1. Medical Assistant Skills Medical Professions Education II Diversified Health Occupations Pages 567- 614

2. Medical Assistant Skills OBJECTIVES Upon Completion of this unit, the student should be able to: Measure and record height and weight of infants and adults Patient positioning Use a Snellen Chart to screen for vision problems Prepare for and assist with ENT, GYN and general exams Define, pronounce, and spell all of the key terms

3. Medical Assistant Skills Measuring /Recording Height & Weight Are you concerned with how much you weigh? Are you concerned with how much you weigh? Why are people interested with their weight and height? Why are people interested with their weight and height?

4. Medical Assistant Skills Medical Assistant Skills Height and Weight Height and weight measurements are used to determine if a person is overweight or underweight Height and weight measurements are used to determine if a person is overweight or underweight Must be accurate~~ ALWAYS RECHECK CALCUALTIONS (10% deviation is usually considered normal) Must be accurate~~ ALWAYS RECHECK CALCUALTIONS (10% deviation is usually considered normal) When are the measurements taken? When are the measurements taken? Admittance to hospital, LTCF, or other health care agency Admittance to hospital, LTCF, or other health care agency General exam General exam At times during certain laboratory exams At times during certain laboratory exams For calculating dosage for certain medications For calculating dosage for certain medications

5. Medical Assistant Skills Medical Assistant Skills Height and Weight For calculating dosage for certain medications For calculating dosage for certain medications Height, weight, and head circumference is checked frequently on infants and toddlers Height, weight, and head circumference is checked frequently on infants and toddlers Infant growth is rapid Infant growth is rapid Usually checked every 2 months to detect changes that may indicate problems with growth and development Usually checked every 2 months to detect changes that may indicate problems with growth and development Measurements recorded on a NCHS growth graph, which allows MD to check the child’s growth and compare it to the average percentiles of other children the same age Measurements recorded on a NCHS growth graph, which allows MD to check the child’s growth and compare it to the average percentiles of other children the same age Abnormal growth patterns may indicate nutritional deficiencies or genetic diseases Abnormal growth patterns may indicate nutritional deficiencies or genetic diseases

6. Medical Assistant Skills Medical Assistant Skills Height and Weight Daily Weights Daily Weights Often order for pts. with edema due to heart, kidney, or other diseases Often order for pts. with edema due to heart, kidney, or other diseases Must use the same scale each day Must use the same scale each day Make sure scale is balanced before weighing patient Make sure scale is balanced before weighing patient Weigh patient at same time each day Weigh patient at same time each day Make sure patient is wearing same amount of clothing Make sure patient is wearing same amount of clothing

7. Medical Assistant Skills Medical Assistant Skills Height and Weight SAFETY!!! WATCH THE PATIENT CLOSELY AT ALL TIMES PREVENT FALLS FROM THE SCALES AVOID POSSIBLE INJURY FROM THE PROTRUDING HEIGHT LEVER

8. Medical Assistant Skills Medical Assistant Skills Height and Weight Most pts. are very WEIGHT conscious! Make only POSITIVE statements while weighing a patient!

9. Medical Assistant Skills Medical Assistant Skills SCALES A wide variety of scales are used to obtain measurements A wide variety of scales are used to obtain measurements CLINICAL SCALES CLINICAL SCALES Contain balance beam for measuring weight Contain balance beam for measuring weight Have measuring rod for determining weight Have measuring rod for determining weight INFANT SCALES INFANT SCALES Provide an area for placing infant in a lying down or flat position Provide an area for placing infant in a lying down or flat position SPECIAL SCALES SPECIAL SCALES Bed scale w/mechanical lift Bed scale w/mechanical lift Wheelchair scale Wheelchair scale

10. Medical Assistant Skills Medical Assistant Skills RECORDING WEIGHT Recorded as lbs. and ozs or as kg. (2.2lbs) Most scales measure lbs. in ¼-pound increments Metric scales use kg with 0.1-kg (1gram) increments ADULT SCALE Top weight scale on a clinical scale Usually goes from 1 to 50 lbs Each small line represents ¼ lbs Scale is read ¼, ½, ¾, and 1 Each long line represents 1 lb For pts who weigh more than 50 lbs, the lower scale is used first

11. Medical Assistant Skills Medical Assistant Skills Recording Weight Adult scale, cont. Bottom scale is usually in 50-lbs increments EXAMPLE: A. A. Bottom scale is set at 100 lbs. B. B. Top scale is set at 24 ½ pounds C. C. 100 + 24 ½ = 124 ½ pounds D. D. PATIENT’S WEIGHT IS 124 ½ LBS.

12. Medical Assistant Skills Medical Assistant Skills Recording Weight Infant Scales Infant Scales Vary…some have digital numbers that are easier to read, others have weights in lbs. and ozs. Remember there are 16 oz in 1 lb Each short line represents 1 oz with lines for 4, 8, and 12 ozs slightly longer Each long line represents 1 lb. At times, ozs. are converted to fractions of a lbs To convert 8 ounces to a fraction of a pound, divide by 16 (16 ounces = 1 pound) 8/16 = ½ pounds EXAMPLE Infant weighs 8lbs 4 oz…divide only the ozs. by 16. 4/16 = ¼ TOTAL WEIGHT = 8 ¼ POUNDS

13. Medical Assistant Skills Medical Assistant Skills Recording Height Recorded as feet and inches or as centimeters Recorded as feet and inches or as centimeters Measuring bar measures inches and fractions or ¼-inch increments Measuring bar measures inches and fractions or ¼-inch increments Metric bar uses one centimeter increments Metric bar uses one centimeter increments 1 inch equals 2.5 centimeters 1 inch equals 2.5 centimeters

14. Medical Assistant Skills Medical Assistant Skills Recording Height Each small line represents ¼ inch Each small line represents ¼ inch Each long line represents 1 inch Each long line represents 1 inch From the bottom of the scale up to the break in the bar, readings are taken in an upward direction From the bottom of the scale up to the break in the bar, readings are taken in an upward direction If a pt is taller than 50 inches, reading are taken in a downward direction and read at the break in the bar If a pt is taller than 50 inches, reading are taken in a downward direction and read at the break in the bar

15. Medical Assistant Skills Medical Assistant Skills Recording Height Height for adults is recorded in feet and inches Height for adults is recorded in feet and inches Inches must be converted Remember there are 12 inches in 1 foot Remember there are 12 inches in 1 foot Divide 12 into the number of inches obtained EXAMPLE: Measurement recorded is 64 inches 12/ 64 ½ = 5 ft 4 ½ inches

16. Medical Assistant Skills Medical Assistant Skills Recording Height TAPE MEASURE FOR INFANT HEIGHT TAPE MEASURE FOR INFANT HEIGHT Tape measure is read like a ruler Each small line is 1/8 inch Each longest line is 1 inch Readings are 1/8, ¼, 3/8, ½, 5/8, ¾, 7/8, and 1 inch

17. Medical Assistant Skills Medical Assistant Skills Height and Weight IMPORTANT PRINCIPLES FOR MEASURING WEIGHT/HEIGHT ON A CLINICAL SCALE IMPORTANT PRINCIPLES FOR MEASURING WEIGHT/HEIGHT ON A CLINICAL SCALEADULT Balance the scale with the weight at zero Ask pt to remove shoes, jacket, heavy outerwear, etc. Make sure pt stands unassisted with feet slightly apart and centered on platform Make sure pt stands erect for height measurement

18. Medical Assistant Skills Medical Assistant Skills Height and Weight IMPORTANT PRINCIPLES FOR MEASURING WEIGHT/HEIGHT ON AN INFANT SCALE IMPORTANT PRINCIPLES FOR MEASURING WEIGHT/HEIGHT ON AN INFANT SCALEINFANT Be ALERT with the infant AT ALL TIMES! Place a sheet of paper on the scale and balance scale at zero Remove infant’s clothing, including diaper To record height place infant on a flat surface and mark the height accurately Head circumference is frequently measured on an infant NEVER LEAVE AN INFANT UNATTENDED!!!

28. Medical Assistant Skills POSITIONING Pts must be positioned correctly for variety of exams, test, and procedures Wide variety of positions are used for different procedures or exams Pt may be in a bed or on an exam table, surgical table, diagnostic or treatment table IMPORTANT to know how to operate the table! DISINFECT the table before and after pt use. Table paper is frequently used to cover the table prior to exams and then removed and replaced before next exam

29. Medical Assistant Skills POSITIONING During any procedure or exam reassure the pt Help them understand what is being done Watch the pt carefully for signs of distress Observe all safety factors to prevent falls or injuries

30. Medical Assistant Skills POSITIONING Use correct body mechanics at all times to prevent injury to yourself Position used depends upon exam, procedure, or test being performed Proper draping is essential for all positions Care must be taken to avoid unnecessary exposure Drape must be applied so MD or tech will have ready access to the area being examined or treated Close door to room and draw curtains if they are present

31. Medical Assistant Skills POSITIONING HORIZONTAL RECUMBENT OR SUPINE POSITION Used to exam or treat the front or anterior part of the body Used to exam or treat the front or anterior part of the body Pt lies flat on back with legs slightly apart Pt lies flat on back with legs slightly apart One small pillow is allowed under the head One small pillow is allowed under the head Arms are flat at the side of the body Arms are flat at the side of the body Drape pt with large sheet or drape Drape pt with large sheet or drape

32. Medical Assistant Skills POSITIONING PRONE POSITION Used for exams of back or spine Used for exams of back or spine Pt lies on the abdomen with head turned to either side Pt lies on the abdomen with head turned to either side Small pillow is placed under the head Small pillow is placed under the head Arms may be flexed Arms may be flexed at elbows and positioned at elbows and positioned on either side of the head on either side of the head Drape pt with large Drape pt with large sheet or drape sheet or drape

33. Medical Assistant Skills POSITIONING SIMS’ OR LEFT LATERAL POSITION Used for simple rectal or sigmoidoscopic exams, enemas, rectal temps, and rectal treatments Used for simple rectal or sigmoidoscopic exams, enemas, rectal temps, and rectal treatments Patient lies on left side Patient lies on left side Head rests on small pillow and is turned to the side Head rests on small pillow and is turned to the side L arm is extended behind the back L arm is extended behind the back R arm is bent at elbow and placed in comfortable position in front of the body R arm is bent at elbow and placed in comfortable position in front of the body L leg is bent or flexed slightly L leg is bent or flexed slightly R leg is bent or flexed sharply and brought up to the abdomen R leg is bent or flexed sharply and brought up to the abdomen Drape pt with one large sheet or drape or two small sheets that meet at the rectal area Drape pt with one large sheet or drape or two small sheets that meet at the rectal area

34. SIM’S OR LEFT LATERAL

35. Medical Assistant Skills POSITIONING KNEE-CHEST POSITION Used for rectal exams- usually a sigmoidoscopic exam Used for rectal exams- usually a sigmoidoscopic exam Pt lies on stomach, abdomen, or prone position Pt lies on stomach, abdomen, or prone position Pt raises buttocks and abdomen until weight is resting on upper chest and knees Pt raises buttocks and abdomen until weight is resting on upper chest and knees Head rest on small pillow and is turned to either side Head rest on small pillow and is turned to either side Arms are flexed slightly at the elbows and extended above the head Arms are flexed slightly at the elbows and extended above the head Knees are separated slightly Knees are separated slightly Thighs are at right angles to the table/bed Thighs are at right angles to the table/bed Draping can be done by Draping can be done by 1 large sheet can be used to cover the pt 1 large sheet can be used to cover the pt 1 large sheet with a hole at the rectal area 1 large sheet with a hole at the rectal area 2 smaller sheets or drapes that meet at the rectal area 2 smaller sheets or drapes that meet at the rectal area

36. KNEE-CHEST

37. Medical Assistant Skills POSITIONING KNEE-CHEST POSITION, cont. Safety precautions!!! Safety precautions!!! Remain with the pt at all times while in the knee- chest position This is a difficult position to maintain and should only be used when absolutely necessary After exam, place pt in a prone position and then turn over to supine Watch closely for s/s dizziness or discomfort

38. Medical Assistant Skills POSITIONING FOWLER’S Used to facilitate breathing, relieve distress, encourage drainage, and examine the head, neck, and chest Pt lies on back with head elevated at different angles A small pillow may be place under the pt’s head Flex knees slightly and place small pillow under knees Drape with a large sheet or drape Don’t tuck sheet! : )

39. Fowler’s Low- Fowlers: head elevated at 25° angle Low- Fowlers: head elevated at 25° angle Mid-fowler’s or semi –Fowler’s- head elevated at 45° angle Mid-fowler’s or semi –Fowler’s- head elevated at 45° angle

40. Fowler’s High Fowler’s- head elevated at 90° angle High Fowler’s- head elevated at 90° angle

41. Medical Assistant Skills POSITIONING LITHOTOMY POSITION for vaginal examinations, pap tests, urinary catherization, cystoscopic examinations, and surgery of the pelvic area Used for vaginal examinations, pap tests, urinary catherization, cystoscopic examinations, and surgery of the pelvic area

42. Medical Assistant Skills POSITIONING LITHOTOMY POSITION Pt lies on back with head on small pillow Arms rest at sides of body Pt slides buttocks down on table to where lower end of table folds down or pulls out Place sheet or drape over pt in diamond position Flex and separate the knees Place feet in stirrups on table Drop the lower end of the table or push it in if this is possible

43. Medical Assistant Skills POSITIONING LITHOTOMY POSITION To remove pt from position: Raise the end of the table or pull it out so it is level Lift feet out of stirrups and place on table Ask pt to slide back up on table

44. Medical Assistant Skills POSITIONING DORSAL RECUMBENT POSITION Similar to lithotomy position and used for same purposes

45. Medical Assistant Skills POSITIONING TRENDELENBURG POSITION Requires a special table or bed and assistance Care must be taken so pt does not slide off table or bed Draping depends on procedure or treatment performed Usually 1 large sheet is used to drape pt For surgical procedures, use a large sheet with a hole to expose the surgical area 2 smaller sheets can be used Do not tuck! Special safety precautions use straps to secure pt in this position Remain with patient at all times

46. Medical Assistant Skills POSITIONING STANDARD TRENDELENBURG POSITION Used for circulatory shock because it increases circulation of the blood to the brain and head Pt lies flat on back with head on small pillow Arms are flat at sides Entire bed or table is elevated at the feet Pt lies in horizontal recumbent with head lower than the feet

47. Medical Assistant Skills POSITIONING Used for surgery on pelvic organs and pelvic treatments Pt lies flat on back with head on small pillow Arms are flat at sides Top of table is lowered at an angle to lower the head Bottom of table is lowered at an angle to incline legs and feet downward Straps are used frequently to hold the pt in position SURGICAL TRENDELENBURG POSITION

48. Medical Assistant Skills POSITIONING JACKKNIFE POSITION Used for rectal surgery or exams, or back surgery and treatments Requires a special table that will break in the middle Care must be taken so pt will not slide off or be injured in any way Pt lies in prone position Secure the safety straps on the table around the pt Lower the top of the table so the head and upper body are inclined at a downward angle Draping is done in a variety of ways Special safety precautions

49. JACKKNIFE POSITION

50. Medical Assistant Skills Basic Principles for Positioning Determine the exam, tx, or procedure to be performed Determine which position will be required Prepare pt correctly Assist pt onto table Position pt in correct position Drape pt correctly for position To change positions: Observe all safety precautions Watch pt at all times for s/s of dizziness, pain, or discomfort When exam/tx is complete, assist pt to a sitting position…SLOWLY Assist pt off of table

51. VISUAL SCREENINGS Vision screening test Vision screening test Often given as a part of a physical examination Often given as a part of a physical examination Given to detect eye disease Given to detect eye disease

52. VISUAL SCREENINGS SNELLEN CHARTS are frequently used to test vision SNELLEN CHARTS are frequently used to test vision Some contain pictures for use with small children Some contain pictures for use with small children Some contain the letter E in a variety of positions Some contain the letter E in a variety of positions “TUMBLING E” “TUMBLING E” Common type contains letters of the alphabet Common type contains letters of the alphabet

53. VISUAL SCREENINGS INTERPRETATION OF READINGS ON SNELLEN CHART Characters have specific heights Range from smallest on the bottom to largest on the top Person with normal vision Should see figures that are 20 mm high while standing at a distance of 20 feet from the chart Person would have 20/20 vision

54. VISUAL SCREENINGS INTERPRETATION OF READINGS ON SNELLEN CHART Top number represents the distance the patient is standing from the chart For the Snellen test, the pt is positioned 20 feet from the chart Special calibrated charts can be used where pt can stand closer but letters are smaller to accommodate closer distance Lower or bottom number refers to the height of the characters that the patient can read

55. VISUAL SCREENINGS BASIC PRINCIPALS FOR SCREENING VISION WITH A SNELLEN CHART Attach chart to wall or place in a lightened stand Attach chart to wall or place in a lightened stand Measure distance of 20 feet directly away from the front of the chart and place a piece of tape on the floor Measure distance of 20 feet directly away from the front of the chart and place a piece of tape on the floor Explain the procedure to pt and check to make sure pt knows letters/characters on chart Explain the procedure to pt and check to make sure pt knows letters/characters on chart Position pt with heels on taped line 20 feet from chart Position pt with heels on taped line 20 feet from chart Point to various letters/figures on the chart and ask pt to identify them Point to various letters/figures on the chart and ask pt to identify them Note the line on which the pt can read all characters correctly and record the reading on this line Note the line on which the pt can read all characters correctly and record the reading on this line Ask pt to cover one eye with an eye shield or card and test the uncovered eye following the same procedure as above, then repeat with opposite eye. Ask pt to cover one eye with an eye shield or card and test the uncovered eye following the same procedure as above, then repeat with opposite eye. If pt wears corrective lenses check the vision with corrective lenses first If pt wears corrective lenses check the vision with corrective lenses first Record all information correctly Record all information correctly

56. VISUAL SCREENINGS INTERPRETATION OF READINGS ON SNELLEN CHART A person has 20/30 vision WHILE STANDING 20 Ft FROM CHART, Pt. CAN SEE FIGURES 30mm HIGH Can also be interpreted that the pt standing 20 feet away can see what a pt with normal vision can see standing 30 feet from the chart A person has 20/100 vision WHILE STANDING 20 Ft FROM CHART, Pt CAN ONLY SEE FIGURES THAT ARE 100mm HIGH Also means that pt, standing 20 feet from chart, can see what person with normal vision could see standing 100 feet from the chart

57. VISUAL SCREENINGS Test for color blindness 1. 1. Usually tested by the Ishihara method 2. 2. Ishihara book contains a series of number printed in colored dots against a background of dots in contrasting colors 3. 3. Pts with normal color vision are able to readily identify the number 4. 4. Pts with color blindness will not be able to see a number or they will identify an incorrect number 5. 5. Test most accurate if conducted in a room illuminated by natural daylight with no bright sunlight

58. VISUAL SCREENINGS IMPORTANT TERMS OR ABBREVIATIONS OD: oculus dexter or RIGHT EYE OD: oculus dexter or RIGHT EYE OS: oculus sinister or LEFT EYE OS: oculus sinister or LEFT EYE OU: oculus uterque, each eye or BOFOFUM OU: oculus uterque, each eye or BOFOFUM Myopia: nearsightedness; defect in distant vision Myopia: nearsightedness; defect in distant vision Hyperopia: farsightedness; defect in close vision Hyperopia: farsightedness; defect in close vision Ophthalmoscope: instrument for examining the eye Ophthalmoscope: instrument for examining the eye Tonometer: instrument to measure intraocuolar tension or pressure; increased pressure often indicated glaucoma Tonometer: instrument to measure intraocuolar tension or pressure; increased pressure often indicated glaucoma

59. Assisting with Physical Exams 3 Major kinds of examinations 1. 1. EENT (eye, ear, nose, and throat exams 1. 1. Examines only these parts of the body 2. 2. Uses special equipment to examine these areas GYN (gynecological exams) Exams the female reproductive organs MD usually exams the breasts, vagina, cervix, and other pelvic organs A Pap or Papanicolaou test is frequently done to detect CA of the cervix or reproductive organs

60. Assisting with Physical Exams 3 Major kinds of examinations, cont. 3. CHECK-UP (general or complete physical exams) 1. 1. All areas of the body are examined 2. 2. Blood and urine tests are done frequently 3. 3. Xrays and electrocardiogram (ECG or EKG) may be included 4. 4. EENT and GYN examination may be performed 5. 5. Necessary equipment and tests to be done are determined by the physician doing the examination

61. Assisting with Physical Exams TECHNIQUES USED DURING THE EXAMINATION Observation or inspection Palpation Percussion Auscultation

62. Assisting with Physical Exams EQUIPMENT USED FOR EXAMS 1. 1. Equipment used will vary depending on body areas to be examined 2. 2. Important to anticipate what MD will need and assemble the items for convenient use AYER BLADELARYNGEAL MIRROR OPHTHALMOSCOPEOTOSCOPEPERCUSSION HAMMER SIGMOIDSCOPESPECULUMSPHYGMOMANOMETER STETHOSCOPETONGUE BLADE/DEPRESSOR TONOMETERTUNING FORK

63. Assisting with Physical Exams Preparing the Patient 1. 1. Carefully explain the procedure to help alleviate fear 2. 2. Pts are often apprehensive and need reassurance 3. 3. Usually pt must remove all clothing and put on exam gown 4. 4. Pt should void before exams so the bladder is empty and internal organs in area of bladder can be palpated. 5. 5. Correct positioning and draping is essential

64. Preparing the Patient TESTS DONE PRIOR TO EXAM 1. 1. Height and weight 2. 2. Vital signs 3. 3. Vision screening 4. 4. Audiometric screening

65. Assisting with Medical Exams Be prepared to assist as needed during examinations 1. 1. Hand equipment to MD as needed 2. 2. Position pt correctly for each part of exam 3. 3. Pay attention so you are ready to help with each procedure

66. Assisting with Medical Exams Observe standard precautions at all times 1. 1. Wash hands frequently 2. 2. Wear gloves if contact with blood or body fluids is likely 3. 3. Wear other PPE accordingly 4. 4. Clean and disinfect or sterilize any instruments or equipment contaminated with blood or body fluids 5. 5. Be aware of and take steps to prevent the spread of infection

67. Assisting with Medical Exams The Doctor is IN! (refer to handout)