Positioning, Examinations, Screening and Irrigations

This is Unit Fourteen of Medical Assistant Prep. Unit Thirteen finished the vital signs and body measurements. This unit moves into the exam itself: positioning and draping the patient, serving as chaperone, screening vision and hearing, and irrigating the ear and eye. Carry one idea through this lecture. Screenings and procedures produce findings, and the medical assistant's job is to record them precisely and report them, while the patient's comfort and dignity stay in view throughout. A constructed morning at the end applies that idea to a screening and an irrigation. By the end you will be able to place a patient in each named position. To drape a patient and act as chaperone. To screen vision and hearing. And to prepare for ear and eye irrigation.

Seven entries on positions: why they matter, lying flat and on the side, raised, tilted, lithotomy and tripod.

Access, safety, cover.

MAS 326 Why Position Matters

Positioning gives the provider access for an exam or procedure while keeping the patient safe, comfortable and covered. Each position has a name, so that the provider can ask for one in a word and the medical assistant knows exactly what is meant. Help the patient into position slowly, and lock the table or bed first.

Supine and prone.

MAS 327 Supine and Prone

In the supine position the patient lies flat on their back; in the prone position the patient lies on their stomach. Supine is common for chest and abdominal exams; in prone, the head is turned to one side, and pillows can support the lower legs. Some patients short of breath cannot lie flat; ask before you position them.

Lateral and Sims'.

MAS 328 Lateral and Sims' Positions

In the lateral position the patient lies on one side with the top leg bent over the bottom leg. The Sims' position is halfway between lying on the back and lying face down, with the legs flexed, a pillow under the top leg, and the arms beside the body. Keep the arms out from under the body to avoid pressure and discomfort.

Fowler's and semi-Fowler's.

MAS 329 Fowler's and Semi-Fowler's

In Fowler's position the head of the bed or table is raised forty-five to ninety degrees; at ninety degrees it is called high Fowler's. In semi-Fowler's the head is raised thirty to forty-five degrees, which many patients tolerate better for long periods. Raised positions often ease breathing, so offer one to a patient who is short of breath.

Head lower than feet.

MAS 330 Trendelenburg Position

In the Trendelenburg position the head is lower than the feet. It may be used in certain situations, such as severe low blood pressure and medical emergencies, to help blood return to the head and heart. Use it only when the provider directs, and stay with the patient while they are in it.

Lithotomy.

MAS 331 Lithotomy Position

In the lithotomy position the patient lies on their back with the buttocks at the edge of the table, hips and knees bent, and legs apart in stirrups. It gives access to the pelvis and perineum for exams and procedures such as a pelvic examination. Drape the patient fully and keep them covered until the provider is ready to begin.

A patient's own position.

MAS 332 The Tripod Position

Patients who are short of breath often lean forward on their own, with elbows on their knees or on a table; this is the tripod position. The position helps the lungs expand, so a patient with breathing difficulty can be helped into it. A patient who takes this position without being asked is telling you they are struggling to breathe; report it.

Five entries on dignity: draping, the chaperone's role and policy, the pelvic exam, and assisting the provider.

Expose only what is needed.

MAS 333 Draping for Dignity

Patients are given a gown and a sheet so that only the area being examined is exposed. Explain how to put the gown on, and give the patient privacy to change before the exam begins. Uncover only what the exam needs, and cover it again as soon as it is done.

Comfort and safety for both.

MAS 334 The Chaperone's Role

A chaperone is a trained staff member present during a sensitive exam to support the comfort, safety, privacy and security of both the patient and the provider. Sensitive exams generally include exams of the breasts, genitals and rectum; medical assistants often serve as chaperones. The chaperone's attention stays on the patient's comfort and safety throughout the sensitive part of the exam.

Practices differ.

MAS 335 When a Chaperone Is Present

Each practice sets its own chaperone policy, and policies differ. Some health systems require a chaperone for every pelvic exam; others offer one for any sensitive exam; patients may request one at any visit, and practices try to honor a request for a chaperone of a particular gender. Know your practice's policy, and record who served as chaperone.

A sensitive exam, prepared.

MAS 336 Assisting With a Pelvic Exam

A pelvic exam needs the room, the patient and the equipment prepared, and usually a chaperone under the practice's policy. Set out the supplies the provider requests, including the speculum and any specimen materials, such as for a Pap test. Give the patient a gown and a sheet and leave while she changes. When the provider is ready, help her into lithotomy, still draped. Stay as chaperone if that is your role, attentive to her comfort. Hand supplies as asked and label any specimen at once. Afterward help her sit up slowly, with privacy to dress. Many patients find this exam stressful, so explaining each step first and checking on her are part of the job.

Room, patient, equipment.

MAS 337 Assisting the Provider During an Exam

Medical assistants help providers during examinations by preparing the room, the patient and the equipment. That means stocking supplies, positioning and draping the patient, handing instruments as requested, and helping the patient up afterward. Stay alert to the patient's comfort throughout, not only to the provider's requests.

Six entries on screening: the Snellen chart, distance and near vision, color vision, referral, and hearing.

Twenty feet away.

MAS 338 The Snellen Chart

Distance vision is commonly screened with a Snellen chart, read from twenty feet away. A result of twenty over twenty is normal; twenty over thirty means the patient sees at twenty feet what a person with normal vision sees at thirty. The larger the second number, the poorer the distance vision.

Each eye, recorded.

MAS 339 Performing a Distance Vision Screening

A distance vision screening follows a consistent routine so results compare between visits. Place the patient twenty feet from a well-lit chart. Ask whether they wear glasses or contacts for distance, and if so test with them on and note it. Cover one eye and ask them to read the smallest line they can. Record that eye as a fraction, such as twenty over forty. Repeat with the other eye covered and record it separately. A result without each eye and the lens details cannot be compared at the next visit.

Handheld chart.

MAS 340 Near Vision Screening

Near vision is screened with a handheld near-vision chart. Trouble with near vision is common in middle-aged and older adults, as the lens stiffens and focuses less well, a condition called presbyopia. Record the result for each eye, and note whether the patient wore reading glasses during the screening.

Dots and numbers.

MAS 341 Color Vision With Ishihara Plates

Color vision can be screened with Ishihara plates, a book of patterns made of colored dots. A person with normal color vision sees a number or shape within the dots that a person with certain color vision deficiencies cannot see. Screening shows that a problem may exist; it does not diagnose its cause.

Screens, not diagnoses.

MAS 342 Screening Leads to Referral

Screening tools identify possible vision problems; they do not diagnose them. When a screening suggests a problem, the provider may refer the patient to an eye specialist, such as an optometrist or ophthalmologist. Report screening results to the provider; do not tell the patient what the result means.

Hearing without equipment.

MAS 343 The Whisper Test

The whisper test is a simple, quick screen for hearing that needs no equipment. Standing behind the seated patient, whisper a few words and ask the patient to repeat them back. Record how many of the whispered words the patient repeated correctly, and report any difficulty to the provider.

Four entries on the ear and eye: positioning for drops, ear and eye irrigation, and a constructed morning.

By age.

MAS 344 Positioning the Ear for Drops

Before ear drops, the ear canal is straightened by gently pulling the outer ear, and the direction depends on age. For adults, pull the outer ear up and back; for children, pull it straight back; for infants, pull it down and back. Aim drops at the side of the canal, not straight at the eardrum.

Flushing the canal, on order.

MAS 345 Ear Irrigation

Ear irrigation flushes earwax or foreign material from the outer canal, only when ordered and as policy allows. Confirm the order and the patient's identity, and explain the procedure. Prepare the solution ordered, typically normal saline at room temperature, and draw it into the irrigating device, often a large needleless syringe. Have the patient hold a basin under the ear. Straighten the canal gently and irrigate as trained. Watch for dizziness, nausea or pain throughout, and stop and report if any occur. Problems with the eardrum change what is safe, so follow the order exactly and ask first if anything about the ear concerns you.

Large amounts of saline.

MAS 346 Eye Irrigation

Eye irrigation flushes debris or chemicals from the eye using large amounts of saline. The amount and length of the flush depend on the contaminant; some emergency eyewash stations deliver a fifteen-minute flush. Keep runoff from flowing into the other eye, unless both eyes need flushing.

A screening and an irrigation.

MAS 347 A Morning of Screenings and an Irrigation

A constructed morning pays off the opening idea. A nine-year-old needs a vision screening for a school physical. At twenty feet, with no glasses, he reads the twenty over twenty line with one eye but only twenty over fifty with the other. The assistant records each eye, notes no lenses, and tells the provider about the difference, without explaining it to the child or his mother. She then screens color vision with the plates and records his answers. Later, an adult has an order for ear irrigation for impacted wax. She confirms identity and order, uses room-temperature saline with a basin, and irrigates gently. When he says he feels dizzy, she stops at once, keeps him seated and tells the provider, who decides how to proceed. Stopping at the first sign of dizziness is part of the procedure.

Look at what you can now do. You can place a patient in each named position, and you know the tripod position signals trouble breathing. You can drape so only the exam area is exposed, serve as chaperone under your practice's policy, and assist with a pelvic exam. You can screen distance, near and color vision and hearing, recording each eye separately and leaving referral to the provider. And you can position the ear for drops, assist with irrigation, and stop at the first sign of a reaction. Unit Fifteen turns to wound care, suture and staple removal, minor procedures and supports.