Bài giảng Clinical procedures - Chapter 9: Assisting with Highly Specialized Examinations

9Assisting with Highly Specialized Examinations9-*Learning Outcomes9.1 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.9-*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. 9-*Introduction Many physicians choose to specialize The medical assistant working for a specialist willAssist with the examinations Assist with diagnostic testing and processing specimens9-*The Medical Assistant’s Role in Specialized ExaminationsPhysicians that specialize focus on one body system, a single type of disease, or medical interventionMedical assistant roleGeneral administrative and clinical tasksAssist with examinationsand proceduresCommunicate with and educate patients9-*AllergyAllergist – diagnoses and treats allergiesAllergies – inappropriate immune system responses to normally harmless substancesAllergen – substance that causes an allergic reactionAllergic reactions may be localized or systemicAnaphylaxis – life-threatening allergic reaction9-*Allergy ExaminationsInvolves a medical history and diagnostic testingYou must understand the function of the immune system and how allergies are treatedAllergen avoidanceMedicationsDesensitization to a substance9-*Allergy TestingScratch testUsed to test for specific allergiesMay cause discomfort and itchingIntradermal testA dilute solution of allergen into the skinMore sensitive than the scratch testPatch testA linen or paper patch is soaked with an allergenContact dermatitisRASTMeasures blood levels of antibodies to specific allergens9-*Apply Your KnowledgeHow 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.Match the following:___ May be localized or systemic response A. Allergen___ Substances causing an allergic reaction B. Anaphylaxis___ Inappropriate immune responses C. Allergic reaction___ Diagnoses and treats allergies D. Allergies___ Life-threatening reaction E. AllergistEDBACANSWER:2 for 2!9-*CardiologyCardiologist – specializes in heart disease and disordersMedical assistant must be familiar withThe structure of the cardiovascular system Typical examination and measurements Tests performed ElectrocardiographyStress testingEchocardiography9-*Cardiology ExaminationAuscultationBlood pressure Overall cardiac healthPalpationChest wallVessels in extremitiesElectrocardiogram (EKG or ECG) Measures the electrical activity of the heart9-*Cardiology Examination (cont.)Stress test Measures the response to a constant or increasing workloadStress thallium ECGPatient is injected with radioisotope Holter monitor – records ECG over a period of time9-*Radiography and Imaging TechniquesChest x-rayRadionuclide studies Contrast medium ingested or injectedAngiography 9-*Radiography and Imaging Techniques (cont.)UltrasoundEchocardiographyTests structures and function of heartHeart MRIProvides detailed pictures of heart and vessels9-*Radiography and Imaging Techniques (cont.)Cardiac catheterization – catheter is threaded through a vein into the heartObtain blood samplesMeasure pressure in the heart’s chambersView the heart’s motionPerform a balloon angioplastyInsert a stent 9-*Diseases and DisordersCategory Condition/DescriptionArterial/vascularDisorders of arteries or veinsCardiomyopathyDisease of heart muscle causing fatigue and breathing problems and leading to heart failureCoronary artery diseasePartial or complete blockage of major coronary arteriesDysrhythmiasDisorders of heart rhythmHeart failureInability of heart to pump blood effectively, resulting in fluid buildup in tissues and lungsInflammations Infections of heart tissueValvular diseasesHeart valves do not open or close fully9-*Apply Your KnowledgeTrue or False: ___ An ECG tests the function of the heart through sound waves.___ Angiography is an x-ray of a blood vessel after injection of a contrast medium.___ Managing heart conditions often involves lifestyle changes.___ A Holter monitor is only done in an inpatient setting.___ A stress test measures the patient’s response to an increasing workload.___ An endocardiography is a form of ultrasound.TFTTTmost often done on an outpatient basis.echocardiogramFANSWER:Very Good!9-*DermatologyDermatologists – diagnose and treat skin diseases and disordersDisorders Some involve only the skinOthers are a sign of disease elsewhere Medical assistant assists byPositioning and draping during skin exams Taking skin scrapings or wound culturesEducating patients9-*Dermatology ExaminationsWhole-body skin examination Top layer of the entire surface of the skinMagnifying lens and bright lightPhotograph or sketch a lesionWood’s light examinationSkin inspected under ultraviolet lamp in a darkened roomHighlights abnormal skin characteristics9-*Skin LesionsMaculeNodule Papule9-*Skin Lesions (cont.)BullaPustuleUlcer9-*Conditions and DisordersCondition/DisorderDescriptionAcne vulgarisInflammation of the follicles of the skin’s sebaceous (oil) glandsContact dermatitisSkin inflammation caused by irritantsPsoriasisCharacterized by patches of red, thickened skin with silver scales; itchingEczemaSkin inflammationRingwormTinea; fungal infections; dry and scaly or moist and crusty9-*Conditions and Disorders (cont.)Condition/DisorderDescriptionMoles (nevus)Brown, black, or tan spot on the skin; raised or unraised; even coloring, round or oval shape and clear bordersWartsBenign skin tumors from a viral skin infection; common, plantar, and venerealImpetigoHighly contagious bacterial skin infectionHerpes zosterAcute viral infection of nerves under the skin; painful skin eruptions; shinglesScabiesContagious skin disease caused by a mite; intense itching9-*Conditions and Disorders (cont.)Skin cancer Basal cell Small waxy craters with rolled bordersSquamous cell Lesions appear ulcerated or have a crustMore likely to spread to other areas of the body than basal cell carcinomasMalignant melanomaOriginates in cells that produce melaninSpreads through bloodstream or lymphatic system9-*Apply Your KnowledgeMalignant Melanoma Basal Cell CarcinomaName the three types of skin cancers pictured here. Which is the most serious type?Bravo!Squamous Cell ANSWER:9-*EndocrinologyEndocrinologists Treat diseases and disorders of the endocrine systemHormonal imbalances can affect growth, metabolism, and reproductionMedical assistant Assists with examinations Collects specimens for analysis9-*Endocrine ExaminationsThorough medical historyAssessment Skin conditionWeight and cardiac functioning Diagnostic urine and blood tests Ultrasound, X-rays, and iodine scans9-*Endocrine Diseases and DisordersDiabetesType IAutoimmune diseaseDeficiency of insulinType IIResistance to insulinMost common in adultsGestational – only occurs during pregnancyThyroid gland disordersHypothyroidismUnderproduction of thyroxineChildren – cretinismAdults – myxedemaHyperthyroidismOverproduction of thyroxineGraves’ diseaseGoiter – enlarged thyroid9-*Apply Your KnowledgeType I: An autoimmune disease of the pancreas Diagnosed most often in childhoodBody does not produce adequate insulin Treatment includes insulin injectionsType II:Most common form Generally diagnosed in adultsChildhood diagnosis is increasingRisk factors: obesity, inactivity, family historyTreatment may include oral medications or insulinWhat is the difference between Type I and Type II diabetes?ANSWER: Excellent!9-*GastroenterologyGastroenterologists – diagnose and treat disorders of the gastrointestinal (GI) tractMedical assistant Understands the basic elements of GI exam and proceduresPatient education – prepares for the examsAnswers patient questions9-*Gastroenterology ExaminationsMay be invasive based on patient symptomsProvide reassurance and ensure comfortPatient instructionsBring someone to drive homeWhat cautions to take if patient had local anesthetic of the throat9-*Gastroenterology Examinations (cont.)Endoscopy Direct visualization of a body cavityMeans for obtaining tissue biopsies or removing polypsPeroral endoscopy – examination of the esophagus, stomach, and duodenumColonoscopy – examination of the large intestineProctoscopy – examination of the lower rectum and anal canalSigmoidoscopy – examination of the sigmoid area of the large intestine9-*Diagnostic Testing (cont.)Lab testsAnalysis of stomach contentsUrineOccult bloodRadiologic examsCholecystography Gallbladder function test Differentiate between bile duct obstruction and gallstonesUltrasound 9-*Diagnostic TestingRadiologic exams (cont.)Barium swallowDetect abnormalities in the esophagus, stomach, and small intestineBarium enema Detect abnormalities of the large intestineRadionuclide imaging9-*Diseases and DisordersLevel of discomfort may be misleading in relation to severityDocument patient’s symptoms accurately and completely Level of painMedications taken, including OTCs Refer to Table 9-3 for disorders and descriptions9-*Apply Your KnowledgeIdentify the following:_____________ Any procedure using a scope to visualize a  cavity of the body_____________ Provides direct visualization of the large intestine_____________ Visualizes only the S-shaped segment of the  large intestine_____________ Used to visualize the upper GI tract _____________ Examination of the lower rectum and colonendoscopycolonoscopysigmoidoscopyperoral endoscopyproctoscopyANSWER:Scoptacular!9-*NeurologyNeurologists Diagnose and treat diseases and disorders of the central nervous systemMedical assistantAssists with examination Readies equipment for usePositions the patient Hands the doctor equipmentEducates patients9-*Neurology ExaminationThe neurologist evaluates Cognitive function Cranial nervesMotor systemReflexes Sensory system9-*Diagnostic TestsElectroencephalography – records the electrical activity of the brainImaging proceduresSkull x-raysAngiogramsBrain scansOther testsElectromyography Lumbar puncture Computed tomographyMagnetic resonance imagingPositron emission tomographyMyelography9-*Diseases and DisordersTraumaLoss of sensation and voluntary motionParalysis AIDS-related neurologic symptomsMeningitisEncephalopathyPeripheral neuropathies9-*Diseases and Disorders (cont.)EncephalopathyAlters brain function or structureCausesMost prevalent sign is altered mental statusOther common diseases – Table 9-49-*Apply Your KnowledgeA 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.CORRECT!9-*OncologyOncologist – specializes in detection and treatment of tumors and cancerous growthsTumor Lump of abnormal cellsBenign or malignantMetastasis Carcinogenesis Medical assistantBe aware of types, symptoms, and treatments of cancersPatient education – side effects of treatmentFamily education and support9-*Oncology Diagnostic TestingBlood specimens – tumor markers X-raysCT and MRI scansUltrasoundBiopsy9-*Cancer TreatmentSurgery Removal of all or part of the tumorRadiation therapy Radiation to kill or stop the growth of tumor cellsChemotherapy Anticancer drugs to kill malignant cells9-*Apply Your KnowledgeWhat 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.Right!9-*OphthalmologyOphthalmologists Treat the eyes and related tissuesMedical assistantPerforms some procedures Visual acuityColor visionIntraocular pressure9-*Ophthalmology ExaminationsThe interior of the patient’s eyes using the ophthalmoscopeRetinaOptic nerveBlood vesselsVisual fieldsGlaucoma – increased intraocular pressure Refraction exam – verify need for corrective lensesSlitlamp – used to examine the anterior structures of the eye9-*Diseases and DisordersExternal eyeBlepharitis PtosisStyFront of eyeConjunctivitis Corneal ulcers and abrasionsInternal eye CataractsGlaucoma IritisRetinal disordersRetinal detachmentDiabetic retinopathyMacular degeneration 9-*Diseases and Disorders (cont.)Eye movement Strabismus Children – misaligned or unbalanced musclesAdults – nerves and/or musclesAmblyopia Refractive disordersMyopia HyperopiaPresbyopiaAstigmatism 9-*Apply Your KnowledgeMatch:___ Drooping eyelid A. Glaucoma___ Pinkeye B. Blepharitis___ Cloudy lens C. Macular degeneration___ Increased intraocular pressure D. Iritis___ Loss of central vision E. Conjunctivitis___ Red, swollen, scaly eyelids F. Sty___ Infection of eyelash follicle G. Cataract___ Uveitis H. PtosisFGEDCBAHANSWER:IMPRESSIVE!9-*OrthopedicsOrthopedics Focuses on disorders, injuries, and diseases of the muscular and skeletal systemsMedical assistant – assists withGeneral examinationsX-raysCastingHot/cold treatmentPatient education9-*Examinations and Procedures Assessment byInspection Palpation Diagnostic tests9-*Examinations and Procedures (cont.) Radiographic examsX-rayCT and MRI scans AngiographyDiscographyArthrographyBone scansArthroscopy – view the inside of a jointBone and muscle biopsiesElectromyographyUrine and blood tests9-*Diseases and DisordersBack painMuscle strainOsteoarthritisTumorsFracturesCommon diseases and disorders – Table 9-79-*Apply Your KnowledgeWhat 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!9-*OtologyOtologist – treats diseases and disorders of the earsOtorhinolaryngologist – specializes in nose and throat disorders Medical assistantAuditory screeningAssists with diagnostic tests9-*Diseases and DisordersOuter earCerumen impactionOtitis externa PruritusMiddle ear Otitis mediaMastoiditisOtosclerosis Ruptured eardrumInner earLabyrinthitisMénière’s diseasePresbycusisTinnitus9-*Apply Your KnowledgeArrange disorders properly:Inner Ear Middle Ear Outer Ear7. Cerumen impaction4. Ruptured eardrum6. Mastoiditis 10. Pruritus 2. Otitis externa3. Otitis media1. Ménière’s Disease5. Tinnitus 11. Presbycusis 8. Otosclerosis9. LabyrinthitisNice Job!9-*SurgerySurgeons Repair wounds and broken bonesRepair or remove diseased or injured organs, limbs, or tissuesUsually specialize in one fieldMedical assistantPresurgical Patient educationOR preparationSkin preparationSurgical assistingPostsurgicalDecontamination of OR and equipmentDressing wounds9-*Surgery (cont.)Biopsy Simple surgical procedureTypesOpenNeedleSterile technique required 9-*UrologyUrologist Diagnoses and treats urological disorders and diseasesMale and female urinary systemMale reproductive systemMedical assistantAssists with general examsCollects and processes urine and bloodPatient education9-*Urology ExaminationsThorough historyFrequency or urgency of urinationDifficulty or pain IncontinencePalpation – kidneys and bladderInspection – external genitalia Male reproductive systemInspection Palpation Testicular self-exam9-*Diagnostic TestingUrine and blood testsSemen analysis and smearsCystometryCystoscopyTesticular biopsy 9-*Diseases and Disorders CystitisEpididymitis Hydrocele Impotence Kidney stone Prostatic hypertrophy Prostatitis Prostate cancerSTDsUrethritis9-*Apply Your KnowledgeWhat are the types of biopsies you might assist with when working for a surgeon?ANSWER: You might assist with open biopsies and needle biopsies.What examination should be done by a 27-year-old male patient to detect cancer?ANSWER: He should do a monthly testicular self-examination.Fantastic!9-*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.9-*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. 9-*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.9-*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. 9-*End of Chapter 9Diagnosis is not the end, but the beginning of practice.  ~Martin H. Fischer