Y khoa, dược - Preparing the examination and treatment area

35Preparing the Examination and Treatment Area35-2Learning Outcomes35.1 Explain the medical assistant’s role in preparing the examination room. 35.2 Describe the layout and features of a typical examination room.35.3 Describe steps to prevent the spread of infection in the examination room.35.4 Explain how and when to disinfect examination room surfaces.35-3Learning Outcomes (cont.)35.5 Describe the importance of such factors as temperature, lighting, and ventilation in the examination room. 35.6 Identify instruments and supplies used in a general physical examination, and tell how to arrange and prepare them.35.7 Explain how to eliminate hazards to physical safety in the examination room. 35-4IntroductionPreparation of the exam room and treatment areaCommon layoutsCleanliness and suppliesComfort of roomSafety Accessibility based on the Americans with Disabilities Act35-5The Medical Assistant’s Role in Preparing the Examination RoomMaintain neatness and cleanliness of the roomEnsure that all supplies and equipment needed are present for the physician’s useMake certain that potential safety hazards are eliminated35-6The Medical Assistant’s Role in Preparing the Examination Room (cont.)Main concerns areSafetyEfficiencyComfort35-7Apply Your KnowledgeWhat are three tasks the medical assistant should do to prepare the examination room?ANSWER: The medical assistant should Maintain neatness and cleanliness of the room Ensure that all supplies and equipment needed are  present for the physician’s use Make certain that potential safety hazards are eliminatedCorrect!35-8The Examination RoomThe area where the physician:Observes the patientListens to patient symptomsPerforms a general physical examination to confirm health or diagnose a medical problem35-9The Examination Room (cont.)Number and size of roomsDepends on the number of physicians in the medical practiceAverage size room is 8 × 12 ftRooms should be large enough for patient, physician, and medical assistant, yet small enough to have supplies within reach35-10Exam Room FurnishingsShould be arranged for:EfficiencyPatient comfortPhysician convenienceItems commonly found in examination rooms One or more chairs A rolling stool Weight scale Biohazard container Wastebasket with lid Puncture-proof containers Wall brackets High-intensity lamp35-11Special FeaturesThe 1990 Americans with Disabilities Act (ADA)Requires “reasonable accommodations”Compliance requires that medical office be accessible to patients with disabilitiesAccessibility – the ease with which people can move in and out of a space 35-12Special FeaturesDoorway must be at least 36 inches wideClearance space in rooms and hallways at least 60 inches wideSlip-resistant floorsDoor-opening hardware can be grasped with one hand and does not require twisting of the wrist to useDoor closers must be adjusted to allow entry and exit timeGrab bars in lavatoriesADA Guidelines35-13Apply Your KnowledgeANSWER: You need to consider efficiency, patient comfort, and physician convenience when arranging an examination room.When arranging an examination room, what three things should you consider?Right!35-14Cleanliness in the Examination RoomStrict housekeeping standardsAdherence to government guidelinesInfection controlMake hand washing a priorityKeep examining table cleanDisinfect all work surfaces35-15Cleanliness in the Exam Room (cont.)Clean hands – first step in preventing infection transmissionWash handsAt the beginning of the dayBefore and after contact with each patientBefore and after using glovesBefore and after eatingAfter coughing or blowing your noseBefore handling clean or sterile equipmentBefore leaving for the day35-16Cleanliness in the Exam Room (cont.)Examining tableChange the disposable paper covering the examination table after each useDispose of paper coverings soiled by body fluids in a biohazardous waste containerAlso place soiled linens and pillowcases in biohazard-labeled bags.35-17Cleanliness in the Exam Room (cont.)Surfaces10% bleach solution or product approved by the EPADisinfect work surfaces if visibly contaminated and at end of shiftSink and countertopsExamination tablePatient lavatory StorageStore biohazardous specimens properlyStore testing kits properly35-18Cleanliness in the Exam Room (cont.)Putting the room in orderStraighten room between patientsBoosts patient confidence in efficiency and abilities of medical personnelHousekeepingJanitorial services for after-hours cleaningMonitor for lapses in cleanlinessMedical assistant may do some housekeeping chores 35-19A medical assistant at a busy pediatrician office notices a foul odor in two of the patient examination rooms. After careful inspection, the medical assistant finds soiled diapers in the biohazardous containers of both rooms. How would you handle this situation? ANSWER: The first priority is to remove the source of odor, then to decontaminate the area. It may also help to designate a separate location in the office for soiled diapers so that parents will know how to dispose of them. Many pediatrician offices have a system in place to prevent such odors in treatment room areas.Apply Your KnowledgeGood Job!35-20Room Temperature, Lighting, and VentilationMaintain examination room temperature at about 72°FEliminate drafts from windows and doorsTemperature35-21Room Temperature, Lighting, and Ventilation (cont.)Good lighting neededAccurate diagnosesPerform medical proceduresRead orders and instructionsPrevent accidents Lighting35-22Room Temperature, Lighting, and Ventilation (cont.)Examination area should smell clean and freshEliminate source of odorsIf opening windows, monitor room temperatureRoom deodorizer or sprayVentilation35-23Apply Your KnowledgeANSWER: Good lighting is needed for making accurate diagnoses, performing medical procedures, reading orders and instructions, and preventing accidents.Why is it important to have good lighting in the examination room?Excellent!35-24Medical Instruments and SuppliesTasks to maintain instruments and suppliesOrder and stock all needed suppliesSanitize, disinfect, and/or sterilize instruments as neededInstruments and supplies should be placed within easy reach for the physician35-25InstrumentPurposeAnoscopeUsed to open the anus for examinationExamination lightProvides additional lightingLaryngeal mirrorReflects inside of mouth and throatNasal speculumUsed to enlarge the opening of the noseOphthalmoscopeUsed to examine the inner eye surfacesInstruments for a General Physical Exam35-26InstrumentPurposeOtoscopeUsed to examine the inner earPenlightSmall flashlight used to view a small areaReflex hammerUsed to check patient’s reflexesSphygmomanometerUsed to measure blood pressure StethoscopeUsed to listen to body soundsInstruments for a General Physical Exam (cont.)35-27InstrumentPurposeTape measureUsed to measure size or development of an areaThermometerUsed to measure body temperatureTuning forkUsed to test patients’ hearingVaginal speculumUsed to enlarge the vagina for specimens from cervix and vaginaInstruments for a General Physical Exam (cont.)35-28Instruments for a General Physical Exam (cont.)Inspecting and maintaining instrumentsBe sure instruments are in good working orderArranging instrumentsKeep instruments in same location, either: Mounted on wall Out on countertop Set on a clean towel or trayPreparing instrumentsSome instruments require warmingCleaning instrumentsPlace used instruments in a container and always handle carefully35-29Cervical scraperCotton ballsCotton-tipped applicatorsCurettesDisposable needlesDisposable syringesGauze, dressings, and bandagesGlass slidesSterile and clean glovesPaper tissuesOccult blood test slidesSpecimen containersTongue depressorsSupplies for a General Physical Exam 35-30Consumable SuppliesSupplies that are used upFixative – chemical spray used for preserving a specimen Isopropyl alcoholLubricant – a water-soluble gelBe sure patients do not have access toPrescription blanksDrugsNeedles 35-31Medical Instruments and Supplies (cont.)Storing supplies in cabinets and drawersLabel so items can be easily locatedRoutinely straighten and clean Restocking suppliesReorder when the first half of a box, tube, or bottle has been used35-32stethoscopenasal speculumreflex hammerotoscopepenlightlaryngeal mirrorophthalmoscopetape measuresphygmomanometertuning forkanoscopeApply Your KnowledgeA medical assistant is preparing the treatment room for a local ENT specialist. Which of the following instruments might be used in this office to assess patient ear, nose, and throat functioning?*nasal speculum*otoscope*penlight*laryngeal mirror*ophthalmoscope*tuning forkANSWER:Good Choices!35-33Physical Safety in the Exam RoomFloorWipe up spills immediatelyPick up dropped itemsBe sure carpets and rugs are intactCabinets and drawersKeep closed Prevents injurySupplies not exposed to patients35-34Physical Safety in the Exam Room (cont.)FurnitureNo rough edges or sharp cornersPull from service and check with supervisorCords and cablesTaped or fastened down Replace if worn35-35Special Safety PrecautionsChildren Keep medication and dangerous items out of reachToys should be washable and safeBe sure toys do not have any sharp surfacesPatients with disabilitiesFall precautionsSafe flooring and handrails 35-36Fire SafetyStore and dispose of hazardous substances correctlyPost “No Smoking” signs in office areasCheck electrical cords, plugs, and outletsHave functional smoke detectorsFire Prevention35-37Fire Safety (cont.)In case of fireUsing safety equipmentFire extinguisher – “PASS” systemHave a safe evacuation routeLocate fire alarms, fire doors, and fire escapesStage fire drills35-38Store the solutions with the other cleaning solutions in the usual cabinet.Lock the new solution up in a separate cabinet.Read the label carefully and check the MSDS information before storing the liquids.The medical assistant has received the recently ordered office cleaning supplies. When unpacking the cleaning solutions for storage, he finds two new disinfectant solutions that he is unfamiliar with. How should the medical assistant handle this?Apply Your KnowledgeANSWER:Impressive!35-39In Summary35.1 It is the medical assistant’s responsibility to ensure that the examination room is neat, clean, and appropriately stocked. 35.2 A typical examination room is about 8 by 12 feet, large enough to accommodate the physician, the patient, and one assistant. Instruments and equipment in the room should be easily accessible. 35-40In Summary (cont.)35.3 Steps involved in preventing the spread of infection in the examination room include covering the examination table with a paper cover and changing the cover between each patient. It is also important to disinfect all surfaces that come in contact with blood or body fluids after each patient, and at the beginning and end of the day.35-41In Summary (cont.)35.4 Examination room surfaces should be disinfected after an examination or treatment during which surfaces have become visibly contaminated, immediately following accidental blood or body fluid spills or splatter, and at the end of the medical assistant’s work shift.35.5 It is important that patients feel comfortable in the examination room. A room that is comfortably warm, well lit, and properly ventilated will help the patient feel comfortable during the examination. 35-42In Summary (cont.)35.6 A variety of instruments and supplies are used in a general physical examination. To ensure that the examination room always has the necessary instruments and supplies, the medical assistant should order and stock all supplies needed for examinations and treatment procedures, keep the instruments sanitized, disinfected, or sterilized and in working order, and place all instruments and supplies where the doctor can easily reach them.35-43In Summary (cont.)35.7 To eliminate hazards to physical safety in the examination room, the medical assistant should be alert for any physical hazards in the area, including spills, dropped objects, open cabinet doors, damaged furniture, or improperly secured cords and cables. 35-44Safety is something that happens between your ears, not something you hold in your hands. ~ Jeff CooperEnd of Chapter 35