Lesson 1, Topic 1
In Progress

The Medical Assistant’s Role in Examinations, Diagnostic Procedures, and Treatments

April 11, 2024

Learning Objective: Examine the medical assistant’s role in examinations, diagnostic procedures, and treatments for respiratory conditions.
     Medical assistants in primary care, urgent care, and pulmonary departments work with patients with respiratory conditions. Medical assistants in occupational health are also involved with performing spirometry for preemployment physicals. The following sections describe the medical assistant’s role in examinations, diagnostic procedures, and treatments.


Assisting with the Examination
Learning Objective: Describe the medical assistant’s role in examinations for pulmonary conditions.
      Preparing a patient for a respiratory examination includes having the patient disrobe to the waist. The patient should put on a gown with the opening in the front or back, depending on the provider’s preference. To assess the status of the respiratory system, the provider uses inspection, palpation, percussion, and auscultation on the anterior thorax, then repeats the process on the posterior and lateral thorax. The medical assistant is responsible for assisting the provider throughout the examination and providing privacy and support for the patient.


Assisting with Diagnostic Procedures
Learning Objective: Describe the medical assistant’s role in diagnostic procedures for pulmonary conditions.
      TABLE 26.3 lists common diagnostic procedures for respiratory diseases. TABLE 26.4 lists common medical laboratory tests for respiratory system diseases. Some diagnostic procedures are done in the clinic, whereas others are done in other departments (e.g., medical laboratory and radiology). The medical assistant may be responsible for coaching patients on diagnostic procedures done in other departments. As with other diagnostic procedures, the medical assistant should coach the patient regarding the following:
                 • Patient preparation (e.g., dietary restrictions and medications to hold)
                 • Location and time of the test
                 • What to expect during the procedure
                 • Any follow-up required after the procedure
The medical assistant performs the following diagnostic procedures.


26.6 Critical Thinking Application
Renee is working with a patient who needs to have an oxygen saturation measurement with a pulse oximeter. The patient asks Renee what this test shows. Thinking back to what you have learned already in this chapter, how would you answer the patient’s question?


Peak Flow Rate Measurement
The peak flow meter measures the amount of air exhaled. A peak flow rate is measured using a manual or digital peak flow meter in an ambulatory care or home setting (see FIGURE 26.8A–B). It is used to diagnose acute conditions and manage chronic diseases, such as asthma. Procedure 26.1 describes the steps to take when measuring a peak flow rate. When a patient is performing a peak flow rate test, it is important that the medical assistant obtain three adequate readings.
      For chronic disease management, providers encourage patients to use peak flow meters at home. The providers create asthma action plans for the patients to follow (see TABLE 26.1). Based on the patient’s peak flow rate at home, the patient follows the directions on the plan.


26.7 Critical Thinking Application
Renee is working with an adult patient newly diagnosed with asthma. She has just explained how to use a peak flow meter at home, and the patient’s “normal” peak flow volume was identified. As Renee explains the asthma action plan the pulmonologist has ordered, the patient begins to look confused. He asks, “Why can’t I just call or come in if I don’t feel good? Why do I need to bother with the asthma action plan?” What might be the benefits to the patient of using the asthma action plan? How might you respond to his question?

TABLE 26.3

Diagnostic Procedures for Respiratory System Diseases and Disorders

Spirometry
Spirometry evaluates lung function as it is affected by respiratory, cardiac, and neuromuscular diseases. It can be ordered if the provider identifies abnormalities in the respiratory system. A spirometer can evaluate the amount of air you exhale and inhale. It looks at how quickly the air is exhaled and the rate at which air is breathed in. Several different tests can be done with spirometry (TABLE 26.5).
      With spirometry testing, it is important that the medical assistant enter accurate patient data into the spirometer computer (FIGURE 26.9). Besides the patient’s name, medical record number, and date of birth, the medical assistant may need to enter the person’s sex, age, race, height, and weight. The patient’s current height and weight need to be obtained prior to the spirometry. The computer pulls stored data and creates a “normal” person for those characteristics. After the patient has completed the test, the computer will print out the patient’s results compared with the “normal” person’s. This helps the provider identify areas of concern.

FIGURE 26.8  (A) Manual peak flow meter. (B) Digital peak flow meter.

Procedure 26.2 describes the spirometry procedure. When performing the spirometry procedure, the following steps should be taken:
                 • Adults should exhale for 6 seconds, and children should exhale for 3 seconds for the forced vital capacity (FVC). For patients with obstructive breathing patterns, the FVC may take up to 15 seconds.
                 • Give patients at least 30 seconds between blows. Have patients indicate when they are ready for the next blow.
                 • Do a minimum of three blows and a maximum of eight blows (unless otherwise indicated by the facility’s protocols).
                 • Make sure to follow the operator’s manual for the machine you are using.
                 • Be encouraging yet respectful of patients when coaching them through the procedure.


26.8 Critical Thinking Application
Renee’s last patient of the day is Janine Butler, who is seeing the provider because of her asthma. After the provider sees Janine, he orders a spirometry test. Renee prepares the equipment and brings Janine into the testing room. However, Janine refuses to have her height and weight measured. Renee explains to Janine the importance of getting accurate height and weight measurements. Discuss how you would explain the importance of obtaining accurate height and weight measurements when doing a spirometry test.

TABLE 26.5

Spirometry Tests

FIGURE 26.9  A spirometer is used for spirometry testing.

Assisting with Treatments
Learning Objective: Describe the medical assistant’s role in treatments for pulmonary conditions.
      Patients with pulmonary conditions are prescribed a variety of medications. The following are some of the more common classifications:
                • Antihistamine: Counteracts the effects of histamine
                • Antiviral: Destroys or inhibits the growth and reproduction of viruses
                • Antitussive: Inhibits the cough center
                • Bronchodilator: Relaxes the smooth muscles of the bronchi
                • Corticosteroid (oral, nasal, and inhaled): Reduces airway inflammation and bronchial resistance
                • Decongestant: Relieves local congestion in the nasal and sinus tissues
                • Expectorant: Thins the secretions in the bronchial tubes to make it easier to cough up the mucus
                • Leukotriene receptor antagonist: Blocks the action of substances that cause asthma and allergic rhinitis
      Refer to TABLE 26.6 for information on the medical classification, including the indication for use, desired effect, side effects, adverse reactions, and generic and trade names. Medical assistants should be familiar with medications that are prescribed to patients.
      In the ambulatory care facility, common respiratory treatments include medication administration and oxygen therapy. Depending on the state’s statutes and the facility’s policies, the medical assistant may be able to administer nebulizer treatments and oxygen therapy when ordered by the provider. The medical assistant may also instruct patients on how to use metered-dose inhalers. The following sections cover metered-dose inhaler education, nebulizer treatments, and oxygen therapy.


Metered-Dose Inhalers
A metered-dose inhaler (MDI) provides aerosol medication that is breathed into the lungs. MDIs are typically ordered for conditions such as asthma and chronic obstructive pulmonary disease (COPD).
      In many cases, the provider will order an MDI with a spacer. A spacer is a long tube that is attached to the mouthpiece of an MDI (FIGURE 26.10A). Spacers slow the delivery of medication from MDIs. Without a spacer, the MDI blasts the medication to the back of the throat and mouth. Inhaled corticosteroids can cause irritation and infections over time. When a spacer is used, the medication is blasted into the tube and, over several breaths, is pulled into the lungs. In an ambulatory care facility, the medical assistant may need to instruct the patient on the proper use of an MDI.
Using a Metered-Dose Inhaler
When teaching a patient to use an MDI, the medical assistant should instruct the patient to shake the MDI three or four times, then remove the cover from the mouthpiece. If using a spacer, the patient should do the following:

TABLE 26.6

Medication Classifications

                 • Attach the spacer. Breathe out. Place the mouthpiece between the lips and close the lips around it.
                 • Press the top of the canister on the MDI.
                 • Breathe in very slowly, taking a full breath in. Some spacers will produce a whistle-like sound if the person is breathing in too fast.
Patients who are not using a spacer should do the following:
                 • Breathe out. Place the inhaler 1 to 2 inches (about 2 finger widths) in front of his or her opened mouth (FIGURE 26.10B).
                 • Press the top of the canister on the MDI.
                 • Breathe in very slowly, taking a full breath in.
After taking the medication, patients should hold their breath for 10 seconds (or count to 10) and then breathe out. When using an inhaled, quick-relief medication (beta-agonists), the patient should wait 1 minute between puffs. These steps should be repeated until the dose is completed.

FIGURE 26.10  (A) Using a metered dose inhaler with spacer. (B) Using a metered dose inhaler without a spacer.

FIGURE 26.11  (A) (Top left to right) Nasal cannula and child non-rebreather mask. Non-rebreather masks have one-way valves (e.g., yellow circle on the mask). (Bottom left to right) Simple face mask and adult non-rebreather mask. (B) OxyMask is an open mask system that reduces the claustrophobic feeling. This mask can deliver 24% to 90% oxygen with flow rates from 1 to 15 L per minute.

Nebulizer Treatment
Inhaled medication for asthma, COPD, and other lung diseases can be given using a nebulizer. A nebulizer treatment can be done in the ambulatory care setting and at home. A nebulizer is a small machine that turns liquid medication into a fine mist that can be inhaled. Typically, the medication used for nebulizers is much stronger than the same medication found in an MDI. When working with pediatric patients, a mask can be used instead of the mouthpiece. The mask should be an appropriate size so it covers their nose and mouth. Procedure 26.3 describes the steps for administering a nebulizer treatment.


Oxygen Therapy
When a patient comes to the ambulatory care facility with a cardiac or respiratory condition, the provider may order oxygen to be administered. Oxygen should be treated like a medication. The medical assistant must get the order from the provider for how much oxygen to administer and how to administer it. In the ambulatory care facility, oxygen may be available in the room by means of a wall-mounted flow meter or oxygen cylinders (portable tanks).
      Room air is about 21% oxygen. Oxygen devices increase the concentration of oxygen for the patient to breathe in. Typically, a nasal cannula (NC) or a simple mask is used in the ambulatory care setting (FIGURE 26.11A). Other masks that deliver higher oxygen concentrations may also be available (FIGURE 26.11A–B).
      TABLE 26.7 provides information on the more common oxygen delivery devices used in the ambulatory care setting. Procedure 26.4 presents the steps for administering oxygen.