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Chapter 20

Chapter 20. Medical Assistant Skills. Skills Lab. Measuring height & weight Chapter 20:1 Procedure 20:1A Positioning Patients Chapter 20:2 Procedure 20:2 Positioning, Turning, Moving and Transferring Patients Chapter 21:2 Procedure 21:1 A, B,C, D, E, F.

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Chapter 20

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  1. Chapter 20 Medical Assistant Skills

  2. Skills Lab • Measuring height & weight • Chapter 20:1 • Procedure 20:1A • Positioning Patients • Chapter 20:2 • Procedure 20:2 • Positioning, Turning, Moving and Transferring Patients • Chapter 21:2 • Procedure 21:1 A, B,C, D, E, F

  3. 20:1 Measuring/RecordingHeight and Weight • Use: to determine if a patient is overweight or underweight • Height & Weight charts are based on averages • Must be accurate • When and why measurements are required ? • Daily weights are commonly taken in hospitals– why? (continued)

  4. Height & Weight • Measurements: • are routinely performed on admission to hospitals, LTC, doctors visits • Provide Information needed for performing and evaluation of certain laboratory tests • Calculation dosages of certain medications— • In all children • In all complex intravenous drip medications • In all IV TPN or total parenteral nutrition

  5. Height & Weight • Height, weight, head circumference: • Monitored frequently in children due to rapid growth • Commonly compared to the National Center for Health Statistics ( NCHS) growth graph • Goal it to identify early growth and developmental conditions in children • Plotting a child’s HT & WT allows the physician to check their G & D to percentile averages of other children their same age

  6. Measuring/Recording Height and Weight (continued) • Basic procedure for infant weight • To evaluate nutrition & growth • Basic procedure for measuring height of infant • To evaluate abnormal growth patterns or genetic conditions • Measuring infant head circumference • To identify hydro or micro cephalic conditions • Measuring infant chest circumference • Recording growth graph

  7. Measuring/Recording Height and Weight (continued) • Wide variety of scales • Recording weight • Adult weight scales • Both lbs. & kg are used however– kg is the standard • Infant weight scales • Recording height • Height bar on adult scale (continues)

  8. Height & Weight • Height & weight charts are used as averages • A 10 % deviation in chart to patient is considered normal • Head circumference > 95 percentile is classified as hydrocephalus • Must be accurate– always recheck all calculations

  9. Equipment • Use the same scale for accuracy • Make sure the scale is balanced • Weigh at the same time each day • Wear the same amount of clothing • Patient should empty bladder before weight is taken

  10. Weight Conversions

  11. Convert the following to kilograms: • 120 lbs • 176 lbs • 200 lbs • 350 lbs • 34 lbs • You must DIVIDE by 2.2 kg to perform this conversion

  12. Convert the following weight to pounds: • 75 kg • 100 kg • 25 kg • 99kg • 145 kg • You must MULTIPLY by 2.2 to perform this conversion

  13. Notes on Weight • Most people are weight conscious • Make only positive statements when measuring all patients • Remember to Ensure patient privacy at all times

  14. Types of Scales • Weight Bar Scales

  15. Types of Scales • Wheelchair Scale

  16. Types of Scales • Bed Scales

  17. Types of Scales • Bed with Scale

  18. Types of Scales • Infant Scales

  19. Height Measurement • Assessed in older adults to assess for osteoporosis • Patient safety must always be considered • Observe patients closely • Prevent falls and injuries

  20. Height Conversions • 1 inch is equal to 2.35 centimeters (cm) • You must MULTIPY by 2.35 to perform this conversion: • Convert the following to cm: • 60 in • 45 in • 25 in • 75 in • 18 in

  21. Height Conversions • You must DIVIDE by 2.35 to convert cm to inches. • Convert the following: • 95 cm • 120 cm • 50 cm • 18 cm • 145 cm

  22. Student Assignment/ Skills Lab for 20:1 • Complete worksheet for 20:1 • Students will then perform Height & Weight measurements on each other

  23. How to Weigh a Patient: • Assemble equipment • Wash hands • Prepare scale • Zero the scale • Greet & introduce self • Check patient ID • Explain the procedure • Patinent should remve shoes, jacket, purses, and all other heavy objects

  24. Continued: • Ask patient to step onto the scale • Move the large 50 pound weight to the right until the balance bar drops on the lower guide. Move this weigh back one notch • Move the smaller weight until the balance bar swings freely between the lower and upper guides • Assist the patient off the scale

  25. How to Measure a Patient: • Raise the height bar • Assist the patient back onto the scale with is back to the scale • Instruct the patient to stand erect • Move the bar until it reaches the top of the patient head • Read the measurement in cm and inches • Elevate bar • Assist patient off the scale • Perform any necessary conversions • Replace equipment and wash hands

  26. CONVERSION ANSWERS • 54.5 KG • 80 KG • 90 KG • 159 KG • 15.4KG • 165 LBS • 220 LBS • 55 LBS • 217.8 LBS • 319 LBS • 141CM • 105.7 CM • 58.7 CM • 176.2 CM • 42.3 CM • 40.4 IN • 51 IN • 21.2 IN • 7.65 IN • 61.7 IN

  27. Positioning Patients

  28. 20:2 Positioning a Patient • Patient must be positioned correctly for variety of examinations, tests, and procedures • Wide variety of positions used • Patient may be on a bed, examination table, surgical table, diagnostic table, or treatment table • Know how to operate all equipment before using it with a patient (continues)

  29. Positioning a Patient(continued) • Reassure patient • Fully explain to the patient what you are going to do and why • Assess patient for any distress • Observe all safety factors to prevent falls and injury • Use correct body mechanics to prevent self-injury (continues)

  30. Positioning a Patient • Never expose a patient during any exam or procedure • Door should be closed and curtain drawn • Properly drape/cover patient to ensure privacy but at the same time allow proper access for examination

  31. Positions • Horizontal recumbent or supine position • Pt is lying flat on their back with legs slightly apart • One small pillow is under the head • Arms flat on the side of the body • Patient drape is always used • Used to examine or treatment of the front part of the body

  32. Horizontal Recumbent or Supine

  33. Prone Position • Used to examine or treat the back of the patient • Patient lies on his or her abdomen with head turned to either side – a small pillow may be used under the head • Arms may be flexed at the elbow or positioned on either side • Drape is always used

  34. Supine vs. Prone

  35. Lithotomy Position (continued) • Lithotomy position • Used for gynecological examinations- vaginal, PAP tests, urine catherizations, cystoscopy exams and surgery of the pelvic area • Position on the back • Knees separated and flexed and feet are placed in stirrups • Arms rest at the sides • Buttock at the lower end of the table/bed • Drape is always used

  36. Lithotomy

  37. Dorsal Recumbent Position • Dorsal recumbent position • Similar to Lithotomy but patient has feet on the bed not in stirrups • Knees are bent • Feet flat on the bed • Draping is always used • Do Not Confuse with HORIZONTAL RECUMBENT

  38. Dorsal Recumbent Position

  39. Trendelenburg Position • Trendelenburg position • Used to increase blood flow to the head and brain • Patient lies in the horizontal position • The head is lower than the feet • Commonly used when a patient is in shock

  40. Trendelenburg Position

  41. Jackknife Position • Mainly used for rectal surgery • Patient is in prone position • Table is elevated at the center so that the rectal area is at a higher elevation • Special table is required for this position • Draping as indicated

  42. Sims Lateral Position • Used for simple rectal exams, enemas, and other rectal treatments • Patient lies on the left side • Left are is extended behind the back • Head turned to the side • Right arm is in front of the patient and elbow is bent • Left leg is slightly bent • Right leg is bent sharply at the knee and brought into the abdomen • Drape the patient accordingly

  43. Fowlers Position • Used to help facilitate breathing, receive distress, encourage drainage and exam the head, neck & chest • Patient lies on their back • Legs flat and slightly bent • Drape the patient for privacy • Head is in one of three different elevations • Low fowler- 25 degree angle • Semi-fowlers- 45 degree angle • High fowlers- 90 degree angle

  44. Fowlers Position

  45. Knee- Chest Position • Used for rectal exams • Patient rests on the body weight • Arms are flexed slightly at the elbows and extended above the head • Knees are slightly separated and the thighs are at the right angles to the table

  46. Knee Chest Position

  47. Tips • REMEMBER • to use good body mechanics while positioning patients to protect yourself as well as the patient!!

  48. 20:3 Screening for Vision Problems • Vision screening tests • Types of Snellen charts • Interpretation of readings on Snellen chart • Snellen chart tests only for defects in distant vision • Nearsightedness or myopia (continues)

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