8.1 Vision & Respiratory Testing; Assisting Providers

Where 3.03.22–3.03.24 Sit on the CMAC

Collecting Specimens and Diagnostic Testing (3.03) is 25% of scored items (~40 of 160). Earlier chapters cover venipuncture, capillary puncture, urine, cultures, CLIA-waived POC, and chain of custody. Tasks 3.03.22–3.03.24 shift you into assisted procedures and office diagnostic tests that still live under the same domain weight: help the provider get the right specimen or measurement, run vision and respiratory screens correctly, and document so results are usable.

Scope rule for the whole section: you perform and assist within training and order; you do not diagnose glaucoma, COPD stage, or “your color vision is fine for driving” as a medical conclusion. Route findings to the attending provider.

3.03.22 Assist the Provider with Obtaining Specimens

Assisting is more than handing a swab. The CMAC is expected to run a safe, labeled, complete assist so the provider can focus on technique and clinical judgment.

What “assist” typically includes

Common office specimens you may assist with

• Wound culture — clean per order, provider swabs base of wound, MA labels and sends in transport media.
• Throat culture / rapid strep — position, tongue blade, light; do not contaminate swab on teeth/tongue before the pharynx.
• Nasal/nasopharyngeal — coach head position; many protocols allow trained MAs to collect under order—follow facility competency.
• Pap/pelvic assist — prepare tray, warm instruments, hand cytology fixative or liquid-based vial, label vial immediately, offer tissues and aftercare instructions.
• Stool / occult blood kit teaching — instruct home collection when ordered; provide written steps.
• Sputum — morning deep cough preferred; distinguish saliva from lower respiratory specimen.

Stop and escalate if the patient refuses, becomes unstable, or the order is incomplete. Assisting does not authorize you to perform invasive collections you are not trained and credentialed to do (e.g., arterial puncture, certain deep tissue samples).

Infection control and dignity during assists

Use Standard Precautions every time: hand hygiene, gloves, eye protection for splash risk, and proper disposal of contaminated supplies. For genital, rectal, or breast-area exams/specimen assists, offer a same-gender chaperone per policy and keep only necessary body areas exposed. Never leave unlabeled tubes “to finish later at the desk”—wrong-patient labeling is a never event.

3.03.23 Vision Testing: Snellen and Ishihara

Office vision screens support school, employment, DMV-related forms (when authorized), and clinical workups for diabetes, headaches, and eye complaints. They are screening, not a full optometric refraction.

Snellen distant visual acuity

Procedure outline:

1. Position the patient at the marked line; explain they should read the smallest line they can see clearly.
2. Cover the left eye; test the right eye first (common convention—follow facility order).
3. Start at a readable middle line; move smaller until the patient misses more than half the letters on a line (facility scoring rules vary slightly—know your form).
4. Record the last line meeting the pass rule; note number of missed letters if required (e.g., 20/30 −1).
5. Repeat for the left eye, then both eyes if ordered.
6. If the patient cannot see the top line at 20 feet, move closer per protocol (e.g., 10 feet and convert) or use counting fingers/hand motion/light perception only under provider direction.

Interpretation for the MA (not diagnosis): 20/20 means the patient reads at 20 feet what a “normal” reference eye reads at 20 feet. 20/40 means they must stand at 20 feet to read what the reference eye reads at 40 feet—larger denominator = worse acuity. Do not tell the patient they “failed” or “passed a driver’s exam” unless you are completing a specific authorized form under protocol; route results to the provider.

Near vision (Jaeger or Rosenbaum card at ~14 inches) may be ordered for reading complaints; hold the card at the stated distance and record the notation the card uses. Do not let the patient inch closer without documenting the actual distance.

Ishihara color vision screening

Ishihara plates (and similar pseudoisochromatic tests) detect common red-green color vision deficiencies.

Patients who cannot read numerals may use pathway/tracing plates. Document if the patient is color-deficient on screening and notify the provider—especially for occupations or medication teaching where color cues matter (e.g., pill identification education may need non-color strategies).

Other vision-related assists (exam context)

You may be asked to prepare for tonometry (intraocular pressure—provider performs or uses a device under protocol), eye irrigation, or fluorescein staining setup. Know the supply tray and infection control; do not independently diagnose corneal abrasion.

3.03.24 Respiratory Testing: Spirometry and Nebulizer

Spirometry (office pulmonary function screening)

Spirometry measures how much air the patient can move and how fast, typically including FVC (forced vital capacity), FEV1 (forced expiratory volume in 1 second), and the FEV1/FVC ratio. Providers use it for asthma, COPD evaluation, pre-op screening, and treatment response. Many ambulatory units use portable spirometers with disposable filters/mouthpieces.

Coaching the forced maneuver (exam-critical):

1. Seat the patient upright, feet flat.
2. Demonstrate: fill lungs completely, seal lips around mouthpiece, blast out hard and fast, then continue exhaling until no more air comes (often ≥6 seconds in adults when protocol requires full FVC).
3. Obtain multiple acceptable efforts (commonly up to 3 acceptable maneuvers meeting reproducibility rules).
4. Watch for early stop, cough, leak, or weak start—discard poor efforts and re-coach.
5. Print/save curves; document number of efforts, patient cooperation, and any symptoms (dizziness, chest pain → stop and escalate).

You may assist with pre- and post-bronchodilator spirometry when ordered: baseline efforts, then nebulizer or inhaler per order, wait the protocol interval (often 10–15 minutes), then repeat. The provider interprets obstruction, restriction patterns, and significance—not the MA.

Contraindications / caution flags (know to check policy and ask before forcing a maximal maneuver): recent eye, chest, or abdominal surgery; unstable angina or recent MI; active hemoptysis; pneumothorax history; severe distress. When in doubt, defer to the provider.

Nebulizer treatments

A nebulizer converts liquid medication into a fine mist the patient inhales over several minutes (commonly 5–15 minutes depending on volume and device).

Peak flow is sometimes paired with respiratory visits: patient exhales forcibly into a peak flow meter; record best of three efforts and compare to personal best if known. It is effort-dependent—coach like spirometry.

Integrating assist + vision + respiratory into one clinical day

A morning clinic might include labeling a wound culture with the provider (3.03.22), school physical Snellen and Ishihara (3.03.23), and an asthma follow-up spirometry plus nebulizer (3.03.24). In every case the quality chain is the same: correct ID → correct prep → correct technique → correct documentation → provider review. For CMAC stems, choose answers that protect specimen integrity, measurement accuracy, and patient safety over speed.

Quick exam traps

Master these procedures as checklists you can run under time pressure—that is how 3.03.22–3.03.24 appear on the AMCA CMAC.