chapter 8: patient care: medical and surgical

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Chapter 8: Patient Care: Medical and Surgical

Chapter 8: Patient Care: Medical and Surgical


Medical AssistantsMedical Assistants

• Overview

– Administrative tasks (office procedures)

– Clinical tasks

• Examining patients

• Helping treat them

– Work settings: doctors’ offices, imaging centers, laboratories, research facilities

– More limited role that that of physician assistant

– No authority to diagnose or treat patients


Medical Assistants (cont’d)Medical Assistants (cont’d)

• History of the Profession

– Early 20th century: office assistants or nurses trained on job

– 1924: M. M. Mandl opened first school to train assistants

– 1956: American Association of Medical Assistants (AAMA) founded

– 1963: AAMA’s certification exam first administered

– Early 1990s: Commission on Accreditation of Allied Health Education Programs (CAAHEP) forms



• Education

– On-job training (HS diploma required)

– 1- to 2-year programs in vocational schools, community colleges

– Nearly 600 accredited programs

– Internship usually included in program

– Additional training for advanced procedures (x-rays, injections)

– Continuing education required for recertification



• Course Work

– Anatomy & physiology

– Medical terminology

– Typing & transcription

– Computer applications

– Office practices

– Insurance processing

– Recordkeeping & accounting

– Patient relations

– Clinical & diagnostic procedures

– Laboratory techniques

– Administration of medications

– Pharmacology

– First aid

– Medical law & ethics



• Professional Certification

– Not required, but offers advantages

– CMA: certified medical assistant

– RMA: registered medical assistant

– Requires graduation from accredited program & passing an exam

– Certification in specialty areas:

• Ophthalmology

• Optometry

• Podiatry



• Clinical Duties

– Obtaining medical histories

– Assisting with physical examinations

– Preparing & administering medications

– Drawing blood samples

– Assisting with or performing diagnostic or basic lab tests

– Preparing & sterilizing instruments

– Collecting & preparing lab specimens

– Recognizing & treating medical emergencies

– Educating patients



• Clinical Procedures

– Measuring blood pressure

– Collecting a throat specimen

– Administering eye medications

– Performing blood glucose testing

– Assisting with therapeutic soaks

– Completing an EKG

– Changing dressings & removing sutures

– Disposing of biohazardous materials

– Measuring a patient for crutches



• Personal Characteristics of Medical Assistants

– Communication skills

– Organization skills

– Time management

– Multitasking

– Interpersonal skills

– Attention to detail

– Ability to remain calm during stressful situations



• Employment Opportunities and Trends

– 34% growth from 2008 to 2018

– In demand due to:

• Rising # of group practices, clinics, etc.

• Dual administrative & clinical skills of medical assistants

• Aging of population

• Prevalence of obesity & diabetes

• Increased # of patients seen by physicians

• Lower-cost alternative to higher-wage workers



• Professional Organizations

– American Association of Medical Assistants (AAMA)

– American Medical Technologists (AMT)



• Professional Organizations: Benefits of Membership

– Access to educational seminars

– Access to continuing education units

– Subscription to professional journals

– Access to annual conventions

– Group insurance plans

– Networking opportunities


Surgical TechnologistsSurgical Technologists


– Emerged after World War II

– Evolved from technicians trained by military during war

– 1969: Association of Operating Room Technicians formed

– Renamed as Association of Surgical Technologists (AST)

– 1972:

• AMA approved educational standards

• Accreditation review committee established

– AST established certification program, code of ethics, & standards of practice


Surgical Technologists (cont’d)Surgical Technologists (cont’d)

• Education

– HS diploma or GED + completion of training program required

– Training program:

• 9 mo to 2 yr

• Certificate, diploma, or associate’s degree

• Community/junior college, vocational school, university, hospital, or military

• Classroom instruction, mock surgery, supervised work

– 455 accredited programs in U.S.

– Continuing ed. or passing an exam required for recertification



• Course Work

– Anatomy & physiology

– Medical terminology

– Microbiology

– Pharmacology

– Physical environment & safety standards

– Sterile techniques

– Surgical procedures

– Patient care & safety

– Legal, moral, & ethical issues


– Skills for professional behavior



• Professional Certification

– Not licensed

– Certification not required, but preferred

– CST: certified surgical technologist

• Awarded by National Board of Surgical Technology and Surgical Assisting

• Requires graduation from accredited school & passing an exam

– TS-C: tech in surgery-certified

• Awarded by National Center for Competency Testing (NCCT)

• Requires completing training program or work experience



• Work Responsibilities: Before an Operation

– Prepares operating room

– Checks all equipment & places instruments

– Counts sponges, needles, & instruments

– Provides emotional support to patient

– Checks patient charts & vital signs

– Transports patient to OR & positions on operating table

– Washes, shaves, & disinfects surgery site

– Creates & maintains sterile field



• Work Responsibilities: During an Operation

– Passes instruments, equipment, & supplies to surgeon

– Holds retractors

– Uses sponges or suction to clear fluids

– Monitors vital signs

– Operates equipment

– Manages specimens collected

– Prepares dressings & applies them to incision site



• Work Responsibilities: After an Operation

– Takes patient to recovery room

– Removes used instruments, equipment, & supplies

– Sets up operating room for next patient



• Personal Characteristics

– Strong sense of responsibility

– Conscientiousness about work

– Organizational skills

– Attention to details

– Accuracy & precision

– Initiative

– Accurate listening

– Ability to work well with others

– Calmness during stressful conditions

– Manual dexterity

– Good physical condition



• Employment Opportunities and Trend

– Rapidly growing occupation: 25% between 2008 & 2018


• Increase in # of surgeries due to population growth & aging of population

• Technological advances, leading to new surgical procedures



• Professional Organization

– Association of Surgical Technologists (AST)

– Ensures surgical technologists have knowledge & skills required

– Works to advance profession by

• Setting accrediting standards & lobbying

– Membership benefits

• Free & discounted continuing education

• Career center

• Subscription to The Surgical Technologist

• Annual conference


Physician AssistantsPhysician Assistants

• Overview

– Examine patients, diagnose illnesses, arrange treatment

– Must work under supervision of a physician

– Provide primary care in areas that lack physicians:

• Rural settings

• Inner-city clinics

– Free up physicians by assuming responsibility for routine tasks

– Ranked as one of the best careers in U.S.


Physician Assistants (cont’d)Physician Assistants (cont’d)


– Began in 1960s

– First members were corpsmen, trained by military

– Created to address shortage of primary care physicians

– 1964: MEDEX (medical extension) training program begun

– 1965: First students enrolled in a program

– 1969: American Association of Physician Assistants (AAPA) formed

– 1973: First national certifying exam was administered

– Fast-growing profession



• Education

– License required in every state

– Licensure requires:

• Graduation from accredited school

• Passing a national exam

– Programs

• Require ≥2 years of college + work experience of applicants

• Last about 2 years

• Most offer master’s degree; some offer bachelor’s

• Continuing education required for recertification



• Course Work

– Biochemistry

– Pathology

– Anatomy

– Physiology

– Microbiology

– Pharmacology

– Physical diagnosis

– Clinical medicine

– Geriatric & home health care

– Disease prevention

– Medical ethics



• Work Responsibilities

– Taking medical histories

– Physical exams

– Interviewing & examining patients

– Diagnosing diseases

– Discussing diagnoses with patients

– Treating patients’ diseases

– Prescribing some medications

– Ordering & analyzing

• Lab tests

• X-rays

• EKGs

– Treating minor injuries

• Applying splints

• Applying casts




– Diligence

– Self-discipline

– Level-headedness

– Good judgment

– Interpersonal skills


– Integrity




– 7th-fastest growing occupation in U.S.

– 39% growth between 2008 & 2018


• Continued growth of health care industries

• Drive to control costs




– American Academy of Physician Assistants (AAPA)

– Offers:

• Annual conference

• Networking opportunities

• Recognition

• Scholarships

• Continuing education

• Journal & other publications


EMTs/ParamedicsEMTs/Paramedics

• Overview

– Provide emergency medical treatment at:

• Homes

• Scenes of accidents

• Other locations

– Transport patients to hospitals

– Care for patients during transport

– Services depend on level of training

– Paramedic is highest level of training


EMTs/Paramedics (cont’d)EMTs/Paramedics (cont’d)


– Began in 1960s

– 1964: Report calling for establishment of standards

– 1966: National Highway Safety Act passed

– 1970: National registry of EMTs formed

– Initial resistance from states, doctors, & nurses

– 1973: Emergency Medical Services Act

– 1980s: EMS management handed over to states



• Education, Training, and Legal Requirements

– HS diploma or GED & formal training program required

– Three levels of training:

• EMT-Basic: 110 hours

• EMT-Intermediate: 30 to 350 hours beyond basic

• EMT-Paramedic: 1- to 2-yr programs

– Certification or registration provided by NREMT

– Recertification every 2-3 yr, requiring exam & continuing ed.



• Work Responsibilities

– Recognize hazards

– Assess patient’s breathing

– Do rapid trauma assessment

– Provide oxygen by mask

– Suction an airway

– Use an AED

– Start an IV

– Run & read an EKG

– Attach a cardiac monitor & a pulse oximeter

– Insert an artificial airway

– Stabilize impaled objects

– Administer certain medications




– Emotional steadiness

– Ability to make quick decisions

– Level-headedness


– Independent & team work skills

– Leadership skills

– Good physical condition

– Willingness & ability to improve knowledge & skills




– 9% growth between 2008 & 2018

– Factors prompting growth:

• Aging of population

• Overcrowding of ERs

• Increased transfers of patients between hospitals

• Turnover, as EMTs change occupations for better pay or benefits




– National Association of Emergency Medical Technicians (NAEMT)

– Advocates for paramedics & EMTs on national level

– Provides three major courses throughout country:

• PreHospital Trauma Life Support

• Advanced Medical Life Support

• Emergency Pediatric Care

– Membership benefits: networking opportunities, free & discounted courses, conference & journal discounts

chapter 8: patient care: medical and surgical

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