Lesson 1, Topic 1
In Progress

Closing Comments

April 11, 2024

Closing Comments

Patient Coaching

An informed patient is better prepared to continue with home care. Skeletal conditions, particularly arthritis, can be so painful and debilitating that these patients may be easy prey for miracle drug promotions. It is important for you to recognize the need for patient education about the condition and work diligently with the patient and family to encourage participation in effective care programs. When you work with the provider and the physical therapist in helping the patient, you become an important member of the healthcare team. This type of involvement leads to patient satisfaction, personal satisfaction, and a sense of achievement for the medical assistant.

Legal and Ethical Issues

When performing a procedure on a patient, it is important to follow these guidelines:

• You must have a written order from the provider.
• You must follow the procedure precisely as it is ordered, without variation.
• Never advise the patient without permission.
• Make sure you know what instructions the provider gave the patient and reinforce them.
• If you have any concerns about a procedure, discuss them with the provider privately before proceeding.
• Do not perform a procedure if you are uncomfortable; get someone to help you.

Always remember that you are the assistant, and this is the provider’s patient. The provider is ultimately responsible for every aspect of the patient’s care. Always stay within the legal and ethical guidelines of the medical assisting profession in your state.

Patient-Centered Care

Patients with musculoskeletal diseases may be on several medications to manage the disease and pain. The medical assistant should ensure the patient is taking the medication as prescribed. It is important to ask questions regarding the side effects of medications and pain levels in order to identify any issues the patient may be having. The information gathered from the patient should be reported to the provider. The goal is to give patients the highest quality of life.

• You must have a written order from the provider.
• You must follow the procedure precisely as it is ordered, without variation.
• Never advise the patient without permission.
• Make sure you know what instructions the provider gave the patient and reinforce them.
• If you have any concerns about a procedure, discuss them with the provider privately before proceeding.
• Do not perform a procedure if you are uncomfortable; get someone to help you.

Always remember that you are the assistant, and this is the provider’s patient. The provider is ultimately responsible for every aspect of the patient’s care. Always stay within the legal and ethical guidelines of the medical assisting profession in your state.

Professional Behaviors

Musculoskeletal injuries and disorders are commonplace in the ambulatory care setting. For this reason, patients may ask for your advice on how to manage their health problems. Remember that as the medical assistant, you should never diagnose or recommend treatment for a patient. That is the provider’s responsibility. Responding professionally to inquiries and offering provider-approved educational materials and websites can be very helpful. Respectful and courteous behavior should be standard practice for medical assistants when they interact with patients and their families.

Table 20.3

Common Treatments Used for Musculoskeletal Diseases and Disorders

ProcedureDescription
ArthrocentesisSurgical procedure that involves a puncture of the joint and removal (aspiration) of fluid.
BunionectomySurgical removal of a bunion.
FasciotomySurgical procedure that involves opening the muscle compartment to reduce the pressure and restore blood flow.
Fixation deviceUsed to keep fractured bones stabilized and in alignment.
• External fixation (EF) device: Screws are placed into the bone above and below the fracture. The external fixation device is attached to the screws outside the skin.
• Internal fixation (IF) device: Rods, screws, or plates are surgically inserted into the bones to stabilize the bones.
MeniscectomySurgical removal of a meniscus.
MyorrhaphySurgical suturing of a muscle.
ProsthesisAn artificial body part, such as a leg, to replace a missing part.
ReductionAlignment and immobilization of; there are two types:
• Open reduction (OR): Requires a surgical incision for the repair.
• Closed reduction (CR): Does not require a surgical incision.
TenomyoplastySurgical procedure to repair a tendon and muscle.
Total or partial joint replacement/arthroplastySurgical removal of part or all of the joint and insertion of artificial plastic or metal joint parts. Partial joint replacement means only part of the joint structures are replaced. With a total joint replacement, all of the joint structures are replaced. Minimally invasive replacement surgery involves less cutting of the tissue. Here are some examples:
• Patellofemoral replacement: Type of partial knee replacement.
• Total elbow replacement: The damaged part of the humerus and ulna are replaced with artificial components.
• Total hip replacement (THR): The damaged femoral head and the acetabulum are replaced with artificial components. Also known as hip arthroplasty.
• Total knee replacement (TKR): Replaces the knee joint. Also known as knee arthroplasty.
• Total shoulder replacement: Replaces the shoulder joint. Also known as shoulder arthroplasty.
Traction Treatment of a dislocation; process of pulling the bone into correct alignment.

Table 20.4

Medication Classifications

ClassificationInformationGeneric Name (Trade Name)
Analgesic
Indications for use: Relieves pain
Desired effects: Reduces the sensory function of the brain; blocks pain receptors
Side effects and adverse reactions: Nonnarcotic: Gastrointestinal (GI) distress, liver and kidney disorders, and tinnitus
Narcotic: hypotension, decreased respirations, agitation, blurred vision, confusion, constipation, sedation, restlessness
Nonnarcotic over the counter (OTCs):
• Aspirin (Ecotrin, Bayer Aspirin, Bufferin)
• Acetaminophen (Tylenol, Tempra)
• Ibuprofen (Advil, Motrin)
Narcotic (opioids):
• Oxycodone (OxyContin)
• Hydrocodone with acetaminophen (Lortab, Norco, Vicodin)
• Oxycodone with acetaminophen (Percocet, Oxycet, Roxicet)
• Tramadol (Conzip)
Table Continued
ClassificationInformationGeneric Name (Trade Name)
Anticonvulsant and mood stabilizerIndications for use: Treats epilepsy, trigeminal neuralgia, mania and mixed episodes (mania and depression) with bipolar disorder
Desired effects: Reduces the frequency and severity of seizures by reducing excessive stimulation of the brain
Side effects and adverse reactions: Sedation, vertigo, visual disturbances, GI disturbances, liver complications
• Carbamazepine (Tegretol, Equetro)
• Lamotrigine (Lamictal)
• Topiramate (Topamax)
• Valproic acid (Depakene, Depakote)
• Gabapentin (Neurontin, Horizant)
AntigoutIndications for use: Treats gout
Desired effects: Reduce the uric acid in the body
Side effects and adverse reactions: GI distress, eye irritation, itching, rash, blood in urine
• Allopurinol (Zyloprim, Aloprim)
• Febuxostat (Uloric)
Anti-inflammatoryIndications for use: Treats arthritis and other inflammatory disorders (e.g., allergic rhinitis)
Desired effect: Reduces inflammation
Side effects and adverse reactions: GI distress, GI bleeding, hepatitis, drowsiness, tinnitus, irregular heart rate, kidney disorders
Nonsteroidal anti-inflammatory drugs (NSAIDs):
• Ibuprofen (Advil, Motrin, Midol)
• Naproxen (Naprosyn)
• Meloxicam (Mobic)
Steroidal:
• See Corticosteroids (oral)
Corticosteroid (oral)Indications for use: Treats chronic inflammatory diseases (e.g., arthritis) and acute conditions (e.g., poison ivy, asthma)
Desired effects: Reduces inflammation
Side effects and adverse reactions: Headache, mood changes, difficulty falling asleep or staying asleep, increased sweating, vision problems, depression, and weight gain
• Prednisone (Prednisone Intensol, Sterapred)
• Prednisolone (Flo-Pred, Orapred, Pediapred)
• Methylprednisolone (Medrol)
Muscle relaxantIndications for use: Treats painful musculoskeletal conditions (e.g., strains, sprains, muscle injuries)
Desired effect: Works on the central nervous system (CNS) to relax muscles, which decreases pain
Side effects and adverse reactions: Drowsiness, clumsiness, tachycardia, GI intolerance, difficulty breathing, fever, weakness, burning in the eyes, seizures
• Carisoprodol (Soma)
• Cyclobenzaprine (Amrix)
Osteoporosis agentIndications for use: Promotes bone mineral density and reverse progression of osteoporosis
Desired effects: Inhibits bone reabsorption or promotes the use of calcium
Side effects and adverse reactions: GI disorders, esophageal irritation
• Alendronate (Fosamax, Binosto)
• Risedronate (Actonel, Atelvia)
• Ibandronate (Boniva)
• Raloxifene (Evista)
Tumor-necrosis factor (TNF) inhibitorIndications for use: Treats autoimmune disorders (e.g., rheumatoid arthritis)
Desired effect: Blocks the action of TNF, preventing inflammation
Side effects and adverse reactions: GI distress, weakness, seizures, bleeding
• Infliximab (Remicade)
• Etanercept (Enbrel)