Module 4- - General Patient Care Part 1

Which of the following must be included in a MAR?

-Name of the medication -Any Allergies -Dosage of Medication -Name of the prescriber

Which of the following is true when transmitting an e-prescription?

-Pharmacy must use approved software. -Provider must use approved software. -Prescribing software must be DEA EPCS approved. -Provider must have DEA number for controlled substances.

Which of the following criteria are appropriate for a telehealth visit with a health care provider?

-Private area is needed. -Patient meets the technology requirements. -Patient is self-reporting blood pressure readings.

Room temperature is...

20˚ to 25˚ C (68˚ to 77˚F).

Which of the following needle size would you select for a tuberculin (TB) test?

26 G ½

Refrigeration means...

2˚ to 8˚ C (35˚ to 46˚ F). As mentioned previously, these medications must be stored in a refrigerator that is not used for any other purpose. It must have a thermometer so that staff can regularly monitor its storage temperature. Check the temperature daily when storing regular medications and twice daily for stored vaccines.

Refrigerated medications must be stored at which of the following temperature ranges?

35˚ to 46˚ F

A patient is at prescribed 40 mg/day of a medication. The medication is dispensed as 10 mg tablets. How many tablets should the patient take a day?

4

A medication is prescribed to a patient at 25 mg tablets twice a day. Which of the following is the total milligrams prescribed to the patient each day?

50 mg

A medication is available at 160 mg per 5 mL. The patient is prescribed 240 mg of the medication. How much should be administered?

7.5 mL

In addition to the elements required on all prescriptions, electronically generated prescriptions must also have the following.

A DEA number of the prescribing health care provider if the prescription is for a controlled substance The telephone number of the health care provider The time and date of the transmission The name of the pharmacy to which the prescription is sent. ⇧ Top

allergic

A condition of sensitivity in which the immune system reacts abnormally to a foreign substance.

sterile technique

A group of strategies used to reduce exposure to micro-organisms and keep the patient as safe as possible.

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. 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.

Dermatology

A medical assistant may assist in minor surgical procedures to help obtain skin biopsies or in the debridement of wounds and collect specimens from wound cultures. Follow sterile procedures when assisting in minor surgical procedures and obtaining wound cultures. Common supplies and equipment: Dermal punch biopsy Dermal cutter Scalpel Gauze Incision and drainage tray​​​​​​​ Specimen collection swabs and containers

Cardiology

A medical assistant may need to perform electrocardiograms (EKGs) and Holter monitoring on patients with cardiac symptoms or diseases. Both tests are used to monitor and record the heart's electric activity and are often used to diagnose heart disorders, especially regarding its rhythm and rate. Common Supplies and equipment: Three-channel electrocardiograph Electrodes EKG paper​​​​​​​ Holter monitor

Which of the following describes a compounding medication?

A medication from a mixture of two or more ingredients

Neurology

A neurological examination focuses on the patient's reflex response, motor response, muscle tone, speech patterns, coordination, sensory response, gait, and mental status and behavior. The MA may assist the provider throughout the exam, as directed. Otoscope Ophthalmoscope Percussion hammer Penlight Tuning fork Cotton balls Safety pin Tongue depressor Small vials containing hot and cold liquids Vials with different scents​​​​​​​ Vials with different tasting liquids

Patient's Allergy Status

A patient's medication allergy status should be checked and updated at every patient appointment. Although a patient might not have had an allergic reaction to a medication or allergen in the past, it is always possible to develop a reaction later. It is common practice for patients to complete a questionnaire about their allergy history, particularly as a new patient. This includes having patients list their current medications, any current allergies to any medication or food or if they have any environmental allergies, and what was the allergic reaction to the medication or allergen. ​​​​​​​

Many CPOE systems work by the following six-step process.

A provider will log into an EMR. Once logged in, the provider will see a list of patients on the screen. The provider can select a patient and use the system to order prescriptions, lab work, and medical scans. The system automatically validates the order against a patient's medical history, health insurance plan, and other relevant data that has been stored in the system. If no error is detected, the order will be sent to a product or service provider, typically a pharmacy or lab. Finally, this order is added to the patient's

Pulmonology

A pulmonology practice may conduct different tests to assess respiratory function, to assist in the diagnosis of patients with suspected obstructive or restrictive pulmonary disease, and to assess the effectiveness of medication and other pulmonary therapies. Peak flow meter Spirometry machine​​​​​​​ Disposable mouthpieces and nose clips

Examination Room Supplies and Equipment

A standard examination room is most often furnished with an examination table (with stirrups in a practice where pelvic exams are performed), a pillow, a footstool, a supply cupboard, a trash can, biohazardous waste and sharps containers, a rolling stool, and a chair. Oftentimes, a writing surface and a sink are present. For health care providers in specialty practices, diagnostic equipment specific to the practice may be present. Some clinics will have a dedicated exam room for specialized procedures and equipment, such as an EKG machine, nebulizer, and sigmoidoscope. For routine physical examinations, ensure that all the necessary supplies and equipment are readily available. Supplies and equipment needed will vary depending on the patient's condition and disease.

anaphylactic shock

A systemic allergic reaction that can be life-threatening without immediate medical intervention.

Tuberculin Syringe

A tuberculin syringe is a narrow syringe that has a capacity of 0.5 mL or 1 mL. The 1-mL size is used most often. The volume of a tuberculin syringe can be measured on the milliliter scale. On the milliliter side of the syringe, the syringe is calibrated in hundredths (0.01 mL) and tenths (0.1 mL) of a milliliter. Tuberculin syringes are used to accurately measure medications given in very small volumes (e.g., heparin). This syringe is also often used in pediatrics and for diagnostic purposes (e.g., skin testing for tuberculosis). It is recommended that dosages less than 0.5 mL be measured with a tuberculin syringe to make certain that the correct dosage is administered to a patient. Dosages such as 0.42 mL and 0.37 mL can be measured accurately with a tuberculin syringe. When using a tuberculin syringe, read the markings carefully to avoid error.​​​​​​​

Which of the following patients would require a specialty pharmacy?

A young patient needing a weight-based dosage of a medication for leukemia

Dosage Calculations

Accurately administering medications is critical to preventing medical errors. The name of the medication, dosage, time, frequency, and route of administration direct the medical assistant in preparing medication for administration.

parenteral

Administered or occurring in the body bypassing the gastrointestinal tract.

Where can you find an advance directive in a patient's medical record?

Administrative data

A patient has been prescribed two 200 mg tablets of ibuprofen. At which point should you initial or sign the MAR during the medication administration process?

After administering the medication to the patient

Which of the following items should be disposed of in the trash and not the sharps container?

Alcohol pad, Bandages, gloves, & Gauze

Allergies

All known patient allergies

Supine Position

Also known as the horizontal recumbent position, patients lie flat on their back with hands at the sides. Be sure that the patients feet are supported by extending the examination table.

Right Documentation

Always document administering a medication after the patient receives it, not before. If you do not administer a medication as prescribed, the documentation must include this and why the patient did not receive it. Proper documentation includes date, time, quantity, medication, strength, lot number, manufacturer, expiration date, consent obtained, and patient outcome.

Ampule

An ampule is a sealed glass container designed to hold a single dose of medication. Ampules have a particular shape with a constricted neck. They are designed to snap open. The neck of the ampule may be scored or have a darkened line or ring around it to indicate where it should be broken to withdraw medication. ​​​​​​​

otoscope

An instrument used for visual examination of the eardrum and ear canal, typically having a light for visibility.

Site, Angle, and Needle Selection for Injections Type-Subcutaneous (SC) Common Sites of Injections-upper, outer arm; abdominal region; and the upper thigh

Angle of Injection-45 degrees Needle Size-23 -25 G Needle Length-5/8 inch

Site, Angle, and Needle Selection for Injections Type-Intradermal (ID) Common Sites of Injections-forearm

Angle of Injection-5 to 15 degrees Needle Size-25-27 G Needle Length-¼ to ½ inch

Site, Angle, and Needle Selection for Injections Type-Intramuscular (IM) Common Sites of Injections-deltoid, ventrogluteal, vastus lateralis

Angle of Injection-90 degrees Needle Size-22-25 G Needle Length-1 to 1 ½ inch

The following information must be documented in the MAR about the medication.

Any allergies or history of allergies What medication is being administered Medication dosage Administration route When is it being administered—what time, how often, how long The name of the health care provider who prescribed the medication

Correspondence

Any correspondence related to the patient (e.g., from patient's insurance company, attorney, or the patient themselves)

Laboratory Data

Any laboratory reports obtained on the patient

Positioning and Draping

As a medical assistant, you will assist the provider with the physical encounter by positioning and draping the patient based on the procedure or examination. Patients are not usually placed in specific examination positions until the exam is conducted. Some positions may not be comfortable for long periods of time, and patients should be placed in them only when necessary. A patient's comfort should be of utmost importance.

Physical Examination

Assessment of each body part

A child is scheduled to get an immunization and is very anxious and scared. What can you do to help calm the child?

Be honest and calm and explain to the child that they will feel a small pinch and that the feeling will not last long. Distract or have the parent or guardian distract the child during the shot. Role play by pretending to administer a shot to a stuffed animal. Reward the child with a treat or toy afterward.

Responding to Allergic Reactions

Be prepared to manage or assist if a patient is experiencing anaphylactic shock, especially if you work in an allergist clinic. Most medical practices should have epinephrine or an epinephrine autoinjector (EpiPen) used to treat patients experiencing anaphylaxis. Epinephrine is considered the first line of treatment for a patient experiencing anaphylactic shock. Epinephrine should be administered as an intramuscular (IM) injection. The upper thigh is a common site and, in an emergency, can be injected through the patient's clothes. Once injected, hold the injector or needle into the thigh for at least 10 seconds.

Withdrawal from a Vial Technique

Before withdrawing medication from a vial, wipe the top with alcohol and allow it to dry. A vial is a closed system, and air must be injected into it to allow for withdrawal of the medication. If air is not injected into the vial before the medication is withdrawn, a vacuum remains in the vial that makes the withdrawal of medication difficult. Inject air equal to the amount of solution being withdrawn into the air space between the solution and the rubber stopper, invert the vial, and the withdraw the desired volume of medication.

You are on a committee to select a new EHR software for your medical practice. How would you describe the advantages of adding a CPOE with a CDSS?

CPOE systems are generally paired with some form of clinical decision support system (CDSS), which can help prevent errors of medication ordering and suggest recommendations for medication dosage, routes of administration, and frequency. More sophisticated CDSSs may have medication safety features, such as checking for medication allergies or drug-drug or even drug-laboratory. This would improve not only efficiency in the medical practice but also patient safety.

Holter monitor

Cardiology

Right Medication

Check the label three times to verify the medication, strength, and dose—often referred to as the "three befores." The first time to check the medication label is when taking the medication container from the storage cabinet or drawer. The second is when taking the medication from its container to prepare to administer it. The third check is when putting the container back in storage or discarding it.

Health History

Chief complaints Present illness Past medical history Family history Social history Review of systems

Which of the following procedures will require specific preparation prior to the procedure?

Colonoscopy

Right Dose

Compare the dosage on the prescription in the patient's MAR with the dosage on the medication's label and determine if medication calculations need to be performed to arrive at the prescribed dose.

Right Route

Compare the route on the prescription in the MAR with the administration route they are planning to use. Determine whether the route is appropriate for the patient and that the medication formulation is right for that route.

Step 1

Comparing the medication label to the medication order.

What are ways a medical assistant can be ready to respond to a patient experiencing an anaphylactic reaction in the medical office?

Complete periodic emergency supply checks. Practice responding to mock emergency situations in the office and identify ways to improve. Identify techniques to help with anxiety in emergency situations. Speak with other colleagues about the emergency action plan for a patient experiencing an anaphylactic reaction.

Which of the following patient conditions is required to be reported to local and state government agencies?

Confirmed tuberculosis

Older Adults

Consider ways to support older adults' physical and emotional needs during the medical visit. When an older adult patient is seen in the medical practice, it is often the medical assistant who is responsible for reviewing their medication list and verifying the dosages taken. Allot extra time for a patient who has an extensive medication history.

Children

Considerations must also be taken when providing patient care to infants and children. In almost every case, the child is accompanied by a parent or guardian. Although the child's medical information most likely will be provided by the parent or guardian, it is important to establish a positive rapport with the child. Smile and speak to the child at eye level. Speak gently and calmly with an even tone and avoid using "baby talk," especially to older or adolescent children. Depending on the child, role playing can be helpful, particularly when preparing a patient for a procedure or trying to get more information from the patient, for example, asking the child to point on a stuffed animal where the pain may be located.

Continuity of Care

Consultation report Home health care report Therapeutic service documents​​​​​​​ Hospital documents

Which of the following is a type of telehealth but not telemedicine?

Continuing education for a medical assistant

All reusable medical devices can be grouped into one of three categories according to the degree of risk of infection associated with the use of the device.

Critical devices, such as surgical forceps, come in contact with blood or normally sterile tissue Semi-critical devices, such as endoscopes, come in contact with mucus membranes Non-critical devices, such as stethoscopes, come in contact with unbroken skin

Many medications require storage in the refrigerator or freezer. How often should the temperatures be checked?

Daily

Medication Record

Detailed information related to patient's medication

Which of the following are signs of anaphylactic shock?

Difficulty swallowing

Ear Irrigation

Ear irrigation is necessary to remove impacted cerumen, or earwax, or a foreign matter from the ear. It will be important for you to explain the procedure to the patient and prepare them for possible mild discomfort. Patient preparation will be similar to the eye irrigation procedure. Supplies you will need are an ear syringe, sterile basin, return basin, warmed irrigation solution, a waterproof drape, towel, and gauze or cotton balls. Take the return ear basin from the patient, observing for any debris, and instruct them to lie on the side that was irrigated for 15 minutes.

Diagnostic Procedures

Electrocardiogram report Holter monitor report Spirometry report Radiology report Diagnostic imaging report

Which of the following process is considered the most convenient and efficient when prescribing?

Electronic order by EHR that is transmitted to the pharmacy

Glucometer

Endocrinology

Endocrinology

Endocrinology involves hormones. Medical assistants should be familiar with venipuncture and capillary punctures (fingersticks). Medical assistants will perform glucose monitoring and patient education related to proper use of glucose monitoring equipment. Common supplies & equipment: Glucometers Alcohol pads Adhesive strips Test strips​​​​​​​ Lancets

Which of the following supplies and equipment are commonly in an examination room for a general patient exam?

Exam gowns, exam table, otoscope

Environmental Considerations

Examination rooms must conform to the standards established by the Americans with Disabilities Act (ADA). These federal standards were designed to make sure that people who have disabilities are not discriminated against in public places because of a lack of proper accommodations. These standards address such things as the width of doorways and hallways; placement of door handles, grab bars, and handrails; spatial accommodations for patients in wheelchairs; and floor surfaces.

Step 3

Examine the affected ear with an otoscope.

Eye Irrigation

Eye irrigation is the process of using a sterile solution to flush the eyes of any foreign bodies or any toxic chemicals. Eye irrigation requires sterile technique and equipment. As with all procedures, review the patient's medical record and the health care provider's order. Introduce yourself and identify the patient. Explain the procedure to the patient and reason why it needs to be performed. Continue the flow until the irrigation solution is empty and the desired results are achieved, such as removal of debris. Repeat if the other eye requires treatment.

Sitting position with back at 90 degree angle to the exam table

Fowler's

The use of telehealth has increased over the last decade due to willingness of both patients and health care providers to use it, regulatory changes enabling greater access and reimbursements, and the need for health care during pandemics. The types of care that you can get using telehealth may include the following.

General health care, like wellness visits Prescriptions for routine medicine Dermatology (skin care) Eye exams Nutrition counseling Mental health counseling Urgent care conditions, such as sinusitis, urinary tract infections, and common rashes​​​​​​​

nonparenteral

Given by mouth, delivered to the gastrointestinal tract.

Vaginal Speculum

Gynecology

Step 4

Hold the wash basin tightly below the affected ear.

Intradermal

ID injections are administered between the upper layers of the skin, between the epidermis and dermis. The most common site for ID injections is the mid forearm. In rare cases, the upper chest and scapula (upper back) regions may be used. When using the forearm, measure using one hand width above the wrist and one hand width from the elbow or antecubital space. Any area within the anterior forearm visible is acceptable for the injection. The forearm is often used to administer a tuberculosis (TB) test. The upper chest and scapula may be used for skin tests, such as allergy testing.

Intramuscular

IM injections are administered into the muscle of the patient. Common sites are the deltoid (shoulder), ventrogluteal (outer hip), and vastus lateralis (upper, outer thigh) muscles. IM injections generally allow for larger administration of medication than SC and ID injections. However, the amount varies with injections sites.

Right Time

In most office and clinic settings, MAs give medications right after the provider writes the order. Nevertheless, always confirm whether the medication has any timing specifications, such as the patient having an empty stomach or waiting several hours after taking another medication (such as an antacid) that might interact with the new medication.

Fowler's

In the Fowler's position, the patient sits on the examination table with the head of the table raised to a 90-degree angle. If able, the patient may be seated on the edge of the table with feet over the edge in an upright position. This position is useful for examinations of the head, neck, and upper body. Patients who have difficulty breathing in the supine position may find this position more comfortable. The drape should be placed over the patient's lap and cover the legs.

Dorsal Recumbent

In the dorsal recumbent position, the patient is lying flat on the back with knees bent and feet flat on the examination table. This position relieves strain on the lower back and relaxes abdominal muscles. The dorsal recumbent position is used to inspect the head, neck, chest, vaginal, rectal, and perineal areas. This position can be used for digital (using the gloved fingers) exams of the vagina and rectum. To drape the patient, place the drape at the patient's neck or underarms and cover the body down to the feet.

Knee-Chest

In the knee-chest position, the patient is placed in the prone position and then asked to pull the knees up to a kneeling position with thighs at a 90-degree angle to the table and buttocks in the air. The head is turned to one side, and the arms may be placed under the head or on either side of the head for comfort and support. This position is used for proctologic exams, sigmoidoscopy procedures, and rectal and vaginal exams.

Supine

In the supine position, also known as the horizontal recumbent position, patients lie flat on their back with hands at the sides. Be sure that the patient's feet are supported by extending the examination table. This position is used to examine anything on the anterior or ventral (front) surface of the body (head, chest, stomach) and for certain types of x-rays. The patient should be draped from the chest down to the feet. During the examination, expose areas as necessary and as indicated by the health care provider. The supine position may not be comfortable for patients who have difficulty breathing or who have lower back problems. For these patients, placing a pillow under the head and under the knees may help alleviate pain and provide more comfort.

Schedule, Financial, and Billing Information

Information regarding any appointments, insurance information, balances

ophthalmoscope

Instrument used to examine the interior of the eye.

Insulin Syringe

Insulin syringes are designed for the administration of insulin only. Insulin dosages are measured in units. Insulin syringes are calibrated to match the dosage strength of the insulin being used. They are marked U-100 and are designed to be used with insulin that is marked U-100. U-100 insulin should be measured only in a U-100 insulin syringe. It is important to note that for U-100 insulin, 100 units = 1 mL. Insulin syringes do not have detachable needles. The needle, hub, and barrel are inseparable.

Irrigation Instruments, Supplies, and Techniques

Irrigations (or lavage) of the eye and ear are done for a variety of reasons. The eye can be irrigated to remove a foreign body or chemical irritants. The ear can be irrigated to remove a foreign body or remove wax that prevents the health care provider from seeing the tympanic membrane through the otoscope.

A medical assistant is preparing a patient for a pelvic exam. Which of the following positions should the patient be placed in?

Lithotomy

Other routes of administration route Transdermal

Location Applied to the skin and designed to release slowly and systemically into circulation. Administered in an adhesive patch in a single layer drug, multi-layer drug, drug in resevoir, or drug matrix.

Other routes of administration route Topical

Location Applied to the skin or mucous membrane (faster) and acts locally. Administered as creams, ointments, or emulsions.

Other routes of administration route Ocular or otic

Location Drops of medication are instilled directly into the eye (ocular) or ear (otic).

Parenteral routes Route Subcutaneous

Location Injection administered below the skin layer into the adipose (fat) layer

Parenteral routes Route Intravenous

Location Injection administered directly into the vein

Parenteral routes Route Intradermal

Location Injection administered into the dermis

Parenteral routes Route Intramuscular

Location Injection administered into the muscle

Other routes of administration route Rectal

Location Inserted into rectum

Other routes of administration route Sublingual

Location Placed under the tongue

Other Routes of Administration Route oral

Location Taken by mouth

Other routes of administration route Buccal

Location Between the cheek and gums resulting in rapid absorption

Other routes of administration route Inhalation

Location Inhaled through the mouth, passes through the trachea into the lungs; inhaled through the nose and absorbed through the nasal mucous membrane

Right Technique

MAs must know the correct techniques for administering every medication they give by every route, for example, taking an apical pulse prior to administering digoxin to ensure the patient's pulse is not less than 60.

Pulse

Manually(fingers)

Right Form

Medications can come in several different forms. Some of these include liquid, tablet, capsules, suppositories, drops, and creams. The same medication can be available in several different forms. For example, amoxicillin can come in a capsule, tablet, chewable tablet, and liquid. Each form of medication has benefits in terms of effectiveness, ease of use, and safety. Checking the correct form of medication to be administered is essential when checking all rights of medication administration.

Demographic Data

Name Address Birthdate Sex Gender Social Security number Phone number Employment information

For medication allergies, ask and document the following.

Name of the suspected medication, prescribed (brand or generic) and non-prescribed (over-the-counter) medications Timeframe of the reaction from initiation of the medication Strength and formulation Description of the reaction Indication for the medication being taken (if there is no clinical diagnosis, describe the illness) Date and time of the reaction Number of doses taken or number of days on the medication before onset of the reaction Route of administration

Each injection type must deliver the medication to the appropriate tissue. To do so, identify the following.

Needle size Syringe/barrel size Site for injection Angle of injection

Percussion hammer

Neurology

Progress Notes

New information each time the patient visits or telephones the office

Administrative Data

Notice of privacy practices form Advance directives Consent forms Medical records release form

over-the-counter

OTC-do not require a prescription

Physical Disability

Observe the patient's overall physical ability to adhere to your requests as you progress with preparing the patient for the examination or procedure. Patients may have decreased mobility and instability. You may need to provide additional assistance while escorting patients to the examination room or provide extra care when assisting them on or off the examination table.

Food and Drug Administration

Organization responsible for protecting the public health by ensuring safety, efficacy, and security of human medications.

Vials

Parenteral medications come packaged in vials, ampules, and premeasured syringes and cartridges. Vials are the most common packaging for medication that is administered parenterally. A vial is a plastic or glass container that has a rubber stopper (diaphragm) on the top. The rubber stopper is covered with a metal lid or plastic cover to maintain sterility until the vial is used for the first time. Some manufacturers do not guarantee a sterile top even though it is covered, and therefore it is necessary to wipe the top with alcohol pad with first use and any use after. Vials are available in different sizes. Multi Dose vials contain more than one dosage of the medication.

Which patients do you think would most benefit from telehealth?

Patients who have difficulty with transportation and getting to an in-person medical visit, such as older adult patients, those who have disabilities, those who are bed- or homebound, and those in rural areas

Step 2

Position the patient

Premeasured Syringes

Premeasured syringes and cartridges are prefilled syringes that are single dosed and packaged with the needle that is provided by the manufacturer. These syringes are disposable and supplied already loaded with the substance to be injected. Premeasured syringes are convenient and help ease the administration process. They allow for convenience and efficiency, accuracy in dosing, reduced risk of infection and contamination, and reduced waste. You do not have to worry about the transfer of a medication from a vial to a syringe or about leaving a small percentage of the dose behind. Common prefilled syringes are often used for immunizations and for emergency administration, such as naloxone for overdoses and sodium bicarbonate for shock and cardiac arrests.

Which of the following are advantages of an order in the CPOE compared to a written order?

Prevents incorrect dosage Identifies medication interactions Recommends treatment options

Right Education

Prior to administration of a medication, explain to the patient the name of the medication, the ordering provider, and the reason and intended effect of the medication; disclose any side effects; and confirm any allergies the patient may have.

Preparing for the Examination

Prior to the patient's arrival, review the patient's medical record, including the completed history and physical examination, to make sure you understand the procedure and what supplies and equipment will be needed in the exam room.

Problem List

Problems identified, updated each visit

computerized provider order entry (CPOE)

Process in which providers enter and send treatment instructions, including medications, laboratory, and radiology orders, via a computer application rather than paper, fax, or phone.

Providing Patient Education

Provide the patient information about any follow-up appointments, additional exams, aftercare instructions, and referrals. Let the patient know when to expect results from lab, radiology, or any other diagnostic tests. Ask if the patient has any questions and direct appropriate questions to the health care provider to answer.

When performing an ear instillation for a child, how should you adjust the auricle of the ear?

Pulling the auricle outward and downward

Spirometer

Pulmonology

Oxygen Level

Pulse Oximeter SpO2

electronic medical record (EMR)

Record in a medical practice or clinic to document the patient's demographic information, care, progress, and treatment.

Which of the following is an advantage of electronic prescriptions?

Reduces the risk of prescriptions being lost, stolen, or altered

The following is an overview of the benefits of a CPOE system.

Reducing the potential for human error Reducing time to care delivery Improving order accuracy Decreasing time for order confirmation and turnaround Improving clinical decision support at the point of care Making crucial information more readily available Improving communication among health care providers and professionals and patients

otic

Relating to the ear.

ophthalmic

Relating to the eye and its diseases.

Which of the following considerations should be done when communicating with older patients?

Repeat questions or comments, if necessary

Step 1

Review the patient's medical chart

Which of the following are part of the nine rights of medication administration?

Right medication, right dose, right technique, & right documentation

Subcutaneous

SC injections are administered beneath the skin and into the adipose (fat) tissue. This allows for slow, sustained release of a medication with long duration of effect. SC injections are used to administer smaller doses of medication, usually less than 1.5 mL. Common medications that are injected SC are insulin, heparin, immunizations, and allergy medications.

ampule

Sealed glass capsule containing a liquid.

Which of the following positions would be best for a patient that has dyspnea?

Semi-fowler's position

After administration of any medication, ask the patient to wait 20 to 30 min before leaving for observation of any possible adverse reactions or allergic reactions. Inform patients they may experience mild discomfort after an injection. However, certain symptoms may be a sign of a more serious complication. Immediately notify the health care provider if patients are experiencing any of the following.

Severe pain at the injection site Tingling or numbness Redness, swelling, or warmth at the injection site Prolonged bleeding Signs of an allergic reaction, such as difficulty breathing or facial swelling

Blood pressure

Sphygmomanometer

Respiration Sounds

Stethoscope

Which of the following equipment and instruments are commonly used during a gynecological exam?

Stirrups Retractor Speculum Cytology Kit

Which of the following is a parenteral route of medication administration?

Subcutaneous

Lying flat on the back with the arms down to the side

Supine

Maintaining a Clean Examination Area

Surfaces, including counters, chairs, any reusable equipment, and exam tables, should be cleaned at the beginning and end of each day and between patients to reduce the risk of transmitting infectious agents. Clean the examination table with the proper disinfectant and allow it to dry before placing new paper on the table. The paper covering the exam table must be disposed of and replaced between each patient. If available, change pillow covers after each patient. Disposable equipment used during the previous examination must be discarded in the appropriate containers. Reusable equipment must be taken to the appropriate area for cleaning and disinfection, following standard precautions.

Which of the following is considered a reusable equipment or supply?

Surgical forceps

Every medication label indicates the medication's form. The following are the different types of medication forms.

Tablets Capsules Oral suspension Emulsions Lozenges​​​​​​​ Liquid

sterilization

The complete destruction of all micro-organisms through specific means.

Left Lateral

The left lateral position (also known as lateral semi-prone recumbent position and formerly known as Sims' position) requires the patient to be placed on the left side with the right leg sharply bent upward and the left leg slightly bent. The right arm is flexed next to the head for support. The patient is draped from under the arm or shoulders to below the knees at an angle. This allows the health care provider to raise a small section of the drape while keeping the rest of the patient covered. This position is used for rectal exams, taking rectal temperatures, enemas, and perineal and pelvic exams.

Lithotomy

The lithotomy position is similar to the dorsal recumbent position, except the patient's feet are placed in stirrups attached to the end and sides of the table. The stirrups must be locked in place to ensure patient safety. Provide additional assistance to patients who may have difficulty placing their feet in the stirrups. After the feet are in place in the stirrups, the patient is instructed to slide down until the buttocks are positioned at the edge of the table. The patient is draped from under the arms to the ankles. This position is used for vaginal examinations, often requiring the use of a vaginal speculum (an instrument used to hold open the walls of the vagina) and for obtaining cell samples of the cervix.

Review Schedule to Determine Reason for Visit

The medical assistant is often responsible for preparing the patient examination and procedure rooms, including assembling all the necessary supplies and equipment. Examination rooms in the medical practice and other facilities vary in size, layout, and type of equipment used. For example, an examination room that is used for general examinations can look very different than a room used specifically for minor surgical procedures. Review the schedule at the beginning of each day that identifies the patient's name and the reason for the visit. This can help in determining what room, supplies, or equipment will need to be prepared for the visit.

Injection Sites

The most commonly used routes of parenteral administration are subcutaneous (SC), intradermal (ID), and intramuscular (IM). Another route is intravenous (IV), which is administering medication directly into the vein. This route is more commonly done in the hospital setting or in the emergency setting. In most cases, medical assistants will not perform an IV administration.

Checking the Medication Order

The name of the medication, dosage, time, and route of administration direct the MA in preparing medication for administration. Consent for administration of a medication should be obtained from the patient or guardian prior to preparing the medication. Tell the patient what the medication is, what it is given for, the dosage, and the route that will be used. Checking the medication three times helps prevent medication errors. The first check is comparing the medication order to the medication. The second check occurs when preparing the medication for administration. The third check is completed when returning the medication back to the shelf.

Prone

The prone position requires the patient to lie face down, flat on the stomach, with the head turned to one side, and arms either alongside the body or crossed under the head. This position is the opposite of the supine position. The drape should cover the patient from upper back to over the feet. This position is used for back exams and certain types of surgery

Rights of Medication Administration

The rights of medication administration are a collection of safety checks that everyone who administers medications to patients must perform to avoid medication errors. Once the medication has been ordered, always follow the rules of medication administration. Ensure the right patient, right medication, right form, right dose, right route, right time, right technique, right education, and right documentation.

Semi-Fowler's

The semi-Fowler's position is a modified Fowler's position with the head of the table at a 45-degree angle instead of a 90-degree angle. This position is used for postsurgical exams and patients with breathing difficulties or lower back injuries. The drape should be placed over the patient's lap and covering the legs.

Hypodermic Syringe

There are generally three types of syringes: hypodermic, tuberculin, and insulin. Hypodermic syringes come in a variety of sizes from 0.5 to 60 mL and even larger. Syringes are calibrated or marked in milliliters but hold varying capacities. Of the small-capacity syringes, the 3 mL syringe is used most often for the administration of medication. Although many syringes are labeled in milliliters, a few syringes are still labeled with cubic centimeters (cc). Milliliter (mL) is the correct unit. The milliliter is a measure of volume, the cubic centimeter is a three-dimensional measure of space and represents the space that a milliliter occupies. The terms, although sometimes used interchangeably, are not the same. Many institutions are now purchasing syringes that indicate mL as opposed to cc, but either is acceptable for use.

Obstetrics and gynecology

This specialty practice may assist in a number of procedures, including minor surgery. A common procedure is a Pap test. A Pap test is a screening procedure that collects and examines cells from the vaginal and cervical mucosa to check for precancerous or abnormal cells. Vaginal speculums and retractors Cytology kits Stitch removal sets Dressing kits Exam tables with stirrups Ultrasound machine​​​​​​​ Handheld fetal Doppler machine

Which of the following syringes would best be used to administer 0.1 mL?

Tuberculin

Used needles should be disposed of in which of the following ways?

Uncapped and placed in the sharps container

Right Patient

Use two patient identifiers, usually full name and date of birth, to verify the right patient. Then verify that data with the information on the medical record or medication administration record (MAR).

Reflex hammer

Used for testing reflexes

Stethoscope:

Used to amplify sounds in the body, such as the beating of the heart, respirations in the lungs, and bowel sounds in the abdomen

Sphygmomanometer:

Used to measure blood pressure

Thermometer:

Used to measure body temperature

Pulse oximeter

Used to measure oxygen saturation in the blood

Since they will be entering the patient's body, needles must be sterile when used for injections. According to the Centers for Disease Control and Prevention (CDC), unsafe injection practices that have resulted in disease transmission have most commonly included the following.

Using the same syringe to administer medication to more than one patient Accessing a medication vial with a syringe that has already been used to administer medication to a patient, then using the remaining contents from that vial or bag for another patient Using medications packaged as single-dose or single-use for more than one patient Failing to use aseptic technique when preparing and administering injections.

Step 1

Warm the solution

A patient reports having a medication allergy. What questions should you ask?

What was the reaction? When did the reaction start after taking the medication? How many doses have you taken? Why are you prescribed this medication?

Withdrawal from an Ampule Technique

When withdrawing medication from an ampule, snap the neck off by grasping it with an alcohol wipe, sterile gauze, or ampule protector. Aspiration of the medication into a syringe occurs easily and may be accomplished with a filter needle, if required by the medical practice's policy. A filter needle prevents withdrawal of glass or rubber particulate. When the needle is inserted into an ampule, take care to prevent the shaft and tip of the needle from touching the rim of the ampule. Withdraw medication into the syringe by gently pulling back on the plunger, which creates a negative pressure and allows the medication to be pulled into the syringe. Discard the needle used to withdraw the medication and replace it with a new needle.

Sterile Techniques

Whenever invasive procedures are to be performed, caution must be taken to maintain sterility. Some medical equipment is intended to be disposable while others are to be reused. Reusable equipment must be disinfected or sterilized accordingly prior to being used with each patient. Reusable equipment includes some surgical instruments (clamps, forceps, some scalpels, and endoscopes). ​​​​​​​

45 degrees

abdominal region upper, outer arm

Subcutaneous

abdominal region upper, outer arm

15 degrees

anterior forearm

Intradermal

anterior forearm

Step 5

assist the patient with dressing, if requested

intramuscular

deltoid Vastus lateralis

90 degrees

deltoid ventrogluteal

Lying flat on the back with the knees bent

dorsal recumbent

Brand names are usually capitalized and are listed first, followed by the generic name, which is not capitalized,

for example, Lopressor (metoprolol) and Toprol XL (metoprolol). Even OTC medications have brand and generic names, such as aspirin (Bayer), acetaminophen (Tylenol), and ibuprofen (Advil, Motrin).

Step 3

identify the patient & introduce yourself

Step 5

insert the tip of the syringe pointed toward the top of the ear canal and spray the solution.

Eye Instillation

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.

Laying on the left side with the left leg slightly flexed & the right leg flexed at 90 degree angle

left lateral

lying flat on the table with feet resting on stirrups

lithotomy

hypertension (high blood pressure)

metoprolol, which is the generic name for Lopressor and Toprol XL—both the medication's brand names.

Which of the following equipment and instruments are commonly used in a pulmonology specialty?

peak flow meter pulse oximeter spirometer

Step 2

prepare the exam room

Step 2

preparing the medication

Step 4

provide the patient a gown & drape

Step 3

returning the medication to the storage cabinet

Sitting position with back at 45 degree angle to the exam table

semi-fowler's

brand name (or trade name)

the name assigned by the medication manufacturer.

generic name

the standard or official name and assigned by the United States Adopted Names (USAN) Council and the World Health Organization (WHO).

Temperature

thermometer

Otoscope

used to examine the ear canal & tympanic membrane

reflex hammer

used to test for reflexes

Ophthalmoscope

used to view the interior of the eye