PowerPoint® presentation to accompany: Medical Assisting Third Edition Booth, Whicker, Wyman, Pugh, Thompson

1. Chapter 39 Assisting with Examinationsin the Basic Specialties PowerPoint® presentation to accompany: Medical Assisting Third Edition Booth, Whicker, Wyman, Pugh, Thompson

2. Learning Outcomes 39.1 Briefly describe the medical specialties of internal medicine, pediatrics, and obstetrics and gynecology. 39.2 Describe the types of examinations and diagnostic tests performed in each of these specialties and the medical assistant’s role in them.

3. Learning Outcomes (cont.) 39.3 List and describe some common diseases and disorders seen in these medical specialties and typical treatments for them. 39.4 Identify common signs of domestic violence and child abuse. 39.5 Describe the medical assistant’s role in assisting with a cervical biopsy.

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

5. Medical practice act Defines the exact duties of physicians and other health-care personnel Medical assistants May perform clinical procedures only under the supervision of the physician The Medical Assistant’s Role in Specialty Examinations State laws vary. You will need to know the scope of practice for medical assistants in the state where you work.

6. The Medical Assistant’s Role in Specialty Examinations (cont.) • Providing emotional support • Helps patients identify and cope • Providing patient education • Effective communication • Provide educational materials • Verify understanding

7. 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. Very Good!

8. Internal Medicine • Diagnosis and treatment of disorders and diseases of thebody’s internal organs • Internist • Often first to see patient • Uses medication and/or treatment modalities • Refers to a specialist

9. Internal Medicine: Assisting with the Physical Exam • 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

10. Internal Medicine: 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

11. Internal Medicine: 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

12. 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 Internal Medicine: Detecting Substance Abuse (cont.)

13. Internal Medicine: Detecting Domestic Violence • Signs of domestic violence – bring to doctor’s attention • Injuries that the patient tries to hide or excuse • Unusual bruising • Signs in a patient’s tone of voice or choice of words • Self blame • Reporting suspected domestic violence is mandatory in some states • Keep a list of services available for a victim of abuse

14. Difficult to detect – no uniform definition Can be mistaken for falls or chronic illnesses Categories Domestic Institutional Self Types Physical, sexual, psychological Neglect Abandonment Exploitation Occurs in all racial, socioeconomic, and religious groups Internal Medicine: Detecting Elder Abuse

15. Internal Medicine: Detecting Elder Abuse (cont.) • Most victims are older women with chronic illness or disabilities • Risk factors • 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

16. Observe interactions between patient and caregiver Take careful history Report suspicions of abuse to physician Signs of neglect Foul odor from the patient’s body Poor skin color Inappropriate clothing for the season Soiled clothing Extreme concern about money Internal Medicine: Detecting Elder Abuse (cont.)

17. Radiologic testing X-rays CT scans MRI scans Ultrasound Nuclear imaging Medical assistant Set up appointments Explain procedures and preps to patient Internal Medicine: Diagnostic Testing

18. Diseases of aging Constipation-diarrhea cycle Hyperlipidemia Osteoporosis Alzheimer’s disease Infectious diseases Lyme disease Pneumonia Rabies Staph and strep infections Internal Medicine: Diseases and Disorders

19. STDs Acquired through sexual contact with an infected person Patient education Prevention Treatment Common types of STDs Candidiasis Chlamydia Genital herpes Genital warts Gonorrhea Trichimoniasis Internal Medicine: Diseases and Disorders (cont.)

20. Internal Medicine: Diseases and Disorders (cont.)

21. 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. Correct!

22. Specialization in the health care of children Monitoring development Diagnosing and treating illnesses Pediatrician – specialist Medical assistant responsibilities Parent or caregiver education Immunization schedule Detection of child abuse Pediatrics

23. Ask about eating habits, sleep patterns, daily activities, immunization schedules, and toilet training Adolescents STDs, drugs, and alcohol Awkward and self-conscious Relieve fear Explain procedures Allow child to examine instruments Speak in terms appropriate to age level Pediatrics: Assisting with the Pediatric Physical Examination

24. Pediatrics: Assisting with the Pediatric Physical Examination (cont.) • Examining the Well Child • Infants need seven well-baby examinations during their first year at these intervals • 2 weeks 6 months • 1 month 9 months • 2 months 1 year • 4 months

25. Pediatrics: Assisting with the Pediatric Physical Examination • Examining the Well Child • Children in the second year of life should have checkups at 15 and 18 months • Annually after 2 years old • Prepare for exam as for an adult • Follow Universal Precautions

26. Watch for problems in relationship between child and parent / caregiver Observe for unexplained injuries Signs of abuse Dirty diaper Neglected appearance Hunger Extreme sadness or fear Inability to communicate Bruises or burns Lesions on child’s genitalia Pediatrics: Pediatric Physical Examination – Detecting Child Abuse

27. Risk factors for abuse Stress Single parenthood Inadequate knowledge of developmental expectations Lack of family support / family hostility Financial problems Mental health problems Pediatrics: Pediatric Physical Examination – Detecting Child Abuse (cont.)

28. Pediatrics: Pediatric Physical Examination – Detecting Child Abuse (cont.) • Physician will examine for: • Internal injuries, tenderness when palpated or auscultated • Malnutrition, tooth discoloration, unhealthy gums • Lack of cognitive ability, dulled neurological responses • You are legally responsible for reporting suspected child abuse or neglect

29. Pediatrics: 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 3 to 5 years • Four – age 6 years to puberty • Five – adolescence

30. 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 Pediatrics: Assisting with the Pediatric Physical Examination (cont.)

31. Pediatrics: Assisting with the Pediatric Physical Examination (cont.) • Immunizations • Store vaccines properly • Administer vaccines correctly • Maintain careful immunizationrecords • Educate parents • Follow recommended schedule for follow-up appointments

32. Pediatrics: 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

33. Pediatrics: Diseases and Disorders (cont.)

34. Pediatrics: Diseases and Disorders (cont.)

35. Pediatrics: Diseases and Disorders (cont.)

36. Pediatrics: Diseases and Disorders (cont.)

37. Pediatrics: Patient and Caregiver Education • Answer questions appropriately • American Academy of Pediatrics • Brochures and booklets

38. 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!

39. Obstetrics and Gynecology • Specialization of the female reproductive system • Obstetrician – focuses on caring for women during pregnancy and childbirth • Gynecologist – focuses on conditions of the female reproductive system

40. Obstetrics and Gynecology: 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 examination

41. Physician’s interview Evaluation of total health Review of factors that may indicate cancer or STDs Breast exam Check for abnormal lumps Patient education Annual mammograms starting at 40 years old Breast exam by physician annually Monthly breast self-examination Obstetrics and Gynecology: Gynecologic Physical Examination (cont.)

42. Obstetrics and Gynecology: 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

43. Menstruation Normal cycle of preparation for conception Menarche – Onset of menstruation 10–15 years of age Prompted by hormonal changes Menopause Cessation of menstrual cycle Stages Premenopause Perimenopause Hormonal changes or surgical removal of uterus and ovaries Obstetrics and Gynecology: Life Cycle Changes

44. Obstetrics and Gynecology: 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

45. 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 Obstetrics and Gynecology: Diagnostic Tests and Procedures (cont.)

46. 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 Obstetrics and Gynecology: Diagnostic Tests and Procedures (cont.)

47. Fine-needle aspiration Remove a sample of tissue from a cyst, lump, 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 Hysterosalpingo-oophorectomy Removal of uterus, fallopian tubes, and ovaries Obstetrics and Gynecology: Diagnostic Tests and Procedures (cont.)

48. Obstetrics and Gynecology: Pregnancy • Stages • First trimester – conception to 12 weeks • Second trimester – 12 weeks to sixth month • Third trimester – sixth month until birth • Nägele’s rule – estimate of delivery date • Subtract 3 months from first day of last period and add 7 days plus one year

49. Obstetrics and Gynecology: Pregnancy (cont.) • Assisting with prenatal care • Patient education (significant other) • Assist with routine visit • Interview patient • Documentation • Specimen testing • Patient and physician assistance

50. 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 Obstetrics and Gynecology: Pregnancy (cont.)