CCMA · General Patient Care · 6 min read
Assisting with Exams, Minor Procedures and Wound Care
- Identify appropriate patient positions, draping techniques, and diagnostic instruments used during physical examinations.
- Apply the principles of surgical asepsis when maintaining a sterile field, preparing skin, and handling tissue specimens.
- Execute safe clinical practices for suture and staple removal, wound irrigation and dressing, and eye and ear procedures.
Patient Positioning, Draping, and Diagnostic Instrumentation
In the outpatient setting, the medical assistant prepares the examination room and rooms the patient under provider supervision. Before initiating any exam, positioning, or clinical procedure, the medical assistant must confirm the patient's identity using at least two unique identifiers. Draping is applied systematically to provide warmth and preserve the patient's modesty while allowing the provider appropriate access to the anatomic areas being evaluated.
Select the examination position according to the provider's instructions and the examination needs while accounting for the patient's condition, mobility, safety, and comfort. For example, during female pelvic examinations and Pap tests, the patient is placed in the lithotomy position, lying supine with the feet elevated in stirrups and the buttocks positioned at the lower edge of the table. If an exam focuses on the back, spine, or posterior lower extremities, the patient lies flat on the abdomen with the head turned to one side in the prone position. When respiratory comfort is an issue, Fowler's positions elevate the torso to ease breathing.
Medical assistants also prepare and hand the provider specific diagnostic tools needed for the evaluation. An otoscope allows the clinician to inspect the external ear canal and tympanic membrane, while an ophthalmoscope provides illumination to examine the interior structures of the eye, including the retina. A reflex hammer is used to elicit deep tendon reflexes, while a tuning fork can test vibratory sensation and compare air and bone conduction during hearing assessment.
| Position | Patient Posture | Clinical Uses and Considerations |
|---|---|---|
| Supine | Lying flat on the back | Used for breast, abdominal, and anterior chest examinations. |
| Dorsal Recumbent | Lying supine with knees bent and feet flat on the exam table | Relieves abdominal tension during physical examinations. |
| Lithotomy | Lying supine with feet elevated in stirrups and buttocks at table edge | Primary position used for female pelvic examinations and Pap tests. |
| Fowler's and Variations | Head of table elevated 45 to 60 degrees (Fowler's), 80 to 90 degrees (high Fowler's), or ~45 degrees (semi-Fowler's) | High Fowler's may help a patient breathe more comfortably. |
| Prone | Lying flat on the abdomen with the head turned to one side | Used for examinations of the spine, back, and posterior lower extremities. |
| Sims' | Lying on the left side with the right knee and thigh drawn up toward the chest | Commonly used for rectal examinations, enemas, and rectal temperature measurements. |
| Knee-Chest | Resting on the knees and chest with the buttocks elevated | Used for proctologic examinations. |
| Trendelenburg | Lying supine with the head lower than the feet | Not recommended as a treatment for shock or severe hypotension. |
Common mistakes
- Explaining procedural risks, benefits, and alternatives to obtain informed consent, which is strictly the provider's responsibility rather than the medical assistant's.
- Dragging contaminated external suture material back through subcutaneous tissue by failing to cut the suture flush with the skin surface.
- Irrigating an ear using cold solution, which induces patient vertigo, dizziness, and nausea, or performing irrigation when a tympanic membrane perforation is present.
- Cleansing a wound from the outside inward can carry contaminants toward the wound; extremity bandages are generally wrapped from distal to proximal to support venous return.
Key points
- Confirm patient identity using at least two unique identifiers and position the patient according to the specific examination or procedure ordered.
- Maintain surgical asepsis by keeping sterile fields at or above waist level, avoiding reaching over fields, and recognizing the 1-inch border as contaminated.
- Handle tissue removed by the provider according to the ordered test and laboratory instructions: routine histology specimens are generally placed in 10% neutral buffered formalin, while specimens for other tests may require a different medium or fresh transport; label the container at the point of collection according to laboratory policy.
- Remove sutures by cutting flush with the skin and pulling toward the incision line; remove staples by depressing the center of the staple with an extractor; count and document all removed closures.
- Cleanse wounds from least contaminated to most contaminated using normal saline (0.9% sodium chloride), and apply extremity bandages from distal to proximal.
- Instill ophthalmic drops into the lower conjunctival sac without touching the applicator to the eye, and irrigate eyes from inner canthus to outer canthus.
- Warm otic irrigation solution to body temperature, confirm absence of tympanic membrane perforation or tubes, and straighten the canal by pulling the pinna up and back for adults or down and back for children under 3.
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Sample lesson: Patient Identification, Health History and Intake Screening25 practice questions on this exam
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