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Chapter 40 - Assisting with examinations in the basic specialties. This chapter introduces you to the basic specialties of internal medicine, pediatrics, and obstetrics and gynecology. You will learn about the types of examinations and diagnostic tests used in these specialties and about the common diseases and disorders seen in these specialities.
PowerPoint® to accompany Medical Assisting Chapter 40 Second Edition Ramutkowski Booth Pugh Thompson Whicker Copyright © The McGraw-Hill Companies, Inc Permission required for reproduction or display Assisting with Examinations in the Basic Specialties Objectives: 401 Briefly describe the medical specialties of internal medicine, pediatrics and obstetrics and gynecology 402 Describe the types of examinations and diagnostic tests performed in each of these specialties and the medical assistant’s role in them 403 List and describe some common diseases and disorders seen in these medical specialties and typical treatment for them Assisting with Examinations in the Basic Specialties Objectives (cont.) 404 Explain the medical assistant’s duties in assessing for chronic fatigue syndrome 405 Identify common signs of domestic violence and child abuse 406 Describe the medical assistant’s responsibilities in performing a scoliosis examination 407 Describe the medical assistant’s role in assisting with a cervical biopsy Introduction Medical practice act is a law that defines the exact duties physicians and other health care personnel may perform Medical assistants are allowed to perform clinical procedures only under the supervision of the physician Because state laws vary, you will need to know the scope of practice for medical assistants in the state where you work Specialty Examinations Specialties are physicians who have taken additional training beyond medical school and their residencies They must pass rigorous examinations in their chosen specialty Internal Medicine Diagnosis and treats disorders and diseases of the body’s internal organs They treat medical problems with medicine, and/or modalities (therapeutic agents.) An internist can refer patients to a doctor in one of the internal medicine subspecialties Assisting with the Physical Examination Usually the same as a general physical examination You may be expected to assess for chronic fatigue syndrome Patients must have four or more of the following: • Impairment in shortterm memory, sore throat, muscle pain, tender lymph nodes, multijoint pain without swelling, unrefreshing sleep and postexertional malaise lasting more than 24 hours Detecting Substance Abuse Signs of abuse Alcohol Depressed pulse rate, respiration and blood pressure Cocaine – Excitation, increase pulse rate and blood pressure Inhalants – Muscle weakness, hearing loss, changes in heart rate, nausea and dizziness Detecting Domestic Violence Report Injuries that the patient tries to hide or excuse Unusual bruising Signs in a patient’s tone of voice or choice of words Reporting suspected domestic violence is mandatory in some states Keep list of services available for patient handy Detecting Elder Abuse Occurs in all racial, socioeconomic and religious groups Risk factors: History of alcoholism, drug abuse or violence in the family History of mental illness in the abuser Isolation of the victim from family members Recent stressful events affecting the abuser or victim 10 Pelvic Examination The doctors checks external genitalia, cervix, vaginal wall, internal reproductive organs, and rectum Doctor uses a speculum – instrument that expands the vaginal opening to permit viewing of the vagina and cervix Your role is to assist the patient into position and provide assistance to the doctor 28 Apply Your Knowledge What is the correct position to have a patient assume for a pelvic examination and how should you assist the patient in assuming this position? 29 Apply Your Knowledge Answer What is the correct position to have a patient assume for a pelvic examination and how should you assist the patient in assuming this position? Lithotomy Assist the patient into position, with her feet in the stirrups of the examining table and her buttocks at the end of the table 30 Diagnostic Tests and Procedures Pregnancy tests – Pregnancy tests Human Chorionic Gonadotropin Tests for STDs Radiologic Tests Ultrasound CT and MRI Hysterosalpingograph – Hysterosalpingograph examination of the fallopian tubes, and uterus Mammogram – detects Mammogram cancer of the breast A patient should schedule mammography for the week after her menstrual period, when the breasts are most normal and least swollen 31 Therapeutic Procedures Amniocentesis – performed when genetic or metabolic defect is suspected Biopsy – surgical Biopsy removal of tissue that assists with determining cancer 32 Therapeutic Procedures (cont.) Colposcopy – examination of the vagina and cervix with a colposcope Fine needle aspiration Fine needle aspiration – obtain sample of cyst, lump or tumor of breast Hysterectomy – Hysterectomy removal of the uterus Laparoscopy – view Laparoscopy internal female organs Pap smear – determine Pap smear presence of abnormal or precancerous cells The physician may use needles or other instruments to obtain tissues or amniotic fluid samples 33 Pregnancy First trimester – conception to 12 weeks Second trimester – 12 weeks to sixth month Third trimester – sixth month until birth Nagele’s rule – to estimate the delivery date for a pregnant women Subtract 3 months from first day of last period and add 7 days plus one year 34 Prenatal Care Assisting with prenatal care Help teach and support both the parents Patient education is important Assist with routine prenatal patient visit 35 Assisting with Prenatal Visits You may : Ask the patient about any problems Ask the patient to empty her bladder and obtain a urine specimen and perform reagent urine test Weigh the patient Assist the patient to the exam table Assist the physician as needed Assist the patient from the table 36 Apply Your Knowledge A pregnant patient of 38 years may be carrying twins. What diagnostic tests may be performed and why? 37 Apply Your Knowledge Answer A pregnant patient of 38 years may be carrying twins. What diagnostic tests may be performed and why? Ultrasound – to determine fetal size and position Amniocentesis – determine genetic or metabolic disorder of the fetus Alpha fetoprotein – measured in the amniotic fluid 38 Apply Your Knowledge A patient has just found out she was pregnant. Her last period started on January 23rd. Using Nagele’s rule what day would be her estimated date of delivery? 39 Apply Your Knowledge Answer A patient has just found out she was pregnant. Her last period started on January 23rd. Using Nagele’s rule what day would be her estimated date of delivery? Nagele’s rule says count back three months [1 December, 2November, 3October], then add seven days, [23 + 7 = 30]. Her estimated date of delivery would be October 30th 40 Summary Medical Assistant Medical assistants positions in the basic specialist usually involve a wide range of responsibilities and tasks You will find many opportunities to develop your skills and interests if you work in one of these medical specialties 41 End of Chapter 42 ... tests performed in each of these specialties and the medical assistant’s role in them 40 3 List and describe some common diseases and disorders seen in these medical specialties and typical treatment for them... Basic Specialties Objectives: 40 1 Briefly describe the medical specialties of internal medicine, pediatrics and obstetrics and gynecology 40 2 Describe the types of examinations and diagnostic tests performed in each of these specialties and the ... Objectives (cont.) 40 4 Explain the medical assistant’s duties in assessing for chronic fatigue syndrome 40 5 Identify common signs of domestic violence and child abuse 40 6 Describe the medical assistant’s responsibilities in