Module 5 - General Patient Care Part 2

Place the steps of performing CPR in the order they should be performed.

1) Give 30 chest compressions 2) Tilt the head back 3) Pinch the nose 4) Give 2 slow breaths, mouth-mouth 5) Continue giving sets of 30 chest compressions & two breaths

QUIZ: What is the ratio of COMPRESSIONS to BREATHS when giving CPR on an ADULT?

30 CHEST COMPRESSIONS, FOLLOWED BY TWO RESCUE BREATHS

Which of the following BURNS would result in NO PAIN but the tissue is WHITISH?

3RD DEGREE BURN Third-degree burns are deep enough to damage the nerves and bones. - Tissue burned to the third degree is charred and white. - A third-degree burn can cause less pain because the nerves are damaged.

Match the description of the wound with the type of wound.

ABRASION: - Outer layers of skin rubbed away because of scraping INCISION: - Smooth cute LACERATION: - Edges torn in an irregular shape PUNCTURE: - Penetrating, made by a sharp, pointed instrument

Types and Sizes of Sutures

ABSORBABLE SUTURES do NOT need to be REMOVED and are digested by tissue enzymes and absorbed by the body tissues. - Sutures used to attach tissues beneath the skin are often made of an absorbable material that disappears in several days. - Absorption usually occurs 5 to 20 DAYS after insertion. NON-ABSORBABLE SUTURES are used on SKIN SURFACES where they can easily be REMOVED after an incision HEALS. - Sutures generally remain in place FIVE or SIX DAYS and then must be removed if they are nonabsorbable and include materials such as nylon, silk, polyester fiber, and even stainless steel. - If sutures remain in the body too long, they can cause skin irritation and infection. - Suture removal times differ depending on the site. The SIZE of the SUTURE MATERIAL, which is measured by the GAUGE or DIAMETER, is stated in terms of "0"—the more 0s, the smaller the gauge. - For example, 0 is thicker or larger than 6-0 (000000). - Sizes 2-0 through 6-0 are the most used. - Delicate tissue, such as areas on the face and neck, would be sutured with 5-0 to 6-0 suture sizes because these finer sutures would leave less scarring. - Heavier sutures, such as 2-0, would be used for the chest or abdomen. - The health care provider will determine the type and gauge of sutures to be used. - The suture package label will indicate type, size, length of the suture material, and if it is absorbable or nonabsorbable. Another common type of wound closures are STAPES. STAPLES are made of stainless steel and applied with a surgical stapler. - Staples allow for the closure of wounds under high tension, such as on the trunk, extremities, and scalp. - They are not generally used in delicate tissues or wounds in finely contoured areas, over bony prominences, or in highly mobile areas. - Staples can shorten the closure time and are used

Which of the following are benefits of wound closure?

AIDS IN HEALING PREVENTS INFECTION HELPS MINIMIZE SCARRING Once the wound is closed, it is not feasible to irrigate the wound bed. - Wound closure can be quite painful, and in some instances, anesthesia should be provided. - Wound closure helps reduce the risk of infection and other complications, aids in the healing process, and minimizes scarring.

An MA is caring for a bleeding wound. The blood is bright red, and the bleeding is fast and profuse. Which of the following kinds of hemorrhage is this?

ARTERIAL Arterial bleeding is high pressure, and, thus, the bleeding is bright red in spurts. - If a large artery, such as the aorta, is ruptured or bleeding has occurred for several minutes, this is a potentially life-threatening situation and can lead to death.

IDENTIFY AND RESPOND TO EMERGENCY/PRIORITY SITUATIONS WOUNDS:

Any break in the skin, whether from injury or a surgical incision, is referred to as a wound. WOUNDS: - Can be OPEN or CLOSED, intentional through surgical intervention, or accidental through trauma. - Wounds heal based on location, mode of injury, available blood supply, and the patient's general health status. There are FOUR TYPES of wound CLASSIFICATION: 1) ABRASION:: outer layers of skin are rubbed away because of scraping; will generally heal without scarring. 2) INCISION: smooth cut resulting from a surgical scalpel or sharp material, such as razor or glass; can result in excessive bleeding and scarring if deep. 3) LACERATION: edges are torn in an irregular shape; can cause profuse bleeding and scarring. 4) PUNCTURE: made by a sharp, pointed instrument such as a bullet, needle, nail, or splinter; external bleeding is usually minimal, but infection can occur because of penetration with a contaminated object, and there can be scarring. Treatments for wounds include managing bleeding by applying pressure, proper wound cleaning, and bandaging. - Deep wounds can require a suture or staple insertion.

Commonly Occurring Types of Surgical Interventions

BIOPSY - The surgical removal of tissue for later microscopic examination. PURPOSE: - Diagnose cancer, skin conditions, or other diseases of the body. REMOVE FOREIGN OBJECT - Surgical removal of an object, such as a small splinter, or a larger object, such as a piece of wood or metal that is embedded in tissue. Splinter forceps are commonly used with this procedure. PURPOSE: - Remove a foreign object to relieve pain and prevent infection. REMOVE SMALL GROWTH (CYST, WART, MOLE) - Surgical removal of a small growth from the body. PURPOSE: - Conduct further examination of the growth, prevent future growth. ENDOSCOPY - Procedure that uses an endoscope to view a hollow organ or body cavity, such as the larynx, bladder, colon, sigmoid colon, stomach, abdomen, and some joints. PURPOSE: - Evaluate a patient having stomach pain, difficulty swallowing, gastrointestinal bleeding, diarrhea or constipation, and colon polyps. COLPOSCOPY - Examination of the vagina and cervix performed using a colposcope, which is a specialized type of endoscope. - With the patient in the lithotomy position, the colposcope allows the health care provider to observe the tissues of this area in detail through light and magnification. PURPOSE: - Examine abnormal tissue development during a routine pelvic examination, when a Papanicolaou (Pap) smear result is abnormal, and to obtain a biopsy specimen. Abnormal areas of tissue or cells can then be removed for biopsy to detect cancer. CRYOSURGERY: - Procedure using local application of intense cold liquid or special instrument called a cryoprobe to destroy unwanted tissue. PURPOSE: -Can be used to destroy abnormal cells and tissues, which uses extremely cold liquid such as liquid nitrogen and an instrument called a cryoprobe. - Cryosurgery can be used in conjunction with other procedures, such as

BURNS:

Burns can result from exposure to heat, chemicals, or radiation. - The severity of a burn is determined by the location, depth, and size. - Injury to the face, arms, legs, and genitals are the most critical. - Burns that cover more than 10% of the body surface generally require hospitalization. BURNS are CLASSIFIED into FOUR DEGREES according to their DEPTH: 1) FIRST DEGREE (superficial): - Burn affects only the outer layer of skin tissue. - The skin becomes red and discolored, and some slight swelling can occur. - Healing of first-degree burns is generally rapid. - Examples of a first-degree burn are sunburn and a burn caused by immersing part of the body briefly into hot water. 2) SECOND DEGREE (partial-thickness): - Burn is one that breaks the surface of the skin and injures the underlying tissue. - Second-degree burns can result from a severe sunburn and exposure to hot liquids or heat. - The appearance of blisters commonly indicates a second-degree burn. - The skin is red or mottled in appearance. - The skin can become wet when plasma is lost through the damaged skin. - This type of burn causes greater pain and swelling. 3) THIRD DEGREE (deep-thickness): - Burn is deep enough to damage the nerves and bones. - Tissue burned to the third degree is charred and white. - A third-degree burn can cause less pain because the nerves are damaged. - Third-degree burns can result from exposure to fire, hot water, hot objects, or electricity. 4) FOURTH DEGREE (deep full-thickness): - Burn goes through both layers of the skin and underlying tissue as well as deeper tissue, possibly involving muscle and bone. - There is no feeling in the area because the nerve endings are destroyed. - Fourth-degree burns are often caused by flames and chemicals, such as from a hot iron or stove, fireplace, and a building fi

An MA observes a patient in the waiting room clutch their chest and collapse. Which of the following should be done first?

CALL 911

QUIZ: Which of the following is the priority action for a major burn, such as a FOUTH DEGREE BURN?

CALL 911 Emergency care is needed with Major Burns

Which of the following are postsurgical discharge instructions for a patient who had a biopsy of the breast?

CHANGE THE DRESSING OBSERVE SIGNS OF INFECTION APPLY MEDICATION TO THE WOUND

Which of the following are COMMON signs and symptoms in a HEART ATTACK?

CHEST PAIN & SHORTNESS OF BREATH Common signs and symptoms of a heart attack (myocardial infarction) are chest pain, pain or discomfort in different parts of the body, shortness of breath when resting or doing a little bit of physical activity, excessive sweating for no reason, nausea, dizziness, and rapid or irregular heartbeat.

QUIZ: Which of the following procedures provide a better view of cervical cells to send to pathology?

COLPOSCOPY - This is used to examine the inside of the vagina and cervix - This is performed after an abnormal PAP smear - A biopsy should be taken of the cervical tissue to end to a pathology lab to determine if it is cancerous

Several days after an office-based surgery, a patient experiences nausea and abdominal pain. Based on postsurgical instructions, which of the following should the patient do?

CONTACT THE MEDICAL OFFICE TO SPEAK WITH THE HEALTH CARE PROVIDER The patient should immediately notify the health care provider if nausea or abdominal pain occurs. - The patient should call 911 or go to the emergency department in case of life-threatening situations. - Although an urgent care center can be helpful, the health care provider should be contacted first because the provider is more aware of the patient's medical history and the surgery performed.

Which of the following DMEPOS requires prior authorization?

CPAP MACHINES POWER WHEELCHAIRS PRESSURE REDUCING AIR MATTRESSES

ORDER AND OBTAIN DURABLE MEDICAL EQUIPMENT (DME) AND SUPPLIES

DURABLE MEDICAL EQUIPMENT (DME): - Includes medical devices and supplies that can be used repeatedly. - The most common examples of durable medical equipment used outside of a hospital are dialysis machines, continuous positive airway pressure (CPAP) machines, oxygen concentrators and ventilators, orthotics and prostheses, bed equipment (hospital beds, lift beds), mobility aids (wheelchairs, crutches), and personal care aids (bath chairs, commodes). - Oftentimes, DME can be written as DMEPOS for durable medical equipment, prosthetics, orthotics, and supplies. The following is NECESSARY to QUALIFY as a DMEPOS: - Primarily serve a medical purpose - Be prescribed by or ordered by a health care provider - Be able to be used repeatedly - Have an expected lifetime of at least three years - Be used in the home - Only be useful to patients who have an injury or disability In a medical office or ambulatory care setting, the medical assistant will assist the health care provider with these devices and will provide education and support for the patient. - In some cases, the MA will TEACH the patient how to use specific DMEPOS, such as crutches and canes. DMEPOS items can be kept in some medical offices as inventory. - If the medical office purchased the item, it is allowed to bill patients and/or their insurance company for it. - In other cases, the health care provider will prescribe the DME item for the patient. - As with any prescriptions or treatment, the health care provider must document the patient's diagnosis and the medical necessity for the patient to have the DMEPOS.

Match the condition or action match with the correct diagnostic procedure.

ENDOSCOPY: - Viewing the stomach for ulcers I&D: - Treating an abscess located in the underarm CRYOSURGERY: - Destruction of abnormal tissue in the cervix BIOPSY: - Further testing of a suspicious lump on the breast COLPOSCOPY: - Viewing of abnormal tissue located in the cervix

WELCOME TO GENERAL PATIENT CARE: PART 2

Emergencies can occur at any time, and medical assistants must prepare themselves and the medical office for different emergency situations. The proper ways to identify and respond to medical emergencies—such as shock, seizures, strains and sprains, choking, hemorrhaging wounds, and burns—are also a part of the MA's foundational knowledge. The MA should be skilled in first aid and cardiopulmonary resuscitation (CPR) and be able to support the health care provider during medical emergencies. SEIZURE: - Uncontrolled muscle activity, that can be caused by high body temperature, head injuries, drugs, and epilepsy. STRAIN: - A stretched or torn MUSCLE or TENDON. SPRAIN: - A stretched or torn LIGAMENT, which are tissues that connect bones to a joint. FIRST AID: - The immediate care given to the victim of injury or sudden illness to sustain life and prevent death. CPR: - Lifesaving technique that consists of chest compressions combined with artificial ventilation.

Administer First Aid and Basic Wound Care

FIRST AID is the immediate care given to the victim of injury or sudden illness. - The purpose of first aid is to sustain life and prevent death. - It includes the prevention of permanent disability and the reduction of time needed for recovery. - First aid includes basic life support and maintenance of vital functions. - The most common need for first aid is for the treatment of shock, seizures, burns, poisoning, fractures, temperature alterations, and wounds.

Place the steps below into the correct sequence for creating a sterile field.

FIRST: - Disinfect the Mayo stand SECOND: - Place the packet on the Mayo stand THIRD: - Open the flap FARTHEST away from MA FOURTH: - Pull both of the side flaps open FIFTH: - Open the flaps CLOSEST to the MA

Which of the following would result in contamination of the sterile field?

FORCEPS THAT ARE PLACED ON THE 1 INCH BORDER Once a sterile field is set up, the border of 1 inch at the edge of the sterile drape is considered nonsterile. Place all objects inside the sterile field and away from the 1-inch border.

The contact information for what organizations in the community is useful to have available for help with emergency situations?

Local emergency response team, poison control center, HAZMAT response team, state and local health departments, local hospitals, Red Cross, local disaster relief agencies

TREATMENT OF BURNS:

MINOR BURNS: - For minor burns, cool the burn by holding the area under cool (but not cold) running water for about 10 min. - If the burn is on the FACE, apply a cool, wet cloth until the pain eases. - For a MOUTH burn from hot food or drink, put a piece of ice in the mouth for a few minutes. - After the burn is cooled, apply a lotion, such as one with aloe vera or cocoa butter. - This helps prevent drying and provides relief. - If a blister appears, do not break it, because this can increase the risk of infection. - If a blister does break, gently clean the area with water and apply an antibiotic ointment. - Cover the burn with a clean bandage. - Wrap it loosely to avoid putting pressure on burned skin. - Bandaging keeps air off the area, reduces pain, and protects blistered skin. - A minor burn might need emergency care if it affects the eyes, mouth, hands, or genital areas. - Infants and older adults might need emergency care for minor burns as well. MAJOR BURNS: - When treating a major burn, emergency care is needed. - Call 911 or seek immediate care. - Until help arrives, protect the patient from further harm. - Do not try to remove clothing stuck in the burn. - Remove jewelry, belts, and other tight items, especially from the burned area and the neck. - Burned areas swell quickly, so ensure the patient does not choke. - Make certain that the person burned is breathing. - If needed, begin CPR. - Cover the burn. - Loosely cover the area with gauze or a clean cloth. - Raise the burned area. - Lift the wound above heart level if possible. - Watch for signs of shock, such as cool, clammy skin; weak pulse; and shallow breathing.

Which of the following should a medical assistant do in the case of a patient having a SEIZURE?

MOVE OBJECTS OUT OF THE WAY TO PREVENT INJURY TURN THE PATIENT TO THE SIDE TO PREVENT CHOKING HELP PATIENT TO THE FLOOR IF STANDING

ASSIST WITH SURGICAL INTERVENTIONS

Many minor surgical procedures can be performed in a medical office. There are advantages to office-based surgeries, such as SAVING the patient the TIME and EXPENSES of having to go into an ambulatory surgical facility or a hospital. The basic surgical setup is the STANDARD SETUP with the addition of specific instruments for each procedure. Some MINOR PROCEDURES performed in the medical office include biopsy, removal of foreign bodies, endoscopy, colposcopy, cryosurgery, and incision and drainage. BIOPSY: The surgical removal of tissue for later microscopic examination. ENDOSCOPY: Procedure that uses an endoscope to view a hollow organ or body cavity, such as the larynx, bladder, colon, sigmoid colon, stomach, abdomen, and some joints. COLPOSCOPY: Examination of the vagina and cervix performed using a colposcope, which is a specialized type of endoscope

PREPARE AND MAINTAIN A STERILE FIELD

Medical assistants assist with many duties related to minor surgical procedures. - Strict adherence to aseptic or sterile technique is necessary when assisting with these procedures. SURGICAL ASEPSIS: Techniques to eliminate pathogenic and other potentially harmful microbes related to invasive procedures. SURGICAL ASEPSIS, or STERILE TECHNIQUE, - Is used when sterility of supplies and the immediate environment is required, as in surgical procedures. - Surgical asepsis requires surgical HANDWASHING or scrub, STERILE GLOVES, and STERILE TECHNIQUE when handling materials. STERILE TECHNIQUE is necessary during any INVASIVE procedure (a procedure in which the body is entered), such as making a surgical INCISION or an OPEN WOUND. During the procedure, the health care provider can ask the medical assistant to add items to the sterile field and, if properly scrubbed and wearing sterile gloves, HAND sterile instruments to the provider. STERILE FIELD is an area free of micro-organisms and is used as a work area during a surgical procedure. - The sterile field must be maintained before and during the procedure.

Perform Suture and Staple Removal:

Medical assistants, generally, can remove sutures and staples under the delegation of a provider. - As with all procedures, explain the procedure to the patient, reminding the patient that there can be a PULLING SENSATION. - Thorough inspection of the wound to approximate the edges and the absence or presence of drainage is necessary. - Wounds that have CRUSTING BLOOD or EXUDENT will usually need SOAKING with SALINE prior to removal of the sutures or staples. - If there are any problems, have the health care provider inspect the wound before starting the procedure. In most cases, a disposable suture removal kit will be used that includes suture scissors and forceps, or a staple removal kit will be used that includes a removal device along with sterile gauze, forceps, sterile gloves, and antiseptic. - After proper hand hygiene, open the kit and create a sterile field with the wrapper. - Thoroughly cleanse the skin with an ANTISEPTIC, such as ALCOHOL or pvidone-iodine solution, and allow to dry.​​​​​​​ To REMOVE the sutures, cut the suture with suture scissors BELOW the KNOT and as CLOSE TO THE SKIN as possible. - Remove EVERY OTHER suture and then go back and remove the remaining sutures until all sutures have been removed, observing the incision line for separation. - Remove the suture by PULLING the LONG REMAINING suture out. - Never pull suture material that is outside the skin through the skin. TAKE NOTE: - To remove STAPLES, begin with the SECOND STAPLE of the wound and carefully place the lower tip of the sterile staple remover under the staple. - Advance the lower jaw of the staple remover under the staple to be removed. - Squeeze the handle together until they are completely closed. - This will bend the staple in the middle and pull the edges of the staple out of the skin. - Do not

QUIZ: A 14 year old patient has a LACERATION on their face from playing field hockey. Which of the following is the recommended type of sutures?

NON-ABSORBABLE, SIZE 6-0 Non-absorbable sutures are used on skin surfaces where they can be easily removed after an incision heals

Procedures to Perform CPR, Basic Life Support, and Automated External Defibrillator (AED)

One of the MOST COMMON medical emergencies inside and outside of the medical office is a MYOCARDIAL INFARCTION, or HEART ATTACK. - A myocardial infarction (MI) happens when the flow of blood that brings oxygen to the heart muscle suddenly becomes blocked. - The heart does not get enough oxygen. - If blood flow is not restored quickly, the heart muscle will begin to die, and sudden cardiac arrest can occur, which is when the heart stops beating. - An MI and cardiac arrest are life-threatening medical emergencies that require immediate treatment. - The longer the patient's heart is without oxygen, the more damage is done to the heart muscle. Symptoms of an MI can vary, although common symptoms are the following: - Chest pain, heaviness, or discomfort in the center or left side of the chest - Pain or discomfort in one or both arms, the back, shoulders, neck, or jaw or above the belly button - Shortness of breath when resting or doing a little bit of physical activity - Excessive sweating for no reason - Feeling unusually tired for no reason, sometimes for days - Nausea (feeling sick to the stomach) and vomiting - Light-headedness or sudden dizziness - Rapid or irregular heartbeat If a patient is experiencing an MI or cardiac arrest, immediately activate the emergency response team. - If the patient is still conscious, the health care provider can administer emergency medication, such as aspirin, nitroglycerin, or thrombolytics to dissolve blood clots that can be blocking the coronary arteries in the heart. - In addition, the health care provider can ask to administer oxygen to the patient via the nasal cannula or face mask. CARDIAC ARREST occurs when the heart suddenly and UNEXPECTENTLY STOPS PUMPING. - If this happens, blood stops flowing to the brain and other vital organs. - Cardiac arrest is a medical e

QUIZ: Which of the following is the proper technique for removing surgical STAPLES?

PLACE THE LOWER TIP OF THE STERILE STAPLE REMOVER UNDER THE STAPLE & SQUEEZE THE HANDLE TOGETHER UNTIL THEY ARE COMPLETELY CLOSED - To use the sterile staple remover, place the lower tip under the staple and squeeze the handle together until they are completely closed. - This will bend the staple in the middle and pull the edges of the stable out of the ekin

Which of the following would QUALIFY an item as a DMEPOS?

PRESCRIBED BY A HEALTHCARE PROVIDER USED BY A PATIENT WITH A DISABILITY CAN BE REPEATEDLY USED To qualify as a DMEPOS, the item must primarily serve a medical purpose, be prescribed by or ordered by a health care provider, be able to be used again and again, have an expected lifetime of at least three years, be used in the home, and only be useful to patients who have an injury or disability.

QUIZ: Which of the following PHASES of WOUND HEALING occurs at approx DAY 10?

PROLIFERATIVE PHASE Between 3 and 21 days

REVIEW PROVIDER'S DISCHARGE INSTRUCTIONS/PLAN OF CARE WITH PATIENTS

Patients should have a clear understanding of what to expect during recovery, how to care for the surgical incision at home, and what to do in case of complications from the surgery. - Patients can be anxious and have difficulty remembering instructions following a procedure. - Provide verbal and written instructions for follow-up care. - Clear instructions about postoperative medications should be given in writing as well as verbally to the patient and possibly to family members, if appropriate. - Review all instructions with patients and answer questions prior to their departure. - Furthermore, the patient should be instructed about whether a follow-up appointment to the office will be necessary and when that should be scheduled. Most medical offices will have a standard set of printed instructions to send home with the patient. - These instructions can include keeping the site CLEAN and DRY, not placing stress on the area, drinking plenty of FLUIDS, getting proper REST, and RETURNING for their follow-up appointment. Depending on the surgery or procedure, additional postsurgical or discharge instructions can include the following: - ACTIVITY RESTRICTIONS: This includes bathing and exercising. - DIET RESTRICTIONS: It is unlikely to have dietary restrictions following minor ambulatory surgery. However, in cases of abdominal pain, diarrhea, or vomiting, a liquid diet with progress as tolerated may be recommended by the provider. - WOULD CARE: This includes instructions such as changing the dressing, applying medications to the wound, and observing for signs of infection. - MEDICATIONS: If the patient has prescriptions for medications such as antibiotics, instruct the patient on how and when to take the medication, how it should be stored, and possible side effects. If the patient is unable to drive after the p

EMERGENCY ACTION PLANS

Preparation for emergencies should include a preparedness plan, or an emergency action plan, that has a detailed emergency protocol that outlines the steps to be followed in the event of an office emergency. In addition to medical emergencies, this can also include other emergencies, such as earthquakes, tornadoes, floods, fires, shootings, and bioterrorism. The emergency action plan can include the following: - Identifying patients who have life-threatening conditions and need immediate care - Identifying when and who should contact emergency medical services during a crisis situation - The location of fire extinguishers and emergency evacuation routes​​​​​​​ - Identifying an individual to make sure all needed equipment and supplies are ready for the provider during an emergent situation Every medical office must have an emergency kit that contains supplies needed during an emergency. - The emergency kit is commonly referred to as a CRASH CART, but it can be a bag or a container of emergency supplies. - Many emergency kits can be purchased with all the necessary items, and some states have specific requirements for emergency kits. - The health care provider can also determine what items and emergency medication should be included. - Equipment and medication choice should reflect each medical office's patient population and specialty. - For example, a pediatric specialty should have more medication appropriately dosed for children, and an allergy specialty practice can increase the number of epinephrine auto-injectors in the emergency kit. MOST EMERGENCY KITS CONTAIN: - Surgical instruments, such as forceps; - Oxygen supply; an airway and suction device; - Ambu-bag; - Heart monitor-defibrillator; and - Emergency medications. The medical office should have several automated external defibrill

Signs and Symptoms Related to Urgent and Emergency Situations

SEVERE HYPOGLYCEMIA: - Low blood glucose levels are a serious heath risk for patients with diabetes. - Also called insulin reaction or insulin shock, it can occur when there is an imbalance between insulin levels and blood glucose in the body. SIGNS: - MILD CASE: irritability, moodiness or change in behavior, hunger, sweating, and rapid heart rate.​​​​​​​ - MODERATE to SEVERE: fainting TREATMENT: - For mild or moderate hypoglycemia, the patient's blood glucose level needs to be raised by consuming foods or liquid high in glucose. - In cases of severe hypoglycemia, glucagon (a prescription medication) is administered HYPOVOLEMIC SHOCK: - This occurs when a patient loses an excessive amount of body fluids or blood. - It can result from internal or external hemorrhaging (hemorrhagic shock), prolonged vomiting or diarrhea, or severe dehydration. SIGNS: - Thirst, muscle cramping, and lightheadedness—symptoms can progress to chest pain, confusion, lethargy, and death if left untreated. TERATMENT: - Control of blood loss, blood transfusion, and IV fluid replacement. HEAT EXHAUSTION OR HEAT STROKE: - When the body temperature varies too much over its normal range. SIGNS: - Muscle cramping, which results from an electrolyte imbalance caused by loss of sodium from sweating, perspiration, and pale and clammy skin. TREATMENT: - The individual will need to be removed from warm temperatures. - Apply any available cold compresses such as ice pack. - Death can result from heat stroke if it is not treated quickly. HYPOTHERMIA OR FROSTBITE: - Exposure to cold temperatures. Frostbite occurs when the skin and tissue are exposed to freezing temperatures. - Tissues are not able to get oxygen supply due to the freezing, causing the tissue to die. - The tissues of the nose, ears, fingers, and toes are the most s

QUIZ: In which of the following medical emergency situations does a patient exhibit pale & clammy skin, rapid pulse and respirations, and the patient appearing weak and becomes UNRESPONSIVE with dilated pupils?

SHOCK

Administer First Aid and Basic Wound Care

SHOCK: - The response of the cardiovascular system to the presence of adrenaline, resulting in CAPILLARY CONSTRUCTION. - This causes inadequate circulation of blood to the body tissues, lowered blood pressure, and decreased kidney function. - Shock can result from trauma, electrical injury, insulin shock, hemorrhage (excessive bleeding), or as a reaction to drugs. - It can occur in conjunction with other injuries or illness such as respiratory distress, fever, heart attack, and poisoning. ANAPHYLACTIC SHOCK: - The response of the body to an ALLERGEN such as a medication or an insect bite or sting. - Early signs and symptoms of shock include pale and clammy skin, weakness, and restlessness. - The pulse and respiratory rate are rapid, and vomiting can occur. - Late signs of shock include apathy, unresponsiveness, dilated pupils, mottled skin, and loss of consciousness, the state of being alert and aware. - Shock can result in death if the condition is not reversed. - An EpiPen, a preloaded pen filled with epinephrine, is the first line of defense for an anaphylactic shock if it is readily available. - If a patient is going into shock, emergency medical care is critical, and 911 should be contacted. - Then, lay the patient down and elevate the legs and feet slightly, unless this can cause the patient pain or further injury, and try to keep the patient still. - Continue monitoring the patient's pulse regularly until emergency services arrive. - If the patient stops breathing, begin CPR. SEIZURE: -Uncontrolled muscle activity, seizures can be caused by high body temperature, head injuries, drugs, and epilepsy. - During the seizure, steps should be taken to prevent injury to the patient. - Help them to the floor if they are sitting or standing. - Do not try to restrain them. - Move objects out of their way

Which of the following should a medical assistant do when caring for hemorrhage? The blood is dark red and has a steady flow.

SITE SHOULD BE COVERED WITH A CLEAN GAUZE SITE SHOULD BE ELEVATED PRESSURE SHOULD BE EXERTED ON THE SITE

Commonly Occurring Types of Injuries and Treatment

SPRAINS & STRAINS: SPRAINS are caused by a stretched or torn LIGAMENT, which are tissues that connect bones to a joint. - Falling, twisting, or landing on an uneven surface can all cause a sprain. - Ankle and wrist sprains are common. Symptoms include pain, swelling, bruising, and being unable to move the joint. - The patient can feel a pop or tear when the injury happens. A STRAIN is a stretched or torn MUSCLE or TENDON. - Tendons are tissues that connect muscle to bone. - Trauma to the tissue, such as excessive twisting or pulling these tissues, can cause a strain. - Strains can happen suddenly or develop over time. - Back and hamstring muscle strains are common. - Strains are common when playing sports. - Symptoms include pain, muscle spasms, swelling, and trouble moving the muscle. TREATMENT of both sprains and strains usually involves resting and elevating the injured area, applying cold compresses, wearing a bandage or brace, and the use of anti-inflammatory medications. - Later treatment might include exercise and physical therapy depending upon the severity of the injury. DISLOCATIONS: Dislocations occur when a BONE end SLIPS out of the SOCK or when the CAPSULE surrounding a JOINT is STRETCHED or TORN. - Dislocations occur usually at any freely moving joint, with the SHOULDER being the MOST COMMON. - Other dislocations can occur at the ankles, knees, hips, elbows, jaw, and finger. - Dislocated joints often are swollen, very painful, and visibly out of place. - The patient may not be able to move it. - A dislocated joint is an EMERGENCY, and the patient should seek medical attention. TREATMENT depends on WHICH JOINT is dislocated and the SEVERITY of the injury. - It might include manipulations to reposition the bones, medication, a splint or sling, and rehabilitation. - When properly reposition

A patient has a deep wound on their scalp. Which of the following types of wound closures should be used?

SURGICAL STAPLES Surgical staples allow for the closure of wounds under high tension, such as on the trunk, extremities, and scalp.

QUIZ: Which of the following areas are considered sterile?

THE DRAPE ON THE MAYO STAND THAT IS 12 INCHES OR MORE AWAY FROM THE BODY

QUIZ: Which of the following should the MA identify when assigned to check the EMERGENCY KIT or CRASH CART?

THE EMERGENCY KIT IS IN THE SAME, ACCESSIBLE AREA

IDENTIFY AND RESPOND TO EMERGENCY/PRIORITY SITUATIONS

The goal of providing care in an emergency is to help STABILIZE the patient and PREVENT FURTHER INJURY. - Although medical offices and ambulatory clinics generally do not see emergency or life-threatening situations, they always need to be prepared, alert, and ready to respond to potential threats or emergencies in the clinical setting. - An EMERGENCY is any condition that leads to CARDIAC or RESPIRATORY FAILURE and mandates rapid implementation of life-saving measures, including calling 911 and cardiopulmonary resuscitation (CPR). - Medical assistants should be able to handle emergencies outside and inside the medical office and on the phone. When SEVERE INJURY or SUDDEN CRITICAL ILLNESS occurs, the patient should receive emergency care as soon as possible. - The FIRST HOUR after the time of injury or appearance of symptoms is considered the MOST CRITICAL. - In fact, the first hour is often coined the "GOLDEN HOUR" and correlates with prognosis and the possibility of recovery. - There has been no evidence to suggest survival rate declines after 60 min; however, rapid intervention in trauma and emergency situations must be provided as soon as possible for the best outcome for the patient. The medical assistant must be able to identify emergency and life-threatening situations. Examples of life-threatening situations are: - CARDIAC ARREST (heart attacks), - RESPIRATORY ARREST, - UNCONTROLLED BLEEDING, - HEAD INJURY, - POISONING, - OPEN CHEST or ABDOMINAL WOUND, - SHOCK, and - THIRD- and FOURTH-DEGREE BURNS. In an emergency, the medical assistant should be able respond to the emergency and support the health care provider during this time. - Evaluate the situation and provide appropriate care as directed. - Every medical office should have a policy manual and an emergency preparedness plan. - All sta

How could the MA have responded differently?

Venous bleeding produces a steady flow of dark red blood. The MA could have covered the wound with a clean cloth or gauze, applying pressure on the wound, and had Anna elevate the hand before getting additional help.

QUIZ: A provider requests additional forceps during a surgical procedure. Which of the following steps should the MA take?

WITHOUT TOUCHING THE DRAPE ON THE MAYO STAND, OPEN THE STERILE PACKAGE & DROP THE FORCEPS INTO THE STERILE FIELD

TECHNIQUES AND INSTRUMENTS FOR SUTURE AND STAPLE REMOVAL

WOUND CLOSURE is often necessary in emergency situations and after office-based surgical procedures. - Properly closing an exposed area of the body prevents infection and other complications, aids in the healing process, and minimizes scarring. - There are many different types of wound closure and materials, such as sutures, surgical staples, skin closure tapes, and adhesives. - The selection of which types to use when closing a wound or incision depends on the wound, how much soft tissue is exposed, how clean the wound is, and the assessment of the health care provider. SUTURING is the use of any device to close or sew together tissue after an injury or surgery. - The most common method in suturing is the use of SPECIALIZED THREAD, or SUTURES. - Sutures are inserted by the health care provider at the end of a procedure to hold tissues in alignment during the healing process. - There are a number of different types of sutures based on size, materials, and absorbability. - Sutures can be made of many different materials and can be absorbable or nonabsorbable.

Prior Authorizations for Medication Durable Medical Equipment

What is considered DMEPOS is defined by Medicare, Medicaid, and other insurance companies—at least for reimbursement purposes. - For example, compression leggings, incontinence pads, and ramps installed in the home are not considered DMEPOS. For a patient to be eligible for DMEPOS, the health care provider must order the item through a prescription or medical order form to be submitted to a supplier. - The health care provider must state that the DMEPOS is needed for the patient's medical condition or injury and is for home use. - Some DMEPOS items, such a power wheelchair, require a face-to-face encounter, where a visit to the health care provider is required within 6 months before the order. - The face-to-face encounter must be documented in the patient's medical record. - The supporting documentation must include subjective and objective information and information used for diagnosing, treating, and managing the patient's condition for which the DMEPOS is ordered. For some DMEPOS items, PRIOR AUTHORIZATION may be required. - Centers for Medicare & Medicaid Services (CMS) established a list of items that are considered DMEPOS, called the Master List. - In addition, CMS created a subset list of items requiring prior authorization, the "Required Prior Authorization List." - Prior authorization is a process through which a request for provisional affirmation or approval of coverage is submitted for review before a DMEPOS item is furnished to a beneficiary and before a claim is submitted for payment. - Items that require prior authorization can include power wheelchairs, powered air flotation beds, powered pressure-reducing air mattresses and more. To submit a DMEPOS item for prior authorization, the health care provider will submit the necessary forms and information to the Durable Medical Equipme

Assist Provider with Patients Presenting with Minor and Traumatic Injury

When a patient presents to the office with minor or traumatic injuries, the medical assistant can be responsible for obtaining the chief complaint, obtaining vital signs, and assisting the provider as necessary. This can also include cleaning wounds, preparing sterile fields for minor surgical interventions, bandaging wounds, administering injections, instructing patients on the signs of infections, providing wound care, and scheduling follow-up appointments. Minor and traumatic injuries include strains and sprains, dislocations, fractures, burns, lacerations, and abrasions.

WOUND CARE:

When providing first aid for a wound, controlling hemorrhage—or excessive, uncontrolled bleeding—is often necessary. There are generally THREE TYPES of HEMORRHAGING based on the blood vessels affected: ARTERIAL, VENOUS, and CAPILLARY. - Identify the specific type of bleeding in order to provide the appropriate first aid and care to minimize the hemorrhage. ARTERIAL BLEEDING is the most SEVERE and URGENT type of bleeding. - It can result from a penetrating injury, blunt trauma, or damage to organs or blood vessels. - Arterial bleeding is high pressure, and, thus, the bleeding is bright red in spurts. - If a large artery, such as the aorta, is ruptured or bleeding has occurred for several minutes, this is a potentially life-threatening situation and can lead to death. - This type of bleeding can be hard to control because of the pressure in the blood vessels. - The first step should be to put PRESSURE on the wound with sterile gauze. - Elevate the site of the bleeding. - In some cases, a tourniquet will need to be applied, above the site of the bleed, if the bleeding continues. - The health care provider should be notified and should advise if a tourniquet should be used. VENOUS BLEEDING produces a steady flow of dark red blood. - Similar to an arterial bleed, the site of the wound should be covered with a clean cloth or gauze, pressure should be exerted on the wound, and the area should be elevated. - Capillaries are the smallest blood vessels, and bleeding is minimal. - There will be a small and steady flow of blood from the site, but it will clot on its own within minutes. AFTER THE BLEEDING HAS BEEN CONTROLLED, clean and dress the wound. - A wound must be cleaned before a sterile dressing can be applied. - The health care provider should inspect the wound site and indicate what should be used to c

Signs and Symptoms of Wound Infection and Wound Stages

Wounds pass through various stages of healing, including inflammation, as the body starts to fight off potential infection. - Inflammation is the body's protective response to trauma and invasion by micro-organisms; it is generally localized around the site of trauma or infection. - Signs of inflammation are redness (erythema), swelling, warmth, and pain. The THREE PHASES of wound healing or restoration of structure and function are the following: 1) INFLAMMATORY PHASE (3 to 4 days): - Marked by pain, swelling, and loss of function at the site of the wound. - Blood clot forms to stop bleeding and plug the opening of a wound. 2) PROLIFERATING PHASE (4 to 21 days): - Fibrin threads extend across the opening of a wound and pull edges together; cells multiply to repair the wound, and eschar or scab begins to form to keep out micro-organisms. 3) MATURATION PHASE (21 days to 2 years): - Tissue cells strengthen and tighten the wound closure, forming a scar; scar eventually fades and thins. If the wound is not properly healing or staying clean, micro-organisms can enter the wound, and complications can occur. Wound complications include the following: - INFECTION (signs of inflammation, swelling, purulent or puslike drainage, fever) - HEMORRHAGE or bleeding - DEHISCENCE (separation of wound edges) - EVISCERATION (separation of wound edges and protrusion of abdominal organs)