Assisting with Examinations in the Basic Specialties

1. 39 Assisting with Examinations in the Basic Specialties

2. 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. 39.4Identify common diseases related to internal medicine, obstetrics and gynecology, and pediatrics. Learning Outcomes

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.

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 • 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 the body’s internal organs • Internist • Often first to see patient • Uses medication and/or treatment modalities • Refers to a specialist

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

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

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

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 Detecting Substance Abuse (cont.)

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

15. 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 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 Diagnostic Testing

18. Diseases of aging Constipation-diarrhea cycle Hyperlipidemia Osteoporosis Alzheimer’s disease Infectious diseases Lyme disease Pneumonia Rabies Staph and strep infections 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 Trichomoniasis Diseases and Disorders (cont.)

20. 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. 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

23. 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

24. 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 Gynecologic Physical Examination(cont.)

25. 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

26. 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 Life Cycle Changes

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

28. 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 Diagnostic Tests and Procedures(cont.)

29. 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 Diagnostic Tests and Procedures(cont.)

30. 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 Diagnostic Tests and Procedures(cont.)

31. 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

32. Assisting with prenatal care Patient education Assist with routine visit Interview patient Documentation Specimen testing Patient and physician assistance • Physician monitors for • Placenta previa • Abruptio placenta • Gestational diabetes Pregnancy (cont.)

33. 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 Pregnancy (cont.)

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 to community resources

35. Contraception

36. Contraception (cont.)

37. Contraception (cont.)

38. Contraception information Planned Parenthood Federation National Library of Medicine FDA Infertility Inability to conceive Patient education Tests Treatments Obstetrics and Gynecology(cont.)

39. Diseases and Disorders

40. Diseases and Disorders (cont.)

41. Diseases and Disorders (cont.)

42. Diseases and Disorders (cont.)

43. Diseases and Disorders (cont.)

44. Apply Your Knowledge A 38-year-old pregnant patient may be carrying twins. What diagnostic tests may be performed and why? ANSWER: Tests will probably include: Ultrasound to determine fetal size, position, and number of fetuses Amniocentesis to determine if there are possible genetic or metabolic disorders of the fetus. Alpha fetoprotein to determine if there is a possible neural tube defect.

45. Apply Your Knowledge A patient has just found out she is pregnant. Her last period started on January 23rd. Using Nägele’s rule, what day would be her estimated date of delivery? ANSWER: Nägele’s rule says count back three months [1-December, 2-November, 3-October], then add seven days plus 1 year, [23 + 7 = 30]. Her estimated date of delivery would be October 30th. Right!

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

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

48. 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

49. Assisting with the Pediatric Physical Examination (cont.) • Examining the well child (cont.) • Children in the second year of life should have checkups at 15 and 18 months • Annually after 2 years old • Prepare for exam as you would for an adult • Follow Universal Precautions

50. 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 Detecting Child Abuse