Specialty Examinations and Procedures

Chapter 36: Specialty Examinations and Procedures

Objectives (1 of 2)

  • Spell and define, using the glossary, all the Words to Know in this chapter.
  • Explain why irrigation of the ear is performed.
  • Describe the audiometric assessment procedures used to assess hearing acuity.
  • Explain why irrigation of the eye is performed.
  • Explain the purpose of the three vision screening tests.

Objectives (2 of 2)

  • Explain the purpose of a spirometry test.
  • Explain the purpose and use of a peak flow meter.
  • Explain the purpose of pulse oximetry testing.
  • Explain the purpose of a flexible sigmoidoscopy.
  • Explain the purpose of a diabetic foot examination.

Ear Examinations

Ear Irrigation (Lavage)
  • Ear irrigation may be required prior to performing procedures due to:
    • Cerumen (earwax) accumulation.
  • Audiometric tests include:
    • Audiometry
    • Tympanometry
    • Tuning fork exams
    • Rinne Test: compares air conduction to bone conduction.
    • Weber Test: uses a tuning fork placed on the crown of the head to determine the lateralization of sound.
Ear Irrigation Purpose
  • The purposes of ear irrigation are to:
    • Remove foreign objects
    • Eliminate impacted cerumen
    • Clear drainage from the ear.
Equipment Required for Ear Irrigation
  • Preferred Method: Elephant ear system.
  • Body temperature solution.
  • Ear basin, gloves, and gauze.
Procedure for Ear Irrigation
  1. Initial Assessment: View ear with otoscope.
  2. Patient Positioning: Patient turns head to the affected side.
  3. Irrigation Process:
    • Direct the flow of the solution upward and to one side.
    • Avoid inserting the tip too far to prevent injury.
  4. Post-Irrigation Assessment: Wipe excess solution and inspect results.
  5. Possible Aftereffects: Patient may experience dizziness afterward.

Hearing Assessment

Signs of Hearing Loss
  • Indicators suggesting potential hearing loss include:
    • Frequently asking for repetition.
    • Speaking too loudly.
    • Not responding when out of sight.
    • Poor pronunciation.
    • Experiencing ringing in the ears (tinnitus).
Audiometry Screening
  • Process: Uses an audiometer with headphones, performed in a quiet room.
  • Color Code for Ears: Red for the right ear, blue for the left.
  • Test Procedure: Patient signals when sounds are heard.
  • Frequency Range Testing: Tests range from low to high frequencies.
  • Results: Recorded and plotted on an audiogram.
Other Hearing Tests
  • Rinne Test: Compares bone conduction to air conduction to determine type of hearing loss.
  • Weber Test: Evaluates lateralization of sound using a tuning fork.
  • Tympanometry: Measures middle ear function and assesses the mobility of the tympanic membrane.

Eye Examinations

General Procedures
  • Providers utilize an ophthalmoscope to examine the internal structures of the eye.
  • Eye exams are performed to check for:
    • Vision acuity
    • Color vision.
Eye Irrigation Procedures
  • Purpose:
    • Soothes tissue
    • Relieves inflammation
    • Removes foreign objects and discharge.
  • Important Technique:
    • Always pour water from the inner canthus (corner closest to the nose) towards the outer canthus to prevent infection from spreading between the eyes.
Visual Acuity
  • Assessment performed under optimal conditions:
    • Conducted in a well-lighted room without interruptions.
    • Tested with and without corrective lenses.
    • Utilize Table 36-1 for indications of visual disturbances.
  • Tools used:
    • Snellen Chart: for distance visual acuity (tests nearsightedness, myopia).
    • Jaeger System: assesses near vision acuity (tests farsightedness, hyperopia).
Color Vision Testing
  • Performed using Ishihara plates to evaluate color vision acuity.
  • Contrast sensitivity screenings may also be conducted.

Respiratory Exams

Vital Capacity Tests
  • Definition: Vital capacity is the greatest volume of air that can be expelled during a complete, slow, unforced expiration following a maximum inspiration.
  • Key Tests:
    • Spirometry: Measures lung capacity and volume.
    • Peak Flow Testing: Measures a patient's ability to forcibly exhale air.
    • Pulse Oximetry: Assesses oxygen saturation (percent of hemoglobin saturated with oxygen) in the blood.

Proctologic Examinations

Purpose of Proctologic Exams
  • Primary purpose is to examine the anus and rectum interior for conditions such as:
    • Hemorrhoids
    • Fissures
    • Ulcerations.
  • Infection Control: All instruments and items in contact with body cavities must be sterilized to eliminate microorganisms.
  • Medical assistants (MAs) are generally responsible for ensuring this.
Patient Preparation
  • Proper patient positioning and preparation with instructions are crucial for comfort and effectiveness of the examination.
  • Sigmoidoscopy: A diagnostic examination of the sigmoid colon useful for identifying cancer, ulcerations, polyps, tumors, bleeding, and other lower intestinal disorders.

Neurological Exams

Importance in Diabetic Care
  • Neurological testing is a vital component of a routine diabetic foot exam, which may include multiple sensing and reflex testing to screen for neuropathy.
Purpose of Neurological Testing
  • To check for signs of neuropathy (nerve damage) in diabetic patients, which should be performed yearly or more frequently based on symptoms.
  • Symptoms to Monitor For: Tingling, pain, numbness, and swelling.
Types of Tests Performed
  1. Monofilament Test: Uses a small nylon fiber to assess sensitivity on foot and toes.
  2. Tuning Fork Test: A tuning fork is struck and placed against the foot to test ability to feel vibrations.
  3. Pinwheel/Foot Pick Test: Assess pressure sensation by pressing against the foot's bottom.
  4. Reflex Hammer Test: Taps the bottom of the foot to evaluate ankle reflexes.

Chapter Summary (1 of 3)

  • Ear inspections can be obstructed by cerumen buildup, which may necessitate lavage to alleviate discomfort and restore hearing.
  • Several audiometric procedures are employed to diagnose hearing loss.
  • Eye irrigation is necessary in cases of inflammation, secretions from infections, chemical exposure, or foreign particles.
  • Visual acuity measurement is commonly performed by a medical assistant using various standardized tests, including the Snellen chart, Jaeger system, and Ishihara plates.

Chapter Summary (2 of 3)

  • The spirometer is a device that tests lung capacity and function, particularly in diagnosing functional abnormalities and evaluating medication effectiveness related to dyspnea.
  • Peak flow testing determines maximum exhalation strength, valuable for monitoring respiratory conditions.

Chapter Summary (3 of 3)

  • Pulse oximetry offers a non-invasive method to track pulse rates and blood oxygen saturation.
  • Flexible sigmoidoscopy is a diagnostic tool examining the sigmoid colon for numerous gastrointestinal disorders.
  • Neurological testing is critical for identifying diabetic-related neuropathy in routine foot examinations.