Text Readings
Pearson’s Comprehensive Medical Assisting, Chapters 51 and 52
Additional Readings
Required Readings
Asthma and COPD
Spirometry
Pulse Oximetry
Oxygen Therapy Training
How to Use an Inhaler
Medquip: How to Use a Nebulizer
Occupational vs Physical Therapy
Rotator Cuff Exercises
Physical Therapy: Massage Physical Therapy Techniques for Plantar Fasciitis
Wound Care: Treatment by a Physical Therapist
How to Transfer a Patient from a Bed to a Wheelchair
Lecture Notes
Pulmonary function deals with how well respiration occurs, or how well our lungs take in oxygen and expel carbon dioxide. A common way to measure this is through a group of tests called pulmonary function tests, or PFTs. PFTs are used to help diagnose issues with the lungs and respiratory conditions. If you work with a pulmonologist, you’ll probably deal with these tests more often than in other settings.
Another important part of health care is rehabilitation. Rehabilitation includes several specialty branches, including physical therapy, occupational therapy, massage therapy, and more. Which specialty area the patient needs depends on his or her particular issue, injury, or illness. In many cases, patients will be treated by multiple rehabilitation specialists to help restore their health or learn how to deal with a disability. Your role in rehabilitating the patient could include helping the patient to perform exercises, demonstrating exercises, or providing patient education on a certain aspect of the rehabilitation process.
The Respiratory System
Pulmonary means “relating to the lungs.” Thus, pulmonology is the specialty area that focuses on diseases and treatments of the respiratory system. A physician who specializes in pulmonology is called a pulmonologist. Pulmonologists generally see patients with more advanced respiratory conditions, such as
Emphysema
Asthma
Tuberculosis
Severe chest infections
Additionally, pulmonologists deal with patients suffering respiratory complications related to AIDS and injuries.
The respiratory system is responsible for oxygenating the blood and removing carbon dioxide waste that’s produced during respiration. The main organs of the respiratory system are the lungs, but it also includes the nose, mouth, windpipe, bronchi, and diaphragm.
The following are some of the more common diseases that can affect the respiratory system:
Laryngitis
Tuberculosis (TB)
Bronchitis
Tonsillitis
Influenza (“the flu”)
Chronic obstructive pulmonary disease (COPD)
Pneumonia
Asthma
Even if you don’t work in a pulmonologist’s office, chances are you’ll still be dealing with patients with respiratory system illnesses and issues on a regular basis.
Pulmonary Function Tests
Pulmonary function tests, or PFTs, are a group of tests and measurements commonly used to assess pulmonary function; that is, how well the lungs are taking in and releasing air and how well oxygen is circulating throughout the body.
PFTs measure
Lung volume
Lung capacity
Flow rates
Gas exchange
Pulmonary function tests can include
Spirometry
Arterial blood gases
Pulse oximetry
PFTs are performed to
Diagnose specific respiratory conditions
Determine the cause of a patient’s shortness of breath (SOB)
Understand how a medication is working for a patient
Verify lung function before surgery
Determine if the lungs have been damaged by chemicals or other substances
Assess if progress is being made in treatment
Spirometry is one of the most common PFTs. It’s used with a spirometer, which is an instrument that measures the amount of air breathed in and out and also how quickly. The patient breathes into the device and then the results are measured on a spirograph and can be printed onto a report called a spirogram.
Analysis of arterial blood gases, or ABGs, is used to determine how well the body is circulating oxygen and eliminating carbon dioxide. The test is performed by drawing the patient’s blood from an artery at a point before it travels to the rest of the body.
ABGs are done to
Help identify breathing problems or diseases
Determine if a particular treatment is working
Check oxygen levels in the body when oxygen is being supplemented
ABGs are usually not the only test performed because they don’t supply enough information to determine the presence of a disease. They’re usually done with other tests.
Pulse oximetry measures the oxygen level in the blood. It works by placing a probe on the patient’s finger. If the pulse oximeter can’t be placed on the patient’s finger, then the earlobe or toe can be used. Inside the probe is a light source, a light detector, and a microprocessor. Light is transmitted from one side of the probe, through the finger, to the detector on the other side of the probe. The microprocessor calculates how much blood is absorbing oxygen and how much isn’t. The result can help determine if the patient’s blood is carrying enough oxygen or if supplemental oxygen is needed.
Pulmonary Treatments
As you can imagine, pulmonary treatments vary based on the type of disease being treated. Some pulmonary diseases are treated with inhalers and nebulizers.
Inhalers are devices used to administer medication to help a person breathe better. Inhalers help to relieve asthma symptoms or other respiratory issues affecting the bronchioles. Inhalers are one of the most common ways that drugs are administered to asthma patients. They can deliver one or two medications to a patient in one short dose.
Nebulizers are instruments used to produce a fine mist of vaporized liquid medication for penetration into the lungs. The patient wears a mask or mouthpiece and inhales the vapor into the lungs. Albuterol, a bronchodilator, is often used with a nebulizer.
Nebulizers are used for a variety of respiratory illnesses, including severe asthma. Although both inhalers and nebulizers are used to administer aerosolized medications, nebulizers are generally favored for those with more serious respiratory illnesses.
Rehabilitation
Rehabilitation seeks to bring patients back as close as possible to where they were before they suffered from an illness or accident. In some cases, rehabilitation may include improving body strength, relearning skills, or adapting to a new way of life because of the changes brought on by the illness or accident.
The goals of rehabilitation will vary based on the reason for rehab. For example, a person who has had a traumatic accident may have a completely different rehabilitation plan than someone who has suffered from a stroke.
Patients who have experienced the following often require rehabilitation:
Stroke
Back injury
Multiple sclerosis
Severe arthritis
Spinal cord injury
Brain injury
In addition, those with speech disorders or autism may require rehabilitation therapy as well.
A patient may require an entire team of therapists for total-body rehabilitation or the rehabilitation may focus on one specific area. There are a number of different types of rehabilitation, including
Occupational therapy (OT) to help improve performance of the activities of daily living
Speech therapy to help with speaking and swallowing skills
Physical therapy (PT) to help with strength and mobility
Physical Therapy
Physical therapy helps people regain body functions that have been lost due to accident, injury, or illness. Physical therapists are trained medical professionals who have specialized in physical therapy. Instead of using surgery, physical therapists use physical methods such as exercise, massage, heat treatment, and more to treat patients.
Physical therapists can specialize in different areas of practice, including
Sports medicine
Cardiopulmonary rehabilitation
Pediatrics
Neurology
Orthopedics
Geriatrics
When most people think of physical therapy, they think of the physical exercises associated with it. However, the physical exercises are only one kind of treatment administered by physical therapists. Physical therapy treatments include
Exercise
Manual treatment
Specialized treatment
Education
Exercise is the treatment most often used by physical therapists. Patients getting exercise physical therapy may be trying to regain or improve physical skills. The exercises that the physical therapist uses will depend on the injury or illness the patient has experienced. Exercises may include walking, lifting weights, doing water aerobics, or stretching.
Physical therapy also includes a variety of manual treatments, or treatments provided with their hands. Manual therapy works to increase a patient’s flexibility, as well as reduce pain and possibly relax the patient.
Manual treatments include
Massage
Mobilization
Manipulation
In some cases, physical therapists are trained to provide treatments other than those pertaining to exercise and manipulation. Specialized physical therapy can include wound care and lymphatic drainage or physical therapy treatment in specialized areas such as cancer care, cardiac rehab, and so on.
All physical therapy involves some level of patient education. PT education may include teaching patients how to perform at-home massage or exercises for their condition, how to use wheelchairs or crutches, and even how to avoid reinjury. In many cases, the PT will also review how the patient should make the home safe while the patient is transitioning and help educate and train family members on how to care for the patient at home.
Text Readings
Pearson’s Comprehensive Medical Assisting, Chapters 53, 54 and 55
Additional Readings
Supplemental Readings
Basic Pharmacology
How to Add and Subtract Fractions in Algebra For Dummies
Solving Ratio Proportions the EASY Way
What Is the Difference Between Generic and Brand Name Drugs?
Generic Drugs: Learn about the Lifecycle from Brand Name Prescriptions to Generics
Don’t Take This With That: Grapefruit, Drug Interaction
Medication Administration
Administer Intramuscular Injections
Medications: Preparing Meds—The Six Rights
Lecture Notes
Pharmacology, or the branch of science that deals with drugs and administering medications, is an important part of working in a medical office. It will be part of your responsibility throughout each day to give patients medication, to ensure that patients understand the prescription written by the physician, and to educate the patients on how and when to take their medications.
When dealing with patient medications, there’s a great deal of room for error. Making mistakes when documenting or measuring dosages can cause serious problems for the patient, and may even lead to death. Because of this, there are specific ways that you must document and measure medications for patients.
When working with patients in a medical office, it’s important for you to understand different medications and how they’re used. When you start to think about all the drugs out there to treat patients, you might begin to feel overwhelmed. However, as you gain more experience in working with patients and the different medications being prescribed, you’ll become more comfortable assisting patients with their medications.
A pharmacologist is a person who has been trained in the field of pharmacology. Pharmacologists engage in drug research, evaluation, and development. Pharmacologists study drugs, including their side effects, to ensure maximum safety and effectiveness. Pharmacists aren’t the same as pharmacologists. A pharmacist is a licensed healthcare professional who can dispense drugs.
Math is an extremely important part of pharmacology. Pharmacology isn’t all about difficult conversions. In fact, many of the mathematical calculations in pharmacology are basic math that you learned long ago—things like addition, subtraction, multiplication, division, fractions, decimals, and more.
Drugs
Drugs come from many different sources. Some are man-made in a laboratory (i.e., synthetic), whereas others come from plants, animals, and minerals. Some drugs, such as penicillin, even come from molds.
Learning drugs names may seem overwhelming, not only because of the number of different drugs available but also because many drugs may have three names:
Chemical name
Brand name
Generic name
When a drug is first created, it’s given a chemical name. This name is actually complicated and describes the chemical and molecular makeup of the new drug. Thankfully, we don’t have to worry about knowing and using the chemical names of a drug, because once it’s approved by the FDA, a brand name is assigned.
The brand name of a drug is created by the company requesting approval of the drug from the FDA. The brand name is also referred to as the drug’s trade name or proprietary name. It’s an important process that helps the pharmaceutical company create an identity for the drug. The entire time that a drug remains under patent protection it must be referred to by the brand name. It isn’t until a drug is no longer under patent that it can be marketed under the generic name. Most doctors use the brand name of the drug when writing prescriptions.
In the United States, there’s actually an organization that names generic drugs. The United States Adopted Names (USAN) Council assigns the generic name for every generic drug; however, the generic name must still be approved by the FDA. Generic drug names tend to be longer and more difficult to pronounce than the brand names. Brand names of drugs are generally capitalized, whereas generic names aren’t.
You don’t need to worry about memorizing all the drugs and their generic names. You’ll have access to online resources as well as books such as the Physician Desk Reference, or PDR, where you can look up the information in the office. However, the more you work with certain drugs, the easier it will be to remember their trade and generic names.
Side Effects and Drug Interactions
In some cases, a prescribed drug can create issues for the patient. The patient may suffer from side effects from the drug or the drug may interact with other medications the patient is taking.
A side effect of a drug is when an undesirable outcome is created from taking the drug as prescribed. Different medications have different side effects. Some patients may experience certain side effects from a drug, whereas others may not experience any. A side effect may also be called an adverse drug reaction, or ADR.
Drug interactions occur when two or more drugs are administered together, altering the way that one or both of the drugs act in the body. In some cases, drug interactions can cause serious problems for a patient. Drug interactions don’t just happen with prescription drugs. Interactions can also happen with over-the-counter drugs, too.
To prevent drug interactions:
Make sure you’ve documented all the medications the patient is taking.
Read the labels on the patient’s current medications, especially “warning” messages.
Talk to the doctor or pharmacist when there are questions or concerns.
Be aware that some foods and liquids can cause drug interactions.
Medication Administration
Giving patients medications is a routine task in the healthcare setting. It’s also one of the healthcare worker’s most important functions because the medication that’s given incorrectly can cause the patient serious problems.
Medications can be administered in multiple ways, including
Orally
Topically
Inhalation
Vaginally
Rectally
By injection
Each administration route has advantages and disadvantages.
Oral Route
With the oral route, medications given by mouth.
Pros: Most convenient and safest route.
Cons: The amount of food in the digestive tract can affect potency. Absorbed relatively slowly.
Topical Route
With the topical route, medications are applied externally locally to the skin or the mucous membranes.
Pros: Fewer side effects than some of the other routes. Reduced chance of an allergic reaction.
Cons: Dosages are hard to control. Only act locally where applied.
Inhalation Route
With the inhalation route, medications are breathed into the system.
Pros: Easy to use. Medications are absorbed and act quickly. Minimum side effects. Fewer doses usually required.
Cons: Special equipment is required. May irritate the respiratory system.
Vaginal Route
With the vaginal route, drugs are administered via a woman’s vagina.
Pros: Can administer low, steady doses less frequently than other routes. Drug isn’t affected by the digestive system.
Cons: The patient may be uncomfortable with this route. Absorption is unpredictable.
The tendency for some forms of drugs to be easily expelled.
Injection Route
Injection routes include the subcutaneous, intramuscular, intravenous, and intrathecal routes.
Pros: Fastest way for drugs to take effect. Some drugs delivered this way can be manufactured to delay their release, meaning that the drug doesn’t have to be given as often. Allows drugs to be used that would be destroyed in the digestive tract.
Cons: Patients need to be watched closely for side effects due to how quickly these drugs elicit an effect. The drug may be effective only for a short time. Healthcare workers need to know different injection locations.
Preventing Medical Errors
The National Coordinating Council for Medication Error Reporting and Prevention (NCCMERP) defines a medical error as
Any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the healthcare professional, patient, or consumer. Such events may be related to professional practice, healthcare products, procedures, and systems, including prescribing; order communication; product labeling, packaging, and nomenclature; compounding; dispensing; distribution; administration; education; monitoring; and use.
Working with medications and patients is obviously something that should be taken very seriously. There are so many factors that go into administering medication for patients that there’s a lot of room for error.
The “Eight Rights” of Medical Administration
When it comes to administering medication, healthcare professionals must follow set standards to ensure patient safety. This is where the “rights” of the medication come in. These “rights” are different ways that a healthcare professional should check to ensure that this is the “right” medication. The “rights” are questions and procedures used when administering medications to every patient, with every administration. Some sources cite five “rights,” whereas others cite six or more. We’ve included eight, but all of the various lists of “rights” include at least the first five listed here:
Right patient
Right medication
Right dose
Right route
Right time
Right documentation
Right reason
Right response