaphylaxis
___
D Inappropriate immune responses
C.
Allergic reaction
___
E Diagnoses and treats allergies
D.
Allergies
___
B Life-threatening reaction
E.
Allergist
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
9-10
Cardiology
• Cardiologist – specializes in heart disease and
disorders
• Medical assistant must be familiar with
– The structure of the cardiovascular system
– Typical examination and measurements
– Tests performed
• Electrocardiography
• Stress testing
• Echocardiography
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
9-11
Cardiology Examination
•
Auscultation
– Blood
pressure
– Overall cardiac
health
•
•
Electrocardiogram
(EKG or ECG)
– Measures the
electrical activity
of the heart
Palpation
– Chest wall
– Vessels in
extremities
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
9-12
Cardiology Examination (cont.)
•
Stress test
– Measures the response to
a constant or increasing
workload
– Stress thallium ECG
•
•
Patient is injected with
radioisotope
Holter monitor – records ECG over a
period of time
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9-13
Radiography and Imaging Techniques
• Chest x-ray
• Radionuclide
studies
– Contrast medium
ingested or injected
– Angiography
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9-14
Radiography and Imaging Techniques
(cont.)
• Ultrasound
• Echocardiography
– Tests structures and function of heart
• Heart MRI
– Provides detailed pictures of heart and
vessels
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9-15
Radiography and Imaging Techniques
(cont.)
• Cardiac catheterization – catheter is
threaded through a vein into the heart
– Obtain blood samples
– Measure pressure in the heart’s chambers
– View the heart’s motion
– Perform a balloon angioplasty
– Insert a stent
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
9-16
Diseases and Disorders
Category
Condition/Description
Arterial/vascular
Disorders of arteries or veins
Cardiomyopathy
Disease of heart muscle causing fatigue and
breathing problems and leading to heart failure
Coronary artery
disease
Partial or complete blockage of major coronary
arteries
Dysrhythmias
Disorders of heart rhythm
Heart failure
Inability of heart to pump blood effectively, resulting
in fluid buildup in tissues and lungs
Inflammations
Infections of heart tissue
Valvular diseases
Heart valves do not open or close fully
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
9-17
Apply Your Knowledge
True or False:
ANSWER:
___
F An ECG tests the function of the heart through sound waves.
echocardiogram
___
T Angiography is an x-ray of a blood vessel after injection of a
contrast medium.
___
T Managing heart conditions often involves lifestyle changes.
___
F A Holter monitor is only done in an inpatient setting.
most often done on an
outpatient basis.
___
T A stress test measures the patient’s response to an increasing workload.
___
T An endocardiography is a form of ultrasound.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
9-18
Dermatology
• Dermatologists –
diagnose and treat
skin diseases and
disorders
• Disorders
– Some involve only
the skin
– Others are a sign
of disease
elsewhere
• Medical assistant
assists by
– Positioning and
draping during skin
exams
– Taking skin
scrapings or wound
cultures
– Educating patients
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
9-19
Dermatology Examinations
• Whole-body skin
examination
– Top layer of the
entire surface of
the skin
• Magnifying lens
and bright light
• Photograph or
sketch a lesion
• Wood’s light
examination
– Skin inspected
under ultraviolet
lamp in a darkened
room
– Highlights
abnormal skin
characteristics
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
9-20
Skin Lesions
Macule
Nodule
Papule
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9-21
Skin Lesions (cont.)
Pustule
Bulla
Ulcer
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9-22
Conditions and Disorders
Condition/Disorder
Description
Acne vulgaris
Inflammation of the follicles of the skin’s
sebaceous (oil) glands
Contact dermatitis
Skin inflammation caused by irritants
Psoriasis
Characterized by patches of red, thickened skin
with silver scales; itching
Eczema
Skin inflammation
Ringworm
Tinea; fungal infections; dry and scaly or moist and
crusty
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
9-23
Conditions and Disorders (cont.)
Condition/Disorder
Description
Moles (nevus)
Brown, black, or tan spot on the skin; raised or
unraised; even coloring, round or oval shape and
clear borders
Warts
Benign skin tumors from a viral skin infection;
common, plantar, and venereal
Impetigo
Highly contagious bacterial skin infection
Herpes zoster
Acute viral infection of nerves under the skin;
painful skin eruptions; shingles
Scabies
Contagious skin disease caused by a mite;
intense itching
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
9-24
Conditions and Disorders (cont.)
• Skin cancer
– Basal cell
• Small waxy craters
with rolled borders
– Squamous cell
– Malignant melanoma
• Originates in cells that
produce melanin
• Spreads through
bloodstream
or lymphatic system
• Lesions appear
ulcerated or have a
crust
• More likely to spread
to other areas of the
body than basal cell
carcinomas
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
9-25
Apply Your Knowledge
Name the three types of skin cancers pictured
here. Which is the most serious type?
ANSWER:
Squamous Cell
Bravo!
Malignant
Melanoma
Basal Cell
Carcinoma
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
9-26
Endocrinology
• Endocrinologists
– Treat diseases and disorders of the
endocrine system
– Hormonal imbalances can affect growth,
metabolism, and reproduction
• Medical assistant
– Assists with examinations
– Collects specimens for analysis
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9-27
Endocrine Examinations
• Thorough medical history
• Assessment
– Skin condition
– Weight and cardiac functioning
• Diagnostic urine and blood
tests
• Ultrasound, X-rays, and iodine
scans
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9-28
Endocrine Diseases and Disorders
• Diabetes
– Type I
• Autoimmune disease
• Deficiency of insulin
– Type II
• Resistance to insulin
• Most common in adults
– Gestational – only
occurs during
pregnancy
• Thyroid gland
disorders
– Hypothyroidism
• Underproduction of
thyroxine
• Children – cretinism
• Adults – myxedema
– Hyperthyroidism
• Overproduction of
thyroxine
• Graves’ disease
– Goiter – enlarged
thyroid
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
9-29
Apply Your Knowledge
Excellent!
What is the difference between Type I and Type II diabetes?
ANSWER:
Type I:
 An autoimmune disease of the
pancreas
 Diagnosed most often in
childhood
 Body does not produce
adequate insulin
 Treatment includes insulin
injections
Type II:
 Most common form
 Generally diagnosed in adults
 Childhood diagnosis is
increasing
 Risk factors: obesity, inactivity,
family history
 Treatment may include oral
medications or insulin
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
9-30
Gastroenterology
• Gastroenterologists – diagnose and treat
disorders of the gastrointestinal (GI) tract
• Medical assistant
– Understands the basic elements of GI exam
and procedures
– Patient education – prepares for the exams
– Answers patient questions
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9-31
Gastroenterology Examinations
• May be invasive based on patient
symptoms
• Provide reassurance and ensure comfort
• Patient instructions
– Bring someone to drive home
– What cautions to take if patient had local
anesthetic of the throat
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9-32
Gastroenterology Examinations (cont.)
• Endoscopy
– Direct visualization of a
body cavity
– Means for obtaining tissue
biopsies or removing
polyps
• Peroral endoscopy –
examination of the
esophagus, stomach, and
duodenum
• Colonoscopy –
examination of the large
intestine
• Proctoscopy –
examination of the lower
rectum and anal canal
• Sigmoidoscopy –
examination of the
sigmoid area of the large
intestine
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
9-33
Diagnostic Testing (cont.)
• Lab tests
– Analysis of
stomach contents
– Urine
– Occult blood
• Radiologic exams
– Cholecystography
• Gallbladder
function test
• Differentiate
between bile duct
obstruction and
gallstones
– Ultrasound
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
9-34
Diagnostic Testing
• Radiologic exams
(cont.)
– Barium swallow
• Detect abnormalities in
the esophagus,
stomach, and small
intestine
– Barium enema
• Detect abnormalities of
the large intestine
– Radionuclide imaging
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
9-35
Diseases and Disorders
• Level of discomfort may be
misleading in relation to severity
• Document patient’s symptoms
accurately and completely
– Level of pain
– Medications taken, including OTCs
• Refer to Table 9-3 for disorders and
descriptions
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
9-36
Apply Your Knowledge
Identify the following:
ANSWER:
endoscopy
_____________
Any procedure using a scope to visualize a
cavity of the body
colonoscopy
_____________
Provides direct visualization of the large intestine
sigmoidoscopy
_____________
Visualizes only the S-shaped segment of the
large intestine
peroral
endoscopy
_____________ Used to visualize the upper GI tract
proctoscopy
_____________
Examination of the lower rectum and colon
Scoptacular!
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
9-37
Neurology
• Neurologists
– Diagnose and treat diseases and disorders
of the central nervous system
• Medical assistant
–
–
–
–
–
Assists with examination
Readies equipment for use
Positions the patient
Hands the doctor equipment
Educates patients
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9-38
Neurology Examination
• The neurologist evaluates
– Cognitive function
– Motor system
– Reflexes
– Cranial nerves
– Sensory system
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9-39
Diagnostic Tests
• Electroencephalography – records the
electrical activity of the brain
• Imaging procedures
– Computed
– Skull x-rays
– Angiograms
– Brain scans
• Other tests
tomography
– Magnetic resonance
imaging
– Positron emission
tomography
– Myelography
– Electromyography
– Lumbar puncture
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
9-40
Diseases and Disorders
• Trauma
– Loss of sensation and voluntary
motion
– Paralysis
• AIDS-related neurologic
symptoms
– Meningitis
– Encephalopathy
– Peripheral neuropathies
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9-41
Diseases and Disorders (cont.)
• Encephalopathy
– Alters brain function or structure
– Causes
– Most prevalent sign is altered
mental status
• Other common diseases –
Table 9-4
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
9-42
Apply Your Knowledge
A patient has a seizure disorder and will be having
an EEG. He asks, “What is an EEG? What should I
expect?” How should you answer this patient?
ANSWER: An EEG records the electrical activity of your brain.
They will place electrodes on your scalp and have you rest
quietly or engage in other activities.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
9-43
Oncology
•
Oncologist – specializes in detection and
treatment of tumors and cancerous growths
•
Tumor
–
–
–
–
Lump of abnormal cells
Benign or malignant
Metastasis
Carcinogenesis
•
Medical assistant
– Be aware of types,
symptoms, and
treatments of cancers
– Patient education –
side effects of
treatment
– Family education and
support
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
9-44
Oncology Diagnostic Testing
• Blood specimens – tumor markers
• X-rays
• CT and MRI scans
• Ultrasound
• Biopsy
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9-45
Cancer Treatment
• Surgery
– Removal of all or part
of the tumor
• Radiation therapy
– Radiation to kill or stop
the growth of tumor
cells
• Chemotherapy
– Anticancer drugs to kill
malignant cells
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
9-46
Apply Your Knowledge
What are the three types of treatments for cancer?
ANSWER: Cancers are treated by surgical removal of the tumors,
radiation therapy to kill or stop the growth of tumor cells, and
chemotherapy, which uses anticancer drugs to kill malignant
cells.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
9-47
Ophthalmology
• Ophthalmologists
– Treat the eyes and related tissues
• Medical assistant
– Performs some procedures
• Visual acuity
• Color vision
• Intraocular pressure
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
9-48
Ophthalmology Examinations
•
The interior of the
patient’s eyes using
the
ophthalmoscope
–
–
–
–
•
Retina
Optic nerve
Blood vessels
Visual fields
Glaucoma –
increased intraocular
pressure
•
Refraction exam –
verify need for
corrective lenses
• Slitlamp – used to
examine the anterior
structures of the eye
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
9-49
Diseases and Disorders
• External eye
– Blepharitis
– Ptosis
– Sty
• Front of eye
– Conjunctivitis
– Corneal ulcers and
abrasions
• Internal eye
– Cataracts
– Glaucoma
– Iritis
• Retinal disorders
– Retinal detachment
– Diabetic retinopathy
– Macular degeneration
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
9-50
Diseases and Disorders (cont.)
• Eye movement
– Strabismus
• Children – misaligned
or unbalanced muscles
• Adults – nerves and/or
muscles
• Refractive disorders
–
–
–
–
Myopia
Hyperopia
Presbyopia
Astigmatism
– Amblyopia
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
9-51
Apply Your Knowledge
Match:
ANSWER:
___
H Drooping eyelid
A. Glaucoma
___
E Pinkeye
B. Blepharitis
___
G Cloudy lens
C. Macular degeneration
___
A Increased intraocular pressure
D. Iritis
___
C Loss of central vision
E. Conjunctivitis
___
B Red, swollen, scaly eyelids
F. Sty
___
F Infection of eyelash follicle
G. Cataract
___
D Uveitis
H. Ptosis
I
M
P
R
E
S
S
I
V
E
!
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
9-52
Orthopedics
• Orthopedics
– Focuses on disorders, injuries, and diseases
of the muscular and skeletal systems
• Medical assistant – assists with
– General examinations
– X-rays
– Casting
– Hot/cold treatment
– Patient education
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9-53
Examinations and Procedures
• Assessment by
– Inspection
– Palpation
– Diagnostic tests
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9-54
Examinations and Procedures (cont.)
• Radiographic exams
– X-ray
• Arthroscopy – view
the inside of a joint
– CT and MRI scans
– Angiography
– Discography
– Arthrography
• Bone and muscle
biopsies
• Electromyography
– Bone scans
• Urine and blood tests
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
9-55
Diseases and Disorders
• Back pain
– Muscle strain
– Osteoarthritis
– Tumors
• Fractures
• Common diseases and disorders – Table
9-7
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
9-56
Apply Your Knowledge
What treatments are commonly used for
orthopedic disorders?
ANSWER: Treatments for orthopedic disorders include application
of heat, analgesic or muscle relaxants, exercise therapy, braces,
and traction.
Nice Job!
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
9-57
Otology
• Otologist – treats diseases and disorders
of the ears
• Otorhinolaryngologist – specializes in nose
and throat disorders
• Medical assistant
– Auditory screening
– Assists with diagnostic tests
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9-58
Diseases and Disorders
• Outer ear
– Cerumen impaction
– Otitis externa
– Pruritus
• Middle ear
–
–
–
–
• Inner ear
–
–
–
–
Labyrinthitis
Ménière’s disease
Presbycusis
Tinnitus
Otitis media
Mastoiditis
Otosclerosis
Ruptured eardrum
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
9-59
Apply Your Knowledge
Arrange disorders properly:
Inner Ear
1. Ménière’s
Disease
7. Cerumen
impaction
8. Otosclerosis
Middle Ear
Outer Ear
2. Otitis externa
6. Mastoiditis
9. Labyrinthitis
5. Tinnitus
10. Pruritus
3. Otitis media
4. Ruptured
eardrum
11. Presbycusis
Nice Job!
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
9-60
Surgery
• Surgeons
– Repair wounds and
broken bones
– Repair or remove
diseased or injured
organs, limbs, or
tissues
– Usually specialize in
one field
• Medical assistant
– Presurgical
• Patient education
• OR preparation
• Skin preparation
– Surgical assisting
– Postsurgical
• Decontamination of OR
and equipment
• Dressing wounds
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9-61
Surgery (cont.)
• Biopsy
– Simple surgical procedure
– Types
• Open
• Needle
– Sterile technique required
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9-62
Urology
• Urologist
– Diagnoses and treats
urological disorders
and diseases
• Male and female
urinary system
• Male reproductive
system
• Medical assistant
– Assists with general
exams
– Collects and
processes urine and
blood
– Patient education
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
9-63
Urology Examinations
• Thorough history
– Frequency or urgency
of urination
– Difficulty or pain
– Incontinence
• Palpation – kidneys
and bladder
• Inspection – external
genitalia
• Male reproductive
system
– Inspection
– Palpation
– Testicular self-exam
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9-64
Diagnostic Testing
• Urine and blood tests
• Semen analysis and
smears
• Cystometry
• Cystoscopy
• Testicular biopsy
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9-65
Diseases and Disorders
• Cystitis
• Prostate cancer
• Epididymitis
• STDs
• Hydrocele
• Urethritis
• Impotence
• Kidney stone
• Prostatic hypertrophy
• Prostatitis
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
9-66
Apply Your Knowledge
1. What are the types of biopsies you might assist with
when working for a surgeon?
ANSWER: You might assist with open biopsies and needle
biopsies.
2. What examination should be done by a 27-year-old male
patient to detect cancer?
ANSWER: He should do a monthly testicular selfexamination.
Fantastic!
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
9-67
In Summary
9.1 The medical specialties discussed in this chapter
include allergy, which is diagnosing and treating
allergies, cardiology, dermatology ,endocrinology,
gastroenterology, neurology, oncology,
ophthalmology, orthopedics, otology, surgery, and
urology.
9.2 Exams and diagnostic tests performed in these
specialties are numerous. During most of these
exams and tests your role may include patient safety
and comfort, educating the patient about the
necessary preparation and the procedure, and
assisting the physician.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
9-68
In Summary (cont.)
9.3
Many common diseases and disorders are identified
in the specialty practices. You should have an
understanding of the implications of these diseases
on the patient and the necessary treatments.
9.4
A scratch test is performed to determine if a patient
has an allergic reaction to substances. It involves
scratching the skin with these substances and then
observing the skin for any reaction.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
9-69
In Summary (cont.)
9.5
A sigmoidoscopy is done to examine the rectum,
anus, and sigmoid colon. The patient is placed in
knee-chest or Sims’ position and should be kept safe
and comfortable during the procedure.
9.6
The ophthalmoscope is used to examine the eye. It is
prepared by checking the charge and turning on the
light, replacing the bulb if necessary and attaching the
lens if needed.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
9-70
In Summary (cont.)
9. 7 During a needle biopsy, a piece of tissue is removed
and tested for abnormalities such as cancer. The
medical assistant may position and drape the patient,
clean and dress the site, and assist the physician as
required.
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9-71
End of Chapter 9
Diagnosis is not
the end, but the
beginning of
practice.
~Martin H. Fischer
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.