Module 3 - Patient Intake And Vitals
Factors That Can Influence Blood Pressure and Cause Hypertension
- An increase in blood volume can increase a person's blood pressure, while a decrease in blood volume can decrease a person's blood pressure - Peripheral resistance can increase blood pressure. The lumen of the blood vessels becomes smaller, making it more difficult for blood to pump through the blood vessels, causing an increase in blood pressure - The overall condition of the heart muscle impacts blood pressure. When the heart muscle gets overworked and becomes weakened, it is unable to contract and provide the force it needs to pump the blood effectively, and the pressure in the vessels tends to increase to maintain an adequate level of circulating blood and oxygen to meet the supply and demand of nutrients the body needs.
Common Causes of Errors and Troubleshooting Blood Pressure Readings
- The limb used for measurement is positioned above the heart rather than at the heart level - 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 or anxious - The patient drank coffee or smoked a cigarette within 30 minutes of the blood pressure measurement - The cuff is applied improperly - The cuff is too large, too small, too loose, or too tight - The bladder is not centered over the artery, or the bladder bulges out from the cover - There was a failure to wait for 1 to 2 minutes between measurements - The instrument is defective: - Air leaks in the valve - Air leaks in the bladder - Aneroid needle not calibrated to zero Contraindications for limb selection: - One-sided mastectomy: Use the arm on the side not impacted by the mastectomy. - Bilateral mastectomy: Use leg. - Lymphedema: Use leg. - Dialysis fistula: Use arm that is not affected.
Place the steps in the correct order.
1) The MA introduces themselves and explains the procedure to the patient 2) Place 2-3 fingers on the Radial Pulse 3) Count pulse for 30 seconds 4) Multiply the number of beats counted in 30 seconds by 2 5) Document the: date, time, pulse, strength, and rhythm
Which of the following is the RESPIRATORY expected reference range for an ADULT?
12 -20/min
he circumference of a child's head should be measured at a well-child visit until which of the following ages?
3 YEARS or 36 MONTHS The brain has completed 75% of its growth by the time a child has reached 3 years of age. Therefore, it is recommended that head circumferences are only measured until the age of 3.
EYE AND EAR MEDICATIONS EAR INSTILLATION:
A medical assistant may also be asked to perform an ear instillation (otic administration). Have the patient lie on one side with the affected ear facing up. TAKE NOTE: - With your nondominant hand, pull the pinna of the auricle (outer ear) OUTWARD and UPWARD for ADULTS, and - OUTWARD and DOWNWARD for INFANTS and CHILDREN This will straighten the ear canal and allow for better medication distribution. Hold the applicator ½ inch above the ear canal and administer the number of prescribed drops. Have the patient remain in the position for at least 5 min. Ask whether the patient is feeling any discomfort or pain and observe for any adverse reactions. Loosely insert a small, clean wad of cotton, if ordered, before treating the other ear, if applicable.
Blood Pressure Expected Reference Range by Age
AGE: Older than 12 years SYSTOLIC: 110 to 130 DIASTOLIC: 65 to 80 AGE: 6 to 12 years SYSTOLIC: 100 to 120 DIASTOLIC: 60 to 75 AGE: 3 to 6 years SYSTOLIC: 95 to 110 DIASTOLIC: 60 to 75 AGE: 1 to 3 years SYSTOLIC: 90 to 105 DIASTOLIC: 55 to 70
Obtain Anthropometric Measurements:
ANTHROPOMETRIC measurements involve the measurement of HEIGHT, WEIGHT, AND SOMETIMES OTHER PARTS OF THE HUMAN BODY. These measurements are documented along with the vital signs. Anthropometric measurements can play a significant role in providing a snapshot of the patient's health to the provider prior to physical examination. Many patients require their weight to be checked every visit, but height is usually only checked annually.
Match the term with the correct definition.
APNEA: Periodic cessation of breathing DYSPNEA: Difficulty breathing ORTHOPNEA: Difficultly breathing unless in an upright position BRADYPNEA: Abnormally slow breathing TACHYPNEA: Rapid shallow breathing
MODULE 3 QUIZ: A patient who had a stroke has left-sided weakness and uses a cane to ambulate. Which of the following actions should the medical assistant take to ensure the patient's safety?
ASSIST THE PATIENT ONTO THE EXAMINATION TABLE Make sure patient is safe & secure
Respiratory Rate Expected Reference Ranges:
Adolescent and older = 12-20 School-age child (6 to 15 years) = 18-25 Preschooler (3 to 5 years) = 20-28 Toddler (1 to 2 years) = 22-37 Infant (1-12 months) = 30-53 Without removing fingers from the pulse, shift eyes to the patient's chest and count the respiratory rate with the rise and fall of the chest. The MA may watch the rise and fall of the shoulders or back to determine the respiratory rate. Count for 30 seconds and multiply the number by two, or count for 1 full minute. Listen for wheezing, which is a whistling sound on expiration as the body attempts to expel trapped air. Also, listen for rales, which are clicking or crackling sounds that can sound like moist or dry rhonchi heard on inspiration. Common rattling snoring sounds are often associated with chronic lung diseases.
Pulse Ranges by Age
Adolescent and older = 60 to 100 School-age child (6 to 15 years) = 75 to 118 Preschooler (3 to 5 years) = 80 to 120 Toddler (1 to 2 years) = 98 to 140 Infant (1-12 months) = 100 to 180
MEASURE VITAL SIGNS: PULSE OXIMETRY
Although usually NOT considered a vital sign, pulse oximetry is a valuable tool and a simple procedure to ascertain the percentage of oxygen saturation in the blood. Many oximeters also display the heart rate, which is why it is termed pulse oximetry. TAKE NOTE: Nail polish and artificial nails block the infared light of the oximeter and interfere with the results. They should be removed prior to the test, or an alternate site should be used to obtain a reading. Obtaining a pulse oximetry reading is done by attaching a probe to the patient, usually on a finger. This probe incorporatesINFRARED LIGHT to obtain the measurement of oxygen saturation. An alternate site is an EARLOBE, which can be used if a finger is not an option. Darker skin may also be impacted when the oxygen level is low (less than 80%). In this case, a pulse oximeter reading of 95% or higher is considered a normal result. Results are notated by using SpO2 and the percentage reading. For example, SpO2 equals 98%. Readings below 90% should be reported to the provider, and often, oxygen therapy for hypoxemia (decreased oxygen in the blood) may be ordered and initiated.
Types of Allergic Reactions:
An important part of the patient medical history is documenting any allergies or history of allergic reactions. An ALLERGY is an abnormal or hypersensitive reaction to an allergen, or a substance that is capable of causing an allergic reaction. Patients can have an allergic reaction to a variety of things, such as dust, mold, pollen, animal dander, foods (peanuts, strawberries), insect bites, and medications. Most allergic reactions are common and present with mild symptoms, such as hives, itching, rashes, watery eyes, and nasal congestion. Treatment usually includes an over-the-counter hydrocortisone cream and an antihistamine. ALLERGIC: A condition of sensitivity in which the immune system reacts abnormally to a foreign substance
MENTAL HEALTH SCREENINGS: ANXIETY
Anxiety is a common emotional response for many people. Anxiety can be a response to fear or an unfamiliar situation. For example, some patients have "white coat syndrome," which is anxiety related to seeing a health care provider for an evaluation. Anxiety can vary from mild to severe symptoms. The GAD-7 questionnaire is for general anxiety and used to screen patients for anxiety. Common Anxiety Symptoms: - Heightened ability to observe or make connections - Difficulty focusing on details - A sense of panic - Irritability - Feeling cold, sweaty - Heart palpitations - Shortness of breath
A patient has come for a routine office visit. The medical assistant is about to measure the patient's weight but sees that they use a cane to ambulate. What can the medical assistant do to help this patient balance on the scale if there are no handrails?
Assist the patient up on the scale. Use a walker to assist the patient in stepping on and off the scale.
Which of the following sites is most commonly used to check a pulse in children?
BRACHIAL PULSE = MOST COMMON IN CHILDREN
Vital Sign Findings: ADULT RANGES
Blood Pressure (mm Hg) NORMAL RANGE: - Systolic: < 120 AND - Diastolic: < 80 ABNORMAL: - Systolic: 120-179 OR - Diastolic: 80-110 EMERGENT: - Systolic: >180 OR - Diastolic: >110 Pulse (beats per minute) NORMAL RANGE: 60-100 ABNORMAL: - Bradycardia: < 60 - Tachycardia: >100 EMERGENT: Varies based on factors Temperature NORMAL RANGE: 97.6 - 99.6 ABNORMAL: 99.6 - 104 EMERGENT: - Dangerous: 104-105 - Fetal: >106 Respiratory Rate (breaths per minute) NORMAL RANGE: 12-20 ABNORMAL: - Bradypnea: < 12 - Tachypnea: > 20 EMERGENT: Varies based on factors
Blood Pressure: CUFF = 1 INCH ABOVE ELBOW
Blood pressure is usually taken with the patient in a sitting position. Different contributing factors can potentially cause errors or influence blood pressure readings. Using the wrong cuff size can impact the systolic and diastolic pressure up to 6.9 mm Hg. If a patient has their legs crossed while taking their blood pressure, the systolic blood pressure may be raised by 2 to 8 mm Hg. The position of the arm can influence the blood pressure reading. - If the arm is above the heart level, the reading is lowered. - If the arm is lower than the right atrium (dangling at their side), the reading will be artificially elevated. - If the patient holds their arm up, the muscular tension will raise the pressure. The arm should be resting on the table or chair next to them at the same level as the heart to avoid these errors. The PALPATORY METHOD: can be used in emergent situations when the blood pressure cannot be auscultated (heard). The systolic pressure may be checked by feeling (palpating) the RADIAL PULSE rather than hearing it (auscultating) with a stethoscope. The blood pressure cuff is placed in the usual position (ONE INCH ABOVE THE BEND OF THE ELBOW, OR ANTECUBITAL SPACE) and palpates the radial pulse, noting the rate and rhythm. Inflate the cuff until the pulse disappears, then add 30 mm Hg more inflation to get above the systolic pressure. Do not remove the fingers from the pulse or change the pressure of the fingers. Carefully watch the gauge while slowly releasing the pressure in the cuff and wait until the first pulse beat is felt. Note the reading on the gauge and document the first pulse felt as the systolic pressure. For example, if the MA first felt the pulse return at 104 mm Hg, the palpated blood pressure would be 104/P, with P indicating that the systolic reading was palpated. Accurat
Blood Pressure:
Blood pressure measures the force of the blood circulating through the arteries. Blood pressure readings can impact decisions related to the patient's treatment or the need for additional diagnostic tests. Equipment used to determine blood pressure manually includes a sphygmomanometer (a blood pressure cuff) and stethoscope. Electronic equipment can interpret blood pressure without the use of auscultation. AUSCULTATION: Listening with a stethoscope SYSTOLIC: Measurement of force while the heart is CONTRACTING - Top number on a blood pressure reading. DIASTOLIC: Measurement of force while the heart is RELAXING - Bottom number on a blood pressure reading ORTHOSTATIC HYPOTENSION: A significant drop in blood pressure during positional changes, particularly when the patient is moving from lying down to sitting or from sitting to standing; also known as postural hypotension. Systolic and diastolic pressure readings are: PHASE I (the first sound heard, systolic); and PHASE V (the final sound heard, diastolic) of the Korotkoff sounds. Korotkoff sounds are distinct sounds that are heard throughout the cardiac cycle. In PHASE II, there is a swishing sound as more blood flows through the artery. In PHASE III, sharp tapping sounds are noted as more blood surges. In PHASE IV, the sound changes to a soft tapping sound, which begins to muffle.
OBTAIN ANTHROPOMETRIC MEASUREMENTS: BODY MASS INDEX (BMI)
Body mass index (BMI) is a tool to screen patients and classify results based on a patient's HEIGHT & WEIGHT This classification can then correlate risk factors or predisposition for conditions such as heart disease or diabetes. A patient's BMI is a percentage used to represent BODY FAT in relation to a person's height and weight. BMI is calculated using the following formula: BMI = (Weight in kg/ Height in m^2) OR BMI = (Weight in lb/ Height in inches^2) x 703 A BMI percentage of 18.5 to 24.9 is considered normal. Results less than 18.5 classify an individual as underweight. Greater than 24.9 leads to a classification of overweight Obesity being 30.0 and greater The MA may be responsible for calculating BMI using calculations and graphs or using a calculation program within the electronic health record
FACTORS AFFECTING VITAL SIGNS:
Consuming a HOT beverage: Increased ORAL temperature reading Consuming a COLD beverage: Decreased ORAL temperature reading Anxiety: Increased BP & HEART RATE Smoking: Increased BP & HEART RATE Exertion (such as a long walk to the exam room): Increased BP & HEART RATE, Lower O2 levels Age: - Increased temperature fluctuation in young children (inability to regulate) - Decreased temperature in older adults (loss of insulation in the form of body fat) Pain: Increased BP & HEART RATE Illness: Increased temperature Beta-blocker medication: Decreased BP & Heart Rate
A patient enters the medical office. The medical assistant greets them and verifies the patient's name, address, telephone number, insurance information, and emergency contact. This specific information describes which of the following?
DEMOGRAPHICS
List three factors that can affect a temperature reading.
Drinking hot or cold liquids, smoking, chewing gum, cold weather, hot weather, age, and menstrual cycle can affect a temperature reading.
EYE AND EAR MEDICATIONS EYE INSTILLATION:
EYE INSTILLATION (ocular or ophthalmic administration) is a common duty of a medical assistant. Only ophthalmic or optic medications should be used in the eye. All OPTIC medications must be sterile, and sterile procedures must be followed before and during the administration. For eye instillation, the patient should be lying down or sitting back in a chair with the head tilted back. Clean any debris from the eye area. Provide a tissue to the patient to blot excess medication. TAKE NOTE: - The patient should look toward the ceiling with BOTH eyes open. With your nondominant hand, gently pull down the lower lid of the affected eye using the thumb or two fingers to expose the conjunctival sac. - Gently rest the dominant hand on the patient's forehead and dispense a drop approximately ½ inch above the sac. - If a cream or ointment is being administered, evenly apply a thin ribbon of the ointment along the inside edge of the lower eyelid on the conjunctiva, moving from the medial to lateral side. - Release the eyelid and instruct the patient to close the eyes. - Repeat if the other eye requires treatment. - Remove any excess medication with a clean tissue. - Ask whether the patient is feeling any discomfort or pain and observe for any adverse reactions. - Apply a clean eye patch, if ordered.
An adult patient has started taking medication for hypertension since their last visit. Which of the following would the MA most likely expect at this visit?
Expect BP to be LOWER than the previous visit The patient just started the blood pressure medication, so it is not certain how the medication is working, but the medical assistant can anticipate the pressure being lower than the last visit.
Which of the following indicates last menstrual period?
FIRST DAY OF THE LAST MENSTRUAL PERIOD (LMP)
A patient tells the medical assistant they smoke. What is an important question to ask before measuring the patient's vital signs?
Find out when the patient last smoked a cigarette. If they just smoked, their temperature will be falsely elevated.
A 30-year-old patient's vital signs are temperature 98.2° F, heart rate 117/min, respirations 18/min, blood pressure 146/94 mm Hg. Which of the following vitals are OUTSIDE the expected reference range
HEART RATE & BP Expected reference range for heart rate is 60 to 100/min. Expected reference range for blood pressure is less than 120/80 mm Hg.
Which of the following criteria is used to determine a patient's BMI?
HEIGHT & WEIGHT
MEASURE VITAL SIGNS: PULSE
Heart rate, also known as the pulse rate, is the number of times the heart beats per minute. The second and third fingers of the dominant hand should be used to palpate the pulse. The number of beats is counted for ONE FULL MINUTE to obtain the patient's pulse rate. There are NINE various pulse points throughout the body. The THREE MOST COMMON sites to palpate a pulse include the following: 1) The RADIAL pulse, located on the thumb side of the wrist, is the most common site for taking an ADULT pulse 2) The BRACHIAL pulse, inside the upper arm, is the most common for measuring pulse in CHILDREN and using to MEASURE BLOOD PRESSURE 3) The CAROTID, located in the neck just below the jawbone, is most common for use in EMERGENCY PROCEDURES Other locations to palpate a pulse include the following: - TEMPORAL artery located on the side of the forehead - FEMORAL artery located on the inner groin area - POPLITEAL artery located behind the knee Posterior tibial artery located behind the ankle - DORSALIS PEDIS artery located on top of the foot In addition to palpation, the pulse can be determined through auscultation. The APICAL pulse is measured by listening with a stethoscope to the heartbeat at the apex of the heart. The apical pulse is commonly measured in children, infants, and adults with irregular heartbeats. The apical pulse is measured for 1 full min. TAKE NOTE: Pulse is evaluated on: - RATE, RHYTHM, OR REGULARITY, AND VOLUME OR STRENGTH. A PULSE can be described as 70/min (rate), regular (rhythm), and thready (strength). Thready reflects a pulse as difficult to detect or faint. Bounding describes a pulse as being very strong. PULSE RATES DEPEND ON THE PATIENTS: - Condition and age. - Time of day - Activity level, and - Medications can also affect heart rate. As identified in
OBTAIN ANTHROPOMETRIC MEASUREMENTS: HEIGHT
Height is a part of a routine physical to track normal development, monitor conditions such as scoliosis or osteoporosis, and assist in determining BMI. Measurements are often obtained in inches, which can be converted to include feet. TO CONVERT HEIGHT FROM INCHES TO FEET: - Divide the total number of inches by 12 - The remainder is inches. EX: 62 inches = 62 / 12 = 5 feet, 2 inches
RESPIRATORY RATE: Types of Abnormal Breathing:
Hyperventilation: Fast/Rapid breathing - Intense pain - Anxiety - Panic attacks Hyperpnea: Excessively deep breathing - Extreme pain or anxiety Dyspnea: Difficult or painful breathing - Chronic obstructive pulmonary disease (COPD) - Pneumonia - Asthma - High altitudes - Physical exertion Orthopnea: Difficulty breathing unless in the upright position - Congestive heart failure - COPD Wheezing: Whistling sound during breathing - Asthma Rales: Small clicking, bubbling, or rattling sounds - Fluid in air sacs - Pneumonia Rhonchi: Large airway sounds - COPD - Chronic bronchitis - Pneumonia RESPIRATORY RHYTHM: is the breathing pattern, and depth describes how much air is inhaled. For example, a patient might have a rate of 28/min with an irregular rhythm and shallow depth. This would indicate some respiratory distress, as all three notations are abnormal. TAKE NOTE: One respiration includes one complete inhalation and exhalation (indicated by the rise and fall of the chest with each breath).
In addition to documenting the NUMBER for the PAIN LEVEL, which of the following characteristics of the patient's pain need to be documented?
LOCATION DURATION ONSET CHARACTERISTICS
PEDIATRIC MEASUREMENTS AND GROWTH CHARTS:
Length, weight, and head circumference are tracked on growth charts from BIRTH TO 36 MONTHS Head circumference is not recommended past 36 months (unless abnormal measurements are found), as the brain reaches 75% of its growth by this point, making continuous measurement and tracking unnecessary. Stature and weight are tracked on specific charts from 2 to 20 years. - These measurements are plotted on a growth chart to represent growth visually. - This alerts the provider to potential concerns. - The growth chart also provides tangible data to have conversations with parents and guardians regarding concerns such as obesity or malnutrition. It may also be noted that many EHR systems will automatically plot the measurements on the appropriate growth charts using the EHR software and the information based on the age and gender of the child. Measurements are plotted on the grid. The outcome of the plot identifies a standard growth percentile ranging from less than 5th percentile to greater than the 95th percentile. For example, a weight measured below the 5th percentile would be considered UNDERWEIGHT. A NORMAL or HEALTHY WEIGHT on the grid would range between the 5th and 85th percentile. A child determined to be OVERWEIGHT would have a reading in the 85th to 95th percentile. Growth chart percentiles indicating OBESITY would be equal to or greater than the 95th percentile.
COMPREHENSIVE CLINICAL INTAKE PROCESS
MEDICATION RECONCILIATION: is a formal process necessary at every office visit. Comparing the patient's list of medications to the medical record is a safety measure that reduces the risk of improperly prescribing an incorrect or contraindicated prescription, including medication interactions and adverse reactions. A personal and family history is completed at or prior to the first office visit. This document contains information reported by the patient as a starting point for the provider collecting the patient's objective information. OBJECTIVE information is observed or can be measured. A patient's past medical history is objective information because it is documented and measured within their health record. When a patient completes a health history form, the MA will ensure that it is complete and answer any patient questions. This documentation identifies any predispositions to diseases and conditions and forms an overall picture of the patient's health based on past events. Although this extensive history is usually only completed once, routinely review it when a patient attends appointments and determine whether changes or updates need to be included. Many clinics request that patients update their medical history forms annually.
OBTAIN ANTHROPOMETRIC MEASUREMENTS: WEIGHT
Measuring a patient's weight is performed at EACH OFFICE VISIT. Medication dosages are often determined based on weight. BMI, predisposition to medical conditions, eating disorders, and weight management are monitored in relation to a patient's overall general health. TAKE NOTE: Assist the patient on and off the scale as needed. Patients should not wear shoes or heavy jackets when being weighed. TO CONVERT POUNDS TO KILOGRAMS: Divide the weight in pounds by 2.2. EX: 148 lb = ? kg 148/ 2.2 = 67.27 kg (Round to the nearest tenth) = 67.3 kg TO CONVERT KILOGRAMS TO POUNDS: Multiply the weight in kilograms by 2.2. EX: 87 kg = ? lb 87 x 2.2 = 191.4 lb Some medical specialties and specific medical problems require continuous monitoring of weight. Hormone disorders (diabetes), growth patterns in children, and eating disorders (anorexia, bulimia) require accurate weight checks during every medical visit. Also, patients who are pregnant must have their weight measured every visit to monitor adequate weight gain and excessive weight, which may indicate fluid retention. Patients who have cardiovascular conditions and patients undergoing dialysis tend to retain fluid and should have their weight checked every visit.
MEASURE VITAL SIGNS: TEMPERATURE
Measuring temperature determines the relationship between heat production and heat loss in the body. PYREXIA: Fever greater than 100.4 The most common cause of pyrexia, or fever, is infection. Fever is the body's natural defense to fight invasive organisms and is a normal reaction to illness. Patients who have a fever can present with chills, loss of appetite, malaise, thirst, and generalized aching. Temperature is usually measured orally via a digital thermometer, with a probe placed under the tongue on either side of the frenulum linguae. Body temperature can also be measured in the armpit for an AXILLARY temperature or in the rectum for a RECTAL temperature. A TYMPANIC thermometer can measure the temperature by being inserted into the ear. The tympanic thermometer is popular due to the speed of obtaining the temperature and its comfort. - This site should not be used if the patient is complaining of pain in both ears when the ear is touched. - Also, a tympanic thermometer will not provide an accurate reading if a patient has a history of IMPACTED CERUMEN in BOTH ears. The TEMPORAL artery scanner is moved across the forehead and behind the ear to produce a temperature reading. Many pediatricians prefer the temporal artery scanner. It has been identified that it is MORE ACCURATE than the tympanic due to high user error rates with the tympanic. When an ORAL temperature is measured, the MA does NOT have to indicate the site when documenting the reading in the patient's health record. If an alternative site was used, document the following identifiers after recording the temperature: (T) for tympanic or (AU) for aural (Ax) for axillary (R) for rectal (TA) for temporal artery AXILLARY temperature (Ax) is approximately 1° F (0.6° C) LOWER than an ORAL reading because axillary readings are not take
CASE STUDY 2: Annie Chang is 30 years old and overweight. Ms. Chang comes into the office for their annual checkup. She appears nervous and anxious and refuses to get on the scale when it comes time to measure her weight. Ms. Chang says she does not want anyone to know how much she weighs, not even the MA.
Medical Assistant: "Ms. Chang, you have the right to refuse to get weighed, and I will respect that. Everything we do in this office is confidential, and nothing is said to anyone. We are only here to help you. No one would ever judge you." Ms. Chang: "I have gained a lot of weight over the last few years. I was involved in a lot of group fitness activities that were stopped or changed due to the pandemic. At first, I didn't like staying home all the time, but now the thought of being in group settings and leaving the house on a regular basis scares me. I'm ashamed that I've put on weight, making it harder to get out and start exercising again. I'm afraid that being weighed today will only make me feel worse." Medical Assistant: "I'm sorry for what you have been going through. I appreciate you sharing that with me. You are not alone in this experience. As I said before, we are here to help you. We can hold off on weighing you for now. I will let the provider know what you shared and encourage you to speak further with her about it." After Ms. Chang sees the provider: Medical Assistant: "Hi, Ms. Chang. I understand you talked more with the provider about your concerns with your weight and the emotions you have been experiencing lately. I hope the conversation was helpful to you." Ms. Chang: "It really was. Thank you for listening to me earlier rather than just pushing me to step on the scale. I now know that my weight gain is more likely a symptom of some mental health concerns I didn't realize I was experiencing. We're going to start me on medication to help with the root cause, and I have a goal of going on three 20-minute walks a week for the next month. I'm not sure if it will help me lose weight, but it sounds like a great step toward regaining control of
CASE STUDY 1:
Medical Assistant: "Ms. Jones, I noticed you seem upset today. Is everything okay?" Ms. Jones: "No, I have been very stressed at work lately and am unsure how to decrease my anxiety. Now I cannot take my medication for my blood pressure, and I am scared something bad will happen." Medical Assistant: "Yes, not taking your blood pressure medication is a concern, and anxiety can also contribute to higher blood pressure readings. Let me get this information to Dr. Lopez and see if he can help you with your medication to start to relieve some of that worry, and we can also have him talk with you about the anxiety. Would you like me to speak to the provider about finding resources to help decrease the anxiety and manage the stress level?" Ms. Jones: "Thank you! I would appreciate any help I can get. I want to be able to take my medication and not have it make me sick." *The MA must provide empathy while identifying and documenting behaviors outside the norm. It is also important for the MA to identify factors that can contribute to abnormal vital sign readings.
MENSTRUAL STATUS AND LAST MENSTRUAL PERIOD
Menstruation is the body's way to prepare for pregnancy or cleanse the uterine lining. Each month (approximately every 28 days), the endometrium, which lines the uterus, is shed a lining via vaginal bleeding. This is commonly known as a period. If the patient becomes pregnant, the endometrium will not shed, and they will miss a period. The hormonal changes of estrogen and progesterone stimulate a menstrual cycle. Evaluate the last menstrual period (LMP), considered the first day of the previous menstrual cycle, at each visit to evaluate the potential of patient pregnancy. For example, at a yearly pelvic exam, the practitioner will ask about the patient's last menstrual period and possibly conduct a urine pregnancy test before any are ordered to ensure no active pregnancy. A patient needs to identify their menstrual period to aid the provider in identifying what diagnostic or laboratory tests must be ordered if issues arise. The LMP will help evaluate the estimated due date if the patient is pregnant.
MENTAL HEALTH SCREENINGS: DEPRESSION
Mental health screenings assess the patient's safety and mental status. Depression screening asks questions about the patient's moods, thoughts, and feelings. The Patient Health Questionnaire-2 (PHQ-2) focuses on the patient's frequency of depressed mood over two weeks. If the patient's answers reflect a positive response to depression, the medical assistant can proceed to the Patient Health Questionnaire-9 (PHQ-9). This screening asks additional questions to assess if the patient meets the criteria for a depressive disorder diagnosis. Older adult patients could require a mini-mental examination to evaluate for dementia or other degenerative disorders. Depression can be difficult to recognize. Therefore, one must know the common symptoms: - Difficulty going to sleep, staying asleep, or getting up in the morning - Profound sadness and fatigue - Change in appetite - Loss of energy
Which of the following are the two MOST COMMON identifiers used to confirm patient identity?
NAME & DOB
STAGES OF HYPERTENSION:
NORMAL SYSTOLIC: < 120 DIASTOLIC: < 80 ELEVATED SYSTOLIC: 120-129 DIASTOLIC: < 80 HTN STAGE 1 SYSTOLIC: 130-139 DIASTOLIC: 80-89 HTN STAGE 2 SYSTOLIC: >140 DIASTOLIC: >90 HTN CRISIS SYSTOLIC: >180 DIASTOLIC: >120
Age-Related Temperature Norms:
Newborn (Axillary) - Fahrenheit: 98.2 - Celsius: 36.8 1 Year (Tympanic) - Fahrenheit: 99.7 - Celsius: 37.6 6 Years to Adult (Oral) - Fahrenheit: 98.6 - Celsius: 37 Older Adults Over Age 70 - Fahrenheit: 96.8 - Celsius: 36
While observing pulse oximetry, the MA notices the reading is 89%. What should the medical assistant do, and why?
Notify the provider of the reading and await further instruction.
Which of the following temperature sites does NOT have to be indicated when documenting the reading in the patient's health record?
ORAL Oral temperatures obtained do not have to indicate the site when documented. The site of the temperature only has to be documented if the medical assistant uses an alternative site other than oral.
MODULE 3 QUIZ: Which of the following manifestations should a medical assistant expect to see in a patient with COPD?
ORTHOPNEA Orthopnea is difficulty breathing in a recumbent position and is relieved by sitting or standing. It often occurs in patients who have COPD because they need to sit up to breath or use multiple pillows to allow them to breath as they sleep
Orthostatic Hypotension: Methods for Obtaining Common Errors
ORTHOSTATIC HYPERTENSION: also known as postural hypotension, is a significant DROP IN BLOOD PRESSURE during POSITIONAL CHANGES, particularly when the patient is moving from lying down to sitting or from sitting to standing. In addition to a decrease in blood pressure, there is an INCREASE IN PULSE RATE. It can lead to the patient falling or even passing out if severe enough. Dehydration, heart disease, diabetes, some medications, and nervous system disorders are all causes of orthostatic hypotension. If the provider is concerned about orthostatic hypotension, they may ask the MA to measure orthostatic vital signs. The CDC recommends having the patient LIE DOWN for 5 minutes and then measure blood pressure and pulse rate. Next, have the patient STAND and then repeat the blood pressure and pulse rate measurements after standing for 1 minute and after 3 minutes. The practice's protocol may also require measurements to be completed while the patient is in a sitting position. **An increased pulse rate of at least 10 beats per minute (bpm) and a decreased blood pressure of at least 20 points between positions indicate orthostatic hypotension. When checking orthostatic vital signs, the medical assistant should keep the patient's arm on a bed or table, as having the patient hang their arm down can lead to a false high blood pressure reading. Additionally, watch the patient closely and monitor for signs of dizziness and any other indications that the patient is close to falling or passing out. If this occurs, help the patient back to a safe position—either sitting or lying down—and talk to the provider. Do not continue with the test if it is unsafe for the patient.
Which of the following does an OXIMETER measure?
OXYGEN SATURATION IN THE BLOOD
Which of the following Korotkoff phases is indicative of the DIASTOLIC recording?
PHASE V All sounds disappear in phase V. Note the gauge reading when the last sound occurs and record it as diastolic.
MODULE 3 QUIZ: Which of the following methods should an MA use to help patients feel comfortable about having their weight measured in the office?
PLACE THE SCALE IN A PRIVATE AREA WITHIN THE OFFICE
PAIN SCALE:
Pain is SUBJECTIVE and therefore difficult to interpret. Observe the patient to gather clues about pain level, such as facial grimacing or holding or clutching areas of pain on the body. TAKE NOTE: Ask the patient to rate pain on a scale of 1 to 10 (with 10 being the worst) to determine the pain level the patient is experiencing. CHILDRENS PAIN: can be assessed using the WONG-BAKER FACES rating scale. Ask additional questions to determine the location, onset, duration, and other characteristics of the pain to get a more precise clinical picture. Ask whether methods used for relief have been effective. Report all verbal and nonverbal responses related to pain to the provider, who can conduct additional assessments as needed to ensure the patient is heard and understood about reporting their pain levels. Health care organizations require that patients are assessed for pain when indicated.
PEDIATRIC MEASUREMENTS AND GROWTH CHARTS:
Pediatric measurements monitor growth. HEIGHT, WEIGHT, & HEAD CIRCUMFERENCE are measured during a routine well-child visit during INFANCY & EARLY TODDLER YEARS. As children age, height and weight are the only anthropometric measurements obtained at each visit. ANTHROPOMETRIC: Related to measurement and proportion of the body. INFANT LENGTH: If the child cannot stand erect, lay the child or infant flat on a paper-covered exam table to obtain a length measurement. - Place a mark at the top of the head and the heel of the flexed foot. - Measure the distance between the two lines and record this measurement in centimeters or inches, according to office protocol. INFANT WEIGHT: Infant scales are desirable when obtaining an infant's weight. - Weigh infants without clothing or a diaper and record the weight using BOTH POUNDS & OUNCES - Always keep one hand hovering over the infant to ensure their safety on the scale. - The medical assistant should never turn their back to an infant on a scale or leave them unattended. INFANT HEAD CIRCUMFERENCE: Using a tape measure, measure the head circumference at the WIDEST area. - This is usually done by placing the measuring tape directly above the eyebrows, around the side of the head, above the ears, and behind the back of the head at its widest point. - The measurement is recorded in inches or centimeters, depending on office protocol. TAKE NOTE: Growth charts compare the child's growth pattern with the national standard. - The Centers for Disease Control and Prevention (CDC) developed growth charts that track growth continuously until age 20. - These growth charts are sex-specific.
When performing an ear instillation for a CHILD, how should you adjust the auricle of the ear?
Pulling the auricle OUTWARD & DOWNWARD
Match the site for temperatures to its abbreviation.
R for rectal, TA for temporal artery, A for axillary, and T for tympanic.
Which of the following are assessed when taking a pulse?
RATE RHYTHEM STRENGTH When assessing a patient's pulse, document the beats per minute (rate), rhythm (regular), and strength (strong, weak, thready).
MEASURE VITAL SIGNS: RESPIRATORY RATE
RESPIRATION: is evaluated on rate, rhythm, and depth. The respiratory rate also DECREASES WITH AGE and is affected by health conditions or environmental factors. FAST RR = TACHYPNEA SLOW RR = BRADYPNEA
An 18-month-old patient is in for a well visit. After the medical assistant weighs the infant and measures their length, the data gets transferred to the electronic health record, which plots the 18-month-old patient's measurements on the growth chart. The medical assistant shows the patient's parent that the infant is in the 90th percentile for their weight. The parent is shocked, thinks their baby is overweight, and asks what they should do. How should the medical assistant respond?
Reassure the parent that this does not indicate that the infant is overweight. Explain that the measurements should stay within the grid and that the patient's weight is in the 90th percentile among other 18 month old patients of their sex The 90th .
How can the medical assistant help alleviate a patient's anxiety regarding having a vital sign measurement taken?
Recognize anxiety and talk to the patient about it. Listen and offer empathy. Help the patient relax. Suggest breathing techniques.
Which of the following are ABNORMAL vital signs in an ADULT?
TEMPERATURE 102 RESPIRATORY RATE 28/MIN
Which of the following can occur if the wrong size blood pressure cuff is used?
THE SYSTOLIC & DIASTOLIC CAN BE IMPACTED UP TO 6.9 MM HG
MEASURE VITAL SIGNS: TEMPERATURE
Take into consideration temperature results, patient history, and clinical appearance. Age influences body temperature. Infants' and children's body temperatures fluctuate in response to the external environment. Adults lose insulation and thermoregulatory control with age. External stressors such as exercise and emotional stress can elevate the body temperature. Genders influence body temperatures also. - Female patients have more hormonal secretion, especially during the menstrual cycle. - This can cause fluctuation in the body temperature. Overall, when evaluating a person's body temperature, you will find that their body temperature is LOWEST in the MORNING and HIGHEST in the LATE AFTERNOON. If the medical assistant experiences erroneous results, retaking the temperature with a different type of thermometer would be appropriate to ensure the correct reading has been measured.
IDENTIFY, DOCUMENT, AND REPORT ABNORMAL SIGNS AND SYMPTOMS
The MA is responsible for obtaining information from patients, documenting the information, and reporting any abnormal findings to the provider. The usual process for obtaining information is first to record anthropometric measurements and vital signs and obtain the chief complaint. Remember that any abnormality or extreme change may indicate a disease or disorder that needs to be brought to the provider's attention.
CASE STUDY 1: Aaniyah Jones, a 60-year-old female patient, comes into the clinic every Monday, Wednesday, and Friday at 12:30 p.m. for a blood pressure check. Ms. Jones's blood pressure has been intermittently high over the past 6 months. Dr. Lopez prescribed a new blood pressure medication 2 weeks ago, which seems to control the patient's blood pressure. However, today Ms. Jones looks upset and hurried. They tell the MA they need to be seen immediately because they need to get back to work as soon as possible. As the MA walks back to the examination room, Ms. Jones tells the medical assistant that the blood pressure medication the doctor prescribed has made them nauseated, and they have not taken it for the past 2 days.
The MA looks back into Ms. Jones' chart and notes that their blood pressure readings had averaged 134/86 mm Hg while taking the blood pressure medication. Their vitals today are 98.9° F, heart rate 88/min, respirations 22/min, and blood pressure 178/92 mm Hg.
EYE AND EAR MEDICATIONS:
The MOST COMMON form of medication is LIQUID solution in the form of DROPS that is applied directly to the eyes and ears. If you are approved to administer this form of medication, the same precautions and rules must be taken when instilling eye and ear medications. You may also be required to provide patient education and instructions on self-administration of eye and ear medication if a treatment is prescribed to the patient to administer at home.
While reviewing a patient's health history form, the medical assistant noticed they did not complete the social and occupational history part of the form. Why might a patient not complete this portion of the form, and what should the medical assistant do?
The patient may have missed that part of the health history form or be uncomfortable answering some questions. Explain the importance of getting all the information and ask the patient if they need help answering the questions. The patient has the right to refuse to answer the questions.
COMPREHENSIVE CLINICAL INTAKE PROCESS
The patient screening process can also be referred to as ROOMING PATIENTS. It is the process of gathering initial information from the patient. Depending on the type of visit, the amount of information collected during the screening process varies, but all patients should have a minimum screening, including the CHIEF COMPLAINT and medication review, at each visit. A CHIEF COMPLAINT, also referred to as chief concern, is SUBJECTIVE information documented in the medical record in the patient's own words. This is likely the first piece of information the medical assistant records that identifies the reason for the visit. "Please tell me why you are coming in today" and "What brings you to the office today?" are open-ended questions that elicit the chief complaint. The patient's response of "My stomach hurts" would be subjective information. When recording a patient's chief complaint, use quotation marks when indicating anything directly stated by the patient. TAKE NOTE: Subjective information is usually described and experienced by the patient and is not measurable.
Health Record Information Section:
The sections of the health record include the following: Administrative Section: - Patient information/demographics - Financial and insurance information - Correspondence Clinical Section: - Past medical history/family history/social history/occupational employment MEDICAL HISTORY: past illnesses, surgeries FAMILY HISTORY: illnesses or diseases relevant to the immediate family SOCIAL HISTORY: diet, exercise, caffeine intake, smoking, use of alcohol or recreational drugs OCCUPATIONAL HISTORY: any occupational employment hazard or exposures -Orders/referrals - Clinical data - Progress notes - Diagnostic imagining information - Laboratory information - Medication list/allergies
Converting Temperatures:
To convert Fahrenheit to Celsius: ° C = (° F − 32) ÷ 1.8 To convert Celsius to Fahrenheit: ° F = (° C × 1.8) + 32 EXAMPLE: Fahrenheit To Celcius: 99 F = ? C 99-32 = 67 67/ 1.8 = 37.2 C EXAMPLE: Celsius To Fahrenheit: 38 C = ? F 38 x 1.8 = 68.4 68.4 + 32 = 100.4 F
MODULE 3 QUIZ: Which of the following methods should a MA use to obtain a WEIGHT measurement from a patient who uses a walker and has balance concerns?
USE A SCALE WITH BUILT IN HANDRAILS - This is the safest and best option for a patient who has balance concerns
Blood Pressure Cuff Sizes:
Upper Arm Circumference (INCHES) VS BP CUFF SIZE: 8.7 TO 10.2 = SMALL ADULT 10.6 TO 13.4 = ADULT 13.8 TO 17.3 = LARGE ADULT 17.7 TO 20.5 = XL ADULT
Which of the following is OBJECTIVE information?
Weight 175 lb BP 128/74 HR 88 bmp Blood pressure, heart rate, and weight are information that can be measured and documented, which makes them objective data. Stomach pain and nausea are subjective because that is what the patient reports.
A 56-year-old patient came in reporting dizziness. The physician ordered orthostatic vital signs only in the lying and standing positions. In the lying position, the patient's vitals were heart rate 90/min and blood pressure 130/80 mm Hg. In the standing position, the patient's vitals were heart rate 115/min and blood pressure 108/68 mm Hg. Did the patient have a positive test for orthostatic hypotension? Explain why.
Yes, the patient had a positive test for orthostatic hypotension. The patient had a greater than 10/min increase in heart rate, and Greater than 20 mm Hg drop in blood pressure, which indicates a positive test.
CASE STUDY 1: Did the medical assistant take the right approach with Ms. Jones regarding their blood pressure reading?
Yes. In this example, the MA identified that Ms. Jones is upset and expressed support around this while recognizing that this can contribute to their elevated blood pressure. The MA demonstrated the importance of reporting the abnormal measurement to the provider and reporting and requesting to help support a potential underlying cause (stress) at the provider's discretion.
CASE STUDY 2: Was the MA's approach to taking Ms. Chang's weight in their final interaction appropriate?
Yes. The MA continued to build trust with Ms. Chang by validating their positive feelings about the plan and listening for their true concerns regarding being weighed. (Ms. Chang was more concerned about knowing their weight than being weighed.) In the end, the MA reframes the weight as a measurement that contributes to the bigger medical picture rather than defining who Ms. Chang is.
CASE STUDY 2: In this situation, did the MA take the right approach with Ms. Chang in the beginning regarding their refusal to measure their body weight?
Yes. The MA gathered beneficial information about Ms. Chang that related to their weight and affected other aspects of their health. Even if the MA suspected depression or anxiety based on Ms. Chang's report of their concerns, they remained professional and stayed within their scope of work by relying on the information to the provider rather than sharing their thoughts with Ms. Chang directly.
