Medical Assistant Skills

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Medical Assistant Skills

• Medical Professions Education II
• Diversified Health Occupations
• Pages 567- 614

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Medical Assistant SkillsOBJECTIVES

• Upon Completion of this unit, the student should
  be able to
• 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

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Medical Assistant SkillsMeasuring /Recording
Height Weight

• Are you concerned with how much you weigh?
• Why are people interested with their weight and
  height?

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Medical Assistant SkillsHeight 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?
• Admittance to hospital, LTCF, or other health
  care agency
• General exam
• At times during certain laboratory exams
• For calculating dosage for certain medications

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Medical Assistant SkillsHeight and Weight

• For calculating dosage for certain medications
• Height, weight, and head circumference is checked
  frequently on infants and toddlers
• 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 childs growth and
  compare it to the average percentiles of other
  children the same age
• Abnormal growth patterns may indicate nutritional
  deficiencies or genetic diseases

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Medical Assistant SkillsHeight and Weight

• 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

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Medical Assistant SkillsHeight and Weight

• SAFETY!!!
• WATCH THE PATIENT CLOSELY AT ALL TIMES
• PREVENT FALLS FROM THE SCALES
• AVOID POSSIBLE INJURY FROM THE PROTRUDING HEIGHT
  LEVER

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Medical Assistant SkillsHeight and Weight

• Most pts. are very WEIGHT conscious!
• Make only POSITIVE statements while weighing a
  patient!

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Medical Assistant SkillsSCALES

• A wide variety of scales are used to obtain
  measurements
• CLINICAL SCALES
• Contain balance beam for measuring weight
• Have measuring rod for determining weight
• INFANT SCALES
• Provide an area for placing infant in a lying
  down or flat position
• SPECIAL SCALES
• Bed scale w/mechanical lift
• Wheelchair scale

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Medical Assistant SkillsRECORDING WEIGHT

• Recorded as lbs. and ozs or as kg. (2.2lbs)
• Most scales measure lbs. in ¼-pound increments
• Metric scales use kg with 0.1-kg (1gram)
  increments

• 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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Medical Assistant SkillsRecording Weight

• Adult scale, cont.
• Bottom scale is usually in 50-lbs increments
• EXAMPLE
• Bottom scale is set at 100 lbs.
• Top scale is set at 24 ½ pounds
• 100 24 ½ 124 ½ pounds
• PATIENTS WEIGHT IS 124 ½ LBS.

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Medical Assistant SkillsRecording Weight

• Infant Scales
• Varysome 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
• To convert 8 ounces to a fraction of a pound,
  divide by 16 (16 ounces 1 pound)
• 8/16 ½ pounds
• EXAMPLE
• Infant weighs 8lbs 4 ozdivide only the ozs. by
  16.
• 4/16 ¼
• TOTAL WEIGHT 8 ¼ POUNDS

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Medical Assistant SkillsRecording Height

• 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

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Medical Assistant SkillsRecording Height

• 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

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Medical Assistant SkillsRecording Height

• Height for adults is recorded in feet and inches
• Inches must be converted
• Remember there are 12 inches in 1 foot
• Divide 12 into the number of inches obtained
• EXAMPLE
• Measurement recorded is 64 inches
• 12/ 64 ½ 5 ft 4
  ½ inches

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Medical Assistant SkillsRecording Height

• TAPE MEASURE FOR INFANT HEIGHT
• 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

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Medical Assistant SkillsHeight and Weight

• 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

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Medical Assistant SkillsHeight 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 infants 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 SkillsPOSITIONING

• 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
• 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

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Medical Assistant SkillsPOSITIONING

• 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

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Medical Assistant SkillsPOSITIONING

• 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
• 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

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Medical Assistant SkillsPOSITIONING

• HORIZONTAL RECUMBENT OR SUPINE POSITION
• 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

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Medical Assistant SkillsPOSITIONING

• PRONE POSITION
• 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

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Medical Assistant SkillsPOSITIONING

• SIMS OR LEFT LATERAL POSITION
• 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

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SIMS OR LEFT LATERAL
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Medical Assistant SkillsPOSITIONING

• KNEE-CHEST POSITION
• 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
• 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

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KNEE-CHEST
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Medical Assistant SkillsPOSITIONING

• KNEE-CHEST POSITION, cont.
• Safety precautions!!!
• Remain with the pt at all times while in the
  knee-chest 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

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Medical Assistant SkillsPOSITIONING

• FOWLERS
• 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 pts head
• Flex knees slightly and place small pillow under
  knees
• Drape with a large sheet or drape
• Dont tuck sheet! )

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Fowlers

• Low- Fowlers head elevated at 25 angle
• Mid-fowlers or semi Fowlers- head elevated at
  45 angle

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Fowlers

• High Fowlers- head elevated at 90 angle

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Medical Assistant SkillsPOSITIONING

• LITHOTOMY POSITION
• Used for vaginal examinations, pap tests, urinary
  catherization, cystoscopic examinations, and
  surgery of the pelvic area

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Medical Assistant SkillsPOSITIONING

• LITHOTOMY POSITION
• 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

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Medical Assistant SkillsPOSITIONING

• LITHOTOMY POSITION
• 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

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Medical Assistant SkillsPOSITIONING

• DORSAL RECUMBENT POSITION
• Similar to lithotomy position and used for same
  purposes

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Medical Assistant SkillsPOSITIONING

• TRENDELENBURG POSITION
• 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
• 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
• use straps to secure pt in this position
• Remain with patient at all times

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Medical Assistant SkillsPOSITIONING

• STANDARD TRENDELENBURG POSITION
• 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

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Medical Assistant SkillsPOSITIONING

• 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

SURGICAL TRENDELENBURG POSITION
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Medical Assistant SkillsPOSITIONING

• JACKKNIFE POSITION
• 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

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JACKKNIFE POSITION
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Medical Assistant SkillsBasic Principles for
Positioning

• 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
• To change positions
• 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
  positionSLOWLY
• Assist pt off of table

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VISUAL SCREENINGS

• Vision screening test
• Often given as a part of a physical examination
• Given to detect eye disease

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VISUAL SCREENINGS

• SNELLEN CHARTS are frequently used to test vision
• Some contain pictures for use with small children
• Some contain the letter E in a variety of
  positions
• TUMBLING E
• Common type contains letters of the alphabet

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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
• 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

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VISUAL SCREENINGS

• INTERPRETATION OF READINGS ON SNELLEN CHART
• Top number represents the distance the patient is
  standing from the chart
• 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

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VISUAL SCREENINGS

• BASIC PRINCIPALS FOR SCREENING VISION WITH A
  SNELLEN CHART
• 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

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VISUAL SCREENINGS

• INTERPRETATION OF READINGS ON SNELLEN CHART
• A person has 20/30 vision
• 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
• 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

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VISUAL SCREENINGS

• Test for color blindness
• 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

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VISUAL SCREENINGS

• IMPORTANT TERMS OR ABBREVIATIONS
• OD oculus dexter or RIGHT EYE
• OS oculus sinister or LEFT EYE
• OU oculus uterque, each eye or BOFOFUM
• Myopia nearsightedness defect in distant
  vision
• Hyperopia farsightedness defect in close
  vision
• Ophthalmoscope instrument for examining the eye
• Tonometer instrument to measure intraocuolar
  tension or pressure increased pressure often
  indicated glaucoma

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Assisting with Physical Exams

• 3 Major kinds of examinations
• EENT (eye, ear, nose, and throat exams
• Examines only these parts of the body
• Uses special equipment to examine these areas
• GYN (gynecological exams)
• 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

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Assisting with Physical Exams

• 3 Major kinds of examinations, cont.
• 3. CHECK-UP (general or complete physical exams)
• 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

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Assisting with Physical Exams

• TECHNIQUES USED DURING THE EXAMINATION
• Observation or inspection
• Palpation
• Percussion
• Auscultation

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Assisting with Physical Exams

• EQUIPMENT USED FOR EXAMS
• 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

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Assisting with Physical Exams

• Preparing the Patient
• 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

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Preparing the Patient

• TESTS DONE PRIOR TO EXAM
• Height and weight
• Vital signs
• Vision screening
• Audiometric screening

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Assisting with Medical Exams

• Be prepared to assist as needed during
  examinations
• Hand equipment to MD as needed
• Position pt correctly for each part of exam
• Pay attention so you are ready to help with each
  procedure

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Assisting with Medical Exams

• Observe standard precautions at all times
• Wash hands frequently
• Wear gloves if contact with blood or body fluids
  is likely
• Wear other PPE accordingly
• Clean and disinfect or sterilize any instruments
  or equipment contaminated with blood or body
  fluids
• Be aware of and take steps to prevent the spread
  of infection

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Assisting with Medical Exams

• The Doctor is IN!
• (refer to handout)