Assisting with Allergy and Dermatology

Assisting with Medical Specialties: Allergies and Skin Disorders

Learning Objectives

  • Define and spell medical terms related to allergies and skin disorders (34.1).
  • List different kinds of medical specialties (34.2).
  • List duties of a medical assistant (MA) when assisting in the field of allergy and immunology (34.3).
  • Describe different methods of allergy testing (34.4).
  • List duties of the MA when assisting in the field of dermatology (34.5).

Case Study: Benito Salvatore

  • Benito Salvatore, a 65-year-old business executive, is scheduled for a sigmoidoscopy with Dr. Bahjat.
  • He expresses nervousness and concern about his preparation to David Dolan, RMA.

The Role of the Medical Assistant

  • Assist the physician during special examinations.
  • Instruct patients before, during, and after procedures.
  • Primary care and internal medicine physicians may perform procedures typically found in specialist offices (e.g., electrocardiograms).
  • MA often serves as a “health coach”:
    • Help patients understand their diagnosis and treatment.
    • Encourage adherence to treatment plans.
    • Educate patients about disease prevention, health promotion, and maintenance practices (weight management, smoking cessation, healthy eating habits).
  • The MA will encounter a variety of conditions and diseases, regardless of the type of office.

Common Medical Specialties

  • Allergy and Immunology
  • Anesthesiology
  • Colon and Rectal Surgery
  • Dermatology
  • Emergency Medicine
  • Family Medicine
  • Internal Medicine
  • Medical Genetics and Genomics
  • Neurological Surgery
  • Nuclear Medicine
  • Obstetrics and Gynecology
  • Ophthalmology
  • Orthopedic Surgery
  • Otolaryngology—Head and Neck Surgery
  • Pathology
  • Pediatrics
  • Physical Medicine and Rehabilitation
  • Plastic Surgery
  • Preventive Medicine
  • Psychiatry and Neurology
  • Radiology
  • Surgery
  • Thoracic Surgery
  • Urology

Assisting with Allergy Care and Immunology

  • An allergist/immunologist is a physician trained in diagnosing, treating, and managing allergies, asthma, and immune disorders.
  • Clinical MA tasks include:
    • Rooming patients and obtaining vital signs and measurements.
    • Reviewing specialized questionnaires about the patient’s allergy or immunology history.
    • Preparing the exam room for specialty procedures (e.g., allergy testing).
    • Administering desensitizing injections.
    • Providing patient education and support based on the physician's treatment protocol.
  • MA needs working knowledge of common allergies:
    • Allergic rhinitis.
    • Asthma.
    • Contact dermatitis.
    • Eczema.
    • Urticaria (hives).

Common Types of Allergies (Table 34-2)

  • Allergic Rhinitis: Inflammation of the nasal mucosa, resulting in nasal congestion, rhinorrhea (runny nose), sneezing, and itching of the nose. Seasonal allergic rhinitis (hay fever) occurs during certain seasons. Children may exhibit the “allergic salute” (rubbing nose upward).
  • Asthma: Common in childhood. Symptoms include wheezing, coughing, and dyspnea. Attacks can be triggered by airborne, food, or drug allergens. The airway is affected by constriction of bronchial passages and increased mucus production. Treatment involves medication and reducing exposure to allergens.
  • Contact Dermatitis: Inflammation and irritation of the skin due to contact with irritants like soap, perfume, cosmetics, metals, plastics, dyes, and plants (e.g., poison ivy). Treatment includes topical and systemic medications and removal of the allergen.
  • Eczema: Superficial dermatitis with papules, vesicles, and crusting. Can be acute or chronic.
  • Urticaria (Hives): Skin eruptions of pale reddish wheals with severe itching, often associated with food allergies, stress, or medication reactions.

Allergy Testing Methods

  • Ordered by the physician to determine a patient’s sensitivities to allergens.
    • Scratch or skin testing.
    • Intradermal tests.
    • Patch tests.
    • Blood tests.
    • Diet elimination tests.

Scratch Test

  • Performed on the patient’s arm or back.
  • Skin is divided into small squares (~1 inch apart) and labeled with a ballpoint pen to indicate the allergen.
  • A drop of allergen is placed on the skin at the labeled site.
  • The skin is scratched with a needle or lancet (a new needle for each allergen).
  • Multiple tests can be performed simultaneously.
  • A wheal forming within 15 minutes indicates an allergy.
  • Advise the patient to remain in the office for at least 30 minutes after testing for delayed reactions.

Procedure 34-1: Performing a Scratch Test

  • Objective: Identify allergens that cause an allergic reaction.
  • Equipment/Supplies: Allergen extracts, control solution, cotton balls, alcohol, sterile needles/lancets, timer, tape, ruler, cold pack/ice bag, medical record, gloves, biohazard waste containers (including sharps container).
  • Method:
    1. Perform hand hygiene.
    2. Greet and identify the patient; explain the procedure.
    3. Seat the patient on the examination table.
    4. Apply gloves, swab the test site (forearm or back) with alcohol, and allow it to air dry.
    5. Label the skin with adhesive tape in rows about 1\frac{1}{2} to 2 inches apart.
    6. Place a drop of allergen above or below the correct label, maintaining consistency.
    7. Use a sterile lancet/needle for each extract to make a small scratch (no more than \frac{1}{8} inch deep) on the skin below each drop.
    8. Set the timer for the specified reaction time (usually 10–30 minutes).
    9. After the time elapses, clean each site with alcohol and a cotton ball, being careful not to remove labels.
    10. Examine and measure each site, and record the results in the patient’s record.
    11. Have the physician examine each site and review measurements.
    12. Apply cold packs or an ice bag to relieve itching, if necessary.
    13. Dispose of used material in proper waste receptacles.
    14. Assist the patient off the examination table and provide further instructions as indicated by the physician.
    15. Clean the examination room.
    16. Perform hand hygiene.
    17. Document information in the patient’s medical record.
  • Charting Example
    • Patient Name: Sarah Haymes
    • Patient DOB: 12/5/1984
    • MR Number: 59465
    • Date: 03/13/YY
    • Time: 9:05 a.m.
    • Chart Note: Prick test performed. Admin Rt. Forearm. No positive reactions. Test sites checked by Doctor Rosen.
    • Staff Member: M. Dennehey, CMA

Intradermal Test

  • Involves injecting 0.01 to 0.02 mL of an allergen extract into the anterior surface of the forearm.
  • Several tests (10-18) can be performed on each arm.
  • A red wheal is a positive sign of an allergy.
  • Considered more accurate than a scratch test and commonly performed in a specialist’s office.

Patch Test

  • A small amount of allergen is placed on the anterior forearm or upper back and covered with a protective wrap (plastic or specialty paper).
  • Several tests can be performed simultaneously, and the results are read after 24-48 hours.
  • Used to detect causative agents in contact dermatitis.

Allergy Blood Tests

  • Allergy blood tests, called immunoassay tests. Commonly used are enzyme-linked immunosorbent assay (ELISA or EIA) and radioallergosorbent test (RAST).
  • Identify triggers of the patient’s allergy symptoms.
  • Performed on blood after it is withdrawn from the patient.
  • Takes more time than scratch or intradermal skin tests.
  • Requires blood samples to be sent to a laboratory for further testing.

Assisting with Dermatology

  • A dermatologist is a physician trained in diagnosing and treating disorders of the skin or integumentary system.
  • Clinical MA duties include:
    • Rooming patients and obtaining vital signs and measurements.
    • Reviewing the patient’s medical history and completing dermatology-related questionnaires.
    • Preparing the exam room for specialty procedures, such as minor skin surgeries and skin biopsies.
    • Preparing the patient and assisting the physician with medical and cosmetic dermatology procedures, including laser surgery and chemical peels.
    • Assisting in the debridement of wounds and obtaining wound cultures.
    • Providing patient education and support based on the treatment protocol established by the physician.
  • An MA may receive special training to work as a Mohs technician, assisting the physician during Mohs surgery.

Mohs Technician and Surgery

  • Mohs surgery removes cancerous skin lesions and surrounding layers of skin.
  • Skin cancer is the most common form of cancer in the United States.

Procedure 34-2: Taking a Wound Culture

  • Objective: Obtain a sample from a wound using a swab technique.
  • Equipment And Supplies: Gloves; culture tube with sterile swab and transport media; tape for dressing; sterile water for cleansing wound; sterile 4 \times 4 gauze dressing; hazardous waste container; bag for soiled dressing; prepared label for culture tube or pen for labeling tube; patient’s medical record
  • Method
    1. Warmly greet and identify the patient, introduce yourself, and explain the procedure.
    2. Assemble equipment, and label the culture tube with the patient’s name, date of birth, your initials, and today’s date.
    3. Perform hand hygiene and don a pair of gloves.
    4. Remove the patient’s wound dressing. Take note of the amount and type of exudate. Dispose of used dressing materials in a biohazard waste container.
    5. Observe the wound for redness, crusting, swelling, and odor.
    6. Carefully remove the sterile swab from the culture tube and place it in the wound. Rotate the swab back and forth to obtain a good sample.
      • Place the swab in the sterile culture tube (Figure A). Crush the ampule of preservative that is found at the bottom of the culture tube, and seal the tube.
      • Label the tube with the patient’s name, date of birth, collection date, and time.
    7. Remove and dispose of gloves properly in hazardous waste container. Perform hand hygiene, and apply new sterile gloves.
    8. Clean the wound using sterile water and 4 \times 4 gauze squares.
    9. Apply sterile dressing over the wound.
    10. Dispose of used gauze squares in the biohazard waste container.
    11. Remove and dispose of gloves properly in hazardous waste container.
    12. Instruct patient regarding proper wound care. Provide both verbal and written instructions.
    13. Document the information in the patient’s medical record, include detailed notes regarding the appearance of the wound and any other outstanding observations.
  • Charting Example
    • Patient Name: Therese Purvis
    • Patient DOB: 4/27/1964
    • MR Number: 52615
    • Date: 2/14/YY
    • Time: 3:30 p.m
    • Chart Note: Small amount of exudate obtained from open wound on L. ankle using sterile swab. Culture tube labeled and sent to lab. Wound cleaned and dressed. Redness surrounded the wound site No odor noted. Home care instructions given.
    • Staff Member: M. King, RMA

Common Skin Disorders

  • Most skin disorders are diagnosed by observing the lesion.
  • Skin lesions occur when the normal surface of the skin is invaded or changed.
  • Include descriptive notes about the lesion’s location, shape, color, size, and any other variances of the skin.
  • Skin lesions (neoplasms or tumors) may be malignant (cancerous) or benign (noncancerous).
  • Bacteria, viruses, and parasites can invade the skin if the protective barrier is broken.