1. Ch 20: medical assisting

2. Medical assistant
An allied health professional that supports the work of physicians and other health professionals. Usually the first and last person with whom the patient will interact with.
Skills of admitting, registering, transferring, and discharging patients.
Projected to be one of the fastest growing occupations in the health services industry.
In 2002, there were 330,000 employed medical assistants. The median salary in 2005 was $30,590.
Education: Training can be offered in public high schools. Vocational programs can be offered to adults at technical and community colleges. Private proprietary schools also offer training. Most programs lead to a certificate of completion or diploma and are usually 1 year or less in length.

3. admission
Important to establish that the patient is not in any kind of acute distress. Assess general appearance for any kind of acute distress.
When a patient is admitted into a hospital there are some basic procedures that are followed:
Making a clothing and personal items list, request that the family take home valuables/put in a safe place, taking vital signs, weighing the patient, explaining the call light and routine, and collecting urine specimens.
All medical information recorded should always signed with your name and certification.
Charting Flow Sheet: many facilities provide a sheet that includes activities of daily living, vital signs, liquids, and type of care given. This checkoff list helps the charter provide all of the necessary information about patient care.

4. Medical history Form (usually filled out by an RN or licensed personnel) give the provider the necessary information to evaluate the physical condition of the patient. Giving you the following information:
Previous surgeries
Allergies
Chronic illness and childhood diseases
Medications taken and any substance abuse history
General, mental health, and family related medical history
Emergency contact
Nutritional status
Activities of daily living and instrumental activities
registration
New patients must complete two basic forms when registering: Patient information forms and medical history forms.
Patient Information Forms give the following information:
Patient name, address, and phone number
Birthdate, gender, martial status, social security number
Patient's employer name, address, phone number
Insurance company's name, address, phone number
Insured employer name, address, phone number
If the patient is a minor, name of the responsible party

5. registration
If a healthcare professional is taking or reviewing a patients medical history, they might want to ask a series of questions about things that cannot be observed, such as:
In general, how are you feeling?
What is your biggest concern?
Do you have any pains?
The type of questions should be asked in a non-leading way
Patient information and medical history forms must be completed accurately and fully. Do not leave any blanks on these forms. If it does not apply to the patient, you should write N/A or not applicable.

6. Height & weight
Patients are weighted and measured when they are admitted. These measurements provide a baseline during the patients stay.
Patients weight is important because it indicates nutritional status and any change in condition, which might indicate potential physical or emotional problems, or other issues.
Height is used as an indicatory of the ideal weight of the patient. With infants, head circumference is also measured. For infants, body measurements are used to monitor growth.

7. Height and weight
A height-weight chart is used to determine if a patient’s weight quality measurement is considered normal, overweight, or underweight. The height-weight chart shows desirable weight by height for men and women.
A height-weight chart also exists for infants and children of both sexes. This chart is also referred to as a growth chart. It is used to compare an infant’s or toddler’s body measurements with those of other children.
Additionally, height and weight information is often needed for laboratory tests and to calculate dosages of medications for adults and children.

8. Height & weight Chart Be sensitive and respectful
Make only positive comments

9. Body mass index
The body mass index (BMI) is a calculation used to determine your level of body fat. It can help a doctor determine your overall fitness and your risk of developing chronic diseases.
The body mass index revolves around weight and height. To calculate BMI, divide your weight in pounds by your height in inches squared, then multiply the result by 703.
Generally, if you’re at a healthy weight, your body mass index should fall between 18.5 and 24.9, notes the National Heart, Lung and Blood Institute. If your BMI is below 18.5, you could be underweight. On the other hand, a BMI greater than 25.0 is categorized as overweight, while a score above 30 is considered obese.

10. Body max index
Why The Number Is Important: low range signals that you could be malnourished. Having a BMI on the higher end alerts your physician that your risks of heart disease, diabetes and certain cancers are higher than someone with a normal BMI.
Problems: it doesn’t account for gender, and women tend to have more body fat than men. So as a woman, even if your body mass index is in the normal range, you could still have a high percentage of body fat.
The calculation also doesn’t account for muscle mass. Muscle weighs more than fat, so if you lift weights and have toned muscles, your BMI could be high even if you’re not overweight. Because of these flaws, your doctor also might run lab tests to evaluate your blood cholesterol levels. In addition, he might measure your waist. A wider than average waist is another indicator for obesity and the risk of related diseases.

11. Bmi chart
For example, if you weigh 160 lbs. and are 68 inches tall, divide 160 by 4,624 (which is 68 squared). Multiply the answer (0.034) by 703 for a BMI of 24.3.
1lbs = .45 Kg
1ft = 12 inches

12. scales
Several types of scales are used to measure body weight and height.
The balance beam scale is used in most cases. With a balance beam scale, the patient stands unassisted on a small platform. The balance beam scale also has a measuring bar for taking a patient’s height.
For infants, a special scale is used so that the child can be laid down on the scale. This type of scale often has measurement markings for taking the infant’s height while the child is lying down.
There are also beds scales and wheelchair scales for patients with disabilities and those that are unable to stand unassisted on a balance beam scale.

13. Transfer and discharge
Different facilities have different policies and procedures for patient transfers and discharges.
Transfer: can be moved to a different hospital, unit, or physician care
When you assist with transferring a patient to another area, the patient may be unhappy about the move. Be calm and pleasant, and explain that you will make the move as easy as possible.
Discharge: means to tell someone that are able to leave. A patient cannot be discharged without an order from their physician.
Be sure the patient has all of their belongings and know what is expected of you when assisting with discharge.

14. Assisting with examinations
Equipment
Pen light- examine areas of the mouth and throat, wounds, and assess pupil response.
BP Cuff- examine blood pressure
Ophthalmoscope-examine the eye
Otoscope- examine the ear
Percussion hammer- examine deep tendon reflexes
Disposable gloves
Basin/pan
Tape measure- measure muscle function, range of motion, circumference, and height
Tongue blade- holds tongue down in order to examine mouth and throat

15. Assisting with examinations

16. Exam positions
During a physical exam, the patient must be positioned in a way that makes the examination as safe and easy as possible for both the patient and physician. Medical assistants are responsible for positioning and draping patients. They must keep in mind the patient's need for safety and comfort, as well as the physician's need to access the body.
Sitting- Generally the first and last position used during a physical exam. The position is used while obtaining a patient's vital signs and gathering a medical history.
Supine- used for examination, treatment, and surgical procedures of the anterior (ventral) part of the body.

17. Exam positions
Prone-used for examination, treatment, and surgical procedures of the posterior (dorsal) part of the body.
Dorsal Lithotomy- used for examining or performing surgical procedures of abdominal membrane and rectal area. Also an alternative to the supine position.
Fowler’s- relieves patients who are having trouble breathing (asthma, chest pain). Allows examination of the anterior and posterior chest.
Trendelenburg- helps restore blood flow to the brain when the body experiences shock. Also helps promote drainage of congested lungs.

18. Sitting Position
The sitting position is generally the first and last position used during a physical exam. The position is used while obtaining a patient's vital signs and gathering a medical history. The sitting position is also used when the physician is examining a patient's head and neck, listening for heart and lung sounds, and testing the reflexes. Finally, the sitting position should be used after an exam. If a patient tries to stand immediately after lying down, he or she may become dizzy and fall. Thus, the sitting position is used as a safety precaution to prevent injuries.
For the sitting position:
The patient sits on the side or end of the exam table with legs hanging down.
The drape is placed over the patient's lap and legs.
Some patients, especially shorter patients or elderly patients, may have trouble getting into this position because of the height of the table. Most exam tables have a pull-out step that may be used to accommodate patients.

19. Examination and diagnostic techniques
Observation/Inspection: The provider looks at the patient for normal and abnormal appearance,. Skin, eyes, hair, movements, or actions that look unusual.
Palpation: Provider feels parts of the body for unusual or abnormal conditions. Feeling and applying pressure also allow the provider to locate tender or painful areas.
Percussion: provider use their fingers to tap over areas of the body. The sounds the provider hears during percussion indicate the fullness, emptiness, and size of internal organs.
Auscultation: Provider listens to body sounds through a stethoscope. Sounds of the heart and lungs, bowel sounds, and even the flow of blood through arteries can be heard.

20. Diagnosis Diagnosis- Identification of a disease or condition.
To determine a final diagnosis the physician looks for clues from the following sources:
Patient history
Physical examination findings
Vital signs
Laboratory results
Diagnostic test results
Symptoms described by the patient

21. Testing visual acuity Visual acuity – sharpness of vision
Medical assistants may perform a variety of visual acuity tests.
Far Vision: Far vision screenings are used to test a patient's ability to see items at a distance. The most common method for testing far vision is the use of a Snellen chart. Patients stand 20 feet from the chart and attempt to read letters or numbers of decreasing size.
Near Vision: Near vision screenings are used to test a patient's ability to see items within a close range. This is often done using a Jaeger chart. Patients hold the chart in front of them and attempt to read paragraphs of differently-sized type.
Color Vision: Color vision screenings are used to test a patient's ability to see and distinguish between colors. There are various types of color blindness, so likewise there are various types of color vision tests. The Ishihara method is a common test that uses color plates to identify a red- green deficiency.

22. Vision test
Medical assistants must observe patients carefully when administering a visual acuity test. It may be difficult for some patients to admit that their vision is not as clear as it used to be. In addition, some patients, such as school-aged children, may be hesitant to discuss vision difficulty because they are apprehensive about wearing corrective lenses. However, patients often show nonverbal cues that indicate visual deficiencies.
Medical assistants should note any of the following patient responses during a visual acuity test.
Straining or squinting
Watering eyes
Closing one eye
Frequent blinking
Tilting the head forward or to the side
Frowning or puckering
Before administering the test, it is important for medical assistants to ask patients if they are wearing corrective lenses. If the patient wears corrective lenses, the far vision test should first be done twice - with and without the lenses.