Pediatric diagnostic procedures
Assisting with diagnostic procedures
The medical assistant that works with pediatric patients will also be involved in assisting with diagnostic procedures. The following sections examine the most common diagnostic procedures done in pediatrics.
Obtaining a urine sample
The easiest way to obtain a urine sample from a child who is toilet trained is to give the parent the container and instructions ahead of time. Then, when the child arrives at the office for the examination, the sample is available to be tested. If the sample is needed while the child is at the office, consult with the parent for the best method to use. If the child is not toilet trained, a pediatric urine collection device can be put on him or her to collect the sample. This device is placed as soon as the child is checked in to increase the chance of obtaining the needed sample before the child leaves. Once the device is in place, the child can be diapered to help hold it properly. Make sure the adhesive sticks tightly so that the specimen collects in the device when the child urinates.
In some cases, the child may need to be catheterized to obtain the specimen. Pediatric catheterization kits contain all the supplies needed for this procedure. When preparing the kit, always remember that this is a sterile procedure. The provider usually asks the parent to help with the infant while the medical assistant labels and prepares the specimen for the laboratory. In some practices, a registered nurse or a specially trained medical assistant may perform a catheterization procedure to collect a pediatric urine sample.
Vision screening
The most common method of performing a distance vision screening with a pediatric patient is using a Snellen chart. You will likely see a variety of charts used. There is one with alphabetic characters, one with tumbling Es, and one with a picture of common objects instead of letters. Each row of characters shown on the chart gets smaller. As the child needs to be cooperative during this screening, it is important to make a game of it and make it fun. When working with the tumbling E chart, it can be helpful to have the E on an individual card and show it to the child before starting the evaluation. Ask the child to point in the direction that the “legs” of the E are pointing. You can rotate the card until you have covered all possible directions. Then when you move to the full chart, the child will have an understanding of what you want him or her to do.
Traditionally the Snellen chart has been mounted on the wall in a hallway that would allow for the 20-foot distance from the chart. There are now Snellen charts that can be displayed on a tablet computer and only require that the patient be 5 feet or less from the chart. For this screening test, patients cover one eye and read each line of the chart until they can no longer get the majority of the characters correct. Then the other eye is covered, and the process is repeated. Finally, patients can view the chart with both eyes and again read each line on the chart until they can no longer get the majority of the characters correct.
The Snellen chart will also have a green bar and red bar that can be used for a very basic color vision test. If a more expanded test is needed, a booklet of polychromatic plates made up of colored dots in a numeric pattern can be used. For pediatric patients who do not know their numbers, there are plates that have a trail the patient can trace . This booklet is referred to as the Ishihara color vision test. For the color vision screening, it is important to have a room with natural sunlight or lights that create that effect and will minimize distractions. If a problem with the patient’s vision is found during either the acuity test or color vision test, the patient will likely be referred to an ophthalmologist.
Hearing screening
Hearing screening is a common test for pediatric patients. It is usually accomplished by using an audiometer. The audiometer can assess hearing at various frequencies and intensities. The screening involves headphones placed over the child’s ears. Before putting on the headphones, explain to children what to expect. They will hear sounds in one ear or the other. When they hear the sound, they should raise that hand; if the sound is in the right ear, they should raise their right hand. Tell them that some of the sounds will be very quiet and some will be louder, so if they think they hear a sound, they should raise their hand.
Audiometers may have the option to do the test manually or automatically. The medical assistant should be familiar with the provider’s preference when performing the screening test. If a hearing deficit is indicated, the patient will likely be referred to an audiologist for further testing.