Lecture Clinical procedures for medical assisting (4/e): Chapter 8 – Booth, Whicker, Wyman

Chapter 8 - Assisting with examinations in the basic specialties. The objectives of this chapter are: Describe the medical specialties of internal medicine, obstetrics and gynecology, and pediatrics; identify the types of examinations and diagnostic tests performed in internal medicine, obstetrics and gynecology, and pediatrics; discuss the role of the medical assistant in working in internal medicine, obstetrics and gynecology, and pediatrics;...

Assisting with

Examinations in the

Learning Outcomes

8.1 Describe the medical specialties of internal medicine,

obstetrics and gynecology, and pediatrics

8.2 Identify the types of examinations and diagnostic tests

performed in internal medicine, obstetrics and gynecology, and pediatrics

8.3 Discuss the role of the medical assistant in working in

internal medicine, obstetrics and gynecology, and pediatrics

8.4 Identify common diseases related to internal

medicine, obstetrics and gynecology, and pediatrics

Learning Outcomes (cont.)

8.5 Describe typical treatments for diseases related to

internal medicine, obstetrics and gynecology, and pediatrics

8.6 Identify common signs of domestic violence, elder

abuse, and child abuse

8.7 Carry out the procedure for assisting with

gynecological examinations and procedures

8.8 Carry out the procedure for meeting the needs of a

pregnant patient during an examination

• Specialties

– Specialist – physician with additional training,

residencies, and certification – Types of examinations and diagnostic tests

– Common diseases and disorders

• Medical assistant

– Assist with specialty examinations

– Observe for signs of domestic violence and child

abuse

care personnel

– May perform clinical procedures only under the

supervision of the physician

State laws vary You will need to know the scope of

Apply Your Knowledge

What defines the procedures health-care

personnel can perform, and how do you determine

what you are able to do as a medical assistant?

ANSWER: In addition to education, training, and certification,

the state’s medical practice act defines what duties and

procedures health-care personnel can perform As a medical

assistant, you have to know your scope of practice for the state

where you work.

Internal Medicine

• Diagnosis and treatment of

disorders and diseases of the

body’s internal organs

• Internist

– Often first to see patient

– Uses medication and/or

treatment modalities – Refers to a specialist

Assisting with the Physical Examination

• Usually the same as a general

Detecting Substance Abuse

• Signs vary and depend on

– Type of drug

– Patient’s response to the drug

• Report suspicion of substance abuse

to the physician

• Know state requirements for

Detecting Substance Abuse (cont.)

• Signs of abuse

– Alcohol – depressed pulse rate, respiration,

and blood pressure – Cocaine – excitation, increased pulse rate

and blood pressure – Hallucinogens – hallucination, poor

perception of time and distance, severe panic, violent and bizarre behavior

Detecting Substance Abuse (cont.)

– Inhalants – muscle

weakness, hearing loss, changes in heart rate, nausea, and dizziness

– Marijuana –

reddening of the eyes, increased heart rate, heightened

appetite, muscular weakness

– Narcotics – drowsiness, depressed respiration, constricted pupils, nausea,

vomiting, constipation

– Sedatives – nausea, slurred speech,

drunken behavior with

no odor of alcohol

Detecting Domestic Violence

• Signs of domestic violence – bring to doctor’s

• Reporting suspected domestic violence is

mandatory in some states

• Keep a list of services available for a victim of

Detecting Elder Abuse

 Domestic

– Types

• Physical, sexual, psychological

Detecting Elder Abuse (cont.)

illness or disabilities

– History of alcoholism, drug abuse, or violence in the

family

– History of mental illness in the abuser or victim

– Isolation of the victim from family members and

friends other than the abuser

– Recent stressful events affecting the abuser or victim

Detecting Elder Abuse (cont.)

– Soiled clothing

– Extreme concern about money

patient

Diseases and Disorders

Diseases and Disorders (cont.)

Diseases and Disorders (cont.)

Condition Description

Anemia Deficiency of iron or vitamins; results from blood loss

Arthritis Chronic inflammatory disease of tissues of joints

Gout Metabolic disease caused by the overproduction or

retention of uric acid

Hypertension Blood pressure greater than 140/90; usually

asymptomatic Peptic ulcer Lesion of mucous membrane of the esophagus,

stomach, or duodenum

Apply Your Knowledge

What are the types of elder abuse, and what is the

medical assistant’s role in identification of elder

abuse?

ANSWER: Elder can be abused physically, sexually, or

psychologically Neglect, abandonment, and exploitation are also

forms of elder abuse The medical assistant should take a careful

history, observe interactions between caregiver and patient,

observe for signs of abuse, and report suspicions to the

physician.

Obstetrics and Gynecology

system

– Obstetrician – focuses on caring for women

during pregnancy and childbirth

– Gynecologist – focuses on

conditions of the female reproductive system

Gynecologic Physical Examination

• Purpose

– Overview of a woman’s health

– Opportunity for cancer-screening exams and tests

• Female assistant should be present during the

exam

– Assist a male doctor

– Provide legal protection

• Your role is similar to that of the general physical

Gynecologic Physical Examination (cont.)

• Physician’s interview

– Evaluation of total

health– Review of factors that

may indicate cancer or STDs

• Breast exam by physician annually

• Monthly breast examination

self-Gynecologic Physical Examination (cont.)

• Pelvic examination

– External genitalia, cervix, vaginal wall, internal

reproductive organs, and rectum

– Speculum – expands the vaginal opening

– Medical assistant’s role

• Assist the patient into position

• Assist the doctor

Life Cycle Changes

• Menstruation

– Normal cycle of

preparation for conception

– Menarche –

• Onset of menstruation

Diagnostic Tests and Procedures

Diagnostic Tests and Procedures (cont.)

– Ultrasound

Diagnostic Tests and Procedures (cont.)

• Amniocentesis

– To determine if there

is a genetic or metabolic problem with the fetus

• Biopsy

– Surgical removal of

tissue– Diagnose cancers

• Colposcopy

– Examination of vagina and cervix

– To identify abnormal cells

• D and C

– Dilation of the cervix and scraping the

uterine lining

Diagnostic Tests and Procedures (cont.)

Hysterosalpingo-• Removal of uterus, fallopian tubes, and ovaries

– First trimester – conception to 12 weeks

– Second trimester – 12 weeks to sixth month

– Third trimester – sixth month until birth

– Subtract 3 months from first day of last period

and add 7 days plus one year

Pregnancy (cont.)

• Physician monitors for

– Placenta previa– Abruptio placenta

• Assisting with prenatal

Pregnancy (cont.)

• Labor – stages

– First – regular

contractions and cervical dilation – Second – complete

cervical dilation and entrance of head into vagina – Third – expulsion of

the placenta

• Delivery

– Baby’s nose and mouth suctioned – Umbilical cord clamped, tied, and cut

– Vaginal vs

cesarean section – Apgar testing of newborn

Pregnancy (cont.)

• Breast-feeding

– Human milk – preferred form of nutrition

• Colostrum – rich in antibodies that provide passive natural immunity to baby

– Economical and convenient

– Provide education

– Refer mother to community resources

Birth control pill Daily oral contraceptive; inhibits ovulation

Birth control patch Inhibits ovulation; replaced weekly for 3 weeks,

Inserted for 3 weeks; removed for 1 week

Cervical cap Similar to diaphragm; covers smaller area of

cervix IUD Small piece of plastic or metal inserted into

uterus; inhibits fertilization or implantation

Contraception (cont.)

Sterilization Surgical procedure; males – vasectomy; female

– fallopian tubes cut or blocked

Periodic abstinence Rhythm method; refraining from intercourse

when woman is fertile Withdrawal Withdrawing the penis before ejaculation

Postcoital pills Prevent implantation

Obstetrics and Gynecology (cont.)

• Contraception

information

– Planned

Parenthood Federation – National Library of

Medicine – FDA

• Infertility

– Inability to conceive – Patient education

• Tests

• Treatments

Diseases and Disorders

Condition Description

Cancer Common occurrence in cervix, endometrium

(uterus), ovaries; cells divide uncontrollably, eventually forming tumor or other growth of abnormal tissue

Ectopic

pregnancy Fertilized egg unable to move out of fallopian tube into uterus for implantation

Endometriosis Endometrial tissue present outside uterus, usually

in pelvic area; not life-threatening but may cause sterility

Diseases and Disorders (cont.)

Diseases and Disorders (cont.)

Condition Description

Pelvic

inflammatory

disease (PID)

Acute or chronic infection of the reproductive tract;

causes include STDs or other organism

Pelvic support

problems Abnormal weakening of vaginal tissue, unusual increase in abdominal pressure, congenital

weakening Polyps Red, soft, and fragile growths, with slender stem

attachment on mucous membranes of cervix or endometrium

Diseases and Disorders (cont.)

Diseases and Disorders (cont.)

Vaginitis Inflammation of vagina caused by bacteria,

viruses, yeasts, or chemicals in sprays, douches, or tampons

Apply Your Knowledge

ANSWER: Tests will probably include:

Ultrasound to determine fetal size, position, and number of

fetuses

Amniocentesis to determine if there are possible genetic or

metabolic disorders of the fetus.

Alpha fetoprotein to determine if there is a possible neural

tube defect.

1 A 38-year-old pregnant patient may be carrying

twins What diagnostic tests may be performed and why?

Apply Your Knowledge

ANSWER: Nägele’s rule says count back three months

[1-December, 2-November, 3-October], then add seven days plus 1 year, [23 + 7 = 30]

Her estimated date of delivery would be October 30 th

2. A patient has just found out she is pregnant Her

last period started on January 23rd Using

Nägele’s rule, what day would be her estimated

date of delivery?

treating illnesses – Pediatrician

• Medical assistant responsibilities

– Parent or caregiver education

– Immunization schedule

– Detection of child abuse

• Ask about eating habits, sleep patterns, daily

activities, immunization schedules, and toilet

training

• Adolescents

– STDs, drugs, and alcohol

– Awkward and self-conscious

Examination (cont.)

• Examining the well child

examinations during their first year at these intervals

• 2 weeks  6 months

• 1 month  9 months

• 2 months  1 year

• 4 months

Examination (cont.)

• Examining the well child (cont.)

– Children in the second year of life should have checkups at 15 and 18 months

– Annually after 2 years old

for an adult

Detecting Child Abuse

• Watch for problems

– Inability to communicate

– Bruises or burns

– Lesions on child’s genitalia

Detecting Child Abuse (cont.)

• Risk factors for abuse

Detecting Child Abuse (cont.)

– Internal injuries, tenderness when palpated or

suspected child abuse or neglect

Examination (cont.)

• Examining for growth abnormalities

– Compare the child’s physical, intellectual, and

social signs to national averages – Growth stages

• One and Two – first and second years

• Three – ages 3 to 5 years

• Four – age 6 years to puberty

• Five – adolescence

– Urine specimens– Blood specimens

Examination (cont.)

• Immunizations

– Store vaccines properly

– Administer vaccines correctly

– Maintain careful immunization

records – Educate parents

– Follow recommended schedule

for follow-up appointments

Diseases and Disorders

• Frequently seen in pediatric office

– Common childhood diseases (Table 8-2)

– Upper respiratory infections

• Do not make assumptions regarding

diagnosis or treatment

• Do not recommend aspirin for fever in

children

Diseases and Disorders (cont.)

Condition Description

AIDS Most transmitted from mother to infant; decreased

chance of infected infant if mother is being treated Juvenile

rheumatoid

arthritis

Autoimmune disease of the joints; occurs in children 16 years or younger

ADHD All conditions identified as hyperactivity, hyperkinesis,

and attention deficit Learning

disabilities Conditions that interfere with learning, including dyslexia, dysgraphia, and dyscalculia

Diseases and Disorders (cont.)

Condition Description

Cerebral

palsy Birth-related disorder of nerves and muscles; caused by brain damage occurring before, during, or after birth

Congenital

heart disease Cardiovascular malformations in the fetus before birth; causes include genetic mutations, maternal infections,

maternal alcoholism, or maternal insulin-dependent diabetes

Down

syndrome Genetic disorder due to one extra chromosome in all cells formed during fetal development; characteristic

facial features

Diseases and Disorders (cont.)

Condition Description

Hepatitis B Infection of liver; virus can be transmitted from the

mother before or during birth; immunization available

RSV Major cause of lower respiratory infections; highly

contagious; difficult to treat; antibiotics only treat any secondary infections

SIDS Unexplained sudden death of an infant during sleep;

Diseases and Disorders (cont.)

Condition Description

Spina bifida Defect of spinal development occurring during the

first trimester of pregnancy; spinal cord not fully protected because tissues fail to close around it

Viral

gastroenteritis Inflammation of stomach and intestines; can cause dehydration and electrolyte imbalance due to fluid

loss

Patient and Caregiver Education

• Answer questions appropriately

• American Academy of Pediatrics

– Brochures and booklets

Apply Your Knowledge

ANSWER: The medical assistant should be sure that

vaccines are stored properly, administer vaccines

correctly (if within scope of practice), maintain

careful immunization records, educate parents,

follow recommended immunization schedule for

follow-up appointments.

What are the responsibilities of the medical

assistant relating to immunizations?

In Summary

8.1 Internal medicine practitioners diagnose and treat

diseases and disorders of the internal organs An obstetrician/ gynecologist (OB/GYN) specializes in the female reproductive system, cares for pregnant

women and delivers babies A pediatrician specializes

in the health care of children

8.2 Examples of exams and diagnostic tests performed in

internal medicine, obstetrics and gynecology and pediatrics include the basic physical exam, the gynecological exam, the cervical biopsy, and the well

In Summary (cont.)

8.3 As a medical assistant in basic specialties, you might

perform or assist with testing such as urine, blood tests, and bacterial cultures You might educate patients on diseases of aging, infectious diseases, and STDs

8.4 Some common diseases related to internal medicine

include hypertension, coronary artery disease, and diabetes mellitus Childhood diseases include

chickenpox, influenza, measles, mumps, rubella, scarlet fever, and tetanus Examples of diseases related to obstetrics and gynecology include cancer, endometriosis, and fibrocystic breast disease Other diseases are outlined in Tables 8-1, 8-3, and 8-5

In Summary (cont.)

8.5 Typical treatments for diseases related to internal

medicine, obstetrics and gynecology, and pediatrics include such things such as local or oral medication, including antibiotics, stress reduction, diet restrictions, and surgery Treatments are outlined in more detail in Tables 8-1, 8-3, and 8-5

8.6 Some common signs of domestic violence, elder

abuse, and child abuse include unusual bruising or injuries that the patient tries to hide or excuse, foul odor, poor skin color, soiled clothing, and malnutrition