Comprehensive RMA and AMT Medical Assisting Study Notes

General Medical Assisting Knowledge and Philosophy

• Medical Assisting Review Outline: The foundational knowledge consists of three primary domains:   - General Knowledge: Anatomy and Physiology (A&P), medical terminology, and medical law mixed with ethics and human relations.   - Administrative Knowledge: Insurance processing, medical coding, financial bookkeeping, and clerical/administrative duties.   - Clinical Knowledge: Asepsis, sterilization, surgical assistance, vital signs, pharmacology, lab procedures, and emergency response.
• Psychological Theories:   - Sigmund Freud: Personality components include the Id (basic drives/impulses for survival/procreation), Ego (awareness, perception, cognition, and action), and Superego (societal values and social mores).   - Elizabeth Kübler-Ross: The five stages of grief include Denial, Anger, Bargaining, Depression, and Acceptance.   - Cognitive Theory: Addresses the identification of irrational beliefs that do not match reality.   - Maslow's Hierarchy: Focuses on a pyramid of needs from basic survival to self-esteem.

Clinical Medical Assisting: Vital Signs and Examination

• Vital Signs (Cardinal Signs): Referred to as "signs of life."   - Temperature ($T$): Normal range is $97\text{ to }99\text{ }^{\circ}\text{F}$. The normal average is $98.6\text{ }^{\circ}\text{F}$ (oral and tympanic).     - Rectal: $99.6\text{ }^{\circ}\text{F}$ (one degree above oral due to being a closed body cavity).     - Axillary: $97.6\text{ }^{\circ}\text{F}$.   - Pulse ($P$): Normal range for an adult at rest is $60\text{--}100\text{ bpm}$. The average is often cited as $60\text{--}80\text{ bpm}$.   - Respiration ($R$): Normal average adult is $12\text{--}20\text{ breaths/min}$; elderly adult is $18\text{--}24\text{ breaths/min}$. In clinical practice, never tell the patient you are measuring respiration to prevent self-conscious alteration of breathing.   - Blood Pressure ($BP$): Normal range is $110\text{--}140\text{ / }60\text{--}90\text{ mmHg}$. The first audible sound is the Systolic pressure; the point where sound disappears is Diastolic.
• Pulse Sites:   - Adults: Most common site is the Radial artery.   - Children: Most common is the Brachial artery. If unreachable, use the Apical pulse (located at the apex or lower part of the heart and auscultated with a stethoscope).   - Other sites: Carotid (neck), Popliteal (behind knee).
• Patient Positioning:   - Supine: Lying on the back.   - Prone: Lying on the stomach.   - Lithotomy: Feet in stirrups, used for pelvic/cervical exams.   - Fowler’s: Sitting up at an angle; used for patients with breathing difficulties or asthma attacks.   - Sims: Lying on the left side; used for rectal or sigmoid exams.   - Trendelenburg: Head lower than feet; used for bleeding, shock, and fainting.   - Dorsal Recumbent: Lying on back with knees bent.
• Physical Examination Methods:   1. Inspection: Visual observation.   2. Palpation: Using fingers/hands to feel body parts (e.g., breast exams).   3. Percussion: Tapping body parts with fingers or instruments to hear sounds.   4. Auscultation: Listening with a stethoscope (e.g., heart or bowel sounds).   5. Mensuration: Measuring height, weight, head circumference ($head circumference measured until 36 months$), $BP$, and temperature.   6. Manipulation: Forced movement to determine range of motion.
• Diagnostic Instruments:   - Stethoscope: Used for auscultation.   - Reflex Hammer: Tests neurological reflexes.   - Otoscope: Used to view inside the ears.   - Ophthalmoscope: Used to examine the eyes.   - Tuning Fork: Tests hearing (sound intensity and pitch).   - Tonometer: Measures intraocular pressure.   - Spirometer: Measures air inhaled/expelled from lungs.   - Snellen Chart: Used to test visual acuity ($20/50 means at 20 feet the patient sees what a normal person sees at 50 feet$).
• Patient History and Records:   - Chief Complaint ($CC$): The patient's primary reason for the visit.   - Review of Systems ($ROS$): Systematic check of all body systems.   - SOAP Notes:     - Subjective: Symptoms reported by the patient.     - Objective: Signs observed by clinical staff (e.g., irregular pulse).     - Assessment: Diagnosis, examination findings, and labs.     - Plan: Treatment and follow-up.

Clinical Asepsis, Sterilization, and Minor Surgery

• Terminology:   - Aseptic: Free from microorganisms.   - Medical Asepsis: Handwashing from fingers to wrist (non-invasive).   - Surgical Asepsis: Handwashing from fingers to elbows (invasive procedures).
• Chain of Infection:   1. Reservoir Host   2. Means of Exit   3. Means of Transmission   4. Means of Entrance   5. Susceptible Host   - Note: Handwashing is the primary means of breaking this chain.
• Sanitization, Disinfection, and Sterilization:   - Sanitization: Cleaning with soap and hot water to remove debris.   - Disinfection: Use of chemicals; $10\%$ Hypochlorite (bleach) is used for HIV decontamination and cleaning exam rooms after every patient.   - Sterilization: Destruction of all microbial life, including spores. Methods include dry heat, gas processing, and steam under pressure (Autoclave).
• Autoclave Procedures:   - Standard requirements often involve reaching $250\text{ }^{\circ}\text{F}$.   - Distilled water must be used to prevent mineral buildup and corrosion.   - Spore tests are the definitive check for sterilization efficacy.   - The door should be opened slightly at the end of the cycle for drying.
• Minor Surgery and Sutures:   - Laceration: A jagged cut.   - Abrasion: A scraping of the skin.   - Suture Sizes: Ranges from $2.0$ (thickest) to $6.0$. Size $2.0$ is often used on the face.   - Materials: Absorbable (e.g., catgut, Vicryl) do not require removal; Non-absorbable (e.g., Nylon, Silk) must be removed.   - Tray Setup: Needle holder, scissors, tissue forceps, suture sponges.   - Technique: Cleanse wound from the center toward the outer edge using iodine or betadine.

Laboratory Procedures and Diagnostics

• Blood Composition:   - Plasma: Contains fibrinogen; forms when blood is separated from anticoagulated samples.   - Serum: Formed when blood clots; does not contain fibrinogen.   - Buffy Coat: Contains white blood cells ($WBCs$) and platelets.   - Formed Elements: Erythrocytes ($RBCs$), Leukocytes ($WBCs$), and Thrombocytes (Platelets).
• Common Lab Tests:   - CBC: Collected in a lavender/purple tube containing $EDTA$.   - Prothrombin Time ($PT$): Coagulation test; light blue tube with sodium citrate.   - Hematocrit ($Hct$): Percentage of packed $RBCs$. Normal adult levels are around $44\%$. High $Hct$ indicates polycythemia vera.   - Blood Sugar: Pancreas secretes insulin and glucagon; failure in regulation results in diabetes.   - Bilirubin: Specimens must be protected from light.   - Sputum Test: Patient should cough deeply and expel material into a sterile container.
• Safety and Quality:   - MSDS (Material Safety Data Sheets): Contain information on hazardous materials.   - Quality Control: Daily checks to ensure the reliability of results.   - Standard Precautions: Treat all blood/body fluids (except sweat) as infectious. PPE (gloves, gowns, face shields) must be used.

EKG/ECG Procedures

• Leads:   - Bipolar (Standard) Leads: Leads $I, II, III$.     - Lead I: Records between right arm and left arm.     - Lead II: Records between right arm and left leg.     - Lead III: Records between left arm and left leg.   - Ground: The Right Leg ($RL$) is used as the ground.   - Chest Leads (Precordial): Designated as $V$ leads.     - $V_1$: Fourth intercostal space, right of sternum.     - $V_4$: Fifth intercostal space, mid-clavicular line.
• Artifacts: Artifacts appear as irregular spikes or markings. Uniform small spikes often indicate interference from nearby electrical appliances.
• Heart Rate Terms: Bradycardia is slow ($<60\text{ bpm}$); Tachycardia is fast ($>100\text{ bpm}$).

Pharmacology and Medication Administration

• Routes of Administration:   - Intradermal ($ID$): $15\text{ }^{\circ}$ angle; used for Tuberculin ($Mantoux$) tests; must produce a wheal.   - Subcutaneous ($SC$): $45\text{ }^{\circ}$ angle; given into adipose tissue.   - Intramuscular ($IM$): $90\text{ }^{\circ}$ angle; sites include gluteus medius, deltoid, and vastus lateralis (preferred for children).   - Sublingual: Under the tongue; do not swallow.   - Buccal: Between cheek and gum.   - Parenteral: Any route other than the mouth ($injections$).
• Drug Categories:   - Analgesic: Relieves pain.   - Antipyretic: Reduces fever.   - Antitussive: Suppresses coughing.   - Anticonvulsant: E.g., Dilantin, used for seizures.   - Cathartic: Hastens bowel evacuation.
• Drug Schedules:   - Schedule I: No acceptable medical use (e.g., Heroin).   - Schedule II: High potential for abuse, restricted medical use.
• Dosage Calculation:   - Ordered: $62.5\,mg$; On Hand: $125\,mg$. Give: $\frac{1}{2}\text{ tablet}$.   - Ordered: $1\,Gram$; On Hand: $0.5\,Gram/mL$. Give: $2.0\,mL$.

Anatomy and Physiology

• Skeletal System:   - Femur: Largest bone.   - Patella: Kneecap.   - Fibula: Lateral bone of the lower leg.   - Periosteum: Strong fibrous membrane covering bone.   - Ligaments: Connect bone to bone.   - Tendons: Connect muscle to bone.
• Nervous System:   - CNS: Brain and spinal cord.   - Cerebrum: Largest part; associated with thought and judgment.   - Cerebellum: Second largest; coordinates balance/equilibrium.   - Meninges: Protective covering of the brain/spinal cord (Dura Mater is the outer layer).
• Reproductive System:   - Female Primary Organ: Ovaries; cell: Ovum.   - Hysterectomy: Removal of the uterus.   - Hysterosalpingooophorectomy: Removal of the uterus, fallopian tubes, and ovaries.
• Cardiovascular System:   - Atria: Receiving chambers; Right Atrium receives deoxygenated blood.   - Valves: Tricuspid (right side); Mitral/Bicuspid (left side).
• Terminology:   - Distal: Furthest from origin.   - Flexion: Decreasing the angle between bones.   - Physiology: Study of body function.   - Anatomy: Study of body structure.

Medical Terminology: Roots, Prefixes, and Suffixes

• Prefixes:   - Hyper-: Excessive/high.   - Hypo-: Decreased/low.   - Brady-: Slow.   - Tachy-: Fast.   - Endo-: Inside.
• Suffixes:   - -algia: Pain.   - -ectomy: Excision of/removal.   - -ostomy: Surgical opening.   - -ptosis: Drooping or prolapse.   - -rrhea: Discharge.   - -itis: Inflammation.
• Specific Terms:   - Verrucae: Warts.   - Phlebitis: Inflammation of veins.   - Edema: Swelling.   - Cyanosis: Blue tint due to anoxia (lack of oxygen).   - Epistaxis: Nosebleed.   - Dysuria: Painful urination.

Administrative Medical Assisting: Insurance and Coding

• Insurance Concepts:   - Premium: Cost charged for the policy.   - Deductible: Yearly amount patient pays before insurance starts coverage.   - Copayment: Fixed amount due at time of service.   - Assignment of Benefits: Authorization for insurance to pay the doctor directly.
• Medicare: Federal coverage.   - Part A: Hospital/Hospice.   - Part B: Outpatient services ($80\%$ Medicare, $20\%$ patient).   - Part D: Prescriptions.
• Military/Other Plans:   - TRICARE: Active duty military and dependents.   - Workers' Compensation: Contract between employer/employee for job injuries; patient never receives a bill.
• Coding:   - CPT: Current Procedural Terminology (5-digit codes for services; implemented by AMA).   - ICD-9: International Classification of Diseases (3--5-digit codes for diagnosis; implemented by WHO).   - HCPCS: Alpha-numeric codes for supplies and injections (implemented by CMS).

Administrative Medical Assisting: Office Finance and Clerical

• Payroll:   - FICA: Federal Insurance Contribution Act (Social Security).   - FUTA: Federal Unemployment Tax Act (paid only by employer).   - Net Pay: Wages after deductions.   - W2: Summary of earnings given by Jan 30th.   - W4: Employee withholding allowance certificate.
• Billing:   - Cycle Billing: Statements sent every $30\text{ days}$.   - Collections: Delinquent accounts (30/60/90 days). Fair Debt Act restricts calls to $8\text{ am to }9\text{ pm}$.
• Clerical Management:   - Correspondence: Filed in reverse chronological order (most recent on top).   - Appointment Methods: Open Hours (walk-ins, urgent care); Stream (specific time slots).   - Patient Privacy: Numeric filing systems provide the greatest degree of confidentiality.

First Aid and Emergency Response

• Emergency Actions:   - Airway: First priority is establishing a patent (clear) airway.   - Fractures: Immobilize the body part.   - Burns: First-degree burns should be submerged in cool water.   - Nosebleed (Epistaxis): Pinch the nostrils.   - Fainting (Syncope): Place patient supine with legs elevated.   - Cardiac Arrest: Initiate CPR immediately. Allow chest to fully recoil between compressions for blood return/refilling.   - Animal Bites: Wash thoroughly with soap and water.
• Bandaging: Use the Figure Eight configuration for ankles, knees, and wrists. Leave fingers/toes exposed to check circulation.