Medical Assistant Skills

1. Medical Assistant Skills Medical Professions Education II Diversified Health Occupations Pages 567- 614

2. Medical Assistant SkillsOBJECTIVES • Upon Completion of this unit, the student should be able to: • Measure and record height and weight of infants and adults • Patient positioning • Use a Snellen Chart to screen for vision problems • Prepare for and assist with ENT, GYN and general exams • Define, pronounce, and spell all of the key terms

3. Medical Assistant SkillsMeasuring /Recording Height & Weight • Are you concerned with how much you weigh? • Why are people interested with their weight and height?

4. Medical Assistant SkillsHeight and Weight • Height and weight measurements are used to determine if a person is overweight or underweight • Must be accurate~~ ALWAYS RECHECK CALCUALTIONS (10% deviation is usually considered normal) • When are the measurements taken? • Admittance to hospital, LTCF, or other health care agency • General exam • At times during certain laboratory exams • For calculating dosage for certain medications

5. Medical Assistant SkillsHeight and Weight • For calculating dosage for certain medications • Height, weight, and head circumference is checked frequently on infants and toddlers • Infant growth is rapid • Usually checked every 2 months to detect changes that may indicate problems with growth and development • Measurements recorded on a NCHS growth graph, which allows MD to check the child’s growth and compare it to the average percentiles of other children the same age • Abnormal growth patterns may indicate nutritional deficiencies or genetic diseases

6. Medical Assistant SkillsHeight and Weight • Daily Weights • Often order for pts. with edema due to heart, kidney, or other diseases • Must use the same scale each day • Make sure scale is balanced before weighing patient • Weigh patient at same time each day • Make sure patient is wearing same amount of clothing

7. Medical Assistant SkillsHeight and Weight SAFETY!!! • WATCH THE PATIENT CLOSELY AT ALL TIMES • PREVENT FALLS FROM THE SCALES • AVOID POSSIBLE INJURY FROM THE PROTRUDING HEIGHT LEVER

8. Medical Assistant SkillsHeight and Weight • Most pts. are very WEIGHT conscious! • Make only POSITIVE statements while weighing a patient!

9. Medical Assistant SkillsSCALES • A wide variety of scales are used to obtain measurements • CLINICAL SCALES • Contain balance beam for measuring weight • Have measuring rod for determining weight • INFANT SCALES • Provide an area for placing infant in a lying down or flat position • SPECIAL SCALES • Bed scale w/mechanical lift • Wheelchair scale

10. Recorded as lbs. and ozs or as kg. (2.2lbs) Most scales measure lbs. in ¼-pound increments Metric scales use kg with 0.1-kg (1gram) increments ADULT SCALE Top weight scale on a clinical scale Usually goes from 1 to 50 lbs Each small line represents ¼ lbs Scale is read ¼, ½, ¾, and 1 Each long line represents 1 lb For pts who weigh more than 50 lbs, the lower scale is used first Medical Assistant SkillsRECORDING WEIGHT

11. Medical Assistant SkillsRecording Weight • Adult scale, cont. • Bottom scale is usually in 50-lbs increments • EXAMPLE: • Bottom scale is set at 100 lbs. • Top scale is set at 24 ½ pounds • 100 + 24 ½ = 124 ½ pounds • PATIENT’S WEIGHT IS 124 ½ LBS.

12. Medical Assistant SkillsRecording Weight • Infant Scales • Vary…some have digital numbers that are easier to read, others have weights in lbs. and ozs. • Remember there are 16 oz in 1 lb • Each short line represents 1 oz with lines for 4, 8, and 12 ozs slightly longer • Each long line represents 1 lb. • At times, ozs. are converted to fractions of a lbs • To convert 8 ounces to a fraction of a pound, divide by 16 (16 ounces = 1 pound) • 8/16 = ½ pounds • EXAMPLE • Infant weighs 8lbs 4 oz…divide only the ozs. by 16. • 4/16 = ¼ • TOTAL WEIGHT = 8 ¼ POUNDS

13. Medical Assistant SkillsRecording Height • Recorded as feet and inches or as centimeters • Measuring bar measures inches and fractions or ¼-inch increments • Metric bar uses one centimeter increments • 1 inch equals 2.5 centimeters

14. Medical Assistant SkillsRecording Height • Each small line represents ¼ inch • Each long line represents 1 inch • From the bottom of the scale up to the break in the bar, readings are taken in an upward direction • If a pt is taller than 50 inches, reading are taken in a downward direction and read at the break in the bar

15. Medical Assistant SkillsRecording Height • Height for adults is recorded in feet and inches • Inches must be converted • Remember there are 12 inches in 1 foot • Divide 12 into the number of inches obtained • EXAMPLE: • Measurement recorded is 64 inches • 12/ 64 ½ = 5 ft 4 ½ inches

16. Medical Assistant SkillsRecording Height • TAPE MEASURE FOR INFANT HEIGHT • Tape measure is read like a ruler • Each small line is 1/8 inch • Each longest line is 1 inch • Readings are 1/8, ¼, 3/8, ½, 5/8, ¾, 7/8, and 1 inch

17. Medical Assistant SkillsHeight and Weight • IMPORTANT PRINCIPLES FOR MEASURING WEIGHT/HEIGHT ON A CLINICAL SCALE ADULT • Balance the scale with the weight at zero • Ask pt to remove shoes, jacket, heavy outerwear, etc. • Make sure pt stands unassisted with feet slightly apart and centered on platform • Make sure pt stands erect for height measurement

18. Medical Assistant SkillsHeight and Weight • IMPORTANT PRINCIPLES FOR MEASURING WEIGHT/HEIGHT ON AN INFANT SCALE INFANT • Be ALERT with the infant AT ALL TIMES! • Place a sheet of paper on the scale and balance scale at zero • Remove infant’s clothing, including diaper • To record height place infant on a flat surface and mark the height accurately • Head circumference is frequently measured on an infant • NEVER LEAVE AN INFANT UNATTENDED!!!

28. Medical Assistant SkillsPOSITIONING • Pts must be positioned correctly for variety of exams, test, and procedures • Wide variety of positions are used for different procedures or exams • Pt may be in a bed or on an exam table, surgical table, diagnostic or treatment table • IMPORTANT to know how to operate the table! • DISINFECT the table before and after pt use. • Table paper is frequently used to cover the table prior to exams and then removed and replaced before next exam

29. Medical Assistant SkillsPOSITIONING • During any procedure or exam reassure the pt • Help them understand what is being done • Watch the pt carefully for signs of distress • Observe all safety factors to prevent falls or injuries

30. Medical Assistant SkillsPOSITIONING • Use correct body mechanics at all times to prevent injury to yourself • Position used depends upon exam, procedure, or test being performed • Proper draping is essential for all positions • Care must be taken to avoid unnecessary exposure • Drape must be applied so MD or tech will have ready access to the area being examined or treated • Close door to room and draw curtains if they are present

31. Medical Assistant SkillsPOSITIONING HORIZONTAL RECUMBENT OR SUPINE POSITION • Used to exam or treat the front or anterior part of the body • Pt lies flat on back with legs slightly apart • One small pillow is allowed under the head • Arms are flat at the side of the body • Drape pt with large sheet or drape

32. Medical Assistant SkillsPOSITIONING PRONE POSITION • Used for exams of back or spine • Pt lies on the abdomen with head turned to either side • Small pillow is placed under the head • Arms may be flexed at elbows and positioned on either side of the head • Drape pt with large sheet or drape

33. Medical Assistant SkillsPOSITIONING SIMS’ OR LEFT LATERAL POSITION • Used for simple rectal or sigmoidoscopic exams, enemas, rectal temps, and rectal treatments • Patient lies on left side • Head rests on small pillow and is turned to the side • L arm is extended behind the back • R arm is bent at elbow and placed in comfortable position in front of the body • L leg is bent or flexed slightly • R leg is bent or flexed sharply and brought up to the abdomen • Drape pt with one large sheet or drape or two small sheets that meet at the rectal area

34. SIM’S OR LEFT LATERAL

35. Medical Assistant SkillsPOSITIONING KNEE-CHEST POSITION • Used for rectal exams- usually a sigmoidoscopic exam • Pt lies on stomach, abdomen, or prone position • Pt raises buttocks and abdomen until weight is resting on upper chest and knees • Head rest on small pillow and is turned to either side • Arms are flexed slightly at the elbows and extended above the head • Knees are separated slightly • Thighs are at right angles to the table/bed • Draping can be done by • 1 large sheet can be used to cover the pt • 1 large sheet with a hole at the rectal area • 2 smaller sheets or drapes that meet at the rectal area

36. KNEE-CHEST

37. Medical Assistant SkillsPOSITIONING KNEE-CHEST POSITION, cont. • Safety precautions!!! • Remain with the pt at all times while in the knee-chest position • This is a difficult position to maintain and should only be used when absolutely necessary • After exam, place pt in a prone position and then turn over to supine • Watch closely for s/s dizziness or discomfort

38. Medical Assistant SkillsPOSITIONING FOWLER’S • Used to facilitate breathing, relieve distress, encourage drainage, and examine the head, neck, and chest • Pt lies on back with head elevated at different angles • A small pillow may be place under the pt’s head • Flex knees slightly and place small pillow under knees • Drape with a large sheet or drape • Don’t tuck sheet! : )

39. Fowler’s • Low- Fowlers: head elevated at 25° angle • Mid-fowler’s or semi –Fowler’s- head elevated at 45° angle

40. Fowler’s • High Fowler’s- head elevated at 90° angle

41. Medical Assistant SkillsPOSITIONING LITHOTOMY POSITION • Used for vaginal examinations, pap tests, urinary catherization, cystoscopic examinations, and surgery of the pelvic area

42. Medical Assistant SkillsPOSITIONING LITHOTOMY POSITION • Pt lies on back with head on small pillow • Arms rest at sides of body • Pt slides buttocks down on table to where lower end of table folds down or pulls out • Place sheet or drape over pt in diamond position • Flex and separate the knees • Place feet in stirrups on table • Drop the lower end of the table or push it in if this is possible

43. Medical Assistant SkillsPOSITIONING LITHOTOMY POSITION • To remove pt from position: • Raise the end of the table or pull it out so it is level • Lift feet out of stirrups and place on table • Ask pt to slide back up on table

44. Medical Assistant SkillsPOSITIONING DORSAL RECUMBENT POSITION • Similar to lithotomy position and used for same purposes

45. Medical Assistant SkillsPOSITIONING TRENDELENBURG POSITION • Requires a special table or bed and assistance • Care must be taken so pt does not slide off table or bed • Draping depends on procedure or treatment performed • Usually 1 large sheet is used to drape pt • For surgical procedures, use a large sheet with a hole to expose the surgical area • 2 smaller sheets can be used • Do not tuck! • Special safety precautions • use straps to secure pt in this position • Remain with patient at all times

46. Medical Assistant SkillsPOSITIONING STANDARD TRENDELENBURG POSITION • Used for circulatory shock because it increases circulation of the blood to the brain and head • Pt lies flat on back with head on small pillow • Arms are flat at sides • Entire bed or table is elevated at the feet • Pt lies in horizontal recumbent with head lower than the feet

47. Medical Assistant SkillsPOSITIONING • Used for surgery on pelvic organs and pelvic treatments • Pt lies flat on back with head on small pillow • Arms are flat at sides • Top of table is lowered at an angle to lower the head • Bottom of table is lowered at an angle to incline legs and feet downward • Straps are used frequently to hold the pt in position SURGICAL TRENDELENBURG POSITION

48. Medical Assistant SkillsPOSITIONING JACKKNIFE POSITION • Used for rectal surgery or exams, or back surgery and treatments • Requires a special table that will break in the middle • Care must be taken so pt will not slide off or be injured in any way • Pt lies in prone position • Secure the safety straps on the table around the pt • Lower the top of the table so the head and upper body are inclined at a downward angle • Draping is done in a variety of ways • Special safety precautions

49. JACKKNIFE POSITION

50. Medical Assistant SkillsBasic Principles for Positioning • Determine the exam, tx, or procedure to be performed • Determine which position will be required • Prepare pt correctly • Assist pt onto table • Position pt in correct position • Drape pt correctly for position • To change positions: • Observe all safety precautions • Watch pt at all times for s/s of dizziness, pain, or discomfort • When exam/tx is complete, assist pt to a sitting position…SLOWLY • Assist pt off of table