#9 NHA CCMA: Discharge, Disinfection/Sanitization, Aseptic, and Psychology

Why is it important to provide both verbal and written discharge instructions?

Patients may be anxious or forgetful after procedures; having both ensures they understand their recovery care and medications clearly.

What should be reviewed with the patient before they leave?

• Postoperative medications (how/when to take them, side effects, storage)

• Wound care

• Signs of complications

• Activity and diet restrictions

• Follow-up appointments

• Transportation arrangements (if needed)

What is the role of the medical assistant in discharge education?

To review instructions, answer questions, ensure the patient understands the healing process, and knows when to contact the provider.

What are examples of standard discharge instructions?

• Keep site clean and dry

• Avoid placing stress on the surgical area

• Rest and hydrate

• Return for follow-up appointment

What are common activity restrictions after surgery?

• No bathing (until cleared)

• Limited or no exercise

When might diet restrictions be given?

• Typically not needed for minor surgeries

• May be given for patients with GI symptoms (start with liquids, advance as tolerated)

What is included in wound care instructions?

• How to change dressings

• How to apply medication

• What signs of infection to watch for

What transportation considerations should be made?

If a patient cannot drive after a procedure, arrangements must be made beforehand; failure to do so may require rescheduling.

What are signs of infection or complications patients should report?

• Unusual pain or burning

• Swelling, redness, or discoloration

• Bleeding or foul-smelling drainage

• Fever of ≥ 100°F (37.7°C)

• Nausea and vomiting

What are the three levels of infection control in a clinical setting?

• Sanitization

• Disinfection

• Sterilization

Why is infection control important?

It prevents the spread of disease-causing microorganisms, protecting both patients and health care workers.

What is sanitization?

The first step in cleaning—removing blood, body fluids, and debris to reduce microbes before disinfection or sterilization.

What precautions should be taken during sanitization?

• Always wear gloves

• Wear utility gloves for sharps

• Follow manufacturer guidelines for water temp and detergent

• Keep clean and dirty areas separate

What is ultrasonic sanitization and when is it used?

A method using sound waves to loosen debris without friction—ideal for delicate instruments and reduces sharps injury risk.

What should you do if you can't sanitize equipment immediately after use?

• Rinse under cold water

• Place in detergent solution

What is disinfection?

The process of destroying or inactivating pathogens on surfaces and instruments—does not kill all spores or viruses.

What types of items can be disinfected?

• Countertops

• Surgical instruments

• Exam tables, sinks, keyboards, and high-touch surfaces

What is a commonly used disinfectant in clinical settings?

• Glutaraldehyde (effective but expensive and requires long submersion)

• 1:10 bleach solution (cheaper and effective alternative)

Can disinfectants be used on patients?

No. They are only for equipment, surfaces, and clinical surroundings.

What is sterilization?

The destruction of all living organisms, including pathogens and spores.

What steps must occur before sterilization?

• Sanitization

• Disinfection

What types of instruments require sterilization?

• Instruments used in surgical procedures

• Instruments used in a sterile field

What are common sterilization methods?

• Steam under pressure (autoclave)

• Dry heat

• Gas

• Chemicals

• Ultraviolet or ionizing radiation

What is the most widely used sterilization method in clinical settings?

Autoclaving – using moist heat and pressure.

What temperature must an autoclave reach to achieve sterilization?

Between 250°F and 270°F.

How long should items be autoclaved?

• Unwrapped items: ~20 minutes

• Wrapped items: ~30 minutes
  (Always follow manufacturer guidelines)

What is the most common autoclave cycle in ambulatory health care?

The gravity cycle – used for stainless steel instruments.

How should instruments be prepared for autoclaving?

• Wrap with 2 layers of autoclave paper or use peel-apart pouches

• Place gauze between hinged tips

• Seal paper with autoclave tape

• Insert indicator strip inside

• Label with date, time, initials, and contents

What do sterilization indicators do?

They change color to confirm proper sterilization conditions were met.

• Chemical indicators (e.g., tape turns black)

• Biologic indicators

• Pouches have arrows that change color

What is chemical sterilization and when is it used?

Sterilization using a chemical bath for heat-sensitive items like endoscopes.

• Must be submerged for 8 hours

• Requires precise mixing and labeling

• Items cannot be wrapped and are no longer sterile once removed

How should sterilized items be handled and stored?

• Keep in dry, covered areas

• Inspect for tears, punctures, or watermarks

• Use oldest to newest (FIFO)

• Double-wrapped items are typically sterile for 30 days if dry and intact

What is asepsis?

A state of being free from disease-causing micro-organisms.

Why is maintaining asepsis important in a medical facility?

It helps reduce the spread of infection in both clinical and reception areas.

List routine cleaning tasks to support asepsis in the facility.

• Clean and disinfect daily, especially high-traffic areas (exam rooms, restrooms, check-in areas).

• Remove trash regularly.

• Separate sick patients from well patients immediately.

• Provide PPE (gloves, gowns, masks, eye protection) as needed.

• Prohibit food and drink in lab/clinical/patient areas.

• Post hand hygiene and cough/sneeze etiquette reminders.

What is medical asepsis?

A technique used to reduce the number and growth of pathogenic micro-organisms.
(Does not eliminate all microbes)

Common examples of medical aseptic practices for MAs?

• Handwashing before and after each patient

• Wiping down workspaces between patients

• Using PPE (e.g., gloves, masks) when handling bodily fluids

• Cleaning and separating lab areas into “clean” and “dirty” sides

• Covering coughs/sneezes and washing hands after

What is surgical asepsis?

The complete removal of all micro-organisms; used in invasive procedures.

When is surgical asepsis required?

During:

• Invasive procedures

• Wound care

• Endoscopies

• Urinary catheter insertion

What supplies are used in surgical asepsis?

• Sterile gloves

• Sterile gowns

• Sterile drapes

• Sterilized instruments

How do you decide between medical vs. surgical asepsis?

• Use medical asepsis for noninvasive procedures when skin/mucosa is intact.

• Use surgical asepsis for invasive procedures or open wounds.

What is the significance of Erikson’s eight stages of development?

They identify psychosocial challenges at different life stages and the tasks to master for healthy ego development, influenced by society and culture.

Trust vs. Mistrust

• Age: Infants

• Successful Outcome: Trust

• Unsuccessful Outcome: Mistrust

• Key Tasks:

  • Form attachment & trust with primary caregiver

  • Develop trust in own body through motor skills

• Success Leads To: Self-confidence, optimism that needs will be met

• Failure Leads To: Suspiciousness, difficulty with relationships

Autonomy vs. Shame and Doubt

• Age: Toddlers

• Successful Outcome: Autonomy (independence)

• Unsuccessful Outcome: Shame and doubt

• Key Tasks:

  • Develop self-control and independence

  • Acquire language skills

• Parenting Tip: Be firm but tolerant

• Success Leads To: Self-control, ability to delay gratification

• Failure Leads To: Anger with self, low self-confidence, lack of pride

Initiative vs. Guilt

• Age: Preschoolers

• Successful Outcome: Initiative

• Unsuccessful Outcome: Guilt

• Key Tasks:

  • Explore new experiences

  • Manage feelings of guilt from moral development

• Child Traits: Active imagination, curiosity

• Success Leads To: Assertiveness, dependability, creativity, achievement

• Failure Leads To: Inadequacy, guilt, belief in deserving punishment

Industry vs. Inferiority

• Age: School-age children

• Successful Outcome: Industry

• Unsuccessful Outcome: Inferiority

• Key Points:

  • Children need recognition for accomplishments to build self-confidence.

  • Positive reinforcement leads to competence, self-satisfaction, and increased participation at school, home, and community.

  • Negative responses lead to feelings of inadequacy and difficulty cooperating with others.

Identity vs. Role Confusion

• Age: Adolescents

• Successful Outcome: Identity

• Unsuccessful Outcome: Role confusion

• Key Points:

  • Adolescents explore where they fit in and life direction.

  • Success results in emotional stability, ability to form committed relationships, and sound decision-making.

  • Failure results in lack of goals, rebelliousness, self-consciousness, and low self-confidence.

Intimacy vs. Isolation

• Age: Young adults

• Successful Outcome: Intimacy

• Unsuccessful Outcome: Isolation

• Key Points:

  • Focus on partnerships, marriage, family, and career.

  • Success leads to mutual respect, love, intimacy, and career commitment.

  • Failure causes social withdrawal, job instability, and inability to form close relationships.

Generativity vs. Stagnation

• Age: Middle adults

• Successful Outcome: Generativity

• Unsuccessful Outcome: Stagnation

• Key Points:

  • Adults raise children, become grandparents, and contribute to society through teaching, coaching, or activism.

  • Success leads to personal and professional achievements and active community involvement.

  • Failure results in self-absorption and inability to share or give to others.

Ego Integrity vs. Despair

• Age: Older adults

• Successful Outcome: Ego integrity

• Unsuccessful Outcome: Despair

• Key Points:

  • Adults reflect on life, retire, and cope with aging and loss.

  • Success brings wisdom, self-acceptance, and peace.

  • Failure leads to dissatisfaction, depression, anger, and difficulty accepting death.

What is mental health?

A person’s cognitive abilities, behaviors, and emotions.

What are common causes of mental health conditions?

Biological factors like genetics, environmental influences such as learned behaviors or trauma, or a combination of both.

Why must medical assistants understand mental health conditions?

To interact empathetically, build trust, communicate appropriately, and support effective treatment.

What treatments are typically used for mental health conditions?

Medications and behavioral therapies.

Define depression.

A mood disorder involving chemical imbalances in the brain.

List signs and symptoms of depression.

Extreme sadness, fatigue, lethargy, hopelessness, digestive problems, lack of motivation, and suicidal thoughts.

How is depression usually managed?

Through a combination of therapy, healthy lifestyle habits, and medication.

Describe ADHD.

A chronic condition that begins in childhood, marked by inattention, hyperactivity, and impulsivity.

What are typical symptoms of ADHD?

Difficulty focusing, trouble following directions, disorganization, fidgeting, excessive talking, and difficulty with quiet activities.

Which gender is ADHD more commonly diagnosed in?

Boys

What are common treatments for ADHD?

Medications and behavioral therapies.

Define anxiety disorders.

Conditions characterized by overwhelming worry and fear that impair normal functioning.

What symptoms are associated with anxiety?

Increased stress, rapid heartbeat, sweating, and persistent worry.

How is anxiety typically treated?

With therapy, lifestyle changes, and medication.

What is PTSD?

A disorder triggered by experiencing or witnessing a traumatic event.

Which groups are at higher risk for PTSD?

War veterans, survivors of abuse or natural disasters, and people who have lost loved ones.

What symptoms indicate PTSD?

Flashbacks, intrusive memories, negative thoughts, behavioral changes, trouble concentrating or sleeping, self-destructive actions, and avoidance of trauma reminders.

What treatments are used for PTSD?

Psychotherapy, exposure therapy, and medication.

What are environmental and socioeconomic stressors?

Factors causing anxiety or stress, including psychological issues like grief and depression, as well as positive life changes.

What is white-coat syndrome?

Anxiety-induced elevated blood pressure readings taken in medical settings, which differ from normal readings at home.

What are environmental stressors?

Situations or physical factors in the environment that cause enough stress to become obstacles to achieving goals or positive experiences.

What are some examples of environmental stressors?

Air pollution, excessive sun exposure, overcrowding, language and cultural barriers, discrimination.

What types of environmental events can cause stress?

Death of a loved one, theft, vandalism, motor vehicle crashes, physical assault, job or school problems.

What are major disasters that can act as environmental stressors?

Fires, floods, tornadoes, earthquakes, hurricanes, and war.

What mental health condition can result from major disasters?

Post-Traumatic Stress Disorder (PTSD).

What symptoms can PTSD cause after a major disaster?

Anxiety, insomnia, anger, loss of interest in daily activities, and flashbacks to the traumatic event.

How does the mind affect the experience of environmental stressors?

It interprets the severity of the situation and helps the person cope positively based on their perception, experience, and resources.

What happens when people cannot cope well with environmental stressors?

They may develop negative outcomes such as increased anxiety or other mental health challenges.

What are socioeconomic stressors?

Financial stresses related to the cost of living, expenses, debts, job loss, or unexpected financial burdens.

What can cause sudden socioeconomic stress even for people who were previously stable?

Retirement, economic changes causing investment losses, identity theft, job insecurity, involuntary job loss, or loss of a home or vehicle.

How can socioeconomic stress affect medical care?

Patients with minimal health insurance may struggle to afford diagnostic tests, treatments, or medications.

What is therapeutic communication?

Techniques used to encourage patients to express feelings and foster positive interactions in healthcare.

How can medical assistants promote positive communication?

By reflecting patients’ statements back to them and recognizing positive changes in their behavior or condition.

Why is understanding communication techniques important for medical assistants?

It helps build and nurture relationships with patients and healthcare staff, improving care quality.

What legal requirements do medical offices have for patients with physical disabilities?

They must provide appropriate access, including marked parking spaces, ramps, and accessible bathrooms with large stalls and handrails.

How can medical assistants help patients with physical disabilities feel comfortable?

By organizing common areas to anticipate their needs and facilitate navigation throughout the office.

What kind of questions should be avoided when talking to patients with disabilities?

Inappropriate or tactless questions unrelated to medical evaluation or history.

How should medical assistants approach questions about a patient’s disability?

Ask only as part of a medical evaluation, and offer assistance by asking what the patient needs rather than making assumptions.

What is important to remember when communicating with patients who have developmental delays?

Determine how they communicate, involve family or caregivers if needed, but always address the patient first and treat them with respect.

How should a medical assistant handle communication if they don’t understand a patient with a developmental delay?

Calmly ask for clarification without showing impatience and speak at a consistent volume.

How should medical assistants respond to patients with chronic or terminal illness?

Welcome them warmly, respect their dignity, offer empathy and support, and let the patient set the tone of the conversation.

Why should phrases like “I know how you feel” be avoided with seriously ill patients?

Because every individual’s feelings are unique, and such phrases can seem belittling or disrespectful.

What is a good way to start a conversation with a patient who has a chronic or terminal illness?

Use an open question like, “What would you like to talk about today?” to let the patient guide the discussion.

What services should be ensured for patients with chronic or terminal illness?

Hospice referrals, meal delivery, home health assistance, support groups, and community services.

What are defense mechanisms?

Coping strategies used unconsciously to protect oneself from negative emotions like guilt, anxiety, fear, and shame.

How can understanding defense mechanisms help medical assistants?

It aids in recognizing patients’ emotional responses and better meeting their needs.

What is it called when someone shows indifference or lack of emotion?

Apathy

What defense mechanism involves balancing a shortcoming with an accomplishment?

Compensation

What mechanism turns psychological stress into physical symptoms without a medical cause?

Conversion

What describes rejecting or ignoring something unpleasant instead of acknowledging it?

Denial

What is it when emotions are redirected toward a less-threatening person or object?

Displacement