medical assistant final

Chapter 1:

Know prefixes and suffix

Know 7 attributes of symptoms

1) Location: Where does it hurt?

2) Quality: What is it like?

3) Quantity: Rate 1-10

4) Timing: When did it start?

5) Setting of occurrences: What contributes?

6) Remitting/Exacerbating factors: Does anything make it better/worse?

7) Associated manifestations: Does anything else accompany it?

Reliably for poor historian

Ethical considerations

1) Nonmalefincene: “Do not harm”

2) Beneficence: “Do good”

3) Autonomy: PT has the right to determine their own interest

4) Confidentiality: Keep things to yourself

Consideration in patient interaction; Ask about the PT feelings, follow their lead, know your limits in knowledge, Clinical reasoning transparently

Charting: source v.s. problem medical records

SOMR: Everything it kept together in chronical order

POMR: Everything is kept in order by relevancy

Soaper and cheddar (Rmbr: don’t erase errors on pt chart, cross it out)

SOAP: Subject information, Objective information, Assessment/Diagnose, Plans for treatment, Educations, Response of Pt

CHEDDER: Chief complaint, History of relevant information, Examination of relevant systems, Details with complaint, Drugs with dosages, Assessment based on diagnostics, returning visits for follow up.

Physical exams

Diagnostic exam: Related to chief complaint

General exam: Looking for thing they weren’t aware of

4 types of physical exams:

1) Auscultation; Listening with stethoscope

2) Percussion: Tapping for hollow areas, organs, tissue, and masses

3) Visual inspection: Visual signs

4) Palpations: Touching and feeling

Electronic health record: Detailed Pt chart available to all medical users.

Chapter 2:

Glove use: Replaced between each PT, tossed out in the same room

Hand washing 20 sec and wash between every pt

Isolation

1. Strict isolation: Requires masks (Contagious diseases)

· Measles, Staph infection

2. Droplet isolation: Requires mask

· Pertussis, meningitis

3. Blood and body fluid: wear gloves

4. Respiratory isolation: Wear mask or N95

· TB, whooping cough

5) Contact isolation: Wear gloves

· Skin/wound infections

6) Reverse isolation: Follow signages (For pt who are susceptible to infection)

· Transplant, immune compromised, burn victims

Different departments

1) OSHA: Workplace safety

2) DOH: Regulates healthcare facilities

3) FDA: Regulates drugs

4) CDC: Monitors public health

5) HHS: Includes Medicare and Medicaid

Medicaid and Medicare

Medicare-

J-co- Accredits hospitals and clinics

OSHA bloodborne pathogen standard

1) Sharps container

2) Exposure control plan

3) Personal protective equipment’s

4) Decontaminating and disposing of personal protective equipment’s

5) Prompt disposal

6) Handling containers

Know codes

1) Black = Bomb threat

2) Blue = Cardiac arrest

3) Grey = Disaster

4) Red = Fire

5) Orange = Hazardous materials

6) Pink = Child abductions

7) White = OB hemorrhage

8) Violent behaviours

9) Silver = Controlled access

PASS and ABCDK

Pull the pin, aim at base, squeeze trigger, sweep

A= Common building materials (wood), B= Flammable gasses, C= Electrical fires, D = Combustible fires, K= Oils

Eye wash= 15 seconds

Know abbreviation for health department

1) SDS

2) OSHA

3) DOH

4) FDA

5) CDC

Chapter 3: (STAR chapter)

Vital definition

Radial artery (Pulse); Located at the wrist below the thumb

Know the vital numbers

1) Pulse adult 60-100 BPM, Infant 70-190 BPM, Child 80-130 BPM

2) Blood pressure: 180/60

3) Temp: 98.6F/37C

Vocab

Know temp equations: C x 9/5 + 32 = F, (F-32) x 5/9 = C

Know ranges for different temp devices

1) Oral: 97.6F-99.6F

2) Aural: 95.7F- 100.0 F

3) Temporal: 99.4-99.6 F

4) Rectal: 98.6F- 100.6 F

Blood pressure phases

1) Phase 1: Systolic number, clear and sharp

2) Phase 2: Softer swishing sound

3) Phase 3: Crisp sound

4) Phase 4: Blowing sound

5) Phase 5: Silence; Diastolic number

Orthostatic blood pressure

1) Have pt lay down for 5 mins

2) Measure and record blood pressure

3) Have pt sit for 1-2 mins

4) Measure and record blood pressure

5) Have pt stand for 1-2 mins

6) Measure and record blood pressure

Peak flow meter – Used to measure muscular effort to exhale forcibly through lungs

· Adult: 16-20 BPM

· Late childhood: 16-26 BPM

· Early childhood: 20-40 BPM

· Newborn/ infancy: 30-80 BPM

Snellen v.s Ishihara

Snellen- Charting visual activity

Ishihara- Charting color vision

Illness associated with vitals signs

High and low blood pressure

BMI

· 18.58 = Underweight

· 18.50-24.04 = Healthy

· 25-29.99 = Overweight

· 30 = Obese

Chapter 4:

Encounter form= super bill (Contains all the procedures completed on pt; including providers, pt, service, and additional information)

Continuity of care = making sure pts get the care they deserve

PPOS (Health insurance plan that is manage car based) vs HmOS (Private or provided by employer)

Transition of care (TOC) – medication management, transition planning, pt and family engagement, Information center, follow up care, Healthcare provider engagement, Shared accountably across providers.

Medicaid vs Medicare (A,B,C,D)

Medicaid- Low income health care

Medicare A) Hospilzations, home health, hospice, and nursing home

Medicare B) Doctor appointments, tests, labs, etc

Medicare C) Medicare advantage plan includes a and b

Medicare D) Drug coverage

Referral – pt name, insurance, PCP name, referral provider, Diagnosis, and DOS

Chapter 5:

Anatomy vs physiology

Anatomy- the study of the body structures visible with the naked eye

Physiology- The study of function systems of the body and the physical and chemical processes involved

Know systems

A) Cardiovascular – Heart

B) Digestive- structures that help inject food

C) Endocrine – Hormones

D) Integumentary – skin

E) Lymphatic – lymph nodes

F) Muscular system – Muscles

G) Nervous system – Brain and spinal cord (CNS and PNS)

H) Reproductive – Tests and uterus

I) Respiratory – Lungs

J) Skeletal – skeleton

Homeostasis- The body’s ability to maintain balance (controlled by the endocrine system)

Anatomic planes-

Medial or mid sagg- Divides right and left evenly

Saggital – Divides left and right unevenly

206 bones in the body

Urine removes waste

Stool test

Know tests

Mastication- Chemical digestion of food

Peristalsis- Muscular squezzing of the digestive tract to push food

Anatomic positions:

A) Cranial, superior, or Rostral = Towards the top

B) Anterior or ventral = Towards the front

Chapter 6:

Lukiema – White blood cell cancer

Lymphoma- cancer that originates from lymphocytes

Thrombosis- Formation/presence of thrombus in blood vessels

Atherosclerosis- Fatty deposits in the arterial walls

Atheroma- Fatty deposits in the inner lining of the artery

Aneurysm- Wearing of the wall causing a ballon like dilation along the arterial wall

Vein vs artery’s

Vein – deoxygenated blood, thin tunica media, carries blood back to heart

Artery – Oxygenated blood, thicker tunica media, carries away from the heart

Capillaries – Smallest blood vessels in the body, 2.4 in depth

Know all the blood cells

Erythrocytes- Red blood cells, deliver oxygen from lungs to body

Lukocytes- White blood cells, Two main types of granulocytes and lymphocytes

· Neutrophils (most numerous)

· Eosinophils (2nd numerous)

· Basophil (least numerous)

Lymphocytes- adaptive immune system (t-cells and b-cells)

Thrombocytes- Platlets

Monocytes- wbc, 1st line of defense in body

Plasma vs Serum
Plasma- The water portion of blood 90% water and 10% solutes, contains fabringens

Serums- The product of blood extracted from the clotted states of the body

Pulse- Fluid wave traveling through the arteries

Blood pressure- The force the aqueous blood exerts on the arterial wall

Layers of vessels –

A) Vascular endothelium (inner)

B) Internal elastic tissue (stretchy)

C) Tunica media (middle)

D) External elastic lamina (stretchy)

E) Tunica adventita (Outer)

Structures of vessels- Outer layer= tunica externa, middle layer = tunic media, inner layer = tunica intima

Blood definition and PH- Self healing mixture of solvent, solutes, and formed elements having a PH of 7.35-7.45

4 steps of clotting- Vasoconstriction, platelet plus formation, Fibrin clot formation, fibrinolysis

Tests- Check page 138

System terms-

Congestive heart failure- heart become congested with blood

Stenosis- Narrowing of the valve

Formed elements- The cells in blood

Flow of blood in the heart: Vena cava – right atrium – right ventricle- pulumary artery – lungs – pulmonary vein – left atrium – left ventricle – aorta

Chapter 7:

Depolarization- release of separated electrical charges (requires no input of energy)

Repolarization- Separating electrical chargers (Requires input of energy)

T-wave is the only one that repolarizes

Pathways of electoral flow: SA (Primary pacemaker) , AV (Secondary pacemaker) , His, Branches, Fibers

Waveforms:

A) P wave= atrial deporlaztion

B) PR segment= AV delay

C) Q wave= septal depolarization

D) R wave = depoloarion of the apex

E) S wave = Depolarization of the left lateral ventricle

F) T wave = Repolarization of the ventricles

Chapter 8:

12 lead + 10 electros- Out patient

Telemetry – In patient 3-5 electrodes

24-72 hrs of monitoring – Holter monitor

Know placements

Know characterises of normal sinus rhythm

A) HR/vent rate = 60-100 BPM

B) 2:1 ratio in intervals

Amplitude = 6 x .1mV = 6mV

Know one of the heart rates calc methods = QRS complex x 10 = Heart rate

J- point- The point where the QRS complex ends and the ST segment begins

Hallmark something

Ventricular asystole = dead

Atrifacts

Seizure

Trembling

Fast/exaggerated breathing

Dry skin

Wet skin

Lotion

Cell phone and medical devices – Can be an artifact, ask pt to remove device before EKG

Chapter 9:

Know diseases and treatments

Cancer stages TMN- Tumor, Node, Metastatis

Cirrhosis

Diabetes: Type 1 vs Type 2

Type 1- Lack of insulin (Treatment: Insulin)

Type 2- Body resisting insulin (Treatment: Lifestyle)

Neuropathy- Tingling and numbness in the hand and feets

Ebola 2 to 21 days

Heart disease symptoms

A) Atherosclerotic disease (heart vessel disease)

B) Arrhythmia (abnormal heartbeat)

C) Congenital heart defects (Affect children)

D) Dilated cardiomyopathy (weakened heart muscle)

E) Infections within cardiac tissue (affects endocardium)

F) Valvular heart disease (Valve damage)

Hep B (Vaccine), Hep C (Cure), HIV (nether)

MRSA – Staph infection that resistant to most antibiotics (skin)

Stroke (5th highest reason of death) – Call 911

TB (Latent and Active) – Airborne bacterial infection (latent has no symptom, active has deadly symptoms)

Know terms

A) Cyanosis – bluing of the lips

B) Lethargy – state of sleepiness

Chapter 10:

Know logys

A) Mycology – studies fungi

B) Parasitology – studies parasites

Cells membranes- All living cells have an membrane

Carbohydrates (sugar, starches, glycogen) , cells, fats (Triglycerides)

Chain of infection (How do we stop it)

A) Infectious agents (Bacteria, Fungi, etc), Chain broken by diagnose and treatment

B) Reservoirs (Dirty surfaces, people, etc), Chain broken by cleaning and disinfectant

C) Portal of exit (Open wounds, etc), Chain broken by hang hygiene, ppe

D) Means of transmission (Contact, airborne, injestion, etc), Chain broken by Hnad hygiene, PPE

E) Portal of entry (Broken skin, etc) Chain broken by Hand hygiene, ppe

F) Susceptible host (Any person), Chain broken by immunization, education, etc

Vakin solution – 1:10 Bleach and water

Transmission precaution -Contact, airborne, and droplet

Sterilization (Autoclave most common)

Injection and vaccination procedures

Intermuscular- Medication and dead virus vaccination (1” 5/8 for ppl under 110lb, 1.5” for people over 275); deltoid site, 90 degrees

Subcutaneous- Live (weakened) virus vaccination (1” for most adults, 5/8” for under 110lb)

Intradermal- TB and allergy stract test (48-72 PPD), 25-27g, 15 degree angle

Allergy stract test (20-30 mins)

Transcription- Makes mRNA

Chapter 11:

Veins vs arteries

Vein- Superfical, no pulse, under low pressure

Arteries- Deeper, more muscular, pulse

Vein selection criteria (Know the terms)

Medical cubital vein- middle vein, most common

Cephalic vein- Outer aspect of A/C, 2nd choice

Basilic vein- 3rd choice, near arteries, avoid pulse 15- 30-degree max

Tourniquet (3-4 in)

Anchoring (4-6 in)

Know different blood collection sets (Butterfly= winged infused blood collection set)

Lancet – Controlled skin piercing device for capillary injections

Syringe- Lack vacuum so its good for fragile veins

Syncope procedures- Remove needle, then lay pt down

Hold arm above heart level for 10 mins if you hit an artery

Label tubes: pt name, time of draw, date, collector initial

Gauges- Small (23-25), Medium (21-22), Large (16-18)

Hill stick (If you go too deep, you’ll give the baby a bone bruise so use the correct lancet)

Engineering practice- Sharps container

Workplace practice- Proper handwashing, proper disposal of needles, no eating, drinking, etc

Phlebotomy terms- Page 250

Chapter 12:

Order of draws-

Yellow (Blood cultures) = Anticoagulant

light blue (PT,PTT) = Anticoagulant

red (serum and chem) = Coagulant

gold (BMP, hCG, etc) = Coagulant

orange (serum) = coagulant

green (Chemistry, lactate on ice) = anticoagulant

purple (CBC, ammonia on ice) = anticoagulant

pink (Blood typing) = anticoagulant

white (Plasma testing) = anticoagulant

gray (glucose) = anti-coagulant

CBC (most common test) = anticoagulant

Cold agglutinins 37 degrees C

Bleeding time (5cm below AC crease), 10-20 mins

Know definition of different tests

Blood cultures; Detect septicemia (bacteria entering blood)

Fasting time – 10 hours

Chapter 13:

Know tests

Know test devices

CILA- wavied vs CLIA regulated

CILA- wavied- Not sent to lab, given to pt

CLIA regulated- sent out to lab (ABG)

Blood typing -

Know grams stains (Dye, mordant, decolorizer, counterstain)

A) Dye (crystal violet)

B) Mordant (Gram iodine)

C) Decolorizer (95% alcohol)

D) Counterstain (Safranin stain)

Urine specimen collection

A) First morning sample – Easiest to identify abnormaltes

B) Mid-stream catch – Void first one 1/3

C) Clean-catch – Most clearest and accurate results

Total urine output – 1200-1500ml

Urine PH- 6.0

Only cetrifucsion urine for microscopic exams

Know what lab section does

A) Hematology – Blood

B) Chemistry – Chemical components

C) Serology – Immune

D) Microbiology – culture and sensitivity

Hemoccult and Throat cultures

A) Hemoccult- Blood in stool

B) Throat culture – bacteria or fungi infection in throat

Gram negative- deep violet

Gram positive- light to dark red

Chapter 14:

Know all the definitions on lecture notes

A) Consent- giving permission

B) Informed consent – ex) sticking arm out for draw

C) Neglect – doing nothing

D) Negligence – attempting to do something right but doing it wrong

E) Malpractice – purposely doing something wrong

MA scope practices (STAR NOTE; know well) – If you ain’t learn it, don’t do it

AMA (against medical advice), LWBS (leaving without being seen), NS (no show)

Title X – federal family planning funding

Abortion age in ohio (18 or with adult) vs cally (Age 12 and below must have adult)

Report abuse to person above

Living will (written), health care proxy (person), advance directive (living will + health care proxy), power of attorney (Lawyer)

MOLST – Medical order for life sustaining treatment (For dying people)

Chapter 15:

Time-specified scheduling 4 names

A) stream scheduling

B) Single booking

C) Fixed apponiments

Know different scheduling

A) Wave scheduling- pt always arriving to be seen (wave)

B) Modified wave scheduling – Intervals

C) Double booking – multiple physicians

D) Open booking – Triage system

E) Clustering - certain types of appointments on certain days

Inventory should be performed by more than one person

Z- codes – Disease classifcation

V- codes – Classify occasion and circumstance

ICD-11 – Codes for diagnosing pt

Refurell speeds- regular (2 weeks), urgent (1-2 days), stat (immediately)

CMS-1500 (typical bill) VS CMS-1400 (hospital bills)

CPT – Codes used to describe medical services to pt

SOP – Standard operating procedures

Resulting – Sharing results

Intake – Bring pt into medical facilites

Chapter 16:

Know triage on page 325

1) Self actualaztion

2) Esteem

3) Love/belonging

4) Safety

5) Physiological

5 stages of grief

1) Denial

2) Anger

3) Bargaining

4) Depression

5) Acceptance

Defense emotions – anger, fear, embarrassment, frustration, confusion, aggression

Inclusive emotions – Happiness, awe, excitement, engagement, and relief

Deceptive emotions – Lying, occlusion, manipulation, suspicion/disbelief, and reluctance

Depression + treatments – Major, persistent, and post-partum; SSRI and talk therapy

Anxiety – persistent state of fear

BPD (Mode stabilizers) – BP, cyclothymic disorder, ADHD

Existential questions for each age group

A) Infancy; Can I trust the world?

B) Early childhood: Is it okay to be me?

C) Preschool age: Is it okay for me to do, move and sit?

D) School age: Can I make it in the world?

E) Adolescence; Who am i? Who can I be?

F) Early adulthood: Can I love?

G) Adulthood: Can I make my life count?

H) Maturity: Is it okay to have been me?

MRDD – Mental retardation and developmental disabilty

Healthy diet (men vs women) – 2 drinks for men, 1 for women

Chapter 17:

Frequents – How often medication is administered

Half life – ½ of time of drug

Loading dose – Larger 1st dose of meds

Indicated vs contraindicated

maintaince dose- Dose needed to maintain effective concentration

pedi dose- Based on weight

Epinephrine – Drug that manages cardiac arrest

Beta blockers- Reduce heart rate, blood pressure, heart attack, oxygen consumption; helps prevent atrial fibrillation, atrial flutter, and some tachycardia

Calcium channel blockers-decreased muscular contractions

Diuretics- Lower BP

ACE inhibitors – Blockade of this enzyme decreases the blood pressure

Know different medications (page 349)

A) Analgesics – anti-inflammatory drugs (HEAVY drugs)

B) Antiemetics – NV (antagonists)

C) Laxatives – anything poo

D) Depression and anxiety – you know the drugs

Absorption vs distribution

Absorption – drug to systemic circulation

Distribution – drug to bloodstream

Prenatal routes- A (tested), B (tested), C (adverse effect), D (harm), X (pregnant women harmed), N (Not tested)

Oral- 30-70% available to body

Sublingual- Under tongue

Rectal- In the bum

Chapter 18:

Types of wounds

A) Laceration- tear in skin

B) Incision – Clean cut

C) Puncture – needle or nails

D) Penetrating – knife

E) GSW – GUN SHOT WOUND

F) Contusion – blunt force

G) Hematoma – blood outside vessel

H) Crush injury – as stated

Wet to dry – Vasline (Gauze)

Suturing (if it starts bleeding get RN or doctor)

Stages of healing

A) Injury

B) Coagulation

C) Early inflammation

D) Late inflammation

E) Proliferation

F) Remodeling

Tendon (4-8 weeks) and ligament (3-6 weeks) injurys numbers

Types of fractures

A) Open/compound fracture : as stated

B) Closed: Closed with gross deformality

C) Stable fracture: minimal to no deformity

D) Transverse fracture: Horizontal fracture

E) Oblique fracture: jagged fracture

F) Comminuted fracture: Fragments

G) Spiral fracture: as stated

Cructes- non-weight baring (NWB)

Gangrene (localized death of body tissue) vs necrosis (Death of tissue)

Chapter 19:

Know how to clean

Position

A) Horizontal recumbent position (most used): Lying on back, for length measurements in infants

B) Dorsal Recumbent Position: Lay on back with knees fixed

C) Fowler position: sitting or semi sitting (45-90 degrees)

D) Dorsal lithotomy position: Used for observing pelvic organs (Open legs)

E) Prone position: Lies on stomach (spine and back)

F) Sim position: Booty out (rectal)

G) Knee Chest: Booty up, chest down (rectal and vaginal)

H) Trendelenburg position: Laying back tilted

Know contents of trays

A) Eye irrigation: Irrigation fluid, delivery method, Kidney shaped basin, clean tissues

B) Ear irrigation: Irrigation fluid, delivery method, kidney shaped basin, Forceps

C) Suture removal: Skin antiseptic, Suture removal scissors, forceps, Gauze

D) Staple removal trap: Skin antiseptic, staple removal tool, gauze

E) Incision and drainage tray: Local anesthetic and delivery method, No. 11 scapel, Forceps, Hemostat, Irrigation syringe and fluid, culture swabs, packing

F) Blood culture: Blood draw shit

G) Punch biopsy tray: Punch biopsy tool, forceps, chux, antiseptic, sutures, gauze

H) Toenail removal tray: Kelly forceps, iris scissors, phobe with eye, nail clipper