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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. 1 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. 2 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. 3 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. 4 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. 5 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. 6 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. 7 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. 8 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. 9 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. 10 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 11 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 12 Diseases and Disorders Diseases of Aging Constipation-diarrhea cycle Hyperlipidemia Osteoporosis Alzheimer’s diseases Infectious diseases Infectious mononucleosis Lyme disease Pneumonia 13 Sexually Transmitted Diseases Diseases acquired through sexual contact with an infected person. Candidiasis Chlamydia Genital herpes Genital warts Gonorrhea Trichimoniasis 14 Apply Your Knowledge What are symptoms seen in patients who are abusing inhalants? 15 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. 16 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. 17 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. 18 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 19 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. 20 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. 21 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 22 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. 23 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 24 Pediatric Diseases and Disorders (cont). Sudden Infant Death Syndrome Spina Bifida Viral Gastroenteritis 25 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.) 26 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 27 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. 28 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? 29 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. 30 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. 31 Therapeutic Procedures Amniocentesis – performed when genetic or metabolic defect is suspected Biopsy – surgical removal of tissue that assists with determining cancer. 32 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 33 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. 34 Prenatal Care Assisting with prenatal care Help teach and support both the parents. Patient education is important Assist with routine prenatal patient visit 35 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. 36 Apply Your Knowledge A pregnant patient of 38 years may be carrying twins. What diagnostic tests may be performed and why? 37 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 38 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? 39 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. 40 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. 41 End of Chapter 42