NHA FOCUSED REVIEW #5

Integumentary system

The following make up the integumentary system.

⦁Skin:

Responsible for protection, temperature regulation, sensation, excretion, and vitamin D

production.

⦁Hair follicles:

Generate hair.

⦁Sebaceous (oil) glands:

Produce sebum to keep skin and hair soft, and prevent bacteria from growing on the skin.

⦁ Fingernails and toenails:

Protect the ends of fingers and toes.

⦁ Sudoriferous (sweat) glands:

Produce sweat to aid in cooling the body.

⦁Epidermis layer:

The outermost layer of epithelial tissue covers the external surface of the body.

⦁ Dermis layer:

The thick layer beneath the dermis contains arteries, veins, and nerves.

⦁ Subcutaneous layer:

Loose, connective tissue composed of adipose tissue and lipocytes. homeostasis. A balanced,

stable state within the body

Skeletal system

The skeletal system includes the following.

⦁Axial skeleton:

The adult axial skeleton has 80 bones including the skull, vertebrae, and ribs.

⦁Appendicular skeleton:

The adult appendicular skeleton has 126 bones including arms, legs, and pelvic girdle.

⦁Ligament:

Attaches bone to bone for joint stability.

The skeletal system’s purpose is to give the body structure and posture, as well as protect the soft

internal organs from injury. The skeletal system also plays a key role by serving as an attachment

point for muscles in the body. This symbiotic relationship between bones and muscles often results in the systems being referenced as one (the musculoskeletal system). Bones of the skeletal system are classified by their shape.

⦁Long bones:

Have epiphysis, diaphysis, and a medullary cavity containing yellow bone marrow. The ends of long bones are covered by articular cartilage to allow joint movement without causing friction. Examples: femur, humerus, tibia, fibula, ulna, radius

⦁Short bones:

Found in the wrists and ankles, typically small and round. Examples: carpals, tarsals

⦁ Flat bones:

The majority of the surface area is flat or slightly curved. Examples: skull, ribs

⦁Irregular bones:

An unusual shape that is typically related to their function.

Examples: vertebrae, pelvis

⦁ Sesamoid bones:

Small, round bones are found in joints that are held in place by tendons.

Example: patella

Muscular system

The muscular system is made up of the following.

⦁Skeletal muscle:

Responsible for body movement, and is also called voluntary muscle or striated muscle.

⦁Smooth muscle:

Found within the walls of hollow organs,

blood vessels, and in the iris of the eye. Also called involuntary muscle.

⦁Cardiac muscle:

Found only in the heart, cross-fibered to allow the heart to contract from the top and bottom in order to pump blood.

⦁Tendon:

Ends of skeletal muscles that attach the muscle to bone

Immune and lymphatic systems

The lymphatic system includes the following.

⦁ Lymph nodes:

Small, glandular structures are concentrated in the neck, axilla, and groin, which produce and store lymphocytes and are home to macrophages that filter lymph.

⦁Lymph nodules:

Masses of lymphoid tissue comprised of macrophages and lymphocytes. Lymph nodules are not

encapsulated like lymph nodes.

⦁Thymus:

Located posterior to the sternum. The thymus is large in children and atrophies (shrinks) after adolescence. It is responsible for the production and maturation

⦁ Spleen:

The largest lymphoid organ is located in the upper-left abdominal quadrant. It is home to macrophages that filter the blood.

⦁Interstitial fluid: Tissue fluid found between cells. Once collected and filtered, it’s called lymph.

Setting up for the procedure

When setting up for the procedure, avoid contamination of the sterilized items or sterile field. When

opening sterile packets or a Mayo stand cover, open the flaps away from you first and then open the

closest flap. At least 1 inch around the sterile field is considered nonsterile, so do not place items in

this area. Basic principles in maintaining a sterile field include the following.

⦁ Open packages so that they can easily drop onto the sterile field or be grasped by the provider

without touching the outer wrapper.

⦁Lip the bottle of liquids prior to pouring into sterile containers.

⦁Do not leave a sterile field unattended, reach over a sterile field, or turn your back to a sterile

field.

⦁Medication vials should be cleaned with alcohol prior to holding with two hands for the provider

to inject the needle int

Growth charts

Pediatric measurements are important in the physical assessment of infants and children up to 3

years of age. These measurements are plotted on a growth chart to provide a visual representation

of growth. This alerts the provider to potential concerns. The growth chart also provides a tangible

piece of data to have conversations with parents and guardians regarding concerns such as obesity

or malnutrition

Pediatric measurements

Pediatric measurements monitor growth. Height, weight, and head circumference are completed during a routine physical exam. If there are no concerns about growth, then weight is typically the only anthropometric measurement obtained at each office visit.

It can be challenging to measure a child’s growth patterns due to lack of cooperation from the child. The medical assistant can need to ask a parent to hold an infant in place to get an accurate height. Another option is giving the child something to hold or distracting them while the measurements are obtained

Considerations related to age, health status, and disability

The medical assistant must be aware of normal growth and development as well as the patient’s physical and medical status in determining the best method to obtain anthropometric measurements. For example, an infant cannot stand on an adult scale, an adult who is unstable might need assistance to get on the scale, and some patients might need a scale that has bars for stability. Patients who have vision and hearing impairments need additional assistance in other instances.

Vital signs

Temperature- Measuring temperature is actually determining the relationship between heat production and heat loss in the body, also referred to as metabolism. The most common cause of pyrexia, or fever, is infection. Fever is the body’s natural defense to fight invasive organisms and is therefore a normal reaction to illness. Patients who have a fever can present with chills, anorexia, malaise, thirst, and a generalized aching

Heart rate

Heart rate is a reflection of pulse and is best palpated when an artery can be pushed against a

bone. The second and third fingers should be used to palpate the pulse. Pulse sites are chosen

based on particular circumstances.

Respiration

Respirations are evaluated on rate, rhythm, and depth. The respiratory rate also decreases with age and is affected by health conditions or environmental factors. Respiratory rhythm is the breathing pattern, and depth describes how much air is inhaled. For example, a patient might have a rate of 28/min with an irregular rhythm and shallow depth. This would indicate some form of respiratory distress, as all three notations are abnormal.

Blood pressure

Blood pressure is the single most important vital sign in identifying the force of the blood

circulating through the arteries. Obtaining accurate blood pressure can significantly affect the

patient’s treatment or additional diagnostic tests. Equipment used to manually determine blood

pressure includes a sphygmomanometer, blood pressure cuff, and stethoscope. Electronic equipment can interpret blood pressure without auscultation. However, it is important to be able to accurately determine blood pressure both manually and electronically

Pulse oximetry (oxygen saturation)

Although usually not considered a vital sign, pulse oximetry is a valuable tool and a simple

procedure to ascertain the percentage of oxygen saturation in the blood. Many pulse oximeters also

display the heart rate. Patient experiencing symptoms associated with lung conditions such as

pneumonia, asthma, or bronchitis are a candidate for this noninvasive assessment

Review order and lab manual for preparation,

collection, handling, and storage instructions Upon receiving the provider’s order, review the order for completion of all required items. Verify accuracy, requested tests, test requirements, and reporting before beginning the procedure. Some of the required items include the following.

⦁ Ordering provider

⦁ Test and test code (unique to each lab, usually on the requisition or in the laboratory reference

manual)

⦁ Diagnosis code that correlates with the tests being ordered (ICD-10)

⦁ Special specimen requirements, such as fasting

⦁Patient demographics

⦁Insurance or other billing information

Complete lab requisition form and prepare labels for tubes

It is crucial to accurately complete the lab requisition and correctly label specimen containers.

Missing or inaccurate information on the laboratory requisition or improper specimen labeling

can lead to excessive blood collection, which could be harmful to the patient’s health. Accurate

lab requisition and labeling helps minimize costly and dangerous errors that result in the wrong

diagnosis and treatment.

Verify the following information against the requisition every time with every phlebotomy

procedure to minimize errors and ensure proper collection and testing of specimens.

⦁Provider’s order

⦁Patient’s identity

⦁Labeling of the specimens

⦁Identification number of the specimens

TRANSITION OF CARE FOR PATIENTS

Successful transitional care occurs when there is appropriate coordination and continued quality in health care as a patient moves from one care setting to another. Transitions are areas that fall short when it comes to providing quality care. Lack of communication between providers regarding patient histories, medication therapies, and overall patient needs are the main reasons for increased risk for rehospitalization, adverse clinical events, increased spending, and poor care quality.

Setting up appointments following inpatient stays

At the time of discharge, the patient will be given instructions on when to follow up with the primary care provider. Sometimes, the hospital nurse or social worker will call to make the arrangements. It is important when scheduling the follow-up appointments to do so in a timely manner. The patient can have an illness that is resolving but not completely gone, or might have a surgical incision that needs to be evaluated for continued healing and to prevent infection. The patient might also be taking a medication that requires bloodwork monitoring

Filing systems and processes

⦁ Conditioning

involves grouping related papers together, removing all paper clips and staples, attaching smaller papers to regular sheets, and fixing damaged records.

⦁Releasing

is marking the form to be filed with a mark of designated preference (ready to be filed, the provider’s initials, using a stamp).

⦁Indexing and coding

is determining where to place the original record in the file and whether it needs to be cross-referenced in another section. A chart number is typically used for this.

⦁Sorting

involves ordering papers in a filing structure and placing the documents in specific groups.

⦁Storing and filing

is securing documents permanently in the file to ensure the medical record documents do not become misplaced

Creating and preparing medical records

When creating and preparing medical records, each section should be grouped according to type, progress notes, laboratory, and radiology. This is a source-oriented medical record (SOMR). There are two methods commonly used to document information on the progress sheet: SOAP and CHEDDAR.

SOAP arranges the progress notes according to:

⦁Subjective impressions

⦁Objective findings or clinical indication

⦁Assessment or medical diagnosis

⦁Plan for treatment

With CHEDDAR the progress note is

arranged

by:

⦁Chief complaint

⦁History

⦁Examination

⦁Details

⦁Drugs and dosages

⦁Assessment

⦁Return visit information

Sending records to patients and other providers

All requests for medical records need to be provided in writing, and the release filed into the

patient’s chart. The patient’s attorney, mediator, or arbitrator must obtain approval from the patient

prior to obtaining access to the patient’s medical records. However, the patient’s attorney may

present a legal power of attorney document that authorizes them to view the medical records on

behalf of the patient if necessary

ICD-10-CMICD-10-CM

coding was implemented on October 1, 2015, after unexpected delays by Congress. ICD-10-CM coding contains approximately 55,000 more codes than ICD-9-CM and allows more specific reporting of diseases and newly recognized conditions.

CD-10-Procedure Coding System (ICD-10-PCS)

is a system comprised of medical classifications for procedural codes typically used within hospitals that record various health treatments and testing

Administrative Assisting CPT codes and modifies current Procedural Terminology (CPT) codes and modifiers are used to document procedures and technical services based on services by providers in outpatient settings

Healthcare Common Procedure Coding System (HCPCS) is a group of codes and descriptions that represent procedures, supplies, products, and services not covered by or included in the CPT coding system. Similar to CPT codes

COMPLIANCE WITH GOVERNMENT AND INSURANCE REQUIREMENTS

Medical assistants should be familiar with the requirements for individual, third-party, and government insurance plans. In addition, it is part of the daily routine to handle tasks associated with an insurance carrier’s handbook, contracts, and forms necessary for plan benefits and any preauthorization or referral requirements. This equips the medical assistant with the knowledge and skills to ensure documentation complies with government and insurance requirements

Billing inquiries

All billing inquiries should be handled in a prompt and courteous manner. If the patient is calling

about an error, place the patient on hold while the account is being pulled up for review, thank the

patient for holding, explain the charges carefully, and make sure all questions and concerns have

been answered. If the medical assistant is unable to resolve the issue, obtain the patient’s contact

information so the appropriate staff can contact them once the issue has been investigated and the

solution has been determined

Steps to appeal a denial

When filing an appeal for a denial received from an insurer, first determine why the claim was denied. Then obtain and complete the insurance company’s appeal document. The appeal document must be filed as quickly as possible so that it doesn’t exceed the time needed for filing. Include a letter from the provider to provide support for medical necessity, progress notes from the treating provider, and relevant results from any testing performed

Affordable Care Act (ACA):

The ACA was put in place to reform the healthcare system by providing

more Americans with affordable, quality health insurance to ultimately curb the growth in health

care spending in the United States

occupational Safety and Health Administration (OSHA):

OSHA states that employers are accountable for providing a safe and healthful workplace for employees by setting and enforcing standards and by providing training, outreach, education, and assistance

Health Insurance Portability and Accountability Act of 1996 (HIPA A):

HIPAA gives patients rights over their health information and sets rules and limits on who can look at and receive patients’ private information.

Controlled Substances Act (CSA):

CSA is a federal policy that regulates the manufacture and

distribution of controlled substance

Title VII of Civil Rights:

Title VII of the Civil Rights Act prohibits an employer with 15 or more

employees from discriminating on the basis of race, national origin, gender, or religion.

Americans with Disabilities Act (ADA):

ADA forbids discrimination against any applicant or employee who could perform a job regardless of a disability. ADA also requires an employer to provide accommodations that are necessary to help the employee perform a job successfully unless these accommodations are unduly burdensome

Family Medical Leave Act (FMLA):

FMLA is a federal law that requires certain employers to give time off to employees for familial or medical reasons.

he Joint Commission (TJC):

Accreditation with TJC helps organizations position for the future of integrated care, strengthen patient safety and the quality of care, improve risk management and risk reduction, and provide a framework for organizational structure and management

tort

is an action that wrongly causes harm to an individual but is not a crime and is dealt with in a

civil court. There are two major classifications of torts: intentional and negligence

• Malfeasance

performance of an unlawful, wrongful act; for example, performing a procedure on

the wrong patient.

⦁ Misfeasance

is a performance of a lawful action in an illegal or improper manner; for example,

performing the procedure on the correct patient, but doing so incorrectly.

⦁ Negligence is

the failure to do something that a reasonable person of ordinary prudence would do

in a certain situation, or doing something that such a person would not do.

⦁ Nonfeasance

is failure to perform a task, duty, or undertaking that one has agreed to perform or

has a legal duty to perform; for example, waiting to treat a patient until it is too late

⦁Mutual assent:

An agreement by all parties to contract; must prove there was an offer and

acceptance

⦁Consideration:

A benefit of some type for entering into the contract, such as financial

reimbursement

⦁Capacity:

Parties must be legally able to contract (legal age and of sound mind)

⦁Legality:

Subject matter must be legal

PERSONAL OR RELIGIOUS BELIEFS AND VALUES, AND UNBIASED CARE

Patients may have religious and personal beliefs and values that affect their decisions surrounding

health care. Some current ethical issues surrounding health care include end-of-life care,

resuscitation orders, euthanasia, abortion, birth control, and genetic testing. There are many areas

of health care that can be tied to a person’s religious or personal beliefs. Regardless of a patient’s

personal or religious beliefs, they must receive standard care