2-10 THE MEDICAL PATIENT

LEARNING OBJECTIVE: Evaluate the needs of a medical patient.

For purposes of this discussion, the term medical patient applies to any person who is receiving diagnostic, therapeutic, and/or supportive care for a condition that is not managed by surgical-, orthopedic-, psychiatric-, or maternity-related therapy. This is not to infer that patients in these other categories are not treated for medical problems. Many surgical, orthopedic, psychiatric, and maternity patients do have secondary medical problems that are treated while they are undergoing management for their primary condition. Although many medical problems can be treated on an outpatient basis, this discussion will address the hospitalized medical patient. It should be noted that the basic principles of management are essentially the same for both the inpatient and outpatient.

The medical management of the patient generally consists of laboratory and diagnostic tests and procedures, medication, food and fluid therapy, and patient teaching. Additionally, for many medical patients, particularly during the initial treatment phase, rest is a part of the prescribed treatment.

Laboratory Tests And Diagnostic Procedures

A variety of laboratory and diagnostic tests and procedures are commonly ordered for the medical patient. Frequently, the medical technician is assigned to prepare the patient for the procedure, collect the specimens, or assist with both the procedure and specimen collection. Whether a specimen is to be collected or a procedure is to be performed, the patient needs a clear and simple explanation about what is to be done and what the patient can do to assist with the activity. Often the success of the test or procedure is dependent upon the patient’s informed cooperation. When collecting specimens, the medical technician must complete the following procedures:

When assisting with a diagnostic procedure, the medical technician must understand the sequence of steps of the procedure and exactly how the assistance can best be provided. Since many procedures terminate in the collection of a specimen, the above principles of specimen collecting must be followed.

Following the completion of a procedure or specimen collection, it is the responsibility of the assisting medical technician to ensure that the patient’s safety and comfort are attended to, the physician’s orders accurately followed, and any supplies or equipment used appropriately discarded.

Medications

A major form of therapy for the treatment of illness is the use of drugs. It is not uncommon for the medical patient to be treated with several drugs. As members of the healthcare team, medical technicians assigned to preparing and administering medications are given a serious responsibility demanding constant vigilance, integrity, and special knowledge and skills. References and the continued in-service training devoted to medication administration at all medical facilities support the importance of accurate preparation and administration of drugs.

An error—which also includes omissions—can seriously affect a patient, even to the point of causing death. Each medical technician is responsible for his own actions, and this responsibility cannot be transferred to another. No one individual is expected to know all there is to know about all patients and medications. However, in every healthcare environment, the medical technician can access other healthcare providers who can assist in clarifying orders; explaining the purposes, actions, and effects of drugs; and, in general, answering any questions that may arise concerning a particular patient and that patient’s medications. There should be basic drug references available to all personnel handling medications, including the Physicians' DeskReference and a hospital formulary. As a medical technician, it is your responsibility to consult these members of the team and these references for assistance in any area in which you are not knowledgeable or whenever you have questions or doubts. You are also responsible for knowing and following local policies and procedures regarding the administration of medications.

Food and Fluid Therapy

The following brief discussion covers food and fluid and how it relates specifically to the medical patient. Loss of appetite, food intolerance, digestive disturbances, lack of exercise, and even excessive weight gain influence a medical patient’s intake requirements. Regardless of their medical problems, patients have basic nutritional needs that frequently differ from those of the healthy person. As a part of the patient’s therapeutic regimen, food is usually prescribed in the form of a special diet. Regardless of the kind of diet prescribed, the patient must understand why certain foods are ordered or eliminated, and how compliance with the regimen will assist in his total care. It is the responsibility of the medical technician to assist the patient in understanding the importance of the prescribed diet and to ensure that accurate recording of the patient’s dietary intake is made on the clinical record.

In many disease conditions, the patient is unable to tolerate food or fluids or may lose these through vomiting, diarrhea, or both. In these cases, replacement fluids as well as nutrients are an important part of the patient’s medical management. On the other hand, there are several disease conditions in which fluid restrictions are important aspects of the patient’s therapy. In both of these instances, accurate measurement and recording of fluid intake and output must be carefully performed. Very frequently this becomes a major task ofthe staff medical technician.

Patient Teaching

Earlier in this chapter, under “Patient Education,” the goals and principles of patient teaching were addressed. When taken in the context of the medical patient, there are some general areas of patient teaching needs that must be considered, particularly as the patient approaches discharge from an inpatient status. Those areas include the following:

Rest

The primary reason for prescribing rest as a therapeutic measure for the medical patient is to prevent further damage to the body or a part ofthe body when the normal demand of use exceeds the ability to respond. However, prolonged or indiscriminate use of rest—particularly bed rest—is potentially hazardous. Some of the common complications occurring as a result of prolonged bed rest are

The prevention of complications is the key concept in therapeutic management for the patient on prolonged bed rest. Awareness of the potential hazards is the first step in prevention. Alert observations are essential: Skin condition, respirations, food and fluid intake, urinary and bowel habits, evidence of discomfort, range of motion, and mood are all critical elements that provide indications of impending problems. When this data is properly reported, the healthcare team has time to employ measures that will arrest the development of preventable complications.