CCMA (NHA) cheat sheet

Common word parts: brady- = slow, tachy- = fast, -itis = inflammation, -ectomy = surgical removal, -ostomy = surgically created opening, -emia = blood condition.

The chain of infection has six links: infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, susceptible host; hand hygiene interrupts the transmission link.

Standard precautions apply to all blood, body fluids, secretions, excretions, non-intact skin, and mucous membranes regardless of a known diagnosis.

PPE removal order: gloves first, then goggles or face shield, then gown, then mask or respirator; perform hand hygiene immediately after removal.

Spore-forming organisms such as C. difficile and C. perfringens require a sporicidal agent (sodium hypochlorite/bleach); alcohol does not destroy spores.

Standard gravity autoclave sterilization: 121 °C (250 °F) at 15 psi for 15–30 minutes; spore strips or biological indicators verify effectiveness.

Metric conversions: 1 kg = 2.2 lb, 1 inch = 2.54 cm, 1 L = 1000 mL, 1 g = 1000 mg, 1 tsp = 5 mL, 1 oz = 30 mL.

Temperature conversion: °F = (°C × 1.8) + 32; normal adult oral temperature is about 98.6 °F (37 °C).

Adult reference ranges: heart rate 60–100 bpm, respirations 12–20 per minute, blood pressure less than 120/80 mmHg, SpO2 95–100%.

Anatomical position: standing erect, face forward, arms at the sides, palms facing anteriorly, feet flat and together.

Body planes: sagittal divides left from right, frontal (coronal) divides anterior from posterior, transverse divides superior from inferior.

Abdominal quadrants: liver and gallbladder in the RUQ, stomach and spleen in the LUQ, appendix and cecum in the RLQ, sigmoid colon in the LLQ.

Blood flow through the heart: right atrium → tricuspid valve → right ventricle → pulmonary valve → lungs → left atrium → mitral valve → left ventricle → aortic valve → aorta.

The SA node in the right atrium is the heart's natural pacemaker; the AV node delays the impulse before it travels to the ventricles.

Digestive sequence: mouth, esophagus, stomach, duodenum, jejunum, ileum, ascending/transverse/descending colon, rectum, anus.

The nephron is the functional unit of the kidney; the glomerulus filters plasma and the tubules reabsorb water, glucose, and electrolytes.

Muscle types: skeletal (voluntary, striated), cardiac (involuntary, striated, intercalated discs), smooth (involuntary, non-striated, hollow organs).

Endocrine glands: pancreas (insulin, glucagon), thyroid (T3, T4), adrenal cortex (cortisol), adrenal medulla (epinephrine), pituitary (master gland).

Injection technique: intradermal 26–27 G at 10–15°; subcutaneous 25–27 G at 45–90°; intramuscular 20–23 G at 90° with 1–1.5 inch needle.

Venous order of draw: blood cultures, light blue (citrate), red or gold (serum), green (heparin), lavender (EDTA), gray (fluoride/oxalate).

Tourniquet is applied 3–4 inches above the venipuncture site and released within 1 minute; cleanse with 70% isopropyl alcohol in concentric circles and allow to dry.

ECG standard calibration is 25 mm/second and 10 mm/mV; one small box = 0.04 second and one large box = 0.20 second.

The six rights of medication administration: right patient, drug, dose, route, time, and documentation.

Patient positions: Fowler (45–60° semi-sitting), Sims (left lateral, used for enemas), lithotomy (pelvic exam), Trendelenburg (head lowered), prone (back procedures).

Orthostatic vital signs are measured with the patient lying, then sitting, then standing; a drop of 20 mmHg systolic or 10 mmHg diastolic indicates orthostasis.

Sterile field rules: the 1-inch border is non-sterile, sterile items must stay above waist level, and the assistant never turns away from or reaches over the field.

Capillary puncture: use the lateral side of the middle or third finger and the fourth finger; avoid thumb, index, and fifth finger; wipe away the first drop.

Teach-back: the patient restates instructions in their own words; it verifies comprehension better than asking whether they have questions.

Prochaska stages of change: precontemplation, contemplation, preparation, action, maintenance, and termination.

Prioritization follows ABCs - airway, breathing, circulation - before comfort measures or administrative tasks.

Written patient education should be at a fifth- to sixth-grade reading level, with pictures and large print for low health literacy.

A qualified medical interpreter is used for limited-English-proficiency patients; family members, especially minors, should not serve as interpreters for sensitive information.

HIPAA patient rights include notice of privacy practices, access to records, request for amendment, request for restrictions, and an accounting of disclosures.

Medication reconciliation is performed at every transition of care: admission, transfer, discharge, and each office visit.

Common chronic disease targets: HbA1c below 7% for many adults with diabetes; patients on warfarin require periodic INR monitoring.

Scheduling models: wave, modified wave, streaming, clustering, and open access (same-day) scheduling; new-patient visits are booked longer than established-patient visits.

CPT codes describe procedures and services; ICD-10-CM codes describe diagnoses; HCPCS codes cover supplies, drugs, and equipment.

Insurance terms: premium is the monthly payment, deductible is the amount owed before coverage, copay is a fixed fee, and coinsurance is a percentage of the allowed amount.

An explanation of benefits (EOB) summarizes allowed amounts, payer payment, and patient responsibility; it is not a bill.

Terminal digit filing sorts records by the last two digits of the number first, then the middle pair, then the first pair.

Alphabetic filing rule: nothing comes before something - a shorter name files before a longer name beginning with the same letters.

Release of information requires a written authorization naming the records, recipient, purpose, and expiration date; psychotherapy notes require separate authorization.

Medical record entries must be dated, timed, signed with credentials, and permanent; late entries are labeled as such and never backdated.

Nonverbal communication carries more meaning than words; keep an open posture, appropriate eye contact, and social distance of roughly 4–12 feet in a professional setting.

Therapeutic techniques include open-ended questions, restatement, reflection, clarification, silence, and summarizing.

Communication barriers to avoid: medical jargon, leading questions, false reassurance, interrupting, and asking "why" questions that sound accusatory.

AIDET framework: Acknowledge, Introduce, Duration, Explanation, Thank you.

Service recovery sequence: listen without interrupting, empathize, apologize, resolve or escalate, then follow up.

Maslow's hierarchy orders needs: physiological, safety, love/belonging, esteem, self-actualization; lower needs are addressed first.

When speaking with a hearing-impaired patient, face them directly, speak clearly without shouting, and arrange a qualified interpreter or assistive device.

Health literacy universal precautions: assume every patient may struggle with health information and use plain language with all patients.

Four ethical principles: autonomy (patient self-determination), beneficence (do good), nonmaleficence (do no harm), and justice (fair distribution of care).

Informed consent requires patient competence, voluntariness, and disclosure of risks, benefits, and alternatives; the provider obtains consent, and the medical assistant may witness the signature.

HIPAA minimum necessary standard limits access and disclosure to the least protected health information needed for the purpose; treatment disclosures are exempt.

Reportable events under mandated reporting laws include suspected child abuse, elder or dependent adult abuse, and specified communicable diseases.

OSHA Bloodborne Pathogens Standard requires the hepatitis B vaccination to be offered within 10 working days of assignment at no cost to the employee.

Medical assistants may perform CLIA-waived testing and clinical tasks within state scope of practice but may not diagnose, prescribe, or give medical advice.

Chain of custody must be maintained for forensic specimens: each transfer is documented with date, time, and signatures.

Errors in the medical record are corrected with a single line, the correction, date, and initials; the original entry is never erased or obliterated.

Advance directives include the living will, durable power of attorney for health care, and POLST; a competent patient may revoke them at any time.