Module 3B: General Patient Care 2

Question 1

Emergency

Answer 1

Unforeseen circumstance that requires immediate attention.

Question 2

First aid

Answer 2

The immediate care given to the victim of injury or sudden illness to sustain life and prevent death.

First aid includes basic life support, maintenance of vital functions, prevention of permanent disability, and the reduction of time needed for recovery.

The most common need for first aid is for the treatment of shock, seizures, burns, poisoning, fractures, temperature alterations, and wounds.

Question 3

Cardiopulmonary resuscitation (CPR)

Answer 3

Lifesaving technique that consists of chest compressions combined with artificial ventilation.

Question 4

Surgical asepsis

Answer 4

Techniques to eliminate pathogenic and other potentially harmful microbes related to invasive procedures.

Requires surgical handwashing or scrub, sterile gloves, and sterile technique when handling materials.

Question 5

When is sterile technique required?

Answer 5

Necessary during any invasive procedure (a procedure in which the body is entered), such as making a surgical incision or an open wound.

Question 6

Sterile packets (packages)

Answer 6

Prepared for use in surgical procedures.

Each one can contain either a single instrument, a piece of equipment, or several items packed together.

These packets are autoclaved and have sterilization indicators (tape) and are dated with the date of sterilization.

These instrument packets can be purchased from a medical supply company or packaged by the medical assistant in the office.

Question 7

Primary method of sterilization of instruments and equipment

Answer 7

autoclaving

Question 8

Autoclaving

Answer 8

The process of using high-temperature steam to kill any micro-organisms.

Question 9

Mayo stand

Answer 9

A movable, stainless steel instrument tray on a stand. The tray should be disinfected and allowed to dry. Adjust the stand to slightly above the waist and position it at least 12 inches from the body.

Question 10

Opening a sterile package

Answer 10

*If a prepackaged sterile kit is used, the packet will be placed on the Mayo stand to be opened.

*If creating the sterile field with individually wrapped items, a sterile drape is placed carefully on the Mayo stand to create the sterile field. ​​​​​​​

1. When opening a sterile packet on the Mayo stand, the flap farthest away from the MA should be opened first, followed by the sides.
2. Then the flap closest to the MA should be opened last without reaching over.

*Keep in mind that the inside area of the drape is sterile and that only sterile items should be placed on the drape.

Question 11

Sterile field parameters

Answer 11

A border of at least 1 inch around the sterile drape is considered nonsterile. Therefore, do not place items in this area.

The inside area of the drape is sterile and that only sterile items should be placed on the drape.

Question 12

Once a sterile field is created

Answer 12

• Only sterile objects and health care professionals and providers (who have enacted sterilization procedures) can be allowed within the sterile field
• The sterile area must be within the field of vision and above the waist.
• Do not leave a sterile field unattended, reach over a sterile field, or turn away from a sterile field.
• If items within this field must be rearranged, use sterile forceps.
• If a sterile item must be opened within the instrument setup, then someone wearing sterile gloves must open it.
• If the health care provider wants an additional instrument while performing a procedure, open a sterile packet and drop the instrument carefully onto the sterile field.
• Open packages so that they can easily drop onto the sterile field or be grasped by the health care provider without touching the outer wrapper.

Question 13

Biopsy

Answer 13

The surgical removal of tissue for later microscopic examination.

Purpose:
- Diagnose cancer, skin conditions, or other diseases of the body.

Question 14

Endoscopy

Answer 14

Procedure that uses an endoscope to view a hollow organ or body cavity, such as the larynx, bladder, colon, sigmoid colon, stomach, abdomen, and some joints.

Purpose:
- Evaluate a patient having stomach pain, difficulty swallowing, gastrointestinal bleeding, diarrhea or constipation, and colon polyps.

Question 15

Colposcopy

Answer 15

Examination of the vagina and cervix performed using a colposcope, which is a specialized type of endoscope. With the patient in the lithotomy position, the colposcope allows the health care provider to observe the tissues of this area in detail through light and magnification.

Purpose:
- Examine abnormal tissue development during a routine pelvic examination, when a Papanicolaou (Pap) smear result is abnormal, and to obtain a biopsy specimen.
- Abnormal areas of tissue or cells can then be removed for biopsy to detect cancer.

Question 16

Removal of a foreign object

Answer 16

Surgical removal of an object, such as a small splinter, or a larger object, such as a piece of wood or metal that is embedded in tissue. Splinter forceps are commonly used with this procedure.

Purpose:
- Remove a foreign object to relieve pain and prevent infection.

Question 17

Removal of a small growth (cyst, wart, mole)

Answer 17

Surgical removal of a small growth from the body.

Purpose:
Conduct further examination of the growth, prevent future growth.

Question 18

Cryosurgery

Answer 18

Procedure using local application of intense cold liquid or special instrument called a cryoprobe to destroy unwanted tissue.

Purpose:
- Can be used to destroy abnormal cells and tissues, which uses extremely cold liquid such as liquid nitrogen and an instrument called a cryoprobe.
- Cryosurgery can be used in conjunction with other procedures, such as a colposcopy as a treatment of cervical erosion and chronic cervicitis.

Question 19

Incision and drainage (I & D)

Answer 19

Lancing a pressure buildup caused by pus or other fluid under the skin to allow it to drain and relieve pressure.

Purpose:
- A procedure is performed to relieve the buildup of purulent (pus) material as a result of infection, such as from an abscess.
- The purulent discharge can be cultured to determine what micro-organism is causing the infection and what antibiotic would be effective in treating it.

Question 20

Suturing

Answer 20

The use of any device to close or sew together tissue after an injury or surgery.

The most common method in suturing is the use of specialized thread, or sutures.

Question 21

Sutures

Answer 21

Specialized thread inserted by the health care provider at the end of a procedure to hold tissues in alignment during the healing process.

There are a number of different types of sutures based on size, materials, and absorbability.

Sutures can be made of many different materials and can be absorbable or nonabsorbable.

Question 22

Absorbable sutures

Answer 22

Do not need to be removed and are digested by tissue enzymes and absorbed by the body tissues.

Sutures used to attach tissues beneath the skin (subcutaneous) are often made of an absorbable material that disappears in several days.

Absorption usually occurs 5 to 20 days after insertion.

Question 23

Nonabsorbable sutures

Answer 23

Used on skin surfaces where they can easily be removed after an incision heals.

Sutures generally remain in place five or six days and then must be removed if they are nonabsorbable and include materials such as nylon, silk, polyester fiber, and even stainless steel.

If sutures remain in the body too long, they can cause skin irritation and infection. Suture removal times differ depending on the site

Question 24

Suture sizing

Answer 24

The size of the suture material, which is measured by the gauge or diameter, is stated in terms of “0”—the more 0s, the smaller the gauge.
Ex: 0 is thicker or larger than 6-0 (000000).

*Sizes 2-0 through 6-0 are the most used (Ex: 5-0 Nylon)

• Delicate tissue, such as areas on the face and neck, would be sutured with 5-0 to 6-0 suture sizes because these finer sutures would leave less scarring.
• Heavier sutures, such as 2-0, would be used for the chest or abdomen.

The suture package label will indicate type, size, length of the suture material, and if it is absorbable or nonabsorbable.

Question 25

Staples

Answer 25

Type of wound closure made of stainless steel and applied with a surgical stapler.

• Staples allow for the closure of wounds under high tension, such as on the trunk, extremities, and scalp.
• Shorten the closure time and are used to rapidly close an incision, which helps decrease risk of infection.

Removal: Using a specialized set of extractors, staples need to be removed within 4 to 14 days.

*They are not generally used in delicate tissues or wounds in finely contoured areas, over bony prominences, or in highly mobile areas.

Question 26

Sterile tape

Answer 26

Type of wound closure adhesive. Nonallergenic and available in a variety of widths.

They are used instead of sutures when not much tension will be applied to a wound, such as on a small facial cut.

Question 27

Skin adhesives

Answer 27

Type of wound closure adhesive composed of cyanoacrylate adhesives that react with water to create an instant, strong, flexible bond.

Question 28

Suture removal

Answer 28

A disposable suture removal kit will be used that includes suture scissors and forceps, or a staple removal kit will be used that includes a removal device along with sterile gauze, forceps, sterile gloves, and antiseptic.
1. After proper hand hygiene, open the kit and create a sterile field with the wrapper.
2. Thoroughly cleanse the skin with an antiseptic, such as alcohol or pvidone-iodine solution, and allow to dry.
3. Cut the suture with suture scissors below the knot and as close to the skin as possible.
4. Remove every other suture and then go back and remove the remaining sutures until all sutures have been removed, observing the incision line for separation.
5. Remove the suture by pulling the long remaining suture out.
6. Never pull suture material that is outside the skin through the skin.

Question 29

Staple removal

Answer 29

1. Begin with the second staple of the wound and carefully place the lower tip of the sterile staple remover under the staple.
2. Advance the lower jaw of the staple remover under the staple to be removed.
3. Squeeze the handle together until they are completely closed. This will bend the staple in the middle and pull the edges of the staple out of the skin.
4. Do not lift the staple remover when squeezing the handles.
5. Remove every other staple until all staples have been removed and while observing the site.

Question 30

Complications during suture/staple removal

Answer 30

Gaping, bleeding, or presence of an exudate

*stop and notify the health care provider.

Question 31

Disposal of sutures

Answer 31

biohazard waste container

Question 32

Disposal of staples

Answer 32

sharps waste container

Question 33

What are benefits of wound closure?

Answer 33

Wound closure helps reduce the risk of infection and other complications, aids in the healing process, and minimizes scarring.

Question 34

Complications after wound closure

Answer 34

The patient should notify the health care provider in the case of the following:
- Unusual pain or burning
- Swelling, redness, or other discoloration in the area
- Bleeding or other drainage, including unpleasant odor
- Fever of 100° F or greater (37.7° C)
- ​​​​​​​Nausea and vomiting

Question 35

Most crucial time after an injury or appearance of symptoms

Answer 35

the first hour
- often coined the “golden hour” and correlates with prognosis and the possibility of recovery.

*There has been no evidence to suggest survival rate declines after 60 min; however, rapid intervention in trauma and emergency situations must be provided as soon as possible for the best outcome for the patient.

Question 36

Examples of life-threatening situations

Answer 36

• cardiac arrest (heart attacks)
• respiratory arrest
• uncontrolled bleeding
• head injury
• poisoning
• open chest or abdominal wound
• shock
• third- and fourth-degree burns

Question 37

The MA’s first step in an emergency situation on the phone is to obtain what critical information?

Answer 37

1. The patient’s name, contact information, and location
2. What the situation is and when did it start
3. The status of the patient—conscious, breathing, presence of pulse

Question 38

Emergency medical services (EMS)

Answer 38

System that provides urgent pre-hospital treatment and care.

Question 39

Severe hypoglycemia

Answer 39

Low blood glucose levels are a serious heath risk for patients with diabetes. Also called insulin reaction or insulin shock, it can occur when there is an imbalance between insulin levels and blood glucose in the body.

Sign and Symptoms:
- Mild case: irritability, moodiness or change in behavior, hunger, sweating, and rapid heart rate.​​​​​​​
- Moderate to severe: fainting, seizures, confusion, headache, coma, and potentially death

Treatment/Prognosis:
- Mild or moderate hypoglycemia: the patient’s blood glucose level needs to be raised by consuming foods or liquid high in glucose.
- Severe hypoglycemia: glucagon (a prescription medication) is administered.

Question 40

Hypovolemic shock

Answer 40

This occurs when a patient loses an excessive amount of body fluids or blood. It can result from internal or external hemorrhaging (hemorrhagic shock), prolonged vomiting or diarrhea, or severe dehydration.

Sign and Symptoms
- Thirst, muscle cramping, and lightheadedness—symptoms can progress to chest pain, confusion, lethargy, and death if left untreated.

Treatment/Prognosis:
- Control of blood loss, blood transfusion, and IV fluid replacement.

Question 41

Heat exhaustion or heat stroke

Answer 41

When the body temperature varies too much over its normal range.

Sign and Symptoms:
- Muscle cramping, which results from an electrolyte imbalance caused by loss of sodium from sweating, perspiration, and pale and clammy skin.

Treatment/Prognosis:
- The individual will need to be removed from warm temperatures. Apply any available cold compresses such as ice pack. Death can result from heat stroke if it is not treated quickly.

Question 42

Hypothermia or frostbite

Answer 42

Hypothermia: Abnormal lowering of body temperature, usually resulting from exposure to cold temperatures, immersion on in cold water or being stranded in subzero weather.

Frostbite: the skin and tissue are exposed to freezing temperatures. Tissues are not able to get oxygen supply due to the freezing, causing the tissue to die. The tissues of the nose, ears, fingers, and toes are the most susceptible.

Sign and Symptoms:
- Frostbite: redness and tingling. As damage progresses, the tissue becomes pale and numb.
- Hypothermia: shivering, numbness, confusion, paleness, and eventual loss of consciousness.

Treatment/Prognosis:
- Individual will need to be removed from cold temperatures. Remove any wet clothing. Cover the individual with a blanket. Provide any available warm/dry compresses and any warm beverages.

*Death can result if not treated.

Question 43

Obstructed airway, or choking

Answer 43

Food aspiration while eating. This occurs when partially chewed food enters the trachea when talking, laughing, or coughing when eating.
*In children, small objects that obstruct airway include toys, toy parts, buttons, or candy.

Sign and Symptoms:
- A patient who is choking usually places their hand at their throat. This is often called “conscious choking.” The patient may not be able to cough or speak.

Treatment/Prognosis:
- adults and children older than 1 year of age: abdominal thrusts are effective for forcing an obstruction for the airway
- infants younger than 1 year old: a combination of chest thrusts and back slaps

Question 44

Syncope

Answer 44

Or fainting; brief episode of unconsciousness.
* Syncope is not a disease but the result of an underlying condition or disease.

Sign and Symptoms:
- Pale, perspiring, and complain of nausea or dizziness.

Treatment/Prognosis:
- Aromatic spirits of ammonia capsules, which can be easily broken and used to wake the patient.

*These should not be held directly under the patient’s nose but moved back and forth at least 6 inches away.

Question 45

Sprain

Answer 45

Caused by a stretched or torn ligament

Causes:
- Falling, twisting, or landing on an uneven surface
*The patient can feel a pop or tear when the injury happens.

Sx:
- pain, swelling, bruising, and being unable to move the joint.

Ex: Ankle and wrist sprains are common.

Question 46

Strain

Answer 46

A stretched or torn muscle or tendon.

Causes:
- Trauma to the tissue, such as excessive twisting or pulling these tissues, can cause a strain.
*Can happen suddenly or develop over time.
*Common when playing sports.

Sx:
- pain, muscle spasms, swelling, and trouble moving the muscle

Ex: Back and hamstring muscle strains are common.

Question 47

Ligament

Answer 47

Tissues that connect bones to a joint

Question 48

Tendon

Answer 48

Tissues that connect muscle to bone

Question 49

Strain vs Sprain

Answer 49

Strain: involves muscles and tendons

Sprain: involves ligaments

Question 50

Treatment of sprains and strains

Answer 50

• resting and elevating the injured area
• applying cold compresses
• wearing a bandage or brace
• use of anti-inflammatory medications

*Later treatment might include exercise and physical therapy depending upon the severity of the injury.

Question 51

Dislocations

Answer 51

Occur when a bone end slips out of the socket or when the capsule surrounding a joint is stretched or torn.

Sites:
- Occur usually at any freely moving joint, with the shoulder being the most common.
- Other dislocations can occur at the ankles, knees, hips, elbows, jaw, and finger.

Signs/Sx:
- swollen, very painful, and visibly out of place.
- the patient may not be able to move it.

*A dislocated joint is an emergency, and the patient should seek medical attention.

Question 52

Dislocation treatment

Answer 52

Treatment depends on which joint is dislocated and the severity of the injury. It might include:
- manipulations to reposition the bones
- medication
- a splint or sling
- rehabilitation.

*When properly repositioned, a joint will usually function and move normally again in a few weeks. However, once a shoulder or kneecap is dislocated, it is more likely to dislocate again. Wearing protective gear during sports can help prevent dislocations.

Question 53

Fractures

Answer 53

A break or crack in a bone that occurs when the bone is subjected to more force than it can withstand.

Fractures can be partial or complete, and are classified as either open or closed

Question 54

Closed fractures

Answer 54

aka simple, do not penetrate the skin.

Question 55

Open fractures

Answer 55

aka compound fractures, the bone breaks through the skin and is exposed.

*Open fractures present a greater chance of infection.

Question 56

Fracture treatment

Answer 56

Immobilize the injured area and apply localized cold to the area, such as an ice pack in cloth.

Question 57

Shock

Answer 57

The response of the cardiovascular system to the presence of adrenaline, resulting in capillary constriction.

This causes inadequate circulation of blood to the body tissues, lowered blood pressure, and decreased kidney function.

Causes:
- trauma, electrical injury, insulin shock, hemorrhage (excessive bleeding), or as a reaction to drugs.
- It can occur in conjunction with other injuries or illness such as respiratory distress, fever, heart attack, and poisoning.

Question 58

Anaphylactic Shock

Answer 58

The response of the body to an allergen such as a medication or an insect bite or sting.

Signs and symptoms:
- Early signs and symptoms of shock include pale and clammy skin, weakness, and restlessness. The pulse and respiratory rate are rapid, and vomiting can occur.
- Late signs of shock include apathy, unresponsiveness, dilated pupils, mottled skin, and loss of consciousness, the state of being alert and aware.

Treatment:
- An EpiPen, a preloaded pen filled with epinephrine, is the first line of defense for an anaphylactic shock if it is readily available.

*Shock can result in death if the condition is not reversed.

Question 59

What to do if a patient goes into shock

Answer 59

1. If a patient is going into shock, emergency medical care is critical, and 911 should be contacted.
2. Then, lay the patient down and elevate the legs and feet slightly, unless this can cause the patient pain or further injury, and try to keep the patient still.
3. Continue monitoring the patient’s pulse regularly until emergency services arrive.
4. If the patient stops breathing, begin CPR.

Question 60

Seizure

Answer 60

Uncontrolled muscle activity, that can be caused by high body temperature, head injuries, drugs, and epilepsy.

Question 61

What to do if a patient is having a seizure

Answer 61

During the seizure, steps should be taken to prevent injury to the patient.

1. Help them to the floor if they are sitting or standing.
2. Do not try to restrain them.
3. Move objects out of their way and turn them to the side to prevent aspiration or choking.
4. After the seizure, or the postictal phase, the patient can be confused, complain of headache, and be exhausted.
5. Allow the patient to rest.

Question 62

Poisoning

Answer 62

This can occur in several ways, and most poisoning occurs in the home. Poison can be ingested, inhaled, absorbed, injected, or obtained by radiation.
- Ingestion is the taking in of a substance by eating or drinking.

Signs and symptoms:
- discoloration or burns on the lips, unusual odor, emesis (vomiting), or presence of a suspicious container.
- Emergency care or 911 is needed if the patient presents as drowsy or unconscious, is having difficulty breathing or has stopped breathing, or is having seizures.

While waiting for emergency care, try to remove any poison present on the patient, such as in the mouth, on the skin, or in the eye. Be cautious of aspiration or choking if the patient vomits and continue to monitor the patient’s vital signs in the case CPR is needed.

Question 63

Open Wound

Answer 63

Any break in the skin, whether from injury or a surgical incision, is referred to as an open wound.

Procedure:
- When applying or changing a dressing, the medical assistant should perform proper hand hygiene prior to donning sterile or nonsterile gloves.

Supplies:
- sterile gloves
- surgical mask (can be recommended to avoid exposure of the wound to micro-organisms).

Question 64

Hemorrhage

Answer 64

Escape of blood from a ruptured blood vessel.

Question 65

Wound

Answer 65

Any break in the skin, whether from injury or a surgical incision
- Can be open or closed, intentional through surgical intervention, or accidental through trauma.

Wounds heal based on location, mode of injury, available blood supply, and the patient’s general health status.

There are four types of wound classification:
1. Abrasion
2. Laceration
3. Incision
4. Puncture

Question 66

Abrasion

Answer 66

Outer layers of skin are rubbed away because of scraping; will generally heal without scarring.

Question 67

Incision

Answer 67

Smooth cut resulting from a surgical scalpel or sharp material, such as razor or glass; can result in excessive bleeding and scarring if deep.

Question 68

Laceration

Answer 68

Edges are torn in an irregular shape; can cause profuse bleeding and scarring.

Question 69

Puncture

Answer 69

Made by a sharp, pointed instrument such as a bullet, needle, nail, or splinter; external bleeding is usually minimal, but infection can occur because of penetration with a contaminated object, and there can be scarring.

Question 70

Wound treatments

Answer 70

Treatments for wounds include managing bleeding by applying pressure, proper wound cleaning, and bandaging.

*Deep wounds can require a suture or staple insertion.

Question 71

3 types of hemorrhaging

Answer 71

based on the blood vessels affected:
1. arterial
2. venous
3. capillary

Question 72

Arterial bleeding

Answer 72

Most severe and urgent type of bleeding.

Cause:
- penetrating injury, blunt trauma, or damage to organs or blood vessels.

Identification:
- Arterial bleeding is high pressure, and, thus, the bleeding is bright red in spurts.

Treatment: This type of bleeding can be hard to control because of the pressure in the blood vessels. 1. The first step should be to put pressure on the wound with sterile gauze.
2. Elevate the site of the bleeding.
3. In some cases, a tourniquet will need to be applied, above the site of the bleed, if the bleeding continues. The health care provider should be notified and should advise if a tourniquet should be used.

*If a large artery, such as the aorta, is ruptured or bleeding has occurred for several minutes, this is a potentially life-threatening situation and can lead to death.

Question 73

Venous bleeding

Answer 73

Produces a steady flow of dark red blood.

Treatment:
- Site of the wound should be covered with a clean cloth or gauze, pressure should be exerted on the wound, and the area should be elevated.

Question 74

Capillary bleeding

Answer 74

Capillaries are the smallest blood vessels, and bleeding is minimal.

There will be a small and steady flow of blood from the site, but it will clot on its own within minutes.

Question 75

Wound cleansing

Answer 75

*Must be cleaned before a sterile dressing can be applied.

The health care provider should inspect the wound site and indicate what should be used to clean the wound, such as an antiseptic cleanser.

Cleanse the center of the incision line or wound from the top to the bottom and discard swab. Repeat this step for both sides of the wound.

Question 76

Applying wound dressing

Answer 76

1. Apply sterile gloves and remove sterile dressing from package.
2. Apply over wound, avoiding dragging the bandage. This will prevent dragging more micro-organisms into the wound.
3. Wrap bandage material over wound and securely fasten the bandage with hypoallergenic tape and check circulation.
4. Discard all waste contaminated with body fluids in a biohazard container.

Question 77

Dressing changes

Answer 77

When changing a bandage and dressing, the wound must be cleaned before a sterile dressing can be applied.
1. Using a set of bandage scissors, cut the bandage material, to the side of both the wound and dressing.
2. Remove the bandage without removing the dressing, if possible.
3. Then, carefully remove the dressing by pulling the corners toward the center of the wound.
4. When changing dressings that are stuck to the wound, soak the dressing in sterile saline or sterile water prior to removal.
5. Always take precautions to prevent further contamination of the wound when conducting a dressing change.
6. Once the bandage has been removed, dispose of the bandages, used gauze, and gloves into the biohazard waste container.

Question 78

Dressing vs bandage

Answer 78

Dressings are sterile and covers wounds

Bandages are nonsterile and covers dressing

Question 79

3 phases of wound healing

Answer 79

1. Inflammatory phase (3 to 4 days): Marked by pain, swelling, and loss of function at the site of the wound. Blood clot forms to stop bleeding and plug the opening of a wound.
2. Proliferating phase (4 to 21 days): Fibrin threads extend across the opening of a wound and pull edges together; cells multiply to repair the wound, and eschar or scab begins to form to keep out micro-organisms.
3. Maturation phase (21 days to 2 years): Tissue cells strengthen and tighten the wound closure, forming a scar; scar eventually fades and thins.

Question 80

Inflammation

Answer 80

The body’s protective response to trauma and invasion by micro-organisms; it is generally localized around the site of trauma or infection.

Question 81

Signs of inflammation

Answer 81

Redness (erythema), swelling, warmth, and pain.

Question 82

Wound complications

Answer 82

Occurs if the wound is not properly healing or staying clean, micro-organisms can enter the wound

• Infection (signs of inflammation, swelling, purulent or puslike drainage, fever)
• Hemorrhage or bleeding
• Dehiscence (separation of wound edges)
• Evisceration (separation of wound edges and protrusion of abdominal organs)

Question 83

Dehiscence

Answer 83

Partial or total separation of a wound’s edges.

Question 84

Evisceration

Answer 84

Separation of wound edges and protrusion of abdominal organs.

Question 85

Burns

Answer 85

Result from exposure to heat, chemicals, or radiation.

The severity of a burn is determined by the location, depth, and size. Burns are classified into four degrees according to their depth.

Injury to the face, arms, legs, and genitals are the most critical.

Burns that cover more than 10% of the body surface generally require hospitalization.

Question 86

First-degree burn

Answer 86

A superficial burn that affects only the outer layer of skin tissue.

Signs/Sx:
- The skin becomes red and discolored, and some slight swelling can occur.

*Healing is generally rapid.

Causes:
- sunburn
- a burn caused by immersing part of the body briefly into hot water.

Question 87

Second-degree burn

Answer 87

A partial-thickness burn is one that breaks the surface of the skin and injures the underlying tissue.

Appearance:
- *blisters commonly indicates a second-degree burn
- red or mottled skin

Signs/Sx:
- The skin can become wet when plasma is lost through the damaged skin.
- This type of burn causes greater pain and swelling.

Causes:
- severe sunburn
- exposure to hot liquids or heat

Question 88

Third-degree burn

Answer 88

A deep-thickness burn is deep enough to damage the nerves and bones.

Appearance:
- Tissue burned to the third degree is charred and white.

Sx:
- can cause less pain because the nerves are damaged.

Causes:
- exposure to fire, hot water, hot objects, or electricity.

Question 89

Fourth-degree burn

Answer 89

A deep full-thickness burn goes through both layers of the skin and underlying tissue as well as deeper tissue, possibly involving muscle and bone.

There is no feeling in the area because the nerve endings are destroyed.

Causes:
- flames and chemicals, such as from a hot iron or stove, fireplace, and a building fire.

Question 90

Treatment of Minor Burns

Answer 90

1. Cool the burn by holding the area under cool (but not cold) running water for about 10 min.
   - If the burn is on the face, apply a cool, wet cloth until the pain eases.
   - For a mouth burn from hot food or drink, put a piece of ice in the mouth for a few minutes.
2. After the burn is cooled, apply a lotion, such as one with aloe vera or cocoa butter. This helps prevent drying and provides relief.
3. If a blister appears, do not break it, because this can increase the risk of infection. If a blister does break, gently clean the area with water and apply an antibiotic ointment.
4. Cover the burn with a clean bandage. Wrap it loosely to avoid putting pressure on burned skin. Bandaging keeps air off the area, reduces pain, and protects blistered skin.

*A minor burn might need emergency care if it affects the eyes, mouth, hands, or genital areas. Infants and older adults might need emergency care for minor burns as well.

Question 91

Treatment of Major Burns

Answer 91

Emergency care is needed. Call 911 or seek immediate care.

1. Until help arrives, protect the patient from further harm.
   *Do not try to remove clothing stuck in the burn.
2. Remove jewelry, belts, and other tight items, especially from the burned area and the neck.
   * Burned areas swell quickly, so ensure the patient does not choke.
3. Make certain that the person burned is breathing. If needed, begin CPR.
4. Cover the burn. Loosely cover the area with gauze or a clean cloth.
5. Raise the burned area. Lift the wound above heart level if possible.
6. Watch for signs of shock, such as cool, clammy skin; weak pulse; and shallow breathing.

Question 92

Emergency action plan

Answer 92

a detailed emergency protocol that outlines the steps to be followed in the event of an office emergency. An emergency action plan can include the following:

• Identifying patients who have life-threatening conditions and need immediate care
• Identifying when and who should contact emergency medical services during a crisis situation
• The location of fire extinguishers and emergency evacuation routes​​​​​​​
• Identifying an individual to make sure all needed equipment and supplies are ready for the provider during an emergent situation

Question 93

Crash cart

Answer 93

aka emergency kit; portable cart stocked with emergency supplies, also termed an emergency kit.

*The emergency kit must be checked regularly, such as once a month, and maintained so that its contents are there when needed.

Question 94

Automated external defibrillators (AEDs)

Answer 94

Lightweight, battery-operated, portable devices that check the heart’s rhythm and send a shock to the heart to restore normal rhythm.

Electrodes are attached to the patient who is experiencing cardiac arrest. The electrodes send information about the patient’s heart rhythm to a computer in the AED.

The computer analyzes the heart rhythm to find out whether an electric shock is needed. If it is needed, the electrodes deliver the shock.

Question 95

Epinephrine auto-injector

Answer 95

treatment for anaphylactic shock

Question 96

Naloxone

Answer 96

rapidly reverses an opioid overdose

Question 97

Morphine

Answer 97

treatment for pain

Question 98

Nitroglycerin (sublingual or spray)

Answer 98

treatment for chest pain

Question 99

Albuterol nebulizer

Answer 99

treatment for difficulty breathing, shortness of breath, wheezing

Question 100

Lidocaine

Answer 100

to treat or prevent localized pain

Question 101

Atropine

Answer 101

treatment for bradycardia

Question 102

Normal saline for IV administration

Answer 102

treatment for dehydration

Question 103

Prochlorperazine suppositories

Answer 103

for nausea and vomiting

Question 104

Myocardial infarction

Answer 104

aka heart attack; The flow of blood that brings oxygen to the heart muscle suddenly becomes blocked, and if not restored quickly, the heart muscle will begin to die and cardiac arrest can occur, which is when the heart stops beating.

*An MI and cardiac arrest are life-threatening medical emergencies that require immediate treatment. The longer the patient’s heart is without oxygen, the more damage is done to the heart muscle.

Question 105

Symptoms of an MI

Answer 105

• Chest pain, heaviness, or discomfort in the center or left side of the chest
• Pain or discomfort in one or both arms, the back, shoulders, neck, or jaw or above the belly button
• Shortness of breath when resting or doing a little bit of physical activity
• Excessive sweating for no reason
• Feeling unusually tired for no reason, sometimes for days
• Nausea (feeling sick to the stomach) and vomiting
• Light-headedness or sudden dizziness
• Rapid or irregular heartbeat

Question 106

Emergency medication administration during an MI

Answer 106

*If the patient is still conscious

• the health care provider can administer emergency medication, such as aspirin, nitroglycerin, or thrombolytics to dissolve blood clots that can be blocking the coronary arteries in the heart.
• the health care provider can ask to administer oxygen to the patient via the nasal cannula or face mask.

Question 107

CPR Steps

Answer 107

1. Begin chest compressions by placing the heel of one hand in the middle of the patient’s sternum and the other hand on top of the base hand.
2. Give 30 chest compressions.​​​​​​​
3. Use the head-tilt, chin-lift method to open the airway.
4. Pinch the nose closed and give two slow mouth-to-mouth breaths. The chest should rise and fall with each breath administered.
5. Continue giving sets of 30 chest compressions and two breaths.
6. If the patient recovers and there are no other signs of injury to the back or neck, turn the victim to their side.​​​​​​​

Question 108

Durable medical equipment (DME)

Answer 108

Includes medical devices and supplies that can be used repeatedly.

The most common examples of durable medical equipment used outside of a hospital are:
-dialysis machines
- continuous positive airway pressure (CPAP) machines
- oxygen concentrators and ventilators
- orthotics and prostheses
- bed equipment (hospital beds, lift beds)
- mobility aids (wheelchairs, crutches)
- personal care aids (bath chairs, commodes).

*Oftentimes, DME can be written as DMEPOS for durable medical equipment, prosthetics, orthotics, and supplies.

Question 109

What is necessary to qualify as a DMEPOS?

Answer 109

1. Primarily serve a medical purpose
2. Be prescribed by or ordered by a health care provider
3. Be able to be used repeatedly
4. Have an expected lifetime of at least three years
5. Be used in the home
6. Only be useful to patients who have an injury or disability

Question 110

Which DMEPOS requires prior authorization?

Answer 110

• power wheelchairs
• powered air flotation beds
• powered pressure-reducing air mattresses