Bài giảng Clinical procedures - Chapter 8: Assisting with Examinations in the Basic Specialties

8Assisting with Examinations in the Basic Specialties8-*Learning Outcomes8.1 Describe the medical specialties of internal medicine, obstetrics and gynecology, and pediatrics.8.2 Identify the types of examinations and diagnostic tests performed in internal medicine, obstetrics and gynecology, and pediatrics.8.3 Discuss the role of the medical assistant in working in internal medicine, obstetrics and gynecology, and pediatrics.8.4 Identify common diseases related to internal medicine, obstetrics and gynecology, and pediatrics.8-*Learning Outcomes (cont.)8.5 Describe typical treatments for diseases related to internal medicine, obstetrics and gynecology, and pediatrics.8.6 Identify common signs of domestic violence, elder abuse, and child abuse.8.7 Carry out the procedure for assisting with gynecological examinations and procedures.8.8 Carry out the procedure for meeting the needs of a pregnant patient during an examination. 8-*IntroductionSpecialtiesSpecialist – physician with additional training, residencies, and certification Types of examinations and diagnostic testsCommon diseases and disordersMedical assistantAssist with specialty examinations Observe for signs of domestic violence and child abuse8-*The Medical Assistant’s Role in Specialty ExaminationsMedical practice act Defines the exact duties of physicians and other health-care personnelMedical assistants May perform clinical procedures only under the supervision of the physicianState laws vary. You will need to know the scope of practice for medical assistants in the state where you work.8-*The Medical Assistant’s Role in Specialty Examinations (cont.) Providing emotional supportProviding patient educationEffective communicationProvide educational materials Verify understanding8-*Apply Your KnowledgeWhat defines the procedures health-care personnel can perform, and how do you determine what you are able to do as a medical assistant?ANSWER: In addition to education, training, and certification, the state’s medical practice act defines what duties and procedures health-care personnel can perform. As a medical assistant, you have to know your scope of practice for the state where you work.Very Good!8-*Internal MedicineDiagnosis and treatment of disorders and diseases of the body’s internal organsInternist Often first to see patientUses medication and/or treatment modalitiesRefers to a specialist8-*Assisting with the Physical ExaminationUsually the same as a general physical examinationMedical assistant responsibilitiesGathering informationDetect substance abuse, domestic violence, or elder abusePreparing patient for the examination8-*Detecting Substance AbuseSigns vary and depend on Type of drugPatient’s response to the drugReport suspicion of substance abuse to the physicianKnow state requirements for reporting 8-*Detecting Substance Abuse (cont.)Signs of abuseAlcohol – depressed pulse rate, respiration, and blood pressureCocaine – excitation, increased pulse rate and blood pressureHallucinogens – hallucination, poor perception of time and distance, severe panic, violent and bizarre behavior8-*Detecting Substance Abuse (cont.)Inhalants – muscle weakness, hearing loss, changes in heart rate, nausea, and dizzinessMarijuana – reddening of the eyes, increased heart rate, heightened appetite, muscular weaknessNarcotics – drowsiness, depressed respiration, constricted pupils, nausea, vomiting, constipationSedatives – nausea, slurred speech, drunken behavior with no odor of alcohol8-*Detecting Domestic ViolenceSigns of domestic violence – bring to doctor’s attentionInjuries that the patient tries to hide or excuseUnusual bruisingSigns in a patient’s tone of voice or choice of wordsSelf blameReporting suspected domestic violence is mandatory in some statesKeep a list of services available for a victim of abuse8-*Detecting Elder Abuse Difficult to detect – no uniform definitionCan be mistaken for falls or chronic illnessesCategories DomesticInstitutionalSelfTypes Physical, sexual, psychologicalNeglectAbandonmentExploitation Occurs in all racial, socioeconomic, and religious groups8-*Detecting Elder Abuse (cont.) Most victims are older women with chronic illness or disabilitiesRisk factorsHistory of alcoholism, drug abuse, or violence in the familyHistory of mental illness in the abuser or victimIsolation of the victim from family members and friends other than the abuserRecent stressful events affecting the abuser or victim8-*Detecting Elder Abuse (cont.) Observe interactions between patient and caregiverTake careful historyReport suspicions of abuse to physicianSigns of neglectFoul odor from the patient’s bodyPoor skin colorInappropriate clothing for the seasonSoiled clothingExtreme concern about money8-*Diagnostic TestingRadiologic testingX-raysCT scansMRI scansUltrasound Nuclear imagingMedical assistantSet up appointmentsExplain procedures and preps to patient8-*Diseases and DisordersDiseases of agingConstipation-diarrhea cycleHyperlipidemiaOsteoporosisAlzheimer’s diseaseInfectious diseasesLyme diseasePneumoniaRabies Staph and strep infections8-*Diseases and Disorders (cont.)STDsAcquired through sexual contact with an infected personPatient education Prevention Treatment Common types of STDsCandidiasisChlamydiaGenital herpesGenital wartsGonorrheaTrichomoniasis8-*Diseases and Disorders (cont.)ConditionDescriptionAnemiaDeficiency of iron or vitamins; results from blood lossArthritisChronic inflammatory disease of tissues of jointsGoutMetabolic disease caused by the overproduction or retention of uric acidHypertension Blood pressure greater than 140/90; usually asymptomatic Peptic ulcerLesion of mucous membrane of the esophagus, stomach, or duodenum8-*Apply Your KnowledgeWhat are the types of elder abuse, and what is the medical assistant’s role in identification of elder abuse?ANSWER: Elder can be abused physically, sexually, or psychologically. Neglect, abandonment, and exploitation are also forms of elder abuse. The medical assistant should take a careful history, observe interactions between caregiver and patient, observe for signs of abuse, and report suspicions to the physician.Correct!8-*Obstetrics and GynecologySpecialization of the female reproductive systemObstetrician – focuses on caring for women during pregnancy and childbirthGynecologist – focuses on conditions of the female reproductive system8-*Gynecologic Physical ExaminationPurposeOverview of a woman’s health Opportunity for cancer-screening exams and testsFemale assistant should be present during the exam Assist a male doctor Provide legal protectionYour role is similar to that of the general physical examination8-*Gynecologic Physical Examination (cont.)Physician’s interviewEvaluation of total healthReview of factors that may indicate cancer or STDsBreast examCheck for abnormal lumpsPatient educationAnnual mammograms starting at 40 years oldBreast exam by physician annuallyMonthly breast self-examination 8-*Gynecologic Physical Examination (cont.)Pelvic examinationExternal genitalia, cervix, vaginal wall, internal reproductive organs, and rectumSpeculum – expands the vaginal opening Medical assistant’s role Assist the patient into position Assist the doctor8-*Life Cycle ChangesMenstruation Normal cycle of preparation for conceptionMenarche – Onset of menstruation10–15 years of age Prompted by hormonal changes MenopauseCessation of menstrual cycleStages PremenopausePerimenopauseHormonal changes or surgical removal of uterus and ovaries8-*Diagnostic Tests and ProceduresPregnancy test – detect presence of HCG BloodFirst voided urineTests for STDsCultures and blood testsExamining lesionsPatient’s history8-*Diagnostic Tests and Procedures (cont.)Radiologic testsX-raysAvoid if pregnantHysterosalpingography MammogramsUltrasoundsCT scanMRIFetal screening Alpha fetoprotein Abnormal levels can indicate neural tube defectUltrasound 8-*Diagnostic Tests and Procedures (cont.)AmniocentesisTo determine if there is a genetic or metabolic problem with the fetusBiopsy Surgical removal of tissueDiagnose cancersColposcopy Examination of vagina and cervixTo identify abnormal cellsD and CDilation of the cervix and scraping the uterine lining8-*Diagnostic Tests and Procedures (cont.)Fine-needle aspirationRemove a sample of tissue from a cyst, lump, or tumorPap smearUsed to determine presence of abnormal or precancerous cellsHysterectomyRemoval of the uterusHysterosalpingectomyRemoval of uterus and fallopian tubesHysterosalpingo-oophorectomyRemoval of uterus, fallopian tubes, and ovaries8-*PregnancyStagesFirst trimester – conception to 12 weeksSecond trimester – 12 weeks to sixth monthThird trimester – sixth month until birthNägele’s rule – estimate of delivery date Subtract 3 months from first day of last period and add 7 days plus one year8-*Pregnancy (cont.)Physician monitors forPlacenta previaAbruptio placentaGestational diabetesAssisting with prenatal carePatient educationAssist with routine visitInterview patientDocumentation Specimen testingPatient and physician assistance8-*Pregnancy (cont.)Labor – stages First – regular contractions and cervical dilationSecond – complete cervical dilation and entrance of head into vaginaThird – expulsion of the placentaDelivery Baby’s nose and mouth suctionedUmbilical cord clamped, tied, and cutVaginal vs. cesarean sectionApgar testing of newborn8-*Pregnancy (cont.)Breast-feedingHuman milk – preferred form of nutritionColostrum – rich in antibodies that provide passive natural immunity to babyEconomical and convenientProvide educationRefer mother to community resources8-*ContraceptionMethodDescriptionBirth control pillDaily oral contraceptive; inhibits ovulationBirth control patchInhibits ovulation; replaced weekly for 3 weeks, no patch 4th weekInjection Synthetic hormone administered every 3 months; inhibits ovulationCondomWorn on penis or inserted into vagina; barrier to spermDiaphragmBarrier device fits over patient’s cervix; used with spermicide8-*Contraception (cont.)MethodDescriptionSpermicidal foam, cream, jelly, vaginal suppositoriesContain chemicals that kill sperm; inserted into vaginaVaginal contraceptive ringInserted for 3 weeks; removed for 1 weekCervical capSimilar to diaphragm; covers smaller area of cervixIUDSmall piece of plastic or metal inserted into uterus; inhibits fertilization or implantation8-*Contraception (cont.)MethodDescriptionSterilizationSurgical procedure; males – vasectomy; female – fallopian tubes cut or blockedPeriodic abstinenceRhythm method; refraining from intercourse when woman is fertileWithdrawal Withdrawing the penis before ejaculationPostcoital pillsPrevent implantation8-*Obstetrics and Gynecology (cont.)Contraception informationPlanned Parenthood FederationNational Library of MedicineFDAInfertilityInability to conceivePatient educationTestsTreatments8-*Diseases and DisordersConditionDescriptionCancerCommon occurrence in cervix, endometrium(uterus), ovaries; cells divide uncontrollably,eventually forming tumor or other growth ofabnormal tissueEctopic pregnancyFertilized egg unable to move out of fallopian tube into uterus for implantationEndometriosisEndometrial tissue present outside uterus, usuallyin pelvic area; not life-threatening but may causesterility8-*Diseases and Disorders (cont.)ConditionDescriptionFibroids, orleiomyomasCommon, benign, smooth tumors of muscle cells(not fibrous tissue) grouped in uterusFibrocysticbreast diseaseBenign, fluid-filled cysts or nodules in breastMenstrual disturbancesAmenorrhea, dysmenorrhea, menorrhagia, or metrorrhagiaOvarian cystsSacs of fluid or semisolid material; usually benign8-*Diseases and Disorders (cont.)ConditionDescriptionPelvic inflammatory disease (PID)Acute or chronic infection of the reproductive tract; causes include STDs or other organismPelvic support problemsAbnormal weakening of vaginal tissue, unusual increase in abdominal pressure, congenital weakeningPolyps Red, soft, and fragile growths, with slender stem attachment on mucous membranes of cervix or endometrium 8-*Diseases and Disorders (cont.)ConditionDescriptionPremenstrual dysphoric disorder (PMDD)Severe premenstrual syndrome affecting 5% of women; symptoms have disrupting effect on patient’s lifePremenstrual syndrome (PMS)Symptoms include swelling, bloating, weightgain, breast tenderness, headaches, and moodshifts 1 week to 10 days before menstruation8-*Diseases and Disorders (cont.)ConditionDescriptionSexual dysfunction disordersInterruption or lack of sexual response cycle(excitement, plateau, orgasm, and resolution);VaginitisInflammation of vagina caused by bacteria,viruses, yeasts, or chemicals in sprays, douches, or tampons8-*Apply Your KnowledgeANSWER: Tests will probably include:Ultrasound to determine fetal size, position, and number of fetusesAmniocentesis to determine if there are possible genetic or metabolic disorders of the fetus.Alpha fetoprotein to determine if there is a possible neural tube defect.A 38-year-old pregnant patient may be carrying twins. What diagnostic tests may be performed and why?8-*Apply Your KnowledgeANSWER: Nägele’s rule says count back three months [1-December, 2-November, 3-October], then add seven days plus 1 year, [23 + 7 = 30]. Her estimated date of delivery would be October 30th.A patient has just found out she is pregnant. Her last period started on January 23rd. Using Nägele’s rule, what day would be her estimated date of delivery? Right!8-*PediatricsSpecialization in the health care of childrenMonitoring developmentDiagnosing and treating illnessesPediatricianMedical assistant responsibilitiesParent or caregiver educationImmunization scheduleDetection of child abuse8-*Assisting with the Pediatric Physical ExaminationAsk about eating habits, sleep patterns, daily activities, immunization schedules, and toilet trainingAdolescentsSTDs, drugs, and alcoholAwkward and self-consciousRelieve fearExplain proceduresAllow child to examine instrumentsSpeak in terms appropriate to age level8-*Assisting with the Pediatric Physical Examination (cont.)Examining the well child Infants need seven well-baby examinations during their first year at these intervals2 weeks  6 months1 month  9 months2 months  1 year4 months 8-*Assisting with the Pediatric Physical Examination (cont.)Examining the well child (cont.)Children in the second year of life should have checkups at 15 and 18 monthsAnnually after 2 years oldPrepare for exam as you would for an adultFollow Universal Precautions 8-*Detecting Child AbuseWatch for problems in relationship between child and parent/caregiverObserve for unexplained injuriesSigns of abuse Dirty diaperNeglected appearanceHungerExtreme sadness or fearInability to communicateBruises or burnsLesions on child’s genitalia8-*Detecting Child Abuse (cont.)Risk factors for abuseStressSingle parenthoodInadequate knowledge of developmental expectationsLack of family support/family hostilityFinancial problemsMental health problems8-*Detecting Child Abuse (cont.)Physician will examine for:Internal injuries, tenderness when palpated or auscultated Malnutrition, tooth discoloration, unhealthy gumsLack of cognitive ability, dulled neurological responsesYou are legally responsible for reporting suspected child abuse or neglect8-*Assisting with the Pediatric Physical Examination (cont.)Examining for growth abnormalitiesCompare the child’s physical, intellectual, and social signs to national averagesGrowth stagesOne and Two – first and second yearsThree – ages 3 to 5 yearsFour – age 6 years to pubertyFive – adolescence 8-*Assisting with the Pediatric Physical Examination (cont.)General eye examPediatrician examines interior of the eyeVisual acuity testingGeneral ear examChildren more susceptible to ear infectionsDiagnostic testing Most are same as for adultsRapid test for presence of streptococcal bacteriaThroat culturesUrine specimensBlood specimens8-*Assisting with the Pediatric Physical Examination (cont.)ImmunizationsStore vaccines properlyAdminister vaccines correctlyMaintain careful immunizationrecordsEducate parentsFollow recommended schedule for follow-up appointments8-*Diseases and DisordersFrequently seen in pediatric officeCommon childhood diseases (Table 8-2)Upper respiratory infectionsDo not make assumptions regarding diagnosis or treatmentDo not recommend aspirin for fever in children8-*Diseases and Disorders (cont.)ConditionDescriptionAIDSMost transmitted from mother to infant; decreased chance of infected infant if mother is being treatedJuvenile rheumatoid arthritisAutoimmune disease of the joints; occurs in children 16 years or youngerADHD All conditions identified as hyperactivity, hyperkinesis, and attention deficitLearning disabilitiesConditions that interfere with learning, including dyslexia, dysgraphia, and dyscalculia8-*Diseases and Disorders (cont.)ConditionDescriptionCerebral palsyBirth-related disorder of nerves and muscles; caused by brain damage occurring before, during, or after birthCongenital heart diseaseCardiovascular malformations in the fetus before birth; causes include genetic mutations, maternal infections, maternal alcoholism, or maternal insulin-dependent diabetesDown syndromeGenetic disorder due to one extra chromosome in all cells formed during fetal development; characteristic facial features8-*Diseases and Disorders (cont.)ConditionDescriptionHepatitis BInfection of liver; virus can be transmitted from the mother before or during birth; immunization availableRSVMajor cause of lower respiratory infections; highly contagious; difficult to treat; antibiotics only treat any secondary infectionsSIDSUnexplained sudden death of an infant during sleep; usually occurs before 6 months old; “Back to Sleep”8-*Diseases and Disorders (cont.)ConditionDescriptionSpina bifidaDefect of spinal development occurring during the first trimester of pregnancy; spinal cord not fully protected because tissues fail to close around itViral gastroenteritisInflammation of stomach and intestines; can cause dehydration and electrolyte imbalance due to fluid loss8-*Patient and Caregiver EducationAnswer questions appropriatelyAmerican Academy of PediatricsBrochures and booklets8-*Apply Your KnowledgeANSWER: The medical assistant should be sure that vaccines are stored properly, administer vaccines correctly (if within scope of practice), maintain careful immunization records, educate parents, follow recommended immunization schedule for follow-up appointments.What are the responsibilities of the medical assistant relating to immunizations?Super!8-*In Summary 8.1 Internal medicine practitioners diagnose and treat diseases and disorders of the internal organs. An obstetrician/ gynecologist (OB/GYN) specializes in the female reproductive system, cares for pregnant women and delivers babies. A pediatrician specializes in the health care of children.8.2 Examples of exams and diagnostic tests performed in internal medicine, obstetrics and gynecology and pediatrics include the basic physical exam, the gynecological exam, the cervical biopsy, and the well child exam.8-*In Summary (cont.)8.3 As a medical assistant in basic specialties, you might perform or assist with testing such as urine, blood tests, and bacterial cultures. You might educate patients on diseases of aging, infectious diseases, and STDs.8.4 Some common diseases related to internal medicine include hypertension, coronary artery disease, and diabetes mellitus. Childhood diseases include chickenpox, influenza, measles, mumps, rubella, scarlet fever, and tetanus. Examples of diseases related to obstetrics and gynecology include cancer, endometriosis, and fibrocystic breast disease. Other diseases are outlined in Tables 8-1, 8-3, and 8-5.8-*In Summary (cont.)8.5 Typical treatments for diseases related to internal medicine, obstetrics and gynecology, and pediatrics include such things such as local or oral medication, including antibiotics, stress reduction, diet restrictions, and surgery. Treat