Instructions
Watch the assigned videos from chapter 40. To access the videos, click on the videos tab that is located under the Course Tools module and then click on the EVOLVE-Elsevier Medical Assisting Procedures Video or Evolve Medical Assisting Videos.View Measure the Peak Flow Rate in Chapter 40: PulmonologyView Administer a Nebulizer Treatment in Chapter 40: PulmonologyView Perform Spirometry Testing in Chapter 40: Pulmonology
Scenario
Renee is rooming Carl Bowden. He is here today for a recheck appointment. He was diagnosed 10 days ago with pneumonia. As Renee is gathering Carl’s history, he tells her that he has smoked two packs a day for the past 30 years. He also states that he has had pneumonia six times over the past 2 years. He asks Renee how smoking may impact his spirometry test ordered by the physician. Thinking back to the respiratory structures and functions and spirometry testing you have learned about in this module, how would you answer his question?
Measure the Peak Flow Rate
Transcript
[ Music ]>> Narrator: In this procedure, you will learn how to instruct a patient in
performing a peak flow meter test. Before you begin, sanitize your hands. All peak flow
meters are disposable. Take the peak flow meter out of the box. Remove the lid and push
the bottom half behind the device. Slide the marker to the bottom of the scale. The indicator
must be at the bottom for proper measurement of expiratory effort. Introduce yourself and
confirm the patient’s identity by asking for his name and date of birth. >> Speaker 1:
Kevin? >> Speaker 2: Yes. >> Speaker 1: How are you today? >> Speaker 2: I’m good. How
are you? >> Speaker 1: I’m David. I am Dr. Jones’ medical assistant. I’m going to be working
with you today. >> Speaker 2: Okay. >> Speaker 1: Okay, could you please give me your full
name and date of birth. >> Speaker 2: Kevin Heron and 5. >> Narrator: To put the patient at
ease and ensure cooperation, explain the purpose of a peak flow meter test and how it is
performed, including the actual maneuver of forced expiration. >> Speaker 1: Kevin, have
you ever done a peak flow meter before? >> Speaker 2: No, I haven’t. >> Speaker 1: Okay, Dr.
Jones has ordered this for you today because of your diagnosis of asthma you just got
recently. Okay, so I’m going to guide you through this first time doing it. >> Speaker 2:
Okay. >> Speaker 1: So that you can perform it every day at home. >> Speaker 2: Okay. >>
Speaker 1: Okay, first thing is to sit up as straight as you can. When I give this to you, I want
you to take a deep breath in as much air as you can get in your lungs. Put it in your
mouth. Tightly seal your lips around it. Try not to put your tongue in it so it doesn’t include
the air. And then blow out as hard as you can. >> Narrator: Make sure the patient is
comfortable and in a proper position, either sitting upright or standing to ensure maximum
lung expansion and accurate results. Tight clothing my restrict breath capacity. So loosen
any tight clothing, such as a neck tie, bra or belt. >> Speaker 1: Will you just loosen your
belt up just so you can get as deep a breath as possible. >> Speaker 2: Okay. >> Speaker 1:
Okay. >> Narrator: Have the patient hold the meter upright, taking care not to block the
opening with his fingers. >> Speaker 1: Okay. >> Speaker 2: Now, do I put this before or
after my teeth? >> Speaker 1: Take a deep breath, put it behind your teeth, after your
teeth and then seal your lips tightly around it. >> Speaker 2: Okay. >> Speaker 1: Good
question. Okay, so go ahead and take a deep breath for me. Put that mouthpiece in, seal it
and blow out as hard as you can. >> Narrator: Instruct the patient to inhale as deeply as
possible, then place the mouthpiece into his mouth beyond his teeth and forming a tight
seal with his lips. Caution the patient not to put his tongue in the mouthpiece when
exhaling. >> Speaker 1: Good. See, that was a little bit better. >> Speaker 2: Yeah, okay. >>
Speaker 1: Do it one more time. >> Speaker 2: Okay. >> Speaker 1: Take a deep breath in. >>
Speaker 2: Okay. >> Speaker 1: And blow out as hard and fast as you can. >> Narrator: Ask
the patient to exhale as fast and as forcefully as possible into the peak flow meter. The
forced exhalation will move the marker up the scale and stop at point of the peak expiratory
flow. Document this number and return the marker to the bottom of the scale. Repeat the
procedure two more times and record each result. Peak flow readings may trigger
bronchospasms or severe coughing in patients experiencing an asthma attack. If this
occurs, instruct the patient to rest and try again. If the patient is unable to perform three
readings because of bronchospasms and/or coughing, follow the provider’s guidelines for
managing this situation. Put on disposable gloves. Clean and disinfect the equipment and
discard waste in a biohazard waste container. Sanitize your hands before returning to the
patient. Give the patient the meter for continued use at home with instructions to follow the
manufacturer’s cleaning recommendations. >> Speaker 1: Just remember to chart your
results daily. >> Speaker 2: Okay. >> Speaker 1: So Dr. Jones can see those on your next
visit. >> Speaker 2: Okay. >> Speaker 1: Okay. Thank you very much. >> Speaker 2: Thank
you. >> Narrator: Sanitize your hands again when finished with the patient. Document the
test results in the patient’s health record for provider to review, noting the time and date of
the highest reading.
Perform Spirometry Testing
Transcript
[ Music ] >> In this procedure, you will learn how to perform volume capacity testing
using a spirometer. Before you begin, sanitize your hands. Then, assemble the
spirometer. >> Introduce yourself, and confirm the patient’s identity by name and date of
birth. >> How are you today? >> I’m good. How are you? >> I’m David. I am Dr. Jones’
medical assistant. I’m going to be working with you. >> Okay. >> Okay. Could you
please give me your full name and date of birth? >> Kevin Hearin and 5/10 — >>
Determine whether the patient needed any special preparation. For example, not
smoking or taking bronchodilators. And if so, whether it was done. If the required
procedures were not followed, the test may have to be rescheduled. >> Kevin? >> Mm
hmm. >> We’re going to do a spirometry test this morning. >> Okay. >> Okay? Did you
call the doctor’s directions about not eating, not smoking — >> Yeah. >> — after this
morning? >> Yeah. >> Okay. >> To help reassure the patient, explain the purpose of
the test and the actual maneuver so that the patient can cooperate fully. >> Okay, so
what we’re going to do with this test is basically look at how much air you can get out
and how quickly. >> Okay. >> Okay? So a lot of it is taking a deep breath — >> Mm
hmm. >> — blasting it out as hard as you can — >> Mm hmm. >> — to get as much air as
possible. It’s going to feel like your lungs are squeezing. >> Oh, okay. >> Okay? >>
Alright. >> Before we do this, I just need to check a couple vitals, get your blood
pressure — >> Okay. >> — pulse, things like that, okay? >> Okay. >>Sure. >> Okay. >>
Measure and document the patient’s vital signs, including blood pressure, heart rate,
and height, and weight. Make sure the patient is comfortable, and is sitting with legs
crossed and feet on the footrest. The test may cause dizziness, so sitting is preferred. If
the patient stands, a chair must be placed next to him. Loosen any tight clothing, such
as a necktie, bra, or belt. >> Okay. >> Mm hmm. >> But I’m going to coach you through
it. I’m going to tell you keep breathing, keep going, keep going. >> Okay. >> And then
afterwards you can take a deep breath, and you’ll feel a little bit better afterwards,
okay? >> Is that what this device does, just measure that? >> It’s going to measure how
much air is coming out and how quickly. >> Mm hmm. >> To prevent air from escaping
through the nose during exhalation, place a soft nose clip on the patient’s nose, if that is
part of your facility’s procedure. >> I’m going to hold this to you. >> Alright. >> Okay.
Remember to sit up straight, take a deep breath, make a tight seal, and blow out. >>
Instruct the patient to place the mouthpiece in his mouth, and seal his lips around it
when exhaling. Tell the patient to take as deep a breath as possible, and blow air out
hard and long. Use active, forceful coaching during exhalation. The patient must exhale
completely to get accurate test results. The patient should continue to exhale, even after
he thinks the process is complete. Carefully observe the patient for indications of vertigo
or dyspnea, or any other signs of difficulty. If complications occur, stop the test and
inform the provider. Provide the patient with feedback after he completes the
maneuver. Continue testing until three acceptable maneuvers have been performed. >>
Okay. >> Alright. >> Alright. Deep breath in. Sit up straight. Tight seal. Blow it out. Keep
going, keep going, push. Perfect. That’s great. All the flows, all the lines they look just
where they need to be, okay? >> Okay. Good. >> You did a great job on it. >> Put on
disposable gloves, and discard waste, including the disposable mouthpiece and
tubing in a biohazardous waste container. Then, clean and disinfect the
equipment. Then, dispose of gloves. When you’re finished, sanitize your
hands. Document the procedure in the patient’s electronic health record. Place the
spirometer print out in the records for the provider to review.
Administer a Nebulizer Treatment
Transcript
[ Music ]>> Narrator: In this procedure, you will learn how to perform a nebulizer
treatment on a patient. Begin by plugging the nebulizer into a properly grounded electrical
outlet. Confirmed the patient’s identity by asking for his name and date of birth. >> Speaker
1: How are you today? >> Speaker 2: I’m good. How are you? >> Speaker 1: I’m David. I am
Dr. Jones’s medical assistant. I’m just going to be working with you today. >> Speaker 2:
Okay. >> Speaker 1: Okay. Could you please give me your full name and date of birth? >>
Speaker 2: Kevin Hern, and 05/10 — >> Narrator: To put the patient at ease, explain the
purpose of the nebulizer treatment. >> Speaker 1: Have you had a nebulizer treatment
before? >> Speaker 2: No, I have not. >> Speaker 1: Okay, Dr. Jones has ordered one for
you because of your recent diagnosis of asthma. It’s not a painful procedure. I’m just going
to use a sanitizer, set up the nebulizer, and we’ll get rolling on that. >> Speaker 2: Okay. >>
Speaker 1: Okay. >> Narrator: Before beginning the treatment, sanitize your
hands. Perform the three routine medication checks. Insert the drug into the nebulizer
medication cup. Connect the disposable tubing to the medication cup, and then to the
nebulizer. The patient should be sitting upright to allow for total lung expansion. If using a
mask, position it comfortably but securely over the patient’s mouth and nose. If using a
mouthpiece, instruct the patient to hold it between his teeth with his lips pursed around
the mouthpiece. >> Speaker 1: What I’m going to have you do is when I turn this on, you’re
going to see the mist coming out. I want you to make a good, tight seal with your mouth. >>
Narrator: Encourage the patient to take slow, deep breaths through the mouth and to hold
each breath two to three seconds to allow the medication to disperse through the lungs. >>
Speaker 2: Okay. >> Speaker 1: Take slow, deep breaths in. When you breathe it in, try to
hold that breath and for about three seconds, and then, slowly let it out through your
nose. >> Speaker 2: Okay. >> Speaker 1: If you can’t hold it for the three second; like you
feel like you’re going to cough or your short of breath, it’s okay. Just let it out. The longer
you hold the medication, in more of its job it can do. >> Narrator: Turn on the
nebulizer. The aerosolized medication should be visible as a mist. Continue the treatment
until aerosol is no longer produced or approximately 10 minutes. If the patient is receiving
a bronchodilator such as albuterol, he may experience dizziness, tremors, or
tachycardia. Continue the treatment unless otherwise ordered by the provider. Turn off the
nebulizer. Ask the patient to take several deep breaths and to cough loosened secretions
into the disposable tissues. >> Speaker 1: Take a couple of Kleenexes, and you’re going to
cause any secretions, anything you have in lungs after that treatment into those Kleenexes,
okay? >> Speaker 2: Okay. >> Speaker 1: And I’ll get you the trashcan in a second.
[ Coughing ]Keep coughing that up.
[ Coughing ]Good. The more that comes out, the better. >> Narrator: Put on a pair of gloves
and dispose of the mouthpiece or mask and tubing in a biohazard container, along with the
gloves. Instruct the patient also to dispose of the contaminated tissues in the biohazard
waste container. When you’re finished, sanitize your hands. If the patient is to continue
home nebulizer treatments, provide patient education for both the patient and caregivers,
as appropriate. Ask him to demonstrate the treatment steps to confirm his
understanding. >> Speaker 1: I’m going to teach you how to put your medication in at home
if you’re doing your nebulizer. Here’s the medication. >> Speaker 2: Okay. >> Speaker 1:
Just make sure to always check the outside of the foil label here, just to know you have the
right medication, right dosage. >> Speaker 2: Okay. >> Speaker 1: It’ll twist right there in
the top. So, you can peel that right off. >> Speaker 2: Okay, like this? >> Speaker 1: Yeah, it
should tear. Good. And take the little vial out. >> Speaker 2: Okay. >> Speaker 1: And on it
will also have the name of the medication you can check. >> Speaker 2: Oh, okay. >>
Speaker 1: Good, and then you just twist that top. >> Speaker 2: Like that? >> Speaker 1:
Yeah, and it’ll pop right off. >> Speaker 2: Okay. >> Speaker 1: And then, I will hold the cup,
or you can hold the cup. There you go. >> Speaker 2: And I just put it right in there? >>
Speaker 1: Yeah, just pour all the contents in there. You’ll need all that medication. Good,
and I’ll take those from you. >> Speaker 2: Okay. >> Speaker 1: Good, and then, all we have
to do hook you up to the nebulizer, and put the mouthpiece on, and you’ll be ready to do
this at home. >> Speaker 2: Okay, all right. >> Speaker 1: Okay. >> Narrator: Document the
nebulizer treatment, the patient’s response, including the amount of coughing and whether
coughing was productive or nonproductive and any side effects of the medication.
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