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CMA Lesson 3, 4 - Chapters 2, 3, 4 Notes

by: Brittney Stevenson

CMA Lesson 3, 4 - Chapters 2, 3, 4 Notes DESU-CM 02

Marketplace > Delaware State University > DESU-CM 02 > CMA Lesson 3 4 Chapters 2 3 4 Notes
Brittney Stevenson

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Notes on textbook chapters & online lesson presentations. Topics covered: Interpersonal Communication, Patient-Centered Care, Considerations of Extended Life
Clinical Medical Assistant Certificate Program with Clinical Externship
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This 9 page Class Notes was uploaded by Brittney Stevenson on Wednesday August 31, 2016. The Class Notes belongs to DESU-CM 02 at Delaware State University taught by in Fall 2016. Since its upload, it has received 5 views.


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Date Created: 08/31/16
Module 1 Lesson 2  Oral Communication o Tone of voice  Pleasant, confident, project intentions o Word choice  Professional & unbiased  Avoid slang o Stay focused  Avoid rambling & sharing personal info o Repeat if necessary o Allow questions/clarification  Written Communication o State facts, not opinion o Use proper grammar, punctuation, sentence/paragraph structure o Writing to patient: avoid technical/med terms, abbreviations or symbols o Write legibly o Keep written communication confidential  Symbolic Communication o American Sign Language  Hearing impaired o Braille  Vocally impaired  Telephone Etiquette o Answering the phone  Answer before 3  ring  Say “Good Morning” or “Good Afternoon”  State facility name & your name  Ask, “How may I help you?” o Listen carefully, don't interrupt o Putting caller on hold  First ask permission to do so  Tell caller what you will be doing  Check in every 20 seconds to keep them informed  Offer alternative to waiting on hold (such as you or them calling  back) o Never show anger or have negative attitude  Faxing o Call ahead before sending fax to a patient (ensure confidentiality) o Note in chart that message was faxed, to whom, date & time it was sent  HIPAA requires facilities to keep fax log (for at least 30 days)  Emailing o Use secure sites to send o Use personal name in your email address o Always fill in subject line o Always use correct spelling/grammar o Never use all caps o Do not send emails expressing strong emotions (phone call instead) o Use signature line to identify who you are with & alternate ways to contact  you o Avoid putting time­sensitive information  Hearing Impaired o Face them at all times o Do not raise your voice o Use gestures or written notes o If available, ask someone who knows ASL to assist you  Non­English Speakers o Use simple terms o Make sure patient can repeat back important points (such as how to take  medication) o Use demonstrations o If available, find interpreter  Communicate directly w/ patient/family, not interpreter  Have patient repeat important info back through the interpreter  Avoid using patient’s child or family member as interpreter  Nonverbal Communication o Be aware of personal space  If you need to touch patient or get closer, explain what you'll be  doing & ask permission o Body Language  Maintain eye contact  Don't stare  Watch facial expressions  Maintain upright, open posture  Listening o Eye contact o Acknowledgement  Nod, use facial expressions, restate what they said o Ask questions (clarify) o Don't interrupt o Avoid interjecting own stories/opinions/thoughts o Allow for silence so patient can organize thoughts  Maslow’s Hierarchy of Needs o Physiological needs  Food, shelter, warmth, health o Safety needs  Feel safe physically and psychologically o Sense of belonging  Friends, family, community o Self­esteem  Can only occur when the previous levels have been met o Self­actualization  Can only occur when the previous levels have been met  Morality, creativity, acceptance of facts  Barriers to Communication o Illness  Cannot effectively communicate or understand  Put important instructions in writing  Ask patient to repeat back important instructions  If available, ensure family member is in the room to offer support &  hear important instructions as well  Family members may also experience this barrier because  they're worried o Culture  Culture, religious, & ethnic factors & health beliefs  Understand various cultural differences & impact on communication & healthcare treatments  Examples: hiding emotion or needing permission/approval  from an older family member, individual saying yes or  agreeing out of respect but not really agreeing or  understanding, patient delaying healthcare because they  believe nothing can help them, needing to first seek advice  for a healer o Age  Pediatric  Are they old/mature enough to grasp the concepts about  their health care?  Elderly  Can they hear, speak, see, and understand what is being  said?  Important to be aware of these things & involve parents/other family members as appropriate  Defense Mechanisms  Grieving Process o First stage: Denial  Refuses to believe the truth or face reality o Second stage: Anger  Responds to illness with resentment/negative emotions o Third stage: Bargaining  Tries to negotiate death or make a deal or delay the inevitable o Fourth stage: Depression  Feels deep sadness or grief as reality sets in o Last stage: Acceptance  Becomes at peace with the truth or reality o Avoid trying to comfort the patients, allow them to go through the process,  listen without personal opinions/statements Module 1 Lesson 3  Wellness o Ongoing practice of healthy lifestyle to fend off disease & maintain healthy parameters o Average life span in U.S. = 76 years o Each individual has different risk factors, compromise wellness o GOAL: reduce as many risk factors as possible o Some factors cannot be changed (such as diseases that have genetic  links, age, and ethnicity) o Many behaviors can increase the likelihood of wellness  Holistic Approach to Healthcare o Holistic: focuses on whole patient& addresses the social, emotional, &  spiritual needs of patient as well as physical treatment o Recognizes link between body & mind o If mind healthy, body has better chance of being healthy o GOAL: achieve and maintain wellness o FOCUS: prevent disease before it occurs o In facilities that emphasize holistic approach, MA’s role = help patients  learn how to implement as many healthful behaviors as possible  The Mind­Body Connection o physical elements associated with this concept  Endorphins: proteins w/ analgesic (pain reducing) properties, cause many beneficial responses in brain such as:   increased immunity to disease, lower stress, decrease in  negative feelings that lead to physical problems  Endorphins are released through laughter, relaxation, love,  friendship, & spirituality  Pain o Acute: immediate & often severe, temporary & lessens when treated &  with time o Chronic: long term; result of chronic disease (such as cancer, arthritis, or  back pain); long term effects (inactivity, decreased quality of sleep,  fatigue, depression, anger, etc.) o Pain tolerance (high or low)  Remember, some cultures teach to not show pain  High pain tolerance might mean early warning signs go undetected  or ignored  Types of Pain o Physical: pain receptors send electrical impulses through nerves to brain  Some people have impaired sense of pain (due to nerve damage)  Origin can be superficial (on the body surface), deep in the muscles & joints, or visceral in organs  Intensity range from minor discomfort to debilitating pain o Psychological  Acute or chronic  Acute: anger, fear, grief, etc.  Chronic: anxiety disorders, PTSD, depression, etc.  Caused by life situations (such as trauma or death) o Phantom  Common occurrence after body part amputated  Severed nerve endings initiate electronic impulses to brain just as  they would if actual pain receptors in the area  Often very severe; tends to subside permanently w/ time  Pain Assessment o “5  vital sign” o May be part of job as a MA o Assess:  When did the pain start?  Where is the pain located?  How frequently does the pain occur?  Can you describe the pain?  What actions or movements tend to lessen or increase the pain?  Rating Pain o Numerical or Symbolic Scale  0 (no pain at all) to 10 (most severe pain they have ever felt) o Face Scale  Similar to numerical scale, but uses smiley faces instead of #  Ranges from happy smiling face to very unhappy face, patient  chooses one that describes pain level  Can be used if patient has trouble w/ number scale o Full Body Picture  Diagram shows entire body front & back, patient marks picture to  indicate areas where there is pain, different marks used for different types of pain  Pain Management o Strategies to minimize or eliminate pain  Medication  Measures to increase comfort  Heat/cold therapy, massage therapy, physical therapy  Alternative therapies (in some cases used because patient can’t  take medications due to dependence and/or side effects)  Relaxation exercises, herbal remedies, magnet therapy,  biofeedback, acupuncture, acupressure, chiropractic  treatments  Exercise  Surgery o Often a combo of strategies used o If don't work effectively, controlled substance may be prescribed w/ close  monitoring  Teaching Pain Management o Important role of MA = teaching patient useful strategies for pain  management o Teaching areas include:  Disease process & why it is causing pain  Treatments available for disease  Medical dosage & treatment frequency  Potential changes in patient’s condition that patient should be  aware of  Patients w/ Special Needs o Physically challenged in variety of ways  Ask patients if they need assistance before helping  As MA, important to learn how to assist patients who use  crutches/canes/walkers/wheelchairs, etc.  Sometimes MA will teach patients how to use assistive  devices effectively/safely o Visually challenged or impaired  Some patients may only need large print educational materials;  others may need Braille or audio version  Introduce yourself upon entering the room; always let them know  when you’re leaving (say their name so they know you're speaking  to them) o Hearing challenged or impaired  May only have slight hearing loss in one ear OR complete hearing  loss  Speak clearly, face person so they can read your lips, use eye  contact & facial expressions, don't walk up behind them o Speech challenged or impaired  Limited ability to speak, distortion of speech sounds, voice disorder, stutter, apraxia (difficulty moving the muscles/structures necessary  to form speech sounds into words), etc.  Maintain eye contact, don't rush or try to finish their sentences (try  other forms of communication such as signing or writing) o Do not speak English well or at all  providing an interpreter when necessary is legal requirement o From different cultural backgrounds o Geriatric patients o Emotionally challenged  Be kind, understanding, calm, empathetic, and speak quietly  MA’s Role in Extended Life Care important to understand considerations, laws, & providers involvement in:  Organ and Tissue Donations o Harvested from live donor or cadaver o Tissue compatibility must be determined before transplant o Source of donation:  Cadaver  Live donor o Waiting period  Warm ischemic (pertaining to decreased blood supply to tissue due to impaired circulation to organ/body part) time = when the body is  not refrigerated, this time cannot exceed 4 hours  Cold ischemic time, where the body is refrigerated in morgue,  cannot exceed 12 hours o Cryopreservation: tissues/organs frozen to preserve o Removal Order  Heart always removed first, then other organs as quickly as  possible o Uniform Anatomical Gift Act of 1968  Donor must be at least 18 yrs old  Intent to donate in writing  Donor may designate specific organs/tissues for transplant  Death of the donor may not be determined by physician(s) involved  in transplant  Donor may revoke intent  recipient or health care provider may  refuse the gift  No financial arrangements  When no organ donation card or indication, decision usually up to  the family  in order: spouse, adult son/daughter, parent, adult sibling,  grandparent, guardian  Transplant of Organs & Tissues o Organ Procurement and Transplant Network (OPTN) Final Rule requires  all hospitals to follow set of rules to receive Medicare/Medicaid  reimbursement o United Network for Organ Sharing (UNOS) established national computer  system for registering patients in need of transplants o The FDA regulates tissue procurement/storage/shipment o Live donor transplants may go to designated recipient o Transplant costs: patients must research full cost (most insurance policies  do not cover transplants)  Medical Directives o Legal documents signed by patient allow them to dictate what happens  medically if he/she incapacitated, may also designate decision­maker  Durable Power of Attorney for Healthcare o If patient no longer mentally competent/incapacitated, appointed person w/ POA makes medical decisions in patient’s best interest  Statement is voluntary, in writing, signed and dated  Appointed person must be at least 18 yrs old  Becomes effective when physician certifies in writing patient not  able to consent  2 competent witnesses at least 18 yrs old required  POA must be notarized  Neither witness can sign on patient’s behalf (but another person  may if patient not capable, at patient’s discretion & in their  presence)  Patient may revoke appointment by destroying document or  informing the physician  Living Wills o Document tells physician of person’s wish to die naturally rather than kept  alive when death inevitable o DNR order can be part of living will o Attending physician must declare in writing:  Patient has incurable injury/disease/illness  Patient’s death will occur within short time  Using life­prolonging procedures would only artificially lengthen  dying process  Life­prolonging Declarations o Some living wills include this, means patient wants providers to perform all possible medical treatment to prolong life o Must be signed while patient in good health o Signed, dated, witnessed by 2 people over age of 18 o A copy must be placed in patient chart  Hospice o Facility or program, provides care for terminally ill, in hospice center or  home setting o Focuses on palliative (relieving pain or discomfort) care o GOAL: allow patient to die with dignity in his/her own home or facility; care for family during difficult time


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