Module 9 - Patient Care Flashcards
Good interviewing techniques
Use Active listening, open-ended questions
Restatement, reflection, and clarification
Be aware of nonverbal communication - posture, gesture, eye contact
Parts of the intake process/rooming
Obtaining chief complaint: subjective information from pt
Performing a drug reconciliation: update med list
Documenting allergy status
Completing personal and family history: objective information, collected once and routinely reviewed
Preventive services/screenings: Often performed during routine exams, includes visual acuity testing, measurements, mini-mental state examinations for dementia, etc
Normal temperature readings
Oral, Tympanic, Temporal: 98.6F
Axillary temperature: 97.6F
Rectal temperature: 99.6F
+- 1 degree
Proper palpation technique for heart rate, three main pulse sites
Use second and third fingers; push artery against a bone
Radial - thumb side of wrist, most common site
Brachial - inside the upper arm, most common for children
Carotid - in the neck just below the jaw bone, most common for emergency
Proper auscultation technique for heart rate
Listening to the heart beat at the apex of the heart, can be incorporated when taking blood pressure
Factors for evaluation of pulse
Rate, rhythm, strength
Ex: 70/min, regular, thready
(thready = faint, bounding = strong)
Normal adult heart rate
60 to 100/min; younger than 15 have faster heart rate
Factors for evaluation of respirations
rate, rhythm, depth
Normal adult respirations, newborn respirations
Adult 12 to 20, newborn 30 to 50
Abnormal sounds during respiration evaluation
Wheezing (high pitched, narrow airways), rales (small clicking or bubbling), rhonchi (sounds that resemble snoring)
Notify provider
Blood pressure manual measurement; what does systolic and diastolic pressure indicate
Systolic is when first tapping sound is heard, blood begins to surge into artery occluded by cuff.
Diastolic is when last sound disappears completely, blood is flowing freely.
Korotkoff sounds
Distinct sounds heard through the cardiac cycle;
Phase I: systolic pressure; blood begins to surge into artery
Phase II: swishing sound as more blood flows through artery
Phase III: sharp tapping as more blood flows
Phase IV: soft tapping which begins to muffle
Phase V: Diastolic pressure
Normal blood pressure readings, hypertension readings
Infants and children: 100-80 / 30-60
Adult: 100-140 / 60-90
Hypertension is 140/90 or higher; 120-139/80-89 is prehypertension
Pulse oximetry locations, possible interferences, normal result
Locations: Finger, toe, earlobe
Nail polish, anything that blocks light can interfere
Reading of 95% or higher considered normal
Interpreting pain
Observe the patient to gather cues: grimacing, holding body parts
Ask patients to rate pain on scale of 1 to 10. Can ask additional questions to determine location, onset, characteristics, whether methods for relief have been effective
Anthropometric measurements
Height, Weight, BMI, and head circumference (pediatrics)
Method for determining height
Patients should stand erect looking forward without shoes. Leveling bar needs to sit squarely on top of head
Method for determining weight; lb to kg conversion
Obtain in private area, be timely and efficient.
Make sure scale is balanced, review record to determine baseline weight.
Assist patient on and off scale, monitor stability as needed
1 lb = 2.2 kg
BMI calculation and interpretation
weight in kg / height in m^2
18.5 to 24.9 is considered normal
<18.5 is underweight
>24.9 is overweight
>30.0 is obesity
Methods for determining height, weight, head circumference in an infant/small child
Height: Lay the infant flat on a paper-covered table. Record from top of head to heel of flexed foot.
Weight: Weigh infants without clothing or diaper, use infant scale if possible
Head circumference: Using a tape measure, measure at widest area (right across eyebrows). Repeat to confirm results
Fowler’s position
Sitting with exam table raised. “sitting position”. Used for exams involving eyes, ears, nose, throat, chest.
Low-Fowlers = 15 to 30, Semi-Fowlers = 30 to 45, High-Fowlers = nearly vertical (90*)
Sims’ position
“lateral position” Lying on the left side with the left leg slightly flexed and the right leg flexed at a 90* angle. Can involve a pillow placed between the knees. Exams involving the rectum, enemas
Knee-chest position
Prone and bent at the waist resting on the knees with the arms above the head.
Gynecological or rectal exams, treatments of spinal adjustments
Jack-knife position
Lying over an exam table that is lifted in the middle.
Rectal exams or instrumentation
Lithotomy position
Lying flat on the table with buttocks at the end of table and feet resting in stirrups.
Female pelvic exams
Dorsal recumbent
Lying flat on back with knees bent.
Catheterizations
Genital examination of younger children
Prone
Lying flat on the abdomen with the arms above the head.
Exams involving the back of the body, including bottoms of feet.
Supine
Lying flat on the back with the arms down to the side.
Exams involving the front of the body, administration of CPR.
Trendelenburg/ modified trendelenburg
Legs elevated above the head to force circulation to vital organs
Shock (requires a specific table)
What is necessary before an injection?
Name of medication, dosage, time, route of administration.
Need consent for administration.
Tell the patient what the medication is, what it is given for, dosage, and route.
Check the medication three times: first to compare order to medication, second after medication is prepared, and third immediately prior to administering medication
Necessary equipment/supplies for an injection
Correct syringe and needle, alcohol swabs to wipe off vial/skin preparation, gauze pad to apply pressure after administration.
Adhesive bandage available if there is bleeding at the site.
Sharps container located nearby.
Biohazard container for disposal of other contaminated items.
Nonsterile gloves and appropriate PPE for invasive procedure.
Proper needle safety per OSHA
Easily accessible sharps container, self-sheathing or safety needles. Never recap a used needle.
How to keep equipment sterile before injection
Needles and syringes must be sterile. Check expiration date of solutions, evaluate container integrity.
Use alcohol swabs on vial stopper. Do not introduce the needle into the vial more than once - dulls the needle and increases likelihood of contamination.
Do not allow solutions to run down needle. Do not place exposed needle on tray or countertop. Only recap clean needle if absolutely necessary.
Needle gauge and length; requirements for intradermal, subcutaneous, and intramuscular injections
Gauge range from 14 (largest) to 31 (smallest)
Length ranges from 3/8 to 4 inches
Intradermal: 27-28 gauge, 3/8 in
Subcutaneous: 25-26 gauge, ~1/2 in
Intramuscular: 20-23 gauge, 1-3 in
Finding intramuscular injection sites and use case: Deltoid, Ventrogluteal, Vastus lateralis
Deltoid: 1-2 inches below acromion; used for many vaccines, > 3 yrs old, dose usually less than 1ml
Ventrogluteal: Palm over greater trochanter of femur, use opposite hand for hip (thumb facing anterior). Place middle finger on posterior iliac crest and spread index finger. Give injection where the V is made between the index and middle finger; site is used when deep IM injections are prescribed or when larger quantities of medicines are needed
Vastus lateralis: mid to upper outer thigh; used for vaccines and medication < 3yrs old
Technique/angle for intramuscular injections, proper site
90* angle, do not aspirate vaccines but do aspirate most other types of medications
Either Deltoid, Ventrogluteal, or Vastus lateralis depending on use case
Technique/angle for subcutaneous injections, proper site
45* angle, do not aspirate for vaccines, insulin, or heparin but do aspirate for most other types of medications
Do not massage site for heparin or insulin
When used regularly, sites should be rotated; common sites are upper outer arm, abdomen, thigh
Technique/angle for intradermal injections, proper site
10-15 angle, do not aspirate; used for testing, do not massage or apply presssure, presence of wheal is expected
When using the forearm, measure using one hand width from the wrist and one hand width from the elbow. Any area within the anterior forearm is acceptable.
Upper back may also be used
How to read measurement of oral liquid dose
Read liquids at lowest point of curve of the liquid (meniscus)
Buccal route of medication; definition and technique
Between the cheek and gums, rapid absorption bypassing digestive system (lower doses required)
Medication is designed to melt there, patient should not chew, swallow
Eating, drinking, or smoking can influence absorption rate.
Sublingual route of medication; definition and technique
Under the tongue, nitroglycerin tablets/spray are common forms of medication administered, bypasses digestive system (lower doses required)
Eating, drinking, or smoking can influence absorption rate.
Inhalation route of medication; definition and technique
Typically used for targeted areas such as the bronchial passages, can be delivered via a nebulizer. For the medication to be effective, patient must hold the medication in lungs as long as possible. Coach on proper breathing techniques
Topical route of medication; definition and technique
Designed to react locally and systemic absorption is minimal.
Can serve as a barrier to prevent irritants from damaging skin or used to treat a local skin condition.
Monitor for skin irritation or reaction.
Mucosal route of medication; definition and technique
Designed to absorb into and through mucous membranes. Can be nasal, vagina, rectum, eye, or ear.
Can cause irritation to the mucosa, ensure patients understand the correct procedure for administering the medication based on the medication and route.
Transdermal route of medication; definition and technique
For continuous slow absorption of various medication; used for smoking cessation, pain medication, hormone delivery.
Avoid touching medication, dispose of carefully, rotate sites and monitor for irritation.
Proper storage of medication and logs
According to directions in original container - may need to be refrigerated or protected from light. Controlled substances must remain locked and secured.
Log book and daily count by two people required for controlled substances.
Technique for administering medication to the ears or eyes; or topical
Ensure medication is at room temperature, wear gloves. Do not allow tip of containers to come in direct contact with the patient
Technique for irrigation of eyes and ears
Solution should be room temperature, patient should be positioned based on the route of irrigation.
Do not allow eye irrigation to flow down the tear duct. Do not irrigate ear if ruptured tympanic membrane
Definition of triage
Define the sorting of patients according to a system of priorities, designed to maximize the success of treatment
Definition of abrasion; emergency procedure
Superficial scrape or rub; apply pressure if bleeding -> clean/flush to remove debris -> apply bandage
Definition of incision; emergency procedure
Open injury typically caused by a sharp object causing a straight cut, bleeding can be profuse; apply pressure until bleeding is controlled -> clean gently to not reinitiate bleeding -> apply bandage
Definition of laceration; emergency procedure
Open injury jagged in nature, caused by sharp object, bleeding can be profuse; apply pressure until bleeding is controlled -> clean gently -> apply bandage
Definition of puncture; emergency procedure
Open wound caused by stabbing instrument, usually small with limited bleeding; apply pressure if bleeding -> clean or flush to remove debris -> apply bandage
Definition of contusion; emergency procedure
Close injury/bruise, caused by blunt-force trauma, ranges in severity based on trauma received and the location; Apply cold pack or ice -> Elevate limb if affected -> observe for signs of increased intracranial pressure if on head (would require immediate emergency care)
Definition of concussion; emergency procedure
Closed head trauma in which the brain has been jolted or shaken; Measure vital signs -> observation -> Provider assessment and possible CT scan
Definition of strain vs sprain; emergency procedure
Strain is muscle <-> bone tearing/stretching, Sprain is bone <-> bone; Emergency procedure RICE (Rest, Ice, Compression, Elevation)
Definition of fracture; emergency procedure
Break in bone, open indicates a break in skin; Control bleeding -> Immobilize area -> Apply ice -> Check pulse below site -> Treat for shock
Anaphylaxis; emergency procedure
Severe allergic reaction with circulatory shutdown and respiratory distress, results in shock; Extreme emergency!: provide life support, administer oxygen and epi based on provider order, call 911
Acute abdominal pain; emergency procedure
General potentially life-threatening symptom; obtain chief complaint, keep patient NPO, have emesis basin available, keep patient warm but do not apply heat, monitor vital signs, observe for signs of shock -> describing severity, quadrant, or abdominal regions assists in diagnosing the condition
Bleeding emergencies; emergency procedure
Internal or external, bleeding depends on blood supply in location. Arterial bleed is more of a crisis; Apply pressure, elevate the site if possible, apply ice, limit movement, keep the patient quiet, monitor vital signs and observe for signs of shock
Burns; emergency procedure (first through third)
Severity is based on location, extent of body surface affected, degree of tissue involvement. Can be electrical, chemical, thermal
First degree: first layer of tissue
Second degree: subcutaneous tissue, blister
Third degree: muscle and possibly bone, appear dry and charred
Remove patient from source -> Flush profusely with cool water -> do not remove clothing unless chemical burn -> monitor vital signs, observe for shock -> Assess body area using Rule of Nines
What is the Rule of Nines assessment tool?
Allows easy estimation of body percentage covered by burn by estimating back or front 18%, each arm 9%, each leg 18%, head 9%, groin 1%
Choking; emergency procedure
Obstruction of airway, patient unable to breathe; Ask the patient “are you choking” -> do nothing if patient can speak or cough, perform Heimlich if patient cannot -> if patient is unconscious, perform CPR, look for foreign body in the mouth
Diabetic emergency; emergency procedure
Diabetic coma (hyperglycemia) is characterized by malaise, dry mouth, polydipsia, polyuria, nausea, vomiting, dyspnea
Insulin shock (hypoglycemia) characterized by sweating, anxiety, irritability, tachycardia, headache, hunger
Can lead to seizures, coma, death if left untreated
Administer glucose for insulin shock, administer insulin for diabetic coma, when in doubt give glucose. Monitor vital signs and call 911 if no rapid improvement
Seizures; emergency procedure
Can result from trauma or alterations in metabolism such as with fever; can be idiopathic (spontaneous), can be generalized (grand mal) to short staring episode (petit mal)
Assist patient to lying position -> protect from injury -> tilt head to side to prevent aspiration -> time the seizure -> stay with patient and observe -> call 911 if seizures continue
Stroke; emergency procedure
Results from hypoxia in the brain, usually due to blood clot or rupture/occlusion of blood vessel. Patient can be aphasic or dysphasic. experience weakness on one side of body/drooping of mouth, lose consciousness
Protect the patient -> Keep NPO -> Obtain vital signs -> Collect as much medical history as possible -> Administer oxygen -> Call 911
What is the responsibility of a medical assistant in wound care follow-up?
patient education: call provider if infection is suspected
7 typical signs of an infection
Redness/swelling
Hot to touch
Drainage (not clear)
Foul odor
Red streaks extending from wound
Fever
Maliase
Procedure for changing a sterile dressing
- Wash hands
- Don gloves
- Soak dressing in sterile saline/water if stuck to wound
- Remove dressing (sterile) and bandages (nonsterile). Discard all waste contaminated with body fluids in biohazard container.
- Use applicator to apply medications to wound, avoid touching container to wound, do not reinsert applicator into container.
- Open dressing packages without touching contents, touch only edges of dressing.
- Place bandage or tape
CPR; safety concerns
Fracturing ribs of patient, exposure to bodily fluids (gloves, CPR mouth barriers)
Procedure before and during CPR (compresion rate, ratio to breaths)
- Ascertain responsiveness
- Activate emergency medical systems (EMS)
- Check carotid artery for pulse
If no pulse:
CPR at rate of 100 to 120 chest compressions per minute with a ratio of 30 compressions to 2 breaths. With two rescuers alternate role to decrease fatigue
AED CPR; procedure
AED is a device that provides automatic voice instruction on how to convert patient back to sinus rhythm.
- Chest leads need to be connected: Remove clothing and attach one pad on upper right side of chest, other pad on lower left side of chest, a few inches below left armpit. Plug connector cable into AED
- “CLEAR!” - allow AED to analyze heart rhythm, do not touch person
- “CLEAR!” - Press button to deliver a shock if necessary
- Start CPR
Medical assistant responsibilities when patient presents to office with wound
Obtaining chief complaint
Collecting vital signs
Assist provider: clean wounds, prepare sterile fields, bandage wounds, administer injections, instruct patients on signs of infections, provide wound care, schedule follow-up appts
Medical assistant responsibilities in preparing for surgery
1) Prepare surgical area and assist provider during procedure
- 1) open packages to easily drop onto sterile field without touching outer wrapper
- 2) lip the bottle of liquids prior to pouring into sterile containers
- 3) do not leave unattended, reach over, turn your back
- 4) medication vials should be cleaned with alcohol
2) Provide education and support to patient
- explain the procedure and obtain consent
Cryosurgery
Exposing tissue to extreme cold to destroy cells; warts, cervical dysplasia; patient should expect some discomfort
Colposcopy/Hysteroscopy
Using an instrument to inspect vaginal or uterus area, deliver treatments; patient in lithotomy position and will experience discomfort, specimens may be collected
Electrosurgery or electrocauterization
A pulse of electrical current to cauterize tissue, used to minimize bleeding or destroy small polyps, etc; Inspect pad and cable prior to usage, avoid placing the pad on areas with excessive hair, over bony parts, or over pacemakers or metal implants
Toenail removal
Completed with local anesthetic, need sterile scissors and forceps or hemostats, anesthetic, bandaging materials; patient will experience throbbing/discomfort, soaking in warm salt water facilitates healing and reduces discomfort, bandage wound
Endoscopy
Small tube with a light and camera inserted into GI tract or through small incision; assist with patient position, avoid touching skin with light source
Mole or cyst removal
Local anesthetic, scalpel or punch device, suture supplies; obtain a detailed history, family history (melanoma), all specimens should be sent to the laboratory for evaluation, instruct the patient to monitor wound for infection and return for follow-up suture removal and care
Staple and suture removal procedure
- Thoroughly inspect wound to approximate edges, absence and presence of drainage. If crusting blood is present soaking with saline may be necessary
- Need stitch/suture scissors and forceps, staple removal device for any staples. Remove every other suture or staple while observing the site for any gaping (if there is any, notify provider).
- Account for the total number of staples and sutures used to close the wound. When cutting, sutures, cut close to the knot and pull the suture out with forceps, observing to ensure the entire suture was removed.
What to include in discharge instructions?
Activity restrictions: bathing/exercise
Diet restrictions
Wound care: dressing change, applying medication to wound, observing for signs of infection
Medications: How and when, possible side effects
Follow up appointments: When to return to the office, how to contact
Federal and state requirements for sending prescriptions, guidelines.
Only licensed or credentialed individuals (including CCMA) may send prescriptions electronically. Controlled substances may not be called, patient must deliver physical prescription to the pharmacy.
Speak clearly, full name and birthdate of the patient, identify medication, avoid abbreviations
Parts of a prescription
Prescriber information
DEA number
Patient information
Medication prescribed
Instructions
Signature
Medical record: Demographic information
Name, address, birthdate, SS#, phone, insurance. Review each visit.
Medical record: Medication record
Medications, including over-the-counter and supplements, allergies. Review each visit.
Medical record: Progress notes
Where chief complaint or SOAP note (subjective, objective, assessment, plan) is located
Medical record: Lab or diagnostic reports
Houses laboratory reports and EKG or other tests
Medical necessity guidelines
Medical necessity is used by third-party payers to identify that a specific procedure is necessary. Documentation is required to support the necessity for the procedure/test and for the insurance company to remit payment
Diagnostic and procedural coding
Universal language of numbers used for billing/reimbursement. Accurate coding maximizes provider reimbursement, upcoding for more than what was performed is fraud
CPOE
Computerized physician order entry, allows for completion of medical documentation at time of visit
