During an emergent crisis, DO NOT
alarm the patient
3 essentials when performing blood draws
1. test requisition review
2. proper patient identification
3. site choice
2 essentials when performing EKG or other cardiac monitoring
1. inform pt. of what is expected
2. observe for complications
CLIA-waived tests
simple, performed with low risk of error
When performing a CLIA-waived test, always...
1. identify the patient
2. wear PPE
3. read all manufacturer directions and instructions
BIG OSHA (needle) protocol
do NOT recap needles
Sharps container
Puncture and leak proof and labeled with biohazard symbol for disposal of scalpels, needles and any other sharp object
Biohazard bag
Leak proof bag for disposal of gloves, gauze and bandages
Standard Precautions
ALL bodily fluids except sweat are to be considered infectious for all patients.
Change gloves...
When handling contaminated surfaces and in-between patients
Before putting gloves on you should always
wash hands with soap and water or use an alcohol-based hand sanitizer
Blood pressure measures the
pressure of blood against the walls of the artery and ventricles
The artery and ventricles contract so that the ...
blood is pushed to the aorta and pulmonary artery
Systole
heart contracts
Diastole
heart relaxes
FIRST thing you do when taking any pt. vitals
Tell patient what you're going to do
If you have to manually obtain a BP, what should you palpate?
Brachial artery in antecubital region of arm
When taking BP, which arm should you use?
Generally the right unless the left has stronger pulse
Heart rate gives physician information about the heart's...
rhythm, volume and vessel elasticity
How long should you count to get a pt.'s HR?
30 sec. (multiply by 2) or 1 minute
*IF there are irregularities, count for 1 minute
T/F: You should tell the pt. when you are measuring their respirations.
False, do NOT tell the pt. as this may cause them to change their breathing patterns.
How long should you observe a pt.'s respirations for?
30 sec. (multiply by 2) or 1 minute
Most common site for a temperature reading
oral
Question to ask pts. before taking their oral temp:
Have you eaten anything, had anything to drink, smoked, or exercised within 30 minutes of coming to the doctor today?
What position do you put patients in to obtain a rectal temperature?
Sims or lateral recumbent position: pt. lies on left side, left hip and leg straight, right hip and knee bent
For an aural/tympanic temperature, how should you manipulate the ear in a pt. over the age of 3?
Pull up and back
For an aural/tympanic temperature, how should you manipulate the ear in a pt. under the age of 3?
Pull down and back
Where is the temporal artery temperature readings taken?
On the forehead
Where is the axillary temperature reading taken?
Armpit
Anthropometric measurements include...
height and weight
For an infant or child up to 3 years old, growth is measured via...
head circumference, length and weight
Conversion C -> F
(C x 9/5) + 32
Conversion F -> C
(F - 32) x 5/9
lbs -> kg
lbs x 0.45
kg -> lbs
kg x 2.2
ft -> in
(ft x 12) + in
in -> cm
in x 2.54
cm -> in
cm x 0.39
Supine
pt. flat on back, face up
Dorsal recumbent
supine, with knees bent
Fowler's position
lay on table, table elevated 90 deg
Prone
pt. lies face down
Sim's position
pt. lay on left side, left leg extended, right bent with knee on table
Knee-Chest
pt. rests knees and chest on table with head turned to side
Trendelenburg
pt. supine, bottom of table elevated 30 deg
After every patient, the exam room must
Be inspected for cleanliness, waste and spills must be cleaned, restocked, paper must be changed
5 steps to prep patient for an exam
1. check medical record for completion
2. pt. needs to sign all consent forms
3. ask pt. reason for visit
4. answer any questions pt. has
5. review medical record and have any lab results out for Doc
T/F: Honestly discuss any discomfort a pt. may have during an exam up front.
True
Most important concepts when administering medications
1. always check pt. allergies
2 double check expiration dates
3. review meds and clarify with Dr. before administering
4. check 3 times to ensure dose matches order and that it is measured properly
How many times should the dose and measurement be checked against the physician's order?
3 times
It's always important to observe a patient for __ & __ __ when administering oral medications
choking & adverse reactions
Before administering parenteral/topical medications, the patient should be notified of
any tingling or burning they may experience
Before administering ___/___ medications, check the skin for any complications
parenteral / topical
Transdermal medication
typically patch of some form
DO NOT place transdermal medication on...
broken skin
What should you write directly on the transdermal patch for a patient?
Removal date
T/F: Pt. cannot shower with transdermal patch.
False
What 4 things should you ALWAYS tell the patient before administering any type of injection?
1. what the medication is
2. how it is applied
3. any side effects
4.the fact that it may pinch
What 2 things should you always check and re-check before administering a medication?
the medication itself and its expiration date
Items to assemble before administering an injection are:
*hint: there are 7!
1. the meds, 2. gloves, 3. alcohol wipes, 4. syring, 5. sterile needle, 6. gauze, 7. sharps container
Steps to take BEFORE administering ANY type of injection:
1. wash hands and glove up
2. assemble items
3. wipe vial with alcohol swab
4. draw up medication- no air!
Steps to take AFTER administering ANY type of injection:
1. place gauze next to needle and remove at the same angle as it was inserted
2. place needle in sharps container
3. if pressure is needed, apply now
4. remove gloves and wash hands
5. document the dosage, method, location and any complications in the pt.
Area to insert needle into for INTRAMUSCULAR injections
deltoid muscle
Area to insert needle into for INTRADERMAL injections
volar forearm
Area to insert needle into for SUBCUTANEOUS injections
abdomen, back of upper arm, outer thighs, upper buttocks
Angle to insert needle for INTRAMUSCULAR injections
90 deg
Angle to insert needle for INTRADERMAL injections
15 deg
Angle to insert needle for SUBCUTANEOUS injections
45 deg
During INTRAMUSCULAR injections, do you aspirate?
Aspirate before injecting, then inject slow and steady
During INTRADERMAL injections, do you aspirate?
NO! Be swift with injection.
During SUBCUTANEOUS injections, do you aspirate?
Aspirate before injecting, then inject slow and steady
After INTRAMUSCULAR injection, what do you do?
Apply pressure and wiggle muscle
After INTRAERMAL injection, what do you do?
DO NOT apply pressure or wiggle
After SUBCUTANEOUS injection, what do you do?
Apply pressure at the Doc's request
PFT
pulmonary function test
For a PFT to be accurate, pt. must not have done what 3 things?
Smoke, use nebulizer, or use bronchodilator within 6 hours of taking test
How many times must you repeat a PFT ?
3
Long distance visual test
Snellen chart
Basic outline of long-distance Snellen chart test
start on line 27, stop when pt. gets 2 incorrect
First step in suture removal (after washing hands & explaining procedure, etc.)
1. place gauze sponge next to first suture
During suture removal, you use forceps to do what?
Grab the knot of the suture, beginning with the first suture, gently pull it away from the skin so that you can cut the suture close to the skin with siccors
After the suture is cut, what do you do next?
Gently pull the suture through the skin and place it on the gauze sponge
What are the final steps of suture removal after the suture has physically been removed?
Inspect the area then continue until all sutures have been removed. Dispose of trash in biohazard container and cover wound with SteriStrip or a bandage.
T/F: You should make conversation with patient throughout suture removal and let them know what is going on.
True
What should you explain to a patient after his/her sutures have been removed?
They need to keep the area clean and dry and call the office with any issues
T/F: When documenting suture removal, it is not important to document that you gave the patient verbal instructions on how to care for their wound.
False; this is a must
Saliva tests are different from other tests because the specimen are treated differently; how?
Saliva specimen are frozen
Semen samples must be... (3 things)
protected from light, kept at normal body temperature and processed within 1 hour of collection
How should a patient be positioned for eye irrigation?
supine or sitting with head back
Difference between documenting an irrigation procedure vs. everything else:
MUST include how much solution was used to irrigate
Basic outline of ear irrigation
1. inspect ear with otoscope
2. drape shoulder, place container for spills on pt shoulder, have pt. stabilize
3. pull pinna up and back for adults or down and back for kids
4. irrigate, inspect with otoscopt
5. repeat until cerumen is gone
6. dry with gau
If a pt. goes into shock, what 3 things can a MA do?
Make sure pt.'s airway is open, position them in supine position with feet elevated and call for help
Signs of syncope
flushed, heavy sweating, faint (or literal fainting)
If syncope occurs when a pt. is on your watch, what do you do?
loosen their clothes, lay them in supine position and monitor vitals for the physician
2 aseptic cleaning techniques
sterilization & disinfection
Sterilization
prevents contamination, usually an autoclave is involved (250-320 F)
Disinfection
KILLS microbes; bleach is most commonly used (1:10)
Sanitization
removes debris and reduces microbes and viruses before sterilizing or disinfecting
What two age groups should be given special patient consideration?
pediatric patients and elderly patients
How would you introduce yourself to a patient who has arrived to have their blood drawn?
Hi, I'm Tess, I'm your medical assistant. I see that today we are going to have some blood drawn. I will be assisting you with that today.
Brady-
slow
Oligo--
scanty
Pari-
all
Trachy-
fast
Eu-
Normal
eu-
normal
ab-
away
de-
down
dia-
through/across
epi-
above
per-
through
hem-
blood
vascul-
blood vessels
-ac, -ar
related to
-ic, -oid, -ous, -tic
related to
-emia
of blood
-plegia
paralysis
-oma
tumor
-rrhaphy
suturing
-stomy
surgical opening
-plasty
repair
As a CCMA, it is NOT in your scope of practice to give a patient...
advice
If vital signs are outside of normal ranges, what should you do with the data?
Record it in the pt's chart and contributing factors, if any
What does the heading of a letter consist of?
letterhead
What is the opening of a letter comprised of?
address, salutations, attention line with title and academic degree
The body of the letter states the
reason for correspondence
A signature is included in the _ of a letter
closing
Form letter" are used in...
routine correspondence
Emails and faxes must have 2 things:
1) confidentiality notice, 2) instructions detailing what to do if the message is received in error
BCC (blind carbon copy) is used for an email when
it is a bulk email message
What two things comprise the "care components" of a patient's EMR?
nursing orders and medications
EHR & EMR help physicians eliminate
duplicate tests and treatments from being ordered
always give patients the following basic education before an appointment:
instructions on what to bring, how early to arrive, any lists or information they need
2 important communication modifications to make for patients using wheelchairs
talk to the pt. at eye level and ask if assistance is needed before giving it
2 important communication modifications to make for a patient with a hearing impairment
speak face-to-face so they can lip-read and speak naturally and clearly
1 important communication modification to make for patients with Alzheimer's or dementia
repeat information and write it down as well
Before giving a pt. information on community resources, you should always do what first?
Check with the resource to make sure they can still aid the pt., but without giving out too much PHI.
S in SOAP
Subjective: the patient's complaint
O in SOAP
Objective: evidence like lab results and the physical exam
A in SOAP
Assessment: diagnosis
P in SOAP
Plan: treatment and therapies for the future
Who owns a medical record?
the facility where the record originated
POMR
problem-oriented medical record
Four components of a POMR
1. database- chief complaint, lab results
2. problem- list of pt. problems
3. treatment- therapy
4. progress- #'d notes to match pt. problems
Five tasks to prepare paper records for storage
1. conditioning
2. releasing
3. indexing/coding
4. sorting
5. filing
Consent forms MUST contain:
the procedure, it's risks and benefits, any alternatives and any important demographic information
Who has to witness the patient's signature?
Someone other than the physician
T/F: The patient's questions must all be answered.
True
The original consent form goes __
in the patient's chart
T/F: If an outside facility needs the consent form for any reason, they can have it.
False, they only get a copy
A consent form for a surgical procedure must be review by the _ and the patient.
Doctor
It (is/is not?) within the CMAA's scope of practice to answer questions and review the consent form with the patient.
Is
When scheduling a pt. for an outpatient procedure, always ask the facility...
if the patient needs to know any special instructions
Outpatient test results are always added to the patient's...
medical record
Urgent care facilities utilize __ __ scheduling
open office
HIPAA allows transfer of persona data for __ __.
insurance payment
HIPAA Privacy Rule
other than the basic minimum, patients must sign a release to give insurance companies any more information
HIPAA Security Rule
any pt. information stored or transmitted must be properly protected
When a pt. refuses treatment, what should your initial response be?
Ask the pt. to repeat the recommended procedure back to you to make sure you know they understand it.
Durable" supplies
(ex. fax and EKG machine) need serial #, maintenance and current condition and status on file
Controlled substances are to be inventoried __
DAILY
How many people must sign off on the daily controlled substance inventory?
2
How often is the inventory submitted to the DEA?
every 2 years
ICD9 Vol. 1
V and E codes, organized by diseases and injuries
In Vol. 1 of the ICD9 manual, 3 digit codes represent...
a specific disease
In the subcategory section of Vol. 1 in the ICD9 manual __ digit codes are used to...
4 digit codes are used to break diseases down further
ICD9 5-digit codes are used to symbolize
subclassifications
ICD9 Vol. 2 contains
an alpha ordered list of all the same diseases as volume 1
ICD9 Vol. 2 is organized into 3 sections, they are:
1. diseases
2. poison and chemical substance
3. alpha index of external causes of disease
ICD9 Vol. 3 is an alpha and tabular index mostly used in _
hospitals
ICD9 Vol. 3's codes are formatted with:
2 digit procedure code followed by a decimal then 1 or 2 digits
CPT codes are __ digit codes used to...
5-digit codes used to described procedures
CPT book that has codes for all patient and physician encounters based on place and type of service is in the __ section
Evaluation & Management
In the __ section of the CPT book, the ASA ranks pts. by level of complexity
Anesthesiology
In the __ section of the CPT book, there are "global periods" that describe all service that are part of patient care
Surgery
The Radiology section of the CPT book includes information on __ and __ __
ultrasound and nuclear medicine
__ and __ services are grouped into panels in the CPT book.
Lab and pathology
Services not in other sections of the CPT book may be found in this section. (ex. immunizations)
Medicine
according to the pt. bill of rights, the pt. has a right to...
info. about their treatment and the professionals and facility involved in their care
according to the pt. bill of rights, a pt. can choose between healthcare providers, ask for a __ __ and have access to help during an __
health screening, emergency
OSHA set guidelines for
environmental protection and workplace safety
according to OSHA, when using an alcohol-based hand sanitizer, use a __-sized amount
quarter
What must be bandaged before donning gloves?
breaks in the skin
OSHA bloodborne pathogen standard limits exposure to...
disease-causing microorganisms
CLSI stands for
Clinical labs and stadards institute
CLSI is an organization that...
helps laboratories develop safety programs
CDC guidelines are a set of standard precautions that...
reduce the risk of pathogens in healthcare
As defined by the CDC standard precautions, pathogens are:
blod, bodily fluids, mucous membranes, tissues and non-intact skin
If a chain of custody form is needed for a patient suspected of illegal drug or alcohol use, what must every person who contacts the specimen do?
Initial and date (time) the form
Once a rape kit is opened, according to chain of custody, anyone who touches it must...
initial and write the time on the form
If you suspect anyone of committing Medicare and/or Medicaid insurance fraud, who should you contact?
Program Integrity contact in state office
In all and any emergent situations, what is your role as a CCMA?
keep calm, keep patients safe and calm as well
Fire extinguishers marked with "A" are designated for what type of fire?
Ordinary
Fire extinguishers marked with "B" are designated for what type of fires?
Flammable liquids and vapors
Fire extinguishers marked with "C" are designated for what type of fires?
Electrical
Fire extinguishers marked with "K" are designated for what type of fires?
Kitchen
Wound should always be wrapped __ to proximal
distal
Bandages should always extend __ inches beyond the dressing
1-2 inches
NORMAL Sodium ranges
135-145 mEq/L
Normal Potassium ranges
3.5-5.1 mEq/L
RBC males
4.3-5.7 x 10^6 microL
RBC females
3.8-5.1 x 10^6 microL
Normal Hematocrit males
39-49%
Normal Hematocrit females
35-45%
Normal Hemoglobin males
13.5-17.5 g/dL
Normal Hb females
12.0-16.0 g/dL
Normal platelet count
150-450 x 10^3 per microL
LDL cholesterol
<130
HDL Cholesterol males
>29 mg/dL
HDL cholesterol females
>35 mg/dL
Normal glucose levels
70-115 mg/dL
When tending to wounds, alginates are good for
cleaning exudating wounds; helps in debridement
When tending to wounds, foam are good for
wounds with large drainage
When tending to wounds, hydrogels are good for
wounds that need sloughing off (ex.necrotic tissue or burns)
When tending to wounds, gauze is good for
minor wounds or as a second dressing
15 mL = __ tbsp.
1