Procedures

Explain different Types of Procedures Performed in SEP Offices and How to Perform Procedures

Pap Smear Procedures

Patient Instructions

• Patient Removes all clothing including undergarments (mostly for first visit because of breast screening)

• Put on gown with opening in the FRONT

• Open drape and place over lap

Supplies

• Brush and spatula or broom (which can do the same function as brush and spatula)

  • Used to collect samples

• Thin prep (pt’s Name, DOB, and specimen origination written on it)

• Speculum

  • Used to open up the walls of the vagina to visualize the cervix and aid in visualizing cervix

• Light

  • Attaches to speculumn and aids in visualization of the cervix

• Lubricant

  • Used to help ease discomfort with entering the speculum

MA Duties

1. Set up field for pap smear including the thin prep, sepculum, lubricant, broom or spatula and brush, gloves

2. Assist provider by handing them what they ask for

3. Properly prepare sample for send out

4. Place vial and requisition in a specimen bag for transport lab

5. This does not involve sterile technique

Sterile Technique Procedure

1. Put on NITRILE gloves (not sterile gloves)

2. Use the Sani-wipes to clean the designated area

3. While surface is drying, take off nitrile gloves and discard

4. Wash hands for 20 seconds

5. Set up sterile drape on the dry surface, making sure to only touch within the 1 inch border

6. Open containers to necessary equioment, avoid touching sterile equipment

7. Drop the necessary equipment nto the sterile field. Do not put your body over it. Just hover no more than 6 inches above the sterile field and drop the sterile equipment onto the drape.

8. Set out unopened STERILE gloves for your PROVIDER. NOT on sterile field, on the side

Sterile Gloves Procedure

1. 

   Ensure that gloves are the appropriate size for the provider before handing them over.

2. Wash your hands (this can be step 1 too)

3. Open the package completely making sure to only touch 1-inch of the outer border

4. Place your dominate hand in the glove on first by pinching the cuff and lift.

5. Put your dominant hand in the inside of the glove, palm up. Make sure you are only touching the inside of the glove that will be touching your skin (The bottom half of the glove is folded for unsterile hand to pinch)

6. Put the fingers of your gloved hand into the folded cuff of the other glove and lift.

7. Position your ungloved hand palm up and slide hand into the glove

8. Pull it over your and ensure that it fits snugly around your wrist. This will help maintain a sterile barrier and prevent contamination. hand

9. Once gloves have been applied, you can touch your two hands together and anything WITHIN the sterile field, not the 1 inch border. KEEP HANDS IN FRONT OF YOU. FACE STERILE FIELD

10. Do not drop your hands below the sterile field, reach over the sterile field exposing your arms, clothes to area or turn your back to the sterile field.

Ear Irrigation Procedure

• Cerumen: earwax

• Cerumen Impaction: is the result of buildup that prevents assessment of ear canal

• Cerumen obstruction: buildup that blocks the ear canal. Results in inability to hear out of the ear

Supplies

• Otoscope

  • used to look inside the ear

  • Confirm where build up is

  • Pull ear Up and back for Adults

  • Pull ear Down and back for Children

• Ear wash spray bottle

  • Fill with lukewarm water (cold will make them pass out)

  • Mix with peroxide

  • Use single use eartip

• Ear wash basin

  • Multi use

  • Designed to be placed under pt’s ear to catch fluid

  • Pt will hold this in place during procedure

• Ear tips

  • Single use

  • Lure lock feature used to twist on to spray bottle

  • Discard after procedure

Procedure

1. Ensure there are no contradictions or situations in which the procedure would be harmful for the patient

2. Explain the procedure to the patient

3. Gather the necessary equipment. Remember to use a moisture proof pad for the patient overtheir shoulder

4. Throughly wash your hands

5. Have the patient remove any dangling earrings and pull their hair back

6. Instruct the patient to sit up with their head tilted toward their ear slightly. Ask them to hold the water basin under their ear

7. Fill your spray bottle with solution

   1. prime the bottle by letting the air escape from rubing

8. Straighten patient’s ear so that it is aligned vertically, allowing for optimal drainage of the solution during the procedure.

   1. Down and back for a child

   2. Up and back for an adult

9. Inject a slow but steady strea of the solution against the roof of the ear canal. Do NOT block the canal with the irrigation nozzle, You want to make the solution flows unimpended

10. Once you have finished, gently place a cotton ball in the auditory meatus. Ask the patient to lie down on the side of their affected ear; they should use a towel or pad

11. DOCUMENT everything. Type, temperature, volume, and solution that you usedshould be recorded in the patient's chart to ensure proper follow-up and to maintain accurate medical records.

Eye Irrigation Procedure

Supplies

• Large syringe or small recetacle with a pouring spout

• Irrigating fluid (normal saline or clean water at roo temperature)

• Local anesthetic eye drops

• Towek or guaz swavs

• Lid retractors if avaiable

• A bowl or kidney dish

Procedure

1. Instill local anesthetic eye drops

2. With patient lying down, protect the neck and shoulders with a towel

3. Place the bowl or kidney dish against the cheek, on the affected side, with the head tilted sideways toward it

4. Fill dish with water and suck it up with syringe

5. Fill feeding cup or syringe with the irrigating fluid and test the temperature on your hand

6. Ask the patient to fix gaze ahead

7. Open the eyelids

8. Pour or syringe the fluid slowly and steadily, from no more than 5 cm away, onto the front surface of the eye, inside the lower eyelid and he upper lid

9. Ask the patient to move the eye in all directions while irrigation is maintained

10. Check and record visual acuity with Snellen chart when the procedure is finished.

11. If vision is worse, go tell provider

EKG or ECG at the Office

What is an EKG: a test used to record the electrical signals in the heart, quickly detect any heart problems, and monitor your patient’s heart health

Natural electrical impulses coordinate contractions of the different parts of the heart to keep blood flowing the way it should be. An EKG records these impulses to show how Fast the heart is beating, the Rhythm of the beats (steady or irregular), and the Strength and Timing of the electrical impulses as they move through the heart,

Common Terms and abbreviations

• CP: chest pain

• MI: heart attack

• CAD: coronary artery disease

• SOA: shortness of air

• Arrythmia: irregular heart rhythm

• Angina: chest pain

Why are EKGs Done?

• For patient’s 55 years or older, it is required for an EKG to be done prior to a surgery. This is to determine the overall health of the heart

• After treatment for conditions such as MI, endocarditism or after heart surgery or cardiac catheterization

• To look for the cause of chest oain

• To evaluate problems that may be heart related: severe fatigue, SOA, dizziness, or fainting.

What is the MA’s role?

• Prepare ypur patient for the procedure (getting them comfortable and calm)

• Utilizing effective communication skills with patients and families to gain the trust and cooperation necessary to get an accurate reading

• Provide post-procedural assistance

• Accurately and effectively perfroming the test

• Noting obvious abnormalities

• Maintain equipment (report when it is broken)

• Oreoare testing paterials for provider interpretation (print it out)

Preparing A Patient

• Communication is Key. Communication allows the patient to understand the why, what, and how BEFORE the EKG is performed.

• What: Use non-medical terms, hat is an EKG: a test to test your heart health

• Why” explain to them why they need one and the importance

  • check their charts before hand

  • “it is for your surgery…” “it is to check your heart health since your last visit for (insert heart issue)”

  • How: explain in detail the process so patient knos what to expect. Ex: disrobing, gowining, and draping instructions

• Patient positioning: supine, Semi-Fowler’s(45 degree angle), Fowlers

  • Best is Supine

    • but people with chronic back pain, old age, obesity is unable to do this

  • Semi'-Fowler’s is restricted because what if patient is in a wheelchair or doesn’t have legs

  • Fowler-lots of artifacts, just inform provider the patient was in Fowler position before they read EKG so provider will know

• Patient’s skin needs to be dry and oil free.

• Use alcohol sway to clean the skin prior to electrode placement.

• Remove excess hair with shaving or trimming.

12 Lead EKG

6 leads go on the chest that follow the shape of the breast dip

4 leads go on the arms and legs (1 on each arm and leg)

The total number of leads is 10

Total images of the heart seen is 12, which is why it is called 12 Lead EKG

MidMark Machine are the cords for the leads

Ordering an EKG

• Go to Point of Care Testing and select POCT EKG($$$) or POCT EKG Welcome to medicare

• Go to enter/edit results and double click the order to begin the resulting process.

• Click Acquire to initiate the MidMark workflow

• Once the EKG leads are placed properly on the patient, and the EKG is running, clock the acquire button to capture the live results

• After clicking acquire you may be prompted to enter additional information. You enter your name for Technician. Reviewed By Field is required-that is the Provider’s name going there. Once ythis is entered, click saved. This will transmit the report back to Epic

• Enter any additional required information in this screen(current date,time, your name for collector). Status should be marked as IN PROCESS so provider can still acess it

Waveforms is a PQRST

Interval is Waveform+Segment

Artifacts are electrical interferences form an outside source NOT “heart-made”

• Coughing, talking, sivering, movement, Parkinson’s, Cell Phones can cause artifacts.

For uncontrolled muscle movement, have patient place hands under buttocks (palms down)

Ensure proper grounding of machine (that the MidMark Machine is plugged into the system

Turn off unnecessary devices

Make sure skin is clean and the elctrodes adhere to the skin properly

Make sure wires are not crossed.