Medical assistant's role in respiratory treatments and patient care
Assisting with treatments
Patients with pulmonary conditions are prescribed a variety of medications. The following are some of the more common classifications:
Example: Identifying a medication classification
A provider orders a nebulizer treatment for a patient having an asthma flare. The medication label states that it “relaxes the smooth muscles of the bronchi.” Which classification does this medication belong to?
A. Antitussive B. Bronchodilator C. Expectorant D. Decongestant
Answer: B. Bronchodilator - this matches the definition given above, since the medication relaxes bronchial smooth muscle rather than suppressing cough, thinning secretions, or relieving congestion.
Medical assistants can use the Physicians’ Desk Reference (PDR) for information on the medical classification, including the indication for use, desired effect, side effects, adverse reactions, and generic and trade names. Medical assistants should be familiar with medications that are prescribed to patients.
In the ambulatory care facility, common respiratory treatments include medication administration and oxygen therapy. Depending on the state’s statutes and the facility’s policies, the medical assistant may be able to administer nebulizer treatments and oxygen therapy when ordered by the provider. The medical assistant may also instruct patients on how to use metered-dose inhalers. The following sections cover metered-dose inhaler education, nebulizer treatments, and oxygen therapy.
Metered-dose inhalers
A metered-dose inhaler (MDI) provides aerosol medication that is breathed into the lungs. MDIs are typically ordered for conditions such as asthma and chronic obstructive pulmonary disease (COPD).
In many cases, the provider will order an MDI with a spacer. A spacer is a long tube that is attached to the mouthpiece of an MDI. Spacers slow the delivery of medication from MDIs. Without a spacer, the MDI blasts the medication to the back of the throat and mouth. Inhaled corticosteroids can cause irritation and infections over time. When a spacer is used, the medication is blasted into the tube and, over several breaths, is pulled into the lungs. In an ambulatory care facility, the medical assistant may need to instruct the patient on the proper use of an MDI.
Using a metered-dose inhaler
When teaching a patient to use an MDI, the medical assistant should instruct the patient to shake the MDI three or four times, then remove the cover from the mouthpiece. From there, the steps depend on whether a spacer is being used.
With a spacer:
- Attach the spacer. Breathe out. Place the mouthpiece between the lips and close the lips around it.
- Press the top of the canister on the MDI.
- Breathe in very slowly, taking a full breath in. Some spacers will produce a whistle-like sound if the person is breathing in too fast.
Without a spacer:
- Breathe out. Place the inhaler 1 to 2 inches (about 2 finger widths) in front of his or her opened mouth.
- Press the top of the canister on the MDI.
- Breathe in very slowly, taking a full breath in.
After taking the medication, patients should hold their breath for 10 seconds (or count to 10) and then breathe out. When using an inhaled, quick-relief medication (beta-agonists), the patient should wait 1 minute between puffs. These steps should be repeated until the dose is completed.
Nebulizer treatment
Inhaled medication for asthma, COPD, and other lung diseases can be given using a nebulizer. A nebulizer treatment can be done in the ambulatory care setting and at home. A nebulizer is a small machine that turns liquid medication into a fine mist that can be inhaled. Typically, the medication used for nebulizers is much stronger than the same medication found in an MDI. When working with pediatric patients, a mask can be used instead of the mouthpiece. The mask should be an appropriate size so it covers their nose and mouth. When administering a nebulizer treatment, the medical assistant follows the facility’s established procedure for setting up the equipment, delivering the medication, and monitoring the patient.
Oxygen therapy
When a patient comes to the ambulatory care facility with a cardiac or respiratory condition, the provider may order oxygen to be administered. Oxygen should be treated like a medication. The medical assistant must get the order from the provider for how much oxygen to administer and how to administer it. In the ambulatory care facility, oxygen may be available in the room by means of a wall-mounted flow meter or oxygen cylinders (portable tanks).
Room air is about 21% oxygen. Oxygen devices increase the concentration of oxygen for the patient to breathe in. Typically, a nasal cannula (NC) or a simple mask is used in the ambulatory care setting. Other masks that deliver higher oxygen concentrations may also be available.
Patient coaching
Many patients who have chronic pulmonary conditions use MDIs as part of their treatments. It is important that patients learn how to clean their MDIs and spacers to prevent additional issues. A blocked or partially blocked MDI can prevent the patient from getting the proper dose of medication. To clean the MDI and spacer, do the following:
- Take the spacer apart. Clean the spacer with mild soap and allow it to air dry.
- Remove the medication canister and the mouthpiece cover from the MDI. Let warm water flow over the top and bottom of the MDI inhaler for about 30 seconds. Shake off and let air dry overnight. When assembling the device, spray twice in the air before taking a dose. Clean the MDI weekly to prevent medication from building up and blocking the sprayer.
Cleaning techniques can vary with medication products. Patients should be encouraged to check the product’s website for directions.
Legal and ethical issues
Many times, with pulmonary disorders and treatments, patients may become dizzy. This can affect their balance or even cause them to faint. If a patient has a recent history of fainting or passing out, it is important for the medical assistant to keep the patient safe in the ambulatory care environment. Here are some ways to assist patients and prevent falls:
- Assist the patient as needed when stepping on and off the scale.
- Assist the patient on and off the exam table.
- Do not leave the patient on the exam table unattended.
- Ask if the patient would like a wheelchair.
Many lawsuits have been brought forward involving situations in which patients were injured from falls in the ambulatory care environment. Several cases have involved medical assistants not helping patients on and off equipment such as scales or having patients wait unattended on exam tables. Remember, safety is one of the most important concerns when caring for patients.
Patient-centered care
To provide patient-centered care, medical assistants need to do the following:
- Provide patients with clear instructions on the pulmonary procedure being done.
- Perform the procedure correctly so the patient’s results are accurate.
- Be sensitive to patients’ concerns and feelings regarding pulmonary diseases.
- Be respectful and empathetic when encouraging patients to breathe for spirometry tests.
Before performing spirometry, the medical assistant should confirm and record a few key details, since results are only meaningful if testing conditions are consistent:
- The patient’s age, height, weight, and sex, which are needed to calculate the predicted values the patient’s results are compared against
- Whether the patient held bronchodilator medication before the test, per the provider’s instructions
- Recent smoking, vigorous exercise, or a large meal, all of which can affect the results
Remember, if the patient is short of breath or coughing due to an illness, blowing for a spirometry test can be difficult. Allow the patient to tell you when he or she is ready to do the next test. Part of being professional is one’s appearance and grooming. When working with patients, medical assistants must have no odors on their bodies. Perfume, cologne, or scented lotions can trigger an allergic reaction or an asthma flare-up in a patient.
Medical assistants who smoke cigarettes need to be especially concerned with the odor. Smoking damages the sense of smell over time, so a smoker may not notice cigarette odor on their own clothing or body even though it’s noticeable to others. Many patients with chronic illnesses such as cancer or COPD have quit smoking tobacco products, so it’s important that healthcare professionals caring for these patients (and all patients) do not smell of cigarette smoke.