CHAPTER 39 Assisting with Examinations in the Basic Specialties © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 39-2 Learning Outcomes 39.1 Describe the medical specialties of internal medicine, obstetrics and gynecology, and pediatrics 39.2 Identify the types of examinations and diagnostic tests performed in internal medicine, obstetrics and gynecology, and pediatrics 39.3 Discuss the role of the medical assistant in working in internal medicine, obstetrics and gynecology, and pediatrics 39.4 Identify common diseases related to internal medicine, obstetrics and gynecology, and pediatrics © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 39-3 Learning Outcomes (cont.) 39.5 Describe typical treatments for diseases related to internal medicine, obstetrics and gynecology, and pediatrics 39.6 Identify common signs of domestic violence, elder abuse, and child abuse 39.7 Carry out the procedure for assisting with gynecological examinations and procedures 39.8 Carry out the procedure for meeting the needs of a pregnant patient during an examination © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 39-4 Introduction • 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 © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 39-5 The Medical Assistant’s Role in Specialty Examinations • Medical practice act – Defines the exact duties of physicians and other healthcare personnel • Medical assistants – May perform clinical procedures only under the supervision of the physician State laws vary You will need to know the scope of practice for medical assistants in the state where you work © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 39-6 The Medical Assistant’s Role in Specialty Examinations (cont.) • Providing emotional support • Providing patient education – Effective communication – Provide educational materials – Verify understanding © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 39-7 Apply Your Knowledge What defines the procedures health-care personnel can perform, and how you determine what you are able to 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 © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 39-8 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 © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 39-9 Assisting with the Physical Examination • Usually the same as a general physical examination • Medical assistant responsibilities – Gathering information • Detect substance abuse, domestic violence, or elder abuse – Preparing patient for the examination © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 39-10 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 reporting © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 39-53 Assisting with the Pediatric Physical 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 to years • Four – age years to puberty • Five – adolescence © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 39-54 Assisting with the Pediatric Physical Examination (cont.) • General eye exam – Pediatrician examines interior of the eye – Visual acuity testing • General ear exam – Children more susceptible to ear infections • Diagnostic testing – Most are same as for adults – Rapid test for presence of streptococcal bacteria – Throat cultures – Urine specimens – Blood specimens © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 39-55 Assisting with the Pediatric Physical Examination (cont.) • Immunizations – Store vaccines properly – Administer vaccines correctly – Maintain careful immunization records – Educate parents – Follow recommended schedule for follow-up appointments © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 39-56 Diseases and Disorders • Frequently seen in pediatric office – Common childhood diseases (Table 39-2) – Upper respiratory infections • Do not make assumptions regarding diagnosis or treatment • Do not recommend aspirin for fever in children © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 39-57 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 © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 39-58 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 Cardiovascular malformations in the fetus before birth; heart disease 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 © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 39-59 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; usually occurs before months old; “Back to Sleep” © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 39-60 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 © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 39-61 Patient and Caregiver Education • Answer questions appropriately • American Academy of Pediatrics – Brochures and booklets © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 39-62 Apply Your Knowledge What are the responsibilities of the medical assistant relating to immunizations? 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 Super © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 39-63 In Summary 39.1 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 39.2 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 child exam © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 39-64 In Summary (cont.) 39.3 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 39.4 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 39-1, 39-3, and 39-5 © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 39-65 In Summary (cont.) 39.5 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 39-1, 39-3, and 39-5 39.6 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 Recognizing the signs of these three problems is essential to your role as a medical assistant © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 39-66 In Summary (cont.) 39.7 During a gynecological exam or procedure, you will need to ensure patient comfort and safety as well as assist the physician with patient positioning, draping, equipment, and specimens obtained 39.8 A pregnant woman will need to have her concerns and questions answered During late pregnancy, she may not be able to move into certain positions and will require assistance © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 39-67 End of Chapter 39 If pregnancy were a book they would cut the last two chapters ~ Nora Ephron © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed [...]... Ultrasound – Nuclear imaging • Medical assistant – Set up appointments – Explain procedures and preps to patient © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 39- 18 Diseases and Disorders • Diseases of aging – – – – Constipationdiarrhea cycle Hyperlipidemia Osteoporosis Alzheimer’s disease • Infectious diseases – – – – Lyme disease Pneumonia Rabies Staph and strep infections © 2011... and physician assistance • Physician monitors for – Placenta previa – Abrupt placenta – Gestational diabetes © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 39- 33 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. .. – Cessation of menstrual cycle – Stages • Premenopause • Perimenopause – Hormonal changes or surgical removal of uterus and ovaries © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 39- 27 Diagnostic Tests and Procedures • Pregnancy test – detect presence of HCG – Blood – First voided urine • Tests for STDs – Cultures and blood tests – Examining lesions – Patient’s history © 2011 T he... reserv ed 39- 28 Diagnostic Tests and Procedures (cont.) • Radiologic tests – X-rays • Avoid if pregnant • Hysterosalpingography • Mammograms – Ultrasounds – CT scan – MRI • Fetal screening – Alpha fetoprotein • Abnormal levels can indicate neural tube defect – Ultrasound © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 39- 29 Diagnostic Tests and Procedures (cont.) • Amniocentesis – To determine... 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 © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 39- 30 Diagnostic Tests and Procedures (cont.) • Fine-needle aspiration – Remove a sample of tissue... organs, and rectum – Speculum – expands the vaginal opening – Medical assistant’s role • Assist the patient into position • Assist the doctor © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 39- 26 Life Cycle Changes • Menstruation – Normal cycle of preparation for conception – Menarche – • Onset of menstruation • 1 0–1 5 years of age – Prompted by hormonal changes • Menopause – Cessation.. .39- 11 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 © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 39- 12 Detecting Substance... patient and caregiver • Signs of neglect – – • Take careful history – • Report suspicions of abuse to physician – – Foul odor from the patient’s body Poor skin color Inappropriate clothing for the season Soiled clothing Extreme concern about money © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 39- 17 Diagnostic Testing • Radiologic testing – X-rays – CT scans – MRI scans – Ultrasound – Nuclear... mouth suctioned – Umbilical cord clamped, tied, and cut – Vaginal vs cesarean section – Apgar testing of newborn © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 39- 34 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... or tumor • Pap smear – Used to determine presence of abnormal or precancerous cells • Hysterectomy – Removal of the uterus – Hysterosalpingectomy • Removal of uterus and fallopian tubes – Hysterosalpingooophorectomy • Removal of uterus, fallopian tubes, and ovaries © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 39- 31 Pregnancy • Stages – – – • First trimester – conception to 12 weeks