Chapter 20 Medical Assistant Skills 2009 Delmar Cengage

Chapter 20 Medical Assistant Skills © 2009 Delmar, Cengage Learning

Skills Lab • Measuring height & weight • Chapter 20: 1 • Procedure 20: 1 A • Positioning Patients • Chapter 20: 2 • Procedure 20: 2 • Positioning, Turning, Moving and Transferring Patients • Chapter 21: 2 • Procedure 21: 1 A, B, C, D, E, F © 2009 Delmar, Cengage Learning

20: 1 Measuring/Recording Height and Weight • Use: to determine if a patient is overweight or underweight • Height & Weight charts are based on averages • Must be accurate • When and why measurements are required ? • Daily weights are commonly taken in hospitals– why? (continued) © 2009 Delmar, Cengage Learning

Height & Weight • Measurements: – are routinely performed on admission to hospitals, LTC, doctors visits – Provide Information needed for performing and evaluation of certain laboratory tests – Calculation dosages of certain medications— • In all children • In all complex intravenous drip medications • In all IV TPN or total parenteral nutrition © 2009 Delmar, Cengage Learning

Height & Weight • Height, weight, head circumference: – Monitored frequently in children due to rapid growth – Commonly compared to the National Center for Health Statistics ( NCHS) growth graph – Goal it to identify early growth and developmental conditions in children – Plotting a child’s HT & WT allows the physician to check their G & D to percentile averages of other children their same age © 2009 Delmar, Cengage Learning

© 2009 Delmar, Cengage Learning

Measuring/Recording Height and Weight (continued) • Basic procedure for infant weight – To evaluate nutrition & growth • Basic procedure for measuring height of infant – To evaluate abnormal growth patterns or genetic conditions • Measuring infant head circumference – To identify hydro or micro cephalic conditions • Measuring infant chest circumference • Recording growth graph © 2009 Delmar, Cengage Learning

Measuring/Recording Height and Weight (continued) • Wide variety of scales • Recording weight • Adult weight scales – Both lbs. & kg are used however– kg is the standard • Infant weight scales • Recording height • Height bar on adult scale (continues) © 2009 Delmar, Cengage Learning

Height & Weight • Height & weight charts are used as averages • A 10 % deviation in chart to patient is considered normal • Head circumference > 95 percentile is classified as hydrocephalus • Must be accurate– always recheck all calculations © 2009 Delmar, Cengage Learning

Equipment • • • Use the same scale for accuracy Make sure the scale is balanced Weigh at the same time each day Wear the same amount of clothing Patient should empty bladder before weight is taken © 2009 Delmar, Cengage Learning

Weight Conversions • 1 kilogram = 2. 2 lbs • 1 inch = 2. 5 centimeters © 2009 Delmar, Cengage Learning

Convert the following to kilograms: • • • 120 lbs 176 lbs 200 lbs 350 lbs 34 lbs You must DIVIDE by 2. 2 kg to perform this conversion © 2009 Delmar, Cengage Learning

Convert the following weight to pounds: • • • 75 kg 100 kg 25 kg 99 kg 145 kg You must MULTIPLY by 2. 2 to perform this conversion © 2009 Delmar, Cengage Learning

Notes on Weight • Most people are weight conscious • Make only positive statements when measuring all patients • Remember to Ensure patient privacy at all times © 2009 Delmar, Cengage Learning

Types of Scales • Weight Bar Scales © 2009 Delmar, Cengage Learning

Types of Scales • Wheelchair Scale © 2009 Delmar, Cengage Learning

Types of Scales • Bed Scales © 2009 Delmar, Cengage Learning

Types of Scales • Bed with Scale © 2009 Delmar, Cengage Learning

Types of Scales • Infant Scales © 2009 Delmar, Cengage Learning

Height Measurement • Assessed in older adults to assess for osteoporosis • Patient safety must always be considered • Observe patients closely • Prevent falls and injuries © 2009 Delmar, Cengage Learning

Height Conversions • 1 inch is equal to 2. 5 centimeters (cm) • You must MULTIPY by 2. 5 cm to perform this conversion: • Convert the following to cm: 1. 60 in 2. 45 in 3. 25 in 4. 75 in 5. 18 in © 2009 Delmar, Cengage Learning

Height Conversions • You must DIVIDE by 2. 5 cm to convert cm to inches. • Convert the following: 1. 95 cm 2. 120 cm 3. 50 cm 4. 18 cm 5. 145 cm © 2009 Delmar, Cengage Learning

Video • Height & Weight Video © 2009 Delmar, Cengage Learning

Student Assignment/ Skills Lab for 20: 1 • Complete worksheet for 20: 1 • Students will then perform Height & Weight measurements on each other © 2009 Delmar, Cengage Learning

How to Weigh a Patient: • • Assemble equipment Wash hands Prepare scale Zero the scale Greet & introduce self Check patient ID Explain the procedure Patinent should remve shoes, jacket, purses, and all other heavy objects © 2009 Delmar, Cengage Learning

Continued: • Ask patient to step onto the scale • Move the large 50 pound weight to the right until the balance bar drops on the lower guide. Move this weigh back one notch • Move the smaller weight until the balance bar swings freely between the lower and upper guides • Assist the patient off the scale © 2009 Delmar, Cengage Learning

How to Measure a Patient: • Raise the height bar • Assist the patient back onto the scale with is back to the scale • Instruct the patient to stand erect • Move the bar until it reaches the top of the patient head • Read the measurement in cm and inches • Elevate bar • Assist patient off the scale • Perform any necessary conversions • Replace equipment and wash hands © 2009 Delmar, Cengage Learning

Positioning Patients © 2009 Delmar, Cengage Learning

20: 2 Positioning a Patient • Patient must be positioned correctly for variety of examinations, tests, and procedures • Wide variety of positions used • Patient may be on a bed, examination table, surgical table, diagnostic table, or treatment table • Know how to operate all equipment before using it with a patient (continues) © 2009 Delmar, Cengage Learning

Positioning a Patient (continued) • Reassure patient • Fully explain to the patient what you are going to do and why • Assess patient for any distress • Observe all safety factors to prevent falls and injury • Use correct body mechanics to prevent selfinjury (continues) © 2009 Delmar, Cengage Learning

Positioning a Patient • Never expose a patient during any exam or procedure • Door should be closed and curtain drawn • Properly drape/cover patient to ensure privacy but at the same time allow proper access for examination © 2009 Delmar, Cengage Learning

Positions • Horizontal recumbent or supine position – – – Pt is lying flat on their back with legs slightly apart One small pillow is under the head Arms flat on the side of the body Patient drape is always used Used to examine or treatment of the front part of the body © 2009 Delmar, Cengage Learning

Horizontal Recumbent or Supine © 2009 Delmar, Cengage Learning

Prone Position • Used to examine or treat the back of the patient • Patient lies on his or her abdomen with head turned to either side – a small pillow may be used under the head • Arms may be flexed at the elbow or positioned on either side • Drape is always used © 2009 Delmar, Cengage Learning

Supine vs. Prone © 2009 Delmar, Cengage Learning

Lithotomy Position (continued) • Lithotomy position – Used for gynecological examinations- vaginal, PAP tests, urine catherizations, cystoscopy exams and surgery of the pelvic area – Position on the back – Knees separated and flexed and feet are placed in stirrups – Arms rest at the sides – Buttock at the lower end of the table/bed – Drape is always used © 2009 Delmar, Cengage Learning

Lithotomy © 2009 Delmar, Cengage Learning

Dorsal Recumbent Position • Dorsal recumbent position – Similar to Lithotomy but patient has feet on the bed not in stirrups – Knees are bent – Feet flat on the bed – Draping is always used – Do Not Confuse with HORIZONTAL RECUMBENT © 2009 Delmar, Cengage Learning

Dorsal Recumbent Position © 2009 Delmar, Cengage Learning

Trendelenburg Position • Trendelenburg position – Used to increase blood flow to the head and brain – Patient lies in the horizontal position – The head is lower than the feet – Commonly used when a patient is in shock © 2009 Delmar, Cengage Learning

Trendelenburg Position © 2009 Delmar, Cengage Learning

Jackknife Position • Mainly used for rectal surgery • Patient is in prone position • Table is elevated at the center so that the rectal area is at a higher elevation • Special table is required for this position • Draping as indicated © 2009 Delmar, Cengage Learning

Sims Lateral Position • Used for simple rectal exams, enemas, and other rectal treatments • Patient lies on the left side • Left are is extended behind the back • Head turned to the side • Right arm is in front of the patient and elbow is bent • Left leg is slightly bent • Right leg is bent sharply at the knee and brought into the abdomen • Drape the patient accordingly © 2009 Delmar, Cengage Learning

Fowlers Position • Used to help facilitate breathing, receive distress, encourage drainage and exam the head, neck & chest • Patient lies on their back • Legs flat and slightly bent • Drape the patient for privacy • Head is in one of three different elevations – Low fowler- 25 degree angle – Semi-fowlers- 45 degree angle – High fowlers- 90 degree angle © 2009 Delmar, Cengage Learning

Fowlers Position © 2009 Delmar, Cengage Learning

Knee- Chest Position • Used for rectal exams • Patient rests on the body weight • Arms are flexed slightly at the elbows and extended above the head • Knees are slightly separated and the thighs are at the right angles to the table © 2009 Delmar, Cengage Learning

Knee Chest Position © 2009 Delmar, Cengage Learning

Tips • REMEMBER – to use good body mechanics while positioning patients to protect yourself as well as the patient!! © 2009 Delmar, Cengage Learning