Medical Assistant Skills Chapter 20 Medical Assistant Skills

Skills Lab Measuring height & weight Positioning Patients Chapter 20:1 Procedure 20:1A Positioning Patients Chapter 20:2 Procedure 20:2 Positioning, Turning, Moving and Transferring Patients Chapter 21:2 Procedure 21:1 A, B,C, D, E, F

20:1 Measuring/Recording Height and Weight Use: to determine if a patient is overweight or underweight Height & Weight charts are based on averages Must be accurate When and why measurements are required ? Daily weights are commonly taken in hospitals– why? (continued)

Height & Weight Measurements: are routinely performed on admission to hospitals, LTC, doctors visits Provide Information needed for performing and evaluation of certain laboratory tests Calculation dosages of certain medications— In all children In all complex intravenous drip medications In all IV TPN or total parenteral nutrition

Height & Weight Height, weight, head circumference: Monitored frequently in children due to rapid growth Commonly compared to the National Center for Health Statistics ( NCHS) growth graph Goal it to identify early growth and developmental conditions in children Plotting a child’s HT & WT allows the physician to check their G & D to percentile averages of other children their same age

Measuring/Recording Height and Weight (continued) Basic procedure for infant weight To evaluate nutrition & growth Basic procedure for measuring height of infant To evaluate abnormal growth patterns or genetic conditions Measuring infant head circumference To identify hydro or micro cephalic conditions Measuring infant chest circumference Recording growth graph

Measuring/Recording Height and Weight (continued) Wide variety of scales Recording weight Adult weight scales Both lbs. & kg are used however– kg is the standard Infant weight scales Recording height Height bar on adult scale (continues)

Height & Weight Height & weight charts are used as averages A 10 % deviation in chart to patient is considered normal Head circumference > 95 percentile is classified as hydrocephalus Must be accurate– always recheck all calculations

Equipment Use the same scale for accuracy Make sure the scale is balanced Weigh at the same time each day Wear the same amount of clothing Patient should empty bladder before weight is taken

Weight Conversions

Convert the following to kilograms: 120 lbs 176 lbs 200 lbs 350 lbs 34 lbs You must DIVIDE by 2.2 kg to perform this conversion

Convert the following weight to pounds: 75 kg 100 kg 25 kg 99kg 145 kg You must MULTIPLY by 2.2 to perform this conversion

Notes on Weight Most people are weight conscious Make only positive statements when measuring all patients Remember to Ensure patient privacy at all times

Types of Scales Weight Bar Scales

Types of Scales Wheelchair Scale

Types of Scales Bed Scales

Types of Scales Bed with Scale

Types of Scales Infant Scales

Height Measurement Assessed in older adults to assess for osteoporosis Patient safety must always be considered Observe patients closely Prevent falls and injuries

Height Conversions 1 inch is equal to 2.35 centimeters (cm) You must MULTIPY by 2.35 to perform this conversion: Convert the following to cm: 60 in 45 in 25 in 75 in 18 in

Height Conversions You must DIVIDE by 2.35 to convert cm to inches. Convert the following: 95 cm 120 cm 50 cm 18 cm 145 cm

Student Assignment/ Skills Lab for 20:1 Complete worksheet for 20:1 Students will then perform Height & Weight measurements on each other

How to Weigh a Patient: Assemble equipment Wash hands Prepare scale Zero the scale Greet & introduce self Check patient ID Explain the procedure Patinent should remve shoes, jacket, purses, and all other heavy objects

Continued: Ask patient to step onto the scale Move the large 50 pound weight to the right until the balance bar drops on the lower guide. Move this weigh back one notch Move the smaller weight until the balance bar swings freely between the lower and upper guides Assist the patient off the scale

How to Measure a Patient: Raise the height bar Assist the patient back onto the scale with is back to the scale Instruct the patient to stand erect Move the bar until it reaches the top of the patient head Read the measurement in cm and inches Elevate bar Assist patient off the scale Perform any necessary conversions Replace equipment and wash hands

CONVERSION ANSWERS 54.5 KG 80 KG 90 KG 159 KG 15.4KG 165 LBS 220 LBS 141CM 105.7 CM 58.7 CM 176.2 CM 42.3 CM 40.4 IN 51 IN 21.2 IN 7.65 IN 61.7 IN CONVERSION ANSWERS

Positioning Patients

20:2 Positioning a Patient Patient must be positioned correctly for variety of examinations, tests, and procedures Wide variety of positions used Patient may be on a bed, examination table, surgical table, diagnostic table, or treatment table Know how to operate all equipment before using it with a patient (continues)

Positioning a Patient (continued) Reassure patient Fully explain to the patient what you are going to do and why Assess patient for any distress Observe all safety factors to prevent falls and injury Use correct body mechanics to prevent self-injury (continues)

Positioning a Patient Never expose a patient during any exam or procedure Door should be closed and curtain drawn Properly drape/cover patient to ensure privacy but at the same time allow proper access for examination

Positions Horizontal recumbent or supine position Pt is lying flat on their back with legs slightly apart One small pillow is under the head Arms flat on the side of the body Patient drape is always used Used to examine or treatment of the front part of the body

Horizontal Recumbent or Supine

Prone Position Used to examine or treat the back of the patient Patient lies on his or her abdomen with head turned to either side – a small pillow may be used under the head Arms may be flexed at the elbow or positioned on either side Drape is always used

Supine vs. Prone

Lithotomy Position (continued) Used for gynecological examinations- vaginal, PAP tests, urine catherizations, cystoscopy exams and surgery of the pelvic area Position on the back Knees separated and flexed and feet are placed in stirrups Arms rest at the sides Buttock at the lower end of the table/bed Drape is always used

Lithotomy

Dorsal Recumbent Position Similar to Lithotomy but patient has feet on the bed not in stirrups Knees are bent Feet flat on the bed Draping is always used Do Not Confuse with HORIZONTAL RECUMBENT

Dorsal Recumbent Position

Trendelenburg Position Used to increase blood flow to the head and brain Patient lies in the horizontal position The head is lower than the feet Commonly used when a patient is in shock

Trendelenburg Position

Jackknife Position Mainly used for rectal surgery Patient is in prone position Table is elevated at the center so that the rectal area is at a higher elevation Special table is required for this position Draping as indicated

Sims Lateral Position Used for simple rectal exams, enemas, and other rectal treatments Patient lies on the left side Left are is extended behind the back Head turned to the side Right arm is in front of the patient and elbow is bent Left leg is slightly bent Right leg is bent sharply at the knee and brought into the abdomen Drape the patient accordingly

Fowlers Position Used to help facilitate breathing, receive distress, encourage drainage and exam the head, neck & chest Patient lies on their back Legs flat and slightly bent Drape the patient for privacy Head is in one of three different elevations Low fowler- 25 degree angle Semi-fowlers- 45 degree angle High fowlers- 90 degree angle

Fowlers Position

Knee- Chest Position Used for rectal exams Patient rests on the body weight Arms are flexed slightly at the elbows and extended above the head Knees are slightly separated and the thighs are at the right angles to the table

Knee Chest Position

Tips REMEMBER to use good body mechanics while positioning patients to protect yourself as well as the patient!!

20:3 Screening for Vision Problems Vision screening tests Types of Snellen charts Interpretation of readings on Snellen chart Snellen chart tests only for defects in distant vision Nearsightedness or myopia (continues)

Screening for Vision Problems (continued) Test for color blindness Terms or abbreviations Basic principles and procedure for screening vision with Snellen chart Procedure for screening vision by the Jaeger system

20:4 Assisting with Physical Examinations Large variety of physical examinations are performed Major types of examinations Techniques used during the examination Equipment used for examination Preparation of the patient (continues)

Assisting with Physical Exams (continued) Tests done prior to physical examinations Be prepared to assist as needed Observe standard precautions (continues)

Assisting with Physical Exams (continued) Basic principles for eye, ear, nose, and throat (EENT) examination Guidelines for assisting with a gynecological examination Procedure for assisting with a general physical examination

20:5 Assisting with Minor Surgery and Suture Removal Done in medical, surgical, and other health care facilities Various types of procedures done Instruments and equipment Strict sterile technique used to prepare surgical tray (continues)

Assisting with Minor Surgery and Suture Removal (continued) Skin prep Local anesthetic Will be expected to assist as needed Sterile dressings available to use Suture removal Patients often fearful and apprehensive (continues)

Assisting with Minor Surgery and Suture Removal (continued) Specimens Observe standard precautions Basic principles of assisting with minor surgery Basic guidelines for assisting with suture removal

20:6 Recording and Mounting an Electrocardiogram Electrical conduction pattern in the heart Waves and what they show Twelve-lead electrocardiogram (ECG) Electrodes Lead markings (continues)

Recording and Mounting an Electrocardiogram (continued) Basic parts of ECG machine PQRST pattern Reassure patient Mounting ECG leads Basic principles for recording and mounting an ECG

20:7 Using the Physicians’ Desk Reference (PDR) Provides information about drugs and medications currently in use Published yearly—periodic supplements Consists of six main sections (continues)

Using the PDR (continued) Manufacturers’ index Brand and generic names Product classification Product identification guide Product information Diagnostic product information

20:8 Working with Math and Medications Medication: a drug used to treat or prevent a disease or condition Extreme care is required while handling any medication Only authorized persons can administer medications Check legal requirements in your state (continues)

Working with Math and Medications (continued) Forms of medications Routes of administration Safety rules to observe when working with medications Report all mistakes immediately Concentrate while handling any medication and avoid distractions (continues)

Working with Math and Medications (continued) Six rights to observe when giving medications Right medication Right dose or amount Right patient Right time Right method or route of administration Right documentation

Roman Numerals Used for some drugs and solutions, and used at times while ordering supplies Key symbols: I, V, X, L, C, D, M Any number can be formed Rules of using Roman numerals

Converting Metric Measurements Metric system used in many health care fields Basic units: gram, liter, meter Based on unit of tens Rules of converting metric measurements

Household or English System of Measurement Common system used in the United States Many different units of measurement Conversion of household to metric Conversion of metric to household