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Clinical Procedures for Medical Assistants 9th Edition Bonewit Test Bank.

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ISBN-10 ‏ : ‎ 145574834X
ISBN-13 ‏ : ‎ 978-1455748341
Author: Kathy Bonewit-West

Learn the procedures and skills you need to succeed as a medical assistant! Clinical Procedures for Medical Assistants, 9th Edition provides clear, step-by-step instructions for common office procedures such as taking vital signs, collecting and processing lab specimens, preparing patients for examinations, and assisting with office surgeries. Written by expert educator Kathy Bonewit-West, this full-color edition covers the latest competencies and topics in today’s medical assisting practice including emergency preparedness and the updated fecal occult blood testing procedure. The Evolve companion website includes videos of 84 procedures described in the book, preparing you to become a competent clinical medical assistant.

Table of Content:

Chapter 1 The Medical Record
Key Terms
Introduction to the Medical Record
Components of the Medical Record
Medical Office Administrative Documents
Patient Registration Record
Demographic Information
Billing Information
NPP Acknowledgment Form
Correspondence
Highlight on the HIPAA Privacy Rule
What Is the HIPAA Privacy Rule?
What Is Included in the HIPAA Privacy Rule?
What if a Medical Office Does Not Comply With the HIPAA Privacy Rule?
Where Can More Information on the HIPAA Privacy Rule Be Found?
Medical Office Clinical Documents
Health History Report
Figure 1-1 Patient registration record.
What Would You Do? What Would You Not Do?
Case Study 1
Categories of Medical Record Documents
Medical Office Administrative Documents
Medical Office Clinical Documents
Laboratory Documents
Diagnostic Procedure Documents
Therapeutic Service Documents
Hospital Documents
Consent Documents
Putting It All Into Practice
Physical Examination Report
Progress Notes
Medication Record
Prescription and Over-the-Counter Medication Record Form
Medication Administration Record Form
Figure 1-2 Medication record.
Consultation Report
Home Health Care Report
Laboratory Documents
Hematology
Clinical Chemistry
Immunology
Urinalysis
Microbiology
Parasitology
Cytology
Histology
Figure 1-3 Consultation report.
Figure 1-4 Home health care report.
Diagnostic Procedure Documents
Electrocardiogram Report
Holter Monitor Report
Sigmoidoscopy Report
Colonoscopy Report
Spirometry Report
Radiology Report
Figure 1-5 Radiology report.
Diagnostic Imaging Report
Therapeutic Service Documents
Physical Therapy
Occupational Therapy
Speech Therapy
Hospital Documents
Figure 1-6 Diagnostic imaging (CT scan) report.
History and Physical Report
Figure 1-7 Physical therapy report.
Figure 1-8 Hospital history and physical examination report.
Operative Report
Figure 1-9 Operative report.
Discharge Summary Report
Pathology Report
Figure 1-10 Discharge summary report.
Emergency Department Report
Figure 1-11 Pathology report.
Figure 1-12 Emergency department report.
Consent Documents
Consent to Treatment Form
Figure 1-13 Consent to treatment form.
Release of Medical Information Form
Mailed or Faxed Requests for Release of Medical Information
Figure 1-14 Release of medical information form.
Procedure 1-1 Completion of a Consent to Treatment Form
Outcome
Equipment/Supplies:
Ask the patient to read the consent form.
Ask the patient to sign the consent form.
Procedure 1-2 Release of Medical Information
Outcome
Equipment/Supplies:
Witness the patient’s signature.
Mailed or Faxed Requests for Release of Medical Information
Types of Medical Records
Electronic Medical Record
Advantages of the Electronic Medical Record
Figure 1-15 The computer can retrieve documents from a patient’s EMR very quickly.
Disadvantages of the Electronic Medical Record
Figure 1-16 Medical assistant taking patient symptoms using a computer and an electronic medical record program.
Medical Assistants’ Use of the EMR
Functions Performed by the Medical Assistant
Physicians’ Use of the EMR
Figure 1-17 Electronic medical record screen.
Figure 1-18 Electronic medical record screen.
Medical Record Formats
Source-Oriented Record
What Would You Do? What Would You Not Do?
Case Study 2
Problem-Oriented Record
Database
Figure 1-19 Chart dividers in a source-oriented record.
Problem List
Plan
Figure 1-20 POR problem list.
Figure 1-21 POR SOAP progress notes.
Progress Notes
Preparing a Medical Record for a New Patient
Procedure 1-3 Preparing a Medical Record
Outcome
Equipment/Supplies:
Affix the name label.
Insert the chart dividers into the metal fasteners.
Place the patient registration form in front of the medical record.
Medical Record Supplies
File Folders
Folder Labels
Chart Dividers
Taking a Health History
Components of the Health History
Identification Data
Chart Divider Subject Titles and Documents Typically Filed Under Each Title
History and Physical
Progress Notes
Laboratory/X-ray
Hospital
Correspondence
Insurance
Miscellaneous
Memories of Practicum
What Would You Do? What Would You Not Do?
Case Study 3
Chief Complaint
Recording Chief Complaints
Correct Examples
Incorrect Examples
Present Illness
Past History
Figure 1-22 Health history form.
Family History
Social History
Review of Systems
Charting in the Medical Record
PPR Charting Guidelines
Common Symptoms
Charting Progress Notes
Charting Patient Symptoms
Other Activities That Need to Be Charted
Procedures
Procedure.
Figure 1-23 Proper method for correcting an error in a patient’s medical record.
Abbreviations and Symbols Commonly Used in the Medical Office*
Administration of Medication
Administration of medication.
Specimen Collection
Specimen collection.
Diagnostic Procedures and Laboratory Tests
Diagnostic/laboratory tests.
Results of Laboratory Tests
Laboratory test results.
Patient Instructions
Figure 1-24 Instruction sheet for patients.
Patient instructions.
Telephone call and missed appointment.
Procedure 1-4 Obtaining and Recording Patient Symptoms
Outcome
Equipment/Supplies:
What Questions:
Where Question:
When Questions:
Medical Practice and the Law
What Would You Do? What Would You Not Do? Responses
Case Study 1
What Did Dawn Do?
What Did Dawn Not Do?
Case Study 2
What Did Dawn Do?
What Did Dawn Not Do?
Case Study 3
What Did Dawn Do?
What Did Dawn Not Do?
Certification Review
Terminology Review
On The Web
Chapter 2 Medical Asepsis and the OSHA Standard
Key Terms
Introduction to Medical Asepsis and the OSHA Standard
Microorganisms and Medical Asepsis
Growth Requirements for Microorganisms
Infection Process Cycle
Protective Mechanisms of the Body
Medical Asepsis in the Medical Office
Hand Hygiene
Figure 2-1 The infection process cycle.
Box 2-1 CDC Guidelines for Hand Hygiene in Health Care Settings
Resident and Transient Flora
Handwashing
Putting It All Into Practice
Figure 2-2 A, Antimicrobial soap. B, Alcohol-based hand rubs.
Antiseptic Handwashing
Alcohol-Based Hand Rubs
Infection Control
Gloves
Types of Gloves
Glove Guidelines
Procedure 2-1 Handwashing
Outcome
Equipment/Supplies:
Turn on the faucets using a paper towel.
Apply soap to the hands.
Wash the palms and the backs of the hands.
Interlace the fingers and thumbs, and use friction.
Rinse well, holding the hands lower than the elbows.
Wash wrists and forearms using friction.
Dry the hands gently and thoroughly.
Procedure 2-2 Applying an Alcohol-Based Hand Rub
Outcome
Equipment/Supplies:
Apply lotion equal to the size of a dime.
Apply foam equal to the size of a walnut.
Rub the hands together until they are dry.
Procedure 2-3 Application and Removal of Clean Disposable Gloves
Outcome
Equipment/Supplies:
Applying Clean Disposable Gloves
Apply the gloves.
Removing Clean Disposable Gloves
Grasp the glove 1 to 2 inches from the top of the glove.
Scrunch the glove into a ball.
Place the index and middle fingers inside the glove.
Discard both gloves in an appropriate container.
Highlight on Latex Glove Allergy
Latex Gloves
Cause of Latex Glove Allergy
Latex Glove Sensitivity Reactions
Treatment
NIOSH Recommendations
Latex glove allergy.
OSHA Bloodborne Pathogens Standard
Purpose of the Standard
Needlestick Safety and Prevention Act
What Would You Do? What Would You Not Do?
Case Study 1
OSHA Terminology
Components of the OSHA Standard
Exposure Control Plan
Figure 2-3 Example of an exposure control plan.
Labeling Requirements
Figure 2-4 A, Biohazard warning label. B, Biohazard bag used to hold and transport blood or other potentially infectious materials.
Communicating Hazards to Employees
Record Keeping
Control Measures
Engineering Controls
OSHA Postexposure Evaluation and Follow-up Procedures
Figure 2-5 A-B, Safety-engineered syringes. C, Safety-engineered phlebotomy device.
Safer Medical Devices
Work Practice Controls
Personal Protective Equipment
Personal Protective Equipment Guidelines
Figure 2-6 Jennifer wears a combination mask and eye-protection device and a laboratory coat to protect against splashes, spray, spatter, and droplets of blood.
Figure 2-7 Examples of eye-protection devices. Left, Face shield; center, goggles; right, glasses with solid side shields.
Housekeeping
Figure 2-8 Clean and decontaminate work surfaces with an appropriate disinfectant after completing procedures involving blood and other potentially infectious materials.
Figure 2-9 Use mechanical means to pick up broken contaminated glass.
Figure 2-10 Biohazard sharps container.
What Would You Do? What Would You Not Do?
Case Study 2
Highlight on OSHA Bloodborne Pathogens Standard
General Information
Control Measures
Needlestick Injuries
Figure 2-11 Hepatitis B declination form. This form must be signed by an employee with occupational exposure who declines hepatitis B vaccination.
Hepatitis B Vaccination
Universal Precautions
Regulated Medical Waste
Handling Regulated Medical Waste
Highlight on Hepatitis B Vaccine
Box 2-2 Guidelines for Discarding Medical Waste in the Medical Office
Disposal of Regulated Medical Waste
Figure 2-12 Jennifer places a biohazard bag inside a cardboard box in preparation for pickup by the medical waste service.
What Would You Do? What Would You Not Do?
Case Study 3
Bloodborne Diseases
Hepatitis B
Postexposure Prophylaxis
Figure 2-13 Hepatitis B vaccine.
Acute Viral Hepatitis B
Chronic Viral Hepatitis B
Memories of Practicum
Hepatitis C
Other Forms of Viral Hepatitis
Acquired Immune Deficiency Syndrome
Stages of AIDS
Stage 1: Acute HIV Infection
Stage 2: Asymptomatic Period
Highlight on Viral Hepatitis
Hepatitis B
Hepatitis C
Stage 3: Symptomatic Period
Table 2-1 Forms of Viral Hepatitis
Stage 4: AIDS
Highlight on AIDS
Prevalence
Transmission
HIV Testing
CDC Definition of AIDS
Treatment
Box 2-3 AIDS-Defining Conditions
Kaposi sarcoma.
Candida.
Transmission of AIDS
Patient Teaching: Acquired Immune Deficiency Syndrome
Teach Patients the Ways in Which HIV is Transmitted
Teach Patients How to Prevent HIV Infection
Teach Patients to Recognize the Symptoms of HIV Infection
Medical Practice and the Law
Ethics and Law
What Would You Do? What Would You Not Do?: Responses
Case Study 1
What Did Jennifer Do?
What Did Jennifer Not Do?
Case Study 2
What Did Jennifer Do?
What Did Jennifer Not Do?
Case Study 3
What Did Jennifer Do?
What Did Jennifer Not Do?
Certification Review
Terminology Review
On The Web
Chapter 3 Sterilization and Disinfection
Key Terms
Introduction to Sterilization and Disinfection
Definitions of Terms
Hazard Communication Standard
Hazard Communication Program
Inventory of Hazardous Chemicals
Labeling of Hazardous Chemicals
Figure 3-1 A, Hazardous chemical container label. B, The label must indicate the possible hazards of the chemical.
Container Label Requirements
Material Safety Data Sheets
What Would You Do? What Would You Not Do?
Case Study 1
Material Safety Data Sheet Requirements
Figure 3-2 Material safety data sheet (MSDS).
Employee Information and Training
Putting It All Into Practice
Sanitization
Sanitizing Instruments
Figure 3-3 Ultrasonic cleaner.
Cleaning Instruments
Manual Method
Ultrasound Method
Guidelines for Sanitizing Instruments
Figure 3-4 Commercially available surgical instrument cleaners. Left, Instrument cleaner; center, stain remover; right, spray lubricant.
Procedure 3-1 Sanitization of Instruments
Outcome
Equipment/Supplies:
Rinse instruments under warm water to remove organic matter.
Manual Method for Cleaning Instruments
Clean the surface of the instrument with a stiff nylon brush.
Clean grooves, crevices, or serrations with a wire brush.
Ultrasound Method for Cleaning Instruments
Completely submerge instruments in the cleaning solution.
Place the lid on the ultrasonic cleaner.
Rinse thoroughly with warm water.
Dry the instrument with a paper towel.
Check the instrument for defects and proper working order.
Scissors should cut through gauze without catching.
Lubricate hinged instruments.
Disinfection
Levels of Disinfection
High-Level Disinfection
Intermediate-Level Disinfection
Low-Level Disinfection
Types of Disinfectants
Glutaraldehyde
Alcohol
Table 3-1 Disinfectants Used in the Medical Office
Figure 3-5 Kara wears utility gloves and safety goggles to protect herself from the irritating effects of glutaraldehyde.
Chlorine and Chlorine Compounds
Phenolics
Quaternary Ammonium Compounds
What Would You Do? What Would You Not Do?
Case Study 2
Guidelines for Disinfection
Sanitize Articles Before Disinfecting Them
Observe Safety Precautions
Properly Prepare and Use the Disinfectant
Properly Store the Disinfectant
Memories of Practicum
Procedure 3-2 Chemical Disinfection of Articles
Outcome
Equipment/Supplies:
Review the MSDS.
Completely immerse the articles in the disinfectant.
Cover the disinfectant container.
Rinse articles thoroughly to remove the disinfectant.
Sterilization
Sterilization Methods
Autoclave
Items Sterilized in the Autoclave
Monitoring Program
Sterilization Indicators
Chemical Indicators
Figure 3-6 Example of an autoclave log.
What Would You Do? What Would You Not Do?
Case Study 3
Biologic Indicators
Figure 3-7 Example of a printout of an autoclave cycle.
Figure 3-8 Autoclave tape. Top, Autoclave tape as it appears before the sterilization process. Bottom, Diagonal lines appear on the tape during autoclaving and indicate that the wrapped article has been autoclaved.
Figure 3-9 Sterilization strips. Sterilization strips contain a thermolabile dye and change color when exposed to steam under pressure for a certain length of time.
Figure 3-10 Biologic indicator. A biologic indicator includes two spore tests that are sterilized (top right) and one spore control that is not sterilized (bottom right).
Wrapping Articles
Sterilization Paper
Figure 3-11 Sterilization paper wraps. Sterilization paper consists of square sheets of paper that are available in different sizes.
Sterilization Pouches
Muslin
Figure 3-12 Sterilization pouches. Sterilization pouches consist of a combination of paper and plastic and are available in different sizes.
Procedure 3-3 Wrapping Instruments Using Paper or Muslin
Outcome
Equipment/Supplies:
Turn the wrap in a diagonal position.
Place a sterilization indicator in the center of the pack next to the instrument.
Fold the wrapping material up from the bottom, and double-back a small corner.
Fold over the other edge of the wrapping material, and double-back the corner.
Fold the pack up from the bottom.
Label and date the pack. Include your initials.
Procedure 3-4 Wrapping Instruments Using a Pouch
Outcome
Equipment/Supplies:
Label and date the pack. Include your initials.
Insert the instrument into the pouch.
Peel off the paper strip.
Press firmly to seal the pack.
Operating the Autoclave
Guidelines for Autoclave Operation
Location of the Autoclave
Figure 3-13 The autoclave cycle for manual and automatic operation.
Filling the Water Reservoir
Loading the Autoclave
Figure 3-14 Arrangement of packs in the autoclave. A, Improper arrangement of packs in the autoclave. This arrangement prevents adequate penetration of steam, resulting in failure to sterilize the portions in the center of the mass. B, Proper arrangement of packs in the autoclave. The packs are separated from each other, and steam can now permeate each pack quickly and in the much shorter period of exposure needed.
Figure 3-15 Jars and glassware should be placed on their sides in the autoclave with their lids removed.
Table 3-2 Minimum Sterilizing Times
Timing the Load
Drying the Load
Handling and Storing Packs
Maintaining the Autoclave
Daily Maintenance
Weekly Maintenance
Monthly Maintenance
Other Sterilization Methods
Dry Heat Oven
Ethylene Oxide Gas Sterilization
Cold Sterilization
Radiation
Procedure 3-5 Sterilizing Articles in the Autoclave
Outcome
Equipment/Supplies:
If needed, add distilled water to the autoclave.
Manually Operated Autoclave
Properly load the autoclave.
Set the timing control.
Crack the door to dry the load.
Automatically Operated Autoclave
Automatic autoclave buttons and indicators.
Remove the load with heat-resistant gloves.
Check the sterilization indicator on the outside of the pack.
Clean the rubber gasket with a damp cloth.
Medical Practice and the Law
What Would You Do? What Would You Not Do?: Responses
Case Study 1
What Did Kara Do?
What Did Kara Not Do?
Case Study 2
What Did Kara Do?
What Did Kara Not Do?
Case Study 3
What Did Kara Do?
What Did Kara Not Do?
Certification Review
Terminology Review
On the Web
Chapter 4 Vital Signs
Key Terms
Introduction to Vital Signs
Temperature
Regulation of Body Temperature
Heat Production
Figure 4-1 Body temperature represents a balance between the heat produced in the body and the heat lost from the body.
Heat Loss
Body Temperature Range
Alterations in Body Temperature
Variations in Body Temperature
Figure 4-2 Heat loss from the body. With radiation, the body gives off heat in the form of waves to the cooler outside air. With conduction, the chair becomes warm as heat is transferred from the individual to the chair. With convection, air currents move heat away from the body.
Table 4-1 Equivalent Fahrenheit and Celsius Temperatures
Figure 4-3 Terms that describe alterations in body temperature (adult oral temperature).
Fever
Table 4-2 Variations in Body Temperature by Age
Stages of a Fever
Assessment of Body Temperature
Assessment Sites
Table 4-3 Fever Patterns
Oral Temperature
Putting It All Into Practice
Highlight on Fever
Axillary Temperature
Rectal Temperature
Aural Temperature
Forehead Temperature
Types of Thermometers
Electronic Thermometer
Figure 4-4 Electronic thermometer.
Tympanic Membrane Thermometer
Temporal Artery Thermometer
Figure 4-5 The tympanic membrane thermometer functions by detecting thermal energy that is naturally radiated from the tympanic membrane.
Figure 4-6 Tympanic membrane thermometer.
Figure 4-7 Temporal artery thermometer.
Earlobe Temperature Measurement
Care and Maintenance
Guidelines for Using a Tympanic Membrane Thermometer
Box 4-1 Temporal Artery Thermometer Guidelines
Chemical Thermometers
Disposable Chemical Single-Use Thermometers
Figure 4-8 Disposable chemical single-use thermometers. A, The thermometer is removed from the wrapper by pulling on the handle. B, The thermometer is inserted under the tongue and is left in place for 60 seconds. C, The thermometer is read by noting the highest reading among the dots that have changed color.
Temperature-Sensitive Strips
Figure 4-9 Temperature-sensitive strip. The plastic strip is pressed onto the forehead and is held in place until the color stops changing (generally for 15 seconds). The results are read by observing the color and noting the corresponding temperature indicated on the strip.
Procedure 4-1 Measuring Oral Body Temperature—Electronic Thermometer
Outcome
Equipment/Supplies:
Attach the oral probe to the thermometer.
Slide the probe into a probe cover.
Insert the probe under the patient’s tongue.
The patient’s temperature appears as a digital display on the screen.
Discard the probe cover by pressing the ejection button.
Procedure 4-2 Measuring Axillary Body Temperature—Electronic Thermometer
Outcome
Equipment/Supplies:
Place the probe in the center of the patient’s axilla.
Return the thermometer to its base.
Procedure 4-3 Measuring Rectal Body Temperature—Electronic Thermometer
Outcome
Equipment/Supplies:
Apply a lubricant to the tip of the probe cover.
Gently insert the probe inch into the rectum.
Procedure 4-4 Measuring Aural Body Temperature—Tympanic Membrane Thermometer
Outcome
Equipment/Supplies:
Place a cover on the probe.
When the thermometer is ready, it displays the word READY.
Straighten the canal of adults and children older than 3 years by pulling the ear auricle upward and backward.
Straighten the canal of children younger than 3 years by pulling the ear auricle downward and backward.
Read the temperature on the digital display.
Dispose of the probe cover.
Procedure 4-5 Measuring Temporal Artery Body Temperature
Outcome
Equipment/Supplies:
Place a disposable probe cover on the thermometer.
Position the probe on the center of the patient’s forehead.
Slowly slide the probe straight across the patient’s forehead.
Place the probe behind the ear lobe.
Read the temperature.
Wipe the probe with an antiseptic wipe.
Pulse
Mechanism of the Pulse
Factors Affecting Pulse Rate
Table 4-4 Pulse Rates of Various Age Groups
What Would You Do? What Would You Not Do?
Case Study 1
Pulse Sites
Radial
Memories of Practicum
Figure 4-10 Pulse sites.
Apical
Brachial
Ulnar
Temporal
Figure 4-11 The apical pulse is found over the apex of the heart, which is located in the fifth intercostal space at the junction of the left midclavicular line.
Carotid
Femoral
Popliteal
Posterior Tibial
Dorsalis Pedis
Assessment of Pulse
Pulse Rate
Pulse Rhythm and Volume
Patient Teaching: Aerobic Exercise
What Is Aerobic Exercise?
What Are the Benefits of an Aerobic Exercise Program?
What Is Target Heart Rate?
How Do I Determine My Target Heart Rate?
How Often Should Aerobic Exercise Be Performed?
Respiration
Mechanism of Respiration
Control of Respiration
Figure 4-12 Inhalation and exhalation.
What Would You Do? What Would You Not Do?
Case Study 2
Assessment of Respiration
Respiratory Rate
Figure 4-13 Exchange of oxygen and carbon dioxide between the alveoli of the lungs and the blood.
Table 4-5 Respiratory Rates of Various Age Groups
Rhythm and Depth of Respiration
Color of the Patient
Respiratory Abnormalities
Patient Teaching: Chronic Obstructive Pulmonary Disease
What Is COPD?
How Many People Have COPD?
What Causes COPD?
What Types of Tests Might the Physician Order?
What Treatment Might the Physician Prescribe?
Table 4-6 Abnormal Breath Sounds
Breath Sounds
Pulse Oximetry
Assessment of Oxygen Saturation
Mechanism of Action
Figure 4-14 Pulse oximeter.
Figure 4-15 The probe of the pulse oximeter is attached to a peripheral capillary bed in the fingertip. The LED transmits light through the capillary bed to a light detector (photodetector) located on the other side of the probe to measure the oxygen saturation of hemoglobin.
Interpretation of Results
Purpose of Pulse Oximetry
Figure 4-16 Pulse oximeter monitor: controls, indicators, and displays.
Components of the Pulse Oximeter
Monitor
Probe
Figure 4-17 Disposable (top) and reusable (bottom) probes for the pulse oximeter.
Figure 4-18 Applying a probe to the tip of a finger.
Factors Affecting Pulse Oximetry
Pulse Oximeter Care and Maintenance
Procedure 4-6 Measuring Pulse and Respiration
Outcome
Equipment/Supplies:
Place the three middle fingers over the radial pulse site.
Count the pulse for 30 seconds.
Count the number of respirations for 30 seconds.
Procedure 4-7 Measuring Apical Pulse
Outcome
Equipment/Supplies:
Insert the earpieces into your ears with the earpieces directed slightly forward.
Count the number of beats for 30 seconds, and multiply by 2.
Procedure 4-8 Performing Pulse Oximetry
Outcome
Equipment/Supplies:
Disinfect the probe with an antiseptic wipe.
Connect the cable to the monitor by plugging it into the port on the monitor.
Position the probe securely on the fingertip.
Allow several seconds for the pulse oximeter to detect the pulse.
Read the oxygen saturation value and pulse rate.
Blood Pressure
Mechanism of Blood Pressure
Interpretation of Blood Pressure
Table 4-7 Classification of Blood Pressure for Adults Age 18 and Older
Pulse Pressure
Factors Affecting Blood Pressure
Table 4-8 Average Optimal Blood Pressure for Age
Assessment of Blood Pressure: Manual Method
Stethoscope
What Would You Do? What Would You Not Do?
Case Study 3
Stethoscope Chest Piece
Manual Sphygmomanometers
Aneroid Sphygmomanometer
Patient Teaching: Hypertension
What Is High Blood Pressure?
What Are the Symptoms of High Blood Pressure?
What Causes High Blood Pressure?
Uncontrollable Risk Factors
Controllable Risk Factors
What Can Happen if High Blood Pressure Is Not Treated?
Can High Blood Pressure Be Cured?
How Long Will I Undergo Treatment?
Figure 4-19 A, The parts of a stethoscope. B, Types of chest pieces.
Figure 4-20 The parts of an aneroid sphygmomanometer.
Figure 4-21 The scale of the gauge of an aneroid sphygmomanometer.
Mercury Sphygmomanometer
Cuff Sizes
Figure 4-22 A, Wall-mounted aneroid sphygmomanometer. B, Mobile floor-stand aneroid sphygmomanometer.
Figure 4-23 The parts of a mercury sphygmomanometer.
Table 4-9 Types of Blood Pressure Cuffs
Figure 4-24 Blood pressure cuffs: child, adult, and thigh.
Highlight on Stethoscopes
Figure 4-25 Determination of proper cuff size. A, The bladder of the cuff should be long enough to encircle 80% of the arm. B, The cuff should be wide enough to cover two thirds of the distance from the axilla to the antecubital space.
Korotkoff Sounds
Figure 4-26 Determination of proper cuff size using the range and index line. A, Blood pressure cuff marked with a range line. B, The index line falls within the range line indicating that this is the proper-sized cuff for this patient.
Prevention of Errors in Blood Pressure Measurement
Table 4-10 Korotkoff Sounds
Assessment of Blood Pressure: Automatic Method
Advantages
Figure 4-27 Automatic blood pressure monitors. A, Portable automatic monitor. B, Mobile floor-stand automatic monitor (also includes an electronic thermometer and pulse oximeter).
Disadvantages
Procedure 4-9 Measuring Blood Pressure
Outcome
Equipment/Supplies:
Rotate the chest piece to the diaphragm position.
The inner bladder should encircle at least 80% of the patient’s arm.
Center the inner bladder over the brachial pulse site.
Locate the brachial pulse again before placing the diaphragm over the site.
Pump air into the cuff as rapidly as possible.
Release the pressure at a moderately steady rate.
Procedure 4-10 Determining Systolic Pressure by Palpation
Outcome
Equipment/Supplies:
Release the valve while palpating the radial artery.
Medical Practice and the Law
What Would You Do? What Would You Not Do?: Responses
Case Study 1
What Did Sergio Do?
What Did Sergio Not Do?
Case Study 2
What Did Sergio Do?
What Did Sergio Not Do?
Case Study 3
What Did Sergio Do?
What Did Sergio Not Do?
Certification Review
Temperature
Pulse
Respiration
Pulse Oximetry
Blood Pressure
Terminology Review
On the Web
Chapter 5 The Physical Examination
Key Terms
Introduction to the Physical Examination
Definitions of Terms
Preparation of the Examining Room
Highlight on Health Screening
Table 5-1 Equipment and Supplies for the Physical Examination
Preparation of the Patient
Figure 5-1 Common instruments and supplies used during the physical examination.
Measuring Weight and Height
Table 5-2 Interpretation of Body Mass Index
Highlight on Patient Teaching
What Would You Do? What Would You Not Do?
Case Study 1
Putting It All Into Practice
Figure 5-2 Body Mass Index Table. To use the table, find the appropriate height in the left-hand column labeled Height. Move across to a given weight (in pounds). The number at the top of the column is the BMI at that height and weight. Pounds have been rounded off.
What Would You Do? What Would You Not Do?
Case Study 2
Highlight on Cultural Diversity
Guidelines for Achieving Cultural Competence
Patient Teaching: Health Promotion and Disease Prevention
Guidelines for Measuring Weight and Height
Weight
Figure 5-3 Calibration markings for measuring weight on an upright balance scale. A, The upper calibration bar is divided into pounds and quarter pounds. B, The longer calibration lines indicate pound increments, and the shorter calibration lines indicate quarter-pound and half-pound increments.
Weight Conversion
Height Conversion
Height
Figure 5-4 Calibration markings for measuring height on an upright balance scale.
Figure 5-5 A, Reading a height measurement at the junction of the stationary calibration rod and the movable calibration rod. The height measurement in this illustration is 6 feet, 1 inch. B(1), Reading a height measurement on the stationary calibration rod. Note: The measuring bar must first be released and moved down to the stationary bar to measure the patient’s height. B(2), Reading the height at the junction of the bar and the rod. The height measurement in this illustration is 3 feet, 2 inches.
Highlight on Body Mass Index
Body Mass Index
Determining BMI
Adult Obesity
Procedure 5-1 Measuring Weight and Height
Outcome
Equipment/Supplies:
Weight
Ensure that the upper and lower weights are on zero.
Correct the balance by adjusting the screw on the balance knob.
Slide the upper weight by tapping it gently.
Height
Slide the bar upward until it is well above the patient’s height.
Lower the bar until it rests on top of the patient’s head.
Read the measurement to the nearest quarter-inch marking.
Body Mechanics
Principles
Figure 5-6 Vertebral column.
Application of Body Mechanics
Standing
Sitting
Figure 5-7 Proper standing position.
Figure 5-8 Proper sitting position.
Lifting
Figure 5-9 A, To lift the object, always bend the body at the knees and hips. B, Lift with the leg muscles, while keeping the back straight. C, Never bend from the waist.
Positioning and Draping
Procedure 5-2 Sitting Position
Outcome
Equipment/Supplies:
Sitting position.
Place the drape over the patient’s thighs and legs.
Procedure 5-3 Supine Position
Outcome
Equipment/Supplies:
Pull out the table extension while supporting the patient’s legs.
Position the patient on the back with the legs together.
Place a drape lengthwise over the patient.
Procedure 5-4 Prone Position
Outcome
Equipment/Supplies:
Position the patient’s legs together with the head turned to one side.
Place a drape lengthwise over the patient.
Procedure 5-5 Dorsal Recumbent Position
Outcome
Equipment/Supplies:
Ask the patient to bend the knees and place each foot at the edge of the examining table.
Place a drape diagonally over the patient.
Procedure 5-6 Lithotomy Position
Outcome
Equipment/Supplies:
Ask the patient to slide the buttocks to the edge of the table and to rotate the thighs outward.
Position the drape diagonally.
Procedure 5-7 Sims Position
Outcome
Equipment/Supplies:
The right leg is flexed sharply, and the left leg is flexed slightly.
Adjust the drape as needed.
Procedure 5-8 Knee-Chest Position
Outcome
Equipment/Supplies:
The buttocks are elevated, and the head is turned to one side.
Position the drape diagonally.
Procedure 5-9 Fowler’s Position
Outcome
Equipment/Supplies:
Ask the patient to lean back against the table head.
Position the table at a 45-degree angle for the semi-Fowler’s position.
Wheelchair Transfer
Figure 5-10 Transfer belts. A, Transfer belt that is 48 inches in length. B, Transfer belt that is 60 inches in length.
Procedure 5-10 Wheelchair Transfer
Outcome
Equipment/Supplies:
Transferring the Patient to the Examining Table
Position the wheelchair at a 45-degree angle.
Lock the brakes.
Grasp the transfer belt on either side of the patient’s waist.
Assist the patient to a standing position.
Position the patient toward the table.
Gradually lower the patient onto the table.
Transferring the Patient to the Wheelchair
Ask the patient to put his or her arms on your shoulders.
Assist the patient to a standing position.
Instruct the patient to step down from the footrest.
Gradually lower the patient into the wheelchair.
Assessment of the Patient
Table 5-3 Physician Assessment During the Physical Examination
Figure 5-11 A preprinted form for recording the results of the physical examination.
Memories of Practicum
Inspection
Palpation
Percussion
Auscultation
Figure 5-12 Palpation is examination of the body using the sense of touch.
Figure 5-13 Percussion involves tapping the patient with the fingers. A, The nondominant hand is placed directly on the area to be assessed, with the fingers slightly separated. B, The fingers of the dominant hand are used to strike the joint of the middle finger to produce a sound vibration.
What Would You Do? What Would You Not Do?
Case Study 3
Assisting the Physician
Procedure 5-11 Assisting With the Physical Examination
Outcome
Equipment/Supplies:
Assemble the equipment.
Greet and identify the patient by name and date of birth.
Instruct and prepare the patient for the examination.
Transfer the tongue depressor by holding it at the center.
Unroll a fresh length of paper.
Medical Practice and the Law
What Would You Do? What Would You Not Do?: Responses
Case Study 1
What Did Hope Do?
What Did Hope Not Do?
Case Study 2
What Did Hope Do?
What Did Hope Not Do?
Case Study 3
What Did Hope Do?
What Did Hope Not Do?
Certification Review
Terminology Review
On The Web
Chapter 6 Eye and Ear Assessment and Procedures
Key Terms
Introduction to Eye and Ear Assessment
The Eye
Structure of the Eye
Figure 6-1 The internal structure of the eye.
Visual Acuity
Figure 6-2 Diagram of normal refraction compared with myopia (nearsightedness) and hyperopia (farsightedness), which are errors of refraction that cause visual defects.
Assessment of Distance Visual Acuity (DVA)
Figure 6-3 Snellen eye chart consisting of letters in decreasing sizes; this chart is used to measure distance visual acuity.
Conducting a Snellen Test
Figure 6-4 Snellen Big E eye chart consisting of the capital letter E in decreasing sizes and arranged in different directions; this chart is used to measure distance visual acuity.
Assessing Distance Visual Acuity in Preschool Children
Assessment of Near Visual Acuity (NVA)
Figure 6-5 A, Cammie teaches a preschool child to point in the direction of the open part of the capital letter E. B, Cammie performs the Snellen Big E visual acuity test.
Highlight on Eye Assessment
Assessment of Color Vision
What Would You Do? What Would You Not Do?
Case Study 1
Figure 6-6 Example of a near visual acuity card.
Figure 6-7 Ishihara color plates. Polychromatic plates. In the left figure, a person with normal color vision reads 74, but a person with red-green color blindness reads 21. In the right figure, a red-blind person (protanope) reads 2, but a green-blind person (deuteranope) reads 4. A normal-vision person reads 42. Reproduced plates are not good for testing for color deficiency.
Ishihara Test
Putting It All Into Practice
Procedure 6-1 Assessing Distance Visual Acuity—Snellen Chart
Outcome
Equipment/Supplies:
Ask the patient to cover the right eye and to keep the left eye open.
Ask the patient to identify one line at a time.
Procedure 6-2 Assessing Color Vision—Ishihara Test
Outcome
Equipment/Supplies:
Hold the color plate 30 inches from the patient.
Eye Irrigation
Eye Instillation
What Would You Do? What Would You Not Do?
Case Study 2
Patient Teaching: Conjunctivitis
What Is Conjunctivitis?
What Are the Symptoms of Conjunctivitis?
Is Conjunctivitis Contagious?
How Can We Avoid Spreading Conjunctivitis?
Bacterial conjunctivitis.
Procedure 6-3 Performing an Eye Irrigation
Outcome
Equipment/Supplies:
Cleanse the eyelids from inner to outer canthus.
Separate the eyelids, and hold the tip of the syringe 1 inch above the eye.
Procedure 6-4 Performing an Eye Instillation
Outcome
Equipment/Supplies:
Ask the patient to look up, and insert the medication.
The Ear
Structure of the Ear
Assessment of Hearing Acuity
Types of Hearing Loss
Figure 6-8 Structure of the ear.
What Would You Do? What Would You Not Do?
Case Study 3
Hearing Acuity Tests
Gross Screening Test
Tuning Fork Tests
Audiometry
Figure 6-9 Weber test.
Figure 6-10 Rinne test.
Tympanometry
Memories from Externship
Figure 6-11 A, Audiometer. B, The patient signals when he hears a sound.
Figure 6-12 A, Tympanometer. B, The earpiece is placed snugly in the patient’s ear.
Ear Irrigation
Patient Teaching: Acute Otitis Media
What Is a Middle Ear Infection?
What Causes a Middle Ear Infection?
What Are the Symptoms of a Middle Ear Infection?
How Does the Physician Know Whether a Middle Ear Infection Is Present?
Chronic otitis media.
How Is the Infection Treated?
Serous otitis media.
Why Are Middle Ear Infections So Common in Children?
Ear Instillation
Highlight on Hearing Impairment
Procedure 6-5 Performing an Ear Irrigation
Outcome
Equipment/Supplies:
Assemble the equipment.
Inject the irrigating solution toward the roof of the ear canal.
Procedure 6-6 Performing an Ear Instillation
Outcome
Equipment/Supplies:
Instill the medication along the side of the ear canal.
Medical Practice and the Law
Patient Rights
What Would You Do? What Would You Not Do?: Responses
Case Study 1
What Did Cammie Do?
What Did Cammie Not Do?
Case Study 2
What Did Cammie Do?
What Did Cammie Not Do?
Case Study 3
What Did Cammie Do?
What Did Cammie Not Do?
Certification Review
Terminology Review
On The Web
Chapter 7 Physical Agents to Promote Tissue Healing
Key Terms
Introduction to Tissue Healing
Local Application of Heat and Cold
Putting it All into Practice
Factors Affecting the Application of Heat and Cold
Heat
Local Effects of Heat
Purpose of Applying Heat
Types of Heat Applications
Heating Pad
Hot Soak
Hot Compress
Figure 7-1 Effects of the local application of heat and cold.
Chemical Hot Pack
What Would You Do? What Would You Not Do?
Case Study 1
Cold
Local Effects of Cold
Purpose of Applying Cold
Types of Cold Applications
Ice Bag
Cold Compress
Chemical Cold Pack
Procedure 7-1 Applying a Heating Pad
Outcome
Equipment/Supplies:
Place the heating pad in a protective covering.
Procedure 7-2 Applying a Hot Soak
Outcome
Equipment/Supplies:
Replace cooler solution with hot solution.
Procedure 7-3 Applying a Hot Compress
Outcome
Equipment/Supplies:
Wring out the compress.
Apply the compress to the affected site.
Procedure 7-4 Applying an Ice Bag
Outcome
Equipment/Supplies:
Expel air from the bag.
Procedure 7-5 Applying a Cold Compress
Outcome
Equipment/Supplies:
Place large ice cubes in the basin.
Procedure 7-6 Applying a Chemical Pack
Outcome
Chemical packs.
Patient Teaching: Low Back Pain
What Causes Low Back Pain?
How Might the Physician Treat Low Back Pain?
What Can Be Done to Prevent Low Back Pain?
Patient Teaching: Body Mechanics
Standing and Walking
Lifting
Sitting
Driving
Sleeping
Figure 7-2 A fracture of the tibia in the left lower leg.
Casts
Figure 7-3 Pressure ulcer.
Memories of Practicum
Synthetic Casts
Cast Application
Figure 7-4 A roll of synthetic tape comes packaged in an airtight pouch.
Figure 7-5 Types of casts.
Figure 7-6 Application of a stockinette.
Figure 7-7 Application of cast padding.
Figure 7-8 Wrapping the tape over the body part, using a spiral turn.
Precautions
Guidelines for Cast Care
Symptoms to Report
Cast Removal
Figure 7-9 Cast removal. A, A cast cutter is used to cut the entire length of the cast. B, The cast is pried open with a cast spreader. C, Bandage scissors are used to cut through the cast padding and stockinette.
What Would You Do? What Would You Not Do?
Case Study 2
Splints and Braces
Figure 7-10 Arm splint.
Figure 7-11 Short leg walker, which is an example of a leg brace.
Patient Teaching: Cast Care
Ambulatory Aids
Crutches
Highlight on Ambulatory Aids
Figure 7-12 Types of crutches.
Axillary Crutch Measurement
Patient Teaching: Crutches
Crutch Guidelines
Crutch Gaits
Canes
Figure 7-13 Examples of a quad cane (left) and a standard cane (right).
Walkers
Figure 7-14 Walkers.
What Would You Do? What Would You Not Do?
Case Study 3
Procedure 7-7 Measuring for Axillary Crutches
Outcome
Determining Crutch Length
Position for measuring for crutches.
Handgrip Positioning
Insert two fingers between the top of the crutch and the axilla.
Procedure 7-8 Instructing a Patient in Crutch Gaits
Outcome
Tripod Position
Tripod position.
Four-Point Gait
Two-Point Gait
Three-Point Gait
Swing Gaits
Procedure 7-9 Instructing a Patient in Use of a Cane
Outcome
Procedure 7-10 Instructing a Patient in Use of a Walker
Outcome
Medical Practice and the Law
What Would You Do? What Would You Not Do?: Responses
Case Study 1
What Did Marlyne Do?
What Did Marlyne Not Do?
Case Study 2
What Did Marlyne Do?
What Did Marlyne Not Do?
Case Study 3
What Did Marlyne Do?
What Did Marlyne Not Do?
Certification Review
Terminology Review
On the Web
Chapter 8 The Gynecologic Examination and Prenatal Care
Key Terms
Introduction to the Gynecologic Examination and Prenatal Care
Gynecologic Examination
Gynecology
Figure 8-1 The female reproductive system.
Terms Related to Gynecology
Breast Examination
Putting It All into Practice
Patient Teaching: Breast Self-Examination
When Should I Examine My Breasts?
Why Is It Important to Examine My Breasts Every Month?
What Is Considered Normal?
What Should be Reported to the Physician?
What Would You Do? What Would You Not Do?
Case Study 1
Pelvic Examination
Inspection of External Genitalia, Vagina, and Cervix
Figure 8-2 Insertion of the vaginal speculum for visualization of the vagina and cervix.
Pap Test
Highlight on Breast Cancer
Survival Rate
Recommendations for Early Detection
Risk Factors
Warning Signs
Diagnosis
Patient Instructions
Specimen Collection
Vaginal Specimen
Figure 8-3 Obtaining the Pap specimen.
Cervical Specimen
Endocervical Specimen
Preparation Methods
Direct Smear
Liquid-Based Preparation
Figure 8-4 Collecting a Pap specimen using a broom.
Cytology Request
General Information
Date and Time of Collection
Collection Method
Source of the Specimen
Collection Technique
Patient History
Previous Treatment
Evaluation of the Pap Specimen
Maturation Index
Figure 8-5 Cytology request form.
Cytology Report
Figure 8-6 Cytology report form (The Bethesda System).
Table 8-1 Pap Test Results
Bimanual Pelvic Examination
Figure 8-7 The bimanual pelvic examination.
Rectal-Vaginal Examination
Procedure 8-1 Breast Self-Examination Instructions
Outcome
Equipment/Supplies:
Before a Mirror
Raise your arms over your head.
Press down firmly to flex the chest muscles.
Lying Down
Use the pads of the middle three fingers.
Use one of three patterns to examine the breasts.
Circular
Vertical Strip
Wedge
Examine the right breast.
In the Shower
Examine the breasts in the shower.
Procedure 8-2 Assisting With a Gynecologic Examination
Outcome
Equipment/Supplies:
Assemble equipment.
Instruct and prepare the patient for the examination.
Vigorously swirl the spatula in the preservative.
Rotate the brush in the preservative.
Push the broom vigorously into the bottom of the vial.
Hold the gauze with the lubricant for the physician.
Insert the laboratory request into the outside pocket.
Vaginal Infections
Trichomoniasis
Figure 8-8 Trichomonas vaginalis under a microscope.
Candidiasis
Figure 8-9 Preparing a wet preparation for the identification of Trichomonas vaginalis.
Figure 8-10 Candida albicans under a microscope.
Chlamydia
Gonorrhea
Highlight on Sexually Transmitted Diseases
Transmission
Symptoms
Treatment
Plan of Action
Prevention and Control
Chlamydia and Gonorrhea Specimen Collection
DNA-Based Detection Test
The physician inserts the swab into the tube and breaks off the shaft.
What Would You Do? What Would You Not Do?
Case Study 2
Memories of Practicum
Prenatal Care
Obstetrics
Obstetric Terminology
Prenatal Visits
First Prenatal Visit
Prenatal Record
Figure 8-11 Example of a prenatal record form.
Past Medical History
Menstrual History
Obstetric History
Present Pregnancy History
Interval Prenatal History
Initial Prenatal Examination
Purpose
Figure 8-12 Gestation calculator. The last menstrual period is July 20, and the expected date of delivery is April 25.
Preparation of the Patient
Patient Education
Warning Signs During Pregnancy
Signs of Infection
Signs of Spontaneous Abortion
Signs of Preeclampsia
Signs of Placental or Fetal Problems
Signs of Preterm Labor
Laboratory Tests
Table 8-2 Components of the Initial Prenatal Examination
Urine Tests
Urinalysis
Swab Tests
Pap Test
Chlamydia and Gonorrhea
Trichomoniasis and Candidiasis
Group B Streptococcus
What Would You Do? What Would You Not Do?
Case Study 3
Blood Tests
Complete Blood Count
Hemoglobin and Hematocrit
Rh Factor and ABO Blood Type
Glucose Challenge Test
Syphilis Test
Highlight on Gestational Diabetes Mellitus
Definition of Gestational Diabetes Mellitus
Cause of Gestational Diabetes Mellitus
Problems for the Child
Problems for the Mother
Risk Factors for Gestational Diabetes Mellitus
Treatment
Rubella Antibody Titer
Rh Antibody Titer (On Rh-Negative Blood Specimens)
Hepatitis B and Human Immunodeficiency Virus
Return Prenatal Visits
Fundal Height Measurement
Figure 8-13 Measurement of fundal height. The physician places one end of a centimeter tape measure on the superior aspect of the symphysis pubis and measures to the top of the uterine fundus.
Figure 8-14 Fundal height showing gestational age in weeks.
Fetal Heart Tones
Figure 8-15 A, Parts of a Doppler device. B, The probe of the Doppler device is moved across the abdomen to detect the fetal pulse.
Vaginal Examination
What Would You Do? What Would You Not Do?
Case Study 4
Figure 8-16 Effacement and dilation occur to permit the passage of the infant into the birth canal. The cervical canal shortens from its normal length of 1 to 2 cm to a structure with paper thin edges in which there is no canal at all. The cervix dilates from an opening a few millimeters wide to an opening large enough to allow the passage of the infant (approximately 10 cm).
Special Tests and Procedures
Multiple Marker Test
Figure 8-17 Obstetric ultrasound scan.
Obstetric Ultrasound Scan
Transabdominal Ultrasound Scan
Box 8-1 Purpose of Obstetric Ultrasound Scanning
Between 7 and 12 Weeks
Embryo at approximately 9 weeks of gestation.
Between 18 and 20 Weeks
Erect fetal penis. 1, urethra; 2, corpus cavernosum; 3, shaft; 4, glans; 5, foreskin.
Twins.
External female genitalia. 1, major labium; 2, minor labium; 3, vaginal cleft; 4, thighs.
At 34 Weeks
Other Purposes
Amniocentesis being performed under ultrasound guidance.
Endovaginal Ultrasound Scan
Amniocentesis
Figure 8-18 Amniocentesis.
Fetal Heart Rate Monitoring
Medical Assisting Responsibilities
Patient Teaching: Obstetric Ultrasound Scan
What Is an Ultrasound Scan?
Why Is an Ultrasound Scan Performed?
What Preparation Is Needed?
Is an Ultrasound Scan Safe?
Can I Learn the Sex of My Baby Through an Ultrasound Scan?
Procedure 8-3 Assisting with a Return Prenatal Examination
Outcome
Equipment/Supplies:
Set up the prenatal tray.
Measure the patient’s blood pressure.
Weigh the patient.
Apply a liberal amount of coupling gel.
Assist the patient off the examining table.
Six Weeks Postpartum Visit
Table 8-3 Six Weeks Postpartum Examination
Medical Practice and the Law
Mature Minor
What Would You Do? What Would You Not Do?: Responses
Case Study 1
What Did Yin-Ling Do?
What Did Yin-Ling Not Do?
Case Study 2
What Did Yin-Ling Do?
What Did Yin-Ling Not Do?
Case Study 3
What Did Yin-Ling Do?
What Did Yin-Ling Not Do?
Case Study 4
What Did Yin-Ling Do?
What Did Yin-Ling Not Do?
Certification Review
Terminology Review
On The Web
Chapter 9 The Pediatric Examination
Key Terms
Introduction to the Pediatric Examination
Pediatric Office Visits
What Would You Do? What Would You Not Do?
Case Study 1
Table 9-1 Milestones of Gross and Fine Motor Development in Infancy
Figure 9-1 The medical assistant should develop a rapport with children to gain their trust and cooperation. Making a game of the procedure (A) and explaining the purpose of the stethoscope and allowing the child to hold it (B) can help the child overcome fears.
Developing a Rapport
Table 9-2 Techniques for Interaction With Children
Carrying the Infant
Cradle Position
Upright Position
Figure 9-2 Traci holds the infant in the cradle position.
Figure 9-3 Traci holds the infant in the upright position.
Growth Measurements
Figure 9-4 Measuring the height of a child.
Weight
Length and Height
Head and Chest Circumference
Putting it All into Practice
Highlight on Childhood Obesity
Statistics
Causes
Related Problems
Prevention
Treatment
Growth Charts
Procedure 9-1 Measuring the Weight and Length of an Infant
Outcome
Equipment/Supplies:
Balance the scale.
Read the results in pounds and ounces.
Properly position the infant.
Read the length in inches.
Procedure 9-2 Measuring Head and Chest Circumference of an Infant
Outcome
Equipment/Supplies:
Measurement of Head Circumference
Position the tape measure around the infant’s head.
Measurement of Chest Circumference
Encircle the tape around the infant’s chest.
Procedure 9-3 Calculating Growth Percentiles
Outcome
Equipment/Supplies:
Pediatric Blood Pressure Measurement
Special Guidelines for Children
Correct Cuff Size
Cooperation of the Child
Table 9-3 Acceptable Bladder Dimensions for Arms of Different Sizes
Figure 9-5 Determination of proper blood pressure cuff size.
Figure 9-6 Traci measures the blood pressure of a pediatric patient.
What Would You Do? What Would You Not Do?
Case Study 2
Blood Pressure Classifications
Memories of Practicum
Collection of a Urine Specimen
Procedure 9-4 Applying a Pediatric Urine Collector
Outcome
Equipment/Supplies:
Remove paper backing from the urine collector bag.
Firmly press the adhesive surface to the skin surrounding the external genitalia.
Female: The opening of the bag should be directly over the urinary meatus. Male: The penis and scrotum are projected through the opening of the bag.
Pediatric Injections
Types of Needles
Intramuscular Injection Sites
Figure 9-7 Dorsogluteal intramuscular injection site.
Figure 9-8 A, Vastus lateralis intramuscular injection site. (Courtesy Wyeth Laboratories, Philadelphia, Penn.) B, Location of the vastus lateralis injection site in an infant. Divide the mid-anterior thigh into thirds. The injection is administered into the middle third of the thigh.
Figure 9-9 A, Compression of the vastus lateralis muscle. B, IM injection into the vastus lateralis injection site.
Immunizations
Figure 9-10 Deltoid intramuscular injection site.
Figure 9-11 Recommended immunization schedule for persons aged 0 through 18 years.
Table 9-4 Infant and Childhood Immunizations
Table 9-5 Infant and Childhood Combination Immunizations
National Childhood Vaccine Injury Act
Figure 9-12 Immunization record card.
What Would You Do? What Would You Not Do?
Case Study 3
Newborn Screening Test
Figure 9-13 Vaccine information statement for diphtheria, tetanus, and pertussis (DTaP).
Figure 9-14 Immunization administration record included in a patient’s medical record.
Figure 9-15 Newborn screening test card.
Patient Teaching: Childhood Immunizations
What is immunity?
How do immunizations prevent disease?
What childhood diseases can be prevented through immunization?
Haven’t most of these diseases been eliminated in the United States?
Do immunizations have side effects?
Are immunizations required by law?
Procedure 9-5 Newborn Screening Test
Outcome
Equipment/Supplies:
Assemble the equipment.
Plantar surface of the heel.
Warm the puncture site.
Grasp the infant’s foot, and make the puncture.
Completely fill the circle with the blood specimen.
Medical Practice and the Law
What Would You Do? What Would You Not Do?: Responses
Case Study 1
What Did Traci Do?
What Did Traci Not Do?
Case Study 2
What Did Traci Do?
What Did Traci Not Do?
Case Study 3
What Did Traci Do?
What Did Traci Not Do?
Certification Review
Terminology Review
On The Web
Chapter 10 Minor Office Surgery
Key Terms
Introduction to Minor Office Surgery
Figure 10-1 Consent to treatment form.
Guidelines for Surgical Asepsis
Surgical Asepsis
Instruments Used in Minor Office Surgery
Scalpels
Figure 10-2 Parts of an instrument.
Scissors
Forceps
Miscellaneous Instruments
Gynecologic Instruments
Figure 10-3 Instruments used in minor office surgery.
Putting It All into Practice
Care of Surgical Instruments
Commercially Prepared Sterile Packages
Figure 10-4 Methods for removing the sterile contents of a peel-apart package so that sterility is maintained. A, Grasp each flap between a bent index finger and an extended thumb, and roll hands outward to pull apart. B, Step back and eject the contents onto the field. C, The medical assistant opens the pack, and the physician removes the sterile contents with a gloved hand. D, The inside of the peel-apart package can be used as a sterile field.
Procedure 10-1 Applying and Removing Sterile Gloves
Outcome
Equipment/Supplies:
Applying Sterile Gloves
Pick up the first glove on the inside of the cuff.
Pick up the second glove.
Turn back the cuff.
Removing Sterile Gloves
Grasp the outside of the glove.
Scrunch the glove into a ball.
Place the fingers on the inside of the glove.
Pull the glove off the hand.
Procedure 10-2 Opening a Sterile Package
Outcome
Equipment/Supplies:
Check the sterilization indicator.
Open the first flap away from the body.
Open the left and right flaps.
Open the flap closest to the body.
Procedure 10-3 Pouring a Sterile Solution
Outcome
Equipment/Supplies:
Pour the proper amount of solution.
Wounds
Wound Healing
Figure 10-5 Types of wounds.
Patient Teaching: Wound Care
Figure 10-6 Phases of wound healing.
Phases of Wound Healing
Phase 1
Phase 2
Phase 3
Wound Drainage
Sterile Dressing Change
Procedure 10-4 Changing a Sterile Dressing
Outcome
Equipment/Supplies:
Side Table
Sterile Field
Prepare the side table.
Remove the soiled dressing.
Apply an antiseptic to the wound.
Prepare the sterile field.
Instruct the patient in wound care.
Sutures
Types of Sutures
Memories of Practicum
Figure 10-7 Swaged suture packets. A, Absorbable sutures. B, Nonabsorbable sutures.
Figure 10-8 A, Sutures come in a box of individually packaged sutures. B, Each individual suture package consists of an outer peel-apart envelope and a sterile inner packet.
Suture Size and Packaging
Suture Needles
Figure 10-9 Common suture needles. A, Needles with a cutting point. B, Eyed needles and a swaged needle.
Insertion of Sutures
Suture Insertion Setup
Items Placed to the Side of the Sterile Field
Suture insertion side table.
Items Included on the Sterile Field
Suture insertion sterile field.
Figure 10-10 Adding sutures to a sterile field.
Procedure: Suture Insertion
Postoperative Instructions: Suture Insertion
Suture Removal
What Would You Do? What Would You Not Do?
Case Study 1
Surgical Skin Staples
Figure 10-11 Disposable skin stapler.
Procedure 10-5 Removing Sutures and Staples
Outcome
Equipment/Supplies:
For Suture Removal
For Staple Removal
Suture removal setup.
Staple removal setup.
Open the suture removal kit.
Cut the suture below the knot on the side closest to the skin.
Gently pull the suture out.
A, Place the bottom jaws of the staple remover under the staple. B, Firmly squeeze the staple handles until they are fully closed.
Adhesive Skin Closures
Figure 10-12 Adhesive skin closures in different sizes.
Procedure 10-6 Applying and Removing Adhesive Skin Closures
Outcome
Equipment/Supplies:
Application of Adhesive Skin Closures
Assemble the equipment.
Clean the wound.
Apply an antiseptic to the wound.
Apply tincture of benzoin.
Peel a strip of tape off the card.
Position the first strip over the center of the wound.
Apply the strips until the edges of the wound are approximated.
Apply a strip along each edge.
Ask the patient to sign the instruction sheet.
Removal of Adhesive Skin Closures
Assisting with Minor Office Surgery
Tray Setup
Methods Used to Set Up a Sterile Tray
Side Table
Skin Preparation
Shaving the Site
Cleansing the Site
Figure 10-13 Cleansing solutions.
Antiseptic Application
Local Anesthetic
Figure 10-14 Fenestrated drape.
Preparing the Anesthetic
Assisting the Physician
Figure 10-15 Drawing up the local anesthetic. A, Trudy holds up the vial so that the physician can verify the name and strength of the local anesthetic. B, Trudy holds the vial securely while the physician withdraws the medication.
Figure 10-16 Trudy hands a hemostat to the physician in its functional position.
Figure 10-17 Biopsy requisition.
What Would You Do? What Would You Not Do?
Case Study 2
Highlight on the History of Surgery
Primitive Surgery
Early 1800s
Mid-1800s
Late 1800s and Early 1900s
Procedure 10-7 Assisting with Minor Office Surgery
Outcome
Equipment/Supplies:
Preparing the Tray
Open the sterile pack using the inside of the wrapper as the sterile field.
Lay the sterile towel down gently and slowly.
Arrange the articles neatly on the sterile field.
Cover the tray setup with a sterile towel.
Preparing the Patient
Cleanse the patient’s skin with an antiseptic solution.
Assisting the Physician
Hold a basin for the physician to deposit soiled instruments.
Hold the container to accept a tissue specimen.
Medical Office Surgical Procedures
Sebaceous Cyst Removal
Figure 10-18 Sebaceous cyst.
Sebaceous Cyst Setup
Items Placed to the Side of the Sterile Field
Figure 10-19 Sebaceous cyst removal. The physician makes an incision, removes the cyst, and sutures the surgical incision.
Sebaceous cyst removal side table.
Items Included on the Sterile Field
Procedure: Sebaceous Cyst Removal
Sebaceous cyst removal sterile field.
Postoperative Instructions: Sebaceous Cyst Removal
Surgical Incision and Drainage of Localized Infections
Incision and Drainage Setup
Items Placed to the Side of the Sterile Field
Figure 10-20 A, Staphylococcus skin abscess. B, An abscess is a collection of pus in a cavity surrounded by inflamed tissue.
Figure 10-21 Furuncle (boil) resulting from a Staphylococcus aureus infection.
Incision and drainage side table.
Items Included on the Sterile Field
Incision and drainage sterile field.
Procedure: Incision and Drainage
Postoperative Instructions: Incision and Drainage
Mole Removal
Figure 10-22 Skin tags.
Figure 10-23 Raised moles.
Figure 10-24 Dysplastic nevi.
Figure 10-25 The ABCDs of melanoma. A: Asymmetry (one half unlike the other half). B: Border (edges of mole are notched, uneven, or blurred). C: Color varied from one area to another; shades of tan, brown, and black, and sometimes white, red, or blue. D: Diameter larger than inch or 6 mm (diameter of a pencil eraser).
Mole Shave Excision Setup
Items Placed to Side of the Sterile Field
Items Placed on the Sterile Field
Procedure: Mole Shave Excision
Surgical Mole Excision Setup
Items Placed to Side of the Sterile Field
Items Placed on the Sterile Field
Procedure: Surgical Mole Excision
Postoperative Instructions: Shave Excision and Surgical Excision
Laser Mole Surgery
Needle Biopsy
Needle Biopsy Setup
Items Placed to the Side of the Sterile Field
Figure 10-26 Biopsy needle. A, A biopsy needle consists of an outer needle for making the puncture and a forked inner needle for obtaining the specimen. B, The inner needle detaches tissue from a part of the body and brings it to the surface through its lumen.
Items Included on the Sterile Field
Procedure: Needle Biopsy
Postoperative Instructions: Needle Biopsy
Ingrown Toenail Removal
Ingrown Toenail Removal Setup
Figure 10-27 Ingrown toenail. A, The edge of the toenail grows deeply into the nail groove. B, In mild cases, treatment consists of inserting a small piece of cotton packing under the toenail. C, In severe and recurring cases, a wedge of the nail is surgically removed. D, A strip of surgical tape is applied over the area.
Figure 10-28 Ingrown toenail.
Items Placed to the Side of the Sterile Field
Items Included on the Sterile Field
Procedure: Ingrown Toenail
Postoperative Instructions: Ingrown Toenail
Colposcopy
Figure 10-29 A colposcope.
Colposcopy Setup
Items Placed to the Side of the Sterile Field
Items Included on the Sterile Field
Procedure: Colposcopy
Figure 10-30 A, Normal cervix. B, Abnormal cervix.
Cervical Punch Biopsy
Cervical Punch Biopsy Setup
Items Placed to the Side of the Sterile Field
What Would You Do? What Would You Not Do?
Case Study 3
Items Included on the Sterile Field
Procedure: Cervical Punch Biopsy
Postoperative Instructions: Cervical Punch Biopsy
Figure 10-31 Cervical punch biopsy. A, Obtaining a tissue specimen from the cervix using cervical biopsy punch forceps. B, Cervical biopsy punch forceps.
Cryosurgery
Cervical Cryosurgery
Cryosurgery Setup
Items Placed to the Side of the Sterile Field
Figure 10-32 Cryosurgery unit.
Items Included on the Sterile Field
Procedure: Cervical Cryosurgery
Postoperative Instructions: Cervical Cryosurgery
Skin Lesions
Bandaging
Guidelines for Application
Types of Bandages
Bandage Turns
Figure 10-33 Procedure for anchoring a bandage.
Figure 10-34 Procedure for making the spiral turn.
Tubular Gauze Bandages
Figure 10-35 Procedure for making the spiral-reverse turn. A, Encircle the part while keeping the bandage at a slant. B, Reverse the spiral turn using the thumb or index finger, and direct the bandage downward to fold it on itself. C, Keep the bandage parallel to the lower edge of the previous turn.
Figure 10-36 Procedure for applying an elastic bandage around the ankle using a figure-eight turn.
Figure 10-37 Procedure for using the recurrent turn to bandage the end of a stump.
Table 10-1 Tubular Gauze Bandage Widths and Recommended Application Sites
Procedure 10-8 Applying a Tubular Gauze Bandage
Outcome
Equipment/Supplies:
Assemble the equipment.
Slide the gauze over one end of the applicator.
Place the applicator over the patient’s finger.
Move the applicator from the proximal to the distal end of the patient’s finger.
Rotate the applicator one full turn.
Cut unused gauze from the applicator.
Medical Practice and the Law
What Would You Do? What Would You Not Do?: Responses
Case Study 1
What Did Trudy Do?
What Did Trudy Not Do?
Case Study 2
What Did Trudy Do?
What Did Trudy Not Do?
Case Study 3
What Did Trudy Do?
What Did Trudy Not Do?
Certification Review
Terminology Review
On The Web
Chapter 11 Administration of Medication and Intravenous Therapy
Key Terms
Introduction to the Administration of Medication
Administering, Prescribing, and Dispensing Medication
Legal Aspects
Routes of Administration
Drug References
Food and Drug Administration
Drug Nomenclature
Figure 11-1 Guidelines for using the Physician’s Desk Reference.
What Would You Do? What Would You Not Do?
Case Study 1
Classification of Drugs Based on Preparation
Liquid Preparations
Solid Preparations
Classification of Drugs Based on Action
Table 11-1 Classification of Drugs Based on Action
Systems of Measurement for Medication
Metric System
Apothecary System
Household System
Converting Units of Measurement
Metric Notation Guidelines
Metric System: Conversion of Equivalent Values
Weight
Volume
Table 11-2 Household System: Conversion of Common Values
Table 11-3 Conversion Charts for Systems of Measurement
Controlled Drugs
Putting It All into Practice
Prescription
Apothecary Notation Guidelines
Apothecary System: Conversion of Equivalent Values
Weight
Volume
Parts of a Prescription
Table 11-4 Classification of Controlled Drugs
Table 11-5 Common Abbreviations and Symbols Used in Medication Documentation
Generic Prescribing
Figure 11-2 Example of a hand-written prescription.
Completing a Prescription Form
EMR Prescription Program
Guidelines for Completing a Prescription Form
Medication Record
Patient Teaching: Prescription Medications
What Would You Do? What Would You Not Do?
Case Study 2
Figure 11-3 Example of a computer-generated prescription.
Figure 11-4 Example of a computer-generated patient medication list.
Figure 11-5 Example of a medication record.
Factors Affecting Drug Action
Therapeutic Effect
Age
Route of Administration
Size
Time of Administration
Tolerance
Memories from Practicum
Undesirable Effects of Drugs
Adverse Reactions
Drug Interactions
Allergic Drug Reaction
Idiosyncratic Reaction
Guidelines for Preparation and Administration of Medication
Oral Administration
Procedure 11-1 Administering Oral Medication
Outcome
Equipment/Supplies:
Compare the medication with the physician’s instructions.
Pour the correct number of capsules or tablets into the bottle cap.
Place the lid of the bottle on a flat surface with the open end facing up.
Hold the cup at eye level, and pour the medication.
Parenteral Administration
Figure 11-6 Diagram of a needle and a 3-mL syringe, with parts identified.
Parts of a Needle and Syringe
Needle
Figure 11-7 Needle lengths and gauges.
Syringe
Figure 11-8 Examples of syringe and needle packages labeled according to contents.
Safety-Engineered Syringes
Figure 11-9 Various syringes used to administer injections. A, Hypodermic. B, Insulin (U-100). C, Tuberculin.
Preparation of Parenteral Medication
Vials
Ampules
Prefilled Syringes
Storage
Reconstitution of Powdered Drugs
Figure 11-10 Safety-engineered syringes.A.Hinged-Shield Syringe (Becton-Dickinson Safety Glide Syringe)1.After administering the injection, push the lever of the hinged shield forward.2.Continue pushing until the needle tip is fully covered by the shield, then discard the syringe in a biohazard sharps container.B.Sliding-Shield Syringe (Monoject Safety Syringe)1.After administering the injection, extend the sliding shield forward fully until a click is heard.2.Lock the shield by twisting it in either direction until a click is heard. Discard the syringe in a biohazard sharps container.C.Retractable needle (Vanish Point Syringe)1.Administer the injection following the proper technique.2.After administering the medication, continue depressing the plunger with the thumb. Use firm pressure past the point of initial resistance. This action delivers the full dose of medication to the patient and activates the needle retraction device, causing the needle to retract automatically from the patient’s skin and into the barrel of the syringe.3.Discard the syringe in a biohazard sharps container.
Subcutaneous Injections
Figure 11-11 The multiple-dose vial (left) and the single-dose vial (middle) consist of a closed glass container with a rubber stopper. The ampule (right) consists of a small, sealed glass container that holds a single dose of medication.
Figure 11-12 Information included on the label of a medication vial.
Figure 11-13 Filter needle used to withdraw medication from an ampule.
Figure 11-14 A prefilled disposable syringe of medication.
Figure 11-15 The measles, mumps, and rubella (MMR) vaccine is a parenteral medication that requires reconstitution before administration. The vial on the left contains the medication in powdered form, and the vial on the right contains the sterile diluent.
Intramuscular Injections
Figure 11-16 Angle of insertion for intradermal, subcutaneous, and intramuscular injections.
Figure 11-17 Common sites for subcutaneous injections. A, Upper outer arm. B, Lower abdomen. C, Upper outer thigh. D, Upper back. E, Flank region.
Intramuscular Injection Sites
Dorsogluteal Site
Deltoid Site
Figure 11-18 Sites of intramuscular injections. A, Dorsogluteal muscle. B, Deltoid muscle. C, Vastus lateralis. D, Ventrogluteal muscle.
Vastus Lateralis Site
Ventrogluteal Site
Figure 11-19 Location of the deltoid site.
Z-Track Method
What Would You Do? What Would You Not Do?
Case Study 3
Figure 11-20 Z-track intramuscular injection method. A, The skin and subcutaneous tissue are pulled to the side before the needle is inserted. B, This causes a zigzag path through the tissue when the skin is released, which seals off the needle track.
Procedure 11-2 Preparing an Injection
Outcome
Equipment/Supplies:
Compare the medication with the physician’s instructions.
Check the drug label three times.
Check the expiration date.
Check the package insert.
Withdrawing Medication From a Vial
Cleanse the rubber stopper.
Draw air into the syringe.
Inject air into the vial.
Withdraw the proper amount of medication.
Tap the barrel with the fingertips to remove air bubbles.
Withdrawing Medication From an Ampule
Snap off the stem away from the body.
Withdraw the medication.
Procedure 11-3 Reconstituting Powdered Drugs
Outcome
Equipment/Supplies:
Inject the diluent into the vial.
Roll the vial between the hands.
Procedure 11-4 Administering a Subcutaneous Injection
Outcome
Equipment/Supplies:
Cleanse the area with an antiseptic wipe.
Grasp the area surrounding the injection site.
Insert the needle at a 45-degree angle.
Pull back gently to determine whether the needle is in a blood vessel.
Procedure 11-5 Administering an Intramuscular Injection
Outcome
Equipment/Supplies:
Cleanse the site with an antiseptic wipe.
A-B, Insert the needle at a 90-degree angle.
Aspirate to determine whether the needle is in a blood vessel.
A-B, Inject the medication slowly and steadily.
Apply gentle pressure to the injection site.
Procedure 11-6 Z-Track Intramuscular Injection Technique
Outcome
Equipment/Supplies:
Intradermal Injections
Figure 11-21 Intradermal injections are used to administer skin tests. Enough medication must be deposited in the skin layers to form a wheal.
Tuberculin Skin Testing
Tuberculosis
Purpose of Tuberculin Skin Testing
Table 11-6 Differences Between Active TB and Latent TB
Tuberculin Skin Test Reactions
Mantoux Tuberculin Skin Test
Figure 11-22 Positive tuberculin skin test.
Highlight on Tuberculosis
What Part of the Body Becomes Infected?
Is TB Contagious?
Who is at Risk for TB?
How is TB Treated?
Is There a Vaccine for Tuberculosis?
Is TB a Reportable Disease?
Guidelines for Administering a Mantoux TST
Guidelines for Reading Mantoux TST Results
Figure 11-23 Positive tuberculin skin test showing induration and erythema. Induration is the only criterion used to determine a positive reaction.
Table 11-7 Interpretation of the Tuberculin Mantoux Skin Test*
Two-Step Tuberculin Skin Test
Tuberculosis Blood Test
Figure 11-24 Interpretation of the two-step Mantoux tuberculin skin test.
Allergy Testing
Allergy
Allergic Reaction
Diagnosis and Treatment
Table 11-8 Clinical Forms of Allergies
Types of Allergy Tests
Direct Skin Testing
Quality Control
Types of Direct Skin Tests
Patch Testing
Highlight on Allergens
House Dust
Insect Stings
Penicillin
Figure 11-25 Patch testing. A patch consists of a small piece of gauze or filter paper impregnated with the allergen, which is applied to the skin and taped in place.
Skin-Prick Testing
Figure 11-26 Patch test showing positive results.
Table 11-9 Guidelines for Recording Direct Skin Test Results
Figure 11-27 Skin-prick testing. Skin-prick testing involves the application of numerous allergen extracts to the skin, followed by the pricking of each with a sterile needle.
Figure 11-28 Intradermal skin testing. Intradermal testing involves the injection of a small amount of allergen extract into the superficial skin layers through the intradermal route of administration.
Intradermal Skin Testing
Figure 11-29 Skin-prick and intradermal skin test results.
In Vitro Allergy Blood Testing
Procedure 11-7 Administering an Intradermal Injection
Outcome
Equipment/Supplies:
Insert the needle at a 10- to 15-degree angle with the bevel upward.
Inject the medication to form a wheal.
Properly dispose of the needle and syringe.
Equipment/Supplies:
Lightly palpate for induration.
Measure the induration.
Intravenous Therapy
Advantages of Outpatient Intravenous Therapy
Figure 11-30 IV therapy.
Figure 11-31 Patient receiving IV therapy in an outpatient setting.
Earlier Hospital Discharge
Avoidance of Hospitalization
Medical Office–Based Intravenous Therapy
Indications for Outpatient Intravenous Therapy
Scheduling the IV Therapy
Medical Office Guidelines
Medical Practice and the Law
What Would You Do? What Would You Not Do?: Responses
Case Study 1
What Did Theresa Do?
What Did Theresa Not Do?
Case Study 2
What Did Theresa Do?
What Did Theresa Not Do?
Case Study 3
What Did Theresa Do?
What Did Theresa Not Do?
Certification Review
Terminology Review
On The Web
Chapter 12 Cardiopulmonary Procedures
Key Terms
Introduction to Electrocardiography
Structure of the Heart
Figure 12-1 A three-channel electrocardiograph.
Conduction System of the Heart
Figure 12-2 Diagram of the heart.
Figure 12-3 Coronary arteries.
Putting it All into Practice
Cardiac Cycle
Figure 12-4 Diagram of the heart, identifying the structures involved with the conduction of an electrical impulse through the heart.
Waves
Figure 12-5 ECG cycle.
Baseline, Segments, and Intervals
Segments
Intervals
Electrocardiograph Paper
Figure 12-6 Diagram of ECG paper with a section enlarged to indicate the sizes of the large and small squares.
Standardization of the Electrocardiograph
Figure 12-7 Standardization mark.
Electrocardiograph Leads
Electrodes
Figure 12-8 Diagram of the basic components of the electrocardiograph. The limb electrodes are attached to the fleshy parts of the limbs, and the lead wires are arranged to follow body contour. The patient cable is not dangling, and the power cord points away from the electrocardiograph.
Figure 12-9 Resting 12-lead ECG electrodes. A, Disposable resting 12-lead electrode. B, The tab allows for attachment of the alligator clip. C, The back of the electrode contains an electrolyte gel combined with an adhesive. D, Disposable 12-lead electrodes are packaged in a foil-lined pouch and come on a card that contains 10 electrodes.
Bipolar Leads
Augmented Leads
Chest Leads
Figure 12-10 Diagram of the heart’s voltage for leads I, II, III, aVR, aVL, and aVF.
Highlight on Cardiac Stress Testing
Description
Purpose
Patient Preparation
How the Test Works
Interpretation of Results
Cardiac treadmill stress test.
Paper Speed
What Would You Do? What Would You Not Do?
Case Study 1
Figure 12-11 Recommended positions for ECG chest electrodes:1.V1, fourth intercostal space at right margin of sternum2.V2, fourth intercostal space at left margin of sternum3.V3, midway between positions 2 and 44.V4, fifth intercostal space at junction of left midclavicular line5.V5, at horizontal level of position 4 at left anterior axillary line6.V6, at horizontal level of position 4 at left midaxillary line
Patient Preparation
Maintenance of the Electrocardiograph
Electrocardiographic Capabilities
Three-Channel Recording Capability
Interpretive Electrocardiograph
Figure 12-12 A three-channel ECG with a rhythm strip.
EMR Connectivity
Teletransmission
Artifacts
Figure 12-13 An ECG recording that has been analyzed by an interpretive electrocardiograph. The computer analysis is printed at the top of the recording, along with the reason for each interpretation.
Muscle Artifact
Figure 12-14 A-D, Examples of ECG artifacts.
Wandering Baseline Artifact
60-Cycle Interference Artifact
Interrupted Baseline Artifact
Procedure 12-1 Running a 12-Lead, Three-Channel Electrocardiogram
Outcome
Equipment/Supplies:
Apply the leg electrodes.
Apply the arm electrodes.
Apply the chest electrodes.
Connect the lead wires to the electrodes.
Enter patient data.
Check the standardization mark.
Holter Monitor Electrocardiography
Figure 12-15 Digital Holter monitor.
Purpose
Digital Holter Monitor
Patient Preparation
Memories from Practicum
Electrode Placement
Figure 12-16 A, Diagram of an electrode used with a Holter monitor. B, Holter monitor electrode (front and back).
Figure 12-17 Holter monitor patient diary.
Patient Diary
Event Marker
Holter Monitor Patient Guidelines
Evaluating Results
Maintenance of the Holter Monitor
Procedure 12-2 Applying a Holter Monitor
Outcome
Equipment/Supplies:
Assemble the equipment.
Insert the battery.
Shave the chest.
Rub the skin with an alcohol wipe.
Slightly abrade the skin with a skin abrader.
Snap the color-coded lead wires onto the electrodes.
Ensure a firm seal of each electrode.
Insert the monitor into a disposable pouch.
Provide the patient with instructions on completion of the diary.
Cardiac Dysrhythmias
Premature Atrial Contraction
Description
Premature atrial contraction.
Clinical Significance
Paroxysmal Atrial Tachycardia
Description
Clinical Significance
Paroxysmal atrial tachycardia.
Patient Teaching: Angina Pectoris
What is Angina Pectoris?
What Causes Angina Pectoris?
What Happens During an Angina Episode?
What Tests Might be Ordered by the Physician?
What Type of Treatment Might be Prescribed by the Physician?
Atrial Flutter
Description
Clinical Significance
Atrial flutter.
Atrial Fibrillation
Description
Clinical Significance
Atrial fibrillation.
Premature Ventricular Contraction
Description
Clinical Significance
Premature ventricular contraction.
Ventricular Tachycardia
Description
Clinical Significance
Ventricular tachycardia.
Ventricular Fibrillation
Description
Clinical Significance
Ventricular fibrillation.
Pulmonary Function Tests
Spirometry
Spirometry Test Results
Forced Vital Capacity
Forced Expiratory Volume after 1 Second
FEV1 /FVC Ratio
What Would You Do? What Would You Not Do?
Case Study 2
Evaluation of Results
Figure 12-18 Spirometry parameters.
Figure 12-19 Predicted values compared with measured values. This individual exhibits a moderate airflow obstruction.
Patient Preparation
Calibration of the Spirometer
Post-Bronchodilator Spirometry
What Would You Do? What Would You Not Do?
Case Study 3
Highlight on Smoking and Chronic Obstructive Pulmonary Disease
COPD Defined
Emphysema
Emphysema caused by smoking.
Chronic Bronchitis
Symptoms of COPD
Treatment for COPD
Procedure 12-3 Spirometry Testing
Outcome
Equipment/Supplies:
Instruct the patient to blow into the mouthpiece.
Figure 12-20 The primary bronchi divide into secondary and tertiary bronchi and then into smaller passages known as bronchioles.
Peak Flow Measurement
Asthma
Asthma Attack
Figure 12-21 A, Normal bronchial tube. B, Bronchial tube during an asthma attack.
Diagnosis and Treatment
Figure 12-22 An inhaler is often used to deliver asthma medication to the bronchial tubes of the lungs.
Peak Flow Meter
Figure 12-23 Manual peak flow meter.
Figure 12-24 Digital peak flow meter.
Figure 12-25 Comparison of a low-range (A, B: left) and full-range (A, B: right) peak flow meter.
Peak Flow Rate
Schedule of Use
Purpose of Peak Flow Measurements
Figure 12-26 An example of a peak flow chart.
Care and Maintenance
Procedure 12-4 Measuring Peak Flow Rate
Outcome
Equipment/Supplies:
Move indicator to bottom of scale.
Apply a disposable mouthpiece.
The patient takes a deep breath.
The patient blows out hard and fast.
Note where the indicator stopped on the scale.
Home Oxygen Therapy
Oxygen Prescription
Oxygen Delivery Systems
Compressed Oxygen Gas
Figure 12-27 A, Compressed oxygen cylinders. B, Oxygen cylinder with regulator and flow meter attached.
Advantage
Disadvantages
Liquid Oxygen
Figure 12-28 Liquid oxygen tank (stationary tank and portable tank).
Advantage
Disadvantages
Oxygen Concentrator
Figure 12-29 A, Stationary oxygen concentrator. B, Portable oxygen concentrator.
Advantages
Disadvantage
Oxygen Administration Devices
Nasal Cannula
Face Mask
Figure 12-30 A, Nasal cannula showing prongs. B-C, The tubing of the prongs loops over the patient’s ears and is secured under the chin.
Oxygen Guidelines
Usage
Figure 12-31 Face mask.
Safety
Medical Practice and the Law
What Would You Do? What Would You Not Do?: Responses
Case Study 1
What Did Janet Do?
What Did Janet Not Do?
Case Study 2
What Did Janet Do?
What Did Janet Not Do?
Case Study 3
What Did Janet Do?
What Did Janet Not Do?
Certification Review
Terminology Review
On The Web
Chapter 13 Colon Procedures and Male Reproductive Health
Key Terms
Introduction to Colon Procedures
Structure of the Large Intestine
Blood in the Stool
Fecal Occult Blood Test
Guaiac Slide Test
Figure 13-1 Large intestine.
Figure 13-2 Examples of fecal occult blood testing kits. Hemoccult (top) and ColoScreen (bottom).
Purpose
Patient Preparation
Quality Control
Putting It All into Practice
Table 13-1 Patient Preparation for the Fecal Occult Guaiac Slide Test
What Would You Do? What Would You Not Do?
Case Study 1
Highlight on Colorectal Cancer
Incidence
Risk Factors
Colon cancer.
Symptoms
Recommendations for Early Detection
Cause
Other Types of Stool Tests
Fecal Immunochemical Test
Figure 13-3 Fecal immunochemical tests: QuickVue iFOB (left) Hemoccult ICT (right).
Fecal DNA Test
Procedure 13-1 Fecal Occult Blood Testing: Guaiac Slide Test
Outcome
Equipment/Supplies:
Check the expiration date.
Each slide contains two squares labeled “A” and “B.”
Instruct the patient on how to complete the information section on the slides.
Spread a thin smear of the specimen over the filter paper.
Place the cardboard slides in the envelope.
Procedure 13-2 Developing the Hemoccult Slide Test
Outcome
Equipment/Supplies:
Apply 2 drops of developing solution.
Apply 1 drop of developing solution to the control area.
The positive area should turn blue, and the negative area should show no color change.
Sigmoidoscopy
Purpose
Figure 13-4 Sigmoidoscopy and colonoscopy.
Patient Preparation for Sigmoidoscopy
Digital Rectal Examination
Sigmoidoscope
Procedure
Table 13-2 Patient Preparation for Sigmoidoscopy
Figure 13-5 Flexible fiberoptic sigmoidoscope.
What Would You Do? What Would You Not Do?
Case Study 2
Colonoscopy
Purpose
Patient Preparation for Colonoscopy
Figure 13-6 Colon polyp.
Procedure
Table 13-3 Patient Preparation for Colonoscopy
Procedure 13-3 Assisting With a Sigmoidoscopy
Outcome
Equipment/Supplies:
Assemble the equipment.
Place lubricant on the sigmoidoscope.
Hold the specimen container to accept the biopsy specimen.
Introduction to Male Reproductive Health
Prostate Cancer
Figure 13-7 Digital rectal examination.
Prostate Cancer Screening
Digital Rectal Examination
Prostate-Specific Antigen Test
Recommendations for Prostate Screening
What Would You Do? What Would You Not Do?
Case Study 3
Testicular Self-Examination
Figure 13-8 Testicular self-examination.
Memories of Practicum
Medical Practice and the Law
Malpractice
What Would You Do? What Would You Not Do?: Responses
Case Study 1
What Did Megan Do?
What Did Megan Not Do?
Case Study 2
What Did Megan Do?
What Did Megan Not Do?
Case Study 3
What Did Megan Do?
What Did Megan Not Do?
Certification Review
Terminology Review
On the Web
Chapter 14 Radiology and Diagnostic Imaging
Key Terms
Introduction to Radiology
Contrast Media
Figure 14-1 Posteroanterior view of the chest. Position of patient and radiograph.
What Would You Do? What Would You Not Do?
Case Study 1
Fluoroscopy
Positioning the Patient
Specific Radiographic Examinations
Mammography
Putting It All into Practice
Figure 14-2 Michelle instructs a patient in proper preparation for a radiographic examination.
Figure 14-3 Patient positioning for mammography.
Bone Density Scan
Figure 14-4 Mammogram. Arrows indicate suspicious area of increased density that needs further evaluation.
Gastrointestinal Series
Upper Gastrointestinal Radiography
Patient Teaching: Mammography
What is the Purpose of Mammography?
Who Should Have a Mammogram?
What Occurs During the Mammography Procedure?
Does Mammography Take the Place of Breast Self-Examination?
Lower Gastrointestinal Radiography
Figure 14-5 Lower GI. Colon is distended with barium. Positioning of patient and radiograph.
Intravenous Pyelography
Figure 14-6 Intravenous pyelogram obtained 15 minutes after intravenous injection of a suitable contrast agent.
Other Types of Radiographs
Introduction to Diagnostic Imaging
Ultrasonography
Figure 14-7 3-D ultrasound of a third-trimester fetus.
Figure 14-8 Sonogram of the right kidney.
Patient Preparation
What Would You Do? What Would You Not Do?
Case Study 2
Computed Tomography
Figure 14-9 Positioning patient for computed tomography (CT) scan.
Patient Preparation
Figure 14-10 The computed tomography (CT) scanner takes multiple cross-sectional radiographic images. The images shown here are cross-sectional pictures of the head used to evaluate the orbits and sinuses.
Magnetic Resonance Imaging
Memories of Practicum
Patient Preparation
What Would You Do? What Would You Not Do?
Case Study 3
Figure 14-11 Magnetic resonance imaging (MRI). The patient lies on a table inside the bore of the cylindrical MRI machine while MRI technicians in an adjoining room monitor the procedure.
Nuclear Medicine
Bone Scans
Nuclear Cardiac Stress Test
Figure 14-12 Bone scan of the foot. Arrows show the hot spot that indicates a stress fracture.
Figure 14-13 Digital image of a chest x-ray. (Screenshot used by permission of MCKESSON Corporation. All rights reserved. © MCKESSON Corporation, 2011.)
Guidelines
Digital Radiology
Medical Practice and the Law
What Would You Do? What Would You Not Do?: Responses
Case Study 1
What Did Michelle Do?
What Did Michelle Not Do?
Case Study 2
What Did Michelle Do?
What Did Michelle Not Do?
Case Study 3
What Did Michelle Do?
What Did Michelle Not Do?
Certification Review
Terminology Review
On the Web
Chapter 15 Introduction to the Clinical Laboratory
Key Terms
Introduction to the Clinical Laboratory
Laboratory Tests
Purpose of Laboratory Testing
Table 15-1 Categories of Laboratory Tests*
Types of Clinical Laboratories
Physician’s Office Laboratory
Figure 15-1 Urinalysis is frequently performed in a physician’s office laboratory (POL).
Physical Structure of the POL
Figure 15-2 Eyewash station.
Outside Laboratories
Figure 15-3 Laboratory directory.
Laboratory Directory
Collection and Testing Categories
Table 15-2 Representative Tests From a (Modified) Laboratory Directory
Laboratory Requests
Purpose
Parts of the Laboratory Request Form
Figure 15-4 Laboratory request form.
Table 15-3 Laboratory Profiles
What Would You Do? What Would You Not Do?
Case Study 1
Putting It All into Practice
Laboratory Reports
Figure 15-5 Laboratory report form.
Figure 15-6 Computer-generated laboratory report.
Laboratory Documents and the EMR
Figure 15-7 Cholesterol flow sheet generated by a computer. (Screenshot used by permission of MCKESSON Corporation. All rights reserved. © MCKESSON Corporation, 2011.)
Patient Preparation and Instructions
What Would You Do? What Would You Not Do?
Case Study 2
Fasting
Figure 15-8 Oral glucose tolerance test patient instruction sheet.
Medication Restrictions
What Would You Do? What Would You Not Do?
Case Study 3
Collecting, Handling, and Transporting Specimens
Guidelines for Specimen Collection
Figure 15-9 Collection and handling requirements for a triglyceride test from a laboratory directory.
Figure 15-10 Blood tube showing expiration date.
Figure 15-11 A, Computerized bar code label. B, Hand-labeled blood tube.
Figure 15-12 Medical and surgical asepsis must be used when collecting a specimen.
Figure 15-13 Serum specimen in a serum separator tube (SST) that has been centrifuged.
Figure 15-14 Biohazard specimen bag containing a specimen and laboratory request form.
Table 15-4 Handling and Storage of Biologic Specimens*
Procedure 15-1 Collecting a Specimen for Transport to an Outside Laboratory
Outcome
Instruct the patient on advance preparation.
Label the tubes.
Collect the specimen.
Centrifuge the specimen.
Prepare the specimen for transport.
Clinical Laboratory Improvement Amendments
Purpose of CLIA 1988
Categories of Laboratory Testing
Requirements for Moderate-Complexity and High-Complexity Testing
Memories of Practicum
CLIA-Waived Laboratory Testing
CLIA-Waived Testing Kits
Figure 15-15 CLIA-waived testing kits.
Table 15-5 Information Included in the Product Insert of a Testing Kit
Figure 15-16 Unitized testing device.
CLIA-Waived Automated Analyzers
Figure 15-17 Digital readout of results on an automated analyzer.
Quality Control
Figure 15-18 Clinical Laboratories Improvement Amendments (CLIA)-waived automated analyzers. Blood cholesterol analyzer (left) and hemoglobin analyzer (right).
Figure 15-19 A, Calibrating an automated analyzer using a calibration device. B, Calibration results are compared with expected results on the calibration device.
Figure 15-20 Internal control. The blue line next to the letter “C” indicates that the internal control has reacted as expected.
Figure 15-21 External controls. Low or level 1 control (left) and high or level 2 control (right).
Figure 15-22 Quality control log sheet for blood glucose testing.
Figure 15-23 Color diagram used to interpret test results.
Categories of Test Results
Qualitative Test Results
Quantitative Test Results
Recording Test Results
Laboratory Safety
Figure 15-24 Patient log of laboratory tests.
Medical Practice and the Law
What Would You Do? What Would You Not Do?: Responses
Case Study 1
What Did Korey Do?
What Did Korey Not Do?
Case Study 2
What Did Korey Do?
What Did Korey Not Do?
Case Study 3
What Did Korey Do?
What Did Korey Not Do?
Certification Review
Terminology Review
On the Web
Chapter 16 Urinalysis
Key Terms
Structure and Function of the Urinary System
Composition of Urine
Terms Related to the Urinary System
Collection of Urine
Figure 16-1 Structures that make up the urinary system.
Guidelines for Urine Collection
Figure 16-2 Nephron.
Urine Specimen Collection Methods
What Would You Do? What Would You Not Do?
Case Study 1
Random Specimen
First-Voided Morning Specimen
Clean-Catch Midstream Specimen
Guidelines
Figure 16-3 Urinalysis laboratory request form.
Twenty-Four–Hour Urine Specimen
Procedure 16-1 Clean-Catch Midstream Specimen Collection Instructions
Outcome
Equipment/Supplies:
Assemble the equipment.
Procedure 16-2 Collection of a 24-Hour Urine Specimen
Outcome
Equipment/Supplies:
Assemble the equipment.
Explain the procedure.
Analysis of Urine
Physical Examination of Urine
Color
Figure 16-4 Color of urine.
Figure 16-5 Appearance of urine.
Appearance
Odor
Specific Gravity
Chemical Examination of Urine
Urine Testing Kits
Table 16-1 Diagnostic Kits Used for Chemical Testing of Urine
What Would You Do? What Would You Not Do?
Case Study 2
Putting It All into Practice
pH
Glucose
Protein
Ketone
Bilirubin
Urobilinogen
Highlight on Drug Testing in the Workplace
Statistics
Testing Programs
Testing Methods
Chain of Custody
Disadvantages
Intervention
Blood
Nitrite
Leukocytes
Reagent Strips
Guidelines for Reagent Strip Urine Testing
Quality Control Testing
Table 16-2 Urine Test Strip Parameters and the Diagnoses They Assist*
Urine Analyzer
Figure 16-6 Chek-Stix control strips.
Figure 16-7 A, Clinitek Urine Analyzer. B, Clinitek printout.
Procedure 16-3 Chemical Testing of Urine With the Multistix 10 SG Reagent Strip
Outcome
Equipment/Supplies:
Completely immerse the reagent strip in the urine.
Run the edge of the strip against the urine container.
Hold the strip horizontally and read the results.
Microscopic Examination of Urine
Red Blood Cells
Memories of Practicum
Patient Teaching: Urinary Tract Infections
What is a UTI?
What are the symptoms of a UTI?
Why do women have UTIs more frequently than men?
What can women do to prevent a UTI?
Table 16-3 Cells in Urine Sediment
Table 16-4 Casts in Urine Sediment
Table 16-5 Urine Crystals
Table 16-6 Microorganisms and Artifacts in the Urine
White Blood Cells
Epithelial Cells
Casts
Crystals
Miscellaneous Structures
Procedure 16-4 Prepare a Urine Specimen for Microscopic Examination: Kova Method
Outcome
Equipment/Supplies:
Preparing the Specimen
Assemble the equipment.
Pour the specimen into the urine tube.
Centrifuge the specimen.
Insert the pipet until it seats firmly.
Pour the supernatant fluid.
Mix the sediment and stain.
Fill the well with the specimen.
Focus the specimen for the physician.
Rapid Urine Cultures
Urine Pregnancy Testing
Human Chorionic Gonadotropin
Immunoassay Tests
Guidelines for Urine Pregnancy Testing
Serum Pregnancy Test
Figure 16-8 Quality control log for urine pregnancy testing.
What Would You Do? What Would You Not Do?
Case Study 3
Procedure 16-5 Performing a Rapid Urine Culture Test
Outcome
Equipment/Supplies:
Preparing the Specimen
Assemble the equipment.
Dip the slide into the urine specimen.
Incubate the specimen.
Reading Test Results
Compare the slide with the reference chart.
Procedure 16-6 Performing a Urine Pregnancy Test
Outcome
Equipment/Supplies:
Assemble the equipment.
Add 3 drops of urine to the test well.
Interpret the results.
Medical Practice and the Law
Civil versus Criminal Law
What Would You Do? What Would You Not Do?: Responses
Case Study 1
What Did Linda Do?
What Did Linda Not Do?
Case Study 2
What Did Linda Do?
What Did Linda Not Do?
Case Study 3
What Did Linda Do?
What Did Linda Not Do?
Certification Review
Terminology Review
On the Web
Chapter 17 Phlebotomy
Key Terms
Introduction to Phlebotomy
Venipuncture
Figure 17-1 Specimen in a biohazard specimen bag along with the laboratory request form.
General Guidelines for Venipuncture
Patient Preparation for Venipuncture
Review Collection and Handling Requirements
Identification of the Patient
Assemble the Equipment and Supplies
Figure 17-2 Collection and handling requirements for a complete blood count (CBC) from a laboratory directory.
Figure 17-3 Blood tube showing expiration date.
Figure 17-4 A, Computerized bar code label. B, Hand-labeled blood tube.
Reassuring the Patient
Figure 17-5 Patient position for obtaining a blood specimen from the antecubital veins.
Patient Position for Venipuncture
Application of the Tourniquet
Guidelines for Applying the Tourniquet
Putting It All into Practice
Types of Tourniquets
Rubber Tourniquet
Procedure: Rubber Tourniquet
Figure 17-6 Application of a rubber tourniquet. A, Create tension by pulling the ends of the tourniquet away from each other. B, With tension, cross one flap over the other at the point of your grasp. C, Form a loop by tucking a portion of the top length into the bottom length.
Velcro-Closure Tourniquet
Figure 17-7 Application of a Velcro-closure tourniquet.
Procedure: Velcro-Closure Tourniquet
Site Selection for Venipuncture
Figure 17-8 Antecubital veins.
Guidelines for Site Selection
Alternative Venipuncture Sites
Types of Blood Specimens
Figure 17-9 Alternative venipuncture sites: the inner forearm, the wrist area above the thumb, and the back of the hand.
Figure 17-10 Layers into which the blood separates when there is no anticoagulant (A) and when an anticoagulant is present (B).
OSHA Safety Precautions
What Would You Do? What Would You Not Do?
Case Study 1
Vacuum Tube Method of Venipuncture
Needle
Figure 17-11 Vacuum tube system.
Figure 17-12 Vacuum tube needle in its container showing the gauge and size of the needle. The gauge of this needle is 21 G, and the size is 1 inch.
Safety-Engineered Venipuncture Devices
Figure 17-13 Safety-engineered venipuncture device. A, Perform the venipuncture with the shield in a downward position. B, After performing the venipuncture, push the shield forward. C, Continue pushing until the needle tip is fully covered by the shield. Discard the needle and holder in a biohazard sharps container.
Figure 17-14 Vacutainer evacuated tubes. The stoppers of the evacuated tubes are color-coded for ease in identifying the additive content. The lavender-, light blue–, green-, gray-, and royal blue–stoppered tubes contain an anticoagulant and are used to obtain whole blood or plasma. The red-stoppered tube contains no additive and is used to obtain clotted blood or serum.
Plastic Holder
Evacuated Tubes
Figure 17-15 Hemogard tubes.
Figure 17-16 Evacuated tube package label.
Additive Content of Evacuated Tubes
Order of Draw for Multiple Tubes
Table 17-1 Order of Draw for Collection of Multiple Evacuated Tubes
What Would You Do? What Would You Not Do?
Case Study 2
Evacuated Tube Guidelines
Figure 17-17 Information included on a laboratory specimen bar code label.
Procedure 17-1 Venipuncture—Vacuum Tube Method
Outcome
Equipment/Supplies:
Assemble the equipment.
Insert the posterior needle into the plastic holder.
Apply the tourniquet.
Palpate the vein.
Rotate the safety shield backward.
Position the needle.
Make the puncture.
Remove the tube from the holder.
Invert the tube 8 to 10 times.
Withdraw the needle.
Figure 17-18 Winged infusion set. A, Luer adapter with evacuated tube. B, Hub adapter with syringe.
Butterfly Method of Venipuncture
Guidelines for the Butterfly Method
Figure 17-19 Butterfly safety needle. The safety needle has a shield that covers the contaminated needle after it is withdrawn from the patient’s vein. A, The medical assistant has covered one half of the needle with the shield. B, The needle is completely covered with the shield.
Figure 17-20 Application of the tourniquet for alternative venipuncture sites.
Procedure 17-2 Venipuncture—Butterfly Method
Outcome
Equipment/Supplies:
Assemble the equipment.
Screw the plastic holder onto the Luer adapter.
Remove the protective shield from the needle.
Make the puncture.
Rest the butterfly wings flat against the patient’s skin.
Fill the tubes in a downward position.
Remove the tube from the holder.
Release the tourniquet and remove the needle.
Memories of Practicum
What Would You Do? What Would You Not Do?
Case Study 3
Problems Encountered With Venipuncture
Failure to Obtain Blood
Figure 17-21 Problems encountered with venipuncture.
Inappropriate Puncture Sites
Scarred and Sclerosed Veins
Rolling Veins
Collapsing Veins
Premature Needle Withdrawal
Hematoma
Hemolysis
Fainting
Obtaining a Serum Specimen
Serum
Highlight on Vasovagal Syncope (Fainting)
Cause and Symptoms
Treatment
Prevention
Tube Selection
Preparation of the Specimen
Figure 17-22 A fibrin clot may interfere with adequate collection of serum.
Removal of Serum
Serum Separator Tubes
Figure 17-23 Serum separator tubes. A, An unused tube that contains the thixotropic gel in the bottom of the tube. B, A tube that has been used to collect a blood specimen. During centrifugation, the gel temporarily becomes fluid and moves to the dividing point between the serum and blood cells in a fibrin clot.
Procedure 17-3 Separating Serum From a Blood Specimen
Outcome
Equipment/Supplies:
Label the tubes.
Allow the specimen to stand for 30 to 45 minutes.
Centrifuge the specimen.
Pipet the serum.
Examine the serum.
Obtaining a Plasma Specimen
Plasma
Tube Selection
Preparation and Removal of the Specimen
Plasma Separator Tube
Skin Puncture
Puncture Sites
Skin Puncture Devices
Disposable Semiautomatic Lancet
Reusable Semiautomatic Lancet
Figure 17-24 A, Surgilance color-coded lancet devices. B, CoaguChek Lancet device. C, Glucolet 2.
Microcollection Devices
Capillary Tubes
Figure 17-25 Microcollection devices.
Microcollection Tubes
Guidelines for Performing a Finger Puncture
Figure 17-26 Recommended sites for a finger puncture.
Procedure 17-4 Skin Puncture—Disposable Semiautomatic Lancet Device
Outcome
Equipment/Supplies:
Assemble the equipment.
Make the puncture.
Discard the lancet.
Wipe away the first drop of blood.
Collect the specimen.
Procedure 17-5 Skin Puncture—Reusable Semiautomatic Lancet Device
Outcome
Equipment/Supplies:
Assemble the equipment.
Push the barrel until it clicks into place.
Insert the retractable lancet onto the device.
Remove the plastic post.
Make the puncture.
Collect the specimen.
Medical Practice and the Law
What Would You Do? What Would You Not Do?: Responses
Case Study 1
What Did Dori Do?
What Did Dori Not Do?
Case Study 2
What Did Dori Do?
What Did Dori Not Do?
Case Study 3
What Did Dori Do?
What Did Dori Not Do?
Certification Review
Terminology Review
On The Web
Chapter 18 Hematology
Key Terms
Introduction to Hematology
Table 18-1 Common Hematologic Tests
Components and Functions of Blood
Erythrocytes
Leukocytes
Figure 18-1 Computer-generated laboratory report for a complete blood count (CBC).
Putting it All into Practice
Thrombocytes
Hemoglobin Determination
Figure 18-2 CLIA-waived hemoglobin analyzer.
Figure 18-3 Hematocrit test results. The blood cells are separated from the plasma by centrifuging an anticoagulated blood specimen, and the results are read at the top of the packed cell column.
Hematocrit
What Would You Do? What Would You Not Do?
Case Study 1
Patient Teaching: Iron-Deficiency Anemia
What is Anemia?
What Causes Iron-Deficiency Anemia?
What Can be Done for Individuals at Risk for Iron-Deficiency Anemia?
What are the Symptoms of Anemia?
How is Iron-Deficiency Anemia Treated?
Procedure 18-1 Hematocrit
Outcome
Equipment/Supplies:
Fill the capillary tube.
Seal one end of the tube.
Place the tube in the centrifuge.
Align the bottom of the red cell column with the 0 line.
Read the results.
White Blood Cell Count
Figure 18-4 Coulter blood cell counter.
Red Blood Cell Count
Red Blood Cell Indices
MCV: Mean Corpuscular Volume
MCH: Mean Corpuscular Hemoglobin
MCHC: Mean Cell Hemoglobin Concentration
RDW: Red Cell Distribution Width
White Blood Cell Differential Count
Automatic Method
Manual Method
Figure 18-5 Types of human blood cells. 1 to 7, White blood cells (leukocytes) stained as they are in the laboratory to show the many types. They play the active role in immune response or in defense against disease. 1, Neutrophil; 2, neutrophilic band; 3, eosinophil; 4, basophil; 5, lymphocyte; 6, (large) lymphocyte; 7, monocyte; 8, platelets (thrombocytes), which are responsible for clotting; and 9, red blood cells (erythrocytes), which carry oxygen.
What Would You Do? What Would You Not Do?
Case Study 2
Types of White Blood Cells
Memories of Practicum
Reference Range
What Would You Do? What Would You Not Do?
Case Study 3
Procedure 18-2 Preparation of a Blood Smear for a Differential Cell Count
Outcome
Equipment/Supplies:
Hold the spreader slide in front of the drop of blood.
Move the spreader into the drop of blood.
Spread the blood across the slide.
Properly prepared blood smear.
Improperly prepared blood smears.
PT/INR
Purpose
Collection of the Specimen
Figure 18-6 Light blue–stoppered tube used to collect a specimen for a PT/INR test.
Figure 18-7 Specimen collection and handling requirements for a PT/INR test from a laboratory directory.
Figure 18-8 PT/INR analyzer.
Performing a PT/INR Test
Figure 18-9 Patient performing a PT/INR test at home.
PT/INR Home Testing
Medical Practice and the Law
What Would You Do? What Would You Not Do?: Responses
Case Study 1
What Did Latisha Do?
What Did Latisha Not Do?
Case Study 2
What Did Latisha Do?
What Did Latisha Not Do?
Case Study 3
What Did Latisha Do?
What Did Latisha Not Do?
Certification Review
Terminology Review
On The Web
Chapter 19 Blood Chemistry and Immunology
Key Terms
Introduction to Blood Chemistry and Immunology
Blood Chemistry
Collection of a Blood Chemistry Specimen
Automated Blood Chemistry Analyzers
Table 19-1 Common Blood Chemistry Tests
Figure 19-1 Most blood chemistry tests are performed on a serum specimen collected in a serum separator tube (SST).
Figure 19-2 Specimen collection and handling requirements for a comprehensive metabolic profile as presented in a laboratory directory.
Figure 19-3 Blood chemistry analyzer.
Quality Control
Figure 19-4 A, Calibrating a blood chemistry analyzer using a calibration device. B, The calibration results are compared with the expected results on the calibration device.
Calibration
Controls
Figure 19-5 Controls come with a product insert, which lists the expected ranges for control results.
Figure 19-6 The control solution is added to a testing strip.
Figure 19-7 The control results are compared with the expected results.
Blood Glucose
Blood Glucose Testing
Fasting Blood Glucose Test
Two-Hour Postprandial Blood Glucose Test
Putting It All into Practice
Oral Glucose Tolerance Test
Testing Requirements
What Would You Do? What Would You Not Do?
Case Study 1
Side Effects
Interpretation of Results
Hypoglycemia
Tests for Management of Diabetes
Self-Monitoring of Blood Glucose
Memories of Practicum
What Would You Do? What Would You Not Do?
Case Study 2
Patient Teaching: Diabetes
What Is Diabetes?
What Is the Function of Insulin?
What are the Symptoms of Diabetes?
What Is the Difference between Type 1 Diabetes and Type 2 Diabetes?
Type 1 Diabetes
Insulin pump.
Type 2 Diabetes
What Factors Increase the Risk of Developing Type 2 Diabetes?
Risk Factors That can be Controlled
Risk Factors that cannot be Controlled
Can Diabetes be Cured?
Frequency of Testing
Test Results
Advantages
Table 19-2 Recommended Blood Glucose Levels for Patients With Diabetes
Hemoglobin A1c Test
Table 19-3 Comparison of Hemoglobin A1c Percentages With Average Blood Glucose Levels
Interpretation of Results
Glucose Meters
Reagent Test Strips
Calibration Procedure
Figure 19-8 Accu-Chek Advantage code key calibration procedure. A, The code key is inserted into the monitor. B, The code number must match the code number of the vial of test strips.
Control Procedure
Figure 19-9 Glucose controls.
Care and Maintenance
Patient Teaching: Obtaining a Capillary Blood Specimen
Procedure 19-1 Blood Glucose Measurement Using the Accu-Chek Advantage Glucose Meter
Outcome
Equipment/Supplies:
Assemble the equipment.
Insert the code key.
Check the code number.
Apply the control solution.
Control results should fall within the expected range.
Apply a drop of blood.
Read the glucose results.
Cholesterol
Highlight on Heart Disease With a Focus on Coronary Artery Disease
Coronary Artery Disease
Cause
CAD Risk Factors
HDL and LDL Cholesterol
Cholesterol Testing
Interpretation of Results
Patient Preparation
Figure 19-10 Cholestech LDX Cholesterol System.
CLIA-Waived Cholesterol Analyzers
What Would You Do? What Would You Not Do?
Case Study 3
Highlight on Lowering Cholesterol
Diet
Dietary Cholesterol
Saturated Fat
Soluble Fiber
Weight Reduction
Exercise
Smoking Cessation
Summary
Triglycerides
Blood Urea Nitrogen
Immunology
Immunologic Tests
Hepatitis Tests
HIV Tests
Syphilis Tests
Mononucleosis Test
Rheumatoid Factor
Antistreptolysin O Test
C-Reactive Protein
Cold Agglutinins
ABO and Rh Blood Typing
Rh Antibody Titer
Rapid Mononucleosis Testing
Figure 19-11 QuickVue+ mononucleosis test setup.
Figure 19-12 Procedure for performing the QuickVue+ Mononucleosis Test.
Figure 19-13 QuickVue+ mononucleosis test results.
Blood Typing
Blood Antigens
Blood Antibodies
Figure 19-14 Blood type depends on which antigens are present on the surface of the red blood cells (RBCs).
Table 19-4 ABO Blood Group System
Rh Blood Group System
Blood Antigen and Antibody Reactions
Highlight on Blood Donor Criteria
Health History
Age
Date of Last Donation
Weight
Temperature
Pulse
Blood Pressure
Hemoglobin
Blood-Donating Process
Processing the Blood
Agglutination and Blood Typing
Figure 19-15 The antigen-antibody reaction that occurs in vitro when the unknown blood sample is type A.
Medical Practice and the Law
Who Can Sue?
What Would You Do? What Would You Not Do?: Responses
Case Study 1
What Did Michelle Do?
What Did Michelle Not Do?
Case Study 2
What Did Michelle Do?
What Did Michelle Not Do?
Case Study 3
What Did Michelle Do?
What Did Michelle Not Do?
Certification Review
Terminology Review
On The Web
Chapter 20 Medical Microbiology
Key Terms
Introduction to Microbiology
Normal Flora
Figure 20-1 Bacteria drawn by van Leeuwenhoek in 1684.
Infection
Stages of an Infectious Disease
Microorganisms and Disease
Bacteria
Figure 20-2 Classification of bacteria based on shape.
Cocci
What Would You Do? What Would You Not Do?
Case Study 1
Bacilli
Spirilla
Viruses
Figure 20-3 Types of bacteria. A, Staphylococci. B, Streptococci. C, Bacilli. D, Escherichia coli. E, Spirilla.
Microscope
Figure 20-4 Parts of the microscope.
Support System
Frame
Stage
Light Source
Condenser
Diaphragm
Adjustment Knobs
Optical System
Eyepiece
Objective Lenses
Focus
Low and High Power
Oil Immersion
Care of the Microscope
Procedure 20-1 Using the Microscope
Outcome
Equipment/Supplies:
Clean the lens.
Place the slide on the stage.
Focus the specimen.
Adjust the light.
Using the Oil-Immersion Objective
Place a drop of oil on the slide.
Move the lens until it just touches the oil.
Clean the oil from the lens.
Microbiologic Specimen Collection
Putting It All into Practice
Handling and Transporting Microbiologic Specimens
Wound Specimens
Collection and Transport Systems
Figure 20-5 Starswab II Collection and Transport System.
What Would You Do? What Would You Not Do?
Case Study 2
Memories of Practicum
Procedure 20-2 Collecting a Throat Specimen
Outcome
Equipment/Supplies:
Remove the swab.
Collect the specimen.
Microbial Cultures
Figure 20-6 Streptococcal colonies growing on a blood agar culture medium contained in a Petri plate.
Streptococcus Testing
Rapid Streptococcus Tests
Hemolytic Reaction and Bacitracin Susceptibility Test
Figure 20-7 Procedure for performing the QuickVue In-Line One-Step Strep A test.
Figure 20-8 Hemolytic reaction and bacitracin susceptibility test. A, Positive reaction for group A beta-hemolytic streptococcus, as evidenced by a clear zone of inhibition present around the bacitracin disc. B, Negative reaction as evidenced by bacteria growing right up to the edge of the disc.
Sensitivity Testing
Microscopic Examination of Microorganisms
Figure 20-9 Sensitivity testing.
Wet Mount Method
Figure 20-10 Wet mount method of slide preparation for examining microorganisms in the living state.
Patient Teaching: Strep Throat
What is Strep Throat?
What are the Symptoms of Strep Throat?
How is Strep Throat Diagnosed and Treated?
What are the Complications of Strep Throat?
What Would You Do? What Would You Not Do?
Case Study 3
Figure 20-11 Gram-positive and gram-negative bacteria. A, Diphtheria is caused by a gram-positive bacillus. B, Gonorrhea is caused by a gram-negative diplococcus.
Smears
Gram Stain
Prevention and Control of Infectious Diseases
Procedure 20-3 Preparing a Smear
Outcome
Equipment/Supplies:
Spread the specimen over the slide.
Heat-fix the smear.
Medical Practice and the Law
What Would You Do? What Would You Not Do?: Responses
Case Study 1
What Did Natalie Do?
What Did Natalie Not Do?
Case Study 2
What Did Natalie Do?
What Did Natalie Not Do?
Case Study 3
What Did Natalie Do?
What Did Natalie Not Do?
Certification Review
Terminology Review
On The Web
Chapter 21 Emergency Medical Procedures
Key Terms
Introduction to Emergency Medical Procedures
Office Crash Cart
Emergency Medical Services System
Table 21-1 Office Crash Cart
First-Aid Kit
Figure 21-1 First aid kit.
OSHA Safety Precautions
Guidelines for Providing Emergency Care
Highlight on Good Samaritan Laws
Respiratory Distress
Asthma
Emphysema
Hyperventilation
Heart Attack
Stroke
Shock
Hypovolemic Shock
Cardiogenic Shock
Neurogenic Shock
Anaphylactic Shock
Figure 21-2 Anaphylactic emergency epinephrine injector.
Psychogenic Shock
Figure 21-3 Prevention and treatment of fainting.
Figure 21-4 Prevention of fainting.
Bleeding
External Bleeding
Capillary Bleeding
Venous Bleeding
Arterial Bleeding
Emergency Care for External Bleeding
Figure 21-5 Locations of pressure points. Shaded areas show the regions in which bleeding may be controlled by pressure at the points indicated.
Nosebleeds
Emergency Care for a Nosebleed
Putting It All into Practice
Figure 21-6 Control of bleeding. A, Apply direct pressure to the wound with a large, thick gauze dressing. B, If blood soaks through the dressing, apply another dressing over the first one, and continue to apply pressure. C, When bleeding has been controlled, apply a pressure bandage.
Figure 21-7 Care of a nosebleed. A, Apply direct pressure by pinching the nostrils together. B, An ice pack can be applied to the bridge of the nose to help control the bleeding.
Internal Bleeding
Wounds
Open Wounds
Incisions and Lacerations
Emergency Care for Incisions and Lacerations
Minor Incisions and Lacerations
Figure 21-8 Types of wounds.
Figure 21-9 Minor incisions and lacerations should be cleaned with soap and water to remove dirt and other debris.
Serious Incisions and Lacerations
Punctures
Emergency Care for Puncture Wounds
Abrasions
Emergency Care for Abrasions
Closed Wounds
Musculoskeletal Injuries
Fracture
Figure 21-10 Fractures. A, Open fracture. B, Closed fracture.
Dislocation
Sprain
Figure 21-11 Types of fractures.
Strain
Emergency Care for a Fracture
Figure 21-12 Emergency care of a fracture. A, The splint should immobilize the area above and below the injury. B, The splint is held in place with a roller gauze bandage. C, After the splint is applied, the pulse below the splint should be checked to ensure that the splint has not been applied too tightly. D, A sling can be used to elevate the extremity to reduce swelling.
Burns
Superficial (First-Degree) Burn
Partial-Thickness (Second-Degree) Burn
Full-Thickness (Third-Degree) Burn
Figure 21-13 Types of burns.
Thermal Burns
Emergency Care for Major Thermal Burns
Emergency Care for Minor Thermal Burns
Chemical Burns
Seizures
Emergency Care for Seizures
Poisoning
Ingested Poisons
Memories of Practicum
What Would You Do? What Would You Not Do?
Case Study 1
Emergency Care for Poisoning by Ingestion
Inhaled Poisons
Emergency Care for Inhaled Poisons
Absorbed Poisons
Emergency Care for Absorbed Poisons
What Would You Do? What Would You Not Do?
Case Study 2
Injected Poisons
Insect Stings
Emergency Care for Insect Stings
Figure 21-14 Removing a honeybee stinger and venom sac using the edge of a credit card.
Spider Bites
Emergency Care for Spider Bites
Snakebites
Emergency Care for Snakebites
Animal Bites
Emergency Care for Animal Bites
Heat and Cold Exposure
Heat Cramps
Heat Exhaustion
Heatstroke
Figure 21-15 Treatment of heat exhaustion consists of moving the patient to a cool environment, replacing fluids and electrolytes, and applying a cold compress to the forehead; the patient should then rest.
What Would You Do? What Would You Not Do?
Case Study 3
Frostbite
Hypothermia
Diabetic Emergencies
Emergency Care in Diabetes
Insulin Shock (Hypoglycemia)
Figure 21-16 Diabetic medical identification. A, Diabetic medical alert bracelet. B, Diabetic wallet card.
Figure 21-17 Orange juice is administered to a diabetic patient showing signs and symptoms of insulin shock.
Diabetic Coma (Diabetic Ketoacidosis)
Doubtful Situations
Medical Practice and the Law
What Would You Do? What Would You Not Do?: Responses
Case Study 1
What Did Judy Do?
What Did Judy Not Do?
Case Study 2
What Did Judy Do?
What Did Judy Not Do?
Case Study 3
What Did Judy Do?
What Did Judy Not Do?
Certification Review
Terminology Review
On The Web
Appendix A Medical Abbreviations
Glossary
Index
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
Q
R
S
T
U
V
W
X
Y
Z