Bài giảng Medical Assisting - Chapter 40: Assisting with Examinations in the Basic Specialties

ChapterPowerPoint® to accompany Second EditionRamutkowski  Booth  Pugh  Thompson  WhickerCopyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.Medical AssistingChapter 401Objectives: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.Assisting with Examinations in the Basic Specialties 2Objectives (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.Assisting with Examinations in the Basic Specialties3Introduction Medical practice act is a law that defines the exact duties physicians and other health care personnel may perform.Medical assistants are allowed to perform clinical 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.4Specialty Examinations Specialties are physicians who have taken additional training beyond medical school and their residencies.They must pass rigorous examinations in their chosen specialty.5Internal MedicineDiagnosis 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.6Assisting with the Physical ExaminationUsually 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. 7Detecting Substance AbuseSigns of abuseAlcohol - 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.8Detecting Domestic ViolenceReport Injuries that the patient tries to hide or excuseUnusual bruisingSigns in a patient’s tone of voice or choice of wordsReporting suspected domestic violence is mandatory in some states.Keep list of services available for patient handy.9Detecting Elder Abuse Occurs in all racial, socioeconomic and religious groupsRisk 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.10Detecting Elder Abuse (cont.)Signs of neglect:Foul odor from the patient’s bodyPoor skin colorInappropriate clothing for the seasonSoiled clothingExtreme concern about money11Diagnostic TestingMeasurement of arterial blood gasesRadiologic testsChest x-rayComputed tomography (CT)Magnetic resonance imaging (MRI)Venography and venous ultrasonographyRadionuclide imaging12Diseases and DisordersDiseases of AgingConstipation-diarrhea cycleHyperlipidemiaOsteoporosisAlzheimer’s diseasesInfectious diseasesInfectious mononucleosisLyme diseasePneumonia13Sexually Transmitted DiseasesDiseases acquired through sexual contact with an infected person.CandidiasisChlamydiaGenital herpesGenital wartsGonorrheaTrichimoniasis 14Apply Your KnowledgeWhat are symptoms seen in patients who are abusing inhalants?15Apply Your Knowledge –AnswerInhalants users can have muscle weakness, hearing loss, changes in heart rate, nausea and dizziness.What are symptoms seen in patients who are abusing inhalants?16PediatricsSpecializes 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.17Assisting with the Pediatric Physical ExaminationAsk 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.18Assisting with the Pediatric Physical Examination (cont.) Examining the Well ChildInfants need seven well-baby examinations during their first year at these intervals2 weeks,1 month2 month4 month6 month9 month1 year19Assisting with the Pediatric Physical Examination (cont.)Examining the Well ChildChildren 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.20Examining for ScoliosisAn 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.21Detecting Child Abuse or NeglectNotice signs of physical injuryBruises or burnsLesions on child’s genitaliaDirty or neglected appearanceHungerExtreme sadness or fearInability to communicate22Detecting Child Abuse or Neglect (cont.)Physician will exam 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 neglect.23Pediatric Diseases and DisordersAIDSAttention Deficit Hyperactivity Disorder and Learning Disabilities (ADH)Cerebral PalsyCongenital Heart DiseaseDown SyndromeHepatitis BRespiratory Syncytial Virus24Pediatric Diseases and Disorders (cont). Sudden Infant Death SyndromeSpina BifidaViral Gastroenteritis 25Obstetrics and GynecologySpecializes in the female reproductive system.Focus on caring for women during pregnancy and childbirth (obstetricians.)Focus on conditions of the female reproductive system (gynecologists.)26Assisting with the Gynecologic Physical ExaminationProvides 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 examination27Pelvic ExaminationThe 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.28Apply Your KnowledgeWhat is the correct position to have a patient assume for a pelvic examination and how should you assist the patient in assuming this position?29Apply Your Knowledge -AnswerLithotomy - Assist the patient into position, with her feet in the stirrups of the examining table and her buttocks at the end of the table.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?30Diagnostic Tests and Procedures Pregnancy tests –Human Chorionic Gonadotropin Tests for STDsRadiologic TestsUltrasoundCT and MRIHysterosalpingograph – 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.31Therapeutic Procedures Amniocentesis –performed when genetic or metabolic defect is suspectedBiopsy – surgical removal of tissue that assists with determining cancer.32Therapeutic Procedures (cont.)Colposcopy – examination of the vagina and cervix with a colposcope.Fine needle aspiration – obtain sample of cyst, lump or tumor of breastHysterectomy – removal of the uterusLaparoscopy – view internal female organsPap smear – determine presence of abnormal or precancerous cells The physician may use needles or other instruments to obtain tissues or amniotic fluid samples33PregnancyFirst trimester – conception to 12 weeksSecond trimester – 12 weeks to sixth monthThird 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.34Prenatal CareAssisting with prenatal careHelp teach and support both the parents.Patient education is importantAssist with routine prenatal patient visit35Assisting with Prenatal VisitsYou 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.36Apply Your KnowledgeA pregnant patient of 38 years may be carrying twins. What diagnostic tests may be performed and why?37Apply Your Knowledge -AnswerUltrasound – to determine fetal size and positionAmniocentesis – determine genetic or metabolic disorder of the fetus.Alpha fetoprotein – measured in the amniotic fluidA pregnant patient of 38 years may be carrying twins. What diagnostic tests may be performed and why?38Apply Your KnowledgeA 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? 39Apply Your Knowledge -AnswerNagele’s rule says count back three months [1-December, 2-November, 3-October], then add seven days, [23 + 7 = 30]. Her estimated date of delivery would be October 30th.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? 40Summary 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.41End of ChapterEnd of Chapter42