Pulmonary Medicine. 1. Spell and define the key terms 2. Identify the primary defense mechanisms

Transcription

1 CHAPTER 30 Pulmonary Medicine Learning Outcomes Cognitive Domain 1. Spell and define the key terms 2. Identify the primary defense mechanisms of the respiratory system 3. Identify common pathology related to each body system 4. Explain various diagnostic procedures of the respiratory system 5. Describe implications for treatment related to pathology 6. Describe the physician s examination of the respiratory system 7. Discuss the role of the medical assistant with regard to various diagnostic and therapeutic procedures Psychomotor Domain 1. Instruct a patient in the use of the peak flowmeter (Procedure 30-1) 2. Assist physician with patient care 3. Prepare a patient for procedures and/or treatments 4. Practice standard precautions 5. Perform patient screening using established protocols 6. Document patient care 7. Document patient education 8. Administer a nebulized breathing treatment (Procedure 30-2) 9. Perform a pulmonary function test (Procedure 30-3) 10. Practice within the standard of care for a medical assistant Affective Domain 1. Apply critical thinking skills in performing patient assessment and care 2. Use language/verbal skills that enable patients understanding 3. Demonstrate empathy in communicating with patients, family, and staff 4. Use appropriate body language and other nonverbal skills in communicating with patients, family, and staff 5. Demonstrate awareness of the territorial boundaries of the person with whom you are communicating 6. Demonstrate sensitivity appropriate to the message being delivered 7. Demonstrate recognition of the patient s level of understanding in communications 8. Recognize and protect personal boundaries in communicating with others 9. Demonstrate respect for individual diversity, incorporating awareness of one s own biases in areas including gender, race, religion, age, and economic status 10. Apply active listening skills 11. Apply local, state, and federal health care legislation and regulation appropriate to the medical assisting practice setting 569

2 570 PART III The Clinical Medical Assistant ABHES Competencies 1. Assist the physician with the regimen of diagnostic and treatment modalities as they relate to each body system 2. Comply with federal, state, and local health laws and regulations 3. Communicate on the recipient s level of comprehension 4. Serve as a liaison between the physician and others 5. Show empathy and impartiality when dealing with patients 6. Document accurately

3 CHAPTER 30 Pulmonary Medicine 571 Name: : Grade: COG MULTIPLE CHOICE Circle the letter preceding the correct answer. 1. A pulmonary function test measures: a. arterial blood gases. b. oxygen saturation. c. sputum cells. d. tidal volume. e. fluid in lungs. 2. A patient in need of an artificial airway will likely undergo: a. laryngectomy. b. tracheostomy. c. chemotherapy. d. bronchoscopy. e. pneumonectomy. 3. Which procedure necessitates a stethoscope? a. Percussion b. Palpation c. Inspection d. Radiation e. Auscultation 4. Which of the following would be a normal pulse oximetry reading for someone with no lung disease? a. 96% b. 94% c. 92% d. 90% e. 88% 5. One lower respiratory disorder is: a. laryngitis. b. bronchitis. c. sinusitis. d. pharyngitis. e. tonsillitis. 6. Which of the following is anesthetized by cigarette smoke? a. Alveoli b. Bronchioles c. Mucus d. Cilia e. Trachea 7. The most prominent symptom of bronchitis is: a. severe wheezing. b. repeated sneezing. c. productive cough. d. shortness of breath. e. coughing blood. 8. Viral pneumonia differs from bacterial pneumonia in that: a. it can be treated by antibiotics. b. it might result in hospitalization. c. it affects gas exchange in the lungs. d. it may lead to a fever and cough. e. it spreads throughout the lungs. 9. People with asthma have difficulty breathing because their: a. airways are narrow. b. cilia are inoperative. c. alveoli are collapsed. d. bronchioles are too wide. e. lungs are underdeveloped. 10. A productive cough refers to a cough that produces: a. blood. b. nasal mucus. c. sputum. d. oxygen. e. antibodies.

4 572 PART III The Clinical Medical Assistant 11. A type of medication that opens the bronchioles and controls bronchospasms is a(n): a. corticosteroid. b. bronchodilator. c. antibiotic. d. antihistamine. e. decongestant. 12. The public health department should be alerted about a diagnosis of: a. tuberculosis. b. pneumonia. c. bronchitis. d. asthma. e. COPD. 13. Which of the following is true of emphysema? a. It is not associated with bronchitis. b. It causes inflammation of the nasal passages. c. It can be cured with steroids. d. It is usually reversible. e. It usually takes many years to develop. 14. The purpose of a nebulizer is to: a. turn a vaporous medicine into a liquid. b. administer an asthma treatment. c. turn a liquid medicine into a vapor. d. cure COPD. e. pump oxygen. 15. Of the following diseases affecting the respiratory system, which, in most cases, is linked to cigarette smoking? a. Liver cancer. b. Cystic fibrosis c. Laryngitis d. Lung cancer e. Allergic rhinitis 16. In the case of a patient receiving oxygen treatment, a cannula: a. stores the oxygen. b. separates oxygen from the air in a room. c. delivers oxygen to the airways. d. ensures proper flow of oxygen. e. prevents accidents caused by oxygen s flammability. 17. COPD patients may take medications that are also prescribed for patients with: a. Influenza b. Pneumonia c. Meningitis d. Lung cancer e. Asthma 18. One acute disease of the lower respiratory tract is: a. asthma. b. pneumonia. c. emphysema. d. sinusitis. e. COPD. 19. The best way to thin mucus in the airways is: a. oxygen therapy. b. steroid medication. c. to increase oral fluid intake. d. to consume a balanced diet. e. frequent exercise. 20. A physician may perform an arterial blood gas test to: a. determine how much gas is in a patient s lungs. b. determine whether a patient has a normal respiratory rate. c. determine when a patient will be ready for respiratory surgery. d. determine whether a patient will be receptive to oxygen therapy. e. determine whether the patient s lungs are adequately exchanging gases.

5 CHAPTER 30 Pulmonary Medicine 573 COG MATCHING Grade: Place the letter preceding the defi nition on the line next to the term. Key Terms Definitions 21. atelectasis 22. chronic obstructive pulmonary disease (COPD) 23. dyspnea 24. forced expiratory volume (FEV) 25. hemoptysis 26. laryngectomy 27. palliative 28. status asthmaticus a. coughing up blood from the respiratory tract b. easing symptoms without curing c. a permanent surgical stoma in the neck with an indwelling tube d. a surgical puncture into the pleural cavity for aspiration of serous fluid or for injection of medication e. a progressive, irreversible condition with diminished respiratory capacity f. the volume of air forced out of the lungs g. difficulty breathing h. the amount of air inhaled and exhaled during normal respiration i. an asthma attack that is not responsive to treatment j. collapsed lung fields; incomplete expansion of the lungs, either partial or complete k. the surgical removal of the larynx 29. thoracentesis 30. tidal volume 31. tracheostomy COG IDENTIFICATION Grade: 32. Place a check mark on the line to indicate if each symptom is a possible symptom of laryngeal cancer. a. hoarseness lasting longer than three weeks b. pain in the throat when drinking hot liquids c. wheezing d. a feeling of a lump in the throat e. chest pain f. burning in the throat when drinking citrus juice g. dyspnea h. night sweats i. general malaise

6 574 PART III The Clinical Medical Assistant 33. Which of the following is/are an element/elements of the traditional examination of the chest? Circle the letter preceding all that apply. a. Palpation b. Auscultation c. Sputum culture d. Chest radiography e. Inspection 34. Which of the following pulmonary diagnostic methods is considered invasive? Place a check mark on the line next to the appropriate diagnostic methods. a. Percussion b. Bronchoscopy c. Auscultation d. Sputum culture e. Posteroanterior x-ray COG SHORT ANSWER Grade: 35. What is the most common cause of chronic obstructive pulmonary disease? 36. Why is the term chronic obstructive pulmonary disease used to characterize a patient suffering from emphysema and chronic bronchitis?

7 CHAPTER 30 Pulmonary Medicine What are two of the most common causes of upper respiratory problems? 38. In the case of a pneumonia patient, what prevents effective gas exchange? 39. What is usually the etiology of chronic bronchitis? 40. What is a symptomatic difference between viral and bacterial pneumonia? 41. What is the role of the medical assistant in the collection and analysis of a sputum specimen?

8 576 PART III The Clinical Medical Assistant 42. What is the purpose of a peak flow meter? 43. Under what circumstance would a physician perform a laryngectomy? 44. Describe the difference between palliative care and a cure. 45. What measures ought to be taken in the case of an asthmatic patient who does not respond to medication? 46. If a patient is prescribed two bronchodilator inhalers, what is the most likely explanation? Why would two be prescribed?

9 CHAPTER 30 Pulmonary Medicine Describe the typical prognosis of a lung cancer patient. COG TRUE OR FALSE? Grade: Indicate whether the statements are true or false by placing the letter T (true) or F (false) on the line preceding the statement. 48. An asthma patient will, upon contracting the disease, suffer from it for her entire life. 49. Emphysema entails chronic inflammation of the airways. 50. A patient who tests positive for tuberculosis is contagious. 51. Lung cancer, one of the most common causes of death in men and women, is believed to result usually from cigarette smoking. COG AFF CASE STUDIES FOR CRITICAL THINKING Grade: 1. Your patient comes to the office with shortness of breath. The physician asks you to perform an arterial blood gas and send it to the laboratory stat. How would you respond to the physician? 2. A patient with a severe lung disease explains that she has been smoking for decades. You explain that she ought to quit, but she contends that it does not matter. She says she has already damaged her lungs enough that continuing to smoke will do no further harm. How do you respond to this patient?

10 578 PART III The Clinical Medical Assistant 3. A patient receiving oxygen therapy calls to complain that his machine is not working. He does not know what to do. What suggestions do you have for the patient? What will you do to assist him? 4. Your patient has just been diagnosed with tuberculosis. Explain to him ways in which he should act to protect others while he undergoes treatment. 5. A healthy patient worries that his exposure to secondhand smoke of his coworkers might cause his health to deteriorate. You are aware of research suggesting that this is so; however, much of the research is controversial. How would you advise the patient? 6. A patient has just been diagnosed with lung cancer that the physician described as not terribly aggressive and potentially curable. The patient asks you if this means that he will be okay. How do you respond?

11 CHAPTER 30 Pulmonary Medicine 579 PSY PROCEDURE 30-1 Instruct a Patient on Using the Peak Flow Meter Name: : Time: Grade: EQUIPMENT/SUPPLIES: Peak fl ow meter, recording documentation form STANDARDS: Given the needed equipment and a place to work the student will perform this skill with % accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be before you begin.) KEY : 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted PROCEDURE STEPS SELF PARTNER INSTRUCTOR 1. Wash your hands. 2. Assemble the peak flow meter, disposable mouthpiece, and patient documentation form. 3. Greet and identify the patient and explain the procedure. 4. Holding the peak flow meter upright, explain how to read and reset the gauge after each reading. 5. AFF Explain how to respond to a patient who is visually impaired. 6. Instruct the patient to place the peak flow meter mouthpiece into the mouth, forming a tight seal with the lips. After taking a deep breath, the patient should blow hard into the mouthpiece without blocking the back of the flow meter. 7. Note the number on the flow meter denoting the level at which the sliding gauge stopped after the hard blowing into the mouthpiece. Reset the gauge to zero. 8. Instruct the patient to perform this procedure a total of three times consecutively, in both the morning and at night, and to record the highest reading on the form. 9. Explain to the patient the procedure for cleaning the mouthpiece of the flow meter by washing with soapy water and rinsing without immersing the flow meter in water. 10. Document the procedure.

12 580 PART III The Clinical Medical Assistant CALCULATION Total Possible Points: Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = % PASS FAIL COMMENTS: Student s signature Partner s signature Instructor s signature

13 PSY PROCEDURE 30-2 Perform a Nebulized Breathing Treatment Name: : Time: Grade: EQUIPMENT/SUPPLIES: Physician s order and patient s medical record, inhalation medication, nebulizer disposable setup, nebulizer machine STANDARDS: Given the needed equipment and a place to work the student will perform this skill with % accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be before you begin.) KEY : 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted PROCEDURE STEPS SELF PARTNER INSTRUCTOR 1. Wash your hands. 2. Assemble the equipment and medication, checking the medication label three times as indicated when administering any medications. 3. Greet and identify the patient and explain the procedure. 4. AFF Explain how you would respond to a patient who is deaf. 5. Remove the nebulizer treatment cup from the setup and add the medication ordered by the physician. 6. Place the top on the cup securely, attach the T piece to the top of the cup, and position the mouthpiece firmly on one end of the T piece. 7. Attach one end of the tubing securely to the connector on the cup and the other end to the connector on the nebulizer machine. 8. Ask the patient to place the mouthpiece into the mouth and make a seal with the lips, without biting the mouthpiece. Instruct the patient to breathe normally during the treatment, occasionally taking a deep breath. 9. Turn the machine on using the on/off switch. The medication in the reservoir cup will become a fine mist that is inhaled by the patient breathing through the mouthpiece. 10. Before, during, and after the breathing treatment, take and record the patient s pulse. 11. When the treatment is over and the medication is gone from the cup, turn the machine off and have the patient remove the mouthpiece. 12. Disconnect the disposable treatment setup and dispose of all parts into a biohazard container. Properly put away the machine. 13. Wash your hands and document the procedure, including the patient s pulse before, during, and after the treatment.

14 582 PART III The Clinical Medical Assistant CALCULATION Total Possible Points: Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = % PASS FAIL COMMENTS: Student s signature Partner s signature Instructor s signature

15 CHAPTER 30 Pulmonary Medicine 583 PSY PROCEDURE 30-3 Perform a Pulmonary Function Test Name: : Time: Grade: EQUIPMENT/SUPPLIES: Physician s order and patient s medical record, spirometer and appropriate cables, calibration syringe and log book, disposable mouthpiece, printer, nose clip STANDARDS: Given the needed equipment and a place to work the student will perform this skill with % accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be before you begin.) KEY : 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted PROCEDURE STEPS SELF PARTNER INSTRUCTOR 1. Wash your hands. 2. Assemble the equipment, greet and identify the patient, and explain the procedure. 3. AFF Explain how to respond to a patient who has dementia. 4. Turn the PFT machine on, and if the spirometer has not been calibrated according to the office policy, calibrate the machine using the calibration syringe according to the manufacturer s instructions, and record the calibration in the appropriate logbook. 5. With the machine on and calibrated, attach the appropriate cable, tubing, and mouthpiece for the type of machine being used. 6. Using the keyboard on the machine, input patient data into the machine including the patient s name or identification number, age, weight, height, sex, race, and smoking history. 7. Ask the patient to remove any restrictive clothing, such as a necktie, and instruct the patient in applying the nose clip. 8. Ask the patient to stand, breathe in deeply, and blow into the mouthpiece as hard as possible. He or she should continue to blow into the mouthpiece until the machine indicates that it is appropriate to stop blowing. A chair should be available in case the patient becomes dizzy or lightheaded. 9. Continue the procedure until three adequate readings or maneuvers are performed.

16 584 PART III The Clinical Medical Assistant 10. Before, during, and after the breathing treatment, take and record the patient s pulse. 11. After printing the results, properly care for the equipment and dispose of the mouthpiece into the biohazard container. Wash your hands. 12. Document the procedure and place the printed results in the patient s medical record. CALCULATION Total Possible Points: Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = % PASS FAIL COMMENTS: Student s signature Partner s signature Instructor s signature