Clinical Procedures Theory (Career) Lesson 1/Clinical Medical Assisting

Nonverbal Communication

communication using body movements, gestures, and facial expressions rather than speech. The body naturally expresses our true feelings.

Red Blood Cell Indices

mathematical calculation of the size, volume, and concentration of hemoglobin for an RBC

Myoglobinuria (myoglobin in the urine)

occurs when muscle tissue is damaged or injured. This can occur with crushing injuries, myocardial infarctions, contact sports, or strenuous exercise. Patients with muscular dystrophy often have myoglobinuria. Hemoglobinuria cannot be distinguished from myoglobinuria by reagent strip testing. Both cause a uniform change in color from light green to dark green on the strip.

Verbal order ( VO )

order over the phone or in person.

Grade

refers to how abnormal the malignant cells look. If the malignant cells and tissues closely resemble normal cells and tissue, the tumor is called "well differentiated."

Stage

refers to the extent of the cancer, including the size and if it has spread. A cancer is staged in this manner.

Abbreviations and Symbols

shortened or contracted forms of words or phrases

The order of the draw is as follows:

sterile (blood culture bottles/tubes)−light blue−red/gold−green−lavender−gray. Use the first letter for each tube color and make up a sentence that helps you remember the order of the draw.

Implantable Loop Recorder

An electronic device that is surgically placed in the patient's body and connected to the heart in order to detect dysrhythmias.

Additional ECG Testing Exercise Stress Test

An exercise stress test records the ECG while the patient is exercising. The patient either walks on a treadmill with an incline or uses an exercise bike. During the test, a continual ECG is recorded, and the blood pressure is monitored.

Drug Legislation and the Ambulatory Care Setting

In the ambulatory care environment, medications can be prescribed, administered, and dispensed.

TNM staging of cancer (3)

M: Refers to whether the tumor has metastasized • MX: Metastasis cannot be measured • M0: No metastasis has occurred • M1: Metastasis has occurred

Manipulation

Manipulation is the passive movement of a joint to determine the range of extension or flexion of a part of the body.

Infectious Pathogens

Many microorganisms are nonpathogenic, which means they do not cause disease. They can be found in our body, maintaining the homeostasis. Other microorganisms are pathogenic, which means disease causing. These pathogens enter our bodies through direct contact, indirect contact, or by vectors.

Nerve Damage and Other Complications

Nerve damage can be a consequence of venipuncture, but the risk is very small. Preventive measures include the following: • Avoiding the basilic vein for phlebotomy • Refraining from blind probing (moving the needle in the arm with the hope of finding a vein) if the vein is missed with the initial draw

Legal and Ethical Issues Related to Blood Transfusion

The Blood Safety Act was passed in 1991 to ensure that all donor blood is tested for human immunodeficiency virus (HIV) and other bloodborne pathogens. The impact of this law can be seen in the ambulatory care environment. The discussion must include positive and negative aspects of autologous transfusion (i.e., transfusion with a person's own blood).

Two types of patient records.

The two major types of patient records are the paper health record and the electronic health record (EHR). The EHR is much more efficient than the paper record, and most healthcare facilities have switched to EHRs for a number of reasons.

White blood cell casts

White blood cell casts are hyaline casts that contain leukocytes. White blood cells seen in casts usually have a multilobed nucleus. White blood cell casts are seen in pyelonephritis.

Z-Track Technique

(A) Displace and then cleanse the skin. (B) Inject the medication. (C) Release the skin and pull the needle out at the same time. The medication is locked in the muscle.

Switching Needles

(A) Place the syringe unit between the fingers of your nondominant hand, and firmly grasp the covered needle. (B) Hold the old covered needle securely as you detach it from the syringe. (C) Attach the new needle while holding the old needle between your fingers.

Interrupted Baseline

(also called intermittent signal artifact) occurs when the tracing looks normal at the beginning, but then it disappears or goes all over when the electrical connection is interrupted. The causes include: • Electrical connection is interrupted: Due to a loose cable or lead wire, or a broken cable, clip, or lead wire. The medical assistant should: • Check that all electrodes and lead wires are attached. • If a broken wire is suspected, a new cable will be needed.

Honesty, Dependability, and Responsibility

- Honest means to be sincere and upright. - Dependable is the same as trustworthy. - Responsible is defined as being trusted or depended upon.

Types of Records

- The paper-based record is good for documentation of patient care, but it is not nearly as useful in other capacities. - With an EHR, multiple users can access the record at the same time. An EHR also includes practice management capabilities that allow for patient scheduling and generation of reports needed for research and quality control. It is important for the medical assistant to be aware of the differences between the practice management software and the EHR.

Two ways that antibodies can be acquired:

- actively acquired immunity, the body actively makes antibodies after exposure to the disease-causing organism. This could result from having the actual disease or from a vaccination. - passively acquired immunity, the body is given the antibodies without having to work for them. This could be the result of placental transfer, breastfeeding, or an injection of immunoglobulins.

PR segment

- follows the P wave and appears as an isoelectric line - The electrical impulse moves slowly through the AV node. This electricity is not picked up on the ECG tracing. - the time between the end of the atrial depolarization and the start of the ventricular depolarization - the atrial chambers finish contracting

Specimen Handling

-Check for leaks and contamination on containers -Wear gloves -Use appropriate container -Handle all specimens as if contaminated The most efficient way to transport capillary tubes is to remove the stopper from a red-topped venipuncture tube, insert the capillary tubes, sealed-end down, replace the stopper, and label the red-topped tube.

Three-Point Scale for Measuring Pulse Volume

3+ full bounding pulse - Pulsation is very strong and does not disappear with moderate pressure. 2+ normal pulse - Pulsation is easily felt but disappears with moderate pressure. 1+ weak, thready pulse - Pulsation is not easily felt and disappears with slight pressure.

Femoral, Popliteal, and Pedal Pulses: Doppler ultrasound unit measuring the pedal pulse.

A Doppler unit is battery operated and can be attached to a stethoscope so that only the provider can hear the beat, or it can be set so that both the provider and the patient can hear the pulsations.

Customer Service

A customer is one who purchases goods or services. A customer can also be a person whom you deal with in the work environment. Great customer service leads to a successful healthcare facility and allows growth. Customer service is whatever we do for our customers to improve their experience at our healthcare facility. Our goal is to provide customer satisfaction, or a sense of contentment with the interaction. The most important things for you to do are: • Be considerate and treat the patient as you would want to be treated • Look and act professional

Tape Measure

A flexible ribbon ruler that is usually printed in inches and feet on one side and in centimeters and meters on the reverse side. Measurements may be used to assess length and head circumference in infants, wound size, etc.

Acronyms:

Abbreviations that are also pronounceable; for example: CABG: Coronary artery bypass graft (a detour around a blockage in an artery of the heart) TURP: Transurethral resection of the prostate (a surgical procedure that removes the prostate through the urethra)

Troubleshooting Artifact

Artifact is signal distortion or unwanted, erratic movement of the stylus caused by outside interference. - find the limb common to the leads showing artifact. For example: artifact in Leads II, III, and aVF -common limb is the left leg - check wires and patches on that limb.

• Total amount or total volume

Both liquid and solid medication labels indicate the amount of medication in the container.

Turbidity of the Urine

Both normal and abnormal urine specimens may range in appearance from clear to very cloudy. Turbidity may be caused by cells, bacteria, yeast, vaginal contaminants, or crystals. It is possible for a urine specimen to be clear when voided, but then as crystals form and precipitate out of the liquid, this causes the urine to become cloudy as it cools.

• Action:

How the drug provides therapeutic results in the body, or the use of the drug.

• Indication:

Conditions or diseases for which the drug is used.

A 3-mL syringe.

Most frequently used syringe Volume of 3 mL Used for giving 1 to 3 mL of meds Calibrated in 0.1 mL Usually for IM injection

Anger

DESCRIPTION: Anger can be directed at self or others. Anger can surface at unrelated times and be directed toward unrelated issues. ADAPTIVE INTERACTIONS: Use therapeutic communication techniques (e.g., reflection) to acknowledge the patient's feelings about the issue. Recognize the real cause of the anger.

Acceptance

DESCRIPTION: Has come to terms with situation. ADAPTIVE INTERACTIONS: Provide coaching on aspects of the disease and self-care management.

• Description:

Describes the medication and its general use.

Theft and Diversion Reporting

Diversion of controlled substances means using the medication for personal reasons. If a medical assistant identifies that controlled substances are missing, it is important to notify the provider and supervisor. A report must be completed and filed by the deadline.

Otic Route

Ear conditions can cause pain and make hearing difficult. Medication may be instilled into the ear to treat infection or inflammation, or to soften cerumen.

Symbols:

Graphic representations of terms ♂ stands for male ♀ stands for female ↑ stands for increased ↓ stands for decreased + stands for present − stands for absent

Helicobacter pylori Testing

Helicobacter pylori is a spiral-shaped bacterium that can infect the stomach's mucous layer or lining. H. pylori causes more than 90% of duodenal (the first portion of the small intestine) ulcers and more than 80% of stomach ulcers

Differentiate between humoral and cell-mediated immunity.

Humoral immunity creates specific antibodies to combat antigens through the action of B cells. The immune system also reacts at the cellular level with T-cell activity in cell-mediated immunity by causing the destruction of pathogenic cells at the site of invasion.

Patient Coaching

If a patient seems to have a need, speak with him or her privately and determine whether any agency or organization might help with the issues at hand. The PCMH model relies on all healthcare workers to participate in the care of patients.

Nervous tissue:

Includes cells that provide transmission of information to control a variety of functions. Nervous tissue controls the body's functions to maintain homeostasis. Nervous tissue is made up of neurons (nerve cells) and supportive structures called neuroglial cells.

Indexing Rules

Indexing rules are standardized and based on current business practices. The Association of Records Managers and Administrators takes an active part in updating these rules.

• Precautions:

Indicates necessary actions or special care that needs to be taken when the patient is on the medication. May include information on laboratory tests, special populations (children and geriatric), pregnancy, breastfeeding, and so on.

Record Stickers

Information on stickers on the outside of the record allows the provider and medical staff to see important information about the patient quickly.

• Directions and storage

Instructions on how to take the medication and how to store the drug may be indicated on the label.

• How supplied:

Lists the form (e.g., chewable tablets, capsules) and the strength (e.g., 250 mg)

Define meaningful use and relate it to the healthcare industry.

Meaningful use, defined simply, means that providers must show that they are using EHR technology in ways that can be measured significantly in quality and quantity. If providers meet the meaningful use requirements, they will qualify for incentive payments.

Measuring Blood Pressure

Measured with a sphygmomanometer and stethoscope Cuff should cover two thirds of upper arm Wrap cuff around patient's upper arm Lower edge of cuff placed about 1 inch above crease of elbow Center of bladder placed over brachial artery

Anthropometric Measurements

Measures of height, weight, and skinfold thickness to evaluate muscle atrophy.

File Folders

Most records to be filed are placed in covers or tabbed folders. The most commonly used is a general purpose, third-cut manila folder that may be expanded to of an inch.

Bloodborne Pathogens Standard

OSHA's Bloodborne Pathogens Standard has been law since 1992. It regulates the handling of blood and blood products, but it also includes other potentially infectious materials (OPIM) that may contain bloodborne pathogens. Urine is the only fluid not specifically included in the standard.

• Premature atrial contractions (PACs)

Occur when the atria contract sooner than they should. The P wave can be abnormally shaped, or an extra P wave can be seen. PACs can be seen in people who smoke or consume large amounts of caffeine. An occasional PAC is not abnormal. More than six PACs in a minute is considered abnormal.

Miscellaneous Files

Papers that do not warrant an individual folder are placed in a miscellaneous folder. ever use paper clips for this purpose.

The Parts of Medicare

Part A - hospital insurance Part B - provides general medical insurance Part C- Medicare advantage Part D - Prescription coverage

Other Healthcare Facilities

Physician office laboratories Diagnostic laboratories Home health agencies Medical suppliers The goal of hospice is to provide peace, comfort, and dignity while controlling pain and promoting the best possible quality of life for the patient. Some communities have inpatient hospice services available either in a special unit in a hospital or in an independent hospice center.

Specify potentially infectious body fluids.

Potentially infectious body fluids include CSF; mucus; synovial, pleural, pericardial, peritoneal, and amniotic fluids; blood; vaginal and seminal secretions; saliva; and human tissue.

Prioritizing and Time Management Skills

Prioritizing means to arrange and complete duties in the order of most importance. Time management strategies are methods that maximize personal efficiencies and prioritize tasks.

Muscle tissue:

Produces movement.

Quality Assurance Guidelines

Quality assurance (QA) is a set of written policies and procedures that ensure the monitoring of all the processes involved before, during, and after a laboratory test is performed in order to produce reliable patient test results. This documentation is a way of comparing what is happening with what should be happening.

• Contraindications:

Reasons or conditions that make administration of the drug improper or undesirable. For example, aspirin is contraindicated in patients with GI bleeding.

• Chemical name:

Represents the drug's exact chemical formula.

• Asystole

Results in the absence of a heartbeat. A flat line appears on the tracing.

• Prostate cancer

Risk factors include being 50 years old or older, being African American, exposure to Agent Orange, and having a father, brother, or son who had prostate cancer. No specific test exists for prostate cancer. The digital rectal exam (DRE) and the prostate-specific antigen (PSA) test are used. The provider may offer either test after age 50. Frequency is based on the patient's history.

Throat Cultures

Streptococcus pyogenes, also known as group A strep (GAS) or beta hemolytic streptococcus, causes strep throat. A throat swab is collected from the patient's throat. Then the swab is streaked for isolation on a blood agar plate (BAP).

Predisposing Factors

Tendencies that promote development of a disease in an individual

• Strength

The amount of drug in the unit dose.

clinical diagnosis

The clinical diagnosis is arrived at after taking a detailed history and doing a comprehensive physical examination, but before any laboratory tests or x-rays, diagnostic testing is done.

Medical History Collecting the History Information

The documentation should include the following: • Purpose of the patient's visit, written as the chief complaint (CC) • Patient's vital signs (VS) • Height and weight • Pain; documented using a scale of 1 to 10, with 1 being the least amount of pain and 10 being the greatest amount

Controlled Substances Act

The federal law giving authority to the Drug Enforcement Administration to regulate the sale and use of drugs.

Forms of Medications

The form is the physical characteristics of the medication. Forms can be grouped into solids, semisolids, and liquids. Solid and semisolid medications are commonly prescribed and found in over-the-counter (OTC) products.

Organism

The organism of the body is made up of many body systems. These work together to maintain a steady environment in the body, called homeostasis. If the balance is off or if the environment moves out of the normal range, diseases can occur.

Reflexes

The patient's reflexes are checked with the patient sitting, in the Fowler position, or supine.

Urine Formation

The urinary tract consists of two kidneys, two ureters, one bladder, and one urethra. Blood passes through microscopic structures in the kidneys called nephrons. In the nephrons blood is filtered to form a filtrate. The composition of the filtrate is adjusted as it passes through the renal tubules of the nephron. Selective reabsorption and secretion occur in the renal tubules until the filtrate reaches its final composition. The final filtrate is known as urine.

Vaginal Route

The vaginal route is used to insert suppositories, tablets, creams, and foams into the vagina.

Prone Position

This position is used for examination of the back and for certain surgical procedures. This is the opposite of the supine position and is another of the recumbent positions.

• Pap test

This test is used to identify cervical cancer.

Whole Grains

Use the entire grain kernel (e.g., bran, germ, and endosperm); they include whole-wheat flour, cracked wheat (bulgur), whole cornmeal, oatmeal, and brown rice.

Color-Coding

When a color-coding system is used, both filing and finding files is easier, and misfiling of folders is kept to a minimum.

Nondecodable Terms

Words used in healthcare whose definitions must be memorized without the benefit of word parts.

Chain of Custody

a legal term that refers to the ability to guarantee the identity and integrity of the specimen from collection to reporting of test results.

Neoplasms

abnormal growths of new tissue that are classified as benign or malignant

Ocular Route

administration route in which medication is placed in the eye; also called the optic route or ophthalmic route. Medication may be instilled (poured drop by drop) into the eye to treat an infection, soothe irritation, anesthetize the eye, or dilate the pupils before examination or treatment.

Right Documentation

always document administering a medication after the patient receives it, not before

Opportunistic Infections

caused by organisms that are not typically pathogenic but cause disease under certain circumstances. A host with an impaired immune system response, such as individuals infected with HIV, is susceptible to opportunistic infections.

Body Systems

composed of several organs and their related structures. These structures work together to perform a specific function in the body.

Casts

created when protein accumulates and precipitates in the kidney tubules and is then washed into the urine. - Casts are cylindric, with flat or rounded ends, and are classified according to the substances observed inside them. - Casts can dissolve in alkaline urine if the sample is not examined promptly.

Disease

defined as a specific illness with a recognizable group of signs and symptoms and a clear cause (e.g., infection, environment).

Abdominopelvic Quadrants and Regions

either the four quadrants or the nine regions can be used. • Right upper quadrant (RUQ): Right lobe of the liver, gallbladder, right kidney, small intestine (duodenum), large intestine (ascending and transverse colon), and head of the pancreas • Left upper quadrant (LUQ): Stomach, spleen, left lobe of the liver, pancreas, left kidney, and large intestine (transverse and descending colon) • Right lower quadrant (RLQ): Appendix, cecum, right ovary, right ureter, right spermatic cord, large intestine (ascending colon), and right kidney • Left lower quadrant (LLQ): Small intestine, large intestine (descending and sigmoid colon), left ovary, left ureter, left spermatic cord, and left kidney

Nutritional Imbalances

fats, minerals, vitamins, amino acids Nutritional imbalances include too little or too much of a nutrient. Nutritional imbalances can impact growth and disease and can result in death.

Dorsalis pedis (pedal) artery

felt across the arch of the foot, just slightly lateral to the midline, beside the extensor tendon of the great toe. This pulse may be congenitally absent in some patients.

Femoral pulse

located at the site where the femoral artery passes through the groin. The examiner must press deeply below the inguinal ligament to palpate this pulse.

Carotid pulse

located between the larynx and the sternocleidomastoid muscle in the front and to the side of the neck. It most frequently is used in emergencies and to check the pulse during cardiopulmonary resuscitation (CPR). It can be felt by pushing the muscle to the side and pressing against the larynx.

• Generic name:

name assigned by the manufacturer who first develops a drug; it is often derived from the chemical name

• Official name:

name under which a drug is listed in one of the official publications

Urobilinogen

normally is present in urine in small amounts. Elevated urobilinogen is seen with increased red blood cell destruction, liver disease, or total obstruction of the bile duct. The liver continues to convert bilirubin to urobilinogen, which is sent to the intestines for excretion.

Dorsal Recumbent Position

patient is lying on the back, face up, with the knees bent This position relieves muscle tension in the abdomen and may be used for examination or inspection of the rectal, vaginal, and perineal areas. This position can be used for digital examination of the vagina and rectum, but it is not used if an instrument such as a speculum is needed.

Medication adherence

patients are taking the right dose at the right times as prescribed by the provider.

Latent Infection

persistent infection in which the symptoms cycle through periods of relapse and remission. Cold sores and genital herpes are latent viral infections caused by the herpes simplex virus (HSV) types 1 and 2, respectively.

Electrocardiography

process of recording the electrical activity of the heart It is important for the medical assistant to: • Know the normal function of the heart • Perform the procedure accurately • Identify problems during the ECG procedure and take appropriate actions

Specialty and Specialist Suffixes

require yet another category of suffixes. Someone who specializes in the study of the heart would be called a cardiologist. Cardi/o means "heart," and -logist means "one who specializes in the study of."

Right Patient

requires confirmation of a patient's identity with two forms of identification before drug administration

Renal tubular epithelial cells

somewhat larger than white blood cells, are round or oval, and have a nucleus that is single, large, oval, and sometimes eccentric. A few may be found in normal urine specimens, but their presence in increased numbers indicates tubular damage of the nephrons.

Pulse Sites

temporal, carotid, apical, brachial, radial, ulnar, femoral, popliteal, posterior tibial, dorsalis pedis

Urinalysis

the examination of urine to determine the presence of abnormal elements Urine is tested with a multiple test strip, also called a dipstick, which tests the following analytes in urine: glucose, protein, ketones, blood, bilirubin, urobilinogen, nitrites, and pH. Microscopically, the provider may examine urine for the presence of RBCs, WBCs, and epithelial cells; mucus, casts, crystals, and microorganisms. Additional quantitative tests may be performed in the urinalysis department of a reference laboratory to confirm routine screening test results.

Excretion

the movement of metabolites out of the body.

Cultural Diversity

the state of having a variety of cultures in the same area

Hematology

the study of blood cells and coagulation. Laboratory testing in the hematology department may be qualitative or quantitative. In a POL, screening tests for hemoglobin, hematocrit, and the International Normalized Ratio (INR, a coagulation test) are typically performed in the ambulatory setting. Microscopic tests determine the characteristics of cells, such as size, shape, and maturity.

Right Time

the time the prescribed dose is ordered to be administered

Holter Monitor

used to monitor the heart over a 24- to 48-hour period while the patient goes about his or her normal activities. Having a longer monitoring period can capture the abnormalities. When placing electrodes for a Holter monitor, consult the operator's manual. Holter monitors typically use three to seven chest electrodes.

Three subcutaneous sites are used in ambulatory care:

• Abdominal site • Outer posterior aspect of the upper arm • Anterior aspect of the thigh

The CDC makes the following recommendations for providers:

• Prescribe antibiotic therapy only when it will benefit the patient. • Treat the patient with an antibiotic that is specific to the infecting pathogen. • Prescribe the recommended dose and treatment duration of the medication.

Documenting in an Electronic Health Record

Documentation in an EHR involves using radio buttons, drop-down menus, and free-text boxes. It is important to carefully review the choices made with the radio buttons and drop-down menus. Information documented using the free-text boxes should be proofread before submitting.

The National Health career Association (NHA)

Certification organization for a variety of health care careers, including the Institute for the Certification of Pharmacy Technicians (ICPT). The NHA also offers two different medical assisting certifications: Certified Clinical Medical Assistant (CCMA) and Certified Medical Administrative Assistant (CMAA).

Characteristics of Respirations: Rate:

The rate of respiration is the number of respirations per minute. shows sample breathing patterns. A ratio of four pulse beats to one respiration is typical. As a rule, both the pulse and respiratory rates respond to exercise or emotional upset. lists normal respiratory ranges for patients in various age groups.

Chain of Custody

refers to the stepwise method used to collect, process, and test a specimen. Forensic or legal specimens should be collected, handled, and stored in a manner consistent with established standards designated by law. Specimen processing must be documented precisely, ensuring that no tampering with evidence has occurred.

Miscellaneous Findings: Oval fat bodies

formed when renal tubular epithelial cells or macrophages absorb fats. The fat droplets in the cells vary in size. They are characteristic of kidney distress.

White blood cells

may occasionally be found in normal urine, but increased numbers are associated with a UTI or with vaginal 782contamination during specimen collection. White blood cells are larger than red blood cells and have a granular appearance. They may have a multilobed nucleus. Most white blood cells in the urine are neutrophils.

For a resting 12-lead ECG:

- the patient rests on the exam table. - An electrode is placed on each of the arms and legs. - The right leg electrode is considered the ground electrode and is required for a clear ECG tracing. - Six electrodes are placed on the chest. - the ECG machine creates 12 images, or pictures, that are called leads. - The three types of leads - bipolar, augmented, and precordial

Cultural Differences: African Americans

• Extended family and church play important roles. • May have a key family member who must be consulted on healthcare decisions. • Older members may look at their health as being up to God's will, although younger members seek health screening and treatments as needed.

Types of genetic disease:

• Monogenic disorders: A defective gene is inherited from one or both parents. • Chromosomal disorders: An abnormal number of chromosomes or a change in the chromosomal structure causes a disease such as Klinefelter syndrome or Turner syndrome.

Patient Coaching Some of the current challenges in healthcare include the following:

• Pressure to reduce cost • Shorter primary care provider visits, yet an increased need for data collection to incorporate patient interviews and outcome measurements (e.g., test results) • Patients leaving the facility not understanding what they were told • An unwillingness on the part of patients to adhere to treatment plans (e.g., not taking medication or not taking it correctly, not making lifestyle changes that would improve their health)

Storage of Medications

• Store controlled substances in a different location than non-narcotic medications. • Refer to package inserts for specific storage information. • Store medications in a cool, dry location. Keep medications away from light, heat, or moisture. • For refrigerated and frozen medications, keep temperature logs to ensure the appropriate temperature range is maintained. • Medications with different lot numbers or expiration dates should not be combined or repackaged. • Keep stock medications (purchased by department) separated from sample medications (given by pharmaceutical manufacturers for patients). • Keep medications out of exam rooms. Lock medication cabinets at the end of the day.

Two types of pacemakers:

• Temporary pacemaker: Used in an emergency until the permanent pacemaker can be placed; also used for temporary conditions (e.g., heart attack and medication overdose). • Permanent pacemaker: Surgically inserted into the chest or abdomen. Patients can use technology (e.g., smart phones) to transmit their pacemaker data to their provider.

Maintenance of the Electrocardiograph

• The lead wires are not disposable; clean as indicated in the operator's manual. • Handle the lead wires and patient cable with care. They should be stored in a loose coil. Tight coils or bending of the wires and cable can result in breakage of the fine wires inside the unit. This will cause artifact on the ECG and requires replacement of the cable. • Clean the tracing stylus and the machine casing as indicated in the operator's manual.

Principles of Electrocardiography All medical assistants must:

• Understand the cardiovascular system • Recognize early symptoms of potential disorders • Coach patients on cardiac tests and treatments ordered by providers • Accurately perform cardiac tests • Identify and troubleshoot problems when performing tests

5 Spelling Rules decodable medical terms 4

4. If two or more combining forms are used in a term, the combining vowel is retained between the two, regardless of whether the second combining form begins with a vowel or a consonant. For example, joining gastr/o and enter/o (small intestine) with the suffix -itis, results in the term gastroenteritis. Notice that the combining vowel is kept between the two combining forms (even though enter/o begins with the vowel "e"), and the combining vowel is dropped before the suffix -itis.

The practices need to be consistent within the system: (2)

5. When you are indexing a foreign name in which you cannot distinguish between the first and last names, index each part of the name in the order in which it is written. If you can make the distinction, use the last name as the first indexing unit. 6. Names with prefixes are filed in the usual alphabetic order, with the prefix considered part of the name. 7. Abbreviated parts of a name are indexed as written if that person generally uses that form. 8. Mac and Mc are filed in their regular place in the alphabet. If the files have a great many names beginning with Mac or Mc, some offices file them as a separate letter of the alphabet for convenience.

Incorrect Tuberculin Skin Test Readings (1)

A false-positive reaction means the person reacted to the test even though no M. tuberculosis is present. Reasons for false-positive reactions with TST include the following: • Lung infection with nontuberculous mycobacteria (NTM). This organism is found in the water and soil and is inhaled. • Previous vaccination with bacillus Calmette-Guérin (BCG) vaccine. Many foreign-born patients from countries with a high risk of TB may have received BCG abroad. The BCG vaccine has been approved by the FDA, but it is used in very limited situations. • Incorrect administration or reading of the TST.

Prescriptions

A prescription is a written order by a provider to the pharmacist. It tells the pharmacist what medication and how much should be dispensed to the patient. The prescription must be written in ink or be computer-generated. A medical assistant can prepare prescriptions for the provider to sign. The provider is responsible for ensuring the prescription meets federal and state laws and regulations. Four parts to a prescription: superscription, inscription, signature, and subscription.

Hyaline casts

Hyaline casts are pale, transparent, cylindric structures that have rounded ends and parallel sides. They are formed when urine flow through individual nephrons is diminished. They can be found in the urine of individuals with kidney disease, but also in the urine of people without such disease who have exercised heavily. Hyaline casts will be missed entirely if the light is not adjusted properly. Occasionally, hyaline casts have granular or cellular inclusions.

Discuss the role of the medical assistant in asepsis.

Asepsis is important the health of the patient, the provider, and the staff. The medical assistant must develop the necessary skills, in addition to a firm grasp of the principles involved, for performing aseptic procedures properly.

Outer posterior aspect of the upper arm:

Expose the arm. The outer posterior site extends from 3 inches above the elbow to about 3 fingerbreadths below the acromion process. It is important to stay away from the shoulder area.

Respiration

External respiration is the exchange of oxygen and carbon dioxide in the lungs. Internal respiration occurs at the cellular level.

Cumulative effect

For medications taken routinely, often the prior dose is not completely metabolized and excreted before the next dose is given. This can lead to a buildup of medication or byproducts that can produce toxic effects.

The Health Information Technology for Economic and Clinical Health Act (HITECH) and Meaningful Use

The HITECH Act provides financial incentives for the meaningful use of certified EHR technology to achieve health and efficiency goals. HIPAA was created in large part to simplify administrative processes using electronic devices. Meaningful use means that providers must show that they are using EHR technology in ways that can be measured significantly in quality and quantity.

Explain the major areas included in the OSHA Compliance Guidelines.

The OSHA Compliance Guidelines include barrier protection devices, environmental protection, housekeeping controls, hepatitis B immunization, and post-exposure follow-up.

According to the AHRQ, the PCMH has five core functions and attributes: 3. Coordinated care:

The PCMH coordinates care across all parts of the healthcare system, including specialty care, hospitals, home healthcare, and community services. Coordination is especially important when patients are transitioning from one site of care to another, such as from hospital to home. The PCMH works at creating and maintaining open communication among patients and families, the medical home, and members of the broader healthcare team.

• TTM with no internal memory

The TTM is placed over the heart, and the phone receiver is placed over the TTM. Once the activation button is pushed, the TTM records and immediately sends the live ECG to the provider via the phone line. The data is not saved in the device. This type of TTM is used for patients with pacemakers and internal cardioverter-defibrillators. It allows the provider to monitor the patient remotely.

Assurance and Quality Control in Urinalysis

The US Food and Drug Administration (FDA) categorizes the chemical analysis of urine performed by an instrument or a reagent strip as a CLIA-waived test. The chemical analysis includes the reagent strip (dipstick) tests for bilirubin, glucose, hemoglobin or blood, ketones, leukocyte esterase, nitrite, pH, protein, specific gravity, and urobilinogen. One such control strip is the Chek-Stix.

• Single order or one-time order:

Medication is administered one time.

Therapeutic Effects

Medications can have local or systemic effects. Medication effects that are seen at the site of administration are local effects. Medication effects that are seen throughout the body are systemic effects. Each medication has one or more therapeutic effect or desired effect.

Professional Appearance

Most ambulatory healthcare facilities have dress codes for employees. Medical assistants are usually required to wear scrubs, along with the facility's nametag (and a photo) clearly visible, provides a typical dress code. Dress codes will vary by facility. Some communities are more conservative, and thus the dress codes reflect this.

Nephron

Notice the blood vessels entering and exiting the glomerulus, where the small particles in the blood are filtered out of the blood into the surrounding capsule of the nephron. Then, follow the filtrate through the proximal convoluted tubule, the descending limb, the loop of Henle, and the ascending limb of the nephron. This is where water and substances from the filtrate are reabsorbed back into the blood vessels. Finally, in the distal convoluted tubule of the nephron, additional waste products are selectively secreted into the filtrate by the blood vessels. The collection duct continues to concentrate the filtrate to form urine ready for excretion.

Out Guides

Out guides are made of heavyweight cardboard or plastic and are used to replace a folder that has been temporarily removed. Out guides are made of heavyweight cardboard or plastic and are used to replace a folder that has been temporarily removed

Heart Structure

The heart is divided into four chambers. Two atrial chambers receive blood from the body. Two ventricular chambers pump blood out to the body. The septum divides the right and left sides of the heart. - The mechanical action of the heart and valves can be assessed by echocardiography (ECHO). - The heart wall has three layers: the epicardium, the myocardium, and the endocardium. - Cardiac muscle fibers in the myocardium are electrically linked together, forming "one unit." - A myocardial cell forms a strong connection to the next cells through special junctions called intercalated discs.

12-Lead ECG

The medical assistant is responsible for: • Assembling the supplies and equipment needed • Preparing the patient for the test • Performing the test * the goal is to give the provider a clear ECG.

One-Time Screenings

The medical assistant may also need to coach patients on one-time screening as indicated by the provider. People are recommended to have the following screenings at least once, unless a person's risk is greater than average: • Abdominal aortic aneurysm • Human immunodeficiency virus (HIV) screen (blood test) • Hepatitis C Risk factors for hepatitis C include the following: • Born between 1945 and 1965 • History of a blood transfusion or organ transplant before 1992 • Use of injected illegal drugs • Has chronic liver disease, HIV, or AIDS

Past Health, Family, and Social History

The medical assistant may review the form for completeness, and he or she may need to clarify any questions or missing information with the patient before the patient is seen by the provider. The responses provide information about: • Any past illnesses (including injuries and/or physical defects, whether congenital or acquired) • Hospitalizations, or surgeries the patient has had • Patient's daily health habits

Hematology in the Reference Laboratory

The most frequently ordered reference laboratory procedure for hematology is the CBC. - requires a lavender-topped EDTA blood specimen. It routinely includes the following: • RBC count, hematocrit, hemoglobin, and RBC indices • WBC count and differential • Platelet count

Affective Domain

The most intangible domain of the learning process. It involves affective behavior, which is conduct that expresses feelings, needs, beliefs, values, and opinions; the feeling domain.

Mouth and Throat

The mouth, or oral cavity, is usually thought of in terms of oral hygiene and dental care. The provider may use a tongue depressor and a piece of gauze to grasp the tongue to examine it carefully. Healthy gums are pale pink, glossy, and smooth and do not bleed when pressure from a tongue depressor is applied.

Distribution

The movement of absorbed drug from the blood to the body tissues.

Nose and Sinuses

The mucosa of the nasal cavity is examined for color and texture. The sinuses cannot be seen, but the frontal and maxillary sinuses may be examined by firm palpation over the area and by transillumination.

• Manufacturer

The name of the manufacturer of the medication.

Reflex Hammer

Sometimes called a percussion hammer. This stainless-steel instrument has a hard rubber head that is used to strike the tendons of the knee and elbow to test the neurologic reflexes.

• Depolarized state:

When the impulse hits the cardiac cell, large amounts of positively charged sodium ions move into the cell. A small amount of potassium ions moves outside of the cell. The 268movement of sodium and potassium changes the cell's charge to positive. The change, also called action potential, allows the impulse to move through the cell. Depolarization (when the impulse hits the cell) causes electrical activity on the ECG.

Solutions

When the manufacturer made the medication, the "recipe" called for powdered drug to be mixed with a liquid: • A 1% solution means 1000 mg of powdered drug is mixed in 100 mL of liquid. • A 2% solution means 2000 mg of powdered drug is mixed in 100 mL of liquid. (The 100 mL of liquid always remains regardless of the number in front of the percentage sign.)

Drug interactions

When two or more drugs are taken, sometimes a drug-drug interaction can occur. The interactions can be helpful or harmful.

Past Health History.

The past health history will include information about: • previous illnesses/injuries (including childhood illnesses, such as chickenpox or measles) • previous hospitalizations • previous surgeries The dates that these occurred will need to be documented, along with any complications that occurred. The provider needs to be aware of this information because it could affect the patient's current condition.

4. Green top

The plasma in their anticoagulated specimen is used for testing when STAT results are needed (usually in chemistry). The dark green tops contain no thixotropic gel. The tubes with marbled green-gray tops and light green Hemogard tops both contain gel to help separate the plasma from the cells when centrifuged.

Right Dose

The provider may have written the order in two different ways, even though the amount is the same. • Acetaminophen 500 mg, 2 tabs po × 1 dose • Acetaminophen 1000 mg po × 1 dose

Differential Cell Count

The purpose of the differential, or diff, in the CBC is to analyze and count the types of WBCs found in a sample of blood. The differential can be manually performed using a stained blood smear and a microscope, or with an automated instrument. Automated cell counters have the ability to analyze the WBCs and gather information about cell size, internal structures, and density.

The most commonly used medical history forms include these components: • Chief complaint (CC)

The purpose of the patient's visit. Generally, this is documented in the patient's own words.

Rectum

The rectal examination usually follows the abdominal examination or may be part of the examination of the genitalia. Preserving the patient's comfort and dignity is vital. Fecal occult blood test specimens are often collected at the time of the digital rectal examination.

Eyes

The sclera is checked for color, which ranges from white to pale yellow. A sclera with a yellow tone indicates liver disease. If eye movement is within average range, "extraocular movement (EOM) intact" is documented. The ophthalmoscope is used to examine the interior of the eye, including the retina and intraocular vessels.

Semi-Fowler Position

The semi-Fowler position is a modification of the Fowler position. The head of the table is positioned at a 45-degree angle instead of at a full 90-degree angle. This position is useful for postoperative examinations, for patients with breathing disorders, and for patients suffering from head trauma or pain. The drape or gown should cover the entire patient from the nipple line down.

Instruments Needed for the Physical Examination: Ophthalmoscope

To inspect the inner structures of the eye. It consists of a stainless-steel handle containing batteries and an attached head, which has a light, magnifying lenses, and an opening through which the eye is viewed.

Microscope

Used to view objects too small to be seen with the naked eye. The microscope is used to evaluate stained blood smears, urine sediment, vaginal secretions, and smears made from body fluids and microorganisms. Microscopes may be monocular or binocular. A monocular microscope has one eyepiece for viewing, and a binocular microscope has two. The eyepiece, or ocular, is located at the top of the microscope and contains a lens to magnify what is being viewed. The usual ocular magnification is 10 times (10×).

Additional Labeling Information A note about specimen labels:

When a clinic sends specimens to multiple laboratories, it is important to have a system in place that meets the labeling and collection needs of all facilities. Each laboratory may require specific information and specific specimen containers. To avoid mistakes and possible specimen recollection issues, double-check the laboratory name and specimen requirements before patient collection. Patient insurance may direct laboratory usage or affiliation.

Generic Versus Brand Medications

When a company creates a medication, the company determines the appearance of the medication (e.g., color, size, and shape). It also comes up with the inactive ingredients or additives. Their bodies may react to the inactive ingredients differently.

Administration Techniques: The following sections address these three goals. (Air Lock Technique)

When an IM injection is given, the air lock technique can be used. Remove the bubbles in the syringe, and measure the exact amount of medication needed. Once these steps have been done, add 0.2 to 0.5 mL of air into the syringe. This is the known as the air lock technique. When the IM injection is given, the medication is pushed in first, followed by the air. When the needle is withdrawn, the air creates a "lock," keeping the medication in the muscle. The air fills in the needle hole. The air lock prevents the irritating medication from tracking back up the tissues to the skin, creating pain for the patient.

5 Spelling Rules decodable medical terms 3

3. If a combining form ends with the same vowel that begins a suffix, one of the vowels is dropped. The term that means "inflammation of the inside of the heart" is built from the suffix -itis (inflammation), the prefix endo- (inside), and the combining form cardi/o. Endo- + cardi/o + -itis would result in endocardiitis. Instead, one of the "i"s is dropped, and the term is spelled endocarditis.

Soluble fiber dissolves in water and forms a gel-like substance. Soluble fiber helps:

• Soften the stool • Lower the blood glucose level by slowing sugar absorption 197• Lower the low-density lipoprotein (LDL, or bad cholesterol) level by binding to fatty acids

Factors that may affect body temperature (1)

• Age: The body temperature of infants and young children fluctuates more rapidly in response to external environmental temperatures. Aging adults lose the insulation of subcutaneous fat and thermoregulatory control. • Stress and physical activity: Both exercise and emotional stress can increase the metabolic rate, causing an elevation in temperature.

Sensory system

the part of your nervous system that detects or senses the environment

Diagnosis

A differential diagnosis is the process of weighing the probability of one disease causing the patient's illness against the probability that other diseases are causative.

Eligibility verification

EHR billing systems can perform online verification of insurance eligibility and can capture demographic data.

Drug dependence

Strong psychological or physical need to take a certain drug. Withdrawal symptoms can be experienced when a person stops using a drug. Drug dependence can occur with or without addiction.

Synthetic Sources of Drugs

Synthetic medications are cheaper to produce because they are created in mass volumes. The quality of synthetic medications can also be controlled.

• National Drug Code (NDC)

A unique 10-digit number indicating the product. The NDC is required by federal law to be on all prescription and nonprescription medication packages and inserts in the United States.

Gender:

Certain diseases occur specifically, or more often, in one gender than the other. Sometimes both genders may get a disease, but one gender has a higher risk factor. Women are at higher risk for breast cancer than men.

Administration Techniques

* When a subcut injection is given, the angle depends on the needle length. If a -inch needle is used, then the medical assistant should use a 45-degree angle. * If a -inch needle is used, then a 90-degree angle should be applied. It is important to pinch up the tissue with the index finger and thumb of the nondominant hand. This ensures that the injection is given into the subcutaneous tissue.

Sinoatrial (SA) node

"pacemaker of the heart" Located in the posterior superior wall of the right atrium. The cardiac cells in the SA node generate the impulse. An impulse from the SA node starts each heartbeat. The impulse also moves quickly across special bands of tissue called intermodal tracts. Bachmann's bundle, a specialized intermodal tract, takes the impulse to the left atrium.

List the three main components of meaningful use legislation.

(1) use of certified EHR in a meaningful manner, such as e-prescribing (2) use of certified EHR technology for electronic exchange of health information to improve the quality of health care (3) use of certified EHR technology to submit clinical quality reports, procedure and diagnosis codes, surveys, and other measures.

Early Warning Signs of Malignant Melanoma: ABCDE Rule

* Asymmetry - One half of the mole does not match the other half. * Border - The edges of the mole are blurred or irregular. * Color - The mole is not the same color throughout and has shades of tan, brown, black, red, white, or blue * Diameter - The mole is larger than 6 mm, about the size of a pencil eraser or pea; but it could be smaller. * Evolving - The mole changes over time.

Empathy and Compassion

* Empathy is the ability to understand another's perspective, experiences, or motivations. * Sympathy is feeling sorrow, concern or pity for what the other person has gone through. * Compassion means we have a deep awareness of the suffering of another and wish to ease it.

Special Situations

* If a needle breaks during an injection or if the needle separates from the syringe, pull out the needle, if it is visible. * If the injection was given in the arm, place a tourniquet above the spot to prevent the needle from moving in the body. Notify the provider immediately. * With intramuscular injections, sometimes the bone can be hit during the procedure. If this occurs, pull the needle out about inch, and give the medication. * Anaphylaxis is a severe allergic reaction that can be life-threatening. Having the patient wait 15 minutes after an injection allows you to monitor for unusual symptoms. If the patient is experiencing any unusual symptoms, it is important to tell the provider immediately. The first-line medication for anaphylaxis is epinephrine.

Summary of Intradermal Injections

* Syringe used - 1 mL (tuberculin syringe) * Needle size - to inch; 25−27 gauge * Angle of entry - 5 to 15 degrees with bevel facing upward * Maximum volume - 0.1 mL * Common sites - Forearm, upper arm, and back * Additional sites - Separate by at least 2 inches * Patient position - Sitting with arm extended * Administration - Pull skin taut at injection site

Each wave in the QRS complex is different:

* The Q wave is a negative deflection and represents interventricular septal depolarization. * The large, triangular-shaped R wave reflects the depolarization of most of the ventricular walls. * The S wave is the final depolarization of the ventricular walls. Not all of these three waves may be seen. The positive and negative deflections of these waves can be different in the 12 leads, or pictures, of the ECG.

Preparation of Blood Smears for the Differential.

- A blood smear enables the examiner to view the preserved cellular structures of blood. - The morphology (form or shape) of WBCs, RBCs, and platelets can be studied. Their size, shape, and maturity can also be evaluated. - A blood smear is prepared by placing a drop of blood from a fingerstick or an EDTA tube (using a DIFF-SAFE blood dispenser) onto a clean glass slide. - The best specimen for a blood smear is capillary blood that has no anticoagulant added.

ECG Intervals

- An interval is a period of time from a start point to an end point. It is not a wave. - The PR interval starts at the beginning of the P wave and ends at the start of the Q wave. It represents atrial depolarization. - The QT interval starts at the beginning of the Q wave and extends to the end of the T wave. During the QT interval, the atrial chambers move from repolarization to the polarized state. The ventricular chambers depolarize and then move into the repolarized state.

Examples of nondecodable terms include the following: 1

- Cataract: From the Greek term meaning "waterfall." In healthcare language, this means the condition in which the lens becomes progressively opaque (loss of transparency). - Asthma: From the Greek term meaning "panting." - Diagnosis: The disease or condition that is determined after a healthcare provider evaluates a patient's signs, symptoms, and history. - Prognosis: Similar to diagnosis, the term prognosis can be broken down into its word parts (pro-, meaning "before" or "in front of," and -gnosis, meaning "state of knowledge"), but this does not give the true definition of the term, which is "a prediction of the probable outcome of a disease or disorder."

Containers

- Disposable, nonsterile, plastic, or coated paper containers are the most frequently used and are available in many sizes with tight-fitting lids. - Most routine UA tests, pregnancy tests, and tests for abnormal analytes are performed on urine collected in nonsterile containers. - Special flexible polyethylene bags with adhesive are used to collect urine from infants and children who are not toilet trained - Special flexible polyethylene bags with adhesive are used to collect urine from infants and children who are not toilet trained

Volume of the Urine

- Once the volume has been measured and recorded, a portion of well-mixed specimen, called an aliquot, is removed for testing. - The normal volume of urine produced every 24 hours varies according to the age of the individual. Infants and children produce smaller volumes than adults. - The normal adult volume of urine produced is approximately 800 to 2000 mL in 24 hours. - Excessive production of urine is called polyuria. This is common in those who have diabetes mellitus, diabetes insipidus, and certain kidney disorders. - Oliguria is an insufficient production of urine, which can be caused by dehydration, decreased fluid intake, shock, renal disease, or urinary tract infections. - The absence of urine production, anuria, occurs when there is renal obstruction and renal failure.

Methods of Specimen Collection

- Random specimen: Most tests are performed on freshly collected urine in clean containers. - First morning specimen: If the specimen ordered should be collected when the patient first wakes up in the morning. - Two-hour postprandial urine specimens: collected 2 hours after a meal, are used in diabetes screening and for home diabetes testing programs. - 24-hour urine specimen: collected over 24 hours to provide a quantitative chemical analysis, such as hormone levels and creatinine clearance rates. - Second-voided specimen: usually is collected to determine glucose levels in urine. The first void of the morning is discarded, and the second void of the day is collected for testing. - Clean-catch midstream specimen (CCMS): The clean-catch technique is used to eliminate microorganisms from the urinary meatus. Ordered when the provider suspects a urinary tract infection. When a UTI is possible, the provider will order a urine culture and sensitivity (C&S).

Three processes are involved in active listening:

- Restatement is simply paraphrasing or repeating the patient's statements with phrases - Reflection involves repeating the main idea of the conversation while also identifying the sender's feelings. - Clarification seeks to summarize or simplify the sender's thoughts and feelings and to resolve any confusion in the message.

Examples of nondecodable terms include the following: 2

- Sequela: A condition that follows and is the result of an injury or disease. - Acute: A term that describes a sudden, severe onset (acu- means "sharp") of a disease. - Chronic: Developing slowly and lasting for 6 months or longer (chron/o means "time"). Diagnoses may be additionally described as being either acute or chronic. - Sign: An objective finding of a disease state (e.g., fever, high blood pressure, rash).

Bacterial Physical Structures

- Some bacteria have long thin flagella (whiplike tails) that help them move. - Proteus vulgaris is a Gram-negative bacillus with many flagella. It can move up the urethra and into the bladder and cause a UTI. - Some bacteria produce a thick, jelly-like substance that surrounds the cell wall called a capsule. - Streptococcus pneumoniae is nonpathogenic if it is not producing a capsule; however, when it produces a capsule it is the most common cause of pneumonia in older adults. - An endospore allows the bacteria to remain viable when environmental conditions are poor. - Clostridium tetani produces spores, and if spores enter a wound and grow, they cause the disease known as tetanus.

Study Skills: Tricks for Becoming a Successful Student

- Spider map showing multiple main ideas with supporting details. - Fishbone map used to describe cause of disease. - Chain-of-events map showing the cause and effect of events. - Cycle map illustrating the way one action leads to another.

Examples of nondecodable terms include the following: 3

- Symptom: A subjective report of a disease (pain, itching). Other types of terms that are not built from word parts include the following: - Eponyms: Terms that are named after a person or place associated with the term. Examples include the following: - Alzheimer disease, which is named after Alois Alzheimer, a German neurologist. The disease is a progressive mental deterioration. - Achilles tendon, which is a body part named after a figure in Greek mythology whose one weak spot was this area of his anatomy. Tendons are bands of tissue that attach muscles to bone. The Achilles tendon is the particular tendon that attaches the calf muscle to the heel bone. Unlike some eponyms, this one does have a medical equivalent, the calcaneal tendon.

Creating an Efficient Paper Health Records Management System

- The paper health records management system should provide an easy method of retrieving information. The files should be organized in an orderly fashion. The information must be documented accurately, and corrections should be made and documented properly. The wording in the record should be easily understood and grammatically correct. - An efficient method of adding documents to the record must be established so that the provider always has the most up-to-date information. The health records management system must work for the individual facility.

What is the difference between scope of practice and standards of care?

- The scope of practice for a medical assistant is what has been established by law in some states or by practice norms, institutions, or physician-employers in states without scope of practice laws. - Standards of care, however, is a legal term that refers to whether the level and quality of patient service provided is the same as what another healthcare worker with similar training and experience in a similar situation would provide. Standards of care set minimum guidelines for job performance. They define what the expected quality of care is and provide specific guidelines on whether the care standard has been met.

Identify and discuss the two methods of organizing a patient's paper medical record.

- The source-oriented medical record (SOMR) categorizes the content by its source, such as provider, laboratory, radiology, hospital, and consultation. Within each source category the content is arranged in reverse chronologic order so that the most recent content is viewed first. - The problem-oriented medical record (POMR) categorizes each of the patient's problems and elaborates on the findings and treatment plans for all concerns. The POMR helps ensure that individual problems are all addressed.

Coagulation Testing: Prothrombin time (PT protime)

- This test can be performed using a handheld, CLIA-waived instrument that uses whole blood from a fingerstick. - a method of measuring how long it takes blood to clot. - Prothrombin is a protein in the liquid part of blood (plasma) that is converted to thrombin as part of the clotting process. - often used in combination with the partial thromboplastin time (PTT) to screen for hemophilia and other clotting disorders. - also used to monitor patients taking anticoagulant drugs such as warfarin (Coumadin) and similar anticoagulants. - Warfarin is given to prevent clots in deep veins of the legs and to treat a pulmonary embolism.

MA will need to master the following subjects:

- Use of laboratory equipment. - Regulations governing laboratory practices and procedures. - Precautions for accident prevention. - Waste disposal requirements. - Housekeeping and maintenance routines. - Quality assurance and control procedures. - Technical aspects of specimen collection and test processing, including expected results. - Communication with patients. - Reporting of test results to the physician. - Recordkeeping of test specimens, procedures, and results. - Inventory and ordering of equipment and supplies. - Use of reference materials in the POL. - Screening and follow-up of test results.

Handling the Specimen After Collection

- after collection, analytes in blood begin to decay - blood may require processing (like centrifugation) before being sent for analysis - whole blood for automated blood counts should be refrigerated and tested within 72 hours - special services for transporting specimens to other facilities

ECG Waves and Segments: P wave

- first deflection in the tracing - created from the electrical impulses moving through the right and left atria - appears as a small, rounded hill - Electricity given off when the atrial cells are depolarized creates the P wave. - represents atrial depolarization - the atrial chambers contract and the blood moves into the ventricles The first part of the P wave reflects the impulse moving from the SA node to the AV node in the right atrium. The second part of the P wave reflects the impulse in the left atrial chamber.

T wave

- follows the ST segment and appears as a smooth, rounded, asymmetric waveform - The electrical activity from ventricular repolarization creates the T wave.

ST segment

- follows the last wave in the QRS complex and ends at the start of the T wave. - The J point is the point where the QRS complex ends and the ST segment starts. - The ST segment is an isoelectric line. - There is no electrical activity in the heart during this segment. (Remember, the impulse moving through the conduction system finished in the QRS complex.) - the ventricles finish contracting.

U wave

- may follow the T wave, but in many cases it is not seen. - created from the repolarization of the Purkinje fibers. - may also appear if the patient has hypercalcemia, hypokalemia, or digoxin toxicity.

Intercalated discs

- responsible for the cell-to-cell communication that is required for coordinated muscle contraction. - help the muscle fibers form one unit that contracts all at once, instead of a little at a time.

QRS complex

- the next wave in the tracing - The impulse moves from the AV node through the remaining conduction system structures. - The electricity given off from the impulse moving down the septum and around the outer walls of the ventricles creates the QRS complex. - can be summarized as ventricular depolarization and atrial repolarization - the ventricles start contracting and the blood moves into the arteries.

Tube Additives

-Anticoagulants: Ethylenediaminetetraacetic acid (EDTA), Citrates, Heparin, Oxalates -Special-use anticoagulants: Acid citrate dextrose, Citrate phosphate dextrose, Sodium polyanethol sulfonate -Antiglycolytic agents: Substances that prevent glycolysis (breakdown of glucose by blood cells) Sodium fluoride (most common) -Clot Activators: Substances that provide more surface for platelet activation Glass (silica) particles Inert clays (Celite) & Clotting factors (thrombin) -Trace element-free tubes: Tubes made of materials free of trace element contamination Used for trace element tests, toxicology studies, & nutrient determinations Feature royal-blue stoppers

Chemical Examination of Urine

-Chemical testing available on urine reagent test strips -Most frequently performed procedure in the medical office

General Appearance

Age, height, weight, and nourishment Explains whether the patient appears well and in good health (e.g., note whether the patient appears disoriented or in distress, well-nourished or undernourished, and answers questions with ease or confusion).

Bacterial Oxygen Requirements

1. Aerobic 2. Anaerobic 3. Facultative anaerobes

Making Corrections and Alterations to Health Records

1. Draw a line through the error. 2. Insert the correction above or immediately after the error in a spot where it can be read clearly. 3. If indicated by the policies and procedures manual, write "Error" or "Err." in the margin. 4. The person making the correction should write his or her initials or signature and the date below the correction. Follow the format indicated in the policy and procedures manual. Corrections to health records must be done in a legible manner and must be clearly understood. Always initial and date corrections to health records.

Right Education

1. Give the name of the medication and who ordered it. 2. Explain the desired effect or action of the medication. 3. Describe common side effects of the medication. 4. Verify the patient's allergies.

5 Spelling Rules decodable medical terms 1

1. If the suffix starts with a vowel, a combining vowel is not needed to join the parts. For example, it is simple to combine the combining form hepat/o and suffix -itis to build the term hepatitis, which means "an inflammation of the liver." The combining vowel "o" is not needed because the suffix starts with the vowel "i."

Analytic Stage

1. Instruments are maintained and calibrated. 2. Controls are run and analyzed for each test method (part of ongoing quality control). 3. The specimen is tested, and the results are compared with reference ranges. 4. The test results are logged and documented in the patient's health record.

The practices need to be consistent within the system: (1)

1. Last names are considered first in filing; then the given name (first name), second; and the middle name or initial, third. Compare the names beginning with the first letter of the name. When a letter is different in the two names, that letter determines the order of filing. 2. Initials precede a name beginning with the same letter. This illustrates the librarian's rule, "Nothing comes before something." 3. With hyphenated personal names, the hyphenated elements, whether first name, middle name, or surname, are considered to be one unit. 4. The apostrophe is disregarded in filing.

The wedge smear is used most frequently and would follow these steps:

1. Place a small drop of blood inch from the frosted end (placed to the right) of a glass slide. 2. The end of a second glass spreader slide is placed in front (to the left) of the drop of blood at an angle of 30 to 35 degrees. 3. The spreader slide is brought back into the drop with a quick but smooth gliding motion until the blood spreads along the edge of the spreader slide. 4. The spreader slide is then pushed to the left with a quick, steady motion, spreading the blood across the slide

Postanalytic Stage

1. Specimens are properly discarded. 2. Analyses of control results are compared over time. 3. Patient reports from outside laboratories are logged or documented. 4. The provider interprets and signs all lab reports. 5. The patient is notified of the results in the office or is contacted by laboratory personnel. 6. The final report and all communication with the patient is documented in the patient's health record.

Chain of Custody Rules. (1)

1. The individual being tested must provide a photo identification. 2. Indirect observation of specimen collection is important to make sure the patient being tested has provided the sample. Indirect methods of observation include: • Measuring the specimen's temperature • Securing water faucets in the restroom so that urine cannot be diluted • Having the patient remove outer clothing and leave personal belongings in the examination room • Not allowing water to be run or the toilet to be flushed in the restroom during the collection

Preanalytic stage

1. The provider orders a test to screen, monitor, or diagnose a patient's condition. 2. A written or electronic requisition is filled out, showing the test requested, the specimen required, and where the specimen will be tested. 3. The specimen is collected, labeled, and processed. 4. The specimen is transported to the laboratory in the POL or properly prepared for offsite laboratory pickup.

Skin Puncture Devices

1. handheld lancet-no longer used 2. automatic puncture devices a. have width and depth puncture controls 3. Lasette laser lancing device - uses laer a. good for 5 or older people

Pulse Oximetry

An assessment tool that measures oxygen saturation of hemoglobin in the capillary beds. Pulse oximetry is a noninvasive method of evaluating both the pulse rate and the oxygen saturation of the blood. It may also be referred to as saturation of peripheral oxygen (SpO2).

Reconstituting Powdered Medication

A powdered medication needs to be mixed with a diluent. (sterile normal saline or sterile water is used as a diluent), although other medications may also be used (according to the provider's order and the manufacturer's directions). The most common powdered medications in primary care are live virus vaccines. These need to be reconstituted.

Examples of Acronyms for Slow-Release Tablets

CD—controlled delivery CR—controlled release DR—delayed release ER—extended release LA—long acting SA—sustained action SR—sustained release TD—time delay TR—time release XL—extended release XR—extended release

5 Spelling Rules decodable medical terms 2

2. If the suffix starts with a consonant, a combining vowel is needed to join the two word parts. For example, to build a term using neur/o and -plasty, the combining vowel is used and the resulting term is spelled neuroplasty, which refers to a surgical repair of a nerve.

Using a Prefilled Sterile Cartridge

A prefilled, sterile cartridge comes filled with a single dose of medication. The cartridge may come with or without a needle. A safety needle can be attached to the Luer-Lok on the prefilled cartridge. A reusable cartridge holder (e.g., Carpuject or Tubex) is needed to dispense the medication

Chain of Custody Rules (2)

3. Within 4 minutes of receiving the specimen, check its temperature (range should be 32° to 38°C [90° to 100°F]). Sample volume should be a minimum of 30 to 45 mL. Inspect the sample for any indications of adulteration (e.g., an unusual color, the presence of foreign materials). 4. Pour the specimen into a specimen bottle and seal the lid with the tamper-evident label/seal provided at the bottom of the chain of custody form.

Chain of Custody Rules (3)

5. Ship the specimen to the testing laboratory as soon as possible. It must be sent the same day it was collected. Individual testing method results may vary. Some tests have lower limits of detection, which can make some results positive at lower substance levels. Also, a person's diet, the volume of urine flow, and recent fluid intake can affect some results. 7. Because of the legal implications of drug testing, chain of custody must be strictly followed. Each step from collection of the specimen to reporting the test results must be strictly monitored and documented.

Alphabetic Filing

A traditional system for patient records in providers' offices and the most widely used Files are arranged by last name, first name and middle initial It is a direct filing system in that the person filing needs to know only the name to find the desired file.

The practices need to be consistent within the system: (3)

9. The name of a married woman who has taken her husband's last name is indexed by her legal name (her husband's surname, her given name, and her middle name or maiden surname). There should be a cross-reference, such as an out guide placed where her maiden name falls directing you to her new name. 10. When followed by a complete name, titles may be used as the last filing unit if needed to distinguish the name from another, identical name. Titles without complete names are considered the first indexing unit. 11. Terms of seniority or professional or academic degrees are used only to distinguish the name from an identical name. 12. Articles (e.g., the, a) are disregarded in indexing.

Transtelephonic Monitoring

A transtelephonic monitor (TTM) is a small device that records a patient's ECG when the patient pushes the activation button. The TTM has four electrodes on the back of the device that can record a single lead. The signal is converted to a readable tracing that can be displayed on a monitor or printed out.

Cardiac Event Recorder

A portable, battery-powered ECG device. The recorder is activated by the patient when symptoms occur, and it records the ECG. Patients may wear a cardiac event recorder for 30 days.

Examples of acceptable abbreviations and symbols include the following: Simple abbreviations:

A combination of letters (often, but not always the first letter of significant word parts) and sometimes numbers; for example: IM: Abbreviation for intramuscular (pertaining to within the muscles) C2: Second cervical vertebra (second bone in neck)

Incorrect Tuberculin Skin Test Readings (2)

A false-negative reaction means the person may not have reacted to the test. even though the patient is infected with M. tuberculosis. Reasons for false-negative results with TST include the following: • Weakened immune system • Exposure to TB infection within previous 8 to 10 weeks • A very old TB infection • Patient is younger than 6 months old • Recently received a live virus vaccine (e.g., measles, yellow fever, chickenpox), or had a viral infection (e.g., influenza), or received corticosteroids or immunosuppressive medications (a false reaction may occur up to 5 to 6 weeks afterward) • Incorrect administration or reading of TST

Tongue Depressor

A flat, wooden blade used to hold down the tongue when the throat is examined.

complementary and alternative medicine (CAM)

A group of diverse medical and healthcare systems, practices, and products that are not generally considered part of conventional medicine. Complementary medicine is used in combination with conventional medicine (allopathic or osteopathic); alternative medicine is used instead of conventional medicine.

Heart Block.

A heart block occurs when there is a disruption or slowing of the electrical impulse through the heart. Heart block can be congenital or acquired. Heart disease, surgery, or medications can cause acquired heart block.

Hematoma

A hematoma is a large, painful, bruised area at the puncture site caused by blood leaking into the tissue, which causes the tissue around the puncture site to swell. The most common causes of hematoma formation during the draw are excessive probing with the needle to locate a vein, failure to insert the needle far enough into the vein, and passing the needle through the vein.

Guthrie card

A laboratory filter paper used to collect a blood sample from newborns is a used to test neonates for certain metabolic disorders such as phenylketonuria (PKU)

Stethoscope

A listening device used when certain areas of the body are auscultated, particularly the heart and lungs.

Loading dose

A loading dose helps the person achieve the therapeutic range sooner. A maintenance dose is the amount of medication needed to keep the blood levels within the therapeutic range. A lethal dose is the amount of medication that could kill a person.

Body Mass Index (BMI)

A measure of body fat that is the ratio of the weight of the body in kilograms to the square of its height in meters.

Use of a Medical Scribe

A medical scribe should have an understanding of medical terminology, excellent computer skills, and a strong attention to detail. It is important that medical scribes understand that they are not obtaining the information from the patient. Their role is to document the information obtained by the provider and enter it into the EHR, per the provider's instructions. Those healthcare facilities that have hired scribes have found that both the patients and providers are more satisfied with patient encounters. Providers are establishing a better relationship with patients because they are able to spend their time with face-to-face interaction rather than interacting with a computer.

Medication Orders

A medication order refers to directions given by a provider for a specific medication to be administered to a patient. The medical assistant receives the information from the provider. • Patient's name and health record number or date of birth (DOB) (e.g., Noemi Rodriguez DOB 11/04/1971) • Medication name, dose, and route (e.g., Tylenol 1 g po)

Patient-Centered Medical Home (PCMH)

A model of primary care that provides comprehensive and timely care to patients, while emphasizing teamwork and patient involvement.

Two types of cardiac event recorders: • Looping memory monitor (also called a cardiac loop recorder)

A pager-sized monitor that connects to two chest electrodes by wires. The monitor continuously records the ECG. When the memory is full, it overwrites from the beginning (i.e., continues loop of recording). When a patient has symptoms, he or she activates the monitor. The ECG from prior to, during, and for a short while after the event is stored. It does not overwrite the stored ECGs.

Using a Graph for Quality Control Results

A paper graph or electronic graph file can be updated with daily QC values. Graphing advantages include the following: • A graph is a physical representation of the QC results that can display data irregularities in an easy-to-see format. • It displays possible trends (data that continue to go upward or downward in value) and shifts (data results that show an abrupt change in value) over time.

Patents and Exclusivity

A patent is granted on a drug for 20 years from the date of filing for the patent. Patents are granted at any point in time along the development of a drug. Exclusivity is granted by the Food and Drug Administration (FDA) to give exclusive marketing rights to the manufacturers of the drug when it earns FDA approval.

Microbiology and Immunology Describe the naming of microorganisms.

A pathogen is a disease-causing organism. Most microbes on and in our bodies are helpful and do not cause disease. In reality, less than 1% of known microorganisms are pathogens. Most microorganisms are good. Without microorganisms, we could not survive. The normal flora in and on our bodies is needed for the following processes: • Digesting food and making nutrients available to the body. • Forming blood clots. Vitamin K is used in the clotting process and is made by bacteria in our intestines. • Preventing pathogens from invading our skin, mucous membranes, and gastrointestinal and genitourinary tracts.

Idiosyncrasy

A peculiar response to a certain drug. For instance, Benadryl causes drowsiness. When it is given to children, they often get extremely agitated.

Profile Testing

A series of laboratory tests associated with a particular organ or disease; also referred to as a "panel" of tests. A screening test examines a specimen for the presence of an analyte that may indicate a disease state (based on their age, history, or gender).

Glucose

A simple sugar that is an important source of energy. Some glucose is stored in the liver and muscles as glycogen. The body uses the stored glycogen in between meals and during strenuous exercise. As the blood glucose levels start to drop, glucagon works on the liver to release the stored glycogen.

Drug Names

A single drug may have up to four names: chemical, generic, official, and brand. The drug is known by its chemical name until it receives FDA approval.

Identifying an Abnormal Rhythm: Sinus Arrhythmias.

A sinus rhythm is considered normal. The electrical activity begins in the SA node and goes through the rest of the conduction system. Atrial and ventricular depolarizations occur. The rate or rhythm of the heartbeat is altered. The alteration may come from the SA node firing too slowly or too quickly. • Sinus bradycardia: The adult heart rate is below 60 beats per minute. This is a normal finding in well-conditioned athletes. It is abnormal in other individuals. • Sinus tachycardia: The adult heart rate is above 100 beats per minute. This is normal in a person doing aerobic exercise. It is abnormal in a resting individual.

Gram Stain

A staining method that distinguishes between two different kinds of bacterial cell walls.

Acid-Fast Stain

A staining procedure for identifying bacteria that have a waxy cell wall. The acid-fast stain is used in the identification protocol for Mycobacterium species. M. tuberculosis causes tuberculosis and can be isolated from sputum or tissue samples. M. avium complex (MAC) is a common soil organism that enters through the respiratory tract and spreads throughout the body. MAC is one of the causes of death among patients with AIDS. • A red primary dye, carbolfuchsin, is applied first. • Then the decolorizer, acid-alcohol, is applied. • These are followed by a counterstain, methylene blue.

The most commonly used medical history forms include these components: • Past history (PH) or past medical history (PMH)

A summary of the patient's previous health. It includes dates and details about the patient: • Usual childhood diseases (UCD or UCHD) • Major illnesses • Surgeries • Allergies • Accidents • Immunization record

Practicing Professionalism as a Team Member

A team is a group of people organized for work or a specific purpose. In the healthcare setting, usually the team consists of the employees working in the same department. A broader definition could include all the employees at the facility. A team member is loyal to the group and works well with the other people in the group. As a member, the medical assistant must help the team function. To be a valuable team member, it is important to have several qualities. Work ethic, punctuality, cooperation, and the willingness to help are important traits in a team member.

Hemolyzed

A term used to describe a blood sample in which the red blood cells have ruptured. A hemolyzed blood specimen shows marked differences in many tests. If a large volume of specimen is collected (e.g., a 24-hour urine specimen), the total volume or weight must be carefully measured and recorded. The specimen must be well mixed before an aliquot is removed and submitted for testing.

Using a Vial

A vial is a plastic or glass container with a rubber stopper that is covered by a cap. Vials contain powdered or liquid medications. The liquid can be a parenteral medication, sterile normal saline (0.9% sodium chloride), or sterile water. Vials come in single dose or multidose. Single-dose or single-use vials are only good for a single patient and a single injection procedure. Multidose vials contain many doses of medication.

Menopause Testing

A woman is said to have reached menopause when she has not had a menstrual period for at least 12 months. The time before menopause, called perimenopause, can last for years, bringing with it uncomfortable symptoms such as irregular periods, hot flashes, vaginal dryness, and sleep problems. Some of this may be due to an increase in follicle-stimulating hormone (FSH).

Work Ethic and Punctuality

A work ethic is composed of sets of values based on hard work and diligence. The medical assistant should always display initiative and be reliable. Excessive absences or tardiness (being late) will negatively affect the employee. It may be grounds for termination (job loss). All employees must be punctual (on time) every day. Providers and patients alike expect this reliability.

Written order

A written order only needs clarification from the provider if the medical assistant cannot read the order or has a question. Usually, these are written on a prescription pad or in an electronic message.

Assisting with Medications Four basic actions occur when a drug is taken:

Absorption Distribution Metabolism Excretion

Preparing for the Venipuncture

According to CLSI standards, the veins in the center of the antecubital area should be located as a first choice before alternative veins within the antecubital area are considered. When choosing the best available vein, palpate the area. Feel for a vein that has "bounce" when lightly palpated. Consider the 3 Ds of vein selection; depth below the surface, diameter of the vein, and direction through the antecubital region. Choosing a vein correctly is one of the most important aspects of a venipuncture.

Epithelial tissue:

Acts as an internal or external covering for organs. Epithelial tissue has the cells packed so closely together that there is little to no intercellular material. Simple epithelium is a single layer of the same-shaped cells. Stratified epithelium contains multiple layers of cells.

Analyze the differences among acute, chronic, latent, and opportunistic infections.

Acute diseases have a rapid onset and short duration. Chronic diseases are present over a long period, perhaps a lifetime. Latent diseases cycle through relapse and remission phases. Opportunistic infections are caused by organisms that are not typically pathogenic but that occur in hosts with an impaired or weakened immune system response, such as individuals with HIV.

Medical billing system

Also known as a practice management system. The EHR billing system can manage all of the practice's billing and accounting systems. The system also can interface with clearinghouses for electronic claims submission and tracking. Reports can be generated that provide accurate details of the financial state of the practice at certain intervals or whenever requested.

Adjective Suffixes

Adjective suffixes usually mean "pertaining to." Remember that when you see an adjective term, you need to see what it is describing. An adjective tells only half of the story. Common adjective suffixes include the following: -ac, -al, -ar, -ary, -eal, -ic, -ous and mean pertaining to.

Adulteration Testing and Chain of Custody

Adulteration is the intentional manipulation of a urine sample that allows someone to falsely pass a drug screening test. Sensitivity limits for drug screening are set by the US Substance Abuse and Mental Health Services Administration (SAMHSA), the National Institute on Drug Abuse (NIDA), and the US Department of Health and Human Services (DHHS).

• Blood glucose test

Adults should be screened for Type 2 diabetes mellitus every 3 years or sooner, depending on their medical history.

• Cholesterol

Adults with a family history of high cholesterol levels or who have high cholesterol need more frequent testing.

• Boxed warning:

Also referred to as a black box warning. It addresses serious or life-threatening risks. This information also appears on the drug's label.

• Repolarized state:

After the impulse passes over the cell, the sodium and potassium ions move back to their original locations. This causes the cell's charge to change back to a negative charge. This recovery phase is called the repolarized state. Electrical activity (less than the depolarized state) can be recorded during the repolarized state.

Findings, Laboratory and Radiology Reports

After the provider has examined the patient, the physical findings are documented in the health record. The results of other tests or requests for these tests are then documented. If the tests were done elsewhere, the report is attached to the paper record. When an EHR is used, the separate sheet may be scanned so that it is in an electronic format and can be added to the patient's EHR.

Storage.

All controlled substances must be adequately safeguarded. They need to be kept in a locked cabinet or safe of substantial construction. Keys should be placed in a locked area accessible only to authorized persons. Controlled substances should be kept in their original containers.

Urine Pregnancy Testing

All pregnancy tests detect the presence of human chorionic gonadotropin (hCG), a hormone produced by the placenta and present in urine during pregnancy. This rapid rise occurs for approximately 7 weeks, and then the level begins to decline. Within 72 hours of delivery, the hormone disappears. The most common type of test for pregnancy is the lateral flow immunoassay test.

Cards Files

Almost every office has some occasion to use a card file. This may be for patient ledgers, a patient index, a library index, an index of surgical tray setups, telephone numbers, or numerous other records. A good-quality steel box or tray is a sound investment.

• Adverse reactions:

Also called side effects in some information. This section describes known undesirable experiences associated with the medication. Reactions may be divided into severe (life-threatening, serious reactions), moderate, and mild.

• Brand name:

Also called the trade name. The manufacturer assigns and registers the medication name. No other company can use that name. Usually the brand name begins with a capital letter and is followed by the registered sign (®).

Tuning Fork

Aluminum, fork-shaped instrument that consists of a handle and two prongs. The prongs produce a humming sound when the provider strikes them against his or her hand. Tuning forks are available in different sizes, and each size produces a different pitch level. A tuning fork is used to check the patient's auditory acuity and to test bone vibration. A tuning fork can also be used to test for diabetic peripheral neuropathy.

Ambulatory Care

Ambulatory care centers include a wide range of facilities that offer healthcare services to patients who seek outpatient health services. A patient seeing a provider for the first time is considered a new patient, whereas a patient who has seen the provider on previous occasions is called an established patient.

Using an Ampule

Ampules contain a single dose of medication. They may contain more than the patient needs. The extra medication is wasted. Medications in ampules react to other substances and require the all-glass environment to remain stable.

Types of Infection: Acute Infection

An acute infection has a rapid onset of symptoms but lasts a relatively short time. • Incubation: The period of time between exposure to the pathogen and the appearance of the first symptoms. It can be from a few days to a few months. The incubation period for mononucleosis is 4 to 6 weeks. • Prodromal: The short period of time when the first symptoms appear. With mononucleosis the patient may have 1 to 2 weeks of fatigue, malaise, myalgia, and a low-grade fever. • Acute: The disease is at its peak and symptoms are fully developed. With mononucleosis, pharyngitis, tonsillitis, and lymphadenopathy are common symptoms. • Declining: The symptoms of the disease start to subside. With mononucleosis, the declining stage can take several weeks or even months. • Convalescent: In this stage, patients will regain their strength and return to a state of good health.

Compactible Files

An office with little space and a great volume of records might use compactible files, which are a variation of open shelf files. The files are mounted on tracks in the floor, and the units slide along the tracks so that access is gained to the needed records. One drawback is that not all records are available at the same time.

Open-Ended Questions or Statements

An open-ended question or statement asks for general information or states the topic to be discussed, but only in general terms. This communication tool is used in various ways: • To begin the interview • To introduce a new section of questions • Whenever the person introduces a new topic

Applying Electrodes and Lead Wires

Apply electrodes to both arms and legs. The electrodes on the lower legs should be placed on the inner side, just above the ankles. If tab electrodes are used, have the tabs on the leg electrodes point toward the center of the person. All the other tabs can be facing the feet. Other machines indicate placement on the upper arms.

Professionalism

As a healthcare professional, medical assistants represent the healthcare facility. They are viewed as an extension of the provider and the facility. A healthcare professional: • has high ethical standards. • displays integrity. • completes work accurately and in a timely fashion.

Retention and destruction of medical records as related to paper records.

As with EHRs, paper health records are classified as active, inactive, or closed. Large healthcare facilities may find it advisable to convert their paper health records to microfilm.

Odor of urine

As with foam, odor is not normally recorded but can be an important clue to metabolic disorders. Normal urine is said to be aromatic or having a distinct or fragrant smell. - Changes in the odor of urine may be caused by disease, the presence of bacteria, or diet. - An ammonia or a putrid (foul or decaying) smell in the urine can be caused by an infection. An ammonia smell may also be noticed in urine that has been at room temperature for too long before it is tested. - Foods such as asparagus and garlic also can produce an abnormal odor in the urine. - Urine from a child with phenylketonuria (PKU) may smell "mousy."

Aspiration

Aspiration is used to check if the needle is in a blood vessel. Insulin is not aspirated. Subcut immunizations do not need to be aspirated, as recommended by the Centers for Disease Control and Prevention (CDC). Anticoagulants, such as enoxaparin and heparin, are administered in the abdomen. They are not aspirated, as specified by the manufacturers.

Atrial Arrhythmias.

Atrial arrhythmias occur when there is a problem with the SA node starting the impulse. They can also occur due to a conduction problem in the atria.

Barriers to Professionalism

Attitude Having a negative attitude can bring down the morale of the whole team. Procrastination Delaying or putting off tasks can be detrimental to patient care and your relationship with your co-workers. Personal Problems and "Baggage" t is important that we push these issues aside and focus on our job. If we carry this "baggage" to work, it can interfere with our ability to do our job. Gossip Gossip is casual or idle chat (rumors) about other people and their business.

Augmented Leads

Augmented leads also provide information on the vertical (frontal) plane of the heart. These unipolar leads are augmented, or increased in size, on the tracing. Augmented leads use the right arm (RA), left arm (LA), and left leg (LL) electrodes. Each augmented lead uses all three extremity electrodes (RA, LA, and LL) to create the picture. Midpoint between two of the electrodes is the negative pole.

Releasing Health Record Information

Authorization to Release Health Records. All requests for health records should be in writing, and the request should be kept in the patient's health record. • Who is releasing the information • To whom the information is being released • What specific information is to be released • An expiration date for the release

Compare viral and bacterial cell invasion.

Bacterial infections can be treated with antibiotics, but viral infections, which involve viral takeover of cellular DNA or RNA material, cannot be treated with antibiotics because viruses are not cells, but parasites within a cell.

Converting Temperatures

Fahrenheit to Celsius °C = (°F − 32) ÷ 1.8 Example: 101°F °C = (101−32) ÷ 1.8 °C = 69 ÷ 1.8 °C = 38.3 Celsius to Fahrenheit °F = (°C × 1.8) + 32 Example: 39°C °F = (39 × 1.8) + 32 °F = 70.2 + 32 °F = 102.2

The cardiac cells cycle through three states, or steps, in the same sequence for each impulse: • Polarized state:

Before the impulse hits the cardiac cell, the cell is in the resting state, or resting potential. The inside of the cardiac cell is negatively charged. Outside of the cell is positively charged. There is no electrical activity seen on the ECG during the polarized state.

Saprophytes

Beneficial microorganisms that are responsible for breaking down organic matter. hey help break down plants and organic waste in farming, water purification, composting, and gardening. The main objective in medical microbiology is to identify the organisms responsible for illness so that the provider can properly treat the patient. The study of immunology, or the immune system, is closely tied to microbiology.

Bilirubin

Bilirubin is a product of the breakdown of hemoglobin. Hemoglobin is released from old red blood cells and is gradually converted to bilirubin in the liver. - Bilirubin is a bile pigment not normally found in urine. - Bilirubin in the urine (bilirubinuria) can occur even before jaundice or other symptoms of liver disease are evident. - Excessive bilirubin colors the urine yellow-brown to greenish orange.

Biohazards and Infection Control

Biohazards, or biologic hazards, are materials or situations that present the possible risk of infection. Infection can be introduced into the body in many ways; a few examples include the following: • Breathing in a pathogen • Accidental inoculation by a needlestick or sharps injury • Aerosols created by uncapping specimen tubes • Centrifuge accidents • Entry of pathogens through a cut, abrasion, burn, or break in the skin

Sites can be used to take temperature readings: Age:

Birth-3 months: rectal or temporal artery 3 months-4 years: rectal, axillary, temporal artery; after the age of 6 months a tympanic thermometer may be used 4 years or older: oral, axillary, tympanic, temporal artery, rectal

Name the main functions of blood.

Blood contains RBCs to deliver oxygen to tissues through hemoglobin, WBCs to fight infections, and platelets to aid in coagulation and the formation of clots. The plasma carries needed nutrients to the cells throughout the body and removes waste products from the cells and carries them to the lungs and kidneys for elimination.

• Symptom event monitor (also called a post-event monitor)

Can be a handheld device or worn on the wrist. When symptoms are felt, the patient activates the monitor and places it on the chest. Small metal discs on the back of the monitor act as electrodes. The current ECG is recorded and stored. Unlike the looping memory monitor, the symptom event monitor cannot record and store the ECG prior to the symptoms.

Capillary Puncture

Capillaries are small blood vessels that connect small arterioles to small venules. A capillary puncture is an efficient means of collecting a blood specimen when only a small amount of blood is needed. Capillaries are connections between arteries and veins, so capillary blood is a mixture of the two. Small volumes of tissue fluid also are present in capillary blood, especially in the first drop.

Carbohydrates

Carbohydrate is a nutrient found in our diet. Carbohydrates are used for energy and to regulate protein and fat metabolism. This nutrient encompasses a broad range of simple sugars, starches, and fiber.

Care Coordination

Care coordination provides personalized patient- and family-centered care in a team-based environment. Advantages of care coordination include the following: • Greater efficiency with providing patient care • Reduced costs • Greater patient care • Individualized patient guidance and services • Encourages patients to focus on goals and self-management • Reduces hospital emergency department visits and readmissions • Ensures the patient's needs and preferences for healthcare services are met A patient navigator (also called a patient advocate) has been described as a type of care coordinator.

Naming Microorganisms

Carolus Linnaeus 1735, scientific naming Organisms assigned two names: Genus - capitalized and underlined & Species (specific epithet) - not capitalized but underlined May be descriptive or honor a scientist: - Escherichia coli: Honors the discoverer Theodor Escherich & describes the bacterium's habitat—the large intestine, or colon - Staphylococcus aureus, Describes the clustered (staphylo-) spherical (cocci) cells & describes the gold-colored (aureus) colonies The genus name of the organism may be represented by a single letter, after the organism's full genus and species names have been written once in a report. For example, Escherichia coli is commonly referred to as E. coli.

Differential Examination

Cells are examined with the oil immersion objective of the microscope. The differential involves counting and classifying 100 consecutive WBCs while moving in a winding pattern through the smear. A count of the cells observed is kept on a differential cell counter or a computer. Normal values for a differential vary with age. The differential exam typically is performed in a reference laboratory.

Cells

Cells determine the functional and structural characteristics of the entire body. Cells are microscopic in size. They have a variety of shapes and perform a vast array of functions. A cell is covered by a plasma membrane. The cell contains cytoplasm and organelles.

Cells

Cells found in the urine include epithelial cells, which come from the lining of the genitourinary tract. Red blood cells and white blood cells, which come from the bloodstream, also may be seen. Red blood cells may enter the urinary tract at any point of inflammation or injury. Red blood cells are smaller than white blood cells and have no nucleus. If they are in hypotonic (dilute) urine, they swell and burst. In hypertonic (concentrated) urine, they may be bumpy or wrinkle.

Environmental factors:

Certain diseases are more common when a person has been exposed to pollutants in the air, land, or water.

Age:

Certain diseases occur in childhood, whereas others occur more often in older adults. Some diseases occur due to changes in the body structures with age. Degenerative diseases occur in older generations due to the wear and tear on the structures.

Doctors of Chiropractic (DC)

Chiropractors (Doctor of Chiropractic [DC]) focus on the relationship between the spine and the function of the body. The goal is to correct alignment problems and thereby alleviate pain, improve function, and support the body's natural ability to heal itself. Chiropractic care is one of the most common fields of complementary and alternative medicine (CAM).

Numeric Color-Coding

Color coding is also used in numeric filing. Numbers 0 through 9 are each assigned a different color. In a terminal digit filing system, the colors for the last two numbers are affixed to the tab. If the number 1 is red and 5 is yellow, all files with numbers ending in 15 have a red and yellow band. Usually a predetermined section of the number is color coded.

The word parts are as follows:

Combining form: Word root with its respective combining vowel. Word root: Foundation of the medical term. Combining vowel: A letter sometimes used to join word parts. Usually an "o" but occasionally an "a," "e," "i," or "u." Suffix: Word part that appears at the end of a term. Suffixes are used to modify the meaning of the combining form. Prefix: Word part that sometimes appears at the beginning of a term. Prefixes also modify the meaning of the combining form. They usually are used to further define the absence, location, number, quantity, or state of the term.

Intermittent fever

Comes and goes, alternating between elevated and normal levels.

Therapeutic Techniques

Communication is an interactive process involving the sender of the message, the receiver, and feedback. Feedback is a crucial component to confirm that the message was received. The message can be sent by a number of methods: • Face-to-face communication • Telephone • Email • Letter

2. Light blue top

Contain sodium citrate, are next because other anticoagulants might contaminate the sample collected for coagulation studies. If no blood culture has been ordered, CLSI recommends that blood for the light blue-topped tube be drawn first if routine coagulation testing has been ordered. Examples of coagulation tests include prothrombin time (PT) and activated partial thromboplastin time (APTT).

Weight Conversion Formulas

Convert Kilograms to Pounds: 1 kg = 2.2 lb Multiply the number of kilograms by 2.2. Example: A patient weighs 68 kg: 68 × 2.2 = 149.6 lb Convert Pounds to Kilograms: 1 lb = 0.45 kg Multiply the number of pounds by 0.45 or divide the number of pounds by 2.2 kg. Example: A patient weighs 120 lb: 120 × 0.45 = 54 kg, or 120 ÷ 2.2 = 54.5 kg.

Health-Related Correspondence

Correspondence pertaining to patients' health should be filed in the patient's health record. Other medical correspondence should be filed in a subject file.

Courtesy and Respect

Courtesy, respect, and dignity often come together when discussing professionalism. Courtesy is having good manners or being polite. Courteous behavior is polite, open, and welcoming. Respect means to show consideration or appreciation for another person. Dignity is the state or quality of being worthy of respect.

Becoming a Critical Thinker: Making Mental Connections (2)

Critical thinking could be described as thorough thinking because it requires learners to keep an open mind to all possibilities. Successful students are thorough thinkers because they must determine the facts about a topic and come to logical conclusions about the material. Critical thinkers also are inquisitive learners; they constantly analyze and sort out conflicting information to reach conclusions.

Crystals

Crystals are common in urine specimens, particularly if the specimen has been allowed to cool. The presence of most crystals is not clinically significant unless the crystals are found in large numbers. Abnormal crystals may be present because of certain disease states or an inherited metabolic condition. They may also be iatrogenic, which means they are present because of medication or treatment. Crystals can be amorphous, or lacking a defined shape. Frequently crystals are difficult to identify without additional chemical testing.

Microbiology Culture and Sensitivity Testing

Culture refers to growing the organisms, and sensitivity refers to the organism's susceptibility to antibiotics. No matter what method is used, sensitivity testing is reported to the provider in one of three categories for each antibiotic tested: • S means that the pathogen is susceptible, or that the antibiotic is effective in destroying that particular organism. • R means that the pathogen is resistant, or that the antibiotic is not effective in destroying that particular organism. • I means intermediate, or that additional testing must be performed to determine the dosage of antibiotic necessary for successful treatment.

Intradermal Flu Vaccine

Currently, the intradermal flu vaccine is the only intradermal vaccine. Fluzone Intradermal contains less antigen than the IM flu vaccines and is approved for use for adults age 18 to 64 years of age. Fluzone Intradermal uses a nontraditional ID site. The vaccine is given in the IM deltoid area, though it goes in the epidermis and not in the muscle like IM injections. The vaccine comes in a prefilled microinjection syringe containing 0.1 mL of medication. The syringe contains a 30-G microneedle.

Bargaining

DESCRIPTION: Attempts to bargain with the higher power the person believes in (i.e., God). Sometimes the patient will bargain with the provider to make lifestyle changes at a later time. ADAPTIVE INTERACTIONS: Work with the healthcare team regarding the bargaining requests. Help provide opportunities where the patient can make decisions.

Depression

DESCRIPTION: People feel sadness, fear, and uncertainty. They may grieve the loss of their health or independence. They may dread the change that is occurring. ADAPTIVE INTERACTIONS: Encourage the use of community and healthcare resources to help ease the change process for the patient and family members.

Stages of Grief and Dying: Denial

DESCRIPTION: Refuses to accept the fact (i.e., diagnosis or prognosis). May refuse to discuss the diagnosis. May not remember the health coaching. Denial is a defense mechanism that allows the person to ignore what is happening. ADAPTIVE INTERACTIONS: Provide handouts that explain the disease and treatment. Encourage family member(s)' support with the treatment. Provide online and community resources (i.e., support groups).

Types of Medical Terms: Decodable Terms

Decodable terms are those that can be broken into their Greek and Latin word parts and given a working definition based on the meanings of those word parts. Most medical terms are decodable, so learning word parts is important.

Dietary Supplements

Dietary supplements are oral products that contain a "dietary ingredient." This ingredient can include a vitamin, mineral, amino acid, herb, or another substance that can supplement a person's diet. The function of dietary supplements is to provide nutrients that are not obtained in the foods we eat and drink.

Digital Thermometer

Digital thermometers are battery operated. Disposable covers fit snugly over the probes and are easily and quickly removed by pushing in the colored end of the probe. The instrument sounds a beep when the process is complete (in 10 to 60 seconds).

Closed-Ended Questions

Direct, or closed-ended, questions ask for specific information. This form of questioning limits the answer to one or two words - in many cases, yes or no. Use this form of question when you need confirmation of specific facts, such as when asking about past health problems.

Causes of Disease

Disease can result from a change in homeostasis or can be the result of the body's response to a perceived threat. There are several common causes of disease, including genetics, infectious pathogens, inflammatory processes, immunity, nutritional imbalance, trauma and environmental agents, and neoplasms.

Respect for Individual Diversity

Diversity describes the differences and similarities in identity, perspective, and points of view among people. When talking about diversity people usually think of things such as nationality or race, but diversity can also include things such as age and economic status.

How to document information in an EHR and a paper health record, and how to make corrections/alterations to health records.

Documenting information in an EHR involves using radio buttons, drop-down menus, and free-text boxes. When you are documenting in a paper health record, the entry will always start with the date in the MM/DD/YYYY format. All entries must be written in black or blue ink and follow the format designated by the healthcare facility. To create a handwritten correction to a health record, a line should be drawn through the error, the correction inserted above or immediately after, and the person making the correction should write his or her initials or signature and the date below the correction.

Needle Holders

Double-pointed needles must be firmly placed into a needle holder. The holders often have a ring that indicates how far the tube can be pushed onto the needle without losing the vacuum.

Filing Equipment

Drawer files Horizontal shelf files Rotary circular files Compactable files Automated files Card files

Adverse Reactions: Allergy

Drug allergy occurs when a person develops antibodies against a specific drug. When the drug is taken, the antibodies attack the antigens from the drug. Tissues are damaged during this process, and histamines are released. Histamines cause the allergic reactions.

Drug Action

Drugs are chemicals that can cause changes in the cells. There are four main drug actions: • Depressing: Slows down the cell's activity. This action slows the respiration rate. • Stimulating: Increases the cell's activity. For instance, caffeine increases brain activity. • Destroying: Kills cells or disrupts parts of cells. • Replacing substances: Substances required by the body can be given as medications.

Sources of Drugs

Drugs are either created from natural sources or made synthetically in a laboratory. Plants, animals, minerals, and microbiologic sources are natural sources of drugs.

Absorption

Drugs can be administered in many ways. Route is the means by which a drug enters the body. Where a drug enters the body is considered the site of administration. Absorption is the movement of drug from the site of administration to the bloodstream.

Nasal Route

Drugs given via the nasal route are breathed in through the nose. The medication is absorbed through the nasal mucous membrane. The medication can have local or systemic effects. Intranasal medications should be charted as "intranasal."

Inspection

During the inspection, the examiner uses observation to detect significant physical features or objective data. This method of examination ranges from focusing on the patient's general appearance (general state of health, including posture, mannerisms, and grooming) to more detailed observations, including body contour, gait, symmetry, visible injuries and deformities, tremors, rashes, and color changes. Inspection will be done before palpation or percussion so that there will be no changes made to the appearance of the skin.

Ovulation Testing

During the menstrual cycle, luteinizing hormone (LH) remains at a relatively stable level. Approximately 14 days before menstruation, the body experiences the "LH surge," a brief, rapid increase in LH. This surge triggers the release of an ovum (egg) from the ovary. Two to 3 days after the surge, the LH level returns to the base level. Conception is most likely to occur within 36 hours after the LH surge. The principle behind this test is similar to that of the pregnancy test. A positive test result indicates a urine LH level of 20 mIU/mL or higher. Testing usually is performed for 5 consecutive days in the middle of a woman's cycle. Once the surge is detected, ovulation can be expected within 2 to 3 days.

Characteristics of an individual's respirations

Dyspnea occurs in patients with pneumonia, asthma, or chronic obstructive pulmonary disease (COPD). Other alterations in breathing are bradypnea, apnea, tachypnea, and hyperpnea. Hyperpnea usually is accompanied by hyperventilation and often occurs when the patient is extremely anxious or in pain. Orthopnea frequently occurs in patients with congestive heart failure (CHF) or COPD. Wheezing signals difficulty breathing in patients with asthma.

Electronic Health Record (EHR) versus Electronic Medical Record (EMR)

ELECTRONIC HEALTH RECORD (EHR) • Electronic record of health-related information about a patient • Conforms to nationally recognized interoperability standards • Can be created, managed, and consulted by authorized clinicians and staff from more than one healthcare organization ELECTRONIC MEDICAL RECORD (EMR) • An electronic record of health-related information about an individual • An electronic version of a paper record • Can be created, gathered, managed, and consulted by authorized clinicians and staff within a single healthcare organization

Filing Supplies: Divider Guides

Each file drawer or shelf should be equipped with plenty of dividers or guides. Some authorities recommend one guide for approximately each inch of material, or every eight to 10 folders. Guides should be of good-quality heavy cardstock or strong plastic. Divider guides have a protruding tab, which may be an integral part of the card or may be made of metal or plastic. They are available in single, third, or fifth cut (i.e., one, three, or five different positions).

Gauge and Length

Each needle has two measurements: the gauge (G) and the length. The lumen size is indicated by the gauge and is given a numeric value. The higher the gauge number, the smaller the lumen. The thickness of the needle wall increases along with the lumen size. This means that an 18 G needle makes a larger hole than a 25 G needle. The 18 G needle has a thicker wall than the 25 G needle. As the gauge number increases, the needles bend more easily. Thicker-walled needles (smaller gauge numbers) are used for deeper injections. Thinner-walled needles (larger gauge numbers) are used for more superficial injections.

Genetics

Each person is made up of 46 chromosomes, which carry genetic information (genes). We get 23 chromosomes from each of our parents. Genes are the basic units of heredity, or the instructions on how our bodies should develop and function. A genetic disease may result from a chromosomal error or from the patient inheriting a defective gene from either parent.

Electrodes

Electrodes are single-use disposable adhesive tabs that are placed on the skin. The skin is a poor conductor of electricity. The electrodes contain an electrolyte gel that helps pick up the electrical impulses.

Automated Files

Electronic equipment that brings records automatically to the operator; used in hospitals, clinics, and large practices.

Collection of Pinworms

Enterobius vermicularis is commonly known as pinworm. This species of parasite primarily infects the colon of young children. Humans are infected by ingesting mature eggs through the following: • Hand-to-mouth transfers • Feces-contaminated fingers • Feces-contaminated foods or liquids • By inhaling eggs in air currents from infected areas

Quality Control Examples

Examples of routine quality control testing in a POL include the following: • Positive and negative controls supplied with pregnancy test kits are performed with each patient specimen or batch of patient specimens • Urinalysis dipstick controls (used for chemical examination of urine) should be checked daily before patient testing and each time a new reagent container is opened • Controls for automated chemistry analyses should be performed before patient testing and at specified intervals during the day, depending on the number of tests run per day and the manufacturer's recommendations

Fiber

Fiber is different from simple sugars and starches. It cannot be digested by the body and thus it does not raise the blood glucose level. Fiber helps a person feel full and can help with weight management. There are two types of fiber: soluble fiber and insoluble fiber.

Anaphylaxis

Extreme hypersensitivity to a specific drug (antigen) can cause life-threatening symptoms, including swelling of the mouth and airway, difficulty breathing, wheezing, loss of consciousness, and death.

The importance of nonverbal communication with patients when an EHR system is used.

Eye contact is critical when an EHR system is used with patients. Body language must indicate that the medical assistant is open to and listening to the patient's concerns, not just concentrating on data entry. Providers and medical assistants alike may have to relearn how to interact with patients in a natural way while using the laptop or tablet in the examination room.

Fat

Fat is an important nutrient in our diet. Fats provide 9 calories per gram, whereas carbohydrates and proteins provide only 4 calories per gram.

Remittent fever

Fluctuates considerably (i.e., by more than 3 degrees) and never returns to the normal range.

Auscultation

For auscultation, the provider uses a stethoscope to listen to sounds from the body. Auscultation is a complex method of examination because the provider must distinguish between a normal sound and an abnormal sound. It is particularly useful for evaluating sounds originating in the lungs, heart, and abdomen, such as a murmur, a bruit, and bowel sounds.

Microbiology Reference Laboratory: Identification of Pathogens (Staining)

Pathogenic microorganisms generally are colorless, and a microscope is needed to see them. Special stains (e.g., Gram stain and acid-fast stain) are used to differentiate bacteria based on cell membrane properties.

Hematology in the Physician Office Laboratory (POL)

For many POL hematology tests, an adequate blood sample can be obtained from a capillary puncture of the finger. - If a larger sample is required, blood can be obtained via venipuncture. - For a complete blood count (CBC), venous blood is collected in a lavender-topped tube containing ethylenediaminetetraacetic acid (EDTA), an anticoagulant that prevents whole blood from clotting. - EDTA is the anticoagulant of choice for hematology testing because it also acts as a preservative for the blood cells.

Abdomen

For the abdominal part of the examination, the patient is lowered to the dorsal recumbent or supine position, and the drape is lowered to the pubic hairline. The provider auscultates the abdomen in all quadrants to confirm the presence of complete bowel sounds and palpates the abdomen for any abnormalities. The provider also may use percussion to determine the density, position, and size of underlying abdominal organs.

Immunohematology

Formerly called the blood bank, the immunohematology department of the laboratory is responsible for blood typing. The major reason for performing immunohematology tests is to prevent problems caused by incompatible blood types during blood transfusions. Identifying potential Rh incompatibility problems in expectant mothers is another procedure done in immunohematology. Rh incompatibility between an expectant mother and the unborn child may result in hemolytic disease of the newborn (HDN).

Apply the concepts of medical and surgical asepsis to the healthcare setting.

Medical asepsis is the removal or destruction of pathogens. Medical aseptic techniques are used to reduce the number of microorganisms as much as possible. Surgical asepsis is destruction of all microorganisms. Surgical asepsis is used when the patient's skin or mucous membranes are disrupted.

Additional Supplies

Gauze, cotton balls, cotton-tipped applicators, disposable tissues, specimen containers, fecal occult blood test cards, Pap test supplies for female patients, lubricating jelly for vaginal and rectal examinations, and laboratory request forms should be easily accessible during the examination.

Legal and Ethical Issues

Medical assistants are responsible for understanding and following the scope of practice in their communities and for always meeting the expected standards of care.

Gloves

Gloves protect the healthcare worker and the patient from microorganisms. According to Standard Precautions, gloves must be worn whenever the potential exists for contact with any body fluid, broken skin or wounds, or contaminated items.

Glucose

Glucose is filtered out of the blood in the glomerulus, and, under normal conditions, most glucose is reabsorbed in the tubules of the nephron. Detectable glycosuria (glucose in the urine) occurs when the filtered glucose in the renal tubules is so high it cannot be reabsorbed into the blood. A positive urine glucose may be the first indication that a patient is diabetic. The glucose pad on a reagent strip test is based on a specific enzyme reaction in which glucose, and no other sugar, causes a positive reaction.

HIPAA uses

HIPAA uses the term protected health information (PHI), which is any information about health status, the provision of healthcare, or payment for healthcare that can be linked to an individual patient. HIPAA requires that all PHI be safeguarded. This applies to: • EHRs • EMRs • PHRs • Patient portals

HIV Testing

HIV attacks and destroys the T-helper (CD4) lymphocytes. The T-helper lymphocytes play a critical role in protecting the body against infection. Note that HIV is a bloodborne pathogen. The test kit includes a testing device that is rubbed once over the upper and lower gums. It then is inserted into the test vial, which is placed in a plastic stand. The test results are read in 20 minutes. The test includes an internal control band that verifies a specimen was added and that the test was run correctly.

Incubator

Incubators are cabinets that maintain constant temperatures. Microbiology departments usually maintain a constant temperature of 35° to 37°C (95° to 98.6°F), although other temperatures may also be appropriate.

Abdominal site:

Have the patient remove the clothing in that area. Provide a drape sheet if needed to protect the patient's modesty. The site is located below the costal margins to the iliac crests. Stay 2 inches away from the umbilicus. It is important to stay away from the waistline and any scars. The patient may have more discomfort if the injection is given at the waistline due to the rubbing of clothing.

State several reasons that accurate health records are important.

Health records must be accurate primarily so that the correct care can be given to the patient. The record also helps ensure continuity of care between providers so that no lapse in treatment occurs. The record serves as indication and proof in court that certain treatments and procedures were performed on the patient; therefore, it can be excellent legal support if it is well maintained and accurate. Health records also aid researchers with statistical information.

Allied Health Professionals

Healthcare professionals who support the work of physicians and perform specific services ordered by the physician. Allied health professionals include nurses, technologists, technicians, therapists, and others. The allied health professions fall into two broad categories: technicians (assistants) and therapists. Technicians are trained to perform procedures, and their education lasts 2 years or less. They are required to work under the supervision of medical providers or licensed therapists.

Hemoglobin

Hemoglobin (Hgb) determination is another way to measure the oxygen-carrying capacity of blood. The hemoglobin concentration can be part of the CBC or an individual test. CLIA-waived methods include the STAT-Site M Hgb, HemoPointH2, and HemoCue, all portable, battery-operated hemoglobin analyzers that fit in the palm of the hand. The HemoCue uses plastic microcuvettes that contain reagents that lyse (break apart) the RBCs in the sample, releasing the hemoglobin. Capillary, venous, or arterial blood can be used in the disposable microcuvette. The cuvettes have a long shelf life.

H & H

Hemoglobin and hematocrit Hemoglobin and hematocrit tests are often performed together and are referred to as an H&H. A quick mental calculation should always be done before H&H results are reported: the hemoglobin value × 3 (± 3) should equal the hematocrit value. For example, if the hemoglobin is 15 g/dL, calculate the hematocrit as: (15 g/dL x 3 = 45 +_ 3 =42 - 48) The hematocrit should be between 42% and 48%.

Moderate- and High-Complexity Tests and Laboratories: High-complexity

High-complexity tests are generally not performed in a POL, but rather in a hospital or reference laboratory. Laboratories that perform moderate- to high-complexity testing must meet rigorous CLIA regulations and are subject to surprise inspections every 2 years. Medical assistants can perform all CLIA-waived tests and some specific moderate-complexity tests. Although medical assistants cannot perform high-complexity tests, they can be involved in patient preparation, provider-directed patient education, specimen collection, and documenting results in the patient's health record.

The History of Medicine

Hippocrates, known as the Father of Medicine, is the most famous of the ancient Greek physicians. He was born in 450 BC on the island of Cos in Greece. He is best remembered for the Hippocratic Oath, which has been administered to physicians for more than 2000 years.

Hospitalists

Hospitalists are physicians whose primary professional focus is the general medical care of hospitalized patients. Hospitalists work a specific, set number of hours each week and receive a set salary from their employers.

Why is it improper to make a diagnosis of hypertension using only one blood pressure reading?

Hypertension should be diagnosed after several blood pressure readings show a continued prolonged elevation of blood pressure or the blood pressure has steadily increased to the hypertension level over the past readings.

Hypodermic Syringes

Hypodermic syringes attach to needles and hold the medication for the injection. They come in many sizes (e.g., 1, 3, 5, 6, 10, and 12 mL), but usually the facility only stocks three or four sizes. Syringes can have either a Luer-Lok tip or a slip tip. Calibration marks are on the barrel of the syringe.

Infectious Mononucleosis Testing

Infectious mononucleosis, commonly called mono, is an acute infectious disease caused by the Epstein-Barr virus (EBV). EBV is one of the many herpes viruses. The viral infection is especially common in teenagers. It is found most frequently in people 10 to 25 years of age and is seen occasionally in adults over the age of 25.

Dictation and Transcription

If dictation is still done in the healthcare facility, the administrative medical assistant may find that transcribing the dictation is a job she or he will sometimes perform. Transcription can be done from handwritten notes or, more likely, from machine dictation. Dictation may be done using a machine transcription unit or a portable transcription unit.

Liquid Medication Dose With Matching Labels

If the unit label of ordered medication is the same as the stock medication, then the units are considered to match.

Sites can be used to take temperature readings: State of consciousness,

If unconscious - oral not an option Thermometers available in the facility: May only have one or two types of thermometers available Healthcare facility procedures: Based on patient's condition or provider's preference

The Medical Assistant's Role

If you are interviewing the patient to obtain history information, do it where the patient's answers cannot be heard by others. If privacy is not possible, the patient should be given a form to fill out. The information can be transferred to the permanent record later. When privacy is available, the medical assistant may ask the patient questions and document the answers directly into the health record. This allows you to become better acquainted with the patient while completing the necessary records.

CLIA-Waived Immunologic Testing

Immunology testing provides information about past or present infections with bacteria or viruses. It also detects certain types of cancers. - The amount of antibody can be measured with a specific test called a titer. The definition of a titer is the lowest concentration of a specific antibody that is still able to neutralize (or precipitate) an antigen. - Most serologic/immunologic testing performed in the ambulatory care center is done using individual test kits (e.g., rapid strep, influenza, infectious mononucleosis [mono], and HIV tests).

Implantable Device Rhythms.

Implantable devices (e.g., pacemaker and implantable cardioverter-defibrillator) create abnormal waveforms on the ECG tracing. A pacemaker is used to treat some types of arrhythmias. It uses low-energy electrical pulses to assist the heart to beat at a normal rate. Pacemakers can change the ECG tracing.

Government Legislation Affecting Clinical Laboratory Testing

In 1988, Congress passed the Clinical Laboratory Improvement Amendments (CLIA). This law established quality standards for all clinical laboratory testing, and it is designed to ensure the accuracy, precision, reliability, and timeliness of patient test results, regardless of which laboratory performed the testing. A clinical laboratory is defined as any facility that performs laboratory testing on human specimens to provide information about the diagnosis, prevention, and treatment of disease or the impairment of health.

Other Blood Types

In addition to the A and B antigens that characterize the ABO blood grouping, more than 600 antigens and more than 20 other blood antigen systems are known. Many are named after the person or family in which the blood antigen system was discovered. They may cause incompatibility issues in rare cases.

Routine Capillary Puncture Site Selection

In adults and children (older than 1 year), capillary puncture sites include the ring or middle finger. Dermal puncture of an infant should be done on the heel of the foot. For children younger than 2 years of age, dermal puncture is performed on the medial or lateral areas of the plantar surface (bottom) of the heel or on the palmar surface of the ring or middle finger. Blood flow from an infant's heel can be increased by applying a warm, moist towel (or other warming device) at a temperature no higher than 108°F (42°C) for 3 to 5 minutes. Never place bandages on the heel or anywhere on infants younger than age 2, because they may peel off and become a choking hazard.

Measurement Systems

In healthcare, both the household and metric systems are used. The provider will use a child's weight in kilograms (kg) to calculate a medication dosage. The oral syringe and plastic medicine cup are more accurate for measuring medications than the spoons used in the kitchen.

Retention and Destruction of Health Records

In most medical offices, records are classified in three ways: • Active: Records of patients currently receiving treatment • Inactive: Records of patients whom the provider has not seen for 6 months or longer • Closed: Records of patients who have died, moved away, or otherwise terminated their relationship with the provider

Referral management

In the case of a referral or consultation, sharing information with another provider can be done electronically. The patient does not have to obtain copies of the record and then bring them to the new provider. This also eliminates the cost of making copies and is faster and more efficient than copying and mailing patients' records.

• Interactions:

Includes medications, foods, and beverages that interact with the medication. These products may either increase or reduce the medication level in the blood. They may also increase the risk of adverse reactions if taken together with the drug.

• Dosage considerations:

Indicates recommended changes in dosages for special populations (e.g., patients with hepatic impairment, renal impairment).

• Lot number:

Indicates the batch of drug the medication came from. The lot number is important to document when giving immunizations. Some agencies may require that lot numbers are documented for all medications administered.

• Expiration date

Indicates when the drug can no longer be used.

Understanding the Results of Microscopic Examination (5)

Miscellaneous elements seen in urine are counted, averaged, and estimated. Reports will be estimated as occasional - not seen in every field; few - covers less than one-fourth of the field; moderate - covers approximately one-half of the field; and many - covers the entire field.

Inoculating Equipment

Inoculating needles and loops are used to transfer samples to culture media or microbes to slides for staining. Needles and loops may be disposable and presterilized. A urine culture uses a loop that delivers a 1-mcL sample. The urine in the loop is spread across the culture medium and allowed to grow overnight. The next day, each bacterium becomes a visible colony, which is a discrete group of organisms. Colonies can then be counted and analyzed to determine the cause of a urinary tract infection.

U-100 insulin syringe.

Insulin is measured in units. The calibration markings are similar to the 60-mL syringe. The numbers labeled are in increments of 5 (5, 10, 15, etc.). Each line is equal to 1 unit. Syringes with this type of calibration can only measure whole number amounts (5, 9, 11, etc.). This type of syringe may be used in ambulatory care for U-100 insulin administration.

Intradermal Injections

Intradermal (ID) injections are given just under the epidermis. Because the drug is dispersed in an area where many nerves are present, it causes momentary burning or stinging. Small amounts of medication are injected.

Intramuscular Injections

Intramuscular injections involve placing medication into the muscle. There are more blood vessels in the muscles; thus, absorption is faster than in the subcutaneous layer. For medications given by IM injection, aqueous (watery) medications should be given with a higher gauge needle than that used for oil-based medications. Note that the needle is inserted at a 90-degree angle, which deposits the medication into the large central part of the muscle. • Several vaccines; for example, hepatitis A and B; tetanus-diphtheria (Td), or with pertussis (Tdap); influenza; and meningococcal • Antibiotics and medroxyprogesterone (Depo-Provera)

Monitoring Intravenous Therapy

Intravenous therapy is performed by nurses in ambulatory care facilities. IVs can be used to deliver medication and fluids. Common concerns with IV therapy include the following: • Edema (swelling) or increasing pain at the IV insertion site • Blood moving up the IV tubing • An almost-empty bag of fluids • A patient who is having difficulty breathing or who has increased audible wheezing

Irrigation Route

Irrigation means to bathe or flush open wounds or body cavities. Irrigation can be used to remove foreign bodies or debris. Irrigation of the external auditory canal will do the following: • Remove excessive or impacted cerumen • Remove a foreign body (contraindicated if the item will absorb fluid [e.g., bean, pea, or corn kernel]) • Treat the inflamed ear with an antiseptic solution

Red Blood Cell Count

It approximates the number of circulating RBCs in a person's blood. The function of an RBC is to transport oxygen to tissues. The RBC count often is decreased in patients with anemia. Increased RBC counts are found in people with dehydration, polycythemia, severe burns, and those living at high altitudes. Normal RBC values range from approximately 4 million to 6 million cells/mm3. RBC counts usually are higher in males than in females.

• Dilated eye exam

It is important to have a dilated eye exam if a person has a risk of eye disease (e.g., glaucoma). The CDC recommends dilated eye exams for the following individuals: • Patients with diabetes (recommended annually) • African American patients age 40 years or older (recommended every 2 years) • Patients older than 60 years of age (recommended every 2 years) • Patients with a family history of glaucoma (recommended every 2 years)

Inventory Records.

It is important to keep an ongoing log of controlled substances received from manufacturers and administered to patients. When a patient needs a controlled substance, the medical assistant must complete the log.

According to the Immunization Action Coalition:

It is safe to give subcut and IM vaccines into a tattoo. However, it is not a good idea to inject into a newly tattooed area. If you must inject into a tattooed area, attempt to use a lighter pigmented area. All injections pose the risk of a reaction or an infection at the injection site. Dark pigments may mask a reaction or an infection.

Ketones

Ketones are the end product of fat metabolism in the body. Ketonuria (ketones in the urine) is commonly seen in patients with diabetes mellitus that is not well controlled; in persons on a very-low-carbohydrate diet; or after excessive vomiting. Examples of ketones include acetoacetate and acetone.

Right Route

Know the correct route of administration by which the drug should be given. The route should be checked, along with the name and form, three times before the medication is given.

Korotkoff Sounds

Korotkoff sounds are the sounds heard during auscultation of blood pressure. Vibrations of the arterial wall produce these sounds when the blood surges back into the vessel after it has been compressed by the blood pressure cuff. The sounds were first discovered and classified into five distinct phases by Russian neurologist Nikolai Korotkoff.

Reference Ranges for Complete Blood Count (CBC) Values

Lab reports, both electronic and paper, must supply their own reference ranges, along with each patient's results. This is because different methodologies may create different reference ranges and different units of measurement. fL, Femtoliter; MCH, mean corpuscular hemoglobin; MCHC, mean corpuscular hemoglobin concentration; MCV, mean corpuscular volume; pg, picograms; RBC, red blood cell; WBC, white blood cell.

Departments of the Clinical Laboratory

Large laboratories are divided into various departments, which may include urinalysis, hematology, chemistry, microbiology, specimen collection and processing, blood bank (immunohematology), coagulation, immunology/serology, histology, cytology, toxicology, and special chemistry. A POL generally performs test procedures in urinalysis, hematology, chemistry, and microbiology.

Stage 3 learners have an abstract active style

Learners with this combination learning style want to experiment and test the information they are learning.

Leukocyte Esterase

Leukocytes (white blood cells) are present in urine when a person has a UTI. The leukocyte esterase test pad on the reagent strip takes 2 minutes to release esterase from white blood cells. Wait a full 2 minutes before reading the leukocyte esterase result. A false-positive result could be caused by WBC contaminants from the vagina, especially if the sample is allowed to sit at room temperature.

Cholesterol Testing

Lipids are evaluated using capillary blood, finger stick. fasting required. Cholesterol is a fatlike substance (lipid) present in cell membranes. - lipoproteins = Cholesterol travels in the blood as distinct particles containing both lipid and proteins. - A high blood level of low-density lipoprotein (LDL) cholesterol is often referred to as "bad" cholesterol. Lower levels of LDL cholesterol reflect a lower risk of heart disease. - high-density lipoprotein (HDL) known as the good cholesterol. LDL results are often interpreted as follows: LDL >100 mg/dL = Optimal LDL 100-129 = Near or above optimal LDL 130-159 = Borderline high LDL 160-189 = High LDL 190+ = Very high

Liquid Medication Forms

Liquid medications have various uses. They can be swallowed, rubbed on the skin, or instilled in the nose, eyes, or ears. Liquid medications are easily taken by children, older adults, and those with swallowing problems. With liquid medications, the active medication is mixed with water, alcohol, or both.

Liquid volume

Liquid volume is measured in liters, distance is measured in meters, and mass is measured in Grams. Prefixes commonly used in the clinical laboratory include deci- (0.1), centi- (0.01), milli- (0.001), micro- (0.000001), and kilo- (1000).

Atrioventricular (AV) node

Located at the base of the interatrial septum. This slowdown allows the atrial chambers to finish contracting, moving the blood into the ventricular chambers.

Right and left bundle branches

Located in the lower interventricular septum. After the impulse passes through the bundle of His, it enters the right and left bundle branches. The right bundle branch brings the impulse to the right ventricle. The left bundle branch brings the impulse to the left ventricle.

Bundle of His (or AV bundle)

Located in the upper interventricular septum. When the impulse leaves the AV node, it moves to the bundle of His.

Right Technique

MAs must know the correct techniques for administering every medication

• Mean cell hemoglobin (MCH):

MCH = (Hgb/RBC) × 10. The MCH is calculated to give the average weight of hemoglobin in the RBC. The reference range is 26 to 34 picograms (pg).

• Mean cell ratio of Hgb and Hct (MCHC):

MCHC = (Hgb × 100)/RBC. The MCHC indicates the average weight of hemoglobin compared with the cell size. The reference range is 32 to 37 g/dL. A decreased MCHC shows hypochromic (pale, lacking color) RBCs in a stained blood smear. An increased MCHC is rare and should be flagged and brought to the attention of the provider.

The indices are mathematical calculations using the three red blood cell tests: • Mean cell volume (MCV):

MCV = (Hct/RBC) × 10. The average size of the RBCs is the most important index for classifying anemias. Abnormally large RBCs are macrocytic and have a higher than normal MCV. Small RBCs are microcytic and have a lower than normal MCV. The normal reference range is 82 to 108 femtoliters (fL).

Health records in two different formats, electronic and paper.

Most healthcare facilities have switched to electronic health records (EHRs). Some of the benefits of EHRs include: • Easy storage of patient information • Availability to multiple users at the same time • More efficient claim submission process

Responsibilities of the Medical Assistant (2)

Medical assistants are the only allied health professionals specifically trained to work in ambulatory care settings, such as physicians' offices, clinics, and group practices. That training includes both clinical and administrative skills, covering a multitude of medical practice needs. The skills performed by an entry-level medical assistant depend on his or her place of employment

Responsibilities of the Medical Assistant (1)

Medical assistants are trained in a variety of clinical and administrative skills that are valuable in ambulatory care settings. From taking accurate vitals to answering the phone and scheduling appointments, medical assistants have many responsibilities.

Achieving a Credential

Medical assistants have several options if they choose to become credentialed. Being a credentialed medical assistant has certain benefits: • Credentialed medical assistants have had to pass a national standardized exam. Passing the exam indicates that they have the knowledge to perform the medical assistant's duties. • Some employers require the credential prior to hiring or within a few months after hiring. • Some employers will pay more if a person has achieved a medical assistant credential.

Doctor of Medicine (MD)

Medical doctors (Doctor of Medicine [MD]) are considered allopathic physicians. - They are the most widely recognized type of physician. - They diagnose illness and disease and prescribe treatment for their patients. - MDs have a wide variety of rights, including writing prescriptions, performing surgery, offering wellness advice, and performing preventive medicine procedures.

Introduction to the Clinical Laboratory: Personnel in the Clinical Laboratory

Medical laboratories are in hospitals, ambulatory care facilities, public health departments, health maintenance organizations, and referral laboratories. The clinical laboratory is staffed with a variety of professionals, including: • A director, who may be a pathologist or a clinical laboratory scientist with a doctorate degree • Certified medical technologists (MTs) and certified medical laboratory technicians (MLTs) • Medical laboratory assistants (MLAs), medical assistants (CMAs, RMAs), and phlebotomists

Medical Professionals and Allied Health Professionals

Medical professionals like MDs, DOs, DCs, hospitalists, nurse practitioners, and physician assistants are all providers of healthcare. Each one has specific expertise and abilities which are obtained by their respective educational requirements. Licensing in the state in which they practice is essential and they are qualified to assess, diagnose, and treat patients.

• Stat order:

Medication is administered one time right now.

• Routine order:

Medication taken at a regular interval until it is canceled or expired. (Most non-narcotic routine orders expire in 12 months.)

• PRN order:

Medication that is given on an "as needed" basis for specific signs and symptoms. (It is important to indicate these symptoms when documenting the administered medication in the patient's health record.)

Oxygen Needs for Different Bacteria

Mycobacterium tuberculosis, which causes tuberculosis, thrives in white blood cells in the lungs; it is an aerobe. Bacteroides fragilis is a common Gram-negative bacillus found in the intestines; it is an anaerobe. E. coli, also an inhabitant of the intestines and the most common cause of urinary tract infections, can live in the presence of oxygen but prefers to live in the absence of oxygen; it is a facultative anaerobe.

Mensuration

Mensuration is the process of measuring. Measurements that are recorded include the following: • Height and weight • Size and depth of a wound • Extent of flexion or extension of an extremity • Size of the uterus during pregnancy • Pressure of a grip • Length and diameter of an extremity

Metabolic Syndrome

Metabolic syndrome occurs when a patient has at least three of the five following conditions: • Abdominal obesity • Elevated blood pressure • Elevated fasting plasma glucose • High serum triglycerides • Low high-density lipoprotein (LDL) levels Metabolic syndrome is associated with an increased risk of developing cardiovascular disease and type 2 diabetes.

Nutrition and Health Promotion: Metabolism

Metabolism is the process the body uses to obtain or make energy from the food eaten. Metabolism has two phases: • Catabolism: The process of breaking down molecules into smaller molecules, resulting in energy being released • Anabolism: The process of smaller molecules being used to build larger molecules with the use of energy

Evaluating an ECG Tracing: Rate

Methods used to calculate a regular heart rate when the paper speed (chart speed) is 25 mm/second include: • Six second method: Count the number of P waves in a 6-second strip (30 large boxes) and multiply by 10 (least accurate method). • 1500 method: Count the number of small boxes between two R waves or the two P waves. Divide the number into 1500. • Sequence method: Count the number of large boxes between the R waves.

Microbiology

Microbiology involves the study of very small, infectious organisms such as bacteria, fungi, yeasts, parasites, and viruses. Specimens used in microbiology include blood, urine, sputum, cerebrospinal fluid (CSF), stool, wound material, and other biologic sources. Specimens used for microbiology testing must be collected aseptically in sterile containers. The goal of the microbiology department is to identify the microorganism that is causing the infection. Microbiology specimens may be grown on culture media. Once the organism is growing and in pure culture, it can be identified. • Rapid strep testing may be performed to screen for strep throat • Microbiologic specimens may be aseptically collected and then sent to a reference laboratory • Some microscope slides may be prepared for the provider to examine

Classification of Microorganisms

Microorganisms are too small to be seen without magnification. Bacteria, fungi, and protozoa are all microorganisms that can be seen with a microscope. Parasitic worm infections are also identified in the microbiology laboratory because their eggs are visible under the microscope. Viruses are the smallest microbe and are visible only with a highly magnified electron microscope.

Understanding the Results of Microscopic Examination (4)

Microscopic examination of epithelial cells is similar. Epithelial cells are counted, totaled, and averaged. Then they are reported as occasional, few, moderate, or many per high-power field (e.g., 1-3 occasional, 4-6 few, 7-12 moderate, >12 many).

Sites can be used to take temperature readings: Condition

Mouth breathing - oral is not an option Ear infection or occlusion - tympanic is not an option Diarrhea - rectal is not an option Open wound or rash on forehead - temporal artery is not an option

Rectal Route

Movement of a drug from outside of the body to the inside of the body through the rectum

Pathogenic Fungi

Mycology is the study of fungi and the diseases they cause. Fungi are eukaryotes that are larger than bacteria and have a nucleus. Fungi include yeasts and molds. Fungi are present in the soil, air, and water, but only a few species cause disease. hey are transmitted by: • Direct contact with infected persons • Prolonged exposure to a moist environment • Inhalation of contaminated dust or soil

TNM staging of cancer (2)

N: Refers to the number of nearby lymph nodes impacted by the malignant cells • NX: Nearby lymph node cancer cannot be measured • N0: No cancer in the nearby lymph nodes • N1, N2, and N4: Refers to the location and quantity of nearby lymph nodes that have cancer; the higher the number, the more nodes are impacted

Tickler or Follow-Up Files

Name comes from its intent to tickle the memory that something needs to be done or followed up. The tickler file is always a chronological arrangement.

• Second-degree heart block

The impulse slows or is blocked as it moves into the ventricles. When blocked, there is no QRS complex after the P wave, and the ventricles do not contract. When the impulse slows, the PR segment is longer. This arrhythmia requires a pacemaker to help maintain the heart rate.

Two-Step Testing

New residents in long-term care facilities (e.g., nursing homes) usually have a two-step TST done. Healthcare students and professionals also need to have a two-step TST. Once the two-step TST has been completed, they need yearly TSTs. If the time since the last TST exceeds 1 year, they may need to complete another two-step TST.

Roman Numerals

Numeric symbols formed with the Roman letters I, V, X, L, C, D, and M.

Color of Urine

Normal urine is a shade of yellow that ranges from pale straw to yellow to amber. The color depends on the concentration of the pigment urochrome, a yellow pigment normally found in urine, and the amount of water in the specimen.

Foam in urine

Not normally recorded Presence of small bubbles that stay after specimen has been shaken. - White foam can indicate the presence of increased protein - Greenish-yellow foam may indicate bilirubin in the urine. Care should be taken in handling such urine specimens because the greenish-yellow color may indicate that the patient has viral hepatitis, which is highly contagious.

Noun-Ending Suffixes

Noun endings are used most often to describe anatomic terms. Noun endings such as -icle, -ole, and -ule describe a small or tiny structure.

The History of Medical Assisting

Nurses were likely to have training only in clinical skills; therefore, many physicians began training individuals - medical assistants - to assist with all the office duties. The first medical assistants started working in individual physicians' offices with on-the-job training to help out when an extra pair of hands was needed.

Objective Information

Objective findings, sometimes referred to as signs, are findings that can be observed and measured. They can include vital signs, measurements, observations made by the medical assistant, and findings from the provider's examination of the patient.

• Premature ventricular contractions (PVCs)

Occur when the ventricles contract sooner than they should. An impulse originating in the ventricles creates this abnormality. The QRS complex appears before a P wave. The P wave can also be absent. The T wave can be abnormally shaped, and a widened QRS complex can be seen. PVCs can be caused by tobacco, alcohol, epinephrine, and anxiety. They can also be caused by hypertension, coronary artery disease, and lung disease. Infrequent PVCs can be normal. More than six PVCs in a minute is abnormal and can lead to a life-threatening condition.

• Atrial flutter

Occurs when the atria contract faster than the ventricles (up to 300 beats per minute). They become out of sync with the ventricles. Extra P waves are seen with regular QRS complexes. Atrial flutter can be caused by alcohol and stimulants (cocaine, caffeine, diet pills, and cold medications). It can also be caused by coronary heart disease, hypertension, cardiomyopathy, heart valve diseases, hyperthyroidism, obstructive pulmonary disease, and pulmonary embolism diseases. Atrial flutter is reversed with medication to slow the heart or with cardioversion (electrical shock).

• Ventricular tachycardia (V-tach)

Occurs when the ventricles beat at a rapid rate (up to 250 beats per minute). It may be seen with multiple PVCs in a row. It may be a short run of fast beats or may last longer than 30 seconds. V-tach is a life-threatening condition. If it is not reversed with drugs and/or cardioversion, it can become ventricular fibrillation.

• Ventricular fibrillation (V-fib)

Occurs when the ventricles quiver uncontrollably. They are essentially ineffective at pumping any blood. The patient has no pulse, is not breathing, and is unresponsive. This is the most critical, life-threatening arrhythmia. Cardioversion with a defibrillator is necessary to restore normal function of the electrical conduction system.

Omega-3 Fatty Acids

Omega-3 fatty acids are a group of polyunsaturated fatty acids found in fish (e.g., salmon, herring, halibut, and mackerel) and some nuts and seeds. These fatty acids play a role in reducing blood cholesterol, heart disease risk, inflammation, and depression. Omega-3 fatty acids also increase the effectiveness of anti-inflammatory and antidepressant drugs.

Platelet Analysis

On a stained smear, the platelets are observed for any abnormalities. Platelets are small and irregularly shaped and may vary considerably in size. The normal platelet count is 150,000 to 450,000/mm3. An increase in platelets is called thrombocytosis, and a decrease is called thrombocytopenia. Excessive clumping of platelets is also reported in a platelet analysis.

Counting Respirations

One inspiration + one expiration= one respiration adult: 12-20 per min children: 15-30 newborns: 30-60

Routes Impact the Dose

Oral medications are absorbed in the stomach or in the intestines. The blood containing the absorbed digestive nutrients and drugs passes through the hepatic portal vein and the liver before it circulates to the rest of the body.

• Standing order:

Order applies to all patients who meet specific criteria. For departments, usually all providers agree collectively on standing orders and sign the order.

• Mammogram

This x-ray of the breasts helps to identify breast cancer. The American Cancer Society recommends women ages 40 to 44 have the option to have annual mammograms. Women ages 45 to 54 should have annual mammograms, and those age 55 years or older should have mammograms every 2 years.

Doctors of Osteopathy (DO)

Osteopathic physicians (Doctor of Osteopathy [DO]) complete requirements similar to those of MDs to graduate and practice medicine. Osteopaths use medicine and surgery, in addition to osteopathic manipulative therapy (OMT), in treating their patients. DOs stress preventive medicine and holistic patient care, in addition to a special focus on the musculoskeletal system and OMT.

Compliance With the Controlled Substance Act

Providers prescribing controlled substances need a DEA registration number. The DEA number is good for 3 years. The medical assistant may need to assist the provider in renewing or obtaining a DEA number. Controlled substances have a paper trail. This record starts with the manufacturer and ends when the medication is dispensed or administered.

• Administration:

Provides information on how the medication should be administered. Includes important administration techniques, such as information on shaking the medication, if it needs to be taken with food, and so on.

Palpation

Palpation may involve touching the skin or performing a firmer exploration of the abdomen for underlying masses. Palpation is performed with one hand, both hands (bimanual), one finger (digital), the fingertips, or the palmar aspect of the hand. A pelvic examination is done bimanually, whereas an anal examination is performed digitally. Do not confuse palpation with palpitation, which is a throbbing pulsation felt in the chest. With this technique, the provider is assessing the following: • Temperature • Vibration • Consistency • Form • Size • Rigidity • Elasticity • Moisture • Texture • Position • Contour

Characteristics of pathogenic microorganisms.

Pathogenic microorganisms include viruses, bacteria, protozoa, fungi, and helminths. Viruses, the smallest of all pathogens, lead the list of important disease-causing agents. Viral particles insert their own deoxyribonucleic acid (DNA) or ribonucleic acid (RNA) into a host cell and then use the host cell to help reproduce more viral particles. Bacteria are tiny, simple cells that produce disease by secreting toxins, act as parasites inside human cells, or grow on body surfaces, disrupting normal human functions. Bacteria are classified according to their shape. Protozoa are unicellular parasites that can replicate and multiply rapidly once inside the host. They are frequently carried by insects that serve as vectors for the disease. Fungi may be unicellular or multicellular; they include molds and yeasts and cause tinea infections. Helminths are multicellular and include tapeworms, roundworms, and flatworms (flukes).

Specialty software

Patient data are captured and processed into a system that is specialty-specific. The terminology and patient care treatments are compatible with the provider's specialty. However, additional features can allow the provider to include terminology from other specialties.

Supine (Horizontal Recumbent) Position

Patient lies flat with face upward and lower legs supported by the table extension. This position is used for examination of the front of the body, including the heart, breasts, and abdominal organs.

Patient-Centered Care

Patient-centered care involves taking care of the whole patient, not just the physical problems. As a professional medical assistant, you can be instrumental in helping the patient with coordination and integration of care, providing information and education as directed by the provider, involving the family with the patient's care, and above all, respecting the patient's preferences.

Regular Screenings: • Blood pressure

Patients at higher risk include African Americans, those who are overweight, and those with previously higher than normal blood pressure readings.

• Lung cancer screening

Patients who are 55 to 80 years old, have a history of heavy smoking, and are currently smoking or quit in the previous 15 years should be screened for lung cancer. (Heavy smoking means smoking one pack of cigarettes a day for 30 years or two packs for 15 years.)

• Pharmacokinetics:

Provides information on the absorption, distribution, metabolism, and excretion of the medication. Information on when the drug is at its highest level in the body or when the drug starts working may be included.

Medical Professionals

Physicians and providers (e.g., nurse practitioners and physician assistants) are portals of entry or first contacts for patients seeking medical care. Primary care providers (PCPs) are healthcare practitioners who monitor a patient's overall health. Family medicine, internal medicine, and pediatrics are generally considered primary care specialties.

Calibration or optics checks

Personnel are required to perform calibration or optics checks on laboratory instruments that use light detection or color change as part of the reaction process. An optics check is a specific type of calibration that assesses the optics of an electronic testing instrument or system. They must run quality control or control materials each day before patient testing.

Pharmacogenomics.

Pharmacogenomics or pharmacogenetics is the study of how genetic factors influence a person's metabolic response to a specific medication. Pharmacogenomics testing usually requires a small blood or saliva sample. Pharmacogenomics is largely used in cancer treatments, but it is becoming more common in other areas of medicine.

Supplies and Instruments Needed for the Physical Examination

Physical examinations typically are performed from the head to the feet; the instruments are listed in the order in which the provider typically would request them.

Physical Hazards

Physical hazards in the laboratory can be classified as electrical, fire, and mechanical hazards. For electrical hazards, do the following: • Use surge protectors. • Inspect all cords and plugs frequently. • Never use extension cords. • Do not overload circuits.

The Three Stages of Quality Assurance in the Laboratory

Preanalytic stage Analytic Stage Postanalytic stage

Anterior aspect of the thigh:

Place one hand above the knee and the other hand below the greater trochanter. The site is the middle one-third of the thigh. The site extends from the front midline to the back midline, wrapping around the outer thigh. Usually only the middle one-third—from the front midline to the outer thigh—is used. Injections are not done on the back of the leg, because sitting would irritate the injection site.

Natural Sources of Drugs

Plants are the oldest source of drugs. Our ancestors found that different plants helped with different symptoms. Leaves, bark, stems, roots, and fruits have been used in medicinal preparations through the years.

Prefixes

Prefixes modify a medical term by indicating a structure's or a condition's • Absence • Location • Number or quantity • State

Patient Preparation

Preparation for a capillary puncture is similar to that for a venipuncture. Put on a fluid-impermeable lab coat, wash your hands or use hand sanitizer, and put on gloves and protective eyewear.

Guidelines for Parenteral Medications

Prepare and store medications in a separate area, away from the exam rooms. Medications can be prepared without the use of gloves. Ensure that all needles are tightly covered and placed on a tray when carrying them to the exam room. Never transport medication in your pockets. Bring only one patient's medication at a time to avoid confusion and error. • Never give an injection near bones or blood vessels. • Avoid scar tissue, a change in skin pigmentation or texture, or abnormal growth (e.g., mole or wart). • Avoid abrasions, lesions, wounds, bruises, and edematous areas. • Select a site that is large enough to hold the amount of medication injected. • Avoid sites recently used (within the last month).

Types of Healthcare Facilities (Hospitals) 2

Private hospitals are run by a corporation or other organization and usually are designed to produce a profit for the owners or stockholders. Nonprofit hospitals exist to serve the community in which they are located and are normally run by a board of directors. 20The term nonprofit sometimes is misleading, because "profit" is different from "making money." A hospital system is a group of facilities that are affiliated and work toward a common goal. Accreditation is considered the highest form of recognition for the quality of care a facility or an organization provides.

Pediatric Phlebotomy

Procedures performed on infants and children and which require specialized training and management. Often done by skin puncture, pediatric phlebotomies also entail matching the procedure with the specimen requirements for testing, the patient's age and emotional condition, and possible parental involvement.

Prodrugs

Prodrugs are medications that are administered in an inactive form. sulfasalazine (Azulfidine) is an anti-inflammatory drug that is used to treat ulcerative colitis.

Professional Organizations for Medical Assistants

Professional organizations provide many benefits to their members, including opportunities for continuing education, national and regional conventions, and networking opportunities. Medical assisting is no different.

The Meaning of Professionalism

Professionalism is defined as having a courteous, conscientious, and respectful approach to all interactions and situations in the workplace. Patients expect professional behavior and base much of their trust and confidence in those who show this type of demeanor in the healthcare facility. The professional medical assistant is an asset to the healthcare facility.

Characteristics of Bacteria

Prokaryotic Single-celled Absorb nutrients/photosynthesis Asexual reproduction

Handling and Transporting a Specimen

Proper handling of specimens is essential. The chemical and cellular components of urine change if the urine warms to room temperature. Urine specimens should therefore be kept refrigerated and should be processed within 1 hour of collection. Chemical reagent strip testing can be performed on preserved specimens within 72 hours.

Protein in the urine

Protein in the urine in detectable amounts is called proteinuria and is one of the first signs of renal disease. We normally excrete a very small amount of protein every day that is undetectable. Some causes of proteinuria may include the following: • Orthostatic proteinuria: protein is excreted only when the patient is in an upright position. • Pregnancy: a common finding in pregnancy and must be monitored along with excessive weight gain and increased blood pressure (three possible symptoms of preeclampsia). • After heavy exercise

Protein

Protein is a nutrient in our diet. Proteins are broken down into amino acids. Amino acids can be used as a source of energy in the absence of carbohydrates. Amino acids are also used to make proteins to help the body do the following: • Break down food (e.g., enzymes) • Grow and repair body tissues (e.g., connective tissue, hair, nails, muscles) • Perform other functions (e.g., those related to hemoglobin, antibodies, and hormones) Protein and amino acids are considered the building blocks of life.

Nurse Practitioners (NP)

Provide basic patient care services, including diagnosing and prescribing medications for common illnesses. These professionals must have advanced academic training beyond the registered nurse (RN) degree and also vast clinical experience. An NP is licensed by individual states and can practice independently or as part of a team of healthcare professionals.

Understanding the Results of Microscopic Examination (2)

Red and white blood cells, epithelial cells, yeasts, bacteria, and crystals are identified using the high-power objective and increased light. From 10 to 15 high-power fields should be scanned and the number counted, averaged, and reported.

3. Red top or gold top

Red serum tubes without clot activator, or gold serum tubes with clot activator, are filled next. These tubes are drawn to test serum after the specimens have clotted and been centrifuged. SSTs with thixotropic gel are also drawn at this time. SST tubes have a marbled red-gray stopper or a gold Hemogard stopper.

Characteristics of Respirations: Rhythm

Refers to the breathing pattern, the space between each breath. A regular breathing pattern is normal in adults; however, the breathing pattern for infants varies. Automatic interruptions, such as sighing, are also considered normal. The terms regular or irregular are used to document rhythm.

Antibiotic Resistance

Resistance evolving rapidly in many species of prokaryotes due to overuse of antibiotics, especially in agriculture. The mutation can occur in the following situations: • An antibiotic is prescribed when it is not needed (e.g., for a viral infection). • The antibiotic is prescribed inaccurately (e.g., lower dosage, fewer days than recommended). • The antibiotic is not taken as prescribed.

Respiratory Syncytial Virus Testing

Respiratory syncytial virus (RSV) is a major cause of upper and lower respiratory tract infections. It is the major cause of bronchiolitis and pneumonia in children and infants. Outbreaks typically occur yearly in the fall, winter, and spring and can be severe for very young children.

Continuous fever

Rises and falls only slightly during a 24-hour period. The temperature consistently remains above the patient's average normal temperature range and fluctuates less than 3 degrees.

Rotary Circular Files

Rotary circular files can hold a large volume of records. They save space and clerical motion. The files revolve easily; some have push-button controls. Several people can work at one rotary file and use records at the same time. One disadvantage is that they afford less privacy and protection than files that can be closed and locked.

Safety Needles

Safety needles are designed to reduce the risk of needlesticks after an injection. A passive safety needle is designed so that the needle is automatically covered after the injection. Passive safety needles are currently used with insulin pens (e.g., the BD Auto Shield Duo pen needle). An active safety needle requires the healthcare professional to activate the safety device.

Scope of Practice and Standards of Care for Medical Assistants (1)

Scope of practice is defined as the range of responsibilities and practice guidelines that determine the boundaries within which a healthcare worker practices. One fact is absolutely true about all practicing medical assistants - they are not independent practitioners. Standards of care set minimum guidelines for job performance and define the expected quality of care. A medical assistant may be charged with professional negligence if they are not following the standards of care.

Specialty Syringe Units

Specialty syringe units are designed so that patients can administer their own medication. The dose of insulin required can be set by the dial. The patient needs to change the needle with each dose. Insulin pens cannot be shared between patients.

Since June 2015, OSHA has required all SDSs to use a uniform format that includes the following section numbers, headings, and information:

Section 1. Identification Section 2. Hazard(s) identification Section 3. Composition/information on ingredients Section 4. First-aid measures Section 5. Fire-fighting measures Section 6. Accidental release measures Section 7. Handling and storage Section 8. Exposure controls/personal protection Section 9. Physical and chemical properties Section 10. Stability and reactivity Section 11. Toxicologic information Section 12. Ecologic information Section 13. Disposal considerations Section 14. Transport information Section 15. Regulatory information Section 16. Other information

• Dosage:

Specifies the route, dose, and timing of the medication; usually corresponds to an indication (disease or condition). May provide information on doses for different age ranges. Maximum dosage indicates the greatest amount of medication a person should have within a 24-hour period.

Speech

Speech may reveal a pathologic condition. Speech is also assessed in well-child checkups. A delay in speech development can indicate an issue (e.g., a neurologic deficit or possible autism spectrum disorder) and the need for a referral.

Horizontal Shelf Files

Shelf files should have doors that lock to protect the contents. A popular type of shelf file has doors that slide back into the cabinet; the door from a lower shelf may be pulled out and used for workspace. Open shelf filing is an efficient method, especially for color-coding filing systems. The shelf doors often can be used as workspace.

Single- and Multiple-Channel ECG Machines

Single-channel: - the machine contains one amplifier channel and one recording stylet. - The single-channel machines record one lead (picture) at a time. - When these machines are used, the process of recording a tracing takes up to 3 to 5 minutes. - Single-channel machines can use paper rolls or Z-fold paper. - small strips of paper need to be mounted. Multichannel: - Multichannel machines monitor all 12 leads. - has several stylets that allow for four groups of three leads to be traced every few seconds. - With some machines, a fourth stylet traces one lead for the entire width of the page. - print the tracing on 8.25 × 11-inch paper or Z-fold paper.

Heart's Conduction System (composed of five structures)

Sinoatrial (SA) node Atrioventricular (AV) node Bundle of His (or AV bundle) Right and left bundle branches Purkinje fibers

Topical Route

Skin (including transdermal patches) Eyes Ears Nose Lungs (inhalation) Rectum Vagina

Lifestyle:

Stress, poor diet, infrequent exercise, or abusing nicotine, alcohol, or drugs can increase the risk for disease.

Voice Recognition Software

Software that allows you to control your computing devices by speaking into the microphone instead of using a keyboard or mouse. The system can be used to dictate the following: • Progress notes • Letters • Emails • Any document in the healthcare facility that needs to be created The provider will need to approve these documents before they are permanently attached to the patient's record.

Somatic Tremor

Somatic tremor artifact appears as jagged peaks with irregular heights and spacing. The causes include: • Involuntary movement: Tremors from disease conditions (e.g., Parkinson's disease), shivering due to coldness • Voluntary movement: Talking, chewing gum, supporting arms or legs because table is too small for the person

Organization of Files

Some types of records common to the healthcare setting, other than patient records, are health-related correspondence, general correspondence, practice management files, miscellaneous files, and tickler or follow-up files.

5 Spelling Rules decodable medical terms 5

Sometimes when two or more combining forms are used to make a medical term, special notice must be paid to the order in which the combining forms are joined. For example, joining esophag/o (which means esophagus), gastr/o (which means stomach), and duoden/o (which means duodenum, the first part of the small intestines) with the suffix -scopy (process of viewing), produces the term esophagogastroduodenoscopy. An esophagogastroduodenoscopy (EGD) is a visual examination of the esophagus, stomach, and duodenum. In this procedure, the examination takes place in a specific sequence (that is, esophagus first, stomach second, and then the duodenum).

Squamous epithelial cells

Squamous epithelial cells line the lower portion of the genitourinary tract. When present in large numbers in female patients, they usually indicate vaginal contamination. Squamous epithelial cells are large, flat, and irregular. They have a single, small, round, centrally located nucleus and often occur in sheets or clumps.

Types of Healthcare Facilities (Hospitals) 3

Standards or indicators have been developed that help determine when patients are receiving high-quality care. The term "quality" refers to much more than whether the patient liked the food served or had to wait to have a procedure or test performed. Categories of compliance include: • Assessment and care of patients • Use of medication • Plant, technology, and safety management • Orientation, education, and training of staff • Medical staff qualifications • Patients' rights Categories of compliance include: • Assessment and care of patients • Use of medication • Plant, technology, and safety management • Orientation, education, and training of staff • Medical staff qualifications • Patients' rights

Starches

Starches are called complex carbohydrates. Complex carbohydrates are digested in the intestine before being absorbed. • Nutrient-rich starches: Legumes (e.g., split peas, beans [kidney, black, garbanzo, and pinto]), starchy vegetables (e.g., corn, green peas, and potatoes), and whole grains (e.g., oats, barley, quinoa seeds, and brown rice) • Non-nutrient-rich starches: White bread, crackers, and white rice

Four major steps in reconstituting powdered medication and withdrawing a dose of the medication

Step 1: Remove air from the powdered medication vial and put air into the diluent vial. Step 2: Withdraw liquid from the diluent vial and add it to the powdered medication vial. Step 3: Mix the liquid with the powdered medication. Step 4: Add in air and withdraw the dose needed.

Subcutaneous Injections

Subcutaneous (subcut) injections involve placing medication into the subcutaneous layer, under the dermis. The subcutaneous layer has fewer blood vessels than the muscles do. The medication absorbs slower in the subcutaneous layer compared with medications injected into the muscles. The patient may complain of discomfort or pain with a subcutaneous injection. Subcutaneous tissue contains pain receptors.

Subject Filing

Subject filing can be either alphabetic or alphanumeric (e.g., A 1-3, B 1-1, B 1-2, and so on) and is used for general correspondence. The main difficulty with subject filing is indexing, or classifying; that is, deciding where to file a document.

Signs and Symptoms

Subjective findings, or symptoms, are perceptible only to the patient; they are what the patient feels and can be interpreted only by the patient. Symptoms of the greatest significance in identifying a disease are called cardinal symptoms. Objective findings, or signs , can be observed or measured by the provider or medical assistant.

Differentiate between subjective and objective information in creating a patient's health record.

Subjective information is provided by the patient, whereas objective information is provided by the provider. Examples of subjective information include the patient's address, Social Security number, 53insurance information, and description of what he or she is experiencing. Objective information is obtained through the provider's questions and observations made during the examination.

Sublingual and Buccal Routes

Sublingual (SL) medications are placed under the tongue. Buccal medications are placed between the cheek and the gums. Both mucous membrane areas are rich in blood vessels. • Do not eat or smoke prior to taking SL and buccal medications. • Do not chew or swallow SL or buccal medications. • Water can be taken prior to the medication to wet the mouth. No liquids can be taken until the medication has dissolved. • Alternate cheeks used for buccal medication to avoid mucosal irritation.

Connective tissue:

Supports and binds other body tissues. Connective tissue is the most frequently occurring tissue in the body.

Assessing a Culture

Suspicious colonies are subcultured onto the appropriate medium to isolate them in pure culture. The definition of pure culture is growth of only one type of microorganism in or on a culture medium. Throat and urine cultures may be performed in POLs that have been CLIA certified to perform moderately complex testing.

Working With the Needle and Syringe

Syringes come packaged in different ways: • A syringe can be packaged by itself. A needle must be added to the syringe when giving an injection. • A syringe may be packaged with a needle. The unit must be assembled. • A syringe and needle unit may come preassembled. Always tighten the needle on the syringe before using the unit.

Blood Pressure

Systole (heart contraction) and diastole (heart relaxation) together make up the cardiac cycle. The difference between systolic and diastolic pressures is the pulse pressure.

Palpatory Method

Systolic blood pressure measured by the sense of touch. It provides an estimate of the systolic pressure to ensure an adequate inflation of the cuff during the actual B/P measurement

TNM staging of cancer (1)

T: Refers to the size and extent of the primary tumor • TX: Primary tumor cannot be measured • T0: Primary tumor cannot be found • T1, T2, T3, and T4: Refer to the size and extent of the primary tumor; the higher the number, the larger or more extensive the tumor

Tact and Diplomacy

Tact and diplomacy are extremely valuable traits in healthcare professionals. * Being tactful means being acutely sensitive to what is proper and appropriate when interacting with others. A tactful person has the ability to speak or act without offending others. * Being diplomatic means using tact and sensitivity when interacting with others. The medical assistant must be sensitive to the needs of others.

Mixing Insulins

Taking insulin requires about four injections a day. Some patients may need two different insulins at the same time. It is better for the rapid-acting or short-acting insulin (Regular insulin) to be mixed in the intermediate-acting insulin vial (e.g., NPH insulin). This means that Regular insulin must be drawn up in the syringe first and then NPH is added. Cloudy insulins (e.g., NPH) are suspensions and need to be mixed before drawing up the insulin. Mix cloudy insulins by gently rolling the vial between 371your hands. Clear insulin (e.g., Regular insulin) does not need to be mixed or rolled in your hand.

Why would temperatures taken by oral, rectal, and axillary methods not have a common value of 98.6º F?

Temperature readings are based on blood supply to the area and the air flow throughout. Rectal temperatures are higher because of the vascularization of the rectum and the closed area. The mouth also has vascular regions under the tongue, but air exchange is made in the mouth. The axilla does not have a high level of blood vessels, and the air flows from anterior and posterior sides of the underarms. Aural temperatures are measured by the tympanic membrane, which has approximately the same heat as the mouth.

Measuring Liquid Volume

Test tubes are used to test or hold liquid reagents, samples, or aliquots, the most common piece of glassware used is the pipet. A pipet is a hollow tube that can be made from glass or plastic. Pipets often have lines to indicate volume on the length of the tube. Some plastic pipets have a built-in bulb to help transfer fluids and are known as transfer pipets. Micropipets are used to deliver very small volumes of liquid.

The Healthcare Team

Teamwork is a vital part of the medical profession. All staff members must work together to care for the patient and perform required duties in the healthcare facility. Knowing which employee to call when help is needed promotes goodwill among employees and often gets a task done more efficiently. A professional medical assistant should perform the duty and later discuss with the supervisor any valid reasons that the task should have been assigned to someone else.

American Association of Medical Assistants (AAMA)

The American Association of Medical Assistants (AAMA) was created in 1956 and remains the only association devoted exclusively to the medical assisting profession.

• Colorectal cancer screening

The American Cancer Society recommends that regular screening start at age 45. Screening can either be stool based or visual exams.

• Dental exam

The American Dental Association recommends a dental exam and cleaning yearly. Dental health can affect the overall health of the body.

Moderate- and High-Complexity Tests and Laboratories: Moderate-complexity

The CLIA program oversees the quality of nearly 200,000 different laboratory procedures. Most laboratory tests are categorized by the FDA as moderate-complexity tests. Some moderate-complexity tests performed in POLs include the following: • Hematology and chemistry: testing done on an automated analyzer • Microbiology: Gram stain procedures • Urinalysis: microscopic analysis of urine sediment Moderate-complexity tests must be performed by qualified personnel as described by CLIA.

Additional CLIA-Waived Urine Tests Clinitest

The Clinitest is based on the chemical reduction of copper. It is used to detect reducing substances (sugars) in the urine. Copper reduction tests are based on the principle that reducing substances can chemically convert one form of copper into another form of copper. The chemical reaction produces a color change. The Clinitest uses a reagent tablet that is dropped directly into a test tube containing diluted urine. Clinitest Reaction Note: If the color change reaches the orange maximum color during the reaction and then ends in a lower color range, the test result is reported as "greater than" the highest positive result.

Portable Handheld ECG Monitors

The ECG data can then be transferred to other devices using software, Bluetooth, smart phones, or USB ports. A person can use the device and save ECG tracings. Finger contact, chest contact (bare skin just below the nipple), and regular chest electrodes can be used to create an ECG tracing.

Two types of TTMs: • TTM with internal memory

The ECG is recorded and stored when the patient pushes a button. The data can be transmitted by phone to the provider. This type of TTM is used for patients with infrequent arrhythmias.

Analyzing an ECG Tracing

The ECG rhythm strip (lead II view) is evaluated from left to right. The following should be assessed: • Rate: What is the rate? • Rhythm: Is it regular or irregular? An irregular rhythm on an ECG tracing will have time differences between cardiac cycles. With a regular rhythm, each cardiac cycle occurs the same length of time apart. • Appearance of the segments, waves, and intervals:

Distinguish between an electronic health record (EHR) and an electronic medical record (EMR).

The EHR is an electronic record of health-related information about an individual that conforms to nationally recognized interoperability standards and that can be created, managed, and consulted by authorized clinicians and staff from more than one healthcare organization. The EMR is an electronic record of health-related information about an individual that can be created, gathered, managed, and consulted by authorized clinicians and staff within one healthcare organization.

Prescription writer

The EHR system can produce electronic prescriptions, which can be printed and given to patients or automatically submitted to a pharmacy. Lists can be created with the provider's most common drug choices and dosages. An allergy function can be linked to the patient's list of allergies and alert the provider of an issue. The system can also generate a patient information sheet on new prescriptions.

Backup systems for the EHR, in addition to the transfer, destruction, and retention of health records as related to the EHR.

The EHR systems can be set to automatically back up the information at specified times during the day. This means that a minimum amount of data would be lost if the power went out. The process of moving a file from active to inactive is called purging. Providers have an obligation to retain patient records. The records of any patient covered by Medicare or Medicaid must be kept at least 10 years.

EpiPen

The EpiPen and other epinephrine pens are automatic injector systems. The pens are dosed for adults or children. People at risk for anaphylactic reactions (e.g., from food allergens, bee stings) should carry epinephrine pens to prevent a fatal reaction. Simulators can accompany some of the injector systems.

Tuberculin Blood Tests

The FDA has approved two tuberculin blood tests: the QuantiFERON-TB Gold In-Tube test (QFT-GIT) and the T-SPOT TB test (T-Spot). A healthcare professional or student only needs one blood test initially, unlike the two-step skin test. After the initial test, a yearly skin or tuberculin blood tests is required. • Positive: The person has been infected with TB. The provider will order additional tests to determine if the person has a latent TB infection or TB disease. • Negative: It is unlikely the person has TB.

Food, Drug, and Cosmetic Act

The Food, Drug, and Cosmetic Act of 1938 is enforced by the Food and Drug Administration (FDA). The FDA is a federal agency in the Department of Health and Human Services (HHS). The FDA is responsible for the safety, effectiveness, security, and quality of drugs, cosmetics, and food.

Controlled Substance Prescriptions

The NPI is a national number that is unique to the provider. This number is found on prescriptions and may be used for tracking or treatment identification purposes. The medical assistant needs to be aware of the special requirements for controlled substances. It is important for the medical assistant to stay updated on which frequently prescribed medications are controlled substances.

According to the AHRQ, the PCMH has five core functions and attributes: 5. Quality and safety:

The PCMH is committed to delivering quality healthcare by providing evidence-based medicine and shared decision making with patients and families; assessing practice performance and working on improvements; collecting safety data; and measuring and responding to patients' experiences and satisfaction.

According to the AHRQ, the PCMH has five core functions and attributes: 4. Accessible services:

The PCMH is designed to deliver accessible care. This is achieved by establishing policies that create shorter wait times for urgent needs, expanded office hours, around-the-clock telephone or electronic access to a member of the care team, and alternative methods of communication, such as email and telephone care.

According to the AHRQ, the PCMH has five core functions and attributes: 2. Patient-centered care:

The PCMH provides primary healthcare that is holistic and relationship based, always considering the 22individual patient and all facets of his or her life. However, establishing a partnership with patients and their families requires understanding and respect of each patient's unique needs, culture, values, and preferences. Medical assistants are trained to provide respectful patient care regardless of individual patient factors. The goal of the PCMH is to encourage and support patients in learning how to manage and organize their own care. Patients and families are recognized as core members of the care team.

Sims Position

The Sims position is sometimes called the left lateral position. This position is used for rectal examinations, for instillation of rectal medication, and for some perineal and pelvic examinations.

Trendelenburg Position

The Trendelenburg position is rarely used in the ambulatory care setting, but it may be needed if a patient has severe hypotension. This position can be achieved only if the examination table separates so that the legs can be elevated higher than the head

Vaccine Information Statement (VIS)

The Vaccine Information Statement was created by the Centers for Disease Control and Prevention (CDC). A VIS provides information to the patient or to the guardian/parent on the benefits and risks of the vaccine. The National Childhood Vaccine Injury Act requires that all patients (or parents/guardians) get the appropriate VIS prior to every dose of vaccine administered, regardless of the age of the patient.

Administration Techniques: The following sections address these three goals. (Z-Track Technique)

The Z-track technique is another injection method that can reduce pain and discomfort for the patient. Like the air lock technique, this method prevents the medication from tracking back through the subcutaneous tissue. The medication is sealed in the muscle, thus minimizing discomfort for the patient. The Z-track technique should be used for irritating medications. For the Z-track technique, the skin is pulled laterally with the medical assistant's nondominant hand.

Appointment scheduler

The appointment scheduler allows the staff to: • Track and schedule appointments • Create the schedule matrix 37• Account for recurring time blocks The scheduler features also allow various search parameters; if a patient calls because he or she cannot remember the appointment time, a search can be initiated using: • Date • Provider's name • Patient's name • Keywords

Analysis of Blood: Introduction

The average body holds 10 to 12 pints of blood. The heart circulates the blood through the circulatory system more than 1000 times every day. More than 70,000 miles of passageways, most of which are narrower than a human hair, carry blood throughout the body. The circulating blood contains more than 25 trillion cells, and every second the body replaces 8 million old red blood cells (RBCs) with 8 million new RBCs.

Family History.

The family history includes: • The physical condition of the various members of the patient's family • Any illnesses or diseases individual members may have had • Causes of death This information is important because certain diseases may have a hereditary pattern. Most providers are interested in the immediate family: parents, grandparents, siblings, and children.

Bipolar (or Standard) Leads

The bipolar (standard) leads are named leads I, II, and III. They use the arm electrodes and the left leg electrode to create pictures of the vertical (or frontal) plane of the heart. (Remember, the right electrode is used as a ground and is important for all leads.) • Lead I: Right arm (RA) to left arm (LA) • Lead II: Right arm (RA) to left leg (LL) • Lead III: Left leg (LL) to left arm (LA) If you join the end points (positive poles) of these three leads, you get a triangle. This triangle is known as Einthoven's triangle.

Body Cavities

The body contains cavities, or hollowed areas, that are filled with organs. The body is separated into the dorsal (posterior) and ventral (anterior) body cavities. The dorsal body cavity protects nervous system organs. It contains the cranial cavity and the spinal cavity. The ventral body cavity is divided into the thoracic and abdominopelvic cavities. The diaphragm creates a physical separation between the thoracic and the abdominopelvic cavities.

Breasts and Testicles

The breasts are examined both by inspection and by palpation with the patient in the supine position.

Purkinje fibers

The bundle branches split into many Purkinje fibers. The Purkinje fibers transmit the impulse quickly and efficiently to the ventricular cardiac cells. This helps the ventricular chambers to contract.

A 60-mL syringe.

The calibration markings are different with this type of syringe. Unlike prior syringes, the numbers labeled are in increments of 5 (5, 10, 15, etc.). Each line is equal to 1 mL. Syringes with this type of calibration can only measure whole number amounts (5, 9, 11, etc.). This type of syringe may be used in ambulatory care for irrigation.

A 10-mL syringe.

The calibration markings on this syringe are the same as on most 5-, 6-, 10- and 12-mL syringes. There are 5 lines for 1 mL, which means each line is equal to 0.2mL. Syringes with this type of calibration can only measure medication ordered in even numbers (i.e. 1.2 mL, 2 mL, 3.6 mL).

Apply the chain of infection process to the healthcare practice.

The chain of infection is the way infectious disease is spread. It begins with the infectious agent and moves to the host, the means or portal of exit from the host, the mode of transmission, and the means or portal of entry into a new host. It ends with the presence of the infection in a susceptible host. At least one of these links must be broken to stop the spread of infection.

Chain of Infection

The chain of infection starts with the infectious agent. There are five types of potentially pathogenic agents or microorganisms: viruses, bacteria, fungi, protozoa, and helminths. Infection cannot occur without the presence of an infectious microorganism.

Charge capture

The charge capture functions can store lists of billing codes, such as: • International Classification of Diseases (ICD) • Current Procedural Terminology (CPT) • Charges for procedures, supplies, and laboratory tests

Chest (or Precordial) Leads

The chest (precordial) leads are also unipolar leads. Each is a positive pole. The precordial leads provide information on the horizontal (front to back) plane of the heart. The six precordial leads are labeled V1, V2, V3, V4, V5, and V6. The six leads are numbered the same as the precordial lead wires (i.e., V1 through V6). If one of the leads is unclear, the medical assistant should refer to the related lead wire and electrode. For instance, with artifact on V4, the medical assistant will check the V4 electrode and lead wire.

Chest

The chest is examined for symmetric expansion. A tape measure may be used, especially if variation exists between the upper and lower chest expansion. A patient with a history of emphysema may have a barrel-shaped chest. The provider may use percussion to determine the density of lung tissues.

Chemistry

The clinical chemistry department analyzes the chemicals found in blood, cerebrospinal fluid, urine, and joint fluid (synovial fluid). Specimen testing may be done manually or with complex chemistry instruments. Procedures may include single analyte tests (of blood glucose) or multitest profiles. Chemistry profiles include tests for a number of related analytes. Lipid profiles, include assessments of total cholesterol, triglycerides, and low-density lipoprotein (LDL) and high-density lipoprotein (HDL).

Skin

The condition of the skin can be a reflection of the patient's nutritional status and hydration level. If dehydration is suspected, skin turgor is checked by pinching the skin on the posterior surface of the hands. Extreme dryness, scaling, extended time for wound healing, or frequent breaks in the skin may indicate systemic disease. Clubbing of the fingertips is associated with some congenital heart or lung diseases.

Phenylketonuria (PKU)

a rare hereditary condition in which the amino acid phenylalanine is not properly metabolized or broken down in the body. PKU that is undiagnosed or untreated can lead to severe cognitive disabilities. Accumulation of phenylalanine in the blood and urine gives body fluids the odor of wet fur.

• Third-degree heart block

The impulse does not reach the ventricles. As a backup system, special ventricular cells create an impulse that causes the ventricles to contract. On the ECG tracing, the P wave is faster than normal and the QRS complex is not coordinated with the P wave. This is a life-threatening arrhythmia and requires emergency treatment and a pacemaker.

Intramuscular Sites: Deltoid Site

The deltoid is a triangular-shaped muscle located near the shoulder and upper arm. This muscle site is used to give a small volume of aqueous medications, such as vitamin B12 and vaccines. The CDC recommends this site be used when vaccines are given to teens and adults.

Health Information Exchanges

The demand for electronic health information exchange (HIE) between one healthcare facility and another, together with nationwide efforts to improve the efficiency and quality of healthcare, is creating a demand for HIEs.

Angle of Needle Entry

The depth and position of the vein may require angle adjustment, but a 15-degree angle is a good place to start.

Characteristics of Respirations: Depth

The depth of respiration is the amount of air inhaled and exhaled. When a patient is at rest, normal respirations have a consistent depth, which can be noted as you watch the rise and fall of the chest. Rapid, shallow breathing at rest occurs with some diseases, such as asthma and emphysema. An alteration in the depth and sometimes the rate of breathing is also seen in Cheyne-Stokes respirations. The terms normal, deep, shallow, and gasping should be used to document depth.

Psychomotor Domain

The domain involved in the learning of a new procedure or skill; often called the doing domain.

Dorsogluteal Site

The dorsogluteal site was a common intramuscular (IM) site for irritating medications. However, the dorsogluteal site is near the sciatic nerve and large blood vessels. Current evidence has demonstrated that dorsogluteal sites pose a high risk for injury. The current recommendation is that the dorsogluteal site should not be used. The ventrogluteal site is ideal for the medications that were always given in the dorsogluteal site.

• Generic name

The drug name used by all manufacturers who make that specific medication. The name is printed in lowercase letters and usually appears under the brand name in smaller print. If the patent and exclusivity have expired, only a generic name may be present on the label.

Ears

The ears are examined with an otoscope covered with a disposable speculum. The external ear is checked first for inflammation of the external auditory canal or for cerumen (earwax). The tympanic membrane (eardrum) is examined and should appear pearly gra

Capabilities of Electronic Health Record Systems

The electronic health record (EHR) can perform numerous tasks, in addition to displaying personal information about the patient. This allows the provider and medical assistants to interact with patients and provide better service.

Microscopic Examination of Urine

The examination of urine is not categorized as CLIA-waived; therefore it cannot be performed by a medical assistant without additional training, additional supervision, and rigid compliance with CLIA quality assurance protocols for the laboratory. The three main categories of microscopic findings are casts, cells, and crystals.

Metabolism

a series of chemical processes whereby enzymes change drugs in the body. Metabolism is necessary so that medications can be cleared from the body.

Numeric Filing

The filing of records, correspondence, or cards by number. Practically every large clinic or hospital uses some form of numeric filing, combined with color and shelf filing. Some recommend numeric filing only if more than 5000 to 10,000 records are involved. Numeric filing is an indirect filing system, or one that requires use of an alphabetic cross-reference to find a given file.

Drug Labels

The first step in safely calculating a drug dosage is to accurately read the label of the drug on hand to determine whether the provider's 343order and the packaged drug are in the same system of measurement.

Liquid Medication Dose With Nonmatching Labels

The first step is to identify if there is a shared base unit between the order and the stock medication. The second step is to change one of the shared unit labels (e.g., mg and gram) so it matches the other label.

If the active medication dissolves in the liquid, the medication is a solution. The following are examples of solutions:

The following are examples of solutions: • Tincture: Very potent solution of alcohol or alcohol and water and the active medicine. • Fluid extract: Alcoholic plant source extractions; very concentrated and more potent than tinctures. • Spirit: An alcoholic solution with substances that easily evaporate. • Elixir: Clear sweetened liquid preparation that contains alcohol. • Syrup: A sugar and water solution that contains flavoring and medicinal substance.

If the active medication does not dissolve and becomes suspended in the liquid, it is called a suspension.

The following are examples of suspensions: • Emulsion: A suspension of oil and water. • Gel and magma: Suspensions consisting of minerals and water. Gels are semisolids and contain finer particles than magmas. The minerals settle out with standing. Shake before using. • Liniment: A suspension that is rubbed on the skin; used to reduce pain and stiffness. • Lotion: A water-based suspension that is applied to the skin. • Aerosol: A suspension of medication in a gas, usually used for respiratory or sinus conditions.

Glycemic Index.

The glycemic index (GI) is a numeric index used to indicate how much a carbohydrate food raises the blood glucose level.

Toxicity

The harmful and possibly deadly effects of the medication that can develop due to the buildup of medication or byproducts in the body. People with liver or kidney disease, young children, older adults, and those who overdose are at risk for toxicity.

Health Belief Model

The health belief model helps explain what factors influence a person's health belief and practices. The health belief model helps explain what factors influence a person's health belief and practices. The second part of this model deals with a person's perception of the severity of the disease. A person's perception is influenced by the following: • Personal factors (e.g., age, gender, race, employment) • Social factors (e.g., peers, personality, family) • Perceived threats of the disease • Cues to action (e.g., mass media campaigns, social media, advice from family, friends, and healthcare providers and professionals)

Describe how and when to release health record information; also, discuss health information exchanges (HIEs).

The healthcare facility must be extremely careful when releasing any type of medical information; the patient must sign a release for information to be given to any third party. Requests for medical information should be made in writing. Pay particular attention to records release requests involving a minor. There are currently three kinds of HIE - directed exchange, query-based exchange, and consumer-mediated exchange - and the implementation of HIE varies from state to state.

Hematocrit

The hematocrit (Hct) is a measurement of the percentage of packed RBCs in a volume of blood. Normal hematocrit (Hct) values vary with gender and age. They range from a low of 36% in women to a high of 52% in men. Low microhematocrit values can indicate anemia or the presence of bleeding. High values may be caused by dehydration or polycythemia. Values can be influenced by physiologic, pathologic, and even geographic factors and by collection techniques.

Needles and Supplies Used in Phlebotomy

The hub of the needle is designed to attach the needle to the vacuum tube needle holder or a syringe. Shafts differ in length, ranging from inch to inches. One end of the shaft is cut at an angle and forms the bevel, which creates a very sharp point. The bevel of the needle makes the entry into the skin much smoother.

Laboratory Safety

The importance of safety in the laboratory cannot be overemphasized. Most laboratory accidents can be prevented using proper techniques and common sense.

There are three types of heart block, with third degree being the most severe: • First-degree heart block

The impulse slows as it moves from the atria to the ventricles. This creates a longer PR segment. First-degree heart block may not cause symptoms. It may not require treatment.

Summarize the impact of the inflammatory response on the body's ability to defend itself against infection.

The inflammatory response is one aspect of the body's ability to defend itself against infection. It involves the body's reaction to the introduction of a foreign substance or an antigen, an increase in blood flow to the site, and the release of inflammatory mediators that attract white blood cells to the site. WBCs isolate and destroy the source of inflammation.

Inflammatory Response

The inflammatory response is the body's efficient way of protecting itself. Inflammation occurs when the tissues are injured. The five key signs of inflammation are redness (erythema), swelling (edema), pain, warmth, and loss of function. The injury could be the result of bacteria, trauma, heat, toxins, or other causes. The cells damaged release chemicals called histamine, prostaglandins, and bradykinin

Influenza A and B Testing

The influenza virus causes influenza, or "the flu." This is a highly contagious, acute viral infection of the respiratory tract. - Type A viruses usually are more common than type B viruses. Type A viruses typically are associated with epidemics, and type B viruses cause a milder infection. - CLIA-waived rapid lateral flow immunoassays detect both influenza A and influenza B antigens from nasal washes or nasopharyngeal swabs.

Labels

The label is a necessary filing and finding device. Use labels to identify each shelf, drawer, divider guide, and folder. A label on the drawer or shelf identifies the nature of its contents. It should also indicate the range (i.e., alphabetic, numeric, or chronologic) of the material filed in that space. The label on the folder identifies the contents of that folder only: • Name of the patient • Subject matter of correspondence • Business topic

Specimen Re-collection

The laboratory may reject a specimen for reasons that include the following: • Unlabeled or mislabeled specimen • Insufficient specimen quantity • Defective tube • Incorrect tube used for the test ordered (incorrect stopper color) • Hemolysis • Clotted blood in an anticoagulated specimen • Improper handling Hemolysis is the major cause of specimen rejection. It cannot be detected until the blood cells are separated from the plasma or serum.

Laboratory order integration

The laboratory order integration feature allows the user to interact with outside laboratories. The EHR can receive and post laboratory results to patients' records. Tests can be ordered from the provider's laptop, tablet, or smart phone. Results can be transmitted by fax, scan, or email and uploaded directly into the patient's record

Standardization mark

The machines usually print a calibration marking either at the beginning or at the end of the tracing. If the machine is set at 10 mm/mV, the standardization mark will be an upward rectangle that is 10 small boxes tall. If the gain is doubled, then the standardization mark also will be doubled in size.

• Brand name

The manufacturer's name for the drug. The brand name is capitalized and typically in bold print. The brand name is copyright protected; therefore, it is followed by an ® symbol that indicates the US government has granted a Federal Registration Certificate for the drug.

Only healthcare providers can request laboratory testing for a patient:

The medical assistant is involved in the process of laboratory testing. To assume this responsibility, the medical assistant must know the following: • Proper patient preparation • Testing procedures common to the provider's practice • Normal range of results for common testing

Characteristics of Professional Medical Assistants

The medical assistant may be the first and last person that a patient encounters during an office visit and should always display professionalism. Courtesy, respect, and dignity often come together when discussing professionalism. Empathy, compassion, tact, diplomacy, respect for individual diversity, honesty, dependability, responsibility, and professional appearance are all characteristics of a professional medical assistant.

Administration techniques for IM injections consist of the following:

The medical assistant must identify the correct site and follow the guidelines for medical asepsis. When administering an IM injection, 378it is important to use a 90-degree angle for entry. The skin should be flattened or stretched over the site with the nondominant hand. • Being safe • Minimizing pain • Finding the correct site

Maintaining a Connection With the Patient When Using the Electronic Health Record

The medical assistant must make eye contact with the patient when using an EHR.

The most commonly used medical history forms include these components: • History of present illness (HPI)

The medical assistant should gather as much information about the health problem as possible and document it concisely in chronologic order.

ECG Procedure

The medical assistant should prepare the patient for an ECG by explaining that: • Ten electrodes and wires are placed on the body. • The machine will take 12 pictures of the electrical activity of the heart. • The procedure is painless. • The patient must be still and not talk during the time the pictures are being made (during the actual tracing). • The patient should not use his or her cell phone or other electronic device during the procedure. • The provider will need to look at the ECG pictures and then the patient will be notified of the results. (Remember, the medical assistant cannot tell the patient if it is normal or abnormal.)

Understanding the Results of Microscopic Examination (1)

The medical assistant should understand how the microscopic findings of the sediment are reported. First, the sediment is examined under the low-power objective and low light to locate casts, which generally are found around the edges of the coverslip. From 10 to 15 low-power fields are scanned, and the number of casts is counted and reported.

Vital Signs and Anthropometric Measurements

The medical assistant's responsibilities include: • Taking the patient's vital signs (i.e., temperature, pulse, respirations, blood pressure, and pulse oximetry reading) • Obtaining the person's anthropometric measurements (i.e., height and weight) These measurements are documented in the patient's health record and are used by the provider in his or her assessment. If the medical assistant observes other signs, such as a rash, this would also be documented in the patient's health record and brought to the provider's attention.

Microhematocrit

The microhematocrit is determined by comparing the volume of RBCs to the total volume of the whole blood sample. Microhematocrit tests should be performed in duplicate and the average of the two results reported. The most common type of microhematocrit tube is self-sealing at one end. The microhematocrit is a commonly performed test requested by providers either separately or as part of the CBC.

Routine Urinalysis

The minimum volume needed for a routine UA usually is about 10 to 12 mL, but more is preferred. A complete UA is an assessment of the following: • Physical properties of the urine • Selected chemical measurements that are important in the diagnosis of disease • Microscopic contents of the urine and its sediment

Lyme Disease Testing

The most common insect-borne infectious disease in North America, and it is a significant public health concern. The disease is contracted from an infected tick that bites a person. The bacteria are in the saliva of the tick. These ticks typically are found on deer, mice, dogs, horses, and birds. The spirochete bacterium Borrelia burgdorferi is the causative agent in Lyme disease.

Venipuncture

The most common method of obtaining a blood specimen is by venipuncture, which is when blood is taken directly from a surface vein. The vein is punctured with a needle, and the blood is collected directly into a stoppered vacuum tube, or into a syringe, and then transferred into the vacuum tube.

Neck

The neck is examined for ROM by having the patient move the head in various directions. The provider manually palpates the thyroid area while the patient swallows several times because this action elevates the thyroid lobes. The carotid artery is palpated and auscultated for possible bruits. The lymph nodes are palpated. Lymphadenopathy (enlargement of the lymph nodes) can occur if the patient has an infection of the face, head, or neck.

Tolerance

The need for a larger dose to get the same therapeutic or desired effect. Tolerance can be seen when taking narcotic pain medications and anticonvulsants.

Nuclear Stress Test

The nuclear stress test shows the blood flow into the heart muscle during rest and activity. A radioactive substance (e.g., thallium or sestamibi) is injected into a vein using an intravenous line (IV). After 15 to 45 minutes of resting, a gamma camera is used to take images of the blood flow in the heart. The radioactive substance is again injected, and the person rests. After the required rest period, the gamma camera is used to take additional images of the blood flow through the coronary vessels. Throughout the test, the blood pressure and ECG are monitored.

Understanding the Results of Microscopic Examination (3)

The numbers of casts, RBCs, and WBCs are counted, totaled, and averaged. They are reported using numeric ranges based on the average seen (e.g., range of 0-1, 1-2, 2-5, 5-10, 10-20, and so forth; also, too numerous to count [TNTC]).

A 1-mL syringe.

The numbers on this syringe are tenths (.1, .2, and so on). There are 10 lines for 0.1 mL, which means each line is equal to 0.01mL. Syringes with this type of calibration can measure to the hundredth place (e.g., 0.08, 0.09, 0.15). The most common use of these syringes is for tuberculin (TB) skin tests. If a medication order indicates that 0.14 mL is to be given, the medical assistant should find the calibration marking for 0.1. A trick is to think of 0.1 as 0.10. The next small line would be 0.11, then 3550.12, and so on.

Organs

a structure composed of two or more types of tissue. An organ may have one or more functions. Organs are grouped within 67body systems. An organ may be part of one or more systems. Organs can be divided into parts.

The pH scale

The pH is a measurement of the acidity or alkalinity of the urine. A urine specimen with a pH of 7 is neutral. A value below 7 indicates acidity, and a value above 7 indicates alkalinity. Normal, freshly voided urine may have a pH range of 5.5 to 8. The urinary pH varies with an individual's metabolic status, diet, drug therapy, and disease. In the case of bacteria in the urine, the urine pH is usually alkaline.

ECG Supplies and Equipment: Thermal ECG Paper

The paper can be either Z-fold paper or 8.25 × 11-inch paper. A special heat-sensitive coating on the paper allows the tracing to be "burnt" onto the paper. Tips for handling the ECG paper include: • Store in a dry, cool, dark location. • Do not expose to heat, bright light, or ultraviolet (UV) light source. • Do not expose to alcohol, adhesives, cleaners, or solvents. • Do not store with vinyl, shrink wrap, or plastics.

Parenteral Route

The parenteral route involves administration by infusion, injection, or implantation. Vaccine administration in primary care settings (e.g., family practice and internal medicine) is a frequent duty of medical assistants. Types of injections performed by medical assistants include the following: • Intramuscular (IM): Administration within a muscle • Subcutaneous (subcut): Administration beneath the skin • Intradermal (ID): Administration within the dermis

Subjective Information Personal Demographics

The patient information form provides all of the information that the medical assistant needs to construct the patient's record. • Patient's full name, spelled correctly • Names of parents/guardians if the patient is a child or legally incompetent • Patient's gender • Date of birth (DOB) • Marital status • Name of spouse if married • Home address, telephone number, and email address • Occupation • Name of employer • Business address and telephone number • Employment information for spouse • Healthcare insurance information • Source of referral • Social Security number

Collecting a Urine Specimen

The patient should first clean the urinary meatus with disposable antiseptic wipes. The patient then begins voiding into the toilet or another receptacle, stops the stream, and voids into the specimen container. Otherwise, contaminants from the skin and opening of the urethra could result in a false-positive result for infection.

Lithotomy Position

The patient should not be placed in the lithotomy position until the provider is in the examination room and is ready for this part of the examination. The lithotomy position is used primarily for vaginal examinations that require the use of a speculum and for Pap tests.

Chief Complaint.

The patient's chief complaint is a concise account of the patient's symptoms, explained in the patient's own words. It should include: • The nature, location, frequency, and duration of pain, if any • When the patient first noticed the symptoms • Treatments the patient may have tried before seeing the provider and whether they have helped with the symptoms or not; when the last dose was taken • Whether the patient has had the same or a similar condition in the past • Other medical treatment received for the same condition in the past

Blood Glucose Testing

The patient's fasting blood glucose (FBG) level should be less than 100 mg/dL. If it is higher than 105 mg/dL, the provider may request a blood glucose tolerance test (GTT). The fasting patient receives a sugary liquid to drink that contains 100 g of glucose. (The amount may be adjusted according to the patient's weight.) A blood sugar level of less than 140 mg/dL after 2 hours is normal. A reading of more than 200 mg/dL after 2 hours may indicate diabetes. A reading between 140 and 199 mg/dL indicates impaired glucose tolerance, or prediabetes.

Contents of the Health Record

The patient's health record is the most important record in a healthcare facility. For completeness, each patient's record should contain subjective information provided by the patient and objective information obtained by the provider and staff of the healthcare facility.

Physical Examination of Urine: Appearance

The physical examination of urine involves observations regarding the appearance of the specimen. This does not involve chemical analysis but rather observation of the characteristics of color, turbidity (cloudiness), volume, presence of foam and/or odor, and specific gravity.

Blood in urine

The presence of blood in urine may indicate infection or trauma to the urinary tract. The blood test pad on the reagent strip reacts with three different blood constituents: intact (whole) red blood cells, hemoglobin from lysed (broken) red blood cells, and myoglobin.

According to the AHRQ, the PCMH has five core functions and attributes: 1. Comprehensive care:

The primary care practice has the potential to provide physical and mental healthcare, prevention and wellness, acute care, and chronic care to all patients in the practice. However, comprehensive care cannot be provided by only the practicing physician. It requires a team of care providers. The healthcare team for a PCMH includes physicians, nurse practitioners, physician assistants, nurses, pharmacists, nutritionists, social workers, educators, and medical assistants.

Becoming a Critical Thinker: Making Mental Connections (1)

The process of critical thinking involves (1) sorting out conflicting information, (2) weighing your knowledge about that information, (3) ignoring or letting go of personal biases, and (4) deciding on a reasonable belief or action. Critical thinking is actually an active search for the truth.

Household and Metric Equivalents

The proportion method is one of the easiest techniques. In the proportion method, the cross-products are equal. This approach is easy if you remember three things: 1. Keep the information separate. The problem information is on one side of the equal sign and the equivalent information is on the other side. 2. Keep the labels in the same place. The labels should be in the exact same location on both sides of the equal sign. 3. Cross-multiply in the direction of the two numbers, then divide by the remaining number. You have your answer!

Explain who owns the health record.

The provider owns the physical health record, but the patient controls the information contained in it.

Finishing the ECG

The provider will read the tracing once it is uploaded. An ECG must be read by the provider before it is filed in the paper medical record. If the tracing was done on small strips of ECG paper, the strips need to be mounted per the facility's procedures. Special 8.5 × 10-inch paper with adhesive strips is used to stick the ECG tracing strips.

General Correspondence

The provider's office operates as both a business and a professional service. Correspondence of a general nature pertaining to the operation of the office is part of the business side of the practice. The correspondence is indexed according to subject matter or the names of the correspondents. The guides in a subject file may appear in one, two, or three positions, depending on the number of headings, subheadings, and subdivisions.

Treatment Prescribed and Progress Notes

The provider's suggested treatment is listed after the diagnosis. On each subsequent visit, when a paper record is used, the date must be entered on the record; information about the patient's condition and the results of treatment, based on the provider's observations, must be added to the health record.

What does the pulse indicate, and why is it important in evaluating the physical condition of a patient?

The pulse is indicative of the heartbeats at the aorta. By measuring the pulse, physiological changes in the heart may be found prior to severe disease processes. They are also an indication that the body is in homeostasis.

Characteristics of a Pulse: Rate

The pulse rate is a measure of the number of beats felt from the movement of blood through an artery. Normally, the beat (rate) and the pulse rate are the same. The rate of the pulse is the number of beats (pulsations) that occur in 1 minute. The rate usually is faster in women (70 to 80 beats per minute) than in men (60 to 70 beats per minute).

Characteristics of a Pulse: Rhythm

The pulse rhythm is the time between pulse beats. A normal rhythm pattern has an even tempo, which indicates that the intervals between the beats are of equal duration. An abnormal rhythm, or arrhythmia, is described according to the rhythm pattern detected. An intermittent pulse may occur in healthy individuals during exercise or after drinking a beverage containing caffeine. A common irregularity found in children and young adults is a sinus arrhythmia

Quality Control Guidelines

The purpose of QC in the laboratory is to ensure the reliability of test results while detecting and eliminating error. It is important to remember a few important terms: • Accuracy is a measure of how close a test result is to the true value of the control material, as established by the manufacturer. • Precision is the ability to consistently reproduce a test result.

Physical Examination

The purpose of a physical examination is to determine the patient's overall state of well-being. All major organs and body systems are checked during a physical examination. The results of these tests are used to do the following: • Refine the patient's diagnosis • Help the provider plan or revise treatment for the patient • Evaluate and maintain current drug therapy • Determine the patient's progress

Radial artery

The radial artery is the most commonly used site for counting the pulse rate. It is found on the thumb side of the wrist, 1 inch below the base of the thumb.

Glucose Reabsorption

The reabsorption of glucose depends on its renal threshold. The renal threshold for blood glucose is below 160 mg/dL. This means that all the glucose will be reabsorbed into the blood if the blood glucose level is below 160 mg/dL. If the blood glucose level is higher than 160 mg/dL, the blood will not reabsorb the glucose. The filtered glucose then remains in the urine, which will show up as a positive test result for glucose during urinalysis.

The most commonly used medical history forms include these components: • Database

The record of the patient's demographic information, along with history, physical examination, and initial laboratory findings. As new information is added, it becomes part of this database.

Blood Flow

The right atrium receives deoxygenated blood from these structures: • Superior vena cava (blood comes from the head, neck, and upper extremities) • Inferior vena cava (blood comes from the thorax, abdomen, pelvis, and lower extremities) • Coronary sinus (blood from the coronary veins) A complete heartbeat, or cardiac cycle, can be divided into diastole and systole phases. During the diastole phase, the heart is at rest and the atria fill with blood. The systole phase occurs when the heart is contracting.

Nine Rights of drug administration:

The right medication The right dose The right route The right time The right patient The right education The right to refuse The right technique The right documentation

Social History.

The social history includes information about the patient's lifestyle, such as: • Living situation • Marital status • Employment • Tobacco use • Alcohol and drug use • Exercise • Nutrition All of these factors can have an impact on a patient's overall health; they also can help highlight risk factors.

Staining Blood Smears.

The stain commonly used for examination of blood cells is all polychromatic because they contain dyes that will stain various cell components different colors. The most commonly used differential blood stain is Wright's stain.

Appointment reminder and confirmation

The system can be programmed to automatically remind patients with a confirmation call. The staff can record the message to be sent, and patients are prompted to choose options, such as "Press one" to confirm or reschedule appointments.

Temporal Artery Thermometer

The temporal artery thermometer uses an infrared beam to assess the temperature of the blood flowing through the temporal artery of the forehead, where the artery lies about 1 mm below the skin

Filing Methods

The three basic filing methods used in healthcare facilities are: • Alphabetic by name • Numeric • Subject Patients' records are filed either alphabetically by name or by one of several numeric methods. Subject filing is used for business records, correspondence, and topical materials.

Identification of Normal Blood Cells

The three features hematologists look for in blood cells are the cell size, the appearance of the nucleus, and the appearance of the cytoplasm.

Thyroid Hormone Testing

The thyroid gland is located anterior to the trachea in the throat. It produces the hormones triiodothyronine (T3) and thyroxine (T4). These hormones are essential for life and regulate body metabolism, growth, and development. - tests are available for point-of-care testing (POCT). Using whole blood from a fingerstick, CLIA-waived tests can screen patients for hypothyroidism, which is deficient activity of the thyroid gland. Hypothyroidism is indicated with elevated TSH levels. The tests use lateral flow immunoassay technology housed in a plastic cassette. One such commercially available test is the ThyroTest Whole Blood TSH Test.

Organization of the Health Record Source-Oriented Records

The traditional patient record is a source-oriented record (SOR). Observations and data are cataloged according to their source: • Provider (progress notes) • Laboratory • Radiology • Hospital • Consultations Forms and progress notes are filed in reverse chronologic order and in separate sections of the record according to the type of form or service rendered (e.g., all laboratory reports together, all x-ray reports together, and so on).

Transitory or Temporary File

The transitory file is used for materials with no permanent value. The paper may be marked with a "T" and then destroyed when the action is completed.

Stage 2 learners have an abstract reflective style

These students are eager to learn just for the sheer pleasure of learning, rather than because the material relates to their personal lives. They like to learn lots of facts and arrange new material in a clear, logical manner. Stage 2 learners plan studying and like to create ways of thinking about the material, but they do not always make the connection with its practical application.

Blood Typing

The two major blood antigen systems are the ABO system and the Rh system. The ABO system has four major blood groups: A, B, O, and AB. Another major blood group is the Rh group. A person is either Rh positive (Rh+) or Rh negative (Rh−). Determinations of ABO and Rh blood groups are simple tests that can be performed easily.

Tympanic Thermometer

The tympanic membrane of the ear can be used for quick, accurate, and safe assessment of a patient's temperature.

Pediatric Dose

The unit of measure for weight is different, one being pounds and the other kilograms. • Step 1: Convert the patient's weight to kilograms. • Step 2: Calculate the number of milligrams of medication the child needs. Imagine this scenario: A person tells you, you can have two chocolate bars for each kilogram you weigh. How would you figure it out? A simple way is to multiply the number of kilograms you weigh by 2 (68 × 2 = 136 bars). You can use this same method to calculate the medication order—multiply the kilograms by the order. • The final step is to calculate the liquid medication dose or the number of milliliters you will give.

Characteristics of a Pulse: Volume

The volume (pulse amplitude) reflects the strength of the heart when it contracts. Volume can be assessed by feeling the strength of the pulse as blood flows through the vessel. The force of each pulse beat is described as bounding, or full; strong, or normal; or thready, or weak.

Beyond ABO and Rh Typing

There are many blood types beyond ABO and Rh. Here are a few blood antigens or antigen systems: MNS - Useful in maternity and paternity testing Duffy - The malarial parasite requires the Duffy antigen to enter the red blood cells. Lack of the antigen confers resistance to malaria. Duffy-negative blood is found only in descendants of African populations. Lewis - Antigens are soluble in blood rather than attached to the red blood cells. These are the only blood group antibodies that have never been implicated in hemolytic disease of the newborn. Other blood group systems - Colton, M, Kell, Kidd, Landsteiner-Wiener, P, Yt or Cartwright, XG, Scianna, Dombrock, Chido/Rodgers, Kx, Gerbich, Cromer, Knops, Indian, Ok, Raph, and JMH.

Professional Medical Assisting Organizations, Credentials, and Continuing Education

There are several options for credentialing by taking a national certification exam, and many agencies offer these. Credentialing has benefits like proof of knowledge and higher salaries and some employers even require credentialing prior to hiring.

Abbreviations for Subcutaneous Injections

There have been many abbreviations for subcutaneous injections over the years. Some may still be used in practice, although they are not recommended. The Institute for Safe Medication Practices (ISMP) discourages the use of SC, SQ, and subQ. Healthcare professionals should use subcut or subcutaneously.

Order of the Draw: 1. Blood culture bottles

These bottles are filled first because they are sterile and should not be contaminated by the other tubes. In addition to blood culture bottles, a yellow-topped tube can be drawn for blood cultures for mycobacteria, fungi, and acid-fast bacilli. These tubes are not drawn frequently in an ambulatory setting. If they are ordered, they would be drawn in the same place as blood culture bottles in the order of the draw.

Knee-Chest Position

These positions are used for proctologic examination and for sigmoid, rectal, and occasionally vaginal examinations. The patient's gown should open in the back, and a fenestrated (opening) drape or a single sheet should be draped diagonally over the patient's back at the sacral area

Stage 4 learners are concrete active learners

These students are concerned about how they can use what they learn to make a difference in their lives. Stage 4 learners enjoy teaching others and working in groups and learn best when they can apply new information to real-world problems.

Stage 1 learners have a concrete reflective style

These students want to know the purpose of the information and have a personal connection to the content. They like to consider a situation from many points of view, observe others, and plan before taking action. They feel most comfortable watching rather than doing, and their strengths include sensitivity toward others, brainstorming, and recognizing and creatively solving problems.

Liquid Medication Doses

These two units include the weight of the powdered medications and the volume of liquid. The units typically used include the following: • Weight of the powdered medication: units, g, mg, or mcg • Volume of liquid: cc or mL

5. Lavender top

They contain an EDTA anticoagulant that preserves blood cell morphology. EDTA tubes are drawn near the end of the draw because the additive interferes with chemistry and coagulation specimens.

• Bone density

This screening provides information on the strength of the patient's bones and if the patient has osteoporosis. Women have a higher risk than men, and it increases with age.

6. Gray top

This tube is drawn last, and the blood is used to test glucose or blood alcohol levels. Its additives may elevate electrolyte levels and damage cells if passed into the other tubes.

Tissues

Tissue is a group of similar cells from the same source that together carry out a specific function. The study of body tissues is known as histology.

Otoscope

To examine the external auditory canal and tympanic membrane. It has a stainless-steel handle containing batteries or is part of a wall-mounted electrical unit. The head of the otoscope has a light that is focused through a magnifying lens; it should be covered with a disposable ear speculum. The light also may be used to illuminate the nasal passages and throat.

Reducing Pain and Anxiety

To minimize pain with injections, insert subcut and IM needles swiftly. Inject the medication at the rate of 10 seconds per 1 mL to avoid unnecessary discomfort. Remove the needle quickly, using the same angle as used for entry.

Tuberculin Skin Test Procedure and Reading (1)

To perform the TST, tuberculin purified protein derivative (PPD) 0.1 mL is given ID into the inner surface of the forearm. A tuberculin syringe and needle, with the bevel facing upward, is used to slowly inject the PPD, creating a wheal. A wheal is a tense, pale elevation of the skin. The wheal must measure 6 to 10 mm in diameter, or the test must be repeated. The patient returns within 48 to 72 hours to have the test read.

Exceptional Customer Service

To provide exceptional customer service, medical assistants need to: • Remember that patients, family members, and co-workers are all customers. • Be professional in behavior and appearance. • Consider cultural differences when using nonverbal communication. • Prepare clear, concise verbal communication (written and oral). • Use therapeutic communication, including active listening.

Tourniquets

Tourniquets prevent the venous blood flow out of the site, causing the veins to bulge or plump up. Single-use, nonlatex tourniquets are available and currently are recommended to do the following: • Reduce cross-contamination between patients and healthcare workers • Help prevent nosocomial infections • Prevent latex exposure Tourniquets are applied 3 to 4 inches above the elbow immediately before the venipuncture procedure begins. Because a tourniquet slows blood flow, leaving it on for longer than 1 minute greatly increases the possibility of hemoconcentration and altered test results.

Urine Toxicology

Toxicology is the study of poisonous substances and drugs, and their effects on the body. A urine specimen is the most reliable choice for most routine screening procedures. Urine drug tests detect drug metabolites and not the drug themselves. A metabolite is a byproduct of drug metabolism. Urine samples will remain positive even after the effects of the drugs are gone

Transdermal Route

Transdermal medications are placed on the skin and absorbed into the bloodstream. Transdermal medications provide a systemic action.

Transitional epithelial cells

Transitional epithelial cells line most of the urinary tract. They are round or oval and may have a tail. Occasionally, two nuclei are seen. They may be seen in diseases of the urinary system.

Cognitive Domain

changes in thinking, memory, problem solving, and other intellectual skills The cognitive domain of learning involves the mental processes of recall, application, and evaluation.

Blood Chemistry in the Physician Office Laboratory

Treatment is based on continued monitoring of glucose and hemoglobin A1c for diabetes and of cholesterol, lipid panels, and liver enzymes for cardiovascular diseases related to fatty deposit in the arteries.

Triglycerides

Triglycerides are stored in the fat cells and have the following characteristics: • Are used for energy when carbohydrates are limited • Absorb vitamins and other nutrients • Contain essential fatty acids, which are important for growth and development The best ways to lower the triglyceride level is to do the following: • Cut back on calories and lose weight. • Avoid sugary and refined food; choose monounsaturated fats over saturated fats. • Limit the amount of alcohol consumed, and exercise daily. • Medications can also be ordered to help reduce the triglyceride level.

Timing of Vaccines

Two main types of vaccines are available: • Live virus vaccines: The microorganism is alive but attenuated (weakened) in the laboratory. Vaccine examples include MMR (measles, mumps, and rubella), varicella (chickenpox), zoster (shingles) (ZOSTAVAX), and yellow fever. • Inactivated vaccines: The microorganism is dead. This type includes toxoid vaccines made from modified toxins of microorganisms (e.g., diphtheria and tetanus).

Measuring Temperature

Two scales are currently used for measuring temperature; each is divided into units called degrees. The Fahrenheit scale is considered part of the English system of measurement and is the scale most commonly used in the United States. The Celsius scale, formerly called the centigrade scale, is used in countries that apply the metric system.

Tuberculin Testing

Two types of tuberculin tests have been approved by the FDA: the skin test and the blood test. * The Mantoux tuberculin skin test (TST) is used to determine whether a patient is infected with Mycobacterium tuberculosis. * The TST can be given to most patients, including infants, pregnant women, patients infected with the human immunodeficiency virus (HIV), and those vaccinated with bacillus Calmette-Guérin (BCG).

Unusual Pathogenic Bacteria: Chlamydia, Mycoplasma, and Rickettsia

Typical pathogenic bacteria measure 1000 to 5000 nm in size. - Chlamydia trachomatis is the cause of a sexually transmitted infection (STI). - Rickettsiae are tiny Gram-negative bacteria that are transmitted by blood-sucking insects. Rickettsia cannot multiply outside a living host cell. Rickettsia rickettsii causes Rocky Mountain spotted fever. - Mycoplasmas are unusual in that they have no PG in the cell wall. Mycoplasmal pneumonia is also referred to as "walking pneumonia."

Clinical Laboratory Improvement Amendments

Under CLIA, all laboratories that perform even one type of test must meet certain federal requirements. The CLIA categories are as follows: waived tests, moderate-complexity tests, and high-complexity tests.

Elimination of Urine

Urine flows through a series of collection areas until it leaves the kidney through the ureter and is stored in the urinary bladder. Urine remains in the bladder until it is voided through the urethra. - The average person voids about 1 to 2 liters of urine per day. - The largest component of urine is water. - Normal waste products found in urine include urea, uric acid, creatinine, and electrolytes (sodium, chloride, potassium). - Abnormal waste products that can be found in urine include protein, glucose, ketones, red blood cells (RBCs), white blood cells (WBCs), bacteria, nitrites, bilirubin, and urobilinogen. - Protein and blood cells are too large to be filtrated by the glomerulus, so when these substances appear in the urine, it may indicate kidney damage.

Drug Terminology: • Names:

Usually the generic name is listed with the trade names. Some references may indicate if the trade name found is in the United States or Canada.

If you use an alternate site, you should document the following identifiers after recording the temperature:

When an oral temperature is obtained, you do not have to indicate the site when documenting the reading in the patient's health record. • (T) for tympanic • (A) for axillary • (R) for rectal • (TA) for temporal artery

Ventricular Arrhythmias.

Ventricular arrhythmias are abnormalities in the ventricles. Most of the ventricular arrhythmias discussed are life-threatening rhythms.

Wandering Baseline

Wandering baseline artifact is an upward and downward movement of the waveform. The isoelectric lines shift locations. This artifact can be the result of: • Poor skin preparation: Patient has oily skin or used lotion. The electrodes are falling off. • Old electrodes: The electrodes are dirty or expired; or the gel on the electrodes is dried. • Placement of electrodes: Electrodes are placed on bony areas. • Movement: The movement of breathing can also be the cause of this artifact.

Waxy casts

Waxy casts are rarely seen. They appear as glassy, brittle, smooth, homogeneous structures. They usually are yellowish, have cracks or fissures, and have squared or broken ends. They are considered to be cellular casts that have broken down and are found in individuals with severe renal disease. Occasionally more than one type of cell is found in a single cast. Mixed cellular casts have been reported, and absolute identification of the cell types present may be difficult. Cast identification is not a CLIA-waived procedure.

Administration Techniques: The following sections address these three goals. (Aspiration)

When giving an intramuscular injection, it is important to aspirate prior to injecting the medication. Once the needle is in the site, the medical assistant should pull back on the plunger for 5 seconds and check the barrel of the syringe. Lack of blood in the barrel means the needle is not in a blood vessel, so it is safe to inject the medication. If blood appears in the barrel, remove the needle, discard the syringe, and restart the procedure. Immunizations do not need to be aspirated, according to the CDC.

Tips for Labeling a Patient Specimen and Sample Label

When labeling a sample container, make sure you only use a black waterproof marker or pen, never pencil! All labels should include the following information, at a minimum: • Patient name: surname, first name, then middle initial • Identification number • Date (MM/DD/YYYY) and time of collection • Phlebotomist or collector's initials

Tuberculin Skin Test Procedure and Reading (2)

When reading the test, palpate the site to check for a raised, hardened area, called an induration. If an induration is felt, measure the raised area across the forearm (perpendicular to the bone). The erythema (redness) is not measured. The diameter of the induration is read in millimeters (mm) and must be noted in the health record. The medical assistant can never state that the test result is positive or negative. The provider uses the test results and the patient history to determine if the patient has tuberculosis (TB). A TST reading between 5 and 15 mm can be positive for different populations.

Urine Cultures

With urine cultures, the bacterial colonies that appear after incubation are counted. A calibrated inoculating loop is dipped into a well-mixed urine sample that was collected by the CCMS method or by catheterization. The urine from the loop is spread on solid culture media and incubated for 18 to 24 hours at 37°C (98.6°F). Each colony that grows on the plate represents 1000 colony-forming units (cfu) per milliliter. The final cfu results are interpreted as follows: • Normal: <10,000 cfu/mL of urine; no urinary tract infection (UTI) is present • Borderline: 10,000 to 100,000 cfu/mL of urine; a chronic or relapsing infection may be present, and the test should be repeated • Positive: >100,000 cfu/mL of urine; a UTI is likely

Right Medication

You check the label: • When you get the medication from the storage area (e.g., cabinet, freezer, or refrigerator) • Before preparing the medication • Before you return the medication to the storage area

How to Succeed as a Medical Assistant Student?

You must first perceive it and then process it. Processing the information is how you internalize it and make it your own. By investigating your learning style: Stage 1: Concrete reflective style Stage 2: Abstract reflective style Stage 3: Abstract active style Stage 4: Concrete active style Each of these learning styles has pros and cons.

Medical Assistant's Role (2)

You will need to master the following subjects: - Use of laboratory equipment. - Regulations governing laboratory practices and procedures. - Precautions for accident prevention. - Waste disposal requirements. - Housekeeping and maintenance routines. - Quality assurance and control procedures. - Technical aspects of specimen collection and test processing, including expected results. - Communication with patients. Reporting of test results to the physician. - Recordkeeping of test specimens, procedures, and results. - Inventory and ordering of equipment and supplies. - Use of reference materials in the POL. - Screening and follow-up of test results.

Red blood cell casts

always indicate a pathologic condition and are highly diagnostic. These casts occur in glomerulonephritis. They are hyaline casts with embedded red blood cells. Their presence indicates damage to the glomerulus. They may appear brown due to the color of the red blood cells present.

Microscopic Preparation of Urine

a laboratory must be certified to perform CLIA Provider-Performed Microscopy Procedures (PPMPs), a subcategory of CLIA moderate-complexity laboratories. Quality assurance is just as important in the microscopic examination as in the chemical analysis of urine. When a urine sample is centrifuged, the clear upper portion of the specimen is called the supernatant. Whatever system is used, the Clinical and Laboratory Standards Institute (CLSI) recommends the following: • The urine volume should be 12 mL. • The specimen should be centrifuged for 5 minutes at a relative centrifugal force of 400 g (i.e., 400 times normal gravity). • A standardized slide should be used to view the sediment. • A consistent reporting format should be used.

Erythrocyte Sedimentation Rate (ESR)

a laboratory test that measures the rate at which red blood cells gradually separate from plasma and settle to the bottom of a specially calibrated tube in 1 hour. ESR and C-reactive protein (CRP) testing should correlate as indicators of inflammation. An increased ESR is seen in conditions such as: • acute and chronic infections, including tuberculosis, hepatitis, and rheumatic fever • rheumatoid arthritis, lupus erythematosus, and other autoimmune conditions • some cancers, including multiple myeloma

Mitosis

a process in which one cell splits into two identical daughter cells. The two cells are genetically identical to the parent cell. Each sister pair of chromosomes (called chromatids) are joined together until they are pulled apart later in the mitosis process. The centromere is also the attachment point for spindle fibers, which will be involved in the mitosis process. The mitosis process consists of four phases; prophase, metaphase, anaphase, and telophase.

Oral Route

administration of drugs by way of the mouth • Oral medications that coat the mouth or throat should not be immediately followed with water. • Oral medications that require water for swallowing call for more than a sip. Some medications require a glass of water after taking the medication. • A straw should be used for liquid medications that stain the teeth. • Liquid medications should be measured only with a plastic medication cup or an oral medication syringe. Household measuring devices, such as spoons, are not accurate.

Patient portals

allow patients to access their actual EHRs. At any time, a patient can view progress notes, laboratory results, medications, or immunizations. Many patient portal systems also allow: • Communication between the patient and provider • Completion of forms online • Requests to be made for prescription refills • Scheduling of appointments

Chronic Infection

an infection that generally develops slowly and lasts for months or years

Centrifuge

an instrument that is used to separate solids from liquids. A centrifuge works by rapidly spinning the specimen, which increases the gravitational force. The three common configurations used in the clinical laboratory are: • A centrifuge that has a fixed-angle rotor, where specimen cups are held in a rigid position at a fixed angle. • A centrifuge that has a horizontal head with buckets that swing out horizontally during centrifugation. • A centrifuge used for centrifuging capillary tubes for microhematocrit testing. Most centrifuges are equipped with a brake, which should be used only in an emergency, the most common of which is a broken glass tube.

AC Interference

appears as a series of small spikes that creates a thick-looking tracing. The causes include: • Electrical interference: Too many electrical devices in the area; patient cable and lead wires are wrapped closely together; electrical cord is under the exam table; and electrical outlet is improperly grounded. A cell phone in a patient's pocket or a smart watch may also cause interference.

Differential Diagnosis (DDx)

based on information gathered from the patient about symptoms; contributing family, personal, and social histories; and a complete physical examination.

Spun microhematocrit tube

based on the principle of separating the cellular elements from plasma using a centrifuge.

Rapid Strep Testing

bring all reagents and devices to room temperature for a minimum of 30 min before the test. - dispense the reagents as free-falling drops. The reagent bottle should not come into contact with the tube. - leave the swab in the tube for exactly 1 min - express the liquid from the swab by squeezing the tube, not squeezing the swab directly The test swab is placed in an extraction well, and the extract is tested for antigens found on the surface of Streptococcus pyogenes (also referred to as group A strep or GAS). The test kit uses a lateral flow immunoassay.

Spermatozoa

can be found in the urine specimens of both male and female patients. In a specimen from a female, their presence represents vaginal contamination. Sperm usually have pointed, oval heads and long, whip-like tails. They may be motile in fresh urine.

Implanted cardioverter-defibrillator (ICD)

can provide low-energy electrical pulses and high-energy pulses. The high-energy pulses can treat life-threatening arrhythmias. ICDs are surgically implanted in the chest or abdomen. The ICD is programmed to meet the needs of the patient. Some ICD functions can be checked using technology such as pacemakers. ICD batteries can last 5 to 7 years.

Hereditary or genetic factors:

certain diseases can be inherited or members of a family can have a higher-than-normal risk for getting a specific disease

Physician Assistants (PA)

certified healthcare professional who provides diagnostic, therapeutic, and preventive healthcare services under the supervision of a medical doctor. Physician assistants must pass the Physician Assistant National Certifying Examination to practice in any state. They may also complete advanced training to focus on a particular specialty practice.

Nitrite

common component of normal urine. Nitrites occur in urine when bacteria break down nitrate. A positive nitrite test result may indicate the presence of a UTI. A negative nitrite test can occur when bacteria are in small numbers or when the urine has not been in the bladder long enough for the chemical breakdown to occur. Escherichia coli (E. coli), the bacteria that is the most common cause of UTIs, does break down nitrate to nitrite. A positive reaction is any pink color on the nitrite dipstick pad.

Microscopic Preparation and Examination of Urine Sediment

consists of categorizing and counting cells, casts, crystals, and miscellaneous constituents in the sediment of a urine sample. The sediment is obtained after a measured portion of urine is centrifuged. The sediment will be prepared for a microscopic exam, and the remaining liquid urine will be poured off and disposed of properly.

Renal tubular epithelial cell casts

contain embedded renal tubular epithelial cells. These casts are easily confused with white blood cell casts, particularly if the cells have started to degenerate. Renal tubular epithelial cell casts are found when excessive damage has occurred in the kidney. Causes include shock, renal ischemia, heavy-metal poisoning, certain allergic reactions, and nephrotoxic drugs.

CLIA-Waived Tests and Laboratories

defined as laboratory tests and procedures that have been approved by the FDA for home use or that are simple laboratory tests and procedures to perform. Waived tests are designed to have straightforward directions and procedures so that they have a minimal risk of incorrect results. Waived tests include tests that do the following: • Use methodologies that are simple and accurate so that the likelihood of incorrect user results is negligible • Pose no unreasonable risk of harm to the patient if it is performed incorrectly

Specific gravity of urine

defined as the weight of a substance compared with the weight of an equal volume of distilled water. The specific gravity of distilled water is 1.000. The normal specific gravity of urine ranges from 1.005 to 1.030, depending on the patient's fluid intake. Most samples fall between 1.010 and 1.025. Conditions such as glomerulonephritis, chronic renal insufficiency, or diabetes may lower the specific gravity. - A refractometer measures the refraction (bending) of light through solids in a liquid. The result is called the refractive index, which, for our purposes, is the same as specific gravity. - The refractometer requires only a drop of urine. One drop of well-mixed urine is placed under the hinged cover of the instrument. - Note that specific gravity carries no unit of measure after the number.

personal health record (PHR

defined by the ONC as an electronic record of health-related information about an individual that conforms to nationally recognized interoperability standards and that can be drawn from multiple sources, but that is managed, shared, and controlled by the individual. There are several ways that a PHR can be created.

Pathology Suffixes

describe a disease process or a sign or symptom. The meanings vary according to the conditions that they describe.

Alphabetic Color-Coding

each color represents a segment of the alphabet. the second letter of the patients last name determines the color. Several color-coding systems use two sets of 13 colors: one set for letters A to M, and a second set of the same colors on a different background for letters N to Z. With color-coding of patients' records, a misplaced file is easily spotted.

Branchial pulse

felt at the inner (antecubital) aspect of the elbow. This is the artery that is felt and listened to when blood pressure is measured. It also can be felt in the groove between the biceps and triceps muscles on the inner surface of the middle upper arm. This is the pulse that is checked on infants and young children receiving CPR.

Popliteal pulse

found at the back of the leg behind the knee (see Fig. 5.5). Palpation of this pulse requires the patient to be in a recumbent position with the knee slightly flexed. The popliteal artery is deep and difficult to feel. It is palpated and also monitored with a stethoscope when a leg blood pressure reading is necessary. The provider checks blood flow through the popliteal artery if a circulatory system problem, such as a blood clot, is suspected in the lower leg.

Mucous threads

found in most urine specimens. They appear as pale, irregular, threadlike structures with tapered ends. Beginners often confuse hyaline casts with mucous threads. They are frequently seen in patients with inflammation and in specimens contaminated with vaginal secretions.

Hemoglobin A1c Testing

glycosylated hemoglobin (sugar-coated hemoglobin). Glycosylated hemoglobin is the result of glucose irreversibly binding to the hemoglobin molecules in the RBCs. It is also referred to as the A1c. - The A1c test is performed every 3 months in patients with diabetes to monitor the person's average blood glucose level during those months. - An A1c value higher than normal indicates that the average blood sugar has been elevated during the past 2 to 3 months. - A normal A1c level for a person without diabetes ranges from 4% to 5.6%. For patients with diabetes, the goal is to maintain the glycosylated hemoglobin level below 7%.

Therapeutic Intervention Suffixes

indicate types of treatment. Treatments may be medical or surgical in nature.

Instrument Suffixes

indicated by yet another set of suffixes. Note the obvious similarities to their diagnostic and therapeutic cousins.

Electrocardiograph

instrument used to record the electrical activity of the heart The lead wires may have a snap or a clip (also called an alligator clip; patient end adaptor) that attaches to the electrode.

Percussion

involves tapping or striking the body, usually with the fingers or a small hammer. Direct percussion is performed by striking the body with a finger or a reflex hammer. With indirect percussion, which is used more frequently, the provider places his or her hand on the area and then strikes the placed hand with a finger of the other hand. Both a sound and a sense of vibration are evident. The examiner assesses the sound in terms of pitch, quality, duration, and resonance.

Ventrogluteal Site

located by placing the palm of the hand over the greater trochanter of the patient's hip with the wrist perpendicular to the femur, pointing the thumb toward the patient's groin and the index finger toward the anterior superior iliac spine, and extending the middle finger back along the iliac crest toward the buttock. The ventrogluteal site is an excellent site for oil-based medications and irritating medications. This site is being used more often, because the dorsogluteal site is no longer a recommended site for IM injections.

Temporal pulse

located in the temple area of the skull, parallel and lateral to the eyes. It is seldom used as a pulse site but may be used as a pressure point to help control bleeding from a head injury.

Vastus Lateralis Site

located on the anterior lateral aspect of the thigh, and extends in an adult from a hand breadth above the knee to a hand breadth below the greater trochanter of the femur The vastus lateralis site is used on patients from birth through adulthood. This site uses a thick, well-developed muscle. The CDC recommends this site until the deltoid muscle is the appropriate size for vaccines (after the patient is 1 year or older).

Few bacteria

may be found in normal urine specimens. High bacterial counts in a urine specimen without white blood cells may indicate that the specimen sat at room temperature and the bacteria 784multiplied. Urine specimens with a putrid odor, numerous white blood cells, and bacteria are common in UTIs. Bacteria are seen under high-power magnification. They are often motile (moving).

Finely and coarsely granular casts

may indicate renal disease. On close examination, granular casts show a hyaline cast with coarse or fine granular inclusions. The granules are thought to be caused by protein clusters or the breakdown of cellular inclusions.

Yeast cells in the urine

may indicate vaginal contamination or a urinary yeast infection). Yeast is common in the urine of patients with diabetes. Yeast cells are oval shaped and may show budding.

• Administer

means to give a prescribed dose of medication to a patient. Medical assistants, nurses, and providers can administer medications. State laws related to medication administration by medical assistants can vary.

• Dispense

means to give a supply of medication that the patient will take at a later time. In most scenarios, pharmacists dispense medications.

• Prescribe

means to order a medication as a treatment for a condition. Doctors (MDs [including psychiatrists], DOs, and dentists) and advanced practice professionals, including physician assistants (PAs), nurse practitioners (NPs), and certified nurse midwives (CNMs), can prescribe medications. State prescribing laws can vary for advanced practice professionals.

CLIA-waived CoaguChek XS PT

measures the time it takes a blood sample to form a fibrin clot. PT test results are reported as the number of seconds blood takes to clot when mixed with the thromboplastin reagent. Normal PT values are 10 to 13 seconds, or an INR of 1 to 1.4.

Inhalation Route

medications absorbed through the nasal passages, oral passage, or endotracheal or tracheostomy tubes

Red Blood Cell Morphology

microscopic examination of a stained blood smear to determine the shape of individual red cells Size. Normal-sized RBCs are said to be normocytic. If the cells are larger than normal, they are macrocytic; if the cells are smaller than normal, they are microcytic. The condition in which different sizes of RBCs are present is known as anisocytosis. Shape. Normal RBCs are round or slightly oval. Cells may be shaped like sickles, targets, crescents, or burs. Poikilocytosis is a significant variation in the shape of RBCs. Content. An RBC with a normal amount of hemoglobin is said to be normochromic. Pale-staining cells are hypochromic and have less hemoglobin than normal. Any inclusions within red cells should be reported.

White Blood Cell Count

number of leukocytes per cubic millimeter or microliter of blood. The normal WBC count varies with age. It is higher in newborns and decreases throughout a lifetime. The average adult range is 4500 to 11,000 cells/mm3. A decrease in the WBC count is called leukopenia. This condition may be caused by viral infection or by exposure to radiation and certain chemicals and drugs.

Apical heart rate

or the heartbeat at the apex of the heart, is heard with a stethoscope. It is used for infants and young children because the radial pulse is difficult to palpate in young patients. An apical count may be requested if the patient is taking cardiac drugs or has bradycardia or tachycardia. To determine the presence of a pulse deficit, the provider may listen to the apical beat while the medical assistant counts the pulse at another site (usually the radial pulse).

Right to Refuse

patients have the right to refuse any prescribed medication or treatment

Diagnostic Procedure Suffixes

point to a procedure that helps to determine the diagnosis

Drawer Files

should be full suspension; they should roll easily, close securely, and be equipped with a locking device. A drawback of the vertical four-drawer files is that only one person can use a file cabinet at a time. Open only one file drawer at a time and close it when the filing has been completed.

Water-soluble vitamins

vitamins B and C Vitamin B12 is an exception, because the liver stores the vitamin for years. Water-soluble vitamins need to be taken in daily. Fat-soluble vitamins are vitamins A, D, E, and K.

Antiviral Agents

• Acyclovir (Zovirax) • Adefovir dipivoxil (Hepsera) • Famciclovir (Famvir) • Oseltamivir (Tamiflu) • Penciclovir (Denavir) • Valacyclovir hydrochloride (Valtrex)

Documenting in a Paper Health Record

the entry will always start with the date in the MM/DD/YYYY format. The date will be followed by the time. This may be written in standard or military time. If standard time is used, it must be followed by a.m. or p.m. (e.g., 2:00 p.m.). All entries must be written in black or blue ink, following the format designated by the healthcare facility. Documentation should be in the order in which the steps were completed. If a temperature, pulse, and respiration (TPR) measurement is done, it would be documented in the "O" or Objective section of the SOAP note starting with temperature, then pulse, and, lastly, respirations.

Plasma

the highly complex liquid that transports the formed elements plus other substances, such as plasma proteins, throughout the body to every cell. Plasma proteins include albumin, the clotting proteins prothrombin and fibrinogen, and immunoglobulins. Plasma also transports nutrients (carbohydrates, fats, and amino acids), hormones, enzymes, mineral salts, gases, and waste products. Plasma is composed of approximately 90% water, 9% protein, and 1% other chemical substances. The liquid portion of the blood in the body is plasma. The liquid that remains after blood has clotted is called serum.

Practice Management Files

the most active financial record is the patient ledger. In facilities that still use a manual system, this is a card or vertical tray file, and the accounts are arranged alphabetically by name. At least two divisions are used: active accounts and paid accounts.

Trichomonas vaginalis

the most commonly encountered protozoan in urine. It is frequently a vaginal contaminant but may also be found in urine specimens from male patients. When urine is fresh and warm, trichomonas may be motile and move rapidly when viewed under the microscope. Trichomonas organisms are pear-shaped protozoa with four flagella, or whip-like tails. They are larger than round epithelial cells but smaller than squamous cells. Trichomonas organisms die when the specimen cools.

Assisting With the Physical Examination: Fowler Position

the patient sits on the examination table with the head of the table elevated 90 degrees. This position is useful for examinations and treatments of the head, neck, and chest, and for patients who have difficulty breathing while lying down. Drape placement varies, depending on the type of physical examination done and the need to maintain the patient's modesty.

Head

the physical examination typically begins with the head and face and moves downward to the feet. As the head is palpated, the provider assesses possible nodules, masses, or signs of trauma.

Hemoglobinuria

the presence of hemolyzed (ruptured, broken) red blood cells in urine. But urine specimens that contain blood may test positive for hemolyzed blood for a few reasons: • The urine specimen has sat for too long at room temperature, causing the RBCs to lyse. Freshly collected specimens give the most accurate testing results. • The pH of the urine is highly alkaline, which can cause RBCs to lyse. • The specific gravity of the sample is below 1.010; this can also cause RBCs to lyse. • Bacteria in the urine can also cause a false-positive hemolyzed blood test result. True hemoglobinuria is the result of intravascular red blood cell destruction and can be caused by blood transfusion reactions, malaria, drug reactions, snakebites, and severe burns.

Hematuria

the presence of intact red blood cells in urine. Hematuria can be caused by irritation of the kidneys, ureters, bladder, or urethra. It also is a common finding in cystitis (inflammation of the urinary bladder) and in individuals passing kidney stones. A random specimen may contain blood from vaginal contamination if the woman is menstruating.

Ownership of the Health Record Who owns the health record?

the provider or medical facility, often called the "maker," that initiated and developed the record. The patient has the right of access to the information within the record but does not own the physical record or other documents pertaining to the record. The patient has a vested interest and therefore has the right to demand confidentiality of all information placed in the record.

When using syringes:

the rubber stopper on the plunger indicates the amount in the syringe. Some rubber stoppers are pointed and others are flat. The top of the rubber stopper that touches the barrel is used for measuring. That part of the rubber stopper should be right on the correct calibration mark.

Pharmacokinetics

the study of drug absorption, distribution, metabolism, and excretion in the body. Through pharmacokinetics, we understand when a medication starts to work in the body.

Principles of Pharmacology: Pharmacology

the study of the properties, actions, and uses of drugs. A drug is a chemical substance used to cure, treat, prevent, or diagnose disease.

Fainting

the sudden loss of consciousness from an inadequate blood supply to the brain. • If the patient begins to faint, quickly remove the tourniquet and needle from the arm, immediately activate the needle safety device, apply pressure to the site, and dispose of the unit in a sharps container to prevent an accidental exposure. • Notify staff members for assistance. • Lay the patient flat or lower the head if the patient is sitting. • Loosen tight clothing. • Do not use ammonia inhalants/capsules because these are associated with adverse effects and are no longer recommended. • Apply a cold compress or washcloth to the patient's forehead and back of the neck. • Stay with the patient until recovery is complete. • Document the incident according to facility policies. • When the patient regains consciousness, he or she must remain in the facility for at least 15 minutes and should not operate a vehicle for at least 30 minutes.

Additional Screenings

• Alcohol misuse screening • Nicotine or tobacco screening • Drug abuse screening • Intimate partner violence screening • Elderly safety screening • Functional status screening • Depression screening • Peripheral neuropathy screening

Syringe magnifiers

used by people with visual impairments. The magnifiers increase the size of the calibration markings on the syringes.

Clinical Laboratory Testing

used in conjunction with a thorough health history and physical examination to obtain essential data for screening, diagnosis, or management of a patient's condition.

Positional and Directional Terminology

used to describe up/down, middle/side, and front/back. The midline of the body is an imaginary line drawn from the crown of the head down between the eyes, through the chest, and separating the legs. Several of the directional terms use the midline as a reference.

Hypodermic Needles

used to inject medications into tissue or intravenous tubing. A hypodermic needle attaches to a hypodermic syringe. Hypodermic needles come with syringes or are packaged separately. • Hub: Attaches or screws onto the syringe • Hilt: Where the needle attaches • Bevel: Slanted end of the shaft • Lumen: Hollow space inside the needle; the size is indicated by the gauge number

Dietary Guidelines

• 1992: Food Guide Pyramid, which showed the five basic food groups, with fats and sugars making up the tip of the pyramid • 2005: MyPyramid Food Guidance System, which continued with the pyramid design but added physical activity and oils • 2011: MyPlate, which was introduced along with the 2010 Dietary Guidelines for Americans

The following are examples of breaks in the standards of care in medical assisting.

• A patient calls reporting a persistent headache for 3 days. You tell the patient to get some rest and take ibuprofen, without referring the call to a provider. What standard of care has been broken? • A patient asks you to explain his lab report. You do your best to explain what his blood count levels mean. What is the problem here? • An elderly patient tells you she cannot afford to get her prescriptions filled. The provider is busy, but you know there are samples of the prescribed drug in the medication cupboard, so you give her several packets. Does this follow standard of care? • A patient tells you her son fell on the playground yesterday, and he is complaining that his arm hurts. You tell the mother 7it is probably just a strain and suggest she wrap the arm with an elastic bandage. Why is this a problem? • You overhear a patient calling one of the other medical assistants "nurse." Should your co-worker correct the patient? Why?

Medical Assistant's Role (1)

• A patient may request refills while the medical assistant is rooming the patient. The medical assistant may prepare the prescriptions, so the provider just needs to sign for the refills. • A patient may call the department and request a refill on a medication. Using a medication refill protocol, the medical assistant needs to see if the patient can get a refill. If the patient can, then the medical assistant prepares the prescription and has the provider sign it.

The TST is contraindicated in patients who had the following:

• A severe reaction to a past TST (e.g., necrosis, ulcers, blisters, or anaphylaxis) • A history of a positive TST result • A live virus vaccine less than 4 to 6 weeks earlier (A TST and a live virus vaccine can be given on the same day, or the TST can be given 4 to 6 weeks after the vaccine.)

The body uses fat for the following:

• A source of energy. If glucose is not available for energy, the body will break down fat and the resulting ketones are used for energy. • Healthy skin and hair. • Vitamin absorption. Vitamins A, D, E, and K are fat soluble. • Insulation (cushion) for organs and to keep the body warm. • Brain development, controlling inflammation, and blood clotting. Linoleic and linolenic acid, which are essential fatty acids, are used for these processes.

According to the AAMA's, becoming a member includes the following benefits:

• AAMA legal counsel represents medical assistants across the United States to fight for the rights of medical assistant practice; in addition, the counsel stays abreast of federal and state laws regarding medical assisting. • Members receive a complimentary subscription to CMA Today, an informative magazine devoted entirely to the medical assistant profession; each issue (six per year) offers continuing education unit (CEU) articles, medical assisting news, and healthcare information.

Immunity Disorders

• Allergies: Reactions occur if a person is exposed to a food (e.g., milk, tree nuts, peanuts, eggs, soy, and wheat), pollen, dust mites, mold, pet dander, inhalants, or other substances. • Autoimmunity: The immune system does not recognize the body's own antigens and starts attacking itself. Rheumatoid arthritis, lupus, and psoriasis are examples of autoimmune disorders. • Immunodeficiency: This is caused by a deficiency in one or more of the immune system's key players, such as white blood cells (e.g., B cells and T cells). A person with immunodeficiency has impaired resistance to infections.

Safe Lifting Techniques

• Always get help if the load is too heavy. • Maintain correct body alignment, with the legs spread apart for a broad base of support. • Do not reach for items; clear barriers out of the way and get as close as possible to what needs to be lifted. • Bend at the knees with the feet shoulder width apart and keep the back straight. Use the major muscle groups of the arms and legs rather than the weaker ones of the back to help lift a heavy item.

Responsibilities of the Medical Assistant: Administrative skills include:

• Answering telephones • Managing patient scheduling • Creating and maintaining patient health records • Documenting accurately in a paper record and an EHR • Performing routine maintenance of facility equipment • Performing basic practice finance procedures • Coordinating third-party reimbursement • Performing procedural and diagnostic coding • Communicating professionally with patients, family members, practitioners, peers, and the public • Managing facility correspondence • Performing patient education and coaching initiatives within the scope of practice • Following legal and ethical principles • Complying with facility safety practices

Three types of drug interactions can occur:

• Antagonism: One drug reduces or blocks the effect of another drug. Example: Naloxone is given for narcotic overdosage. • Synergism: The combined effect of two drugs used together is greater than the sum of each drug's effect (e.g., 1 + 1 > 2). Example of a harmful interaction: Alcohol has a synergistic effect on antidepressants. • Potentiation: A type of synergism; one drug increases the effect of the second drug. With L-dopa and carbidopa, one drug has no effect but increases the effect of the other drug (e.g., 0 + 1 > 1).

Signs and Symptoms of Anaphylaxis

• Anxiety, warm feeling, and flushing • Shortness of breath, dyspnea (difficulty breathing), and wheezing • Cough, throat tightening, and difficulty swallowing • Pain, cramping, vomiting, and diarrhea • Palpitations, dizziness, loss of consciousness, and shock

Blood Collection: Phlebotomy is performed primarily to do the following:

• Assist the provider in diagnosing disease • Monitor a patient's condition, treatment, or medication levels • Document the existing good health of a patient According to the American Society of Clinical Pathologists (ASCP), nearly 80% of providers base at least part of their diagnostic decisions on the results of laboratory tests. - The most common specimen used in the laboratory is blood. - Phlebotomy is the process of acquiring blood from a patient. - Phlebotomy involves highly developed skills, procedures, and equipment to ensure the patient's comfort and safety.

Responsibilities of the Medical Assistant: Clinical skills include:

• Assisting during physical examinations • Performing patient screening procedures • Assisting with minor surgical procedures, including sterilization procedures • Performing electrocardiograms (ECGs) • Obtaining and recording vital signs and medical histories • Performing phlebotomy • Performing tests permitted by the Clinical Laboratory Improvement Amendments (i.e., CLIA-waived tests) • Collecting and managing laboratory specimens • Following Occupational Safety and Health Administration (OSHA) regulations on infection control • Administering vaccinations and medications as ordered by the provider • Performing patient education and coaching initiatives within the scope of practice • Documenting accurately in a paper record or an EHR • Performing first aid procedures as needed • Performing infection control procedures • Applying therapeutic communication techniques • Adapting to the special needs of a patient based on his or her developmental life stage, cultural diversity, and individual communication barriers • Acting as a patient advocate or navigator, including referring patients to community resources • Acting within legal and ethical boundaries

How can medical assistants perform their duties using these three characteristics?

• Be honest and straightforward when interacting with others. • Accept responsibility for your mistakes. Determine how to prevent them in the future. • Follow through on your promises. • Complete your work to the best of your abilities. Complete it on time. • Be self-motivated. Don't wait to be asked to complete a task. • Embrace change.

Somali

• Believe that individuals do not prevent illness, which is only done through prayer and living a life according to their religion. • Use traditional spiritual healers. • May not take medication if they feel healthy. • Healthcare decisions are made by the family, and the father gives consent for procedures. • Male and female circumcisions are performed; being uncircumcised means the person is unclean.

Important terms for understanding the pharmacokinetics of a drug include:

• Biologic half-life: The time it takes half of the drug to be metabolized or eliminated by normal biologic processes. • Onset: The time it takes for the drug to produce a response. 327• Peak: The time it takes for the drug to reach its greatest effective concentration in the blood. • Duration: The time during which the drug is present in the blood at great enough levels to produce a response.

These chemicals cause the following responses:

• Blood vessels at the site dilate. This causes more local blood flow. With the increase in blood flow, redness and warmth occur in that area. Blood vessel walls allow more white blood cells and plasma to move out of the vessel into the surrounding tissues. The white blood cells work to protect the cells and clean up the dead tissue. The extra fluid from the blood causes swelling, pain, and loss of movement. For instance, if an injury occurs in your finger joint area, the swelling may be so great that it prevents you from moving your finger.

Factors Affecting Blood Pressure

• Blood volume • Peripheral resistance created by blood viscosity (the thickness of the blood) • Vessel elasticity • Condition of the heart muscle and arterial walls

Items contaminated with any of the following potentially infectious materials require special handling:

• Body fluids • Semen • Vaginal secretions • Cerebrospinal fluid (CSF) • Synovial fluid • Pleural fluid • Pericardial fluid • Peritoneal fluid • Amniotic fluid • Saliva in dental procedures • Any body fluid that is visibly contaminated with blood • All body fluids in situations in which it is difficult or impossible to differentiate between body fluids • Any unfixed tissue • Any pathogenic microorganism

The two types of ECG devices in ambulatory healthcare facilities include:

• Box model ECG machine: Usually has an LCD screen. • Computer-based ECG: May have a touch screen and stress testing features. Can have its own computer device with preloaded software, or a facility can purchase software to add to any laptop computer.

Solid Medication Forms (2)

• Buffered: A solid medication containing the active medication and an antacid. The antacid neutralizes the stomach acid and thereby reduces stomach irritation. • Fast-dissolving tablet or film strip: Also called oral disintegrating tablets. Solid form of medicine that is placed on the tongue (or by the cheek [buccal]) and breaks down rapidly in the presence of saliva. • Extended release tablet or capsule: Designed to break down over time. These tablets should not be crushed, cut, or chewed because doing so may cause an overdose. Many acronyms are used.

Some examples of uses of dietary supplements include:

• Calcium and vitamin D for bone health and low vitamin D levels • Folic acid in pregnancy to prevent spina bifida • Iron for low iron levels • Fiber for constipation

Medical Assistant's Role in Preventing Drug Abuse.

• Carefully monitor patients who repeatedly call for prescription refills of controlled substances. Be aware that some patients will give aliases (false names). • Request health records from other facilities for patients who report previous prescriptions for scheduled drugs. • If the facility uses paper prescription pads, keep blank pads in a locked cabinet. They should be stored away from patient treatment areas. • Never use prescription pads for notepads. Never use preprinted or presigned forms. • Secure computers used for electronic health record (EHR) documentation to prevent patient access to prescription generation. • Keep only a limited supply of controlled substances on hand. • Keep accurate, complete records of controlled substances administered. Patients' records should contain information on prescribed and administered controlled substances.

To summarize the structural organization of the body, from simple to complex:

• Cells: The most basic unit • Tissues: Groups of similar cells from the same source that carry out a specific function • Organ: A structure made up of two or more types of tissues 68• Body system: Made up of several organs and their related structures • Organism: Made up of many body systems that work together to maintain homeostasis in the body

Decoding Terms

• Check for the word parts in a term. • Assign meanings to the word parts. • Reverse the meaning of the suffix to the front of your definition. • Define the term.

Documentation Guidelines (1)

• Check the name on the record and make sure the information being documented is recorded on the correct form in the correct patient's health record or, with an EHR system, that the correct information is recorded using the correct system prompts. Confirm the patient's identity by checking his or her birth date. • The month, day, and year must precede the entry; many facilities also require the time of the documentation. • All unusual complaints, symptoms, or reactions must be noted in detail. Include complete information about the onset (when the problem started), duration (how long episodes last), and frequency (how often episodes occur) of each reported sign and symptom.

Complementary and Alternative Medicine Therapies

• Chiropractic • Massage therapy • Acupuncture • Biofeedback • Meditation • Guided imagery • Healing touch • Natural products • Yoga, Tai Chi, or Qi Gong • Homeopathy • Naturopathy • Progressive relaxation • Hypnotherapy • Ayurvedic medicine

Wandering Baseline The medical assistant should:

• Clean the skin with alcohol and allow it to dry. Slightly abrade the skin with a gauze pad or fine sandpaper tape to help the electrodes stick to the skin. • Replace the electrode with a new one. Ensure the electrodes are not expired and the gel is not dried. • Make sure all electrodes and lead wires are firmly attached. • Make sure the baseline filter is turned on (if it is a feature of the machine).

Artifacts: fibers

• Clothing fibers often are long and twisted and sometimes are colored. Diaper fibers can be confused with casts • Plant fibers appear in the urine because of fecal contamination • Hair is distinct not only because of the visible rough look to the strand but also because of the large size • Air bubbles are common if the coverslip was improperly placed over the sediment. Air bubbles are structureless and refractile (refracting light, causing a glow) and have a dark outline

Viral diseases

• Common cold • Influenza A and B • Herpes • Infectious hepatitis (e.g., hepatitis B and C) • Acquired immunodeficiency syndrome (AIDS), which is caused by the human immunodeficiency virus (HIV)

How can a medical assistant use these traits when communicating with others?

• Consistently be polite and honest during your communication. Show sensitivity to others through your communication and behaviors. • Recognize the needs and rights of others. Attempt to reach a mutually beneficial resolution to the problem. • Assess your personal response to the situation. Your personal beliefs and biases should not prevent you from interacting diplomatically and tactfully with others.

Pathogenic bacteria can secrete toxic substances that do the following:

• Damage human tissues • Act as parasites inside human cells • Grow on body surfaces, disrupting normal functions

All prescriptions need to include this information:

• Date of issue (when it was written) • Patient information (name and address are required; date of birth is helpful) • Provider's full name and address • Drug name (e.g., amoxicillin) • Drug strength (e.g., 500 mg) 335• Dosage form (e.g., tablets) • Quantity prescribed (e.g., 14 [fourteen]) - writing out the number prevents people from altering the prescription. This is especially important with controlled substances. • Directions for use (e.g., take 1 tablet q 12 hr.) • Number of refills (e.g., Refills 0) • National Provider Identifier (NPI) and signature of provider (a manual signature is required for controlled substances) • Indicate if a generic is acceptable

The following are defense mechanisms she might display to protect herself from the psychological reality of her disease.

• Denial: The patient completely rejects the information. • Suppression: The patient is consciously aware of the information or feeling but refuses to admit it. • Reaction formation: The patient expresses her feelings as the opposite of what she really feels. • Projection: The patient accuses someone else of having the feelings that she has. • Rationalization: The patient comes up with various explanations to justify her response. • Undoing: The patient tries to reverse a negative feeling by doing something that indicates the opposite feeling. • Regression: The patient reverts to an old, usually immature behavior to vent her feelings. • Sublimation: The patient redirects her negative feelings into a socially productive activity.

Documentation Guidelines (2)

• Describe objective data, such as the presence of a wound, using correct anatomic medical terminology. • If the patient reports pain, record the quality and intensity of the pain using a pain scale of 1 to 10. • If the patient's comments are entered in the patient's own words, enclose them in quotation marks. • Document the complete medication history, including both prescription and OTC medications taken on a regular basis, the last dose taken of the medication, its effectiveness, and any other pertinent details. • Record details about the previous history of the current CC.

The appropriate antibiotic agent meets the following criteria:

• Destroys the infectious agent with a reasonable level of the drug • Is the least toxic to the patient • Has the least impact on normal flora of the body • Has the desired pharmacologic characteristics (preparation, route of delivery, effectiveness) • If possible, is the most economical for the patient

Some examples of medicinal plant sources include:

• Digitalis, an antiarrhythmic medication, comes from the purple foxglove flower. • Nicotine comes from tobacco leaves. • Quinidine, an antimalarial medication, comes from the bark of the cinchona tree.

The ONC states, There are currently three forms of HIE:

• Directed Exchange - The ability to send and receive secure information electronically between care providers to support coordinated care • Query-Based Exchange - The ability of providers to find and/or request information on a patient from other providers, often used for unplanned care • Consumer-Mediated Exchange - The ability of patients to aggregate and control the use of their health information among providers

When the results of the tests are obtained, a laboratory report is sent to the office. The laboratory reports can be sent in two ways:

• Directly from the referral laboratory to the patient's EHR • Electronically to the facility and then staff upload the electronic document to the EHR or print it out for the paper medical record

Pathology Terminology

• Disease: A specific illness with a recognizable group of signs and symptoms and a clear cause (e.g., infection, environment). • Syndrome: A group of signs and symptoms that occur together and are associated with a condition. • Disorder: A disruption of the function or structure of the body. Many times the words disorder and disease are used interchangeably in healthcare. • Prevalence: How often the disease occurs. • Incidence: Reflects the number of newly diagnosed people with the disease. • Morbidity: Illness. • Mortality: Death. • Acute: A severe, sudden onset of a disease. • Chronic: A disease, disorder, or syndrome that lasts longer than 6 months.

Additional Patient Instructions for At-Home 24-Hour Urine Collection

• Do not put anything but urine into the container. • Do not pour out any liquid or powdered preservative from the container. • If you accidentally spill some of the preservative on yourself, immediately wash with water and call the POL, provider's office, or testing laboratory. • Always keep the collection container cool. Refrigerate the container or keep it in an ice-filled cooler or pail. • Keep the cap on the container.

Solid Medication Forms (3)

• Effervescent tablet: Contains an acid substance and carbonate or bicarbonate. When placed in water, it releases carbon dioxide, creating a carbonated drink. • Lozenge (troche): Flat, round form containing active medication and a sweetened flavoring; dissolves on the tongue. Used for local treatment of the mouth and throat. • Powder: Nonpotent powdered medication that must be mixed with a liquid before it can be taken.

During the test:

• Electrodes and lead wires will be placed on the patient. A blood pressure cuff will be applied to the patient's arm. • The patient will begin to exercise slowly, and gradually the exercise difficulty will increase. • The provider should always be present during the test. If the patient has chest discomfort, dizziness, palpitations, or shortness of breath, the test will stop. Emergency supplies or a crash cart should be kept nearby in case of an emergency.

Amino acids are classified into three groups:

• Essential amino acids: Cannot be made by the body, thus must come from food eaten throughout the day • Nonessential amino acids: Can be made by the body from essential amino acids or in the normal breakdown of proteins • Conditional amino acids: Usually not essential, except in times of illness and stress

High-complexity: Each laboratory that performs these tests must do the following:

• Establish a system to maintain the identification of patients' specimens throughout the testing process and ensure accurate reporting of results. • Establish and follow written quality assurance, quality control, and standard operating procedures (SOPs). • Participate in proficiency testing, which is a form of external quality control. Three times a year, the laboratory must test samples provided by an approved proficiency-testing agency. The proficiency samples are tested in the same way as patient samples. Results are then reported to the proficiency-testing agency, and the accuracy of testing is verified. • Employ personnel that meet CLIA regulations and specific qualifications for a moderate- to high-complexity laboratory. Requirements are most rigorous for high-complexity testing.

It is important for the medical assistant to be familiar with the terminology used:

• Etiology: The cause of the disorder or disease. • Sign: An indicator that is measured or observed by others; also called objective data. Examples of signs include redness, swelling (edema), blood pressure, and pulse. • Symptom: An indicator that is only perceived by the patient; also called subjective data. Examples include pain, headache, dizziness, and nausea. Many times signs and symptoms are used interchangeably, but there is a difference in their definitions. • Diagnostic procedures: Tests and procedures that are used to help diagnose or monitor a condition.

Backup Systems for the Electronic Health Record: Three options are available for data preservation and backup (1)

• External hard drive. An external hard drive connects to the main computer, and with fairly simple programming it can copy the information in the EHR daily. Seven electronic folders, one for each day of the week, can hold the information from the previous day; these folders are replaced with new, updated information at designated periods. CDs and DVDs can hold daily data, and some thumb drives have enough capacity to perform this task. Once a habit of a daily backup to the external hard drive has been established, the method is relatively simple and reliable.

When it comes to giving injections, over time you will gain confidence and it will become easy. Always do the following:

• Follow the nine rights of medication administration. • Check the medication's label against the order three times. • Know about the medication you are giving. (What is it, why is it being ordered, how is it given, and what are the common side effects?) • Label all syringes with the name of the medication they contain. • Follow medical asepsis and the Bloodborne Pathogens Standard established by the Occupational Safety and Health Administration (OSHA). • Ensure that the needle is not directed at your hand holding the patient when giving an injection. Slight movement may cause a needlestick.

Four rules to follow when writing medication dosages in healthcare:

• Follow the number with the correct abbreviation for the unit of measure. Leave a space between the number and the abbreviation. Do not use a period with the abbreviations. • Correct examples: 2 mg, 10 mL, and 2 tabs • Incorrect examples: mg2, 10mL, and 2 tabs. • Write a fraction of a dose as a decimal. • Correct examples: 0.2 mg and 0.5 mg • Incorrect examples: mg and mg • If the dose is less than 1, place a zero to the left of the decimal point. This reduces the risk of misreading the dose as a whole number. • Correct examples: 0.75 mcg and 0.2 mL • Incorrect examples: .75 mcg and .2 mL • Do not place a decimal point and a zero after a whole number. This can be easily misread, and the patient would be given an overdose of medication. • Correct examples: 2 mL and 5 mL • Incorrect examples: 2.0 mL and 5.0 mL

Some of the areas overseen by the FDA include:

• Foods: Dietary supplements, bottled water, food additives, infant formula, and other food products • Drugs: Prescription drugs (brand name and generic) and nonprescription (over-the-counter) drugs • Biologics: Vaccines, blood, and blood products • Medical devices: Medical equipment (from simple [tongue depressor] to complex [heart pacemaker]), dental devices, and surgical implants

Simple Sugars

• Fruits and vegetables, which contain fructose and glucose • Milk and milk products, which contain lactose

Three options are available for data preservation and backup (2)

• Full server backup. The provider may want to back up the EHR system on a dedicated server, which is a large-capacity computer set aside specifically for the EHR system. With these servers, a full backup should be performed monthly. Many large medical facilities and hospitals have one or more dedicated servers for the EHR system.

To help promote professionalism when you first meet a patient, it is important to GIVE:

• G reet the patient. • I dentify yourself. • V erify the patient's identity by asking for the person's full name and date of birth. • E xplain the procedure to be performed in a manner that is understood by the patient.

Factors that may affect body temperature (2)

• Gender: Hormone secretions result in fluctuations of the core body temperature in women throughout the menstrual cycle. • External factors: Smoking, drinking hot fluids, and chewing gum can temporarily elevate an oral temperature. Environmental factors also can change body temperature. Cold weather tends to reduce body temperature, and hot weather tends to increase it.

Various factors contribute to a host's susceptibility:

• Genetic factors • Quantity of organisms • State of the individual's physical health • Stress • Poor health • Poor nutrition • Poor hygiene or crowded living conditions

Variables That Affect the Basal Metabolic Rate (BMR)

• Genetics: Some people are born with a higher metabolism. • Gender: Males have a higher density of lean muscle mass with a lower body fat percentage. This causes a higher BMR. • Age: BMR decreases with age. • Weight: The heavier an individual, the higher the BMR. • Body surface area: This relates to a person's height and weight. The larger the body surface area, the higher the BMR. • Body fat percentage: The lower a person's body fat percentage, the higher his or her BMR. • Diet: Starvation and low-calorie diets can decrease the BMR. • Body temperature: A higher body temperature results in an increased BMR. • External temperature: The colder the external temperature, the more the body has to provide additional heat to maintain the body's temperature. This increases the BMR. • Thyroxin: Produced by the thyroid gland, thyroxin can increase the BMR. • Exercise and lean muscle tissue: Exercise will create lean muscle tissue, which increases the BMR. • Drugs: Certain drugs (e.g., caffeine) can increase the BMR.

Various techniques can be used to reduce a patient's pain and anxiety about injections:

• Giving a sugar-coated pacifier or sugar water (must be ordered by the provider), which helps to soothe children under age 1 year after injections. • Applying a topical anesthetic skin refrigerant (e.g., Pain Ease), which works immediately. • Applying a topical anesthetic (e.g., EMLA cream) at the injection site, which works in about 30 to 40 minutes. • Talking with the patient to distract him or her from the procedure. • Having the patient move his or her toes or fingers on the extremity used when an IM injection is given. (Have a patient "play the piano" with his or her fingers when giving a deltoid injection.) • Using products that provide cold and vibration sensations (e.g., Buzzy), which overwhelm the nerves affected by the injection. • Administering the most painful injection last.

Cambodians

• Good health means the person is balanced; believe in the balance of hot and cold. • Illness may be seen as punishment for sins in a past life. • Typically use traditional healing practices before seeking conventional medicine. May use herbs, cupping and coining, acupuncture and acupressure. • They may not be interested in preventive care and screenings.

Health records are kept for five basic reasons: (5)

• To provide support for claims reimbursement. This is required by most insurance companies.

Bacterial Staining Properties

• Gram-positive cells contain a thick layer of PG, which looks deep blue/violet when stained with Gram stain. • Gram-negative cells contain a thin layer of PG, which looks pinkish red when stained with Gram stain. • Acid-fast cells contain a thin layer of PG surrounded by a thick layer of waxlike lipids (fats). Acid-fast bacteria do not stain well with a Gram stain, but they stain pink with the acid-fast stain.

Assisting the Provider

• Hand him or her instruments and equipment as requested, and provide supplies as needed. • Alter the position of the light source to better illuminate the area being examined and turn lights on and off during specific phases of the examination. • Position and drape the patient during different phases of the examination. • Assist in collecting and properly labeling specimens such as urine, Pap test specimens, and throat cultures. • Conduct any diagnostic tests preordered by the provider, including hearing and visual screenings. • Conduct follow-up diagnostic procedures as ordered, including an electrocardiogram (ECG, EKG), urinalysis, and phlebotomy. • Document patient data in the health record, completing all forms required. • Schedule postexamination diagnostic procedures, such as mammography, x-ray examination, or colonoscopy.

Standard Precautions include the following five elements:

• Hand hygiene • Use of PPE (e.g., gloves, gowns, masks, eye protection) • Safe needle practices • Safe handling of potentially contaminated equipment or surfaces in the patient environment • Respiratory hygiene/cough etiquette

Somatic tremor The medical assistant should:

• Help the patient relax. Cover the patient with a blanket if he or she is cold. • Remind the patient to not move or talk during the tracing. • Watch to see if there is a pattern with involuntary movements. Take the tracing when the movements lessen. • Use a larger exam table for the procedure. • If the machine has a muscle tremor filter, make sure it is turned on.

Complete Blood Count (CBC) Laboratory Reports

• Hematology reference ranges • The patient report form, which is a sample lab report, also identifies the lab's reference ranges. Lab reports, both electronic and paper, must supply their own reference ranges, along with each patient's results.

Documentation Guidelines (4)

• If documenting in a paper record: • Do all charting in black ink except for noting allergies in red ink; never use pencil. • Write in a clear, legible manner. • Do not leave any blank spaces on the paper record, and do not skip lines between documentation entries. • Never scribble, erase, or use whiteout on an error. For legal purposes, it is crucial that the corrected error be readable. • Correct the error by drawing one line through it. Write "error" above the corrected word or words and date and initial the correction. Then write in the correction. • If details are omitted, add information by documenting

Preparing Parenteral Medication

• If the medication looks abnormal in color or clarity, discard it. • Some medications will have precipitate at the bottom of the vial. If this is normal for that medication, make sure to mix it prior to withdrawing medication. If the precipitate is abnormal, a chemical reaction may have occurred. The vial needs to be discarded. • If the medication has expired, discard it. • If the medication is no longer sterile, discard it.

Vietnamese

• Illness is often explained by mystical beliefs. • Health is the balance between the hot and cold poles that govern the bodily functions. • Use alternative therapies, such as acupuncture, coining, spooning, and cupping.

Several types of numeric filing systems can be used:

• In a straight, or consecutive, numeric system, patients are given consecutive numbers as they first start using the practice. • In a terminal digit system, patients also are assigned consecutive numbers, but the digits in the number usually are separated into groups of twos or threes and are read in groups from right to left instead of from left to right. • Middle-digit filing begins with the middle digits, followed by the first digits, and finally by the terminal digits. Numeric filing requires more training.

Healthcare providers use six methods to examine the human body:

• Inspection • Palpation • Percussion • Auscultation • Mensuration • Manipulation

The Body's Natural Protective Mechanisms

• Intact skin serves as a natural barrier to disease. • Mucous membranes lining the openings of the body help protect underlying tissues and trap foreign substances. • Tiny, hairlike projections, called cilia, line the respiratory tract and move in a coordinated upward motion to expel trapped foreign substances. • Trapped substances can be expelled with sneezing and coughing before the organisms invade underlying tissue. • Some body secretions, such as tears, have antimicrobial properties that help destroy invading pathogens. • The natural pH of many of the body's organs discourages the growth of microbes. The acidic pH of urine, the vaginal mucosa, and the stomach helps prevent pathogenic invasion. The body's resident microbes create and maintain this environment.

Additional features commonly seen in both types of ECG devices:

• Interpretive software: Assists providers with reading the tracing. • Bluetooth or Wi-Fi capacity: Allows the ECG to be sent to providers and printers and to be uploaded into an electronic health record (EHR). • Thermal printers • Spirometer

Examples of minerals include:

• Iron is used to treat iron-deficiency anemia. • Iodine is an antiseptic. • Zinc is used as a supplement and is found in topical pastes for wounds. Minerals and microbiologic substances are other natural sources of medications. One microbiologic source is Penicillium chrysogenum. This is a fungus that creates penicillin.

ECG Terminology

• Isoelectric line: A straight line that is also called the baseline. It represents a period of time with no electrical activity. • Deflection: Any movement away from the baseline in the tracing. The deflections reflect the heart's electrical flow. Upward movement is called a positive deflection. Downward movement is a negative deflection. • Wave: A deflection from the baseline. • Complex: A form made up of many waves (e.g., QRS complex). • Segment: A part of a line between two points (e.g., the ST segment starts at the end of the S wave and ends at the start of the T wave). • Interval: A period of time between two points or events. During an interval, many waves can occur.

Some object to this added step and overlook the advantages of numeric filing:

• It allows unlimited expansion without periodic shifting of folders, and shelves are usually evenly filled. • It provides additional confidentiality to the record. • It saves time in retrieving and filing records quickly. One knows immediately that the number 978 falls between 977 and 979. By contrast, an alphabetic system, even with color coding, requires a longer search to locate the exact spot.

If new patients must complete a lengthy form, there are several options:

• It can be mailed to the patient. The accompanying letter can request that it be completed and returned to the provider before the appointment. • If the record is electronic, the patient may access his or her record through a patient portal. Using this method, the information is documented directly into the EHR system. It would then be reviewed by the medical assistant and provider during the office visit. • Another option with an EHR is for the patient to complete a paper form, and the medical assistant enters the information into the EHR while reviewing the form with the patient.

Parenteral medication administration has several advantages:

• It is useful when the patient has gastrointestinal distress or is unconscious. • It offers good absorption compared with other routes, such as the oral route. • The onset (time medication starts working) is more rapid than with other routes. • Some types of parenteral medications have a longer duration time (time it works in the body).

Hmong

• Lack words in native language for medical terms and some body organs. • May seek care from folk medicine doctors and shaman. • Herbs, massage, coining or spooning, and cupping can be used. • Accessories may be worn around wrists, necks, or ankles for health or religious reasons. • Respecting older family members is very important. Often oldest male in the family is the decision maker. Extended family is very important. • Eye contact is considered rude. • Touching the head of a child is not accepted. The head is considered sacred.

Helpful Listening Guidelines

• Listen to the main points in the discussion. • Respond to both verbal and nonverbal messages. • Be patient and nonjudgmental. • Do not interrupt. • Never intimidate the patient. • Use active listening techniques: restatement, reflection, and clarification.

Several staging systems are used, and various factors must be taken into consideration with staging systems:

• Location of the tumor • Type of cell • Size of the tumor • If it has spread to nearby lymph nodes 80• If it has spread to other locations in the body • Tumor grade, or how abnormal the cells look compared with normal cells and how quickly the tumor grows and spreads

Patients with fever usually have the following indicators:

• Loss of appetite (anorexia) • Headache • Thirst • Flushed face • Hot skin • General malaise

EHR systems must:

• Maintain the security and confidentiality of data • Be easily retrievable • Have safeguards against the loss of information • Protect patients' rights to confidentiality and privacy • Require identification and authentication for access Legal and Ethical Issues: The record belongs to the provider; the information belongs to the patient.

How can the medical assistant treat others with courtesy and respect?

• Make patients feel welcome and respected. A pleasant greeting and eye contact should be the first things patients experience. Thanking patients at the end of the visit is also important. • Display positive nonverbal behaviors. Use a calm tone of voice, eye contact when appropriate, and provide privacy for patients. Maintain patient confidentiality. • Learn about other cultures in your area. When working with patients from those cultures, make sure to avoid gestures, words, and behaviors that could be perceived as disrespectful. • Always use proper grammar, without slang words. Explain medical treatments and conditions in simple lay language. If you need to use a medical term, explain it to the patient.

Special Considerations When Giving Enoxaparin (Lovenox):

• Make sure the drug is clear and colorless or pale yellow. • Do not push any air or drug out of the syringe before giving the injection unless your healthcare provider tells you to. The air allows the medication to enter slower, reducing the risk of bruising. • Using your finger and thumb, pinch a fold of skin 1 to 2 inches away from the umbilicus in the lower abdomen. Push the entire needle into the skin. Press down on the syringe plunger and inject the medication. Hold the pinched skin the entire time during the injection. Remove the needle. Do not rub or massage the site after the injection. Hold pressure to the site after the injection until the bleeding has stopped.

In ambulatory care, the following intradermal injections may be given:

• Mantoux tuberculin skin test (TST) • Intradermal flu vaccine (e.g., Fluzone Intradermal) • Allergy testing

Hispanics/Latinos

• May have strong family and religious beliefs. Family is respected and plays an important role. May view an illness as God's will. • May use home remedies or folk healer's advice over conventional medicine. • Sickness is caused by a person having too much heat or cold. Foods and herbs are used to bring back the balance. (Heat and cold are not temperature related.) Cold diseases have more unseen symptoms, such as a chest cold and an earache. Hot diseases have more visible symptoms, such as vomiting, fever, and sore throat. • Males often answer questions and give consent. Make sure to address the patient also. Friendliness and respectfulness are very important.

Native Americans

• May place a lot of value in family and spiritual beliefs. • State of health occurs when living in total harmony with nature. Illness is the imbalance between the person and nature. • May use a traditional tribal medicine person. • Often avoid direct eye contact out of respect and concern for the loss of one's soul.

Chinese

• May use acupuncture, massage, and herbs, seeking care from traditional practitioners for less severe illnesses. • Respectful of elders, teachers, and healthcare professionals. May affect how a person interacts and discusses health topics with the healthcare professional. The person may not ask questions or discuss concerns.

Russians

• May view healthcare with some mistrust, based on past experience. • May not be used to asking questions and participating in a discussion with a provider. • Some practice home remedies and bonki. Bonki is practiced by pressing glass cups against the person's shoulders to ease the symptoms. Bruising can occur, which should not be confused with abuse. • Family likes to receive news about patient's condition and prognosis and may not give bad news to the patient. This lessens the person's anxieties and promotes calmness.

Examples of soluble fiber foods include the following:

• Nutrient-rich: Legumes, oats, barley, fruits (e.g., avocados, apples, and citrus fruits) and carrots • Non-nutrient rich: Processed and refined goods

Insoluble fiber bulks up the stool and helps to prevent constipation. Examples of insoluble fiber include the following:

• Nutrient-rich: Whole grains (whole wheat and brown rice), vegetables (corn, broccoli, green beans, cauliflower, and potato with skins), nuts and seeds, popcorn, and prunes • Non-nutrient rich: Processed and refined goods

Several factors should be considered when selecting filing equipment:

• Office space availability • Structural considerations • Cost of space and equipment • Size, type, and volume of records • Confidentiality requirements • Retrieval speed • Fire protection • Cost

Semisolid Medication Forms

• Ointment and paste: Semisolid, greasy drug preparations that are applied to the skin, rectum, or nasal mucosa. Pastes are thicker and less penetrating than ointments. • Cream: Semisolid drug preparation made of active medication, oil, and water. • Suppository and pessary: Active medication mixed in an oil base (e.g., cocoa butter). Solid at room temperature but melts at body temperature. Suppositories are typically shaped like a small bullet and used in the rectum, urethra, or vagina. Pessaries are vaginal suppositories.

Capillary puncture is warranted for the following patients:

• Older adult patients • Pediatric patients (especially younger than age 2) • Patients who require frequent glucose monitoring • Patients with burns or scars in venipuncture sites • Obese patients • Patients receiving intravenous (IV) therapy or chemotherapy • Patients who have had a mastectomy • Patients at risk for venous thrombosis • Patients who are severely dehydrated • Patients who are undergoing tests that require a small volume of blood (i.e., some CLIA-wiaved tests)

Three options are available for data preservation and backup (3)

• Online backup system. An online backup system can be used, usually for a subscription fee. Although the cost may be higher than for some other methods, online systems are easy to use because there is no external drive to carry and no CD or thumb drive to put through the process of downloading data. However, time investment is involved, because the process of contacting the company that offers the service and then downloading all the data takes several hours. Also, the initial download can take quite a while. Even so, an online system is stable and reliable.

Drug Destruction

• Only part of the medication is used for the patient, and the extra amount must be destroyed. • The patient refuses the medication after it has been opened and prepared. 324• The medication is accidentally contaminated before it can be administered.

The following are commonly used routes:

• Oral (po): Medications taken by mouth. • Sublingual (SL): Placed under the tongue to dissolve; absorbs quickly into the bloodstream. • Buccal: Placed between the cheek and the gums dissolve and absorb quickly. • Intramuscular (IM): Injected into the muscle. The greater the number of blood vessels in the muscle, the quicker the absorption. • Subcutaneous (subcut): Injected just below the skin; moves into the capillaries or the lymphatic vessels and is brought to the bloodstream. This process is slower than the absorption of intramuscular drugs. • Intravenous (IV): Injected directly in the bloodstream and has the fastest absorption rate.

Time Management Strategies

• Organize and review your daily "to do" list. If you honestly believe you can't possibly get everything that is a priority done, ask for help. It is better to admit you can't do it all than to ignore a task that is important. • Brainstorm with your peers about ways to achieve all the tasks facing everyone each day. Maybe someone can come up with a unique way to solve a problem; but if not, at least all of you will be on the same page. • Make a master list of important tasks so nothing is forgotten. • Try to accomplish like tasks in the same block of time. If you have phone calls to return or insurance referrals to complete, do both at the same time to be more efficient. • At the end of each day, create a new "to do" list for the next day so that nothing important is forgotten.

Disadvantages of parenteral medication administration:

• Pain with the injection • Risk for infection due to the injection • An unpredictable absorption rate for those with poor circulation (e.g., patients with peripheral artery disease, diabetes, obesity, or Raynaud disease)

A laboratory request form, paper or electronic, must be completed for all specimens that will be transported to another site for analysis:

• Patient's name and the date • Type of urinalysis ordered • Name of the provider requesting the examination • Appropriate Current Procedural Terminology (CPT) code for the diagnosis • A line on which the provider signs after he or she has reviewed the results

Some specific tasks are beyond the scope of practice of medical assistants, including the following:

• Performing telephone or in-person triage; medical assistants are not legally authorized to assess or diagnose symptoms • Prescribing medications or making recommendations about over-the-counter drugs and remedies • Giving out drug samples without provider permission • Automatically submitting refill prescription requests without provider orders • Administering intravenous (IV) medications and starting, flushing, or removing IV lines unless permitted by state law • Analyzing or interpreting test results 6• Operating laser equipment • Performing laboratory tests that are not CLIA-waived • Ordering diagnostic or radiographic tests/procedures

Venipuncture Equipment

• Permanent marker • Alcohol wipes • Gauze • Hypoallergenic self-stick wrap, tape, or bandages • Nonlatex tourniquets • Double-pointed safety needles • Winged infusion sets (butterfly needles) • Disposable needle holders • Evacuated, stoppered tubes • Syringes and removable needles with safety devices • Biohazard sharps container • Biohazard waste container

Types and Signs of Elder Abuse and Neglect

• Physical abuse: Fractures, rope marks, cuts, bruising, dislocations, broken glasses, giving too little or too much medication, bleeding, and sudden changes in the person's personality or behavior • Sexual abuse: Unexplained sexually transmitted infections, bruising in the genital region, and reports from the older person • Emotional abuse: Not communicating, withdrawn, agitated, and symptoms that mimic dementia • Neglect: Malnutrition, dehydration, lack of proper living conditions, and failing to treat health problems • Abandonment: Leaving the person in a public place • Financial abuse: Stealing from the older person, forging signatures on financial transactions, and any other illegal action that represents a financial loss for the older person

The final analysis of a microscope slide must be made by one of the following personnel:

• Physician (medical doctor, doctor of osteopathy, or doctor of podiatric medicine) • Midlevel practitioner (nurse midwife, nurse practitioner, or physician's assistant) • Dentist (doctor of dental surgery or doctor of dental medicine) trained as a laboratory professional with CLIA moderate- or high-complexity training

Proper patient care demands attention to detail in all three areas of the testing process:

• Preanalytic: Proper care of the testing supplies and equipment, and proper patient identification and specimen collection • Analytic: Running the tests according to the specific manufacturer's instructions; recording and analyzing the controls and the patient results • Postanalytic: Proper disposal of biohazard supplies; routing of test results to the provider and patient

Pregnancy and Lactation Labeling Rule: The system consists of three subcategories with detailed information about the following:

• Pregnancy: Includes information on the risks during pregnancy for the mother and baby, in addition to data on the risk of adverse developmental outcomes. • Lactation: Includes information on the presence of the drug in breast milk, the effects on a breast-fed child, and the impact on milk production. • Females and males of reproductive potential: Includes information about when pregnancy testing or contraception is required during drug therapy and data that suggest drug-associated fertility effects.

There are eight common uses of drugs:

• Prevention: Drugs used to prevent diseases. Example: vaccines are given, and the body creates antibodies to protect against specific diseases. • Treatment: Drugs that relieve the symptoms while the body fights off the disease. Example: acetaminophen brings down a fever (antipyretic), while the body fights off a viral infection. • Diagnosis: Drugs used to diagnose or monitor a condition. Example: contrast medium (radiopaque dye) is given to highlight organs on x-rays. • Cure: Drugs that eliminate the disease. Example: amoxicillin, an antibiotic, is used to cure strep throat. • Contraceptive: Drugs used to prevent pregnancy. Example: Depo-Provera is a contraceptive injectable medication. 319• Health maintenance: Medications used to maintain or enhance health. Examples: vitamins and minerals. • Palliative: Drugs that do not cure or treat the disease but improve the quality of life. Example: Morphine, an analgesic, is commonly used by patients with cancer. • Replacement: Drugs used to increase the blood levels of naturally occurring substances in the body. Example: levothyroxine is used for patients with hypothyroidism.

Types of Healthcare Facilities (Hospitals) 1

• Primary level of care • Smaller city or community hospitals • Usually serve as the first level of contact between the community members and the hospital setting • Secondary level of care • Both PCPs and specialists provide care • Larger municipal or district hospitals that provide a wider variety of specialty care and departments • Tertiary level of care • Referral system for primary or secondary care facilities • Provide care for complicated cases and trauma • Medical centers, regional and specialty hospitals

Current active safety needles fall into two groups:

• Protective sheaths and hinged needle shields: The safety device is a sleeve over the syringe barrel or a hinged needle shield. These devices are moved over the needle after the injection. Once in place, the needle cannot be uncovered. The risk of needlesticks decreases if the safety device is activated with the hand holding the syringe. • Retractable needles: After the injection, the healthcare professional activates a device that retracts the needle either into the syringe or into another chamber.

Elements that should be in the documentation include the following:

• Provider ordering the medication • Assessment done (e.g., vital signs or pain level) • Allergies • Coaching/instructions given to patient (includes the edition date of the VIS for vaccine teaching) • Name of medication (e.g., acetaminophen) • Dose given (e.g., 650 mg) • Route given (e.g., po) • Lot number, expiration date, and manufacturer (usually only required for vaccines and controlled substances) • How the patient tolerated the medication • Additional information as needed (e.g., patient is resting on exam table) • Signature if the note is handwritten (an electronic health record [EHR] uses automatic signatures for documentation entries)

Laboratory Requisitions and Reports

• Provider's name, account number, address, and phone number • Patient's full name, age, date of birth, gender, address, and insurance information • Source of specimen • Date and time of collection, and initials of the person collecting the specimen • Specific test (or tests) requested • Medications the patient is taking • Whether the patient fasted or followed dietary restrictions if required; time of last intake • Possible diagnosis • Indication of whether the test is to be performed STAT

Refined Grains

• Refined grains: Are milled, and the bran and germ are removed to create a finer texture and longer shelf life. Examples include white flour, degermed cornmeal, white rice, and white bread. During the milling process, dietary fiber, iron, and many B vitamins are removed. For this reason, most refined grains are enriched. This means certain B vitamins and iron are added back to the grains. Fiber is not added back into the product.

Discarding Medications in the Healthcare Facility

• Return expired controlled substances to the place from which they were received (e.g., manufacturer), accompanied by the proper paperwork. • Flush liquids down the sink. • Flush pills down the toilet. • Mix powdered medications with water and flush them down the toilet. • Flush fluid from syringes down the sink and discard the syringe in a biohazard sharps container.

Bacterial Shapes

• Round bacteria are called cocci. • Rod-shaped bacteria are called bacilli. • Spiral-shaped bacteria are called spirilla. Tightly coiled spirilla are called spirochetes.

The rate of absorption is influenced by the following factors:

• Route: Oral medications need to pass through the gastrointestinal (GI) tract. This takes time. They start working faster than drugs given by other routes. • Blood flow to the absorption area: Medication given by the sublingual and buccal routes is absorbed quickly into the bloodstream. The muscle tissue has more blood vessels than the subcutaneous tissue. • Ability of the medication to be absorbed: Liquid medications are easier to absorb than solid medications. Solid medications need to be broken down before they absorb. • Conditions at the site of the absorption: Some medications must be taken with food, which can slow the absorption of the medication. The intestines provide more surface area than the stomach for the absorption of medications.

Five types of medication order:

• Routine order • Standing order • PRN order • Single order or one-time order • Stat order

SOAP

• S ubjective impressions or patient reports • O bjective clinical evidence or observations • A ssessment or diagnosis • P lans for further studies, treatment, or management SOAP Progress Notes. The SOAP method keeps information organized and in a logical sequence. An actual progress note would include the provider's or medical assistant's signature or initials after each entry.

Risk Factors for Skin Cancer

• Skin that is lighter than normal skin color; burns, freckles, or reddens easily; becomes painful in the sun • Family or personal history of skin cancer • History of sunburns (especially early in life) or indoor tanning • Exposure to sun through work or play • Green or blue eyes • Red or blond hair • Certain types and a large number of moles

Medications that cannot be crushed:

• Slow- or extended-release tablets: Crushing, chewing, or cutting the tablet can cause a person to get the dose faster than he or she should, resulting in an overdose. • Enteric-coated tablets: Crushing, chewing, or cutting the tablet causes the protective nature of the coating to be lost. The person could have more stomach distress.

In the POL, the most common hazardous chemicals are as follows:

• Sodium hypochlorite, commonly known as bleach, which is used for disinfecting laboratory work areas • Caviwipes and glutaraldehyde, which are disinfectants • Acetone and dyes, which are used for staining slides

Solid Medication Forms (1)

• Tablet: Solid formed by compressed powdered medication; may be coated. • Chewable tablet: Designed to be chewed prior to swallowing. • Caplet: Coated, oval medication tablet. • Capsule: Medication in a hard or soft gelatin shell. • Scored tablet: A notched tablet, which can be split into half with a pill cutter or splitter. • Enteric coated tablets or capsules: Coated to pass through the acidic environment of the stomach. Breaks down in the base environment of the intestines. These tablets should not be crushed, cut, or chewed because the protective property will be lost.

Other anatomic defense mechanisms

• Tears • Cilia • Mucous membranes • pH of body fluids • Defecation and vomiting

Alphabetic filing does have some drawbacks:

• The correct spelling of the name must be known. • As the number of files increases, more space is needed for each section of the alphabet. This results in periodic shifting of folders to allow for expansion. • As the files expand, more time is required for filing or retrieving each folder because of the greater number of folders involved in the search. The time can be greatly reduced by color coding.

Problem-Oriented Records (POR) Components

• The database includes the chief complaint, present illness, patient profile, review of systems, physical examination, and laboratory reports. • The problem list is a numbered, titled list of every problem the patient has that requires management or workup. This may include social and demographic troubles in addition to strictly medical or surgical ones. • The treatment plan includes management, additional workups needed, and therapy. Each plan is titled and numbered with respect to the problem. • The progress notes include structured notes that are numbered to correspond with each problem number.

the medical assistant must document the following in the patient's health record:

• The edition date of the VIS. This is found on the back of the document in the bottom right corner. Make sure to have the latest edition of the VIS. • The date the VIS was provided and the date the vaccine was administered (usually the two are done on the same day). • The office address, name, and title of the person who administered the vaccine. • The vaccine's manufacturer and lot number.

Common Causes of Errors in Blood Pressure Readings

• The limb used for measurement is above the level of the heart. • The bladder in the cuff is not completely deflated before a reading is started or retaken. • The pressure in the cuff is released too rapidly. • The patient is nervous, uncomfortable, or anxious (may cause a reading to be higher than the patient's actual blood pressure). • The patient drank coffee or smoked cigarettes within 30 minutes of the blood pressure measurement. • The cuff was applied improperly. • The cuff is too large, too small, too loose, or too tight. • The cuff was not placed around the arm smoothly. • The bladder is not centered over the artery, or the bladder bulges out from the cover. • There was a failure to wait 1 to 2 minutes between measurements. • Instruments are defective: • Air leaks in the valve • Air leaks in the bladder • Aneroid needle not calibrated to zero

Microscopes have three components:

• The magnification system, which focuses the image • The illumination system, which brings the image from the slide to the viewer • The framework, which includes all components responsible for positioning the slide.

Tips on Patient Education Materials

• The material should be written in lay language at a sixth- to eighth-grade level to promote understanding. • Good pictures can help patients understand the information. • Information should be well organized and clearly described. • All material should be checked for accuracy. (Providers will request to approve the information ahead of time.) • Handouts should be attractive and professional. • Copies should be available in languages other than English when possible and in large print for visually impaired clients. • Do not use disease information literature from medical and pharmaceutical companies that includes advertising of their products. (This type of information can create confusion, if the patient is not using the product advertised.)

The log typically requires:

• The medication information (name, dose, lot number, and expiration date) • The ordering provider's name • Information on the patient receiving the medication (name, date of birth, address, health record number, etc.) • The name or initials of the healthcare professional administering the medication The log must be kept separate from the patient's health record. The medication must also be documented in the patient's health record after it is administered.

Why the test is ordered?

• The patient is starting an exercise program. • The patient has angina that is getting worse. • To evaluate the patient's heart after an angioplasty or bypass surgery. • To evaluate heart rhythm changes with the stress of exercise.

Preparation for the test:

• The patient should wear clothes and shoes for exercising. • The provider will indicate what daily medications should be taken prior to the test. • The patient should not take a dose of Viagra, Cialis, or Levitra for erectile dysfunction 48 hours before a stress test. • The patient should not smoke or consume caffeine or alcohol 3 hours before the test. • The patient signs a consent form prior to the test.

This is when you use various therapeutic communication techniques to determine the following:

• The reason the patient is seeking healthcare • The patient's perception of the problem • The characteristics of the problem • The patient's expectations of care

Most microscopes have four objectives, each with a different magnifying power:

• The shortest objective has the lowest power (4×) and is called the scanning lens. This lens is used to scan the field of interest and then focus on a particular object. • Greater detail is observed with the next longest objective, which is low power (10×). • The high or high dry objective usually has a magnification of 40× or 45× • The longest objective, oil immersion (100×), allows the finest focusing of the object and requires the use of a special oil that is placed directly on the slide. This special oil, called immersion oil, prevents refraction of the light and improves the resolution (clarity) of the magnified image. Oil immersion is used to view cells and extremely small materials (e.g., bacteria and platelets) and to examine stained specimens.

Handling, Processing, and Storing Specimens

• The storage temperature of the specimen should follow manufacturer's testing requirements. • Serum must be separated from red blood cells as soon as possible after the specimen has clotted to prevent changes caused by the metabolism of the blood cells. • Specimens for chemistry and liver panels may need to be protected from light. • Specimens may need to be frozen to prevent chemical constituents from changing. Follow manufacturer's guidelines for freezing a specimen. • Manufacturer's package inserts or reference laboratory specimen requirements should be consulted to ensure that each specimen is handled and processed properly.

Limitations of Reagent Strip Testing

• The test strip is soaked in the specimen, and chemicals in the pads may be overly diluted. • The test strip is not held horizontally while read, and colors from one pad may bleed onto another. • The test pads on the strip are not read at the proper time, or the chemical reaction may be read incorrectly. • Certain chemicals, such as vitamin C, also called ascorbic acid, may affect the results of nitrite, glucose, bilirubin, and blood tests. Normal levels of vitamin C do not interfere with routine urinalysis, but large amounts can alter test results.

Chemical Labels

• The top diamond is red and indicates flammability (the potential to catch on fire). • The diamond on the left is blue and indicates a health hazard such as a dangerous inhalant or corrosive acid. • The bottom diamond is white and provides special hazard information, including recommended personal protective equipment (PPE) if biohazards are present, and other dangerous situations. • The diamond on the right is yellow and indicates a reactivity or stability hazard. An example of reactivity is mixing an acid (e.g., bleach) with a base (e.g., ammonia), creating a dangerous gas.

Urinalysis Urine is analyzed for several reasons:

• To detect diseases or disorders in which the kidneys are working normally but are excreting abnormal substances that are the result of an imbalance of homeostasis in the body. An example would be an individual with diabetes mellitus who is excreting glucose. • To detect diseases or disorders of the kidneys or urinary tract. Examples would be the presence of kidney stones or a urinary tract infection (UTI). • To detect medications or drugs that are excreted by the kidneys.

Laboratory tests are used for four main purposes:

• To document the good health of a patient • To screen patients for diseases and conditions such as diabetes, high cholesterol, or urinary tract infections (UTIs) • To help the provider diagnose a medical disease, disorder, or condition • To help the provider decide the most appropriate treatment, to monitor the effects of medications and treatments, and to monitor a disease process

Health records are kept for five basic reasons: (2)

• To provide critical information for others. By reading through the record and discovering the methods used to treat the patient, healthcare professionals can provide continuity of care . Each provider knows what services have been provided and can continue the care, even from one facility to another.

Health records are kept for five basic reasons: (3)

• To provide legal protection for those who provided care to the patient. A well-documented health record is excellent proof that certain procedures were performed or that medical advice was given. An accurate record is the foundation for a legal defense in cases of medical professional liability. This is one reason that writing legibly in the paper record to document exactly what happened to the patient and the provider's response are critical. Remember: If it is not documented, it did not happen.

Health records are kept for five basic reasons: (4)

• To provide statistical information that is helpful to researchers. The patient's record provides information about medications taken and the reactions to them. Health records may be used to evaluate the effectiveness of certain kinds of treatment or to determine the incidence of a given disease. Providers often take part in drug studies that track adverse reactions and side effects. The effects of various treatments and procedures also can be tracked, and statistics gathered from patients' records. When statistical information is tracked, the patient-specific data are removed. This information may result in a new outlook on some phases of medicine and can lead to revised techniques and treatments. The statistical data from health records also are valuable in the preparation of scientific papers, books, and lectures.

Importance of Accurate Health Records Health records are kept for five basic reasons: (1)

• To provide the best possible medical care for the patient. The provider examines the patient and enters the findings in the patient's health record. These findings are clues to the diagnosis. The provider may order many types of tests to confirm the clinical findings. As the reports of these tests come in, the findings fall into place, much like the pieces of a jigsaw puzzle. With these data, the provider can prescribe treatment and form an opinion about the patient's prognosis. The health record provides a complete history of all the care given to the patient.

Uncapping and Recapping Needles

• To uncap: Hold the cover between the fingers and thumb of your nondominant hand. Hold the syringe with the fingers and thumb of your dominant hand. Pull your hands apart horizontally (side to side) in a smooth continuous motion. • To recap: Use the one-handed scoop technique. Place the cover on a firm, flat surface. If the cover rolls, place a finger of your nondominant hand at the far end of the cover. This will keep the cover in place. Carefully insert the needle into the cover. If the needle touches the outside surface of the cover or any other surface, it is contaminated and must be replaced. Scoop up the cover and secure the cover onto the needle

Common diseases caused by bacteria

• Tuberculosis • Urinary tract infections • Pneumonia • Strep throat

AC Interference The medical assistant should:

• Unplug the ECG machine. • Unplug or remove nearby electrical devices (e.g., laptops, pagers, cell phones). • Separate the lead wires so they do not overlap. • Move the table away from the wall or move to another room for the procedure. • Ensure cell phones are not near the procedure area.

When prioritizing your tasks, use a code system to indicate when they need to be done. For instance:

• Use an "M" for tasks that must be done that day. • Use an "S" for tasks that should be done that day. • Use a "C" for tasks that could be done if time permits.

Three main components of meaningful use can be identified:

• Use of certified EHR technology in a meaningful manner, such as e-prescribing • Use of certified EHR technology for electronic exchange of health information to improve the quality of healthcare • Use of certified EHR technology to submit clinical quality reports, procedure and diagnosis codes, surveys, and other measures

Patient Education for a Holter Monitor Test

• Wear the monitor continuously. The monitor will be removed during your appointment in 24 to 48 hours. • While wearing the Holter monitor, avoid metal detectors, large magnets, high-voltage areas, x-rays, and electric blankets. Do not get the monitor wet (e.g., no bathing, showering, or swimming). • Keep a detailed journal of the symptoms experienced. These symptoms could include chest pain, shortness of breath, palpitations or changes in the heartbeat, dizziness, or fainting. Document: • Date and time • Symptoms experienced • Activity being done at the time • At the return visit, the provider will look at the tracing for abnormalities. The journal of timed activities will help the provider identify what is occurring. • What to do if the electrodes or lead wires fall off. • Who to contact in case of questions or if problems occur.

Metric System

• Weight is measured in grams (g). • Volume is measured in liters (L). • Length is measured in meters (m). Gram, liter, and meter are called root words. Prefixes are added to the front of root words to indicate the size of the unit.

Patients may not receive a live virus vaccine if they meet the following conditions:

• Were vaccinated with another live virus vaccine less than 28 days earlier. • Are pregnant or may become pregnant in the next month. The human papillomavirus (HPV) vaccine is also contraindicated with pregnancy. • Are immunocompromised (e.g., cancer, leukemia, HIV/AIDS). • Are receiving chemotherapy or high-dose steroid therapy. • Recently received a blood transfusion, immune (gamma) globulin, or antiviral medication.

Singular/Plural Rules

• When a singular form of a word ends with -a, keep the -a and add an -e. • When a singular form of the word ends with -ax, drop the -x and add -ces. • When a singular form of the word ends with -ex or -ix, drop the -ex or -ix and add -ices. • When a singular form of the word ends with -is, drop the -is and add -es • When a singular form of the word ends with -us, drop the -us and add -i. • When the singular form of the word ends with -um, drop the -um and add -a. • When the singular form of the word ends with -y, drop the -y and add -ies. • When a singular form of the word ends with -x, drop the -x and add -ges.

Documentation Guidelines (3)

• When entering information in the medical record, sign the entry, including the appropriate initials after your name (e.g., CMA). • Learn to be observant and to note anything that seems pertinent. • Use accurate abbreviations, symbols, and terminology • Review your documentation immediately after completion so that you can detect errors while the information is fresh in your mind. • The electronic record system will automatically track any corrections made to the original documentation entry.

Symptoms of Oral Cancer

• White or red patches in the mouth or on the gums, tongue, or lips • Numbness or pain in the mouth; pain with chewing or talking • Long-term hoarseness or sore throat • Swelling in the jaw area or constant earache • Bleeding in the mouth or a long-term sore • Feeling of a lump or something stuck in the throat

There are several techniques used to prepare the skin:

• Wipe the area with an alcohol pad to clean it. This helps to remove sweat and lotion that may prevent the electrodes from adhering to the skin. • Use a razor to shave chest hair. Obtain the patient's verbal consent before shaving the chest. • Gently abrade the skin, using a gauze sponge, special gel, or special fine sandpaper tape

When replacing a patch or teaching a patient to use transdermal patches, follow these steps:

• Write the date and time on the new patch. • Wear disposable gloves if changing a patch on another person. • Remove the old patch. Fold the sticky sides together and discard. If the old patch is not removed, the person may be at risk for an overdose. • Remove any residual medication from the skin using a tissue. • Decide where to apply the new patch. Select a different location. Depending on the medication, it may be on the shoulder, back, upper arm, lower abdomen, or hip. Clean and dry the new site. • Remove the protective liner on the patch. Do not use torn patches. Do not touch the sticky side of the patch. • Place the patch's sticky side on the skin. Press down on the patch to ensure it adheres to the skin. Make sure the patch is smooth, without folds.