Y khoa - Dược - Chapter 39: Assisting in reproductive and urinary specialties

39Assisting in Reproductive and Urinary SpecialtiesLearning Outcomes (cont.)39.1 Carry out the role of the medical assistant in the medical specialty of gynecology.39.2 Carry out the role of the medical assistant in the medical specialty of obstetrics.39.3 Identify diagnostic and therapeutic procedures performed in obstetrics and gynecology.Learning Outcomes (cont.)39.4 Relate the role of medical assisting to the medical specialty of urology.39.5 Identify diagnostic tests and procedures performed in urology.39.6 Recognize diseases and disorders of the reproductive and urinary systems.IntroductionObstetrics – pregnancyGynecology – female reproductive systemUrology Male and female urinary systemsMale reproductive systemMedical assistantUnderstanding of disorders, tests, and treatments Assist licensed practitionersAssisting with the Gynecologic PatientMenstruationNormal cycle of preparation for conceptionMenarche – onset Periods Monthly3-7 daysHormonal changesMenopauseCessation of the menstrual cycleNatural ~ between ages 45 and 55Surgical Stages PremenopausePerimenopauseThe Gynecologic ExamPurposeOverview of a woman’s health Cancer-screening exams and testsFemale assistant should be present during the exam To assist the doctor To provide legal protectionThe Gynecologic Exam (cont.)Medical assistant roleHave patient empty bladderProvide a gownInterview patient and check vital signsObserve for problemsDetermine the 1st day of her last menstrual period (LMP)The Gynecologic Exam (cont.)Physician’s interviewEvaluation of total healthReview of factors that may indicate cancer or sexually transmitted infections (STIs)Breast ExamCheck for abnormal lumpsBreast cancer detection guidelinesMammogramsAnnual breast exam Know normal appearance and feelMRI with family historyPelvic ExamInspection External genitaliaVagina and cervix ~ speculumPalpation – bimanual Vagina and abdomenRectum and abdomenTests Pap smearKOHWet mountPelvic ExamMedical assistant’s role Assist the patient into position Drape patientAssist the licensed practitionerGloves and instrumentsLubricantTesting materialsApply Your KnowledgeWhen assisting with a gynecologic exam what would be your duties?ANSWER: Have patient empty bladderProvide a gownInterview patient and check vital signsObserve for problemsDetermine the 1st day of her LMPAssist into correct position and provide a drapeAssist the licensed practitionerPrepare instruments and testing materialsPatient teachingAssisting with the Obstetrical PatientNägele’s rule Estimate of delivery date Subtract 3 months from first day of last period and add 7 days plus one yearPrenatal CareDuring pregnancyEat well and exerciseKeep medical appointsAttend childbirth classesAvoidTobacco AlcoholDrugs Prenatal Care (cont.)Normal changesMorning sicknessWeight gain Urinary frequencyDepressionConstipationSwollen hands and feetPrenatal Care (cont.)Frequency of prenatal appointmentsMedical assistant roleAssist with routine testsAssist with prenatal examsPatient teaching and supportPrenatal Care by the Licensed PractitionerMonitors Blood pressureWeight gainUrine for proteinPrescribes vitamins and ironObserves forPlacenta previaAbruptio placentaGestational diabetesLaborPatient instructions – when to go to the hospitalRegular contractions ~ 6 or more per hour for at least two hoursIf her “water breaks” ~ sign of impending laborDeliveryDelivery Natural Following induction Cesarean sectionClamps, ties, cuts umbilical cord Presents infant to motherDeliveryMedical assistantSchedule inductionSchedule C-sectionAssist with emergency deliveryAssisting with the Obstetrical Patient (cont.)BreastfeedingColostrum ~ immunityEconomical and convenientPatient instructionRefer to community resourcesAssisting with the Obstetrical Patient (cont.)Bottle feedingAcceptable alternativeFormula Patient instructions Type of formulaPreparation Avoid cow’s milk PostpartumReturn to normal stateUterus shrinkingDifficulty with urination and bowel movementsPostpartum bleedingEmotional stressMedical assistantAsk questions, educate, and documentAssist with examsApply Your KnowledgeANSWER: Nägele’s rule says count back three months [1-December, 2-November, 3-October], then add seven days plus 1 year, [23 + 7 = 30]. Her estimated date of delivery would be October 30th.A patient has just found out she is pregnant. Her last period started on January 23rd. Using Nägele’s rule, what day would be her estimated date of delivery? Right!OB/GYN Diagnostic and Therapeutic Tests and ProceduresPregnancy testsDetect presence of HCG Blood or first voided urineOB/GYN Diagnostic and Therapeutic Tests and ProceduresTests for STIsBacterial and tissue cultures Examining lesionsBlood testsPatient’s historyWritten consent to release resultsReporting STIs to the stateRadiologic TestsX-rays – avoid if pregnantUltrasonography, CT scan, MRIHysterosalpingography Mammogram Medical assistantSchedule appointmentPatient instructionsFetal ScreeningRoutine or for at-risk pregnanciesAlpha fetoprotein – abnormalities indicate neural tube defectUltrasound Cysts, tumors, or obstructionsFetal size and positionGuide for amniocentesis or chorionic villus samplingInvasive ProceduresPap smear – presence of abnormal or precancerous cellsAmniocentesis – genetic or metabolic problem with the fetusChorionic Villus Sampling – genetic disordersInvasive Procedures (cont.)Biopsy Surgical removal of tissueDiagnose cancersMedical assistantPatient educationAssist with procedureInvasive Procedures (cont.)Colposcopy Examination of vagina and cervix to identify abnormal cellsD and C ~ dilation of the cervix and scraping the uterine liningDiagnostic Tests and Procedures (cont.)Stereotactic Core Biopsy Obtain tissue sample Uses three-dimensional coordinatesHysterectomyRemoval of the uterusHysterosalpingectomy ~ uterus and fallopian tubesHysterosalpingo-oophorectomy ~ uterus, fallopian tubes, and ovariesDiagnostic Tests and Procedures (cont.)Laparoscopy – view internal organsLoop Electrosurgical Excision Procedure (LEEP) Removal of abnormal cervical tissueDone as part of a colposcopy Cryosurgery – freezing abnormal tissueApply Your KnowledgeANSWER: Ultrasound to determine fetal size, position, and number of fetuses.A 38-year-old pregnant patient may be carrying twins. What diagnostic test(s) may be performed and why?Very Good!Assisting in UrologyUrologist Diagnoses and treats urological disorders and diseasesMale and female urinary systemMale reproductive systemMedical assistantAssists with general examsCollects and processes urine and bloodPatient educationAssisting in Urology (cont.) HistoryChanged in urinationDysuria Incontinence Assisting in Urology (cont.) Exam Palpation of kidneys and bladderInspection of external genitaliaIn malesPalpation of penis and scrotum Exam of prostate glandPatient instruction – testicular self-examUrology ExaminationsThorough historyFrequency or urgency of urinationDifficulty or pain IncontinencePalpation – kidneys and bladderUrology ExaminationsInspection – external genitalia Male reproductive systemInspection Palpation Testicular self-examApply Your KnowledgeWhen obtaining the patient’s history as part of an urologic exam, what information to you need to obtain?ANSWER If the patient has had changes in urination, painful urination or incontinence.Urological Diagnostic Tests and ProceduresImaging techniquesCT scan or MRIPyelographyUrine and blood testsSemen analysis and smearsDetermine fertilityEvaluate success of a vasectomyUrological Diagnostic Tests and ProceduresCystometry – bladder capacity and pressureCystoscopy – inspection of the bladder and urethra wallsTesticular biopsy – tissue sampling Apply Your KnowledgeThe physician has written an order for pyelography for a patient. What will this involve?ANSWER: The patient will have an X-ray of the kidney area with an iodine-based contrast agent.Nice Job!Diseases and Disorders of the Reproductive SystemConditionDescriptionCancerCommon occurrence in cervix, endometrium, ovaries; cells divide uncontrollably, eventually forming tumor or other growth of abnormal tissueEctopic pregnancyFertilized egg unable to move out of fallopian tube into uterus for implantationDiseases and Disorders of the Reproductive SystemConditionDescriptionEndometriosisEndometrial tissue present outside uterus, usually in pelvic area; not life-threatening but may cause sterilityFibroids, orleiomyomasCommon, benign, smooth tumors of muscle cells grouped in uterusFibrocysticbreast diseaseBenign, fluid-filled cysts or nodules in breastDiseases and Disorders of the Reproductive System (cont.)ConditionDescriptionMenstrual disturbancesAmenorrhea, dysmenorrhea, menorrhagia, or metrorrhagiaOvarian cystsSacs of fluid or semisolid material; usually benignPelvic inflammatory disease (PID)Acute or chronic infection of the reproductive tract; causes include STDs or other organismDiseases and Disorders of the Reproductive System (cont.)ConditionDescriptionPelvic support problemsAbnormal weakening of vaginal tissue, unusual increase in abdominal pressure, congenital weakeningPolyps Red, soft, and fragile growths, with slender stem attachment on mucous membranes of cervix or endometrium Diseases and Disorders of the Reproductive System (cont.)ConditionDescriptionPremenstrual dysphoric disorder (PMDD)Severe premenstrual syndrome affecting 5% of women; symptoms have disrupting effect on patient’s lifePremenstrual syndrome (PMS)Symptoms include swelling, bloating, weight gain, breast tenderness, headaches, and mood shifts 1 week to 10 days before menstruationDiseases and Disorders of the Reproductive System (cont.)ConditionDescriptionSexual dysfunction disordersInterruption or lack of sexual response cycle; unhealthy view of one’s feelings about oneself and feelings toward sexVaginitisInflammation of vagina caused by bacteria, viruses, yeasts, or chemicals in sprays, douches, or tamponsDiseases and Disorders of the Urinary SystemConditionDescriptionEpididymitisBacterial infection of the epididymisHydroceleExcess fluid in the scrotum; usually caused by an infection of the epididymis or testesImpotenceInability to achieve or to maintain an erection; cause may be physical, a side effect of medication or psychological or emotionalDiseases and Disorders of the Urinary SystemConditionDescriptionIncontinence Loss of bladder control; causes include weak muscles or muscles that are too activeKidney StonesChemical substances in the urine form crystals in the kidney, ureter, or bladderProstatic hypertrophyEnlargement of the prostate gland; common in men over 50; constricts the urethra Diseases and Disorders of the Urinary System (cont.)ConditionDescriptionProstatitis Inflammation of the prostate; usually bacterialProstate cancerMost common cancer in men; usually symptomless; PSA used for screeningUrethritisInflammation of the urethra; usually bacterialSexually Transmitted InfectionsAcquired through sexual contactPatient education important Sensitive topic ~ ensure patient privacyComplete course of therapyAvoid sexual contact Sexual partners must be treatedApply Your KnowledgeMatching: common, benign, tumors in the  uterus absence of menstruation acute or chronic infection of the  reproductive tract excess fluid in the scrotum loss of bladder control crystals in the kidney, ureter, or  bladderPIDFibroidsIncontinence Kidney stonesAmenorrhea Hydrocele ANSWER:ABCDEFYES!In Summary39.1 Medical assistants assist with gynecological exams, provide patient teaching for OB/GYN and breast health issues, and must handle cervical and other specimens correctly.39.2 Medical assistants assist with examinations for pregnant females, providing for their needs, and provide education for the pregnant patient and new motherIn Summary (cont.)39.3 Diagnostic and therapeutic procedures performed in OB/GYN include pregnancy tests, tests for STIs, radiologic tests such as mammograms, fetal screening, Pap smears, D&C, and fine-needle aspiration.39.4 Medical assistants assist with urological exams and diagnostic tests. Patient education for urologic patients regarding TSE and other information are also duties of a medical assistant working in urologyIn Summary (cont.)39.5 Various urologic diagnostic tests and procedures are performed, including semen analysis, cystometry, cystoscopy, and testicular biopsy.39.6 Diseases and disorders of the reproductive and urinary systems are listed for review in Table 39-4 Common Obstetric and Gynecologic Diseases and Disorders and Table 39-5 Common Urologic Diseases and DisordersEnd of Chapter 39If pregnancy were a book they would cut the last two chapters. ~ Nora Ephron